Our complaint

At the orientation to the Corrigan IPU, a nurse complacently says, “We provide the patients with four Rec. Breaks each day so they can get their nice time outside.” That captures the sum total of Corrigan’s woefully inadequate response to the Fresh Air law. Corrigan’s approach is to say that it has four scheduled Rec. Breaks and then leave it to the patients to see which of them end up going outside.

But the regulations anticipate such a one-size-fits-all approach, and they explicitly reject it. [See 104 CMR § 27.13 (6)(f)(1)(a)(i)] Each patient has to be considered individually. The patient’s clinical condition—their diagnoses—must be taken into account. The pertinent question is: in light of each patient’s specific diagnoses, do the unit’s scheduled Rec. Breaks constitute a reasonable opportunity for that patient to access the outdoors on a daily basis.

In other words, it is necessary to consider the match between the unit’s procedures and the patient’s condition. A one-size-fits-all approach does not satisfy the law.

For about half of the Corrigan patients, the Rec. Breaks, as provided at Corrigan, do not constitute a reasonable opportunity for outdoors access. To see this, we consider (1) Corrigan’s Rec. Breaks and (2) the clinical conditions of the approximately 50% of patients who never or almost never go outside (for weeks, months, and perhaps even years) (the “Compromised Patients”).

(1) Corrigan’s Rec. Breaks. Going to the Rec. Break typically requires going down two dark, steep, austere staircases in a large group while being corralled by techs holding keys, locks, and even a heavy chain. It feels like prison.  Alternatively, it is, in theory, possible to take an elevator down, but the elevator is often not working, and when it is working, it is precarious; it is always an adventure to see if the doors will open and close as they should.  In addition, to take the elevator, a patient would need to have a level of self-awareness, executive functioning, social confidence, and public assertiveness that the Compromised patients do not possess. 

(2) The Compromised patients. Each Compromised patient is unique. What unites them is that they typically have several of the following clinical conditions or diagnoses: social anxiety, paranoia, PTSD, claustrophobia, morbid obesity, dementia, catatonia, and (especially important to note) so-called “negative symptoms,” including e.g., apathy, avolition, cognitive impairment, asociality, anosognosia, disorganized communication etc.

For the Compromised patients, there is no match.

For some narrative examples based on specific patients, click here. Already, however, it should be apparent why, for patients with these diagnoses, simply offering scheduled Rec. Breaks—given the Corrigan physical plant—does not constitute reasonable access. Simply put, the Compromised patients do not have the executive functioning, social comfort, equanimity, or assertiveness either

(a) to go down two dark, steep staircases in a group being herded by guards holding chains and keys, through locked doors and chain link fences and midst chains, locks, and fences or

(b) to have the cognitive awareness and spiritual / motivational wherewithal to approach MHCs not only at the right time, but in the right place, and with an appropriate amount of assertiveness, to arrange to take an elevator down—and then to take the elevator without an individual escort while tolerating the attendant paranoia, hallucinations, and anxiety.