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03-22-2003, 06:05 AM By David Tuller New York Times SAN FRANCISCO | More than 1,000 jail inmates in Los Angeles County have suffered painful and aggressive skin infections caused by a bacterium resistant to many antibiotics, medical authorities say. The unusual outbreak over the last year is still not contained. The same pathogen, which causes fast-growing boils and unsightly abscesses, also appears to have infected dozens of gay men, many of them HIV patients, in Los Angeles and San Francisco, health officials say. Epidemiologists say the outbreaks stem from Staphylococcus aureus, a bacterium that causes many infections in hospitals and nursing homes. But the experts are worried because this strain — resistant to methicillin, penicillin and other standard antibiotics — is spreading outside its traditional setting. The ability of this bacterium to cause sudden and dangerous lesions on apparently healthy skin concerns health officials because it differs from other strains of methicillin-resistant Staphylococcus aureus, or MRSA, which generally attack the skin only at weak points, like surgical incisions or open wounds. And epidemiologists are concerned that the bacterium may develop resistance to the handful of antibiotics that still work against it. They are also worried that it may be spreading to other groups. Dr. Elizabeth Bancroft, an epidemiologist with the Los Angeles County Department of Health Services, said she had received a growing number of reports of comparable ailments from people who were neither gay nor in prison. ‘‘My voice mail and e-mail are overflowing from people saying they’ve had similar infections in the past few months,’’ said Bancroft, who is overseeing an investigation to pinpoint risk factors and routes of transmission. In the Los Angeles jail system, the authorities at first believed that the infections were from spider bites, but no spider was ever identified. As the number of cases grew and the lesions failed to respond to standard antibiotics, officials realized they were facing a more serious problem. The standard antibiotic-resistant bacterium — which can be spread during skin-to-skin contact or indirectly through shared hospital equipment and other items — has been increasingly common in hospitals and other health care centers since the 1980s. In recent years, health officials around the country have reported scattered outbreaks, apparently acquired through social contact outside hospitals and in various groups of children, injection drug users, athletes, American Indians and prisoners. No one has a clear idea how widespread the skin disorder actually is outside hospitals, because states do not require doctors to report cases of drug-resistant staph infection, unlike diseases such as AIDS and tuberculosis. But, said Dr. Matthew Kuehnert, an epidemiologist with the Centers for Disease Control and Prevention: ‘‘This is the largest cluster of infections that we’ve heard about in prison or jail. And we haven’t previously seen MRSA specifically being associated with gay men. The agency plans to compare samples of the staph strain from California with those found in previous MRSA outbreaks elsewhere. Staph infections can be fatal if antibiotics fail to control them. In the current wave, no one identified as having the ailment is believed to have died, but in some cases doctors have had to cut away diseased tissue and administer intravenous antibiotics for weeks. Dozens of infected patients have been hospitalized. Epidemiologists have told the jail authorities in Los Angeles that increasing inmate access to showers, clean laundry and medical treatment can help bring the outbreak under control. The exact number of cases in the parallel outbreak among gay men is unknown. But doctors in Los Angeles say they have identified more than three dozen gay patients with the skin infections. Many, but not all, have HIV. Dr. Peter Ruane, who treats many gay men and people with HIV at Tower Infectious Disease Medical Associates in Los Angeles, said the boils and abscesses appeared suddenly, grew rapidly and were far more virulent than previous staph infections he had seen. ‘‘This is a nasty bug,’’ he said. ‘‘Some of these infections take your breath away.’’ While the outbreaks were first publicly reported in Los Angeles, doctors who treat gay patients in San Francisco say they have seen similar infections. ‘‘It’s really rampant,’’ said Dr. Bill Owen, a primary care physician in San Francisco with a gay and HIV practice. ‘‘We’ve seen 10 or 15 cases in the last couple of months.’’ Owen said he knew of other doctors in the area who had also noticed an increase in the unusual skin infections. Health officials in San Francisco said they were aware of the reports and were considering ways to assess the scope of the problem. Medical authorities speculate that gay men could be contracting the infections through sexual encounters or in shared facilities like gyms and steam rooms. Through a technology known as molecular fingerprinting, health officials have already determined that the staph strain found in the jails and among gay men was virtually identical with one implicated in two much smaller outbreaks last year in Los Angeles, one among newborns and the other in young adult athletes. The staph strain has proved resistant to a host of commonly used antibiotics besides methicillin and penicillin. But it appears to respond to some other lesser-known oral antibiotics and to vancomycin, an intravenous antibiotic. Health officials say that even if an infection appears to have abated, it is critical that patients complete their entire course of antibiotic treatment, which helps prevent the pathogen from mutating and developing further resistance. ‘‘We don’t want the bacteria to become resistant to the antibiotics that it’s still sensitive to,’’ Bancroft said, ‘‘because that would really be a nightmare.’’ [From the Dayton Daily News: 02.04.2003]


03-22-2003, 06:14 AM Inmates allege spider bites; jailers say it's an infection By ADRIAN ANGELETTE [email protected] Advocate staff writer More than 30 Parish Prison inmates claim in lawsuits that they were bitten by venomous brown recluse spiders. The two suits say the East Baton Rouge Parish Sheriff's Office, which operates the prison, has not worked to eliminate the hazard. "Either no steps were taken to control the spider problem or the steps taken were wholly inadequate," one suit says. Defendants named in the suits are East Baton Rouge Parish Prison Warden Joe Sabella, the Sheriff's Office and the city-parish. However, attorneys for the city-parish said a state expert found that the inmates are suffering from a staph infection, not spider bites. None of the inmates who sued has produced a spider, one lawyer said. "No one has ever come up with a single brown recluse spider," said Leu Anne Greco, an attorney for the Sheriff's Office. The lawsuits contend that after a spider bites, the area around the bite turns red and swells, leaving a red ulcerous sore that causes a scar. Some of the inmates claim to have been bitten multiple times. Greco said the city-parish and Sheriff's Office had Raoul Ratard, the state epidemiologist, review the inmates' medical files. Epidemiology is the study of disease and its distribution within a population. Ratard determined that the health problems were caused by a staph infection called methicillin resistant Staphylococcus aureus, Greco said. The strain of the infection is the same one that has been reported in prisons in other states, she said. The Centers for Disease Control and Prevention says that since 1999, the Staphylococcus aureus has been found in prisons in Mississippi, Tennessee, California, Texas, Georgia and Pennsylvania. MRSA is spread through physical contact, most often to people with weak immune systems, the CDC reports. To stop the spread, patients are often isolated and antibiotics are used for treatment. Surgery is sometimes necessary at the source of the infection, the CDC says. The infection can cause oozing boils, infections or pneumonia. James Hilburn, an assistant parish attorney, said the staph infection is common throughout the nation and is often found in hospitals. He also said the staph infection spreads easily. "It only needs broken skin to spread," Hilburn said. Hilburn said Ratard found nothing wrong with the way the prison is operated. It is sprayed twice each month to kill harmful insects, including spiders. Greco said the city-parish also had an entomologist inspect the prison, and that he found no spider problem. Entomology is the study of insects. Brown recluse spiders are common in Louisiana, Mississippi, and the section of the United States between Dallas and Atlanta, from the Gulf of Mexico to the northern boundary of Missouri.

Hilde Bogaerts

03-22-2003, 09:05 AM

printed it out and mailed it to Clinton!n Thank you Teb! he is always very gratefull for information like know they don't tell these men anything. If they don't hear it from us they just don't know. I know that whenever I sent something like this to Clinton, he gives the papers around all over prison to make sure many people know and can do something in time.

Eric's Homegirl

03-18-2004, 07:50 AM

Hey Teb~ When Eric went to san quentin, he started getting what the co's were calling a brown recluse spider bite, Eric has had many of these types of infections. I know that from being in nursing for many years (LVN) that these are not spider bites, they are Staph Infection. Eric has had them on his buttocks, hip and now on one of his legs. I am very concerned about this outbreak at San Quentin, and have gone as far to speak to the Director of Medicine At the prison, who says it is a spider bite. B.S.! A spider bite would respond to antiboctics, Staph Infection ususally doesn't do very well with antiboctics. Eric has had to have daily dressings applied. He told me that he had 4 separate doses of anitboctics in a 4 week time frame, and finally the 4th dose cleared it up. Then he got two more, and now the one on his leg. It totally freaks me out, as Staph Infection at San Quentin is running out of control at this prison. And the prison is doing nothing to bring it under control. Eric will be home in 5 days and a wake up and he will be going to our health care specialist to get this infection under control and gone. I saw his hip one day in visiting, and I knew the minute that I saw it with the discolor of the skin, it wasn't a spider bite. Just another "cover up" brought to you in part of the State Prisons here in California.


07-19-2004, 06:19 PM

I've just been informed by someone that this staph infection is rampant in a prison and nothing is being done about. Prisoners are walking around with oozing sores among the general inmate population. Sharing the same bathrooms and showers, no isolation at all. Don't understand how they can do nothing about it. What is wrong with the people in charge?? After all the guards and workers there are being exposed as well. They in turn if infected are bringing it home to their families, who then bring it out to the general public. Will it take a major epedimic to the general public for the people in charge to do something?? A very scary thought. After all many of these guys are being released on a daily basis. What or whom can we contact to help in this matter?? Thank for any leads as to where I can turn to.


07-19-2004, 07:31 PM

OTRA, I don't know who you are "supposed" to contact with something like this but you could start with the health department. Whether you get a response or not just keep ringing someone's phone at every office that might have even the slightest impact on what is going on. Nothing gets to the "higher ups" like phone calls pouring in from citizens.


07-20-2004, 01:40 PM

That's exactly what was happening at Parchman in camp 30. Guys kept getting "spider bites" and had awful pussy sore. It took them forever to get to the doctor to get treated. Some guys actually pretended to pass out so they could get faster treatment. They were led to believe they were spider bites until one doctor finally told an inmate that it was a staph infection. This was several months ago and I don't think it's going around there anymore. I know this sounds awful too but my husband and I both ended up with scabies which we think we got from the conjugal visit room perhaps. Anyway I kept calling and calling to get him to medical and they wouldn't see him. Finally I talked to a couple of different people and told them that if they didn't get my husband treated they would all end up with parasites and they sent him to medical that night. Hey Teb~ When Eric went to san quentin, he started getting what the co's were calling a brown recluse spider bite, Eric has had many of these types of infections. I know that from being in nursing for many years (LVN) that these are not spider bites, they are Staph Infection. Eric has had them on his buttocks, hip and now on one of his legs. I am very concerned about this outbreak at San Quentin, and have gone as far to speak to the Director of Medicine At the prison, who says it is a spider bite. B.S.! A spider bite would respond to antiboctics, Staph Infection ususally doesn't do very well with antiboctics. Eric has had to have daily dressings applied. He told me that he had 4 separate doses of anitboctics in a 4 week time frame, and finally the 4th dose cleared it up. Then he got two more, and now the one on his leg. It totally freaks me out, as Staph Infection at San Quentin is running out of control at this prison. And the prison is doing nothing to bring it under control. Eric will be home in 5 days and a wake up and he will be going to our health care specialist to get this infection under control and gone. I saw his hip one day in visiting, and I knew the minute that I saw it with the discolor of the skin, it wasn't a spider bite. Just another "cover up" brought to you in part of the State Prisons here in California.


07-24-2004, 04:10 PM

Just a few days ago an inmate at FCC Coleman Low died of a acute Staph infection which was not properly cured. He started vomiting blood and died on his way to the hospital. They burnt his matress and all his belongings. LP


07-26-2004, 12:09 AM

My son who was in Halawa Corr. Facility here in Hawaii complained to me 6 months ago about this problem. Evidently there were a minimum of 30 guys that had which he described as very painful, huge boils. The only treatment they received was an iodine wipe. Reading this information makes me furious as my son is a heart patient and has to really watch any type of infection. Thank you so much for posting this as tomorrow I will be faxing a copy of the article to the warden over there and let him know he better take immediate action and do something for these guys. Aloha, MomofJosh


09-08-2004, 07:52 PM

My fiance is in an ALabama prison and has experienced the same problem! He was given Penicillin for a couple of weeks but the "boil" is still there!!! What can be done???


09-09-2004, 12:17 AM

That skin infection is call a staff infection and that is in the blood. It is from dirty everything..It has another name and I can't think of it..I had a article from the LA times but don't know where I put it..minnie:cool: .


09-10-2004, 09:55 PM

I have attached a copy of a recent article that appeared in the NYTimes. The recent increase of women contracting the AIDS virus has prompted much interest, talk and research into men "on the down low". It is quite unfortunate but the prison environment has helped to perpetuate this because of the married men who have intimate relations with their wives and also with men on the inside. I think it is a great idea to issue condoms in the prisons to help prevent the spread of this deadly virus to the unsuspecting wives of inmates. I hope you find this article educational, informative and enlightening! ----------------Fighting the AIDS Epidemic by Issuing Condoms in the Prisons September 7, 2004 By BRENT STAPLES The novelist E. Lynn Harris has become a fixture on the best-seller list and a favorite among black women by writing steamy books about men who live "on the down low" men who cheat on wives and girlfriends by having sex with other men. The fear of men "on the down low" is now palpable among black women, who are more than 20 times as likely to contract AIDS as white women and are understandably anxious about protecting themselves. This fixation has also become a cottage industry, dealt with in books, lectures, plays and an episode of the popular television series "Law & Order." The hyperbole and exaggeration surrounding the "down low" has taken the public health debate in a counterproductive direction. It has spread paranoia and pushed a much-needed discussion about bisexual behavior further underground. Moreover, it has kept the country from focusing on the long-neglected connection between H.I.V. and the prison system, where infection rates are high and unprotected sex among male inmates is far more common than prison officials care to admit. Men who have sex with men in prison pose an enormous threat to women when they return to the outside world and heterosexual behavior. In any given year, 35 percent of the people with tuberculosis, nearly a third of those with hepatitis C and 17 percent of the people with AIDS pass through jails and prisons. Faced with budget crises, many correctional facilities back away from testing inmates, fearing they will be required to pay for expensive treatments. Condoms are banned or simply unavailable in more than 95 percent of the nation's prisons. The corrections system processes nearly 12 million people a year. It is especially vulnerable to AIDS and other blood-borne diseases that spread easily through risky, unprotected sex acts. Congress was forced to confront the issue in legislation after a series of reports suggested that prisoner-against-prisoner rape, often accompanied by horrific violence, was commonplace. Concern over the problem led to the federal Prison Rape Elimination Act of 2003, a groundbreaking law that requires the Justice Department to collect data on prisoner-against-prisoner rape and act to prevent it. Research on sex in prison is limited. But a much-cited study of California prisoners in the 1980's found that 65 percent of them participated in sex acts behind bars. The data, though sketchy, suggests that men who regard themselves as heterosexuals are more likely to have sex with other men the longer they remain in jail. Starved for intimacy, many inmates apparently enter relationships that they would never have considered in the world outside. In an article published two years ago in The Prison Journal by Christopher Krebs of the Research Triangle Institute, inmates reported that 44 percent of the people they knew participated in sex acts in prison. The Krebs study disputes the standard hypothesis that sex acts behind bars mainly involve men who were already active homosexuals. Indeed, fewer than one-third of the people mentioned in the study seem to fit that category, which suggests that about 70 percent experienced their first same-sex encounters only after landing behind bars. The infections these men pick up in prison cycle back into the community once they are released. The prison data cries out for an AIDS-prevention strategy that would encompass all of the nation's jails and prisons. At a minimum, the program would give inmates free and open access to condoms. The American prison system is now dominated by the dangerous notion that distributing condoms would encourage prisoners to break the rules by having sex. As a result, condoms are unavailable in an overwhelming majority of jails and prisons. Prison authorities have resisted condom distribution despite intense criticism from public health officials, who have pointed out time and again that condoms are freely distributed in prisons in many countries, including Canada.

The Canadian model is commendable in that it applies clear, specific rules throughout the prison system and leaves little to the judgment of local prison officials. The directive requires that condoms be made "easily and discreetly available" in gyms, libraries, schools, laundry rooms and other areas where inmates can get them without having to interact with guards. The point is to ensure that inmates do not bypass condoms out of fear or embarrassment.

The connection between the prison experience and the spread of AIDS outside prison is especially clear in poor communities, where a great many men spend time behind bars at some point in their lives. But with millions of people regularly exposed to H.I.V. in the prison system, the entire country has both a moral and a medical obligation to confront the sexual realities of prison life. Until then, lives will be lost and prison-borne diseases will continue to spread from the corrections system into the community at large.


09-10-2004, 10:28 PM

Cant say I agree

The American prison system is now dominated by the dangerous notion that distributing condoms would encourage prisoners to break the rules by having sex. As a result, condoms are unavailable in an overwhelming majority of jails and prisons.

This I agree with


09-10-2004, 10:35 PM

Well it is about time that they realize that inmates have sex...Now they are giving condoms out..Better late than never...minnie:cool:


09-11-2004, 04:02 AM

In South African prisons it has been the norm that when an inmate gets put into custody he gets given a box of condoms. It is not a fact that they condone the sex that happens there, but AIDS is rife in SA and any prevention is better than no cure. I cant say that i condone any sexual interaction between inmates, but it does happen and it will happen, no matter what. So i say, give them the condoms and prevent them from being another statistic.


09-11-2004, 06:16 AM

Tony told me one guy where he is got in trouble for having condoms. He got a trip to the "hole" as condoms are contraband there


09-11-2004, 07:01 AM

You don't have to condone the activity - but if sex is taking place in prison and diseases are spreading becasue of it then it is obviously happening even if it is against the rules or policies of the prison. Is it not better to offer 'protection' to eliminate or reduce the spread of deadly disease than to ignore it and say that sex in prison does not happen becasue it is against the rules? I recently read an article that suggested that 25% of men that leave prison with a potentially deadly and spreadable disease did not enter prison with this disease. One of the major factors is what is the collateral damage of ignoring or not addressing this situation. Your man comes home from prison. Your man went to prison disease free. Your man now has either AIDS or Hep C. He is not exhibiting any symptoms yet. Through sexual contact you are now in danger of contracting either of these diseases. How did he get either one of these diseases? Either through sexual contact or tattoos. He may have been forced into the sexual situation or he may have entered it willingly. I think one of the main reasons that this issue is ignored is because it brings up the discussion of homosexuality - no one wants to think that their guy goes to prison straight and is gay inside the prison. This issue of 'physical contact' goes far deeper than 'am I gay or straight' - physical contact is a basic human need - some people deal with the absence of this better than others. For the straight men in prison that may engage in sexual contact with another man they are not all of a sudden gay - they are using sex as a means to get the physical contact that they so need and desire. They are not now gay. I am Canadian - we consider ourselves more liberal with this kind of thinking and these kinds of solutions. We offer condoms to our Inmates. We are now considering tattoo parlors in prisons so that tattoos are done in a sterile environment. We offer needle exchanges for addicts. Sometimes you can lessen the damage of the bigger issue by offering a solution or a band aid to a smaller part of the problem. We don't condone drug use, but if you get a clean needle each time you use drugs then you may be an addict but not an addict with AIDS or HepC. When you are ready to go into rehab we can clean you of the drug addiction and we don't have to treat you for another problem. Offering condoms in prison is just good sense. Closing your eyes to the spread of disease in a prison - no matter how it is spread - is not good sense.

Dee Dee

09-12-2004, 11:59 AM

I agree totaly.COndoms should be passed out in prisons.and tattos should be legal in there with a sanitary place to do them. They also need to do manditory testing every year in prison.alot of people with the diseases dont tell for fear of ridicule and then they knowingly spread this to others in there thru sexual contact and needles.I also agree that it is a basic human need to touch and doesn't mean a man is gay because he has needs.they should have visits for coulples to engage in sexual contact. This would help the spread of disease tremendously.Its unfair to families on the outside to aquire these diseases from their men when they are released.Society and the goverment need to adress this problem with realistic solutions.My man has been down for almost 10 yrs and 3 more to go. The thought scares me to death that he might catch something and bring it home. They need to test test test and PREVENT... Im sure thats just wishful thinking.This is a very important topic.


09-29-2004, 08:20 PM

Is the World Finally Waking up to HIV/AIDS in Prisons? A Report from the International AIDS Conference.


10-08-2004, 06:31 PM

U.S. appeals for flu vaccine rationing Officials ask healthy people to defer to those at risk

WASHINGTON (AP) -- A top federal health official, lamenting "a very fragile vaccine production system," urged healthy people Wednesday to defer getting their influenza shots so medication will be available for those most at risk. "We really need a long-term solution so we don't end up in this year-to-year situation where we don't have a reliable supply," Dr. Julie Gerberding said, after the supply of vaccine to the United States was abruptly cut in half. Gerberding, head of the federal Centers for Disease Control and Prevention in Atlanta, and other government officials appealed for voluntary rationing in the wake of a major supply interruption. British regulators unexpectedly shut down a major flu-shot supplier Tuesday, citing manufacturing problems at the Chiron Corp. factory in England where roughly 46 million doses destined for the United States had been made. That means only about 54 million flu shots will be available this year from a competing firm, and the U.S. government decided quickly that most healthy adults should delay or skip them to leave enough vaccine for the elderly and other high-risk patients. Vaccine should be reserved for babies and toddlers ages 6-23 months; people 65 or older; anyone with a chronic condition such as heart or lung disease; pregnant women; nursing home residents; children on aspirin therapy; health care workers who care for high-risk groups; and anyone who cares for or lives with babies younger than 6 months. For everyone else, "Take a deep breath. This is not an emergency," Gerberding said Tuesday. "We don't want people to rush out and look for a vaccine today." The government has urged voluntary rationing before, during a shortage in 2000. This year, however, will mark a record shortage just before flu season begins. "We will need the help of the public," said Health and Human Services Secretary Tommy Thompson. Gerberding, appearing Wednesday on CBS News' "The Early Show," said that if officials "prioritize" the disbursement of available flu vaccine, "we will make it possible for people to get vaccine if they really need it." Chiron's problem began in August, when it discovered contamination in a small amount of vaccine that delayed its U.S. shipments. Still, top U.S. health officials assured the public less than two weeks ago that close monitoring showed the rest of Chiron's supply was fine, and plenty of vaccine would be available. Tuesday, British regulators disagreed and suspended Chiron's license for three months, officially prohibiting export of the Fluvirin brand that Chiron manufactures in Liverpool. The sanction means more than a delay, Chiron officials said. The company will ship no Fluvirin anywhere this year. The move took U.S. regulators by surprise. Food and Drug Administration officials headed to Britain Tuesday night to investigate but wouldn't say if they would ask British regulators for a special release of shots for use here if the flu season proves a bad one. Chiron had brought more than 1 million doses to this country before its license was suspended but hasn't released the batch, Thompson said. He would not say if those doses were potentially usable. Thompson asked the maker of the remaining 54 million flu shots to try to make more. Aventis Pasteur plans to try, but can't increase production until it meets existing orders in November. High-risk patients depend on flu shots because the injections are made of killed influenza virus. Other people have another option: About 1 million doses of an inhaled flu vaccine, MedImmune Inc.'s FluMist, will be available for healthy 5- to 49-year-olds. It's made from live but weakened influenza virus. A flu treatment called Tamiflu also can protect against infection if swallowed daily during an outbreak. Manufacturer Roche Pharmaceuticals said Tuesday it would step up production in anticipation of greater demand this winter. Flu vaccine is made using chicken eggs and takes months to brew, meaning manufacturers cannot suddenly produce more. Yet vaccine shortages and delays have plagued the country for several years, and Tuesday's debacle prompted scientists to urge that the system be modernized. "This points up the vulnerability of our influenza vaccine supply," said Dr. William Schaffner of Vanderbilt University, a government vaccine adviser. Congress allocated $50 million in the 2004 budget to begin making such changes, half the amount federal health officials had requested. Thompson urged Tuesday that lawmakers provide $100 million next year. The government is taking other steps to ease the shortage:

CDC is working with Aventis to alter its flu-shot distribution so that shipments also go to parts of the country that had depended on Chiron's supplies. FDA and NIH are studying whether Aventis' vaccine could be diluted to get two doses out of each original shot. A small NIH study several years ago suggested doing so could provide enough protection for healthy people, said Dr. Anthony Fauci, infectious disease chief for the National Institutes of Health.


10-10-2004, 10:32 AM

Another Unnecessary Death in D.C. The Washington Post; 10/9/2004; Colbert I. King 10-09-2004 Too bad that 27-year-old Jonathan Magbie, at this late stage, didn't know the right people. If he did, he might still be alive today. But Magbie had no ties to this town's rich, famous or influential. As his life drew to a close, everyone who wanted to could exercise veto power over him. It had been that way ever since he was hit by a car at age 4 and left paralyzed from the chin down. Magbie's story was told a week ago in The Post by reporter Henri Cauvin. It was a sad tale about a quadriplegic, unable to breathe on his own since childhood (and mobile only with the help of a chin-operated, motorized wheelchair), who was arrested, convicted and sent to the city's jail for 10 days for marijuana possession. His five days in custody of the D.C. Department of Corrections -- interrupted by a one-night stay at Greater Southeast Community Hospital -- ended in death. Questions concerning the quality of care provided by the hospital and the Corrections Department to Magbie are still unanswered. Unless his mother, Mary Scott, and his lawyer kick up a fuss, the late Magbie will be another closed chapter in the city's long and sickening history of dumping on the least among us. The last five days of Magbie's life, as pieced together this week through e-mail exchanges and interviews conducted with court and corrections officials, paint a picture of a kind of official treatment that would never be accorded a senator's son or someone with friends in city hall. Let's begin with the office of Judge Judith Retchin. On Friday, Sept. 17, three days before Magbie appeared in court for sentencing, Retchin directed her law clerk to check with the person in the chief judge's office who serves as a liaison with the D.C. Corrections Department to determine whether the department would be able to accommodate a "paralyzed, wheelchair-bound defendant." The clerk was told that the jail could handle such an inmate. But did the clerk discuss Magbie's reliance on a ventilator? The court's e-mail response: "No. The law clerk did not inquire about a ventilator. Mr. Magbie had never used a ventilator in the courtroom during any of his court appearances." A serious omission indeed. Corrections Department Director Odie Washington told me that if his department had known Magbie needed a ventilator, it would have advised the court that on-site ventilator care was not available in corrections facilities. Contrary to Retchin's announcement at the time of Magbie's sentencing, the Corrections Department could not attend to his needs. Let's consider other matters that have turned up since The Post's story. The article stated that what happened between Magbie's arrival at the jail on Sept. 20 at 2 p.m. and his being taken to the hospital at 9 p.m. was not explained. An Oct. 7 e-mail response from the Corrections Department to my inquiry indicated that Magbie went through medical and mental health processing through the afternoon of Sept. 20 and was awaiting transfer from the jail to the jail's annex, the Correctional Treatment Facility (CTF), when he started having difficulty breathing at 9 p.m. A registered nurse on duty asked if he used oxygen at home and Magbie stated that he did not use oxygen at home but he needs continuous breathing ventilator treatment at night. "This is the first time that [the Corrections Department] learns of Mr. Magbie's need for a ventilator," the e-mail stated. The nurse told CTF doctors, and after a second medical evaluation and finding that Magbie needed acute medical care, they decided at 9:15 p.m. to transport him as an emergency patient to Greater Southeast Community Hospital. The Post story reported that a court official, speaking on condition of anonymity, said that Greater Southeast discharged Magbie back to the Corrections Department the following day, and when a senior CTF doctor who believed Magbie belonged in a hospital asked Greater Southeast to take him back, the hospital refused. "That is absolutely not true," Joan Phillips, chief executive officer of Greater Southeast, told me on Thursday. "They did not ask us to take the patient back." Bill Meeks, public information officer for the Corrections Department, concurred. No Corrections Department medical personnel asked the hospital to re-admit Magbie, he said. So where did that story about Greater Southeast's refusal come from? Court spokeswoman Leah Gurowitz said she and those she spoke with didn't know. Another query: Why did the Corrections Department retain custody of a ventilator-dependent inmate for three nights when it knew that neither the jail nor the CTF provided on-site ventilator care? "That was not our decision," said corrections chief Washington when I asked him for an explanation. "We provided the care directed to us by Greater Southeast Community Hospital," he said, and cited his department's e-mail to me: "Magbie was returned to the CTF from Greater Southeast with a patient discharge form with instructions for nasal oxygen at night as needed. No ventilator was ordered." But does Washington's finger-pointing hold up? According to a Superior Court e-mail reply, on Sept. 21 -- the day after Magbie's sentencing and overnight stay in the hospital -- a CTF doctor contacted Judge Retchin's law clerk, informed her that Magbie needed a ventilator when he slept and inquired about procedures to transfer him to Greater Southeast. The clerk consulted with the chief judge's liaison to corrections and was told that the doctor should speak with the Corrections Department's medical administrator, because the court cannot direct medical placements. Washington acknowledged that a CTF physician, "acting on his own," discussed the ventilator situation with Magbie's attorney and that the two reached an agreement to have Magbie's mother bring her son's ventilator to the CTF on the morning of Sept. 24. Unfortunately, by the time she arrived, at approximately 10 a.m., her son, having difficulty breathing, had already been taken to Greater Southeast, where he later died. Court, corrections and hospital bureaucrats have now scurried to their bunkers. Jonathan Magbie wasn't always so little thought of. Twenty-two years ago this month, a chipper 5-year old Jonathan "John-John" Magbie was invited to take part in a White House ceremony commemorating National Respiratory Therapy Week. He had suffered the paralyzing injury a year earlier and was breathing with the help of a mechanical device inserted in his neck and speaking through a battery-powered device that he operated with a flick of his tongue. On the way to the White House, "John-John" told his doctor, Dean Sterling, director of respiratory care services at Children's Hospital, and nurse Nancy Rivers that he wanted to ask President Reagan something. After the ceremony, and as Reagan was saying hello to "John-John," the doctor said: " 'John-John,' you had something you wanted to ask the president, didn't you?" "Yes," said the boy. "What are you going to be for Halloween?" Startled, the president replied: "I think I'll just keep being me. That's been tough enough recently" [Bob Levey's Washington, Oct. 29, 1982]. This Halloween, both are gone. (For the record: I have never met Judge Retchin. I did, however -- along with other family and friends -- write a letter of recommendation last year to the judge in behalf of a jailed relative who was being sentenced on a felony conviction. At sentencing, Retchin credited him with time served in jail, ordered him into drug treatment and called for a subsequent assignment to a halfway house. He is now on probation and employed. As noted in an earlier column, the King family tree includes members who have attended Penn State and the state pen.) [email protected] Keywords: ED Copyright 2004, The Washington Post Co. All Rights Reserved.


10-10-2004, 10:36 AM

WHY AREN'T WE TALKING ABOUT JUVENILE ADDICTIONS? Wisconsin State Journal; 10/8/2004; William Wineke This report ought to form the basis of tonight's presidential debate - but it most likely won't even be mentioned. The National Center on Addiction and Substance Abuse at Columbia University reported Thursday that four of every five young people in the juvenile justice system either was drunk or high when committing a crime or has a long-term history of substance abuse. Of an estimated 1.9 million juveniles who are arrested for crimes and who have substance abuse and addiction problems, about 68,000 - or 3.6 percent - receive some kind of treatment for those addictions. That's pretty shocking, isn't it? Here's an estimate that's even more shocking: The center suggests that if we spent an average of $5,000 in treatment programs for each of the 120,000 juveniles who are now incarcerated in out-of-home facilities, those programs would pay for themselves within a year. And those programs wouldn't have to be "successful." All it would take, the CASA report estimates, is that just 12 percent of those children treated remain free of drugs and alcohol and commit no further crimes in order for the treatment program to break even. By "break even" the agency means save the system the costs incurred by the juveniles in terms of committing crimes, being arrested and being incarcerated. The report is 200 pages long and I can't really substantiate those figures here - but you can read the whole thing online at the National Center for Addiction and Substance Abuse Web site. What's important here is that we have a national scandal that could not only be addressed but that, by addressing it, we could save society billions of dollars a year and, at the same time, save thousands of lives. I have a feeling that, if we were to do the job right, it would cost more than $5,000 a year per child. The research agency also estimates that up to 75 percent of all incarcerated juveniles suffer from "diagnosable mental health disorders" that also need treatment. But the potential payoff is staggering. We save the productive lives of the kids we treat - at least, we save many of them. We protect the lives of the people those kids prey upon if they're not treated. And, since a very large percentage of adult inmates were originally juvenile offenders, we reduce our adult crime rate as well. And, are we doing it? Nationally, not very well. Dane County, it must be said, has long had fairly humane juvenile policies, at least compared to the rest of the country. But county officials have trouble just holding the line on spending for social services, let alone increase funding. Nationally, our answer to juvenile crime seems to be to get tough with the kids. As Dr. Phil would ask, "How's that working for ya?" The CASA study makes the point another way: "Public policy for juvenile crime has focused increasingly on accountability from the juvenile offender. But accountability is a two-way street. Demanding accountability from children while refusing to be accountable to them is criminal neglect." Isn't this issue worthy of attention from the men seeking the highest office in the land? (Copyright (c) Madison Newspapers, Inc. 2004)


10-15-2004, 02:48 AM

Providing HELP to HIV-Positive Offenders in the Community By Michelle Gaseau (, Managing Editor The transition from prison cell to the community can be a bleak one for many ex-offenders: jobs are scarce, money is tight and housing is non-existent. These challenges are multiplied for offenders who are HIV positive. A new program supported by a grant from the Minnesota Department of Health aims to address some of those problems and, in particular, help rectify health care disparities among offenders of color. "When the inmates are being released, it's already difficult for them when they come back into society. It's even more difficult if they have a health disparity," said Agustina Martinez, Manager of Projects for the Minneapolis-based Council on Crime and Justice, the non-profit that is managing the new program. The Healthy Educational Lifestyles Project (HELP) is designed to identify HIV positive and hepatitis C positive inmates who are released from Minnesota prisons to residences in Hennepin and Ramsay Counties. The goal, once identified, is to help these offenders develop new attitudes that will help them remain crime-free, become self-sufficient and live a healthier lifestyle. It began working with offenders last fall. To get to this point, the council received a planning grant in 2002 that it used to create a service plan for a particular group of HIV-positive and hepatitis C-positive offenders - men and women of color. According to Martinez, the council realized through information from AIDS-related service providers that this group of offenders had the most difficult time transitioning back into the community. So HELP uses a two-pronged approach to assist these offenders: education and advocacy. Education About Behaviors The council sends staff members into two Minnesota prisons to conduct health education classes and then provide advocacy services both pre and post-release to offenders. HELP's health educator, Willie Wessley conducts 10-week course at Lino Lakes and Rush City prisons teaching inmates about sexually transmitted diseases, HIV, hepatitis C and other health issues. The courses have been ongoing since 2003, but this year HELP changed its curriculum to also include information and suggestions for changing high-risk behaviors that affect health. "It's not only that they are learning the knowledge of HIV, but also what could happen if they have unprotected sex, for example," said Martinez. In the courses, inmates are given a pre-test to determine what their knowledge base is and then a post-test to determine what they have learned. In addition, the courses offer an open forum for questions and discussion, which the council believes is an important part of learning and behavior change. "We want to make sure they have an open place where they can discuss their issues," said Martinez. The courses are open to all inmates with the hope of educating those who even refuse to be tested for HIV or even those who do not have HIV at all. "Let's say they probably know they are positive and they are about to be released. What we do is as soon as they are released, within two weeks, we make them have a full medical check up -to see if they are positive or not," said Martinez. The medical check-up is just the start of the services after release. Post-Release Connections HELP's advocacy services begin with staff member Eric McCoy who works with offenders pre-release to provide on-on-one counseling based on need. The advocacy part of the program includes interactions with community clinics, doctors as well as housing program and services and employment services. "If there's any need that we cannot provide them, we make sure that we [get] them to the right agency so they get their [needs met]," said Martinez. And, even though the program is fairly new, it has an idea that it has made a difference. One recent success story has given council staff the feeling that he programming is right on track. Martinez said that one offender who began the HELP classes earlier this year was at the end of a two-year sentence and wanted to make life better for himself. He attended classes faithfully and contacted his case advocate from prison and began meeting with his advocate. Then in March 2004, he was released and began receiving services outside. Today he works in the construction field and lives successfully in the community. Martinez believes that small success stories like this one will make a cumulative difference in the long run for many. "He has changed his outlook on life and has a strong will to support his family," she said. By connecting these offenders to employment and giving them a leg up in starting a new life, HELP hopes to show offenders how changes in behavior can benefit them and their loved ones. "The hope for this program is that we can reduce recidivism and we teach them we can change their behavior," she said. And, the more that HELP produces success stories, the more word will come back to offenders on the inside that education and asking for help is worth the effort. "They [get] employment and they [get] housing and they have changed their ways because they have worked with a case advocate," Martinez said. "I think it's important because there is a huge stigma out there and there's not many programs that are doing what we're doing." Resources: Council on Crime and Justice ( Martinez - [email protected] ([email protected])


10-15-2004, 02:56 AM

HIV inmates to be desegregated The Press-Enterprise Some inmates at the California Institution for Men in Chino are fighting a proposal to move them into a housing unit for prisoners infected with the virus that causes AIDS. Many say they are afraid of contracting HIV themselves, but prison officials say the change is needed to keep dorms from overcrowding. Sgt. Arioma Sams said inmates in the prison's east yard permanent work crew have raised concerns about the proposed transfer into Del Norte, a two-story facility built in the 1980s to treat inmates who are HIV positive. The transfer will take place next month. Prison officials said the move is needed to save money and prevent housing units at the prison from becoming overcrowded. The Del Norte facility has space available, now that the number of inmates with HIV has gone down, officials said. AIDS is not an airborne virus and living together will not spread the disease, said Sams. The work crew and HIV-positive inmates already coexist in the yard, attending classes and visiting hours together, he said. Prisoners with HIV are already integrated with the general population at many of California's 32 other prisons, said Terry Thornton, spokeswoman for the state Department of Corrections. In 2002, the California Department of Corrections estimated that about 1.4 percent of the state's 160,000 inmates are infected with HIV. Thornton said her department encourages testing and education because inmates often lead lifestyles that can lead to a higher risk of transmitting the disease, such as unprotected sex and drug use.


10-15-2004, 02:57 AM

Bill would establish mental health standards for prisons Associated Press The beating of a man with mental problems at a Lincoln, Neb. prison demonstrates the need for setting standards for treating inmates with mental illness, a legislative committee was told Thursday. "Because a significant number of inmates have psychological, mental, drug, alcohol and other problems, it's necessary that the system recognize these problems and address them," Sen. Ernie Chambers of Omaha told the Judiciary Committee about his bill. Chambers said the recent beating of Daniel Luethke at the prison system's Diagnostic and Evaluation Center illustrates the need for setting such standards. Luethke, 32, has a history of mental health problems. He was booked into the Seward County Jail early on Dec. 5 on suspicion of making terroristic threats. Sheriff's deputies later took Luethke to the evaluation center after he threatened jail staff and broke a window in his cell. His aunt said Luethke had failed to take the medication he needs for his bipolar disorder. One hour after being placed in a holding cell at the center, Luethke was severely beaten, apparently by another inmate. Chambers said his plan, which would cost more than $5 million a year, is especially critical because of a plan being pushed by Gov. Mike Johanns to close two of the state's three mental health hospitals. That, Chambers said, means that more people with serious mental illness could wind up in the prison system. A report issued in December by the American Civil Liberties Union said health care for inmates in Nebraska prisons and county jails is dangerously close to cruel and unusual punishment. Although the Department of Correctional Services now provides mental health care and some substance abuse counseling and treatment, Chambers' bill would set standards for providing such treatment.


10-15-2004, 02:58 AM

Dying inmates seek release Press-Enterprise Lonnie Creech is dying. So is Helen Loheac. Both sit behind razor wire and iron bars at California prisons. Both are waiting for a compassionate release. Creech, 52, has lung cancer and has been given less than three months to live. Loheac, 81, has a chronic kidney ailment and goes to dialysis three times a week. Their chances of going home to die, though, are slim. Legislation passed in 1991 allows some sick inmates with fewer than six months to live and who are not threats to society to die at home. Last year, only 17 inmates out of 48 who applied won a compassionate release from the California Department of Corrections. Seven more applied to the Board of Prison Terms. One was denied and three more are being considered by the board. Last year, Vidilla Spragin of San Bernardino was granted her request and was released from the California Institution for Women in Chino. Spragin, who had killed her husband by setting him on fire, died last month from liver cancer. Creech was sentenced six years ago to 14 years for assaulting a Riverside police officer and making terrorist threats. He spends his days in the infirmary at the California Rehabilitation Center in Norco, said Lt. Tim Shirlock. In July he was diagnosed with small cell lung cancer and a tumor in his stomach, according to Sarv M. Grover, California Rehabilitation Center Chief Medical Officer. A compassionate release request with the California Department of Corrections was denied in September by then-director Edward Alameida. Two weeks ago, a second request was denied by acting director Richard Rimmer. Spokeswoman Terry Thornton said the decision was based on Creech's criminal history and current medical condition. "He is still ambulatory," Thornton said. Creech's family plans to appeal the decision to the Youth and Adult Correctional Agency and legislators.


10-16-2004, 02:42 PM

Profile: State of prison health care in California All Things Considered (NPR) 10-14-2004 Profile: State of prison health care in California Host: MICHELE NORRIS Time: 8:00-9:00 PM MICHELE NORRIS, host: In California, lawmakers are lamenting the state of health care in the state's huge prison system, and they want to know why a health-care system that costs a billion dollars a year is plagued with incompetent doctors and unexplained deaths. NPR's Mandalit del Barco reports. (Soundbite of ambient noise in exercise yard) Unidentified Woman: Yard recall. MANDALIT DEL BARCO reporting: In the exercise yard at Corcoran State Prison, Broderick Crawford(ph) daydreams about life after he serves his sentence for attempted murder. But right now he has a more pressing problem: a cracked tooth that he's afraid to let the prison dentist work on. Mr. BRODERICK CRAWFORD (Inmate): I have two more years left. DEL BARCO: You have to wait two years to get your tooth looked at? Mr. CRAWFORD: Right. Unless, of course, I want to just pull it all the way out. DEL BARCO: Does it hurt you right now? Mr. CRAWFORD: I don't eat on that side. I just eat over here and wait. DEL BARCO: You hear similar worries and worse from inmates throughout the California prison system. Many doctors and medical staff have been hit with charges of incompetence and medical neglect. And in recent days, the case of an inmate who died after having his wisdom teeth pulled has generated more negative headlines. Forty-one-year-old Anthony Shumake suffered a complication that eventually led to heart failure. His family is suing the state for wrongful death. And there's the ongoing class-action lawsuit against the California Department of Corrections, the CDC. State Senator JACKIE SPEIER (Democrat, California): To put it very bluntly, the health-care system at CDC is sick. DEL BARCO: During a recent public hearing in Sacramento, state Senator Jackie Speier painted a grim picture of how prison doctors have been responsible for costly lawsuits and unnecessary deaths. State Sen. SPEIER: Twenty percent of the physicians have either a bad mark on their record or a series of malpractice lawsuits, a figure that is four to five times higher than the general population of physicians in California. DEL BARCO: A new state report spells out the details, such as prison doctors who themselves have criminal convictions, others who have a history of alcohol or drug addiction, and some prison physicians who've lost the privilege of working at outside hospitals. Senator Gloria Romero says the system is broken. State Senator GLORIA ROMERO (Democrat, California): The problem is much like our correctional system itself, we haven't quite rehabilitated our behavior, and this must stop. DEL BARCO: The allegations are not new. One inmate lawsuit recently labeled California's prison medical care as `cruel and unusual punishment.' But some doctors bristle at charges of incompetence. Dr. JUAN TORR(ph) (Prison Doctor): We are as good as anybody out there doing medicine. DEL BARCO: Dr. Juan Torr practices medicine in Chowchilla, at the country's largest women's prison. At 73 years old, he's worked for the prison system for the past decade. Dr. TORR: There's no doctor that I know of that hasn't had a lawsuit against him, OK? We all have them, but if they're dismissed, they're dismissed. DEL BARCO: So in other words, you're saying that doctors here are no different from any doctor anywhere? Dr. TORR: No. I believe we're more scrutinized, to check our license completely. DEL BARCO: Doctors complain about not having up-to-date equipment and adequate staffs. Dr. JOE BICK (California Medical Facility): Hi, gentlemen. DEL BARCO: At the California Medical Facility in Vacaville, the state's largest prison hospital, Dr. Joe Bick says his staff could use twice as many nurses, more examination tables and even something as basic as chairs. And the patients themselves are a challenge. Dr. BICK: For many of them, when they were on the street, health care was not their priority, so they've never seen a dentist; their teeth are rotting out. They've got terrible feet because they've been living on the street. They've been shot; they've been stabbed. They've jumped out of buildings. They've had car crashes. They've ignored their diabetes and their hypertension. And now they have a moment of clarity where they can focus on their medical care, and they want it all done now. DEL BARCO: As for why California spends a billion dollars a year on this troubled system, Dr. Bick blames it mostly on costly drugs for treating inmates with chronic problems: HIV, AIDS, hepatitis C and mental illness. And because of the aging inmate population, many of the prisons in California have become de facto nursing homes. Clyde Hoffman is 80 years old and dying of emphysema and lung cancer. He's spending the remainder of his life sentence for murder at the prison in Vacaville. He's one inmate who says he's grateful for the hospice care he's getting. Mr. CLYDE HOFFMAN (Inmate): Everybody that works up here is excellent. This was far beyond my hopes and dreams that there'd be a place like that in prison. DEL BARCO: Hoffman's doctor, Joe Bick, the chief medical officer, admits some of the prison doctors probably should have their licenses removed. But the majority, he says, are doing their best to heal the sickest of the sick in California's prisons. Dr. BICK: Many of us who are here are not here because this is the only choice we have. We didn't come here because we're running away from something. We came here because this is something we care deeply about. DEL BARCO: Dr. Bick says, in a strange way, prison doctors have a lot in common with the inmate. They sometimes feel just as isolated as their patients, spending their days behind bars. (Soundbite of prison door) DEL BARCO: Mandalit del Barco, NPR News, Los Angeles. (Soundbite of prison door) NORRIS: You can see photos of the conditions in some of California's health-care systems at our Web site, Content and Programming copyright © 2004 National Public Radio, Inc. All rights reserved.


10-16-2004, 02:45 PM

MALPRACTICE AT THE JAIL The Palm Beach Post 10-13-2004 Providing health care at jails and prisons is a tough business. Inmates often are uncooperative and sometimes hostile. Medical records are hard to find. Substance abuse complicates treatment efforts. But none of this excuses the manner in which the Palm Beach County Jail's private medical provider, Prison Health Services, ignored Patrick Bilello in the weeks before his death last year. Bilello, who had a history of heroin abuse, also had HIV, hepatitis C, anemia, abnormally low blood pressure, pneumonia and heart problems. Yet he was in jail for 53 days without seeing a doctor. By the time he was examined, it was too late. PHS transferred the 47-year-old man to the emergency room at Columbia Hospital as a non-emergency patient. Bilello died there after his heart stopped five times. His widow, Rosanne Bilello of Palm Springs, is suing PHS and its corporate parent, America Service Group Inc., as well as two doctors - jail medical director Erin Cody and her interim replacement, Edgar Escobar - and Sheriff Ed Bieluch. PHS has fired Dr. Escobar but announced no disciplinary action. Sheriff Bieluch has fired PHS and hired its rival, Correctional Medical Services, the lowest bidder for a two-year contract that began Oct. 1. The case for firing PHS went beyond Bilello. Several inmates had died after receiving questionable care; judges ordered other inmates released to receive private care; and PHS was slow to respond to a persistent staph infection at the jail. PHS has contracts in 22 Florida counties, including St. Lucie, where the firm also provides health care at the jail. Palm Beach County prosecutors considered pursuing criminal charges and presenting the Bilello case to a grand jury. They pulled back, saying investigators had not uncovered sufficient evidence. Boynton Beach lawyer Gary Susser, who represents Ms. Bilello, said he was pleased with the depth of the PBSO's internal investigation, which confirmed that none of the jail's doctors saw Bilello. In statements to lawyers, Dr. Escobar admitted that he only stamped his name, initialed and dated a critical lab report that showed a dangerously low level of oxygen in the blood. Ms. Bilello and Mr. Susser repeatedly sent PHS letters, imploring the company to give Bilello all his medication. It took an order from Circuit Judge Kenneth Stern to force PHS to give him his medication three weeks before his death. Prosecutors may be waiting until the civil case uncovers more evidence to consider filing charges. But if 53 days of neglect, indifference and intransigence aren't enough to suggest criminal behavior, how many days does it take?

Copyright © Palm Beach Newspapers, Inc., 2004


10-16-2004, 02:48 PM

Legionnaires bacteria found in women's prison AAP General News (Australia) 10-15-2004 Qld: Legionnaires bacteria found in women's prison By Alex Murdoch BRISBANE, Oct 15 AAP - Bacteria that causes the deadly legionnaires' disease has been found in an airconditioning system at Brisbane Women's Prison, authorities said today. Corrective Services spokesman Ron Watson said the bacteria was picked up on Wednesday as part of the service's regular screening process at the prison and was eradicated yesterday. He said the unit was in one of the prison's kitchens, and as such was not in an area frequented by children who visit the facility. "It's also not a unit that has a full thoroughfare of all staff and prisoners," Mr Watson said. Legionnaires' disease is a potentially fatal form of bronchopneumonia (lung infection), with an incubation rate of two to 10 days. The water coolant systems of some air conditioning systems have been found to be an ideal breeding environment for the bacterium. Mr Watson said a maximum of 10 staff and 16 inmates had been exposed to the disease and had been offered free medical checks. He said anyone who displayed the symptoms of legionnaires' disease would be immediately tested. "Delegates of the Queensland Public Sector Union, which represents custodial staff, were briefed this morning on the find and eradication," Mr Watson said. "The prison was locked down at 10am to enable all staff to be briefed by Workplace Health and Safety, health and air-conditioning experts." Mr Watson said legionnaires' disease was not contagious; it cannot be spread from person to person or from contaminated food. It can only be spread by breathing in the bacteria from a contaminated air supply. AAP am/sc/cdh/was/de KEYWORD: LEGIONNAIRES © 2004 AAP Information Services Pty Limited (AAP) or its Licensors.


10-16-2004, 02:50 PM

Reports: Over 80 percent of Russian prison inmates sick AP Worldstream 10-15-2004 Dateline: MOSCOW More than 80 percent of Russia's prison inmates have health problems, Russian news agencies reported Friday, quoting the country's human rights ombudsman calling the situation catastrophic. Of the 615,000 people currently in prisons in the nation of 144 million, nearly 500,000 have some kind of illness, the Interfax news agency quoted Justice Ministry spokesman Oleg Filimonov as saying. About 36,000 inmates are HIV-positive, 56,000 have tuberculosis and many are suffering from the effects of previous drug use, Filimonov was quoted as saying. Human rights commissioner Vladimir Lukin called the state of medical facilities in Russian prisons "wild and catastrophic." Lukin said only half of the nation's correctional facilities have been certified by doctors. Russia has one of the largest per capita prison populations in the world, and its jails and labor colonies have become severely overcrowded. Cells intended for eight people are sometimes packed with up to 30, forcing inmates to sleep in shifts. Copyright 2004, AP News All Rights Reserved


10-18-2004, 09:02 AM

PRISONER LEFT BRAIN-DEAD He gave help, but got beaten Inmate was allegedly attacked by another he had just been assisting with legal matters at a Bronx courthouse


An inmate at a jail barge could face murder or manslaughter charges in a Bronx courthouse beating that left a prisoner comatose and brain-dead, police said yesterday. Kenny Taylor, 27, was charged yesterday with assault in the Tuesday beating of Ronald Fesce, 54, inside a holding pen at Bronx Criminal Court, on East 161st Street. A law enforcement source familiar with the incident said Fesce has a working knowledge of the legal system and was helping Taylor with his pending assault case. But the two got into an argument, possibly regarding the assistance Fesce was providing Taylor, and Taylor attacked Fesce, the source said. Fesce fell, hitting his head on a bench, then on the concrete floor, police said. He was aided by prisoners and regained consciousness, police said. The city's Correction Department said correction officers did not witness the assault. The agency and police also said Fesce did not tell anyone in authority what had happened. On Thursday, Fesce, back in his cell at the Vernon C. Bain Center, a jail barge in Hunts Point, complained of body and head pain - both of his eyes were black, the source said - and he was taken to Lincoln Medical and Mental Health Center. He later lapsed into a coma and is brain-dead, police and the source said. Fesce, who was in custody for allegedly selling drugs near a school, is divorced and has a 16-year-old son. Many of Fesce's neighbors, on Dawson Street in Morrisania, were unaware of the alleged assault but said it was characteristic of Fesce to want to provide legal assistance. He had a keen interest in the law, fueled in part, they acknowledged, by his arrests, mostly for drug offenses. Often, they said, he would retreat to the quiet of the library on nearby Kelly Street and research legal matters, sometimes for friends. "He loved the law a lot," said neighbor Jamie Baker, 24. "That was his main subject." Neighbor Vivian Torres, 41, said that when her son was arrested on a marijuana charge, Fesce provided legal counsel that helped her son avoid jail. "If he wasn't the way he was, trying to help everybody, maybe he wouldn't have ended up the way he did," said a third neighbor, Lisa Joyce, 28. "He was a real good person." Copyright 2004, Newsday Inc.


10-18-2004, 04:05 PM

That is a shame - actually that is so sad.:(

Lamon'ts Girl

10-18-2004, 04:39 PM

My prayes go out to his family and loved ones. That is a horrible way to go - trying to help someone who didn't appreciate him or his efforts.:mad:

California Sunshine

10-18-2004, 06:11 PM

Gosh that is terrible :(


10-20-2004, 01:11 AM

Posted 10/19/2004 8:06 PM Updated 10/19/2004 8:11 PM Some inmates will get flu shots The Associated Press Norman Cooper has been unable to find a flu shot for his wife who takes daily oxygen treatments for asthma, emphysema and bronchitis. So he was incensed to learn that some inmates in the state prison 30 miles down the road were getting flu shots. (Related story: U.S. to get more flu vaccine in January ( "This deal with the prisons has got me so upset," said Cooper, who also hoped to help an 80-year-old friend who was on oxygen for a chronic lung illness. "I don't think they should get flu shots over citizens who are at high risk. They're being treated like first-class citizens, and we are second-class citizens." Federal and state prison officials say the inmates getting the shots are also high-risk — either 65 and over or suffering from a chronic medical condition. They say it's the surest way to fend off a flu epidemic inside the prisons that could be costly to taxpayers. But Cooper's distress over the situation is just one example of the difficulty of fairly distributing the nation's short supply of flu vaccine. The government estimates there are 98 million people at high risk of flu complications, and expects to have a little more than half of that number of flu shots. The Missouri prison system's medical services contractor, Correctional Medical Services, got 8,780 of the 9,460 doses it had requested, said spokesman Ken Fields. And he said all of those shots have already been given to high-risk inmates as well as some high-risk staffers who have direct contact with them. "By being proactive about this, we hope to keep inmates from having to be housed in outside hospitals," said John Fougere, corrections spokesman. Meanwhile, Cooper and thousands of others have spent countless hours calling doctors and health departments seeking flu shots. Cooper, who lives in Scott City in southeast Missouri, says his 64year-old wife was hospitalized in June and was warned that a cold or the flu could be fatal. But prison officials argue that inmates also need protection. Even though they are confined, they are susceptible to flu through contact with staff, visitors and turnover among inmates, said Joe Weedon, spokesman for American Correctional Association, a trade group that accredits jails and prisons. A large number of inmates also suffer from alcohol and drug addictions, which can compromise their immunity. "You've got an environment where inmates are living in close quarters, coming into contact with each other and not necessarily in the most sanitary conditions because they don't wash their hands," Weedon said. "The inmates throw fecal matter at other inmates or at officers, things like that do happen, and they lead to the spread of disease." Even so, while prison populations often have infectious outbreaks like staph infections or hepatitis, no corrections officials could recall a serious outbreak of flu among an inmates. Like the rest of the country, prison officials have been told not to expect all of the vaccine they ordered. While Missouri had enough vaccine for nearly a third of its inmates, Texas, with one of the nation's largest prison populations, is mapping plans for doling out 1,100 flu shots among 150,000 inmates — or less than 1%. "Our infection control policy is to give a flu vaccine to chronic disease patients, HIV/AIDS patients, offenders 65 years of age and older and pregnant females," said Texas prisons spokesman Mike Viesca. As part of its infection control policy, health officials with the Texas corrections system also vaccinate to protect against pneumococcal bacteria, a common flu complication, and Hepatitis B, measlesmumps-rubella and tetanus and diphtheria. In Kansas, the Department of Corrections doesn't have any flu vaccine for its 9,000-plus inmates. Officials hoped to learn later this week whether it would get some, spokesman Bill Miskell said. Last year, 5,500 flu shots were given to inmates and employees, he said. Dan Dunne, a spokesman for the Federal Bureau of Prisons, which has 152,811 inmates across the country, said the system didn't expect to use a disproportionate amount of vaccine. He said he didn't know how many flu shots were available for federal prisoners. Shots to employees will be limited to those at greatest risk of getting the flu and spreading it to prisoners, he said. Article found here: (


10-20-2004, 09:31 AM

BRONX CRIMINAL COURT HOLDING FACILITY Inmate death under investigation Man was released from clinic after being injured during fight; second local jail death in two weeks Newsday 10-19-2004 BY GRAHAM RAYMAN. STAFF WRITER The wife and son of an inmate who was fatally assaulted in a city holding pen on Oct. 12 demanded answers yesterday. Ronald Fesce, 54, of the Bronx, was removed from life support Sunday at Lincoln Medical and Mental Health Center, five days after police said he struck his head on a bench and a concrete floor in a fight with another inmate in the pen at Bronx Criminal Court. "He was under the city's care, and somebody has to be held accountable," Fesce's wife, Carmen Cerezo, 50, said yesterday. Assemb. Ruben Diaz Jr. (D-Bronx), noted that the Fesce case followed the Oct. 3 beating death of Tyrrell Abney at another jail facility. "The mayor was outraged at one killing in Rikers, and now we have another," he said. "Nobody deserves to die this way. The family is not getting answers." Thomas Antenen, a Correction Department spokesman, said an investigation by police and prosecutors is ongoing. "The answers will be forthcoming as the investigation continues," he said. Ellen Borakove, spokeswoman for the city medical examiner's office, said an autopsy is pending. Cerezo said Fesce, who faces drug charges, was known as "the street lawyer," often representing himself in court. "He learned a lot about the law, and he would try to advise people of their rights," she said. Fesce had a close relationship with his son, Ronald Jr., 17, a high school senior. "He was a guy who tried to make friends with everybody," his son said. "It's a shock." The extent of Fesce's injuries was not discovered until more than 24 hours after the incident. Cerezo said Fesce had scratches, bruises and black eyes, when she saw him in a comatose state at Lincoln Friday night. "It was like he had been in a fight with a truck," she said. "How is it that no one noticed?" Cerezo said she questions why Fesce was sent back to his cell after a visit to a jail clinic a day after the assault. Police said inmate Kenny Taylor, 27, who was facing assault charges, pushed or struck Fesce on Oct. 12 during an argument, possibly over legal advice. Antenen said the altercation wasn't witnessed by correction staff. After the assault, Fesce was transferred back to the Vernon C. Bain Center. On Oct. 13, an officer noticed a bruise on Fesce's face and sent him to a clinic for treatment, a correction source said. Fesce told doctors he was OK, the source said. That same day, he was transported to the criminal court, where he pleaded not guilty, and was returned to the Bain center. Just after 5 a.m. on Oct. 14, Antenen said, Fesce complained that he felt ill, triggering a trip to the clinic and then a transfer to Lincoln. Cerezo said she was told an officer saw Fesce passed out in his cell, and took him to the clinic. Another inmate, she said, also reported that Fesce seemed sick. Once at Lincoln, Cerezo said, doctors noted he was already in poor condition, with visible injuries on the front and rear of his head. They did a CT scan and operated to try to relieve brain swelling. Fesce was moved to intensive care Friday, she said. She did not learn that Fesce had been taken to the hospital until that night, when she found a note from a correction chaplain taped to her door. Copyright 2004, Newsday Inc.


10-22-2004, 07:51 AM

California Blasted for Poor Prison Health Care Mandalit del Barco, NPR The HIV ward at Vacaville State Prison in California. “To put it very bluntly, the health care system at (the California Department of Corrections) is sick. Twenty percent of the physicians that work at the CDC have either a bad mark on their record or a series of malpractice lawsuits -- a figure that is four to five times higher than the general population of physicians in California. ” California state Sen. Jackie Speier (D-San Mateo/San Francisco)

All Things Considered (, October 14, 2004 · California spends $1 billion each year to provide medical services for inmates of the state's 32 prisons. But the quality of that care is being scrutinized. NPR's Mandalit del Barco ( reports on accusations of medical incompetence, lax staffing and outdated equipment, and the challenge of treating patients who often ignore their health until their illness is all but untreatable. Broderick Crawford, an inmate serving time for attempted murder at Corcoran State Prison, is typical of many prisoners who simply don't trust the quality of care behind bars. He's got a cracked tooth, but he's afraid to let the prison dentist fix it. He's willing to wait until his sentence is served -- two years and counting -- and get it fixed on the outside. Many California prison doctors and medical staff have been hit with charges of incompetence and medical neglect. A recent case involving an inmate who died after having his wisdom tooth pulled has generated more negative headlines. There's also an ongoing class-action lawsuit against the California Department of Corrections( CDC). "To put it very bluntly, the healthcare system at CDC is sick," says state Sen. Jackie Speier (D-San Mateo/San Francisco). "Twenty percent of the physicians that work at CDC have either a bad mark on their record or a series of malpractice lawsuits -- a figure that is four to five times higher than the general population of physicians in California." One inmate lawsuit recently labeled California's prison medical care as "cruel and unusual punishment." But some prison doctors bristle at charges of incompetence. "We are as good as anybody out there doing medicine," says 73-year-old Dr. Juan Tur, who practices medicine at Chowchilla, the nation's largest women's prison. "I believe we're more scrutinized, to check our license completely." Other prison doctors complain of outdated equipment and inadequate staffing. And the patients themselves can be a huge challenge to treat. "When they were on the streets, health care was never a priority, says Dr. Joe Bick, who works at the California Medical Facility in Vacaville -- the state's largest prison hospital. "So they've never seen a dentist, their teeth are rotting out, they've got terrible feet cause they've been living on the street, they've been shot, they've been stabbed, they've jumped out of buildings, they've had car crashes, they've got diabetes and hypertension. "They're first diagnosed with HIV when their immune systems are shot. And now they have a moment of clarity, where they can focus on their medical care, and they want it all done now," Bick says.


10-22-2004, 09:57 AM

Peace....HIV is real in all communities. Given this reality it only makes sense to have condoms available to cease, as much as possible, the spread of the disease. I work in a hospital. Have seen too many patients who have this disease. As I have told people, one can not look at a person and tell whether he/she has the disease...if you were able to simply one would have it. Its real! Everyone should have access to all tools to fight it and to protect themselves from it. It another arena that folk need to organize around. Thanks for the inforamtion. Blessings...


10-22-2004, 10:05 AM

Did anyone read the article in the most recent issue of READERS DIGEST about prison health care? I only got a chance to glance at it, but it talked about how GOOD the inmate's medical care was & that they get better health care than people in the community. I don't have the magazine with me, but maybe I can get it & read the whole thing & post more on the article.


10-22-2004, 02:34 PM

No, I haven't had a chance to read it. Please do post it if you can get it. I will look for it also.


11-12-2004, 11:29 AM

Nutrition: A Proactive Approach to Inmate Health By Kelen Tuttle (, Internet Reporter Nutrition in correctional facilities has come a long way in the past two decades. While in the 1980s the recommended dietary allowances published by the Food and Nutrition Board sought to meet the needs of healthy people, they now endeavor to help people stay healthy by preventing nutritional deficiency diseases and chronic disease. According to Barbara Wakeen, a registered licensed dietitian, correctional systems are beginning to successfully incorporate these nationally recognized standards into correctional menus. Wakeen, who plans correctional menus and researches the standards upon which they are based, believes that correctional systems are generally in compliance with both national standards and the often more stringent statewide standards. Yet Wakeen also said that if more states and jails instituted a "heart healthy" menu, it could lead to fewer specialized diets and healthier inmates overall. "It's important to take the proactive approach to prevention instead of just maintaining health," Wakeen said. By providing more nutrition education and serving heart healthy meals, Wakeen believes prisons will "prevent disease down the road instead of just treating it later." A heart healthy diet as promoted by the American Heart Association consists of foods high in fiber and low in saturated fat, sodium, and cholesterol. While many states already serve healthy heart meals to inmates, Wakeen advocates the use of these kinds of diets in all correctional facilities. "By streamlining the process using these nationally recognized standards and offering a healthy heart menu to all inmates, we can optimize nutritional care to ensure that all inmates get adequate nutrients," Wakeen said. Although Wakeen expresses satisfaction with the overall nationwide compliance with dietary regulations, she also said that the accuracy of medical meals is an ongoing concern. "If medical diets for inmates with health conditions such as diabetes, hypertension, or cardiovascular disease are not followed, serious consequences can result," she said. Wakeen indicated that varying monitoring systems are used nationwide to ensure that those who need special diets receive them consistently. Universal Diet Cards A new program in Washington State addresses this concern with the Universal Diet Card, a system that ensures consistency in the diets of offenders. According to Cheryl Johnson, Registered Dietitian and Food Program Manager for the Washington State Department of Corrections, the program "successfully reduces costs while also ensuring the dietary health of offenders." The program requires that a medical provider or religious chaplain screen new inmates for special nutritional requirements when they first enter the prison system. As usual, inmates with special dietary needs receive a card listing their dietary requirements. Yet, by laminating this card to the back of the offender's identification badge and marking the front of the badge with a red stripe to indicate the presence of a dietary requirement, prison officials ensure that the inmate's diet remains consistent no matter how often he is transferred from prison to prison. "Before we had to repeat the screening process at every institution, reissuing dietary cards every time," said Johnson. This allowed inmates to change their dietary requests frequently, often without cause. "Even then," Johnson said, "inmates could take their dietary requirement badge off or put it on depending on the meal, [leading to a lack of dietary consistency and effectiveness]." By issuing permanent cards that are consistent throughout the prison system, Washington State increased offender accountability and compliance. According to Johnson, inmates now receive the right meal every time they come through the chow line, which helps to maintain the inmates' health. It has also decreased the number of confrontations between inmates and food service staff, which is good news for Johnson. Inmates can no longer claim false dietary needs because staff can confidently determine an offender's dietary status with a glance at his identification badge. "There are much fewer arguments over meals because the dietary cards are always right there on the inmate's badge," she said. Another benefit of the Universal Dietary Card is lowered operating costs in Washington prisons, according to Johnson. Although prisons continue to screen inmates at regular intervals to reevaluate dietary needs, administrative costs have declined because prisons no longer conduct a new screening every time an offender transfers. The program also saves money in the kitchen, reducing waste by ensuring that all special meals are eaten. "If we make 10 vegetarian meals because there are 10 inmates registered as vegetarians, all 10 will be eaten," said Johnson. "This way, we make only as many meals as we need." Johnson recommends the program to prison systems across the nation. "It has real medical implications, especially with the cost of healthcare on the rise," she said. Wakeen and Johnson will present their work in a joint presentation at the NCCHC Conference in November.


11-16-2004, 02:08 AM

Prison system fails female inmates

Kristin Kelley ([email protected]), Editorial Board Mammograms, pap smears and chemotherapy are not often words one would associate with prisons, but in recent years, many women have died because the prison system is refusing to grant women proper medical care. Prison officials are denying medical treatment for women inmates because they feel the women are either faking illness or just want drugs to feed an addiction.

Women represent fewer than 10 percent of the total prison population, but this does not excuse our system for failing our women. While it is true most women are in prison on drug-related charges, granting them a mammogram when they find a lump on their breast or a regular pap smear to prevent against cervical cancer has nothing to do with an addiction to drugs. "Deadly Health Care at California's Prisons," published in Revolutionary Worker, recounts the story of Pamela Coffey. Coffey, 46, was sent to prison after being convicted of selling drugs. While in prison, Coffey complained about a large knot in her stomach, which other inmates described as being so large it looked as though she was pregnant with twins. The only medical attention Coffey received was a few tablets of Benadryl. In December 2000, Coffey died in front of her fellow inmates. Coffey had collapsed on the floor of her cell. Her cellmates called for medical assistance which did not arrive until approximately 45 minutes later. By the time the medical officials arrived, Coffey could barely speak and could no longer sit up. The medical official on the scene, upon arriving and finding that Coffey could no longer talk because her tongue was so swollen, told the other inmates that they could do more for her than he could and walked away laughing. Minutes later, Coffey died without receiving any help from the medical staff on duty within her prison. Coffey's story is one of many horrendous stories of women who died in prison because they did not receive proper medical attention. In 1999, two women were given tuberculosis medicine when they did not have the disease, which caused their livers to fail, their waists to bloat to over 60 inches and eventually led to their deaths. In many cases, women are not allowed to receive needed medication such as chemotherapy to battle cancer or AIDS-related drugs to keep them alive. Some are even forced to walk back to their cells after major surgeries. Often when comparing the United States to the world, we see this nation as superior, but with regards to our treatment of women in the prison system this is not the case. Internationally, shackles are only used when absolutely necessary, but in the U.S. these are a common sight. In fact, women giving birth are often shackled, which can cause some serious complications for the babies being born as well as for the mothers themselves. While we are sending these women to jail to teach them a lesson, are we really trying to kill them? The U.S. sends individuals to prison for murder, but each day this nation is killing or advancing women within the prison system toward their deaths. Women should not be dying from preventable causes within our prisons. It may cost a few extra taxpayer dollars, but in the end is not the life of a human worth it? Yes, these are criminals, but we send them to jail to become reformed, and we should give them that chance. They should especially be given the chance to live through their sentence. Article found here: (


11-16-2004, 02:34 AM

Great article! The correctional health care system is making strides in some areas and has so much room to grow in other areas. Keeping these issues out in the forefront should guide continued progress, we hope!


11-20-2004, 06:45 PM

:eek: THAT'S OUTRAGEOUS! Reader's Digest October 2004 I got a hold of the Reader's Digest article that I was talking about earlier that's about "health care in prisons". The article is written by Michael Crowley, a regular columnist for READER'S DIGEST , also a senior editor at the New Republic magazine. Write to him at [email protected] I think this writer needs to get in touch with the "real world" of prison healthcare! CRIME PAYS......... if you need top-notch medical care The article starts out......... "James Wolfe was doing hard time in Pennsylvania for raping an eight-year-old girl when he discovered that prison can be a pretty good deal. It seems James had always wanted to be a woman (he had even changed his name to Jessica). and a doctor labeled his condition "gender identity disorder." That made James eligible for hormone treatments to help change his gender---at taxpayer expense. The state says these treatments don't cost much, but according to an estimate by the Pittsburgh Tribune-Review, they can run up to $8,000 per year." "Here's the really bitter medicine: That amount could go a long way toward providing health insurance for a family. With an estimated 44 million peple in America lacking health coverage, one million of them in Pennsylvania alone, you'd think inmates would be the last to receive elective procedures." ".....It gets worse because the problem goes well beyond these sorts of unusual treatments. Around the country, hardened criminals of every stripe receive top-notch care that many average families don't get, including expensive dental surgery......." "In Oregon, which has recently cut public health benefits, the state is spending about $120,000 per year on dialysis treatments for a convicted murderer on death row. In other words, it's shelling out big bucks to keep him alive until it's time to kill him. True, there's always the chance he'll get his death sentence revoked, but why are his costly treatments guaranteed and fully covered when plenty of law-abiding people can't affor the care they need?" "Something to think about. So is the fact that other hugely expensive treatments, like bone marrow transplants and heart-bypass surgery, have been provided to prisoners, courtesy of your wallet and mine." "Convicts sometimes even qualify for precious organ transplants. Two years ago in California, a twice-convicted felon serving time for armed robbery got a new "ticker", at an initial cost to the state of $900,000. At the time, 3.900 people were on the national waiting list for a new heart, and hundreds of them eventually died waiting." Meanwhile, a person without health insurance might never have made the list in the first place. Unlike an inmate with guaranteed coverage from the government, an uninsured individual may be judged too financially risky by many hospitals." "It's all startling evidence of a little-known quirk of american life: the only class of people with a constitutional right to health care in the United states are prison inmates." For the roughly one in seven Americans living without coverage, their best hope of seeing a doctor for free might be getting thrown behind bars." "....At times, the inmates even get top-dollar treatment. ...The California state prison system spent $11 million for dermatology services in just one budget year---including services performed by a Beverly Hills dermatologist. The state has also spent millions on hearing aids for prisoners, even thought many private health plans don't cover them. It's no wonder, then, that California's prison health care costs soared 11% over the past year...." "....Sure, this can be a tricky issue. Should we just let inmates die of illness without treatment? Does anyone want to deny a jailed shoplifter an emergency room visit? Of course not. But maybe it's time to ration care behind bars more carefully." "Maybe a violent criminal who needs a liver should be bumped down the long waiting list. And surely criminals shouldn't be rewarded with better coverage than law-abiding people, who deal with everstricter managed-care plans. The bottom line, though, is simply this: Premium health care shouldn't be the reward for robbing a bank." Well, what do you think? Myself, I'm OUTRAGED at his view of how health care is in US prisons! I think we should write to him at the email address above and tell him some of the true stories of health care behind bars! I think he should write a retraction to HIS outrageous opinions. For instance the issue about transplants: Not everyone who is on an organ receipient list gets the next available organ! They might not be a match. My boss just died suddenly (at age 57). She was able to donate her liver & kidneys, but not her heart, because there wasn't a match on the list that could receive it. Well, anyway, as you can see, I'm passionate about this issue. I hope we'll all give this writer an ear-full!


11-27-2004, 12:46 PM

November 27, 2004 EDITORIAL OBSERVER The Federal Government Gets Real About Sex Behind Bars By BRENT STAPLES

Thirteen million Americans have been convicted of felonies and spent time in prison. The prison system now releases an astonishing 650,000 people each year - more than the population of Boston or Washington. In city after city, newly released felons return to a handful of neighborhoods where many households have some prison connection. The so-called prison ZIP codes have more in common than large populations of felons or children who grow up visiting their mothers and fathers in jail. These neighborhoods are also public health disaster areas and epicenters of blood borne diseases like hepatitis C and AIDS. Infection rates in these areas are many times higher than in neighborhoods short distances away. No one can say how many infections begin in prison. But the proportion could be high given the enormous concentrations of disease behind bars and the risky behaviors that inmates commonly practice. They carve tattoos in themselves using contaminated tools borrowed from other inmates. They inject themselves with drugs using dirty syringes. The most common source of infection could easily be risky, unprotected sex, which, despite denials by prison officials, is clearly a regular occurrence behind bars. A recent study of male inmates in several prisons, for example, found that more than 40 percent had participated in sexual encounters with another man. Most of these inmates, by the way, viewed themselves as heterosexual and planned to resume sex with women once they got out of prison. Prison systems in Canada and Europe have tried to cut down infection by making condoms available to inmates. Prompted by research showing that sterile syringes slow the spread of AIDS among intravenous drug users, several countries have actually moved programs that supply clean needles right into the prisons. Public health officials who favor needle exchanges in the United States are fully aware that this country has just emerged from a presidential election that witnessed heightened activism by conservative Christians. Indeed, even nonreligious Americans would prefer to see prisons shut off the flow of illegal drugs and provide addicts with treatment instead of syringes. The condom issue, however, seems somehow less explosive. But as of now, condoms are banned or unavailable in 48 of 50 state prison systems, on the theory that distributing them would condone illicit sex. When confronted with public health data from abroad, American prison officials have blithely suggested that all the fuss is overblown - because there is little sex to speak of in jail. Congress seemed comfortable with this fiction until 2001, when the Human Rights Watch organization issued a grisly report titled "No Escape: Male Rape in U.S. Prisons." The study suggested that rape accompanied by horrific violence was a regular aspect of American prison life. Based partly on the accounts of more than 200 prisoners in nearly 40 states, the report told of prison officials who stood by while sexual predators raped fellow inmates and sometimes sold them - as sex slaves - to gangs and other inmates. The study led directly to the Prison Rape Elimination Act of 2003, which sailed through Congress and was signed into law by President Bush. The law, which requires the Justice Department to collect data on prison rape and develop a national strategy for combating it, provided a much needed mechanism for weeding out sexual predators behind bars. But this law is, at its heart, a public health law. It provides for grants that could be used to underwrite public health initiatives - including sorely needed studies of disease transmission in the criminal justice system. The law has already resulted in fruitful discussions about expanding disease testing and prevention behind bars. Lawmakers find it easy to discuss prison sex in the context of rape because everyone agrees that sexual assault is horrible and needs to be rooted out. The conversation about consensual sex among inmates will be trickier to handle. Even so, the law will inevitably force prison officials to confront all the varieties of sexual contact that public health researchers have known about for a long time. The commission created by Congress to oversee the new law is just getting started. But it has already brought some honesty to the historically dishonest conversation about sexual behavior in prison. Commission members who have spent time in the public health world, for example, are well aware that people who participate in sex behind bars do so for a variety of reasons. Some barter their bodies - and risk disease - in exchange for protection from marauding gangs. Others perform sex acts in exchange for necessities like soap, food and access to telephone calls. Not all sex in prison, however, can be attributed to rape or bartering. Recent research suggests that some of it is consensual among lonely inmates who experience same-sex encounters for the first time - and for many of them, the only time - while in prison. The new law is pushing some states to create new strategies for dealing with sexual assault in prison. But common sense tells us that sex among inmates will not disappear even if rape and coercion are taken out of the equation. That said, prison officials need to revisit rules that outlaw condoms behind bars. These rules aid the spread of diseases that flourish in prison - and then make the leap to the world outside. Copyright 2004 ( The New York Times Company (


11-30-2004, 05:37 PM

I totally disagree with the Readers Digest writter, I wonder if he visited any of the prisons in California to really get an idea about how poor the medical and especially the mental health care is. I think it is a disgrace to the people of California. Inmates are dying from lack of care, the mentally ill are being brutalized by guards and other inmates. Inmates are taken off their medications and left to die. The mentally ill are taken off their meds, and when they get to the state when they start to get out of control, they are handled brutally, and the acts of these sick are then reported to the media to make the citizens turn against any help for inmates. But in the reports to the media, the reason for the sick to get out of control isn't mentioned, removal from necessary meds. A bill was passed by our Govenor which said that any inmate not diagonised by a prison doctor will not be medicated or illness recognised regardless if he or she was diagonised by a civilian doctor. And we pay for this medical abuse as tax payers. Sure hope I never find myself having to go to prison.


12-02-2004, 07:42 PM

Let me tell you a little story about a inmate in a womens prison in Ca. This inmate went to get her tooth fixed or pulled either one. They told her to come back in two weeks. In the mean time I caleld as I felt this was a little long to have to wait for tooth repair. When she did see the dentist they told he because I called she would have to wait and was going to the bottom of the list. They said this in front of witnesses and then began to share person history with the other inmates about this patient with her sitting right there to hear the whole conversation. When she did finally get her tooth fixed the doctor told her I put you to the bottom of the list TWICE because your husband called and bothered me. They then deadened the tooth and proceeded to drill before the anesthesia set in. Now you tell me where any of this fulfills any of the hippocratic oath that a doctor swears to. Also tell me what part of this was legal, humane, or ethical. You cannot. These fine doctors in these fine institutions need to spend a little time behind bars themselves. This is my loved one they did this to, I am not done. They violated Title 15 and Title 24 of the BOC regs. I worry about retribution which is rampant, so I wait.


12-05-2004, 10:43 AM

Hospital Faulted In Death Of Inmate; Quadriplegic's Care Lacking, Probe Finds The Washington Post 12-04-2004 The D.C. Department of Health has found that Greater Southeast Community Hospital failed to provide adequate care to a quadriplegic jail inmate who died in September after he was taken to the emergency room for severe breathing problems. The inmate, Jonathan Magbie, died Sept. 24 of acute respiratory failure, raising questions about his medical care as well as why he was incarcerated in the first place. Magbie, 27, of Mitchellville, was serving a 10-day sentence after pleading guilty in D.C. Superior Court to possession of marijuana, an offense that rarely carries jail time for a first-time offender. The Health Department's investigation focused on what happened after Magbie arrived at the D.C. jail Sept. 20 and primarily on his treatment at the hospital. The findings, released late yesterday in response to a Freedom of Information Act request, represent the most comprehensive official accounting of his death. The hospital will be cited for violating local and federal regulations. Last year, Greater Southeast was faulted by District hospital inspectors for persistent problems with the quality of medical care. The city later determined that the hospital had addressed deficiencies. "This was a tragic incident," Gregg A. Pane, director of the Health Department, said in a statement released with the report. Magbie's mother, Mary Scott, said last night that she was pleased to see Greater Southeast held accountable but that others shared in the blame for her son's death. All knew, she said, that he had serious medical problems. "It's misconduct on everyone's part," Scott said. "I still hold the judge responsible, the jail responsible and the hospital responsible." Hospital officials issued a statement saying they had not received an advance copy of the report, but they defended the care they gave Magbie. "We are confident that appropriate care was provided in this case, but privacy rules prevent us from talking about specifics," the hospital statement said. "We would welcome a fair and impartial review, but question whether the District's conflict of interest in this matter allows it to be fair and impartial." Magbie, who was struck by a drunk driver at age 4, was paralyzed from the neck down and his growth stunted. But, helped by a settlement that paid him $30,000 a month, he tried to make the most of his life. He traveled frequently, wore what he said was a $7,000 watch and lived in what he called a mansion. Although he had never before been accused of criminal wrongdoing, Magbie was known to keep rough company, according to prosecutors, who said his name came up on a wiretap of a suspect in a major drug-trafficking investigation. He was arrested in April 2003 while riding with a cousin in his family's Hummer in Southeast Washington. Police found cocaine, marijuana and a gun in the vehicle. Magbie pleaded guilty to possession of marijuana, and probation seemed to be the likely sentence. But the judge, Judith E. Retchin, noting the gun in the car and Magbie's insistence that he would continue to smoke marijuana because it made him feel better, sentenced him to jail. Hours after he arrived at the D.C. jail Sept. 20, he began having difficulty breathing. Magbie told a jail nurse that he used a ventilator to help him breathe at night, according to the Health Department's investigation, but the jail did not have the equipment. The jail's doctor had Magbie taken to Greater Southeast. William Vaughn, a doctor in the hospital's emergency room, told Health Department investigators that Magbie was brought to Greater Southeast because he might need a ventilator. Vaughn initially planned to admit Magbie but changed his mind after Magbie's condition improved, the investigation found. He discharged Magbie back to the jail the next day with instructions that Magbie could need nasal oxygen. The Health Department said that the doctor erred by releasing Magbie without addressing his ventilator needs at night. Magbie never got a ventilator while at the jail. The staff at the Correctional Treatment Facility, the medical jail annex where Magbie was being held, was concerned when Magbie reappeared at the jail, the Health Department investigation found. Its chief medical officer, Malek Malekghasemi, told investigators that the facility "should not have a patient that required a vent." Malekghasemi said he called Retchin's chambers to find out why someone in Magbie's condition would be in jail. The doctor wanted a court order to have Magbie sent to the hospital but told investigators that the judge said she could not take that action. Magbie was returned to Greater Southeast on the morning of Sept. 24, again with breathing problems. The Health Department said it found "no documentation" that the nursing staff kept doctors informed as his condition worsened. Medical records show that a doctor was brought in at 5:40 p.m. when Magbie was in respiratory distress; his breathing tube had become disconnected. Doctors reattached the tube, but Magbie died within an hour. Staff writers Nicole Fuller and Cheryl W. Thompson contributed to this report. Copyright 2004, The Washington Post Co. All Rights Reserved.


12-17-2004, 07:40 AM

Dealing with Meth in Michigan: Allegan County Targets Addicted Inmates for Treatment By Meghan Mandeville (, News Research Reporter Tucked away, hidden within the rural landscape of Allegan County, Michigan, lie methamphetamine laboratories - breeding grounds for a drug that has left a portion of the population there addicted, and oftentimes incarcerated, for meth-related crimes. While the county has been grappling with the issue for the past few years, a new treatment program aimed at helping meth-addicted offenders kick the habit has criminal justice officials optimistic that they can reduce the number of people who are returning to the county jail as a result of their substance abuse problem. Modeled after treatment programs like Alcoholics Anonymous and Narcotics Anonymous, the Allegan County meth treatment program is designed to both reduce overcrowding at the jail by diverting offenders before their sentences are complete and help addicts to recover so they will not reoffend. "In Michigan, Allegan County, unfortunately, is the hotbed for meth labs and meth activity," said Sergeant Mike Larsen, who coordinates the programs division of the Allegan County Sheriff's Department. "We are a rural county [and] we have a lot of state game areas that are conducive to setting up labs and cooking the drug." According to Larsen, since Allegan County has many farming communities, anhydrous ammonia, a form of nitrogen fertilizer that is a main ingredient of the drug, is readily available for people to steal and transform into meth. In fact, he said, meth has become such a problem in the southwestern Michigan county that roughly 15-20 percent of the jail's inmate population is incarcerated for crimes related to it. With the problem growing, the county realized that it needed to take steps to address meth addiction and crime. "The sheriff had obviously noted it as a problem [and] we took great lengths on the law enforcement side to curb the problem," Larsen said. But with so many offenders returning to jail time and time again for meth-related crimes, the county decided that corrections needed to get involved. "We realized that the law enforcement and corrections community needed to do what it could to help these people get over the addiction," Larsen said. "The level of addiction is so high that we [know] most people are not capable of defeating the drug or the activities that go with it on their own." Finding Solutions To assess this problem and brainstorm possible solutions, in 2002, the county created a task force, which included corrections and law enforcement personnel, drug treatment providers, circuit and district court staff and citizens. "We pooled everyone together to get a general perspective on what and how we could offer treatment that would, hopefully, [help offenders] defeat the addiction," Larsen said. From the task force's research and ideas, a five-phase, cognitive behavioral and substance abuse treatment program emerged at the Allegan County Jail in June of 2004. According to Larsen, it's essentially a variety of elements from different treatment models bundled together and geared specifically towards people who are addicted to meth. "Basically, what we have done is we have stolen from every semi-successful or very successful program and assembled it all into one," said Larsen. Offenders are identified for the program by a circuit court probation agent, who handles every meth-related felony case, according to Larsen. After considering an offender's offense and background, the probation officer decides whether or not to recommend people to the program. If an offender is recommended for the program, a judge must agree to his placement in it. Then a review team, which, according to Larsen, is a smaller version of the task force, votes on whether or not to accept the candidate into the program. According to Larsen, during the process, offenders are screened to determine if they recognize that they have a problem and are willing to accept help. Offenders must also be non-violent and eligible for placement into the program based on the state's sentencing guidelines and statutes, he said. Because of the state's sentencing guidelines and the Michigan Community Corrections Act (511), through which the program is currently funded, Larsen said that of the 17-22 people who are in jail for meth-related crimes at any given time, only about two or three of them qualify for the program. Recently, however, the Sheriff's Department received a $94,000 grant from the state Department of Community Health's Office of Drug Control Policy, which will enable the program to expand to include offenders who do not qualify for it based on 511 requirements. "We've heard that the statistics for recovering from a meth addiction are very low," said Nancy Becker Bennett, Manager of the Division of Law Enforcement for the Michigan Department of Community Health's Office of Drug Control Policy. "We're hoping to reduce that number." Offenders who are accepted into the program begin Phase I when they enter the jail. During this initial period, which lasts for a minimum of 45 days, inmates receive group and individual counseling three times per week and are assigned homework that they are required to complete in the interim. After finishing Phase I, which typically takes about 60 days, Larsen said inmates are eligible for release from the facility. In Phase II, offenders are coming back into the jail to receive services for a minimum of five months. While some do remain incarcerated during this phase, most are living on their own in the community. According to Larsen, aside from being required to return to the jail to participate in group and individual treatment sessions, the offenders also must attend meetings in the community, like AA and NA, and provide documentation of their attendance there. They must also submit to random drug testing, have a payment plan for court fees and restitution and be working or in school. "Any violation of the program rules is technically a probation violation, in which the judge can send them to prison," Larsen said. Upon successful completion of Phase II, offenders transition into Phase III of the meth treatment program, which lasts for no less than six months. During this period of time, offenders are focusing on maintaining the skills they have developed and the behavioral changes they have made during the first two phases. They return to the jail at least once a week for group sessions and to meet with a case manager and keep journals to monitor their daily activities. Once offenders have completed the first three phases of the program, they enter Phase IV. This three-month period is meant to reinforce the life changes they have made throughout the program. "It kind of weans them out of the process," Larsen said. Offenders graduate from the program during Phase V; although they are released from the requirements of the program at that point, Larsen said, they are still monitored and evaluated until the 24th month of their participation, even if they have completed all of the phases in less time. Larsen added that offenders can be sent back to previous phases if they have not successfully moved forward through the program. And, he said, in order for offenders to make progress through the program, the review team must approve their advancement at each level. A Growing Focus There are currently only six people taking part in the program now, all of whom are living in the community at this point Larsen said, noting that, for each offender, the program has already spared them an average of 90 days in jail. The additional grant money from the state will enable the program to expand to serve about 20 offenders, starting in 2005, he added. In addition, a full-time case manager will be hired next year to better meet offenders' needs. "My hopes are that we are going to see the average daily population of meth-related offenders decrease significantly," Larsen said. And the ultimate goal of the program is to help offenders recover from their meth addictions in Allegan County. "There's a very intensive level of requirements on them to get through the program," Larsen said. "It mimics the amount of energy they used to put into meth - now they have to put it into completing the program." Resources: Larsen (269) 673-0500


12-17-2004, 07:56 AM

I lived in Allegan ,Alegan County Michigan for 8 years until I moved to BC and yes there is a lot of farming and state land there but you know .. It is also a nice place to live.Allegan is a quaint little town and a clean town.My kids and I miss our friends and family there .Just wanted to post so that not everyone reading this thinks it is completely drug and crime ridden area.Its a community where you can go away and leave your door unlocked and not worry about it..We lived 2 miles out of town and also right in town and NEVER had a problem :D


12-17-2004, 12:06 PM

I live in CA and we've had meth here since I can remember. All the rehabs are FILLED w/ meth addicts. Its a sick and sad drug. I was amazed years back that it wasn't as prolific in other parts of the country but thanks to the internet and the ease of gaining access to the recipes, its just moved across the states like a plague. The drug you get now tweaks your mind so much more than they did 20 years ago. More people smoke it than ever before and are even turning to rigs. Meth has ruined more lives that I know personally than I care to count. Thanks for posting this

Doc's Sis

01-05-2005, 11:47 AM

Do a search for the Board of Nursing in the state in which you live and send them an email about lack of medical care. Also find email address, phone, address of your Dept. of Corrections main office. Such info should be at their web site I contacted OH Nursing Board and got immediate response. The person who responded to my email CCd 3 or 4 people at DOC office in Columbus! Within 24 hours, my brother was moved and a couple of other fellows were taken to a hospital (where they should have been taken days earlier) and an investigation was started! The medical staff at all prisons must follow guidelines or they (RNs and MDs) could be fined and/or lose license! I then wrote up a grievance against one particular nurse. Haven't yet heard what they did about her, but she doesn't belong there, supposedly taking care of ill men.


01-10-2005, 07:16 AM

2004 Healthcare Year in Review By Corrections Connection News Network A variety of healthcare issues affected corrections in 2004. Practitioners in the field faced many challenges relating to HIV treatment, mental health, and the aging inmate population. The Corrections Connection reported on each of these topics over the past year; a summary of our correctional healthcare coverage is presented below. HIV Elderly Offenders Mental Health Keeping Offenders Healthy Rape HIV While in-house HIV treatments have greatly benefited offenders across the U.S. in the past decade, paroled HIV-positive offenders still face great difficulties as they transition back into the community. Two innovative programs in Illinois and Florida began in 2004 to ensure the health of HIV-positive parolees. The Illinois Public Health Corrections and Community Initiative, a five-year demonstration project, began in 1999 with the goal of supporting HIV-positive offenders who are reintegrating to Chicago and surrounding communities by providing them with intensive case management services. The project, which wrapped up in late September, was a huge success, said Kendall Moore, Director of the HIV Continuity of Care, STD/HIV Prevention and Care Program for the Chicago Department of Public Health. "We showed if these folks could afford these types of services in the community, it would certainly cut down on the increasing rate of HIV in this population," Moore said. "It would also cut down on recidivism. [The program has] been a huge success, not just for Chicago, but for the state of Illinois. They are currently in development of a state continuity of care system similar to this demonstration project." The Florida Department of Corrections recently initiated a similar program to help HIV-positive offenders carry on productive, healthy lives after their release. Like the Illinois program, the Florida Department of Corrections' Pre-Release Planning Program provides HIV-positive parolees with an intensive support system both before and after release. Through the program, HIV-positive parolees receive extensive guidance from DOC planners who help connect them with community services. "[Once offenders are released,] we allow community organizations to take the lead. Our job is to be sure that they are getting what they need," said Graham Smith, Medical and Health Education Director for the Florida DOC. "The belief when we first entered into this program was that with the appropriate social support system on the outside that it would reduce people returning [to prison], which it has [done]," he said. This program, like the Illinois Public Health Corrections and Community Initiative, has successfully helped HIV-positive offenders live healthy lives after their release, Smith said. Elderly Inmates While helping HIV-positive offenders to transition into the community continues to be an important issue in healthcare, meeting the needs of elderly offenders is a long-term issue as well. Department of Justice figures from 2003 show that the number of incarcerated offenders 55 and older has risen 85 percent since 1995 and estimates are that it will continue. "[The inmate] population is getting more vulnerable and [therefore] has increasing medical needs," said Herbert Hoelter, cofounder and chief executive officer of the National Center on Institutions and Alternatives, which has studied the elderly offender problem. To address this issue, many corrections agencies have either built prison nursing home facilities or designated special units for aging offenders in existing facilities in order to provide more specialized care. One example of this expanded care for elderly offenders comes from the Correctional Services Canada, which over the past 10 years has changed requirements for the older inmates it confines. According to Julie Keravel, Director of Institutional Reintegration Operations, CSC tries to meet the physical and mental needs of the older offenders who are being housed in its correctional facilities. In some cases, she said, facilities have been altered so that they accessible for those inmates who are in wheelchairs and special bars have been added in some showers for offenders who require extra support. Also, Keravel said, older offenders with limited physical abilities are not required to do heavy lifting or difficult manual labor as part of their work assignments. In the past few years, corrections officials in the U.S. and Canada have also seen that the transition back into the community is especially difficult for elderly offenders who are often unfamiliar with modern society. In 2004, California's SCAN Health Plan and Friends Outside in Los Angeles County began to develop a program to carve a path back into the community for offenders over the age of 55. "They're coming into a whole different world," said Kit Donaldson, vice president of programs for Friends Outside in Los Angeles County. "Their thought process is going to be different - they might not even know what an ATM-Debit card is," she said. "You just don't know what the prisoner is going to come out to." In early 2005, the program will conduct focus groups with older, released offenders and their families to determine what types of issues they are faced with during re-entry and how to help ease this transition. "They'll be coming out with somebody there to help them," Donaldson said. "They won't be coming out into society with nothing." Mental Health While agencies make changes to better serve the aging inmate population, mentally ill offenders continue to be treated in a dramatically different manner from state to state. Corrections agencies need to focus on good screening at intake, said Jeffrey Metzner, a forensic psychiatrist with the University of Colorado Health Sciences Center, an author on correctional psychiatry and a contributor to several NCCHC health guidelines and publications. "One of the things you need to do is have a process in place that adequately screens and identifies people who need mental health services. Then you need to have different levels of care and continuity of care," Metzner said. Beyond this, Metzner thinks that corrections agencies need to also work with the community to ensure that when these offenders are released from incarceration they have access to adequate services so that they remain out of trouble and, ultimately, out of the criminal justice system. "At a minimum, we have to do a better job of communicating with the courts at the front end and at back end with community providers. I think the mind set just needs to change in the community," said Tom Fagan, Chair of the Board of Directors for the National Commission on Correctional Healthcare. At a time when the deficiencies in many states' mental health care practices were voiced, a new community partnership program was created in Illinois to treat offenders' mental health problems in an innovative way without crippling the finances of correctional facilities. In 2004, the Illinois Department of Corrections partnered with Argosy University to provide interns to the DOC to assess and treat inmates' mental health issues. By adding additional, highly qualified manpower to its staff, the Illinois DOC has been able to provide better mental health services to more of its inmates by testing everyone coming through the door for mental health problems, said Tracy Robinson, Director of Clinical Training for the Illinois School of Professional Psychology at Argosy University/Chicago Northwest. This enables the DOC to effectively treat inmates and send people back into the community with a decreased likelihood of reoffense. "Hopefully, when they are released, they are going to be in a better place than when they came in," said Robinson. Two other programs to treat mental health problems resulted from a major lawsuit against the Ohio DRC in 1993, which alleged inadequate mental health care in the system. This lawsuit spurred the interagency collaboration that exists in the delivery of correctional mental health services in Ohio today. Some of the best examples in the DRC of continuity of mental health care are in two pilot programs that the agency has begun with community service providers in Cincinnati and Cleveland, said Reginald Wilkinson, Director of the Ohio Department of Rehabilitation and Corrections According to Wilkinson, the DRC has contracted with these local service providers to provide complete wrap-around services for persons with mental illness who are released from prison. These providers conduct interviews with the offenders while they are incarcerated and help set up a no-gap service delivery for after release. The partnership in the community is between adult parole and the community service providers. "The service provider is connecting with the [offender] candidates alongside our parole staff. The minute that person gets out of prison, the parole officer knows he is a participant in that particular program," he said. Wilkinson said the parole officer is key to ensuring that the community service delivery keeps flowing. To support this, the DRC has trained parole officers to deal specifically with a mental health caseload and to specialize in managing these offenders. "We anticipate this is a model that can be replicated around the state. We're hoping that funds can be saved by reducing recidivism," said Wilkinson. To help other states find ways to effectively treat mentally ill offenders, the NCCHC published new guidelines in 2004. The guidelines were meant to help agencies understand the recommended goals for treatment and how to accomplish them. "The commission was trying to establish a clear community standard that could work in a correctional environment. There was a thought that we had done a nice job with several medical problems but had not addressed any of the significant mental health problems," said Fagan, who was involved in the development of the guidelines. Correctional practitioners are concerned as well. Wilkinson believes that it is only a matter of time before more agencies begin to put comprehensive mental health treatment programs in place. "One of the biggest reason to [treat this population] is a public safety component," said Wilkinson. "We don't want people with mental illness to continue to victimize more people. [And,] if it's because of a mental illness, then it is something we can control. The philosophy is that public safety is public health and public health is public safety." Keeping Offenders Healthy While developing effective programs to help mentally ill offenders continued to be a priority in 2004, so too was the push to maintain the physical health of offenders while incarcerated and beyond. According to Barbara Wakeen, a registered licensed dietitian, correctional systems are beginning to successfully incorporate nationally recognized dietary standards into correctional menus. Yet Wakeen suggested that if more states and jails instituted a "heart healthy" menu, it could lead to fewer specialized diets and healthier inmates overall. A heart healthy diet as promoted by the American Heart Association consists of foods high in fiber and low in saturated fat, sodium, and cholesterol. While many states already serve healthy heart meals to inmates, Wakeen advocated the use of these kinds of diets in all correctional facilities. "It's important to take the proactive approach to prevention instead of just maintaining health," Wakeen said. Concern over the accuracy of medical meals also came to the forefront in 2004. This year saw the establishment of a Washington State program that directly addresses this concern by implementing the Universal Diet Card, a system that ensures consistency in the diets of offenders. According to Cheryl Johnson, Registered Dietitian and Food Program Manager for the Washington State Department of Corrections, the program "successfully reduces costs while also ensuring the dietary health of offenders." By laminating an inmate's dietary needs to the back of each identification badge, prison officials ensure that the inmate's diet remains consistent no matter how often he is transferred from prison to prison. According to Johnson, inmates now receive the right meal every time they come through the chow line, which helps to maintain the inmates' health. Johnson recommends the program to prison systems across the nation. "It has real medical implications, especially with the cost of healthcare on the rise," she said. Two other programs instituted in 2004 partner with the community to help offenders remain healthy after their release. The Edward Harris men's evening clinic, run by the Whittier Street Health Center in Boston, Mass., accommodates the specific health concerns of urban-centered adult males, providing services from primary care, eye care and a dental clinic to more preventive measures, such as prostate cancer screenings, HIV counseling and testing and a diabetes clinic to ex-offenders. Joe Rowell, the clinic's post-prison release Program Coordinator, said sky-high medical bills and overconfidence are what prevent Boston's men of color, including ex-offenders, from paying regular visits to the doctor. "We are targeting all kinds of male populations, including ex-offenders and victims of AIDS and hepatitis C," Rowell said. The second such program is the Wisconsin Department of Corrections' innovated partnership with the Advanced General Dentistry Program at Marquette University. This partnership seeks to offer offenders much-needed dental services and provide students with hands-on work experience. Typically, the inmates visit the dental school for cleanings and fillings. Having Marquette students take care of these types of inmate dental needs is a huge help to the DOC, which is already shortstaffed when it comes to dental professionals, with only 24 dentists and 12 dental hygenists for all of the institutions. "I think it is a great opportunity for both organizations," said Dr.Barbara Ripani, Dental Director for the Wisconsin DOC. "We are very grateful to have additional treatment help. We don't have a facility that would be able to handle all of these inmates." Rape Another issue that corrections workers continue to face is inmate rape. Since the Prison Rape Elimination Act was passed by Congress in December 2003 with the goals of gathering national information about the problem and helping states to combat inmate sexual assaults in their correctional facilities, many states have made this issue a priority. The Ohio Department of Rehabilitation and Correction's campaign to help prevent the sexual abuse of inmates is one of the many programs instituted in 2004 to increase awareness about this problem. "We really wanted to tackle it head on," said Thomas Stickrath, Assistant Director of the Ohio DRC. "We've made [addressing prisoner rape] a priority. We've been very public about it, both within our organization as well as externally." The agency's Ten Point Plan called for the creation of several committees to help develop goals for the future. Additionally, enhanced staff training has already begun for both new employees, who are educated about inmate sexual abuse during their orientations, and current staff members, who receive the training during their annual in-service sessions. While staff are educated about how to end rape in correctional facitilies, so, too are the inmates. According to Stickrath, the DRC has created literature that is being disseminated to all offenders. Furthermore, the Plan calls for a process improvement team to examine the issue of under-reporting. As we head into 2005, correctional healthcare providers will continue to face issues associated with HIV treatment, mental health, the aging inmate population, rape and the like. Undoubtedly, new concerns will also emerge for healthcare practitioners working in the field. As developments and problems unfold, The Corrections Connection Network News will bring you information about the many facets of correctional healthcare.

Truth Seeker

01-13-2005, 12:21 PM

CORDARO's TICKER Gist of an article about a case of medical care in a US jail, by Justin Kendall in "Cityview", Des Moines, Ohio, USA, 1.1.2005 Peace activist Frank Cordaro is for the xth time in jail this time doing 30 days for trespassing at the Iowa National Guard Armory. This vacation in the Polk County Jail took a nasty turn when he wasn't allowed to bring his prescription heart medication with him. He's been taking heart medication daily after a serious heart attack almost killed him three years ago. He had his pills and a doctor's note with him but it took three days of frantic telephone call by often influential friends before he was finally given his medication. Iowa Civil Liberties Union Executive Director Ben Stone says: "Cordaro's isn't the first case of an inmate going without needed medical treatment. I get the county's reasons for screening the drugs. There's no guarantee of what's in a pill bottle, and I certainly don't expect anyone to analyze every pill. But if everything's as Cordaro's friends say, there's something seriously wrong at the Polk County Jail, especially when someone goes three days without the medicine he needs to live. If Cordaro had suffered a heart attack and died, the county would be facing a wrongful-death lawsuit and an outraged public, especially after Mr Cordaro showed up at his sentencing with a doctor's note. And let's not forget about the poor schmucks without connections. Would they be shit out of luck? I hope not. Whatever the reason they're behind bars, no one should be without their medication. The county lucked out this time. Next time, it might not. Let's hope the problem is fixed before the county's luck runs out."


01-17-2005, 09:47 AM

'Sickly' Kids Could Have More Serious Condition Primary Immune Deficiency Often Not Detected UPDATED: 12:03 PM EST January 14, 2005 Some kids are sick all the time, and parents and doctors just leave it at that. But sometimes, the problem might be much more serious than just the sniffles.

Some children who get sick a lot are suffering from something called primary immune deficiency. As many as one in 300 children has some form of the condition, reported WCAU-TV in Philadelphia. Often the diagnosis is missed because the child's recurrent infections are fairly common. But it is important to get an early diagnosis because there are treatments to help keep these kids healthy and to help them live better and longer lives. Olivia Rader, 6, was born with a hole in her immune system. "A person with primary immune deficiency is unable to protect themselves from even common infections," said Dr. Jordan Orange, a pediatric immunologist at Children's Hospital of Philadelphia. Olivia goes through the same routine every month at the hospital. "What we're doing with this treatment is replacing that missing part of her immune system," Orange said. SURVEY Does your child get sick often? Yes, it seems like he/she is always sick. Yes, more often than other kids. No, my child is sick about as often as other kids. No, my child rarely gets sick. I don't have children. Results | Disclaimer

Olivia's mom, Patricia Rader, knew something was wrong when her daughter kept getting the same infections over and over. "She spent at least once a month at our local hospital," Patricia Rader said. "The main reason that these things would go undetected, is oftentimes they just get written off to this being a particularly sick child," Orange said. That's what happened with Cathy Schorn's oldest son, Eddie. As a baby, he had frequent stomach infections, ear infections and pneumonia. "Our pediatrician actually told us that the reason he was sick was because he was in day care, so I pulled him out of day care (and) he continued to get sick," Schorn said. The puzzle started coming together when Eddie's younger brother, Andrew, was taken to the Children's Hospital's emergency room with pneumonia as an infant. "The doctors started questioning us about Eddie. We said, 'Wait a minute, we're here with Andrew. Why are you asking us about Eddie?' They said, 'Just bear with us, tell us all about him, what has he been sick with, how many times?'" Schorn said. Andrew and Eddie both had the same type of inherited primary immune deficiency. Their little brother, Nicholas, was tested at birth. His condition was then treated before he got sick. Like Olivia, the Shorn boys will get monthly treatments forever to prevent infections and long-term damage. "Most notoriously, it can damage the lungs. I certainly have seen teenage children that have the lungs of 70-year-old people," Orange said. Here are some of the warning signs that a child might have a primary immune deficiency: Eight or more ear infections or pneumonias in one year Two months or more on antibiotics that have little effect Recurrent skin abscesses If your child has any of these signs, talk to your pediatrician about a test for primary immune deficiency. Fact Sheet: Primary Immune Deficiency Distributed by Internet Broadcasting Systems, Inc.


01-17-2005, 09:48 AM

Medical Advances Take Guesswork Out Of Diabetes Treatment Designer Insulins, Injectable Pens Among Options UPDATED: 9:58 AM EST January 17, 2005 RALEIGH, N.C. -- In the old days, many diabetics had to do a lot of guessing about when they needed an insulin dose and how much they needed. But new designer insulins and equipment take the guesswork out of staying healthy.

Instead of injecting insulin with a syringe, a pager-sized pump can deliver insulin throughout the day and before meals.

Every meal for Lyndsey Beutin involves decisions not just about what to eat, but how much insulin she will need, reported WRAL-TV in Raleigh. "The pump is just connected to me. I wear it all over, but right now, it's on my back," she said. Four years ago, Lyndsey learned she had type 1 diabetes, an insulin deficiency that keeps her body from absorbing blood sugar. She used to inject insulin with a syringe. Now, a pager-sized pump delivers the insulin she needs throughout the day and before meals.

Inside Diabetes What Is It? Treatment Options Medication Take Control Preventing Complications Diet Considerations Diabetic Kids Spread Word Diabetes And Kids

"The pump really makes eating a lot more flexible," Beutin said. However, health experts claim insulin pumps are not for everybody. "Insulin pumps are very expensive, typically about $7,000 for the initial pump and the training and education to learn how to use it," said Dr. Susan Spratt, an endocrinologist at Duke University Medical Center. Spratt supplies many of her patients with insulin pens. Several doses are stored inside. One can dial up the number of units needed and inject. Spratt also recommends several designer insulins. Some provide a day's worth of insulin in one shot, while others are absorbed quickly to cover an unplanned meal. Glucose monitors are getting more high-tech. Some use an infrared beam to send results to an insulin pump. Beutin does not have the high-tech equipment, but she said she is happy with what she has got. "[It] really makes life a whole lot easier," she said. Spratt believes the day is coming soon when insulin-dependent diabetics can get glucose monitors that show the rise and fall in blood sugar in real time, which will take a lot of guesswork out of keeping the right amount of insulin in the blood. Distributed by Internet Broadcasting Systems, Inc.


01-26-2005, 08:37 AM

Influenza leaves two prisoners critically ill The Atlanta Journal and Constitution; 1/25/2005; CARLOS CAMPOS STAFF Two Middle Georgia prison inmates were hospitalized in critical condition Monday after contracting influenza, Department of Corrections officials said. The inmates are both older than 60 and had pre-existing respiratory illnesses --- two conditions that put them in a high- risk category for susceptibility to the flu, Georgia prison officials said. Both of the men are in intensive care at Oconee Regional Medical Center in Milledgeville, and one of them is breathing with a ventilator, said Georgia Department of Corrections spokeswoman Scheree Lipscomb. Thirty-one inmates at Men's State Prison in Hardwick --- near Milledgeville --- became ill with flu-like symptoms over the weekend, Lipscomb said. Men's State Prison holds about 650 inmates, most of whom are either elderly or chronically ill. Prisons are particularly susceptible to infectious diseases due to close living quarters. Lipscomb would not say whether the inmates with symptoms received flu shots. The Department of Corrections, like other public agencies and private health care providers, had trouble securing flu vaccine last year. After vaccine maker Chiron Corp. lost its license in Britain in October, flu shots became scarce in the United States. As a result, health officials recommended that the vaccine be given only to people at highest risk of getting the flu, including those older than 64, children 6 to 23 months old, chronically ill adults and children, and health workers. As more vaccine has become available, the CDC has added healthy adults age 50 and up to the list of people who should get shots. The department, which incarcerates more than 48,000 inmates, got 10,000 doses, she said. Prison health care officials used Centers for Disease Control and Prevention guidelines to determine which inmates were considered high-risk and applied the vaccines accordingly, Lipscomb said. The prison system has acquired another 400 doses which will be used to vaccinate the inmates and staff at Men's State Prison, she said. (Copyright, The Atlanta Journal and Constitution - 2005)


02-06-2005, 02:46 PM

Do you have the link to this article? PAK


02-08-2005, 06:14 AM

Sorry but I don't. I posted it when I read the article. I did check their website but the article is no longer posted on their site.


02-23-2005, 05:20 PM

QC jail inmates fear spread of mystery disease.(Metro & National News) Manila Bulletin; 2/20/2005 Byline: RICO C. NAVARRO Inmates of Quezon City Jail, fearful of an outbreak of diseases in the facility, urged the Department of Health (DOH) to conduct an investigation to determine the real cause of death of two prisoners who died after complaining of severe stomach pain. The inmates said that they believed that a mysterious disease or virus struck the two inmates because they both died after complaining of severe stomach pain or both died of the same symptoms. "Nagtataka kami kung ano ang ikinamatay ng dalawa naming kasama dito dahil pareho silang bigla na lang sumakit ang tiyan bago namatay," inmates said. Last February 14, an inmate identified as Rolando Palma, 28, of Block 30, Woodpecker St., Rolling Meadows II, San Bartolome, Novaliches, Quezon City, died after spitting blood shortly after complaining of severe stomach pain. The incident was repeated Friday night when Gerardo Adona, 40, single of Old Balara, Quezon City also died of severe stomach pain. They were both rushed to the East Avenue Medical Center. They both died hours after being treated of the mysterious disease. Record showed that Adona was arrested last June 1, 2004 by operatives of Central Police District Office (CPDO) for drug pushing while Palma was nabbed last February 1, 2004 for theft. Inmates said the the two victims complained of severe stomach pain days before they were rushed to the hospital. The families of the two victims also urged the authorities to conduct an autopsy to determine the real cause of death of the two inmates. COPYRIGHT 2005 Manila Bulletin Publishing Corp.


02-27-2005, 10:28 AM

( lions%2Findex%5Fnyt%2Ehtml%20) February 27, 2005 Private Health Care in Jails Can Be a Death Sentence By PAUL von ZIELBAUER Brian Tetrault was 44 when he was led into a dim county jail cell in upstate New York in 2001, charged with taking some skis and other items from his ex-wife's home. A former nuclear scientist who had struggled with Parkinson's disease, he began to die almost immediately, and state investigators would later discover why: The jail's medical director had cut off all but a few of the 32 pills he needed each day to quell his tremors. Over the next 10 days, Mr. Tetrault slid into a stupor, soaked in his own sweat and urine. But he never saw the jail doctor again, and the nurses dismissed him as a faker. After his heart finally stopped, investigators said, correction officers at the Schenectady jail doctored records to make it appear he had been released before he died. Two months later, Victoria Williams Smith, the mother of a teenage boy, was booked into another upstate jail, in Dutchess County, charged with smuggling drugs to her husband in prison. She, too, had only 10 days to live after she began complaining of chest pains. She phoned friends in desperation: The medical director would not prescribe anything more potent than Bengay or the arthritis medicine she had brought with her, investigators said. A nurse scorned her pleas to be hospitalized as a ploy to get drugs. When at last an ambulance was called, Ms. Smith was on the floor of her cell, shaking from a heart attack that would kill her within the hour. She was 35. In these two harrowing deaths, state investigators concluded, the culprit was a for-profit corporation, Prison Health Services, that had moved aggressively into New York State in the last decade, winning jail contracts worth hundreds of millions of dollars with an enticing sales pitch: Take the messy and expensive job of providing medical care from overmatched government officials, and give it to an experienced nationwide outfit that could recruit doctors, battle lawsuits and keep costs down. A yearlong examination of Prison Health by The New York Times reveals repeated instances of medical care that has been flawed and sometimes lethal. The company's performance around the nation has provoked criticism from judges and sheriffs, lawsuits from inmates' families and whistle-blowers, and condemnations by federal, state and local authorities. The company has paid millions of dollars in fines and settlements. In the two deaths, and eight others across upstate New York, state investigators say they kept discovering the same failings: medical staffs trimmed to the bone, doctors underqualified or out of reach, nurses doing tasks beyond their training, prescription drugs withheld, patient records unread and employee misconduct unpunished. Not surprisingly, Prison Health, which is based outside Nashville, is no longer working in most of those upstate jails. But it is hardly out of work. Despite a tarnished record, Prison Health has sold its promise of lower costs and better care, and become the biggest for-profit company providing medical care in jails and prisons. It has amassed 86 contracts in 28 states, and now cares for 237,000 inmates, or about one in every 10 people behind bars. Prison Health Services says that any lapses that have occurred are far outnumbered by its successes, and that many cities and states have been pleased with its work. Company executives dispute the state's findings in the upstate deaths, saying their policy is never to deny necessary medical care. And they say that many complaints - from litigious inmates, disgruntled employees and overzealous investigators - simply come with the hugely challenging work they have taken on. "What we do," said Michael Catalano, the company chairman, "is provide a public health service that many others are unable or unwilling to do." The examination of Prison Health also reveals a company that is very much a creature of a growing phenomenon: the privatization of jail and prison health care. As governments try to shed the burden of soaring medical costs - driven by the exploding problems of AIDS and mental illness among inmates - this field has become a $2 billion-a-year industry. It is an intensely competitive world populated by a handful of companies, each striving to find enough doctors and nurses for a demanding and sometimes dangerous job. The companies, overseen by local governments with limited choices and money, regularly move from jail to jail, and scandal to scandal - often disliked but always needed. Perhaps the most striking example of Prison Health's ability to prosper amid its set of troubles unfolded in New York State. Despite disappointed customers and official investigations in Florida and Pennsylvania, the company still managed to win its largest contract ever in 2000, when New York City agreed to pay it $254 million over three years to provide care at the correctional labyrinth on Rikers Island. The city, in fact, just renewed that deal in January for another three years - despite the deaths upstate, and a chorus of criticism over Prison Health's work at Rikers, where employees and government monitors have complained of staff shortages and delays in drugs and treatments for H.I.V. and mental illnesses. A rash of suicides in 2003 prompted a scramble by officials to fill serious gaps in care and oversight. Along the way, though, Prison Health has acquired at least one tenacious adversary. The State Commission of Correction, appointed by the governor to investigate every death in jail, has moved over the last several years from polite recommendations to bitter denunciations, frustrated by what it says is the company's refusal to admit and address deadly mistakes. The commission has faulted company policies, or mistakes and misconduct by its employees, in 23 deaths of inmates in the city and six upstate counties. Fifteen times in the last four years, it has recommended that the state discipline Prison Health doctors and nurses. And since 2001, the commission, along with the State Education Department, which regulates the practice of medicine, has urged Attorney General Eliot Spitzer to halt the company's operations in New York, saying that Prison Health lacks any legal authority to practice medicine because business executives are in charge. New York, like many other states, requires that for-profit corporations providing medical services be owned and controlled by doctors, to keep business calculations from driving medical decisions. Prison Health says its work in New York is legal because it has set up two corporations headed by doctors to run medical care. But state investigators have called those corporations shams. Elsewhere, Prison Health did not go that far, until questioned by The Times. Now it says it is creating doctor-run corporations in 11 other states with similar laws, including New Jersey and California. "Had we realized this would be a question, we would have addressed it earlier," said Mr. Catalano, the company's chairman. "We have nothing to hide here." But in one report after another, the state commission has exposed what it says is the dangerous way Prison Health has operated. One investigation found that the doctor overseeing care in several upstate jails in 2001 - continually overruling the doctors there, and refusing drugs and treatments - was not even licensed to practice in New York State. He did the job, the commission found, by telephone - from Washington. The commission's gravest findings have involved deaths on the company's watch, mostly of people who had not been convicted of anything. Candy Brown, a 46-year-old Rochester woman jailed in 2000 on a parole violation, died when her withdrawal from heroin went untreated for two days as she lay in her own vomit and excrement in the Monroe County Jail, moaning and crying for help. But nurses did not call a doctor or even clean her off, investigators said. Her fellow inmates took pity and washed her face; some guards took it on themselves to ease her into a shower and a final change of clothes. Scott Mayo Jr. was only a few minutes old in 2001 when guards fished him out of a toilet in the maternity unit of Albany County Jail. It was the guards, investigators said, who found a faint pulse in the premature baby and worked fiercely to keep his heart beating as a nurse stood by, offering little help. "We're a jail," the nurse told state officials after the infant died. "There's no equipment for a fetus. Or a newborn." In at least one death report, the commission took the opportunity to voice a broad indictment of the company. Frederick C. Lamy, chairman of the commission's medical review board, denounced Prison Health, or P.H.S. as it widely known, as "reckless and unprincipled in its corporate pursuits, irrespective of patient care." "The lack of credentials, lack of training, shocking incompetence and outright misconduct" of the doctors and nurses in the case was "emblematic of P.H.S. Inc.'s conduct as a business corporation, holding itself out as a medical care provider while seemingly bereft of any quality control." In its review of Prison Health's work, The Times interviewed government regulators, law enforcement officials and legal and medical specialists, including current and former company employees. The review included thousands of pages of public and internal company documents, state and city records, and every New York State report on deaths under the company's care. The examination shows that in many parts of the country, including counties in New Jersey and Florida, Prison Health has become a mainstay, satisfying officials by paring expenses and marshaling medical staffs without the rules and union issues that constrain government efforts. But elsewhere, it has hopscotched from place to place, largely unscathed by accusations that in cutting costs, it has cut corners. Georgia, which hired Prison Health in 1995, replaced the company two years later, complaining that it had understaffed prison clinics. Similar complaints led Maine to end its contract in 2003. In Alabama, one prison has only two doctors for more than 2,200 prisoners; one AIDS specialist, before she left this month, called staffing "skeletal" and said she sometimes lacked even soap to wash her hands between treating patients. In Philadelphia's jails, state and federal court monitors in the late 1990's told of potentially dangerous delays and gaps in treatment and medication for inmates under Prison Health, which nonetheless went on in 2000 to win a contract not far away in the Baltimore City Detention Center. There, two years later, the federal Department of Justice reported that better care might have prevented four inmate deaths. One guard, it said, complained that she had to fight nurses to get sick inmates examined. Such stories can be heard around the country. In Las Vegas, after an H.I.V.-positive inmate died in 2002, nurses and public defenders said the county jail's medical director had refused medications for AIDS and mental illness, calling inmates junkies. In Indiana, Barbara Logan, a former Prison Health administrator who filed a whistleblower suit last year, said in an interview that the pharmacy at her state prison was so poorly stocked that nurses often had to run out to CVS to refill routine prescriptions for diabetes and high blood pressure. Before Prison Health even started in Georgia, there had been several inmate deaths in neighboring Florida that cost the company three county contracts, millions of dollars in settlements - and an apology for its part in the 1994 death of 46-year-old Diane Nelson. Jailed in Pinellas County on charges that she had slapped her teenage daughter, Ms. Nelson suffered a heart attack after nurses failed for two days to order the heart medication her private doctor had prescribed. As she collapsed, a nurse told her, "Stop the theatrics." The same nurse, in a deposition, also admitted that she had joked to the jail staff, "We save money because we skip the ambulance and bring them right to the morgue." A Tough Business: Taking On Headaches, and Creating Some, Too Few jobs are harder to get right than tending to the health of inmates, who are sicker and more dependent on alcohol and drugs than people outside. AIDS and hepatitis have torn through cellblocks, and mental illness is a mushrooming problem. In the last decade, state and local government spending for inmate health care has tripled nationwide, to roughly $5 billion a year. Qualified doctors and nurses are difficult to find, as jails are hardly the most prestigious or best-paying places to work. The potential costs of failure, though, are high - because most inmates will eventually be let out, along with any disease or mental illness that went untreated. For decades the task fell to state and local governments that typically lacked resources or expertise, acting in sometimes conflicting roles as punisher and medical protector. Often, the results were tragic. Three skeletons dug up at an Arkansas penal farm in 1968 led to the uncovering of a monstrous system in which a prison hospital served as torture chamber and a doctor as chief tormentor. The 1971 uprising at Attica state prison in upstate New York, which was sparked in part by complaints about health care, left 43 inmates and guards dead. The debacle unleashed a flood of prisoner lawsuits that culminated in a 1976 United States Supreme Court decision declaring that governments must provide adequate medical care in jails and prisons. But where governments saw a burden, others spotted an opportunity. Two years after the ruling, a Delaware nurse named Doyle Moore founded Prison Health, pioneering a for-profit medical-care industry that offered local officials a grand solution: hand off the headache. About 40 percent of all inmate medical care in America is now contracted to for-profit companies, led by Prison Health, its closest rival, Correctional Medical Services, and four or five others. Though the remaining 60 percent of inmate care is still supplied by governments, most often by their Health Departments, that number has been shrinking as medical expenses soar. A few big-city hospitals and other nonprofit enterprises have stepped into the fray, and while not perfect themselves, have performed the best by many accounts, bringing a sense of mission to the work. But that care usually costs more than governments want to spend, and most hospitals are neither equipped nor motivated to enter a jail or prison, where profit margins linger in the single digits. In this world, where governments are limited in their choices, a half-dozen for-profit companies jockey to underbid each other and promise the biggest savings. "It's almost like a game of attrition, where the companies will take bids for amounts that you just can't do it," said Dr. Michael Puisis, a national expert and editor of "Clinical Practice in Correctional Medicine," an anthology of articles by doctors. "They figure out how to make money after they get the contract." Businesses with the most dubious track records can survive, and thrive. When cost-trimming cuts into the quality of care, harming inmates and prompting lawsuits and investigations, governments often see no alternatives but to keep the company, or hire another, then another when that one fails - a revolving-door process that sometimes ends with governments rehiring the company they fired years earlier. Prison Health has mastered the game. When its mistakes have become public, the company has quietly settled lawsuits and nimbly brokered its exits by quickly resigning, thus preserving its marketable claim that it has never been let go for cause. Even dissatisfied government clients can be reluctant to discuss their complaints openly, or share them with other counties or states. Some fear being exposed to lawsuits and criticism; others worry that the company dropped this year may return next year as the only bidder for the job. Or, as some former Prison Health customers discovered to their dismay, the new company they hire may be bought by the company they fired. "You've got the professionals dealing with amateurs," said Dr. Ronald Shansky, a former medical director for the Illinois prison system. He said most sheriffs and jailers were not sophisticated enough about medicine to know what to demand for their money until things go wrong. Local laws requiring that contracts be regularly put out for bid - and go to the lowest bidder - can force officials to switch providers constantly, disrupting care and demoralizing staffs. Yet once they turn jail medicine over to an outside enterprise, governments rarely go back to providing it themselves. "It's like an article of faith that private is better," Dr. Shansky said, even though a 1997 study comparing government and for-profit prison care, commissioned by the Michigan Department of Corrections, found little difference in cost or quality. On this playing field, Prison Health has prevailed by thinking big, buying up competitors and creating a nationwide pharmacy to supply its operations. Its revenues have risen in the last decade to an estimated $690 million last year from $110 million in 1994, and its stock has leapt to $27.46 a share - its closing price on Friday - from a split-adjusted price of $3.33. But day by day, Prison Health - like all of its competitors - faces the most basic challenge: finding people to do the job. For openings in Philadelphia last year, it advertised on a Web page called the Job Resource. "Psychiatrists - Feel shackled to an unsatisfying job? Discover correctional medicine!" said one ad. A Las Vegas posting urged, "Come do some time with us!" Those who Prison Health hires wind up responsible for the legion of people locked up every day. When the doors shut behind them, the care those prisoners get is shuttered from public view. Deaths behind bars provoke scant outcry. But if the public has little information about inmates, and not much inclination to care, it may have even less sympathy for the notion that they should die for want of medical attention. Cutting a Lifeline: For Parkinson's Patient, a Countdown to Death Four days into his stay at the Schenectady County Jail, it all began to come apart for Brian Richard Tetrault. He could no longer walk the four steps from his bunk to the door of Cell 22, in A-block, where a nurse was waiting with his small ration of pills. Since his arrest, the state commission said, he had been denied most of the medication he had used for a decade to control his Parkinson's disease and psychological problems. The medical staff knew about his ailments from the day he arrived, soft-spoken and clutching a plastic pill organizer; they even phoned his doctor for his charts. But the jail's medical director took him off all but two of his seven medications, and nurses concluded that the new inmate was more uncooperative than ill, state investigators said. Mr. Tetrault, a former nuclear scientist at the nearby Knolls Atomic Power Laboratory, had only seven days left before an agonizing death that investigators would label "physician induced." He had grown up in the Albany suburbs, a hunter and amateur mechanic with a gift for mathematics. He joined the Navy, and spent a year on classified missions in a nuclear submarine. By 1990, he had a wife and two sons, a house on a lake and his pick of good-paying jobs in nuclear engineering. But try as he did to ignore its slow trespass, Parkinson's ruined everything. His sister Barbara first noticed how his hand shook during a game of pinochle. By 1995, Mr. Tetrault was popping prescription Sinemet tablets every two hours to counter the loss of dopamine, a brain chemical vital to muscle function. Every day became a battle with dyskinesia, the drug-induced tremors common to Parkinson's patients. "He'd call it 'disky,' " said Larry Broderick, a high school friend. "He'd say, 'I'm getting disky.' " By 2001, the disease had destroyed Mr. Tetrault's marriage and estranged his two teenage sons. His ex-wife, Eileen, had obtained an order of protection as he grew increasingly depressed and angry. That Nov. 10, he stormed into her home while she was away and snatched some items - skis and a push broom - before the police arrived and charged him with burglary and harassment. His mistreatment began that day, according to the state commission. Without seeing Mr. Tetrault, the jail's medical director, Dr. W. J. Duke Dufresne, prescribed Sinemet and an anti-ulcer drug, but none of the other five medications for his Parkinson's, pain and psychiatric troubles. On his second day in jail, Mr. Tetrault saw Dr. Dufresne, the only physician for the jail's 300 or so inmates. In a brief visit, the commission said, the doctor reduced even the Sinemet. As for the mental health drugs, Dr. Dufresne later told investigators that only a psychiatrist should prescribe them. But no one ever arranged for Mr. Tetrault to see the jail psychiatrist, the commission said. And never again did he see Dr. Dufresne, who told investigators he had believed that Mr. Tetrault was merely feeling the typical ups and downs of Parkinson's; he had planned to check on him in three months. Mr. Tetrault had only days. On his fourth day in jail, medical records show, he grew increasingly "disky" and belligerent, as his body withdrew from the medications that had sustained him for years. On the sixth day, he lay in his bunk, steeped in his own urine and unable to move. "Continues to be manipulative," a nurse wrote. On the seventh day, the commission said, nurses continued to look in on him, chronicle his deterioration and do little about it. "Inmate remains very stiff," one wrote. "Head arched back, sweating profusely," another noted. A third nurse forced him to walk to the jail clinic, though he could barely move. On the eighth day, alerted by a nurse's phone call, Dr. Dufresne ordered Mr. Tetrault hospitalized. At Ellis Hospital in Schenectady, emergency-room doctors diagnosed the ravages of his untreated Parkinson's. "I suspect, in the prison setting, he was not getting his full dose of medication as needed," wrote Dr. Richard B. Brooks. There was not much the hospital could do. On the 10th day, Mr. Tetrault went into septic shock. On the 11th, he died. The state commission ultimately referred Dr. Dufresne to the State Board for Professional Medical Conduct for what it alleged was "grossly inadequate" care, urged Prison Health to fire him and asked the county to fire Prison Health. The commission found that Dr. Dufresne had never given Mr. Tetrault a physical examination; and nurses had transcribed the doctor's orders incorrectly, reducing even the Sinemet. The medical conduct board has taken no action against Dr. Dufresne. The company, in its lawyer's response to the commission, disputed virtually all of the commission's findings, saying that Mr. Tetrault sometimes resisted taking his medication, and that he was well able to move when he wanted. The company's internal one-page review of Mr. Tetrault's care passed no judgment on the doctor or the nurses. But it did recommend six minor changes, like keeping medical records in chronological order. Dr. Dufresne, who is now the company's regional medical director for upstate jails, did not return calls seeking comment. Richard D. Wright, the president and chief executive of Prison Health, would not discuss details of the case, citing a lawsuit by Mr. Tetrault's son Zachary. He said that over all, Schenectady County "was extremely pleased with the work of the company." But the county moved to fire Prison Health the day after the commission's report was made public last June. "We were going to terminate them for cause," said Chris Gardner, the county attorney. "But they approached us and we mutually agreed to terminate the relationship." The humiliation of Mr. Tetrault did not end with his passing, or with Prison Health, the commission said. On the day he died, Nov. 20, 2001, sheriff's officials altered records to change the time of his release from custody, in the early evening, to 2:45 p.m. - 10 minutes before he was pronounced dead, the commission said. The Sheriff's Department denied the charge, and said it had done nothing untoward in trying to formally release Mr. Tetrault. But the commission said the time change allowed the department to avoid an investigation, at least for a while. Commissioners learned of Mr. Tetrault's death by reading a newspaper article about Zachary's lawsuit, 20 months later. The Revolving Door: After Trouble in Florida, Moving On, and Up If Schenectady County was learning hard lessons about Prison Health, it was old news in South Florida, where several counties had tangled, and re-tangled, with the company years earlier. By the time Pinellas County hired Prison Health in 1992, the company was hitting its stride. Fourteen years after its founding, it had established a wide beachhead in the state, and had just begun a nationwide push that by the end of the decade would put it in the three biggest cities of the Northeast and the prison systems of entire states. A year earlier, the company began selling stock under the name of a holding company, America Service Group. But for Pinellas, halfway down Florida's Gulf Coast, things were headed downhill. Everett S. Rice, who was sheriff then, said that Prison Health understaffed the county jail in Clearwater. The company seemed reluctant, he said, to send seriously ill inmates to hospitals, which could cost it thousands of dollars a day. Inmates were regularly showing up in court incompetent to stand trial, said Bob Dillinger, the county public defender, because they were not getting their psychiatric medicines. The sheriff's office learned that even the most basic care had to be spelled out in the contract. When one inmate died after a delay in calling for help, Mr. Rice said, the agreement was rewritten to require that Prison Health call 911 at a specific time after the start of a medical emergency. Then, in March 1994, came the death of Diane Nelson, who collapsed of a heart attack in front of the nurse whose words would echo in news reports: "We save money because we skip the ambulance." Saving money was the reason the county had hired Prison Health. Pinellas was actually on its second round with the company, having first enlisted it in 1986 because of worries about the ballooning costs of the county's own jail health care. When the contract went back out for bid three years later, Pinellas switched to a cheaper competitor; three years after that, Prison Health bid the lowest and retook the job. But Mr. Rice said the bidding process never turned up a whisper of criticism about Prison Health, or any of its competitors. "Every time we'd be up for renewal, we'd talk to the other counties and institutions, and surprisingly, most of them had glowing reports," he said. In the end, the deal with Prison Health "probably saved a little money," Mr. Rice said, but the human and political costs were too high. "I thought if I'm going to get the blame for this, I'm going to bring it back inside," he said. The county did that in April 1995, going back into the business of jail medical care. Three months later, an hour's drive to the east, rural Polk County - which had hired Prison Health the same year as Pinellas - broke off with the company after three inmate deaths that cost Polk taxpayers thousands of dollars in settlements. "There were instances where we would actually send somebody to the hospital by ambulance because P.H.S. wouldn't do so," said David Bergdoll, counsel to the Polk County Sheriff's office. Since 1992, at least 15 inmates have died in 11 Florida jails in cases where Prison Health appears to have provided inadequate care, according to documents and interviews with state and county officials. As it grew, Prison Health proved adept at ingratiating itself with local politicians, hiring lobbyists and contributing to campaigns for sheriff. Under a promise of immunity from prosecution, the nurse who founded the company, Mr. Moore, testified at a 1993 Florida corruption trial that he had paid the Broward County Republican chairman $5,000 a month - "basically extortion," he said - to keep the contract there and in neighboring Palm Beach County. Some counties say Prison Health has done good work and saved taxpayers money. In Tampa, the medical bill at the Hillsborough County Jail fell to $1.2 million, from $1.8 million in 1982, the year Prison Health replaced the county's medical operation, said Col. David M. Parrish, who runs the jail. There have been other costs. Last year, the company dismissed a nurse and reprimanded two others after an inmate's baby died; the mother, Kimberly Grey, said in a federal lawsuit that although she had been leaking amniotic fluid for five days, nurses refused to examine her until she gave birth over a cell toilet. But Colonel Parrish said that mistakes, and second-guessing, were part of the job, no matter who does it. "Anybody who is in the health care business for inmates is going to get blasted because inmates have nothing better to do than complain and sue and find somebody who is going to make a big stink about nothing," he said. Certainly, a litany of complaints followed as Prison Health expanded across the nation. In Philadelphia, a 1999 federal court monitor's report warned that the company's failure to segregate inmates who were suffering from tuberculosis posed "a public health emergency." Pregnant inmates, it said, were not routinely tested or counseled for H.I.V., endangering their babies. Dr. Robert Cohen, a state court monitor, said in an interview that Philadelphia doctors "actually encouraged women to refuse pelvic examinations." Prison Health still works in Philadelphia, where officials have persistently prodded it to improve care. Like many governments, the city has moved from a fixed-cost contract in which the company's profit comes out of whatever it does not spend to one that covers most medical costs and pays Prison Health a management fee. When other governments have shown less patience, Prison Health has survived, and even grown, by buying rivals like Correctional Health Services, of Verona, N.J. In 1999, its biggest purchase, EMSA Government Services, brought with it contracts with dozens of prisons and jails. Back in Florida, the purchase brought some unwelcome déjà vu to Polk County, which thought it was through with Prison Health when it hired EMSA. When Prison Health bought EMSA, Polk officials soon replaced it yet again. "P.H.S. was the lowest bidder, but we didn't accept their bid," said Mr. Bergdoll, the sheriff's counsel. "That should tell you something." Since then, he said, the number of lawsuits has fallen so sharply that the county's insurer lowered its premiums. The EMSA purchase also brought Prison Health back to Broward County, Fla., which had dropped it years earlier because it had been unhappy with the medical care. Two years after its return, three state judges noticed the phenomenon that had played out in Pinellas - a parade of inmates showing up in court incoherent - and ordered the company to stop withholding psychiatric drugs. "My impression was that it was money," Judge Susan Lebow said in an interview. "The doctors were under corporate direction to not continue the medications." Prison Health denies it gave any such order. The Broward sheriff would not comment on the company, which the county replaced again in 2001. But the revolving door of for-profit health care spins on. Last December, Broward hired Armor Correctional Health Services, a company formed just a few weeks earlier by a familiar figure: Doyle Moore, the nurse who founded Prison Health. A Jailhouse Birth: Chaos on a Cell Floor as a Baby Is Discovered It could not have been much worse. A newborn baby lay in a pool of blood on the floor of the Albany County Jail. At least four adults were there: the mother, a registered nurse and two correction officers who struggled to save the tiny boy. But the nurse looked on passively, tending to the dazed mother, convinced that little could be done, state records show. The baby, who was named Scott Mayo Jr., died two days later. The mistreatment and missed chances to help the young mother, Aja Venny, began soon after her arrival 11 days earlier, investigators said. A 22-year-old secretary and community-college student from the Bronx, she knew she had done something stupid: taken a ride with a drug dealer she knew from her neighborhood. When a state trooper pulled them over, she stuffed his small bags of drugs into her bra. She was booked into jail on Aug. 30, 2001, nearly six months pregnant. The medical staff made an appointment with an obstetrician it paid to visit every two weeks, but Ms. Venny never saw him, state investigators said; nurses ordered her files from a Bronx women's clinic, but never received them. The one concession to her condition, it seems, was her assignment to the maternity unit, a six-bunk cell with a toilet cordoned off by a white curtain. On Sept. 9, Ms. Venny awoke before dawn with excruciating cramps. Another inmate told the guard that Ms. Venny was about to give birth. After two calls to the nursing supervisor, Donna Hunt, a jail sergeant sent an officer to fetch her immediately. When she arrived at 7:15 a.m., Ms. Hunt found Ms. Venny sitting on the toilet crying and "blood everywhere," she told investigators. She cleaned off and consoled the inmate, and told the officers to call an ambulance. She said later that she assumed that Ms. Venny had miscarried and saw no reason to check the toilet. But ambulance technicians, on the phone with the sergeant, asked if there was a baby. Guards looked in the toilet and discovered the infant, still in his placental sac. Officer Dave Verrelli scooped him out using a red biohazard waste bag and laid him on a towel on the cell floor as Nurse Hunt watched. "I knew that there was probably nothing we could do for this fetus," she told investigators. Officer Verrelli detected a slight pulse. "What should I do now?" he frantically asked the nurse, who told him to cut open the sac. Officer Verrelli cut it, removed the baby and uncoiled the umbilical cord from its neck. Ms. Hunt confirmed that there was a faint heartbeat, investigators said, but did nothing to get the baby breathing in the quarter-hour before ambulance workers arrived and administered oxygen. At the hospital, the boy was placed on a ventilator, his heart pumping but his temperature too low to be measured. On his third day of life, he died. The State Board of Regents found that three Prison Health nurses, including Ms. Hunt, had failed to care properly for Ms. Venny or her baby. Each nurse was placed on a year's probation and fined $500. The State Commission of Correction did not say whether anyone might have saved the child, but it emphasized that Ms. Hunt did not take basic steps to help. She did not return calls seeking comment. The commission also found more deep-seated failures: a disorganized staff and prenatal training for nurses that consisted of e-mail messages with instructions copied from a university Web site. Prison Health's lawyers defended Nurse Hunt - saying she found the child in the toilet, but was pushed aside by guards - and accused the commission of ignoring "inconvenient facts." Ms. Venny, who completed a six-month boot-camp prison program after her son's death, now lives in the Bronx with her husband, Scott, and their 20-month-old daughter, Skye. The ashes of Scott Jr. are kept in a golden urn in the bedroom. "I know what I was doing was wrong," she said. But still, "I can't find a reason why a baby had to die." Connecting the Deaths: A Pattern Emerges, and a Battle Begins It was late 2000 when state investigators began to notice something strange. Reviewing deaths that had occurred in jails in upstate New York, they were not struck by the number or even the grim details of the cases, which they routinely examined as employees of the State Commission of Correction. Something else was wrong. Working out of a cluttered office in Albany, the three commissioners and a six-member medical review board noticed that low-level employees were doing work normally done by better-credentialed people. Nurses without the proper qualifications, they said, were making medical decisions and pronouncing patients dead. In Rochester, where Candy Brown had died that September, pleading for help as she withdrew from heroin, investigators found that one of the nurses responsible for her had been suspended by the state three times for negligent care. In that case and others, commission members said, the people offering the most help and compassion were guards and inmates. And the company, it turned out, was always the same: Prison Health. "Our sense was that what we were dealing with was not clinical problems but business practices," said James E. Lawrence, the commission's director of operations. It was the start of a long fight to get the company to change its ways, and when that failed, to get other officials in Albany to step in. Four years later, the commission has been stymied on both fronts. Mr. Lawrence said Prison Health seemed unfamiliar with New York's tradition of regulated health care, "and dismissive of it." When the agency sought out those in charge, it would often be routed to lawyers or executives at the company's headquarters in Brentwood, Tenn., who bristled at the suggestion that they were answerable to New York State regulators. "The rules were not of any consequence," Mr. Lawrence said. Prison Health entered New York in 1985 as medical provider for the Dutchess County Jail. Orange and Broome Counties hired the company for a few years, but ended those contracts in the 1990's. By late 2000, when the company began to attract the state commission's notice, it had signed contracts with Schenectady, Ulster, Monroe and Albany Counties. The Albany jail superintendent at the time called the company "a godsend." The commission called it a disaster. "Grossly and flagrantly inadequate," for instance, was its verdict on the care given Candy Brown. Prison Health, in turn, challenged the commission's authority, and even sued over its report on one inmate's treatment, saying the panel had acted maliciously. The suit was dismissed on its merits. Dr. Carl J. Keldie, the corporation's medical director, said the commission seemed to make up its mind before an investigation and then overstate its case in reports. "The tone, the timbre, the language is egregious," he said. Company executives said the commission has refused to meet and try to reconcile their differences. The commission in 2001 moved beyond the specific criticisms in its reports to sound a general alarm. Asking state education officials to investigate, it said Prison Health was allowing "dangerously substandard medicine" by hiring doctors and nurses with questionable credentials. A month later, spurred by the commission, the Department of Education alerted the state attorney general that the company was operating illegally in New York by not having doctors in charge of medical care. "Nobody really noticed that they weren't licensed," one commission doctor said of Prison Health's presence in New York. In the three years since, nothing has come of either complaint. The only agency with the power to enforce the state law - the attorney general's office - finally replied last October, telling the commission to resolve the matter on its own. In a heated exchange of letters, an assistant attorney general, Ronda C. Lustman, scolded the commission for refusing to meet with executives. The company says that it is acting legally because it has set up local corporations with doctors in charge. But there is abundant evidence, state investigators say, that those corporations are shams. For example, Dr. Trevor Parks is listed as the sole shareholder of P.H.S. Medical Services P.C., which the company says provides all medical care at Rikers Island, free of any influence from Prison Health executives. But investigators say that when they interviewed him, he had little idea of his role, or his corporation's. Moreover, records show that Dr. Parks's corporation went out of business in July, for nonpayment of taxes and fees. After The Times pointed that out to company executives in December, Prison Health paid the money. Dr. Parks did not respond to phone calls and e-mail messages. If frustration mounted at the commission, a sense of impending trouble was growing at the jail in Albany County, where the commission said doctors' decisions on inmate treatment were being overruled by a regional medical director in Washington who was not licensed to practice in New York. The doctor, Akin Ayeni, said in an interview that he never overruled any doctor there. But a former medical director at the jail said she quit in April 2001 because she felt the company's policies, and Dr. Ayeni's decisions, were dangerous. "I told my staff, 'I know it's only a matter of time before they kill someone,' " she said, asking that her name not be used because she feared retribution. "I knew there was going to be a death. I could feel it." In the six months after she left, two people died and a third was seriously injured after poor treatment by Prison Health, the state commission found; the dead included Aja Venny's newborn son. The county and the company parted ways six months later, said Thomas J. Wigger, the jail superintendent, because he was unsatisfied with the quality of care. One by one, other counties have followed suit. Ulster County, for example, caught Prison Health overbilling it for thousands of dollars of nurse hours and switched to another company in 2001. The company, for its part, said it lost most of the upstate contracts to competitors who had underbid them. Strangely, it said it had no record of working in Orange County, even though the state commission faulted the company in two inmate deaths, in 1989 and 1990. Last October, Schenectady County dropped Prison Health after the death of Mr. Tetrault, the inmate with Parkinson's disease. The jail director, Maj. Robert Elwell, said in an interview that the medical director, Dr. Dufresne, had discouraged treatment for anything but the most urgent problems. "When you're dealing with a for-profit corporation, those are the types of decisions that get made," Major Elwell said. The company's only remaining outpost in upstate New York is Dutchess County. "I believe they are a good company," said David W. Rugar, the county jail administrator. "It's just an intense thing to do, when you provide medical services." Indeed, just days before it renewed its deal with Prison Health in 2002, the jail had an intense experience that would cost the company's medical director there his job. Cries From the Heart: Despite Days of Agony, 'Nobody Will Help Me' When they cleaned out Cell 6 in Unit 10 on Feb. 16, 2002, workers at the Dutchess County Jail found a letter that Victoria Williams Smith had written to her husband. "My chest is tight & burns, my arms are numb," it said. "I been to the nurse about five times & no body will help me. I need to get out of this jail. It feels like I'm having a stroke, no bull." Actually, it was a heart attack, and it had killed Ms. Smith a few hours earlier at the age of 35. The letter was just one in a skein of increasingly panicked pleas for help during her last 10 days in jail. Ms. Smith was born in Brooklyn, but settled in North Carolina with her second husband, Justin Smith. They married in 1997, shortly after he was sent to a prison in Dutchess County for attempted robbery. She shipped him canned food that he could sell for cash, and in January 2002 drove to the prison for what friends said was a visit allowed to married couples. The reunion was called off by state troopers, who were waiting at the prison to search her. They found about seven ounces of heroin clearly intended for her husband to use or sell, state records show. Thirteen days passed, state investigators said, before Ms. Smith was examined by a doctor: Vidyadhara A. Kagali, the part-time medical director at the jail in Poughkeepsie, who worked only on Wednesday and Friday evenings even though he was responsible for about 300 inmates. She could have hoped for better. Dr. Kagali, who was board certified only as a pathologist, had never treated patients in a hospital and had "limited knowledge of his responsibilities as jail medical director," according to commission records. On Feb. 6, when she began to complain of chest pains and numbness, Dr. Kagali told her she was suffering from inflamed cartilage in her chest, and had her continue taking the Vioxx arthritis medication that friends in North Carolina mailed to her. The next day, after Ms. Smith was found crying in pain in her cell, an electrocardiogram revealed abnormalities in her heart. But Dr. Kagali, notified by a nurse, did not see her, according to the state commission. On her third day in jail, records show, a second EKG showed the same heart problem, but the doctor still did not see her. On the seventh day, a nurse turned to the jail's part-time psychiatrist for help in easing Ms. Smith's chest pain and labored breathing. Without seeing her, he prescribed a drug for intestinal problems. On the eighth day, Dr. Kagali saw Ms. Smith; he ordered a spinal X-ray and recommended Bengay. Two days later, in tears, she phoned her North Carolina friends, Chris and Marjorie Bowers, three times. "She said these people would not help her at all," Ms. Bowers said. In the early morning of Feb. 16, Ms. Smith's untreated heart ailment became an emergency, according to jail records and sworn statements from nurses and guards. Around 4:30 a.m., a guard found her rocking on her bunk, clutching her chest, and called Barbara Light, the registered nurse on duty. Ms. Light concluded that Ms. Smith was having an anxiety attack - even though, the commission said, the nurse had never seen the inmate's medical record. A half-hour later, Ms. Smith, weeping, told the guard she wanted to go to a hospital - a plea Nurse Light dismissed as an attempt to get drugs. Minutes after that, the guard placed a frantic third call to the nurse, who arrived to find the inmate on the floor, shaking. An ambulance rushed Ms. Smith to Vassar Brothers Medical Center, where she died in less than an hour. The state commission, in its report, seemed hardly to know where to begin to catalog the failures. It urged that Dr. Kagali be fired for "gross incompetence," and referred Ms. Light to state regulators for discipline. State health authorities eventually suspended the doctor's license for six months, but have not taken action against Ms. Light. Neither she nor Dr. Kagali would comment. The company's confidential review of Ms. Smith's death found no fault with her treatment, but recommended that its staff offer grief counseling to colleagues and inmates after future jail deaths. In a letter to the commission, Prison Health defended Ms. Light and Dr. Kagali. It said that over Ms. Smith's five weeks in jail the doctor had seen her numerous times and provided medications, knee braces and even an extra mattress for her arthritis. Ms. Smith had no known history of heart disease, the company said, and any suggestion that her death could have been prevented was "20-20 hindsight." The letter was signed by Dr. Dufresne, whom the commission would later blame for Brian Tetrault's death.

Joseph Plambeck contributed reporting for this article. Copyright 2005 ( The New York Times Company (


02-28-2005, 08:21 AM

February 28, 2005 In City's Jails, Missed Signals Open Way to Season of Suicides By PAUL von ZIELBAUER The warnings were right there in her medical file: a childhood of sexual abuse, a diagnosis of manic depression, a suicide attempt at age 13 - all noted when Carina Montes arrived at Rikers Island in September 2002. But none of them, state investigators said, were ever seen by the mental health specialist caring for her. He could never track down the file, which by December included another troubling fact: Ms. Montes had been placed on suicide watch by a jail social worker. Not that the suicide watch was terribly reliable; it depended in part on inmates paid 39 cents an hour to check on their suicidal peers. In her five months at Rikers, investigators later discovered, Ms. Montes never saw a psychiatrist. It did not, however, take a psychiatrist to pick up on the alarms she sounded near the end, when another inmate saw her tearing bedsheets and threatening to kill herself. But the guard who was called had no idea she was on suicide watch, did not notice the sheets and never reported the incident. Six hours later Ms. Montes was dead, hanging from a sheet tied to a ventilation grate. She was 29. Her offense: shoplifting 30 lipsticks. The death of Carina Montes was one in a spate of suicides in New York City jails in 2003 - six in just six months, more than in any similar stretch since 1985. None of these people had been convicted of the charges that put them in jail. But in Ms. Montes's death and four of the five others, government investigators reached a stinging judgment about one or both of the authorities responsible for their safety: Prison Health Services, the nation's largest for-profit provider of inmate medical care, and the city correction system. In their reports, investigators faulted a system in which patients' charts were missing, alerts about despondent inmates were lost or unheeded, and neither medical personnel nor correction officers were properly trained in preventing suicide, the leading cause of deaths in American jails. Prison Health came to Rikers in 2001 after signing a three-year, $254 million contract and promising to deliver the health care that, compared with jails around the country, had helped make New York something of a model. And it spoke confidently about tackling the jails' biggest problem: how to handle their vast and volatile population of the mentally ill. The rash of suicides, and nine more during Prison Health's tenure, is one measure of the company's uneven and at times troubling record in meeting that challenge. But there are others. Ten psychiatrists with foreign medical degrees were allowed to practice without state certification for more than a year after they were supposed to have been fired for failing to pass the necessary test. When it finally dismissed them on the city's orders in 2003, Prison Health was left with about one-third of its full-time psychiatrist positions empty, according to city health department figures. The company has employed five doctors with criminal convictions, including one who had been jailed for selling human blood for phony tests to be billed to Medicaid. In all, at least 14 doctors who have worked for Prison Health have state or federal disciplinary records, among them a psychiatrist forbidden to practice in New Jersey after state officials blamed him for a patient's fatal drug overdose. The city's Board of Correction, an oversight agency that sets minimum standards for jails, has complained that the company shuffles doctors from jail to jail - regardless of where they are needed - to avoid city fines and create the illusion that each building is properly staffed. Many of the 30 current or former Prison Health employees interviewed for this article described an effort that, whatever its good intentions, frequently fails to adequately treat the mental illnesses that inmates take into jail and that follow them back out. Dr. Douglas Cooper, a psychiatrist who helped supervise mental health treatment at the nine Rikers jails until, he says, he quit in frustration in 2003, summed up the care as triage, buffeted by a sense of nonstop crisis. "The staff does the best they can," he said, "and what's left they sweep under the rug." Prison Health Services, a Nashville-area corporation that bills itself as the gold standard of jail health care, says it has done a solid job at Rikers and a 10th jail, in Lower Manhattan, caring for more than 100,000 inmates a year as part of its largest contract among scores across the nation. The company says it has worked hard to find qualified mental health specialists, held increases in medical expenses below the national average, and saved the city hundreds of thousands of dollars. There is little dispute that New York City has long insisted on more generous jail care than most other places; the suicide rate, even under Prison Health, is about half the national average for jails. Then again, the rate was lower before Prison Health arrived. And in the four years since, the rate of suicides at Rikers has been higher than in the Los Angeles jail system, the largest and one of the most violent in the nation. Suicides - "hang-ups" in the cold vernacular of the cellblock - have always been a jailhouse reality. Because inmates can be resourceful when they set out to kill themselves, few people believe that hang-ups can be prevented entirely. Yet they can be a critical barometer of how well medical and correction workers are performing an essential task: protecting the vulnerable people in their care. In 2003, something broke in the city's jail system, and inmates slipped through a bewildering series of cracks. The first, Jose Cruz, a 48-year-old with H.I.V. and hepatitis, hanged himself with a torn bedsheet in January. Even though he had been put on suicide watch, correction officers placed him at the end of a cellblock where they could not see him from their post, said the State Commission of Correction, a panel appointed by the governor to investigate every death in jail. The medical staff, the commission noted, had inadequate training in preventing suicides. Thirteen days later, Joseph Hughes, a severely disturbed 24-year-old charged with murder, was found hanged four hours after a jail psychiatrist wrote that he was no danger to himself. The commission criticized the Prison Health staff, saying that Mr. Hughes's history of hallucinations and suicidal gestures required closer observation. Ten days after that, guards cut down Ms. Montes - whose increasing desperation had gone unnoticed because her medical file was missing, a failing the state commission had already criticized in three other deaths during Prison Health's time at Rikers. After two more suicides, an inmate found James Davis, 43, in his cell in June with a bootlace tied around his neck. A doctor, two nurses and two guards spent 15 minutes vainly administering C.P.R., unaware that oxygen tanks and cardiac medication were nearby, the commission said. No one thought to unknot the bootlace. Sixteen days later in a jail-clinic waiting room, a 19-year-old who had just returned from a psychiatric evaluation unit managed to hang himself from a metal stud in the ceiling, according to the city's Board of Correction. Another inmate rescued him while he was still semiconscious. The city's health department, which now oversees Prison Health's work at Rikers, did not contest many of the commission's findings, though it defended the work of the psychiatrist who evaluated Mr. Hughes as "not inappropriate." Company executives did not respond to the commission's reports, saying that they had never read them because city officials did not give them copies.Promising Vigilance The catalog of missteps and missed signals could not have come as a complete shock to city officials. Prison Health, after all, had attracted criticism around the country for faulty care. And by the time of the suicides, the state commission was busy investigating - and blaming - Prison Health for inmate deaths in county jails upstate. The city, though, has insisted that it has the tools to strictly monitor the company's performance. The state commission, too, concedes that city health officials are more vigilant than any county sheriff. In fact, soon after the city hired Prison Health in 2001 to salvage jail medical services after three tumultuous years under the direction of St. Barnabas Hospital, New York City officials battled the company over its failure to meet many of the city's most basic clinical standards, and threatened to cancel the contract. Now, after a series of changes the city ordered - including suicide prevention and oversight measures prompted by the 2003 deaths - the health department says care has improved. On Jan. 1, it granted the company a $300 million contract for another three years. "They were the most qualified bidder and they were the most cost effective," said Dr. Thomas R. Frieden, the health commissioner, who described Prison Health as willing to make improvements when asked. "I don't think they're angels." Others are more skeptical. The city comptroller's office, prompted by Prison Health's record and questions raised by The New York Times, asked the health department to delay signing the new contract until the department addressed concerns, including the Board of Correction's complaints of staff shortages at Rikers. Dr. Frieden replied that he saw no reason to wait. But the new contract, according to two state officials, appears to violate a state law intended to keep business interests from influencing medical care. For example, it fails to ensure that doctors are the ultimate overseers of all medical treatment, policy and records. And the contract makes the doctors who are actually doing the work at Rikers subcontractors to Prison Health, the reverse of what the law requires. The health department and the company say the contract is legal. For those who work in the jails, though, the larger issue is the quality of the care. Figures provided by the city and St. Barnabas show that the clinical staff at Rikers has shrunk by 20 percent since the hospital was in charge, despite only a modest decline in the jail population. And several doctors and other employees said that mental health care is worse than before. Forever unable to find enough psychiatrists, the company plugs the gap by hiring part-timers, as well as psychiatrists from temporary agencies, some of whom may never have treated inmates. More than one-third of the mental health staff is part time. Doctors rely on medical charts that have often been out of date or simply unavailable because of a shortage of clerks, according to the Board of Correction. Psychiatric evaluations and medications have been delayed for days or weeks, while inmates sometimes turn violent or suicidal, say the board and Prison Health employees. Of course, the demands on Prison Health and the correction system are tremendous. The mentally ill have flooded New York's jails ever since the city cracked down a decade ago on lesser crimes like vagrancy. As many as one in four of the 14,000 prisoners in city jails on an average day have psychological ills, which need close supervision and expensive medicines. Often they fake symptoms or attempt suicide as a way of getting special treatment. In those ways, a mentally ill inmate jailed on a minor charge usually requires closer attention than a career criminal. "If you asked every jail administrator in the country what kind of criminal they want in their jails, everyone would say murderers," said Michael P. Jacobson, who was city correction commissioner from 1995 to 1997. " 'Give me a nice murderer.' " Just what society owes these troubled inmates is open to debate. But the guilt or innocence of most of them have not been settled. Many are in jail on minor charges or because they are unable to make bail. And though most leave within a week, many remain for months, and jail is the only place where they are likely to get any treatment or medication. The city, in fact, is required to create treatment plans for the most seriously disturbed upon their release. Since The Times began last year to request information on the suicides, examining jail records and details of the Prison Health contract, city and company officials have made changes to prevent more deaths. The rate of suicides has slowed; in the 20 months since the spate of six suicides, there have been four. Still, there are lapses. One of those four, David Pennington, 27, killed himself in July. Over three days in which he became increasingly irrational, correction officers went to the mental health staff for help three times, and a doctor even sent him to a psychiatrist, yet Mr. Pennington was never examined, state records say. In a letter, a health department official disputed that finding and defended the care Mr. Pennington received. The official said the inmate was seen by a psychiatrist the day he died and was not clearly suicidal. The psychiatrist was fired three months later, Prison Health said, for reasons unrelated to the death. In the end, though, Prison Health is just the latest partner of a bureaucracy with its own blemished history: the correction system, which was unable to deal decisively with suicides for decades, as recommendations from state and local authorities were ignored, and fitful attempts at change failed. A Moment of Opportunity The company's arrival at Rikers in January 2001 was a milestone for New York. The contract, negotiated with the administration of Mayor Rudolph W. Giuliani, was a linchpin in the city's effort to privatize government programs, and made New York's jail system the largest in the nation to entrust its health care to a commercial enterprise. The deal was driven in great part by a determination to save money, and dovetailed with efforts to get the city out of the business of everything from job training to welfare enforcement. For years the city had used public hospitals to provide care in its jails, only to face skyrocketing costs and plenty of embarrassments. Prison Health, with its already shaky reputation, marked a calculated gamble. The contract, though, was an even bigger deal for Prison Health. It raised the company's $382 million yearly revenue by 21 percent, and pushed Prison Health to the forefront of a booming correctional health care industry. It also made the company responsible for treating more mentally ill people than anyone else in the nation except the Los Angeles County Jail. Yet Prison Health had not told its new employer the whole nature of its operations, records and officials in the city comptroller's office suggest. In 1999, the company bought EMSA Correctional Care, which had been working for the city's Department of Juvenile Justice for three years. Prison Health, according to documents and interviews with city officials, subsequently became responsible for providing care to the 5,000 youngsters in the juvenile system every year. That care, during 2000, would come under fire by a half-dozen Family Court judges in the city, who found that children were often receiving inadequate treatment. But when negotiating the Rikers contract later that year, Prison Health filed papers with the city saying the company had "no N.Y.C. presence." The comptroller's office, which was not obligated to review the Rikers contract at the time, now says that Prison Health's filings were incomplete and misleading. The company rejects that claim, and says the papers were accurate and honest, and had properly listed EMSA as an affiliate doing the work at juvenile justice. City health officials say they have no problems with Prison Health's representations. Prison Health not only won the Rikers contract, but also benefited from an added bonus: an easy act to follow. St. Barnabas Hospital in the Bronx had just been fired after a striking number of jail deaths - 34 in its final year, including 2 suicides - prompted a criminal investigation. Though no charges resulted, the Board of Correction, an eight-member watchdog panel, complained about the cost-cutting it saw as a root cause. But under Prison Health, the rates of inmate deaths and suicides have risen slightly. In a foreshadowing of the spurt of suicides to come, six inmates killed themselves from May 2001 to January 2002. In a string of memos to city health officials, the Board of Correction told of missing medical records, delayed psychiatric medications and minimal, inexperienced staffs. Correction officers, it said, sometimes had to pitch in, referring inmates for mental evaluations. It was not supposed to be that way. Stung by the St. Barnabas experience, city health officials had set up elaborate ways of measuring Prison Health's performance, including a beefed-up quarterly report card with 35 standards. But during its first year, the company met those standards only 39 percent of the time. Its overseer at the time, the city's Health and Hospitals Corporation, threatened in July 2001 to scuttle the contract, and fined the company $568,000. Company executives say that the transition from St. Barnabas was rocky, but that their performance has improved, and they have managed some significant achievements: speeding distribution of medicine, creating a program to monitor inmates with hypertension and installing a computer system for appointment scheduling. Yet the company has not made good on several requirements in its contract. For example, it frequently sends inmates to hospitals without performing tests or providing information on their medical history and treatment, according to reports by the State Commission of Correction. And Prison Health never came up with the rigorous suicide-prevention plan it promised the city in 2000. "I had no training as to what we do when a patient becomes depressed and becomes suicidal," said Michele Garden, a psychologist who was treating Mr. Cruz, the first to kill himself in 2003. She quit later that year. The correction system had its own problems, having failed to tackle the issue of suicides despite a series of detailed studies that began in the late 1960's. The city hired a suicide-prevention coordinator in 1980, but gave him only a paltry budget. John Rakis, who got the job, recalls having doubts about the assignment while interviewing his first patient in the only spot available in the Bronx House of Detention: the barbershop. "He was hallucinating, and at some point got up and started screaming and threw over the barber chair," said Mr. Rakis, who now advises the state and city on jail health care. "I went upstairs and thought, 'I don't think this is going to work.' " He was right. When he quit in 1984, the Correction Department eliminated the job. A rash of suicides followed in 1985 - 11 for the year, with 3 in one week. In the early 1980's, the city created a Prison Death Review Board, including members from the mayor's office and the Health and Hospitals Corporation, to investigate and prevent deaths. But fearing that the board's inquiries could fuel lawsuits, Health and Hospitals representatives began refusing to discuss the deaths, said Board of Correction officials. The review board has not met since 1997. When Prison Health arrived in 2001, the entire machinery for monitoring suicidal inmates remained lethally porous. The system depended, as it still does, on "suicide prevention aides," inmates paid pennies an hour to make checks every 10 minutes. In an investigation last year, the state commission found that one of these aides was responsible for watching troubled or newly admitted inmates in 34 separate cells. Guards were supposed to help, too, looking in on suicidal inmates every 15 minutes. But that often became a half-hour, said the correction commissioner, Martin F. Horn. "You could pick and choose which rules you wanted to follow," said Mr. Horn, who arrived in January 2003. Inmates continued to kill themselves, and in its reports on the deaths, the state commission insisted repeatedly that those on suicide watch be observed at all times. In late 1999, it sent all jails and prisons a directive to make that the rule. City correction officials ignored it. Not until four years later, after the spate of six suicides, did the city follow the directive. Two weeks after the sixth suicide, in July 2003, the health department replaced the Health and Hospitals Corporation as Prison Health's direct overseer, and took action to tighten suicide watches. The Correction Department ordered a flurry of other changes to ensure closer monitoring, and hired Lindsay M. Hayes, a nationally known expert on jail suicides, to recommend improvements. But it gave The Times only an edited version of his report, stripped of his analysis and recommendations, and would not allow Mr. Hayes to discuss his findings publicly. The health department also refused to disclose its own investigations of the 2003 suicides. Yet Mr. Horn, who became correction commissioner the month the six suicides began, said they were a jarring sign that something was dangerously wrong. "I found it personally distressing," he said. "I was shellshocked."' A Scramble for Help On any given day, a psychiatrist walking the halls at Rikers could be a doctor from a temp agency who had never practiced there before. He could be a doctor who had never treated prisoners at all. Or he could be someone like Dr. Edward M. Berkelhammer, whose work the New Jersey Board of Medical Examiners called "a danger to the public" in 1986. It suspended his medical license for two years, fined him and ordered him to see a psychiatrist himself after a patient died in his care. Dr. Berkelhammer was putting a 26-year-old woman through drug detoxification when his mistake in administering drugs resulted in her overdose, the board ruled. He was working with an expired license, and he continued to compound his troubles. In 1989, New York suspended him for two months for lying about his record in applications for a license. And in 1990, New Jersey revoked his license for failing to obey its orders. In an interview, Dr. Berkelhammer said that the girl's death was a single incident long ago, and that he was "very well thought of" at Kings County Hospital in Brooklyn, where he worked for several years afterward, treating psychotic inmates. "Of all the people at Rikers, I'm the last person anyone has to worry about," he said. Indeed, there are doctors at Rikers with checkered pasts, including criminal convictions. Dr. Ammaji Manyam, for instance, was sentenced to a year in jail in 1990 on charges of conspiracy and attempted grand larceny, for selling blood in a scheme to charge the state for bogus tests. Her medical license was revoked in New York, New Jersey and California, but restored in New York in 1997, after she said she wanted to work in a jail clinic because she knew from experience how poor the medical services were. Dr. Manyam did not return calls seeking comment for this article. Others have had their medical credentials called into question. New York officials revoked the license of a Prison Health psychiatrist, Joseph S. Kleinplatz, in 2003 after Illinois officials concluded that his diploma from a Mexican medical school had been forged. The company then fired him. His lawyer, Karen S. Burstein, said he was a good doctor with a real diploma; a state appellate court has ordered that his case be reconsidered. The health department is now reviewing Prison Health's system for checking doctors' credentials. Becky Pinney, the vice president in charge of Prison Health operations in New York City, said the company had done its best to weed out doctors with disciplinary records. Most of them, she said, had first been hired by St. Barnabas Hospital - though Prison Health rehired them, as it did most of the hospital's staff at Rikers. She said the company was thorough in investigating job candidates, running names through state and federal databanks, and rechecking credentials every two years. Finding qualified doctors, particularly psychiatrists, is a fundamental challenge for any jail medical operation. While Prison Health says it pays competitive salaries, doctors who have left for other jobs said they made much more working fewer hours. "You have so many people vying for psychiatrists in a city this size, it makes it even more difficult," Ms. Pinney said. The company has responded aggressively, she said, recruiting at Columbia University's medical school and mailing solicitations to every psychiatrist in the city and North Jersey. The company, then, often takes what it can get - witness the 10 unlicensed psychiatrists who Prison Health was supposed to fire by the end of 2001 because they had failed to pass state medical tests. The city allowed the company to keep them on for another 16 months, but when the doctors failed even then to obtain certification, it had them dismissed. Prison Health soon rehired three of the psychiatrists, at reduced salaries, as social workers and mental health specialists. "There's a reason these people have failed to demonstrate to the board that they are qualified," said Dr. Robert L. Cohen, who was medical director at Rikers from 1982 to 1986, when Montefiore Medical Center ran health care. But if hiring doctors is hard, keeping them is tougher, say many who have worked at Rikers. "They cannot get psychiatrists to stay there," said Roberta Posner, a psychologist who headed a mental health unit when she was fired in 2001 after 12 years at Rikers. The company would not say why it dismissed her; Ms. Posner said it was for complaining. "The staff is so stressed and so spread out that they can barely manage," she said. There are only 10 full-time psychiatrists working with inmates at Rikers, the company said. It employs 30 part-timers, and 8 others from two temporary agencies, including one in Atlanta called Psychiatrists Only. Some current and former workers at Rikers said the reliance on such help disrupts treatment. A deputy health commissioner, James L. Capoziello, conceded, "It's not the optimal way of doing things." When doctors cannot be found, the company has filled in with less skilled workers, say city officials and Prison Health employees. Since 2002, the city has allowed more than one-third of the psychiatrist positions to be filled by nurse practitioners or physician assistants, who are licensed to diagnose medical problems and prescribe medications. The health department says that the company is now using only seven of those workers to substitute for psychiatrists, and that it plans to end the practice. Cathy Potler, deputy director of the Board of Correction, said that some of those nurses and physician assistants had little or no background in psychiatry. "The result," she told city officials in a May 2003 letter, "is that the least experienced mental health staff are assigned to the facility with patients who are in need of the highest level of care." 'Juggling Hand Grenades' As soon as Dr. Douglas Cooper arrived at work in the summer of 2003, the phone would ring and, he said, his heart would sink. He was facing another day of too few employees, too many psychotic inmates and a corporate boss that he says was more interested in paperwork than patients. As the assistant supervising psychiatrist for all nine Rikers jails, he would have to figure out how to handle more than 300 patients at the island's largest mental health unit, in the largest jail at Rikers, where he worked. On the line was Prison Health's Rikers office, ordering him to send one or two of his four or five psychiatrists - each of whom might already have 30 patients to see - to jails that could not meet their city-mandated staffing quotas that day. Rikers had a lyrical name for the practice: floating. But Dr. Cooper likened it to a bumpy ride on a unicycle with three punctures and only one patch. "They move the patch around to whichever hole is leaking air the fastest," he said. Mental health care, he said, was merely damage control, and the inmates treated first were the many who knew they could get attention by threatening violence to themselves or others. Meanwhile, the staff tried to keep tabs on the patients who were quieter but often in more peril. "You were juggling hand grenades, and one of them was going to go off, hopefully not in your hands," said Dr. Cooper, 52, who quit that August after nine years at Rikers. His experience goes to the heart of what many employees say is the reality of daily medicine at Rikers. In interviews, more than two dozen current and former Prison Health doctors, physician assistants, psychologists and social workers said they were spread so thin that most mental health care was minimal. Most spoke on the condition that their names not be printed, saying they feared losing their jobs. The numbers do not lie, they say. In 2000, the last year under St. Barnabas, the jails had about 830 full-time clinical employees, according to the hospital. Today, Prison Health has a clinical staff of about 670, the health department said. That figure, set by the city, is inadequate, Dr. Cooper said - "designed to ration health care to cut costs as close to the bone as possible, and to provide a semblance of health care when one doesn't really exist." Prison Health, or P.H.S. as it is commonly known, goes along, more concerned with pleasing the city than with serving patients, he said. The company's approach, he said, is essentially this: "Put your best face forward, hide as many problems as you can and hang on to the contract for as long as you can." As a case in point, he and others cited the way the company regards different kinds of paperwork. Medical records, on one hand, are often outdated or unavailable, they said. Senior clinicians said they commonly had to sign off on treatment without seeing a medical history, a practice they said could jeopardize their licenses, and inmates' health. But at the same time, employees said, Prison Health uses doctors and other highly trained specialists to produce and double-check another set of papers: the blizzard of documents that city bureaucrats use to gauge the company's performance. The paper chase actually appears to have grown out of an effort by the city to prevent a reprise of the St. Barnabas years. In its first contract with Prison Health, the city listed the numbers of doctors, nurses, clerks and other staff required at each jail. Failure to document compliance with that list, known as the staffing matrix, for a single day, or even a shift, could result in a $5,000 fine. But Prison Health has turned the matrix into a meaningless yardstick, several doctors and physician assistants said. Some mental health clinicians said that a number of their most experienced colleagues - the clinical supervisors helping run the medical programs in each jail - work full time reviewing reports for the city, making sure boxes are marked and evaluations signed. Even those working with inmates said they were overwhelmed. "It became impossible to have a therapeutic conversation with a patient - it was just checking off boxes," said Dr. Daniel Selling, a clinical psychologist who quit in March after about eight months at Rikers. "The P.H.S. administration could care less what I do with a patient." In the practice known as floating, the company has often sent a doctor or nurse with a backlog of patients at one jail to another where there are fewer inmates to treat, simply to avoid fines, the Board of Correction said. The city has repeatedly fined Prison Health for incomplete filings, but never for treatment that resulted in injury or death. "The constant shuffling of mental health providers from one facility to the next keeps them from being able to see his/her patient caseload," Ms. Potler, the board's deputy director, complained to city officials in her May 2003 memo. The company says it has greatly reduced that problem. Floating, in turn, led to fudging, said several current and former employees. To sidestep a fine, they said, Prison Health has had employees sign in at one jail but then work at another. When there have been too few doctors to float, medical administrators have signed in - but without seeing any patients, said three senior clinicians. One added, "The practice is clearly fraudulent." Health department officials said they were not aware of any deception by Prison Health. But they said the staffing matrix had been changed in the new contract to ensure that a core group of mental health workers at each jail cannot be floated. The fines have been eliminated, officials said, and the company will be graded more on treatment than on paperwork. Company officials denied that any employees had been forced to sign in at jails falsely. Ms. Pinney said that she tried to avoid moving employees between jails, but that it was sometimes necessary to meet patients' needs. The complaints about short-staffing, she said, were untrue, if expected. "We've set a very high standard of performance for our employees," she said. "Some people like that and some people don't like that." Several doctors said that an overextended and discouraged medical staff would not pick up on suicidal behavior. "People lose touch, because the pressure is on," one mental health supervisor said in exasperation. "And if patients are not the priority," he added, "the consequence is those six suicides." Alone at the End From the first days she spent at Rikers Island, charged with shoplifting 30 tubes of Revlon lipstick from a Rite-Aid in the Bronx, it was obvious that Carina Montes was carrying around something a lot weightier than stolen merchandise. A 29-year-old former gang member with a gunshot scar on her stomach and a teardrop tattooed under her right eye, Ms. Montes was sexually abused as a child. She was 8 when she began seeing a psychiatrist for depression, medical records show. She tried to kill herself three times, at ages 13, 18 and 25, and arrived at Rikers severely depressed. She told some of this in her intake exam, to a physician who diagnosed manic depression and prescribed antipsychotic medication, state investigators said. But little of the information would follow Ms. Montes, they said, as Prison Health passed her from one staff member to another, losing track of her records and even seeming for months to lose track of the young woman herself. Over the five months she had left, she would never be seen by a doctor again, the State Commission of Correction found. At the end, she would have no one to help her but other inmates and a rookie jail guard. Isolation was nothing new for Ms. Montes. Born in Puerto Rico, she dropped out after the ninth grade into a different sort of education, selling crack on the Grand Concourse, then paying for it in city jails and upstate prisons. Paroled from a drug sentence in March 2002, she had no family to turn to - just Ana Torres, a lover who took her in from a women's shelter. That Sept. 13, the day after Ms. Montes landed at Rikers, the doctor recommended an immediate mental health examination. But nearly three months passed before Prison Health performed the exam, which took place only because a guard had noticed Ms. Montes acting strangely, records show. The social worker who finally examined her on Dec. 7 was a "floater" who rarely worked in the women's jail. Learning of Ms. Montes's three attempts to kill herself, he placed her on suicide watch. It took another 23 days before Ms. Montes was seen by a mental health specialist, Brett Bergman. But he did not know his patient was on suicide watch, he later told investigators, because he could not find her medical file. "Patient appears to be doing well and was stable," Mr. Bergman wrote. Although he saw her twice more in the next month, he still could not locate the file. No other clinician had a chance to help her; on Dec. 2, after she fought with another inmate, the correction staff placed her in a protective-custody cellblock that had no regular mental health services. On Feb. 6, her isolation proved deadly. Although she was on suicide watch, Ms. Montes had not been seen by any mental health worker for nine days, records show. No one noticed that Ms. Montes, a diabetic, had refused her insulin injections for two days. But another inmate, Linda Vega, saw her weeping in her cell that morning, distraught over a quarrel with a new lover four cells away. "Everything I love don't love me," she lamented, according to Ms. Vega, and said she would hang herself. "I then noticed sheets torn apart between her legs," Ms. Vega told city investigators. At 11 a.m., alerted by inmates, a newly hired guard, Kje Demas, stood outside Ms. Montes's open cell door and asked if she was all right. "I'm O.K., I'm just going through something," she said, the guard told investigators. Officer Demas said he had never been told she was on suicide watch. He did not see the bedsheets or any cause for alarm. Shortly before 5 p.m., another guard heard inmates screaming and found Ms. Montes hanging from an air vent. The Correction Department fired Officer Demas for failing to notify a superior. The health department said it "counseled" Mr. Bergman and his supervisor for not reviewing the medical charts they could not find, and imposed a rule that inmates on suicide watch be interviewed every two days. There was no penalty for Prison Health. Ms. Montes's body was shipped a few miles northeast of Rikers - to Hart Island, where the city buries its unclaimed dead.

Joseph Plambeck contributed reporting for this article. Copyright 2005 ( The New York Times Company (


03-06-2005, 10:52 AM

March 6, 2005 The Failings of Prison Health Care (5 Letters) To the Editor: Re "As Health Care in Jails Goes Private, 10 Days Can Be a Death Sentence" ("Harsh Medicine" series, front page, Feb. 27), about Prison Health Services, a for-profit company that won a contract in 2000 to provide care at the Rikers Island jail: I was a mental health supervisor at Rikers Island from 1987 to 1997, under a city contract with Montefiore Medical Center to provide dental, medical and psychiatric care for inmates. TB and AIDS patients were treated separately in an effort to honor public health mandates. At that time, the pharmacy was well stocked and vigilant. Patients were sent to hospitals as needed. It was not a perfect system, and as fee-for-service it was costly. But there were many fewer inmate deaths than under subsequent managed care providers. We have seen the destruction of our efforts to treat inmates with basic dignity. A humane system has been replaced by abuse and neglect. Susan Braiman New York, Feb. 27, 2005 • To the Editor: Health care behind bars has been a scandal for as long as we've had prisons and jails. A key factor is the lack of visibility and accountability in our prisons and jails, especially for health services. The New York State Health Department has jurisdiction over hospitals and clinics, whether run by the government or not, except in prisons and jails. There, the Health Department has historically said it has no authority to set standards, inspect or take action to correct violations. An important first step to bringing health care for inmates up to humane, professional standards would be for the Legislature to put correctional health facilities under the Health Department's regulatory jurisdiction. Richard N. Gottfried Chairman Assembly Committee on Health Albany, Feb. 28, 2005 • To the Editor: Re "Missed Signals in New York Jails Open Way to Season of Suicides" ("Harsh Medicine" series, front page, Feb. 28): Jails and prisons are an inhumane and inappropriate solution for people with mental illness. Our mental health system is in crisis, and people inadequately served by the mental health system often find themselves in the criminal justice system instead. As a member of Rights for Imprisoned People With Psychiatric Disabilities, I and other members of this group who have family members in prison have seen this suffering firsthand. It is time for our society to recognize that the criminal justice system, in its handling of people with mental illness, exemplifies cruel and unusual punishment. Alternatives to incarceration, like treatment programs, must be expanded so that tragedies, like those highlighted in this article, are no longer a reality in New York City. Ellen Logan New York, Feb. 28, 2005 • To the Editor: Enriching shareholders is Prison Health Services' priority. Its executives are paid to extract profits from tax revenues allotted to prisoner care. The expense of providing prisoner health care would seem to eliminate any reasonable profit. Privatization and profiting from it are legitimate business goals. Providing health care to a vulnerable segment of the population is a legitimate social goal. But in combination, they are predatory. Why is that so difficult to understand? Rebecca Stofer Des Moines, Feb. 28, 2005 • To the Editor: Private companies have been given responsibility for prison health care, and now the patterns can be recognized: unlicensed or uncertified "professionals"; egregious mistakes in administering drugs; withholding of necessary medications; the use of inexperienced, and often unqualified, medical personnel. There was mention of the absence of a mission statement by corporations that provide health care services to prisons. For openers, what about "Do no harm"? Martha L. Merz New York, March 2, 2005

Copyright 2005 ( The New York Times Company (


03-06-2005, 11:50 AM

There were actually three articles: I posted the first in the World Prison & Related News ( forum on the 26th under its original title Private Health Care in Jails Can Be a Death Sentence The other two are in New York News and Events A Spotty Record of Health Care at Juvenile Sites in New York and In City's Jails, Missed Signals Open Way to Season of Suicides

All three are worth reading...but horrible and disgusting. Mrs G posted a related Democracy Now transcript also well worth reading on the same thread! _


03-06-2005, 11:46 PM

Letter to the NY Times March 7, 2005 Health Care in America's Prisons

To the Editor: Re "Harsh Medicine" series (front page, Feb. 27-March 1): New York City should be proud of the health care services provided at Rikers Island. In fact, Rikers is a model for public health practices in correctional settings for the country. Prison Health Services, under the supervision of the New York City Department of Health and Mental Hygiene, provides high-quality and compassionate care for the tens of thousands of people who pass each year through these facilities. Public officials work with our administrators and clinicians to provide health care to a population of more than 235,000 in 250 correctional facilities around the country. In more than one million patient encounters a year, our professionals save lives. Jail facilities served by Prison Health Services are accredited by the National Commission on Correctional Health Care at a much higher rate than other jail facilities around the country. Our clinicians are screened in a process similar to the credentialing process used by most community hospitals. They are guided by the principle that patient safety and welfare come first. We take strong issue with any suggestion that our employees operate in a reckless manner or put profits ahead of patients' needs. There will always be cases with unanticipated outcomes, even when proper health care is rendered with the best of intentions. Rarely, poor outcomes occur for the wrong reasons, and these avoidable circumstances cause us particular concern. Unfortunately, such cases arise in all health care systems. Like others, we learn from mistakes and take proper corrective action as part of our continuous quality improvement process. Michael Catalano Chairman, Prison Health Services Brentwood, Tenn., March 3, 2005


03-07-2005, 02:41 AM

yesterday i spent hours researching past articles and cases pending against Prison Health Services (PHS). According to what i have learned, PHS is getting to be a monopoly, buying up other health services at an incredible rate. I read that they now hold contracts for 37 states. The lawsuits pending against them seem to be endless. I never did get even close to the end of the links provided by the google search I have listed the articles I have found so far on Google, below. because there was so much found I had to make a "part 2" the link below is a link for a public forum in regards to healthcare in prisons..

State officials say they aim for better care Star report March 1, 2005 Indiana prison officials say Prison Health Services has met its obligations to provide health care to Indiana inmates, but "we are striving to do better." "We want to do more than the contract provides for," said Randy Koester, a spokesman for the Indiana Department of Correction. "We're probably never satisfied when it comes to medical care. Whether we do it ourselves or are outsourcing, we are always pushing to do better." Prison Health Services oversees the health care for about 21,500 inmates in Indiana prisons under an agreement that pays the company about $35 million annually. The state has worked with the company since the late 1990s. Prison health care has been an issue in Indiana for several years. In 2003, the Indiana Civil Liberties Union sued the Department of Correction over what it described as substandard care offered to inmates suffering from hernias. The suit was filed on behalf of Wabash Valley Correctional Facility inmate Ed Brown, 65, who suffered a hernia in 1997. He was denied an operation; the suit later claimed the injury was "the size of a football." The lawsuit is pending, ICLU Legal Director Ken Falk said Monday, and Brown has yet to receive his operation. The prison system, Falk said, has changed its hernia policy to offer surgeries to more inmates. Barbara Logan, 51, Muncie, worked at the New Castle Correctional Facility, which opened in 2002 and is designed as a 378-bed health care facility for sick prisoners. She claims she was wrongfully dismissed for questioning what she described as substandard care. In April, she sued the Indiana Department of Correction and Prison Health Services. The case is scheduled to go to trial Oct. 31. At that same New Castle facility, a prison nurse and a guard were fired in 2004 after convicted thief Wayne Spencer, 40, died suddenly after just one night when he suffered seizures. He was rushed to Henry County Memorial Hospital, where he died the next day. A prison guard served a five-day suspension in connection with what happened to Spencer. Prison officials have refused to disclose why the workers were disciplined and have not explained the events that led to Spencer's death. Kevin Likes, a lawyer for Spencer's estate, has said he intends to sue. Koester declined to comment on the Spencer case, citing the litigation. Also, he said the Correction Department does not discuss confidential medical matters. Prison Health Services defends itself against lawsuits over withholding medication. BY KEITH RUSHING - Daily Press 247-7870 June 20 2004 PORTSMOUTH -- Three inmates at Hampton Roads Regional Jail in Portsmouth who suffer from mental illnesses say the jail's medical staff failed to prescribe drugs that effectively treat their conditions. For months they were wracked with feelings of hopelessness, anxiety, sleeplessness and delusional thoughts, they say. Sometimes they even wanted to harm themselves. The men didn't get the medicine they requested until the end of May, after repeated calls to the press and to an advocacy group for the mentally ill. Since then, they say they're feeling better. Hampton Roads Regional Jail holds about 1,060 inmates from Hampton, Newport News, Norfolk and Portsmouth. Of those, about 260 inmates are treated for mental illness by Prison Health Services, Inc., a private company that provides health care to inmates in 400 jails and prisons in 35 states. The quality of medical care for mentally ill inmates treated by private companies has been the subject of investigations and lawsuits throughout the country in recent years. In Virginia, officials are examining the quality of mental health care at jails and prisons to see if mentally ill inmates are receiving the proper medications. The issue boils down to this: Mental health advocates say these private companies often care more about their bottom lines than about the well-being of inmates. They say these companies are reluctant to prescribe expensive drugs, even if they provide the most effective treatment. Officials at Prison Health Services and other companies say they pay attention to drug costs, but they say their first concern is the health of inmates. Prison Health Services, based in Tennessee, provides medical care for about 235,000 inmates nationwide. The company is defending itself against more than 1,000 lawsuits, according to the Associated Press. A Florida newspaper, The Tallahassee Democrat, reported that most of the suits charge the company with providing inadequate medical care. Maine dropped the company as a healthcare provider at its jails and prisons after an audit showed that inmates were sometimes going without medicine and treatment. Of the three inmates at Hampton Roads Regional Jail who complained about not getting the drugs they need, two say - and medical records confirm - that a doctor at the jail prescribed the drugs but a jail psychiatrist discontinued them. The drugs that helped the inmates weren't on a list of drugs that Prison Health Services chooses to prescribe, according to the inmates' medical records. The jail psychiatrist refused to comment, but other jail officials said the company meets inmates' mental health needs and provides quality care. "The decision to treat is dependent on the attending psychiatrist's circumstance," said Prison Health Services Division Vice President Leon Joyner. The psychiatrist "has to evaluate the person and decide whether a treatment is appropriate." Of the 260 inmates at Hampton Roads Regional Jail who are treated for mental illnesses, about 175 get medicine. Tom Cooper, an inmate at the jail since March, said he suffers from anxiety, depression and schizophrenia but was forced to go without any medicine for two months after being transferred to the regional jail from the Hampton jail. Without the medicine, he was depressed and hallucinated, he said. "I'm all hyped up," said Cooper, who was interviewed at the jail last month, a couple of weeks before the jail's psychiatrist resumed a prescription for Trazodone, adding Prozac. "Sometimes I feel like I'm having a heart attack." Cooper, who is 43 and from Virginia Beach, said he had bouts of crying, couldn't sleep and thought about harming himself. Shortly after Cooper was transferred to the regional jail from the Hampton jail in March, a doctor prescribed Trazodone, Paxil and Seroquel. Trazodone treats feelings of sadness and worthlessness. Paxil treats anxiety. Seroquel - an anti-psychotic medication - is typically used to treat confusion. Cooper was in jail on charges that he violated the terms of his probation by driving with a suspended license. The regional jail's psychiatrist issued an opinion that he abused alcohol and cocaine in the past and was suffering from withdrawal. And he ordered that Cooper stop receiving the medicines because they weren't on the list of drugs the company typically prescribes for his illnesses. In May, Cooper still wasn't receiving medicine for depression, anxiety or paranoid feelings, medical records show. His sister, Charlene Cooper, said no one would tell her how treatment decisions were made at the jail. She said she knows her brother wasn't himself at the time. "For him to start crying on the phone was really bizarre," she said. "He says he can't sit still. He can't sleep at night and is tossing and turning and moving around." On May 20, Cooper began receiving Trazodone and Prozac. Six days later, he started receiving Vistaril and the Trazodone was discontinued. Now that he's getting medicine, he said he no longer feels depressed. "I feel like I got hope," he said. "All of a sudden, I've been thinking of different things - going back to school. I'm thinking regular. It's helping me. I'm sleeping better." Trisha Phelps, a clinical social worker with the National Alliance for the Mentally Ill of Virginia, said the problems Cooper faced aren't unusual. "It's more common than not," she said, "for a person with mental illness to not receive any medication or not adequate medication when they are incarcerated." Phelps said she has helped more than 100 inmates in jails and prisons in Virginia to get medicine they need for mental illness. Prison health care companies typically devise their own pre-approved lists of drugs that often don't include more expensive, proven drugs, said Valerie Marsh, director of the Alliance. They can prescribe drugs not on the list, Phelps said, but they may be reluctant to do it. Marsh notes that federal law requires adequate treatment for mentally ill inmates, and jails and prisons have been required to improve mental health treatment under that federal law, called the Civil Rights of Institutionalized Persons Act. Medical staff members at jails sometimes tell inmates who have asked for medicine to treat depression that jail is a form of punishment and they should expect it to be uncomfortable, Marsh said. Wayne Butts, who was transferred to the regional jail from the Hampton jail, said he heard a similar explanation from a psychiatrist at the regional jail in April. When Butts met with the psychiatrist after waiting about a month for an appointment, he told the doctor he was suffering from depression, sleeplessness and self-destructive thoughts. Butts, 42, said the psychiatrist decided not to prescribe anything. The psychiatrist told him he should feel uncomfortable so that he avoids jail in the future, Butts said. Butts was initially sent to jail in Hampton on a habitual offender conviction. He received no medicine during his three months there, Butts said. In March, he was transferred to the regional jail for mental health treatment. He initially received no medicine, then filled out a grievance form. In mid-April, he began getting Prozac and Vistaril, which treat anxiety and depression, records show. May 20 when Butts visited the jail psychiatrist, he told him the Prozac wasn't helping to reduce his depressive thoughts and that Vistaril wasn't helping him sleep. He told him Seroquel and Wellbutrin helped him have a restful sleep in the past. At the end of May, after Butts and Cooper complained to the National Alliance for the Mentally Ill of Virginia, Butts began receiving Wellbutrin, and he was given more Vistaril. Phelps said cutting back on medicine to treat mental illness or taking it away can have a long-term negative affect on inmates' health. "Research has shown that every psychotic episode a person has causes brain damage," specifically problems with memory loss and abstract thinking. Richard Cook, another inmate, said the regional jail's psychiatrist told him Zoloft, which was effective in reducing his anxiousness and paranoia, wasn't a drug they prescribed at the jail because it's too expensive. Cook, who is facing assault and battery and threat charges in Newport News, received Zoloft in late November for five days, his medical records show, but the psychiatrist discontinued it. He did so, the psychiatrist's notes show, because it isn't on the pre-approved list of drugs. The psychiatrist gave him Prozac. Like Zoloft, it treats depression. But Cook, 43, said the Prozac wasn't helping. He wanted Zoloft, which records show was prescribed for him in the Newport News jail before he was transferred. Cook started receiving Zoloft at the end of May after he saw the jail's psychiatrist again and a comprehensive medical review was completed. The retail price for the Zoloft he takes is roughly $100 for a 40-day supply - about double the cost of the Prozac. Staff members at the regional jail disagree with allegations that inmates are denied medicine they need. Cook, Cooper and Butts all began receiving some of the medicine they requested after a review of their medical case was conducted by the medical director in May. The evaluations occurred after the men contacted the press with their concerns, their medical records show. Col. David Simons, the jail's assistant superintendent, characterized the medical care provided by Prison Health Services as excellent. "We basically give all the care that's required," Simons said. He said it's not uncommon for inmates to complain about the medicine they're getting because they often think they should take whatever a previous psychiatrist prescribed. But he said the jail's staff must defer to the medical opinion of the psychiatrist who works there. Simons also said many of the inmates have had alcohol or drug addictions and look for ways to get additional prescription drugs. And inmates may have a preference for a certain drug but a different medicine may be prescribed that's just as effective, he said. But Phelps said when doctors find a particular prescription that works, you can't simply substitute a similar medicine and assume it'll be sufficient. "Because the nature of mental illness is so person-specific," she said, "the medications are very person-specific too." Simons said the jail has a responsibility to taxpayers to keep costs as low as possible, while providing adequate care. "We are stewards of the taxpayer's money," Simons said. "We will save money where we can. But whatever the doctor orders, that's what we're going to make sure the inmate gets." "I know I spend $80,000 each month on medications," he said. Simons added that the jail meets all federal requirements. Joyner, the Prison Health Services division vice president, said they base decisions on money, but health care needs are the primary factor in treatment. "Finances are only part of the issue," Joyner said. "Our first issue is clinical efficacy. If the clinical physician believes the medicine is available to treat a disorder, it is likely that that will be prescribed." Simons said the regional jail pays Prison Health Services about $4.5 million each year to provide health care. He said the company has the experience and know-how to treat a large numbers of inmates. Joyner said the pre-approved list of drugs for the regional jail doesn't prevent an inmate from getting prescriptions that aren't on it. Dispensing a drug not on the list requires a review and approval process, he said. Concerns have arisen nationally in recent years because of complaints from inmates and their families about these pre-approved lists, said James Morris, the director of forensic services for the state mental health agency. He said the agency is working with criminal justice agencies throughout Virginia to investigate whether the pre-approved lists of drugs at jails and prisons are too restrictive. These issues were raised in state senate hearings in recent years, Morris said. He said he's under the impression that Hampton Roads Regional Jail has a comprehensive medical program and a full range of medicine available for inmates. Morris said every inmate there who has agreed to receive medicine for depression should be getting it. Joyner doesn't think the 1,000 or so lawsuits pending against Prison Health Services are a reflection of the quality of health care the company provides. "Litigation is commonplace in our industry," he said. "The presence of litigation isn't a good indication of anything other than the number of lawsuits that have been filed."

A medical organization that provides healthcare to hundreds of jails and prisons across the United States is under investigation after nurses failed to provide proper medical treatment to a Florida inmate before she gave birth to a baby boy. Kimberly Grey, who was 6 1/2 months pregnant at the time, allegedly pleaded for treatment for hours on March 5, 2004 upon experiencing severe back pain and other symptoms that indicated she was in labor. Nurses supplied by Prison Health Services (PHS), however, did not call 911 until after she gave birth prematurely. The baby died before arriving at a local hospital. Homicide detectives are investigating the baby's death to determine if nurses made mistakes. Grey claims she complained of symptoms for 12 hours prior to giving birth at the Tampa jail. She was also reportedly leaking amniotic fluid hours before a nurse finally administered a pelvic exam. The investigation is not the first to involve Prison Health Services. The company has settled a number of lawsuits filed over improper medical treatment in the last 10 years. Pinellas County, Florida severed ties with PHS in 1995 after an inmate died of a heart attack because she was denied medication. The company also paid over $3 million in 1994 to settle a lawsuit filed by the family of a man who was denied proper treatment after corrections officers severely beat him.

Friday, 07/20/01 Prison Health Services penalized $100,000 By KEITH RUSSELL Staff Writer and New York Times News Service Prison Health Services must pay penalties of more than $100,000 for inadequate care of New York City inmates, which the Brentwood-based prison health-care company provides under its largest contract. The penalties are tied to a comprehensive review of the company's performance in New York by the city's Health and Hospitals Corporation, which awarded the $314 million contract to Prison Health last September. Prison Health is a wholly owned subsidiary of Brentwood-based and publicly traded America Service Group Inc. Through Prison Health and other subsidiaries, America Service Group provides health-care and pharmacy services to 340,000 inmates nationwide and employs a total of 7,000 people. The company had annual revenues of $389.1 million and net income of $2.2 million in 2000 and is projecting revenues in excess of $500 million this year. Prison Health provides everything from dental work to cardiac care for more than 175,000 inmates in 27 states and Washington, D.C. But along the way, in Pennsylvania, Georgia, Florida, Maine, Washington and elsewhere, it has been dogged by reports of staffing problems, poor or unstable management and substandard care. Prison Health's contract with New York calls for the company to provide for the health care of the city's 13,500 inmates in 12 jails. The contract requires Prison Health to pay penalties if it fails to meet any of a list of 40 performance standards, some reviewed only at year's end. City officials said the company's work in the first three months this year was inadequate in 30 of 33 categories of care set out in its contract. The report did say Prison Health "substantially" met requirements in 10 of the 30 categories described as inadequate. The review found, among other things, that the company had failed to give all pregnant inmates HIV tests and had not properly dealt with the threat of tuberculosis and sexually transmitted diseases. Ernesto Marrero Jr., executive director of Correctional Health Services, the division of the city agency that conducted the review, described the contract as one of the toughest in the country and noted that it contained strict requirements for staffing and treatment levels. Lawrence Pomeroy, senior vice president of marketing with America Service Group, also noted the contract's tough language, which often requires 100% compliance. Pomeroy added that the company believes it is still in good standing in New York, despite start-up obstacles that included the hiring of approximately 1,000 new employees and creation of a new medical records system from scratch. "We're very pleased with our performance and our ability to affect a smooth transition during the first quarter," Pomeroy said. City officials conceded that the company had improved more recently and said that they were optimistic that it had a turned a corner after a rocky start. They also pointed out that ill or injured inmates were often taken to emergency rooms at city hospitals, a practice city officials believe can improve the care of the sickest inmates. America Service Group shares fell $1.16 yesterday to $21.10. Metro Jail Inmate's Death May Have Been Caused By Prison Health Services Posted: 3/1/2005 5:13:00 PM Updated: 3/1/2005 6:22:43 PM There's new information about what caused a Metro jail inmate to die behind bars.

The company that's hired to take care of the inmate's medical needs say they made major mistakes.

Prison Health Services admits to losing track of Ricky Douglas's medical history and that members of their staff did not finish reading medical forms showing he was a diabetic.

A recent report also shows that a series of mix-ups even caused the staff to ignore his request for diabetic medicine.

Douglas was found dead on his cell bunk a day after receiving a physical examination. The exact cause of death is still not known.

Prison Health Services, which is based in Brentwood, says they hope to prevent other problems by giving their staff more training and changing some current procedures.

The Metro Health Department is expected to release the results from their investigation very soon.

11/20/04 Jail nurse locked up

Woman allegedly gave fiancee-inmate drugs

She was a nurse at the Charlotte County Jail. He was an inmate. The 43-year-old nurse fell in love with the 34-year-old inmate, leading to their engagement. But, she gave him drugs, according to detectives. And the detectives united the nurse with her inmate-fiancee behind bars Thursday. Ruth E. Brodis, of 14464 Amada St., Port Charlotte, was arrested Thursday and charged with a third-degree felony of introducing contraband into a correctional facility. Brodis worked for a contractor which provides medical services to the county and was not a Sheriff's Office employee. According to the arrest report: Detectives learned that Brodis may have been having a relationship with inmate Tyler Schwartzkopf, of Englewood, who is currently in jail on a second-degree felony charge of grand theft. Detectives listened to phone calls between the two and learned Brodis may have been giving Schwartzkopf drugs. "In these phone calls it was said that Ms. Brodis gave inmate Schwartzkopf a pill of some sort to make him feel better," the report states. When Brodis arrived at work Thursday afternoon, she was met by detectives. They searched her belongings, finding numerous pills including Darvocet and Paxil among others. Brodis told detectives she began helping Schwartzkopf in April. "During this time, she fell in love with him and he in love with her," the report states. "She became engaged to inmate Schwartzkopf and planned to marry him once he was released from jail." Brodis told detectives Schwartzkopf was in a lot of pain. "She could not bear to see him in pain and she saved her Darvocet and gave them to him," the report states. Detectives then arrested the nurse and booked her in the jail. She could face up to five years in prison. Brodis wasn't locked up in the same jail that houses her fiance. After her arrest Thursday afternoon, Brodis posted a $5,000 bond and was released from the jail at 9 p.m. Thursday. Brodis will be arraigned on Dec. 27. Her fiance could take a plea offer on the grand theft charge on Dec. 3. But even then, it's unlikely the two will be free together. Illinois authorities plan to haul him back to the Land of Lincoln on a violation of parole charge. Schwartzkopf has spent time in the Illinois Department of Corrections on robbery, drugs, burglary and grand theft auto charges. According to the Illinois Department of Corrections, Schwartzkopf was in and out of prison in the early 1990s. He served almost nine years in prison, being paroled in September 2003 on an armed robbery charge. His parole was not supposed to expire until 2006. If he's convicted of violating his parole, Schwartzkopf could serve up to three more years in prison -- postponing any nuptial plans. Brodis worked at the jail through the company Prison Health Services, which is housed out of Brentwood, Tenn. and employs more than 6,900 healthcare workers. Along with PHS' sister-company, Secure Pharmacy Plus, the two work in more than 400 jails and prisons in 35 states. PHS hired Brodis in May 2003. She has been suspended without pay pending the outcome of the investigation, confirmed PHS officials. PHS released a statement Friday about Brodis' arrest. An inventory of the jail's pharmaceuticals, "it does not appear Brodis obtained the drugs from the jail infirmary." "It also appears the illegal activity was confined to one inmate with whom Brodis had a personal relationship," states the press release. "However, PHS already has launched a full internal investigation and will continue to cooperate in every way possible with the Sheriff's investigation." Brodis had no criminal background, nor were any complaints filed against her with the Board of Nursing or the Department of Health, according to PHS. Brodis could not be reached for comment Thursday. Brodis has an answering machine for her "office," claiming to be place "where your success is my goal," states the recording. Prison medical firm has lethal record Flawed care implicated in complaints, inmate deaths across the country, investigation shows By Paul Von Zielbauer The New York Times March 1, 2005 Brian Tetrault was 44 when he was led into a dim county jail cell in upstate New York in 2001, charged with taking skis from his ex-wife's home. A former nuclear scientist who had struggled with Parkinson's disease, he began to die almost immediately, and state investigators would later discover why: The jail's medical director had cut off all but a few of the 32 pills he needed daily to quell his tremors. During the next 10 days, Tetrault slid into a stupor, soaked in his own sweat and urine. But he never saw the jail doctor again, and the nurses dismissed him as a faker. After his heart finally stopped, investigators said, correction officers at the Schenectady jail doctored records to make it appear he had been released before he died. Two months later, Victoria Williams Smith, the mother of a teenage boy, was booked into another upstate jail, in Dutchess County, charged with smuggling drugs to her husband in prison. She, too, had only 10 days to live after she began complaining of chest pains. She phoned friends in desperation: The medical director would not prescribe anything more potent than BENGAY, investigators said. A nurse scorned her pleas to be hospitalized as a ploy to get drugs. When an ambulance was called, Smith was on the floor of her cell, shaking from a heart attack that would kill her within the hour. She was 35. In these two deaths, state investigators concluded, the culprit was a for-profit corporation, Prison Health Services. The company, based outside Nashville, Tenn., no longer works in most of those New York jails, but it hardly is out of work. It has amassed 86 contracts in 28 states -- including Indiana -- and now cares for 237,000 inmates, or about one in every 10 people behind bars. Nearly 23,000 Indiana inmates are served by Prison Health, one of the top five largest regions served by the company that has sold its promise of lower costs and better care, and become the biggest for-profit company providing medical care in jails and prisons. Its enticing sales pitch: take the messy and expensive job of providing medical care from overmatched government officials, and give it to an experienced nationwide company that could recruit doctors, battle lawsuits and keep costs down. A yearlong examination of Prison Health by The New York Times reveals repeated instances of flawed medical care that sometimes turns lethal. The company's performance around the nation has provoked criticism from judges and sheriffs, lawsuits from inmates' families and whistle-blowers, and condemnation by federal, state and local authorities. The company has paid millions of dollars in fines and settlements. Medical failings In the two deaths, and eight others in upstate New York, state investigators say they kept discovering the same failings: medical staffs trimmed to the bone, underqualified doctors, nurses doing tasks beyond their training, prescription drugs withheld, patient records unread and employee misconduct unpunished. Prison Health Services officials say that any lapses that have occurred are far outnumbered by the firm's successes, and that many cities and states have been pleased with its work. Company executives dispute the state's findings in the upstate deaths, saying their policy is never to deny necessary medical care. And they say that many complaints simply come with the hugely challenging work they have taken on. "What we do," said Michael Catalano, the company chairman, "is provide a public health service that many others are unable or unwilling to do." The examination of Prison Health also reveals a company that is part of a growing phenomenon: the intensely competitive world of privatized health care in jails and prisons. As governments try to shed the burden of soaring medical costs -- driven by the exploding problems of AIDS and mental illness among inmates -- this field has become a $2 billion-a-year industry. New York, problem state Perhaps the most striking example of Prison Health's ability to prosper amid its set of troubles unfolded in New York. Despite disappointed customers and official investigations in Florida and Pennsylvania, the company still managed to win its largest contract ever in 2000, when New York City agreed to pay it $254 million over three years to provide care at Rikers Island facilities. The city, in fact, just renewed that deal in January for another three years -- despite the deaths upstate, and a chorus of criticism over Prison Health's work at Rikers, where employees and government monitors have complained of staff shortages and delays in drugs and treatments for HIV and mental illnesses. A rash of suicides in 2003 prompted a scramble by officials to fill serious gaps in care and oversight. But Prison Health has acquired at least one adversary. The State Commission of Correction, appointed by the governor to investigate every death in jail, has faulted company policies, or mistakes and misconduct by its employees, in 23 deaths of inmates in New York City and six upstate counties. Fifteen times in the last four years, the commission has recommended that the state discipline Prison Health doctors and nurses. And since 2001, the commission, along with the State Education Department, which regulates the practice of medicine, has urged Attorney General Eliot Spitzer to halt the company's operations in New York, saying that Prison Health lacks legal authority to practice medicine because business executives are in charge. New York, like many states, requires that for-profit corporations providing medical services be owned and controlled by doctors, to keep business calculations from driving medical decisions. Supervision flaws In one report after another, the state commission exposes what it says is the dangerous way Prison Health operates. One investigation found that the doctor overseeing care in several upstate New York jails in 2001 -- continually overruling the doctors there, and refusing drugs and treatments -- was not even licensed to practice in New York. He did the job, the commission found, by telephone -- from Washington. The commission's gravest findings have involved deaths on the company's watch, mostly of people who had not been convicted of anything. Candy Brown, a 46-year-old Rochester, N.Y., woman jailed in 2000 on a parole violation, died when her withdrawal from heroin went untreated for two days as she lay in her own vomit and excrement in the Monroe County Jail, crying for help. But nurses did not call a doctor or even clean her, investigators said. Her fellow inmates took pity and washed her face; some guards took it on themselves to ease her into a shower and a final change of clothes. Scott Mayo Jr. was only a few minutes old in 2001 when guards fished him out of a toilet in the maternity unit of Albany County Jail. It was the guards, investigators said, who found a faint pulse in the premature baby and worked fiercely to keep his heart beating as a nurse stood by, offering little help. "We're a jail," the nurse told state officials after the infant died. "There's no equipment for a fetus. Or a newborn." In at least one death report, the commission took the opportunity to voice a broad indictment of the company. Frederick C. Lamy, chairman of the commission's medical review board, denounced Prison Health, or PHS as it widely known, as "reckless and unprincipled in its corporate pursuits, irrespective of patient care." "The lack of credentials, lack of training, shocking incompetence and outright misconduct" of the doctors and nurses in the case was "emblematic of PHS Inc.'s conduct as a business corporation, holding itself out as a medical care provider while seemingly bereft of any quality control." How inquiry was done In its review of Prison Health's work, The Times interviewed government regulators, law enforcement officials and legal and medical specialists, including current and former company employees. The review included thousands of pages of public and internal company documents, state and city records, and every New York state report on deaths under the company's care. The examination shows that in many parts of the country, Prison Health has become a mainstay, satisfying officials by paring expenses and marshaling medical staffs without the rules and union issues that constrain government efforts. But elsewhere, it has hopscotched around, largely unscathed by accusations that in cutting costs, it has cut corners: • In Indiana, Barbara Logan, a former Prison Health administrator who filed a whistle-blower lawsuit last year, said in an interview that the pharmacy at her state prison was so poorly stocked that nurses often had to run out to CVS to refill routine prescriptions for diabetes and high blood pressure. • In Georgia, state officials replaced Prison Health in 1995 after just two years one the job, complaining that it had understaffed prison clinics. Similar complaints led Maine to end its contract in 2003. • In Alabama, one prison has only two doctors for more than 2,200 prisoners; one AIDS specialist, before she left this month, called staffing "skeletal" and said she sometimes lacked even soap to wash her hands between treating patients. Before Prison Health even started in Georgia, there had been several inmate deaths in neighboring Florida that cost the company three county contracts, millions of dollars in settlements -- and an apology for its part in the 1994 death of 46-year-old Diane Nelson. Jailed in Pinellas County on charges that she had slapped her teenage daughter, Nelson suffered a heart attack after nurses failed for two days to order the heart medication Nelson's private doctor had prescribed. As she collapsed, a nurse told her, "Stop the theatrics," according to a deposition. "It's like an article of faith that private is better," said Dr. Ronald Shansky, a former medical director for the Illinois prison system, even though a 1997 study comparing government and for-profit prison care, commissioned by the Michigan Department of Corrections, found little difference in cost or quality. On this playing field, Prison Health has prevailed by thinking big -- buying up competitors and creating a nationwide pharmacy to supply its operations. Its revenues have risen in the last decade to an estimated $690 million last year from $110 million in 1994.


03-07-2005, 02:43 AM

Below the articles are more articles, but because of the cost i was unable to read those. Articles that cost $$$$ to read... STAPH INFECTIONS AT JAIL DROP 50% ( Author: MARY McLACHLIN, Palm Beach Post Staff Writer Date: January 29, 2005 Publication: Palm Beach Post, The (FL) Page Number: 3B Word Count: 881

New cases of the dangerous staph infection that plagued Palm Beach County Jail inmates for the past two years dropped by nearly 50 percent after a new company took over the jail's medical care in October. In July, county health officials had threatened to take legal action against the jail and its former medical contractor, Prison Health Services Inc., if it didn't control the outbreak of methicillin-resistant Staphylococcus aureus, known as MRSA. The fast-spreading staph causes AT THE JAIL ( Date: October 13, 2004 Publication: Palm Beach Post, The (FL) Page Number: 12A Word Count: 490

Providing health care at jails and prisons is a tough business. Inmates often are uncooperative and sometimes hostile. Medical records are hard to find. Substance abuse complicates treatment efforts. But none of this excuses the manner in which the Palm Beach County Jail's private medical provider, Prison Health Services, ignored Patrick Bilello in the weeks before his death last year. Bilello, who had a history of heroin abuse, also had HIV, hepatitis C, anemia, abnormally low blood JAIL DOCTOR SAW SICK INMATE ONLY ON DAY HE DIED ( Author: MARY McLACHLIN Palm Beach Post Staff Writer Date: September 30, 2004 Publication: Palm Beach Post, The (FL) Page Number: 1A Word Count: 1031

Patrick Bilello, who had HIV, hepatitis C and anemia, was in jail for 53 days before being examined by a doctor - and then only on the day he died, according to an internal investigation by the Palm Beach County Sheriff's Office. The investigation highlights critical lapses by two doctors and two nurses employed by the jail's private medical provider, Prison Health Services Inc., and quotes the county medical examiner's office as saying Bilello's treatment was "below BALKS AT INMATE'S NO-CONTEST MURDER PLEA ( Author: SUSAN SPENCER-WENDEL and CHRISTINE STAPLETON, Palm Beach Post Staff Writers Date: September 22, 2004 Publication: Palm Beach Post, The (FL) Page Number: 1A Word Count: 980

Lying in the jail infirmary with a 1 1/2-foot incision in his belly and a warning sign about staph infections on the door, inmate Kevin Coleman decided to do something he vowed never to do - confess to murder in exchange for freedom. On Tuesday, all that stood between Coleman and the free world was a judge who vowed not to allow a person who claims he is innocent to plead to a crime. "My obligation is to accept only pleas that I believe are in the best interest of justice," FREES INMATES FROM STIFLING JAIL, BUT NO LOOTERS ( Author: ROCHELLE BRENNER, SUSAN SPENCER-WENDEL and DANI DAVIES, Palm Beach Post Staff Writers Date: September 8, 2004 Publication: Palm Beach Post, The (FL) Page Number: 1C Word Count: 748

Three days without air conditioning turned the air-tight Palm Beach County Jail into a concrete sauna stuffed with 2,000 prisoners and hundreds of employees - creating a hazardous environment in a place already struggling to control staph infections. As the temperature soared to 88 degrees, windows fogged and condensation rained down the walls into puddles. "We found out this building sweats," jail supervisor Capt. Mark Chamberlain said. It was difficult to breathe and a HOSPITALIZES COLEMAN ( Author: CHRISTINE STAPLETON, Palm Beach Post Staff Writer Date: September 2, 2004 Publication: Palm Beach Post, The (FL) Page Number: 7C Word Count: 420

A bond hearing for Kevin Coleman was canceled Wednesday after Coleman was rushed to Palm West Hospital with a ruptured appendix. Coleman had been complaining to jail officials for weeks about abdominal pain and was given antacids to treat it. Coleman's attorney, Donnie Murrell, said Coleman had emergency surgery Wednesday morning. Murrell intends to file court papers to extend Coleman's hospital stay until his wound heals for fear of a staph infection that has plagued inmates at WHO WON NEW TRIAL SUFFERS RUPTURED APPENDIX ( Author: CHRISTINE STAPLETON Palm Beach Post Staff Writer Date: September 2, 2004 Publication: Palm Beach Post, The (FL) Page Number: 2C Word Count: 429

A bond hearing for Kevin Coleman was canceled Wednesday after Coleman was rushed to Palm West Hospital with a ruptured appendix. Coleman had been complaining to jail officials for weeks about abdominal pain and was given antacids to treat it. Coleman's attorney, Donnie Murrell, said Coleman had emergency surgery Wednesday morning. Murrell intends to file court papers to extend Coleman's hospital stay until his wound heals for fear of a staph infection that has plagued inmates BID WRONG PRIORITY FOR HEALTH CARE AT JAIL ( Date: August 30, 2004 Publication: Palm Beach Post, The (FL) Page Number: 10A Word Count: 466

There are good reasons for Palm Beach County Sheriff Ed Bieluch to pick a company other than Prison Health Services to provide health care at the jail. It's just not clear that Sheriff Bieluch dropped PHS for one of those good reasons. PHS rival Correctional Medical Services was lowest bidder, asking $20.3 million for the two-year contract that starts Oct. 1. PHS, which has had a string of complaints and lawsuits in Palm Beach County and elsewhere, asked for $28.8 million. Several DOCTOR SAYS HE FAILED TO STUDY DATA PRIOR TO DEATH ( Author: JOHN PACENTI, Palm Beach Post Staff Writer Date: August 26, 2004 Publication: Palm Beach Post, The (FL) Page Number: 1B Word Count: 944

A former jailhouse doctor under fire for the death of an inmate said he failed to look at a critical lab report that showed that the patient needed immediate hospitalization. The inmate, Patrick Bilello, died on Oct. 24, four days after Dr. Edgar Escobar only stamped his name, initialed and dated the lab report, which showed a dangerously low level of oxygen in the blood, according to the transcript of an Aug. 13 unsworn statement the doctor gave lawyers. In an April 27 affidavit, BIDDER TO TREAT INMATES ( Author: JOHN PACENTI and MARY McLACHLIN, Palm Beach Post Staff Writers Date: August 26, 2004 Publication: Palm Beach Post, The (FL) Page Number: 1A Word Count: 772

Sheriff's officials have opted for the lowest bidder on health care for Palm Beach County Jail inmates, overruling a screening committee that ranked the current contractor higher despite its record of lawsuits and complaints of poor care. The sheriff's office said Wednesday it would award a contract to St. Louis-based Correctional Medical Services Inc., which bid $20.3 million to provide medical services for two years. The bid includes partnering with the South County Mental Health BEACH COUNTY JAIL INMATE DIES ( Author: JOHN PACENTI, Palm Beach Post Staff Writer Date: July 28, 2004 Publication: Palm Beach Post, The (FL) Page Number: 3C Word Count: 912

Ernesto Benavidez, a 35-year-old father of two from Greenacres, died in the Palm Beach County Jail on July 16, becoming the third inmate this year to die for medical reasons while in custody. Benavidez, who was accused of drug trafficking, died from a massive pulmonary embolism due to deep vein thrombosis, the sheriff's office said. A blood clot had formed in his leg and settled in his lungs, filling them with fluid and stopping his heart. Benavidez's wife, Nilda, said she did WOES KILL 3RD JAIL INMATE ( Author: JOHN PACENTI, Palm Beach Post Staff Writer Date: July 28, 2004 Publication: Palm Beach Post, The (FL) Page Number: 1A Word Count: 1028

Ernesto Benavidez, a 35-year-old father of two from Greenacres, died in the Palm Beach County Jail on July 16, becoming the third inmate this year to die for medical reasons while in custody. Benavidez, who was accused of drug trafficking, died from a massive pulmonary embolism due to deep vein thrombosis, the sheriff's office said. A blood clot had formed in his leg and settled in his lungs, filling them with fluid and stopping his heart. Benavidez's wife, Nilda, said she did INFECTION FIGHT AT JAIL IN PLACE ( Author: MARY McLACHLIN, Palm Beach Post Staff Writer Date: July 23, 2004 Publication: Palm Beach Post, The (FL) Page Number: 1D Word Count: 812

Jail medical staff have ordered new mattresses and antibacterial soap, put incoming prisoners with open sores in separate cells and appear to be trying to meet health department demands to quell a staph-infection outbreak, a county official said after an inspection Thursday. At the same time, the spread of an antibiotic-resistant strain of the bacterium through the community is "alarming," said Dr. Alina Alonso, assistant director of the Palm Beach County Health DEATHS IN N.Y. RAISE QUESTIONS ( Author: JOHN PACENTI, Palm Beach Post Staff Writer Date: July 19, 2004 Publication: Palm Beach Post, The (FL) Page Number: 1A Word Count: 1580

New York state investigators have accused Prison Health Services, the company seeking to renew its contact at the Palm Beach County Jail, of causing the death of a Schenectady, N.Y., inmate suffering from Parkinson's disease. A scathing report issued last month by the New York Commission on Correction echoed criticism in Palm Beach County that Prison Health Services has withheld care to inmates for added profit. The company is one of five bidding on the county contract. The New York DOCTORS DENIED BID FOR PRISON CARE ( Author: MARY McLACHLIN, Palm Beach Post Staff Writer Date: July 17, 2004 Publication: Palm Beach Post, The (FL) Page Number: 1C Word Count: 549

A group of Wellington-based doctors protested the disqualification of its bid to provide medical service at the Palm Beach County Jail, but the protest also was rejected this week. Dr. David Soria, emergency medical services director at Wellington Regional Medical Center, sent a letter to Sheriff Ed Bieluch on July 9, saying the bid of Clovix Inc. should be considered even though it was filed seven minutes past the deadline on June 27. Clovix, the only local group to bid, is a consortium of HEALTH REBUTS CRITICS IN BID TO RENEW JAIL CONTRACT ( Author: JOHN PACENTI, Palm Beach Post Staff Writer Date: July 10, 2004 Publication: Palm Beach Post, The (FL) Page Number: 5B Word Count: 1126

In an effort to retain its lucrative medical contract with the Palm Beach County Jail, the medical provider presented the negatives of the last year as positives during an oral presentation Friday to a selection committee. Prison Health Services has been criticized by inmates, their families, judges and the county health department in the past year. The Tennessee-based company has been accused of putting profits ahead of care when it comes to a variety of inmates, whether they have A NEW COMPANY FOR MEDICAL CARE AT JAIL ( Date: July 10, 2004 Publication: Palm Beach Post, The (FL) Page Number: 10A Word Count: 473

Five companies are bidding to provide medical services at the Palm Beach County Jail. The bids became public this week, but already it is clear which one the sheriff's office should not pick. Prison Health Services, which for nearly 18 months - at nearly $800,000 a month - has provided what it says with a straight face is medical care, doesn't deserve to keep the contract after expiration on Sept. 30. The company's inaction threatens not only the safety of jail inmates but INFECTIONS DOUBLE AT PALM BEACH COUNTY JAIL ( Author: JOHN PACENTI, and MARY McLACHLIN, Palm Beach Post Staff Writers Date: July 8, 2004 Publication: Palm Beach Post, The (FL) Page Number: 3B Word Count: 672

The number of dangerous staph-infection cases doubled in the Palm Beach County Jail last month, leading county health officials to threaten to take the jail and its private medical provider to court if the outbreak isn't under control within two weeks. Jean Malecki, director of the Palm Beach County Health Department, said Wednesday that her office will "review legal options" if Prison Health Services Inc. does not follow hygiene procedures to quell the spread of CASES DOUBLE AT JAIL ( Author: JOHN PACENTI and MARY McLACHLIN, Palm Beach Post Staff Writers Date: July 8, 2004 Publication: Palm Beach Post, The (FL) Page Number: 1A Word Count: 938

The number of dangerous staph-infection cases doubled in the Palm Beach County Jail last month, leading county health officials to threaten to take the jail and its private medical provider to court if the outbreak isn't under control within two weeks. Jean Malecki, director of the Palm Beach County Health Department, said Wednesday that her office will "review legal options" if Prison Health Services Inc. does not follow hygiene procedures to quell the spread of

Mental state of inmate has court in a fix (,0,4268256.story?coll=sfla-news-palm) Jun 05, 2004 He also said he had strong concerns about health care at the jail being provided by a private contractor, Prison Health Services, which has come under recent criticism for care at the jail ... Korbelak has been a model inmate who interacts well with other prisoners and shows no signs of mental illness, according to Dr. David Hager, a jail psychiatrist who works for Prison Health Services. (South Florida Sun-Sentinel, FL).

Judge orders another inmate released over care issues ( Jun 05, 2004 Hager works for Prison Health Services, which has a $779,625-a-month jail contract ... Davis says his gangrenous right leg had to be amputated after a circulatory problem went untreated by Prison Health Services ... At the hearing, Lynch sat next to Roseanne Bilello, who is suing Prison Health Services. (Palm Beach Post, FL). Accused child molester, 72, to be released for leg care ( Jun 04, 2004 His family and his lawyer have said the jail's private medical provider, Prison Health Services, failed to treat a circulatory problem in the leg ... Davis is one of a growing list of inmates who have accused Tennessee-based Prison Health Services of failing to provide adequate medical treatment at the jail ... Prison Health Services also is facing a grand jury inquiry into the death of Patrick Bilello, an inmate with HIV and hepatitis C whose family and lawyer had complained that he wasn't... (Palm Beach Post, FL).

Judge questions jail's care of inmate ( Jun 03, 2004 Paid to care for county inmates is Prison Health Services ... Friday's hearing represents yet another legal showdown over the quality of care that Prison Health Services provides in the county's jails ... Prison Health Services won't talk about Korbelak, citing patient-privacy laws. (Palm Beach Post, FL). Edgecombe County Prison Accused Of Having Substandard Health Care ( Jun 03, 2004 - News - Local Prison Faces Allegations Of 'Gross Negligence. Local Prison Faces Allegations Of 'Gross Negligence. (, NC).


03-07-2005, 01:57 PM

Wingy What a great job you did. Thanks. I am travelling right now but will look at it in detail as soon as I can.


03-11-2005, 08:02 AM

FDA Warns Of Cancer Risks From 2 Eczema Drugs POSTED: 6:00 pm EST March 10, 2005 WASHINGTON -- The Food and Drug Administration is cautioning doctors against prescribing two eczema drugs that could cause cancer. The agency Thursday sent an advisory out to doctors. It said Elidel and Protopic will be sold with new black-box warning labels that spell out the risk. The drugs are applied to the skin to control eczema by suppressing the immune system. But animal tests show an increased cancer risk. The FDA said a small number of cancers have been reported in children and adults who use the medicines. The FDA said the drugmakers have agreed to conduct more tests. The advisory also urges doctors to prescribe Elidel and Protopic only for short-term and intermittent use, and for patients who don't respond to other treatment. The drugs shouldn't be used on children younger than 2 or anyone with a weak immune system. Protopic was approved in 2000 and Elidel in 2001 to treat eczema.


03-22-2005, 10:45 PM

The following article appeared in the Dallas Morning News on Page 5A on Friday, Feb. 4, 2005 with ref. to the Texas Prison Health Care for those of you who may be interested: (I certainly was as my son was being treated for skin cancer at the time I ran across it.) I am typing it verbatim as it appeared: Medical school seeks more prison care funds Officials of the University of Texas Medical Branch at Galveston, which cares for 80 percent of the state's 150,000 inmates, said Thursday that recent budget cuts have undermined the quality of health care. UTMB has eliminated hepatitis B vaccines and cut staffing at prisons from 24 hours to 12. At the same time, prison hospital admissions rose 13.5 percent and the overall prison population is aging. Ben G. Raimer, a UTMB vice president, said the prison system could open itself to lawsuits if health care worsens. UTMB is asking the Legislature for an additional $32 million. Dave Michaels (reporter) ******* I became unglued as UTMB was treating my son for skin cancer near his eye on the side of his nose & planning their subsequent removal at the time. (The 80% of the inmates they care for all over Texas catch a chain gang, so to speak, and are taken to UTMB in Galveston when they need medical care.) I immediately forwarded a letter CRRR to the Practice Manager at the unit where my son is incarcerated with a copy of the article & I stated in part: I DON'T KNOW WHAT QUALITY OF HEALTH CARE they intend to give my son, nor do I have any control over whether they get their $32 million from the Legislature, but rest assured of a lawsuit if their health care worsens while treating my son! I rec'd. a call the same day the Practice Mgr. rec'd. my ltr. & assured me my son would be well taken care of. He was as it turned out, but I wonder if he would have been if I hadn't run across the article. The previous summer I typed a letter that went out CRRR to the state jail he was at as they had him doing community service in the hot sun. I explained skin cancer runs in my family! They called me then transferred him out a week later to a trusty camp which he really enjoys now, but he still got skin cancer later. YOU MUST REQUEST THAT THEY GIVE THE INMATE A SLIP GIVING THEM PERMISSION TO SPEAK TO YOU WITH REF. TO THE INMATE'S MEDICAL CONDITION. THE SIGNED SLIP IS GOOD FOR 6 MONTHS, THEN THE INMATE MUST SIGN ANOTHER ONE.


03-22-2005, 10:58 PM

good information. Hope his cancer was eliminated


04-04-2005, 05:34 PM

'Disease the cause of prison deaths'

New Straits Times; 3/31/2005; Chok Suat Ling; Anis Ibrahim; Eileen Ng; Arman Ahmad PRISON deaths are not caused by substandard health facilities but by disease that inmates were already suffering from, said Internal Security Minister Datuk Seri Abdullah Ahmad Badawi. "The Malaysian Prisons Department is a responsible and sensitive body that looks after the health of its inmates," said Abdullah in a written reply to Opposition leader Lim Kit Siang. Refuting Lim's statement that prison deaths from 2001-2004 were caused by poor medical services, Abdullah said statistics also showed low mortality rates. Measures taken to ensure that adequate health facilities are provided include medical checkups upon start of imprisonment and, when- ever necessary, expediting checkups at prison clinics or external hospitals and enlisting services of visiting doctors (clinical, psychiatric and dentistry) from hospitals. The services of panel doctors are also to be expanded. Three pilot projects have so far been set up at the Sungai Buloh Prison, the Women's Prison in Kajang and the Kajang Central Prison. "The impression that (Lim) has that the Prisons Department and its health authorities are irresponsible, inefficient and lacking in integrity is inaccurate." A total of 1,085 inmates died in prison from 2001-2004. Of this, 631 or 58.2 per cent died of HIV/AIDS while the remaining 454 (41.2 per cent) died of other diseases. From 2001-2004, 7,242 inmates had HIV/ AIDS, while 1,744 had other diseases. (Copyright 2005)


04-09-2005, 12:59 AM

My husband is in prison and he has been denied meds for his health problems. what can I do about this? Im new at this forum here. My husband was told and he sent the paper home to me that the prison has no medicine there, yet it is given daily to other prisoners.

This is a detail of what the law says regarding inmate health ( care in general.

In 1976, the U.S. Supreme Court established a constitutional standard for inmate health ( care (Estelle vs. Gamble) thus guaranteeing prison inmates medical treatment. The Court ruled in Estelle that "deliberate indifference" regarding the serious medical needs of prisoners violates the U.S. Constitution's Eight-Amendment prohibition against cruel and unusual punishment. Consequently, federal, state and local ( criminal justice policy makers struggle daily to address the issue of adequate health care for the incarcerated inmate and, in many jurisdictions, the population of offenders under community supervision.


04-18-2005, 10:24 AM


04-18-2005, 11:01 AM

Experts: San Quentin Prison Conditions Bad

AP Online; 4/14/2005; DON THOMPSON, Associated Press Writer

Dateline: SACRAMENTO, Calif. Conditions at California's historic San Quentin prison are so bad that it's dangerous to house new or sick inmates there, according to a report by a team of medical experts. The team also told a federal judge last week that the administration of the San Francisco prison has not complied with a court order requiring improvements in medical care. The report was obtained by The Associated Press in advance of a state Senate committee hearing Thursday on health care at the Department of Corrections. The team of two doctors and two nurses found the prison was too dangerous to house people with certain medical conditions or to use as an intake facility for new inmates because it was overcrowded and "old, antiquated, dirty, poorly staffed, poorly maintained, with inadequate medical space and equipment." Youth and Adult Correctional Secretary Roderick Hickman and other top corrections officials met Wednesday with the experts and U.S. District Judge Thelton Henderson to go over the report. Spokesmen for Hickman and the Department of Corrections said they were working with the courts to comply with the experts' suggestions. The report is the first on the prison system's adherence to last year's court order, but the experts found that "overall compliance ... was nonexistent." Democratic Senate Majority Leader Gloria Romero, who heads two prison oversight committees, reviewed the reports Wednesday and met with the judge and the experts, who told her the conditions at San Quentin were among the worst they had seen nationwide. "It's deplorable, it's abominable," Romero said. "This is cardiac arrest of the health care system in corrections." "Can it be saved?" Romero asked. "We're pouring a billion dollars into health care in corrections. To my mind, that's enough. The question is, where is it going?" Officials have periodically proposed closing the 153-year-old prison that sits on prime waterfront property along San Francisco Bay and houses California's death row. But attempts to move the state's condemned inmates elsewhere have run into opposition. ___ On the Net: California Youth and Adult Correctional Agency: California Department of Corrections: Copyright 2005, AP News All Rights Reserved


04-18-2005, 11:03 AM

Inmate health bills creating financial 'crisis' for local jail.

The Times and Democrat (Orangeburg, South Carolina) (via Knight-Ridder/Tribune Business News); 4/14/2005

Apr. 14--Inmates' medical bills are "building to the point of a crisis," says Robert Hooper, chairman of the Orangeburg-Calhoun Law Enforcement Commission. With 10 weeks to go in the fiscal year, the $330,000 budgeted for inmates' health care has been exhausted. Detention center officials have received, or are expecting, medical bills totaling another $250,000. "This medical thing is really getting out of hand," Hooper said at the commission's monthly meeting Tuesday. Medical expenses fluctuate from year to year, but "this year it seems like the bottom dropped out." One inmate has cost the county $166,000 for cancer treatments, detention center director Willie Bamberg said. Another inmate incurred $46,000 in medical bills after a heart attack. "We have a mandate" to pay the bills, Hooper said; the question is where to get the money. Commissioners agreed to send each member of the Orangeburg and Calhoun county councils, and the county administrators, a fact sheet explaining the situation, along with a written invitation to attend the commission's May 10 meeting and discuss solutions. Most of the money is owed to The Regional Medical Center of Orangeburg & Calhoun Counties. Commission members said the hospital was unlikely to foreclose on the jail or the county. Bamberg said he "started some dialogue" with a doctor at Family Health Centers about contracting for some services at lower cost than the hospital, but those talks broke down over some disagreements. He said nine detention centers in South Carolina have contracted with private health care programs, and this might be an option here. Bamberg said the non-medical accounts in the jail budget are generally in line with projections. Overall, the inmate count decreased to an average of 340 last month, Bamberg said. Hooper credited 1st Circuit Solicitor David Pascoe with bringing a lot of cases to trial. "Evidently Mr. Pascoe is doing a good job," he said. Local officials hope to boost the census -- and the financial bottom line -- by regaining authorization to hold federal prisoners. An inspection is set for next Tuesday. Federal officials, too, hope the jail passes muster this time. "They said they've got a whole lot that are just waiting," Bamberg said. "They want to bring more than we have a contract with them," which is 20 inmates. Local officials believe the previously negotiated compensation for each of the first 20 inmates is inadequate, but the contract is binding until it expires, Bamberg said. Bamberg said he'd gladly accept additional inmates, beyond the 20, if the federal government agreed to pay higher compensation, but "I'm not going to take but 20 inmates until they renegotiate the contract." The jail is rated for 362 beds. Certain areas of the jail are crowded, particularly on weekends, because non-violent offenders can't be placed in the same area as accused murderers, Bamberg has said. Bamberg also reported: --His budget request for fiscal year 2005-06 will include replacement of the security camera network. Buying a new system will cost less than repairing the existing one, he explained. --One female corrections officer's employment was terminated last month. The jail now has eight vacancies for corrections officers. --Work-release privileges were revoked for four prisoners after they tested positive for marijuana or cocaine. Another 36 work-release prisoners passed their drug tests. To see more of The Times and Democrat, or to subscribe to the newspaper, go to Copyright (c) 2005, The Times and Democrat, Orangeburg, S.C. Distributed by Knight Ridder/Tribune Business News. For information on republishing this content, contact us at (800) 661-2511 (U.S.), (213) 237-4914 (worldwide), fax (213) 237-6515, or e-mail [email protected] COPYRIGHT 2005 The Times and Democrat


04-18-2005, 11:05 AM

Inmate's death fails to stir urgency Charges yet to be filed 3 1/2 months after fatal beating in prison cell

The Atlanta Journal and Constitution; 4/15/2005; ALAN JUDD

The Atlanta Journal and Constitution 04-15-2005 Christopher Southerland lay unconscious in his prison cell, his head resting in a puddle of blood. His cellmate stood nearby, blood splattered across his pant legs. Officials say the cellmate quickly confessed to beating Southerland, who died from his head wounds almost three weeks later. Yet, police say that officials from Rutledge State Prison in Columbus did not call them until six days after Southerland's death - -- two days after his funeral. That lag --- from mid-December to early January --- allowed Southerland to be buried without an autopsy or coroner's inquest, even though state law requires such examinations whenever a homicide is suspected or an inmate dies under unusual circumstances. Police had no opportunity to examine the crime scene, collect evidence or interview witnesses while their memories were fresh. No charges have been filed in Southerland's assault and death. Three months after Southerland died, authorities are preparing to exhume his body, perform an autopsy and present the case to a grand jury. But questions remain: Were Southerland and his cellmate adequately supervised the morning of the assault? Why were the two men --- one with a history of property crimes and parole violations, the other convicted of armed robbery and aggravated assault --- placed in the same cell? And why didn't the Department of Corrections promptly tell police about the assault and Southerland's death? 'Just done little things' Corrections officials have concluded their own investigation but won't discuss its scope or the results. Commissioner James Donald denied a request from The Atlanta Journal-Constitution to release the investigative report. He gave no reason. The agency is studying the report, spokeswoman Scheree Lipscomb said. "If something was wrong," she said, "we're going to take the necessary steps to correct it." Lipscomb disputes the date --- Jan. 7 --- that the GBI says it learned of the inmate's Jan. 1 death. She says prison officials notified the GBI on Jan. 4, "the first working day" after a holiday weekend. She says officials didn't call the police before Southerland's death because they rarely report "inmate-on-inmate fights," even though a corrections policy requires prosecution of significant crimes inside prisons. "Fighting is not one of those," Lipscomb said. Corrections employees, rather than police officers, typically investigate such incidents --- and even larger episodes such as riots, she said. State law allows the commissioner to keep reports of those internal investigations secret. Officials released only an initial incident report filed by a corrections officer and the statements of inmates who were questioned immediately after the attack. In Southerland's case, Lipscomb said, "he died, and we took care of notifying the GBI once he died." Southerland, 32, was one of 12 homicide victims inside Georgia prisons since June 2000, according to reports filed by the corrections agency. Prison officials say they made the proper notifications in the other deaths. Southerland never regained consciousness after the beating. Only his grandmother --- who adopted him as her own child when he was 6 - -- is left to speak for him. She is angry that prison officials didn't protect him in the mental health unit of the medium-security facility. "I wish I could have kept him out," said Louise Southerland, 76, of Adel, a small town in South Georgia. "But I couldn't. He just done little things. He didn't kill nobody. He didn't break into nothing. He didn't have a gun. None of those things. And now he's gone." 50-pound advantage Chris Southerland was incarcerated at Rutledge in March 2004 after wrecking a borrowed truck while drinking, violating the terms of his parole from the last of his three theft convictions. On Dec. 12, a Sunday, he was one of 96 inmates housed in the mental health unit, guarded by two corrections officers. One of the officers, Inga Morgan, wrote in the incident report that she took Southerland out of his cell for breakfast at 6:25 a.m. He returned 15 minutes later, at 6:40. By 7 a.m., Southerland was unconscious on the floor of his cell. One inmate, Russell Jones, later told corrections officers that he was awakened by "a thumping." Another, Robert McDonald, said he "heard a couple of bangs like someone fighting." Inmate Walter Freeman said he followed "trails of blood on the floor," saw Southerland injured in his cell and notified Morgan. Southerland's cellmate was 25-year-old Antwain Beasley, who is serving a 15-year sentence for two armed robberies and two aggravated assaults. At 5-feet-11 and almost 200 pounds, he stood half a foot taller than Southerland and outweighed his cellmate by nearly 50 pounds. When Morgan got to the cell, she wrote in her report, Beasley was "acting nervous and anxious" and had blood on his pant legs. He told officers that the previous night, Southerland had been "acting stupid and said one of us was gonna go out, either me or him." Less than two hours later, prison reports say, Beasley confessed to assaulting Southerland. Officials later moved Beasley to Georgia State Prison, a maximum- security facility in Reidsville. Peggy Chapman, a spokeswoman for the corrections agency, said that, despite the differences in Beasley's and Southerland's criminal histories, they were placed together "appropriately." At the Medical Center in Columbus, doctors put Southerland on a respirator, his grandmother said. A hole in his ear bled for two weeks, she said, and shoe prints were embedded in his head. She visited him daily. "When he was little, I'd put him to bed and kiss him good night," Louise Southerland said. "I'd have to get up out of my bed and go hug him and kiss him again. I'd hug his neck and put him in my lap and he'd go to sleep." In the hospital, she said, "I'd go there and look at him. I couldn't believe anybody could beat him like that." For a few days, she said, the warden kept her informed about the prison's investigation of the beating. She said he promised that the assailant would be charged --- with attempted murder if her grandson survived, with murder if he did not. Then prison officials transferred Southerland to a private prison hospital in Columbia, S.C. Officials told his grandmother that the hospital, Columbia Care, could provide rehabilitative treatment. It was Dec. 30. That Saturday, New Year's Day, Louise Southerland got a call from the hospital. Her grandson was dead. "I said, 'I want him home,' " she recalled. But hospital officials --- who decline to discuss the case --- told her she'd have to wait. They were turning the body over to the Georgia Department of Corrections. 'Such a delay' On Jan. 2, Louise Southerland says, a Georgia official told her to send a funeral director to pick up the body in Augusta, where the state's prison hospital is located. Christopher Southerland's funeral was Jan. 5 in Adel. He was buried in Woodlawn Cemetery, beside a brother who died eight years ago. The obituary published in a local newspaper described Southerland as a member of the Adel Church of God and as a carpenter. It did not mention his time in prison. On Jan. 7, two days after the funeral, a prison official called the Muscogee County Sheriff's Office to report Southerland's death, said Capt. Joe McCrea, a spokesman for the sheriff's office. "In this case," McCrea said, "there was such a delay in it, we told them to go ahead and call the GBI." The GBI opened an investigation that day, spokeswoman Vicki Metz Vickery said. Working with District Attorney Gray Conger of Columbus, agents are looking at "the cause and manner of death," Vickery said, and plan to exhume Southerland's body. Conger declined to discuss the investigation, other than to say he expected to take the case to a grand jury. Louise Southerland said she hoped the investigation would produce criminal charges against whoever is responsible for her grandson's death. She has hired a lawyer, Sam Dennis of Valdosta, who said, "We are in the process of investigating this suspicious set of circumstances, and if the facts merit it, we will file a lawsuit against the responsible party." In the meantime, Louise Southerland wants people to know her grandson was not a hardened criminal. She remembers the little boy who loved to fish, the "baby" of the family who made sure he called from prison at least once a week. As evidence of his desire to be a good citizen, she cites the high school equivalency diploma he earned in prison and the landscaping course he completed. Holding his landscaping certificate, she said quietly, "There must have been a little something good about him." CAPTION: Officials say Antwain Beasley confessed to assaulting his cellmate, who later died. Authorities disagree on how quickly the death was reported to police. No charges have yet been filed. (Copyright, The Atlanta Journal and Constitution - 2005)


04-18-2005, 11:14 AM

i am so sorry to hear about this, god bless


04-18-2005, 11:21 AM

A truly senseless death, my heart goes out to his family. DOC his blood is on your hands.


04-19-2005, 05:12 PM

Do anyone know anything about medical parole in the federal prisons? My husband has both state & fed time running concurrant and has multiple medical issues. State has said if they released him on medical parole that the feds would pick him up. Which is worst the federal prison hopital or CMS? As it is when he is released he will have to go to a nursing home as I cannot take care of him but he says it would be better than where he is!!!!


04-29-2005, 03:34 AM

Staff blamed for death of prison inmate.(News)

The Independent (London, England); 4/27/2005 A women's prison where six inmates died within a year has come under renewed criticism after an inquest jury concluded that its staff were to blame for one of the deaths. The jury said that the failure of a nurse to secure a medication trolley containing anti-depressants contributed to the death of Julie Walsh, 39, at Styal prison in Cheshire. Walsh died in August 2003, after drinking 500ml of dothiepin thinking it would help her sleep through the acute discomfort of a heroin withdrawal programme. Four other women who also drank the medication survived. Nicholas Rheinberg, the Cheshire coroner, sitting at Macclesfield, censured the prison for its peremptory treatment of Walsh's grieving family after her death. He said the family was 'not welcomed' at the prison, where her belongings were handed over in a black bin bag, and not notified of a memorial service for her until it was under way. The coroner will be drawing the prison's actions to the attention of Paul Goggins, the Prisons minister. Mr Rheinberg, who has presided over the inquests of all six women to die at Styal over a 12-month period, said he lacked the powers to order a public inquiry into sentencing policies which have seen the female prison population in England increase from 2,600 to 4,000 since 1997 and the number of women's self-inflicted deaths reach record numbers. But he indicated his 'private view' that there is a 'disproportionality of sentencing practices in respect of the women who are sent to Styal'. Walsh, like the other five women whose inquests Mr Rheinberg has presided over, was drug-dependent when sent to Styal. A call in 2001 for a proper detoxification unit at Styal had not been acted upon and the programme was not set up until after a public furore surrounding Walsh's death. Mr Rheinberg's doubts about whether prison is the right place for mentally ill, drug-dependent women are repeated in a report into the six Styal deaths by Stephen Shaw, the prisons ombudsman. The report, which the Home Office has refused to publish but which has been seen by The Independent, declares the 'current use of imprisonment' of mentally ill and drug dependent women to be 'disproportionate, ineffective and unkind'. All six of the Styal women shared a 'vulnerability' borne of drug dependency, according to Mr Shaw, who notes that three of the six also had a history of mental illness. He concludes that 'sentencing should be reduced' and that the prison service has a 'duty to protect life and apply lessons from adverse incidents'. The report reveals that other grieving relatives were also treated poorly. The family of Hayley Williams, who hanged herself in her cell, were not invited to a memorial service and the families of Nissa Ann Smith and Anna Baker were not sent a report into deaths, as was promised. Walsh's inquest heard that a nurse left the drugs trolley unattended for several minutes after handing out medicines. Dr Rupert Evans, a consultant in A&E at University College, Cardiff, said that the dothiepin, which Walsh and her four fellow inmates took and drank in a nearby shower facility, might not have killed her had she been taken to an intensive care ward quickly enough: 'I would hope to save as many [patients who overdosed on it] as I lost.' Frances Kelly Jones, who also took the anti-depressant, claimed a fellow prisoner had screamed for help for five minutes. After the verdict, Deborah Coles, co-director of Inquest, renewed her call for a public inquiry. 'Inquests into deaths in prison are subject to delay, can only examine individual deaths in isolation and have a limited remit " all of which frustrate the opportunity to learn the lessons,' she said. 'Since Julie's death another 25 women have died in prisons around the country. There needs to be a wideranging independent public inquiry that examines the wider issues outside the scope of inquests: sentencing, allocation and whether prison can ever be an appropriate place for vulnerable women.' COPYRIGHT 2005 Independent Newspapers (UK) Ltd.


04-29-2005, 10:35 PM

April 29, 2005 EDITORIAL A Simple Way to Fight H.I.V. and AIDS

In any given year, perhaps a third of the people infected with hepatitis C and more than 15 percent of those with AIDS spend time behind bars. With infection levels far higher than in the outside world, the jails and prisons are a potential public health menace. Officials have a special duty to curb the spread of disease among the more than 11 million people who pass through the system each year. No one knows for sure how many people pick up H.I.V. while incarcerated. But a 2002 survey of prisoners' own estimates found that about 44 percent of the inmates were probably participating in sex acts. Researchers suspect that about 70 percent had their first same-sex experiences in prison. If those estimates are anywhere near accurate, the risk of infection behind bars is substantial, and the men who contract H.I.V. in prison return home to infect wives and girlfriends. Still, condoms are barred or unavailable in 95 percent of the country's prisons. The national picture could well change if the California Legislature passes a timely bill, introduced by Paul Koretz, a Democrat from West Hollywood, that would require California's corrections system, the nation's largest, to allow public health and nonprofit groups to distribute condoms. In documents filed in support of the bill, Mr. Koretz notes that prevention programs make financial sense, too, given that treating an H.I.V.-positive person outside prison costs California nearly $23,000 a year. Distributing condoms does not encourage sex in prison - that appears to be going on anyway. And data from Canada and American jurisdictions found no evidence that sexual activity goes up or that security declines once prisoners have access to condoms. On the contrary, jurisdictions that adopt such programs tend to keep and build upon them. Corrections officers usually support the programs once they have been proved to be effective.


04-30-2005, 06:04 PM

FDA Approves Lizard-Derived Drug For Diabetes POSTED: 4:45 pm EDT April 29, 2005 WASHINGTON -- Type 2 diabetics are getting a new option to control their blood sugar -- one derived from the saliva of the Gila monster.

The Food and Drug Administration has approved the drug Byetta, but only in conjunction with older diabetes treatments. The makers -- Amylin Pharmaceuticals and Eli Lilly and Co. -- said the prescription drug, which is injected, will begin selling by June 1. They did not provide a price. Some type 2 diabetes patients can try certain oral medications to lower blood sugar. The FDA's decision Friday would allow them to be used with the new drug before patients resort to injecting insulin. The new drug is a synthetic version of a protein found in the saliva of the Gila monster that spurs insulin production. Byetta: Drug Details


05-10-2005, 07:35 PM

'Orgasm Day' Celebrated As Official City Holiday POSTED: 8:32 am EDT May 10, 2005 RIO DE JANEIRO, Brazil -- It was Orgasm Day Monday in Espertantina, a small town in northeast Brazil. Mayor Felipe Santolia said his town has unofficially celebrated orgasm day for years. But this year is the first when it was recognized as an official municipal holiday. Santolia said the idea is to improve marriages. Santolia notes that when a woman is unsatisfied, it affects all aspects of her life, including her relationship with the city. Santolia added that Monday's official holiday was to celebrate "orgasm in all its senses."


05-11-2005, 07:49 AM

May 11, 2005 Medical Group for City Jails Is Investigated By PAUL von ZIELBAUER State officials have opened an investigation into whether the corporation that provides health care for more than 100,000 inmates each year in New York City jails is violating state law governing medical services. The State Department of Education, which regulates the practice of medicine, is examining the terms of the three-year, $300 million contract renewal the city signed in December with the corporation, Prison Health Services. The inquiry will determine whether the contract complies with a state requirement that for-profit corporations providing medical services be owned and controlled by doctors a law intended to prevent business considerations, like maximizing profits, from influencing medical decisions. Prison Health executives and the city officials who oversee the company's work say they believe that the contract is in compliance. But state education officials say the matter of who is in charge is a serious one, with grave repercussions for the well-being and survival of inmates, as well as the public health. The investigation, in fact, marks a renewed effort by the Education Department, which first began to look into the Tennessee-based corporation in 2001, after several inmate deaths in upstate jails staffed by Prison Health began to draw stinging criticism from the State Commission of Correction, which monitors jail conditions. The department's investigators concluded then that Prison Health was violating the state law, saying that company executives were ultimately responsible for medical decisions and profiting from medical services. The two agencies asked the state attorney general, Eliot Spitzer, to halt the company's operations in New York, but Mr. Spitzer's office has declined to investigate. Now, however, education officials have decided to look into the company's largest contract of scores across the country, providing medical and mental health care at nine city jails on Rikers Island and a 10th in Lower Manhattan. State officials familiar with the new contract Prison Health signed with the city's Department of Health and Mental Hygiene have said in interviews that it appears to violate the state law because it makes the doctors who are actually doing the work at Rikers answerable to Prison Health executives in Tennessee for the care they provide. Prison Health hires all doctors at Rikers Island. On April 20, Education Department investigators met with three state assemblymen, city health officials and Richard Rifkin, a deputy to Mr. Spitzer, to discuss Prison Health's legal status. The Assembly members at the session were Richard N. Gottfried, chairman of the Assembly's Health Committee; Jeffrion L. Aubry, chairman of the Correction Committee; and Ron Canestrari, chairman of the Higher Education Committee. Mr. Gottfried said he called the meeting to answer questions raised by a recent series of articles in The New York Times examining Prison Health's record in New York. Among other things, the series detailed State Commission of Correction reports that faulted company policies and medical errors in the treatment of 24 inmates who had died in city or upstate jails. "I and my colleagues are very concerned both about the quality of health care in our jails and prisons, and also concerned about the principal of corporatizing health care," Mr. Gottfried said in an interview last week. "If there is something illegal going on, I would want to work to enforce the law. If medical decisions are being directly or indirectly dictated by nonprofessionals, that's what we don't want." Assemblyman Canestrari said Prison Health appeared to be in violation of the state law governing for-profit medical services. "My understanding is their structure doesn't comply with the law," he said in an interview last week. "There have been attempts to meet the legal standard, but they have fallen short." But company officials insist doctors are in charge of medical decisions. In New York City, Prison Health says it provides only administrative services to a doctor-run corporation, P. H. S. Medical Services P. C., that directs all medical care at Rikers. But that corporation is run by Dr. Trevor Parks, who is a regional medical director for Prison Health. State education investigators have called Dr. Parks's corporation a sham, and said that when they questioned him, he had only a vague idea of his role in it. Several Prison Health employees at Rikers said in interviews that Dr. Parks recently gathered a group of supervising doctors there and informed them that they were employees of his corporation. Dr. Parks declined to comment yesterday. City Health Department officials believe the Prison Health contract is legal, said Sandra Mullin, a department spokeswoman, in an e-mailed statement. "We welcome any state review that may offer additional information," she said. Trey Hartman, Prison Health's president, said in a statement yesterday: "The city of New York has said that our structure under the Rikers Island contract is appropriate and in compliance with all legal requirements, and we have received guidance confirming that by widely respected outside legal counsel." A spokesman for Attorney General Spitzer declined to comment on the Education Department's new investigation into Prison Health. City health officials first hired the company in 2001 after competitive bidding, making Prison Health the first for-profit enterprise to deliver medical care in the city's jails. The company beat out three other companies for the new contract. Assemblyman Canestrari said that as troublesome as the fallout may be, the legal issues must be explored. "The law is the law," he said, "and it's not going to go away." Copyright 2005 ( The New York Times Company (


05-13-2005, 02:15 PM

12-Year-Old Maryland Girl Has Not Aged In Years Syndrome Remains Undiagnosed UPDATED: 11:15 am EDT May 13, 2005 BALTIMORE -- Imagine being frozen in time as a baby forever. It sounds impossible, but it describes Brooke Greenberg. The Baltimore-area girl may look like a baby, but she's nearly a teenager. In most respects, Brooke looks and acts like your average 6-month-old baby -- she weighs 13 pounds and she is 27 inches long.

Brooke Greenberg, 12, weighs 13 pounds and is 27 inches long.

But Brooke is actually 12 years old, reported WBAL-TV in Baltimore.



Brooke doesn't age. Her syndrome remains undiagnosed and unnamed, and as far as doctors can tell, she is the only one in the world who has it. Dr. Laurence Pakula has been Brooke's pediatrician since she was born. "In height, weight, she's 6 to 12 months," Pakula said. "If you ask any physician who knows nothing about her, the response is that she is maybe a handicapped 2-year-old."

Doctors say Brooke has thrived because of the support of her parents and three sisters.

Her body may not be aging, but Brooke's health is deteriorating. She is fed through a tube, and she's had strokes, seizures, ulcers, severe respiratory problems and a tumor the size of a lemon. The four times Brooke has come dangerously close to death, she bounced back and no one knows why. Pakula points out that the girl has a strong sense of self and of sibling rivalry. Brooke has no language skills, but she does have enough motor skills to pull herself up in her crib or scoot across the kitchen floor. Pakula said Brooke has thrived because of the support of her parents and three sisters. "When one sees how much she has accomplished, it's a wonderful reminder that even for someone who's limited, it's a wonderful world out there," Pakula said. As genetic research expands, scientists might be able to learn the secrets of this little girl. But until then, it is Brooke who is doing the teaching.

To see this beautiful little girl go to:


05-13-2005, 03:03 PM

Very intresting story. Thanks for sharing. Ive never heard of or seen of anything like this. My thoughts and prayers go out to the family of this little one.

Beth Ann


05-16-2005, 02:47 PM

Study: Prolonged Labor Affects Many Moms For Life Most Still Find Experience Exciting POSTED: 11:29 am EDT May 16, 2005 Six out of 10 first-time mothers who had a prolonged labor said the experience will affect them for life, but more than eight out of 10 still found giving birth exciting, according to a new study.

A Swedish survey of more than 250 women, published in the May issue of the Journal of Clinical Nursing, found that 34 percent of women who experienced prolonged labor felt negative about the overall experience, compared with 4 percent of women with a normal delivery.


Researchers compared the experiences of 84 women who had prolonged labor with assisted vaginal or Caesarean delivery to the experiences of 171 women who had normal deliveries. Sixty percent of the women with prolonged labor said the delivery would affect them for life, compared with 12 percent of the women experiencing normal delivery, according to a news release from the journal.

The majority of women remained calm during the birthing process, with only 31 percent of those with prolonged labors saying that they "almost went into a panic because I didn't know what was happening." Pain was a key issue for both sets of women, with 62 percent of women with prolonged deliveries agreeing with the statement that "it was so painful I thought I was going to die" and 69 percent that "pain relief during delivery saved me." Forty-seven percent of women who had normal deliveries agreed with both statements. Overall, 76 percent of women with prolonged deliveries said it "was a pain to give birth," compared with 48 percent of those with normal deliveries. "Women who had a negative experience associated giving birth with feelings of pain and panic," said lead researcher Astrid Nystedt, of Umea University in Sweden. "It may have far-reaching and powerful psychological consequences if the childbirth experience ends in an unplanned Caesarean or unexpected forceps or vacuum delivery." The research also provides some insight into the women's background. According to the researchers, 75 percent of women with prolonged deliveries had planned their pregnancy. This was "significantly higher" than the 60 percent of women with normal deliveries.


05-16-2005, 02:48 PM

Research: Tonsil-Swabbing Best Way To Detect Strep Throat More Tolerable Tests Aren't Accurate Enough, Study Finds POSTED: 2:55 pm EDT May 16, 2005 Strep throat is pain for kids and adults alike, but one of the most unpleasant parts of the condition is diagnosing it.

Despite the discomfort involved, a new study found that swabbing the tonsils directly is the best way to accurately detect the infection. Researchers from the Mayo Clinic in Rochester, Minn., were looking for more tolerable alternatives to the tonsil-swabbing technique.

"Tonsil swabbing is terrible -- it makes people gag," study leader Dr. Jonathan Lee said in a news release. "Children hate it." Dr. Laura Orvidas, who worked with Lee on the research, agreed. "With lots of children, it's a struggle just to look in their throats, not to mention stick a swab back there," she said. "There are certain children for whom this is hugely traumatic. We're motivated to try to save them from 'the gag.'" In the study of 130 children, surgeons swabbed each patient's tonsil surface, the inside of the cheek by the back molars, and in between the lip and the gums in the front of the mouth. They found that only 35 percent of those patients with strep on their tonsils were positive on the swab that came from between the lip and gum and in 43 percent of the cases where the swab was taken from the inside of the cheek. "If we could have said that children don't have to have their tonsils swabbed -- that we could get the swab from the front of the mouth -- that would have been a good thing," Orvidas said. "But we're saying you can't do that." Distributed by Internet Broadcasting Systems, Inc. This material may not be published, broadcast, rewritten or redistributed.


05-16-2005, 02:57 PM

I remember having strep and having that super long swap stuck down my throat. It was awful. I always thought that there was something that could "numb" the gag reflex, but I guess that would mess up the swap results. :shrug:


05-16-2005, 03:01 PM

My kids hate to have their throats swabbed! ONE


05-17-2005, 07:40 PM

Antidepressants Late In Pregnancy Can Affect Newborns Researchers: Tapering Strategy May Work For Some Women POSTED: 4:08 pm EDT May 17, 2005 CHICAGO -- Researchers say taking antidepressants late in pregnancy may have an effect on newborns.

A University of Pittsburgh study shows women who took the drugs in the last three months of their pregnancy raised the risk that their babies would suffer jitteriness, irritability, feeding problems and serious respiratory problems during their first couple of weeks. Some doctors call it neonatal behavioral syndrome, or withdrawal syndrome. Based on their review of medical literature, researchers noted that symptoms are mild and usually disappear after about two weeks, but infants exposed to antidepressants late in pregnancy had twice the rate of hospital admissions of those not exposed. But reports of prolonged hospitalization are rare, and no deaths related to neonatal behavioral syndrome have been recorded. The study is published in Wednesday's issue of the Journal of the American Medical Association. Researchers said at least 80,000 U.S. women take antidepressants each year during their pregnancy. The greatest number of antidepressant-related complication reports involved exposures to Prozac and Paxil. Complications related to Zoloft, Celexa and Effexor were less frequent, but still significant, said Dr. Katherine Wisner, one of the study researchers. The researchers said that the findings don't necessarily mean that mothers-to-be should stop taking antidepressants during pregnancy. "Uncontrolled maternal psychiatric illness during pregnancy carries its own dangers," Wisner said. They said gradually tapering back medication in the final stages of pregnancy might be an option, but only on a case-by-case basis. "We still don't know whether a tapering strategy might be effective to limit neonatal behavioral syndrome, but an increased risk for maternal postpartum depression is well known," said Dr. Eydie Moses-Kolko, another study researcher. "Until we know more, treatment of the disabling disorder of depression must be a primary consideration."


05-18-2005, 07:26 AM

Court to Review Rights of Disabled Inmates

AP Online; 5/16/2005; GINA HOLLAND, Associated Press Writer Dateline: WASHINGTON The Supreme Court said Monday that it will decide if states and counties can be sued for not accommodating disabled prisoners, setting up another legal showdown over the power of Congress to tell states what to do. The high court ruled seven years ago that a landmark federal civil rights law protects people being held in state prisons. Since then, however, lower court judges have disagreed over whether states can be sued for damages by prisoners under the Americans With Disabilities Act, a law meant to ensure equal treatment for the disabled in many areas of life. Supporters of the law contend that the threat of damages is needed to force states to comply. The Bush administration filed an appeal on behalf of a paraplegic Georgia prisoner, in the case with major implications for states because of the costs of retrofitting old prisons to accommodate people with disabilities. Justices will consider the case of Tony Goodman, who claims he has been held for more than 23 hours a day in a cell so narrow he cannot turn his wheelchair. Goodman, who suffered his injuries in a car accident, is serving time for aggravated assault and a cocaine conviction. He claims that because the prison in Reidsville, Ga., is not equipped for people in wheelchairs, he cannot go to the bathroom or bathe without help, and does not have access to counseling, classes and religious services. He has sometimes been forced to sit in his own waste, according to Goodman's lawsuit. Paul Clement, the president's lead Supreme Court lawyer, told justices in a filing that ADA's protections address "the inhumane, degrading, and health-endangering conditions of daily living for inmates." Lawyers for the state of Georgia had urged the court to refuse to hear the case, so that other courts will have more time to sort out a recent Supreme Court ruling in another case involving the disabilities law. States have repeatedly clashed with the federal government over their liability under the 1990 law, seeking immunity from lawsuits because the Constitution says a state government cannot be sued in federal court without its consent. Justices have sharply disagreed on when states are immune. Last May, the Supreme Court ruled 5-4 that states can be sued over inaccessible courthouses. Chief Justice William H. Rehnquist, who has championed states rights, disagreed with the courthouse decision last year. The cases are United States v. Georgia, 04-1203, and Goodman v. Georgia, 04-1236. ___ On the Net: Supreme Court: Copyright 2005, AP News All Rights Reserved


05-21-2005, 05:15 AM

Jailhouse medicine: a million-dollar patient.

The Hartford Courant (Hartford, Connecticut) (via Knight-Ridder/Tribune Business News); 5/15/2005

Byline: Robert A. Frahm May 15--When the University of Connecticut Health Center's budget tipped into the red this year, officials blamed the cost of a single patient -- a prison inmate whose pharmacy bill topped $1 million. The Health Center handles medical care for state prisons under an arrangement designed to keep medical costs in check, but the high cost of treating this one inmate, who has a serious blood disorder and three years ago had an even larger bill, came as a financial jolt. "We run a pretty tight ship, but when a million-dollar cost comes out of nowhere and breaks the bank ... the issue becomes: Who pays for it?" said David L. Budlong, executive director of UConn's Correctional Managed Health Care Program. UConn has asked for reimbursement from the state Department of Correction, which, in turn, has requested a special appropriation from the legislature. Aside from monitoring costs, officials from several state agencies have met jointly to develop plans for the inmate's continued care and his transition to the community -- including efforts to keep him from committing new crimes to gain access to prison medical services. He was jailed earlier this year on a larceny charge but was released recently and is on probation, a prison official said. The inmate, a heroin user in his early 30s, has been in and out of prison over the past decade. He is believed to be the most expensive patient in the 10 years since UConn has handled medical care for state prisoners. When the man was arrested again last year, a doctor e-mailed top UConn officials to alert them that the high-cost patient had been admitted to the university's John Dempsey Hospital even before his court date. "The Million Dollar Man is back," the e-mail said. The latest pharmacy bill of $1.1 million, including the cost of a rarely used coagulant to treat bleeding disorders such as hemophilia, was the result of treatments over several weeks late in 2004, including a single day's treatment in December that cost more than a quarter of a million dollars, according to documents obtained by The Courant under the state's Freedom of Information Act. UConn refused to pay a pharmacy bill of $1.3 million for the same patient in 2002, the same year the university's Correctional Managed Health Care Program laid off 36 workers to offset a $2 million budget reduction. That bill eventually was paid by the Department of Correction. Although the million-dollar drug treatment is a rarity, similar extraordinary medical cases elsewhere have highlighted the growing cost of health care in the nation's prisons. One widely publicized case occurred in California, where a convicted robber received a state-funded heart transplant three years ago. The inmate, whose transplant stirred a statewide controversy, died about a year later. The right of prisoners to receive standard medical care has been established under various court rulings, including a 1976 U.S. Supreme Court decision that said "deliberate indifference" to an inmate's medical needs violates the constitutional ban against "cruel and unusual punishment." "I would argue, because someone is incarcerated, we have a higher obligation to provide them care because we have deprived them of their liberty," said Dr. Michael A. Grodin, director of medical ethics at the Boston University School of Medicine and Public Health. "One of the only places you have a legal right to health care in this country is if you're in prison," he said. "Paradoxically, it may mean better care because 45 million people in the country have access to no health care." Patricia A. Ottolini, director of health and addiction services for Connecticut's correction department, said, "With 18,500 inmates, somewhere in that number we're going to have extraordinary costs." Officials at UConn and the correction department refused to identify the inmate with the blood disorder and would not discuss details of his case, citing federal patient privacy laws. Nevertheless, state records, including e-mails and letters about the case, describe the man as a habitual criminal who has been transferred frequently to Dempsey Hospital while he was imprisoned periodically at Somers and Uncasville over the past decade. He has been jailed for various offenses, including violation of probation, possession of drugs and larceny. "On the street, he uses heroin to control pain and depression. All arrests were due to stealing to buy heroin," a doctor wrote in one memo earlier this year. What made his treatment so expensive was the use of a relatively new drug known as Factor 7A, most commonly used to treat hemophilia patients who do not respond to more conventional forms of therapy. The drug, produced by the Danish-based company Novo Nordisk Inc., is made using genetic engineering techniques. It is costly to develop but can be lifesaving, said Dr. Harold R. Roberts of the University of North Carolina at Chapel Hill, a specialist who has written about the use of Factor 7A. Connecticut is one of only a handful of states with a partnership between a university medical center and a prison system. The UConn Health Center provides medical, mental health, pharmacy and dental services for inmates. The program, part of the Health Center's public service mission, provides services at all of the state's prisons and jails. Its budget this year is $81 million. Aside from providing a training ground for medical and dental students, the arrangement is considered to be safer, more manageable and more efficient than sending inmates to private doctors and hospitals. Nevertheless, several factors continue to push costs up. "The drugs keep getting more expensive for us, and we are getting sicker patients," said Budlong, the program director. A report by UConn to the legislature earlier this year said the prison population "is proportionately sicker than the general population on virtually any measure of mental illness and chronic and communicable diseases." The report said, for example, that the number of inmates on medications is up 46 percent since 1999 in the state. The occurrence of diabetes and hypertension among inmates has roughly doubled over the same period. The aging prison population and growing level of medical need illustrates a need to focus on education and prevention of illness, said Claire Leonardi, chairwoman of the UConn Health Center's board of directors. "This is not about one patient and a million-dollar drug," she said. "We'd love the [UConn program] to be a national model of care for inmates -- prevention, diagnostics, early detection." Although the program has been able to hold overall pharmaceutical costs down through a nationwide purchasing consortium, the cost can still be high. Interferon treatment for an inmate with hepatitis C, for instance, costs about $35,000 a year, according to the report to the legislature. "New medications, new therapies -- those costs all add up," said Edward A. Harrison, president of the Chicago-based National Commission on Correctional Health Care. The cost of treating inmates "is definitely a big issue. We get a lot of calls on it." A U.S. Bureau of Justice Statistics report in 2001 said Connecticut spent $3,620 per inmate on medical care, well above the national average of $2,625 but less than several other states. Maine reported the highest cost, $5,601. Nevertheless, the report said spending on health care for inmates nationwide averaged just over $7 a day, compared with nearly $12 a day for U.S. residents. In Connecticut, the cost of treatment for the inmate with the blood disorder was so extraordinary that it became one of the issues under discussion as UConn and the correction department work on a revision of their partnership agreement. Two years ago, as the inmate was being released from prison to a supervised program for his transition to the community, officials recommended assisting him in applying for Medicaid benefits. Those benefits "could keep him from re-offending to get back into the health care offered" in prison, said an e-mail from Carol Salsbury, deputy commissioner in the correction department. More recently, officials from several state agencies -- including UConn, the correction department, the Department of Mental Health and Addiction Services, the state budget office and parole and probation officials -- have met to discuss the inmate's ongoing need for care, including treatment for drug addiction. "Merely assisting him with [his] release [from prison] will not address the financial, custodial, medical, substance abuse, and potential human rights problems that this individual represents," Dan Bannish, health services program director for the correction department, wrote in February. The objective, Bannish said recently, is to create a comprehensive state plan for him. "Whether he's out [of prison] or in, it will impact us one way or another," he said. "It's not [just] a corrections issue, not a probation issue. It's a state issue, top to bottom." A discussion of this story with Courant Staff Writer Robert A. Frahm is scheduled to be shown on New England Cable News each hour Monday between 9 a.m. and noon. Copyright (c) 2005, The Hartford Courant, Conn. For information on republishing this content, contact us at (800) 661-2511 (U.S.), (213) 237-4914 (worldwide), fax (213) 237-6515.


05-25-2005, 04:34 PM

Drugmaker Recalls Entire Product Line Company Withdraws Some New Drug Applications UPDATED: 10:53 am EDT May 25, 2005 BALTIMORE -- A New Jersey-based drug manufacturer announced Monday a recall of its entire product line. An internal investigation revealed improper lab practices and noncompliance with standard operation procedures at Able Laboratories Inc., according to company statements. Able, the manufacturer and developer of some 40 generic drugs, reported that the company cannot identify how far its labs deviated from standard operating procedures and manufacturing practices, reported WBAL-TV in Baltimore.


List: Products Made By Able Laboratories Inc.


Thus, company officials decided to temporarily suspend its manufacturing operations and stop all shipments as a precaution. Among some of Able's products include generic versions of Tylenol with codeine, Vicodin, Ritalin and Anusol. Also, Able announced it intends to withdraw seven of its recently approved new drug applications filed with the Food and Drug Administration. The statement reports that the company is no longer confident about relying on the data used in those applications. The company had announced several product recalls earlier in the year and has notified the FDA of its findings resulting from its internal review of its practices. Able officials and outside FDA consultants identified instances in which certain lab testing practices did not follow standard operating procedures, the company said. In 2004, the FDA sent Able a warning letter following an inspection of the company's New Jersey facilities. In that letter, officials addressed compliance issues with federal regulations. Able CEO Dhananjay G. Wadekar announced his resignation from the company last Thursday. Wadekar could, however, continue as a consultant, according to a company statement. In the meantime, the company's president and chief operating officer, Robert G. Mauro, has taken over. Sharon DiStefano, an independent health care analyst with Sky Capital, told CNN: "To withdraw all of your products, shut down your manufacturing plant, have your CEO take flight that day, those are unusual occurrences." DiStefano told CNN that financial analysts had considered Able an up-and-coming company projected to reach $100 million in sales for 2004. Able, in its statement, said further federal action from the FDA remains unclear. Distributed by Internet Broadcasting Systems, Inc.


05-26-2005, 05:17 AM

man, thats scary, huh?????


06-04-2005, 03:44 AM

Aromatherapy massage to ease prisoners' stress.

The Daily Mail (London, England); 6/1/2005 A JAIL'S inmates are to be given access to aromatherapy, acupuncture, massage and reflexology. The new HM Prison Peterborough is advertising for two [pounds sterling]18,000a-year part-time 'holistic therapists' to carry out the treatments. They will also be asked to do Indian head massage and the Japanese reiki and shiatsu massage techniques alongside general relaxation and health promotion. Last night, a local MP said the move will turn the [pounds sterling]65million prison into 'a holiday camp'. But UK Detention Services, which runs Peterborough, defended the decision. The jail holds 216 men and 95 women, although the sexes are segregated. Company spokesman Nicholas Hopkins said: 'We look at the whole person and try to treat them in the round. There are some prisoners for whom holistic therapy will be extremely beneficial.' Prison director Mike Conway said: 'The incidence of self-harm among female prisoners is very high and this was part of an initiative to help resolve that problem and help to save lives.' Holistic therapist Brian Fossett, of Garden of Eden Holistic Therapies in Peterborough, said: 'There is no point in sending people out from prison full of anger and stress, it just increases the chance of reoffending.' Reflexology involves stimulating and massaging the feet and hands to tackle tension, stress and other health problems. Treatments can cost up to [pounds sterling]40 a session at salons, with most practioners recommending a course of six sessions. Indian head massage aims to relieve tension in the head, neck and shoulders, with sessions generally lasting an hour and costing between [pounds sterling]30 and [pounds sterling]35. Aromatherapy is a more personalised treatment, with therapists blending different oils for each patients needs. Sessions, which usually involve a full- body massage, cost upwards of [pounds sterling]30. The Peterborough prison is a Category B unit, designed to hold the second-most dangerous tier of inmates. Last night, Stewart Jackson, Conservative MP for Peterborough, said it is absurd that prisoners are being 'pampered' at taxpayers' expense with the therapy plan. He added: 'It is wrong that they are treated in this way. Are they using it as a Butlin's holiday camp? 'It reflects badly on hardworking families in the city that prisoners, men and women guilty of committing serious crimes, are being pampered instead of punished.' Crime victim Danny Giles, 84, who was targeted with his partner Maisie Forster, 90, by burglars at their bungalow in Peterborough, was furious. 'This is disgusting,' he said. 'These people know what they are doing and are in prison to be punished, not pampered.' David Sanders, a member of Cambridgeshire Police Authority, said: 'I question whether it is good use of taxpayers' money. 'If I was a victim of crime, I would feel very let down by this.' [email protected] COPYRIGHT 2005 Solo Syndication Limited


06-05-2005, 08:57 AM

Court doles out compassion Mental health court puts offenders into treatment programs instead of jail. It may soon be expanded to include all of St. Louis County.

St. Louis Post-Dispatch; 6/3/2005; CLAY BARBOUR; Of the Post-Dispatch

Theresa Kollefrath's day in court ended in applause. Six long months after suffering a psychotic break and assaulting her husband, the 37-year-old mother of two stood before the court one final time. As the judge dismissed the charges against her, a court- appointed caseworker hugged Kollefrath. The judge shook her hand. And the gallery erupted into cheers. It was not a scene usually associated with courtrooms. But the St. Louis County Municipal Mental Health Court is not your typical courtroom. Since it started in 2001, nearly 300 people have come through the mental health court, all of them suffering from some form of mental illness that contributed to their legal problems. About 95 percent of them had their charges dismissed, the result of successfully completing a prescribed treatment program. The court, according to officials, has been a tremendous success. The only problem is that it reaches too few people. A proposal before the County Council could soon change that. County Executive Charlie A. Dooley has asked the council to approve legislation that would allow county municipalities to use the court. Currently it is available only in unincorporated St. Louis County. "Fully two-thirds of our county can't access this," Dooley said. "Opening it up to them is the right thing to do." If approved, the measure would allow municipalities to pay a yearly fee of $3,000 for the right to send certain offenders to the court. Officials in Chesterfield, Town and Country, Maryland Heights, Normandy, Hazelwood and Clayton have already expressed interest. "Our local municipal courts just aren't equipped to deal with this," said Mark Levin, Maryland Heights city administrator. Inspired by the success of drug courts, mental health courts have spread across the country. The first one started in Broward County, Fla., in 1997. Since then, almost 100 have opened in 33 states. There are five such courts in Missouri: St. Louis, St. Louis County, Greene County, Boone County and Jackson County. Madison County has applied for a $400,000 grant to start its own mental health court, and officials in St. Charles County said they're considering starting one as well. Marcia Wikenhauser, executive director of Madison County's Mental Health Board, said the decision to create a mental health court came after a study of the county's jails revealed that 32 percent of inmates suffered from some form of mental illness. "These courts only make sense," she said. "They get people into treatment, rather than letting them languish in jail." Mental health courts team caseworkers and mental health professionals with prosecutors and judges to come up with the best possible treatment for offenders, who are typically charged with a minor or nonviolent offense. In normal court, justice is blind. In mental health court, it has 20-20 vision and a good set of ears to boot. Setting up effective treatment programs requires a lot of talking and listening. The court tailors treatment to certain illnesses and requires that offenders come back to court for monthly updates. Depending on their progress, offenders can stay in the program for up to two years. "This is justice tempered with compassion," said Linda Wasserman, a county prosecutor. "Punishment alone would serve no one's interest. But that doesn't mean that we mollycoddle them. If they don't get with the program, we bring the hammer down." Because the court deals only with ordinance cases, which are the equivalent of misdemeanors in state court, the "hammer" is up to a year in jail or a $1,000 fine. But that is rarely necessary. Most who come before the court want to avoid having a record and acknowledge that they need help. Kollefrath had wrestled with her mental illness for years before it got the best of her. Kollefrath heard voices telling her that her husband was trying to kill her. She ran barefoot out of her South County home and up the street, where she began banging on a neighbor's door for help. When her husband tried to calm her down, she wrestled with him and bit him. Her husband, not knowing what to do, called the police. Officials with the mental health court set up a program for Kollefrath that included therapy and medication. Today she has returned to the person she was before her illness took hold: bright, articulate and friendly. "You wouldn't have recognized me when I started this," she said. "I'm me again. This program is great. I have my life back."

(Copyright (c) 2005 The Post-Dispatch)


06-05-2005, 08:58 AM

AHF Hails California Assembly for Passing Condoms in Prisons Bill.

PR Newswire; 6/2/2005

SACRAMENTO, Calif., June 2 /PRNewswire/ -- AB 1677 (Koretz, D-West Hollywood), a bill that would allow the state of California to permit nonprofit healthcare agencies permission to distribute 'sexual barrier protection devices' (such as condoms and dental dams) to be distributed in California prisons in an effort to reduce the spread of HIV and other sexually transmitted diseases among inmates, cleared the Assembly Floor Tuesday in a 41 to 34 vote. The bill, which is sponsored by the Southern California HIV/AIDS Coalition (SCHAC), AIDS Project Los Angeles (APLA), and AIDS Healthcare Foundation (AHF), the largest AIDS organization in the US, which operates AIDS treatment clinics in the US, Africa, and Central America, was introduced by Assemblyman Paul Koretz in late February. AB 1677 would allow the state's Department of Corrections to, "... require the director to allow any nonprofit or health care agency to distribute sexual barrier protection devices, as specified. The bill would state that the distribution of those devices shall not be considered a crime nor shall it be deemed to encourage sexual acts between inmates. The bill would specify that possession of one of those devices shall not be used as evidence of illegal activity for purposes of administrative sanctions... " "California's prison and public health officials often walk a fine line as they try to grapple with controlling the spread of HIV and other sexually transmitted diseases among inmates in the state's prison population while following state law," said Michael Weinstein, AHF's President. "Allowing the distribution of condoms in prisons would help reduce the spread of HIV and these other STDs, but it runs contrary to current law. Widespread availability and use of condoms, a proven risk-reduction strategy, could both improve inmates' health outcomes and ultimately reduce costs to the state's overburdened prison health care system. We thank Assembly Member Koretz for introducing and carrying this important legislation and applaud the Assembly for clearing this bill earlier this week. We will now work with other legislators as the bill moves on through the Senate to ensure that this life-saving legislation makes it to the Governor's desk." CONTACT: Ged Kenslea, AHF Communications Director, +1-323-860-5225 COPYRIGHT 2005 PR Newswire Association LLC


06-05-2005, 12:59 PM

June 5, 2005 Sleep Anxiety Leads Many to the Medicine Cabinet By BONNIE ROTHMAN MORRIS ( ROTHMAN MORRIS&fdq=19960101&td=sysdate&sort=newest&ac=BONNIE ROTHMAN MORRIS&inline=nyt-per) IT'S hard to write this sentence: There is something women don't do as well as men. Sleep. So what's a woman to do? If you are swayed by advertising, the easy answer is to take a pill. Americans spend more than $2 billion on prescription sleep medicines. Since women are twice as likely as men to have difficulty falling and staying asleep, according to research at the National Institutes of Health, they are likely to be spending much of that money. The market for sleeping pills is expected to grow substantially, and drug companies are bullish about pitching these to women, even though some experts question whether such medicines are necessary. One of the most ubiquitous advertisements for sleeping pills is for Ambien, the current market leader. Sales of the drug, made by Sanofi-Aventis, a French company, increased 17.8 percent in the United States last year and reached $1.5 billion. Ambien currently has 86 percent of the United States market share for prescription sleep medicine, the company said. A new sleeping pill, Lunesta, came on the market in April. Unlike Ambien, which is indicated for use of a week to 10 days, Lunesta, manufactured by Sepracor, is approved for up to six months' use by the Food and Drug Administration. Lunesta is being backed by a $60 million marketing campaign. Women will be treated to their own set of ads. Two new drugs are also in the pipeline for F.D.A. approval: Ramelteon, from the Japanese drug maker Takeda Pharmaceutical, and Indiplon from Pfizer. The ads and the drug company Web sites suggest that these drugs are safe, and imply that they may even be necessary, noting that lack of sleep is cited as a factor in heart disease, obesity and other complications. Poor sleep is blamed for lack of sex, missed workdays and car accidents, too. And to look good, of course, you have to get rest. These messages nestle neatly with prevailing attitudes that women have about themselves. Many women say, for example, that sleep is something they should be able to master. "Some women think they are failing at sleep," said Dr. Gary K. Zammit, who is the director of the Sleep Disorders Institute at St. Luke's-Roosevelt Hospital in Manhattan and an expert in clinical pharmacology; he is also a consultant and has done research for most sleep medicine on the market. He described one patient who saw sleep as one more item on her to-do list. Over-the-counter drug companies have caught on to this desire for more sleep. Recently, a Tylenol PM ad in three women's magazines suggested that the pill could help prevent acne and dry skin. "Women have always been the target for sleep aids," said Kathy Fallon, director of communications for McNeil Consumer and Specialty Pharmaceuticals, which makes Tylenol. "They sleep less and they tend to medicate." She said that the ad was inspired by a 2001 article in The Journal of Investigative Dermatology that found that stress from lack of sleep could cause skin problems. It's enough to make women do just about anything to get some rest. There are lots of products and services that capitalize on this anxiety and promote the idea that sleep is a luxury: masks, teas, DVD's. In May, the Neiman Marcus catalog included a $1,250 traveling sleep kit from Chanel with a silk eye mask, silk pillow and cashmere socks. But women may still resort to a pill to get to sleep. Celeste Lee, 42, a furniture designer in Manhattan, has had lifelong trouble falling and staying asleep. About 10 years ago, Stephanie Casado, 29, a lawyer in Philadelphia, stopped sleeping well. Cory Olsen, 26, a part-time bartender in Manhattan who also works in financial services, has trouble sleeping on weekends when she finishes her bar shift. Ms. Olsen takes Ambien, prescribed by her doctor; Ms. Casado takes Ativan, which she gets over the Internet; and, Ms. Lee takes whatever prescription sleeping pills she can get from her friends, who, these days, are taking either Ambien or Xanax. Though these women say that not sleeping is frustrating, they are not concerned about their drug use. "It's perceived as if they are benign," Ms. Lee said. "They are these tiny little things, and because you believe that having a good night's sleep allows you to perform better, it's a happy drug." Ms. Olsen takes half of an Ambien pill most Sunday mornings when she arrives home from her bartending job. She says she is too wired to sleep after mixing martinis until dawn. And on Sunday nights, when she knows she needs to get a good night's sleep before heading to her day job, she takes the other half of the pill. "It's O.K. if I have an aid every once in a while if I get a good night's sleep," she said. The notion that it's fine to use a pill to schedule sleep when it's convenient is a relatively new concept, said Dr. Meir Kryger, professor of medicine at the University of Manitoba and author of "A Woman's Guide to Sleep Disorders." "We don't know if it's a good thing or a bad thing," Dr. Kryger said. Some doctors and other experts think that sleeping pills may do more harm than good. "The idea that you take a sleeping pill, you sleep better and do better the next day is just not true according to data," said Dr. Daniel F. Kripke, research professor of psychiatry at the University of California, San Diego. Dr. Kripke runs his own Web site, ( "There's a lot of scare talk about automobile accidents," he said. "The best evidence is that sleeping pills cause the auto accidents." Dr. Kryger said that sleep medications could be useful, but added that "the most important thing with insomnia is to make a diagnosis." He stressed the importance of treating the underlying disorder, not simply the insomnia. A recent study published in the Archives of Internal Medicine suggested that cognitive behavioral therapy may be more effective than Ambien in the long term. "The data are quite clear; good sleep hygiene goes a long way to solving intransigent moderate insomnia problems," said Dr. Carl Hunt, director of the National Institutes of Health's National Center on Sleep Disorders Research. Sleep hygiene means making sure your bedroom is comfortable, your pillow plumped, your lights are dimmed and nothing can distract you from falling asleep. Part of good sleep hygiene is living healthfully, including exercising and limiting caffeine and alcohol. That worked for Ann Peterson, 41, a caterer and mother of three who lives in a Seattle suburb. When Ms. Peterson was 37, she woke every night for two months around 2 a.m. and stayed awake for hours. "I thought I was going crazy," she said. Her doctor diagnosed depression and put Ms. Peterson on an antidepressant, which she hated and stopped taking. Soon after, Ms. Peterson started doing yoga and occasionally taking a natural sleep aid called Calms Forté. She doesn't watch TV or read in bed. Instead, she does the corpse pose, the last pose in a yoga session. "Then I'm snoring!" she said.


06-06-2005, 03:32 AM

This is so true!! I suffer insomnia so bad.


06-09-2005, 01:49 PM

I currently have a Brown Recluse bite, and I can tell you that the spider numbs the area before biting, so you don't feel the bite. Also, if they had done a culture on the bite, it would come back as a Brown Recluse bite. That is how my doctor decided the treatment for it. I can also tell you that the Brown Recluse has traveled much farther north than they are saying, I live in Indiana and I was bitten while working outside, my daughter was bitten last year at an outdoor theater. These bites hurt alot becuase they swell up with so much infection your skin get's real tight and you really just want someone to cut it out so the pain will stop. They are like boils in a way, they ooze puss once the sore is opened. There has been instances where, if not treated properly people have lost arm's or legs. The spider bite can deteriorate the skin and just eat it away. These are very dangerous. Rhon Inmates allege spider bites; jailers say it's an infection By ADRIAN ANGELETTE [email protected] Advocate staff writer More than 30 Parish Prison inmates claim in lawsuits that they were bitten by venomous brown recluse spiders. The two suits say the East Baton Rouge Parish Sheriff's Office, which operates the prison, has not worked to eliminate the hazard. "Either no steps were taken to control the spider problem or the steps taken were wholly inadequate," one suit says. Defendants named in the suits are East Baton Rouge Parish Prison Warden Joe Sabella, the Sheriff's Office and the city-parish. However, attorneys for the city-parish said a state expert found that the inmates are suffering from a staph infection, not spider bites. None of the inmates who sued has produced a spider, one lawyer said. "No one has ever come up with a single brown recluse spider," said Leu Anne Greco, an attorney for the Sheriff's Office. The lawsuits contend that after a spider bites, the area around the bite turns red and swells, leaving a red ulcerous sore that causes a scar. Some of the inmates claim to have been bitten multiple times. Greco said the city-parish and Sheriff's Office had Raoul Ratard, the state epidemiologist, review the inmates' medical files. Epidemiology is the study of disease and its distribution within a population. Ratard determined that the health problems were caused by a staph infection called methicillin resistant Staphylococcus aureus, Greco said. The strain of the infection is the same one that has been reported in prisons in other states, she said. The Centers for Disease Control and Prevention says that since 1999, the Staphylococcus aureus has been found in prisons in Mississippi, Tennessee, California, Texas, Georgia and Pennsylvania. MRSA is spread through physical contact, most often to people with weak immune systems, the CDC reports. To stop the spread, patients are often isolated and antibiotics are used for treatment. Surgery is sometimes necessary at the source of the infection, the CDC says. The infection can cause oozing boils, infections or pneumonia. James Hilburn, an assistant parish attorney, said the staph infection is common throughout the nation and is often found in hospitals. He also said the staph infection spreads easily. "It only needs broken skin to spread," Hilburn said. Hilburn said Ratard found nothing wrong with the way the prison is operated. It is sprayed twice each month to kill harmful insects, including spiders. Greco said the city-parish also had an entomologist inspect the prison, and that he found no spider problem. Entomology is the study of insects. Brown recluse spiders are common in Louisiana, Mississippi, and the section of the United States between Dallas and Atlanta, from the Gulf of Mexico to the northern boundary of Missouri.


06-09-2005, 02:23 PM

Missing Mineral May Mean More Maladies Magnesium Found In Nuts, Vegetables UPDATED: 11:15 am EDT June 9, 2005 DALLAS -- Seemingly healthy people who feel run down, anxious or achy could be lacking an important dietary mineral rather than suffering from a mysterious illness, reported KXAS-TV in Dallas. According to health experts, most Americans are short on magnesium, which is an essential part of good health.

Magnesium plays such a key role in healthy living that the new food pyramid created by the U.S. Department of Agriculture was designed to increase the mineral's intake in a recommended diet. The mineral is necessary for more than 300 biochemical reactions in the body, according to medical researchers. Studies show magnesium could help to regulate blood pressure, and a lack of magnesium has been found in people with diabetes and osteoporosis. More studies are under way. "One of the areas where there's just preliminary studies is on whether giving magnesium supplements could help someone with a migraine headache," said Dr. Jo Ann Carson, a nutritionist at the University of Texas Southwest Medical Center at Dallas. Nutritionists suggest adding more fruits, nuts and vegetables to a diet to balance the magnesium intake-to-necessity scale. They warn, however, that taking more than 350 milligrams per day could be dangerous. An increase in magnesium intake has proved beneficial to some people. "It seems to make me feel better, and it seems to be more preventive," Allison Nance said. "I feel good," Stephanie Ross said. "I can do a lot more than friends my age." "That's all anyone wants to do -- feel good," Beth Fitzgerald said.


06-10-2005, 03:00 PM

Inmates' Medical Care Failing in Evaluation by Health Dept. By PAUL VON ZIELBAUER A recent evaluation of the company in charge of inmate health care at Rikers Island, coming months after it was awarded a new $300 million contract, has found that it has failed to meet a number of the most basic treatment goals. City records showed that the company, Prison Health Services Inc., did not meet standards on practices ranging from H.I.V. and diabetes therapy to the timely distribution of medication to adequately conducting mental health evaluations. The city Department of Health and Mental Hygiene, which oversees the company's work at Rikers Island and at a jail in Lower Manhattan, found that during the first quarter of 2005, Prison Health failed to earn a passing grade on 12 of 39 performance standards the city sets for treating jail inmates. Some of the problems, like incomplete medical records or slipshod evaluations of mentally ill inmates, have been evident since 2004 but have not been corrected, according to health department reports. Other problems identified in the department's review, involving things as serious as the oversight of inmates who have been placed on suicide watch, are more recent or had not been evaluated by city health auditors in the past. As a result, the city is withholding $55,000 in payments to the company, the largest penalty for poor performance it has incurred since 2001, the first year of its work in New York City adult jails. The evaluation came months after the health department gave Prison Health, the largest private provider of prison and jail health services in the nation, a new three-year contract to care for about 14,000 inmates a day. The company's work at Rikers had been criticized by independent city and state monitors, but the health department had defended its decision to renew the contract, and said it had devised a more effective and demanding way of evaluating the company's performance. The company, in a statement, said it has provided sound care to inmates at Rikers since taking over health care operations there. It described the shortcomings documented by the city as temporary, and said its poor evaluation was because of changes in the way the city had chosen to gauge its work. "At all times during the first quarter, P.H.S. continued to deliver quality care to our patients," Benjamin S. Purser Jr., the company's vice president for ethics and compliance, said in the statement that was sent out via e-mail. Robert Berding, the health department official in charge of overseeing Prison Health's work, said the city's medical standards are exacting - a company is required to meet the standards in every measured category at least 95 percent of the time over a three-month period. Each area that needed improvement, he said, would be closely monitored. But some members of the city Board of Correction, a panel appointed by the mayor that sets jail standards, said the city's review was disturbing . "It seems like the needle is moving in the wrong direction, not the right one," said Hildy J. Simmons, the chairwoman of the Board of Correction. Ms. Simmons made her remarks at the board's monthly meeting in Lower Manhattan yesterday. Another board member, Paul A. Vallone, criticized the health department's decision to allow the company to come up with its own plan to correct the problems in care. "It's like a judge allowing a criminal to determine his sentence," Mr. Vallone said, adding that the Board of Corrections should take a more active role in ensuring that the care would be improved. Several board members seemed eager for a more comprehensive understanding about Prison Health's performance, and about how closely city health officials were monitoring the company at Rikers. "I think it's time for us to be asking some questions and getting some clearer answers," Ms. Simmons said. Mr. Vallone and a third board member, Gwen L. Zornberg, said several Prison Health employees at Rikers believed the biggest obstacle to improving inmate medical care were missing records that often forced doctors to examine patients without knowing their full medical histories, or what medications they took. "Medical records seem to be getting lost over and over," Dr. Zornberg said. Colleen Roche, a Prison Health spokeswoman, said the company was planning to begin using computerized medical history forms in July, allowing doctors to more easily summon patient records. The company, she said, was also building a new computer server to track specialized medical care in jail, a chronic problem during Prison Health's four-and-a-half-year tenure at Rikers.

Copyright 2005 ( The New York Times Company (

Truth Seeker

06-14-2005, 05:51 AM More Inmates Suffering From 'Meth Mouth' Mon Jun 13, 7:25 PM ET Increasing numbers of inmates are arriving at prisons and jails with rotted teeth. It's called "meth mouth" — a condition rampant among methamphetamine users — and its taxing corrections officials' dental budgets. Contract dentists are having to put in more time to keep up with the demand for dental visits. Some jails have a two-month waiting list. In Salt Lake County, dental costs for jail inmates increased 30 percent between 2003 and 2004, said Jared Davis in the county's finance office. Dental costs for county inmates: $44,756 in 2003; $58,193 in 2004. The county does try to charge inmates a co-payment for the dental. Inmates paid nearly 12,000 of the $58,193 dental costs in 2004. Still, Davis said, "It's a pretty dramatic increase." Dr. Robert Anderson sees about a dozen inmates at the Davis County Jail each week. "Sometimes every one of them is a meth user," he said. He also sees them in his private practice. His jail workload has recently increased from five hours per session to eight hours at the jail — all because of the number of meth users. Anderson figures meth mouth costs the county as much as $3,000 a year that could have been directed to other services. "It's going to become an issue here more than it already is," he said. "The problem is growing." Jack Ford, spokesman for the Utah Department of Corrections, is reluctant to tie "meth mouth" to any financial burdens. "The medical area is real sensitive," he said. "But it is an ongoing problem." "I'd say most dentists in the state are familiar with it," said Monte Thompson, director of Utah Dental Association. He plans to include an article about it in the organization's newsletter. Much of the dental work is extraction. "There are 28 teeth," said Dr. Richard Johnson, a dentist who works regularly at the Utah State Prison and the Utah County Jail. "There are 26 of them that need to be extracted sometimes, and sometimes you just have to dig 'em out." A few weeks ago, Johnson pulled seven soft, black teeth out of an inmate's mouth. A week later, he pulled out four more of the patient's teeth. Dentists in private practice and public health clinics also see young meth users who have to wear dentures. "They look like someone shot a gun through their mouths," said Dr. Richard G. Ellis, who volunteers at Salt Lake Donated Dental Services. "It just destroys them." Opinions differ as to what causes meth mouth. Some dentists believe the acid in the drug eats away the teeth. Others say it's meth addicts' huge consumption of sugar-laden soda to alleviate dry mouth. The pseudoephedrine in meth slows saliva production, Anderson said. Saliva naturally neutralizes acids and clears food from the teeth. Decreased saliva flow allows bacteria to build up 10 times over normal levels. Without it, acids can erode tooth enamel, which in turn causes cavities. Poor oral hygiene and neglect also might be a factor in tooth decay. ___ Information from: Deseret Morning News,


06-20-2005, 01:08 PM

One of the other major factors is that speed is a vasoconstrictor, so the blood flow, which would normally nourish the gum and teeth, is diminished.


06-20-2005, 01:10 PM

One of the best ways to NOT lower your magnesium levels is to avoid coffee!! (Rats, rats, rats!)


06-20-2005, 06:46 PM

I did a quick search within the Federal Bureau of Prisons website and found this link. Hopefully this info can give you a place to start to hopefully getting your questions answered. Good luck. Ronnie

Do anyone know anything about medical parole in the federal prisons? My husband has both state & fed time running concurrant and has multiple medical issues. State has said if they released him on medical parole that the feds would pick him up. Which is worst the federal prison hopital or CMS? As it is when he is released he will have to go to a nursing home as I cannot take care of him but he says it would be better than where he is!!!!


07-05-2005, 08:13 AM

Feds to Oversee Calif.'s Prison Health

AP Online; 6/30/2005; DON THOMPSON, Associated Press Writers

Dateline: SACRAMENTO, Calif. A federal judge on Thursday said he will appoint an independent overseer for California's prison health care system, so plagued with problems that basic sanitation is lacking and examinations are sometimes performed on cell floors. U.S. District Judge Thelton Henderson called the nation's largest inmate health care system "terribly broken. ... We're dealing literally with life and death." The judge is expected to appoint a monitor during a hearing July 8, when he also will set the scope and duration of the oversight. He could choose one or more monitors from among candidates suggested by the state prison system and attorneys for plaintiffs who sued the governor and corrections officials in 2001. The Prison Law Office, a nonprofit prisoner rights group representing the plaintiffs, claimed in the suit that medical treatment for inmates was so poor it was unconstitutional. Earlier this year, medical experts who toured one facility _ San Quentin State Prison _ told the court it was "old, antiquated, dirty, poorly staffed, poorly maintained, with inadequate medical space and equipment, and overcrowded." Henderson also visited the prison in February, saying he found examinations being performed on cell floors and through food slots, according to court documents. The main medical examining area, where about 100 men a day undergo medical screening, lacked any means of sanitation, and the dentist didn't wash his hands or change his gloves after treating each patient, court documents said. A settlement in the case was reached, but the two sides have been sparring over its implementation. "The judge has clearly recognized the ongoing risk of death and harm to patients is unconstitutional and basically horrifying," said Alison Hardy, an attorney with the Prison Law Office. California Youth and Adult Corrections Secretary Roderick Hickman welcomed the ruling and said he hoped it would provide "a sustainable solution" to problems that have led to repeated lawsuits. "The taxpayers of this state can't afford to keep paying for repeated lawsuits that result from the same kinds of problems such as inadequate health care, poor mental health treatment and insufficient staffing," Hickman said. The judge's decision comes as an effort by Gov. Arnold Schwarzenegger to reorganize the prison system takes effect Friday. The restructuring will concentrate power and responsibility for the prison system in Hickman's hands. Top prison officials have acknowledged they can't manage the inmate medical system and had been counting on consultants and the reorganization to make improvements. State Senate Majority Leader Gloria Romero said the federal receivership is unprecedented in scale because California's prison system is so large, spanning 163,000 inmates and 33 prisons. She expects reforms to take several years. "There has been a quarter-century of neglect when it comes to health care for inmates," the Democrat said. "It's a billion-dollar failure at this point. Corrections has not proved itself able to adequately deal with the challenges." ___ On the Net: California Youth and Adult Correctional Agency: Prison Law Office: Copyright 2005, AP News All Rights Reserved


07-06-2005, 01:57 PM


The Kentucky Post (Covington, KY); 7/4/2005

Byline: Brett Barrouquere Associated Press LOUISVILLE -- Cliff Gill hardly finds it unusual to see dental problems among new inmates at his jail. After all, life behind bars is often the first time they use two things they ignored on the outside: "a toothbrush and a Bible." But the explosion of methamphetamine use has taken it to a scary new level, with inmates coming in every week with black-orange smiles, enamel completely rotted, gums bleeding and receding, and no choice but to have every tooth pulled. "It's almost unbelievable," said Gill, who sees four or five inmates a month at his lockup in Western Kentucky's McCracken County who must be sent to an oral surgeon for a complete tooth extraction --at a cost to the taxpayer of $500 per inmate. Jails and prisons across the South and Midwest have become besieged with an increasingly expensive problem called "meth mouth," the catchall for the methamphetamine side-effects that combine to lay waste to a mouthful of teeth in a matter of months. "Meth mouth" is caused in part by the harsh chemicals used to make methamphetamine -- such as brake cleaner and lithium from batteries -- which slow the blood flow to teeth, speeding up decay. The drug also dries up the saliva in the mouth and gives users a sweet tooth often fed by copious amounts of sugary junk food and soft drinks with high caffeine content, such as Mountain Dew. Dr. Tom Shields, director of Dental Services for the Florida Department of Corrections, said inmates with "meth mouth" stand out from ordinary inmates who just haven't taken care of their teeth. "Meth mouth" inmates look similar to patients treated for head and neck cancer, Shields said. "It just looks like the enamel is eaten off the teeth." Statistics on "meth mouth" are hard to come by. Many prison systems don't ask dental patients what their crimes are and aren't equipped to track the cases anyway. Anecdotal evidence from jailers and corrections departments everywhere from Florida to Wyoming show the problem growing. "It's in every state I can think of," said Ken Fields, a spokesman for Correctional Medical Services in St. Louis, which provides dental and medical care in prisons in 27 states. Darcy Jensen, a drug prevention and treatment counselor who runs Methamphetamine Awareness and Prevention Project of South Dakota, said meth's toll on the mouth, teeth and rest of the body is quick and obvious. Cocaine and heroin have a physical impact, as do alcohol and marijuana, on the user but over a longer period of time. With meth, teeth quickly change colors and fall out, gums recede, cheeks collapse and the person loses weight. "It happens rapidly and in so many ways," Jensen said. "It just kind of multiplies." That was the case with Steve Collett, of Manchester, who had his teeth pulled and repaired after getting out of prison last year. Collett said meth was "his drug of choice," and the realization of its effects hit him one morning when he had sobered up. "I looked in the mirror and it was, 'God, what did I do to me?'" he said. "I couldn't look people in the face. I hated the way I looked." A generous donor from his church gave Collett the $1,900 to have his teeth repaired. Of the few states that have tracked the disorder behind bars, the jump in dental visits and costs have been noticeable. The number of days a dentist served inmates in North Dakota shot from 50 in 2000 to 78 in 2004. Minnesota's bill for inmate dental care went from $1.2 million in 2000 to $2 million in 2004. Most states, including Kentucky, can offer only anecdotal evidence that "meth mouth" is growing into an expensive problem. Dr. James Cecil, administrator of oral health for the Kentucky Cabinet of Health Services, has heard about the disorder from oral surgeons and dental students who call looking for help in diagnosing and treating the disorder. "It's coming up the expressways, I-64, I-75 and the Western Kentucky Parkway," he said. "Those are the drug delivery routes." Collett said, based on his experience, he expects more cases to pop up before things get better. "It's just amazing what drugs will do," Collett said. "Drugs became my god. I didn't care about my teeth. I didn't care about nothing." COPYRIGHT 2005 The Kentucky Post. All rights reserved. Reproduced with the permission of the Dialog Corporation by Gale Group.


07-08-2005, 11:47 AM


Rocky Mountain News (Denver, CO); 7/6/2005; Scanlon, Bill

Byline: Bill Scanlon, Rocky Mountain News The Colorado Department of Corrections denied proper care to two inmates who now have end-stage cancer, their families charge, at the same time the prison system's medical staff decreased because of state budget cuts. By ignoring the inmates' pain, officials turned their prison terms into death sentences, say the families. "They let him sit and suffer with acute symptoms for 90 days," businessman Ed Smith said of his brother, Daniel Brian Smith, 44, a former methamphetamine addict now in the Denver Reception and Diagnostic Center's infirmary with lymphoma and leukemia. Betty Vigil has a similar story about her son, Deric Barber, 31, serving 45 years for second-degree murder. "I pleaded with them that my son had all the indications of colon cancer and needed a colonoscopy," Vigil said. "They didn't do anything. "Then three months later I got a call from an assistant warden saying Deric was critically ill." Both men are in advanced stages of cancer and don't have long to live, their relatives said. The DOC declined a reporter's request to interview the men, saying they're at an infirmary considered maximum security. DOC spokeswoman Alison Morgan said she can't talk about Smith's or Barber's cases because of federal privacy rules. But prison resources are public record. Between 2002 and 2004, the DOC let go of 43 nurses and doctors and saw its funding for substance-abuse treatment, mental health and sexual-abuse treatment fall 36 percent, 17 percent and 12 percent respectively, said Barry Pardus, director of clinical services. Medical staff is now at 408, down from 470 three years ago. Patient loads are increasing, the budget is shrinking, nurses are quitting to opt for $15,000 signing bonuses with Front Range hospitals, Pardus said. To stem the stream of prisoners signing up to see the doctor for imaginary ills, the DOC recently upped the charge for an office visit from 50 cents to $5, Pardus said. "We saw a 30 percent reduction in requests to come to the clinics," Pardus said. He doesn't know if that change might have led to some prisoners not being seen for serious problems. "But it's part of that difficult task" of trying to find those who are truly sick at a time of tight resources, he said. It's possible that a prisoner who complains of chronic pain may not be treated for several months, Pardus said. "Pain is one of the hardest things to diagnose. We do have a lot of patients who are narcotics-seekers." A new DOC program is trying to reduce the amount of narcotics to the lowest necessary level, he added. "We get grievances because we used to have them on narcotics and no longer do." In June, a state audit criticized the DOC for weak oversight of private prisons, which house about 2,800 of the state's 18,000 prisoners. The audit found that private-prison doctors twice changed prescriptions for inmates without examining the patients first. Both men died, possibly as a result, auditors said. And doctors often delayed required services for mentally ill prisoners, the audit said. Daniel Smith and Deric Barber were in Colorado's state-run prisons. Daniel Smith was found guilty of conspiracy to manufacture methamphetamine in 2003. His lawyer portrayed Smith as a man down on his luck, trying to help his mother who had suffered several strokes. But Adams County prosecutors noted that he hadn't worked since 1999 and still lived well - the result, they said, of being involved in the methamphetamine business. Smith was sentenced to 12 years and went to Four Mile Correctional Facility in Canon City. "My brother had had chronic back pain, but it got a lot worse in July and August (of 2004) and even worse in October and November," Ed Smith said. "In late November, they put him in the hole for goofing off and took away his pain meds. "He'd call me every few weeks, he was in tears, saying, 'What can I do?' " In December, Dan Smith complained to doctors about extreme pain, Ed Smith said. But the doctors noted that he was able to get up and down several times and leave the room without limping, according to records Ed Smith obtained from DOC. "In early January he called me and said he was in so much pain I had to do something. I went through the ombudsman's office and the governor's office." In late February, Ed Smith got a letter from DOC's clinical services saying an MRI had been scheduled for his brother. By then, his brother was in a wheelchair, Ed Smith said. "They found a 10-inch tumor on his spine and one attached to his pancreas," Ed Smith said. The tumor was removed, and Dan Smith started chemotherapy. "He's terminal," Ed Smith said. "The tumor on his back is growing. It's the size of his hand." Ed Smith says the medical team at the DOC center in Denver isn't trained for hospice care, so his brother's last days may include a lot of suffering. DOC doesn't run a hospice, but it has 60 beds for severely ill inmates who could be terminal - about half in Denver, half in Canon City, Pardus said. It also has 48 beds at a Fort Lyons facility for the geriatric population. Ed Smith said he had a difficult time getting a DOC chaplain to see his brother and getting permission for the family priest to see him. Ed Smith describes his younger brother as bright, but a person who never liked uniformity. He kicked a drug habit once, but "his addictions came back and he learned to be a very good meth cooker." His brother had overcome his addiction in prison and was close to eligibility for release to community corrections, Ed Smith said. "Could they have stopped the cancer in time if they'd spent the money on the MRI sooner?" Ed Smith asked. "I really don't know. "But eight months in really chronic pain, and all they give him is ibuprofen, before they finally got him an MRI and found the tumor? Give me a break." Vigil says she got a letter from her son, Deric Barber, 2 1/2 years ago, saying he'd lost a lot of weight, had popped blood vessels in his eyes, was sick and having trouble moving his bowels. "I called his case manager at the prison and told him these are all indications of colon cancer. I said he needs a colonoscopy. They didn't do anything," she said. "In April I get the call from an assistant warden saying Deric is critically ill." At that point, doctors performed a colostomy, which permits Barber to eliminate body waste, and gave him radiation and chemotherapy. "He is so sick," Vigil said. "I just want to bring him home to die." "All I hear from him is how much it hurts," Vigil said. " 'It hurts, I'm scared and I don't want to die.' "What do you tell your kid?" Barber was convicted of second-degree murder in Pueblo County in 1993, when he was 20, and given 45 years in prison for the beating death of a fellow gang member. The battered and frozen body of Sam Casados was found on Dec. 4, 1992, in a field near a party both men had attended. The Pueblo County coroner ruled that Barber's victim died of hypothermia. Jorgensen said he filed appeals complaining that evidence against his client was planted, but they failed. Barber was at the Supermax Colorado State Penitentiary in Canon City when he started complaining about severe pain. Barber's lawyer, Randall Jorgensen of Pueblo, said Barber's uncle showed him some medical records, which he sent to a prison warden, along with a note saying a colonoscopy is probably needed. "Apparently nothing goes on for a while," Jorgensen said. "I sent them another letter to take him to the infirmary. But we didn't get much more there." Barber was in Territorial, the old penitentiary in Canon City, when the colonoscopy finally was ordered, Jorgensen said. By the time the colonoscopy was arranged, it was too late, he said. "At that point, he was terminal." Jorgensen said he asked that DOC let Barber go home to die. He said he got some help from a physician at DOC who urged the executive director to do a humanitarian commute of Barber's sentence because, the doctor wrote, the "care was less than optimal." "The bottom line is Deric isn't worth anything" in the eyes of DOC, Jorgensen said. "He was complaining actively for six to nine months. "He had a lot of pain and bleeding, but they didn't pursue it." Jorgensen said medical costs in prisons are skyrocketing because "so many people are locked up" for a long time and the prison population is getting older and more sickly. The lawyer acknowledged that DOC has a tough balancing act, because prisoners are infamous for feigning illnesses to get attention or a day on a soft bed. "They get malingerers, game players," Jorgensen said. "They've heard it all, seen it all, they get gamed all the time. Still, denying narcotics to anyone in severe pain "flies in the face of the Colorado Medical Practices Act," Jorgensen said. A year ago, DOC hired Dr. Cary Shames as chief medical officer. Shames has a background in managed care "and is trying to improve quality while reducing cost," Pardus said. DOC has shown some success in lowering the number of hospital days for inmates, he said. INFOBOX Prison: by the numbers 18,000 Colorado prisoners 470 Medical staff in 2002 408 Medical staff in 2005 COPYRIGHT 2005 Rocky Mountain News.


07-08-2005, 11:49 AM


Seattle Post-Intelligencer (Seattle, WA); 7/5/2005; Galloway, Angela

Byline: ANGELA GALLOWAY P-I reporter Local health and jail officials are seeking permission to administer methadone, a synthetic opiate, to inmates addicted to heroin and other drugs. If approved, King County would be the second jail system in the nation to enroll inmates in methadone treatment while they are behind bars, according to Mark Alstead, who manages the program for Public Health - Seattle & King County. Methadone has been used for decades as an oral opiate substitute to help wean addicts from heroin, morphine, oxycodone and other drugs. Supporters say it helps stabilize addicts while they stay clean, thus saving taxpayers' money by cutting repeat offenses and emergency health bills. "What we're trying to do is focus on the people who have the opioid dependency but are also the ones who return to jail over and over again so we can interrupt that cycle," said Alstead, who last year visited the other program, at New York's Rikers Island jail complex. When participants are released from the county's jails in Seattle and Kent, they will be given vouchers to continue treatment for up to nine months, he said. If they still need methadone, the goal will be to enroll them in treatment through health insurance or social programs that pay for methadone, such as Veterans Affairs benefits and Medicaid, a state and federal health plan for the poor, Alstead said. Deb Cummins, a drug treatment manager with the state, added: "It's going to save taxpayer money in the long haul - plus give people a chance for a better life." Inmates in the program would be given a liquid methadone formula, which they would be required to drink in front of health department professionals, Alstead said. They would also be enrolled in counseling with certified chemical dependency professionals and required to submit to random urinalysis tests. Methadone programs are regulated by the federal Drug Enforcement Administration and the Center for Substance Abuse Treatment, as well as the state Board of Pharmacy and the Department of Social and Health Services. DSHS is considering the health department's application for certification. The cumbersome nature of the process is one reason it has not yet been tried elsewhere, Alstead said. Also, it's a controversial treatment approach with some people. Cummins said skeptics mistake methadone treatment for government-endorsed narcotics use. "People see this as just a legal dope-giving kind of role, when it's actually a medication," she said. "They're not taking it to do anything other than function normally." Alstead added that some people disapprove of addicts relying on the chemical, even with a prescription. "They think if you're taking methadone you're not clean," Alstead said. "What they don't understand is when people are addicted to heroin and other opioid substances there are permanent changes in their brain. "That's why they need the medication." For 2006, the budget for the program is $200,000 for staffing and medications, Alstead said. In addition, the department has about $150,000 reserved for community treatment vouchers. But Alstead and others said it would save much more money in reduced costs to the criminal justice system and hospitals. Methadone costs an average of $10.36 a day. Jail costs $92 per day, Alstead said. The local program will prioritize longtime addicts who are convicted of misdemeanors or low-level felonies, Alstead said. It will also target the mentally ill, he said, because they are "of the highest need" for help. On any given day, about 300 to 400 of King County's inmates are addicted to opiates, Alstead estimated. He hopes to start the methadone program next spring, phasing it in to eventually treat 50 and 100 inmates a day, he said. That would include a separate short-term program for newly booked inmates. Some addicts who don't enroll or qualify for the long-term program would be given a 12-day low-dose program to help them through the withdrawal process, he said. But there's a big difference between detoxification and rehabilitation, said Ron Jackson, director of Evergreen Treatment Services, a private non-profit drug treatment agency that treats 1,200 methadone patients each day at three sites and via a mobile van. Flulike withdrawal systems usually peak for heroin addicts about two to three days after their last hit, Jackson said. But even after that subsides, some addicts need help from opiate substitutes such as methadone to keep clean. There's "all the difference in the world from getting that drug out of your system and having the skills to keep it out of your system," Jackson said. "Anybody can be on a diet for 12 hours." About a year ago, the local health department began issuing methadone treatment vouchers to some inmates when they were released. But this program would actually get them established in treatment before they're shown the door, Alstead said. "It's a long way between here and even Harborview (Medical Center's treatment program) for someone who has addiction issues," Alstead said. "They can easily get sucked into the drug life." Currently, only inmates who were in methadone programs before they were booked can receive it while in jail, Alstead said. Those doses are administered by a private contractor who delivers doses daily to several dozen of the two jails' approximately 2,000 to 2,500 inmates, he said. But once the in-jail program is running, the public health department plans to assume that duty, too. COPYRIGHT 2005 Seattle Post-Intelligencer.


07-14-2005, 10:44 AM

Cutting Calories in Corrections: Utah Pilot Program Helps Inmates Slim Down By Meghan Mandeville (, News Research Reporter This summer, some female inmates at Utah State Prison in Draper are cutting down on calories and strapping on their sneakers to try to shed some extra pounds. Believe it or not, a hefty portion of the inmate population there is overweight. The facility's pilot weight-loss program kicked off three weeks ago with the goal of helping incarcerated women trim down by downsizing their meals, giving them some extra exercise and teaching them the basics about nutrition. Obesity has become a hot topic in the news and in literature in the U.S. Because the problem so widely affects society, corrections is not immune to it, said Utah Department of Corrections Medical Director Rich Garden. "I don't know if it's a corrections issue, rather than a national problem," Garden said. ", it makes sense that obesity would impact the incarcerated population, as well." To get an idea of how the issue affects inmates in Utah, Garden talked with some medical providers in the state to find out what their experiences have been with offenders and obesity, anecdotally. The consensus was that many inmates tend to gain weight after they become incarcerated and the data supports that fact. According to Garden, male inmates in Utah gain an average of 34 pounds within their first year of incarceration, while their female counterparts add on an average of 17 pounds during their first year behind bars. The driving forces behind this weight gain are a high calorie diet and a lack of exercise, Garden said. "For the most part, people are less active once they arrive at prison," said Garden. "Prison is sedentary." In addition, the DOC serves 2,700 calories worth of meals to inmates each day, regardless of their gender or size, when the Food and Drug Administration recommends a daily caloric intake of only 2,000. "We basically provide the same number of calories to people that might be 4'8" and weigh 100 pounds or 6'8" and weigh 350 pounds," said Garden. "We are actually providing them with an overabundance of calories." While providing inmates with hearty meals and keeping them full is a tactic for custody staff, who find that inmates are generally happier and easier to manage when they are well-fed, Gardner said that it, at the same time, causes inmates to gain weight and become unhealthy. At intake, 73 percent of people are overweight and 20 percent are obese, according to Gardner. After three months of incarceration, those percentages jump to 80 and 43, respectively, he said. With numbers like that, Gardner and other medical staff in Utah saw a need for an intervention. But, first, they distributed a survey to 288 male and female inmates at Draper to determine if they would be interested in learning more about nutrition and slimming down. According to Garden, 90 percent of the women who responded to the survey and 80 percent of the men said that they would enjoy more exercise and education about living a healthy lifestyle. And more than half of the respondents said that they would opt for a lower calorie diet, if special trays with reduced portions were available for them during meal times. Since the response from the inmates was so positive, a weight loss pilot program was born. To start out, it was first offered to only female inmates on a voluntary basis. The 30 women who signed up for the program agreed to meet three times a week for half an hour of education and discussion and another 30-45 minutes of exercise, such as jogging, push-ups or sit-ups. They were allowed to have family members bring sneakers in to them at the facility or to purchase a pair from the commissary, Garden said. Garden explained women who are not incarcerated have a variety of places to turn for help losing weight, like Weight Watchers, but those organizations do not exist behind bars. "[The inmates] have no options and we are simply trying to provide them with an option," said Garden. Draper's pilot program follows the Weight Watchers model, where women weigh in once a week, have discussions about weight loss strategies and lean on each other for support. "For the most part it's been a very good program in terms of camaraderie," said Garden, noting that the women have been a great source of support for each other. He added that once a month, a dietician meets with them to talk about nutrition. Giving these women information about healthy eating and an opportunity to try to lose weight is a benefit to both the inmates and the DOC, Gardner said. "It really boils down to the fact that this is preventative medicine," said Gardner. For the department, he said, a program like this can cut down on inmate healthcare costs for problems related to obesity - like coronary artery disease and diabetes - and it can reduce the amount of money spent on food, if portions are decreased. And the program requires no additional funding, Garden explained. There is no special food served or additional staff required; program participants eat the same food as other inmates, just less of it, and existing employees have put in a bit more time to accommodate the program, he said. "The benefit of this is that this is not an expensive endeavor whatsoever," Garden said. "And the benefits, in terms of cost and human health, are absolutely tremendous." For the inmates, losing weight can help improve their self-esteem, which may translate into more success in society once they are released, he said. "That is really our hope, but we won't know all these things until we get some time under our belt," Garden said. In August, Garden said that he and his colleagues will sit down, tally the results of the program and see what sort of progress the women have made. "[We'll] talk to the [women] that participated and see how maybe we can tweak the program, how we can do things better," said Garden. At that point, they'll take that data to the administration to discuss expanding the program, he said. "We are excited about it. We think it's a great idea," said Garden. "It's certainly a program whose time is long overdue." [b]Resources: Garden [email protected]


07-19-2005, 11:44 AM

MAY/JUNE 2005 Main Article: HIV infection among Women in Prison: Considerations for Care Anne S. De Groot*, MD, Brown University Susan Cu Uvin**, MD, Brown University HIV has a Woman's Face According to Nelson Mandela, who spoke about the disproportionate burden of HIV infection on women at a recent event in South Africa, the world wide epidemic of HIV is taking on the face of a woman.1 Due to their status in society and for physiological reasons discussed in greater detail below, women are disproportionately at risk for HIV infection, and this is particularly true for women who are incarcerated. The overall prevalence of HIV infection among U.S. women is approximately 0.2%; incarcerated women are 15 times more likely to be HIV-infected compared to women in the general population. In several states, nearly one in 10 incarcerated women are HIV-infected. At yearend 2002, 3% of all incarcerated women in U.S. state prisons were HIV-infected, compared to 2% of incarcerated men in U.S. state prisons (see table 1). ( More than 10% of female inmates in two states (New York and Maryland) were known to be HIVinfected.2 Social Factors Incarcerated women have higher prevalence rates of HIV infection than incarcerated men because the behaviors for which they are incarcerated put them at risk for HIV infection.3,4 They are often injection drug users (IDUs), sexual partners of IDUs, have supported themselves through sex work, and more often than not, they have been forced to have (unprotected) sex or trade sex for housing and food.5 Women who are more likely to be HIV-infected in the U.S. also belong to subgroups of the population that are at increased risk of incarceration: women living in poverty, women who lack marketable job skills,6 and certain ethnic groups (African American, Hispanic). Many of the women at highest risk for HIV infection are unaware of their risk, have little or no access to HIV prevention, and are afraid, for fear of violence, to ask their partners to use condoms.7 These risk factors are clearly demonstrated in one of the most recent published studies of incarcerated women. Researchers in Brazil interviewed and evaluated 290 incarcerated females and found prevalence rates for HIV, hepatitis C virus (HCV), and syphilis of 13.9%, 16.2%, and 22.8%, respectively. The most significant risks for HIV infection included HIV-infected sexual partners, casual partners, partners who inject drugs, and a history of sexually transmitted infections (STIs). Even women with a single sex partner presented a significant risk for HIV infection, reflecting their vulnerability for acquiring HIV infection, most likely due to their trust in their partner who did not use a condom. While the use of injectable drugs was associated with HIV infection, the study results pointed to sexual behavior as the most important component of HIV transmission in the incarcerated female population.8 Mental Health Factors Mental illness is a common co-morbidity for HIV-infected incarcerated women. A number of studies have linked prior childhood experiences of abuse and neglect with women's healthcare needs, mental health needs, and HIV risk behaviors. According to self-reported data, 33%-65% of incarcerated women in the US report prior sexual abuse and 19%-42% report a history of childhood sexual abuse.9,10 These percentages are likely under-representative of the prevalence of abuse histories among incarcerated women, but they are still two-fold higher than the prevalence of such histories among women who are not incarcerated. Mental health problems contribute to the high prevalence of HIV infection among incarcerated women and make the management of their HIV care substantially more challenging. In a recent US study, 25% of women discontinued highly active antiretroviral therapy (HAART) for at least six months during study follow-up of five years, and women who discontinued HAART were more likely to be depressed than those who did not discontinue medication.11 Access to treatment for depression may be helpful for improving the management of HIV-infected incarcerated women. Since many incarcerated women have experienced childhood sexual abuse and adult sexual trauma, gynecological and obstetric examination takes special care and sensitivity. Some of the issues that may interfere with the examination of sexually abused women include their need to trust the examiner, their need for control (wishing to control the time and place of the exam), their fear of disclosure, and their fear of having their body touched during the exam.12 Sensitive gynecological healthcare providers are critically important members of the correctional HIV management team. Biological Factors HIV transmission estimates vary by the type of exposure. Per-event transmission probability estimates are 0.7% (about one in 150) per episode of intravenous needle or syringe sharing, and 0.09% (less than one in 1,000) after a mucous membrane exposure (such as a splash to eyes or mouth). The risk for HIV transmission per episode of receptive penile-anal sexual intercourse is estimated at 0.1%- 3.0%, while the risk per episode of receptive vaginal intercourse is estimated at 0.1%-0.2%. While published estimates of the risk for HIV transmission from receptive oral exposure do not exist, instances of suspected transmission have been reported.13,14 Data has suggested that men with HIV infection are biologically more likely to transmit HIV than women, due to increased genital shedding of HIV-1, leading to the thought that male-to-female transmission is more efficient than female-to-male transmission during asymptomatic infection (early in HIV disease). However, the risk of transmission during symptomatic infection does not appear to vary.15 In a recent study in Uganda, plasma HIV RNA levels and genital ulcer disease, but not gender, were the main determinants of HIV transmission16. There is also recent data that shows higher levels of HIV in semen versus female genital tract secretions. Collectively, these data may suggest that women are at a greater risk for infection as compared to men. Additionally, incarcerated women, in general, and HIV-infected incarcerated women in particular, have remarkably high rates of STIs and gynecologic infections, which are associated with higher risks of HIV infection.15 At yearend 2003, 1.8%, 6.3%, and 7.5% of incarcerated women tested positive for gonorrhea, chlamydia, and syphilis, respectively.17 In younger women, cervical ectopy (extra mucosal tissue around the entry to the cervical canal) makes the cervix more vulnerable to HIV infection.18 High rates of STIs are associated with high risk for HIV infection for three main reasons: 1. Unprotected sex that results in the transmission of an STI can also result in HIV transmission. 2. STIs can cause genital lesions and recruit white blood cells to the region which may increase a person's susceptibility to HIV infection. 3. Persons who are co-infected with HIV and an STI may have increased HIV shedding in genital secretions, thereby increasing the chances that the co-infected person will infect another person if he or she engages in unprotected sex. High rates of syphilis among incarcerated women have prompted a number of studies assessing methods of syphilis screening and treatment in the correctional setting. Several studies have shown the efficacy of administering qualitative rapid plasma reagin (RPR) testing for syphilis.19,20 A study conducted at a New York City jail found that qualitative nontreponemal syphilis testing, online access to the local syphilis registry, and immediate treatment (if indicated), following admission, increased the rate of syphilis treatment from 7% to 84% of cases.21 Testing for or making a diagnosis of an STI provides an important opportunity for healthcare providers to counsel inmates about the issue of HIV transmission. HIV testing should be offered at each HIV encounter. Rapid HIV testing (see table 2) ( is a particularly important tool for getting HIV-infected women into care; more than 98% of individuals are able to receive their test results and most enter care following rapid test diagnosis.22 Incarcerated Women and Motherhood Between 1998-1999, 1,400 women gave birth within prisons. During this time, in Georgia alone, more than 150 women who entered prison were pregnant.24 Both the number of HIV-infected women giving birth in prisons and the extent of prenatal screening for HIV infection that is performed in federal and state prisons are unknown at this time. Even though mother-to-child transmission (MTCT) of HIV has been all but eradicated in the U.S., MTCT still occurs among high-risk women who seek care late in the course of pregnancy. Between 280-370 U.S. babies continue to be born each year with HIV infection.25 Prior to the institution of MTCT prevention, transmission from HIV-infected mother to child ranged from 16%-25% in North America and Europe. Today, the risk of perinatal transmission can be less than 2% with effective antiretroviral therapy (ART), elective cesarean section as appropriate, and formula feeding. The correctional setting clearly provides a critical opportunity to reach women who may not have accessed pre-natal testing in the community and routine pre-natal screening in correctional settings may be cost-effective.26 According to standards set forth by Centers for Disease Control and Prevention (CDC), thorough and non-judgmental discussion of HIV testing and ART is a required component of all pre-natal care.27 Certain aspects of long-term incarceration, such as shelter, food, and sobriety may be health promoting for high-risk pregnant women and have been reported to improve their pregnancy outcomes.28 However, few correctional facilities allow women to house their infants in a nursery at the institution after delivery (residential programs for infants exist in only 11 states and select federal facilities). Most correctional facilities remove newborns from their mothers during or immediately after the hospital stay. Most incarcerated women are mothers and were the custodial parent of a minor child prior to incarceration. In 1998, 70% of women in jails, 65% of women in state prisons, and 59% of women in Federal prisons had at least one child under the age of 18 at home. The total number of minor children whose mothers were in federal or state prisons increased from 61,000 in 1991 to 110,000 in 1998. In 1998, 84% and 64% of minor children whose mothers were in federal and state prisons, respectively, lived with their mothers before their mothers entered prisons. Women are allowed to receive visits by their children. However, these visits are infrequent; 56% of women do not see their children at all while they are incarcerated.29 The impact of this separation on the wellbeing of the mother and the bond between the mother and infant deserves further study. Incarcerated women at Risk for Hepatitis The prevalence of HCV is much greater among incarcerated populations than the general public. The incidence of HCV in the US general population has been estimated at 1.8%, while the incidence among state and federal facilities in 1999 was 2.1%. Incarcerated females typically have high rates of HCV infection. In 1994, 63.5% of female inmates entering the California correctional system were found to be anti-HCV positive, compared to 39.4% of male inmates.30 Testing for and appropriately treating HCV and hepatitis B virus (HBV) co-infection among incarcerated females should be a routine component of HIV care.31 For more information on testing and treating HCV and HBV, please refer to CDC's Sexually Transmitted Diseases Treatment guidelines - 2002.32,33 Managing HIV infection Because incarcerated women have a high prevalence of HIV infection, multiple sources of HIV risk in their lives, and limited access to HIV testing and counseling services outside of prison or jail, there should be multiple opportunities for women to say "yes" to HIV counseling and education while they are incarcerated (see table 3). ( However, the incarcerated woman's fear of stigmatization by her peers and correctional staff can have a negative impact on the detection and management of HIV/AIDS in prisons and jails. The closed setting of correctional institutions makes confidentiality difficult to maintain (particularly if a clinic or care provider is identified as being associated with HIV), though total confidentiality should always be the goal. Peer HIV/AIDS education programs may reduce stigmatization among prisoners and increase the general awareness of HIV in the incarcerated female population.34 Factors that are likely to encourage incarcerated women to become tested include concern about the impact of HIV infection on their present or future children, and about having contracted HIV infection in the context of having acquired other STIs. Many incarcerated women may have been tested for HIV during prior pregnancies and may therefore be familiar with the concepts and procedures related to HIV testing. However, younger women (with fewer arrests, fewer pregnancies, and fewer opportunities to interact with HIV testers and counselors) may be less familiar with the concept of HIV testing, and hence, more fearful. In many facilities the list of "risk factors" will include virtually every female prisoner in the institution. With HIV/AIDS prevalence rates approximately 15 times higher among incarcerated women compared to the general population, HIV testing should be regularly offered and easily available to all women prisoners. Considerations for Care Ideally, correctional management of HIV would include a network of interconnected services that would address the needs of HIV-infected incarcerated women. These services might include clinical medical services, physical and sexual abuse recovery programs, drug treatment, and mental health services. They may also include vocational training and skills building workshops that, by helping women to become socio-economically more powerful, facilitate their ability to continue to effectively manage their healthcare needs and to prevent HIV transmission upon prison release. The opportunity to test and treat HIV-infected pregnant women who are incarcerated should not be missed. Finally, discharge planning programs initiated during incarceration can help connect women to community medical services, drug treatment, support services that provide child care, safe affordable housing, job training and employment opportunities that will all serve to increase their ability to continue to care for their own health needs. Incarceration provides a critical opportunity for the education, diagnosis, and medical care of HIV-infected women and high-risk HIV seronegative women, as well as a critically important public health opportunity to reduce the spread of HIV.


07-19-2005, 11:51 AM

Help for Heroin Addicts: Naltrexone Offers Options to the Criminal Justice System By Meghan Mandeville (, News Research Reporter Probationers and parolees who are addicted to heroin may soon have a new treatment option--one researchers hope will help them to kick the habit and leave their criminal lifestyles behind. Some people believe that naltrexone, an anti-opiate drug, which may soon be approved by FDA in an injectable form, could benefit the criminal justice system in a big way, by reducing recidivism. "[Addiction] seems to be the reason that so many [offenders] have this revolving door. They get re-addicted after they hit the streets and they have to start committing crimes in order to support that habit," said Dr. Charles O'Brien, a psychiatrist at the University of Pennsylvania, who has been studying naltrexone for the past 30 years. "This could break the cycle." O'Brien and his colleagues propose that naltrexone be given to some drug-addicted offenders who are on probation and parole as a way to help them stay clean and get their lives back together. According to O'Brien, taking naltrexone on a regular basis will prevent these people from feeling the effects of heroin, morphine, oxycontin, or the like, even if they take those drugs. In order for an opiate, like heroin or morphine, to have an effect on the body, O'Brien said, the drug must attach to opiate receptors on the brain. Naltrexone targets those same receptors, but doesn't excite them the way an opiate would, he explained. If people who have been taking naltrexone then add heroin or morphine into their system, they won't be able to feel the effects of the drug, O'Brien said, because it can't attach to the receptor. "If we block that receptor, then we basically [take away] the ability for a person to get high and to feel any effect from the opiate," said Dr. James Cornish, a psychiatrist, who works closely with O'Brien at the University of Pennsylvania And, if a person already has an opiate tagged onto those receptors, naltrexone will overpower the drug, O'Brien said. "[It] will displace it from the receptor if it's already there first," O'Brien said. Because of naltrexone's ability to block heroin, and other opiates, from having an effect on a person's body, both O'Brien and Cornish see potential for the drug in the criminal justice arena, especially with probationers and parolees whose freedom is at stake if they relapse and fall back into a life of crime. O'Brien explained that the drug, which was originally approved in pill form by the FDA in 1985, has traditionally worked well with drug-addicted members of the medical profession, who really want to get clean because their careers are on the line. "The reason that it works so well with doctors who are addicts is because they have so much to lose. They are highly motivated," O'Brien said. "My colleagues and I decided that maybe people who are on parole would also be highly motivated." With this inclination, O'Brien and his fellow researchers at Penn conducted a study, funded by that National Institute on Drug Abuse (NIDA), over a decade ago to determine how taking naltrexone would impact the rearrest rates of probationers and parolees. "[When] we did the initial study, our feeling was that this medication would allow people who are on parole or probation to stay away from their drug of abuse and, thereby, have less drug use and have a better opportunity to complete their parole or probation," said Cornish. "[It] clearly showed exactly that; people who were on naltrexone were rearrested at half the rate of those not on naltrexone." In 2000, O'Brien and Cornish kicked off yet another NIDA-funded study to further examine the issue. "This was a study that was a follow-up of our original work," said Cornish. "The basic study was to randomize people to either take naltrexone or no medication, combined with the standard mandated treatment by the courts." Now in its fifth year, the study has included about 100 drug-addicted probationers and parolees in Philadelphia County, Cornish said. People who volunteer for the program are either given naltrexone twice a week or become part of the control group, which receives no medication. Both groups, however, receive the same amount of counseling. According to O'Brien, counseling may just not be enough for people who are involved in the criminal justice system and have serious substance abuse problems. "Everyone talks about giving drug counseling to these people, but drug counseling, by itself, is not enough," said O'Brien. "The track record is that they almost always relapse." Counseling combined with naltrexone can benefit this population, O'Brien said. But O'Brien also pointed out one problem with the current pill form of naltrexone that is approved by the FDA; people might just stop taking it, he said, especially when they want to get high. That is why he is hopeful that an injectable form of the drug will be approved by the FDA this fall. "This opens up some really interesting possibilities," he said. With a naltrexone shot, probationers and parolees would only have to receive the drug every 30 to 40 days in order for it to continuously work in their system. If the shot becomes available, O'Brien and his colleagues believe it could be a useful way to let drug-addicted offenders out of prison sooner, if they agree to take the drug. "We think that it would be worth a try to offer people naltrexone in lieu of prison or [they] get an early release if they are to take the naltrexone injection every month," said O'Brien. He said that he and his colleagues are currently trying to get funding from NIDA to conduct a national study involving the injectable form of naltrexone in a variety of trial sites, including Providence, R.I. and Charlottesville, Va. "To get this more widely used, we have to demonstrate that it really works and that takes a large, complicated study," O'Brien said. He added that, traditionally, folks in the criminal justice field are timid about anything that feels like research. "Even though it has potential for doing a lot of good in the criminal justice system, there is tremendous reluctance to do anything that feels like research," O'Brien said. "People are very shy about this." To try to allay some fears about the use of naltrexone, O'Brien held a symposium last January to give corrections professionals, lawyers, judges and ethicists an opportunity to debate the concept of using the drug with probationers and parolees. "The vast majority of people felt this was an effort to help the prisoners, to prevent them from relapsing," said O'Brien. "It's not an experimental drug. There is nothing unethical about this. We are not using the people- convicted parolees - as guinea pigs. We are essentially trying to help them stay [clean]." While there are questions about involving offenders in the study of the drug, there are is also the issue of its cost when it comes to using naltrexone in the criminal justice system. Although O'Brien hopes that the shots will cost about the same as the pills would if they were taken on a daily basis for a month- which equates to about $150 per shot. That price tag may be too high for the cash-strapped criminal justice system, but O'Brien hopes that corrections and criminal justice officials will look at the big picture when it comes to spending money on naltrexone. "The cost of [putting] each person in a prison bed is just astronomical," said O'Brien. "It's way more than the cost of treatment." O'Brien hopes to get his next study off the ground shortly after the FDA approves the injectable form of naltrexone. But, in the meantime, he just wants to get the word out to the criminal justice community about what naltrexone has to offer. "It's something that is a benefit," O'Brien said. "I want people to know about it and I want them to see that this can be helpful." Resources: O'Brien [email protected]


07-24-2005, 01:30 PM

2 guards suspended over death of inmate

The Atlanta Journal and Constitution; 7/23/2005; CARLOS CAMPOS

Two guards at the state prison in Jackson have been suspended while the Department of Corrections investigates the death of a 27- year-old inmate there. Charles B. Clarke III of Blairsville died of natural causes on April 19 after a blood clot in his right calf dislodged and moved to block his pulmonary artery, according to a GBI autopsy. Clarke arrived at the Georgia Diagnostic and Classification Prison on Dec. 2, 2004, to begin a 15-year sentence for statutory rape involving a 14-year-old girl. Since Clarke's death, prison officials have learned of allegations from other inmates and Clarke's family that he was beaten by guards while handcuffed. Corrections spokeswoman Scheree Lipscomb said Capt. Ricky Goodrum, 47, of Jackson and Lt. Reginald Goodrum, 39, of Griffin were suspended with pay last week pending the outcome of the investigation. The two men are not related, Lipscomb said. She said neither has been been implicated in any wrongdoing. Neither corrections officer returned telephone messages left at their homes seeking comment Friday. News of the suspensions comes two weeks after the Corrections Department fired seven guards at Rogers State Prison in Reidsville following allegations that handcuffed inmates had been beaten. The GBI is investigating those incidents and is discussing possible criminal charges with local prosecutors. William Terry, warden of the prison in Jackson, asked for the internal investigation "due to the [relatively young] age of the inmate and the fact that he is a mental health inmate," according to an e-mail obtained by The Atlanta Journal-Constitution through the state Open Records Act. The GBI is not involved in that investigation. Other records show that Ricky Goodrum and Reginald Goodrum were involved in a "use of force" incident involving Clarke on March 18. Clarke was being held in the prison's mental health wing because of suicide attempts, records indicate. In a report on the incident, Reginald Goodrum wrote that Clarke had cut himself, was threatening guards and had flooded the toilet in his cell and tied sheets to the door to keep officers out. Clarke later threw "what appeared to be urine" on Reginald Goodrum, the report indicates. Reginald Goodrum wrote that Clarke tried to break free from him and slipped on a wet staircase while handcuffed. Clarke fell down some steps, striking his head on a handrail, Goodrum wrote. The GBI autopsy found that Clarke had a few healing bruises, including a nearly 10-by-4-inch bruise on his left thigh, which examiners characterized as "minor traumatic injuries." In sworn statements gathered by Clarke family lawyer McNeill Stokes of Atlanta, several inmates allege that they saw guards hit and kick Clarke. Stokes said Friday that he was encouraged by the suspensions and was confident the department would seek the truth. "The commissioner, the general counsel and the people investigating it all, they understand the seriousness at this point," Stokes said. "How much more serious can it get when a guy dies as a result of it?" Lipscomb pointed to the autopsy results as evidence that department personnel did not cause Clarke's death. "We are not going to tolerate the abuse of inmates," Lipscomb said.

(Copyright, The Atlanta Journal and Constitution - 2005)


07-24-2005, 01:33 PM

Painfully, doctor is chief of staph.

The Wichita Eagle (Wichita, Kansas ) (via Knight-Ridder/Tribune Business News); 7/21/2005

Byline: Karen Shideler Jul. 21--Tom Moore knows his infectious diseases. As a physician who specializes in them, he takes great care to prevent their spread. And yet, even he has been a victim of a new "superbug" that's becoming increasingly common. He calls it Frankenstaph. "This is not a bug you want to have," he said. In medical terms, the bug is community-associated methicillin-resistant Staphylococcus aureus. In simple terms, it's a highly contagious, aggressive bug that causes painful skin infections, and it's often mistaken (even by doctors) for a spider bite. If you get it, you probably won't have to be hospitalized and you probably will get better on your own. But it'll hurt like heck, and there's a good chance you'll pass it along, through person-to-person contact. Staphylococcus aureus -- staph -- is a common bacterium, found on the skin or in the nose of many healthy people. Some staph bacteria have become resistant to antibiotics such as penicillin and amoxicillin. In health-care settings, drug-resistant staph cause wound infections after surgery, pneumonia and bloodstream infections. The bacteria have mutated again, and now drug-resistant skin infections are showing up in otherwise healthy people. These "community-associated" infections started about five years ago on the coasts, said Mansoor Tahir, senior epidemiologist for the Sedgwick County Health Department. Many states, including Kansas, don't require the infections to be reported, so no one knows how many cases there are. But Moore hears about or treats a case each week. The federal Centers for Disease Control and Prevention has reported on outbreaks in prisons and among sports teams, including high school and college football and wrestling teams. Several players for the St. Louis Rams had infections in 2003. "It's a new monster," Moore said, explaining why he favored calling the mutant Frankenstaph. The infections, which aren't linked to antibiotic overuse, start with the feeling that you've been bitten by something, followed by a red bump or pimple that eventually opens and drains pus. You may develop other sores as well. Most often, the bacteria are spread by direct contact between people, Moore said. When people and their doctors suspect a spider bite and do nothing or prescribe the wrong antibiotic, the bacteria have a chance to spread to others. Moore said it can pingpong among family members. Three or four months ago, he developed "a stinging or burning sensation on my chin" that itched. He knew immediately what it was -- he's an expert in such things, and he'd treated a patient with a Frankenstaph infection a few hours earlier -- so he scrubbed down with Hibiclens, an antimicrobial cleanser. But soap and water will do the job, too, he said. That was a Friday night. The next day, he and his wife took their children to the zoo. His wife thought she was being bitten by something there. "Sure enough, she developed this Staph aureus on her skin, and the kids all got it, too, in short order," Moore said. AVOIDING INFECTION Close skin-to-skin contact, skin openings such as cuts or scrapes, contaminated surfaces, crowded living conditions and poor hygiene have been linked to community-associated methicillin-resistant Staphylococcus aureus infections. To prevent them: -- Keep your hands clean, with soap and water or hand sanitizer. -- Keep wounds clean and covered with a bandage until healed. -- Avoid contact with other people's wounds or bandages. -- Don't share razors, towels, uniforms and other personal items. -- Wipe surfaces of workout equipment before and after use. If you have what you think might be a staph infection, see your health-care provider -- and make sure to mention it before the exam begins. For more information about staph infections, visit or Copyright (c) 2005, The Wichita Eagle, Kan.


08-01-2005, 09:51 AM

Hey Ronnie: thanks for posting this. My husband has gained 20 lbs since he has been in. I think the biggest problem is the high starch, high carb diet they serve. Rob tries to diet, but there is very little healthy food available, even if they have the means to buy it! Also, the "gym" programs are not the great, since they are meant for younger guys who are buddies and play basketball together! For an older guy, like Rob who is in his 40's and does not want to play basketball, there is not a whole lot, other than walking the track. I think it is about more than self-esteem, I think that if we want these guys and woman to heal from addictions and self-destructive behaviors, we need to make sure they live healthy. Healthy thinking needs a healthy body!!!!!!!


08-01-2005, 09:51 AM

Hey Ronnie: thanks for posting this. My husband has gained 20 lbs since he has been in. I think the biggest problem is the high starch, high carb diet they serve. Rob tries to diet, but there is very little healthy food available, even if they have the means to buy it! Also, the "gym" programs are not the great, since they are meant for younger guys who are buddies and play basketball together! For an older guy, like Rob who is in his 40's and does not want to play basketball, there is not a whole lot, other than walking the track. I think it is about more than self-esteem, I think that if we want these guys and woman to heal from addictions and self-destructive behaviors, we need to make sure they live healthy. Healthy thinking needs a healthy body!!!!!!!


08-02-2005, 08:08 AM

I agree with you that the high starch, high carb diet is a big contributor. The lack of fruits and vegetables is also a concern. My husband had not only gained weight since being inside but also has developed high blood pressure I believe due to the high salt foods that they are eating.


08-02-2005, 09:41 AM

I worry about Rob's blood pressure too. He had a physical when he went in two years ago and was fine. Now, of course since he's not smoking or drinking his blood pressure should be even lower, but you know how it is, they don't get to see a doctor unless they are sick. So I know he has not had his blood pressure checked since then. I worry about it, especially hearing that your husband has developed it. Do they give him medication for it?


08-04-2005, 12:40 AM

I have a ? , My nephew was just sent to prison for felony DWI. He is on medication for anxiety (Zanex) he has been on the meds for 2 years, He quit taking in when he went in last week. He is now having anxiety attacks. How do I get them to start giving him he meds again. They gave him a pill the other night when is had the attack but he should be taking them once a day. Do I need a Dr note or do I need to talk to someone at the jail? Help please I dont know where to start Thanks :(


08-05-2005, 08:37 AM

They have given my husband water pills for the high blood pressure but he rarely takes them. He is trying to control his pressure by modifying his diet. He is trying to lower his sodium intake and exercise at least 6 days a week. Thus far he is doing a good job of cotrolling it. I too suffer from high blood pressure and I DO NOT suport his not taking the medication; but men have to do it their way. I watch my diet and take my medication.


08-05-2005, 08:40 AM

I would suggest calling the facility medical office and explain the situation and ask how you should handle the situation. If you do not get any cooperation on the local level then look in the State by State medical contacts thread in this forum for the medical office director for the state or federal system and contact them.

I have a ? , My nephew was just sent to prison for felony DWI. He is on medication for anxiety (Zanex) he has been on the meds for 2 years, He quit taking in when he went in last week. He is now having anxiety attacks. How do I get them to start giving him he meds again. They gave him a pill the other night when is had the attack but he should be taking them once a day. Do I need a Dr note or do I need to talk to someone at the jail? Help please I dont know where to start Thanks :(


08-10-2005, 06:23 PM

Pennsylvania prison kept food unsafely.

The Morning Call (Allentown, Pennsylvania) (via Knight-Ridder/Tribune Business News); 8/8/2005

Aug. 8--Northampton County Prison has stored food in a bathroom, did not have hot water or soap for kitchen workers to wash their hands and used refrigerators not cold enough to safely store food. The conditions are revealed in the Easton Health Bureau's inspection records of 2004 and 2005, which were released last week to The Morning Call following a legal challenge by the newspaper to the city's refusal to make the records public. City inspector Ed Ferraro, interviewed about the city's inspection of prison conditions, described the violations as so severe that, had they been found in a private business, he would have asked the owner to close voluntarily until problems were corrected. Prison officials said they followed Ferraro's reports line by line and have since corrected the problems, which Ferraro confirms. Prison officials said problems were never severe enough to shut down the kitchen. "I don't think that our kitchen is any worse than any other kitchen that you would find anywhere else in the Lehigh Valley," Acting Warden Scott Hoke said. "Was our inspection absolutely terrible? I don't think so. Did we have deficiencies? Sure." Many of Easton's 2004 inspection records were destroyed by floods last year and this year, but of all available 2004 and 2005 reports, the prison logged more violations than any other food establishment. Ferraro believes the Easton prison's problem will return because the prison's kitchen is outdated. A complete prison kitchen remodeling plan has been called off because of cost. "Unfortunately, the county just couldn't afford it," Hoke said. He said keeping a clean, well-maintained kitchen is a priority for the county. He said it is challenging, though, because equipment is old, the kitchen makes 1,800 meals a day and inmates do most of the work. Some problems might be expected under those conditions, Hoke said, especially when restaurants with professional employees "are lax on occasions, too." The Morning Call first sought the Easton inspection records as part of a nine-month analysis of Pennsylvania's system for inspecting restaurants, school cafeterias, day-care center kitchens and other food establishments. The newspaper analyzed inspection reports and compiled 200,000 records into the first online database in the state. The public can view those inspection records at After initially arguing that the public did not have a right to the records, Easton relented after an appeal by the newspaper under the Pennsylvania Right to Know law. Like other food establishments, county prisons are covered by a patchwork of agencies. And just like restaurants and food retailers, some prisons are inspected more often than others and score better or worse than others. State inspectors, for example, also found problems at the Berks County Prison in Leesport last year, and Allentown Health Bureau inspectors have found problems at the Lehigh County Prison. "We receive inspections by three different agencies," Hoke said. "I don't know of a restaurant that has that same scrutiny." The only directly comparable reports are through annual inspections by the Pennsylvania Department of Corrections, which examines everything from security to inmate rights to food services. Northampton County Prison failed two categories in its 2004 inspection by state officials, which is separate from inspections done by the city. It failed to meet general cleanliness standards because of missing and damaged floor tiles, and it failed to provide health exams to kitchen workers to ensure they are disease-free. Corrections Director Todd Buskirk said the tiles were repaired and the physicals were given within days of the state inspection. While maintaining a clean kitchen is ultimately the responsibility of Northampton County Prison administrators, the county pays a private company, Aramark, to run its food services. Aramark is responsible for how the kitchen runs on a daily basis, Buskirk and Hoke said, and violations such as storing chicken and roast beef at room temperature and storing boxes of dry food in the bathroom would fall under Aramark's responsibility. "Absolutely, some of that's their responsibility," Hoke said. Hoke said administrators also rely on Aramark to tell them about problems such as malfunctioning refrigerators and leaky plumbing. "You just have to hope that the kitchen staff reads the temperature gauges," Hoke said. Sarah Jarvis, an Aramark spokeswoman, noted that most of the critical violations found at the Northampton prison, including storing chicken and roast beef at room temperature, occurred more than a year ago. She said the company takes the violations seriously and will work with prison officials to make sure faulty equipment is repaired or replaced. "As to last year's report, we consider the situation to be resolved," Jarvis said. "We are pleased with how we maintain this kitchen, given the challenges of its physical plant." Jarvis also noted the prison kitchen routinely passes monthly inspections by PrimeCare Medical Inc., the company that provides health care to inmates. "They've had a clean record," she said, "and it's seen as a clean physical plant." In the city inspection, Buskirk said, the inspection identified food in a refrigerator at 73 degrees because the inspection occurred during a busy time, when the refrigerator door was repeatedly opened. Ferraro, the city inspector, said commercial kitchen equipment should be able to keep foods cold regardless of how often the door is opened. Buskirk added that there was no hot water because the gas company had shut off the gas the day of the inspection to work on the line. "I think it was all bad timing," he said. Hoke believes that if the problems raised in the Easton inspections occurred over a long period of time, PrimeCare would have found them during its monthly inspections. "If it would have been defective at the time, I'm sure they would have picked up on it," Hoke said. Easton inspector Ferraro stressed that every violation he found in 2004 and 2005 was corrected when he returned for re-inspections. But he said the outdated equipment should be replaced instead of repaired because it is likely to break down again. "What we have is an old, rusty Cadillac that you're trying to wash and wax, and it's not working," Ferraro said. "Everything is being repaired with a Band-Aid and just waiting for the county to step in and do what they promised and [rehabilitate] the entire kitchen area." Other prisons' violations Among the other county prisons in the region, inspectors have found problems in Lehigh and Berks. Inspectors found no violations in prisons in Bucks, Carbon, Monroe and Montgomery counties. Inspection reports from Schuylkill County were not available. At the Berks County Prison last year, a state inspector found missing chunks of wall plaster and worn wall paint in the kitchen "butcher shop," possible mold on the ceiling and on a wall in the dishwasher room, and worn and peeling wall paint in the dishwasher room. And, for the fourth consecutive inspection, the state found the prison was not sterilizing drinking cups. The report says inmates are issued a cup when they enter the prison, with no provision for it to be sterilized. Inspector Edward Pfister scolded prison officials for failing to change the practice, saying in his report "that the county has demonstrated a blatant disregard to correct a minimum standard violation." Berks County Warden George Wagner did not return a call for comment. Allentown inspectors inspected the Lehigh County Prison 15 times between 2000 and 2004 and found nine critical violations, which can directly affect food safety. Of those, three violations were for not storing food at or below 41 degrees and one dealt with fruit flies. Nine of the 15 reports had no critical violations. (Additional inspection reports by the state for the Lehigh prison were unavailable.) In Bucks, the county Health Department provides an informal review of food services. "There's multiple levels of inspections that go on," Bucks County Corrections Director Harris Gubernick said. "There's a whole series of things, plus our own." Perhaps conducting more inspections at prisons is a good idea, for officials say prison cafeterias often are cramped and outdated and serve large populations. They also have that one fundamental difference when compared to other food establishments: Prison kitchens rely on inmates. Inmates who perhaps are not schooled in sanitary procedures that traditional restaurant workers know and follow, such as where to store food. "These kitchens take a lot of abuse," Gubernick said. "If you have 700 inmates and you have 300 staff, you're cooking a whole lot of meals. You also have inmate labor in there who aren't real friendly with equipment sometimes." By Paul Muschick and Christopher Schnaars Copyright (c) 2005, The Morning Call, Allentown, Pa.


08-11-2005, 07:34 PM

Analysis: Meth mouth strains prison health-care budgets

Morning Edition (NPR); 8/10/2005; LINDA WERTHEIMER, STEVE INSKEEP

Host: LINDA WERTHEIMER, STEVE INSKEEP Time: 10:00-11:00 AM LINDA WERTHEIMER, host: This is MORNING EDITION from NPR News. I'm Linda Wertheimer in for Renee Montagne. She's on vacation. STEVE INSKEEP, host: I'm Steve Inskeep. Here's the story of one small problem that shows the widespread cost of methamphetamines. Meth addiction first gained attention in farm towns and has now spread to suburbs, even inner cities, and the cost of cracking down has strained law enforcement. Now you can see the effect in state prisons. As more addicts end up behind bars, prisons have to manage their medical problems, including this one: The drug destroys their teeth, and the repair is costing a fortune. NPR's Laura Sullivan reports. (Soundbite of prison doors closing) LAURA SULLIVAN reporting: The prison dentist's office at the St. Cloud Correctional Facility in Minnesota is hidden down a long metal staircase in the basement. (Soundbite of door closing) SULLIVAN: It's a cave-like room with stone walls, no windows and a group of prisoners on a cement bench waiting patiently for their turn. (Soundbite of dental tool) SULLIVAN: Most of them are here for a lot more than a checkup. (Soundbite of plastic gloves) Dr. CHRIS HERRINGLAKE(ph) (Dentist): We'll just put some gloves on here and take a look. SULLIVAN: Dr. Chris Herringlake leans over the open mouth of inmate James Clecatsky(ph). Most of his teeth are missing. Others are black and rotting. Dr. HERRINGLAKE: As we're looking through the mouth, we can look at some of the areas here that we've taken the teeth out already that he had come in with some abscesses. They were swelling and painful. SULLIVAN: Herringlake and other prison dentists have a name for this condition. It's called meth mouth. Blackened teeth ground into little nubs or brown holes in the gums where teeth used to be, all from smoking methamphetamine. Dr. HERRINGLAKE: Got some areas that still are very extensive cavities, as we can see here. The tooth is just mostly gone or portions thereof. SULLIVAN: Herringlake first saw meth mouth eight years ago. His dental colleagues on the outside were unable to imagine what he was describing. Now the dentist works on meth mouth every day. Mr. JAMES CLECATSKY (Inmate): Dr. Chris is a great, great dentist. He's a craftsman at what he does. SULLIVAN: Patients, like inmate James Clecatsky, hope Herringlake will be able to save even five or six of their teeth. Clecatsky is serving a two-year sentence for meth possession. He started smoking the drug three or four years ago. It wasn't long before he noticed something was wrong with his teeth. Mr. CLECATSKY: They started falling out of my face. You know, you notice one break and then all of a sudden they're all going to hell. I mean, it's--if you're doping, you're not going to the dentist. (Soundbite of background dental office noise) SULLIVAN: The drug's impact on teeth is twofold. Meth is made out of hydrochloric acid. Dr. Herringlake says tooth enamel is no match. Dr. HERRINGLAKE: And they are just literally dissolving the surface. It would be like pouring battery acid on your car fender and then wondering why your fender is starting to fall off. (Soundbite of background dental office noise) SULLIVAN: And meth users, like Clecatsky, say the drug makes you dehydrated and craving sweets. Mr. CLECATSKY: Sugar seems to be one of the needs for amphetamine users. It is for me. I love chocolate, and soda pop is just--I mean, that's a gift from God. (Soundbite of background dental office noise) SULLIVAN: And the drink of choice for meth users, Mountain Dew, with twice the sugar and almost twice the caffeine of other drinks. Dr. HERRINGLAKE: Each 12-ounce can contains 11 teaspoons of sugar. One fellow was even drinking 48 cans of Mountain Dew a day. Mr. CLECATSKY: And you're constantly quenching that thirst from your drug use, and Mountain Dew's the one. Yes, indeed, good stuff. Dr. HERRINGLAKE: Well, my motto is: `Don't Do the Dew.' Mr. CLECATSKY: But it's so tasty. (Soundbite of background dental office noise) SULLIVAN: With tooth enamel gone, constant sugar and no brushing, the results are dramatic. Dr. Herringlake's next patient, inmate George Nichols(ph), flies into the rickety-old dentist chair to wait for his exam. Mr. GEORGE NICHOLS (Inmate): I'm 30, from Minneapolis, and I'm here on a second-degree controlled substance of methamphetamines. (Soundbite of background dental office noise) SULLIVAN: Nichols is missing most of his back teeth. Since coming to prison, he's been brushing and flossing, hoping to save his front teeth. But it hasn't been easy. Just four days earlier while out in the yard, one of his better teeth, one that hadn't turned entirely black, snapped in half. Mr. NICHOLS: When it cracked, everyone around me turned and looked. It was like (snaps fingers)--Pow!--you know. I put my hand up to my mouth and it felt like my whole tooth was missing, but it was paper thin with a sharp hook on the bottom. And when that happened, it was, `Oh, man.' SULLIVAN: It took Dr. Herringlake three and a half hours of intensive dental work to rebuild the tooth. This kind of dental work doesn't come cheap, inside or outside prison. Since 2001, the cost of dental care alone in Minnesota's prisons has almost doubled to $2 million a year. Prison officials say the amount of time and money they're spending fixing prisoners' teeth has wreaked havoc on their budgets, cutting into money they used to spend on health care, staffing or even just giving inmates yearly dental checkups. (Soundbite of cafeteria noise) SULLIVAN: Daniel Olmshank(ph) makes his way past a line of prisoners waiting for lunch in the cafeteria next to his office. (Soundbite of doors swinging closed) SULLIVAN: As the prison health administrator, his records show a virtual onslaught of prisoners needing emergency dental work and a problem that is getting worse by the month. (Soundbite of file cabinet doors being opened) SULLIVAN: He pulls papers from a file cabinet that show that in the first quarter of 2004, about 690 prisoners went to the dentist, mostly with meth-related problems. (Soundbite of papers being shuffled) Mr. DANIEL OLMSHANK (Prison Health Administrator): This is the first quarter of 2005 and here we are at 1,238. It's not going to go away. SULLIVAN: On top of the costs of dental works, prosthetic teeth can cost $2,000 per inmate, and though officials make the prisoners wait two years for them, it makes little difference. They either spend the money on new teeth or spend it on special liquid food and dietary supplements. And the problem isn't just in Minnesota. Prison systems across the country, from Missouri to South Dakota to Georgia, say the cost of dental care has exploded. Dentist Dr. Herringlake. Dr. HERRINGLAKE: I really think this is like a giant train locomotive that's just going to be gaining steam and going down the track unless something's done about it. SULLIVAN: Even as their teeth became the consistency of cantaloupe, meth addicts say when they were high, they didn't care and they didn't feel the pain. Inmates like George Nichols say nothing felt better. Mr. NICHOLS: At first, it felt like being almost like Superman. I mean, I just--I had incredible amounts of energy, and the--I was just on top of the world. And, you know, I thought I could do anything and I thought I could do everything. SULLIVAN: After a while, he says he used meth just to keep from the unavoidable comedown. Today he keeps the teeth he's lost in a plastic case, lined up just the way they used to be in his mouth, a reminder to himself that when he gets out, he never wants to use meth again. Mr. NICHOLS: They symbolize a lot of things to me. There is the pain that went along with them. There's the fact that you only get one set, you know, just like wh--you only get one life. You look at a person when they smile and, you know, you see their teeth. When I smile a lot and I look in the mirror I see my teeth. They're a very physical way of showing how I destroyed myself. You look at that, and it's like seeing a skeleton of yourself. SULLIVAN: But in a sign of just what corrections officials are up against, that message isn't reaching everybody. Dr. HERRINGLAKE: We still have more to do. (Soundbite of background dental office noise) SULLIVAN: For other inmates, like James Clecatsky, the addiction to meth is just too strong. Even as he learns on this day that he will have to lose several more teeth, Clecatsky says there is no doubt that he will use meth again when he gets out in a year. He's just not going to smoke it anymore. Mr. CLECATSKY: I have a ball using drugs. I'll always be a drug addict, and that's just the way it is. (Soundbite of background dental office noise) Mr. CLECATSKY: It's just like getting up in the morning and brushing your teeth. SULLIVAN: Or in his case, not brushing. As the fiscal year draws to a close, prison officials in Minnesota say they're expecting to set another new record this year in dental costs. Laura Sullivan, NPR News. INSKEEP: Over the years, Dr. Herringlake has kept a collection of photos from his patients, and you can find examples if you like at You're listening to MORNING EDITION from NPR News. Content and Programming copyright © 2005 National Public Radio, Inc.


08-14-2005, 04:44 AM

What a heartbreaker! I have seen this meth mouth ... someone who broke my heart and that I love dearly will only give a closed mouth smile. And a gal I grew up with lost all her teeth in her 30's from coke. My sister's teeth are horrible from heroin use. Meth must be even worse, how sad with all these users. Heartbreaking to read the guy say he's going right back to meth when he gets out too.


08-14-2005, 05:19 AM

My husband brushes his teeth 4-5x a day but the damage is done. He hasn't lost any teeth but the cavities keep popping up. I work in a dental office and it is so sad to see the damage meth continues to do even years after the user stops. I feel fortunate that I can have my husbands dental work 100% paid for when he gets out.


08-25-2005, 05:27 AM

08-22-2005 Numbers Down for Deaths in Prison Prisoner-rights advocates are crediting improved medical care and better separation of violent from peaceful inmates for a big drop in death rates behind bars from suicide, homicide and AIDS. State prison homicide rates declined by more than 90 percent, from 54 per 100,000 in 1980 to four per 100,000 in 2002, the latest year for which data is available, the Justice Department's Bureau of Justice Statistics reported Sunday. Jail suicide rates fell more than 60 percent, dropping from 129 per 100,000 inmates in 1983 _ when suicide was the leading cause of death among inmates _ to 47 per 100,000 in 2002. Death rates from AIDS-related causes in jails also fell sharply, from 20 per 100,000 in 1988 to eight per 100,000 in 2002. In state prisons, AIDS-related death rates fell from 100 per 100,000 inmates in 1995 to 15 per 100,000 in 2000. One reason for the downward trend is that advocacy groups have become much more aggressive in filing lawsuits to improve conditions behind bars, said Kara Gotsch, public policy coordinator for the ACLU's National Prison Project. The prevalence of gangs in prisons spurred violence that prompted corrections officials to pay more attention to classifying inmates, Gotsch added. "There's much more awareness about the problem of suicides in jails," said Lindsay Hayes, project director for the National Center On Institutions and Alternatives. "Twenty years ago if you asked a sheriff, he wouldn't have any information on it or any sensitivity to it. It wouldn't be on his radar screen." Today, there is better screening, better training and better mental and medical health staff, said Hayes. The improvements are occurring as the size of the population behind bars heads upward. The number of inmates has been on the increase since the 1980s, with the U.S. prison and jail population now at 2.1 million. Copyright 2005, AP News All Rights Reserved

donovans wife

07-19-2006, 11:51 PM

OK this scares the crap out of me!

number one son

07-20-2006, 07:01 AM

i just knew i was checking my sons teeth for a reason!!....i have 4 sons, and i always say "let me see a smile". 2 of my sons have tried every drug out there, i'm sure, but thank god they have cleaned up their acts and are'nt dependant on that stuff any more. good story


08-07-2006, 11:40 PM

Management of Methicillin-Resistant Staphylococcus Aureus (MRSA) Infections: Federal Bureau of Prisons Clinical Practice Guidelines National Institute of Corrections -- Published Date: 2005 Recommendations for the prevention, treatment, and containment of methicillin-resistant Staphylococcus aureus infections within Federal correctional facilities are provided. Procedures include: colonization; transmission; screening and surveillance; diagnosis; reporting; treatment; infection control -- primary prevention; infection control -- secondary prevention; outbreak management; inpatient units; MRSA Tracking and Reporting Form; oral antibiotic treatment options for skin or soft tissue MRSA infections; treatment options for serious MRSA infections; evaluation and treatment of skin and soft tissue infections; MRSA Fact Sheet; Correctional Standard Precautions in the General Population; Correctional Contact Precautions in the General Population; Correctional Standard Precautions in the Health Care Setting; Correctional Contact Precautions in the Health Care Setting; Inmate Fact Sheet - General Instructions for Skin Infections; MRSA Containment Guidelines; MRSA Containment Checklist; and Line Listing of Contacts to MRSA Cases form. Download PDF:


08-08-2006, 06:27 PM

This information though unpleasant is important to know, for anyone who has a love one in the prison(poison) system. I thank you for taking the time to post this for others to be aware of.


08-14-2006, 10:40 AM

PHILADELPHIA ( An influential panel of medical advisers has recommended that the U.S. government loosen regulations that severely limit the testing of pharmaceuticals on inmates, a practice that was all but stopped three decades ago after disclosures of abuse. The proposed change includes provisions intended to prevent problems that plagued earlier programs. Nevertheless, it has dredged up a painful history of medical maltreatment and sparked debate among prison rights advocates and researchers about whether prisoners can make uncoerced decisions Herald Tribune Artical


08-16-2006, 02:07 PM Paroled to die at home, and eager for justice. by Jeff Gerritt (article two in a series) I first wrote about Martell on June 19, revealing that his cancer probably could have been contained if doctors had treated it 20 months ago. In December 2004, Martell had what he thought was a hemorrhoid lanced. Medical records show it was actually a cancerous polyp that doctors ignored. His story became part of a Free Press investigation into the medical care provided by the Michigan Department of Corrections and Correctional Medical Services Inc. of Missouri, a private for-profit company under contract to provide primary care physicians and other services. In hundreds of cases, diseases have been misdiagnosed, undiagnosed or treatment is delayed or denied.

Jeff Gerritt's first article can be found here... Needless Death Sentence


02-04-2007, 04:12 AM

All are pretty well sources we can utilize thanks


06-11-2007, 05:07 AM


06-11-2007, 11:43 AM

Gotta love this: "It's not the kind of thing that's easily passed from a patient to a healthy person," Agnew said. He said medical personnel do use masks, gowns and gloves when treating such patients." What's wrong with this picture?

Dances in Rain

06-11-2007, 12:05 PM

she said the prison system has seen other cases of this illness in the past, and none of them resulted in infection of staff members. that is an even more alarming quote -- its ok for the prisoners to get it just as long as not the staff?


06-11-2007, 12:19 PM

that is an even more alarming quote -- its ok for the prisoners to get it just as long as not the staff? my thoughts exactly and at the same time i wasnt even shocked that it was said.


06-12-2007, 08:20 AM

New weapons in the raging HIV battle By Jim Montalto, News Editor Maraviroc and Raltegravir may not stir emotions in many folks working inside corrections or even in facility health care units, but they did excite the Infectious Diseases in Corrections Report staff enough to include information about these two new antiretroviral agents in their coverage of the Conference on Retroviruses and Opportunistic Infections. According to April's IDCR, CROI is a premier venue to find data related to the clinical management of HIV infection. To read entire article click here (


06-15-2007, 09:06 AM

Official: Inmate safety 'balancing act' By Sharna Johnson ([email protected]) June 13 The Curry County Adult Detention Center has an inmate population of around 230. Jails have an inherent threat of violence, which makes keeping inmates safe a challenge, according to Curry County Adult Detention Center administrator Leslie Johnson. Safety among inmates is in many ways a balancing act, Johnson said, and officers must constantly watch behaviors and dynamics among the inmates. “When you take some of the roughest people in the county and you put them together, it gets more than interesting,” she said. To read entire article click here (


06-18-2007, 06:26 AM

San Quentin presents new medical facilities ER only first in changes planned for area prisons By Josh Richman, STAFF WRITER Article Last Updated: 06/15/2007 02:50:19 AM PDT SAN QUENTIN — Officials cut a ceremonial ribbon Thursday on a new, $1.6 million emergency room for San Quentin State Prison, the first step in a stem-to-stern overhaul of health care at this and all other state lockups. It's among the first structural changes wrought by Robert Sillen, the receiver placed in charge of California's prison health system by a federal judge in order to bring inmate care up to constitutional muster. And by all accounts, it's just an early, tiny step that pales in the context of what's still needed. The new Triage and Treatment Area (TTA) is already in use, and inmate Jay Herman, 37, looked on curiously as a crowd of reporters and prison officials filed past the hospital bed on which he reclined. Herman, who said he's been in and out of San Quentin for 20 years and is back now on a parole violation, said the care he receives for his diabetes and heart problems has improved a lot in the past year. To read entire article click here (


06-25-2007, 12:27 PM

Cutting health screening for inmates a risky way to save We are missing a critical opportunity to help inmates -- and to protect the wider community June 23, 2007 BY HAROLD POLLACK As a child, Italian writer Ignazio Silone once joked to his father about a ragged prisoner they saw being led off to prison. His father angrily responded: "Never make fun of a man who has been arrested! He can't defend himself. He may be innocent. In any case, he is unhappy." I remembered this story when I heard that Cook County is cutting medical and public health services in our local jails. This is stunningly unwise. Prisoners may be the highest-risk population we serve in public health, if you consider the prevalence of untreated substance use disorders, serious mental illness or undetected infectious diseases. This is something we should all care about. Prisoners are a transient population, who are difficult to serve during their typically brief periods of incarceration. Many of these men and women have not seen a doctor in many years. The same behaviors that land them in jail often expose them to serious physical and mental health risks. When these issues go undetected or are poorly treated behind bars, thousands of people exit correctional systems within a few weeks or months with their serious problems unaddressed. In many cases, problems neglected in correctional care are never addressed at all. To read entire article click here (,CST-EDT-REF23A.article)


06-30-2007, 12:48 AM

Handshakes Bumped Out at Indiana Prisons "...The commissioner wants to see people great each other with a gentle bump of their fists instead of a handshake. Correction department spokeswoman Java Ahmed said Indiana got the idea from Oklahoma as a way to cut down on the spread of illnesses...." NOW I'VE HEARD EVERYTHING!! Northstar


07-01-2007, 08:19 AM

Woman gets prison for hiding HIV status MALMO, Sweden, June 30 (UPI) -- A Swedish appeals court ( has upheld the conviction and prison sentence in the case of a woman who did not let her husband know she was HIV positive. The woman was diagnosed in 1987 when she was 19. A few years later, when she met the man she eventually married, she did not tell him of her status, The Local reported. The couple have two children. To read more click here (


07-01-2007, 09:26 AM

whats done in the dark always comes tothe may take a while but its coming.for keeping a secret,sometimes there is no warning when it will be glad that her family is okay.


07-01-2007, 09:30 AM

She could have killed him. That's wrong and I don't like to see people in prison, but that can't be tolerated.


07-01-2007, 07:16 PM

This is just my opinion but I think she should spend time in jail.It is one thing to not know you have hiv and accidently give it to someone but it is a totally other thing when you know you have hiv and do not warn the partner you have it.To me that would be the same as attempting to kill someone. Because that is in a way what she did.No it wasnt 100% she would give him hiv but she knew there was a high risk of it and hiv leads to death. Therefore she tried to kill him.


07-01-2007, 11:33 PM

Sounds like a harsh thing to do but she definitely deserves time in jail. No thought or concern for her husband or children! Pathetic!


08-14-2007, 05:03 PM

The Shame of Prison Health by SASHA ABRAMSKY The Nation

A report is sitting at the Justice Department, unpublished. It has been there for two years. Titled The Health Status of Soon-to-be-Released Inmates, it was compiled by experts who sat on three panels: one on communicable diseases, one on chronic diseases and a third on mental illness. Their findings are, to say the least, somewhat startling. Estimating that 11.5 million Americans cycle in and out of jail or prison each year (the great majority of them short-term jail inmates), the report suggests that more than 18 percent of hepatitis C virus (HCV) carriers in the country pass through the jail or prison system annually, as do 8 percent of those with HIV and one-third of those with active tuberculosis (TB). [...] In interviews, recently released inmates describe a patchwork health system with gaping holes. At the Fortune Society in New York, ex-inmates with HIV gather in peer education groups, where their stories reveal widely varying degrees of access to medical care. Rochelle, for example, left New York State's Bedford Hills Correctional Facility in 1995 with an AIDS Drug Assistance Program (ADAP) card that gave her immediate access to the medications she needed for her HIV infection, and with contacts at a residential therapeutic community where she went to wean herself off drugs. Hector, by contrast, left his prison in 2000 with no ADAP card and only one month's supply of HIV medication. Carol, a resident of Bedford-Stuyvesant with a string of convictions behind her, took no medication for her HIV while in prison, and only began taking these lifesaving drugs when she was sent to Phoenix House upon her release. None of those in the room also infected with HCV had received treatment for it while behind bars.

When such nonprofits as the Fortune Society are not available to help ex-inmates navigate the medical bureaucracy, many never manage to access the public health system--because they do not know how to fill in application forms for Medicaid, because they lack the necessary identification to apply, because they have no permanent address. And even those who do successfully complete the process generally have to wait several months before their benefits kick in. "Public assistance is expedited for HIV sufferers to get these services. For people with other serious illnesses it's very difficult," explains Deborah Santana, risk-reduction services coordinator of the Osborne Association program in the Bronx.

"Once I was released, I had absolutely no medical benefits," says 44-year-old Edmond Taylor, who served fifteen years in New York prisons for drug-sales convictions. Taylor, a tall AfricanAmerican man with a cleanshaven head and a gentle, expressive, bespectacled face, suffers from acute facial psoriasis. "I was released back to New York City with very little cream and no pills left. I had no way of getting any help." When he applied for Medicaid at a center in Harlem--after standing in lines for two afternoons straight--they told him his application wouldn't even begin to be processed for forty-five days. "So," says Taylor, "I found someone who had Medicaid and I got them to go to the doctor and ask for stuff I needed. I paid them. I know it's illegal. I needed to get it because it affected me in my facial area and forehead--which made me very uncomfortable to go look for a job."

Because this stratagem was illegal, Taylor could have been sent back to prison as a parole violator. As it happens, he was lucky. Instead of winding up in prison again, Taylor was eventually hired by the Fortune Society, and his job provides him with health coverage. "The systems in place are designed to have people go back to prison," argues Santana. "Because they make it so difficult for them to access the services they need." [...]

Full article at:


08-27-2007, 01:49 AM

Full: August 27, 2007 Using Muscle to Improve Health Care for Prisoners By Solomon Moore[/URL]

SAN JOSE, Calif. — Last year, shortly after receiving extraordinary powers to overhaul the medical system in California's prisons, Robert Sillen, armed with a stack of court papers, issued a blunt warning to cabinet officials at the governor’s office in Sacramento.

“Every one of you is subject to being in contempt of court if you thwart my efforts or impede my progress,” said Mr. Sillen, a silver-haired former hospital administrator chosen to carry out the overhaul of the prison medical system as the result of a class-action suit brought by a prison advocacy group.

Backing up his warning, Mr. Sillen handed out copies of a federal court order that named him the health care receiver for the California prison system. In a subsequent warning, Mr. Sillen threatened to “back up the Brink’s truck” to the state’s treasury, if need be, to finance better medical services for the state’s 173,000 inmates.

State figures show that court-ordered changes to California’s prison system, including those in Mr. Sillen’s health care domain, have cost more than $1.3 billion, and the meter is still running.

For decades, California officials have tried to bring order to the state’s prison system, which is the largest in the nation. There have been lawsuits, special legislative committees and a declaration of a state of emergency by Gov. [URL=""]Arnold Schwarzenegger (, but never has one person attacked a problem, piece by piece, with such blunt force and disregard for political convention as Mr. Sillen has the prison system.

Mr. Sillen, whose $500,000 annual salary puts him among California’s highest paid public officials, said he had never visited a prison or thought much about the penal system until a recruiter called last year to persuade him to accept what the recruiter called a “mission impossible.”

Now he has the power to hire, fire, raise salaries, build facilities, waive laws, tap the state treasury and have jailed any bureaucrat who tries to thwart him.

“In my opinion, Robert Sillen is not going to be happy until he’s running the entire prison system,” said a state assemblyman, Todd Spitzer, an Orange County Republican and one of Mr. Sillen’s detractors. “He’s a man who has utter disdain for the legislature despite the fact that we’re the appropriate body for budgeting.”

Mr. Sillen asked the federal courts last month to take on the costly — and politically contentious — task of reducing California’s prison population, including the early release of some felons.

The appointment of Mr. Sillen as federal receiver in February 2006 resulted from a class-action lawsuit brought by the Prison Law Office, an advocacy group based at San Quentin. A federal court in the suit found an average of 65 preventable inmate deaths a year in the prison medical system, which the court ruled was tantamount to cruel and usual punishment. [...]



08-27-2007, 05:43 AM 17 Dead Since 2000, dozens have died in county jails. Poor medical care has contributed to the problem. By Tamara Lush ( Dead&issuedate=2007-08-16) Published: August 16, 2007 Yeisleny Nodarse inhaled sharply when she walked into the Kendall Regional Medical Center's intensive care unit. It was March 2007 and the pretty, raven-haired 20-year-old was there to visit her uncle, Rodolfo Ramos. But she barely recognized the man who lay in the bed before her. His eyes, once a warm, mischievous brown, were half-closed, dull, and unfocused. He was slack-jawed — lips purple, swollen, and cracked. His normally latte-color skin was pale and tinged with death. Shaking, Yeisleny stepped closer and gently stroked his skinny arm. She peered at his face, focusing on his nose and cheeks, where there were dozens of tiny, raised black spots. She would later discover they were ant bites. Her eyes traveled slowly down his body, past the open sores on his forearms to bruises on his emaciated legs. His hands were enormous, "like an elephant's," she recalls. It was difficult to know where to look without cringing. The last time she had seen Tio Rodolfo, he was a barrel-chested, grinning guy who liked to salsa dance. Now his feet had a bluish tint, and there were open sores on the tips of his big toes. These wounds, she would learn, were the work of rats. Then Yeisleny noticed the 41-year-old's ankles were shackled to the bed. Please Read This:


09-01-2007, 05:17 PM

Thank you so much for posting that Logan. I read the article and then I went and found a way to reach the appropriate person in Mr. Sillin's staff to report what is happening to my son. Maybe if everyone would write to these people about the medical care our loved ones in prison are getting in California we could improve their plight.


09-28-2007, 04:24 AM

thanks for the article

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