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Attica CORRECTIONAL FACILITY The Correctional Association of New York April 2011 A REPORT FROM THE PRISON VISITING PROJECT Prison Visiting Project Correctional Association of NY Attica Correctional Facility April 2011 ATTICA CORRECTIONAL FACILITY: 2011 Attica Correctional Facility, a maximum-security prison located in Wyoming County in Western New York is the one of most notorious prisons in New York State, if not the country. The facility’s infamous history continues to infect the atmosphere and conditions facing inmates. A shadow was cast upon the facility in early September 1971, when 1,300 inmates rebelled to protest their conditions of confinement. The rebellion, during which the inmates held 40 correction officers hostage for five days, resulted in a siege of the facility by state troopers that left 43 casualties, including 33 inmates and 10 guard hostages. The Attica rebellion brought the plight of incarcerated individuals to the forefront of the nation’s consciousness. No longer were these invisible people experiencing invisible injustice behind brick walls and barbed wire fences. The prisoners’ demands included basic civil rights such as medical care, religious and political freedom, and education, in addition to parole reform and a living wage. Something had to be done to ensure that incarcerated individuals were afforded basic civil rights and given some opportunities for education and rehabilitation. We have certainly made substantial progress since 1971 – inmates are afforded medical care, opportunities for religious expression, and mandatory educational programming for those without a high school diploma or equivalent; however we have a significant ways to go. The Visiting Committee of the Correctional Association of New York (CA) visited Attica on April 12th and 13th, 2011. We were pleased to find a college program and a variety of mental health treatment services, in addition to other positive programming. However, it was apparent that the atmosphere that existed prior to the 1971 rebellion lingers and pervades nearly every aspect of the facility, from inmate-staff relations to housing assignments, facility movement and even program times. A constant level of tension is felt throughout the facility, where officers walk through the corridor and mess halls smacking their batons against the palms of their hands and inmates walk in military fashion, in two lines side-by-side, eyes downcast, in eerie silence. After providing a draft of this report to Department of Corrections and Community Supervision (DOCCS) and Attica officials, we had a conference call on December 2, 2011 with prison administrators to discuss our findings and recommendations. We appreciate the prison officials’ input during that conversation and their response to our request for updated information about recent prison operations. We have included this information in the report. -2- Prison Visiting Project Correctional Association of NY Attica Correctional Facility April 2011 METHODOLOGY The CA’s Visiting Committee visited Attica to assess the services and conditions at the prison. We obtained surveys about general prison conditions from 269 inmates in general confinement, in addition to 63 program- or location-specific surveys from inmates in the Special Housing Unit (SHU), Intermediate Care Program (ICP), Transitional ICP (TrICP), Special Treatment Program (STP), Protective Custody (PC), and the Alcohol and Substance Abuse Treatment (ASAT) program.1 To obtain survey participants, the Visiting Committee asks inmates in programs and in their housing units if they would like to participate in this voluntary process. We then mail surveys to each inmate who provides us with identifying information. Inmates are assured that the CA has “privileged mail status,” permitting Department staff to open surveys only to search for contraband but not to read the contents, as with regular mail. We also assure inmates that we do not include any names or identifying information in our reports, because retaliation by staff is a significant concern for survey participants. Despite our efforts to preserve inmate confidentiality, we cannot ensure that inmates will not be targeted or retaliated against for assisting us in our work. We visited nearly every housing area during our two-day visit and mailed in 956 surveys; however, less than a third were returned to us. We do not allege that staff interfered with the survey process, but there was clearly some level of intimidation, as we received several inmate letters following our visit alleging harassment by security staff for survey participation and expressing concerns about their safety. This report is based on findings from data supplied by the facility and DOCCS prior to our visit; inmate surveys; conversations with the superintendent, executive team, program staff, and inmates; and meetings with the staff union representatives and members of the Inmate Liaison Committee (ILC) and Inmate Grievance Resolution Committee (IGRC). We appreciate the cooperation of the facility’s administration during our tour and the extensive information staff provided to us prior to, during, and after our visit. We would also like to thank all those confined at Attica who participated in our surveys. SUMMARY OF FINDINGS & KEY RECOMMENDATIONS Both the recognition of prisoners’ rights in the early 1970s and changes in societal beliefs regarding punishment and rehabilitation have transformed prisons throughout the United States, including those in New York State, over the last 40 years. As mentioned above, Attica Correctional Facility is no exception. During our two-day visit we found several positive aspects of the prison including a college program which received enthusiastic praise from inmates, higher than average satisfaction rates with Transitional Services programming and dental care, an impressive variety of vocational programs, and a substantial array of services for inmates with mental health issues. Despite the aforementioned quality of programming and services, the Visiting Committee was extremely concerned to find that Attica stands out among New York State prisons for its high level of violence among staff and inmates, particularly for allegations of sexual abuse both in general population and in disciplinary confinement units (Special Housing Unit and keeplock). We 1 We received 33 SHU surveys, 7 ICP surveys, 1 TRICP survey, 7 STP surveys, 8 PC surveys, and 7 ASAT surveys. -3- Prison Visiting Project Correctional Association of NY Attica Correctional Facility April 2011 also have concerns about the efficacy of the Special Treatment Program for disciplinary inmates with serious mental illness. Additionally, due to its large population and limited staffing levels, Attica inmates had far less programming options than at other prisons, and, accordingly, a larger proportion of inmates with little or no programming. We also received a significant number of complaints from inmates regarding limited access to the general and law libraries. Our principal recommendations include that relevant state, DOCCS and prison officials: More closely monitor allegations of sexual abuse and abusive pat frisks by staff and meet with the ILC and IGRC to explore ways to reduce sexual abuse and to promptly identify and respond to staff sexual misconduct or abusive pat frisks. Encourage line staff to engage inmates in more positive interactions and investigate any allegations of harassment, threats or excessive use of force and implement prompt disciplinary action if substantiated. Assess the level of and causes for tension between staff and inmates, and develop a plan to reduce tension, including additional training for staff regarding how to manage inmates with significant mental health needs and installation of cameras in areas where such incidents more frequently occur. Take steps to train all security staff working on a mental health unit on how to properly manage and interact with inmates with mental health care needs and remove from these units any staff who fail to perform their job duties properly. Assess the level of and causes for tension between SHU/keeplock staff and inmates, and develop a plan to reduce perceived and actual incidents of verbal harassment, physical confrontations and sexual abuse by staff. Consider methods of increasing available programs for all inmates, including potentially hiring additional staff, changing program times, or modifying facility movement schedules and procedures. Provide more meaningful prison job opportunities that will permit inmates to develop skills and experiences that enhance their ability to find employment upon release. Review patient-clinician confidentiality protocols with OMH staff and DOCCS security staff and ensure that proper protocols are followed, investigating any complaints of confidentiality breaches or misuse of sensitive information. Improve access to the general library and the law library by expanding their hours of operation, potentially by hiring additional staff or inmate clerks. Review the services provided during STP group sessions and individual counseling to disciplinary inmates with serious mental illness to determine what additional measures can be taken to better engage the patient population. Reconsider the conversion of Attica’s STP to a residential mental health treatment unit for disciplinary inmates with serious mental illness. Fill all medical staff vacancies and investigate whether additional nursing and clinic staff are needed. Review the quality of sick call encounters and clinic call-outs to ensure that all providers are properly diagnosing and treating each patient they see. -4- Prison Visiting Project Correctional Association of NY Attica Correctional Facility April 2011 GENERAL INMATE POPULATION and OFFICER DATA Attica has a capacity of 2,253 and held 2,152 inmates at the time of our visit. In general, the facility houses an older population with longer sentences than other prisons in New York State. According to data provided by the facility, the median age at Attica at the time of our visit was 38.4 years old and 22% of the population was under the age of 30.2 The median minimum sentence was 15 years and 68% of Attica inmates had a minimum sentence of 10 years or more, with 84% of the total population convicted of a violent felony.3 Attica’s racial demographics were slightly different than those at other New York prisons, with a higher percentage of inmates identifying as African-American and fewer inmates identifying as White.4 Sixty-one percent of the population had their high school diploma, General Equivalency Diploma (GED) or higher education degree, slightly higher than the system-wide average of 57%.5 One percent of the population was Spanish speaking with limited or no proficiency in English. According to facility data provided during our visit, of the 582 correctional officers (COs) employed at Attica, only 12 were female. Facility staff did not give us any information regarding the racial demographics of security staff; however, from our observations we noted that COs were overwhelmingly White. The racial disparities between staff and inmates appeared to contribute to the tense environment inside the facility. Furthermore, officers with whom we spoke at Attica expressed concern about properly managing the continually changing composition of the inmate population, both in terms of racial composition and percentage of inmates with mental illness, and the staff articulated a desire for more educational and training opportunities. One of the demands during the 1971 rebellion was to “educate all correctional officers to the needs of the inmates, i.e., understanding rather than punishment.”6 COs are required to undergo significantly more training today than in 1971, particularly in the areas of diversity and managing populations; however, this level of training remains inadequate. We recommend that facility administrators and DOCCS examine ways of recruiting a more diverse staff population and increase opportunities for diversity training. We also suggest that the Department implement more substantial and regular trainings for staff on how to effectively manage mentally ill individuals. PHYSICAL PLANT Built with the assistance of inmates from Auburn C.F. in 1931, at the time of its construction Attica was the most expensive prison built in New York State and believed to be the most secure.7 The prison consists of four wings, each of which has the capacity to house approximately 500 inmates, in addition to a 116-capacity Special Housing Unit (SHU), and 2 Compared to a median age of 36 and 31% under the age of 30 state-wide. According to DOCCS system-wide data as of April 1, 2010, the median minimum sentence for all maximumsecurity prisons is 13 years. 4 Fifty-eight percent of Attica’s population identified as African-American, 22% as Hispanic, and 20% as White, compared to the system-wide population of 52% African-American, 23% Hispanic, and 23% White. 5 According to DOCCS system-wide data as of April 1, 2010. 6 See Attica Prisoners’ Demands: September 9, 1971. 7 According to “The Evolution of NY’s Prison System, Part II,” New York Correction History Society, available at http://www.correctionhistory.org/html/chronicl/state/html/nyprisons2.html. 3 -5- Prison Visiting Project Correctional Association of NY Attica Correctional Facility April 2011 several other special population units within the prison. According to staff, due to security concerns, inmates’ movement is more limited than other maximum-security prisons in New York State, with inmates only interacting with the population assigned to their particular housing block. The facility has four recreation yards, one for each housing block, where inmates only mingle with other inmates from their unit. Inmates are assigned to a housing block based on their program and job. We observed during our visit that Attica’s unique housing protocols appeared to result in shorter programming hours due to the long periods of facility movement. Like many maximum-security prisons in New York State, staff have the ability to administer tear gas through the mess hall ceilings in the case of a violent incident. Attica, however, is unique in that the mess halls are also staffed with officers holding portable tear gas guns. Since these portable gas guns are significant safety hazards, all inmates must be locked in their cells while the gun is being transported from a central location to the mess hall before and after each meal, resulting in approximately 30 minutes of restricted inmate movement before and after each meal. Additionally, each gun requires multiple staff escorts, who could be more useful to the facility in other areas. According to staff, the gas has not been used since the late 1980s, yet staff continue to take this precautionary measure, which requires significant staff resources and decreases the amount of time inmates may spend in meaningful program areas. Numerous construction projects were under way at the time of our visit, including the installation of new flush panels, water-saving toilets and lighting upgrades in certain housing blocks. Other planned projects included replacement of the facility-wide fire alarm system, replacement of heating systems in several housing blocks, and replacement of refrigerators in the storehouse and kitchens. SAFETY Given its reputation and history, one may not be surprised to find a high level of violence at Attica, both between staff and inmates and among inmates. The Visiting Committee did in fact find the facility to be significantly more violent than most other CA-visited maximum-security facilities and perceived a noticeably high level of intimidation and fear throughout the facility. This high level of intimidation was evident during our visit, where officers walked the blocks with batons in their hands, an uncommon practice in New York State prisons and after our visit when we received numerous letters describing threats and retaliation for participating in the CA survey. Furthermore, when we visited the recreation yard to interview inmates, fewer individuals than at other facilities wished to speak with us out of concern for their safety. We understand that the Attica administration must take every precaution to ensure that all staff and inmates are safe; however, there appears to be an “us and them” culture at Attica which results in significantly more violence, intimidation and harassment by staff than at other CA-visited prisons, potentially elevating the already high stress level of a maximum-security prison. Inmate-Staff Relations Attica inmates’ perception of staff abuse at the facility was far worse than at most other CA-visited prisons, and the facility had an extremely high number of incidents of abuse, both as described in survey data and in DOCCS-supplied records. Based upon an analysis of inmate -6- Prison Visiting Project Correctional Association of NY Attica Correctional Facility April 2011 survey responses, the facility ranked8 the fifth worst of all 29 CA-visited prisons for inmate-staff relations, with 78% of survey respondents describing them as bad.9 Most concerning is that Attica ranked as the second worst facility among CA-visited prisons for sexual abuse and racial harassment by staff. Inmates estimated that a median of 75% of officers engage in serious misconduct, which is significantly higher than at other facilities, and only 20% do a particularly good job.10 Attica survey respondents reported that the most common forms of abuse were verbal harassment, threats and intimidation, and physical abuse. Attica inmates also reported the highest frequency of physical assaults, verbal harassment, threats and intimidation, abusive pat frisks, turning off lights and water and retaliation for complaints out of all 29 CA-visited prisons, ranking Attica as the worst facility for these forms of abuse. Inmates also complained that retaliation often materialized in the form of officers not letting inmates out of their cells for meals. We asked inmates to describe common locations and times for abuse and overwhelmingly, inmates described the 3:00 p.m. to 11:00 p.m. shift as problematic. While abuse occurs throughout most areas of the prison, we received an alarming number of complaints regarding C-Block. Eighty-eight percent of survey respondents said the Attica administration does very little or nothing to prevent abuse, and 91% stated that video cameras would reduce abuse at least somewhat. Survey results indicated a higher rate of physical confrontations between staff and inmates than at many other facilities, with 38% of inmates stating that they had experienced a physical confrontation with staff at least once, ranking Attica fifth worst of all 29 CA-visited prisons for frequency of physical confrontations.11 Eighty-five percent of survey respondents stated that physical confrontations were frequent throughout the prison, the highest of all CA-visited prisons and significantly higher than the average of rate 57%. Furthermore, according to information supplied by DOCCS, Attica ranked third worst of all maximum-security prisons for frequency of assaults between inmates and staff from 2007 through 2009.12 Attica reported 17 such incidents from January through March 2011, and 56 such reports in 2010, down from 72 in 2009. Attica inmates felt the least safe of all CA-visited prisons, with 71% of surveyed inmates reporting that they frequently felt unsafe at Attica, ranking the facility the lowest of all CA-visited facilities for safety.13 Attica was worse than nearly two-thirds of CA-visited prisons for survey respondents experiencing verbal harassment and fourth worst of all CA-visited prisons for the frequency of it occurring throughout the facility.14 8 The CA ranks facilities according to an analysis of inmate survey responses. Facilities are ranked from best to worst with one being the best and 29 being the worst. 9 Compared to an average of 63% at all CA-visited prisons. Seventy-four percent described relations as worse than at other prisons. 10 Compared to a median of 55% who engage in serious misconduct and 30% who do a particularly good job at other CA-visited prisons. 11 Thirty-eight percent of Attica survey respondents reported experiencing a physical confrontation at least once, compared to an average of 27% at all CA-visited prisons. 12 This is based upon DOCCS system-wide data of Unusual Incident Reports (UIRs) for assault-on-staff incidents from 2007 through 2009. 13 Compared to an average of 48% at all CA-visited prisons. 14 Only 9% of Attica survey participants reported never being verbally harassed by staff compared to 16% of all CA survey participants. -7- Prison Visiting Project Correctional Association of NY Attica Correctional Facility April 2011 Sexual abuse by staff also appears to be a serious concern at Attica, with the facility ranking in the bottom third of all New York State facilities for frequency of reported incidents of sexual abuse between staff and inmates from 2008 through 2011.15 Inmate survey responses echoed this trend, with respondents ranking the facility second worst of all CA-visited prisons for the commonality of these incidents throughout the prison.16 Thirty percent of survey respondents reported frequently hearing about sexual abuse by staff, and while abusive pat frisks are often described as “sexual abuse” by inmates, 64% stated that sexual abuse during a pat frisk was not the only type of sexual abuse in the prison and 75% of survey respondents reported hearing about sexual abuse other than abusive pat frisks at least once. Additionally, Attica ranked in the bottom fifth of all CA-visited prisons for the frequency with which inmates reported having experienced an abusive pat frisk and ranked as the second worst facility for the frequent occurrence of this form of abuse.17 Staff with whom we spoke described the facility as a very dangerous place, and stated that the higher percentage of inmates on the OMH caseload has led to increased problems within the facility. Staff also explained that inmate-staff tension at the facility was the lowest it had been in years, and largely attributed this improvement to the new administration. The superintendent appeared to be engaged with inmates during our tour, and seemed to have knowledge about what was happening inside the facility. In our discussion, he explained that he believes it to be important for him and the rest of his executive staff to have a frequent and consistent physical presence throughout the facility including regular conversations with both inmates and line staff. The superintendent also informed us that outside of his regular monthly meetings with the Inmate Liaison Committee, he frequently has more informal conversations with members while in the housing blocks in order to keep cognizant of any concerns voiced by the inmate population. Comments from inmates and our own observations suggest that he has implemented this practice to a greater extent than superintendents at some other prisons we have visited. We were pleased to hear from inmates that the superintendent “walks the blocks” of the facility; however, it was clear that the majority of the threats, intimidation, and violence takes place during hours when the administrative staff is not at the facility. We commend the superintendent for his efforts, but believe his actions are not sufficient to overcome the otherwise pervasive atmosphere of tension and violence that exists between the prison inmate population and staff. We are very concerned about the level of tension between staff and inmates at Attica. We understand that the facility houses a substantial population of individuals convicted of violent offenses and that there are important security concerns, but the inmate population at Attica is not significantly different from other maximum-security prisons in the state. We believe that this higher level of tension at Attica is due in part to the facility’s history, which influences the attitudes of both staff and inmates. We recommend that facility staff take steps to alleviate this tension, potentially through additional trainings for correction officers and regular meetings with 15 This assessment is based upon DOCCS data collected in response to the federal Prison Rape Elimination Act (PREA) which requires the federal Bureau of Justice Statistics to evaluate allegations of sexual abuse by staff and by inmates. The CA analyzed DOCCS staff sexual abuse data for each facility for the period 2008-2011. 16 Forty percent of survey respondents described staff-inmate sexual abuse as common at Attica, compared to an average of 12% at all CA-visited prisons. 17 Thirty-five percent of Attica survey respondents reported frequently experiencing an abusive pat frisk and 78% described them as occurring frequently throughout the prison, compared to an average of 24% and 49%, respectively, at all CA-visited prisons. -8- Prison Visiting Project Correctional Association of NY Attica Correctional Facility April 2011 the ILC. Line staff should be encouraged to engage inmates in more positive interactions and any allegations of harassment, threats or excessive use of force should be swiftly investigated and result in prompt disciplinary action if substantiated. Furthermore, we recommend that the administration reconsider whether it is necessary for staff to escort inmates throughout the facility with their batons unsheathed. Inmate-Inmate Relations Attica inmates reported a relatively high level of inmate-inmate violence, with the facility ranking sixth worst of all 29 CA-visited facilities for frequency of inmate fights and seventh worst for survey respondents personally being involved in a fight; however, 57% of survey respondents stated that the level of violence at the facility was average in comparison to other prisons.18 According to DOCCS statistics, Attica ranked in the bottom third of all maximum-security facilities and worse than all but one medium or minimum-security prisons for frequency of recorded inmate-on-inmate assaults for 2007 through 2009.19 The facility recorded eight such incidents from January through March 2011 and 22 in 2010, up from 18 UIRs in 2009. Inmates indicated that personal conflicts and the stress of being in prison were major causes of tension among inmates; however, gangs were also a significant cause of inmate fights. Gangs and Drugs Gangs and drugs were more prevalent at Attica than at many other facilities and may contribute to the high level of violence in the prison. Attica ranked in the bottom third of all CAvisited prisons for presence of gangs and contraband drug use. Staff with whom we spoke described gang activity as a common source of tension between inmates at the facility, even explaining that many inmates do not go to recreation in the yard due to gang presence. Staff explained, however, that the level of gang activity at Attica has remained relatively unchanged over the past several years. Eighty-eight percent of survey respondents described it as at least somewhat common, ranking the facility the seventh worst prison out of all 29 CA-visited prisons for prevalence of gang activity.20 Seventy-seven percent of survey respondents stated that gang activity was at least somewhat a source of violence at the facility, ranking Attica the ninth worst prison out of all CA-visited prisons for likelihood of gang activity leading to violence.21 Seventy-seven percent of Attica survey respondents described contraband drug use as common within the prison, with 27% of survey respondents describing drug use as at least somewhat more common at Attica than other prisons.22 Attica also ranked the ninth worst facility 18 Sixty-one percent of survey respondents reported that inmate fights occur frequently in the facility and 39% reported being in a fight with another inmate at least once, compared to averages of 39% and 30% at all CA-visited prisons, respectively. Thirty percent of survey respondents stated that the level of violence at Attica was worse than at other prisons. 19 This assessment is based upon DOCCS system-wide data for UIRs for assault-on-inmates incidents from 2007 through 2009. 20 Compared to an average of 75% of survey respondents describing gang activity as at least somewhat common at all CA-visited prisons. 21 Compared to an average of 61% of inmates at CA-visited facilities who identified gang activity as a cause of violence at least somewhat. 22 Compared to an average of 19% of inmates at CA-visited facilities who described drugs as more common than other prisons and ranking Attica 7th of 29 CA-visited prisons for drugs being more common. -9- Prison Visiting Project Correctional Association of NY Attica Correctional Facility April 2011 out of all CA-visited prisons for the prevalence of drug use as a source of violence, with 47% of survey respondents identifying contraband drug use as at least somewhat a source of violence. 23 Protective Custody Prisoners who feel that they are vulnerable or may be potential victims among general population inmates may choose to be housed in Protective Custody (PC). Additionally, the Department may also determine that an inmate would be at risk in general population and place him in Involuntary Protective Custody (IPC). Reasons why inmates might be housed in PC include conflicts with other inmates and gangs, or the particular nature of their criminal case. There is minimum contact between PC inmates and the general population and typically, for ease of administration, inmates housed in PC are placed in cells next to one another in a particular area of the facility. The Visiting Committee toured the PC unit and received surveys from 12 PC inmates, 92% of whom stated that they felt at least somewhat safer in the Attica PC than in general population, 42% much safer. Fifty percent of Attica PC survey respondents reported feeling safer in the Attica PC unit than in other PC units throughout the Department. Similar to inmates in disciplinary confinement, PC and IPC inmates spend the majority of their time in their cells; they are allowed three hours out of cell per day for recreation, showers, phone calls, or visits. Seventy-five percent of PC survey respondents reported going to recreation frequently. Attica does not permit recreation on the gallery, similar to several other facilities, and inmates must go outside for recreation. The PC recreation yard is a small area with a basketball court, weights, showers, and one telephone. We received numerous complaints that there was only one telephone in the yard, and survey respondents explained that this was a constant source of tension for inmates, often leading to arguments and fights. Nearly half of all PC respondents reported being involved in a physical altercation with another PC inmate at least once; however, only 9% stated that altercations occur frequently in PC. We suggest that facility administrators install at least one additional telephone in the PC yard, as this might alleviate tension and conflict among inmates. At the time of our visit, there were no programming options for PC inmates aside from a cell study program, in which two survey respondents participated. Additionally, due to their restricted movement, PC inmates may only receive law library materials delivered to their cells, and 63% of survey respondents were unsatisfied with these materials. We are greatly concerned about this high degree of idleness and recommend that facility administrators explore methods of bringing additional therapeutic, educational, and vocational programming and materials to the housing unit. Inmate-staff relations appeared to be more satisfactory in the PC unit than in other Attica locations, with 33% of survey respondents describing inmate-staff relations as good, 25% as bad, and 42% as equally good and bad. When asked to describe the most common forms of abuse on the unit, PC survey respondents cited verbal harassment, threats and intimidation, and retaliation for complaints. Twenty-seven percent of survey respondents reported frequently hearing about physical conflicts between inmates and staff, and 40% reported frequently hearing about verbal 23 Compared to an average of 37% at CA-visited facilities who identified drug use as at least somewhat a cause of violence. - 10 - Prison Visiting Project Correctional Association of NY Attica Correctional Facility April 2011 harassment. We were concerned to find that 40% of PC survey respondents had heard about sexual abuse by staff throughout the unit at least once, and 56% percent described these confrontations as consisting of abusive pat frisks. These inmates are housed on the unit to seek protection during their confinement, and we are concerned that such a high percentage, albeit lower than in the general population, experience threats, abuse, and harassment. We recommend that facility administrators review these allegations and ensure that all security staff are trained to manage this potentially sensitive population. PC survey respondents were generally dissatisfied with medical care, with 50% rating it as poor, 25% rating it as fair, and 25% rating it as good. When asked to explain their ratings, survey respondents complained of long delays for medical callouts, delays and changes in medication, and that providers “just didn’t care.”24 Despite these complaints, 83% of PC survey respondents reported being able to access sick call at least sometimes, though 50% reported frequently experiencing delays for medical callouts and a total of 75% said they experienced delays at least once. Survey respondents rated sick call nurses more favorably than doctors, with 33% rating nurses as good and 25% as poor, and 25% rating doctors as good and 50% as poor. Although we recognize that delivering programs and services remotely can pose an administrative challenge, PC inmates are not in PC for punitive reasons. Therefore, we urge the prison administration to make every effort to ensure that PC inmates receive all essential services at rates comparable to the general population. Discipline and Disciplinary Housing Special Housing Unit (SHU) Nearly half of all Attica general survey respondents reported having received a misbehavior report while at the facility and 15% reported having been in Attica’s SHU. The SHU held 83 inmates at the time of our visit and had a capacity of 116 inmates. We received 24 surveys from Attica SHU inmates. These survey respondents had spent a median of three months in Attica’s SHU and had a median SHU sentence of 12 months. As described above, we are extremely concerned about the high number of violent incidents between inmates and staff and significant levels of harassment and intimidation at Attica, and the SHU is no exception. SHU surveys illustrated an atmosphere of overwhelming isolation and intimidation. Sixty percent of SHU survey respondents described inmate-staff relations as very bad, significantly higher than 42% of all SHU survey participants at CA-visited SHUs, ranking Attica in the bottom quarter for poor inmate-staff relations.25 Forty-four percent of SHU survey respondents reported being in a physical confrontation with staff at least once and 67% of Attica SHU survey respondents reported being frequently harassed by staff, ranking the facility in the bottom third of all CA-visited SHUs for frequency of harassment.26 We asked survey respondents to describe the most common forms of abuse in the SHU, and Attica inmates described physical assaults as common at the fourth highest rate and verbal harassment as 24 Half of all PC survey respondents reported experiencing delays receiving medication refills at least once and 30% reported experiencing problems receiving mental health medications. 25 The term “disciplinary confinement areas” includes all facility SHUs and keeplocks for which we have data. 26 Compared to an average of 30% of SHU survey respondents at all CA-visited SHUs experiencing a physical confrontation with staff at least once and 47% of SHU survey respondents frequently experiencing verbal harassment. - 11 - Prison Visiting Project Correctional Association of NY Attica Correctional Facility April 2011 common at the highest rate of all CA-visited SHUs. Theft or destruction of property, threats from officers, and retaliation for complaints were also common forms of harassment at rates significantly higher than most other visited SHUs. We are also particularly concerned about the high number of SHU survey respondents who reported some form of sexual misconduct by staff. A majority of Attica SHU inmates reported sexual assault as a common form of abuse, a rate much higher than all CA-visited SHUs.27 Sixtythree percent of SHU survey respondents reported frequently hearing about sexual abuse in the SHU, 84% reported that sexual abuse was not limited to abusive pat frisks, and 45% reported frequently hearing about sexual abuse other than pat frisks. Abusive pat frisks were also a problem in the SHU. Forty-five percent of Attica SHU respondents stated that they had experienced an abusive pat frisk while in the SHU. Of the 29 SHUs we surveyed, Attica SHU survey participants had the second highest rate for reporting abusive pat frisks as a common form of mistreatment on the unit. We recommend that facility administration ensure that security staff are trained to administer proper pat frisks and institute harsher punishments for staff who are conducting themselves in an inappropriate manner. Installation of video cameras throughout the SHU may be one remedy for this serious problem. Attica inmates utilized the one-hour out-of-cell recreation time at a rate lower than nearly any other CA-visited SHU, with 68% reportedly not going to recreation. SHU survey respondents reported that some of the reasons they did not attend recreation were that they do not have the proper attire to go outside, recreation is offered in the morning before breakfast and food gets cold while they are outside, and officers sometimes enter their cells when they are out to recreation. Numerous survey respondents reported that they do not attend recreation because they are afraid of being assaulted on their way to or from the outdoor pen. Since this is the only time these individuals are allowed to leave their cells, we recommend that the administration examine ways of encouraging inmates to utilize recreation by providing the proper attire for the weather and installing cameras on the route to and from the recreation pens. The Visiting Committee received a significant number of complaints regarding medical care from SHU inmates during our visit, and surveys echoed those same concerns. Three-quarters of Attica SHU survey respondents rated overall medical care as poor, a rate worse than nearly all CA-visited SHUs. Similarly, almost 80% of Attica SHU respondents reported frequently experiencing delays in accessing care, a rate higher than all but two CA-visited SHUs. SHU survey respondents’ satisfaction with medical providers themselves ranked the facility in the bottom fifth of all CA-visited SHUs, with 74% of survey respondents rating them as poor. We asked survey respondents to explain their ratings of medical care and reasons included that medical staff did not seem to care about individuals they were treating and that “someone would have to be dying before they received attention.” Survey respondents also repeatedly mentioned that meetings with medical staff were not confidential and often held within hearing range of security staff. Attica SHU survey respondents also reported experiencing retaliation by security staff for filing grievances regarding medical care. 27 Thirty-two percent of Attica SHU respondents reported sexual abuse as “most common”, 53% said it was “common” and only 16% assessed it as “not common,” compared to the 5%, 13% and 82% for all SHU survey participants. Attica’s SHU rated the worse facility for this indicator among the 29 SHUs we have surveyed. - 12 - Prison Visiting Project Correctional Association of NY Attica Correctional Facility April 2011 Nearly three-quarters of Attica SHU survey respondents reported having received mental health care while in the SHU at least once and 70% rated the individual therapy they received on the unit as poor. Sixty-four percent reported that their conversations with mental health staff were not confidential, explaining that security staff sometimes make comments to inmates regarding the subject matter of the mental health interviews. Most alarmingly, 60% of survey respondents had been to the Residential Crisis Treatment Program (RCTP), a short-term observation unit for individuals experiencing a psychiatric crisis, during their current incarceration, and more than 20% had been to the RCTP while confined in the Attica SHU. Survey respondents also reported high level of suicide attempts or self-harm by individuals in the SHU.28 When asked how often they have attempted to harm themselves, 44% said that they had attempted to harm themselves at least once while incarcerated and a quarter of all Attica SHU survey respondents said they had attempted to harm themselves while in the Attica SHU. When asked to describe the facility’s response to attempts of self-harm, the majority of survey respondents reported that there was no response. Attica SHU survey respondents were less satisfied with mail services than at any other CA-visited SHU with the exception of Great Meadow C.F., with only 35% at least somewhat satisfied with these services. Individuals in the SHU are also allowed access to reading materials, law library materials, and cell-study programs, which are run by Attica’s library and academic program staff. A porter brings a book cart through the SHU daily, the contents of which are rotated every 60 days. SHU survey respondents’ ratings for cell study and general reading materials were in the middle of all CA-visited SHUs, although survey respondents were less satisfied with law library materials than nearly every other CA-visited SHU, with 74% not satisfied.29 Inmates’ dissatisfaction with law library materials may reflect larger issues with Attica’s law library, to be discussed below; however, we recommend that facility administrators take steps to ensure that SHU inmates have timely and sufficient access to up-to-date and relevant legal materials. We also recommend that the facility assess the pickup and delivery of mail to SHU inmates. Keeplock The Visiting Committee also spoke to individuals being held in keeplock, a disciplinary measure whereby inmates confined to their cells for 23 hours a day with limited privileges. Ninety-one inmates were in keeplock at the time of our visit. Sixty-nine percent of survey respondents had been in keeplock at least once while at Attica. We received nine surveys from inmates in keeplock, who had served an average of three months in keeplock and had an average of a four month total keeplock sentence. Attica keeplock respondents reported inmate-officer relationships as being worse than those in the Attica SHU, ranking Attica’s keeplock fifth worst of all CA-visited SHUs for inmatestaff relations; however, it ranked in the bottom third for frequency of survey respondents experiencing physical confrontations with staff.30 Keeplock survey respondents reported that 28 Eighty-seven percent of SHU inmates responding to the question reported acts of self harm by residents in the SHU with half saying these occur frequently. 29 Fifty-seven percent of survey respondents were dissatisfied with reading materials and 74% were dissatisfied with law library materials. 30 Attica keeplock data is compared to all CA-visited SHUs for the purposes of this study. - 13 - Prison Visiting Project Correctional Association of NY Attica Correctional Facility April 2011 physical assault, sexual assault, and verbal harassment were common forms of abuse at rates higher than nearly every other CA-visited SHU except for the Attica SHU. Of even greater concern, keeplock inmates perceived physical assaults to be more common than Attica SHU inmates, and a greater percentage of keeplock inmates attributed incidents of sexual abuse to abusive pat frisks.31 Attica keeplock survey respondents were dissatisfied with overall medical care and medical providers at rates similar to Attica SHU inmates and were more dissatisfied than fourfifths of all CA-visited SHUs; however, they experienced fewer delays in access to medical care than SHU inmates, ranking Attica’s keeplock in the bottom third of all CA-visited SHUs for delays in access. Individuals in keeplock rated the quality of their individual mental therapy much higher than those in Attica’s SHU, with three of the four surveyed keeplock inmates rating the care as good or fair. Individuals in keeplock, like inmates in the SHU, also have access to reading and law library materials, cell-study, and recreation. Attica keeplock survey respondents were less satisfied with access to reading materials and cell study than all CA-visited SHUs and ranked in the bottom third for the least access to law library materials.32 Keeplock survey respondents also reported dissatisfaction with mail services at the fourth highest rate of all CA-visited SHUs and 89% of survey respondents reported being dissatisfied with food. Keeplock inmates did appear to access recreation at rates significantly higher than SHU inmates, with 78% of keeplock inmates taking advantage of the one-hour period outside of their cells. We are extremely concerned about the delivery of services to keeplock inmates and recommend that the facility review its policies for delivering food and other materials to these inmates. INMATE GRIEVANCE PROGRAM Unlike other facilities, Attica contains two grievance offices, one in the front near the administrative part of the facility and one towards the back of the facility. These offices are staffed by two full-time grievance supervisors. The back grievance office is also staffed by five inmate clerks, two elected grievance representatives, and one inmate porter. The grievance supervisor explained that the grievance system is supposed to have one clerk per housing block, but inmates in A-Block and B-Block refused. None of the clerks speak Spanish, although the supervisor with whom we spoke explained that hiring a Spanish-speaking clerk was a priority. Attica inmates filed a total of 1,448 grievances in 2010, a marked decrease from 1,700 grievances in 2009. In 2010, the most grieved issues were medical (19% or 276 grievances) and staff conduct (11% or 156 grievances).33 Staff explained that the majority of the grievances related to staff conduct are from inmates in the SHU. The grievance supervisor estimated that inmates 31 Seventy-eight percent of keeplock survey respondents reported hearing about sexual abuse, and 50% stated that abusive pat frisks were not the only form of sexual abuse; however, 44% reported frequently hearing about sexual abuse other than abusive pat frisks. Forty-four percent of keeplock survey respondents reported frequently experiencing an abusive pat frisk. 32 Eight-seven percent of keeplock survey respondents reported being unsatisfied with the reading material available to them and 100% reported being unsatisfied with cell-study. 33 In 2009, inmates filed a total of 349 grievances related to medical concerns (21%) and 190 grievances related to staff conduct (11%). - 14 - Prison Visiting Project Correctional Association of NY Attica Correctional Facility April 2011 appealed approximately 60 grievances each month. When asked what is the biggest challenge in running Attica’s grievance program, staff explained that often inmates with no legitimate interest in the process and who already know what the response is going to be file grievances in order to exhaust administrative remedies before filing a lawsuit. Staff also explained that staff conduct grievances often result in becoming a game of “he said, she said,” with no clear resolution. From surveys, letters, and conversations with inmates, it was apparent that most inmates do not find the grievance system to be an effective means of resolving problems, as the vast majority of grievances are not resolved in favor of the inmate, and that the main reason to file grievances is to exhaust administrative remedies. Forty-four percent of Attica survey respondents stated that they had used the grievance system at the facility, and 77% of survey respondents characterized it as poor, with 74% stating that it was worse than at other prisons and ranking the prison in the bottom 40% of CA-visited prisons for effectiveness of the grievance system. Sixty-three percent of all inmates who reported filing a grievance at Attica described being retaliated against at least once for using the grievance system. PROGRAMS Several of the Attica prisoners’ demands in 1971 related to jobs and programs, specifically that the Department apply the State minimum wage to all institutions, including prisons, that the Department “institute realistic rehabilitation programs for all inmates according to their offense and personal needs,” that educational programs be improved, and that religious freedom be permitted.34 As will be discussed below, New York State has come a long way regarding many of these issues; however, inmate wages remain despairingly low. At the time of the Attica rebellion, inmates received between $.30 and $.50 an hour. Today, the inmate pay scale is between $.16 and $.65 an hour, with the majority of inmates making between $.16 and $.25. The Visiting Committee toured Attica’s academic, vocational, and Transitional Services (TS) programs. We observed various class sessions and spoke with staff and inmates about the programs. According to information provided by the facility, 44% of Attica inmates had full-time programming (two modules per day), 10% part-time programming, and 29% were idle.35 This idleness rate is higher than the rate at nearly all the prisons we have visited. Of the 473 inmates assigned to facility jobs at the time of our visit, 60% were assigned to porter positions, where inmates conduct cleaning and maintenance tasks and typically do not learn productive skills that could help them find jobs outside of prison. The facility’s two industry programs, Metal Shop and Mess Hall, were both near capacity with 187 and 143 inmates, respectively. Attica ranked in the middle of all CA-visited prisons for job satisfaction, with 74% of survey respondents satisfied with their job at least sometimes.36 When asked to explain their job satisfaction ratings, survey respondents primarily complained about long waits for job placement or that the facility will not give them a job, and that wages were too low. 34 Attica Prisoners’ Demands: September 9, 1971. Nine hundred fifty Attica inmates were programmed full-time, 210 part-time, and 630 were idle. 36 Compared to an average of 70% of survey respondents at all CA-visited prisons for job satisfaction. 35 - 15 - Prison Visiting Project Correctional Association of NY Attica Correctional Facility April 2011 Academic Programs One crucial issue to the inmates involved in the Attica rebellion was to “modernize” educational programming. Since New York State requires all inmates without a high school diploma or equivalent to be placed in academic programs, school is available at every prison in the state. The quality and accessibility of academic programming, however, varies from prison to prison, as does availability of post-secondary educational opportunities. With the launching of a college program run by Genesee Community College, Attica stands out as one of the few maximum-security prisons in New York that provides inmates an opportunity for a college education. The classrooms we visited appeared bright and clean, with maps and posters on the walls, and all inmates in the academic program have access to the computer lab. At the time of our visit, Attica employed nine full-time and one part-time teachers. The facility also had two full-time and one part-time vacancies since June 2008 and January 2011, and one of the nine current instructors had been on temporary leave since January 2011. None of the academic staff spoke Spanish, although staff explained that the part-time assistant librarian sometimes serves as an interpreter. Attica offers five levels of academic programming, the capacity and enrollment of which is laid out in the table below. Inmates enrolled in Attica’s academic program are housed in A and DBlocks, along with most of the inmates enrolled in vocational programs. Cell study is available for inmates in the SHU, long-term keeplock, PC, infirmary, and some inmates on a waiting list for academic programs. Spanish language materials are available. At the time of our visit, 17 SHU inmates and 78 non-SHU inmates were enrolled in the cell study program. Table A – Attica’s Educational Program Capacity, Enrollment and Waiting List 37 # of Sections Capacity Enrollment Waiting List Total Enrolled + Waiting List ABE37 2 76 70 112 182 Pre-GED 3 91 91 112 203 GED 2 59 59 97 156 ESL 2 17 10 11 21 Multi-Level 1 34 34 27 61 Total 9 277 264 359 623 Adult Basic Education. - 16 - Prison Visiting Project Correctional Association of NY Attica Correctional Facility April 2011 Attica has a lower percentage of the population without a high school diploma than other facilities in New York State; however, it also has lower capacity to place those without this degree in educational programming. According to data provided by the facility, 39% of Attica inmates do not have a high school diploma or equivalent, lower than the 43% average system-wide. The ratio of GED class capacity and enrollment to the total number of Attica inmates without a GED is lower than two-thirds of all CA-visited facilities. Sixty-four percent of students who took the GED test in 2009 passed (34 out of 53) and 48% of students passed in 2010 (25 out of 52). Compared to other prisons for which we have data, Attica inmates without a high school diploma took and passed the GED test at rates lower in 2009 and 2010 than most of the prisons for which we have GED passage rates.38 Genesee Community College initiated its Attica college program in January 2011 and had already been receiving positive reviews from inmates and staff. The program is funded for two years and is conducted in the evenings, three nights a week. Courses offered were U.S. History, English Composition 101, and a college-prep course. Participants must pass an entry exam, have good disciplinary records, and be more than three years from their conditional release date. Candidates must also submit a writing sample. Five inmates were enrolled in correspondence courses with other post-secondary schools. At the time of our visit, 23 students were working towards Associates degrees in science or general studies/liberal arts. Of the seven Attica survey respondents participating in the college program, six rated the program as good. Fifty-nine percent of Attica survey respondents were at least somewhat satisfied with the facility’s educational program, similar to the average satisfaction rate at all 29 CA-visited prisons.39 Survey respondents in the Pre-GED and GED programs generally rated the programs as fair, with inmates slightly more satisfied with the Pre-GED course.40 When asked to explain their ratings of Attica’s educational programs, a large number of inmates stated that teachers appeared apathetic and uncommitted to student progress. We also received a significant number of complaints from inmates that there were not enough educational programs, particularly for those who already had a high school diploma or equivalent. Those who rated the academic program positively said that the teachers were nice and helpful, and that the program was beneficial to those who put the work in. Vocational Programs With a staff of ten instructors, Attica offers an impressive array of nine vocational programs. Two additional positions, instructors for the Plumbing and Heating and Sheltered Workshop programs, had been vacant since early 2010. The Visiting Committee was impressed with the vocational area, which was clean and displayed electronic signs made by the program participants labeling every classroom. Vocational resources for Spanish-speaking inmates were scarce, although the Building Maintenance program offered some books in Spanish, and the Printing program accommodated many Spanish speakers. 38 Attica ranked third lowest out of nine prisons in 2009 and second lowest out of five facilities in 2010. Compared to an average of 58% satisfaction at all CA-visited prisons. 40 Forty-three percent of survey respondents enrolled in the Pre-GED program rated it as fair and 29% rated it as good. Fifty-seven percent of those in the GED program rated it as fair and 17% rated it as good. 39 - 17 - Prison Visiting Project Correctional Association of NY Attica Correctional Facility April 2011 Table B – Attica’s Vocational Program Capacity, Enrollment and Waiting List Capacity Enrollment Waiting List Total Enrolled + Waiting List 34 31 98 129 30 27 104 131 Electrical Trades 30 29 62 91 Floor Covering 30 29 51 80 General Business 74 66 84 150 Radio & Television Repair 30 29 51 80 Printing 30 30 25 55 Welding 30 29 51 80 Small Engine Repair 30 30 38 68 Total 318 300 564 864 Building Maintenance Custodial Maintenance The Visiting Committee visited several vocational programs and were impressed with instructor knowledge and the level of inmate engagement. It takes inmates six months to a year and a half to complete a program, depending on the program and the speed at which the inmate progresses. Staff explained that the inmates in the Intermediate Care Program (ICP) can participate in most vocational programs depending on the severity of their mental illness and ability to cope in the program, but the Custodial Maintenance program was the most accommodating to this special population. Due to the unique schedule at Attica and segregation of the four different housing blocks, inmates without a GED cannot take most vocational programs if they are enrolled in academic programs which are located in a different part of the facility. Some inmates without a GED can enroll in the Electrical Trades program and are permitted to do cell study. Attica survey respondents rated the facility’s vocational programs higher than many other prisons, ranking Attica eighth best of all CA-visited prisons.41 When asked to explain their ratings, many survey respondents stated that they liked the programs, particularly those run by Mr. Foust and Mr. Sherwood, with some stating, “Good staff. Well rounded course - enough supplies and books to have hands on training,” and “I like that it gets me out of my cell to do hands-on activities.” Inmates who were dissatisfied with Attica’s vocational program complained that only 41 Seventy-three percent of Attica survey respondents were at least somewhat satisfied with vocational programs at the facility, compared to an average satisfaction rate of 64%. - 18 - Prison Visiting Project Correctional Association of NY Attica Correctional Facility April 2011 one class is allowed during a person’s entire sentence, materials were outdated and insufficient, and that there were too few spaces and a long waiting list. We are concerned by the fact that the number of inmates on Attica’s vocational program waiting lists is nearly twice the number of inmates actually enrolled in the programs, particularly due to the fact that each vocational program takes at least one year to complete. We suggest that the Department fill the two vacant vocational instructor positions, in addition to considering program expansion in order to fulfill the programmatic needs of a higher percentage of inmates. Transitional Services Attica survey respondents rated the facility’s Transitional Services program higher than many other CA-visited facilities, particularly the Aggression Replacement Training (ART) and Thinking for a Change (T4C) programs. Attica employed one Transitional Services coordinator and one ART coordinator at the time of our visit, in addition to several IPAs. Attica operates all of the available Transitional Services programs including Phase I, T4C, Phase III, and ART, the capacity and enrollment of which are described in the table below. Along with the traditional classroom sessions, inmates may make use of the Transitional Services office to research reentry resources and other information, which contained resources on housing, HIV treatment, substance abuse treatment, and reentry organizations, in addition to several typewriters for IPA use. Staff informed the Visiting Committee that the IPA has approximately 20 appointments per week with inmates to assist them in finding resources and referrals. Table C – Attica’s Transitional Services Capacity, Enrollment and Waiting List Capacity Enrollment Waiting List Completed Completed 2009 2010 Completed 1/11-3/11 Phase I 15 15 39 180 184 51 T4C 15 15 1809 8 26 15 Phase III 15 8 1807 58 63 21 ART 30 28 1091 176 152 18 Total 75 66 4746 422 425 105 Phase I, the general introduction to DOCCS policies and life in prison, operates at Attica in the afternoons Monday through Friday, for a period of two weeks. Phase II has been entirely phased out as T4C has been running at the facility for two years. Four of the counselors at Attica are trained to facilitate the T4C course; however, only one course was running at the time of our visit and operated on Tuesday and Thursday mornings for a duration of 22 sessions. Higher than any other CA-visited prison, 70% of all Attica survey respondents were at least somewhat satisfied with T4C.42 42 Compared to an average satisfaction rating of 58% for T4C at all CA-visited prisons. - 19 - Prison Visiting Project Correctional Association of NY Attica Correctional Facility April 2011 Phase III is available to inmates who have less than 120 days until their release date and operates four days a week for six weeks. Inmates in Phase III do not leave the program with a typed resume; however, the class covers basics of resume creation and inmates are encouraged to make an appointment to use the library’s Career Zone program to complete a resume on their own time. Transitional Services staff will assist inmates who do not have a copy of their birth certificate or Social Security card to obtain these documents; however, according to staff, most inmates get these documents well before they enter Phase III. One hundred and forty-eight Social Security cards and 224 Birth Certificates were given to inmates at Attica in 2010, an increase from 143 and 181 in 2009, respectively. Many survey participants provided positive reviews of their class time and appreciated the assistance of peer facilitators and IPAs. Half of all Attica survey respondents were at least somewhat satisfied with Phase III, ranking the facility in the top third of all CA-visited prisons.43 Attica operates two separate ART programs to cater to different populations in the facility. One ART program operates Monday through Friday and the other program operates one or two days a week for a longer period of time, allowing inmates with other academic or vocational program assignments to participate. Survey participants generally liked the instructor and gave the program positive reviews, finding the behavior management skills curriculum to be interesting, useful and applicable to real life situations. Third highest of all CA-visited prisons, 74% of Attica survey respondents were at least somewhat satisfied with the facility’s ART program.44 Many inmates who participated in our survey complained that the resources provided were not useful, outdated, or that there were not enough referrals for those inmates that live outside of the New York City area. We encourage the facility to ensure that reentry resources are up-to-date and relevant to inmates being released to a variety of locations. Furthermore, given the extremely long program waiting list, we encourage them to explore ways of expanding the program. Recreation and Other Programs In 1971, Attica inmates demanded that the Department give them “true religious freedom,” less time in their cells and better recreational equipment, and that the Department remove the inside walls of the quartered yard, “making one open yard.” Forty years later, Attica’s yard remains divided into four sections; however, today inmates are afforded many opportunities for religious freedom and expression. Recreational opportunities have significantly improved, although idleness at the facility remains a problem. According to a list provided by facility administrators, inmates may participate in Baptist Bible Study, Elim Bible Study, Protestant Bible Study, Meditation, Cephas prison ministry, creative writing, and the Vietnam Veterans program. Additionally, chaplains for several different major religions, including Islam and Judaism, run regularly scheduled worship services and religious festivals, and are also available for individual religious counseling. During our December 2011 call with prison officials, we were pleased to learn that the facility has implemented a Lifers Offender Organization, which is a mentoring program that 43 44 Compared to an average satisfaction rating of 48% for Phase III at all CA-visited prisons. Compared to an average satisfaction rating of 64% for ART at all CA-visited prisons. - 20 - Prison Visiting Project Correctional Association of NY Attica Correctional Facility April 2011 utilizes individuals serving life sentences to mentor younger prisoners regarding issues pertaining to prison life. Administration informed the visiting committee that there were 10 mentors and about 200 mentees engaged in the program. As previously mentioned, Attica contains four yards separated by walls in which one housing block is permitted entry at a time. This housing block segregation serves to cut down on violent incidents between inmates. Each yard contains six payphones, a baseball diamond, a bathhouse, weights, and picnic tables. We did not observe any shaded or covered areas. Inmates with whom we spoke generally expressed satisfaction with Attica’s recreation program. Others, however, complained about the limited number of telephones per yard and the dirty conditions inside the outdoor bathhouses, explaining that since they are only permitted two showers per week, many inmates must utilize the outdoor bathhouses to keep clean. The facility also contains an indoor gymnasium which contains basketball courts and an impressive weight room. Additionally, fields upon which inmates play football and soccer are accessible through the gymnasium. This outdoor area also contains two wooden shelters with grills and picnic tables that are used for special events and certain religious festivals. Access to the gym is severely limited, and only available to inmates participating in Attica’s 90-day physical education program with a capacity for 20 inmates, inmates participating in the annual bodybuilding competition, inmates on sports teams, and ICP inmates. Otherwise, all other inmates must go to the outdoor yard during recreation times, except during the winter when all inmates may visit the gymnasium twice a week. We were impressed with Attica’s indoor gymnasium and recreation program and encourage prison administrators to examine ways for more inmates to have greater access to the facility as a means of reducing both idleness and violence in the outdoor yard, and to give inmates more significant opportunities for exercise. SUBSTANCE ABUSE TREATMENT PROGRAMS The Visiting Committee visited Attica’s Alcohol and Substance Abuse Treatment (ASAT) program, which was at its capacity of 82 inmates at the time of our visit, with 1,079 inmates on the waiting list. Attica employs one full-time correction counselor and one program assistant (PA) for the ASAT program in general population and another correction counselor to run the Integrated Dual Disorder Treatment (IDDT) ASAT program, with one vacancy for a PA. According to staff, this position has been vacant for four years. According to facility staff, the inmate-staff ratio is one staff person for every 41 inmates. ASAT program participants must attend sessions during both morning and afternoon programming modules each day. The ASAT program operates as a modified Therapeutic Community (TC) and program participants are housed together in C-Block where the dayrooms have been converted into classrooms.45 Typical TC elements are employed in the program including community meetings, the use of push-ups and pull-ups, and some type of structured hierarchy.46 Classrooms contained boards describing program rules and participant roles, in 45 TC cell standards include strict rules describing how an inmate’s bed should be made, how shoes must be aligned, and various other regulations regarding how an inmate’s possessions must be kept and organized. 46 Pull-ups are verbal concerns participants or staff give to other participants who may not be appropriately managing emotions, behaviors or tasks. Push-ups are verbal acknowledgements participants or staff give to other participants who have demonstrated good behavior and/or progress. DOCS ASAT Program Operations Manual, 2002. - 21 - Prison Visiting Project Correctional Association of NY Attica Correctional Facility April 2011 addition to posters on the walls. Staff explained that program participants do not need to keep their cells according to strict TC standards; however, they must keep them relatively neat. Security staff assigned to the C-Block 7:00 a.m. to 3:00 p.m. shift have been trained in the TC technique, although staff expressed a necessity for training security staff working all shifts on the unit. Inmates can be dismissed from the ASAT program due to: (1) a disciplinary removal— when an inmate is convicted of violating important prison or program rules and/or is given more than 30 days of keeplock; (2) an inadequate program performance removal, e.g., if an inmate fails to participate in the program or receives more than two negative program evaluations; or (3) an administrative removal, e.g., if an inmate is discharged or transferred to another facility unrelated to his performance in the program. The table below shows the numbers of graduations and removals for Attica’s ASAT program. Staff explained that Attica has a relatively low number of disciplinary removals due to counseling and program staff’s efforts at holding treatment meetings to discuss how to treat individual cases, particularly inmates who misbehave and those who are released from the SHU and placed directly in ASAT. They attributed the high number of administrative removals to the fact that the security status of many Attica inmates is altered while at the facility, particularly those that were transferred to the Attica SHU from a medium-security prison and then are transferred back to a medium-security prison after a certain length of time at Attica. From the data given to us by the facility, there appears to be no program performance removals, unless they have been placed in the disciplinary removal category. We are concerned that Attica’s ASAT has almost as many participant removals per year as program graduates. Table D – Attica ASAT Program Completions and Removals 2009 – 2010 Completions Disciplinary Administrative Total Removals: 2009 92 49 38 87 2010 86 47 22 69 The Visiting Committee observed two ASAT program sessions, each of which contained 15 participants at the time of our visit, although staff informed us that each class usually contains 18 participants. Participants in both classes appeared engaged in the course material, contributing to the discussion and asking questions, and both instructors appeared to be enthusiastic. We did observe that one of the classrooms was extremely loud, as noise from the outside housing block interfered with exchanges among class participants. Additionally, there were no restrooms in the classrooms and participants complained of having to wait until after class to use the facilities. Eighty-six percent of survey respondents who were not enrolled in ASAT at the time of our visit but had participated in the program at a prior time were at least somewhat satisfied with substance abuse treatment at Attica. We received seven surveys from inmates enrolled in the program and they were generally at least somewhat satisfied with the program, although some inmates raised concerns about interactions with the security staff on the housing unit and expressed a desire for more substantial discharge planning. Although we had a limited number of survey participants, their level of satisfaction with the treatment staff was higher than most CA-visited ASAT - 22 - Prison Visiting Project Correctional Association of NY Attica Correctional Facility April 2011 programs. Similarly, they expressed greater confidence in their ability to discuss issues within the program without being exposed to criticism from the group than most other programs.47 The CA was also pleased to learn during our December 2011 follow-up call that there had been a regional training for DOCCS substance abuse providers and that Attica’s ASAT staff had participated in training on the modifications to the DOCCS Substance Abuse Treatment Operation Manual, including diagnostic determination, treatment planning, therapeutic community and treatment recording. MENTAL HEALTH CARE One significant feature setting New York State’s correctional system today apart from 1971 is the provision of mental health services to inmates throughout the Department. Attica is an Office of Mental Health (OMH) Level-1 facility, which means that the facility has the capability of treating a “person diagnosed with a major mental illness and/or severe personality disorder[s] with active symptoms and/or a history of psychiatric instability.”48 Mental health personnel must be present in the facility at all times. All prison mental health services are provided by New York State OMH staff, rather than DOCCS staff, and at the time of our visit OMH was authorized to maintain 28 full-time employees at Attica. The Visiting Committee met with OMH staff during our visit, and we appreciate the extensive information provided by the facility staff during our meeting and tour of program areas. OMH has the capacity to provide services to a substantially larger population at Attica than other CA-visited Level-1 facilities. At the time of our visit, OMH staff estimated that there were 443 Attica inmates on the OMH caseload, representing 21% of the prison population. OMH is responsible for programs and monitoring in several special housing areas, including a 15-bed Residential Crisis Treatment Program (RCTP), a 78-bed Intermediate Care Program (ICP), a 36bed Transitional Intermediate Care Program (TRICP), and a 34-bed Special Treatment Program (STP) in the SHU. Attica general population survey respondents rated mental health services higher than the average ratings at all CA-visited facilities, with 31% rating services as good, 32% rating them as fair, and 37% rating them as poor, placing the prison in the top half of CA-visited prisons for assessment of mental health services.49 Residential Crisis Treatment Program (RCTP) Attica’s Residential Crisis Treatment Program (RCTP) is intended to temporarily house inmates who experience mental health crises and may be a danger to themselves or others, or who otherwise exhibit serious psychological problems and need an assessment to determine appropriate 47 For a more detailed discussion of substance abuse treatment in New York State, see the Correctional Association’s recent report Treatment Behind Bars: Substance Abuse Treatment in New York State Prisons, 2007-2010, available at http://www.correctionalassociation.org/PVP/substance_abuse.htm. 48 When a Person with Mental Illness Goes to Prison: How to Help, a 2010 guide published by The Urban Justice Center’s Mental Health Project (MHP) and the National Alliance on Mental Illness – New York State (NAMI-NYS), Appendix A. 49 Compared to average ratings of 24% good, 40% fair, and 36% for mental health services at all CA visited prisons. Twenty-three percent of general survey participants were on the OMH caseload at Attica and 20% had been at some point in the past. - 23 - Prison Visiting Project Correctional Association of NY Attica Correctional Facility April 2011 treatment. Inmates in crisis remain in observation cells until OMH staff determine appropriate treatment plans and placements. Staff informed us that security staff assigned to the RCTP are encouraged to help inmates feel safe and secure and are specially trained to work with this delicate population and, in fact, have been assigned to OMH programs for 10 to 15 years. The Visiting Committee visited the RCTP, which consisted of 10 observation cells and five dormitory beds. The unit was dark and extremely quiet, a stark contrast from the rest of the prison. According to OMH staff, most inmates admitted to the RCTP have threatened to commit acts of self harm. RCTP inmates are generally from Attica itself, although nearby facilities without an RCTP such as Groveland, Livingston, and Wyoming may also send inmates in crisis to Attica. The mental health records of inmates actively on the OMH caseload accompany inmates transferred from other facilities. Staff informed us that a low percentage of RCTP admissions come from disciplinary housing. OMH staff hold a team meeting each morning with all staff and discuss each case and determine a treatment plan for each inmate before conducting private interviews. Inmates admitted to the RCTP are given a mandatory initial interview, the length of which depends on the severity of an individual’s mental health diagnosis, and are then offered an optional interview with OMH staff each subsequent day they are in the RCTP. Staff informed us that nearly every RCTP inmate engages in the daily interviews and if inmates do refuse to participate in an interview, staff try to engage them or complete the interview cell-side. Staff told us that language barriers have not been an issue, but staff may use the AT&T translation service if necessary. After an average length of stay of four days, newly stabilized inmates are returned to their original housing units or facilities. Intermediate Care Program (ICP) The Intermediate Care Program (ICP) is a residential treatment program for inmates with serious mental illness (SMI). Inmates in the ICP are housed on a 78-bed unit separate from Attica’s general prison population and attend special programs and weekly community meetings in a program area located on the housing unit. Some inmates may also enroll in regular educational and vocational programs away from the unit and have job assignments throughout the facility. The goal of the ICP is to provide inmates with sufficient mental health treatment and support so that they may eventually return to the general prison population, although inmates with chronic mental illness may spend the duration of their prison sentence in the ICP. Attica’s ICP held 73 inmates at the time of our visit. The Visiting Committee toured the ICP housing units, two housing blocks with OMH staff offices located directly on them, and program spaces. We received a total of 21 written and oral surveys from ICP inmates who generally expressed that they feel safer in the ICP than in general housing. ICP survey respondents also appeared to have achieved some degree of progress while in the ICP, although the levels of counseling and individual attention varied per inmate. Nearly half of ICP survey respondents had been sent to the RCTP or Central New York Psychiatric Center (CNYPC) prior to their admittance to the ICP and less than 30% of those had returned to either location while housed in the ICP. The ICP is divided into four phases, according to an inmate’s degree of functioning. Each inmate is continuously working on developing his skills in order to progress through the phases - 24 - Prison Visiting Project Correctional Association of NY Attica Correctional Facility April 2011 and eventually off the ICP. ICP staff make rounds on the ICP block each morning and speak to each inmate to assess their progress. Staff also hold treatment team meetings each morning to determine the needs of each inmate. There were 10 Phase I inmates at the time of our visit and, according to staff, most inmates spend one month in Phase I. The majority of ICP inmates were in Phase II and there were seven Phase III inmates, who had the capacity to be programmed off the ICP unit for the entire day. Inmates must complete Phase IV before being transferred from the ICP. Discharge from the ICP is discussed in OMH team meetings in coordination with DOCCS and all discharges are transferred to the Transitional ICP (TRICP). Staff explained that no inmate is in the same phase for more than one year and the average ICP stay is between 24 and 30 months, although there are five to six inmates who have been in the ICP for more than four years and will never be placed in general population. ICP inmates are offered a variety of programs, including those related to mental illness such as socialization, skills development, symptom management, and various academic and vocational programs. OMH runs 18 groups weekly in addition to an Integrated Dual Disorder Treatment (IDDT) program for ICP inmates requiring substance abuse treatment in collaboration with DOCCS. DOCCS runs a Sex Offender Program (SOP) exclusively for ICP inmates which contained 12 inmates at the time of our visit. ICP inmates must meet the minimum 20 hours per week of programming, Monday through Friday, and there are six to 15 inmates in each group. Staff explained that inmates who are extremely low-functioning participate in groups with other inmates, and staff rely on peer support to help these individuals understand the materials. OMH runs an Activities of Daily Living (ADL) program for individuals requiring more intensive care and attention to hygiene and these inmates are taught daily living and hygiene skills. OMH may issue misbehavior reports to ICP inmates, but also utilize positive and negative informational reports to moderate inmate behavior. According to OMH staff, a total of two negative and five informational reports were issued in the year prior to our visit, and two ICP inmates were transferred to the SHU. ICP inmates with SHU sentences are first placed in the SHU and from there may be transferred to a residential mental health unit (RMHU). Staff explained that Special Treatment Program (STP) inmates may come directly to the ICP after completing their disciplinary sentence, and that these inmates usually have 60 days left on their disciplinary sentence. These individuals are brought to the ICP for a trial period to ensure that they can adjust properly to the ICP and they remain keeplocked until it is clear that they are adjusting well and reintegration is possible. The Attica ICP has a capacity for six of these individuals at a time and therefore there is a waiting list. From inmate comments, it appeared that counselors were readily available for conversation and individual therapy sessions, although the length of these sessions ranged from five to 30 minutes. Inmates were generally satisfied with programming, particularly ART and Metal Shop. When asked to describe components of the program they disliked, several inmates stated that they disliked the living skills program, describing it as unnecessary, and did not like recreation in the gym as it is a location for harassment by security staff. Some survey respondents cited delayed medical treatment as a concern, although all appeared to be receiving their mental health medications in a timely manner. The Visiting Committee observed the IDDT program, which had a total of 12 inmates enrolled at the time of our visit with 12 on the waiting list and was run by a DOCCS ASAT - 25 - Prison Visiting Project Correctional Association of NY Attica Correctional Facility April 2011 counselor and an OMH social worker. The room contained inspirational and informational posters, in addition to two boards describing classroom job assignments and a television. Inmates appeared engaged and interested and staff clarified issues that were unclear and encouraged inmates to express themselves. Despite positive reviews of programs and mental health care, relations with security staff appear to be a significant concern and nearly every survey respondent complained of a lack of confidentiality between clinicians and security staff. While some inmates reported positive interactions with security staff, the majority complained of verbal harassment and several complained of abusive pat frisks. Furthermore, a majority of survey respondents reported that OMH staff were not receptive to complaints regarding security staff and there appears to be no means for ICP inmates to combat potential abusive behavior on the part of security staff. We are extremely concerned about complaints regarding confidentiality. Although the CA understands the need for OMH to share pertinent information regarding the treatment of individuals in residential mental health units with DOCCS staff who work on those units, we strongly urge that OMH staff review how much and what information should be shared. Limitation should be established as to what information is important for security staff to be most effective. We also recommend that OMH staff review confidentiality protocols and ensure that proper protocols are followed. Additionally, harassment by security staff assigned to the ICP is counterproductive to therapeutic treatment. We recommend that DOCCS take steps to train all ICP security staff on how to properly interact with this vulnerable population and remove from the ICP unit any staff who fail to comply. Transitional Intermediate Care Program (TRICP) Attica’s Transitional Intermediate Care Program (TRICP) is a 36-cell transitory unit for inmates with mental illness who require a more supportive environment than those in general population, but whose illnesses are not severe enough for placement in the ICP. TRICP inmates are programmed with general population inmates but also receive group and individual therapy. Staff informed us that Attica’s TRICP is always at its capacity of 36 inmates, and that inmates spend varied amounts of time on the unit, from six months to two years. Inmates are generally sent to the TRICP from the ICP, STP, or general population and TRICP inmates who have difficulty with being programmed with general population inmates are referred back to the ICP. TRICP inmates attend nine OMH-run TRICP-specific programs a week, in addition to regular general population program callouts. OMH runs a variety of eight TRICP programs each week, with approximately nine inmates in each program. We received a total of four written and oral surveys from TRICP inmates whose time on the unit ranged from two months to two years. When asked what they liked about the TRICP, survey respondents stated that they liked going off the unit for programming and that it kept them “active.” One survey respondent expressed satisfaction with the stress management program in particular. Like inmates in the ICP, TRICP inmates complained about confidentiality, reporting that security staff stand nearby during inmate meetings with OMH staff. We have significant concerns about patient confidentiality at Attica and request that OMH and DOCCS investigate these complaints. - 26 - Prison Visiting Project Correctional Association of NY Attica Correctional Facility April 2011 Special Treatment Program (STP) The Visiting Committee also toured the Special Treatment Program (STP), which provides mental health services for inmates with serious mental illness confined in disciplinary housing. The STP at Attica began in 2000 with an 18-bed program in its SHU and was expanded to 34 beds in 2007. During the years 2008 and 2009, 44 and 77 inmates, respectively, were admitted to the program and 44 and 76 patients, respectively, were discharged. At the time of our visit, there were approximately 20 inmates in the program. Staff estimated that the average number of inmates in the program has been between 20 and 25 participants for the past few years. OMH data for 2009 reported that the median length of stay for all STP patients throughout the Department discharged during that year was 123 days. The STP is designed to provide mental health services while the inmate is still confined in the restrictive setting of Attica’s SHU. The STP Program Operations Description Manual states that the program “incorporates cognitive programs, utilizing an eclectic psycho-educational approach and uses principles and practices from the fields of rehabilitation, client-centered therapies and behavioral psychology.”50 The primary components of the program are two-hour group sessions five days per week conducted by OMH and to a lesser extent DOCCS treatment staff, individual meetings with the patients’ therapists and psychiatrist and coordination of the treatment program through a joint OMH-DOCCS treatment team that meets daily on the unit. Staff informed us that there are approximately 20 different psycho-educational modules presented in the group sessions that deal with subjects such as symptom management; education about psychotropic medications; activities of daily living; interpersonal relationships and communication; decision making, anger management, and criminal thinking; goal setting; and discharge planning. DOCCS and OMH staff also conduct educational activities (ABE and GEDlevel) and an alcohol and substance abuse treatment program for STP patients. During our visit, the Visiting Committee interviewed 16 STP inmates and collected identifying information from a total of 23 program participants, 7 of whom provided us with detailed written surveys about conditions on the unit. Attica STP inmates were housed in two SHU disciplinary units in cells that were often dirty and somewhat dark; many of the cells had plastic cell shields that further isolated the individuals from contact with staff. Each weekday STP inmates are offered the opportunity to participate in a group therapy session and, if they agree, the patients are escorted to one of the two group treatment rooms for approximately two hours, where up to five STP inmates are placed in individual caged therapeutic cubicles, each about the size of a phone booth, to speak with a group therapist or observe videos.51 The CA has long objected to the use of these confined treatment units for group therapy. Using such imposing physical barriers to separate therapists from their patients inhibits the establishment of a therapeutic environment and undermines the trust that should develop between therapist and patient, particularly when these restrictions are imposed throughout the treatment process, which, for some STP inmates, could extend for years. It should be noted that at Central New York Psychiatric Center, inmates with more significant mental health problems regularly see their therapist without such physical restrictions being employed. 50 51 DOCCS and OMH, Special Treatment Program (STP) – Program Operations Description at p. 5 (August 2008). The size of a therapeutic cubicle is 4’ wide by 4’8” deep by 7’ high. - 27 - Prison Visiting Project Correctional Association of NY Attica Correctional Facility April 2011 The STP population we observed during our visit reveals both the challenges faced by the program and the problems many participants encounter during their time in the STP. A majority of the inmates with whom we spoke reported long SHU sentences, with some having a total SHU sentence of five to more than ten years. The median SHU sentence for inmates who responded to our written survey was three years. Many of these individuals accumulated additional SHU time while they were in other SHUs or one of the several mental health treatment programs for SHU inmates, such as the Residential Mental Health Treatment Unit (RMHTU) at Marcy C.F., the Behavioral Health Units (BHUs) at Great Meadow and Sullivan, or the STP programs at Five Points and Green Haven. Accordingly, not only had some of these patients been in a disciplinary setting for several years prior to being sent to Attica, some patients were facing three to seven additional years in disciplinary confinement. It appears that many of the Attica STP patients have been removed from these other programs and sent to Attica. This suggests that the Department’s treatment model may not have worked for these individuals, and it is unclear what actions, if any, are being taken at Attica to alter the treatment plan for these individuals to be more effective. One of the incentives for inmates to actively participate in the STP program is to obtain reductions, known as time cuts, in their disciplinary sentence. The treatment team and the facility Joint Case Management Committee can make recommendations to the superintendent for reductions in an inmate’s SHU time and/or conversion of his SHU time to keeplock status. Although we strongly endorse this approach, it does not appear that the time-cut process is significantly reducing STP inmates’ sentences. OMH’s annual report on the STP program for calendar year 2009 indicated that only half of the STP inmates discharged during that year received a reduction in their SHU sentence, and the average amount of the time cut was 87 days.52 Of the STP inmates who provided us with time-cut information, most had reductions that were from one to eight months. Given the very lengthy sentences of these inmates, these reductions meant that these inmates were still spending multiple years in a disciplinary setting. We urge the prison administration to be more aggressive in reducing SHU time so that the patients can graduate from the program more quickly and be reintegrated into a non-disciplinary environment where their mental health needs can more appropriately be addressed. The inmates are assigned to Attica’s STP to receive more intense mental health care than other SHU inmates, and this care is provided primarily through group sessions. Of the individuals we interviewed or who provided us with written survey responses, a majority of those who commented on the group sessions expressed negative opinions; four of the seven written survey respondents rated the sessions as poor. Several said the group sessions did not address their needs and that too often the patients watched videos. Some patients told us that they refuse the counseling sessions because they feel the program is not helping them. Refusals of group sessions appear to be a problem in Attica’s STP; the OMH annual report on the STP program for calendar year 2009 documented that 24% of Attica STP patients refused to participate in the daily out-ofcell program.53 The main positive statements we received about the group sessions were that the patients appreciated the opportunity to talk to other inmates in the program. STP patients also see an individual therapist, and again, a significant majority of the patients who communicated with us had negative views of their therapists. Most reported seeing their individual therapist once or twice 52 53 OMH, Special Treatment Program Annual Report 2010 at 5 (April 2010). OMH, Special Treatment Program Annual Report 2010, Table 7 (April 2010). - 28 - Prison Visiting Project Correctional Association of NY Attica Correctional Facility April 2011 per month for 10 to 15 minutes. Six of the seven written survey respondents rated the individual counseling as poor. A nearly universal complaint by the STP patients was that their conversations with mental health staff were not kept confidential and, consequently, they were confronted by security staff with private information they had provided to their therapist. We are very concerned that patients are being confronted with information that they divulged to their therapist in confidence, which is detrimental to an effective therapeutic relationship. We understand the importance of maintaining a multi-disciplinary treatment approach to address the needs of the patients. However, we strongly recommend that OMH staff review what information is provided to security staff and ensure that only the minimum amount of information is provided and only that information that will better inform security staffs’ interaction with the patients. We also strongly suggest that all staff working on any mental health unit review confidentiality protocols. STP inmates also had mixed views of many of the other services provided on the unit. Of the seven respondents to the written survey, none were satisfied with the cell study program, most were dissatisfied with law library services and three were dissatisfied with the reading material provided. In contrast, a majority of the respondents were satisfied with food services, and all but two participated in the one-hour recreation program, even though it involved going to the small recreation cages outside. STP inmates also expressed negative views about the quality of health care services. Although all written survey respondents said they could access sick call at least sometimes, a majority rated the nursing care as poor. Of greater concern, all STP respondents reported delays in seeing a physician and all but one rated the doctor's care as poor. Overall, twothirds of these respondents said medical care was poor. STP survey participants and those we interviewed expressed mixed views about the security staff on the unit. Overall, only one patient expressed the view that relations with the staff were good; the remainder were neutral or expressed the view that relations were bad. Besides the uniform concern about lack of confidentiality, the most common complaints were about frequent verbal harassment and threats and retaliation for complaining about staff or services. We were particularly disturbed about reports of sexual abuse and abusive pat frisks. Although we did not seek information about specific incidents of sexual abuse involving a particular patient because of our inability to ensure absolute confidentiality in obtaining this information, several inmates reported that sexual abuse, even incidents beyond an abusive pat frisk, occur in the STP. We urge the facility to carefully review prior allegations of staff misconduct for suggestions of sexual abuse and to develop means by which STP inmates can safely report sexual abuse to the program staff without creating a risk of retaliation. Pursuant to the SHU Exclusion Law, as of July 1, 2011 patients with serious mental illness and SHU sentences greater than 30 days could no longer be placed in the STP unless extraordinary circumstances existed, but rather had to be transferred to a residential mental health treatment program for disciplinary inmates. At the time of our visit, only the RMHTU at Marcy or the BHUs would satisfy the law's requirements for program content. We were told then that the prison did not know what would happen to the STP or its patients. Since then, we have been in correspondence with several of the STP patients we met during our visit. It appears that several have been transferred from the STP to the Marcy RMHTU or one of the BHUs, or discharged from the STP to an ICP. Several patients, however, have remained on the unit and informed us that Attica's STP has been designated a residential mental health treatment unit pursuant to the SHU Exclusion Law. - 29 - Prison Visiting Project Correctional Association of NY Attica Correctional Facility April 2011 During our December 2011 conference call, facility staff confirmed that Attica’s STP program had been converted into a 10-bed RMHTU located on the 2nd floor of the north gallery of the Special Housing Unit. Facility administrators told us that all inmate-patients housed in the RMHTU are receiving four hours out-of-cell time for group therapy, modules in the morning and afternoon. Facility administrators also informed the CA that security staff received an additional seven days of enhanced mental health training pursuant to the requirements of the SHU Exclusion Law and that the facility had obtained an additional OMH physicians assistant, but no further additional security or mental health staff. Although the physical environment of the STP we visited does not violate the requirements of the SHU Exclusion Law since the patients are segregated from other SHU inmates, we are concerned about this re-classification of the Attica STP. Given the serious complaints we received from the STP inmates in April 2011, we believe the Attica program needs a thorough review to ascertain whether all patients’ needs are properly being met, and that OMH and DOCCS administrative staff should provide additional training and greater supervision of the mental health and security staff to ensure that the program is effectively treating all residents. We are particularly concerned that inmates who have not been successful at more intense mental health programs for disciplinary inmates, such as in the Marcy RMHTU and BHU at Sullivan, have been or will be placed at Attica. We believe these individuals are the most challenging patients and that Attica has not demonstrated that its current program can effectively treat these individuals. MEDICAL CARE The Visiting Committee toured the medical area and spoke with the nurse administrator about medical services at the prison. We appreciate the detailed information provided prior to our visit and during our tour. The medical area contained two waiting areas for inmates, six examination rooms, and a pharmacy. At the time of our visit, unlike most prisons, Attica does not bring inmates to the medical area for sick call; instead, sick call is conducted in small rooms in the housing blocks. The prison also has a 28-bed infirmary, and we were informed by staff that the infirmary usually serves 10 to 12 patients, including inmates from other area prisons that do not have an infirmary. Staff told us the usual length of stay for infirmary patients was less than seven days. Overall, inmate survey participants rated prison medical care at a rate that was about average for all CA-visited prisons. The responses to most of the medical care questions in the survey placed the prison near the middle of rankings of all CA-visited prisons, except that the care by clinic providers ranked near the top third of all surveyed prisons. Table E – Summary of Attica Survey Participants’ Response about Prison Medical Care, on page 30, summarizes this data, along with the prison ranking. - 30 - Prison Visiting Project Correctional Association of NY Attica Correctional Facility April 2011 Table E – Summary of Attica Survey Participants’ Responses to Prison Medical Care Medical Service Yes Sometimes No Rank* Good Fair Poor Rank* Can you see RN when 49% 39% 12% 18 needed Rate Nursing care 15% 36% 50% 17 Do you experience delays in 39% 42% 20% 18 seeing a clinic provider ** Rate Physician care 20% 35% 45% 10 Experience delays in 45% 11% 44% 18 specialty care Good follow-up to specialists 47% 54% 9 Problems getting medication 38% 17% 45% 17 Rate Overall Healthcare 15% 39% 46% 13 * Attica’s ranking from best access/care to worst based upon survey responses for all 29 CAvisited prisons. ** The three categories for this variable are: Yes=Frequently; Sometimes=Once or once in a while; and No=Never. Medical Staffing Attica is authorized to have two full time equivalent (FTE) doctors, two physician assistants, one nurse practitioner (NP) and 17 registered nurses (RN). At the time of our visit, the nurse practitioner position had been vacant for nine months and one nursing item had been vacant for a month. In addition to the permanent medical staff, Attica regularly employed two per diem nurses who worked approximately two to three 10-hour shifts every two weeks. Due to the nurse practitioner vacancy, the facility had employed a doctor on a fee-for-service basis for approximately two to three days per week. Given the size of the facility, the facility does not have sufficient number of nurses; the nurse-patient staffing levels of one nurse for every 125 patients is significantly higher than the department-wide figure of one nurse per 80 to 100 patients. Since Attica is a medical Level-1 prison, signifying it can handle inmates with the most serious medical problems, and has a larger than average infirmary, we urge DOCCS to evaluate Attica’s nursing need to determine whether its nursing staff should be increased. With five authorized clinic providers (two FTE doctors, two PAs and one NP), Attica has a ratio of one provider for every 430 to 440 patients; this ratio is higher than the department-wide average of 1:400. The actual ratio is even higher, given the vacant NP position, which is not being fully replaced by the parttime, fee-for-services doctor. Once the NP item is filled, we believe the Department should assess whether additional clinic staff is also needed. Sick Call Sick call is conducted in the housing units in very small rooms at the front of the blocks. During the visit, we inspected several of these rooms and found them to be inadequate for a proper medical examination. The rooms we saw were dark and in poor condition, had old furniture, no examination table, and limited medical equipment. It is also difficult to monitor activity in these rooms, and several inmates commented that security staff often remained in or very near the room - 31 - Prison Visiting Project Correctional Association of NY Attica Correctional Facility April 2011 so that the inmates could not have a confidential conversation with the nurse during the sick call encounter. During our December 2011 conference call with facility staff, we were informed that since our visit, the prison has altered its sick call procedures and has initiated a program to conduct sick call in the clinic area for all the housing units. At the time of our conference call, four of the five housing areas were attending early morning sick-call in the clinic area and the fifth housing area was scheduled to be changed over shortly. The CA commends the administration for implementing this change. Sick call under this new procedure begins at 6:00 am and prisoners from all but housing Block-A are attending this early morning sick call. Patients who wish to attend sick call submit a request the previous night before the 10:00pm count and are then escorted to the clinic area at 5:45 a.m. the next day. The facility currently has four nurses attending to sick call patients and will assign additional staff if needed; an additional sick call nurse will be added when the last housing area starts attending sick call in the clinic area. The facility estimates that approximately 35 inmates from four of the housing blocks are seen each day for sick call. Medical staff will continue to make rounds to SHU, keeplock and PC every day for sick call. Prisoners who have a medical emergency after sick call can request an emergency sick call (ESC) visit to the medical clinic to be seen by a nurse. The facility estimated that 80 ESC encounters occur each month. As summarized in Table E above, Attica survey participants had mixed views of the sick call process and the adequacy of the nursing care provided during these meetings. Approximately half of the survey participants said they sometimes experience delays in getting access to sick call, a response rate that places Attica in the lower 40% of the prisons we have visited for a sick call access. More importantly, half of the survey respondents said the care provided during sick call was poor, ranking the prison in the lower half of CA-visited prisons for quality of such care. We reviewed the nearly 270 Attica survey responses for individuals’ comments about the nurses and sick call and found a disturbing pattern of explanations for their assessment of care. Many inmates said that the care provided during sick call varied substantially according to the staff providing the services. A frequent complaint was that some nurses exhibited a poor attitude towards their patients with some being rude, discourteous, or uncaring. Other complaints mentioned the failure to listen to the inmates and to provide appropriate care, and follow-up. A minority of survey participants expressed a more positive review, with some complimenting the nurses that they saw for their prompt action and care. These comments strongly suggest that there is significant variability in the care being provided by the sick call nurses. We urge the prison to conduct an assessment of the care provided by all sick call providers to ensure that each is performing an effective examination of all patients. Clinic Call-Outs Attica has five FTE clinic providers, three permanent physicians (one full-time and two half-time doctors), two NPs and one fee-for-service doctor who works about two to four days per week. Clinic appointments are scheduled six days per week, with both morning and afternoon appointments. The facility estimated that each month 550 to 600 patients are seen by the clinic providers. - 32 - Prison Visiting Project Correctional Association of NY Attica Correctional Facility April 2011 Overall, Attica survey participants had a more favorable view of the clinic providers than of the sick call nurses, but access to the clinic was still problematic. According to staff, it takes two to three weeks to see a clinic provider for a routine appointment. Based upon inmate survey responses, the median time to see a provider was three weeks, placing the prison in the middle of all CA-visited prison for the length of time to see a doctor. Thirty-nine percent of survey participants said they frequently experienced delays in getting to the clinic, which placed the prison in the bottom 40% of all CA-visited prisons. We received numerous complaints from the survey participants that they were delayed in seeing their doctor or other provider. We believe the problems in access to the clinic may be a function of the limited clinic staff, particularly with the vacant nurse practitioner position, which is only partly being filled by a part-time doctor. We urge the prison medical staff and DOCCS Division of Health Services to evaluate whether additional clinic staff is needed. In contrast to the mixed reviews on access to the clinic, as noted in Table E above, 55% of the respondents said the care provided by the clinic staff was good or fair, a rating that was better than two-thirds of the prisons we have visited. Survey participants’ responses focused again on the variability in the care provided based upon the medical staff serving the patient. Many inmates said that several of the clinic providers afforded them appropriate care when they were seen, but some respondents had significant problems with clinic providers they were seeing, asserting they were rude, uncaring or unresponsive to the patient’s medical needs. Even many inmates who rated the medical care as fair said their experiences with the medical department were very dependent upon the individual who examined them. We urge the facility to review the care being provided by each member of the clinic medical team to ensure that all providers are adequately serving every patient. Care for Patients with Chronic Medical Problems As with most DOCCS facilities, Attica has a large population of inmates with chronic medical problems. Table F – Summary of Attica Inmates with Chronic Medical Conditions details the conditions experienced by the inmate population at the time of our visit and the percentage of the population with these conditions. Patients with specific chronic conditions are generally not referred to a particular provider, but are distributed among all clinic staff. The prison does, however, attempt to have that patient seen by the same provider once initially assigned to a specific staff member. In addition, medical staff informed us that specific nurses are assigned to be chronic care coordinators to follow patients infected with HIV or viral hepatitis, or those who have diabetes, seizure disorder, asthma, or hypertension. The chronic care nurses are assigned to coordinating the care for these patients and performing patient education. In addition, the clinic providers see patients with chronic conditions at least every three months and also perform patient education. Table F – Summary of Attica Inmates with Chronic Medical Conditions Infected % Infected Treated HIV 49 2.3% 30 AIDS 20 0.9% HCV 208 9.7% 4 HIV & HCV 40 1.9% - 33 - Asthma 312 15.0% 200 Diabetes 142 6.6% 100-10 Hypertension 397 18.4% 300 Prison Visiting Project Correctional Association of NY Attica Correctional Facility April 2011 Attica has one provider, physician assistant Graf, who is certified as an HIV specialist by DOCCS. HIV-infected patients may also see an infectious disease specialist; the prison estimated that on average less than five HIV-infected patients are seen each month by this specialist. The percentage of Attica inmates who are known to be HIV-infected is similar to the average for all DOCCS facilities; however, this figure is substantially less than the estimate of 5% to 6% of the entire DOCCS population who are believed to be infected with HIV based upon NY Department of Health studies. With more than 200 inmates infected with hepatitis C (HCV), representing nearly 10% of the prison population, Attica is similar to most New York State prisons in facing a significant medical burden from this disease. Attica’s rate for inmates known to be HCV-infected is similar to the rate for the entire Department. In contrast, only four of the 208 HCV-infected patients, representing less than 2% of those infected, were receiving HCV treatment. This rate of treatment is less than the system-wide average of 5% and much less than treatment rates in the community. Prison staff told us that previously the prison typically treated six to seven HCV-infected patients at a time, but that figure has been lower recently. We urge the prison medical staff to review the population of HCV-infected patients to determine whether any individuals not receiving treatment may be appropriate candidates for the therapy. Specialty Care Patients who require specialty care services are seen at the regional medical unit at Wende C.F., by specialists who come to the prison, or at area hospitals or other medical care locations outside the prison. Approximately one-third of the survey respondents said they had seen a specialist in the last two years, a rate similar to the average for all CA-visited facilities. As reported above in Table E, when survey participants were asked if they experienced delays in seeing a specialist, a majority reported experiencing delays at least some of the time, at rates placing Attica in the lower half of CA-visited prisons for access to specialists. In contrast with this negative assessment on access to specialists, 47% of respondents said that the clinic staff provided good follow-up to the specialists’ recommendations, a rating that exceeds two-thirds of the prisons we have surveyed. Again, it appears that inmates are more satisfied with the quality of the care they receive from the clinic providers, but still express concerns with delayed care. Medications Attica has a pharmacy staffed by three pharmacists and three pharmacy aides, which also provides medications to nearby Wyoming C.F. Fifty-five percent of survey participants reported that they sometimes experienced problems in getting their medications, a rate that is about average for all CA-visited prisons. Some of the concerns expressed by survey respondents were that they experienced delays in getting their medications or that the medications prescribed by the doctor were changed without consultation with the patient, were not the medications suggested by the specialist or did not adequately treat their medical condition. Quality Improvement Program Attica’s Quality Improvement (QI) Committee meets quarterly and consists of medical staff (facility health services director, nurse administrator, senior utilization review nurse, - 34 - Prison Visiting Project Correctional Association of NY Attica Correctional Facility April 2011 infection control nurse, pharmacy representative, and health information management technician), and prison administrative staff (deputy superintendents for administration and security). We were informed by the facility that during the period 2009 through the first quarter of 2011, the QI committee performed evaluations of hepatitis B and C, asthma, diabetes, infirmary care, emergency room referrals, periodic health appraisals, sick call, and consultations to specialists. We did not review the records of the QI committee, so we cannot comment on the thoroughness of these reviews, but we commend the committee for the scope of issues that it has covered during the past two years. Dental Care The Visiting Committee toured the dental area, which has five dental chairs, and spoke with the dental staff. Attica has three half-time dentists and two full-time dentists. The dental staff informed us that they see approximately 25 patients per day, estimating that 50% of their dental work is restorative care, 20% involves extractions and 5% of dental patients are seen for dental emergencies. The dental hygienist also performs about five cleanings per day. The survey participants expressed mostly a positive assessment of the dental services they received; 36% rated dental care as good, 39% said it was fair, and only 24% reported it as poor. These figures place the prison in the top 30% of the 14 prisons for which we have dental care data. Concerning access to the dental department, survey respondents estimated it can take 60 days to be seen, a delay that is average for the CA-visited prisons. Survey participants’ comments about the dental care system included many positive statements about the dentists, including that the care was good to even excellent and that the staff was consistently attentive, caring, courteous and professional in dealing with the inmates. The one consistent negative comment expressed by many survey respondents was that the patients experienced delays in getting seen, both for care and especially for teeth cleaning. We commend the dental staff for the quality of the services provided and their caring attitude, but urge the Department to investigate whether additional dental staff is needed to meet the needs of the prison population. OTHER SERVICES General Library The Visiting Committee toured Attica’s general library, which has a capacity to accommodate 20 inmates at a time, appeared clean and well organized at the time of our visit, and employed one full-time senior librarian, one part-time library aide, and five inmate clerks. The library is open Monday through Saturday from 8:30 a.m. to 2:15 p.m. and is only open in the evening on Thursdays. Each general population inmate may visit the library once per week, space permitting. Porters bring book carts to inmates in the SHU, infirmary, PC, and ICP. The library maintains a collection of more than 5,000 books, including approximately 1,000 books in Spanish which inmates may access through six computer terminals or by browsing the stacks. The library recently purchased a new encyclopedia, but staff explained that the facility has not acquired many other new titles due to the limitations of the state budget; however, Attica participates in the interlibrary loan program so that inmates can obtain materials from other - 35 - Prison Visiting Project Correctional Association of NY Attica Correctional Facility April 2011 libraries. Several educational programs are available on the library computers, including Rosetta Stone, GED 21st Century, and Career Zone. Fifty-four percent of Attica survey respondents were at least somewhat satisfied with the facility’s library, slightly lower than the average of 62% at all CA-visited facilities and ranking the prison in the bottom half of all surveyed prisons. Inmate library access at Attica appears to be significantly more limited than at other CA-visited prisons, both due to the one visit per week limitation and its shorter operating hours, particularly the limited nighttime hours. We are concerned about this limited access and recommend that facility administrators consider expanding library hours, potentially by hiring additional staff or inmate clerks. Law Library The Visiting Committee toured the law library, which is located in a different location within the facility than the general library. Open seven days a week and five evenings a week, the law library has no civilian staff but instead is staffed by several knowledgeable inmate clerks. The law library officer serves as the notary. We were pleased to learn that 20 computers were installed in November 2010 for legal research and that there are 16 additional computers dedicated to word processing. Attica survey respondents were less satisfied with law library services than at any other CA-visited facility, with only 31% at least somewhat satisfied.54 According to staff, inmates may access the law library once per week via call-out and the schedule rotates by housing block. Staff also explained that inmates with upcoming court dates may spend additional time at the law library; however, inmates with whom we spoke seemed dubious about whether inmates may actually take advantage of this and complained of extremely limited access to the law library. Inmates were also concerned that there were no trained paid staff and insufficient training for inmate clerks. As sufficient law library access is a constitutional right and integral to inmates being able to pursue any pending court cases, we are extremely concerned about the low level of research assistance and limited law library access, particularly for a facility as large as Attica. As discussed above, we recommend that the facility find ways to expand inmate law library access and improve the quality of legal research and writing assistance. Mess Hall The Visiting Committee toured one of Attica’s three mess halls during our visit. Each mess hall is designated for particular housing areas: A mess hall for A block residents, with a capacity of 132; B mess hall for B and E block, also with a capacity of 132; and C mess hall for C and D inmates, with a smaller capacity of 90. The mess halls were updated with new tables in 2007 and new lighting in 2009. Due to inmates’ very limited options to cook for themselves, on average 1,900 inmates attend each meal. On the day of our visit, there were over 600 remote meals being delivered to inmates on keep lock, 164 medical diets, and 69 cold alternative diets. 54 Compared to an average satisfaction rating of 57% for law library services at all CA-visited prisons. - 36 - Prison Visiting Project Correctional Association of NY Attica Correctional Facility April 2011 The majority of the food comes from the state’s Cook-Chill program; however, dairy and produce contracts are negotiated monthly by DOCCS with local producers. The facility spends a total of $2.65 per day for each inmate’s three meals. Inmates at Attica had generally negative opinions of food services within the prison, with 73% of inmates stating that they were not satisfied with the food services, ranking Attica 22nd in food satisfaction out of the 29 CA-visited facilities. Inmates reported being less satisfied than the system-wide averages relating to the temperature of their food and cleanliness of their trays and utensils.55 A majority of Attica survey respondents were dissatisfied with the quantity of the food, and we received numerous comments and complaints from inmates during and after our visit regarding smaller portions than had previously been served. The Food Service Administrator told us at the time of the visit that there was no portion reduction, although the facility had switched to the “plus” system in which portions remain the same but inmates are given a fraction of the portion and are allowed to ask for more; for example, instead of providing four slices of bread, inmates will initially receive two slices and may request two more. Considering the high number of complaints we received relating to food quantity, we encourage the facility to take steps to ensure that inmates are aware of this change in food distribution procedures. In 1971, Attica prisoners demanded: “Give us a healthy diet, stop feeding us so much pork, and give us some fresh fruit daily.” Forty years later, only 24% of inmates at Attica expressed being at least somewhat satisfied with the nutritional value of the food, and an average 62% of inmates expressed dissatisfaction at CA-visited prisons statewide. Although fresh fruit is provided and there are alternative diets that are pork free, nutritional, balanced, healthy meals appear to still be largely absent from DOCCS mess halls. Commissary Since Attica is a TV facility, inmates may only receive two packages per year from friends or family and must rely more heavily on the facility’s commissary if they have the funds to do so. Items on the commissary buy sheet are often updated by the ILC and there were 12 new items at the time of our visit. Inmates commissary buys are conducted between 2:00 p.m. and 3:00 p.m. and 6:00 p.m. and 9:40 p.m. According to commissary staff, approximately 25% of inmates reach the maximum buy limit of $55 per visit. Used TVs may be purchased for $30 at the Commissary and do not count toward the $55 limit. Forty-eight percent of survey respondents were at least somewhat satisfied with Attica’s commissary, ranking the facility in the top third of all CA-visited prisons for commissary satisfaction. Visiting Room Attica’s general visiting room has a capacity for 41 inmates and is open seven days a week. The overflow visiting room is open on weekends to expand visiting capacity to approximately 75 inmates in addition to their families. In the event that the visiting room is over capacity, Attica 55 Fifty-six percent of Attica survey respondents were at least somewhat satisfied with food temperature and 33% with cleanliness of trays and utensils compared to 62%, and 45% averages respectively at all CA-visited prisons. - 37 - Prison Visiting Project Correctional Association of NY Attica Correctional Facility April 2011 uses a first-in first-out policy for visitors residing within 100 miles, and according to staff this happens approximately once a month. At the time of our visit, the visiting room was generally clean and pleasant looking, painted with colorful murals and containing several vending machines. Attica operates the Click-Click program so that families may take pictures together in the visiting area. The children’s play area was sparse with several torn books, one small table, and a television; there were no mats or games. Over 50% of survey respondents were at least somewhat satisfied with the visiting services at Attica, consistent with the statewide averages for all CA-visited prisons. Inmates with whom we spoke complained that facility staff often harass visitors, particularly during processing for Family Reunion Program (FRP) visits. Mail and Package Services Attica survey respondents were generally dissatisfied with mail and package services, ranking Attica seventh worst out of all 29 CA-visited facilities for mail and package room satisfaction.56 Generally, inmates reported delays in receiving mail and packages, particularly those containing money orders from family members. Theft or missing items from packages were also significant areas of concern. Attica is a TV facility, meaning that inmates are allowed small televisions in their cell in exchange for limited package privileges. Some inmates with whom we spoke did not understand the unique restriction on packages for TV facilities, and we urge the facility to ensure that all inmates are aware of these guidelines as explained by DOCCS Directive 4921. Forty years ago, in the 1971 Attica Rebellion inmates demanded that they be allowed to communicate with anyone they please at their own expense. Decades later, mail and package services still remain a high area of concern. Mail review directives are complex and limiting, and inmates cannot communicate with their peers housed in other facilities. Recommendations We recommend that state policy makers work with DOCCS Central Office administrators and facility officials in implementing the following measures: Safety and Inmate Grievance Program Safety Assess the level and causes for tension between staff and inmates, and develop a plan to reduce tension and incidents of verbal harassment, including additional training for staff regarding how to manage inmates with significant mental health needs. Review Unusual Incident Reports, grievances and misbehavior reports to assess whether there are patterns of violence within the prison, whether specific staff members are more frequently involved in inmate-staff confrontations, and whether certain areas within the prison are more 56 Seventy-two percent of Attica survey respondents were dissatisfied with mail and package services, compared to an average of 66% at all CA-visited prisons. - 38 - Prison Visiting Project Correctional Association of NY Attica Correctional Facility April 2011 frequent locations for violence. Following this review, develop a plan, including additional staff training, to continue to reduce violence between inmates and staff. Install video cameras in areas of the prison, including the special housing unit, where incidents of violence are alleged to have occurred more frequently and develop a system to preserve these recording so that they can be used in subsequent investigations of allegations of improper behavior by inmates and/or staff. Encourage line staff to engage inmates in more positive interactions and investigate any allegations of harassment, threats or excessive use of force and implement prompt disciplinary action if substantiated. Reconsider whether it is necessary for staff to escort inmates throughout the facility with their batons unsheathed. More closely monitor allegations of sexual abuse and abusive pat frisks by staff and meet with the ILC and IGRC to explore ways to reduce sexual abuse and how to promptly identify and respond to staff sexual misconduct or abusive pat frisks. Develop and implement additional measures to reduce gang participation and drug usage in the prison through non-punitive methods. Increase supervision during the evening shift to reduce the level of violence and inappropriate staff-inmate interactions during this tour. Protective Custody Install at least one additional telephone in the PC yard. Explore methods of bringing additional therapeutic, educational, and vocational programming and materials to the PC unit and increasing access to medical care and medication refills. Special Housing Unit/Keeplock Review the provision of services in the SHU, with a focus on medical care, reading materials, library services and the cell study program, to ensure that all SHU and keeplock inmates promptly receive required services. Examine ways of encouraging inmates in the SHU and keeplock to utilized recreation by providing the proper attire for the weather and installing cameras on the route to and from the recreation pens. Assess the level and causes for tension between SHU/keeplock staff and inmates, and develop a plan to reduce perceived and actual incidents of verbal harassment, physical confrontations and sexual abuse by staff. Grievance System More closely monitor allegations of retaliation by staff in response to inmate grievances and assertions that staff are filling false misbehavior reports. Meet with the ILC and IGRC to discuss ways to reduce tension at the prison and to improve the effectiveness and credibility among inmates of the grievance system. Programs Consider methods of increasing available programs for all inmates, including potentially hiring additional staff, changing program times, or modifying facility movement schedules and procedures. - 39 - Prison Visiting Project Correctional Association of NY Attica Correctional Facility April 2011 Provide more meaningful prison job opportunities that will permit inmates to develop skills and experiences that enhance their ability to find employment upon release. Increase the rate of pay for inmates at all DOCCS facilities to reflect increases in the cost of items in the commissary. Fill all vacant educational and vocational positions and prioritize the hiring of teachers and instructors who are bilingual to meet the needs of Spanish-speaking inmates. Decrease the number of inmates on the waiting list for academic classes, particularly by increasing GED class capacity and enrollment. Initiate additional vocational programs and Department of Labor and NCCER apprenticeships so that inmates can learn skills that will benefit them upon release. Provide program participants with educational and vocational materials in Spanish. Ensure that Transitional Services reentry resources are up-to-date and relevant to inmates being released to a variety of locations. Examine ways for more inmates to have greater access to the indoor gymnasium as a means of reducing both idleness and violence in the outdoor yard, and to give inmates more significant opportunities for exercise Substance Abuse Treatment Programs Fill the Program Assistant vacancy in the ASAT program. Require all security staff working in the ASAT program and housing areas to participate in Therapeutic Community (TC) training. Provide clinical supervision to treatment staff in the ASAT program to ensure greater consistency in services provided among the two ASAT groups. Enhance efforts by treatment staff to assist program participants in developing effective discharge plans for continuing treatment in the community when it is needed. Mental Health Care Review patient-clinician confidentiality protocols with OMH staff and DOCCS security staff and ensure that proper protocols are followed, investigating any complaints of confidentiality breaches or misuse of sensitive information. Take steps to train all security staff working on a mental health unit on how to properly manage and interact with inmates with mental health care needs and remove from these units any staff who fail to perform their job duties properly. Review the services provided during STP group sessions and individual counseling to disciplinary inmates with serious mental illness to determine what additional measures can be taken to better engage the patient population. Increase efforts to reduce SHU sentences for STP patients and more expeditiously transfer STP patients to non-punitive residential mental health treatment units. Reconsider the decision to convert Attica’s STP to a residential mental health treatment unit for disciplinary inmates with serious mental illness. - 40 - Prison Visiting Project Correctional Association of NY Attica Correctional Facility April 2011 Medical and Dental Care Fill all vacant medical positions and investigate whether additional nursing and clinic provider positions should be allocated to the prison to ensure that all inmates get prompt access to sick call and clinic call-outs. Review the quality of care provided by all sick call nurses and clinic providers to ensure that medical conditions are properly diagnosed and promptly treated. Enhance efforts to reduce the delay in getting patients seen for medical call-outs. Implement measures to ensure that HCV-infected patients are thoroughly evaluated to determine if they are appropriate candidates for treatment. Review the utilization of specialty care services to determine if all patients are getting prompt access to all needed specialty care services. Review the delays dental patients experience in accessing dental care and institute measures to provide prompt access to such care. Other Services Improve access to the general library and the law library by expanding their hours of operation, potentially by hiring additional staff or inmate clerks. Enhance the quality of legal research and writing assistance. Raise the limit on the amount inmates can spend at the commissary. Review the processing and treatment of visitors to ensure courteous and professional treatment by the visiting staff. Implement measures to prevent delays in outgoing mail, improve the delivery of mail and packages to inmates, and ensure that all inmates understand the particular package restrictions for those housed in a television facility. - 41 -