Uncertain Futures, Being Released from Prison Without Healthcare

By Cassie M. Chew | May 1, 2019

In addition to the rest of us, there are hundreds of inmates being released from prison, only to face the reality that the Trump administration is going all out to dismantle the ACA. As the ACA also provides Medicaid for those who are either unemployed or at the poverty level; the formerly incarcerated now face the possibility of no health insurance.

Of Note: Short on funding, and then healthcare following release.

I) First Step Act Comes Up Short in Trump’s 2020 Budget

Supporters worry because law seeks $75 million a year for five years, but president’s plan lists $14 million.  By JUSTIN GEORGE

II) Trump Administration Files Formal Request to Strike Down All of Obamacare

By Jan Hoffman and Abby Goodnough, May 1, 2019

Then there are the governors (Republican only) who refused to allow the medicaid expansion into their states! How can they govern over their constituents, while at the same time going out of their way to in effect, deny healthcare to their poorest populations. We all as a nation are facing an historic constitutional crisis in Washington, but this also disproportionately affects the poorest among us.


Photo by Chris Marchant via Flickr

For those who are being released from prison(s), many have been treated for both medical and mental healthcare problems, as well as being treated for addictions. What they now face is returning into our communities without any medical safety net. Without access to medical care, for some their only resource may be to the streets, a cycle that we’ve tried to change, the “in and out” of of the prison cycle.

This result ultimately impacts all of us, and our communities for we are all only as strong as our weakest link.

Do they get a Second Chance? No, plus they face an Uncertain Future; Post-Prison, Without Health Care.

Autism and Access to Dentistry – Challenges those Incarcerated

Presenting with autism (or other developmental disabilities), getting a routine root canal is not routine because here, general anesthesia is required, and most dentists are not prepared to provide this service within their office settings.

Even on the outside, most insurers do not cover general anesthesia for these routine dental procedures, leaving the guardians to cover this cost out of pocket. Being incarcerated makes this routine experience even more challenging.

Autism’s many faces
Social Interactions:

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

2 May 2019, 7:00 am EDTBy Rina Doctor Tech Times.

Specifically this drug shows improved adaptive behaviors in men with autism spectrum disorder; Science Translational Medicine  08 May 2019

Ongoing substandard care and treatment of Immigrant Detainees at the GEO Group’s Privatized Adelanto, California Facility

During our May 2018 unannounced inspection of the Adelanto ICE Processing Center in Adelanto, California, OIG identified a number of serious issues that violate ICE’s 2011 Performance-Based National Detention Standards and pose significant health and safety risks at the facility. Specifically, we are concerned about the following:

  • Nooses in Detainee Cells (Page 3)
  • Improper and Overly Restrictive Segregation (Page 4-7)
  • Untimely and Inadequate Detainee Medical Care (Page 7-9)

The Adelanto Center was to comply with ICE’s 2011 Performance-
Based National Detention Standards, as revised in December 2016. These detention standards establish requirements for areas such as:

  • environmental health and safety: e.g., cleanliness, sanitation, security, admission into facilities, classification, detainee searches, segregation 2 (Special Management Units), and disciplinary system;
  • detainee care: e.g., food service, medical care, and personal hygiene;
  • activities: e.g., religious practices, telephone access, and visitation; and
  • grievance system.

GEO’s (a privatized federal prison) facility’s deficiency’s continue to demonstrate:

1. Under the Obama Adm., the Justice Department phased out its use of private prisons after officials concluded the facilities are both less safe and less effective at providing correctional services than those run by the government.

2. The OIG’s most recent report: 9/2018 continues to demonstrate GEO’s inability to function without oversight.

How we treat immigrants is a reflection of our core value history, is this us?

Please click the link and read the report if full.



The Benefits Of A College Program In Prison


Programs like the Education Justice Project out of St. Louis University Prison Program brought classes to Danville Correctional Center — a medium security, all male prison with about 1,700 inmates in east central Illinois, and California’s San Quentin’s ‘The last Mile’ are both great steps in addressing the recidivism paradigm.


Photo credit: SEBASTIÁN HIDALGO

Currently, there is no pathway ‘within the PSR’ process that addresses recidivism. This could match a defendant with a facility that supports an interest the defendant may have in either college, or in learning a specific occupational or trade.

In an attempt to positively change their and their family’s future, this would go a long way towards ensuring a successful reentry back into their communities, while being a first step towards reducing the recidivism paradigm.

Prison Design and Mental Health Outcomes

Can Prison Design Affect Inmates’ Mental Health Outcomes?

by Joyce Frieden, News Editor, MedPage Today 

As written in the article:

The researchers listed two theories of prison design:

  • Deprivation Theory: This is the idea that 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 behaviors.
  • Situational Theory: This is the idea that 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.

Getting the PSR right before sentencing.

Getting the PSR right before sentencing.

Abstract

Imprisonment is a frightening experience for both your client and their family. Counsel and family can assuage some of these fears by addressing federal prison healthcare both before the sentence begins, and while the inmate is in Federal Bureau of Prisons (“BOP”) custody.

Role of the Presentence Report

The Presentence Investigation Report (“PSR” or “PSI” or “PSIR”) plays a critical role in Sentencing Guidelines departures and statutory sentencing considerations. From the judge at sentencing to the Probation Office’s use during Supervised Release, the PSR is considered gospel fact about the defendant.

Once in BOP custody, the PSR becomes a bible about the inmate. The BOP’s interpretation of the PSR drives its decisions about security level and prison placement, programming, pre-release, and even medical care. The inmate’s federal prison life depends on that PSR.

One cannot overstate the PSR’s importance, or the need for it to be accurate the first time. Asking to change the PSR later asks a court to change positions that it has already adopted as accurate. Even if this can be done – a big if – the amendment process can take years and many billable hours to complete.

Should there be a medical or mental healthcare issue, the PSR drafting process is the time to get it right. An inaccurate PSR can mean a lack of consideration at sentencing and inappropriate or absent care after imprisonment.

For example, if kidney dialysis is necessary, submit related physician notes to the Probation Officer through their PSR. If the defendant is undergoing liver dialysis while waiting for a liver transplant (Mars, for their transition period until they receive a liver transplant), make sure all events are documented. Everything is important, from osteoarthritis and degenerative joint diseases to food allergies and medically necessary diets. Everything needs to be documented, including how any maladies would limit “activities of daily living” (“ADL”). Patient-inmates are considered ‘independent’ if they can accomplish their Activities of Daily Living (ADL) – things like dressing, bathing, and eating – on their own.

Medications must also be identified to estimate which prescription drugs the BOP will make available. It is critical to identify whether given medications are available on formulary, or if they require a request for non-formulary medications. Understand that the BOP will discourage non-formulary medications that require special approval. More likely, BOP physicians will just switch the inmate’s treatment medications to similar equivalents.

These issues should be addressed with the court before incarceration, because after incarceration the court has no real oversight. Letters from the client’s personal physicians should provide documentation about their prescription selection, and reasons why “similar” medicines are not appropriate for individual inmates.

Today the BOP uses a complicated method to convert a person’s medical diagnoses and treatments into a CARE LEVEL Classification. Classifications range from CARE LEVEL I for the healthiest inmate-patient, to CARE LEVEL IV for gravely ailing inmate-patients who need ‘in-patient’ care. Each facility then is identified by both a Security Level and this CARE LEVEL structure, and inmates are placed accordingly.

Photo Credit: https://pixabay.com

Reducing Recidivism – A Personal Holistic Approach

…supporting those who wish to create positive futures for themselves and their families.’ One example is, the Last Mile. The Last Mile (TLM) was created to provide programs that result in successful reentry and reduce recidivism. We believe that jobs are the key to breaking the cycle of incarceration. Our mission is to provide marketable skills that lead to employment. Our in an out program provides career training in prison with mentorship and job placement upon release.

Currently ‘Felony’, forever is on one’s record:

We can all agree that leaving prison with a “Felony” on one’s record disqualifies them from most jobs in our current workforce. While discouraging, this existing ‘disclosure requirement’ that appears on most employment applications inhibits those affected from moving forward with their lives, thus contributing to this recidivism paradigm.

The issue of a “Felony” on one’s record is a political issue, and one that politicians all across the country need to address. Our society’s reality is that released inmates are facing this challenge every day; this is their albatross. Even so, if the effort is made early before prison placement, we can begin to start changing some of their future ‘paradigm’ challenges.

92% of defendants with public counsel and 91% with private counsel either pleaded guilty or were found guilty at trial. DOJ Cases, November 2000

While this is a difficult and fearful time, it is worthwhile to discuss with your client what job, educational or lifetime goals they (and their families) may have, and then including this in their PSR.

A personalized Presentence Report (PSR) submitted before sentencing that matches your client with a facility that provides for their individual healthcare needs, security level, encourages and supports their interests in: Education (College) as well as interests they may have in a specific occupational trades training (i.e.: Accounting – Welder), is all a great start.

Who Benefits:

Society’s benefit: Individuals released with a new futures for themselves, now becoming contributing members to their communities.

Your Client’s benefit is that they are now released with enhanced life skills and future positive goals.

The Last Mile’s is a successful example of what can be done in changing our existing recidivism paradigm.

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