Archive 08/25/2022

Protecting Your Privacy and Personal Healthcare Information

Dobbs Protecting Your Privacy and Healthcare Information

The Dobbs decision opened the conversation to the security of your private privacy healthcare information that we all assumed was secure. We have all been made aware of securing our company’s web infrastructure and firming up its variabilities. The weak link that remains involves our personal lives.

Our family’s cell phones, computers, laptops, note pads, i-pads, gaming things if they’re web-connected, and Alexa, right? Then we have electric cars, and homes, you get the picture. Last, let’s not forget our healthcare privacy.

HIPPA – NATIONAL LAW REVIEW 7/2022

Protecting the Privacy and Security of Your Health Information When Using Your Personal Cell Phone1 or Tablet

HIPAA Privacy Rule and Disclosures of Information Relating to Reproductive Health Care

HHS Issues Guidance to Protect Patient Privacy in Wake of Supreme Court Decision on Roe

1-Where a state law prohibits abortion but

  • does not expressly require that a hospital report an individual for terminating her pregnancy,
    • The Privacy Rule would not permit disclosure of the individual’s PHI to law enforcement under the “required by law” provision.

2-The Privacy Rule Permits Does Not Require the disclosure of PHI

PHI, for law enforcement purposes “pursuant to the process and as otherwise required by law.”

    • If a law enforcement official requests records of abortion, but
    • there is no Court Order or other Mandate Enforceable in the court of law,
    • the Privacy Rule would Not Permit the Disclosure.

3- For disclosures permitted “to avert a serious threat to the health or safety of the individual or the public,”

HHS guidance provides this example.

  • A woman informs her health care provider,
    • in a state that bans abortion,
    • about her intent to seek an abortion in another state where abortion is legal.
      • The Privacy Rule would not permit the disclosure of the woman’s PHI to law enforcement
      • “to avert a serious threat to the health or safety of the individual or the public,”
      • because the woman’s statement tied to pregnancy loss does not constitute such a threat.
  • The guidance observes, moreover, that
    • the disclosure of such PHI would generally
      • increase the risk of harm to the individual and
      • detrimentally affect the patient-physician relationship and
      • would therefore conflict with professional ethical standards.
  • Can technology platforms be prevented from scraping databases to find the patients who had abortions out of state?

4- Protect your medical information when using health information apps (e.g., period trackers, and others).

5- In summary, none of this looks promising, but here it is:

  • Patient Privacy and Reproductive Health Data in the Dobbs Aftermath
  • Second, the FTC warns companies
    • not to make misleading claims that they “anonymize” or “aggregate” sensitive data to try to placate customers who might otherwise have concerns about their privacy.
  • Finally, the Commission points to several recent cases it has brought against companies that misuse customers’ data, without parental consent,
  • What can you do to protect yourself, but will we?
    • data encryption,
    • username ID and
    • password, and
    • two-factor authentication,
    • together can be used to help ensure the confidentiality of information.
    • But nothing is perfect, so you must keep your passwords updated.
  • Personal Data Examples: Credit card or personnel number of a person, account data, number plate, appearance, customer number, or address.
  • Sensitive Information Examples: Social security number, Birthdate/place, Home/Mobile phone number, Home address, Medical Records, Bank Account Numbers, IP address, Passwords, Gender, and Ethnicity.

HIPAA: applies to Healthcare providers and Healthcare Plans.

Safeguard: “protects health Information” or “PHI.”

  • Steps you can take to decrease how your cell phone or tablet collects and shares your health and other personal information, such as where you go and what you do, without your knowledge.
    • Avoid, downloading unnecessary or random apps, especially those that are “free.”
    •  ” giving any app permission to access your device’s location data, other than (e.g., navigation and traffic apps).
    • turn off the location services on your personal cell phone or tablet.
    • consider using communication apps, mobile web browsers, and search engines that are recognized as supporting increased privacy and security.
    • https://consumer.ftc.gov/articles/how-protect-your-privacy-apps
    • https://www.consumerreports.org/issue/data-privacy

Additional Resources:

FCC’s Protecting Your Privacy: Phone and Cable Records

How To Protect Your Phone From Hackers | Consumer Advice

Protect Your Personal Information and Data

FTC’s What to Know About Medical Identity Theft

NSA’s Limiting Location Data Exposure

ONC’s How Can You Protect and Security Health Information When Using a Mobile Device

Electronic Frontier Foundation (EFF) Surveillance Security Scenarios

Consumer Reports website on consumer data privacy

New York Times 3 Steps to Protect Your Phone

 

If you believe that your (or someone else’s) health privacy rights have been violated, at

(800) 368-1019, TDD toll-free: (800) 537-7697, or by emailing:  OCRMail@hhs.gov   https://ocrportal.hhs.gov/ocr/smartscreen/main.jsf

Thomas Court Denies Women The Right To Choose…

Justice Thomas on Dobbs

Credit: REUTERS/Jonathan Ernst

The Thomas Court – Denying Women The ‘Freedom To Choose’ Their Medical Reproductive Healthcare

Justice Thomas’s Message, Next: contraception, same-sex marriage…

Inside the Court’s ruling, Justice Thomas wrote that

  • “in future cases, we should reconsider all of this Court’s substantive due process precedents.”
  • “Because any substantive due process decision is ‘demonstrably erroneous,’ we have a duty to ‘correct the error’ established in those precedents.”  Just food for thought…

The More Restrictive States

Louisiana.

Louisiana is an example of extreme regulations, which defines “a viable in vitro fertilized human ovum” as ajuridical person which shall not be intentionally destroyed,” along with at least five states, that have introduced bills establishing fetal personhood. Now,

  • the ’embryo’ may be considered an individual, and if a couple is undergoing IVF, your criminal liability implications have suddenly exploded.
  • Why, because all of the embryos will have to be used.

IVF – Fertility Treatments

IVF and in some cases, even genetic screening, is seeing extreme statements from extreme states;

Will patients have to use all the embryos they develop,

  • a) which forces an individual or couple to expand their family before they can afford to do so, or
  • b) forgo the opportunity to have children, or
  • c) suggests that the couple limit the number of embryos to one or two, and hope that they are chromosomally balanced and will result in a live birth, but if not…
  • d) putting them through IVF stimulation over and over again, associated with the financial, emotional, psychological, and physical implications.

For states that take abortion bans to the extreme, and specify that,

Life begins at fertilization,

  • a) each excess embryo would have the same rights as an embryo,
  • b) all the embryos would then have to be implanted (by law), and
  • c) which could lead to financial hardships for an unprepared family to have multiple children all at once, high-risk pregnancy, multiple babies, risking the life of the mother and/or the children,
  • d) or regarding the fear of prosecution, the couple would decide not to have any children or
  • e) they would elect to move to another state.
  • Added to all this; are threats of violence that extremists have targeted at our behavior and beliefs, while representatives have kept quiet, and made this acceptable behavior.

Pregnancy Loss or Miscarriage.

Pregnancy Loss (NIH) | Miscarriage (Cleveland Clinic).

  • Some miscarriages require immediate medical interventions to prevent life-threatening infections or tubal rupture. Every year between 10% and 20% of known pregnancies end in miscarriages, mostly because the fetus is not developing normally, according to the Mayo Clinic.
  • Post Dobb’s, providers may now fear that the ‘state’ may view their treatment – as if they are providing abortion services, even if they have the necessary training and clinical skills, albeit the services may be similar.
  • If there is a malpractice (or negligence) claim where the provider was handicapped by the laws of their state, how then will this be reflected in their malpractice and liability carriers’ representation(s) going forward?

But it is in those most restrictive states, that women of color (and not those of means) could see even higher maternal mortality rates, increased child poverty, and face a greater risk of prosecution for seeking illegal abortions.

Religion

Religious freedom in America should mean that we all have a right to our religious beliefs. But it should not give us the right to use religion and beliefs to discriminate against others who do not share them—especially when doing so risks lives.

Attorneys – You Can Hear The Dam Breaking

Bloomberg Law – “There is so much confusion”

Aiding and Abetting

Abortion bans before six weeks in some states can depend on enforcement through lawsuits filed by private citizens. Possible targets: abortion providers and anyone who aids and abets an abortion – after an assumed heartbeat is detected – which is aflutter (or the beginning of our pacemaker),” and not a heartbeat.

Hospitals, Healthcare Systems, Telehealth providers, Pharmacists, Nurses, and Providers are all looking for answers (and to date, getting few). I am sure that most of you are getting calls (if not, you will), as confusion reigns, from Coast to Coast.

Regulations

The Emergency Medical Treatment and Labor Act obligates all Medicare-participating hospitals with emergency departments to furnish all medical conditions that pose serious jeopardy to health, bodily severe impairment, or serious organ damage. This duty extends to emergency care for pregnancy or pregnancy loss.

Medical Societies Speak Out

The American Psychiatric Association

By dismantling nearly 50 years of legal precedent, the Court has jeopardized millions of American women’s physical and mental health and undermined the physician-patient relationship’s privacy.

This move will disproportionately impact our most vulnerable populations, such as communities of color, people living in rural areas, and those with low incomes who may have to travel long distances to receive abortions.

Today’s ruling will put many pregnant women and their families into life-threatening and/or traumatic situations.

American Society and Association, of Clinical Oncology

Unfortunately, with the implementation of Dobbs, doctors have been handicapped in this critical patient-doctor decision-making process. Still, ASCO will work to help our members navigate this new situation and preserve their patients’ access to the highest quality care by providing evidence-based clinical guidance, including fertility preservation, and by advocating for access to all the components of high-quality care.

The American College of Obstetricians and Gynecologists (ACOG)

“We are treating this as a disaster response,” Verma said. “We are in an emergency, and this is a disaster.” Its impact on situations will include miscarriage and in vitro fertilization. The practice of medicine will be reshaped, the group said, or even contradicted by “by-laws not founded in science or based on evidence.” She wondered, “Are surgeons going to be afraid to intervene when a pregnant patient ruptures their appendix because they might inadvertently end the pregnancy?”

The American Academy of Pediatrics (AAP)

Today’s ruling means that in many places in the United States, this evidence-based care will be difficult or impossible to access, threatening the health and safety of our patients and jeopardizing the patient-physician relationship.

New England Journal of Medicine

The Supreme Court’s fig-leaf justification behind these restrictions was that induced abortion was a dangerous procedure that required tighter regulation to protect the health of persons seeking that care. Facts belie this disingenuous rhetoric.1,2. In view of these predictable consequences, the editors of the New England Journal of Medicine strongly condemn the U.S. Supreme Court’s decision

AAMC (Association of American Medical Colleges)

These laws and policies that restrict or otherwise interfere with the patient-physician relationship put patients at risk by limiting access to quality, evidence-based care.

Dobbs Non Medical, Legislator – Directed Patient Care

Dobbs

Doctor, ‘Patient-Care’ – Out

Non-Medical, ‘Legislator-Care’ – In

 

Today Families and Their Physicians are faced with impossible choices.

Physicians.

Recently, some states have enacted Legislator Directed Patient Care, that conflict with the doctor-patient ethical relationship, and the oath, to do no harm.

Since forever, as part of that relationship, providers try to educate patients to make decisions for themselves, about what they feel is right for them, saysDr. Stephanie Mischell.”

  • For some doctors, the debate comes down to medical ethics.
  • But now, can providers (or anyone) even discuss, refer, or contact out-of-state providers to give them information about patients, regarding abortion services without the fear of litigation, or prosecution?

Prenatal Care.

Prenatal Care may also be affected, particularly if they allow prosecutions to go forward against women.

  • Healthcare providers might find themselves caught in the middle – being forced to make ethical choices when asking routine past history questions regarding past pregnancies, and their outcomes.
  • In doing so, they may place themselves and their patients in the position of being criminally prosecuted, for what otherwise would have been considered usual and customary medical care.

Heartbeat Detection.

Pediatric cardiologist and researcher, Colin Phoon of New York University Langone Health, shared that before the sixth week, “there is no heart; there’s nothing beating.”heartbeat detection

  • What they are hearing is “a little flutter in the area that will later become, the future heart“- but

It’s not the actual heartbeat, said another physician, Dr. Saima Aftab, medical director of the Fetal Care Center at Nicklaus Children’s Hospital in Miami.

  • This flutter happens because that group of cells
  • will become the futurepacemaker of the heart and gain the capacity to fire electrical signals, she said.

Erika Werner, a maternal-fetal medicine physician at Brown University, and a Society for Maternal-Fetal Medicine board member explained, “You can see a little flicker,” she said.” That’s it.

As a product manual (Huntleigh High Sensitivity Pocket Dopplers) for one such device explains, the sound is the amplified version of the difference between the transmitted and received signals.

  • “It is not the real sound made by blood rushing through an artery or vein, or movement of the fetal heart.”
  • It’s only been in the last few decades that doctors have been able to detect this “flutter” at six weeks, thanks to the use of more sophisticated ultrasound technologies.
  • …at around 21-23 days after conception, two groups of cells form a horseshoe – known as a heart tube,
  • with cells creating a sound that seems like the first heartbeat,
  • although it may not pump the blood for another day or two.

All of the major structures appear mostly intact after nine weeks and one day of pregnancy when the entire process is largely complete.

Lupus.

In patients with Lupus (an autoimmune disease), should an inflammatory response flare during their pregnancy, this could then rise to the level of being consideredhigh risk“.

  • In this case, trained medical providers’ treatment plans may be interrupted by Legislator Directed Patient Care, without medical training, forcing themselves into the doctor-patient relationship, which may result in the loss of life. A scary result when considering Dobb’s.

Should the physician decide to ignore Dobbs, and provide what is the standard of care in the medical community, that would likely result in pregnancy loss or miscarriage, they and possibly their patients could expect to be criminally prosecuted – as you see, these are not easy decisions.

  • If the moral code of the provider is such that they go ahead and, provide what is considered usual and customary care, that is in line with their medical board code of ethics, and is the standard of care in the community, how will this impact their future should prosecution proceed?
  • Will some providers, depending on the severity of the state’s laws, begin to avoid practicing in those states altogether?
  • Could they face incarceration as an example to other providers?
  • Where does it end?

The Loss of an Experienced Medical Specialty – Who Suffers?

As state Legislator Directed Patient Care laws insert themselves into the physician-patient care model, this may create ethical issues for the provider, and malpractice liabilities for the doctor, hospital, and their associated healthcare systems.

The result of having no contingency plans for the “dead space” that immediately followed Dobbs, created this cascading series of events that result in

  • reduced access to specialists – in states where certain procedures are not permitted.
  • ultimately to be mostly felt by minority populations,
  • with a decrease in new resident training,
  • leads to a generation of fewer and “less qualified physicians in this niche specialty,” which makes up Obstetrics and Gynecology.

This new wave of disillusioned providers will not be used to being,

  • dictated to by non-medically trained legislators who
  • do not have their patient’s best healthcare interests at heart, or based on science, and then
  • tell them how to practice medicine.

Some may even face incarceration in some of the more extreme states, and if so – is practicing in those states even worth it?

  • Will their colleagues look the other way – or be concerned?
  • Likely, as we all have gone to school, before books started being banned, of course, we will be concerned.

Attorneys | You Can Help The Dam From Breaking | Bloomberg Law |“There is so much confusion”

Aiding and Abetting’.

Abortion bans before six weeks in some states depend on enforcement through lawsuits filed by private citizens.

Possible targets: abortion providers and anyone who aids and abets an abortion – after an assumed heartbeat is detected – but which is a “flutter,” only.

Hospitals, Healthcare Systems, Telehealth providers, Pharmacists, Nurses, and Providers are all looking to the legal community for guidance, as confusion reigns from Coast to Coast.

Regulations

The Emergency Medical Treatment and Labor Act obligates all Medicare-participating hospitals with emergency departments to furnish all medical conditions that pose serious jeopardy to health, bodily severe impairment, or serious organ damage.

This duty extends to emergency care for pregnancy or pregnancy loss.

Regarding Catholic Hospitals, the ACLU has collected numerous stories of women being denied emergency care at Catholic hospitals, with more emerging all the time.

Medical Societies Speak Out

The American Psychiatric Association

By dismantling nearly 50 years of legal precedent, the Court has jeopardized millions of American women’s physical and mental health and undermined the physician-patient relationship’s privacy.

This move will disproportionately impact our most vulnerable populations, such as communities of color, people living in rural areas, and those with low incomes who may have to travel long distances to receive abortions.

Today’s ruling will put many pregnant women and their families into life-threatening and/or traumatic situations.

American Society and Association, of Clinical Oncology

Unfortunately, with the implementation of Dobbs, doctors have been handicapped in this critical patient-doctor decision-making process. Still, ASCO will work to help our members navigate this new situation and preserve their patients’ access to the highest quality care by providing evidence-based clinical guidance, including fertility preservation, and by advocating for access to all the components of high-quality care.

The American College of Obstetricians and Gynecologists (ACOG)

“We are treating this as a disaster response,” Verma said. “We are in an emergency, and this is a disaster.” Its impact on situations will include miscarriage and in vitro fertilization. The practice of medicine will be reshaped, the group said, or even contradicted by “by-laws not founded in science or based on evidence.” She wondered, “Are surgeons going to be afraid to intervene when a pregnant patient ruptures their appendix because they might inadvertently end the pregnancy?”

The American Academy of Pediatrics (AAP)

Today’s ruling means that in many places in the United States, this evidence-based care will be difficult or impossible to access, threatening the health and safety of our patients and jeopardizing the patient-physician relationship.

New England Journal of Medicine

The Supreme Court’s fig-leaf justification behind these restrictions was that induced abortion was a dangerous procedure that required tighter regulation to protect the health of persons seeking that care. Facts belie this disingenuous rhetoric.1,2. In view of these predictable consequences, the editors of the New England Journal of Medicine strongly condemn the U.S. Supreme Court’s decision

AAMC (Association of American Medical Colleges)

These laws and policies that restrict or otherwise interfere with the patient-physician relationship put patients at risk by limiting access to quality, evidence-based care.

Prison Design | Inmates Mental Health |

Prison Design Affect Inmates’ Mental Health 

Two parts: Deprivation | Situational

Deprivation Theory:

  • When an inmate is subjected to a restrictive environment, certain
  • Basic needs may go unsatisfied and an inmate may adapt to the situation by satisfying needs via maladaptive mental health behaviors.

Situational Theory:

  • Here architectural and social determinants can impact one’s perception of his/her experience (safety, available resources, relationships) and
  • the likelihood of engaging in violence.

Reading the article in full should be considered in future building contracts.

BOP Prisons and Jails 2020 | Unprepared | COVID-19

BOP Prisons and Jails 2020 | Unprepared | COVID-19

COVID- 19 in Prisons and Jails are unprepared and may now be forced to recommend, in some cases alternative diversion sentences and/or home confinement.
I can only believe that the PSR could play a significant role in this process.

Six feet apart, unlikely

6' apart, unlikely

 Prisons and Jails (, like Cruise Ships, act as perfect breeding grounds

John Hopkins has a Live Interactive Dashboard

Provides Current Reported Cases of COVID-19. Use our interactive web-based map to track cases of the virus around the world

UpToDate/Coronavirus disease 2019 (COVID-19)

_____________________________

Recent Press Releases:

September 2020

Visitation beginning to restart.

June 3, 2020 (Marshall Project)

How Prisons in Each State Are Restricting Visits Due to Coronavirus

 

June 3, 2020 (Marshall Project)

Jails Are Coronavirus Hotbeds. How Many People Should Be Released To Slow The Spread?

May 15, 2020 (Marshall Project)

For Mentally Ill Defendants, Coronavirus Means Few Safe Options

While their mental health deteriorates, some are stuck in jail as hospitals are decreasing admissions to prevent the spread of infections

April 17, 2020                                                                                           

Inadequate access to medical care poses a severe threat to a population that is already more vulnerable to coronavirus: there are about 10,000 people over 60 in federal custody, and about a third have pre-existing conditions. Photograph: Jonny Weeks/The Guardian

In prisons and jails across the deep south, coronavirus threatens to overwhelm

chronically underfunded, understaffed and overpopulated facilities

Mar 21, 2020;

Forbes; Can US Prisons React Fast Enough To COVID-19? By Walter Pavlo

 

March 22, 2020; 

Assistant U.S. Attorney Tanya Hajjar –  – wrote that no inmates at the Metropolitan Detention Center (MDC) in Brooklyn, NY or any other federal facility had tested positive for the coronavirus. What she failed to mention is that the BOP was not doing any testing of prisoners. ByJ.J. O’Hara

 

3-23-2020;

At least 38 people in New York City jails have contracted the virus. Associated Press

First federal prisoner, in Brooklyn, tests positive for COVID-19. Associated Press

3-20-2020

Florida beaches covered with 1000’s on spring break, 2020.
All of this while COVID-19 is spreading across our country and the world. As a growing number of state governors urged all of us to Shelter in Place, in Florida, their beaches were covered with 1000’s on spring break.
You ask why and I have no idea. But these revelers are now on their way home to spread the virus throughout their families, friends and fellow workers’ personal space. Yet another vector.
The spread of COVID-19 from these beaches will ultimately whether direct or indirectly impact our society and prison system.

The Marshall Project, 3-19-2020

‘Those 55 and older are a growing share of the people in prisons. They’re also the most at risk as coronavirus spreads.’ By WEIHUA LI and NICOLE LEWIS

Couple this with the unprecedented delay of the federal government to act in any manner to assist state governors since January 2020, COVID-19 has exploded across the country exponentially! These same prisons and jails are already overcrowded, resulting in a healthcare disaster ready to get out of control.

Marshall Project: Jails are perfect incubators for COVID-19.” By Cary Aspinwall, Keri Blakinger, Abbie VanSickle and Christie Thompson

3-19-2020

ICE Now could be another vector waiting to explode, impacting immigrants and ICE officers alike. While ICE claims to “have a plan”, the horse has already left the barn.

_____________________________

#covid19 #Covid19Prison #covidBOP

BOP Psychology Programs

 

BOP Psychology Programs

If your client has replied ‘Yes’ to the questions (I- IX) below, one of these 9 BOP Psychology Programs may provide the best placement option for your client.

RDAP eligibility and an overview are covered in section VIII.

I) Is your client a first-timer young male offender 32 years of age or younger, facing a sentence of 60 months or more?

  • If yes, would your client be interested in participating in a program that teaches how to create a smoother adjustment to federal Prison?
  • Will they be sentenced to a medium-security facility?
  • If all three answers are yes, this program may help □;

BOP Brave Program– Facility Locations:

    • FCI Victorville, CA-Medium
    • FCI Beckley, WV-Medium

II) Is your client a male inmate in (or facing) a

  • high-security penitentiary setting with a history of substance abuse/dependence or
  • a major mental illness as evidenced by a current diagnosis of a Psychotic Disorder that may include;
    • Mood,
    • Anxiety,
    • Schizophrenia,
    • Delusion, and/or a
    • Substance-induced Psychotic Disorder?
  • If the answers are yes, this program may help □;

BOP Challenge Program – Facility Locations:

    • USP Big Sandy, KY-High
    • USP Hazelton, WV-High
    • USP Lee, VA-High
    • USP McCreary, KY-High
    • USP Allenwood, PA-High
    • USP Canaan, PA-High
    • USP Beaumont, TX-High
    • USP Coleman I, FL-High
    • USP Coleman II, FL-High
    • USP Pollock, LA-High
    • USP Tucson, AZ-High
    • USP Atwater, CA-High
    • USP Terre Haute, IN-High
    • USP Coleman I, FL (H)
    • USP Coleman II, FL (H)

III) Is your client a male or female with

  • a serious mental illness, but
  • who does not require inpatient treatment?
  • Do they lack the skills to function in a general population prison setting?
  • Would they be interested in a psychology program that
    • works closely with Psychiatry Services to
    • ensure they receive appropriate medication and
    • have the opportunity to build a positive relationship with the treating psychiatrist?
  • If your answers are yes, this program may help: □;

BOP Mental Health Step Down Program- Facility Locations:

    • FCI Butner, NC-Medium
    • USP Atlanta, GA-High

* Male inmates with a primary diagnosis of Borderline Personality Disorder are referred to the BOP STAGES Program

IV) Is your client a male or female with a

  • history of mental illness related to
    • physical, mental, intimate domestic violence, or traumatic PTSD?
  • Would your client be interested in a mental healthcare program that
    • focuses on the development of personal resilience,
    • effective coping skills,
    • emotional self-regulation, and
    • healthy interpersonal relationships?
  • If both answers are yes, this program may help: □;

BOP Resolve ProgramFacility Locations:

    • FPC Alderson, WV-Minimum (F)
    • SFF Hazelton, WV -Low (F)
    • SCP Lexington, KY-Minimum (F)
    • SCP Greenville, IL-Minimum (F)
    • FCI Aliceville, AL-Low (F)
    • SCP Coleman, FL-Minimum (F)
    • SCP Marianna, FL-Minimum (F)
    • FCI Tallahassee, FL-Low (F)
    • FCI Dublin, CA-Low (F)
    • SCP Victorville, CA-Minimum (F)
    • ADX Florence, CO-Maximum (M)
    • FCI Waseca, MN-Low (F)
    • FCI Danbury, CT-Low (M)
    • SCP Danbury, CT-Minimum (F)
    • FSL Danbury, CT-Low (F) (Activating)
    • FFPC Bryan, TX-Minimum (F)
    • FMC Carswell, TX-Adm. (F)

V) Does your client have a

  • significant functional impairment due to
    • intellectual disabilities,
    • neurological deficits, and/or
    • remarkable social skills deficits?
  • For example, do any of these apply to your client:
    • Autism Spectrum Disorder,
    • Obsessive-Compulsive Disorder,
    • Epilepsy, Alzheimer’s,
    • Parkinson’s, or
    • Traumatic brain injuries (TBIs) to mention just a few?
  • Would your client be interested in improving their institutional adjustment and
    • the likelihood of successful community reentry?
  • If your answers are yes, this program may help: □;

BOP Skills Program– Facility Locations:

    • FCI Coleman, FL-Medium
    • FCI Danbury, CT-Low

Note:

New Drug Improves Empathy And Social Skills In People With Autism; 

Dental care is tough to find for people with autism
Inmate patients (who need specified dental procedures) with autism and other developmental disorders require general anesthesia for non-routine dental work.

Most dentists are not equipped to provide it, and insurers will not cover general anesthesia for root canals.

VI) Is your client a male inmate (or facing prison) with

  • serious mental illnesses and
    • a primary diagnosis of Borderline Personality Disorder, along with
    • a history of unfavorable institutional adjustment linked to this disorder?
  • Would they be willing to volunteer for this mental healthcare psychology program?
  • If both answers are yes, this program may help: □;

BOP Stages Program– Facility Locations:

    • FCI Terre Haute, IN-Medium
    • USP Florence, CO-High (Effective 9/ 2014)

VII) Sex Offender Conviction(s)

VIIa) Sex Offender Treatment Program: Nonresidential (SOTP -NR)

  • Is your client considered a low to moderate-risk sexual offender?
  • Does your client have a history of a single-sex crime; or
    • are they serving a sentence for a first-time Internet Sex Offense?
  • If both answers are yes, this program may help: □;

BOP Sex Offender Non-Residential SOTP-NR ProgramFacility Locations:

    • FCI Petersburg- Medium
    • FCI Englewood, CO-Low
    • USP Marion, IL-Medium
    • FCI Elkton, OH-Low
    • FMC Carswell, TX-Med. Ctr.(Females)
    • FCI Seagoville, TX-Low
    • FCI Marianna, FL-Medium
    • USP Tucson, AZ-High

VIIb) Sex Offender Treatment Program: Residential (SOTP -R)

  • Is your client considered a high-risk sex offender?
  • Does your client have a history of multiple sex crimes (re-offense sex offender),
    • extensive non-sexual criminal histories, and/or
    • a high level of sexual deviancy or hyper-sexuality?
  • Does their criminal history include;
    • rape,
    • sodomy,
    • incest,
    • carnal knowledge,
    • transportation with coercion,
    • the force for commercial purposes or sexual exploitation of children,
    • unlawful sexual conduct with a minor, and/or
    • Internet pornography?
  • If your answers are yes, this mental healthcare program may help: □;

BOP SOTP-Residential Program Facility Locations:

    • USP Marion, IL-Medium
    • High FMC Devens, MA-Med. Ctr.

VIIc) New: BOP Commitment and Treatment Program for Sexually Dangerous Persons.

  • Is your client a candidate for
    • psychological treatment,
    • implementation of a behavior management plan, and
    • coordination of a multidisciplinary treatment team?
  • Can your client be considered sexually dangerous with
    • the possibility of criminal recidivism?
  • If both answers are yes, this program may help □;

Butner ‘New’ Commitment and Treatment Program – Facility Location:

    • FCC Butner, NC

VIII) RDAP

To verify RDAP eligibility, in addition to drug and alcohol abuse, prescription medications along with other medications available over the counter are also included.

According to the American Bar Association: there must be a verifiable, documented pattern of substance abuse or dependence within the 12-month period preceding arrest.

IX) NEW: The BOP Female Integrated Treatment (FIT) Program

  • Is your client a candidate for cognitive-behavioral treatment for females with substance use disorders, mental illness, and trauma-related disorders to female inmates?
  • Would your client also qualify for RDAP and those treatment plans which would also address substance use in this residential program may qualify for the early release benefit associated with RDAP?
  • If your answer is yes, this program may help □;

BOP FIT Program and Locations:

    • FSL Danbury, CT-Low – The New (FIT) Program

__________________

A Good Medical Resource: UpToDate

An evidence-based clinical decision support resource (one of many), that is authored and peer-reviewed exclusively by physicians who are recognized experts in their medical specialties.

Probation Officers | Federal | The PSR

Probation Officers Representing The Court:

They Conduct The Presentence Interview,

This is critical – as from it they prepare

Your Presentence Report (PSR),

Which acts as your “referral” to

The Federal Bureau of Prisons for everything

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For a No Obligation Free Consult Call Dr.Blatstein at: 240.888.7778, or through email at: info@PPRSUS.com. Dr. Blatstein answers and personally returns all of his calls.

Probation receives and evaluates pre-sentence investigation requests.

Their Process:

  • 1st they interview you, and then
    • Identify and pursue leads to obtain evidence.
    • Gather and document evidence by interviewing involved parties, obtaining statements, reviewing and analyzing records and files, etc.
    • Gather criminal history, police reports, victim impact statements, criminal complaints, and information and review them prior to the interview with the offender.
    • Conduct offender criminal history checks, warrant inquiries, and driver’s license abstract checks.
    • Compile and maintain history and case records.
    • Inform offenders of their rights, responsibilities, and purposes of the pre-sentence investigation process.
    • Interview offenders are required by the courts to have a pre-sentence investigation completed.
    • Utilize PSI interview guide and the Criminogenic Domains of Criminal History, Education/Employment, Financial, Family/Marital, Accommodation, Leisure/Recreation, Companions, Alcohol/Drug, Emotional/Personal, and Attitude/Orientation.
    • Complete various extensive assessment tools to gauge offender risk and needs.
    • Collect PSI fees.
    • Coordinate investigations with other law enforcement agencies, regulatory agencies, and other relevant entities.
    • Confirm information gathered during the interview.
    • Communicate with the appropriate Department of Corrections and Rehabilitation staff, other state agencies, related organizations, other entities, volunteers, and the public to provide information, referral services, technical advice, and consultation regarding PSI.
    • Communicate with Courts, attorneys, law enforcement, and other agencies involved in a court-ordered pre-sentence investigation.
    • Document interview and investigation.
  • Identify and Inform crime victims of their rights.
    • Assist the victim advocates in coordinating victim requests for offender information; victim issues such as recovery from injury, financial losses, or victim mediation; preparation of victim impact statements and reports; communicate offender progress and victim assistance to various local, state, and federal officials, and to treatment staff.

Prepare The Presentence Report and

Recommend administrative, legal, and/or sentencing action.

  • Present evidence to prosecutors, legal staff, or courts.
  • Prepare and present testimony as required for legal proceedings or administrative hearings.
  • Report offender compliance with the presentence investigation to courts.
  • Summarize information gathered during the investigation and interview into the pre-sentence format.

Make sentencing recommendations

  • based on sentencing guidelines and a thorough analysis of:
  • Ensure the report is distributed according to Applicable Code standards.
  • Monitor programs for compliance with state and federal laws compliance.
  • Gather, compile, and maintain statistics for required and requested reports.
  • Investigate and confirm the information on offender release plans or interstate compact investigations.
  • Maintain working knowledge of the Department of Correction and Rehabilitation (DOCR) programs and community-based programs that are available for offenders.

Note: The duties of probation officers listed above are not intended to be all-inclusive.

BOP Challenge Program

Photo Credit: The Marshall Project

BOP Challenge Program

Addresses Mental Illness Disorders

The BOP Challenge Program focuses on

Psychotic disorders make up a group of serious mental illness disorders that affect the mind. Psychotic disorders make it hard for someone to think clearly, make good judgments, respond emotionally, communicate effectively, understand reality, and behave appropriately.

When severe, those with mental illness disorders have trouble staying in touch with reality.

 

I) The BOP Challenge Program

  • for high-security inmates
  • in penitentiary settings
  • with substance abuse problems, and/or
  • mental illness disorders.

The inmate must meet one of the following criteria:

  • Has a history of substance abuse/dependence or,
  • Has a major mental illness as evidenced by a current diagnosis of a;
    1. Psychotic disorder
    2. Mood disorder
    3. Anxiety disorder
    4. Personality disorder

The responsibility for your client’s mental and physical health should be safeguarded in order to protect them from themselves (and others) while providing a safe environment for the duration of their incarceration.

This should be the responsibility of the legal counsel, the court, and BOP.

________________________

Below is an overview of the

    • BOP Challenge Programs ‘types and symptoms of psychotic disorders along with an
    • List of BOP ‘Formulary’ and
    • ‘Non-Formulary’ Medications currently available

 

_____________________________________

A)   Types and Symptoms

I- Schizophrenia

Note: Clozapine is the only FDA-approved medication for treating schizophrenia that is resistant to other treatments. It’s also indicated for decreasing suicidal behaviors in those with schizophrenia who are at risk.

II-    Schizophreniform, a Mental Illness Disorder

  • Includes symptoms of schizophrenia.
  • The symptoms last for a shorter time: between 1 and 6 months.
    • Medication* and Psychotherapy —to help the patient manage everyday problems related to the disorder.
      • Clozapine (Clozaril®) – On Formulary
      • Olanzapine (Zyprexa®)– On Formulary
      • Quetiapine (Seroquel®)– Non Formulary
      • Risperidone (Risperdal®)– On Formulary
      • Ziprasidone (Geodon®)– On Formulary

III- Brief Psychotic Disorder

IV- Delusional Disorder

  • The key symptom is having a delusion (a false, fixed belief) involving a real-life situation that could be true, but isn’t; such as being followed, being plotted against, or having a delusion. The delusion lasts for at least 1 month. Symptoms may include;
    • The cold, detached manner with the inability to express emotion.
    • Confused thinking;
      • Disorganized or incoherent speech.
      • Loss of interest in activities.
      • Loss of interest in personal hygiene.
      • Mood swings or other mood symptoms, such as depression or mania.
      • Problems at school or work and with relationships.
      • Slowed or unusual movements.
      • Strange, possibly dangerous behavior.
    • The primary typical medications* used;
    • Atypical antipsychotics* have fewer movement-related side effects;
    • Other medications*:
      • Antidepressants might be used to treat depression, which often happens in people with delusional disorders.
      • Psychotherapy can also be helpful, along with medications, as a way to help people better manage and cope with the stresses related to their delusional beliefs and its impact in their lives.
      • Sedatives and antidepressants might also be used to treat anxiety or mood symptoms, if they happen with a delusional disorder.
      • Tranquilizers might be used if the person has a very high level of anxiety or problems sleeping.

V- Shared Psychotic Disorder (also called folie à deux)

  • Here one person in a relationship has a delusion, and the other person in the relationship adopts that same delusion.
  • Diagnosing is difficult.

VI- Substance-Induced Psychotic Disorder

  • This condition is caused by the use of or withdrawal from drugs, such as hallucinogens or crack cocaine that causes hallucinations, delusions, or confused speech.
  • The hallucinations and delusions displayed should be in excess of those that typically accompany simple substance intoxication or withdrawal, although the patient could also be intoxicated and/or going through withdrawal.
  • Some precipitating substances:
  • Treatments
    • A calm environment.
    • Often a benzodiazepine or antipsychotic in most substance-induced psychoses, stopping the substance and giving an anxiolytic (eg., a benzodiazepine [Not Available]) or an antipsychotic drug can be effective.
    • Psychosis due to:
      • dopamine-stimulating drugs such as amphetamine; an antipsychotic drug could be used here.
      • For drugs such as LSD, quiet observation may be all that is needed.
    • For substances with actions that do not involve dopamine, observation may be all that is needed, or possibly an anxiolytic may help.

VII- Psychotic Disorders due to other medical conditions;

  • Hallucinations, delusions, or other symptoms may happen because of another illness that affects brain function, such as a head injury or brain tumor.

VIII- Paraphrenia: (Symptoms similar to schizophrenia).

  • It starts late in life in the elderly.
    • Generally has a much better prognosis than other psychotic disorders.
    • Antipsychotic medication can be helpful.
    • Paraphrenia sometimes co-occurs with depression and anxiety.

IX- Mood Disorder

  • Depression [Slide Show]; can be emotionally crippling.
  • Bipolar disorder is also known as manic depression.
    • Can cause risky behavior, even suicidal.
    • Can cause periods ranging from overly happy and energized, to other periods feeling very sad, hopeless, and sluggish.
    • Symptoms of mania (“the highs”):
      • Angry, and hostile.
      • Becoming more impulsive.
      • Drug and alcohol abuse.
      • Excessive happiness, hopefulness, and excitement.
      • Increased energy and less need for sleep.
      • Making grand and unrealistic plans.
      • Rapid speech and poor concentration.
      • Restlessness.
      • Showing poor judgment.
      • Sudden changes from being joyful to being irritable.
      • Unusually high sex drive.
    • Symptoms of (“the lows”):
      • Appetite changes make them lose or gain weight.
      • Attempting suicide.
      • Feelings of hopelessness or worthlessness.
      • Insomnia.
      • Irritability.
      • Loss of energy.
      • Needing more sleep.
      • Sadness.
      • Thoughts of death or suicide.
      • Trouble concentrating.
      • Trouble making decisions.
      • Uncontrollable crying.

B) Other possible treatment medications*

C- Note: Psychotherapy, or “talk therapy,” is recommended.

_____________________

BOP  Challenge Facility Penitentiary (USP) Locations:

Allenwood, PA-High

Atwater, CA-High

Beaumont, TX-High

Big Sandy KY-High

Cannan, PA-High

Coleman I, FL-High

Coleman II, FL-High

Hazelton, WV-High

Lee, VA-High

McCreary, KY-High

Pollock, LA-High

Terre Haute, IN-High

Tucson, AZ-High

 

* Medication availability:
  • On Formulary – These are available.
  • Non-Formulary – These medications require a lengthy review process.  It is prudent to document these at the sentencing hearing and through their PSR.

PSR / Sentencing Preparation Software

240.888.7778 * info@PPRSUS.com

https://live-pprsus.pantheonsite.io/

_______________________________________

-UpToDate-

Just one of many medical resources that consist of practicing physicians, editors, and researchers.

Federal Sentencing and Placement – The Process

98% of federal defendants plea

Federal Sentencing

1st: Federal Defendants indicted, >93% likely will receive a federal sentence to a BOP facility

 

2nd: The defendant’s first appearance in court
  • ~93+%, can result in either a plea or verdict of guilty to a federal sentence
  • Between the Defendant’s 1stand, 2nd court appearance; a resume or CV of the defendant’s background is developed: called the Presentence Report (PSR).
  • The PSR is where the Defense Team Can make a Placement Request, while documenting the defendant’s medical, criminal, work & education histories, etc.
3rd: The defendant’s second court appearance is for the Sentencing Hearing
  • The details of sentencing are not taught in most law schools
  • Judges determine the length of time the defendant is imprisoned
  • Judges can also make a placement request to the BOP
4th: The BOP determines placement
  • Some of the factors that affect placement (BOP Policy Statement P5100.08 (Chapter 4 Pages 5-13 and Chapter 5 Pages 12-13):
    • Judges recommendations
    • Public Safety Factor (PSF) Variables
      • Accepting Responsibility
      • Age
      • Criminal History
      • Education Level
      • Legal Release Residence
    • Management Variables; Pre-determined Security levels
      • Disruptive Group-confirmed member
      • Greatest Offense Severity #
      • Greatest Severity Offense
      • Prison Disturbance
      • Serious escape
      • Serious Telephone Abuse
      • Sex Offender
      • The threat to Government Officials
    • Medical CARE LEVELS I-IV Structure
    • Mental Healthcare CARE LEVELS I-IV Structure
    • Psychology Treatment Programs
    • Medication Availability

      • On Formulary, or available
      • Non-Formulary requires a lengthy preapproval process
      • Or Just Not Available, where a similar substitute may be implemented

For Groups: My PowerPoint Presentation

BOP BRAVE Program – For Those New To Federal Prison

BOP BRAVE Program 

A part of The First Step Act – Admission Criteria

A 6-month program designed to facilitate favorable initial adjustment to incarceration – for young males new to federal prison, serving their first sentence in a medium facility.  Photo Credit: The Marshall Project

______________________

BOP Brave Program – Admission Criteria:

I- Designed for medium security male inmates.

II- The inmate is 32 years old or younger.

III- They will be serving a sentence of 60 months or more, and is their 1st time in the BOP.

IV- The program is assigned at the beginning of their sentence.

The responsibility for your client’s mental and physical health should be safeguarded in order to protect them from themselves (and others) while providing a safe environment for the duration of their incarceration.

This should be the responsibility of the legal counsel, the court, and BOP.

_______________________

The BRAVE Program is located at the following federal prison facilities:

 

info@PPRSUS.com * 240.888.7778

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