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COVID In Prison

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Omicron, B.1.1.529- Fears Of Catching COVID In Prison

When I first started writing on Omicron, B.1.1.529 (a variant of COVID-19), it was back in January 2022,

At the time we have watched it become a ‘variant of concern. along with fears of catching COVID in prison more of a reality. While not as prevalent and lethal as Delta, it’s a more contagious spreader, and testing is best done with an oral swab which has to be done in a certain and exact way.

The Centers for Disease Control and Prevention (CDC) listed the possible symptoms of Omicron as:

  • cough,
  • fatigue,
  • diarrhea
  • headache,
  • sore throat,
  • fever or chills,
  • nausea or vomiting
  • shortness of breath,
  • difficulty breathing,
  • muscle or body aches
  • new loss of taste or smell,
  • congestion or runny nose

“However, the CDC noted that this list is not exhaustive, and people might experience different symptoms or combinations of symptoms.”

Unfortunately, this presents a challenge not only to all of us, but to all prisons (state and federal), jails, and detention centers. As history has shown us, these facilities likely may be unable to meet this medical need due to:

  1. the current ‘politicization of COVID-19’ and vaccinations,
  2. the physical nature of how inmates are housed,
  3. the continued refusal of some correction staff to get vaccinated, and masked
  4. the limited availability of medications and masks.
  5. I am adding to the list those with Post-COVID19 which I will cover later, but which no prison or jail has the staff, supplies, or finances to provide the support required to meet their needs.

Definition: The novel coronavirus, or SARS-CoV-2, is the deadly virus that led to COVID-19. Oversimplifying, a virus replicates its RNA by making copies of itself, but while coping, if a mistake in replication is made, these ‘mistakes’ result in creating the mutation.

How we get exposed(CDC.gov), is through these respiratory fluids that carry COVID, which occurs in three principal ways. Though not mutually exclusive, these are ‘physical particles, some of which we cannot see, but most of which can be blocked with physical masks; either N-95 masks, (double layer) surgical masks, or multi-layer cloth physical masks, by blocking the majority of these aerosolized viral fluids before they enter our respiratory system.

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1st- Inhalation – Air Bourne Transmission (Top Photo) this 20-minute uTube, “a Must-View and Listen” – on How To Protect Yourself

While not perfect, a little knowledge is helpfulby Mike Hansen MD, Board Certified in Internal Medicine, Critical Care Medicine, and Pulmonary Disease.

Just the act of breathing in the air allows these small, fine, physical droplets including the aerosolized particles that contain these viruses, into our system. Here, the risk of transmission is greatest:

  • within three to six feet from the infected source. Don’t be fooled though, as these
  • exhaled aerosolized particles can travel, likely well past the
    • 9-12 feet (and up to 27 feet) in an enclosed space.

 2nd- The viral particles, as noted, can be physically exhaled as aerosolized droplets.

  • As we breathe in these physical particles, they too can be blocked, for the most part
  • by appropriate physical masks. But again, the risk of transmission is greatest:
    • the closer we are to the infected person, which is where
    • the concentration of these exhaled droplets and particles is greatest.

 3rd- Rubbing your nose and eyes with viral residue on your hands just spreads the infection.

Therefore, ensuring an adequate supply of:

  • soap and hand sanitizer are available to allow frequent washing and hand sanitizing
  • is the responsibility of each facility, no matter whether state, county, or federal.
  • Viral residue in indoor settings may originate from either:
    • exhaled respiratory fluids, or
    • from touching inanimate surfaces contaminated with the virus. Therefore;
      • cleaning all surfaces is critical as well as
      • understanding that when you cough or sneeze, please
        • cover your mouth and nose with
        • the sleeve of your shirt or arm, and
        • not your bare hand if you can help it.

The basic protection we can all do:

  1. Social distancing indoors where practical, and
    • outside where ≥6 feet cannot be maintained.
  2. All types of masks are reviewed by the (Mayo Clinic.Org), and this is a very good resource. Multilayer physical cloth masks are cheap, and most importantly, should be made available by each facility to be used in indoor spaces. Photo Credit: ACLU
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  • Having two or more layers of washable, breathable fabric
  • Completely cover your nose and mouth
  • Fit snugly against the sides of your face while not having any gaps
  • Have a nose wire (or equivalent) to prevent air from leaking out of the top of the mask
  • Follow the recommendations of science, take the appropriate medications approved by the FDA, and get vaccinated, and this goes for staff and inmates alike!

I understand that for some this may be a non-starter, but please understand that just because:

  • we can’t see these physical droplets, or
  • don’t know anyone personally who has passed due to COVID; that doesn’t mean that
  • neither has happened; like the story of the tree that fell in the forest,
  • it still fell even though we didn’t see, or hear it.

While you may have No Symptoms, you

  • still could be a carrier,
  • pass the virus on to an older loved one who is
  • later hospitalized, and then
  • may fatally succumb to the infection.
  • That is not a burden that anyone would want to carry.

Your client’s looking for COVID sentencing relief, but were they vaccinated?

If your client’s going to prison and has not been vaccinated, it is important to learn why. If their reasoning is because it imposes on their freedom, or they just do not want to, I cannot believe that this reason is going to endear any sympathy for any alternative sentencing, from any court in the land.

Obviously, this does not take into account those with cancer, immunocompromised diseases, etc., as these are private conversations between your client and their physician. Should this be the case, I feel confident that the court would likely take this into consideration when considering your request.

If your client’s been vaccinated, has been wearing a mask, and falls into any of the following groups, now you have a good argument, especially with Omicron, B.1.1.529, and Delta ever-present across our country. The positive is that now in 2022, antivirals could be the ‘holy grail’ as far as controlling this pandemic, although their availability in a prison setting is anyone’s guess.

For more…

Federal Prison Camps

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“MINIMUM” FEDERAL PRISON CAMPS (FPC) vs “MINIMUM” SATELLITE CAMPS

There are differences;

 

Minimum Satellite Camps are adjacent to higher secure facilities.

Minimum Federal Prison Camps (FPC) are not, hence usually may have No” Solitary Confinement or Razorwire.

This may result in overall less tension among staff and inmates alike and is possibly due to the absence of the adjacent higher secure facility. Above are the BOP Federal Prison Camps, only.

 

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After the sentencing  designation is made:

With your client and their family, review relevant information such as nearby hotels and prison visiting (list and hours), mail (including email), commissary, telephone, items that are allowed in prison, and how to get money to your client (including when they self-surrender and then monthly via Western Union, Money Gram, or other services), will go a long way to helping take the edge off this life-altering event.

  • If there are medications involved, are they on Formulary (easily available), Non-Formulary (available, but require a lengthy pre-authorization process), or just Not Available? If either of the latter two applies, then what medical/legal options have been presented to the court? Hopefully, all of these issues have already been resolved, long before the PSI was finalized.

 

SELF SURRENDERING – WHAT YOU CAN BRING WITH YOU

§ Basic wedding band, Bible.

§ Prescriptions; I recommend that prescriptions be attached to everything you bring with you, including, medications and medical devices, prosthetics, etc. Together with your attorney, make sure that copies of these prescriptions are included in your PSR, which was developed from your PSI.

Below is a sample from the BOP online Formulary that is available for your attorney’s use.

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  • BOP Medication Formulary is based on a 3 Tier Structure. If you are able, I recommend bringing a month’s supply, at best you can use them, at worst they just throw them out. If you arrive on a holiday or weekend, they may be allowed.

Medical Devices:(CPAP, etc.). Prosthetics / Orthotics, Diabetic shoes (P6031.01, Patient Care, (Page 58): may need extra deep, extra wide toe box )/ Wheelchairs, etc.

Glasses that are not made with metal.

AUTHORIZATION ‘FORM’ TO RECEIVE PACKAGES, is provided by the facility, but you can print the form here.

§ Forms of ID: birth certificate, passport, driver’s license, and social security card.

§ Cash; Then Per Month- $320, ($370 in November and December), Money Gram or Western Union for monthly deposits.

§ Legal papers.

§ List of personal names (including phone numbers and addresses).

Noteworthy: 20-minute video that shows you basic steps on how to protect yourself from COVID; whether or not you are in prison, by Mike Hansen MD

  • Mike Hansen MD, a Board-Certified Internist, Intensivist, and Pulmonologist who specializes in Internal Medicine, Critical Care Medicine, and Pulmonary Disease.
  • He explains what has been at best; a politically challenged topic these past several years – in a way that all of us can understand.
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Also available through an article I previously published titled: How Do You Address Your Client’s Fears Of Catching COVID?

My background and experiences have provided me with a unique understanding of the federal Security Classification structure, Medical and Mental Healthcare – CARE LEVELS, along with an understanding of the BOP’s Medication Formulary (availability through their 3 Tier System).

Career Transition: My skills and experiences, together with 31+ years in medicine (my license is current and active), along with my lifelong compassion for others, have made me uniquely qualified to develop a Comprehensive PSR while providing the ‘best and appropriate’ placement outcome recommendations, along with counsel, to the court.

For more…

Long-COVID In Prison

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Long-COVID

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Kara Gormont, former Chief of Staff for the Defense Health Agency. A year and a half after developing Long-COVID in November 2020, she learned, that the military at the time had no process to deal with it.

“I truly felt very abandoned by the healthcare system that I had at that time given 28 years of my life to,” read (or listen) to her story, American Homefront Project | By Andrew Hirschfeld, Published April 27, 2022.

Current Treatment Challenges – CDC, 2022: Living with a Long-COVID condition can be hard, especially when there are no immediate answers or solutions. Their website then links to the 2021 page linked below…

Treatment Though Medical Management – CDC, 2021: for Long-COVID In Prison conditions is developed through a comprehensive plan based on:

  • Medical and psychiatric conditions, personal and social situations,
  • Through already established symptom management approaches (e.g., breathing exercises to improve symptoms of dyspnea).
  • Different therapies might include physical and occupational therapy, speech and language therapy, vocational therapy, as well as neurologic rehabilitation for cognitive symptoms.
  • A gradual physical rehabilitation plan for some patients (e.g., persons with post-exertional malaise);
  • Consultation with physiatry for cautious initiation of exercise and recommendations about pacing may be useful.

While not mentioned above, reported in REUTERS, April 18, 2022, The case for testing Pfizer’s Paxlovid for treating long COVID. The article makes several points; 1st, while there have been positive patient results, 2nd, there should be more scientifically regulated studies before conclusions can be made. You be the judge, but either way, it is hard to see this antiviral making its way into any prison pharmacy.

  • To date, there are no established treatments for Long-COVID In Prison. Why is this important, because the symptoms identified with post-acute sequelae of COVID-19 adversely affect the inmates’ ability to care for themselves or function normally, during a normal work day.
  • A remaining question still exists, are 100% of corrections staff fully vaccinated and boosted? Why, because as imperfect as the vaccines are, they do prevent hospitalizations and death. Unvaccinated (and if appropriate unmasked) staff can be active spreaders of the virus.

more…

Post-COVID In Prison

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Just consider, if COVID is on the rise now, [Post-COVID may follow] when we are all outside, then come fall 2022/2023 (when we are all inside in enclosed spaces (like prisons), it is anyone’s guess. The next more medically challenging question is, when and not if, will there be a treatment for the Post-COVID inmate/patient.

Should Post-COVID reflect your client’s current past medical history sometime over the past 30 months, the opportunity could be in place for either a downward departure or alternative sentencing. Why, because prisons are just not prepared to provide the required Post-COVID medical care. Additionally, corrections staff may just not be able to deal with sequelae of symptoms that they will encounter.

While hard to conceive, these efforts alone could also go a long way in relieving some of the life-altering fears your client and their families are going through. If you like what you are reading, send it to friends, ask them to subscribe using the button above, and consider engaging us.

The Post-acute sequelae of SARS CoV-2 infection (PASC), can include a wide range of ongoing health problems which can last weeks, months, or years. It is this author’s opinion that the sequelae and current treatments are constantly being adjusted in order to keep up with the ever-changing variants. This, unfortunately, compounds our efforts to gain the public trust in the science, while countering the pervasive misinformation.

It is still my belief that no jail, prison, or detention center (state or federal) has the: staff, in place training, time, supplies, or finances to provide this quality care. Why, because if our current hospital systems are still in the ‘research and study’ mode, this likely has not been part of their mission statement as it is still being studied. I’ll let the rest speak for itself.

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4/2022 | UC Davis Post-COVID Clinic | 2 years into the pandemic, pulmonologists are still trying to understand the syndrome, and this is just one hospital research system among many nationwide. Mark Avdalovic, is a pulmonologist, vice-chair for the Department of Medicine, and director of the Post-COVID-19 Clinic at UC Davis Medical Center. As one of the first health systems in the U.S. to create a clinic for Post-COVID patients, studies revealed that:

  • One-third of COVID-19 patients will have one or more symptoms three to six months after their diagnosis – or, as the US reaches 80 million infections, ~26 million Americans could potentially experience some degree of long-COVID. How many wind up in our prisons and jails? They probably do not even know due to our lack of comprehensive testing since its inception in 2019/2020.
  • Rehabilitation treatment is officially identified as post-acute sequelae of COVID-19 and is abbreviated as PASCBradley Sanville, also a pulmonary and critical care physician who specializes in exercise physiology, “Imaging of their lungs, lung function, and cardiopulmonary testing are often very normal. It’s still a mystery, but at this time, most of the available evidence is pointing away from it being a lung problem.” Sanville generally prescribes inhalers for those who are short of breath, but for those who can tolerate the exercise, he prescribes heart or lung rehab.
  • 4-2022 UC Davis Post-COVID-219-Clinic, Nontraditional approaches: the UC Davis Integrated Medicine team — which includes acupuncture, mind-body medicine such as meditation, and special diets — are used together for a forthcoming clinical trial.

more…

Pregnant Inmates

PPRS - PPRSUS - Physician Presentence Report Service

Whether federal or state, all pregnant inmates have the constitutional right to obtain appropriate medical care. To what extent prison policies address pregnancy-related services is one indicator of how that facility and state or federal agency treat pregnant women in its custody. We will cover federal prison policies today, and my next issue will cover several individual state policy examples, so stay tuned!

While the National Commission on Correctional Health Care (NCCHC) has been at the forefront leading to dramatic improvements in pregnancy inpatient care, they are by no means alone. As you will see, they are accompanied by the:

Introduction

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A significant percentage of women entering prison are of the age where they’re sexually active, are either at risk for pregnancy, or are already pregnant. A 2019 study reported that a total of 4% of women in federal custody were pregnant and 753 gave birth (Sufrin, 2019).

Most women entering prisons are mothers, as well as the primary caregivers to young children, (Glaze & Maruschak, 2010). It would be helpful if facilities (federal and state) made a conscious effort in recognizing the resulting psychological difficulties that result when forced separation occurs following childbirth. While it’s a lot to ask, creating areas for new mothers to pump breast milk for their infants, then having a place to store it, goes a long way in allowing them to establish their relationship with their new child, at a minimum.

NCCHC Has Set National Standards for Pregnancy-Related Health Care in Correctional Settings

ACOG: specialists in Obstetrics and Gynecology, “The use of restraints on pregnant incarcerated women and not only compromise health care but are rarely necessary.”

Department of Justice Office of the Inspector General, Review of the Federal Bureau of Prisons Management of Its Female Inmate Population, Evaluations and Inspections Division 18-05 (Washington, DC: September 2018).

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An interview with an Assistant Federal Public Defender (Page 82 bottom)

1-    They found the lack of information and communication about the MINT program for pregnant women facing prison time, problematic.

2-    Specifically, as pregnant women await sentencing, they do not have a sense of what to expect, or decisions they need to make in terms of medical care or custody of their infant.

3-    BOP was not forthcoming with any substantive information about how to initiate the approval process for MINT participation while the defender’s pregnant client awaited sentencing, despite their and the judge’s efforts to contact BOP and MINT programs.

The views expressed by the defender are their own and do not represent the views of the Administrative Office of the U.S. Courts or the federal judiciary.

For more…

Pregnant In Federal Prison

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A significant percentage of women entering prison are of the age where they’re sexually active, are either at risk for pregnancy, or are already pregnant.

Federal – While onsite nurseries are not available, they do have limited offsite programs

  1. MINT: Mothers and Infants Together (MINT) Program (GAO, Page 79)
  2. RPP: Residential Parenting Program (RPP) (GAO, Page 82).
  3. A reason to be very proactive:

Department of Justice Office of the Inspector General, Review of the Federal Bureau of Prisons Management of Its Female Inmate Population, Evaluations and Inspections Division 18-05 (Washington, DC: September 2018).

 

I) Fort Worth, Texas (Mothers and Infants Nurturing Together (MINT) Program, Tx.);

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CONTACT: The “Little House”, houses the MINT women and their babies.

Volunteers of America Texas, 2710 Avenue J., Fort Worth, Texas 76105, 817) 535-0853

BOP (PS 5200.02, CN-1):

  • If RRC placement is medically appropriate and documents this on the Medical/ Psychological Pre-Release Evaluation (BP-A0351), which is forwarded to Unit Management.
  • Direct court commitments have a secondary designation noted on the Inmate Load and Security Designation form (BP-A0337).

From the GAO-21-147, Pregnant Women in DOJ Custody, Page 79

  • They also have a Residential Reentry Center for men.
  • They work to reduce recidivism and the stigma for children born to incarcerated parents, by enhancing the bond between the mother and infant, while teaching the women how to care for their infants and be better citizens.
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  • Women have a weekly check-in with a nurse and are taken outside of the facility for prenatal care.
  • The program holds up to six women at one time.
  • They usually have approximately two or three participants at any given time,
  • And approximately 10 participants annually.
  • The women typically stay 3 months postpartum and BOP officials noted that women may request an additional 6-month extension (PS 5200.02, CN-1, page 16).
  • When interviewed by GAO staff, the women stated that they received regular medical care, including any special care that was needed, and any special accommodations that they requested.
  • The mother is then returned to an institution to complete her sentence, if necessary.

II) The Greenbrier ‘MINT’ Program, WV.

CONTACT: Operates under The Baltimore Residential Reentry Office, Baltimore Maryland, Appalachian Mountains in Pocahontas County, Hillsboro, WV. Facility Director: Starlena Robertson, Case Manager’s Susan Lane or Mary Eggert, (304) 653-4882 or (304) 653-4570, mint3vz@frontiernet.net

BOP (PS 5200.02, CN-1):

  • If RRC placement is medically appropriate and documents this on the Medical/ Psychological Pre-Release Evaluation (BP-A0351), which is forwarded to Unit Management.
  • Direct court commitments have a secondary designation noted on the Inmate Load and Security Designation form (BP-A0337).
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  • Here they promote maternal bonding and parenting skills in a home-like environment.
  • There is no medical care provided onsite.
  • Mental health providers offer onsite services twice weekly and women are taken outside of the facility for prenatal care.
  • The program has ten staff and can hold up to 20 women at one time.
  • The program has approximately 10 participants at any given time and approximately 20 annually.
  • The women typically stay 3 months postpartum and BOP officials noted that women may request an additional 6-month extension (PS 5200.02, CN-1, page 16).
  • Interviewed by GAO staff, the women stated that they received regular medical care, including any special care that was needed, and any special accommodations that they requested.
  • One woman stated that she appreciated the welcome basket she received upon arriving at the Hillsboro MINT program of donated items such as toiletries for the woman, as well as infant clothing and accessories.
  • The mother is then returned to an institution to complete her sentence, if necessary.

III) Residential Parenting Program (RPP), Washington State Department of Corrections

CONTACT: Sonja Alley, Correctional Unit Supervisor, Washington Corrections Center for Women, Washington State Department of Corrections (253) 858-4200 X 8274, sonja.alley@doc.wa.gov

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BOP (PS 5200.02, CN-1):

  • Unit Team completes the BP-A0210, Institutional Referral for CCC Placement, and submits it to the Seattle Residential Reentry Manager.
  • Furloughs are only accepted Tuesdays through Thursdays at RPP. Release residence can be to any state.
  • The Designation and Sentence Computation Center (DSCC) may also refer initial designations to the Seattle Residential Reentry Manager, with a copy to the Female Offender Branch Administrator.

For more click here

Access 2022

FSA - First step act

Productive Activities (PA)
Access 2022

Program Description

This program is designed for incarcerated women who are survivors of domestic violence.

It assists women in identifying suitable career options to be economically independent upon reentry. An interactive computer component (which can be printed and used in class) is used
to explore career options. Participants also complete testing to determine what career field is best for them.

Hours 10
Location(s) All-female sites
Needs Addressed Cognitions, Mental Health, Trauma
Program Delivery Special Population Program Coordinator

Facing The BOP With: Intellectual Disabilities, Neurological Impairments, Social Deficiencies Or Autism

FSA - First step act
CorrectionalOfficer.org © 2020 – Screen Shot[i]

 

The Skills Program[i] There are only 2 locations nationwide.

Do you have clients facing incarceration in the BOP, and who are being treated for intellectual disabilities, neurological impairments, social deficiencies, or autism? If yes; which of the BOP’s ‘2’ available prison facilities are best suited for their placement? That’s right, there are only 2 locations.

I ask this is because the concept of prison officials engaging individuals with autism (for example), has its own brand of procedural issues. For those with a documented history, this could be critical for the safety of all parties; the inmate, correction officers, and the facility general population.

Increasingly, media outlets are reporting instances whereby police officers are confronting subjects on the streets and encountering behaviors of some as “resisting verbal commands” and “obstructing justice,” among others. Eventually, the presence of autism or a different disability is discovered after these police/civilian engagements. Thus, a BOP facility who at a minimum, provides this type of care at a couple of facilities, should be made part of the BOP placement request through the PSR.

Inmates with significant functional impairment due to intellectual disabilities, neurological deficits, and/or remarkable social skills deficits are considered for the program. Participants must be appropriate for housing in a low or medium security institution. Inmates must volunteer for the program.[i] While this program is conducted over 12-18 months, inmates may continue with the program at additional times.

Autism spectrum disorder

Autism spectrum disorder (ASD[ii]) occurs in all ages, racial, ethnic, and socioeconomic groups, according to the Centers for Disease Control (CDC)[iii]. Autism is generally characterized by social and communication difficulties and repetitive behaviors. Signs of autism[iv] occur in three main areas:

  • Social interactions
  • Verbal and nonverbal communication
  • Repetitive or ritualistic behaviors
  • Characteristics 
    • having difficulty with everyday conversations
    • sharing emotions or interests less often than peers
    • having difficulty responding to or understanding social cues
    • having difficulty understanding other people’s facial expressions or emotions
    • having delayed speech or language skills
    • having trouble developing or understanding relationships
    • doing repetitive actions, such as hand-flapping or rocking
    • becoming intensely interested in certain topics
    • speaking in atypical ways, such as in a singsong voice
    • having a significant need for predictable structure and order
    • becoming overwhelmed or angry in new situations
    • having a sensitivity to certain stimulants, such as being overwhelmed by loud noises or bright lights experiencing intellectual delays

A particular focus on autism-affected inmates, classified by BOP under the umbrella category as “Intellectual Disabilities, Autism Spectrum Disorders” and “Major Neurocognitive Disorders,” seeks to treat affected inmates with a multidisciplinary modality, albeit only available at two BOP locations nationwide. The Federal Bureau of Prisons amended and published (May 2014)[v] its agenda to handle/treat mentally unstable inmates while incarcerated.

Intellectual disabilities are classified by severity, [i]

  • Mild to Moderate
    • Mild
      • slower in all areas of conceptual development and social and daily living skills
      • can learn practical life skills, which allows them to function in ordinary life with minimal levels of support.
    • Moderate
      • care of themselves,
      • travel to familiar places in their community, and
      • learn basic skills related to safety and health.
      • Their self-care requires moderate support.
    • Severe
      • has the ability to understand speech but otherwise has limited communication skills ()[ii].
    • Profound (MH CARE LEVEL III [iii])
      • cannot live independently, and
      • they require close supervision and
      • help with self-care activities.
      • limited ability to communicate and often have physical limitations.

Social Deficiency[iv]; reasons why a person may have a social skills deficit.

    • inability to acquire new skills,
    • because of a competency deficit,
    • they may struggle to perform because of limited practice or inadequate feedback, or
    • external factors
      • anxiety or
      • chaotic surroundings.

Basic Communication

  • inability to listen,
  • follow directions and/or
  • refrain from speaking.

Empathy and Rapport

Interpersonal Skills

  • Those who have a social skill deficit may struggle with asking accurate and concise questions.
    • appear disinterested and even
    • anti-social,
    • they may struggle to understand proper manners in different social contexts and settings.

Problem Solving: involves asking for help, apologizing to others, deciding what to do, and accepting consequences;

  • morbidly shy or
  • clinically introverted.

Accountability, fear of being criticized in public;

  • struggle with accepting blame for problems or
  • dealing with constructive feedback.

Other neurological impairments[vi] (e.g. traumatic brain injury, Spina Bifida, Prader-Willi syndrome, Alcohol-Related Neurodevelopmental Disorders or FASD)

As a Police Officer, Cheri Maples, stated earlier, “…wisdom is being able to discern when gentle compassion is called for and when fierce compassion is called for.” That, my friends, rather sums it up.[ix]

Criminal Justice Advocacy – Screen Shot[i]

 ‘The responsibility for a client’s mental and physical health should be safeguarded to protect them from themselves and others, providing a safe environment for the duration of their incarceration.’

This is the responsibility of the legal defense team, court, and BOP.

The Skills Program[ii] is available at these two facilities:
FCI Coleman, FL-Medium

FCI Danbury, CT-Low

 

[i] https://www.arcnj.org/programs/criminal-justice-advocacy-program/

[ii] https://dev-pprsus.pantheonsite.io/bop-psychology-treatment-the-federal-presentence-report-sentencing-and-prison-placement-preparation/skills-program/

[i] https://www.ncbi.nlm.nih.gov/books/NBK332877/#:~:text=Historically%2C%20intellectual%20disability%20(previously%20termed,100%20in%20the%20population)%E2%80%94and

[ii] https://www.ncbi.nlm.nih.gov/books/NBK332877/#

[iii] https://dev-pprsus.pantheonsite.io/programs/bop-mental-healthcare/

[iv] https://www.masters-in-special-education.com/lists/5-types-of-social-skills-deficit/

[v] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1350917/

[vi] https://www.ninds.nih.gov/Disorders/Support-Resources

[vii] https://www.cerebralpalsyguide.com/cerebral-palsy/

[viii] https://www.epilepsy.com/learn/about-epilepsy-basics/what-epilepsy

[ix] https://www.correctionalofficer.org/overseeing-inmates-with-autism

[i] https://dev-pprsus.pantheonsite.io/bop-psychology-treatment-the-federal-presentence-report-sentencing-and-prison-placement-preparation/skills-program/

[ii] https://www.additudemag.com/autism-spectrum-disorder-in-adults/

[iii] https://www.additudemag.com/autism-spectrum-disorder-in-adults/#footnote1

[iv] https://www.additudemag.com/signs-of-autism-in-adults/

[v] https://www.bop.gov/policy/progstat/5310_16.pdf

[i] https://www.correctionalofficer.org/overseeing-inmates-with-autism

[i] https://dev-pprsus.pantheonsite.io/bop-psychology-treatment-the-federal-presentence-report-sentencing-and-prison-placement-preparation/skills-program/

COVID Policy In BOP | What Are Your Client’s Fears?

COVID Policy In The BOP | What Are Your Client’s Fears?

Vaccines – mAb, A New COVID Drug Category – Antivirals Could Be The Holy Grail”

Globally, since 2020, we have all been waiting on science for an answer. 

Their efforts have led to the development of a new generation of Vaccines: (mRNA), along with the traditional J&J. Now, to the Federal Bureau of Prisons Clinical Guidance on COVID-19 Vaccines and other therapies.  

I. BOP Vaccination Policy 10/13/2021(BOP.gov)

Per The BOP, vaccination supplies initially may be limited, and will be dispensed according to the BOP COVID-19 Vaccine Guidance Manual; October 13, 2021. This though does not take into account the new variants that may continue to evolve.

For Inmates Who Are:

·      Waiting to get their Covid Vaccine while pending a Court-Ordered Release or Transfer,

They may be vaccinated either:

1.    By using a single-dose COVID-19 vaccine, or

2.    By using a multi-dose series on a case-by-case basis, or

3.    But if there is insufficient time to complete a multi-dose series, it should only be started if the final dose can be verified that it can be completed at the receiving location.

Each BOP facility will (Page 3).

1.         Create and implement a COVID-19 immunization plan to offer the vaccine (1-dose or 2-dose, initial primary series) for,

  • New staff & intakes, and
  • Any staff or inmate that hasn’t yet been vaccinated,
  • US prison guards refusing the vaccine, despite COVID-19 outbreaks, The Associated Press, March 15, 2021

2.  Develop a plan for when, and by whom staff and inmates will be screened and scheduled for the vaccine, and

3.  Ensure that responsibility is assigned to health care personnel for patient assessment and vaccine administration.

4.   For the 2-dose vaccination series, a medical hold should be placed on the inmate’s electronic health record until the due date of the second dose. This is to keep them from being transferred or released before the last dose is given.

5.   For Third doses of mRNA COVID-19 vaccines, page 5 [See Appendix], in immunocompromised persons: should be offered a third dose at least 28 days after 2nd mRNA dose. 

The Three Vaccines available in the BOP Will be Given In The Priority Level Order, # 1-3 (page 5)

Pfizer (page 3):

The Pfizer-BioNTech COVID-19 vaccine (Comirnaty®) – an mRNA vaccine 

Priority Level 1:

·      Inmates assigned as health service unit workers,

·      Inmates in health service unit job assignments,

·      Inmates in nursing care centers (long-term care) or other residential health care units.

Priority Level 2: Inmates aged 65 years and older or those of any age with underlying medical conditions.

Priority Level 3: All other inmates.

Fact Sheets for the approved* and EUA-authorized(FDA.gov) Vaccines,

For recipients, caregivers, and healthcare providers administering vaccines. [see appendix]

COVID-19 FDA, Approved:

·      For persons 16 years of age and older: 2-dose primary series

·      Should be offered a booster dose at least 6 months after the second dose.

COVID-19 FDA, Emergency Use Authorization (EUA):

·      For persons 12 to 15 years of age: 2-dose primary series.

·      Third dose for certain immunocompromised persons.

·      Single booster dose for certain non-immunocompromised persons.

 Moderna, (page 3)

Fact Sheets for the approved* and EUA-authorized Recipients, For caregivers, and healthcare providers administering vaccines [see Appendix]

COVID-19 FDA, Emergency Use Authorization (EUA):

·      For persons 18 years of age and older: 2-dose primary series.

·      Third dose for certain immunocompromised persons.

J&J, (page 4)

Fact Sheets for the approved* and EUA-authorized [see Appendix] Recipients, caregivers, and healthcare providers administering vaccines

COVID-19 FDA, Emergency Use Authorization (EUA):

·      For persons 18 years of age and older: 1 dose required

II. Monoclonal Antibody (mAb) Drug Therapy for COVID-19, BOP Clinical Guidance, 08/2021.

1. Mitigate the need for hospitalizations, ICU, and O2 Ventilators

2. After exposure, and quickly implemented before a positive COVID-19 test.

3. At 1st glance it appears that the mAb medications are not on the most recent:

  • Or their BOP Health Services, National Formulary Part II, Lists (above, again, here too I could be wrong, as they appear to be available, just not listed).

The BOP Monoclonal Antibody (mAb) Therapy, Clinical Guidance COVID-19, 08/2021.

BOP Nurse Charting is very good (page 14), as they use the same S.O.A.P. Note Format that we have all been taught for patent encounters. It’s a good thing to know if you are not already familiar with it. Because medicine, like law, even if treatment (or work) was done, if it was not documented, then it will not be believed as performed, and vice versa.

Subjective: The Inmate/Patient Complaints (in terms of their current condition, function, activity level, disability, symptoms, social history, family history, employment status, and environmental history).

Objective: What the healthcare provider gathers from their exam, labs, X-rays, physical findings, observations and talking, etc.

Assessment: At the end of the encounter, their detailed notes will either support Inclusion Criteria or Exclusion Criteria (see included tables), with regards to the Inmate/patient qualifying (or not) for Monoclonal Antibody Treatment. Regarding a diagnosis, here there may be multiple.

Plan: If Inclusion Criteria have been met, informed consent for mAb needs to be gotten. All mAb requires a non-formulary request to be submitted and approved.

All Criteria must be met for (mAb) Treatment:

·      Positive results of direct SARS-CoV-2 viral testing, and

·      A clinical presentation of mild to moderate COVID-19 symptoms, and

·      Symptom onset within the 10 days preceding mAb treatment and

·      Risk factors for severe COVID-19 illness (see Risk Factors for Severe COVID-19 Illness), and

·      Age ≥ 12 years old; weight ≥ 40 kg (88 lb)

Treatment symptoms to look for, within 10 days of (mAb) treatment.

·      Fever

·      Cough

·      Sore throat

·      Malaise

·      Headache

·      Muscle pain

·      Gastrointestinal symptoms

·      Shortness of breath with exertion.

At a minimum‘1’ of the following must be present to qualify for treatment.

·      Body mass index (BMI) ≥25

·      Chronic kidney disease (CKD)

·      Type 1 or type 2 diabetes

·      Immunosuppressive disease

·      ≥ 65 years of age

·      Currently receiving immunosuppressive treatment

·      Cardiovascular disease (CVD) or hypertension

·      Chronic obstructive pulmonary disease (COPD) or other chronic respiratory diseases

·      Sickle cell disease

·      Neurodevelopmental disorders or other conditions that confer medical complexity

·      Medical-related technological dependence (i.e. tracheostomy, gastrostomy, positive pressure ventilation not related to COVID-19)

·      Oxygen saturation (SpO2) ≤ 93% on room air

·      Respiratory rate ≥ 30 per minute

·      Heart rate ≥125 per minute

Patients must have positive results of direct SARS-CoV-2 viral testing no more than 10 days before starting the mAb infusion 

All of these tests are acceptable for confirming COVID:

·      Commercial lab PCR test,

·      A rapid PCR test (Abbott ID Now) or

·      Rapid Ag test (BinaxNOW) 

III. Monoclonal Antibody Medications:

1)    REGEN-COV (casirivimab and imdevimab(BOP.gov), administered together),

When there is a Limited Supply, The BOP has created: PATIENT CRITERIA LEVELS (Page 5) to determine who gets treated.

PRIORITY 1, Patient Criteria:

• Three or more risk factors for progression to severe disease or

• ≤ 3 days of symptoms or

• Any one of the following risk factors:

1.   Body mass index (BMI) ≥35, or

2.   Type 1 or type 2 diabetes, or

3.   ≥ 65 years of age. 

PRIORITY 2, Patient Criteria:

• Two or more risk factors (from PRIORITY 1) for progression to severe disease. 

PRIORITY 3, Patient Criteria:

• One risk factor for progression to severe disease

• Contact the Regional Medical Director (RMD) to discuss any proposed deviation from the below criteria.

• Submission and approval of a non-formulary request is required before initiation of any mAb for COVID

2)    Tocilizumab (Actemra) – hospitalized patients only

3)    Sotrovimab – hospitalized patients only

4)    Baracitinib (works better with either Tocilizumab or Remdesivir)

Where: Treatment Is NOT‘ Indicated.

·      Pregnancy and lactation: considered on a case-by-case basis

·      Allergies to any of the medication ingredients

·      Hospitalized due to COVID-19

·      Require oxygen therapy due to COVID-19, OR

·      Require an increase in baseline oxygen flow rate due to COVID-19.

·      For those on chronic oxygen therapy due to underlying non-COVID-19 related comorbidity, these Inmates/Patients should be considered for hospital transport.

IV. Antivirals: The “holy grail” of viral therapeutics, The Atlantic 11/29/2021

“Until now, the only outpatient therapeutic for COVID-19 has been monoclonal antibody treatments, which are effective in preventing severe disease in high-risk patients. “The New COVID Drugs Are a Bigger Deal Than People Realize”.

Photo Credit, The Atlantic

Merck’s molnupiravir (EAU for mild-to-moderate cases of COVID-19 who were not hospitalized). Initially, in Nature, 10/8/2021, Merck’s antiviral was touted as may cut hospitalizations and deaths among people with COVID-19 by half. Recently, on November 26, 2021, Merck revealed its Covid antiviral treatment is less effective than first thought. A full analysis of their trial results shows Molnupiravir had a risk reduction of 30%, Reuters.

Pfizer’s Oral Antiviral PAXLOVID™ (“Potential Game-Changer in the pandemic”), Reduced The Risk Of Hospitalization or Death By 89%.

Appendix:

In closing, we believe that the responsibility for a client’s Mental and Physical Health should be safeguarded to protect them from themselves and others, …while providing a safe environment for the duration of their incarceration. This is the responsibility of the Court, Defense Team, and BOP.

If this was helpful, please share it with your colleagues. With more to follow, should you have any questions, are interested in engaging my services, or have any ideas for future topics, I am easy to reach, and thank you for your time.

 

 

 

Marc

  • email, info@PPRSUS.com, or
  • Voice: 240-888-7778.

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