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.
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The BRAVE Program is located at the following federal prison facilities:
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.)
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.
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].
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.
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.)
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.
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).
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
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.
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.
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
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.
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
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.
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.
These medications are available for BOP healthcare providers for inmate use.
2nd) Non-Formulary –These require a lengthy Preauthorization Process
While they are stocked, these medications are not available and require lengthy pre-authorization.
As the BOP Formulary is available online, and should your medication fall into this category, this discussion should occur long before the Presentence Interview for obvious reasons.
3rd) Similar equivalents – Not On Formulary (Not Available)
Here, similar or equivalent substitutions are used. After consulting with the current treating physician of record, the defense needs to make appropriate decisions regarding this medical problem before this point and long before the PSI.
However, addressing it before the PSR is complete, with the backing of the US Attorney and, finally, the court.
Examples of medication confusion for Cholesterol Control:
PCSK9 Inhibitors vs. Statins. Statins are a popular treatment that has been available since the 1980s. PCSK9 inhibitors, on the other hand, are a new type of cholesterol drug. They were approved by the Food and Drug Administration in 2015.
Generics
These are the drug of choice for the BOP as they are cheaper than brand-name medications.
It may be beneficial to inform your client ahead of time that, while they’ll be taking a generic medication
since there are many manufacturers who each produce similar generic drugs
these same drugs, while may differ in color, size, and shape;
they should be the same
Nobody likes surprises, especially if they are entering prison for the first time.
For a No ObligationFree ConsultCall Dr.Blatstein at: 240.888.7778, or through emailat:info@PPRSUS.com. Dr. Blatstein answers and personally returns all of his calls.
How and where inmates are placed according to their medical and mental healthcare needs is via the BOP’s CARE LEVEL I-IV structure.
Medical CARE LEVEL I [under 70, healthy, needing limited to no medical contact].
Inmates are generally healthy but may have limited medical needs that can be easily managed by clinician evaluations every 6 months and are located approximately one hour or more from community medical centers.
Inmates are less than 70 years of age.
Examples: mild asthma or diet-controlled diabetes not requiring medications.
FCI Manchester, Medium [Includes Satellite Camp], KY.
FCI Three Rivers, Medium [Includes Satellite], TX.
FCI Bennettsville, Medium [Includes: Satellite Camp], SC.
FCI Williamsburg, Medium [Includes Satellite Camp], SC.
FCI Herlong Medium [Includes Satellite Camp], CA.
FPC Yankton, SD.
FCI McKean, Medium [Includes Satellite Camp], PA.
USP Atwater, [Includes Satellite Camp], CA.
FCI Oxford Medium [Includes Satellite], WI.
USP Big Sandy, [Includes Satellite Camp], KY.
FCI Ray Brook,[Includes Detention Ctr], NY.
USP Lee,[Includes Satellite Camp], VA.
FCI Safford ‘Low’, AZ.
USP Pollock,[Includes Satellite Camp], LA.
FCI Sandstone Low, MN.
USP Yazoo City, Yazoo City FCC[Low-Med] MS.
Medical CARE LEVEL II – the majority of BOP facilities, overall healthy with routine medical visits.
Inmates are stable outpatients who require at least quarterly clinician evaluations and are located within one hour of major regional medical centers.
Can be managed in chronic care clinics, including mental healthcare issues.
Examples: medication-controlled diabetes, epilepsy, and emphysema.
e.g.: Dialysis, or needing inpatient hospital care; 24/7
Medical CARE LEVEL III – outpatient care or unable to perform ADL.
Inmates are fragile outpatients who require frequent clinical contact to prevent re-hospitalization and may be located within Level IV institutions.
May require assistance with activities of daily living, but does not need daily nursing care.
Examples: cancer in remission of less than a year, advanced HIV disease, severe mental illness in remission and 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).
Requires 24-hour skilled nursing care or 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.
Requesting a CARE LEVEL IV placement should be carefully considered as the inmates there are of all security levels, including both violent and non-violent offenders.
There are seven Federal Medical Centers (A brief overview)
FMC Butner (North Carolina); the cancer center for the BOP, provides inpatient mental healthcare and houses 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); for lower security inmates.
FMC Rochester (Minnesota); contracted with the Mayo Clinic providing all levels of complex medical care along with inpatient mental healthcare.
Plus FMC, Springfield (Missouri), a higher security facility provides; dialysis, and inpatient mental healthcare services.
Unfortunately, in general, the BOP is not equipped to provide any meaningful treatment for the following underlying disorders, several examples:
□ Post-traumatic stress disorder
□ Major depressive
□ Bipolar
□ (Eye Movement Desensitization and Reprocessing) for treatment of PTSD is not available.
As medical staffing differs from one facility to another, and if the care by chance is available within the BOP; this may necessitate a transfer to a facility further away from their home.
MH CARE LEVEL I – under 70, healthy with limited medical visits
No Remarkable Issues, no significant level of functional impairment.
No history of regular Mental Illness Interventions, seeking help should there be a returning episode.
MH CARE LEVEL II – the majority of BOP facilities, overall healthy with routine medical visits
Has a current or recent historical need for inpatient psychiatric care.
Requires psychotropic medication control may require MH Care Level IV.
Requesting a CARE LEVEL IV placement should be carefully considered as the inmates there are of all security levels that include both violent and non-violent offenders.
An evidence-based clinical decision support resource that is authored and peer-reviewed exclusively by physicians who are recognized experts in their medical specialties.
Vocational Training (2022) This program combines three broad categories: 1) Apprenticeship Training, 2) Certification Course Training, and 3) Vocational Training.
WORK [vocational training and job readiness programs]
‘…reducsupporting those who wish to create positive futures for themselves and their families.’
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. It inhibits those affected from moving forward with their lives by not even then making it into the interview phase, 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 withpublic counsel and 91% withprivate 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 include 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 are released with new futures for themselves, now becoming contributing members of their communities.
Your Client’s benefit is that they are now released with enhanced life skills and future positive goals.
The Last Mile is a successful example of what can be done in changing our existing recidivism paradigm.
Beyond the fatigue, neuropsychological problems range from headaches,
dizziness, and
lingering loss of smell or taste to mood disorders and deeper cognitive impairment.
Doctors have concerns that patients may also suffer lasting damage to their
heart, kidneys, and liver from the inflammation and blood clotting the disease causes.
Additionally, between 30% and 50% of people with an infection that has clinical manifestations are going to have some form of mental health issues,” said Teodor Postolache, professor of psychiatry at the University of Maryland School of Medicine.
So far the virus appears to cause its damage to the brain and nervous system not as much through direct infection as through the indirect effects of inflammation, said Victoria Pelak, professor of neurology and ophthalmology at the University of Colorado School of Medicine.
“Strokes are larger, potentially more damaging with this disorder. Once inflammation or blood vessel problems occur within the nervous system itself, those people will have a lot longer road to recovery or may die from those illnesses,” Colorado’s Pelak said.
Doctors are also watching for a syndrome called demyelination, as in the autoimmune disease multiple sclerosis, which can cause weakness, numbness, and tingling. It can also disrupt how people think, in some cases spurring psychosis and hallucinations. “We’re just not sure if this virus causes it more commonly than other viruses,” Pelak said.
The COVID-19 infection might also act as a “priming event” for problems to resurface in the future said Teodor Postolache. Psychological stress could reactivate behavioral and emotional problems that were initially triggered by the immune system responding to the virus. “What we call psychological versus biological may actually be quite biological,” he said.
“We can open the hospitals back up to the families. That’s important,” he said.
“We can be aware of these problems and tell the families about them so that the families will know that this is coming. [And]
we can do counseling and psychological help on the back end.”
8/12/2020, MIT Technology Review:[2] Covid-19 “long haulers” are organizing online to study themselves.
Slack groups and social media are connecting people who have never fully recovered from coronavirus to collect data on their condition.
Gina Assaf was running in Washington, DC, on March 19 when she suddenly couldn’t take another step. “I was so out of breath I had to stop,” she says. Five days earlier, she’d hung out with a friend; within days, that friend and their partner had started showing three classic signs of COVID-19: fever, cough, and shortness of breath.
Assaf had those symptoms too, but a full month after falling ill, she attempted to go grocery shopping and ended up in bed for days. In those first few months, Assaf found a legion of people in situations similar to her own in a Slack support group for COVID-19 patients, including hundreds who self-identified as “long-haulers,” the term most commonly used to describe those who remain sick long after being infected.
It wasn’t until late July that the US Centers for Disease Control published a paper recognizing that as many as one-third of coronavirus patients not sick enough to be admitted to the hospital don’t fully recover. So Assaf, a technology design consultant, launched Patient-Led Research for Covid-19[ii], and released its first report[iii].
Based on 640 responses, it provides perhaps the most in-depth look at long-haulers to date and offers a window into what life is like for certain coronavirus patients who are taking longer—much longer—to recover.
On 8/12/2020, Wes Ely, a pulmonologist and critical care physician at Vanderbilt University Medical Center who studiesdelirium during intensive care (watch video)[22] stay. “The problem for these people (when coming off ventilators), is not over when they leave the hospital.”
Long-term effects are health issues that are caused by an illness, disease, or treatment that lasts for several months or years after infection. Long-term effects can be physical, mental, or emotional and can occur even if the initial illness or disease is no longer present in the body.[23].
This applies to post-COVID-19 patients (Long-Haulers), as physicians and scientists from around the globe begin to study these patients post-hospitalization.
The Presentence Interview, and its preparation, long before the interview takes place is likely the pivotal time when the defense team can make a difference in their client’s future. Properly prepared for the presentence interview can at best provide a pathway for the defense to get “their” message on the record.
Abstract
Imprisonment is a frightening experience for your client and their family. Counsel and the defendant’s family together can assuage some of these fears by addressing healthcare and the specialty programs available in Federal Prison before the defendant is in the custody of the Federal Bureau of Prisons (“BOP”) through being properly prepared for their presentence interview,
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
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
Non-Formulary medication.
Understand that the BOP will discourage the use of non-formulary medications
They require that they need special approval.
More likely, BOP physicians will just switch the inmate’s treatment medications to those that have similar equivalents.
Do you know which medications are either available and on-formulary or non-formulary?
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.
Last, What do you do if you learn that your client’s medication are not available?
There are options, but you need:
Time
The cooperation of the current treating physician
Medical Care
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 then placed accordingly.
FSA, Productive Activities (PA)
Healthy Steps for Older Adults 2022
Program Description
Healthy Steps for Older Adults is an evidence-based falls prevention program designed to raise participants’ knowledge and awareness of steps to take to reduce falls and improve health and well-being. The goal of the program is to prevent falls, promote health, and ensure that
older adults remain as independent as possible for as long as possible.
Hours
3
Location(s)
All institutions
Needs Addressed
Medical/Recreation/Leisure/Fitness
Program Delivery
Contractors
Health Services
Recreation
Unit Team
Volunteers
Routine Ongoing Outpatient visits
Not In-patient
Tx plan reviewed every 90 days
FAQ Home Confinement On COVID-19. BOP Website Displays…..
