Archive 08/25/2022

Protecting Your Privacy and Personal Healthcare Information

By inDr. M Blatstein's Blog Tag

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…

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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 a “juridical 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 a “flutter (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.

Prison Design | Inmates Mental Health |

By inDr. M Blatstein's Blog

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 Psychology Programs

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FSA - First step act

 

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 Program– Facility 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 Program– Facility 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

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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

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FSA - First step act
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.

BOP BRAVE Program – For Those New To Federal Prison

By inDr. M Blatstein's Blog Tag , , ,
FSA - First step act

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

Mental Healthcare In The BOP – Is This Your Client?

By inDr. M Blatstein's Blog Tag , , , , , , , ,
FSA - First step act

Serious Mental Illness In The BOP 

The BOP provides Medical and Mental Healthcare (MH), through their 4 CARE LEVELS.

The BOP’s Psychology Data System (Page 2) Is Filled Out For All MH Levels.

The Designation and Sentence Computation Center places inmates into Care Levels 1 and 2

CARE LEVEL 1 MH

  • No Significant Need.
  • No history of serious functional impairment due to mental illness
  • No need for regular mental health visits
  • No hospitalization in the last 5 years
  • Defendant on their own has sought help
  • Controlled with 2 psychotropic meds (Not MH I if taking antipsychotic)
  1. Psychotropic medications:
    • anti-anxiety agents
    • mood stabilizers
    • stimulants
  2. Antipsychotic medicines, 
    • delusions (false, fixed beliefs) or
    • hallucinations (hearing or seeing things that are not really there).
    • schizophrenia, bipolar disorder, or
    • very severe depression (also known as “psychotic depression”).
  • Clinical visits q 6 mo

CARE LEVEL 2 MH

  • He/she has a mental illness requiring:
  • Routine Ongoing Outpatient visits
    • Medication controlled,
    • Medical visits q 1-6 months
    • Group Therapy, interventions every other week
  • Crisis Oriented, BRIEF MH Care, g., placement on suicide watch
  • Psychiatric Hospitalizations within the last 5 yrs
  • On Antipsychotic or 2 psychotropic meds

CARE LEVEL III & IV designation is made by the BOP’s Office of Medical Designations and Transportation

 CARE LEVEL 3 MH

  • Not In-patient
  • Enhanced Outpatient (Requires outpatient contacts with a prescribing doc > than monthly [at least weekly]); or
  • Housed in A Residential Treatment Program.
  • 2+ Psychiatric Hospitalizations within the last 3 yrs
  • 3+ anti-psychotic meds [Or > 5 meds for multiple Dx]

If you have a client with an MH CARE LEVEL of III, and a Medical CARE LEVEL of II,
The MH placement takes precedence.

Care Level 4 MH

  • Inpatient
    • gravely disabled and
    • cannot function in the general population, as in CARE3-MH
    • medical care 24/7/365
  • Tx plan reviewed every 90 days

BOP | COVID-19 | Hydroxychloroquine | The Science

By inDr. M Blatstein's Blog

BOP/ COVID-19 / Hydroxychloroquine / The Science Was Not There

BOP buys $60,000 worth of hydroxychloroquine

White House economic adviser Peter Navarro reportedly clashed with the National Institute of Infectious Diseases director Dr. Anthony Fauci over the efficacy of hydroxychloroquine as a coronavirus treatment.

Unproven COVID-19 treatment drug;

Many Trump-friendly pundits, however, are convinced of the drug’s effectiveness, most notably those on Fox News shows from which the president is known to take policy cues.

INDICATIONS:

Malaria (not recommended for the treatment of complicated malaria.)

Lupus Erythematosus

Rheumatoid Arthritis: the treatment of acute and chronic RA in adults.

Common side effects of Hydroxychloroquine include:

  • nausea,
  • vomiting,
  • stomach pain or cramps,
  • loss of appetite,
  • weight loss,
  • diarrhea,
  • dizziness,
  • spinning sensation,
  • headache,
  • ringing in your ears,
  • mood changes,
  • nervousness,
  • irritability,
  • skin rash,
  • itching, or
  • hair loss.

________________________

Clinical Effectiveness COVID-19 Resources Available to All

UpToDate (Medical Experts for Physicians)

Clinical Effectiveness COVID-19 Resources

Drugs – COVID-19

Coronavirus disease 2019 (COVID-19): Management in adults

 

I) Hydroxychloroquine/chloroquine— 

There are insufficient data thus far to know whether hydroxychloroquine or chloroquine has a role in the treatment of COVID-19. For this reason, we strongly recommend that patients should be referred to a clinical trial whenever possible.

If hydroxychloroquine or chloroquine is used outside of a clinical trial, the potential for adverse effects should be carefully assessed. (See “Coronavirus disease 2019 (COVID-19): Arrhythmias and conduction system disease”, the section on ‘Monitoring for QT prolongation.)

 

Ia) Azithromycin and hydroxychloroquine –

We do not routinely use azithromycin in combination with hydroxychloroquine for treating COVID-19. Although one study suggested the use of azithromycin in combination with hydroxychloroquine was associated with more rapid resolution of virus detection than hydroxychloroquine alone [62], this result should be interpreted with caution…

 

II) Remdesivir (Testing canceled, not because the drug wasn’t working, but because it proved too difficult to enroll the required number of patients. (Endpoints News))

…is a novel nucleotide analog that has activity against SARS-CoV-2 in vitro [43] and related coronaviruses (including SARS and MERS-CoV) both in vitro and in animal studies [44]. Several randomized trials are underway to evaluate the efficacy of remdesivir for moderate or severe COVID-19 [45].

IIa) The WHO is launching a trial to further evaluate:

…remdesivir, hydroxychloroquine/chloroquine, and lopinavir-ritonavir with and without interferon beta [76]. Various other antiviral and immunomodulating agents are in various stages of evaluation for COVID-19. A registry of international clinical trials can be found on the WHO website and at clinicaltrials.gov.

 

III) Convalescent plasma —

In the United States, the Food and Drug Administration (FDA) is accepting investigational new drug applications for use of convalescent plasma for patients with severe or life-threatening COVID-19 [50]; pathways for use through these applications include clinical trials, expanded access programs, and emergency individual use.

 

IV) Tocilizumab

…is an interleukin (IL)-6 receptor inhibitor used for rheumatic diseases and cytokine release syndrome. Elevated IL-6 levels have been described in patients with severe COVID-19, and case reports have described good outcomes with tocilizumab [66-69].

 

COVID-19 | BOP | 2019 – Current

By inDr. M Blatstein's Blog

6′ of Separation (In The BOP)

COVID

Then and now, Today BA.5 is a spreader, but


COVID-19 

  • Prisons (Federal, State) and 
  • Jails,
  • like Cruise Ships,

Unfortunately, act as perfect breeding grounds for any kind of virus and especially one that currently has few treatment protocols.

7/9/2020 (6 South Florida)

South Florida Federal Corrections Officers Warn of Potential Coronavirus Crisis Brewing

6/30/2020 (Reason)

These Women Received a Death Sentence for Being Sick In Prison – alleged medical neglect at FCI Aliceville, a federal women’s prison.

6/28/2020 (Forbes)

Otisville Federal Prison Camp Is More Like A Higher Security Prison In Fight Against Covid-19

6/11/2020 (Fort Worth Star)

11th inmate from a federal medical prison in Fort Worth died from coronavirus. This is discouraging as Fort Worth is a BOP Federal Medical Center.

5/28/2020 (Lexington Herald Leader)

Federal Medical Center prison helps drive a single-day spike in Lexington (FMC) COVID-19 cases.

5/28/2020 (LA Times)

Inmate labeled as ‘recovered’ from coronavirus dies at Terminal Island

 

5/28/2020 (Morning Journal)

Forest City Low-FCI prison in Arkansas currently has more federal prison coronavirus cases, according to the BOP website.

 

5/27/2020 (The Crime Report)

A task force led by current and former justice officials has proposed a 15-point platform to improve the federal criminal justice system.

5/27/2020 (Salon)

Even as the Justice Department announced that federal prisons would release vulnerable, nonviolent inmates to home confinement to avoid the spread of COVID-19, the agency was quietly adopting a policy that makes it harder for inmates to qualify for release, not easier.

5/27/2020 (AP)

TERRE HAUTE – An inmate at the federal prison complex in Terre Haute who had COVID-19 has died, and three others there also have tested positive for the disease, the Bureau of Prison said Tuesday.

 

5/26/2020 (Government Executive)

…a secret BOP policy has kept all but 1.8% of federal inmates behind bars where the virus rages.

May 22, 2020 (KSAT.com)

A Federal Bureau of Federal Prisons truck drives past barbed wire fences at the Federal Medical Center prison in Fort Worth, Texas, Saturday, May 16, 2020. Hundreds of inmates inside the facility have tested positive for COVID-19 and several inmates have died with numbers expected to rise. (AP Photo/LM Otero) (Copyright 2020 The Associated Press. All rights reserved.)

Federal prison system to begin moving nearly 7K inmates to one of three designated quarantine sites — FCC Yazoo City in Mississippi, FCC Victorville in California, and FTC Oklahoma City — or to a Bureau of Prisons detention center.

May 16, 2020 (The Review)

Of the 399 accumulated COVID-19 cases in Columbiana County, the health department reports nearly 25 percent, 94 of the cases, have been inmates from FCI-Elkton, totaling 118 for inmates and 12 corrections staff.

May 11, 2020

Inmates, families fear worst for Fort Worth Federal Medical Center – as the prison is ‘consumed’ by coronavirus where 636 inmates — 43% of the total population — had tested positive, and five have died.

May 10, 2020 (CBS DFW)

Tarrant County Public Health (TCPH) reported 485 new cases of the coronavirus Sunday, of which 423 were caused by the Texas Fort Worth Federal Medical Center prison outbreak. So far, the county has seen 3,695 positive cases and 780 recoveries.

May 9, 2020 (FCI Lompoc):

But covid-19 at FCI Lompoc is straining the relationship with LOMPOC, Calif. residents, part of this central California agricultural community.

70% of inmates test positive for coronavirus at Lompoc federal prison.

May 8, 2020 (KTLA5):

As of Friday 5/8/2020, 823 inmates tested positive in FCI Lompoc (2 have died), and another 644 at FCI Terminal Island (6 have died at the San Pedro facility).

May 8, 2020 (The Appeal):

FCI Hazelton is one of 11 federal prisons designated quarantine facilities. When new people are convicted or otherwise brought into the federal system, they will be sent to one of the facilities for a two-week quarantine period, BOP spokesperson Justin Long told The Appeal.

May 5-6, 2020 (Lex 18):

70 inmates test positive at the Lexington Federal Medical Center (FMC) in Lexington, Kentucky, however “communication with [FMC Lexington] has been sporadic, and sometimes it’s non-existent,” Lexington Health Department Spokesman Kevin Hall

May 5-6, 2020 (Lex 18):

LEXINGTON Federal Medical Center is quickly emerging as a hot spot for Coronavirus in Kentucky, without providing the needed communication with Lexington Fayette County Health Department.

May 1, 2020 (Penn Live Patriot-News):

LEWISBURG – Lewisburg Federal Penitentiary will transition into a medium-security facility is complete (and every unit will have multiple rooms with televisions, computer stations, and telephones).

May 1, 2020 (The Marshall Project):

COVID-19 continues to spread through Ohio prisons, with the FCI Marion and Pickaway correctional institutions combining for nearly 2,500 confirmed cases of the coronavirus. That is an estimated 80 percent of the inmates in those two prisons.

 

April 30, 2020 (The Marshall Project):

Texas prison system failed for years to equip employees with personal protective equipment…

Over 70 percent of tested inmates in the federal prison system have COVID-19. AP

COVID-19 outbreak at FCI Terminal Island is now the largest within the Bureau of Prisons system…

 

April 28, 2020 (ABC, WQAD8)

Thomson USP is one of 11 facilities designated as a “quarantine location,” now concerns over-testing.

April 23, 2020

…a federal judge dismissed a class-action lawsuit that was aimed at getting medically vulnerable prisoners released from the federal prison in Oakdale, Louisiana.

 

April 22, 2020 (Forbes):

Bureau Of Prisons Removes Webpage FAQ Home Confinement On COVID-19. BOP Website Displays…..

 

April 20, 2020 (Government Executive):

Union Files National Grievance Over Alleged Safety Violations at Federal Prisons During Coronavirus Pandemic. Forced leave, lack of protective gear, and privacy breaches are among the allegations.

April 18, 2020 (NYT):

‘Something Is Going to Explode’: When Coronavirus Strikes a Prison. An oral history of the first fatal outbreak in the federal prison system, in Oakdale, La.

 

Friday, April 17, 2020 (ABC):

Butner ( a BOP Federal Medical Center) has more COVID-19 cases than any other prison in the federal system: 66 inmates and 25 staff members have tested positive for COVID-19 at Butner; four inmates have died

 

April 15, 2020 (Forbes):

COVID-19 Positive Tests in Bureau of Prisons Institutions (April 14, 2020) W PAVLO

Federal Bureau Of Prisons Institutions Not Showing Any Signs Of “Flattening Curve”, By Walter Pavlo

The continued inaction of the BOP to swiftly reduce the population of inmates, particularly the elderly and those with underlying health conditions, is an unfolding story with tragic consequences.

April 14, 2020 (Marshall Project):

Nearly 600 prisoners and staff members are infected with COVID-19 in the federal system. Thirteen prisoners have died. Bureau of Prisons

 

April 8, 2020 (The Appeal):

Don’t Look to the DOJ to Keep Federal Prisons and Their Surrounding Communities Safe During the COVID-19 Pandemic. By  Shon Hopwood/Felon turned Georgetown Law Professor, Apr 08, 2020

April 8, 2020 (NYT):

…1,324 confirmed coronavirus cases are tied to prisons and jails across

Prisoners hung signs pleading for help in a window of the Cook County jail on Tuesday.Credit…Jim Vondruska/Reuters

the United States

 

April 7, 2020 (News Observer):

The Federal Correctional Complex at Butner is moving to the top of the list of prisons for early release 

April 6, 2020 (NPR):

Inmates, Staff On Edge As COVID-19 Spreads Through Federal Prisons  The Federal Bureau of Prisons says 138 inmates and 59 employees have tested positive and at least seven inmates have died.

April 4, 2020 (FEDweek):

 

Brooklyn, NY - Feb 2019: Protest over inmate conditions in front of the Brooklyn Metropolitan Detention Center which partially lost power and heat, resulting in a lockdown.

Brooklyn, NY – Feb 2019: Protest over inmate conditions in front of the Brooklyn Metropolitan Detention Center which partially lost power and heat, resulting in a lockdown.

Bureau of Prisons Implements Partial Lockdown to Halt Spread; The challenge is that prisons and jails are not built to provide 6′ of separation to inmates and correction staff.  I have to assume that PPE, cleaning materials and testing for all parties are not diligently implemented.

April 2, 2020:

Marshall Project: Coronavirus Tracker By State: How Justice Systems Are Responding in Each State; Coronavirus • Published 03.17.2020 • Updated 2:03 P.M. 03.25.2020

April 1, 2020 (Gov Exec Daily):

Federal Prison System Goes Into ‘Modified Lockdown’.

The Metropolitan Detention Center in Brooklyn, N.Y., had the first known case of coronavirus in the federal prison system. The facility is shown here in February 2019. KATHY WILLENS / AP

New procedures due to coronavirus concerns will last 14 days, after which the agency will re-evaluate. By COURTNEY BUBLÉ

Mar 31, 2020 (The Appeal, MedPage):

BOP Halfway House Residents Describe ‘A Scary Situation’ As Coronavirus Sweeps The U.S. By Lauren Gill. These halfway houses appear ill-prepared for the influx of those who may have (or haven’t yet contracted), COVID-19.

 

wearing a basic face mask in the community setting to augment our protection against SARS-CoV-2, the virus that causes COVID-19, is biologically plausible, and potentially impactful.

wearing a basic face mask in the community setting to augment our protection against SARS-CoV-2, the virus that causes COVID-19, is biologically plausible, and potentially impactful.

Could Wearing a Face Mask Be a COVID-19 Game Changer?— Augmenting protection during a global pandemic. by Rossi A. Hassad Ph.D., MPH

An easy and cheap option for all inmates and correction staff, in either Jail, Halfway House, State, Federal or Private facility. We can argue the efficacy benefit later.

Mar 30, 2020 (Vice News, NYT):

Inside the Federal Prison, That’s ‘Ground Zero’ For the Coronavirus Outbreak, By Keegan Hamilton

Mar 27, 2020 (The Marshall Project):

156-beds-in-Elm-Hall-a-minimum-security-dormitory-at-the-California-Institution-for-Men

No such thing as social distancing in prison. From THE MARSHALL PROJECT

PUBLIC HEALTH DOCTOR AND HEAD OF CORRECTIONS AGREE: WE

MUST IMMEDIATELY RELEASE PEOPLE FROM JAILS AND PRISONS; By Brie Williams, Leann Bertsch

Mar 26, 2020 (The Hill):

COVID-19 gives us an urgent argument for compassionate release, BY KEVIN RING, OPINION CONTRIBUTOR – The Hill

Mar 24, 2020 (wbur):

A medical exam room in the Worcester County jail in West Boylston

A medical exam room in the Worcester County jail in West Boylston

Pain And Profits: Sheriffs Hand Off Inmate Care To Private Health Companies; By Christine Willmsen  and Beth Healy