Replace 'cold steel' of hospital-bed shackles with warmth of compassion

By Jessica Nutik ZitterDec. 4, 2020

“Why do they have that cold steel on my son’s ankle?”

The father of Jacob Blake, a 29-year-old Black man who was newly paralyzed from the waist down, wanted to know why his son was shackled to his hospital bed. Jacob Blake had been shot in the back seven times by police in Kenosha, Wis., and the bullets had severed his spinal cord. He was absolutely no flight risk, yet a police officer had cuffed him to the bed.

His father’s question, which was echoed on front pages across the country, captured in 11 words an issue I have been grappling with for years.

As a physician who has spent most of my career practicing in public hospitals around the country, I have cared for more patients than I care to admit who were shackled to the bed as I examined them, sometimes by their ankles, sometimes by their wrists. Many of them were so sick, sedated, or incapacitated that, like Blake, they could not possibly have posed a flight or safety risk. The New York Times and other media outlets have reported on women shackled while giving birth.

I’m not saying there aren’t times when a prisoner legitimately needs to be restrained when in a civilian hospital for care. A colleague of mine told me about caring for a shackled violent prisoner with Covid-19 who lunged at one of the nurses. But the vast majority of shackled patients I have cared for have posed no flight risk or threat to anyone’s safety.

My first experience with a patient cuffed to the bed was many years ago on the East Coast. He was in his 70s, weak and wasted from illness. I knew he was a prisoner by the police officer sitting on a chair outside his room, armed with a newspaper and cardboard coffee cup. But that didn’t prepare me for the shackles. Until that point, I’d only seen them on television, where cops restrained violent and nefarious criminals.

I felt a flash of fear, even though there was absolutely nothing to be afraid of. I could have restrained this tiny man myself with one hand. The patient saw my surprise and quickly covered the metal on his leg with his hospital blanket. We both tried our best to ignore the situation: He recounted stories about his grandchildren as I kept my exam focused above his waist to spare him any more embarrassment. Even though our interaction was civil and cooperative, I couldn’t get over the fact that I was caring for a person who was chained to the bed.

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When I asked the police officer if he would remove the shackles, he shrugged and shook his head. He admitted that the man wasn’t a danger. In fact, he told me that the man was being held for not paying parking tickets. I felt sick. It felt punitive and unnecessary, and I was shocked by the disproportionate response. I called the commander of the jail to request that the shackles be removed, but it yielded nothing. The best I could do was try to ignore the “cold steel” that punitively asserted power over this powerless man and try to avoid the bias it stirred in me.

Kindly old grandfathers with unpaid parking tickets are not the only shackled patients I have cared for. The Department of Corrections recently brought a patient to our hospital who was dying from Covid-19. Even though he had a breathing tube down his windpipe, requiring maximum sedation, he was cuffed to the ICU bed. His wife, who had been visiting remotely via iPad, watched as his bound leg snagged against the bedrails when the nurses tried to turn him for a sponge bath.

“Why do they have to shackle him in his dying hours?” she asked me.

Why indeed? This man was only a few hours from his death and any doctor — any civilian for that matter —would know he was no flight risk or danger to anyone. And yet punishment and judgment were being inflicted on him even as he lay dying in a semi-comatose state. He would have known that he was, and always would be, a prisoner until his death.

Is this what we want for patients in our hospitals?

It’s become clear to me that shackles on hospitalized prisoners are usually not about safety. They are instead a punitive act, cruelty without function. They are a demonstration of hierarchy, power, and punishment — things that have no place in a hospital.

Shackles create humiliation and emotional harm for the patient and a sense of unwilling complicity for the people caring for them. Clinicians should be able to encounter patients who come under their care as unique individuals, untarnished by their penal history. A doctor should not be a judge or member of the jury.

If we allow the criminal justice system to have the ultimate say, we will never succeed in freeing the health care system and the people it serves from the shackles of bias, racism, and inequity. In effect, it makes hospitals an extension of the prison system, not the safe and nonjudging places they need to be.

I have tried many times over the years to get jailers to unshackle my patients. I’ve never been successful. I’ve made numerous calls to commanders at a variety of jails, holding cells, and federal prisons. I’ve been caught in webs of phone calls that go nowhere, permanently left on hold, or experienced verbal shrugs from the person on the other end of the line, telling me that “It’s just the way it is, ma’am.”

In the case of Jacob Blake, it took widespread public outcry and increasing media pressure to get him unshackled from his hospital bed. My Covid-19 patient was untethered just moments before his death at my colleague’s insistence. Patients who pose absolutely no risk to anyone should not have to be the focus of a media investigation, or on the verge of death, to be liberated from their shackles.

Use of these devices should be the exception, not the rule.

This moment, when the nation’s attention is focused on reimagining the role of police in public safety, offers an opportunity to reassess the role the prison system plays in U.S. hospitals.

As we move toward a model in which some of the power of the police is distributed among a wider network of social service professionals, hospital-based clinicians must have a voice in how prisoners will be managed in hospitals. To ensure that doctors remain true to their mission — providing appropriate and humane care to every patient they serve — they should be empowered to advise on the most appropriate restraint situation, if one is needed at all. If we take orders from the police, we are serving as lackeys of the prison system. Ultimately, collaboration between the health care and prison systems will make more both humane.

As a medical practitioner with a mandate to do no harm, I would like to see us replace cold steel with warm compassion. We still have a long way to go, but putting an end to unnecessary shackling would be a start.

Jessica Nutik Zitter is a pulmonary/critical care and palliative physician at Highland Hospital in Oakland, Calif. She is the author of “Extreme Measures: Finding a Better Path to the End of Life” (Penguin, 2017).

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