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Review of Life and Death in Rikers Island, by Homer Venters (Johns Hopkins University Press, 2019).

“Incarceration harms health,” Homer Venters declares at the outset of Life and Death in Rikers Island . Venters worked for almost a decade administering health care in the New York City jail system — the bulk of which is clustered on Rikers Island — including as chief medical officer and assistant commissioner of Correctional Health Services for the New York City Department of Health (DOH). In Life and Death , Venters draws from his experience in the highest echelons of the DOH, numerous clinical studies on Rikers Island, and a background in public health that includes examining asylum seekers for evidence of torture. His conclusion: incarceration itself must be treated as a cause of harm to incarcerated people. Life and Death is at once measured and scathing, a fitting combination for a staid medical professional navigating a brutally authoritarian environment. Venters casts himself as neither a whistle-blower nor a score-settler, focusing instead on interpreting the information available in the public domain through the lens of his professional experience and ethical perspective. Much of the book will be nothing new to those who follow highly publicized Rikers scandals like the deaths of Christopher Robinson, Bradley Ballard, and Kalief Browder; the growing chorus of state-sponsored and private investigations into abuses on the island; and employee memoirs like former Rikers social worker Mary Buser’s Lockdown on Rikers . The novelty of Venters’s account is not so much the stories he tells as the framework he brings to understanding them. The result is a damning indictment of the Rikers Island penal colony — and the conditions of jails across the country.

The Complicity of Medical Professionals Venters introduces a variety of categories to help us understand the horrors of the US prison system. The first is “jail-attributable deaths”: jail itself, Venters argues, can be treated — and measured — as a cause of death. Jail-attributable deaths include fatalities from violence, suicide, substance withdrawal, and overdoses upon release (a silent epidemic, Venters says). Criticizing the incomplete and often nonexistent data measuring harm inflicted upon incarcerated people, Venters argues for a systematic quantification of jail-attributable deaths, which he expects would shed light on particularly egregious facilities like those on Rikers. Next is “nosocomial rape” — a medically derived term (a nosocomial infection originates from the hospital setting and is therefore attributable to hospitalization) that Venters uses to describe sexual assaults that would not have occurred if a detainee were not in jail. Tellingly, the cases Venters spotlights are not between detainees, but between guards and detainees, with the former taking advantage of their unchecked power to terrorize their prey — and their families — on both sides of the bars. Finally, there is Venters’s notion of “dual loyalty”: the often contradictory allegiances medical professionals hold between their patients and the security dictates of the jail environment. Venters writes that medical professionals have become complicit in both human rights abuses and their erasure from the record. They struggle to provide the level of care their profession demands as detainees are denied medical appointments and medicine, held in torturous conditions like solitary confinement, and subjected to a brutal regime of discipline. The complicity of medical staff in the violation of detainees’ rights is multifaceted. In his own investigation into prisoner injuries at the hands of guards, Venters found more than half had been threatened by guards and told to lie about the origins of their injuries — 80 percent of which were sustained, at least in part, after the prisoner was restrained. Venters re-creates scenes, familiar to readers of Buser’s Lockdown on Rikers , of guards brutalizing prisoners in full view of medical staff and then intimidating the clinicians into keeping quiet. Even as a high-ranking city official, Venters recalls being threatened at times, once by a group of guards in the notoriously violent solitary confinement building who told him point blank: “That ID badge won’t help you here.” A thornier form of dual loyalty comes less from external threats than from medical providers’ internalization of the “security” perspective pushed by the guards. In a review of hundreds of medical staff’s notes written on detainees, Venters finds 12.2 percent were “not in the patient’s interest,” meaning they were not simply detrimental to the patient but rather something no medical professional should do ethically. Most commonly, this meant leaving medical observation to parrot the contention, hurled by guards at pretty much any detainee requiring medical assistance, that the prisoner was lying in order to improve their situation in the jail. Venters also draws on his experiences to cast doubt on the validity of a popular category used by medical providers in jails: “excited delirium.” According to Venters, this is a pseudoscientific diagnosis that can cover just about any behavior that occasions violent treatment by guards. Often, it exculpates death. Similarly, the widespread practice of mental health professionals approving prisoners for solitary confinement on the grounds they are fit to withstand the punishment is not only baseless in its medical pretense, it also “violates basic ethics principles, because, of course, that patient is supposed to suffer.” Venters furnishes his own data that shows black detainees are twice as likely to land in solitary confinement at Rikers as white prisoners, who make up roughly 10 percent of the island’s population. The blame for the wrongs wrought by dual loyalty by no means falls on individual guards, nor on individual care providers. Venters describes how medical professionals are pushed from the heights of the jail hierarchy — and the very structure of the reporting process — to downplay the severity of prisoner injuries, which are classified by a rubric of A, B, C, or D. “A” injuries require notifying outside investigative bodies like the Department of Investigation, and the jail bureaucracy, Venters claims, does everything in its power to avoid those classifications: “Leadership in these jails place tremendous pressure on managers to keep these numbers down and limit external inquiries.”