Probation Officers | Federal | The PSR

Probation Officers Representing The Court:

They Conduct The Presentence Interview,

This is critical – as from it they prepare

Your Presentence Report (PSR),

Which acts as your “referral” to

The Federal Bureau of Prisons for everything

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For a No Obligation Free Consult Call Dr.Blatstein at: 240.888.7778, or through email at: info@PPRSUS.com. Dr. Blatstein answers and personally returns all of his calls.

Probation receives and evaluates pre-sentence investigation requests.

Their Process:

  • 1st they interview you, and then
    • Identify and pursue leads to obtain evidence.
    • Gather and document evidence by interviewing involved parties, obtaining statements, reviewing and analyzing records and files, etc.
    • Gather criminal history, police reports, victim impact statements, criminal complaints, and information and review them prior to the interview with the offender.
    • Conduct offender criminal history checks, warrant inquiries, and driver’s license abstract checks.
    • Compile and maintain history and case records.
    • Inform offenders of their rights, responsibilities, and purposes of the pre-sentence investigation process.
    • Interview offenders are required by the courts to have a pre-sentence investigation completed.
    • Utilize PSI interview guide and the Criminogenic Domains of Criminal History, Education/Employment, Financial, Family/Marital, Accommodation, Leisure/Recreation, Companions, Alcohol/Drug, Emotional/Personal, and Attitude/Orientation.
    • Complete various extensive assessment tools to gauge offender risk and needs.
    • Collect PSI fees.
    • Coordinate investigations with other law enforcement agencies, regulatory agencies, and other relevant entities.
    • Confirm information gathered during the interview.
    • Communicate with the appropriate Department of Corrections and Rehabilitation staff, other state agencies, related organizations, other entities, volunteers, and the public to provide information, referral services, technical advice, and consultation regarding PSI.
    • Communicate with Courts, attorneys, law enforcement, and other agencies involved in a court-ordered pre-sentence investigation.
    • Document interview and investigation.
  • Identify and Inform crime victims of their rights.
    • Assist the victim advocates in coordinating victim requests for offender information; victim issues such as recovery from injury, financial losses, or victim mediation; preparation of victim impact statements and reports; communicate offender progress and victim assistance to various local, state, and federal officials, and to treatment staff.

Prepare The Presentence Report and

Recommend administrative, legal, and/or sentencing action.

  • Present evidence to prosecutors, legal staff, or courts.
  • Prepare and present testimony as required for legal proceedings or administrative hearings.
  • Report offender compliance with the presentence investigation to courts.
  • Summarize information gathered during the investigation and interview into the pre-sentence format.

Make sentencing recommendations

  • based on sentencing guidelines and a thorough analysis of:
  • Ensure the report is distributed according to Applicable Code standards.
  • Monitor programs for compliance with state and federal laws compliance.
  • Gather, compile, and maintain statistics for required and requested reports.
  • Investigate and confirm the information on offender release plans or interstate compact investigations.
  • Maintain working knowledge of the Department of Correction and Rehabilitation (DOCR) programs and community-based programs that are available for offenders.

Note: The duties of probation officers listed above are not intended to be all-inclusive.

Federal Sentencing and Placement – The Process

98% of federal defendants plea

Federal Sentencing

1st: Federal Defendants indicted, >93% likely will receive a federal sentence to a BOP facility

 

2nd: The defendant’s first appearance in court
  • ~93+%, can result in either a plea or verdict of guilty to a federal sentence
  • Between the Defendant’s 1stand, 2nd court appearance; a resume or CV of the defendant’s background is developed: called the Presentence Report (PSR).
  • The PSR is where the Defense Team Can make a Placement Request, while documenting the defendant’s medical, criminal, work & education histories, etc.
3rd: The defendant’s second court appearance is for the Sentencing Hearing
  • The details of sentencing are not taught in most law schools
  • Judges determine the length of time the defendant is imprisoned
  • Judges can also make a placement request to the BOP
4th: The BOP determines placement
  • Some of the factors that affect placement (BOP Policy Statement P5100.08 (Chapter 4 Pages 5-13 and Chapter 5 Pages 12-13):
    • Judges recommendations
    • Public Safety Factor (PSF) Variables
      • Accepting Responsibility
      • Age
      • Criminal History
      • Education Level
      • Legal Release Residence
    • Management Variables; Pre-determined Security levels
      • Disruptive Group-confirmed member
      • Greatest Offense Severity #
      • Greatest Severity Offense
      • Prison Disturbance
      • Serious escape
      • Serious Telephone Abuse
      • Sex Offender
      • The threat to Government Officials
    • Medical CARE LEVELS I-IV Structure
    • Mental Healthcare CARE LEVELS I-IV Structure
    • Psychology Treatment Programs
    • Medication Availability

      • On Formulary, or available
      • Non-Formulary requires a lengthy preapproval process
      • Or Just Not Available, where a similar substitute may be implemented

For Groups: My PowerPoint Presentation

Federal Prison Placement Preparation

The Presentence Report

1st. Prepare For Your Presentence Interview

Properly prepared, will allow the probation Office the draft an accurate

Presentence Report – which will control your future

Incorporate these federal prison placement data points:

Federal prison placement includes

  • Medical and Mental Healthcare needs to be implemented through

  • Psychological Treatment Programs while available, have limited access and maybe security level specific.

The First Step Act Includes;

I) Brave Program A first-timer young male offender 32 years of age or younger, facing a sentence of 60 months or more

II) Challenge Program A male inmate facing a high-security penitentiary with a current diagnosis of either: Mood, Anxiety, Schizophrenia, Delusion, and/or Substance-induced Psychotic Disorders

III) Mental Health Step Down A male or female who lacks the skills to function in a general population prison setting and is willing to work with Psychiatry Services

IV) Resolve A male or female with a current diagnosis of a mental illness related to physical, mental, and/or intimate domestic violence or traumatic PTSD

V) Skills A significant functional impairment due to intellectual disabilities, neurological and/or remarkable social skills deficits such as Autism Spectrum Disorder, Obsessive Compulsive Disorder, Epilepsy, Alzheimer’s, Parkinson’s, or Traumatic Brain Injuries (TBIs) to mention just a few.

VI) Stages  A male inmate with a serious mental illness and a primary diagnostic of Borderline Personality Disorder, along with a history of unfavorable institutional adjustment.

VIIa) Sex Offender Non-Residential Single Sex Crime or first-time Internet Sex Offense

VIIb) Sex Offender Residential Multiple sex crimes.

VIIc) Butner’s Commitment and Treatment Program for Sexually Dangerous Persons, Page 12Is considered for sexually dangerous persons with the possibility of criminal recidivism

VIII) Female Integrated Treatment Is a female with substance abuse (RDAP Eligibility Possible), trauma-related disorders, and other mental illnesses. (FIT) Program

Medication availability falls into 3 tiers:

  1. On the BOP Formulary (available).
  2. Non-Formulary; these require a lengthy preauthorization process.
  3. Last: these are just not available. While similar medications are substituted, how is their efficacy verified?

Security Requirements

  1. Offense Level vs Criminal History Calculation
  2. Criminal History Calculation
    • +3 points for each prior sentence > 1 Year + 1 Month.
    • +2 points for each prior sentence > 60 days, not counted above.
    • +1 point for each prior sentence, <= 60 days not counted above; for up to a maximum of 4 points in this category.
    • +2 points for each revocation that has a new charge or occurs under federal supervision.
    • + 1 point for each prior sentence resulting from a conviction of a crime of violence that did not receive any points as noted above because the sentence was treated as a single sentence, up to a total of 3 points for this subsection.

The BOP and Prison Security Level Placement

Helpful articles in preparation for the sentencing hearing;

  1. Judges are interested in placement recommendations; THE FEDERAL LAWYER • September 2017
  2. When recommending a facility placement; How Federal Prisoners Are Placed, Published in Criminal Justice, Volume 31, Number 1, Spring 2016. © 2016 by the American Bar Association

The Presentence Report – A Medical, Medication, and Security Requirement Referral

PPRSUS.com

As found in my LinkedIn 2/29/2020 post

First Step Act – Revised 2022

Reduction in Recidivism

Requires the Attorney General to develop a risk and needs assessment system

  • The BOP assess the recidivism risk and criminogenic needs of all federal prisoners
  • Place them in recidivism reducing programs
  • Including productive activities to address their needs and reduce this risk.
  •  Under the act, the system provides guidance on the:
    • type,
    • amount, and
    • the intensity of recidivism reduction programming and
    • productive activities to which each prisoner is assigned, including
    • information on which programs prisoners should participate in based on their criminogenic needs.
    • on how to group, to the extent practicable,
      • prisoners with similar risk levels together in recidivism reduction programming and
      • housing assignments.
  • The Act also amends 18 U.S.C. § 4042(a), requiring the BOP to assist inmates in:
    • applying for federal and state benefits and
    • obtain identification, including a
      • social security card,
      • driver’s license or
      • other official photo identification, and
      • birth certificate.
  • The First Step Act also expands the Second Chance Act to deliver recidivism reduction programming.

Incentives for Success

  • The Act amended 18 U.S.C. § 3624(b), so that federal inmate can earn:
    • up to 54 days of good time credit for every year of their imposed sentence
    • rather than, for every year of their sentence served.
    • For example, you’re sentenced to 10 years, your maximum good time credit = 540 days.
    • These good-time credits go towards pre-release custody.
    • Ineligible for good-time credit are generally categorized as:
      • violent, or involve
      • terrorism,
      • espionage,
      • human trafficking,
      • sex and sexual exploitation; additionally
      • excluded offenses are a repeat felon in possession of a firearm, or
      • high-level drug offenses
      • For a more complete list, see disqualifying offenses

Confinement

  • 18 U.S.C. § 3621(b) requires the BOP to house inmates in facilities within 500 driving miles of their primary residence.
  • The BOP variety of factors goes into placement, including:
    • bed space availability,
    • security designation,
    • programmatic needs,
    • mental and medical health needs,
    • any request made by the inmate related to faith-based needs,
    • recommendations of the sentencing court, and
    • other security concerns.
  • The FSA reauthorizes and modifies a pilot program that allows the BOP to place certain elderly and terminally ill prisoners on home confinement to serve the remainder of their sentences.

Correctional Reforms

  • Criminal justice-related provisions, including;
    • prohibition on the use of restraints on pregnant inmates in the custody of BOP and the U.S. Marshals Service.
    • requirement the BOP to provide tampons and sanitary napkins for free
    • The FSA requires BOP to provide training to correctional officers and other BOP employees:
      • on how to interact and de-escalate encounters with people who are diagnosed with mental illness or other cognitive deficits.
      • Also included is a prohibition against the use of solitary confinement for juvenile delinquents in federal custody.

Sentencing Reforms

  • Changes to Mandatory Minimums for Certain Drug Offenders for some drug traffickers with prior drug convictions
    • the threshold for prior convictions that count toward triggering higher mandatory minimums for repeat offenders,
      • is reduced from the 20-year to a 15-year mandatory minimum,
    • The life-in-prison mandatory minimum (where there are two or more prior qualifying convictions),
      • to a 25-year mandatory minimum.
  • Retroactivity of the Fair Sentencing Act (FSA)
    •  Those who received longer sentences for crack cocaine than if sentenced for possession of powder cocaine can submit a petition in federal court to have their sentences reduced.
  • Expanding the Safety Valve

FEMALE PATTERN RISK SCORING

MALE PATTERN RISK SCORING

Violent Offense Codes for PATTERN Risk Assessment *

Cut points used when calculating an inmates Risk of Recidivism

AARP Foundation Finances 50+ (2022)

AARP Foundation Finances 50+ (2022)

Program Description

This program provides financial education and counseling for vulnerable households, particularly adults age 50+.

Older adults face unique challenges in financial planning and weak job prospects. This program will assist the older adult in financial goal setting that translates into positive financial behaviors.

Hours 1.5
Location(s) All BOP Locations
Needs Addressed Finance/Poverty

Federal Sentencing: From PSR Preparation To Drafting The BOP Placement Request

PPRS - PPRSUS - Physician Presentence Report Service

Preparing for the Sentencing Hearing, in some cases should start as soon as possible.
Why?
a) Depending on if it’s a state or federal case, there may only be only weeks (or months) after the guilty verdict to start.
b) Getting all medical records via the HIPPA release can take a long time as some physicians and hospitals have been busy, especially in the age of COVID. HIPAA COMPLIANT AUTHORIZATION FOR THE RELEASE OF PATIENT INFORMATION PURSUANT TO 45 CFR 164.508.
c) Coordinating character references, expert witnesses, and documentation for their PSR all takes time.
d) Developing the PSR along with recommendations for placement takes time.

I- The Presentence Report is used by;
1st) Judges
To establish the length of the sentence, along with they have the option to make a placement request.

2nd) The BOP, For Use It For Facility Placement.

3rd) Probation Uses it during Supervised Release.

4th) It then becomes a permanent part of the defendant’s record.

5th) Lastly, for inmates, it’s referred to as the ‘Inmates Bible’.

II) Sentence Length Determined By The Court based on;
USSC Sentencing Table (Point Based), [2018, CHAPTER 5: SENTENCING TABLE]
Offense Level (0-43+): *24+ categories.

Vs
Criminal History (0-13+)
Points for each prior sentence > 1 Year + 1 Month.
Points for each prior sentence > 60 days, not counted above.
Point for each prior sentence, <= 60 days not counted above; for up to a maximum of 4 points in this category.
Points for each revocation that has a new charge or occurs under federal supervision.
Point for each prior sentence resulting from a conviction of a crime of violence that did not receive any points as noted above because such sentence was treated as a single sentence, up to a total of 3 points for this subsection.

III) BOP Determines Placement Designation
1st) Healthcare: provided based on a CARE LEVEL I-IV Structure
Applies to Medical and Mental Healthcare CARE LEVELs.
Psychology and Life Skills National Programs have now been embedded into the First Step Act, with its limited availability and associated security requirements.
There are approximately 3500 Medications in the BOP, which fall into 3 tiers. PPRS Prison Match™ has all of these drugs categorized by tier level should this applies to your client.
Is there a special diet request?
Allergies: all need to be documented in the PSR.

2nd) Non-Medical Placement is based on;
Bed Space Availability. 
Aspirational: placement within 500 driving miles of legal residence.
Population Management; some inmates, for specified reasons, need to be monitored or separated from others.

2a) Public Safety Factors (PSF) & Management Variables [P5100.08, CN-I, 9/4/2019, Tables: Chapter 5, pages 12-13]
Could a Public Safety Factor (PSF: Chapter 4, pages 5-13) warrant a reduced security level?
Accepting Responsibility (may get point reductions).
Voluntary Surrender (gets point reductions).
Drug / Alcohol Abuse may allow RDAP.
RDAP; Required usage is within 1 year prior to date arrested (illegal or legal medications or drugs).
AGE: 55+ (0Pts), 36-54 (2pts), 25-35 (4pts), <25 (8pts), Unknown (8pts).
Education Level: High School (0pts), GED Progress (1pt), No degree (2pts).

Sentence Length
>10 years – Low
>20 yrs – Medium, (Females: High)
>30 yrs – High

Disruptive Group
Male inmates will be housed in a High-security level institution unless the PSF has been waived.

Greatest Severity Offense
Male will be housed in at least a Low-security level institution unless the PSF has been waived.

Threat to Government Official
Male or female will be housed in at least a Low.

Deportable Alien: (male inmate who is not a citizen will be housed in at least a Low).

History Violent Behavior
A female inmate whose current term of confinement or history involves two convictions or findings – Low.

Serious Escape
A female, serious escape with the last 10 yrs. designated to Carswell Adm. Unit, unless the PSF has been waived.
A male inmate with or without the threat of violence or escapes housed in at least a Medium.

Juvenile Violence
A male or female who has any documented:
a) Violent behavior, past or present, which resulted in a conviction, delinquency adjudication, or finding of guilt.
b) Violence: aggressive behavior causing bodily harm, death, or behavior likely to cause serious bodily harm. 

Serious Phone Abuse
a) A male or female who utilizes the telephone to further criminal activities or Promote Illicit Organizations.
b) Conviction is Not Required, housed at least in a Low.
c) The PSF should be entered regarding any one of the following, if applicable.

Criminal acts conducted by telephone
-Leader/Organizer or primary motivator; or
a) communicate threats of bodily injury, death, assaults, or homicides.
b) conducts Fraudulent activity (actual or attempted) in an institution.
-Leader / Organizer who used the telephone to conduct fraudulent activity (actual or attempted)…
a) Smuggled narcotics or alcohol into a prison.
-Federal Law Enforcement notifies the BOP of concern and needs to monitor an inmate’s telephone calls…
a) The inmate has been found guilty of a 100 or 200-level offense code for telephone abuse.
b) A Bureau of Prisons official has reasonable suspicion and/or documented intelligence supporting telephone abuse.

Prison Disturbance
A male or female inmate who was involved in a serious incident of violence; Engaging / Encouraging a Riot:
a) Males will be housed in at least a HIGH-security level institution and
b) Females will be assigned to the Carswell Adm. Unit.

2b) Plus
a) Judicial Recommendations
b) Options For Work Cadre Participation (at secure facilities without satellite camps), where the inmate is allowed to work outside the perimeter of the institution.
c) PSF Waved: An inmate may receive up to three Public Safety Factors (PSFs) wavers.
d) Long Term Detainee transfers for positive or negative behavior may cause placement in a facility different from scored security or custody level.

IV) Making The Placement Request
In recommending a facility placement, it’s helpful to provide a reason, for example:
To facilitate regular family visitation, or
To permit participation in a specific:
a) Medical CARE LEVEL
b) Mental Healthcare CARE LEVEL
c) Psychology has limited in availability and has associated security requirements.
d) Vocational Training Program
e) UNICOR job availability

V) Military: Is your client a Veteran?
If possible, connect your client with a facility that caters to veterans.
FCI Morgantown started a Veterans to Veterans Service Dog Training Program in 2016.
The Participants are federally imprisoned military veterans who are housed in a special wing that is responsible for training service guide dogs, for veterans who have mobility impairments, Post Traumatic Stress Disorders (PTSD), or other military service missions.

If you’d like to discuss this, I look forward to speaking with you.

Dr. Blatstein                                                                                                                            Physician Presentence Report Service                                                      info@PPRSUS.com, 240.888.7778

Access 2022

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

Dr. Marc Blatstein | About

Marc Blatstein was born in Philadelphia, Pennsylvania where he attended high school. He later decided to go to George Washington University in Washington DC for his undergraduate degree where he received a Bachelor of Arts in Psychology all the while working a job on the side to help offset the high costs of a college education.

Marc Blatstein later went on to Ohio College of Podiatric Medicine where he studied medical training and obtained his Doctor of Podiatric Medicine Degree. While Marc was studying there, he started the “Pink Panther Bartenders” along with his brother and two of his classmates, to help with some of the costs of higher education. At one point, he was grateful to be asked to participate in a Gala for the Cleveland Opera, to which he agreed.

He then attended a surgical residency that covered Podiatric Medicine and Surgery, which was followed by a 31+ year career as a single practitioner. While in practice Marc Blatstein incorporated a medically oriented shoe store, wound care, and physical therapy programs into his practice.

Education | Timeline

– George Washington Univ., BA in Psych. (’77),
– Externship(s): * Lutheran Hospital Baltimore MD. (’82), * Atlanta Hospital & Medical Center, Atlanta GA (’82).
– Ohio College of Podiatric Medicine, Doctor of Podiatric Medicine, DPM (’83),
– Lawndale Community Hospital Surgical Residency in Podiatric Medicine & Surgery (’84)
– Podiatric Licensure, 1985 – present

HOBBIES

As most of my joys have been spent on the water, while I have enjoyed power boats with my best 1st mate Bailey.

In the end though, the peace and quiet of sailing are where I have spent most of my time.

 

 

PUBLICATION:

Nails Magazine, Contributor, 1990’s

 

MY PRACTICE

PLANTAR FASCITIS

According to Dr. Marc Blatstein, morning heel pain’s the most common complaint he treats. Patients relate that it is pain upon standing first thing in the morning. While the pain initially is excruciating, with ambulating the pain may subside, only to come back again with a vengeance after sitting, and then immediately returning again after standing up again.

The plantar fascia is a ligament attached at one end to the bottom of the heel (in a medial, central, and lateral band), then fanning out into the ball of the foot, thus acting as a shock absorber for the foot. As the foot impacts the ground, with each step the plantar fascia stretches slightly. When these excessive pressures of pulling the plantar fascia on the heel occur over time, with an innocent step (like stepping on a marble, or off a curb), they create small tears in the plantar fascia (the ligament on the bottom of the foot) resulting in a small amount of bleeding, pain & inflammation. Medical literature originally thought that heel pain was due to a bone spur on the bottom of the heel bone (or calcaneus). We now know that the pain is due to excessive tension on the plantar fascia as it pulls on its attachment to the inside/medial aspect of the calcaneus (heel) bone.

In the diagnosis of heel pain, Dr. Marc Blatstein relates that over the years, patient care has demonstrated that not all bone spurs are painful, and everyone with heel pain (or plantar fascitis) does not necessarily have to have bone spurs. A complete history and physical exam play a large role in approaching this diagnosis, along with weight-bearing x-rays, which are useful in determining if a heel spur is present (fractured), or associated with other pathologies contributing to the diagnosis.

Initially, treatment by Dr. Marc Blatstein can start with a combination of one or all of the following: padding & taping of the foot in a supportive nature, taking oral anti-inflammatory medications, immobilization of the foot in a walking cast, physical therapy as well as implementing specific stretching exercises. Should additional treatment be necessary, cortisone injections, as well as orthopedic functional foot orthotics, may be prescribed. Should any or all of these treatments fail, and after a detailed review of X- Rays, Lab results with your physician; surgical intervention may be considered, and according to Dr. Marc Blatstein, is very effective. Here an Endoscopic Plantar Fasciotomy is one (of many) of the possible procedures that could be recommended. A plan then is formed between you and your doctor for a successful outcome that is meant to add a full and enjoyable life to your years.

 

THE CIRCULATOR BOOT™

 

A major part of Dr. Blatstein’s practice is using The Circulator Boot™ as a method of treatment that helps with the core elements of lower extremity wound therapy: bacterial control, increased blood supply, moisture, and the removal of dead or damaged tissues to help the healing of healthy tissue. Along with other modes of treatment, surgical debridement of infected wounds, the use of antibiotic medications along with home care, and boot therapy in Marc Blatstein’s eyes may improve the blood supply and control the infection when standard methods of treatment are failing.

The Circulator Boot™(Mayo Clinic.org), from Dr. Marc Blatstein’s years of experience, the end-diastolic timing of its leg compressions, (this FDA-approved non-invasive technology) provides benefits in the prevention of leg amputation. Poor circulation and infection are the leading causes of 90,000 diabetic amputations that occur every year in the United States.

The Circulator Boot™ “A leg with poor arterial blood flow may be likened to a dirty sponge that is half wet. Squeezing such a sponge disseminates the water throughout the sponge. Soaking and wringing the water repeatedly from the sponge may help clean it. In like fashion, the heart monitor of the Circulator Boot™ is timed to allow each arterial pulse wave to enter the leg as best it can (to partially wet the leg “sponge”). Boot compressions provide a driving force to disseminate blood around the leg and at the same time press venous blood and excess tissue water from the leg. Patients with a pulse rate of 80 beats per minute might receive 4800 such compressions an hour. Patients with severe arterial leg disease might receive 100 such treatments or close to a half-million compressions! Breakdown of the clot, re-channelization of blocked vessels, and the formation of small new vessels may help restore blood flow.”

For those who may be facing amputation, this may be an option. Dr. Marc Blatstein recommends learning more about The Circulator Boot™ as a Method of Treatment, via The Circulatory Boot Service at the Mayo Clinic.

 

TARSAL TUNNEL SYNDROME

Similar to Carpal Tunnel, Tarsal Tunnel Syndrome is due to the compression of a nerve called the Posterior Tibial Nerve. Dr. Marc Blatstein, a Podiatric Surgeon, explained that Tarsal Tunnel Syndrome occurs over time as the nerve becomes inflamed resulting in symptoms such as burning, electric shocks, tingling, as well as a shooting type of pain. Other factors that Dr. Marc Blatstein, has found factors contributing to Tarsal Tunnel Syndrome come from either an overly pronated foot which puts a stretch on the nerve, pressure on the nerve from soft tissue masses such as ganglions, fibromas, or lipomas that physically compress the nerve, as well as other insults to the nerve.
The diagnosis is usually quickly made by physical exam as well as the patient’s history of their complaint. Observation may reveal a slight swelling just on the inside of the ankle joint. As part of the physical exam, Dr. Marc Blatstein finds that gently tapping the inside of the ankle joint in the acute phase will result in a tingling sensation that may shoot, both up the leg and/or into the foot. Nerve conduction studies are another tool that will reveal if there is damage to the nerve.

Treatment of the Tarsal Tunnel involves many different components, some of which are: correcting the abnormal pronation of the foot [which is accomplished with prescription functional foot orthotics]. Along with this, oral anti-inflammatory medications, vitamin B supplements, &/or steroids may provide some benefit, but are rarely curative. Should there be a soft tissue mass compressing the nerve, then surgical removal of the mass may be necessary. Surgical correction of Tarsal Tunnel Syndrome has a good chance of success, at the same time the over-pronation of the foot still needs to be followed with functional foot orthotics.

 

THE PAINFUL HAMMERTOE

According to Dr. Marc Blatstein, hammertoes appear with the toes bent in a clawing fashion. Hammertoes may be flexible or rigid, flexible infers that you can manually straighten the toes, while it is not possible to straighten a rigid toe. Because most of us wear enclosed shoe gear, the pressure caused by the shoe gear we wear causes the toes to become painful. On top of this pressure forms hard corn, while on the bottom of the foot the toe actually pushes the metatarsal bone down forming a callus. Treatment of hammertoes can be approached in many ways. Dr. Marc Blatstein starts by recommending a combination of appropriate shoe gear, as well as a functional orthotic, prescribed as a shoe insert to help the hammertoes from progressing or getting worse. In the very initial stages while the toe is still flexible, it can be tapped into its corrected position, also utilizing a functional orthotic. This conservative treatment also consists of hammertoe and buttress pads all available over the counter, in addition, to open-toe shoes.

With continued pain, correction of the deformity while successful depends on whether they are rigid or flexible. While the hammertoe is still flexible, a simple tendon release followed by taping it in the corrected position is usually effective. Then a functional orthotic may be prescribed to help maintain this correction. With a rigid hammertoe, the surgical procedure consists of removing some skin along with a small section of bone. Dr. Marc Blatstein told us that in cases of a severe hammertoe deformity a pin may be used to hold the toe in its corrected position for several weeks & then it is removed. In all cases, it is very important to follow your surgeon’s after-surgery instructions in order to get the best result.

 

INGROWN TOENAIL

Victoria Azaranka recently dropped out of a tennis match because of an ingrown toenail. Dr. Marc Blatstein, tells us how to prevent ingrown toenails. There are several people who wait far too long to have the   procedure and they have more complications 

Most of the time people do not think that an ingrown toenail will get in the way of their profession, for one person it did. Victoria Azaranka who is the world’s No. 1 tennis player was sidelined due to an ingrown toenail in her right big toe. The toenail had become ingrown and made it so painful she had to sit out of a match against Serena Williams a former world’s No. 1 women’s tennis player. The cause behind the ingrown toenail is a surprise, a bad pedicure.

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

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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