Restraining Prisoners In Public Hospitals: Methods And Protocols

Prisoners are entitled to healthcare equivalent to community patients. However, they are often restrained in hospitals, which can be distressing and compromise their privacy. In some cases, restraints are necessary for security reasons, but there are concerns about the inappropriate use of restraints on vulnerable prisoners. This includes instances of pregnant women being handcuffed during and after labour, and prisoners being restrained while receiving end-of-life care or undergoing medical procedures. While hospitals aim to provide equivalent care to prisoners, the use of restraints can create challenges in ensuring their physical and emotional well-being.

Handcuffs and shackles

When transporting a prisoner to a hospital, it is standard practice to use handcuffs, belly chains, or shackles as a precautionary measure. In addition to these restraints, it is recommended to secure the prisoner to the seat frame of a chair or a gurney using a second set of cuffs or chains. This is done to impede the prisoner's movement and ensure they cannot run out of the hospital. To minimise embarrassment and maintain the prisoner's dignity, it is advised to cover them with a blanket to conceal the restraints from public view.

Once inside the hospital, the decision to remove restraints depends on various factors. Prison staff are required to conduct risk assessments that consider the prisoner's offending history, potential risk to the public and staff, health, and mobility. However, in some cases, these assessments are not adequately conducted, leading to the inappropriate use of restraints on vulnerable individuals.

The use of handcuffs and shackles on hospitalised prisoners has been widely criticised as inhumane and degrading, with reports of prisoners being restrained even when they pose no flight risk or threat to safety. Clinicians and hospital administrators often advocate for the removal of restraints to preserve therapeutic relationships and provide accurate examinations. Additionally, the presence of restraints can negatively impact the empathy of medical staff towards incarcerated patients and elicit fears for their own safety.

While handcuffs and shackles are commonly used to restrain prisoners in public hospitals, there is a growing consensus that their use should be minimised and reserved only for situations where there is a credible need related to safety. Blanket shackling policies that do not consider individual medical risk assessments can disproportionately impact patients with disabilities and those with impaired cognition. As such, alternatives to restraints, such as the use of a back strap or the presence of security officers, should be considered whenever possible.

Security vs healthcare

Prisoners are entitled to healthcare equivalent to community patients. However, this is challenging due to the physical and practical considerations of security in hospitals. The use of restraints on prisoners in hospitals has been a topic of debate, with some arguing that it is necessary for security reasons, while others argue that it causes public humiliation and fear.

Prisoners are typically handcuffed or shackled to the gurney or wheelchair during hospital visits to prevent escape and ensure the safety of the public. Some hospitals have forensic rooms or emergency seclusion facilities for prisoner patients, but these are not common. The use of restraints can be uncomfortable and stigmatizing, with prisoners expressing distress and compromised privacy due to being handcuffed in front of other patients and staff.

In some cases, prisoners have been restrained inappropriately, including pregnant women being handcuffed during and after labour, and dying patients being shackled to their hospital beds. These cases have raised concerns about the inhumane treatment of vulnerable prisoners. While security is a priority, it should not override the healthcare needs and experiences of prisoners.

Prison officers play a role in medical consultations, which can create difficulties. Their presence may restrict patient autonomy and compromise privacy, as they are not bound by the same duty of confidentiality as medical staff. Delays in access to healthcare due to prison transport requirements and security considerations can also impact the equivalence of care for prisoners.

To improve the situation, frontline prison and healthcare staff should address the stigma associated with prisoners seeking healthcare. Understanding the common issues faced by prisoners, such as fear, shame, and reduced autonomy, can help ensure they receive equitable and dignified treatment.

Public humiliation

Prisoners in hospitals are often restrained with handcuffs or shackles, which can be humiliating and stigmatizing. Some officers believe that this public humiliation serves as a beneficial form of punishment. Additionally, prisoners are usually handcuffed to officers during hospital visits, which can be highly stigmatizing and distressing, impacting their privacy and autonomy.

Furthermore, the presence of uniformed officers during medical consultations can lead to public humiliation for prisoners. This practice identifies them as prisoners to other patients and staff, evoking negative emotions and fears. The officers' lack of confidentiality obligations may also lead to concerns about personal information disclosure.

In some cases, prisoners may be transported to hospitals in wheelchairs with blankets to conceal their restraints. While this practice aims to prevent public attention, it still restricts the prisoner's movement and can be considered a form of public humiliation.

Restroom supervision

Restraints are used on prisoners in public hospitals for safety reasons, but human rights groups have criticised this practice, arguing that it can cause pain, injury, and even death. Restraint chairs, for example, have been described as a form of torture by the United Nations Committee Against Torture, and Amnesty International has criticised the inadequate training and supervision provided to staff who use them.

In the context of restroom supervision, prisoners are sometimes released from restraint chairs to use the restroom. In one case, a man in Madison County who had threatened self-harm was restrained for 37 hours, during which he was periodically released from the chair to use the restroom, walk, eat, and drink water. However, he also refused some offers to be released for a break. This case highlights the importance of balancing safety and security concerns with the need to treat prisoners humanely and preserve their dignity.

When prisoners are restrained in public hospitals, they are typically handcuffed or shackled to the gurney or bed, with one free arm and one free leg, or sometimes just one free wrist. This level of restraint is generally considered sufficient to prevent prisoners from escaping, while still allowing them to perform basic functions like using the restroom.

However, there are times when restraints may need to be removed or loosened, such as for MRI imaging procedures, X-rays, or other medical procedures that may be incompatible with standard restraints. In these cases, it is important to find alternatives to ensure the safety of both the prisoner and hospital staff. For example, a blanket can be used to cover the prisoner's restraints when moving them through the hospital to minimise the risk of escape while preserving the prisoner's dignity. Additionally, having a security officer walk ahead can help keep bystanders away and provide a level of privacy.

Overall, restroom supervision for restrained prisoners in public hospitals requires a balance between safety and security concerns and the need to treat prisoners humanely. This includes finding alternatives to restraints when necessary, preserving the prisoner's dignity, and providing proper training and supervision to staff to prevent misuse and abuse.

Transporting prisoners

Prisoner transport is a risky procedure due to the introduction of dangerous inmates into a public environment, which presents opportunities for escape and assault. Hence, vigilance at every step is critical to avoid complacency and ward off such incidents. Here are some detailed instructions for transporting prisoners, focusing on the use of restraints:

Planning and Preparation:

• Always conduct a thorough search of the prisoner and the areas where they will be detained, including before and after prisoner access. Secure any items that could be used for escape or assault, such as office supplies and scissors.
• Restrain the prisoner appropriately for transport, considering the security level and any medical or physical conditions. The type of restraints may vary between departments.
• Ensure you have assistance during transport. Never transport alone if personnel are available.
• If the prisoner is being transported to a hospital, request another officer from your department to assist, especially if the hospital lacks dedicated security or behavioural restraint equipment.

Transporting by Vehicle:

• Utilise specially-designed prisoner transport vehicles that meet security requirements. Ensure the vehicle has a safety barrier separating the driver from the prisoner while allowing clear communication.
• Modify the vehicle to prevent escape attempts: disable inside operation of rear door handles and windows.
• Position the prisoner in the vehicle for constant observation. In a caged vehicle, place them in the rear compartment. In a non-caged vehicle, seat them in the front passenger seat, never directly behind the driver.
• Handcuff the prisoner with their hands behind their back, palms outward if possible. Use double locks and a handcuff cover to prevent manipulation of the keyhole.
• Apply additional restraints as needed, such as a belly chain or leather/nylon belt, to shackle the prisoner's hands to their waist.
• Consider the use of leg irons or a stun belt for further control, especially if the prisoner will be walking outside of a secure area.
• Ensure the prisoner wears a prison uniform during transport for instant identification.

Transporting by Air:

• For extradition of dangerous prisoners, use a rendition aircraft.
• For non-violent prisoners with a low risk of escape, commercial airliners may be utilised, with the presence of escorting law enforcement officers.

Transporting in Hospitals:

• Use a wheelchair to transport the prisoner through the hospital. Restrain the prisoner directly to the chair, ensuring they do not have a free hand.
• Secure the prisoner to the wheelchair frame with an additional set of cuffs, chains, or leg shackles. A back strap can also be used.
• Cover the prisoner with a blanket to conceal the restraints, minimising public attention and maintaining the prisoner's dignity.
• Maintain control by pushing the wheelchair yourself, with a security officer ahead to navigate locked doors and keep bystanders away.

Arrival at Destination:

• Upon arrival, remove restraints as needed, based on the prisoner's cooperation and the security of the facility.
• Document and advise the receiving agency of any potential medical or security risks, and confirm the transfer of custody.
• In the event of an escape during transport, notify local authorities and request assistance.

Frequently asked questions