"Chains or irons shall not be used as restraints. Other instruments of restraint shall not be used except in the following circumstances:
as a precaution against escape during a transfer...
on medical grounds by direction of the medical officer;
by order of the director, if other methods of control fail, in order to prevent a prisoner from injuring himself or others or from damaging property.... (Instruments of restraint) must not be applied for any longer time than is strictly necessary."
Rule 33, United Nations Standard Minimum Rules for the Treatment of Prisoners
"Giving birth while incarcerated was one of the most horrifying experiences of my life. While enduring intense labour pains, I was handcuffed while being taken to the hospital, even though I was in a secured vehicle with a metal grating between the driver's and passenger's compartments and with no interior door handles on the passenger doors. With the handcuffs on, I could not even hold my stomach to get some comfort from the pain...At the hospital I was shackled to a metal bed post by my right ankle throughout seven hours of labour, although a correctional officer was in the room with me at all times. The shackles were not removed until 30 minutes prior to my delivery...Imagine being shackled to a metal bedpost, excruciating pains going through my body, and not being able to adjust myself to even try to feel any type of comfort, trying to move and with each turn having hard, cold metal restraining my movements. Not only was this painful, it was traumatizing, and very stressful for myself and also for my child...Even animals would not be shackled during labour, a household dog or a cow on a farm..The birth of a child is supposed to be a joyous experience, and I was robbed of the joy of my daughter's birth..Is it really necessary to handcuff and shackle mothers who are in labour? With all the other security measures that were in place, and with my minimum security status, did they really have to put me and my infant through that torture?"
Statement of Warnice Robinson, imprisoned in Illinois for shoplifting
1. The use of restraints on pregnant and sick inmates
On 18 November, 1998, Amnesty International delegates visited Madera County Hospital in California. Prison officials took them through a ward where women are held when they are seriously ill or in labour and for a short period after giving birth. The ward is locked. Inside the ward are four armed guards. Yet every woman is chained by a leg to her bed. A woman showed the Amnesty International delegates her shackle. She could lie on her side but she could not roll over. Prison officials explained to the delegates that the shackle is removed only if a doctor informs them that it is interfering with medical treatment or is injurious to a woman's health. Shortly before Amnesty International's visit, the organization received a report from a lawyer that at the same hospital in 1998 she had seen a woman who was shackled having a seizure and that guards refused the request of nursing staff to remove the restraint.
The sick women chained to their hospital beds in California are not an exception. Around the USA, jails and prisons commonly use restraints on incarcerated women when the women are being transported to and kept in hospital. In Illinois in October 1998, a woman who was recently incarcerated in a prison in that state told Amnesty International that earlier in the year she had been taken handcuffed to a hospital for surgery and was shackled to her bed when she woke from the anaesthetic.
The same policy is in place in Chicago's Cook County jail. In November 1998, in relation to a lawsuit, an officer of the Cook County Sheriff's Department was asked about the Department's policy on the use of restraints on jail inmates in hospital. He described it as follows:
Q. (question from the lawyer seeking information): Once the medical staff has determined the (inmate) should be in Ward X, what, if any, arrangements are made to secure that person by the sheriff's department?
A. (answer by the officer): We would place an officer, individual officer, on an individual patient, and we would restrain the inmate via handcuff and leg shackle.
Q. Is that always the case or usually the case that you restrain them? A. When there's a medical condition that precludes us from securing a patient, then there would be an exception.
Q. Okay. Can you give me an example? A. If an inmate has no legs, we would not put a leg shackle on them.
Q. Okay. Let's say that the person was in a coma but alive. Do they get restrained? A. Yes.
Q. Let's say a person has just had a heart attack and is recuperating but is so weak they can't get out of bed. Do they get restrained? A. Yes.
As these and other reports indicate, jails and prisons use restraints on women as a matter of course, regardless of whether a woman has a history of violence (which only a minority have); regardless of whether she has ever absconded or attempted to escape (which few women have); regardless of her state of consciousness. While exceptions are made if a doctor asks on medical grounds, Amnesty International has received reports of cases where a doctor was not present to request the removal of restraints in circumstances where approval would generally have been given or a guard with a key was not immediately available. For example, Amnesty International received the following statement from "Maria Jones," a recent inmate of Cook County jail in Illinois. Maria Jones was charged with violating drug laws and stated that she had never tried to escape or been charged with a violent offence or been classified as dangerous. She had a prior conviction, in the 1980s, for shoplifting. Nevertheless, she was always placed in handcuffs and leg shackles when she was taken from the jail to hospital for pre-natal care and to give birth, as she describes:
"I told the nurse that my water broke, and the officer took off the handcuffs so that I could put on the hospital gown. I was placed on a monitoring machine with the leg shackles still on. I was taken into the labour room and my leg was shackled to the hospital bed. The officer was stationed just outside the door. I was in labour for almost twelve hours. I asked the officer to disconnect the leg iron from the bed when I needed to use the bathroom, but the officer made me use the bedpan instead. I was not permitted to move around to help the labour along.
"I was given an epidural, and I carefully moved into a sitting position while dealing with the leg iron. While the needle was still in my back, I felt a strong contraction and I knew that the baby was coming. When I told the nurse, she told me not to push and said that the baby wasn't coming yet. I asked for the doctor and worked the leg chain around so that I could lay down again.
The doctor came and said that yes, this baby is coming right now, and started to prepare the bed for delivery. Because I was shackled to the bed, they couldn't remove the lower part of the bed for the delivery, and they couldn't put my feet in the stirrups. My feet were still shackled together, and I couldn't get my legs apart. The doctor called for the officer, but the officer had gone down the hall. No one else could unlock the shackles, and my baby was coming but I couldn't open my legs.
Finally the officer came and unlocked the shackles from my ankles. My baby was born then. I stayed in the delivery room with my baby for a little while, but then the officer put the leg shackles and handcuffs back on me and I was taken out of the delivery room.
I was in the hospital for about three days, with one hand and one foot shackled to the bed. There was a heavy blue box connecting the cuff with the bed, which left me no room to move. My handcuffs were removed when I was eating or holding my baby, but the leg irons were always on. My leg was disconnected from the bed only when I used the bathroom. Otherwise I was handcuffed and shackled, with one hand and one foot shackled to the hospital bed. Since I went back to the jail, every visit with my baby has been through the glass. I have not been permitted to hold my baby since my release from the hospital."
Amnesty International also received reports that six women were restrained while in hospital waiting to give birth in New York City in 1998. The women were reportedly restrained despite the fact that none of them had a history of violence or had attempted to escape from custody: the policy of the New York City Department of Corrections prohibits the use of restraints on pregnant inmates admitted to hospital for delivery "unless the inmate attempts to escape at the hospital or the inmate engages in violent behaviour at the hospital which presents a danger of injury," According to the reports, one of the women gave birth while handcuffed to her bed in the labour room, unattended, screaming for assistance. Another was put into handcuffs while labour was being induced. The report continued:
"They took the handcuffs off when the baby was about to be born. After the baby was born she was shackled in the recovery room. She was shackled while she held the baby. Had to walk with shackles when she went to the baby. She asked the officer to hold the baby while she went to pick something up. The officer said it was against the rules. She had to manoeuvre with the shackles and the baby to pick up the item. In the room she had a civilian roommate and the roommate had visitors and she had to cover the shackles, she said she felt so ashamed....She said she was traumatized and humiliated by the shackles. She was shackled when she saw her baby in the hospital nursery (a long distance from the room). Passing visitors were staring and making remarks. She was shackled when she took a shower; only one time when she was not."
A third woman reported that she was shackled to the bed after the birth of her baby by caesarian section even though a doctor had requested that, because of her surgery, she be allowed to walk around. A fourth woman said she was shackled in the recovery room and while she held her baby. She said she felt traumatized and humiliated by the shackles when she went to see her baby in the nursery which is located in a public area.
The use of restraints on women who are about to give birth endangers the woman and her child, as described by physician Dr Patricia Garcia:
"Women in labour need to be mobile so that they can assume various positions as needed and so they can quickly be moved to an operating room. Having the woman in shackles compromises the ability to manipulate her legs into the proper position for necessary treatment. The mother and baby's health could be compromised if there were complications during delivery, such as haemorrhage or decrease in fetal heart tones. If there were a need for a C-section (caesarian delivery), the mother needs to be moved to an operating room immediately and a delay of even five minutes could result in permanent brain damage for the baby. The use of restraints creates a hazardous situation for the mother and the baby, compromises the mother's ability post-partum to care for her baby and keeps her from being able to breast-feed."
Amnesty International welcomes the fact that a growing number of corrections departments acknowledge that special attention is required for pregnant prisoners. In a recent national survey, 20 of the 52 state, city and federal corrections departments that responded reported that they have specific policies or procedures for the physical control and transportation of pregnant inmates. In 38 systems, medical personnel are involved in evaluating individual cases prior to the restraint of pregnant women. However, policies for pregnant women that Amnesty International has seen still permit the routine use of restraints without consideration of the necessity for restraints to be employed.
Ohio The state correctional authority informed Amnesty International that pregnant inmates are scheduled to deliver their babies at the Ohio State University Hospital and "are treated as any patient would be treated regarding procedures during labour and childbirth. The exception is one arm or leg is secured to the bed during labour unless the doctor requests the restraints be removed. During delivery, there are no restraints on the inmate."
Massachusetts The policy of the correctional authority provides that during their second and third trimester, pregnant inmates are to be transported to hospital only in handcuffs. The policy prohibits the use of restraints on inmates in hospital who are in active labour unless they are disruptive.
Kentucky In contrast, the policy of the Kentucky correctional authority is that pregnant inmates may not be restrained from the time they enter labour and the delivery area until they leave the recovery room. However, after leaving the recovery area, "one leg may be restrained."
Michigan Women who gave birth while in prison in Michigan told Amnesty International in October 1998 that they were transported to the hospital secured by belly chains and handcuffs, and were kept in restraints at the hospital even though they were constantly supervised by prison guards. One woman reported that she was handcuffed to the hospital bed until she was close to delivery, and that the cuffs were removed at the request of a doctor. A second woman reported that, at the hospital, her legs were chained together until shortly before she gave birth. She told Amnesty International that the restraints were removed at the request of a doctor and only after the guard had obtained approval by telephone from a superior officer. Both women reported that they were cuffed to their beds shortly after giving birth. In November 1998, Detroit City Council passed a resolution calling on state governor, John Engler, to ban the use of restraints on pregnant women before and during labour. The head of the Michigan Department of Corrections has stated that he is not aware of cases where prisoners who were shackled while giving birth. Amnesty International is seeking a detailed account of the Department's policy.
In March 1998 the Illinois Department of Corrections informed Amnesty International that all pregnant prisoners were restrained when being transported to hospital and kept in restraints while in hospital, even when in labour, unless a doctor asked for them to be removed and a correctional officer approved. During the course of 1998, legislators drafted proposed laws to prohibit the use of restraints on pregnant women when they were being transported and in hospital, and on women in hospital after giving birth. In January 1999, the Department of Corrections informed Amnesty International that it was preparing a new policy to stop the use of restraints on pregnant women while being transported and in hospital. The policy will apply only to prisons. It will therefore not apply to Cook County jail, the policy of which was described at the beginning of this chapter.
In October 1998, Amnesty International wrote to the US Attorney General, Janet Reno, requesting an inquiry into the use of restraints on pregnant women prisoners. The letter was referred for response to the section of the US Department of Justice that is responsible for enforcing federal criminal civil rights laws. The chief officer of the section informed Amnesty International that the section was unable to authorize an investigation because the information concerning shackling "does not disclose a prosecutable violation of federal criminal civil rights statutes." Amnesty International acknowledges that the routine use of shackles on pregnant women does not violate criminal laws. It considers that an inquiry is warranted because the practice violates internationally recognized human rights standards which the USA should respect.
2. Other concerns about the use of restraints
The use of restraints on women who are pregnant and women who are ill is part of a pattern of the use of restraints in prisons and jails and by police agencies that Amnesty International considers constitutes cruel, inhuman and degrading treatment in contravention of international standards. Some authorities in the US use chains or leg irons, restraints that are expressly prohibited by international standards. In a recent report on human rights violations in the USA, Amnesty International described human rights concerns about the use of restraints because of the nature of the restraint or the manner in which it was being used.
(i) The restraint chair
Some of the most serious abuses have involved a mechanical restraint chair which allows prisoners to be immobilized with four-point restraints securing both arms and legs, and straps which can be tightened across the shoulders and chest. Amnesty International's concerns include reports that the chair was used to torture and ill-treat more than a dozen inmates in Sacramento County Jail, California, between 1995 and 1997. According to a lawsuit filed against the Sacramento County Sheriff's Department, a disproportionate number of the victims were women and members of racial minorities. The complaints allege that unresisting detainees, most of whom had been arrested for minor offences, were strapped into the chair for hours as a punishment. Many of the victims had masks held over their faces while being placed in the chair or were hooded. They were denied bathroom facilities, food and water, and were subjected to taunts and sexually derogatory remarks by guards. Some of the victims are reported to have suffered serious injuries as a result of being held in the chair in straps and shackles which had deliberately been pulled too tight. Cases include:
A 32-year-old Caucasian woman with a heart condition was held in the chair for eight and a half hours in December 1995. She was allegedly forced to urinate on herself after pleading repeatedly to use the bathroom and was cursed at and taunted by guards. She is reported to have suffered cuts to her shoulders and damage to her wrists, feet and ankles from the tight leather straps and metal cuffs.
A 38-year-old woman from the Dominican Republic was strapped into the chair in May 1996 after a guard overheard her complaining to a nurse about her treatment. Despite suffering from asthma, she was bound, temporarily hooded, and left in a restraint chair for five hours during which period she reportedly had breathing difficulties and was taunted by guards. She is reported to have suffered numerous bruises, swellings and pain as a result of being held in the chair.
A 30-year-old African-American woman with a thyroid complaint, was stripped naked by male and female guards and strapped into a restraint chair where she was left with a hood over her head for eight and a half hours in May 1997. The chair was placed in the centre of an illuminated room with a floor-to-ceiling window through which she was allegedly stared at and jeered at by male guards and other employees, including outside contract workers. She was forced to sit in her own urine which deputies later made her clean up using only her jail-issue T-shirt and bare hands.
Negotiations to settle the lawsuit in these and other cases were underway in February 1999. Meanwhile, the chair continues to be used in the jail. Amnesty International has received reports of misuse of the restraint chair in other US prisons and detention facilities and several inmates have died after being placed in the chair (see USA: Rights For All, 1998). Other cases include that of Annette Romo, who alleged that she was brutalized and placed in a restraint chair while in pre-trial detention in Estrella Jail, Maricopa County, Arizona, in June 1997, after she complained to guards about conditions in her jail unit and asked to be transferred. This was two months after she had lost her baby due to alleged medical neglect in the same jail.
Amnesty International has called for the chair to be banned in the Sacramento County Jail pending a full, independent inquiry. It has also called on the federal authorities to institute an urgent national inquiry into use of restraint chairs, in US prisons and jails.
(ii) Electro-shock devices
Other forms of restraint about which Amnesty International is concerned are electro-shock devices. In one case, Amnesty International received a report that at Muncy Prison, Pennsylvania in 1996, an "Electronic Body Immobilizer Shield" (EBID) was used against a prisoner who was in distress after she was informed of the scheduled date of her execution. Amnesty International wrote to the Pennsylvania Department of Corrections expressing concern that an electro-shock device had been used against a female prisoner who, according to reports, was not threatening other people. The authorities responded that the device was used because the woman "was displaying significant injurious behaviour and was refusing all orders given by the supervising commissioned officer." As well, the head of the Department of Corrections explained:
"The EBID shield was utilized as the least amount of force necessary to gain control of the inmate and have her comply with the orders. This shield is a non-lethal defensive device and was used in compliance with Department of Corrections Use of Force Policy, including appropriate documentation and review."
On 17 March 1998 and 14 August 1998 Amnesty International asked the Department of Corrections for a copy of its policy on the use of the device. The Department has not provided a copy. In its correspondence to Amnesty International concerning this case, the Pennsylvania Department of Corrections has not asserted that the woman was threatening staff. Amnesty International therefore considers that the description of the device as "defensive" and as a "shield" is inaccurate. In the incident described above, it was used as a weapon to secure compliance with orders, not to protect staff from attack.
Recommendations on the use of restraints
In prisons and jails around the USA, restraints are commonly used when they are not essential to prevent escape or to protect people and property. This is evident in the cases of women who are in labour or who have just given birth, or who are seriously ill. Restraint chairs and electro-shock devices have also been used in circumstances which appear to violate the prohibition on the infliction of torture and other forms of cruel, inhuman or degrading treatment and punishment.
Amnesty International recommends that jails and prisons adopt policies on the use of restraints that accord with international standards, as follows:
Restraints should be used only when they are required as a precaution against escape or to prevent an inmate from injuring herself or other people or damaging property. In every case, due regard must be given to an inmate's history and physical condition. Restraints must never be used as punishment.
Policies on the use of restraints should prohibit their use on
pregnant women when they are being transported and when they are in hospital awaiting delivery
women who have just given birth
seriously sick inmates when they are being transported to and when they are in hospital.
Policies on restraints should specify that the types of restraints and the circumstances of their use must not be hazardous to the health and safety of inmates.
Four-point restraints should only be used when strictly necessary as an emergency short-term measure to prevent damage or injury, and in accordance with international and US medical standards. The federal authorities should institute an urgent national inquiry into the use of restraint chairs in prisons and jails.
Jails and prisons should suspend the use of electro-shock weapons pending the outcome of a rigorous, independent and impartial inquiry into the use and effects of the equipment.
Authorities that are responsible for jails and prisons should monitor the use of restraints to ensure strict compliance with policies.