AB 1922: Restraint of incarcerated persons.

The Legislature finds and declares all of the following:

(a)Incarceration is associated with significant adverse health outcomes, including evidence that each year of incarceration is correlated with an approximate two-year reduction in life expectancy. The Legislature further finds that Black, indigenous, and other people of color are disproportionately represented among the approximately 2,100,000 individuals incarcerated in jails and prisons in the United States, compounding existing health inequities.

(b)Incarcerated patients are routinely shackled in hospitals outside their correctional facility when receiving medical care.

(c)According to the American Public Health Association, shackling is a “violent practice” with detrimental effects on both patients and health care providers.

(d)The American Medical Association reported that the shackling of incarcerated pregnant people is a “barbaric” practice that inflicts pain and humiliation on patients.

(e)In Estelle v. Gamble (1976) 429 U.S. 97, the United States Supreme Court ruled that willful neglect of serious medical needs was a violation of the Eighth Amendment right to be free from cruel and unusual punishment. Since then, federal courts have condemned shackling of incarcerated pregnant patients as a violation of the Eighth Amendment of the United States Constitution.

(f)In 2012, California became a national leader in the movement to ban shackling for incarcerated pregnant people by enacting Assembly Bill 2530 (Chapter 726 of the Statutes of 2012). Existing law permits the use of waist chains or leg restraints, and requires handcuffs to be applied in front for incarcerated pregnant people, and transport restraints are limited to front-handcuffing unless the person is in labor. Any restraint ordered by a licensed clinician is required to be documented in the medical file.

(g)Restricting shackling for incarcerated pregnant people received overwhelmingly bipartisan support in the California Legislature.

(h)Shackling impedes medical care and increases the patient’s health risks. It limits clinicians’ ability to perform examinations, delays positioning during seizures, increases the risk of falls, contributes to physical deconditioning, and elevates the likelihood of blood clots. Shackles can also interfere with surgical procedures, diminish therapeutic rapport between patients and clinicians, and restrict the provision of compassionate end-of-life care.

(i)Shackling incarcerated patients exacerbates clinicians’ implicit biases, reduces empathy, and contributes to diagnostic skepticism, thereby undermining the quality and equity of medical care.

(j)The state should follow suit for all incarcerated patients in outside hospitals who are transferred for serious or complex medical care and for whom shackling poses documented risks of injury, clinical interference, and worsened health outcomes in order to prevent avoidable harm, ensure the safety of patients and others, and promote access to adequate, dignified, and humane medical care.

(k)The Legislature further finds that hospitals are governed by federal standards regulating medical restraints, which require use of restraints only when necessary, the least restrictive means, and ongoing reassessment. Evidence shows that escape attempts from hospitals are exceedingly rare, making routine correctional shackling unnecessary to ensure safety.

(l)Existing law authorizes the Secretary of the Department of Corrections and Rehabilitation to prescribe and amend rules and regulations for the administration of prisons.

(m)Existing regulations governing health care transfers require continuity of care when incarcerated patients are transferred to medical facilities outside of the Department of Corrections and Rehabilitation.

(n)This bill would extend and expand existing limits on the use of shackles, including handcuffs, except during transport, to medically vulnerable incarcerated patients once they have been admitted to an outside hospital.