Report 2 of the Council on Scientific Affairs (I-00)
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Preventing Assault and Rape of Inmates by Custodial Staff 

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Resolution 404 (I-99), introduced by the Medical Student Section and referred to the Board of Trustees, asked the American Medical Association (AMA) to:

1. Urge health care professionals working in prisons to be aware of the growing problem of custodial assault and sexual misconduct, and report it to the proper authorities without requiring the inmate to report it him/herself to alleviate guard retaliation; and    
2. Urge all states to create statues providing legal protection for inmates against custodial molestation and abuse.

Although inmates are at risk for sexual abuse and assault from both inmates and staff, this report will only address the latter. 

The Federal Bureau of Prisons (BOP) defines staff-on-inmate sexual abuse/assault as: "Engaging in, or attempting to engage in a sexual act with any inmate or the intentional touching of an inmate's genitalia, anus, groin, breast, inner thigh, or buttocks with the intent to abuse, humiliate, harass, degrade, arouse, or gratify the sexual desire of any person. Sexual acts or contacts between an inmate and a staff member, even when no objections are raised, are always illegal."¹ 

Because there is no national, systematic data collection procedure, the extent of custodial assault and sexual misconduct of prisoners is unknown. However, information from surveys conducted with correctional officials, lawyers, advocacy groups, and prisoners incarcerated in prisons in California, Georgia, Illinois, Michigan, New York, and the District of Columbia implies that sexual abuse of women is widespread as is retaliation by the accused officer and his or her colleagues.^2,3 Evidence of the problem is also suggested by data showing that approximately half of U.S. state Departments of Correction (DOCs) report involvement in litigation arising from sexual misconduct.^4,5 

Standards for federal prisons are developed by the Department of Justice through the federal BOP, while standards for state prisons are developed by each state. Protocols of both prison systems are monitored by the National Institute of Corrections (NIC), an agency of the Department of Justice. 

Relevant to Resolution 404 (I-99), the BOP has delineated procedures for handling inmates who report sexual assault or misconduct. Federal BOP recommendations⁶ state that: "The staff member who first identifies that an assault may have occurred should refer the matter to the institution's Sexual Assault Prevention Coordinator." Also, "[a]ny inmate who alleges that he or she has been sexually assaulted shall be offered immediate protection, and will be referred for a medical examination as well as a clinical assessment of the potential for suicide or other related problematic behavior." The BOP describes the services and responsibility for the health care management of victims of sexual assault. These include: a medical evaluation that includes documenting the extent of the injury and testing for HIV and other sexually transmissible diseases; psychological counseling, including suicide prevention, and family and peer support group counseling; transfer to a hospital or appropriate medical center for seriously injured inmates; and protective action to prevent further assaults including close supervision and transfer, if appropriate. 

In response to litigation and state legislation, a sexual assault prevention/intervention program was instituted in the mid-1990 by the BOP. In a series of documents, the BOP delineated grievance, screening, and treatment procedures and protocols directed at sexual misconduct and assault perpetrated by both other inmates and by staff.

Protocols for preventing and managing sexual misconduct by staff in prisons were also addressed in a 1996 special report by the NIC based on data from a survey of state and federal agencies responsible for the administration of adult prisons.⁴ NIC concluded that "relatively few DOCs have looked closely at whether and to what extent their policies and practices offer clear direction to staff and inmates on the issue of sexual misconduct." Using elements of various existing programs, guidelines were provided for how DOCs should manage reporting of incidents, investigating the allegations, determining the role that other agencies might have in the investigation, obtaining and managing evidence needed to substantiate an allegation, identifying administrative responsibility, taking actions toward staff and inmates, and training staff and inmates on agency policies and prevention. 

A subsequent report by the NIC in 2000, "Sexual Misconduct in Prisons: Law, Remedies, and Incidence,"⁵ provided information on efforts and changes that prisons have taken since the previous NIC report in 1996 to prevent sexual abuse of inmates by staff. Data of relevance include:

1. All but eight states (Alabama, Kentucky, Minnesota, Montana, Oregon, Utah, Vermont, and West Virginia) have statutes that prohibit sexual misconduct involving correctional staff and inmates. Statutes define sexual misconduct as either a misdemeanor (8), felony (27), or both (5). Statutes from three states were present, but the type was unknown.    
2. Most DOCs have implemented new policies, investigation practices, staff training, and inmate education since 1996: Thirty-two DOCs are or have developed or revised their policies related to sexual misconduct; of these 32, policies from 24 DOCs now include language that is explicit in defining and prohibiting sexual misconduct between staff and inmates. Forty-three DOCs are or have developed new staff training; 28 DOCs are or have reassessed their investigation practices for allegations; 15 DOCs have developed special procedures directed specifically at sexual misconduct; 17 DOCs are or have developed or revised their methods for informing inmates about issues of sexual misconduct.

In summary, although the extent of sexual misconduct of inmates in prisons by staff is unknown, the problem is recognized by the BOP, agencies directing state prisons, state legislators, inmates, and advocacy groups. Over the past four years preventive interventions have been implemented in most state systems. Procedures and protocols are defined that direct the management of allegations and for providing medical and psychological services. Although physicians may identify abuse among inmates prior to their filing a grievance, it appears that physicians' major role is in medical evaluation and treatment. 

RECOMMENDATIONS

The following statements, recommended by the Council on Scientific Affairs, were adopted as Directives at the 2000 AMA Interim Meeting. 

1. The AMA urges that all states have legislation that protects prisoners from sexual misconduct and assault.    
2. The AMA will urge physicians who work within prisons to ensure procedures are followed for preventing sexual misconduct and assault of prisoners by staff and appropriately managing prisoners if abuse or assault does occur; the investigation of sexual misconduct should be confidential with information disclosed only to those individuals involved in the process.

References

1. Bureau of Prisons. Health Services Manual; December 31, 1997.  
2. All Too Familiar: Sexual Abuse of Women in U.S. State Prisons. New York: Human Rights Watch; 1996.  
3. Nowhere to Hide: Retaliation Against Women in Michigan State Prisons. New York: Human Rights Watch; 1998.  
4. Sexual Misconduct in Prisons: Law, Agency Response, and Prevention. Longmont, Colorado: National Institute of Corrections Information Center; 1996.  
5. Sexual Misconduct in Prisons: Law, Remedies, and Incidence. Longmont, Colorado: National Institute of Corrections Information Center; 2000.  
6. Bureau of Prisons. Health Services Manual; February 2, 1995.

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