Medical Healthcare CARE LEVEL (I-IV) Placement

This video provides an overview of how healthcare is provided in federal prisons and is dependent on several factors. First, an accurate and comprehensive Presentence Report, then, unfortunately, staffing as there is a severe shortage.

As of 10/2023, a client returned from Butner Low and reported that only contracted doctors would come in from the outside to the Low and FMC (the BOP’s best hospital) every 2-3 weeks. All surgeries were going to Duke Medical Center, which is good. This is just something to keep in mind as, hopefully, things there have improved.

Is Determined By The Information You Provided For Your Presentence Interview

Through my story, this video explains why finding the right attorney for you is important. Although this is your life-altering event, preparation and Knowledge of what you are about to do could still result in a positive outcome. Knowing that the DOJ has a 98% conviction rate, what is a positive outcome for you? Learn from my experiences through my video.

Pregnant Prison Programs for Women

MINT Programs

Call 240.888.7778 for a personal one-on-one call
to discuss your current issue or that of a loved one.

-Marc Blatstein

We are not Attorneys; you need Legal Representation.

Corrections Agencies Responses to Opioid Abuse in Facilities (CIC, 2017)

Medical Health Mental Health

NEW Reentry Act legislation is introduced that expands access to health care, including mental health services and substance use disorder treatment, for Medicaid-eligible individuals 30 days before their release from jail or prison.

Senators Tammy Baldwin (D-WI) and Mike Braun (R-IN), 3/30/2023

Before any initial designation decision is made, DSCC staff assess a provisional BOP CARE LEVEL from I–IV for each inmate. BOP institutions also have a care level assignment that reflects the medical care resources available at that facility.

The Designation and Sentencing Computation Center (DSCC) designates those inmates with Medical (and Mental Healthcare) CARE LEVEL I and II.

The Office of Medical Determinations and Transportation (OMDT) will make the designation decision for inmates with medical (and mental healthcare) care levels III and IV.

I co-published The Critical Role of the Presentence Report. In this video I have added commentary that I hope you find helpful.

Prisoners have a constitutional right to adequate medical care, but what that means and how to get needed treatment is often not well understood by attorneys representing criminal defendants. This article attempts to address that knowledge deficit by explaining the medical, mental health, and substance abuse programs and policies in the federal Bureau of Prisons (BOP), as well as some of the educational, vocational, and other available programs intended to rehabilitate inmates and prepare them for return to society.

Equally important, the article explains the Critical Role of the Presentence Report (PSR) in determining whether and how treatment and programs will be available to a defendant. Documentation is paramount, and the diligent attorney must proactively gather and supply the appropriate documentation to the probation officer preparing their client’s PSR. In this video, I read the article Published in The Federal Lawyer regarding Medical Care in Federal Prison, including my commentaries throughout the article. If you have a medical issue, I recommend listening; it is very informative and detailed.

Medical Health CARE LEVEL I

  • Inmates are generally healthy but may have limited medical needs that can be easily managed by clinician evaluations every six months.
  • Inmates are less than 70 years of age.
  • Examples: mild asthma or diet-controlled diabetes not requiring medications.
  • Community Hospital Medical centers may be located over one hour away.

Medical Health CARE LEVEL II (the majority of BOP facilities)

  • Inmates are stable outpatients who require at least quarterly clinician evaluations.
  • It can be managed in chronic care clinics, including mental health issues.
  • Examples: medication-controlled diabetes, epilepsy, and emphysema.
  • Hospital Medical centers may be located within one hour of the facility.

Medical Health CARE LEVEL III

  • Inmates are fragile outpatients who require frequent clinical contact to prevent hospitalization.
  • They may require some assistance with activities of daily living (BOP Program Statement 5200.05, page 2) but do not need daily nursing care.
  • Examples: cancer in remission of less than one year, advanced HIV disease, severe mental illness in remission on medication, severe congestive heart failure, and end-stage liver disease.
  • The designation is done by BOP’s Office of Medical Determinations and Transportation (OMDT).

Medical Health CARE LEVEL IV

  • Functioning is severely impaired.
  • Cannot perform Activities of Daily Living (ADL), such as caring for oneself, performing manual tasks, eating, sleeping, walking, standing, sitting, reaching, lifting, bending, speaking, breathing, learning, reading, concentrating, thinking, communicating, bathing, and cleaning oneself.
  • Requires 24-hour skilled nursing care or nursing assistance.
  • Examples: cancer on active treatment, dialysis, quadriplegia, stroke or head injury patients, major surgical patients, acute psychiatric illness requiring inpatient treatment, and high-risk pregnancy.
  • BOP’s OMDT does the designation.
  • There are seven Federal Medical Centers.
    • FMC Butner (North Carolina), the BOP’s cancer center, provides inpatient medical/surgery, mental healthcare, and sex offender treatment programs, as well as housing at all security levels.
    • FMC Carswell (Texas) is the only facility just for women.
    • FMC Devens (Massachusetts) provides dialysis, one of several facilities that provide a residential sex offender program, along with inpatient mental healthcare.
    • FMC Forth Worth (Texas)
    • FMC Lexington (Kentucky) houses lower security.
    • FMC Rochester (Minnesota); contracted with the Mayo Clinic, providing all levels of complex medical care and inpatient mental healthcare.
    • FMC, Springfield (Missouri); higher security, dialysis, and inpatient mental healthcare.

BOP Psychology Programs
Medication availability (~ 3500 different drugs) falls into 3 tiers

  • Available- On Formulary (Which are they?)
  • Non-Formulary; Requires a lengthy Preauthorization Process. Which are they? How do you ensure their availability for your client upon their admission starting on day 1?
  • Just not available; what similar (equivalent) substitutions will be used? Now, what do or can you do if this impacts Continuity of Care and is not within the Standard of Care within the Medical Community?


BOP COVID-19 Modified Operational Level Indicators

These are raised or lowered after 48 hours of respective sustained increases or decreases in the following indicators:

Level 1 Minimal, No isolation required.
Level 2 {Yellow}, Medical isolation rate 2% to < 7%, or Facility vaccination rate 50% to < 65% or    the Community transmission rate is 50-99 per 100,000 over the last seven days
Level 3, Medical isolation rate ≥ 7%, Facility vaccination rate < 50%, or Community transmission rate ≥ 100 per 100,000 over the last seven days.

The challenge is that although the Pandemic is now behind us (10/2023), as an Epidemic, it will remain since the COVID virus continues to mutate. This has researchers around the world busy, along with the residual effect that persists in some POST-COVID Long-Haulers. Significant is that POST-COVID Long-Haulers may test negative but are very symptomatic. In turn, they may be unable to participate in ADL or PADL.

BOP General Modifications For Testing, Masks, Vaccines and Boosters;
The BOP does not appear to conduct random COVID Testing proactively, nor do they keep accurate records (requiring?) of all Vaccines and Boosters given (to staff and inmates), as well as enforcing (or at least making available) Masks. We now know that the immunities of a vaccine decrease over time (as in < Months). Compassionate Release or Second Look may be an option if you are immunocompromised.

Learn CPR – Save Lives – Hands-Only (30 sec) – The Next Life It Saves Could Be Yours.

As a cardiologist, I have been frustrated learning of athletes dying on the playing field unnecessarily and resuscitating people brought into our ER with no brain viability – because people do not know what to do, and it’s so simple. We have to change this.”


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Cardiologist at NewYork-Presbyterian Hospital.
Director of Education and Outreach for The Ronald O. Perelman Heart Institute.

Whether You’re The Target of a Federal Investigation or Already Incarcerated – There Are Things At All Levels We Can Do


Call for a personal one-on-one call (240.888.7778) to answer your questions and concerns.
-Marc Blatstein