The Department of Justice’s Office of the Inspector General (OIG) issued a report on the Federal Bureau of Prisons (BOP) policies and practices in using restraints on inmates. The OIG’s investigation into allegations made by inmates at various BOP institutions revealed that inmates were placed in restraints for prolonged periods while being confined to beds or chairs. Some inmates suffered severe or long-term injuries, such as the amputation of a limb after being restrained for over two days. The OIG found that shortcomings in BOP's policies and practices contributed to these issues, limiting evidence availability and impairing investigations into potential misconduct by BOP staff.
The investigation into the BOP’s use of restraints revealed significant issues that compromise inmate safety and well-being. These include a lack of clear definitions and guidance regarding terms like "four-point restraints" and inadequate instructions for the necessary medical and psychological checks. BOP policies also permit prolonged use of restraints without sufficient oversight, resulting in injuries such as nerve damage and scarring. Additionally, the documentation of restraint checks is often insufficient, with no requirements for video or audio recordings to support or dispute inmate claims of mistreatment. Furthermore, while medical and psychological assessments are required, there is inconsistent documentation and follow-up regarding inmates’ injuries or health concerns.
The BOP’s use of force and restraint policies are outlined in the BOP’s program statement 5566, and the applicable regulations are codified in 28 C.F.R. § 552. These policies state that force, including restraints, should only be used as a last resort when all other efforts to resolve a situation have failed. However, the BOP had run into issues with restraints in 2023 when USP Thomson was suddenly closed over abuses uncovered in its Special Management Unit (SMU). According to a study by The Washington Lawyers’ Committee for Civil Rights & Urban Affairs, inmates were subjected to prolonged use of four-point restraints. Psychological abuse was also rampant, including extended solitary confinement, racial slurs, and deliberate placement with dangerous cellmates. Staff often denied mental health care to vulnerable individuals, exacerbating their conditions. These practices, which were described as pervasive torture, continued even after the closure of the Thomson SMU in 2023.
One of the primary issues raised by the OIG is the BOP's failure to limit the duration of time an inmate can be kept in restraints, particularly in extreme cases like four-point restraints. According to the Use of Force Policy, inmates must be checked every 15 minutes by correctional officers, every two hours by a lieutenant, and twice per 8-hour shift by medical staff. However, the OIG found that restraints were often applied for extended periods without appropriate interventions, with some inmates being kept in restraints for over a week. This prolonged use has been linked to significant physical harm, such as nerve damage and injuries requiring medical attention. The OIG also found a lack of clarity in the BOP's guidelines about how long restraints should be applied, which is particularly concerning for inmates with mental health or self-harm issues.
The OIG’s review also highlighted significant deficiencies in the medical and psychological assessments of inmates in restraints. Although the BOP mandates medical assessments for inmates placed in four-point restraints, the OIG found that these assessments were often insufficient and lacked detailed documentation. In addition, medical checks, particularly those performed after the initial assessment, were not always video recorded, nor were the injuries adequately documented. The OIG also noted that BOP's medical and psychological staff may not always be well-equipped to identify injuries that result from prolonged restraint, such as nerve or muscle damage. In one case, an inmate's injury worsened to the point of requiring amputation, despite the fact that medical checks were being performed.
The OIG found that the BOP’s documentation of restraint checks was often inadequate. The 15-minute checks were sometimes minimal and lacked sufficient detail to assess whether the inmate’s welfare was being appropriately monitored. For example, in some cases, the only notes in the records were vague descriptions like "inmate manipulating restraints" or "inmate unresponsive." The OIG believes that these check forms need to include more comprehensive information about the inmate's condition and behavior to help determine whether restraints should be continued. Furthermore, the lack of video or audio recordings of restraint checks limits the OIG’s ability to investigate claims of mistreatment and misconduct. The OIG has recommended that the BOP implement video and audio recording of all restraint checks to ensure that both the welfare of the inmate and the actions of the staff are properly documented.
The OIG expressed concern about the psychological support available to inmates placed in restraints, especially those with mental health issues. While the BOP’s Use of Force Policy requires that inmates in four-point restraints be seen by Psychology Services at least once every 24 hours, the OIG found that in practice, these visits were infrequent and inadequate. In some cases, inmates who had attempted suicide or engaged in self-harm were restrained for extended periods without sufficient mental health intervention. The OIG stressed the importance of more frequent psychological assessments for inmates in restraints, particularly those with severe mental health issues.
In response to the identified concerns, the OIG has recommended several key revisions to the BOP’s restraint policies and practices. These include providing clearer definitions and guidelines for restraint types, including medical, psychological, and behavioral checks. The OIG also suggests limiting the duration of restraints to prevent physical harm and unnecessary exposure to prolonged restraint. Additionally, the OIG recommends improved documentation of restraint checks, with more detailed information about inmates’ behavior and welfare, and the requirement for video and audio recordings for accountability. Enhanced medical and psychological assessments, especially for inmates with mental health issues, are also advised. Finally, the OIG calls for greater involvement of regional staff to oversee restraints and offer an objective perspective on their continued use.
The OIG’s investigation into the use of restraints by the BOP has highlighted significant issues regarding the prolonged use of restraints, inadequate medical and psychological assessments, and insufficient documentation of restraint checks. BOP Director William Marshall III provided an initial statement in response to OIG’s report deficiencies stating, “The BOP is committed to addressing these issues and implementing meaningful improvements and views OIG’s recommendations as a crucial oppo1tunity to enhance agency practices and ensure the humane treatment of all inmates. As noted in OIG’s MAM, BOP 's statutory duty is to provide for the safekeeping and protection of inmates, and this duty is integral to the agency’s mission.”
I reached out to the American Civil Liberties Union (ACLU) regarding OIG’s report and Maria Morris, senior staff attorney at the ACLU’s National Prison Project, provided the following statement:
"The use of four-point restraints for hours on end, sometimes resulting in serious and permanent injury, is the latest example of the cruelty that has come to define conditions in the Federal Bureau of Prisons. This type of abuse is unconstitutional and unacceptable, and it underscores exactly why robust oversight is essential. With President Trump threatening to gut federal accountability mechanisms, we’re facing a dangerous moment where this kind of brutality could become even more common and even harder to uncover and stop."
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