Articles Posted in Medical Care

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Last week, Inspector General Michael Horowitz sent a memorandum to the Attorney General and Deputy Attorney General concerning “Top Management and Performance Challenges Facing the Department of Justice.” The first identified challenge? Addressing the Persisting Crisis in the Federal Prison System,” namely the system’s ever escalating cost, which consumes a significant percent of DOJ’s budget, and safety and security issues stemming from chronic overcrowding.

Containing the Cost of the Federal Prison System

The costs to operate and maintain the federal prison system continue to grow, resulting in less funding being available for the Department’s other critical law enforcement missions. Although the size of the federal prison population decreased for the first time since 1980, from 219,298 inmates at the end of FY 2013 to 214,149 inmates at the end of FY 2014, and the Department now projects that the number of inmates will decrease by 10,000 in FY 2016, the downward trend has yet to result in a decrease in federal prison system costs. For example, in FY 2000, the budget for the Federal Bureau of Prisons (BOP) totaled $3.8 billion and accounted for about 18 percent of the Department’s discretionary budget. In comparison, in FY 2014, the BOP’s enacted budget totaled $6.9 billion and accounted for about 25 percent of the Department’s discretionary budget. During this same period, the rate of growth in the BOP’s budget was almost twice the rate of growth of the rest of the Department. The BOP currently has more employees than any other Department component, including the Federal Bureau of Investigation (FBI), and has the second largest budget of any Department component, trailing only the FBI.  The Department’s leadership has acknowledged the dangers the rising costs of the federal prison system present to the Department’s ability to fulfill its mission in other areas. Nevertheless, federal prison spending continues to impact the Department’s ability to make other public safety investments, as the Department’s FY 2015 budget request for the BOP is a 0.5 percent increase from the enacted FY 2014 level.

Our work has identified several funding categories where rising prison costs will present particularly significant challenges in future years. For example, inmate healthcare costs constitute a rapidly growing portion of the federal prison system budget. According to BOP data, the cost for providing healthcare services to inmates increased 55 percent from FY 2006 to FY 2013. The BOP spent over $1 billion on inmate healthcare services in FY 2013, which nearly equaled the entire budget of the U.S. Marshals Service (USMS) or the Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF). Continue reading

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OSHA has announced that its January 2014 investigation of FCI McDowell (WV) found that “correctional officers and other staff” there were exposed to “bloodborne pathogens and other workplace safety and health hazards.” Ten serious violations, that is, those where “there is substantial probability that death or serious physical harm could result from a hazard about which the employer knew or should have known,” were identified.  These include McDowell’s failure to:

  • Train employees on the bloodborne pathogens policy and limitations of personal protective equipment.
  • Ensure the person conducting training was knowledgeable about the subject.
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Just after the New Year, the Bureau of Prisons updated its formulary, from which most medications for federal prisoners are prescribed. (Part I of the formulary is here.).


As I’ve written previously, “Where a client is taking medication, counsel should also provide the prescribing physician a copy of the BOP’s national formulary to confirm that the medication is available or, if not, to facilitate a possible transition to another medication.” What this means is that where a defendant facing federal imprisonment is taking prescribed medication to manage medical or mental health issues, it is advisable that the prescribing physician review the BOP formulary to confirm whether the individual’s medication is included. If so, there is a greater likelihood that the individual will continue to receive said medication upon placement in Bureau custody (though prison doctors routinely review and modify medications upon a prisoner’s arrival at an institution, much to prisoners’ understandable consternation).

If a medication is not included in the formulary, consideration should be given to substituting formulary medications well in advance of sentencing so as to enable the prescribing physician an opportunity to assess how the individual responds to the change. Again, if successful, there is a better chance that the same medication will be prescribed once in BOP custody. If not, the doctor can and should provide counsel a letter (to be forwarded to the U.S. Probation Office for inclusion in the presentence report) confirming that the BOP’s formulary was consulted; that a substitution was attempted; and the reason both for the discontinuation of the formulary medication and the need for the medication prescribed in its place. Such a letter, a copy of which can be taken to a facility when surrendering and presented to staff during admission and orientation, increases the odds that the BOP will recognize the legitimate need for a non-formulary medication, and accommodate the individual accordingly.

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Following conviction, federal defendants, who were released on bond while their cases were pending, are often permitted to surrender voluntarily to their designated places of imprisonment. This practice has several tangible benefits. From the Bureau of Prisons’ perspective, it provides a cost savings since the agency does not have to transport a newly sentenced prisoner from a local jail to the correctional facility at which he will be housed. For the defendant, the practice affords further opportunity to get one’s affairs in order while also lessening one’s security point total since the BOP subtracts three points for self-surrender. The latter can often be the difference between qualifying for minimum-, as opposed to low-, security placement.


Occasionally, a defendant may need to seek an extension of the surrender date. The BOP cannot modify the date. That authority rests exclusively with the court. Among the reasons that an extension may be sought are to allow time for the BOP to complete a defendant’s designation (and assign a facility to which to report) — less of an issue in recent years; to permit a potential re-designation, where BOP has assigned a defendant inconsistent with a judicial recommendation; or to enable religious observance, where the surrender date falls on or just before a religious holiday. Another reason to postpone surrender is where a defendant’s medical circumstances necessitate immediate treatment or aftercare under the supervision of his primary care physician(s). A story out of Alabamahighlights this circumstance:

A federal prosecutor said Tuesday the government opposes Country Crossing casino developer Ronnie Gilley’s request to delay his trip to prison until after Christmas.
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Last Friday, OSU law professor Doug Berman’s always excellent Sentencing Law and Policy blog included a post concerning Montana medical marijuana activist Tom Daubert being sentenced to a term of probation. The post brought to mind a recent, sad story about the death of Richard Flor, Montana’s first registered medical marijuana caregiver, while in federal custody. As the Great Falls Tribune reported:

Richard Flor, a former Miles City medical marijuana caregiver sentenced in April to five years in federal prison on charges that he illegally maintained drug-related premises, died in federal custody Wednesday.
Flor, who suffered from a lengthy list of serious medical conditions, died in a Las Vegas hospital a day after suffering two heart attacks while awaiting transport to a federal medical facility, according to his attorney, Brad Arndorfer of Billings.
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Last Thursday, Dr. Lewis Jackson, 30, appeared in the United States District Court for the Northern District of Georgia, where he was arraigned on charges of sexually abusing inmates at USP Atlanta:


According to United States Attorney Yates, the charges and other information presented in court, from January 2011 through July 2012, Jackson was a physician at the United States Penitentiary (USP) in Atlanta where he provided medical care to inmates in USP’s medical ward. The USP houses medium security male inmates and has a satellite camp for minimum security male inmates.
The indictment alleges that in October 2011, Jackson molested three inmates who were seeking medical treatment at the USP. In each case, Jackson tried to perform oral sex on the inmates during the course of their medical exams. In one case, Jackson also attempted to engage in anal sex with an inmate.[…]
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In 2004, Arjang Panah was sentenced to six years’ imprisonment for his involvement in a methamphetamine conspiracy. Panah was originally housed in New York before the Bureau of Prisons transferred him to the Taft (CA) Correctional Institution, a BOP contract facility, where he contracted Coccidioidomycosis(a.k.a., cocci or Valley Fever). Panah filed suit and, last August, survived the government’s motion for summary judgment.

Panah’s lawyers, Ian Wallach and Jason K. Feldman of Feldman & Wallach, argued that prison officials were negligent in failing to educate Panah about the symptoms and ways to prevent Valley fever, even though the disease had stricken more than 80 inmates in the two years before Panah arrived at Taft, according to court documents. They also alleged that prison authorities failed to limit inmates’ exposure through basic safeguards like paving over dirt areas or prohibiting outdoor activities on dusty days.

 

“[The prison] had an obligation under California law to provide a safe environment for inmates and knew there was a risk,” Wallach said in an interview. “Inmates are extremely vulnerable.”
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In the wake of the Supreme Court’s ruling in National Federation of Independent Business v. Sebelius comes this from John Jay College’s The Crime Report concerning the potential impact of the Patient Protection and Affordable Care Act on the incarcerated, an important question given that “an estimated 90 percent of the nation’s jail inmates and 85 percent of state and federal prisoners currently lack health insurance.”


Medicaid, which is paid for with state and federal funds, is currently mandated only for inmates who are under 21, over 65, disabled, or pregnant. Prison health care experts contacted for this story worried that at least in the short run, the costs of extending Medicaid to a larger number of inmates in states that are willing to accept the expanded program will strain a correctional system already having difficulty attracting physicians and other health professionals.
Many medical professionals simply do not find prisons and jails appealing places to work. That is one reason why the level of current care available in jails and prisons differs widely among states and localities and, some critics contend, is often of abysmal quality.
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That is the title of a Birmingham News article which surveyed five high-profile Alabamians serving time in the Bureau of Prisons. The differing views on federal prison life provide insight into experiences common to many prisoners (e.g., how to cope with the tedium and make productive use of one’s time).


With respect to designations far from a prisoner’s release residence, 65-year-old John Katopodis, a former county commissioner, was housed at Devens, MA before being transferred to Fort Dix, NJ, and former state senator 72-year-old E.B. McClain was recently moved from “a federal prison camp in Pennsylvania” to a “facility in North Carolina.” There are numerous minimum- and low-security institutions closer to Alabama, which is located in the BOP’s Southeast Region, than those found in Massachusetts, New Jersey and Pennsylvania, all in the Bureau’s Northeast Region. As reflected in what McClain told loved ones when in Pennsylvania, proximity most directly impacts visitation and, consequently, a prisoner’s community ties: “I encouraged my family not to travel here to visit [….] The distance is too great[….]”
Katopodis reports being transferred to Fort Dix following three episodes that resulted in SHU placement.
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The University of Massachusetts Medical School (UMMS) has announced a contract, valued at $24.7 million for the first year and possibly $136 million through 2016, “to manage comprehensive medical services to approximately 4,900 inmates at the Federal Medical Center (FMC) located in Butner, North Carolina.”

UMMS’s Health and Criminal Justice Program, part of its Commonwealth Medicine division, will manage the contract. The Medical School’s work at FMC Butner will begin later this month.[…]
The contract calls for UMMS to coordinate both inpatient and outpatient physician and hospital services. The Medical School will manage care at the correctional facility and in community settings, through a partnership with Duke University Health System, which will provide most of the direct care services.
UMMS […] has also provided comprehensive health services for the past 12 years at the Federal Bureau of Prisons’ medical facility located in Devens, Mass. In addition, the Medical School has a long track record of providing care at 17 state-run prisons in Massachusetts, serving the health needs of approximately 11,500 inmates.