Some Lessons I Learned in Prison – Dale Mortimer, M.D.

“I did a favor for a friend, and the next thing I knew I was in prison!”

Isn’t that how it always happens? In my case, my friend was Phil Shapiro, M.D. – the Chief Psychiatrist for Oregon State Hospital (OSH) in Salem, Oregon. Phil had been one of my supervisors during my adult psychiatry training from 1987 to 1988. We stayed in contact after I completed my general adult psychiatry (– and then my child & adolescent psychiatry) training. In the summer of 1990, the Oregon Attorney General asked Dr. Shapiro to recruit a psychiatrist – ASAP – who had the diagnostic and treatment skills, and behavioral flexibility necessary to work with the inmates, security staff, medical staff, and nursing staff in Oregon’s maximum security prison. Phil thought I would be perfect for the job. His sales pitch to me over the telephone on September 10, 1990 was succinct and effective: “Hello, Dale. This is Phil. I need a favor. How would you like the worst job in the State of Oregon?” I replied immediately: “Sure, Phil. What do you have for me?”

Phil then arranged for a lunch meeting with several Oregon State Hospital psychiatrists (who assured me that I could call them for any problems I might encounter in a maximum security prison), and Oregon State Penitentiary’s Superintendent Fred Maass. As we all chatted, I quickly sensed that this Mr. Maass was a brusk, “no nonsense” sort of man with a thick German accent who appeared to be in the midst of an internal struggle. One the one hand, he needed a psychiatrist to start work in his prison as soon as possible. However, any psychiatrist who worked in a maximum security prison would need a thick skin, would need to think fast on his feet in accurately identifying those inmates who were lying, and – most importantly – he needed an experienced psychiatrist who knew how to work collaboratively with security, medical, nursing staff – and with prison administration. Otherwise, the introduction of a new, inexperienced, politically liberal and gullible psychiatrist into the prison population would be an administrative nightmare. Colonel Mass had scowled when I mentioned that I had only completed my psychiatric training two months earlier. Picking up on Mr. Maass’ non–verbal cues, I knew that I had a credibility problem and had to think fast. Among other things, I mentioned to Mr. Maass (– I mean, Colonel Maass) that I was a fast learner, and had had the good fortune to have had a lot of very good supervisors. When I mentioned that psychologist Dr. Ed Scott had been one of my supervisors, Mr. Maass gasped, and then told me to stop talking. He relaxed and smiled broadly. He looked at everyone in turn around the table, and said: “I remember Dr. Scott…Over thirty years ago, when I was just starting out as a rookie parole officer, I was assigned to watch Dr. Scott work with alcoholics in his chemical treatment program in downtown Portland. He was tough but fair. He held my parolees completely accountable for their behavior, and wouldn’t let them get away with anything. Dr. Scott was the best damned supervisor I ever had. If Dr. Mortimer here was Ed’s student, then this young doctor here has my blessing… I’ll make sure that his security clearance paperwork is expedited.” With that, Mr. Maass stood up, said a gruff German thanks to us all, and left.

On September 28, 1990, I started my first day as the principle psychiatrist for the Oregon Department of Corrections (ODOC). My primary task was to perform comprehensive psychiatric assessments and design effective psychiatric treatment plans for the 50 to 68 “special needs” inmates who were at any one time housed in Oregon State Penitentiary’s Special Management Unit (SMU). This special housing unit accepted inmates from Oregon’s thirteen prisons located around the state – as well as from Oregon Correctional Intake Center (where newly arrived inmates are individually assessed and then oriented to the prison culture, prison rules, and prison programs available to them). In addition to alcohol abuse, learning disorders, and medical problems, SMU’s inmate–patients had a wide range of psychiatric problems: schizophrenia, bipolar disorder, delusional disorders, post-traumatic stress disorder, Asperger’s syndrome, attention deficit hyperactivity disorder, and impaired judgement due to bullets in their brains. Many patients were in SMU because of high suicide risk; recurring unpredictable assaultive behaviors; or because they “lacked common sense.”

Lesson One:  “The New Guy” Can Expect to Be Tested – Repeatedly.

During my training in consultation psychiatry, I learned that when starting a new job as a psychiatric consultant, I should expect to be tested by the clinic staff. Repeatedly. I should expect be asked to evaluate the most difficult patients in the clinic – not in order to “fix” an unsolvable clinical or administrative problem, but in order to demonstrate to the staff how I would respond under pressure, and – more importantly – in order to demonstrate to the staff that I could be trusted – and “have their back.” I had learned to: “Listen with the third ear.” If I could satisfactorily address the staff’s unspoken concerns, then I would be much more likely to be trusted and respected by the staff– and thus, I would be much more likely to be effective in my role as a clinical and program psychiatric consultant.

On my first day as the principle correctional psychiatrist for Oregon Department of Corrections, I arrived in Oregon State Penitentiary’s Reception Room where I met the Sergeant in charge. Broadly smiling, he ushered me into his office, where he invited me to “sit in that chair and look real mean for my camera.” It seemed easy enough. It wasn’t. For what seemed like an hour, the Sergeant repeatedly “attempted” to photograph me looking my most menacing. Here was the routine: the Sergeant started by casually asking me about my parents, my family, friends, where I was born, what schools I attended, my previous occupations, and my relationship with my wife and her family. Interspersed with this casual questions, the Sergeant would tell me a corny psychiatrist joke. As I laughed, the Sergeant would photograph me. He would then examine my picture, scowl, shake his head, and scold me for “not looking mean enough... Let’s try again.” I soon realized that I was being interrogated, so I played along, and started reciting my repertoire of elephant jokes. Twenty (or fifty?) snapshots later, it appeared that my interrogation had concluded satisfactorily. The Sergeant was quiet long enough for me to “look  real mean” for the camera. We obtained a reasonably menacing photograph for my ID badge (– I still carry my prison ID card in my wallet). The Sergeant then excused himself, picked up his telephone, and I thought I heard the Sergeant say something like: “Hi! It’s me...Yup. The new SMU [Special Management Unit] psychiatrist is ready to go…Good improv skills… Yes, yes, I think he’ll fit in nicely with the group.”

I had passed the first test as “the new guy.” I knew that there would be many more unschedule tests coming. And at some point over the next several months, I realized that “without pride, pomp and circumstance,” I had been accepted into the very tightly–knit, highly skilled, improvisational theatre troupe officially known to others as the SMU security staff.

Once I had obtained a reasonably menacing photo for my identification card, a tall (74 inches), trim, good–looking, muscular man about 25 years old wearing casual clothes arrived in the Reception Room. He introduced himself as Correctional Officer Tim Clark. (“Call me Tim”). He would be my escort to SMU. As we shook hands, Tim looked around the room, then urgently whispered: “Stay close to me. Follow my lead. Don’t talk to the inmates....In fact, don’t make eye contact with anyone...And if I say run, then you run as fast and as far as you can.”

We then wandered through the prison’s maze of concrete corridors with its many metal gates. We passed groups of prison staff who chatted casually and easily while waiting for the electronically–controlled doors and gates to open. As we turned a corner, Tim cautioned: “At the top of these stairs is the entrance to the Special Management Unit. Stay alert. The lighting is here is poor. Stay sharp!” With Officer Clark taking the lead and repeatedly looking carefully to his right and left, we climbed the metal stairs. Every footstep echoed loudly in the enclosed metal and concrete stairwell. From Tim’s behavior, I imagined that, at any moment, an inmate would emerge from under the stairwell to stab us with a shiv. Nothing like that happened, of course. Nevertheless, I did follow Tim’s advice: I stayed close to him, I didn’t make eye contact, and I certainly didn’t talk to any strangers.

My Introduction to the Special Management Unit

At the top of that metal staircase was a solid metal door. Tim said: “This is ‘One Gate.’ On the other side of this door is SMU.” He then used his fist to pound on the metal door three times. Nothing happened. He pounded his fist on the solid metal door again. Again, no response. Tim frowned and muttered: “That’s odd...Maybe there’s a fight going on…Or maybe a riot…” As I watched Tim pound the door again, I felt as if I were a member of Tolkien’s Fellowship of the Ring, watching Gandalf standing in front of a similarly massive door, uttering chants in his attempt to enter the door into the Mines of Moria. After what seemed a very long three minutes, I heard an electronic buzzing sound. Tim then opened the solid metal door and through the threshold we stepped into the magical world of the Special Management Unit. I was relieved to realize that I had been safely escorted to SMU!

Standing behind a double set of bars on the other side of “One Gate” was Jim, the correctional officer who worked in “The Cage.” While Jim gruffly said hello and carefully examined my newly–issued identification badge, Tim explained.“ The Cage is the most secure area in SMU. As you can see, it is located in the front corner of SMU. The Cage is protected by a double row of solid metal bars bolted in the floor and ceiling. In The Cage is the electronic mechanism which controls each of SMU’s 68 cell doors - as well as all the main doors leading into and out of SMU. Also stored in The Cage are items which have to be protected such as camera monitors, cleaning supplies, hammers, screw drivers, scissors, official records in filing cabinets, computers, fire hoses – “and” whispered Tim mysteriously – “ the ping pong paddles.” Hearing this, Jim just snorted.

Jim buzzed Tim and me through Two Gate into the front area of SMU. There, standing and waiting for us was Lieutenant Don Mills. Smiling, Lieutenant Mills introduced himself (“Call me Don”) and welcomed me to SMU. He then introduced me to his security staff – in addition to Tim and Jim, there were: Al, Bill, Carla, Dave, Ellen, John, Ron, Tim, and Estelle. Smiling as she shook (and nearly crushed) my hand, Estelle said: “Call me Cookie – like everyone else does – because I’m so sweet.” Everyone laughed. This was clearly a group who enjoyed each other – and, as I soon learned – who also entrusted each other with their lives.

Lieutenant Mills (“Call me Don”)

While he was physically present in SMU from 6AM to 3PM Monday through Friday, Lieutenant Mills was responsible for SMU’s security 24 hours daily, seven days a week. If the SMU correctional staff had any concerns about the SMU inmates,  Lieutenant Mills expected them to contact him at any time – days, nights, or weekends. On the day that we met in September 1990, Lieutenant Mills was 42 years old. He was about 67 inches tall, and weighed about 150 pounds. He was clean shaven. He wore a black cowboy hat, white cowboy shirt, black string tie, black belt with a large cowboy buckle, black Levi jeans, and new, shiny, black cowboy boots. He walked and talked with a slight swagger that appeared to be part–cowboy and part–Marine. I subsequently learned that “Don” was born on a ranch in eastern Oregon, enlisted in the Marines at age 18, and served in Viet Nam during which time he was wounded in a fire fight – “but only slightly,” he explained. After his honorable discharge from the Marines, Don returned to Oregon, married his childhood sweetheart. and took a position as the Chief of Police in a small town east of Salem. Commenting on his past jobs, he said: “I liked being the Chief of Police, and I enjoyed working with the staff, but I got tired of arresting drunk drivers. And I hated carrying a gun... I hate guns. I don’t own one now and never will again. Prison is much safer. The inmates are clean and sober. They don’t have guns, and I don’t ever have to carry a gun here. Ever!”

My Tour of the Special Management Unit

The Lieutenant suggested we start with “The Tour.” He said that he would define prison terms as we walked and he lectured. After telling his security staff to order all inmates into their cells (“Cell in!”), we walked to the dining room to the left of “One Gate” where the SMU inmates  (“...we call them patients here in SMU”) who were on Open Ward status (“...these are the patients who are allowed out of their cells during free time”) ate their meals. Inmates sat either with each other around a metal table bolted to the floor, or with one of the SMU security staff. The dining room was clean, tidy and sterile. Everything I saw was composed of either cold metal, concrete, or painted cinder block. I noticed an absence of curtains on the windows “...because in the past, the patients used them for garrotes.” There weren’t any pictures on the walls “...because in the past, the patients would smash the frames and use the broken glass and broken wood frame for weapons.” I observed that all the chairs and tables were bolted to the floor “ the patients can’t throw furniture at each other – or at us.” Lieutenant Mills then showed me the shower room, explaining: “We shower each patient separately to prevent fights and sexual assaults. It takes longer to get them all showered in the morning, but it’s safer this way. And because we have fewer assaults in the showers now, that means I have less paperwork to complete.” Lieutenant Mills then smiled to himself.

Lieutenant Mills then showed me the specially constructed inmate cells (known as the “side rooms”) where new patient arrivals were first housed until they had been assessed by the SMU security staff, nursing staff, and by Lieutenant Mills. These “side room” cells were located close to The Cage, across from the offices of the security and nursing staff. Lieutenant Mills explained: “These new arrivals stay in a side room until I get to know them. I have to be certain that they are both able and willing to follow SMU rules before I let them out of their side room. If they don’t behave themselves, then they stay in their cells.I don’t want any tough guys hurting the more vulnerable patients. And I don’t want any of my staff getting hurt either.” He then looked at the floor, pursed his lips, and shook his head slowly to the right and left.

I noticed each cell door had an unbreakable polycarbonate window inserted and then bolted into the solid metal door. Below each window at about waist level was an exterior metal flap which covered a rectangular hole in the cell door. The port’s dimensions were about 12 inches wide by 6 inches tall. Lieutenant Mills was clearly very proud of his patent–pending invention. “If the patient is having a psychotic or manic episode, we can still feed him by sliding a tray containing food and juice through this port. The patient can then grab the food tray – without grabbing us. And if we need to escort the patient somewhere, then the patient first walks backward to the cell door, and places his wrists through the port. We then handcuff him. Then when Jim opens the cell door, the patient can’t rush us with a weapon in his hand. This way, no one gets hurt.”

Lieutenant Mills then asked Jim to open one of the unoccupied “side room” cell doors. The room was dimly lit. He explained: “Before the prison budget cuts, the patients had 60 watt light bulbs in their cells. Now they have 50 watt light bulbs – not enough light for reading in their cells.”) Inside the cell was a narrow metal bed frame which was bolted to the floor. Fitting snugly on top of the metal bed frame was a light gray, two–inch–thick, rip–stop mattress. On top of the mattress was a neatly folded, dark green, thick wool blanket which The Lieutenant explained was “...very difficult for a patient to use it to fashion a noose.” A stainless steel toilet was bolted to the floor. The Lieutenant explained: “The old toilets were ceramic. The inmates would first bail the water out of the toilet bowl, then heat the toilet bowl with burning paper, and then flush the toilets with cold water. The cold water then exploded the hot ceramic tile into sharp shards which they then used for very effective and very dangerous weapons.” Bolted to the wall was a stainless steel wash basin with two tamper–resistant faucets. Above the sink was a metal mirror. Lieutenant Mills explained: “Years ago, we had glass mirrors here, but the patients would break the glass, and then use the glass shards as weapons.” I saw that the cell’s lightbulb was protected by a thick wire screen “…so that the inmate can’t unscrew the light bulb to electrocute himself – or us!” At the far end of the cell was a barred window. In front of the bars was a thick sheet of fine metal mesh. The Lieutenant emphasized: “You can see how tiny the mesh holes are – this prevents inmates from wrapping a belt, a shoe lace, or a shirt around the bars. Over the years, we’ve learned a lot from these inmates, and made improvements after every incident.  It is now impossible for an inmate to successfully hang himself in these cells…I hope!” Lieutenant Mills then smiled ruefully.

As we walked away from the “front area” of SMU, Lieutenant Mills shouted to Jim: “Open Three Gate.” We then stepped through Three Gate into the “back ward” of SMU where the majority of the 50 to 68 SMU inmates were housed. While the physical “wall” in which “Three Gate” was placed looked like an ordinary chain–link fence, I presumed that it was “prison grade” chain link fence – just as the two–inch thick plexiglass in the “security sensitive” areas of the prison was composed of beautifully flawless, bullet–resistant glass.

Lieutenant Mills pointed to the fence: “Since this is chain–link, we can see everything that happens back here. If there is a fight, we can quickly break it up before someone gets seriously hurt. No one has been killed back here for .... least three months....maybe four.” Lieutenant Mills then stared off and smiled to himself. I thought I saw him chuckle.

Lesson Two: Even Acutely Psychotic and Manic Patients Are Responsible for their Behavior

On the other side of Three Gate were two dozen lounge chairs bolted to the floor. The chairs faced a large television which was bolted and suspended from the ceiling about five feet above the floor. Lieutenant Mills explained to me that he bought the television with SMU general operating funds  “...not inmate funds.” He emphasized that while it was a large TV, it was an ordinary TV “…as you can see, without Plexiglass or wire screen protection.” I was puzzled. Why was the Lieutenant spending so much time talking about an ordinary TV set? I responded simply: “Got it. Vulnerable TV!”

We continued the tour. Lieutenant Mills waved his hand in a sweeping gesture toward the inmate cells lining the walls of SMU, commenting:“In mainline population there can be three inmates in each of these small cells. Here in SMU, because of the risk of fights and the risk of sexual predation, almost all SMU patients have single cells. I’ll introduce you to our patients after we finish The Tour.”

We walked to the back of the SMU “common area” where Lieutenant Mills showed me the Unit’s two ping pong tables. They were clean and level. Lieutenant Mills explained to me that he paid for the ping pong tables “…from SMU’s general operating funds – not inmate funds.” He explained that once the inmates’ morning chores were completed (e.g., making their beds, sweeping their cells, showering, organizing their laundry, cleaning the dining hall, running errands for the security staff), the inmates who had were on  “Open Ward” status were then permitted out of their cells. “They can read, watch TV, walk laps around the SMU common area for exercise, play chess or checkers. They can play ping pong with each other, or with invited security staff. The patients just have to ask Jim for ping pong paddles and ping pong balls, and then sign a check–out card – just like they were borrowing a book from the public library.”

We then walked briskly back to the “front area” of SMU and then into SMU’s largest office. This served as the patient interview room – and it was to be my office. Lieutenant Mills’ office was adjacent to mine. Lieutenant Mills then invited me to sit in what was to be my chair in front of what was to be my very large desk. He invited me to ask questions. I was stunned. Prison was nothing like it was portrayed in the movies! I said to Lieutenant Mills that I didn’t see how a psychiatrist could provide safe and responsible psychiatric treatment to such complicated and potentially dangerous patients while the psychiatrist was physically present in the prison only two days weekly. The Lieutenant smiled, and assured me that: “This was the way it had always been done – and I’ve been doing this a long time. My staff and I can handle anything that might happen while you’re gone. I’ll phone you every morning with an update. If you pay attention, and  listen to good advice, then you’ll do fine here. And I only give good advice.” He then smiled. He was clearly proud of his staff and pleased with what he had been able to accomplish over the years as the officer in charge of the Special Management Unit.

Lieutenant Mills then expatiated on his earlier comments. While he didn’t attend college, and while he didn’t have “all the book learning” that I had, he did have common sense and plenty of experience. His major complaint was with the mental health staff at Oregon State Hospital (OSH). “Too many of the hospital staff and administration lack common sense. They repeatedly make excuses for inmates’ bad behaviors just because the inmates have a mental disorder or had an unpleasant childhood. We’ve all had unpleasant childhoods. So what? During their time attending mental health programs at OSH, these inmates get away with everything short of murder – they can assault other patients; they assault the treatment and security staff; heck, they even rape the nurses. And they do this knowing they won’t be held accountable by OSH staff or administration. Then, when the inmates are transferred back to prison, they return with the attitude that they can do whatever they please because they have a psychiatric diagnosis. The psychiatrists, administration and therapists at OSH turn these inmates into monsters. This ain’t right. If you hold everyone accountable, then everyone’s behavior improves… eventually.” Lieutenant Mills then stared off, and smiled to himself.

Lieutenant Mills continued: “I have worked in the Special Management Unit for the past eighteen years. First as a Sergeant, and now as the Lieutenant. I have seen hundreds of fights - patients attacking other patients; and patients attacking security staff. During many of these fights, the patients were in the middle of a manic or a psychotic episode. And during these episodes, these inmates often used weapons. Yet, no matter how wildly psychotic or manic they were, the patients never – ever – used a ping pong paddle as a weapon. Do you know why?” I replied: “Not really, Lieutenant.”

Lieutenant Mills continued his lecture: “In the past eighteen years, we have had dozens of patients in the midst of psychotic or manic episodes. They can be wild – tearing up the offices, tearing up their cells, or destroying the nurse’s station. Yet, regardless of how crazy the patients behave, they have never – ever – damaged the TV set. Do you know why?” I again said: “Nope.”

Lieutenant Mills explained: “Even when they are manic, or psychotic, or just having a temper tantrum, the patients CHOOSE how they behave. They all know that I bought the TV with SMU general operating funds. So, if any patient damages the SMU television – even in the midst of a psychotic or manic episode – I won’t spend SMU funds to repair or replace the TV. Ever. They all know this. The patients also know that I bought the ping pong tables with SMU general operating funds. They all know that if they ever use a ping pong paddle as a weapon – even in the midst of a psychotic or manic episode – I will remove the ping pong tables and paddles. Forever. So when patients have their psychotic or manic episode, they may smash all sorts of things and they may use sharpened toothbrushes or ceramic shards for weapons, but they will never ever touch the TV set or the ping pong paddles during their acting–out episode. If they do, they know I’ll remove their favorite leisure activities. Their fellow patients won’t be fooled by the patient’s theatrics, and these fellow inmates will hold this acting–out patient personally responsible for the consequences of his behavior. The other inmates won’t kill the misbehaving patient, but they will hurt him real bad.” Lieutenant Mills concluded: “It seems to me that everyone knows we are each personally responsible for our own behavior – that is, everyone knows this except for the mental health staff and psychiatrists working at Oregon State Hospital... Think about it.”

Lieutenant Mills then left my office so I could “think about it.” He then returned carrying his security notebook, sat in a chair, looked at me with his pen in his hand, and asked me: “Ready?” I said that I was. The Lieutenant then shouted: “Jim, bring in the first patient.”

Lesson Three: Crimes May be Similar, But Dispositions Can Be Very Different – Dante

Dante was a 16 year old boy with recurring homicidal fantasies, panic attacks, and extreme social anxiety (“stage fright”) around girls. One sunny October afternoon, Dante was alone – sitting in his father’s Oldsmobile in a wealthy Portland suburb. Dante then spotted a pretty twelve year old girl with curly blonde hair who had just gotten off a school bus. She was walking on a sidewalk and walking away from Dante. The girl met Dante’s criteria. Driving his parents’ car at 35 to 40 miles per hour, Dante hit Beatrice from behind. First Beatrice’s knees buckled as the car bumper slammed into her, then her head smashed onto the car hood. Her thin body then flew up in the air and landed in a nearby tree. This little girl was killed instantly. Dante then drove away from the scene of the crime. Arrested later that day, Dante confessed immediately: “It wasn’t an accident. I did it on purpose.” Because of the heinousness of the crime, Dante was tried in court as an adult. Even though this was clearly a premeditated murder, Dante was only convicted of Manslaughter some nine or ten months later. After his conviction – and at the age of 17 – Dante was remanded into the custody of the Oregon Department of Corrections, and then transferred to the Oregon Correctional Intake Center (OCIC) for his requisite two weeks’ assessment and prison orientation classes. On the day of his arrival at OCIC, nurse practitioner Lynnda Transue talked with Dante briefly, then said to the officer in charge: “This is crazy. Send Dante to SMU right away. Tell Dale that I want a second opinion.”

I arrived in SMU the following morning. Lieutenant Mills suggested that we start the interviews with Dante. One of the security staff walked to a side room, handcuffed Dante, then brought him into my office. Dante was maybe 65 inches tall, weighing at most 100 pounds. He looked terrified – his wrists handcuffed in front of him, sitting in the interview chair surrounded by imposing, scowling security staff. All I knew about Dante was that he was a 17 year old kid who had just arrived in prison, and that Lynnda Transue wanted me to see him right away. I introduced myself, the nurse, the security staff, and Lieutenant Mills to Dante. First, I asked Dante if we were in any danger of being attacked by him. When Dante responded to my question with genuine shock, I got my answer. I looked at the Lieutenant. Lieutenant Mills then nodded to his security staff. Dante’ handcuffs were then removed. Dante sighed, and relaxed in the interview chair. I then asked Dante how he was adjusting to life in an adult prison. Dante said laconically that he was “...doing all right.” I then asked Dante what he intended to work on while in prison, and with what did he think we could do to help him. Dante haltingly answered: “… I need to work on my social skills?”

No one spoke, but eyebrows were raised as each of the security and nursing staff glanced at his or her colleague. Was Dante serious? Did he really think a maximum security prison was a suitable place to practice his social skills? I looked again at Lieutenant Mills. He was staring at the floor, elbows on his knees, fingers interlaced. I knew that Lieutenant Mills was thinking –reviewing every possible placement option for Dante and the likely outcome for each option. Then The Lieutenant shook his head slowly back and forth and – still staring at the floor – said: “This kid doesn’t belong in any of our prisons… He’ll be eaten alive… And he’ll cause a riot – all the predatory inmates will want him for a cellmate.” Continuing to stare at the floor, Lieutenant Mills then said quietly to his staff: “Put Dante back in his side room where he’ll be safe from the adult patients. I have to figure out what to do with him… Doc, keep interviewing patients. I might be on the phone for a while.” I then interviewed the other new inmate arrivals. then did my morning “rounds” which consisted of checking in with each of the older SMU patients, reviewing what treatment progress they had made since being admitted to SMU. All the inmates were doing well. I noted that The Lieutenant was in his office on the phone for the remainder of the day shift.

When I returned the following Monday, I heard that the Lieutenant was able to pull off a minor miracle. He was able to successfully broker an agreement between the administrators at both Oregon Department of Corrections and the Oregon juvenile corrections department to authorize Dante’s transfer from Oregon State Penitentiary to McLaren School for Boys “...where he should be safe until he paroles.” The Lieutenant then shook his head: “Improve his social skills... God help us all!”

Lesson Four: Crimes May be Similar, But Dispositions Can Be Very Different –  Juan

When in a reflective mood, I’ve heard inmates say with wry facial expressions: “If you think there is good in everybody, then you haven’t met everybody.” After having worked in Oregon Department of Corrections for over four years, and having interviewed over 1,300 inmates, I thought I had seen and heard just about everything – and from just about everybody. Then I met Juan.

In late January, seventeen year–old Juan and his twin brother were sentenced to life in prison for Aggravated Murder. Juan was sent to Eastern Oregon Correction Institution (EOCI) in Pendleton – a five–hour drive from his Salem home. (For those who don’t know, Pendleton is the site for the yearly Pendleton Roundup and Rodeo celebration). Juan’s brother was sent to Oregon State Correctional Institution (OSCI) located about three miles east of Oregon State Penitentiary. In late March of the same year, Juan had “had it with the cowboys.” Juan told security staff that if he wasn’t transferred to Salem immediately, he would hang himself. The security staff took Juan’s threat seriously, and told him that they would grant his wish. They put Juan in an orange prison “jump suit,” handcuffed him, shackled him, and then transported Juan to Salem as promised – but not to OSCI where his brother was incarcerated. Juan arrived at the maximum security prison (Oregon State Penitentiary) instead.

I arrived in SMU early the following Monday morning, so I had time to review Juan’s thick “central file.” During the previous five years, Juan had been arrested for dozens of felonies: these included Arson (at a high school), Burglary, Assault with a Deadly Weapon, and Armed Robbery. However, it appeared that almost all of Juan’s criminal charges had been dismissed. I then read the details of his most recent crime: At the age of 15, Juan and his identical twin brother randomly selected a trailer home in a nearby retirement community for their target. They first kicked in the flimsy front door, then beat, robbed, raped, and tortured the frail homeowners. The victims were an elderly Caucasian couple in their mid–80s. Finally, using their bare hands, the twins then strangled the defenseless, elderly couple. Unlike their previous crimes, this double homicide had not been carefully planned. It looked to me like the twins had been at least somewhat impaired by alcohol and drugs at the time of the double–murder. Because the crime was poorly executed, the twins were quickly arrested. When interrogated, the twins explained to the investigating officer that they had killed the elderly couple “for prestige and excitement.” Fifteen months after their arrest, the twins were convicted of Aggravated Murder – but, curiously, they were not sentenced to death. Instead, each identical twin was given a life sentence. I calculated that the twins would be eligible for parole when they reached 71 years of age. I thus concluded that the twins would probably die in prison before their parole release date.

When I met Juan in my office, he had been in the prison system for only six weeks. Juan was a six foot tall African–American male with a weight of about 200 pounds. He had a short thick neck. And Juan was “solid muscle.” Juan was clearly displeased to be in SMU rather than at OSCI. Handcuffed, Juan sat in my interview chair, and stared menacingly at everyone in my office. This inmate was clearly capable of being lethally dangerous. Because of Juan’s size and his criminal reputation, all of the SMU security staff were crowded into my office in order to keep everyone (i.e., me) safe. I introduced myself and the staff to Juan. I then asked Juan why he was in SMU. He explained that he didn’t like cowboys, and thus didn’t like being in Pendleton. He wanted to be transferred to OSCI in Salem to be with his brother. I then asked Juan if he was thinking of harming himself. He snorted and replied “Hell no.” Juan insisted that he just wanted to be transferred to Salem to be near his family. I then asked Juan if anyone was in danger of being harmed by him. He responded cryptically: “Probably not.” However, Juan then assured us that if he wasn’t promptly transferred to OSCI, “...there could be trouble.”

I tried, but I wasn’t able to find anything treatable – except for Juan’s substance abuse. I asked Juan if he was interested in chemical dependence treatment. Juan said no. I suggested that since he was in SMU, perhaps he would want to socialize with the other inmates in SMU’s “Big Dudes” therapy group which was led by our 72 year–old psychologist, Dr. Ed Scott. Juan said he didn’t have anything to say either to “mental patients – or to shrinks.” This seemed like a good time to end our first meeting. I thanked Juan for talking with me. I told Juan that Lieutenant Mills and I would discuss his situation privately to see if we could find a solution for his situation. Juan grunted acknowledgement. He was then escorted back to his side room.

Lieutenant Mills and I were alone in my office. The Lieutenant was leaning forward in his chair, elbows on his knees, fingers interlaced, staring at the floor in front of him. I knew he was reviewing placement options and their probable outcomes.

I thought about Juan – and then about Dante. Both were 17 years old when I met them. Their victims were previously unknown to them. All their victims were easy targets – defenseless prey, really. All the murders were premeditated. However, in Dante’s situation, Beatrice’s murder was his first violent offense. For Juan, the murder of the elderly couple was the culmination of at least five years of increasingly more deviant and more violent assaults. Dante was terrified of prison. Juan looked completely comfortable in prison. Dante was a security threat because of his immaturity and physical vulnerability – he was prey. Juan was a security threat because he was a gang member; he was large, powerful, and knew how to intimidate others – he was a predator. Dante wanted to go home. Juan wanted to be transferred to another prison. Dante was motivated to look at himself, and would do well in both individual and group therapy. Juan was uninterested in – or incapable of – self–observation, and was unwilling to take advantage of the treatment programs offered in prison. Dante didn’t belong in the adult correctional system. Juan clearly belonged in the adult correctional system.

But where? Housing identical twin gang members in the same prison was a security nightmare. I had read Juan’s “central file,” so I knew how Juan and his brother had avoided incarceration prior to their most recent crime and conviction. Except for the double murder in August 1993, the twins had carefully planned their crimes: One twin would establish a “solid” alibi for himself (and therefore, also for his identical twin brother), while the other brother committed a crime. If then either were to be arrested for the crime, witnesses would not be able to positively identify which twin was responsible, so the criminal charges would have to be dismissed. Their “fatal mistake” was both actively participating in the same crime. I considered Juan’s placement options.

What if the twins were housed in the same prison? What would be the outcome if one brother assaulted security staff – or assassinated a rival gang member? How could a witness “positively identify” which twin committed the crime?

If we kept Juan in SMU, I worried that Juan would quickly find a way to bully and “manipulate” (prison lingo) our vulnerable SMU patients (SMU patients must walk past the side rooms to enter the showers or the dining room). And while some of the SMU security staff were strong and agile, most of the SMU staff were 50 to 100 pounds lighter than Juan. If Juan started a fight, security staff would likely be injured.

If we discharged Juan to the General Population at Oregon State Penitentiary, Juan would then have the opportunity to first join and then assume control of the gang members housed there. Or if discharged to General Population, Juan would soon locate his father and  physically express his opinion of the domestic violence Juan witnessed as a boy. (Juan’s father was currently an inmate at OSP.). No – OSP didn’t appear to be a viable housing option for Juan.

What if we sent Juan back to Pendleton? I predicted that Juan would persist in doing whatever was necessary to be transferred to Salem – and eventually to OSCI. Once back in Pendleton, Juan would resume threatening suicide. Juan might even follow–through with his threat. But, what if Juan miscalculated the timing of his hanging attempt (as many inmates did) and if he were not found by prison staff quickly enough for the inmate to be “cut down”? I could see the newspaper headlines: “Desperate, hopeless, incarcerated African–American adolescent suicides – his repeated pleas to see his Salem family members ignored by prison mental health and security staff.”

I then looked at Lieutenant Mills. He slowly shook his head from side to side as he stared at the floor in front of him: “If this kid is housed in the same prison as his brother, they’ll start a gang within the month. Within six months, they’ll be running the prison. They will put everyone there at risk. Juan clearly needs to be in our adult correctional system, but I don’t know where he can be safely housed. I’ll keep Juan in the side room on ‘Lock Up’ status until I can sort out what to do with him. We’ll probably be stuck with him for a while.”

I then had an idea. What if the Lieutenant and I asserted that Juan looked terribly depressed, and that we insisted that Juan attend group therapy with Dr. Ed Scott? Ed always enjoyed working with the most challenging, stubborn, and most sociopathic patients. Maybe Ed could “crack” Juan’s tough–guy exterior. Whatever the outcome of Juan’s group therapy “participation,” this would provide useful information which could be incorporated into Juan’s prison management plan. If – after a reasonable period of time attempting to provide treatment for Juan – we then transferred Juan back to the prison in Pendleton, then no one could accuse the Department of Corrections of “deliberate indifference” should Juan or his family later file a groundless complaint (or lawsuit).

Lieutenant Mills liked my idea. So did Dr. Scott (“...Please, call me Ed”). So, twice a week, Juan “joined” the other SMU patient “power brokers” in Ed’s “Big Dudes” therapy group. Over the next month, despite Ed’s best attempts to “connect” with Juan, this adolescent inmate remained disengaged, menacing, unwilling to discuss his crime, and unwilling to introspect. At the end of the four weeks, Ed concluded that Juan was as likely to benefit from further attempts at mental health treatment “ I am to see my hair grow back on the top of my head.” Lieutenant Mills then worked with Oregon State Penitentiary’s Chief of Security and Eastern Oregon Correctional Institute’s Chief of Security to develop what is known in prison as “a security management plan.” Juan was then transferred back to Pendleton, Oregon.

Lesson Five: High Noon in Oregon’s Maximum Security Prison

One Saturday morning some years later, another inmate was transferred from EOCI in Pendleton to SMU. As was the standard operating procedure, this new arrival was placed in a “side room” without “Open Ward” privileges until Lieutenant Mills and I evaluated him Monday morning. Since this inmate arrived from Pendleton over the weekend, he had been “stuck” in the side room for two days. And he was miserable.

I arrived as usual on Monday morning, and was being briefed by the SMU nurse about medical concerns she had about several inmates. My office was directly across from the “side rooms.” I heard an inmate yelling from his cell loudly but politely: “Hey, are you the psychiatrist? Could you please get me out of here. I’m going crazy!”

Lieutenant Mills was busy in his office, so I asked Lieutenant Mills if I could start interviewing the new patients without him. He said to “...go ahead without me. You know what you’re doing.” The new inmate from Pendleton was then handcuffed through the port hole. The solid metal door was then electronically opened and this inmate from Pendleton was escorted to my office. He sat in the interview chair between me and the doorway. A correctional officer stood to either side of him.

I introduced myself and the SMU staff, then asked the inmate why he was sent to SMU. The inmate said that he had a simple “disagreement” with the security staff in Pendleton. “Maybe” he lost his temper and “maybe” he said a discouraging word. The next thing he knew, on Saturday morning at dawn, he found himself “being loaded up for transport to SMU.” He said he had been “stuck” in the side room for the past two days, was terribly claustrophobic, and would I please let him out of his cell so he could stretch his legs? He promised that if he were granted more freedom, he wouldn’t cause any trouble.

Upon completing my correctional psychiatric interview, I didn’t find anything to justify keeping this inmate in SMU. He just seemed a relatively typical, incarcerated Oregon cowboy who did something very stupid while intoxicated, ended up in prison, and was eager to return to eastern Oregon to complete his short prison sentence. But would I please let him out of his cell? I felt sorry for the inmate. I knew that I needed the Lieutenant’s OK before the security staff would give this inmate more freedom. I asked security staff if Lieutenant Mills was available. Yes, he was. The Lieutenant joined us. The Lieutenant was wearing his usual white cowboy shirt, his black jeans, and black cowboy boots. Lieutenant Mills sat in a chair directly to the right of the inmate. They sat with shoulders almost touching. Both were facing me where I was sitting about ten feet away. I summarized the inmate’s situation for Lieutenant Mills, and asked the inmate to correct me if I misrepresented the situation. I advocated as best as I could for increasing the inmate’s freedom, knowing that inmates often lie, and knowing all too well that I could be duped just as easily as anyone else.

The Lieutenant listened quietly and politely. He then turned to the inmate, and explained that since he was in charge, he was responsible for everyone’s safety, and he was very reluctant to grant this new inmate “Open Ward” status “because I don’t know you well enough yet.” Then, most respectfully and deferentially, I tried once more to plead my case. Both listened; the inmate nodding “Yes” vigorously while I made my most compelling argument for more freedom for this allegedly claustrophobic inmate.

Elbows resting on his knees, fingers interlocked, Lieutenant Mills looked at the floor. I knew from years of working with the Lieutenant that this posture meant that he was generating scenarios and reviewing options, looking for a solution with which he could feel comfortable –one that would satisfy his criteria for safety, security and fairness. Then he looked up. I knew that the Lieutenant had an idea.

Lieutenant Mills turned his head to the left toward the inmate, made brief eye contract with the inmate, then looked back at the floor. Lieutenant Mills asked the inmate where he was from. “Eastern Oregon,” answered the inmate. Lieutenant Mills asked if the inmate was a cowboy. “Yes, I am, Lieutenant,” replied the inmate. What crime had he committed? “Drunk and disorderly.” Lieutenant Mills then asked the inmate if he had had any “DRs” while in prison (a “DR” is a Disciplinary Report describing a prison rule violation.). “None,” replied the inmate.

Lieutenant Mills then asked one of his security staff to check the Oregon Corrections computer database to see if it would corroborated this inmate’s story. Within a minute or two, the Corrections Officer replied: “His story checks out, Lieutenant. Drunk and disorderly. No prior charges or convictions. No DRs. No problems since he’s been incarcerated.”

Expressionless, Lieutenant Mills turned to his left again and this time looked briefly into the inmate’s eyes. He then asked: “Are you a man of your word?”

Shocked, the inmate leaned back in his chair. What a strange question! Here was the head of security in Oregon’s maximum security prison Special Management Unit asking an inmate if he was honorable! The inmate then looked briefly at Lieutenant Mills and replied: “Yes I am, Lieutenant.”

Lieutenant Mills again made eye contact with the inmate: “If you give me your word –cowboy to cowboy – that you’ll behave yourself if I let you out of the side room, will you keep your word?”

The inmate then looked at Lieutenant Mills, and said solemnly: “Lieutenant, if you let me out of my cell, I’ll behave myself. You and your staff won’t have any problems with me. You have my word, cowboy to cowboy.”

Satisfied, Lieutenant Mills said: “All right then. I’ll let you out. But if you don’t keep your word, I’ll never, ever forget it. And you know what I mean.”

And with that, Lieutenant Mills nodded to Officer Clark. The inmate stood up, and I watched Officer Clark escort the inmate out of our office. Once in front of his cell door, I heard the familiar clicking sound of handcuffs being unlocked. Officer Clark then yelled to Jim: “This guy’s now on Open Ward Status.” I then heard Officer Clark say much more quietly to the inmate: “You’re free to join the other patients while we arrange for transportation to get you back to Pendleton. In the meantime, you behave yourself, you hear?”

Lieutenant Mills sat motionless in his chair. His elbows were propped on his knees. He knew that I was watching him. And he knew that I was astonished by what I had just witnessed.

Without my clearance, Lieutenant Mills would never have entertained the idea of allowing this new inmate out of the “side room.” But Lieutenant Mills still had to be convinced that granting this new inmate more freedom would be a safe decision for everyone in SMU. Lieutenant Mills had to find a solution with which he could feel comfortable. And he did. Lieutenant Mills found a way to exercise his personal power – not as a security officer to inmate, but as one cowboy to another cowboy.

Lieutenant Mills knew I was pondering the import of what I had just witnessed, so he gave me a few moments to “take it in.” The Lieutenant continued staring at the floor for a little while longer. He then took a deep breath, exhaled, and looked up at me. I nodded my head slightly to him. The Lieutenant then turned his head to the left, and shouted: “Jim, send in the next patient.”