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MEDICAL TREATMENT AND REHABILITATION IN FEDERAL PRISON | The Federal Lawyer 1/2021

The Critical Role of the Presentence Report

Dr. MARC BLATSTEIN, D.P.M.; FAY F. SPENCE, J.D.; E.J. HURST II, J.D.; AND MAUREEN BAIRD

The Federal Lawyer January/February 2021

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 needed treatment and programs will be available to a defendant.
    • Documentation is paramount, and,
      • The diligent attorney must be proactive in gathering and supplying the appropriate documentation to,
      • The probation officer preparing the PSR and to the court, along with,
      • A sentencing memorandum advocating for the defendant’s desired,
        • Sentencing outcome and institutional placement,
        • Supported by the sentencing factors set forth in 18 U.S.C. § 3553(a).

The PSR plays a critical role in a defendant’s post-conviction life.

In federal court,

  • The sentencing judge relies on the report to determine sentencing guidelines, departures, and statutory sentencing considerations under 18 U.S.C. § 3553(a).

The BOP

  • Relies on the PSR to make decisions about custodial placement, security classification, educational/vocational needs, and medical/psychological treatment needs.

On supervised release after incarceration,

  • The PSR influences the probation officer’s supervision of the defendant and the requirements of supervision. In short,

The PSR is now part of the defendant’s permanent record and is considered the gospel truth about the defendant. It truly is

  • “The gift that keeps on giving,” so accuracy is key.

Given the PSR’s permanence and omnipresence,

  • One cannot overstate its importance or the need for accuracy. Counsel must
  • Object to inaccurate facts and omissions of important information in the report.
  • Once the court has made final rulings on all objections, and
    • Before the PSR is sent to the BOP, counsel must ensure that the report is updated in accordance with the court’s ruling.
    • Asking to amend the PSR later, when an inmate is already in the BOP,
      • 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 attorney hours to complete.2

 

Components of the Federal PSR

First and foremost,

  • The PSR provides details about the offense for which a defendant is being sentenced,
  • Whether the defendant has accepted responsibility for his or her conduct, and
  • How the sentencing guidelines apply.

The report also contains some

  • Background information about the defendant that the court may consider in deciding what sentence to impose, including
  • Prior criminal history,
  • Educational background,
  • Work history,
  • Family background, and health.

Many attorneys seem to forget, however, that sentencing is only one purpose of the PSR.

The BOP initially relies on the PSR to determine, a defendant’s security classification and whether to house the inmate in a high-security U.S. penitentiary (USP), a medium or low-security federal correctional institution (FCI), or a minimum-security prison camp.

The BOP also determines whether a defendant has

  • Medical or mental health needs that affect placement.
  • Continuity of care in the BOP, to the extent it will happen, depends on an accurate PSR.

The PSR acts as a

  • “Medical referral” for the client based on his or her
    • Medical and mental healthcare history,
    • Current medications, and
  • Security referral regarding their requirements.

The PSR needs to be as complete as possible to reduce unnecessary lapses in medical care.

Finally, the PSR can provide information about a defendant’s

  • Educational, vocational, and avocational interests, can
  • Facilitate placement in a facility with appropriate programs to enhance rehabilitation and successful return to society.
  • By knowing what programs and treatment the BOP provides, an attorney can better assist the client in making sure the PSR has appropriate documentation to improve the chances of a client’s placement in the most appropriate location.

Healthcare in the Federal BOP

A defendant has a constitutional right to adequate health care.

This means that prisons must provide necessary medical attention and may,

  • Not act with deliberate indifference to a prisoner’s pain and suffering.3
  • The BOP attempts to meet its constitutional obligation efficiently and cost-effectively by having inmates placed at different facilities based on their
    • Medical CARE LEVEL.
  • All BOP facilities have staff members who are trained as first responders to use the automatic external defibrillator and to perform cardiopulmonary resuscitation in emergency situations.4

As an inmate first enters the BOP system, the Designation and Sentence Computation Center enters the defendant’s information, including

  • criminal history, offense, sentence, medical documents, and treatment history from the PSR
  • into their SENTRY software to
  • determine both
    • security classification and
    • medical care level designation for that inmate.
  • Designations range from
    • CARE LEVEL I for the healthiest inmates to
    • CARE LEVEL IV for gravely ailing inmate-patients needing inpatient care.

An institution designation is then determined, based on the appropriate medical care level and security classification level. Final placement decisions for those inmates with significant health concerns/conditions are made by the Office of Medical Designation and Transportation at the BOP.

 

Medical CARE LEVELS in the BOP

Care Level I

  • Is comparable to the care provided by a general practice physician
  • Here one rarely visits for the occasional minor illness or injury.
  • For inmates who are less than 70 years old and healthy, with limited medical needs.
  • Stable mental and physical health and
  • Typically need physicians no more than once every six months.
  • Mental health crises would be of short duration and
    • would not require hospitalization.
  • Examples of “limited” medical needs include;
    • Mild asthma,
    • Diet-controlled diabetes, and
    • Stable HIV for which medications are unnecessary.
  • A community hospital is usually approximately one hour away.

See Table 1 for BOP Care Level I facilities, grouped by security classification.

Most federal prison facilities are designated Care Level II

  • This is the level of care needed by the majority of people.
  • These facilities provide medical care similar to a fully staffed internal medicine practice.
  • Some chronic illnesses or those requiring regular medication, but their
  • Health is generally stable, and hospitalizations are not usually required.
  • Inmates may have a mental health diagnosis requiring
    • routine outpatient care,
    • controlled with medication or talk therapy.
    • Medical or psychological patient care visits may be available monthly to quarterly.
  • The Care Level II facilities are within one hour of a regional hospital center, but
    • the need for hospitalization for such an inmate would not be expected more than once every two years. See Table 2 for BOP Care Level II facilities, grouped by security classification.

Care Level III facilities are located near a major community medical facility to ensure outside necessary medical care is within close proximity to the designated institution. Care Level III inmates include those needing “companions” to help with their activities of daily living (but not needing daily nursing supervision) and those needing daily to monthly medical or psychiatric visits.

Other Care Level III inmates include those suffering from cancer in remission of less than one year, advanced HIV, severe mental illness in remission on medication, congestive heart failure, and end-stage liver disease. These inmates may have chronic or recurrent mental illnesses or ongoing cognitive impairments. Daily inpatient nursing care is not available, but inmates at this care level may require hospitalization periodically to stabilize their medical or mental health conditions enough to keep them from deteriorating to the point of requiring around-the-clock nursing care. See Table 3 for BOP Care Level III facilities, grouped by security classification.

Care Level IV facilities are known as Medical Centers For Federal Prisoners (MCFP) or Federal Medical Centers (FMC). They operate like small hospitals and provide varying degrees of nursing and medical care, including surgical, diagnostic, and therapeutic services. They are the only BOP facilities able to provide Care Level IV inmates with the around-the-clock nursing care needed for acute

medical or chronic mental health conditions resulting in severe physical and cognitive impairments. Physical ailments designated to this level include end-stage kidney failure (requiring dialysis), unremitted cancer, quadriplegia, stroke, debilitating neurological trauma, major surgery, or high-risk pregnancy, and recent transplant recipients (within one year). Mental health diagnoses so severe that an inmate cannot function in the general population may be designated to a mental health unit within one of the prison medical facilities. Care Level IV facilities accommodate inmates of every security level, which makes the safety of a nonviolent offender an issue to be raised. See Table 4 for more detailed information about the BOP Care Level IV facilities.

 

Scope of Services Covered

Federal prison healthcare is implemented through a mix of BOP employees and public health service officers. Primary responsibilities fall on the primary care provider team, which provides medical care to inmate patients under a medical or clinical director’s supervision.5 This is the BOP’s equivalent of a staffed medical practice.

Working under staff physicians (and psychiatrists at selected facilities), mid-level practitioners include registered nurses, licensed practical nurses, licensed vocational nurses, nurse practitioners, physician assistants, and certified nursing assistants. These staffers are in turn supported by general laboratory technicians, like X-ray technicians and phlebotomists, as well as not-yet-licensed foreign medical school graduates. EMTs also act as mid-level practitioners. Additionally, all facilities have a dentist and may have contracts with orthopedics, neurologists, optometrists, and other specialists from the local community who come to the prison for onsite medical visits. Mid-level practitioners are the inmate-patient’s primary point of contact. They serve as the primary care provider for routine requests, new complaint evaluations, and ongoing management of recur- ring conditions, and emergencies.

The BOP sorts medical treatment into five categories, which can objectively be called:

1. Life-Threatening Conditions

Treatment for life-threatening conditions is essential to sustain the life or function of a critical bodily system and requires immediate attention. The BOP refers to these conditions as “Medically Necessary–Acute or Emergent” and includes the following conditions in this category: heart attacks, severe trauma such as head injury, hemorrhage, stroke, detached retina, sudden vision loss, and complications of pregnancy or labor.7

 

2. Medically  Necessary Conditions

The BOP defines this category to include conditions that are not immediately life-threatening but which without treatment now, the inmate could not be maintained without significant risk of:

  • Serious deterioration leading to premature
  • Significant reduction in the possibility of repair later without present
  • Significant pain or discomfort that impairs the inmate’s participation in activities of daily 8 Examples of conditions the BOP includes here are chronic conditions such as high blood pressure, high cholesterol, heart disease, and diabetes; severe mental health issues (e.g., bipolar disorder, schizophrenia); infectious disorders (e.g., HIV, tuberculosis); and cancer.9

3. Medically Necessary but Not Urgent

The BOP actually defines this category as “Medically Acceptable— Not Always Necessary.”10 The group includes conditions for which “treatment may improve the inmate’s quality of life.”11 Examples of treatments for conditions in this category, as listed in the BOP Policy on Patient Care, include joint replacements, reconstruction of the anterior cruciate ligament (ACL) in the knee, and treatment of noncancerous skin conditions.12 Such treatment procedures require review and approval by the institution’s Utilization Review Committee, which considers various factors, including risks and benefits of the treatment, available resources (including the cost of security staffing and transportation), the inmate-patient’s medical history, and how an intervention (or lack thereof ) will impact the inmate’s activities of daily living.13

Should an outside specialist consult be needed for a nonemergent condition, a referral request is made to the prison’s Utilization Review Committee and clinical director. Other members involved in this decision-making process include the associate warden or warden, health service administrator or assistant, the medical trip coordinator, any health care providers directly involved in the referral, and perhaps the director of nursing and the chaplain or a social worker.14

The clinical director has the final say over all Utilization Review Committee decisions.15 If approved, the inmate-patient will be placed on a schedule or waitlisted until the specialist has an opening during the contract’s limited monthly hours, which may be several months or years later. Notably, the clinical director is under no obligation to follow medical recommendations made by the outside physician consultant specialist. If the recommendations are not followed, the clinical director will document his/her justification in the inmate’s health record.16 Justification may be based on the category of care sought.

 

4. Medically Appropriate

Some treatments, even though recommended by a health care provider and deemed appropriate by the clinical director, still require approval by the Utilization Review Committee, which is not likely to be granted. These treatments are considered by the BOP to have “limited medical value” and include cosmetic procedures and the removal of noncancerous skin lesions.17 It is worth noting that some skin lesions may be misdiagnosed, so the denial of treatment for these appropriate medical procedures is a concern for inmates with such health needs.

 

5. Extraordinary Treatments

The BOP considers a medical treatment extraordinary if it “affect[s] the life of another individual, such as organ transplantation.”18 Thus, organ transplants and experimental/investigational treatments require approval of the Utilization Review Committee, which is not likely to be granted.

 

Medical Devices and Pharmaceuticals

If an incarcerated inmate needs medical devices, glasses, prosthetics, or other medical support items, these can be mailed directly from his or her personal physician’s office or a medical business (e.g., Pearl Vision) with the attached physician orders and using form BP-AO331.19 These items cannot be mailed by family members, friends, or other nonmedical civilians. Prescription eyeglasses, medical devices (such as CPAP or BiPAP, or other machines for sleep apnea), prosthetics, and similar devices should also be brought with the patient, along with doctors’ prescriptions and orders. The PSR should also mention that the defendant has these devices pursuant to medical orders. If the client does not take these devices with him or her when reporting, he or she may have to wait several weeks for the BOP to obtain appropriate medical devices; the inmate’s family will not be allowed to mail/send the items to the facility, as they must come directly from a medical company or health care provider.

If the inmate regularly takes prescribed medication, the BOP will usually substitute generic medications for brand-name drugs. Not only does BOP policy generally require generic medications, but BOP medical personnel, pharmacists, and consulting physicians are required to use “the least expensive generic equivalent … when available.”20 Thus, instead of generic equivalents, the BOP may prescribe an alternative (but less expensive) generic medication that is for the treatment of the same medical condition. Much like insurance companies, the BOP has a formulary of approved medications.21

The formulary includes the generic name of the medication, what conditions it may be prescribed for, acceptable dose levels, and limits on the number of days the medication can be prescribed.22 Use of any medication that is not on the formulary or use of a medication in a different manner, for treatment of a different condition than authorized by the formulary, or longer than authorized, requires pre-approval from the BOP medical director, after going through the institution’s clinical director and the BOP regional medical director—an extensive and lengthy process.23 Some nonformulary drugs are available only in limited circumstances, such as the preferred medication’s failure to work for the patient, but only after the lengthy pre-approval process. Some medications, such as opiate narcotics, are only available in Care Level IV facilities for very limited circumstances; those medications and psychiatric medications must be crushed by the health care provider and administered to the patient in the provider’s presence.24 This is to prevent diversion of the medication by inmates for unlawful purposes. Prescribing medication without pre-approval is considered an unauthorized use of government funds, a felony offense.25

In short, the medications the patient-inmate receives in custody will not necessarily match the medications that the inmate received before incarceration. Even if the inmate is lucky enough to be taking the same medications as before, a variety of manufacturers will pro- vide the same generic drug in different colors, sizes, and shapes than the inmate may have been used to. To avoid unnecessary anxiety and surprise for the client, an attorney should educate his or her client about these BOP policies. If a client is on nonformulary medication, the attorney needs to assist the client in obtaining pre-approval before arrival at the facility, which takes substantial time, in order to prevent unnecessary and potentially harmful interruption of the client’s medical treatment.

If a client is self-surrendering to the BOP, he or she should bring along a three to four-week supply of his or her medication in original, properly labeled bottles. These prescriptions may ultimately be returned to the client’s home, but at least they will be available if needed for continuity of care purposes, in case the institution does not have the correct medication in stock.

Programming in the Federal BOP

In the last century, American society transitioned from institutionalizing people with mental health conditions in mental health facilities (often underfunded and operating under poor conditions) to incarcerating the mentally ill in jails and prisons.26 Nearly 50 percent of jail inmates and over one-third of prison inmates suffer from mental health problems.27 Mental illness often underlies behavioral problems, and if an incarcerated inmate has not been properly diagnosed or given treatment for a mental illness, chances are high that the inmate will be involved in fights, assaults, self-injurious behavior, or other misconduct in prison that leads to disciplinary consequences, including restrictive housing units;28 use of restrictive housing units, especially solitary confinement, exacerbates mental illness rather than helping the inmate.29

Therefore, it is imperative that the defense attorney makes sure that psychiatric and psychological issues are identified and included in the defendant’s presentence report, along with the appropriate treatment plan recommended by a qualified psychiatric health provider. If mental health issues are apparent, but the defendant has no documentation of diagnosis or treatment, the attorney should obtain a professional psychological evaluation before the probation officer begins preparing the PSR. Failure to do so will consign the defendant to an increased risk of restrictive housing or solitary confinement. When requesting placement in a specific facility or program, the defense counsel should ask the court not only to recommend the placement but to include the reasons for his recommendation, which will improve the chances of securing the placement. One additional measure to possibly increase the chance of the BOP following the recommendation of the court is to ask the sentencing judge to order the BOP to provide in writing, the reason for not following the judicial recommendation.

Documentation of known mental health issues and treatment (including substance abuse and addiction) is essential for continuity of care. Without documentation of the diagnosis and need for specific medication in the PSR, for example, an inmate entering the BOP will have no access to medication.

In that case, there will be a waiting period, sometimes several weeks, before the inmate will be seen and evaluated, and prescribed a medication deemed suitable by the prison medical establishment. During the delay without any medication, the inmate’s condition is likely to deteriorate. In addition, when providing the substance abuse history, it is imperative that the PSR document frequency and current substance use activity. Upon initial remand or voluntary surrender to the assigned prison, the defendant may require placement in an institution that is equipped to provide a safe detox environment. If the BOP is unaware—from documented medical records in the PSR—that some medications have been unsuccessful, the patient-inmate may be doomed to another trial period of medication already known to be ineffective for him.

Beyond access to basic mental health care and medication, documentation of known mental health and related conditions is necessary for inmates to be eligible to participate in some programs. The BOP offers a variety of programs to provide mental health support, substance abuse education and treatment, continuing education, and vocational training. Other programs help inmates adjust to prison life, develop coping skills, or heal from past trauma that may have played a contributing role in an inmate’s criminal conduct. However, some of the programs have the minimal capacity and are offered only at certain facilities. If a defendant’s need and desire for a particular program are made clear in the PSR, his or her chances for placement at a facility offering the program will be improved. Addressing program needs with the assigned assistant U.S. attorney before sentencing and obtaining the government’s agreement to recommend the placement will also improve the defendant’s chances. These programs are discussed in this section.

 

Programs Promoting Psychological Well-Being

1. The Mental Health Treatment Programs

The BOP has a series of residential Mental Health Treatment Programs to treat inmates diagnosed with serious mental illness and behavioral disorders, particularly for inmates who do not require hospitalization but nonetheless need intensive treatment services and/ or lack the ability to function in a general population setting. These programs include the Habilitation Program, the Skills Program, the Axis II Program, and Mental Health Step-Down units.30

The Habilitation Program is for high-security inmates who lack the ability to adapt to the penitentiary environment because of mental illness, but who may be able to function in a medium-security environment with proper residential treatment.31

The Skills Program is for inmates with both mental illness and cognitive/intellectual limitations that limit their ability to adapt to living in the community and in prison.32 The program is currently available at FCI Danbury (Low) and FCI Coleman (Medium). The Skills Program has evolved into a residential program that now has an emphasis on addressing the needs of offenders who are determined to be on the Autism Spectrum. This 12-18 month program assists in providing inmates on the autism spectrum with coping mechanisms and tools to be able to manage better once released from the program and assigned to the general population.

The Axis II Program is for inmates with Borderline Personality Disorder or other severe personality disorders who have a history of behavioral problems in the prison, but who are amenable to treatment.33 More recently, this program, also known as STAGES (Steps Toward Awareness, Growth, and Emotional Strength). The program is designed to increase the time between disruptive behaviors, foster living within the general population or community setting, and increase pro-social skills. The Stages Program is available at FMC Rochester, USP Florence, and FCI Terre Haute.34

Mental Health Step-Down Units provide intensive treatment for inmates recently released from in-patient psychiatric hospitalization. Sometimes, inmates are placed in these units in an effort to avoid the need for in-patient hospitalization.35

Acceptance into any of the Mental Health Treatment Programs requires a diagnosis of mental illness or behavior disorder and a demonstrated need for intensive treatment (demonstrated by prior psychiatric hospitalizations/interventions, complex treatment with psychotropic medication, major functional impairment, or repeated incidents of severe behavioral problems in prison). Inmates in a residential treatment program reside together in a unit, with their living areas being separate from the general population, allowing the inmates to create a therapeutic community environment.

Most of their other activities, recreation, work assignment, and meals are shared with the general population inmates assigned to that particular facility. This placement also helps to protect mentally ill inmates from injuring themselves, from being victimized, and from being negatively influenced by peers in the general population. Inmates in these residential programs are still subject to being victimized; however, the potential for victimization is reduced. Unfortunately, the BOP has very limited capacity and lengthy waiting lists for placing inmates in one of these programs. With such limited capacity, the need for thorough documentation of prior mental health history in the PSR is readily imperative. Without the documented need for special placement, an inmate will be placed in the general population, with greatly increased chances of restrictive housing, isolation, and other counter-productive sanctions rather than treatment.

 

2. The Resolve Program

The Resolve Program is a cognitive-behavioral program designed to address the trauma-related mental health needs of inmates. Specifically, the program works with those who have previously been victims of child abuse or neglect, sexual assault, domestic violence, or other trauma is known to correlate with psychological disorders. Starting with an eight-hour workshop, the program is followed by six months of nonresidential treatment and seeks to decrease the incidence of trauma-related pathology and improve inmates’ level of functioning.36 Since 2007, the Resolve Program has been implemented at all BOP facilities housing women (except during times when the institution lacks a psychologist to lead the program).37 The program is available for men at the maximum security prison in Florence, Colo., and at FCI Danbury (Low) in Connecticut.38

 

3. The Challenge Program

The Challenge Program is a residential cognitive-behavioral treatment program developed for male inmates in penitentiary settings. The Challenge Program, which lasts at least nine months, provides three phases of treatment to high-security inmates with substance abuse problems and/or mental illness. Like the Mental Health Treatment Programs, participants live together in a unit separate from the general population. Incentives and rewards are available for the successful completion of all phases of the program.39 The program is available at several BOP facilities, but not at all of them.

 

Substance Abuse Programs

The BOP offers several different options for those inmates dealing with substance abuse issues, ranging from education to intensive treatment.40

 

1. Drug Abuse Education

Drug abuse education includes a series of classes providing education about substance abuse and its unwanted side effects. The classes may help identify offenders who need more than education.41 Any inmate is eligible to participate in drug abuse education classes, as long as he or she is not already enrolled in or has not already completed the residential drug abuse treatment program and has enough time remaining in custody to complete the course. The course is available at all BOP institutions.

2. Nonresidential Drug Abuse Treatment

Nonresidential drug abuse treatment is a 12-week cognitive-behavioral therapy, treatment program, usually conducted in group-therapy sessions. The program addresses the link between substance abuse and criminal lifestyles and provides opportunities for building and improving skills in rational thinking, communication, and community adjustment. The program is intended for inmates with relatively short sentences, those transitioning to the community, those who have failed a urinalysis drug screen, and for addicts in need of substantial treatment who are on the waiting list for the RDAP intensive treatment program or who are not eligible for RDAP.42 All BOP institutions have this program, which is open to any inmate who volunteers.43

3. Residential Drug Abuse Program (RDAP)

RDAP is an intensive residential treatment program, followed by transitional treatment in the community following release. Inmates in the program live in a prison housing unit separate from the general population in a modified therapeutic community setting. They spend half of each weekday in treatment, including individual and group counseling, and the other half of each day is spent in school, work, or vocational training.44 This portion of RDAP must last at least six months.45 The usual length of time of the residential portion of the treatment is approximately 10 months.

To be eligible for RDAP, the inmate must have a verifiable substance use disorder that was active within one year of the offense for which he or she is incarcerated.46 This means for eligibility, the offender must have been actively using substances within one year from the date of the arrest. For this reason, it is critical for the PSR to document active substance abuse and any prior efforts at treatment. Details of where and when treatment in the community was obtained should also be documented in the PSR for easy reference. A defendant who denies having a substance abuse problem during his or her presentence interview will have a much harder time establishing eligibility for the program later. An inmate must also sign an agreement to comply with program responsibilities and requirements; finally, an inmate must have sufficient remaining time on his or her sentence to complete the full program, or admission to the program will be denied.47

The RDAP program is widely sought because studies have demonstrated its effectiveness in preventing relapse to drug use and in reducing criminal recidivism.48 The program is also popular because eligible inmates who successfully complete the program can reduce the length of their prison sentences by 10 percent, up to a maximum of one year.49 Because of the program’s popularity, there is a waiting list to get into RDAP, and not all who need the program can get it.

There are also eligibility requirements for early release, such that not every participant in the program will receive the benefit of early release under 18 U.S.C. § 3621 (e). Those ineligible for early release include illegal aliens; pretrial detainees; military inmates or state inmates serving time in a BOP facility; inmates who previously completed the program and got an early release the first time; inmates currently serving a sentence for any violent felony,  sex offense involving a minor, or any attempt, solicitation, or conspiracy to commit such violent felony or sex offense; and inmates with a detainer and inmates with a previous conviction (within 10 years of the sentence on current offense) for homicide, rape, robbery, aggravated assault, arson, kidnapping, or sexual abuse of a minor.50

Sex Offender Programs

The BOP offers sex offender treatment programs for inmates serving criminal sentences and for those who have been civilly committed as predatory sex offenders suffering from mental illness that renders them dangerous to the community.

1. Nonresidential Sex Offender Treatment Program

The non-residential sex offender treatment program consists of outpatient groups meeting two to three times per week for a total of six to eight hours per week. Completion of this moderate-intensity program takes at least nine months. Participants learn basic skills and concepts to help them understand their past offenses and to reduce the risk of future offenses. Eligibility for this program is limited to offenders who have been evaluated and found to have a low to moderate risk of re-offending. Attorneys should advise clients that the BOP uses this program to identify persons likely to re-offend; therefore, participation carries risks. However, failure to participate, if recommended by the BOP, can result in a loss of good-time credit. The non-residential sex offender treatment program is available at FCI Elkton, FCI Englewood, FCI Marianna, FCI Petersburg, FCI Seagoville, USP Marion, and USP Tucson for male offenders and at FMC Carswell for female offenders.51

2. Residential Sex Offender Treatment Program

The residential sex offender treatment program involves high-intensity programming for a period of 12 to 18 months. The BOP provides this program at FMC Devens in Massachusetts. Participants benefit from a therapeutic community in a residential housing unit where they work to reduce their risk of future offending. Offenders receive treatment five days per week. The program is targeted at offenders with an elevated risk of re-offending.52

3. New Butner Program

Butner recently added a new program—the Commitment and Treatment Program (CTP) for Sexually Dangerous Persons—in lieu of the residential sex offender treatment program. Little information is available about this program due to its recency.

 

4. Involuntary  Civil Commitment

Inmates who have served their sentences but are deemed at high risk of re-offending because of severe mental illness can be involuntarily committed to the custody of the attorney general for continued confinement and treatment.53 Some defense attorneys may advise their clients not to participate in sex offender treatment programs because information disclosed in treatment has sometimes been the basis for seeking an order of civil commitment.54

 

Policies and Programs for Pregnant Inmates

Female inmates are medically screened for pregnancy upon admission to the BOP, and they are instructed to inform medical staff immediately if they suspect they are pregnant.55 The BOP provides female inmates with medical and social services related to pregnancy, birth control, and child placement, as well as access to abortion. If necessary, childbirth takes place at a hospital outside the institution.56 Previously, an inmate could be handcuffed during delivery, but a provision of the First Step Act now prohibits such use of restraints except in limited circumstances.57 Outside social service agencies are contacted to help the inmate find an appropriate placement for the baby. Newborns are not allowed to return to the prison with their mothers, but they can accompany an adult visitor to the prison for visitation, in accordance with the prison’s visitation policies.

Attorneys representing a client who is pregnant or has a young child need to be aware of two special situations in the BOP discussed below.

 

Abortion

Federal law popularly known as the “Hyde Amendment” prohibits the use of federal funds to perform or facilitate abortions except where the mother’s life is endangered or in cases of rape or incest.58 This law applies to and is followed by the BOP.59 Pursuant to 28 C.F.R. §551.23, a pregnant inmate receives medical, religious, and social counseling about her pregnancy decision. If she decides to have an abortion, arrangements are made for these medical services to be provided at an appropriate clinic outside the institution, at the inmate’s expense (or her family’s). Even though not paying for the abortion procedure, the BOP may pay to escort the inmate to the procedure. Under BOP policy, BOP employees may decline to participate in the provision of abortion counseling or services, including transportation.60

 

The MINT Program

MINT (Mothers and Infants Nurturing Together) is an alternative residential program for low-risk female inmates who are pregnant when they arrive in prison. Eligible female inmates can enter the program two months before their delivery due date, and they can remain in the program for three months after the baby is born.61 The program’s purpose is to promote parent-child bonding and to improve parenting skills for the new mother. The program is administered through the Community Corrections Centers (CCC) and Residential Re-entry Centers (RRC), and the inmate must qualify to participate. A woman with more than five years to serve, who gets pregnant while incarcerated, or who plans to place the child for adoption is not eligible for the program, nor are sex offenders; deportable non-citizens, those with pending charges or a history of violence, or those requiring psychiatric hospitalization.62 Another requirement is that the mother is able to provide financial support for herself and her child (so that the BOP does not have to pay), but she may seek help from Social Services.63 Prior to the child’s birth, the mother must make custodial arrangements for the child, because, after the three-month bonding period, she must return to her original prison to finish her sentence.64 The CCC or RRC provides psychological counseling, drug counseling, and parenting classes.

One facility differs from the other federal MINT programs: Greenbrier Birthing Center, overseen by the Baltimore Residential Reentry Office, operates under a contract with the BOP. A female may remain at Greenbrier for up to 12 months with her child after birth. Located in Hillsboro, W. Va., the program seeks to provide a “home-like environment” to promote bonding and parenting skills. The facility has 20 private bedrooms, with every two rooms sharing a bathroom. The common area has a kitchen, recreation room, education room, physical training area, laundry facilities, and a phone room. Greenbrier also offers more programming than the minimum required by the BOP; in addition to parenting classes, psychological counseling, substance abuse counseling, and weekly screening, Greenbrier provides life skills classes, financial management, job readiness, and GED classes and testing onsite, all of which are intended to motivate and help the mother provide a stable environment for the child upon her release from custody.65

 

BRAVE Program

The BRAVE Program (Bureau Rehabilitation and Values Enhancement) is for young male offenders serving their first federal sentence. To qualify for the program, an inmate must be 32 years of age or younger, with a sentence of five years or longer, and federally incarcerated for the first time. The program utilizes a cognitive-behavioral approach to promote favorable institutional adjustment, positive interaction with staff members, and self-improvement activities. During the six-month residential program, inmates live together in a unit, completing an Orientation Phase, Core Treatment Phase, and Transition Phase.66 The BRAVE Program is offered at FCI Beckley and FCI Victorville-medium.

 

Educational Programs

An adult literacy program leading to the completion of a GED is available in each BOP institution. Inmates without a verified high school diploma or GED certificate who have the capacity to obtain one are expected to work towards completion of this program while incarcerated.67 The Warden at each facility is also to ensure the availability of an English as a Second Language program for non-En- English-speaking inmates who score below eighth-grade proficiency in reading and listening comprehension in English.68

The BOP Program Statement on Education notes the goal of providing postsecondary educational opportunities and adult continuing education classes for inmates.69 Individual classes in typing, computer literacy, and parenting skills are available as continuing education courses, but the reality is that … [2nd Chance Act for Incarcerated Individuals allowed eligible students in college-in-prison programs to access Federal Pell Grants beginning on July 1, 2023] Some BOP facilities have access to community college programs in which professors come to the facility to teach classes, and some have correspondence school options available to inmates. The attorney for a defendant who hopes to obtain some collegiate education should check the handbook for facilities where the client is likely to be placed to determine what advanced programs, if any, are available at the institutions.

 

Vocational Programs

The BOP endeavors to provide vocational education opportunities for inmates with limited employment history and few marketable skills. Vocational training is available in the form of apprenticeship programs, certificate programs, and on-the-job training in various fields.70 Popular apprenticeship programs include HVAC, electrical, and welding. The same programs are not available at every facility, however, and an attorney should determine which facilities offer a program that the client wishes to learn.

 

Conclusion

A defendant’s legal team must determine what medical and nonmedical information needs to be included (or not included) in the client’s presentence report. The goal is to request the client’s placement in a facility appropriate to his or her security classification, taking into consideration the defendant’s medical, psychological, and educational/programming needs. Accuracy and documentation of information from the beginning of representation is key to accomplishing this goal. Further, it is advisable for the legal team to call the classification center in Grand Prairie or to speak with staff at specific facilities to verify that desired programs are still available at that facility. Individual facilities sometimes “supplement” BOP practices based on local needs and resources, without public notification. Particularly if the defendant may be placed in a private contract facility, the attorney needs to learn about the programs, medical resources, and mental health care available at that facility and the requirements for eligibility. Most low-security non-U.S. citizen inmates are placed in one of the BOP’s contract for-profit prisons. Only by knowing the client’s needs and obtaining the appropriate documentation for the presentence report can the attorney give a defendant the best shot at receiving appropriate treatment and programming while incarcerated. 8

Dr. Marc Blatstein (info@pprsus.com) had a successful podiatric medical practice for 30 years providing quality patient care. In 2006, he was convicted of felony mail fraud and served one year and one day in prison for the actions of his office billing department’s use of incorrect billing codes. He maintains an active medical license and is the founder of Physician Presentence Report Service, LLC. 

Fay F. Spence is an attorney with more than 30 years of experience in criminal law. She currently serves as a pro se law clerk for the U.S. District Court for the Western District of Virginia.

E.J. “Jay” Hurst II (jayhurst@jayhurst.net) has worked with BOP inmates and federal defendants since 2001. Besides criminal defense and post-conviction law, Hurst pursues federal government records under the Freedom of Information Act and will periodically go to court on civil rights matters.

Maureen Baird (moiep@aol.com) served as warden at the Federal Correctional Institution in Danbury, Conn., and at the Metropolitan Correctional Center in New York City. While there, she was appointed to senior executive staff by the U.S. Attorney General. She then became warden of the U.S. Penitentiary in Marion, Ill.

Endnotes

1Estelle v. Gamble, 429 U.S. 97, 103 (1976).

2U.S. Dep’t of Just., Criminal Resource Manual § 734 (Mar. 2012), https://www.justice.gov/jm/criminal-resource-manual-734- processing-prisoner-transfer-requests.

3Estelle, 429 U.S. at 104.

4Fed. Bureau of Prisons, Patient Care 9 ( June 13, 2014), www. bop.gov/policy/progstat/6031_004.pdf.

5Id. at 13-14.

6Id. at 5-7.

7Id. at 5.

8Id. at 6.

9Id.

10Id.

11Id.

12Id.

13Id.

14Id. at 7-8.

15Id. at 8.

16Id.

17Id. at 6-7.

18Id. at 8.

19Fed. Bureau of Prisons, Form BP-A0331, Authorization to Receive Package or Property ( June 2010), https://www.bop. gov/PublicInfo/execute/forms?todo=query.

20Fed. Bureau of Prisons Health Servs., National Formulary, Part I 6 (May 16, 2019), https://www.bop.gov/ resources/pdfs/2019_winter_national_formulary_part_I.pdf. 21A list of the approved medications on the BOP Formulary, including the generic equivalents for commonly used brand-name prescriptions, is available on the BOP website at https://www.bop. gov/resources/pdfs/2019_winter_  national_formulary-part_II.pdf.

22Id.

23Fed. Bureau of Prisons Health Servs., supra note 20, at 4-6.

24Id. at 12-32.

25Id. at 2.

26Mental  Health  Am.,  Position  Statement  56:  Mental Health Treatment in Correctional Facilities (Mar. 7, 2015), https://www.mhanational.org/issues/position-statement-56-mental- health-treatment-correctional-facilities#:~:text=Position%20 Statement%2056%3A%20Mental%20Health,Correctional%20Facil- ities%20%7C%20Mental%20Health%20America&text=Mental%20 Health%20America%20understands%20that,in%20all%20that%20 we%20do.

27Allen J. Beck, Use of Restrictive Housing in U.S. Prisons and Jails, 2011-12 6, Bureau of Justice Statistics (Oct. 2015), https:// www.bjs.gov/content/pub/pdf/urhuspj1112.pdf.

28Id.

29Id.

30Fed. Bureau of Prisons, Psychology Treatment  Programs 6-1 (Apr. 26, 2016)www.bop.gov/policy/progstat/5330.11.pdf.

31Id.at 6-2.

32Id. at 6-3.

33Id.

34Federal Correctional Complex, Doctoral Psychology Internship, 2018-2019 8, https://www.bop.gov/jobs/docs/ pex_internship_201709.pdf (last visited Jan. 17, 2021); Federal Medical Center, Pre-Doctoral Psychology Internship 2019-2020 5, https://www.bop.gov/jobs/docs/rch     internship_

brochure20200904.pdf (last visited Jan. 17, 2021). 35Fed. Bureau of Prisons, supra note 30, at 6-3. 36Id. at 3-1 through 3-5.

37Fed. Bureau of Prisons, Directory of National Programs 18 (Sept. 13, 2017), https://www.bop.gov/inmates/custody_and_ care/docs20170914_BOP_National_Program_catalog.pdf.

38Id.

39Fed. Bureau of Prisons, supra note 30, at 5-1 through 5-7. 40Fed. Bureau of Prisons, Substance Abuse Treatment, http:// bop.gov/inmates/ custody_and_care/substance_abuse_treatment. jsp (last visited Dec. 15, 2020).

41Id.; 28 C.F.R. § 550.51.

42Fed. Bureau of Prisons, supra note 40.

4328 C.F.R. § 550.52.

44Fed. Bureau of Prisons, supra note 40.

4528 C.F.R. § 550.53(a)(1).

4628 C.F.R. § 550.53(b).

47Id.

48Fed. Bureau of Prisons, supra note 40.

4928 C.F.R. § 550.55.

50Id.

51U.S. Dep’t of Just., Legal Resource Guide to the Federal Bureau of Prisons 29-30 (2019), https://www.bop.gov/ resources/pdfs/legal_guide_march_2019.pdf.

52Id. at 30.

5318 U.S.C. § 4248.

54John Rhodes & Daniel Donovan, Branded for Life by the Modern Scarlet Letters: Do Convicted Sex Offenders Have Rights While on Parole, Probation, or Supervised Release?, 38 The Champion 14, 17

(2014).

55U.S. Dep’t of Just., supra note 51, at 23.

56Id.

5718 U.S.C. § 4322. Exceptions to the prohibition on use of restraints include patients who pose an immediate and credible risk of flight that cannot be prevented by other means, patients who pose an immediate and serious threat of harm to themselves or others that cannot reasonably be prevented by other means, and patients for whom the treating healthcare provider determines that restraints are appropriate for the medical safety of the prisoner.

58Departments of Health, Education, and Welfare Appropriation Act of 1977, Pub. L. 94-439, § 209, 90 Stat. 1418 (1977); see also H.R. Rep.

No. 94-1555 (1976).

59Fed. Bureau of Prisons, Birth Control, Pregnancy, Child Placement and Abortion 3 (Aug. 9, 1996), www.bop.gov/policy/ progstat/6070_005.pdf.

60Id. at 4.

 

61Fed. Bureau of Prisons, Community Corrections Center Utilization and Transfer Procedures 5 (Dec. 16, 1998), www. bop.gov/policy/progstat/7310_004.pdf.

62Id. at 10-11.

63Id. at 9; Lisa Barrett & Jamila T. Davis, How to Navigate through Federal Prison and Gain an Early Release (2015). 64Barrett & Davis, supra note 63.

65Id.; Zelma W. Henriques & Bridget P. Gladwin, Pregnancy and Motherhood Behind Bars, in Special Needs Offenders in Correctional  Institutions  (Lior  Gideon  ed.,  2012).

66Fed. Bureau of Prisons, supra note 30, at 4-1 through 4-3. 67Fed. Bureau of Prisons, Education, Training and Leisure Time Program Standards 3-4 (Feb. 18, 2002), https://www.bop. gov/policy/progstat/5300_021.pdf.

68Id. at 4.

69Id. at 6.

70Id. at 4-6.

The Presentence Interview Investigation Report: Is Your Chance To Get Your Message On The Record

The Presentence Interview Investigation Report 

The Personal Narrative

Start  preparation as early as possible after your conviction,

* Your attorney should reach out to the Probation Officer

* When is the initial Presentence Report “date due”

* Defense can be 1st to explain your position if the PO was not at trial, and has not already spoken with the Prosecutor

* They still may have an open mind.

 

A little extra effort goes a long way …

* Consider presenting your client’s biographical history that explains your position in an “organized” letter to the PO, ASAP.

* As Probation Officers are: Very busy Doing their best – and Never have enough time.

  • They may appreciate your efforts in easing this portion    of their workload,

* Remember, a little effort does go a long way.
DrMB@PPRSUS.com

Take Ownership of Your Defense – What Happens When You Don’t

Take Ownership of Your Defense – What Happens When You Don’t

I wanted to do this podcast regarding a phone call that I had earlier this morning. Someone who has a disease and is on medication., and yet his attorney had not prepared all his medical records – or any of his medical records for his PSR and sentencing hearing.

Speaking with him this morning, I was taken aback to learn that he had already been sentenced. Here I was trying to ask questions and learn how it was he was sentenced with an incomplete pre-sentence report. – That didn’t make any sense.

But, if the information I learned was accurate, his presentence report was incomplete.

The person’s main concern was that his medication did not appear available on the BOP online Formulary. Initially, I must give credit to this gentleman and his wife (who is in school to be a nurse practitioner). They recognized that the medication was not on the formulary, which is not easy to figure out – it is a complicated table.

As he was to surrender in the next 45-60 days, my recommendations were to meet with his treating physician to:

·        Get copies of “all” his records

·        Copies of his prescriptions

·        Review the BOP Formulary with his physician to see if there were any acceptable medications to substitute.

·        If Yes, he needs to get a copy of this new notification regarding a medication change, due to the BOP Formulary

  • Get a hard copy of the prescription and fill it.

·        If No, and this is a Continuity of Care and/or life-threatening issue, then appearing in court at the Sentencing Hearing is preferred, as Judges would usually like to question the Specialist. The challenge – he has already been sentenced, so I suppose he will call me back…

While I hope this Case Is rare, it points out that every defendant must take ownership of all aspects of their defense once they’re indicted.

Then, Be honest with yourself (and your attorney) regarding the case’s facts, and start interviewing attorneys.

·        Ask for referrals to speak to some happy clients, then.

·        Ask to read some of their sentencing memorandums in cases like yours.

·        The goal is to see if they’re the same or if each is individualized – In the same Criminal defense space.

·        If the attorney says this is private information, which is understandable, agree and then request that they block out all personal information.

Then you just can’t assume that the attorney is going to do everything right – which is why I am doing this podcast.

  • This must be a partnership with your attorney.

 So, what does that mean? This partnership extends into preparation for the pre-sentence interview. Which will impact your future.
The short version is that the probation officer’s responsibility is to Interview you., Investigate, and then draft the Presentence Report (PSR).

  • They then provide your PSR to the judge and their recommendations for your sentence and placement.

Part I) So, how do you take Ownership?

First. Your attorney reaches out to learn who your probation officer is, and then contact them.

Assume that the probation officer has Googled you &/or spoken to the prosecutor. Because if they have, then they may already have a bias Against you,

Why, because the Justice Department has already released all the information about you that makes you look horrible.

1st           So this first step by your attorney reaching out to the PO, Sets the Tone 

  • For Your Defense, it allows them to hear from
  • you first before they’ve been 
  • tainted by others’ perceptions of who you are. 

This allows them to make their case regarding their defense strategy, on the record – to the PO. This is followed by a very organized, detailed letter that details this strategy.

They will also Ask the probation officer:

  • what documents they will need at the time of the interview.
  • What date is best for them to do the pre-sentence interview?
  • And what is their final dictation Deadline date to have their official pre-sentence report due to their supervisor?

2nd          Review with your legal team that all the information you have collected, to ensure all your background information is available and accurate

3rd         The PO has scored your Public Safety Factors (PSF), Management Variables, Criminal History Score, Offense Level (current charges), 

  • Be prepared, so should you and your attorneys

4th          RDAP Eligible, Then INCLUDE It. I didn’t, and I stayed a bit longer inside…

5th          Don’t try for a CARE LEVEL III or IV unless it is required because it houses both violent and non-violent offenders
Part II) So how do you take Ownership?
You, as the defendant has jobs. 

1st           You must collect All of your biographical background information.

Copies of all your medical and mental healthcare records and your physician’s contact information (name, Phone number, address, e-mail.)

Copies of all surgery reports, medication prescriptions, and medical devices. 

·        If you’ve had any hospitalizations, copies of those records.

·        If you’ve had any sort of laboratory blood test, copies of those, or X-rays, CT scans, MRI scans, PET scans, or ultrasounds, all of those will have reports associated with them. You need to get copies of everything. 

  • You should also get them on CDs. 

·        While you’re doing this, it’s been my impression that most people don’t have a copy of their medical records. Therefore, it would be simpler if you asked for two copies of everything from each provider of all these documents. 

Next, you will have to get copies of your birth certificate, driver’s license, Social Security card, and passport.

Also, the highest level of education that you’ve achieved, if you’ve been in the military, what’s the highest rank you had, and what type of discharge? Any certificates – include them.

 

Character reference letters. 

Those writing character reference letters (or references about your character) must include that they know you’re facing a criminal charge. 

  • They should reference good deeds that they have seen you do, tutoring, and volunteering. 
  • It also could be letters from former employers who say they know you are willing to rehire you. A VERY BIG DEAL

 2nd          Your Personal Narrative – takes work, and starts with writing your life story, the good, the bad, and the ugly. 

  • If it starts a book, great, it will be re-written, multiple times and distilled until it represents 

·        You- YOUR REMORSE TO THE VICTIMS – HOW YOU GOT TO THIS POINT = NOT TO BE REPEATED

 

3rd          Reentry Planning: Starts now, extending through the prison, RRC, and supervised release

When I was sentenced – I WAS UNPREPARED

This is why I was concerned during this conversation, and my recommendations were simple:

·        Meet with your doctor and let them review the BOP Formulary Drug List for a substitution

  • Get copies of all of his medical records, lab tests, surgery reports, physician contact information, and all of the X-Rays, CTs, MRIs, Ultrasounds, and any other scans both in a report form and on CDs
  • Put them in a big envelope, labeled legal mail for his surrender

·        Don’t forget about Your Personal Narrative and Allocution

 

This is why it’s important to participate in your defense – I sympathize with those who like me, are “The deer in Headlights.” But the “Symbolic Act” of participating in your defense, that “taking back Control” will begin to slowly build the Confidence back that made you the success that you are

REMEMBER – THIS IS TEMPORARY
Dr. Blatstein
240.888.7778

Healthcare, You’re The Target – DOJ and HHS White-Collar Task Force

DOJ and HHS Enforcement White-Collar Task Force
You suspected that you were an FBI Target, but just not convinced, 

First, is getting a great WHITE-COLLAR criminal defense attorney, whom you trust, then you have,
Two options; Trial or Plea.

·        Trial (or Plea): The costs could easily exceed $100, 000 ++

·        Trial: While the goal is to win, understand that should you lose,

·        Here The US Attorney will request a longer sentence (payback!) –

·        But if you and your attorney are Confident – Stay Strong!

GUILTY

The probation officer controls your future. They conduct your interview, draft the presentence report, and can sway the court regarding your sentence length and placement.

Preparation for your Presentence Interview (PSI) cannot be overstated, your future depends on it.

·        First contact. After “guilty”, it’s helpful for your attorney to

·        connect with your Probation Officer, to

·        learn the date for their “dictation deadline”, which is the date that their Presentence Report (PSR) draft is due to their supervisor,

·        plus the date for your interview.

  • This provides the opportunity to get your ‘message’ to the officer
  •  before they speak with the prosecutor or
  •  Read online, which is biased against you.

·        Generally speaking, when working with the probation officer, a little extra effort goes a long way.

  • Consider presenting your entire view of the case, clearly in a letter to the PO as soon as possible.
  • If you feel the PO is receptive to a variance, this may be key to convincing the court to consider a sentence below the guideline range.
  • Consider presenting your entire view of the case, clearly in a letter to the PO as soon as possible – getting your message “on the record”.
  • As Probation Officers are very busy, doing their best, and never have enough time, they may actually appreciate your efforts in easing a portion of their workload,
  • Remember, a little thoughtful effort does go a long way.

The Probation Officer (P.O.) will write the official Presentence Report (PSR), and with it,

·        The Judge will determine the length of your sentence.

·        The Bureau of Prisons Administration uses the same PSR to place or designate you in a prison.

  • Your Unit Team, Case Managers, Psychologists, and Medical will refer to it throughout your stay.
  • Visitation is determined by it

 

Are you happy about the DOJ Narrative Story they have released to Google about you,


No
,

Then start working on your

Personal Narrative, it’s your chance to explain your narrative to the Judge.

1st. Express remorse for the victim(s), understanding their pain, suffering, and how it has impacted them.

2. Agree with the court as to the seriousness of the crime, without minimizing it. Expand on this topic

3. What in your life brought you to this moment, what happened that caused you to do this?
a. You can expand on this, with salient points from your childhood, while,

·        Get feedback from a consultant, attorney, or someone with this skill

·        If there was a “trigger,” what was that trigger, and how do you remove it from your life?

·        It will be a slow start, but when complete, you will be a different person, with a unique Personal Narrative or Story to tell directly to the Judge.

·        It is now Your Story, Unique and Honest.

4. What has this experience taught you? Did it bring up moments from your past?

5. Explain to the Judge that you have a plan (ONLY IF YOU DO) to start making this right with those you have victimized

6. What is your plan to never re-offend, and you will NEVER Be Back Again In Their Courtroom? 

Meanwhile, you have been,

1.     Collecting copies of your medical records

·        Hospital, laboratory, radiology, physician, surgical, prescription, and medical devices.

·        As all of these take time, medical practices are also very busy – so don’t wait.


2. Other records:

·        Educational, military, character, community service, work references, original birth certificates, social security card, license, etc, and, you get the picture.


3. Of significance to your life in the BOP;

·        Bottom Bunk: Past medical history of Tinnitus, vertigo, or back problems.

·        Diabetic Soft Shoes, Sneakers Instead of Rigid Institutional Boots: Past medical history of a torn Achilles heel, knee, or hip issues

·        Being of a certain age / Having weight, or a Hernia issue: could result in getting passes of “no standing for prolonged periods” and/or “no lifting over 15 pounds,” helping you escape some of the crappier work assignments.

·        “Medical idles,” which get you out of everything, are also available, either short or long-term, for various ongoing ailments (ranging from a bad hip to PTSD).

 

Once the PSR is done, these can/should be checked for accuracy

PREPARATION: The PROBATION INTERVIEW (FORM) starts out with; can you explain what happened, and then follow a format similar to this outline, which could include:

VICTIM IMPACT: The chance for victims to speak

OFFENSE CONDUCT STATEMENT: Review for accuracy

USSC CRIMINAL HISTORY: A scored calculation based on criminal history

USSC OFFENSE LEVEL/CONDUCT: A scored calculation based on your current charges.

OFFENSE LEVEL/CONDUCT VS CRIMINAL HISTORY

PUBLIC SAFETY FACTORS vs MANAGEMENT VARIABLES: BOP placement guidelines

OFFENDER CHARACTERISTICS: Through conversation, the officer learns who you are. Saying nothing leaves ‘all’ including the court to believe what the DOJ has released to the press is 100% true. If Not, THEN THIS IS YOUR TIME TO TO WRITE YOUR STORY/NARRATIVE AND PROVIDE YOUR PERSPECTIVE

FAMILIAL HISTORY: Married – Children – parents’ responsibilities and sole caregiver

DEFENDANT’S PHYSICAL CONDITION: Medically documented bad Back-Hip-Knees-Shoulder could provide you with a Bottom Bunk. Diabetic, Vascular Disease, Raynaylds could allow the Medicare soft shoe or sneakers.

MEDICAL/PHYSICAL HEALTH, MENTAL AND EMOTIONAL HEALTH: Include ALL medical records, Labs, Surgery Reports, X-ray – CT-MRI-Ultrasound-Pet Scans (in Written and CD Format), Prescriptions for medications (Check Generic Medication Availability), and medical devices, along will ALL physician contact information.

SUBSTANCE ABUSE: Alcohol, Drug (Legal or Illegal), within the previous 12 months before the arrest. RDAP allows up to 1 year off the sentence. They may do a Urine test.

EDUCATION AND VOCATIONAL SKILLS: Copied of the highest level, otherwise a GED will be required in prison. If you have experience in/with computers, administrators frown on these skills, so you may want to reconsider using these.

MILITARY: Copies, branch, discharge?

EMPLOYMENT: The PO will check. Judges love a good work record/history

STATEMENT FINANCIAL RECORDS: If there are financial fines/restitution, Congress and The BOP now require a Financial Responsibility Plan to benefit from all Earned Time Credits and access to Programming. Therefore if the events allow, counsel could ask that the court writes into the record that payments should only start after release from the BOP.

·        Financial Responsibility Plan (FRP). If you have a hefty fine or restitution, and money is a problem, the BOP ‘FRP’ Program requires participation. If you refuse, this could hinder your involvement in PATTERN Programs’ efforts towards early release and Halfway House along with restricting some of your commissary use.

It may help if your attorney could ask the judge to write into the order, that the defendant does not have to participate in the Financial Responsibility Plan until after they are released from the BOP, as they have a job and will then be able to make payments at that time.

Otherwise, be proactive, and at your first team meeting, offer what you can ($0.00/month) towards your FRP account. Be aware that at your next team meeting, they will know exactly how much money you have spent, and it’s too early to create a bad – first impression.

12/17/2022, I learned today that a Judge recently put into their “Order”, that the defendant has to pay $25/quarter.


ADDITIONAL DOCUMENTS THAT LIKELY WILL BE NEEDED

·        Birth or baptismal certificate

·        Divorce decreeDraft registration card Immigration papers or passport

·        Employment verification (pay stubs)

·        Income tax reports for the last three years

·        Letters of (CHARACTER) recommendation

·        Marriage certificate Car registration papers

·        Medical reports (if presently under a doctor’s

·        Military disability information (C-number)

·        Military discharge certificate

·        Naturalization papers

·        Professional papers (COPIES: Social Security Care, Drivers Lic., certificates, licenses, or Seaman’s papers permits)

·        Proof of residence (rent receipts, property and Union, lodge, or club cards mortgage papers, etc.)

·        School diplomas


OFFICIAL PRESENTENCE REPORT REVIEWED FOR ACCURACY – BEFORE SENTENCING HEARING

 

But even if all things are done right, the Judge may still not change your sentence and placement – even so,

Your Narrative is now part of your Reentry Planning – helping you through the BOP, FSA Programming, and into Halfway House as you work towards early release

Sam Bankman (FTX) – Could face lifetime: Personal Narrative Only Option?

Sam Bankman was charged with multiple counts of conspiracy: wire- commodities- securities fraud, and campaign finance violations.
 In December, Bankman-Fried was arrested in the Bahamas and charged with wire fraud, securities fraud, and money laundering, among other things;
·        defrauding FTX investors.
·       extradited to the US and released on a $250 million bond  with an ankle bracelet, and
·       submit to mental health counseling
 
Sam Bankman’s bail dwarfs other federal white-collar bonds.
·       Bernie Madoff posted a $10 million bond while awaiting trial on his multibillion-dollar Ponzi scheme.
·       Jeff Skilling, former Enron CEO, posted a $5 million bond, while
·       Elizabeth Holmes, Theranos founder, posted a scant $500,000.
A trial date is expected in the Southern District of New York.
·       Caroline Ellison and Gary Wang, two former top executives at Bankman-Fried’s companies,
·       have pleaded guilty to several fraud charges and FTX co-founder Gary Wang and former Alameda Research co-CEO Caroline Ellison are cooperating with federal prosecutors in the investigation.

 He will face his next hearing, presided over by Judge Ronnie Abrams, in New York City on Jan. 3., where he’ll enter his plea and be arraigned.

Typical questions – do not apply:
1: shortest time, and
2: How to get out of prison altogether.
Sam Bankman can’t leave all of the sentencing mitigation decisions up to his lawyer – These decisions are made jointly – as jail time could be a lifetime.
But they do not have to be.
Interviews with Federal Judges tell us;
·        Judge Bough discounts some of what lawyers say because they’re paid to do so.
·        Judge Pearson– approaching sentencing should be with the seriousness of a job.  What happened in your life that led to this courtroom.”
·        Judge Boulware said, “The order of decision-making should be: 
1: Defendant,
2: Lawyer,
3: Friends and family.
…too many defendants get this order wrong.”
Sam’s options:
Spend  time with introspection, because
·        It is/was his company,
·        He’s responsible for all decisions made
·        He is responsible for his own actions: between all of his interviews, defending and deflecting his actions in the public domain is now, ‘on the record’.
He has a real legal challenge, comparing;
His bond: 250 M 
  • Bernie Madoff = $10 million, with ~ 100Yrs
  • Jeff Skilling, former Enron CEO, = $5 million
  • Elizabeth Holmes, = $500,000, ~ 11.5 years
If he insists on Trial, the odds are against him, especially as his ‘2 lieutenants’ have already pleaded Guilty and are cooperating.
That only leaves a Plea Bargain –
  • Leave most of the Law work, to his attorneys
Consider sentence Mitigation Experts, starting after the guilty hearing
OTHERWISE, STARTING AT 30 YEARS OLD – IS A LONG TIME TO FACE IN PRISON
…and there are no guarantees either way.

Take Ownership of Your Defense – What Happens When You Don’t

Take Ownership of Your Defense – What Happens When You Don’t

I wanted to do this podcast on a phone call that I had earlier this morning. Someone who has a disease and is on medication., and yet his attorney had not prepared all his medical records – or any of his medical records for his PSR and sentencing hearing.

Hello and welcome My name is Marc Blatstein – and I’m the Physician who found Physician Presentence Report Service (PPRS)

Speaking with him this morning, I was taken aback to learn that: he had already been sentenced. Here I was trying to ask questions and learn how it was he was sentenced with an incomplete pre-sentence report. – That didn’t make any sense.

But. If the information I learned was accurate, his presentence report was incomplete.

The person’s main concern was that his medication did not appear available on the BOP online Formulary. Initially, I must give credit to this gentleman and his wife (who is in school to be a nurse practitioner). They recognized that the medication was not on the formulary, which is not an easy thing to read.

As he was to surrender in the next 45-60 days, my recommendations were to meet with his treating physician to:

·        Get copies of “all” his records

·        Copies of his prescriptions

·        Review the BOP Formulary with his physician to see if there were any acceptable medications to substitute.

·        If Yes, he needs to get a copy of this new notification regarding a medication change, due to the BOP Formulary

  • Get a hard copy of the prescription and fill it.

·        If No, and this is a Continuity of Care and/or life-threatening issue, then appearing in court at the Sentencing Hearing is preferred as Judges would usually like to question the Specialist. The challenge – he has already been sentenced, so I suppose he will call me back…

While I hope this Case Is rare, it points out that every defendant, once you’re indicted, needs to take ownership of all aspects of their defense. 


Then Be honest with yourself (and your attorney) regarding all the facts of the case, then, start interviewing attorneys.

·        Ask for referrals to see speak to some happy clients, then.

·        Ask to read some of their sentencing memorandums, in cases like yours. 

·        The goal is to see if they’re the same or if each is individualized – In the same Criminal defense space.

·        If the attorney says this is private information, which is understandable.

·        You agree, and then request that they block out all personal information.

Then you just can’t assume that the attorney is going to do everything right – which is why I am doing this podcast.

  • This must be a partnership with your attorney.

 

So, what does that mean? This partnership extends into preparation for the Presentence Interview, which will impact your future.

The short version is that the probation officer’s responsibility is to Interview you., Investigate, and then draft the Presentence Report (PSR)

  • They then provide that PSR to the judge, along with their recommendations for your sentence and placement.

 

Part I) How do you take Ownership?
First. Your attorney 

Reaches out to learn who your probation officer is, and then contact them.

Assume that the probation officer has Googled you &/or spoken to the prosecutor. Because if they have, then they may already have a bias Against you,

Why, because the Justice Department has already released all the information about you that makes you look horrible.

1st           So this first step, your attorney reaching out to the PO Sets the Tone 

  • For Your Defense, it allows them to hear from
  • you first before they’ve been 
  • tainted by others’ perceptions of who you are. 

This allows them to make their case regarding their defense strategy, on the record – to the PO. This is followed by a very organized, detailed letter that details this strategy.

They will also Ask the probation officer:

  • what documents they will need at the time of the interview.
  • What date is best for them to do the pre-sentence interview?
  • And what is their final dictation Deadline date to have their official pre-sentence report due to their supervisor?

2nd          Review with your legal team that all the information you have collected, to ensure all your background information is available and accurate

3rd         The PO has scored your Public Safety Factors (PSF), Management Variables, Criminal History Score, Offense Level (current charges), and FSA Programs,

  • Be prepared, so should you and your attorneys

4th          RDAP Eligible, Then INCLUDE It.

5th          Don’t try for a CARE LEVEL III or IV unless it is required because it houses both violent and non-violent offenders

Part II) How do you take Ownership?
You, as the defendant has jobs.

1st           You must collect All of your biographical background information.

Copies of all your medical and mental healthcare records and your physician’s contact information (name, Phone number, address, e-mail.)

Copies of all surgery reports, medication prescriptions, and medical devices.

·        If you’ve had any hospitalizations, copies of those records.

·        If you’ve had any sort of laboratory blood test, copies of those, or X-rays, CT scans, MRI scans, PET scans, or ultrasounds, all of those will have reports associated with them. You need to get copies of everything. 

  • You should also get them on CDs.

·        While you’re doing this, it’s been my impression that most people don’t have a copy of their medical records. Therefore, it would be simpler if you asked for two copies of everything from each provider of all these documents.

 

Next, you will have to get copies of your birth certificate, driver’s license, Social Security card, and passport.

Also, the highest level of education that you’ve achieved, if you’ve been in the military, what’s the highest rank you had, and what type of discharge? Any certificates – include them.

 

Character reference letters. 

Those writing character reference letters (or references about your character) must include that they know you’re facing a criminal charge.

  • They should reference good deeds that they have seen you do, tutoring, and volunteering.
  • It also could be letters from former employers who say they know you are willing to rehire you. A VERY BIG DEAL

2nd          Your Personal Narrative – takes work, and starts with writing your life story, the good, the bad, and the ugly.

  • If it starts a book, great, it will be re-written, multiple times and distilled until it represents

·        You- YOUR REMORSE TO THE VICTIMS – HOW YOU GOT TO THIS POINT = NOT TO BE REPEATED

 

3rd          Reentry Planning: Starts now, extending through the prison, RRC, and supervised release

When I was sentenced – I WAS UNPREPARED

This is why I was concerned during this conversation, and my recommendations were simple:

·        Meet with your doctor and let them review the BOP Formulary Drug List for a substitution

  • Get copies of all of his medical records, lab tests, surgery reports, physician contact information, and all of the X-Rays, CTs, MRIs, Ultrasounds, and any other scans both in a report form and on CDs
  • Put them in a big envelope, labeled legal mail for his surrender

·        Don’t forget about Your Personal Narrative and Allocution

 

This is why it’s important to participate in your defense – I sympathize with those who like me, were “The deer in Headlights”

  • But the “Symbolic Act” of participating in your defense, that
  • “taking back Control” will begin to slowly build the Confidence back that made you the success that you are

REMEMBER – THIS IS TEMPORARY
Dr. Blatstein
240.888.7778

COMMENTS

You’re the FBI Target

You’re the FBI Target

5 Areas You Must Advocate For Yourself

 

PREPARATION = SURVIVAL


If You Suspect You’re The Target of a Federal Investigation | Before The Presentence Interview (PSI) | After The PSI – But Before The Sentencing Hearing | After Sentencing or You’re Already Incarcerated | There Are Still Things We Can Do

For a No Obligation Free Consult, Call: 240.888.7778 or by emailI answer and personally return all of his calls.


1st, Start interviewing Attorneys

  • Ask for References
    • I am sure you have several “happy” clients willing to speak with you. Don’t be shy; before I had a hip replacement, I, too, interviewed many orthopedic surgeons asking similar questions.
  • Ask to see “several Sentencing Memorandums,”
    • If they ask Why, or that is Confidential, politely respond by agreeing, but PDF Adobe documents can be redacted, ‘blacking out’ all personal identification.
    • Here, we want to see if they take the time to write each separately, or are they Boilerplate?

 

2nd, You and your attorney,

  • YOU HAVE TO BE HONEST WITH THEM ABOUT EVERYTHING (again, here, too, I was not; Another Lesson Learned)
  • NEXT: as the DOJ has a 98% conviction rate, do you want to go to Trial or Plea?

 

3rd, If you win at Trial: CONGRATS!!

 

4th. If you lose at Trial or Plea, at best, you now only have 90 days to prepare for your Presentence Interview

YOU

  • Collecting copies of your medical records – Everything
  • Hospital, laboratory, radiology, physician, surgical, prescription, and medical devices

Other: copies

  • You get the picture: educational, military, character, community service, work references, original birth certificates, social security cards, licenses, etc.

 

Your Attorney: Preparing their strategy for The Presentence Interview, then

ASAP, they will contact The Probation Officer to learn when their Final Dictation Date Is for Your PRESENTENCE REPORT

  • Why: because they want to get a feel for what the Officer knows while getting their “message on the record, “… AKA Bonding
  • To Set Up YOUR INTERVIEW

BE PREPARED because the P.O. will write your PRESENTENCE REPORT based on your INTERVIEW.

  • YOU NEED TO KNOW – YOUR NARRATIVE COLD

 

Your PRESENTENCE REPORT IMPACTS

  1. Release Date
  2. Security Level Requirements
  3. Medical and Mental Healthcare Needs
  4. Psychology Programs – Limited Availability
  5. FSA Programming, and Criminogenic Needs, Risk AssessmentETC towards early release

 

5th. YOUR PERSONAL NARRATIVE

MEANWHILE, for the last 3 months, you have been writing and rewriting your story – YOUR PERSONAL NARRATIVE that challenges the DOJ Narrative of you – Your INDICTMENT.

Well written, this is your chance to speak directly to the Judge – and where he gets to know who you are, humanizing yourself to the court. Judges understand that crimes do not happen in a vacuum and want to know why you committed your crime.  You now have the opportunity to accept responsibility and have remorse for the pain you have inflicted on your victims.

Done right, it could lower your sentence, but no guarantees

 

Still not convinced – Listen to what these five Judges Say:

A Federal Judge’s Musings on Defendants’ Right and Rite of Allocution,

NACDL, The Champion, March 2011

Judge Mark Bennett, My basic principles of allocution include:

(1) be sincere.

(2) discuss what “taking full responsibility” means;

(3) acknowledge that there are victims (e.g., even when the PSR indicates “no identifiable victim,” as it does in most drug cases);

(4) an understanding of how the crime affected the victims;

(5) express genuine remorse;

(6) a plan to use prison or probation time in a productive manner;

(7) a discussion of why the defendant wants to change his or her criminal behavior; and, perhaps most importantly,

  • a true desire to learn a specific trade and a request to go to a specific Bureau of Prisons institution that offers that trade can sometimes be beneficial.

(8) information that helps humanize the defendant and the defendant’s role in the crime.

 

THE FEDERAL LAWYER • September/October 2019

VIEWS FROM THE BENCH, Own the Mistake – Demonstrate Sincere Remorse

Judge Richard G. Kopf of the District of Nebraska,

One of the best allocutions I have ever heard was:

“Judge, I want to atone for what I did to the victims and my family. I deserve some prison time. I hurt the victims, I hurt my family, and I’ve hurt myself. When I get out, I am ready to take the following steps.”

 

Judge Jon D. Levy of the District of Maine in Portland, “Allocution matters,”

“I will never hold poor communication skills against a defendant. What’s important is whether I am persuaded that the defendant is sincere and demonstrates insight about the crime…”

 

Judge Cynthia A. Bashant of the Southern District of California

“I want him to apologize to the victim and his or her family, particularly if they are in the courtroom. Just like a parent with a child who has done wrong, I am looking for ‘insight’ from the defendant,”

 

Judge Marcia S. Krieger of the District of Colorado in Denver has “seen allocutions where a defendant has shown that he is sincere and thoughtful about what he is saying.”

It is very important for the lawyer to prepare his client for allocution if allocution is to be made.

It is essential for Judge Krieger that a defendant “publicly admit his shame,” which shows her that he has internalized his crime.


If You Suspect You’re The Target of a Federal Investigation | Before The Presentence Interview (PSI) | After The PSI – But Before The Sentencing Hearing | After Sentencing or You’re Already Incarcerated | There Are Still Things We Can Do

For a No Obligation Free Consult Call: 240.888.7778 or by email. I answer and personally return all of my calls.

Presentence Interview Preparation – Gets Your “Message On The Record”

Getting The Presentence Interview (PSI) Right

Gets Your “Message On The Record”

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,

The Presentence Interview

The Presentence Interview:

  • is done by the Probation Officer (the court’s representative).
  • Following their investigation where they verify your background history,
  • the Probation Officer will take what she/he learned from the presentence interview and draft the official Presentence Report (PSR) along with,
  • making sentencing and placement recommendations to the judge.

 

The Presentence Report (PSR) Importance

The Presentence Report (PSR) also plays a critical role in the Sentencing Guidelines and statutory sentencing considerations, meaning,

  • The judge at sentencing will use it to determine how long you will be incarcerated,
  • The BOP will use it to 1st: place or designate you to a specific facility while matching you according to any needs you may have based on: 
    • security level,
    • prison placement,
    • programming,
    • pre-release, and even
    • medical care.
    • The inmate’s federal prison life depends on that PSR.
  • Should you qualify for Supervised Release,
    • Probation will then get a copy before meeting you in order to get an idea as to whom they are going to supervise over the next several years. 
  • Last, The Presentence Report (PSR) is considered:
    • gospel fact about the defendant.
    • This is because it is often considered the “Inmates Bible”.
    • So you see: It Truly Is The Gift That Keeps On Giving...

One cannot overstate the importance of The Presentence Interview to be properly prepared for – as it impacts The Presentence Report (PSR).

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,

Everything is important, from osteoarthritis and degenerative joint diseases to food allergies and medically necessary diets.

Activities of Daily Living (ADL)

  • 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

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,

  1. On- Formulary, or
  2. 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.
  3. 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

  1. 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. 
  1. Each facility then is identified by both a Security Level and this
  2. CARE LEVEL structure and inmates are then placed accordingly.

Photo Credit: https://pixabay.com

SEX OFFENDER SAFETY IN PRISON- PART OF YOUR SENTENCING CALCULATION

PPRS - PPRSUS - Physician Presentence Report Service

SEX OFFENDER SAFETY – PART OF YOUR SENTENCING CALCULATION

It is important for the court to consider your client’s, (sex offender) safety, by requesting the court grant initial placement into a Sex Offender Management Program (SOMP), while waiting for your client’s voluntary admittance into a SOTP Program.

Following their interview and investigation, the Probation Officer will draft the official Presentence Report (PSR). Together with preparation, your message stands a better chance of being part of the PSR, and is included “on the record”.

Not being placed into a SOMP, and should an incident occur, could at best result in your client spending the remainder of their sentence in isolation for their protection. Then over time, this may yield a host of mental health phobias, leading to more severe ailments.

The benefit of being proactive as you help your client during their transition into the prison environment safely; cannot be overstated. This is especially significant if the PSR includes the documentation of a mental illness with diagnosis, including the treating physician’s records and testimony.

 

ENSURING THE PHYSICAL SAFETY OF YOUR CLIENT

No alt text provided for this image

Among inmates and convicts, sex offenders are at the bottom of the prison hierarchy and generally, are greeted with hostility.

The BOP, where needed, assigns sex offenders to higher security facilities, which may not be perfect. But this can be especially evident when they’re placed in general population.

Next, when the new sex offender first arrives and meets their new bunkmate, it is not unusual for them to be asked, what did you do?

No matter how they answer, eventually, their roommate or bunkmate Will Find Out! After that, at best, the sex offender is avoided – at worse, they could be robbed, beaten, or even killed. Then he/she may have to spend the rest of their entire sentence in solitary confinement?

Therefore, in your memorandum, safety may dictate placement in either a facility with a Sex Offender Management Program (SOMP) or at minimum, a camp.

For more…

Mental Health Step Down Program (2022)

FSA – MENTAL HEALTH STEP DOWN Residential (2022)

Learn more, as this is part of The First Step Act

Program Description is taken from The First Step Act Approved Program Guide,  1/2022 Mental Health Step Down (Step Down) is a unit-based, residential program offering an intermediate level of care for inmates with serious mental illnesses who do not require inpatient treatment but lack the skills to function in the general population. The goal of Step Down is to provide evidence-based treatment that maximizes the ability to function while minimizing relapse and the need for inpatient hospitalization.

Step Down operates as a modified therapeutic community (MTC) using cognitive behavioral treatments, peer support, and skills training. Staff works closely with psychiatry to ensure participants receive appropriate medication and have the opportunity to build a positive relationship with the psychiatrist. Criminal thinking is addressed through the identification of criminal thinking errors and engagement in prosocial interactions with staff and peers. When inmates are preparing for release, intense coordination is done with social workers, Community Treatment Services (CTS), Residential Reentry Centers (RRC), Court Services and Offender Supervision Agency (CSOSA), and United States Probation Officers (USPOs) to facilitate continuity of care for reentry.

Time Frame
Hours This program is typically completed in 500 hours.
Needs Addressed Antisocial Peers, Cognitions, and Mental Health
Program Delivery To ensure program fidelity and proper credit, the Mental Health Step Down program must be delivered by Psychology Services staff.
Institution Locations USP Allenwood (H)
USP Atlanta (H)
FCC Butner (M)
FMC Fort Worth (L)
Key:
(L) = Low;
(M) = Medium;
(H) = High