More than 95 per cent of prisoners hospitalized or receiving medical treatment in various hospitals in Israel are handcuffed to a bed and accompanied by guards, according to data published in an article in the prestigious scientific journal The Lancet. Handcuffing has medical consequences such as pain, pressure sores and venous thrombosis.
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At the same time, the patient's trust and responsiveness to treatment are damaged, while he is not treated as other patients. According to data collected for the first time from 14 hospitals, in 80 per cent of cases, patients were shackled to a bed with an opposite hand and leg. It also emerges that nearly 10,000 detainees and prisoners are treated in hospitals each year, and that about 700 of them are hospitalized. The study is intended to lead to a public debate on the issue, and to a national program that will reduce the number of shackles that contradict medical ethics, the IPS ordinance, and Health Ministry directives. The data was collected over two years and two months, from January 2020 to March 2022.
Documentation from inside the cell at Gilboa Prison from which the security prisoners escaped // Photo: IPS Spokesperson's Office
During this period, a total of 2,950 prisoner visits were reported in the same hospitals. In 95.3 per cent of them (2,812 visits), the ciders were handcuffed. In all visits, prisoners were accompanied by guards: in 11 per cent of the cases one guard, in 48 per cent two guards and in 41 per cent three or more guards. In addition, 95.8% of prisoner visits to outpatient clinics were handcuffed, as well as 93.6% of hospitalizations.The study found no large difference in the rate of shackling between adults (93%) and children and youth under the age of 18 (95% out of 81 patients).
However, the rate of shackling was about 30 per cent lower over the age of 65 (81 per cent).The shackling rate was not spared even for those who had limited movement for medical reasons, and even those on ventilators: 106 patients had severe mobility restrictions, but still 84 per cent of them were shackled, including patients who were on ventilators, who had undergone significant surgeries and who suffered severe orthopedic injuries.Israeli criminal law defines prisoners not to be handcuffed in a public place unless there is a risk of escape or injury to others or themselves. The law does not specifically address the situation of receiving medical treatment.
Data on prisoners' ties in medical care, Photo: GettyImages
Doctors are bound by Ministry of Health guidelines, which state that medical staff have a responsibility to exercise discretion and intervene in cases of handcuffing patients, when shackling may harm them. A government committee (the Mazuz Committee) that examined the issue also determined that shackling will not be done as a routine and automatic act, unless there is real information or a well-founded intelligence assessment." How is it possible that a person after surgery wakes up and cannot turn over in bed because his right leg and left hand are handcuffed?" wonders Prof. Dan Turner, deputy director general of Shaare Zedek Hospital and director of the Institute of Pediatric Gastroenterology and Nutrition, who collected the data in the study with his colleagues at the hospitals. "These are very severe physical pains. What reason is there to handcuff people with their stomachs open and on guard? It can't be that most of the prisoners in hospitals are handcuffed. This raises the suspicion that there is no individual assessment, but a sweeping policy." The study shows that starting in June 2021, when the IPS updated its guidelines for shackling prisoners in medical care, the rate of shackling dropped to 83.7%. But after the escape of the six security prisoners from Gilboa Prison in September 2021, the rate of binding rose sharply to about 98%. "In one of the cases I treated, a terminal cancer patient with metastases said he couldn't be handcuffed another night because of the pain, preferring to go back to die in prison."
"There is a suspicion that there is no individual assessment." Prof. Dan Turner, Photo: Elad Berti
Prof. Turner is also a representative of the Medical Association's Ethics Bureau on the issue of handcuffing prisoners in hospitals. He came to the subject by chance. "Four years ago, a thin 14-year-old boy ended up in intensive care after being shot in the legs. He woke up in the hospital with a leg amputated above the knee and a second leg full of nails due to a crushed bone. There are three guards around his bed, and both hands are handcuffed. The child's tears - it was an extreme situation that opened my eyes. What danger is it to escape from a boy without a leg?"
Program: Full documentation
As mentioned, the purpose of the study was to be a first step to action. Now, with the assistance of the Ministry of Health's Nursing Administration, visas have been embedded in the electronic medical record in hospitals to collect data on the extent of shackling, in the hope that documentation will improve the situation.
Health Minister Moshe Arbel, who submitted a bill in the previous Knesset to define the situations in which prisoners treated in hospitals would need to be handcuffed. "As someone who closely monitors the phenomenon of handcuffing prisoners in hospitals, even before I took up my current position, I am certain that its scope can be significantly reduced," Minister Arbel said.
Works on the subject. Health Minister Moshe Arbel, Photo: Gideon Markowitz
"As soon as I entered the Ministry of Health, I instructed the professionals to insist that every person receive medical treatment with dignity and efficiency, in all hospitals. I have also instructed to examine and promote measures that will enable close supervision and control of the phenomenon while registering and monitoring each case. Registration is an effective tool that enables ongoing monitoring and control, as part of the trend to eradicate this evil phenomenon."
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