Video Counseling, Focused Training Help an Illinois Jail Address Inmates’ Mental Health  

As rural jails bear an increasing burden of individuals with mental health problems, jail authorities in Quincy, Il.,  have deployed innovative measures such as video counseling, special training for corrections officers, and partnerships with police and health providers.

Every Monday, a representative from Clarity Healthcare, based in Hannibal, Mo., visits the small Adams County jail in Quincy, Ill., to help authorities treat inmates who need mental health counseling.

The “visit” is often connected through video, allowing authorities to speak with a psychiatrist who can prescribe medications and assist with any issues they have with the medications.

“If we feel that Clarity needs to (help) somebody, we will definitely get them hooked up with it,” said Adams County Sheriff Brian VonderHaar. “From there’s up to the individual.”

Diagnosis by video is just one of the options jails in smaller jurisdictions are using to help them deal with a growing population of mentally ill inmates.

Bipolar disorder, schizophrenia and depression are just a few of the diagnoses some inmates at the Adams County Jail in Quincy have received.

With no elevator up to the booking area on the fourth floor, inmates must walk—or at times be carried—up the stairs to get booked, putting staff and the inmate at risk, especially if a mental health illness makes them uncooperative.

It’s a nationwide problem.

According to the Vera Institute of Justice,  about 14.5 percent of men and 31 percent of women in jails have a serious mental illness, compared to 3.2 percent of men and 4.9 percent of women in the general population.

Going by that estimate, it means with a capacity of 118, 21 inmates—15 men and six woman—in the Adams County Jail could be expected to have a serious mental health illness.

However, the jail has exceeded its capacity in recent years. Recent populations have soared to more than 140.

Although construction continues next to the Adams County Courthouse on a new, larger facility, local authorities are deploying in the interim a number of innovative options such as video counseling to address mental health.

Another option is focused staff training. New hires for the jail automatically go through crisis intervention courses after they complete their Basic Correctional Officer Training.

The crisis intervention team training is specifically designed to help jail officers deal with individuals who suffer from mental health illness.

Jail Administrator Chad Downs said four or five corrections officers recently completed the crisis intervention team training.

With the new jail set to open before the end of the year, VonderHaar said it is possible that more services could be offered, including in-jail counseling, but more discussions are needed for that.

Downs said after an inmate leaves, he or she might stop taking medication and then end up getting sent back to the jail after getting arrested. After they get back on their medications, he says they’re fine.

“It’s when they leave here that they might get off track,” he said, adding aftercare is another area that needs to be addressed.

Partnerships with Police

The Quincy Police Department has also changed how it interacts with those with mental health illness.

Sgt. Erica Scott, a 15-year veteran of the Quincy Police Department, has seen the change in approach when police officers are given crisis intervention training to deal with individuals suffering from mental health illness.

“It basically teaches officers not to diagnose, but how to recognize someone in crisis and how to recognize someone who is potentially mentally ill, and then how to handle it — ways to approach them, things to do, things not to do and a little bit of a de-escalation,” Scott said.

The Quincy Police Department also is working with Clarity to provide mental health evaluations as needed. The department contracted Clarity last year for evaluations and to provide services during crisis to crime victims or even officers.

“They are basically on call to us 24 hours a day to provide mental health services, so if we have someone in custody that is suicidal or homicidal and they need to be evaluated prior to being put in jail, they will come and do an assessment and determine whether or not that person really needs to go to the hospital or if they can go to jail,” Scott said.

*In 2018, officers with the Quincy Police Department responded to about 660 calls for service involving an individual with mental illness.

Scott or another assigned officer along with someone from Clarity will occasionally reach out to individuals with mental illness to make sure they are keeping up with medications and follow-up appointments they may have with an area provider.

*”I think law enforcement as a whole has taken a new perspective that jail is not a solution for a lot of these people,” she said. “It’s getting them follow-up services. A lot of people don’t need to be hospitalized. There can be out-patient services that can treat them.”

Aftercare for jail inmates is cited by both law enforcement and justice officials as an area that particularly needs attention. Last year, Adams County launched a Mental Health Court in 2018 to help divert former inmates with mental health issues to treatment.

State’s Attorney Gary Farha said the goal of Mental Health Court is to stop a pattern of behavior of repeat offending by inmates suffering from mental health illness. Cases can range from multiple counts of retail theft to violation of an order of protection.

The Mental Health Court team includes representatives from Transitions of Western Illinois, Blessing Hospital, Quincy Medical Group, the state’s attorney’s office, the Adams County public defender’s office, the Adams County Probation Department, and other representatives from law enforcement.

“You’re not only getting treatment providers looking at (inmates’) cognitive thinking, but they’re also looking at their medication and what it might do to them—and what not taking their medication might do to them,” Farha said.

“That’s the wonderful thing about the team approach, because you get everything from different prospective. Ultimately, the judge is the arbitrator.”

The problem-solving court is a more intensive version of probation for those convicted of crimes who suffer from mental health illness.

However, Farha takes issue with a state requirement that sets specific standards for admission in the program. With space for just 20 to 25 people, that could limit people who staff believe would be successful from entering the program, he said.

“That’s a little bit frustrating when you’re trying to start (an inmate) out a program because we’ve already had an individual that has left the program for not being able to handle it, and there are a couple others that are having difficulty with it,” he said.

Matt Hopf, a staff writer for The Herald-Whig, is a 2018 John Jay Rural Justice Reporting Fellow. This is a condensed and slightly edited version of an article written as part of his fellowship project. The full version can be accessed here.

from https://thecrimereport.org

Can We Help Opioid Abusers Without Jailing Them?

As the nation continue to suffer from the opioid epidemic, programs that can divert substance abusers away from the criminal justice system are critical. One increasingly popular approach called “deflection” partners police and public health workers.

Out of the tremendous heartbreak and suffering of our nation’s opioid epidemic, something new and hopeful is happening in communities across the country.

Police officers and drug treatment providers, previously unaccustomed and sometimes even reluctant to partner with one another, now can be found working side by side to reverse overdoses and connect people to drug treatment.

And while these emerging public safety-public health partnerships are not limited to combatting opioids—they also can address drug use in general, housing, mental health, and social services—it is the overwhelming number of people overdosing and dying from opioids that has accelerated the growth of these collaborations, and catalyzed their value in both saving lives and fighting crime.

The new approach is called ‘deflection.”

In deflection, law enforcement plays the critical role of connecting people to community-based treatment partners. This interaction may occur right on the street at the point of encounter, in the police or fire station, at the person’s home, or wherever the initial encounter occurs, all without fear of arrest.

On the receiving end of this “warm hand-off” are treatment providers and/or peer recovery partners who follow through to ensure the individual’s access to services. The operational specifics of each deflection program depend on the design of the local initiative, but the core idea is consistent: Instead of being a doorway into the justice system, law enforcement instead deflects people with substance use disorders to treatment.

Taken together, these new relationships signify the growing importance of “deflection,” which operates squarely at the intersection of law enforcement and treatment.

Sometimes referred to by other terms such as pre-arrest diversion, deflection is growing rapidly from its infancy. A few such programs came about in the 1990s and then faded, but the opioid epidemic has prompted new urgency for these efforts, birthing, or rebirthing, a wide variety of deflection efforts.

The most visible entry to this new stage was Seattle’s Law Enforcement Assisted Diversion (LEAD) program in 2011. Others soon followed, from the 2014 Civil Citation Network in Alachua and Leon County (FL) and the 2014 Drug Abuse Resistance Team (DART) in Lucas County, Ohio; to the 2015 “Angel” and “Arlington Outreach” programs in Massachusetts and the 2015 Quick Response Teams (QRT) developing in communities in Ohio and elsewhere around the country.

Combined with its longer-serving counterparts on the mental health side—such as Crisis Intervention Teams, co-responders, and triage centers—deflection is changing the narrative about fighting crime from “We can’t arrest our way out of this” to “We have better options than arrest.”

Deflection as a term is differentiated from its cousin in the justice system: diversion. In deflection, it is the presence of a behavioral health issue that is driving the contact with police that in turn triggers the deflection (movement) away from the justice system and to community-based behavioral health.

In the vast majority of these cases there are no criminal charges present, responding to the reality that 81 percent of police encounters are, in the final analysis, social service calls. (There are a smaller number of deflection efforts that allow for criminal charges to be placed in abeyance by the police or a citation with mandatory treatment is issued but still in these cases, no traditional justice involvement is required.)

To be sure, some ongoing contact between law enforcement and treatment is helpful beyond that deflection handoff. In some cases, ongoing communication between partners can serve to de-conflict ongoing encounters, share status updates, and support the person who’s been deflected to treatment.

Still, the intent is not meant to add to the already unrealistic expectations placed upon law enforcement to solve chronic social problems, but instead to lighten the burden from where it does not belong – law enforcement – and instead place it with community treatment, housing, healthcare, and social services.

Deflection does increase the demand for treatment capacity and, as such, strategies and action are needed to assure quick and sufficient treatment availability wherever deflection initiatives exist.

In looking at the variety of existing deflection programs, five “pathways” broadly summarize different ways that law enforcement is connecting people to treatment:

  • Self-referral
  • Active Outreach
  • Naloxone Plus
  • Officer Prevention
  • Officer Intervention

Each of these pathways describes the linkage point between police and treatment. While jurisdictions will usually start by facilitating a single pathway, in time as they get experience in deflection and see first-hand the power of their collaborative work, they will begin to add in additional pathways.

Currently, out of 18,000 law enforcement agencies in the United States, it is estimated that slightly over 600 departments are doing some type of deflection.

In the face of a national opioid epidemic, the growth of the field has occurred almost entirely in the last three years. As such, programs continue to be developed and implemented across the county—responding not just to opioids, but to any drug crises that communities face—collectively they can actually reduce the flow of people into the criminal justice system, while also offering necessary referrals to community-based treatment, housing, and services.

Annually, our nation’s 800,000 law enforcement officers encounter 68 million people, some 12 million of whom will end up churning through our jails. Police also encounter millions of people each year for whom there are no criminal charges present, but who have health, housing, and social service needs.

Jac Charlier

Jac A. Charlier

And, given that the majority of people who currently enter the justice system have a substance use disorder, a mental health condition, or both, deflection provides the opportunity to redirect people to treatment before they reach the justice system, emergency rooms, or homeless shelters.

In a country where over 72,000 people died from overdose in 2017 alone, the expansion of these deflection efforts by law enforcement, and the parallel expansion of treatment capacity, cannot happen soon enough.

Jac A. Charlier is executive director of the TASC Center for Health and Justice, and co-founder of the Police, Treatment, and Community Collaborative (PTACC). He welcomes readers’comments. NOTE: Jac is among the speakers scheduled for this year’s John Jay/HF Guggenheim Symposium on Crime in America. Please watch our site for upcoming information on how to register.

from https://thecrimereport.org

Can For-Profit Providers Help Rural Jails Cut Health Costs?

One Mississippi county claims its contract with a private healthcare provider has helped cut costs and reduce its exposure to lawsuits.

With health care for inmates one of the main drivers of the high cost of incarceration around the U.S., some local jail authorities are looking at for-profit providers as one way of reducing the bill.

How well is it working?

Since 2008, Mississippi’s Lauderdale County has operated under an annual renewable contract with Southern Health Partners to provide services for defendants held at the Lauderdale County Detention Facility. The current year’s contract, ending in September, 2019, will cost the county just over $448,000—a two percent increase over the previous year, roughly in line with inflation.

But compared to decades past, this marks a decrease in healthcare expenses for the county.

“Before we got into this agreement, we were spending almost $600,000,” Lauderdale County Sheriff’s Department Chief Deputy Ward Calhoun said.

ward calhoun

Ward Calhoun. Photo courtesy The Meridian Star

“If an inmate ended up in a hospital for weeks on end, you’re talking about a substantial amount of money,” Calhoun said. “Once we incarcerate a person, we — meaning the government — have to care for them.”

At the Lauderdale County Detention Facility, a nurse is on site 16 hours of the day, with another nurse on call for the remaining eight hours. Southern is also responsible for dispensing medications as well as running an on-site pharmacy and doctor’s office, which is capable of taking X-Rays.

“Our goal, if at all possible, is to keep it in-house,” Calhoun said.

According to 2017 and 2018 service reports from Southern, most of its care for defendants includes blood pressure and blood sugar checks. In 2017, Southern conducted 4,459 blood pressure checks and 2,215 blood sugar checks for the 3,158 defendants who came through the facility’s doors.

As of the end of September, 2,057 defendants came through the facility in 2018, requiring 2,209 blood sugar checks and 3,476 blood pressure checks.

Other medical necessities for defendants may include caring for pregnant women (10 in 2017, three in 2018), treating defendants with HIV (39 in 2017, three in 2018) or placing defendants on suicide watch (64 in 2017, 62 in 2018).

Fifty defendants saw a mental health professional in the first nine months of 2018 while 77 total defendants saw a mental health professional in 2017.

“We do have a co-pay of $10,” Calhoun said, adding that cash is contraband within the facility.

Defendants use money from their canteen, which their family can contribute to throughout their imprisonment, to make that co-pay.

For a defendant without money, and no family support, their account is “dinged,” Calhoun said, and they owe the county money.

A judge has discretion to release a defendant on their own recognizance, meaning defendants swear to show up for court dates without paying bail, for medical reasons.

Detoxing a ‘Regular’ Part of Care

Melissa McCarter, the jail administrator, said that part of the intake for the facility includes a medical assessment and, at times, that includes detoxifying people from alcohol or drugs.

“We see it on a regular basis,” Calhoun said about the frequency of the detox process.

“But it requires them to be honest about what they took,” McCarter said. “And it depends on the severity — if we have to give them space until they’ve detoxed and they’re safe.”

In 2017, Southern reported 51 detox protocols, for an average of four a month. Detox protocols decreased slightly so far in 2018, with 28 total detox protocols, averaging three a month.

Defendants without insurance, who may have lapsed on their healthcare outside of the facility, complicate healthcare within the facility, McCarter said.

If the number of defendants in the facility exceeds 280 people, a fee of $1.98 will be added on top of the contract for each additional defendant, according to the contract.

The county exceeded this 280-person cap three times in 2017, in January, February and May, by 11 defendants, two defendants and one defendant, respectively. This cost the county roughly $28 in fees. The population of the facility hasn’t exceeded 280 in 2018, according to the service reports.

healthcare

The Lauderdale County Sheriff’s Department claims that using a private health contractor, reduces healthcare costs over the previous system of county-provided healthcare. Photo by Paula Merritt/The Meridian Star

The contract allows for up to $40,000 in out-of-facility services, such as ambulance costs or procedures done at a local hospital. Beyond that, the county pays. In the previous year, the county paid $20,600 more than that $40,000 cap.

“We’ve had a multitude of years where we’ve exceeded $90,000,” said Sheriff Billy Sollie.

According to the service reports, 49 defendants were admitted to the emergency room in 2017 and 26 so far in 2018. Outside medical visits (which includes any specialized visits) numbered 44 and 54 in 2017 and 2018, respectively.

Most recently, Southern added a $39,000 cap on pharmacy costs, as discussed by the county’s Board of Supervisors during budget negotiations, who ultimately approve each year’s contract.

With recent reforms recommended by the Mississippi Supreme Court, however, the number of defendants held pre-trial on bond amounts they can’t afford may be reduced, decreasing the number of defendants in the facility.

“If fewer people are being held pre-trial, then we’re going to have lower medical costs and meal costs,” Sollie said.

The number of defendants seeking care from Southern has decreased in 2018 compared to 2017.

Though reports for 2018 are incomplete, the average number of defendants per month decreased from 263 to 229. January of 2017 began with 291 defendants and the year ended with 253 defendants.

Legal Concerns

Calhoun sees another benefit to the contract with Southern Health Partners: legal protection.

Southern carries the responsibility for its court proceedings and Calhoun said defendants in the facility most frequently file complaints in federal court about their healthcare.

“That’s one of the leading issues we get sued over — not providing adequate healthcare,” Calhoun said.

One example is the wrongful death suit of Davie Lee Chapman, who died in the custody of Lauderdale County on Feb. 2, 2015 from bronchial asthma, according to an autopsy report.

In December of 2014, Chapman alleged that Southern, specifically Sheila Hamlin, a Southern nurse, and John Mutziger, a Southern doctor, had denied him medical care by not giving him adequate breathing treatments for his asthma, a rash and hernia.

“Been having trouble with my asthma for several weeks. Clog up so bad, I couldn’t sleep, half the time,” Chapman said in his complaint. “I have request(ed) outside help for my skin condition, hernia and my asthma… We inmate(s) been charge(d) like we got a job. $10 for (a) clinic visit and $2 for (over the counter) medication.”

In a Mississippi Bureau of Investigations death investigation report, attached to the court records, various logs and sign-in sheets detail the efforts of guards to administer breathing treatments and Chapman’s multiple visits to the on-site clinic. Chapman requested to be released on his own recognizance, or released without bond, in order to continue seeking outside treatment.

The case was settled in December of 2016 and dismissed by Judge Daniel P. Jordan III the following May, according to the court docket. Details of the settlement aren’t included and the county hasn’t yet responded to an information request about the settlement.

In a different case, Gary Hugh Curtis filed an Aug. 2012 complaint against the county for failing to deliver his medication, which he said was prescribed by a doctor outside of the facility.

“The medical records submitted reflect that Plaintiff was being treated conservatively by Defendant (Sheila) Hanlin with medication, but was sent to the emergency room as soon as the need for further treatment was identified.

Mere disagreement with the prescribed course of medical treatment does not give rise to a Section 1983 claim, nor does medical malpractice,” the report filed by U.S. Magistrate Judge Linda R. Anderson said.

Anderson, adding that the evidence didn’t suggest the defendants had been “deliberately indifferent,” dismissed the claim on Nov. 3, 2014.

For reasons such as those, Calhoun sees multiple benefits to working with Southern to provide healthcare, rather than supplying it completely on the county’s dime, even if the costs increase annually.

“It is the best way to do business,” Calhoun said about hiring companies such as Southern. “It’s not an option for government to not take care of them.”

See also: Cost of Incarceration a Statewide Concern

Whitney Downard is  a staff writer for The Meridian Star and a 2018 John Jay Rural Justice Reporting Fellow. This is a condensed and slightly edited version of a story published this month as part of Downard’s fellowship project. The full version is available here.

from https://thecrimereport.org

How High-Priced Drugs Cripple Prison Health Care—and Reform

Expensive medications for inmates not only strain state and county corrections budgets. They can lead to delays in treatment and substandard care that can have lasting—even deadly—consequences for incarcerated individuals, writes a prison health care advocate.

In a deeply divided political electorate, prison reform is one of the few issues that attracts bipartisan support. Yet there’s something missing from the current conversation about criminal justice reform: the high cost of prescription drugs.

In 1976, a landmark Supreme Court case, Estelle v. Gamble, established an individual’s fundamental right to access medical treatment while behind bars. Specifically, the court found that “deliberate indifference by prison personnel to a prisoner’s serious illness or injury constitutes cruel and unusual punishment contravening the Eighth Amendment.”

Prisons and jails, in other words, are constitutionally required to provide health care to people in their care.

When the drugs needed to treat inmates are expensive, it puts enormous strain on state and county corrections budgets. That, in turn, leads to delays in treatment and substandard care that can have lasting, even deadly, consequences for people who are incarcerated.

It also impacts the state’s ability to improve prison conditions or implement rehabilitative programming that helps keep people from re-offending, things that the current First Step bill currently before the Senate seeks to do.

Unless high drug prices are addressed, prisons and, to a lesser extent, jails will face a difficult trade-off between providing healthcare and enacting the reforms needed to keep people out of the system for good.

Nothing illustrates this problem as powerfully as the ongoing Hepatitis C crisis in state prisons. According to the Centers for Disease Control and Prevention, 17 percent of inmates in prisons and jails—around 400,000 people—are infected with the virus, which is transmitted through blood contact and can lead to liver failure if left untreated.

People who are incarcerated represent less than 1 percent of the population, but they account for about a quarter of all diagnosed Hep C cases in the U.S.

The most common way for an inmate to get the disease is by sharing needles used for injecting drugs, tattooing, or piercing with people who are already infected. And since prisons and jails hold a large number of people with histories of substance abuse— a situation that has gotten worse with the opioid and heroin epidemics—the disease is widespread.

There are highly effective cures for Hep C. Prisons pay anywhere from $25,000 to list prices of $90,000 for a two- or three-month course of one-pill-a-day Sovaldi-based treatment combination, manufactured by the pharmaceutical company Gilead.

Using the low end of that range, it would cost $1 billion to treat 40,000 people—just 10 percent of the number of incarcerated people infected.

Sovaldi is so expensive in part because the drug is protected in the U.S. by a fortress of 29 granted patent and patent applications, amounting to more than 30 years of monopoly power that prevents generic competition. Other countries, including Egypt, Ukraine, Argentina, Brazil, Russia, and 38 countries in Europe, have rejected or restricted Gilead’s patents on Sovaldi for failing to meet the requirements warranting a patent.

Last year, my organization, the Initiative for Medicines, Access & Knowledge, successfully challenged Gilead’s patents on Sovaldi in China, opening the door for generic competition and billions of dollars in savings in that country. The U.S. Patent Office, in contrast, would not allow our challenges to Gilead’s patents on Sovaldi to go to trial.

Gilead’s monopoly pricing in the U.S., unsurprisingly, puts the drug out of reach of millions of Americans, not least those in our prisons and jails. According to a recent survey, 97 percent of people in state prisons with Hep C aren’t being treated.

That has led to a string of lawsuits. Prisoners in Massachusetts, Colorado, Indiana, Pennsylvania, Michigan, Minnesota and Florida have sued and either won or reached a settlement securing their right to effective and timely treatment for Hep C. Similar lawsuits are pending in California and Tennessee.

Across the board, state administrators have cited the prohibitive price of Hep C treatment, and in virtually every case the courts concluded that cost couldn’t be used as justification for failing to screen for Hep C, not treating, or treating with older, less effective drugs.

And that’s just one drug for one disease.

People in prison or jail with diabetes, asthma, opioid addiction, and other conditions also need treatment and many of these are also expensive. Drugmaker monopolies lie at the heart of the problem, and we need our policymakers to take bold action to correct this abuse.

Where else could those billions of state and corrections dollars be spent on if America didn’t pay more per capita for prescription drugs than any other nation in the world? Some of that money could go to reforms like treating mental illness and substance abuse, reuniting families, implementing job and educational programs, and expanding transitional housing facilities.

Priti Krishtell

Priti Krishtell. Photo by Bethanie Hines

These and other reforms, including the First Step bill currently before the Senate, will be far harder to achieve if nothing is done about abusive drug-maker monopolies that are causing over-the-top prescription drug prices.

Priti Krishtel is the Co-Executive Director of I-MAK.org, a global non-profit organization comprised of senior attorneys, scientists and health experts who have worked to lower drug prices through the patent system for 15 years. She can be reached at @pritikrishtel.Readers’ comments are welcome.

from https://thecrimereport.org

How High-Priced Drugs Cripple Prison Health Care—and Reform

Expensive medications for inmates can lead to delays in treatment and substandard care that may have lasting—even deadly—consequences for incarcerated individuals, writes a prison health care advocate.

In a deeply divided political electorate, prison reform is one of the few issues that attracts bipartisan support. Yet there’s something missing from the current conversation about criminal justice reform: the high cost of prescription drugs.

In 1976, a landmark Supreme Court case, Estelle v. Gamble, established an individual’s fundamental right to access medical treatment while behind bars. Specifically, the court found that “deliberate indifference by prison personnel to a prisoner’s serious illness or injury constitutes cruel and unusual punishment contravening the Eighth Amendment.”

Prisons and jails, in other words, are constitutionally required to provide health care to people in their care.

When the drugs needed to treat inmates are expensive, it puts enormous strain on state and county corrections budgets. That, in turn, leads to delays in treatment and substandard care that can have lasting, even deadly, consequences for people who are incarcerated.

It also impacts the state’s ability to improve prison conditions or implement rehabilitative programming that helps keep people from re-offending, things that the current First Step bill currently before the Senate seeks to do.

Unless high drug prices are addressed, prisons and, to a lesser extent, jails will face a difficult trade-off between providing healthcare and enacting the reforms needed to keep people out of the system for good.

Nothing illustrates this problem as powerfully as the ongoing Hepatitis C crisis in state prisons. According to the Centers for Disease Control and Prevention, 17 percent of inmates in prisons and jails—around 400,000 people—are infected with the virus, which is transmitted through blood contact and can lead to liver failure if left untreated.

People who are incarcerated represent less than 1 percent of the population, but they account for about a quarter of all diagnosed Hep C cases in the U.S.

The most common way for an inmate to get the disease is by sharing needles used for injecting drugs, tattooing, or piercing with people who are already infected. And since prisons and jails hold a large number of people with histories of substance abuse— a situation that has gotten worse with the opioid and heroin epidemics—the disease is widespread.

There are highly effective cures for Hep C. Prisons pay anywhere from $25,000 to list prices of $90,000 for a two- or three-month course of one-pill-a-day Sovaldi-based treatment combination, manufactured by the pharmaceutical company Gilead.

Using the low end of that range, it would cost $1 billion to treat 40,000 people—just 10 percent of the number of incarcerated people infected.

Sovaldi is so expensive in part because the drug is protected in the U.S. by a fortress of 29 granted patent and patent applications, amounting to more than 30 years of monopoly power that prevents generic competition. Other countries, including Egypt, Ukraine, Argentina, Brazil, Russia, and 38 countries in Europe, have rejected or restricted Gilead’s patents on Sovaldi for failing to meet the requirements warranting a patent.

Last year, my organization, the Initiative for Medicines, Access & Knowledge, successfully challenged Gilead’s patents on Sovaldi in China, opening the door for generic competition and billions of dollars in savings in that country. The U.S. Patent Office, in contrast, would not allow our challenges to Gilead’s patents on Sovaldi to go to trial.

Gilead’s monopoly pricing in the U.S., unsurprisingly, puts the drug out of reach of millions of Americans, not least those in our prisons and jails. According to a recent survey, 97 percent of people in state prisons with Hep C aren’t being treated.

That has led to a string of lawsuits. Prisoners in Massachusetts, Colorado, Indiana, Pennsylvania, Michigan, Minnesota and Florida have sued and either won or reached a settlement securing their right to effective and timely treatment for Hep C. Similar lawsuits are pending in California and Tennessee.

Across the board, state administrators have cited the prohibitive price of Hep C treatment, and in virtually every case the courts concluded that cost couldn’t be used as justification for failing to screen for Hep C, not treating, or treating with older, less effective drugs.

And that’s just one drug for one disease.

People in prison or jail with diabetes, asthma, opioid addiction, and other conditions also need treatment and many of these are also expensive. Drugmaker monopolies lie at the heart of the problem, and we need our policymakers to take bold action to correct this abuse.

Where else could those billions of state and corrections dollars be spent on if America didn’t pay more per capita for prescription drugs than any other nation in the world? Some of that money could go to reforms like treating mental illness and substance abuse, reuniting families, implementing job and educational programs, and expanding transitional housing facilities.

Priti Krishtell

Priti Krishtell. Photo by Bethanie Hines

These and other reforms, including the First Step bill currently before the Senate, will be far harder to achieve if nothing is done about abusive drug-maker monopolies that are causing over-the-top prescription drug prices.

Priti Krishtel is the Co-Executive Director of I-MAK.org, a global non-profit organization comprised of senior attorneys, scientists and health experts who have worked to lower drug prices through the patent system for 15 years. She can be reached at @pritikrishtel.Readers’ comments are welcome.

from https://thecrimereport.org

‘You Spend Real Time With a Doctor’: Halfway House Resident on Medicaid Expansion

The expansion of Medicaid to all halfway house residents in 2016 has motivated former incarcerees to seek medical help for chronic behavioral health and substance abuse problems that might otherwise have led to recidivism, according to an Urban Institute study.

The expansion of Medicaid to all halfway house residents has motivated former incarcerees to seek medical help for chronic behavioral health and substance abuse problems that might otherwise have led to recidivism, according to an Urban Institute study.

The study, supported by the Office of Justice Programs’ National Institute of Justice, interviewed correctional and halfway house managers as well as 58 halfway residents in Connecticut to gauge the effect of a 2016 federal government decision to allow all individuals released into halfway houses to qualify for Medicaid services.

Previously, only those inmates released to transitional facilities on parole could be covered under federal rules that banned Medicaid support for those legally defined as “inmates”—a restriction that automatically disqualified many individuals who remained under Department of Corrections (DOC) custody.

“DOC-supervised” halfway house residents could only get medical treatment from designated prisons or penal facilities, which not only created extra red tape for staff members  who had to arrange appointments but left many residents unwilling to seek treatment.

The change made a significant difference, according to the study, which conducted interviews during 2017 over a several-month period following enactment of the revised rules.

“Residents and program staff described Medicaid enrollment as a critical early step in the transition from correctional facilities to the halfway house, particularly for individuals with chronic conditions or daily medications, for whom obtaining or transferring prescriptions was essential to avoid medication lapses,” the study said.

Within two months of the policy change, the study reported, many residents who had previously been barred from seeking outside medical help, had set up appointments with community-based health providers.

The report said interviews with correction staff confirmed that the change “promoted greater self-sufficiency and accountability” as well significantly reducing the burden on medical services inside the prisons.

And it quoted several halfway house residents who described what the change meant to them.

“The two doctors that I have had dealings with since I’ve been here have been really good,” said one. “Pleasant bedside manner, medical skills…just all around good experiences.”

“You spend real time with the doctor,” said another. “In the jail, they just try to get you in and out. The doctor will try to really see what’s going on with you.”

“I have an opinion now,” added a third. “I can go to a doctor now just like anybody else that’s free, and he understands my opinion, and this is how I’m feeling, and he works with you and gives you what you need.”

Several compared it favorably to the bad or demeaning experiences they had when they were forced to go to jailhouse medics.

“I’d rather be sick in jail than go see the doctor, because it’s…the worst,” said one. “It takes about three weeks (to set up an appointment). By the time you see them, you’re probably gonna be dead.”

But the study also noted that there were still serious issues connected with the Medicaid expansion that raised questions about whether halfway house residents were able to take full advantage of the program.

One issue noted by the authors was whether allowing patients with serious mental health or substance abuse issues to determine their own care, and maintain, for example, the medications they needed, could lead to serious relapses.

And the authors argued that it was important to ensure that halfway house residents continued to get access to care for chronic issues after leaving the facilities, which normally house them for just three or four months before they are released into the community.

“This underscores the importance of teaching residents how to navigate health care services,” the report said.

The Urban Institute said further studies would be conducted to measure whether the regulatory changes had significantly affected health outcomes.

The report was written by Kamala Malik Kane, Ellen Paddock and Rachisha Shukla.

A complete copy is available here.

from https://thecrimereport.org

Texas Prisons to Print Dentures for Inmates by 3-D

As of 2016, Texas prisons were providing dentures only to 71 inmates of a population of 149,000. Now, the state will become what’s believed to be the first in the U.S. to 3-D-print dentures for inmates on site,

Starting next spring, the Texas Department of Criminal Justice will become what’s believed to be the first corrections agency in the U.S. to 3-D-print dentures for inmates on site, the Houston Chronicle reports. “It sounds like a miracle,” said criminal justice consultant Michele Deitch of the University of Texas at Austin’s LBJ School of Public Affairs. “I’ve never heard of anything like it.” In a faster alternative to traditional denture-making, technicians at prisons across the state will use wands to scan the mouths of toothless inmates, then send off the image to a central location for 3-D-printing, cutting down the process from months to weeks.

The system will avoid the need to transport prisoners across the state and, though the initial purchase of the equipment is pricey, officials said the individual sets of dentures could be as little as $50 apiece. For years, the prison system provided dentures produced in-house through a vocational program for inmates. That ended in 2003, and the availability of dentures fell sharply. In 2004, prison medical providers ordered 1,295 dentures. The following year, that number fell to 518 and then 258. By 2016, prison medical providers approved giving out 71 dentures to a population of more than 149,000 inmates. California — the next-largest prison system — gave inmates a total of 4,818 complete and partial dentures in 2016. , according to state data there. Over the course of a year-long investigation, more than two dozen inmates wrote letters or spoke to the Chronicle to detail the problem. In October, prison officials announced plans to change policies, hire a denture specialist, start a denture clinic, train unit dentists to better identify when dentures are necessary, and review all denture-related grievances from the past year to re-evaluate any prisoners who filed complaints.

from https://thecrimereport.org

Think Twice Before Using Pot to Treat Opioid Addiction: Study Warns

The nation seems to be emerging from the “long tunnel” of the opioid crisis, but substituting medical marijuana as an alternative form of care may land us in a “fog of extensive, additional public health repercussions,” warn Arizona researchers.

While medical marijuana has emerged as an alternative for the treatment of opioid abuse, its effect on public health needs more study before pot is widely used in palliative care, according to a forthcoming paper in the Kansas Law Review.

“Promoting marijuana over opioids is risky, given substantial uncertainties over short- and long-term impacts of its widespread use,” the paper warned.

“Even as the nation slowly exits the long tunnel of the opioid crisis, it may be heading into a fog of extensive, additional public health repercussions.”

The co-authors, James G. Hodge, Walter Johnson and Drew Hensley, observed that while opioids are effective “pain killers,” marijuana is more like a “pain distracter.”

Hodge is law professor at Sandra Day O’Connor School of Law at Arizona State University (ASU). Johnson and Hensley are law students and legal researchers at ASU.

Last year, the White House issued a statement declaring opioid abuse a “public health emergency.” More than 300,000 Americans have died from overdoses involving opioids since 2000, and in 2016 alone, opioids killed more Americans than breast cancer.

But as local, state and federal officials work to lessen the impact of opioids, “public health interventions to curb opioids consequentially mean fewer patients are gaining regular access to opioids to control their pain,” said the paper.

The authors noted that some caregivers and substance abusers are turning to medical marijuana as an alternative form of care, since other treatments, such as ibuprofen or physical therapy, can be ineffective or prohibitively expensive.

Though as of September, 2018, medical marijuana was legal in 30 states and the District of Columbia (additional states approved medical marijuana in ballots during the midterm elections), the authors caution there is only a “thin proof of [its] efficacy for treating many conditions.”

The authors don’t dispute the benefits of medical marijuana for many patients in need.

But they note that although medical marijuana can be effective for patients suffering from HIV/AIDS, epilepsy, multiple sclerosis, and others, “the efficacy of marijuana as a palliative drug is not fully proven.”

Before medical providers exchange opioid prescriptions with medical marijuana prescriptions, the study argued the public needs more substantive research that balances its potential palliative effects against the public health and safety risks of long-term marijuana use.

The full study can be downloaded here.

This summary was prepared by Lauren Sonnenberg, a TCR news intern.

from https://thecrimereport.org

Do America’s Sick, Aging Inmates Deserve the Right to Die at Home?

Terminally ill Vermont  inmate Bobby Hutt made it home to die, thanks to the fierce advocacy of his sisters. But although nearly all states allow “compassionate release,” it’s often underused.

Two photo albums encompass Bobby Hutt’s 48 years of life.

Black-and-white photos show him as a baby petting a dog, and as a moppy-haired boy playing basketball. The pages lead to an adult Bobby in a blue jumpsuit standing in a prison yard with two other inmates.

Hutt, who died from cancer four years ago shortly after he was granted medical release from prison, spent 30 years struggling with drug addiction, which repeatedly got him in trouble with the law.

His sister Melissa Dumont fought tears as she looked at the photos. Those she prefers are an image of Bobby captured between his prison sentences, wearing a backward baseball.

“That was Bobby, he always wore his hat like that,” Dumont said.

A unrecognizable Bobby stares back from the following page: a skeletal man in a hospital bed. His eyes barely open, he manages a weak smile for the family members who came to say goodbye.

prisoner

Bobby Hutt’s sisters Janice Hull (left) and Lisa Dumont. It took more than a year of efforts to obtain his release from an Arizona prison on compassionate grounds. Photo by Elizabeth Murray/Free Press

Those final moments would have been impossible without the fierce advocacy of Bobby’s sisters, who lobbied to bring him back to Vermont from an out-of-state prison and then to get him home.

Dumont and Janice Hutt made hundreds of phone calls to navigate a complex and often unclear process while they say their brother wasted away. They can’t imagine what would have happened if they hadn’t been fighting for him.

“He would have died in Arizona,” Hutt said.

Vermont is one of 49 states to pass compassionate release legislation, which is a special dispensation for inmates suffering from terminal or serious illnesses to die outside prison.

The need for such laws is likely to grow, as the nation’s aging prison population is at risk of chronic and terminal diseases that corrections officials and inmate advocates say are more appropriately treated outside prison.

Typically, in Vermont, the population of inmates who are 55 and older has increased in the past five years, even as the total number of inmates has dropped.

Mary Price, general counsel for Families Against Mandatory Minimums and a national expert on compassionate release, says the U.S. as whole underuses compassionate release.  She gives Vermont’s laws — officially termed medical furlough and medical parole — a B-minus or C-plus.

Thanks to Bobby’s sisters, he died holding his mother’s hand.

But not all inmates get the chance to end their days close to loved ones.

Vermont offers an example.  While prison officials are supposed to initiate consideration of medical release when an inmate presents severe health issues, those providing inmate health care have sometimes failed to recognize terminal illnesses.

That was likely the case for Roger Brown of Windham County who was among about 270 Vermont inmates sent to SCI-Camp Hill in Pennsylvania in June 2017. He died there in October.

“[From] everything we’ve seen both from Roger and the witnesses, it appears to be obvious that he was ignored,” said James Valente, the lawyer for Brown’s estate.

Valente said he is still collecting evidence, but no information has yet been released publicly that suggests otherwise.

Brown developed cancer while incarcerated, but it’s unclear whether he knew about it.

Brown’s diary chronicles months of illness, for which he was treated with ibuprofen, and was told his chronic pain was not a medical emergency. Weeks before he died, he could barely move from his bed.

“We were continually rebuffed and refused medical attention,” wrote his cellmate Clifton Matthews, 67, who took over the log of Brown’s deterioration when he could no longer write.

“[He was] told repeatedly it was all in his head, even at the point he could no longer stand or sit up.”

Sending people out of state creates an extra layer of issues when trying to identify who might qualify for medical furlough or medical parole, said Vermont Defender General

Matt Valerio, of Vermont’s Prisoner’s Rights Office, said trying to get information from SCI-Camp Hill was “a nightmare,” since the prison contract stipulated that grievances must first go through the Pennsylvania administration.

Valerio said he was unaware of the severity of Brown’s condition since his office never received any complaints or grievances.

Typically, he said, when the office hears an inmate is in that condition, the agency’s staff begins to communicate with the inmate’s family and the Vermont Department of Corrections about options for release.

More than 200 out-of-state inmates from Vermont have since moved to a prison in Mississippi.

 RELATED: Why Vermont inmates eligible for medical release often remain behind bars

‘You Felt Like You Had to Beg’

Bobby began noticing pain while was serving 10 to 15 years in an out-of-state prison for three counts of assault and robbery with a weapon.

He put in multiple sick slips to be seen by a doctor and get an X-ray, his sisters say.

“Everybody always accused him of med-seeking,” Hutt said.

“You’re a drug addict, you’re med-seeking.”

Dumont said she continued to insist, in almost monthly conversations with her brother, that he keep asking for an X-ray.

“It got so bad that he would end up crawling on the floor because he couldn’t stand,” she said.

Bobby’s femur snapped underneath him while he was putting on his pants in November 2013 after months of receiving ibuprofen for pain management, but not much further treatment. That’s when Dumont and Hutt say they began their yearlong fight to secure their brother’s return to Vermont and his eventual release.

In Vermont, the decision about who is eligible for medical release is made by prison staff and officials. There is no formal process for families to advocate for the medically necessitated release of their loved ones. Inmates can request consideration for release through sick slips, but are given no other options to advocate on their own behalf.

The sisters made hundreds of phone calls trying to find someone who could help. Some people hung up on them.

They sent emails. A number went unanswered.

“You felt like you had to beg,” Dumont said.

Lisa Menard, commissioner of the Vermont Department of Corrections. Photo by Glenn Russell/Free Press

When first asked whether the Department of Corrections made information on medical release available to inmates’ families, Commissioner Lisa Menard said all policies were accessible on the agency’s website.

A review of “Friends and Families of a Person Incarcerated in a Vermont Correctional Facility,” which is posted on the department’s website and was last updated in 2017, failed to list any explanation of medical release options.

The other uploaded document, a “Health Services Handbook,” which was last updated in 2007, briefly defines the three types of medical furlough.

The section concludes: “If you have questions about your loved one’s health there are several steps to take.” But, rather than outlining actions that can be taken or listing departments to contact, the Q&A that follows repeatedly instructs concerned family members to consult the inmate.

In a follow-up conversation, Menard said she was unaware that the resources referenced in her previous conversation with the Free Press were so out-of-date and confusing.

“That’s a good catch,” Menard said. “I truly thought that there was more information in those, and that is unfortunate. We will make those more accessible.”

Menard said the handbooks were due for an update and she would like to bring inmates’ families into the process.

“We want family members involved in these cases, we really truly do; and certainly we need to make some more effort to make sure it’s easy and clear to find out how to do that,” Menard said.

Bobby’s sisters say they eventually made contact with Vermont’s out-of-state unit supervisor, who kept them in the loop. That connection gave them a leg up in trying to navigate the process.

Two months after receiving an advanced cancer diagnosis, Bobby was brought back to Southern State Correctional Facility in Springfield, Vermont. When his family went to visit, the healthy, athletic man they remembered had all but disappeared. Bobby could barely walk.

For their mother, seeing his condition was devastating.

“This damn near killed her,” Janice Hutt said. “I think she lost nearly 60 pounds.”

After that, the sisters say Bobby Hutt didn’t want them to visit as much. It was too painful physically, and he didn’t want them to see him so sick.

The family continued to work with the Vermont Corrections Department to coordinate an approved residence and medical coverage if he was released from prison. Dumont converted her living room into a bedroom where Bobby’s hospital bed was placed, and, in August, Bobby was finally released on medical furlough.

Two months later, Bobby was dead. But, home.

“For all that we went through, he died where he wanted to die,” Dumont said.

 This is a condensed and slightly edited version of a story by Elizabeth Murray, a staff writer with the Burlington Free Press, as part of her 2018 John Jay Rural Justice Reporting Fellowship. The full version and sidebars are available here. A video interview with Hutt’s sister can be accessed here. Follow Murray on Twitter at @LizMurrayBF.

from https://thecrimereport.org

Rural Jails Struggle to Cope with Rise in Mentally Troubled Inmates

The growing population of offenders with mental health or substance abuse issues is a nationwide problem, but it’s especially challenging in rural communities. One Wisconsin jail has risen to the challenge.

When someone is booked into Polk County jail in rural Wisconsin, the first step is a screening process to determine the individual’s medical and mental health care needs. The information from that screen is reviewed by the jail nurse and jail sergeant, who determine if the jail nurse needs to follow up.

Once in the general jail population, the inmate can submit a nurse call slip for non-emergency mental health concerns, and the nurse or jail staff member will follow up as needed. An urgent mental health need is handled through a request by call slip to a nurse or staff on regular rounds.

Many big-city jails, which are now the main source of medical help and counseling for the mentally ill, have used similar strategies to deal with a growing roster of inmates who need special medical help.  But the approach has now spread to smaller rural jails in states like Wisconsin.

“Our jail staff is excellent in recognizing symptoms of mental health and of untreated mental health issues, notifying me, and addressing those issues,” said Donna Johnson, the Polk County public health nurse, who has worked in the county jail for 20 years.

Rural jails often bear the brunt of what has become a growing national problem. A 2016 survey of 230 jail staff members across 39 states found that 96 percent reported having inmates with serious mental illnesses during the previous year.

Three-quarters of the jails reported seeing more or far more seriously mentally ill inmates compared to five to 10 years ago.

More than 80 percent of people incarcerated in the Polk County Jail have mental health needs, according to Johnson.

“For the people we’re seeing with serious and pervasive mental health issues in the jail setting, methamphetamine (addiction) is by far the greatest issue that we’re dealing with,” she said.

According to the federal Substance Abuse and Mental Health Services Administration (SAMHSA),  the toxic effects of substances can mimic mental illness in ways that can be difficult to distinguish from mental illnesses.

Substance-induced mental health disorders involve psychiatric symptoms that are caused by using a substance. People can also have co-occurring mental disorders, where they have a mental illness and a substance use disorder.

jail

The 160-bed Polk County Jail in rural Wisconsin has seen a rise in inmates suffering from mental health and substance abuse issues. Photo courtesy Leader-Register.

Rob Drew, captain of the Polk County Jail, estimates that around 70 percent of the county jail’s inmate population would benefit from some type of mental health care, be it from a counseling session or meeting with a psychologist.

“We have a fairly low number of people that rise to the level of being suicidal, but the number of people that could benefit from general mental health services is very high,” said Drew, who oversees the county’s 160-bed jail.

Drew said it is difficult to calculate the specific amount of people in jail with mental health needs due to the variation in inmate mental health needs, which aren’t tracked with jail records.

Polk County’s Johnson says that the mental health of those in the county jail has always been a concern, but it has dramatically changed over the years.

“It used to be a rare occasion when we had someone who displayed [suicidal tendencies] … (and was in need of) psychiatric services,” said Johnson.  “Now it is really the norm,”

Looking back to the first methamphetamine epidemic that occurred about 20 years ago, Johnson says that they had people in the jail displaying acutely psychotic behavior where they experienced both auditory and visual hallucinations.

“We see that on a chronic basis now,” said Johnson, who believes the mental health issues the county is experiencing right now are largely due to methamphetamine and alcohol use.

“Alcohol remains our Number One issue,” said Johnson. “It (alcohol) doesn’t get as much attention because it’s legal.”

The American Psychiatric Association reports that chronic heavy methamphetamine use can cause temporary paranoid delusional states that may last for weeks, months and even years. Symptoms can also include dementia, psychotic episodes, and evidence of “bipolar” disorder.

Heavy long-term alcohol use can cause brain damage that causes symptoms of dementia that are not entirely reversible even with sobriety.

However, most substance-induced symptoms begin to improve within hours or days after substance use has stopped.

In 2017 the Leader-Register reported that Polk County leads the state of Wisconsin in per capita criminal prosecutions of methamphetamine. That year there were 184 individuals arrested for methamphetamine alone with 393 drug charges against them.

The Polk County behavioral health unit pychiatrist, Dr. James Rugowski, visits the jail once a month for about five hours to handle medication assessment, management and to assess individuals’ mental health needs.

Crisis workers connect incarcerated individuals with behavioral health services before they are released from jail, so there is a continuation of care. Before their release individuals who are identified in need get help processing their (medical assistance) BadgerCare application from a county health department staff member.

“When they walk out of the jail doors, they can have their BadgerCare application already processed so they have insurance to cover their mental health services, medications and medical needs,” said Johnson.

Stark and Johnson also provide suicide and mental health training to jail staff.

“From administration all the way down to the line staff, we all strongly believe that it’s equally as important to care for [inmates’] mental health as it is to care for their physical health,” said Johnson.

The county offers a crisis call line through Northwest Connections, a third-party organization contracted by the county’s mental health unit to handle the county’s crisis call work. This allows the county 24/7, 365-day coverage for crisis calls and is used in the jail.

“The officer can bring the inmate to the phone and give the call taker a synopsis of what’s going on and the inmate will speak to the crisis call person and they determine the appropriate care for them,” said Drew.

Challenges they still face include serving non-county residents, and a lack of resources for proactive care and the continuation of care outside of jail.

“I do think we are doing a really good job of managing what we have with the resources that we have available,” said Drew.

“More resources would be nice, but you can only play with the cards you’re dealt.”

Johnson has found connecting individuals from outside of Polk County to services once they leave jail a challenge, because not all counties have the same services or resources.

“I can’t always have an appointment scheduled for them when they walk out the door, whereas I can if they are a Polk County resident,” she said.

Barriers for individuals continuing their mental health care outside of jail include finding housing and transportation to appointments. Those that are enrolled in BadgerCare can access the state’s nonemergency medical transportation services.

However, in Johnson’s experience, that extra step of organizing transportation can become a barrier for some people.

Polk County has one transitional housing facility for those returning to society after incarceration called the Serenity Home, but its future at its current location, in the old county jail, is uncertain.

“It has been a godsend to have them where they are, but unfortunately the county board opted not to renew their lease when it is up,” said Johnson.

The Serenity Home, operated by the Salvation Army, is located across the street from the Polk County Jail and neighbors the county’s behavioral health unit.

Looking to the future, Johnson and Drew are hopeful about the potential to better serve individuals incarcerated in the county jail who have mental health needs.

Recently, the county’s community services unit proposed two positions to expand behavioral health services. The positions are an additional half-time jail nurse, specializing in mental health services, and a full-time nurse practitioner for the behavioral health unit.

Drew supports both positions.

“If that comes to fruition, which I am hoping it does, I think it will be a really good model for other counties to provide more preventative care,” said Drew.

Danielle Danford, a staff writer for the Leader-Register, is a 2018 John Jay Rural Justice Reporting Fellow. This is a condensed and slightly edited version of a story written as part of her Fellowship project. The full story is available here.

from https://thecrimereport.org