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 inmate’s Risk of Recidivism

BOP Psychology Programs

 

BOP Psychology Programs

If your client has replied ‘Yes’ to the questions (I- IX) below, one of these 9 BOP Psychology Programs may provide the best placement option for your client.

RDAP eligibility and an overview are covered in section VIII.

I) Is your client a first-timer young male offender 32 years of age or younger, facing a sentence of 60 months or more?

  • If yes, would your client be interested in participating in a program that teaches how to create a smoother adjustment to federal Prison?
  • Will they be sentenced to a medium-security facility?
  • If all three answers are yes, this program may help □;

BOP Brave Program– Facility Locations:

    • FCI Victorville, CA-Medium
    • FCI Beckley, WV-Medium

II) Is your client a male inmate in (or facing) a

  • high-security penitentiary setting with a history of substance abuse/dependence or
  • a major mental illness as evidenced by a current diagnosis of a Psychotic Disorder that may include;
    • Mood,
    • Anxiety,
    • Schizophrenia,
    • Delusion, and/or a
    • Substance-induced Psychotic Disorder?
  • If the answers are yes, this program may help □;

BOP Challenge Program – Facility Locations:

    • USP Big Sandy, KY-High
    • USP Hazelton, WV-High
    • USP Lee, VA-High
    • USP McCreary, KY-High
    • USP Allenwood, PA-High
    • USP Canaan, PA-High
    • USP Beaumont, TX-High
    • USP Coleman I, FL-High
    • USP Coleman II, FL-High
    • USP Pollock, LA-High
    • USP Tucson, AZ-High
    • USP Atwater, CA-High
    • USP Terre Haute, IN-High
    • USP Coleman I, FL (H)
    • USP Coleman II, FL (H)

III) Is your client a male or female with

  • a serious mental illness, but
  • who does not require inpatient treatment?
  • Do they lack the skills to function in a general population prison setting?
  • Would they be interested in a psychology program that
    • works closely with Psychiatry Services to
    • ensure they receive appropriate medication and
    • have the opportunity to build a positive relationship with the treating psychiatrist?
  • If your answers are yes, this program may help: □;

BOP Mental Health Step Down Program- Facility Locations:

    • FCI Butner, NC-Medium
    • USP Atlanta, GA-High

* Male inmates with a primary diagnosis of Borderline Personality Disorder are referred to the BOP STAGES Program

IV) Is your client a male or female with a

  • history of mental illness related to
    • physical, mental, intimate domestic violence, or traumatic PTSD?
  • Would your client be interested in a mental healthcare program that
    • focuses on the development of personal resilience,
    • effective coping skills,
    • emotional self-regulation, and
    • healthy interpersonal relationships?
  • If both answers are yes, this program may help: □;

BOP Resolve ProgramFacility Locations:

    • FPC Alderson, WV-Minimum (F)
    • SFF Hazelton, WV -Low (F)
    • SCP Lexington, KY-Minimum (F)
    • SCP Greenville, IL-Minimum (F)
    • FCI Aliceville, AL-Low (F)
    • SCP Coleman, FL-Minimum (F)
    • SCP Marianna, FL-Minimum (F)
    • FCI Tallahassee, FL-Low (F)
    • FCI Dublin, CA-Low (F)
    • SCP Victorville, CA-Minimum (F)
    • ADX Florence, CO-Maximum (M)
    • FCI Waseca, MN-Low (F)
    • FCI Danbury, CT-Low (M)
    • SCP Danbury, CT-Minimum (F)
    • FSL Danbury, CT-Low (F) (Activating)
    • FFPC Bryan, TX-Minimum (F)
    • FMC Carswell, TX-Adm. (F)

V) Does your client have a

  • significant functional impairment due to
    • intellectual disabilities,
    • neurological deficits, and/or
    • remarkable social skills deficits?
  • For example, do any of these apply to your client:
    • Autism Spectrum Disorder,
    • Obsessive-Compulsive Disorder,
    • Epilepsy, Alzheimer’s,
    • Parkinson’s, or
    • Traumatic brain injuries (TBIs) to mention just a few?
  • Would your client be interested in improving their institutional adjustment and
    • the likelihood of successful community reentry?
  • If your answers are yes, this program may help: □;

BOP Skills Program– Facility Locations:

    • FCI Coleman, FL-Medium
    • FCI Danbury, CT-Low

Note:

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

Dental care is tough to find for people with autism
Inmate patients (who need specified dental procedures) with autism and other developmental disorders require general anesthesia for non-routine dental work.

Most dentists are not equipped to provide it, and insurers will not cover general anesthesia for root canals.

VI) Is your client a male inmate (or facing prison) with

  • serious mental illnesses and
    • a primary diagnosis of Borderline Personality Disorder, along with
    • a history of unfavorable institutional adjustment linked to this disorder?
  • Would they be willing to volunteer for this mental healthcare psychology program?
  • If both answers are yes, this program may help: □;

BOP Stages Program– Facility Locations:

    • FCI Terre Haute, IN-Medium
    • USP Florence, CO-High (Effective 9/ 2014)

VII) Sex Offender Conviction(s)

VIIa) Sex Offender Treatment Program: Nonresidential (SOTP -NR)

  • Is your client considered a low to moderate-risk sexual offender?
  • Does your client have a history of a single-sex crime; or
    • are they serving a sentence for a first-time Internet Sex Offense?
  • If both answers are yes, this program may help: □;

BOP Sex Offender Non-Residential SOTP-NR ProgramFacility Locations:

    • FCI Petersburg- Medium
    • FCI Englewood, CO-Low
    • USP Marion, IL-Medium
    • FCI Elkton, OH-Low
    • FMC Carswell, TX-Med. Ctr.(Females)
    • FCI Seagoville, TX-Low
    • FCI Marianna, FL-Medium
    • USP Tucson, AZ-High

VIIb) Sex Offender Treatment Program: Residential (SOTP -R)

  • Is your client considered a high-risk sex offender?
  • Does your client have a history of multiple sex crimes (re-offense sex offender),
    • extensive non-sexual criminal histories, and/or
    • a high level of sexual deviancy or hyper-sexuality?
  • Does their criminal history include;
    • rape,
    • sodomy,
    • incest,
    • carnal knowledge,
    • transportation with coercion,
    • the force for commercial purposes or sexual exploitation of children,
    • unlawful sexual conduct with a minor, and/or
    • Internet pornography?
  • If your answers are yes, this mental healthcare program may help: □;

BOP SOTP-Residential Program Facility Locations:

    • USP Marion, IL-Medium
    • High FMC Devens, MA-Med. Ctr.

VIIc) New: BOP Commitment and Treatment Program for Sexually Dangerous Persons.

  • Is your client a candidate for
    • psychological treatment,
    • implementation of a behavior management plan, and
    • coordination of a multidisciplinary treatment team?
  • Can your client be considered sexually dangerous with
    • the possibility of criminal recidivism?
  • If both answers are yes, this program may help □;

Butner ‘New’ Commitment and Treatment Program – Facility Location:

    • FCC Butner, NC

VIII) RDAP

To verify RDAP eligibility, in addition to drug and alcohol abuse, prescription medications along with other medications available over the counter are also included.

According to the American Bar Association: there must be a verifiable, documented pattern of substance abuse or dependence within the 12-month period preceding arrest.

IX) NEW: The BOP Female Integrated Treatment (FIT) Program

  • Is your client a candidate for cognitive-behavioral treatment for females with substance use disorders, mental illness, and trauma-related disorders to female inmates?
  • Would your client also qualify for RDAP and those treatment plans which would also address substance use in this residential program may qualify for the early release benefit associated with RDAP?
  • If your answer is yes, this program may help □;

BOP FIT Program and Locations:

    • FSL Danbury, CT-Low – The New (FIT) Program

__________________

A Good Medical Resource: UpToDate

An evidence-based clinical decision support resource (one of many), that is authored and peer-reviewed exclusively by physicians who are recognized experts in their medical specialties.

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 to draft an accurate

Presentence Report – which will control your future

Incorporate these federal prison placement data points:

Medical and Mental Healthcare needs to be implemented through

  • Psychological Treatment Programs while available, have limited access and several may be 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

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

PPRSUS.com

As found in my LinkedIn 2/29/2020 post

Healthy Steps for Older Adults 2022

FSA, Productive Activities (PA)
Healthy Steps for Older Adults 2022

Program Description Healthy Steps for Older Adults is an evidence-based falls prevention program designed to raise participants’ knowledge and awareness of steps to take to reduce falls and improve health and well-being. The goal of the program is to prevent falls, promote health, and ensure that
older adults remain as independent as possible for as long as possible.
Hours 3
Location(s) All institutions
Needs Addressed Medical/Recreation/Leisure/Fitness
Program Delivery Contractors
Health Services
Recreation
Unit Team
Volunteers

Sex Offender Programs – Federal Prison

PPRS - PPRSUS - Physician Presentence Report Service

FEDERAL PRISON SEX OFFENDER:

BOP PROGRAMMING WITH 2 LOCATIONS NATIONWIDE

SEX OFFENDER PROGRAM RESIDENTIAL (SOTP-R) is a voluntary program (P5324.10) for Sex Offenders, and those with a history of multiple sexual offenses, re-offense, extensive non-sexual criminal histories, and/or a high level of sexual deviancy or hypersexuality. Inmates ordinarily participate in the program during the remaining 36 to 48 months of their sentence. The duration of the program is 12-18 months. Placement in the SOTP-R is reserved for inmates with more extensive sex offense histories, and cohousing participants permit the implementation of a modified therapeutic community, separate from the general population.

Having only 2 SOTP-R facilities nationwide – before they enter the program, initial placement into a free-standing Federal Prison Camp (FPC), or satellite minimum camp (adjacent to a higher secure facility), if practical, should be part of the court’s calculation.

This is because should an inmate consider acting violently towards your client – most would likely refrain as a single incident would have them transferred behind the wall, to a higher security facility, which they would not want.

Ultimately it just may come down to you knowing your client and the facility recommendation options available during the period before SOTP-R placement. Keep in mind that no matter what the BOP says, this could be a real-life event, therefore having this discussion with your client may prove crucial.

BOP PROGRAMMING WITH 9 LOCATIONS NATIONWIDE

SEX OFFENDER PROGRAM NON-RESIDENTIAL (SOTP-NR), is also a voluntary program (P5324.10) for low to moderate first-time sex offenders with a single history of Internet Sex Crime, intended to identify offenders who are likely to re-offend. Inmates ordinarily participate in the program during the remaining 36-48 months of their sentence. SOTP-NR participants reside in the general population.

Having only 9 facilities nationwide – before they enter the SOTP-NR program, if practical, other than an FPC, or satellite minimum camp, should an inmate act violently towards your client – again, they would most likely refrain, as a single incident would have them transferred behind the wall, to a higher security facility. Otherwise, any other placement could result in a life-threatening sentence.

Consideration may again come down to knowing your client and understanding the facility options available for the period before their SOTP-NR placement.

BOP, 1 LOCATION NATIONWIDE

BUTNER’S COMMITMENT AND TREATMENT PROGRAM FOR SEXUALLY DANGEROUS PERSONS (2022-2023), “This FCI remains a flagship facility and is frequently chosen to pilot new programs such as the Sex Offender Commitment and Treatment Program,” (Page 6).

  • FCI Butner is responsible for the psychological treatment and implementation of behavior management plans, with the coordination of the multidisciplinary treatment teams. Treatment is holistic and multidimensional with the ultimate goal of reducing sexual dangerousness and criminal recidivism potential.
  • FCC Butner has an internship integrated practitioner-scholar model which seeks “the productive interaction of theory and practice in a primarily practice-based approach to inquiry”. The internship component of the Psychology Service strives to meet the training needs of doctoral candidates in applied psychology through supervised experience, didactic programs, and focused scholarship.
  • As there is only 1 location, which appears ‘court ordered’, there should be no other issues regarding inmate threats.

Fore more…

SEX OFFENDER SAFETY IN PRISON- PART OF YOUR SENTENCING CALCULATION

PPRS - PPRSUS - Physician Presentence Report Service

SEX OFFENDER SAFETY – PART OF YOUR SENTENCING CALCULATION

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

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

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

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

 

ENSURING THE PHYSICAL SAFETY OF YOUR CLIENT

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

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

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

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

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

For more…

Post-COVID Virus Causes Lingering or Ongoing Symptoms

PPRS - PPRSUS - Physician Presentence Report Service

The complicated care required for Post-COVID Long-Haulers is likely beyond the mission of most (if not all) prisons, jails, and detention centers.

According to researchers, this is still an active area of investigation. As we are approaching spring/fall 2022/2023, the Post-COVID Pandemic may be becoming an Endemic. Still, with that in mind, treating Post-COVID Long-Haulers and the amount and variety of staff, equipment, finances, and time needed, may just not be available to those incarcerated.

COVID is a true roller coaster of symptoms and severities, with each new day offering many unknowns.”

 “The difficulty is sorting out long-term consequences,” says Joseph Brennan, a cardiologist at the Yale School of Medicine.

While some patients may fully recover, he and other experts worry others will suffer long-term damage, including lung scarring, heart damage, and neurological and mental health effects.

Long after the fire of a Covid-19 infection, mental and neurological effects can still smolder[1]. ‘Long-Haulers’ after the initial COVID-19 hospitalization: fall into 3 categories (Dr. Sanghavi)

1st) The COVID virus causes lingering or ongoing symptoms, meaning that “ symptoms do not recover completely and are ongoing because of direct cell damage from the virus,”

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2nd) involves chronic ICU hospitalization for weeks. This causes:

  • muscle weakness,
  • cognitive brain dysfunction,
  • psychosocial stress-causing post-traumatic stress disorder (from chronic hospitalization).

3rd) symptoms appearing after recovery. “Interplay with the immune system of a person, and then the impact that both those things have on the body.”

“We are still trying to understand exactly how this interplay between the immune system and inflammatory markers work, but there’s no doubt that that is a group of symptoms because of ramped up immunity or ramped up inflammatory system,” Dr. Sanghavi added.

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Peripheral nerve issues, such as Guillain-Barré Syndrome, can lead to paralysis and respiratory failure.

Post-COVID Stress Disorder is another emerging consequence of the global pandemic.

Although most cases of COVID-19 appear to be mild with a recovery time of a few weeks, health experts are seeing more patients who suffer symptoms for months or get better, and then relapse down the road.

Isolation Is Not the Answer, Precautions for Adults with COVID-19[ii]

For more…

POST – COVID A PHYSICIAN’S JOURNEY

PPRS - PPRSUS - Physician Presentence Report Service

POST – COVID, A PHYSICIAN’S JOURNEY

Post – COVID a physician’s journey in the summer of 2020 working on both general medical and COVID-positive wards. But by November of that year, the U.K. was in its second wave and second lockdown, with COVID deaths and hospital admissions rising.

“Like being on a treadmill I could not get off”

Being given only basic personal protective equipment (PPE), Dr. Fearnley and her newly graduated doctors were sent onto medical and COVID wards. While on a COVID ward, and after not feeling well, a PCR Test returned positive for COVID, and what comes next follows the phases she went through:

  • “The acute phase lasted 2 weeks – comparable to a case of mild-to-moderate flu.”
  • “As a fit and healthy 35-year-old with no comorbidities, she naively expected to recover quickly,”
  • “By week 3, she still had a lingering fever,”
  • By week 4, Dr. Fearnley wanted to return to work, but being lightheaded and jelly-legged, just made it home.

Thus began the start of her long Post-COVID Long-Hauler (as it was later defined) Journey.

Getting slightly graphic, these attacks “were associated with an unquenchable thirst, with or without an urgent need to open to my bowels, vomiting, or increased shortness of breath. These came in daily cycles lasting up to 14 hours at a time. I would frequently shake through the entire night”.

For more…