DOJ Study Identifies Racism's Persistence in Criminal Justice: Can Medicaid Change That? DOJ & HHS Webinar: Juvenile Justice & Medicaid; AWS Update

Highlighted Stories

Editor's Note

This week's first highlighted story comes from a study done by the Department of Justice required by the First Step Act of 2018 (FSA). That act mandated the development and implementation of a risk and needs assessment tool: Prisoner Assessment Tool Targeting Estimated Risk and Needs (PATTERN). The reason for the development of this tool was to establish a more consistent and rational process of predicting recidivism of incarcerated people. The study, the fourth annual review of the Federal Bureau of Prison's use of PATTERN, found that the tool overpredicts the recidivism risk of non-white people. This overprediction raises a valid concern that the criminal justice system has an inherent bias to be discriminatory against people of color and the efforts to create a more fair and equitable system through the development of tools such as PATTERN, face a substantial uphill battle.

COCHS’ advocacy for bringing Medicaid coverage behind the wall comes from an understanding of an historical connection between plantation culture and correctional culture (see remarks of Gary Puckrein the CEO of the National Minority Quality Forum at COCHS’ 2015 Convening ), and how the criminal justice system remains open to accusations of racism. While the COVID epidemic and the opioid epidemic demonstrated that health disparities and outcomes have a high correlation with race (see 2021 JAMA study and the second highlighted article from News Medical Life Sciences), Medicaid as a payer is uniquely positioned to escape racial bias. Medicaid sets standards that are equally applied across all beneficiaries, sets payment rates that are equally applied amongst all beneficiaries in a given state, and creates health and safety standards that are equally applied across all beneficiaries in a state.

Not only does Medicaid create equal sets of standards among all beneficiaries in a given state, it also gives each and every one of those beneficiaries a due process right to enforce the standards that have been established on their behalf. Looking at our correctional system through the lens of Medicaid will not, on day one, create an equal and fair non-racist environment. But at COCHS, we posit that it is only through the development of these uniform standards and the right to enforce due process rights, that we can create an equal and just environment for the millions of incarcerated Americans.

Continuing on the subject of Medicaid, the third highlighted story is a link to register for a webinar sponsored by the Department of Health and Human Services (HHS) and the Department of Justice (DOJ) today Tuesday, August 27, 2024, at 2 pm ET. This webinar delves into new policy approaches designed to connect justice-involved youth with Medicaid and CHIP services that address the statutory requirements in the Consolidated Appropriations Act, 2023, Section 5121, and how this legislation changes the availability of certain state plan services for incarcerated youth.

Finally, as a follow-up to last week’s Editor’s Note highlighting Amazon’s entry into the correctional health care environment, the last story is a study that tracks prescription patterns in jails based on data transferred from NaphCare's EHRs to a repository in Amazon Web Services (AWS). This data provided the necessary information to make the analysis for this investigation.

Racism In The Criminal Justice System

The First Step Act of 2018 (FSA) mandated the development and implementation of a risk and needs assessment system in the Federal Bureau of Prisons (FBOP). The FSA also required the U.S. Department of Justice (DOJ) to review, validate, and publicly release the risk and needs assessment system on an annual basis. This study reviews the predictive reliability of the Prisoner Assessment Tool Targeting Estimated Risk and Needs (PATTERN). Although the study found the tool to have predictive accuracy, it also found that the tool continued to worsen the overprediction of recidivism for Black males. Black males were 6% less likely to engage in general recidivism compared to White males. The study reports that "there remains evidence that the instruments predict differently across those groups, including overprediction of risk for Black, Hispanic, and Asian males and females, relative to White individuals, on the general recidivism tools."

Patients with a prescription for an opioid use disorder medication may have a tough time getting it filled if their pharmacy is in a community that's racially and economically segregated, according to a new study led by scientists at Oregon State University and Johns Hopkins University. The findings shed additional light on inequities in health care as the U.S.'s overdose crisis continues to accelerate, with fatality rates rising fastest in Black and Hispanic/Latinx communities.

Webinar

This webinar is scheduled for today Tuesday, August 27, 2024, at 2 pm ET over Zoom. The Centers for Medicare & Medicaid Services (CMS) last month issued a letter to State Health Officials addressing the statutory requirements in the Consolidated Appropriations Act, 2023 (CAA, 2023) regarding the availability of certain state plan services for incarcerated youth in Medicaid and the Children's Health Insurance Program (CHIP) and modification of CHIP eligibility requirements for children who become incarcerated in juvenile or adult corrections systems. HHS and DOJ leadership and subject matter experts will discuss how this opportunity will help advance health equity and build healthier and safer communities.

This article provides a map of the states that have had their 1115 waivers approved and those with pending waivers.

AWS Update

In response to the COVID-19 pandemic, jails were advised to reduce facility census, particularly the growing population of those with medical/behavioral health vulnerabilities that increased susceptibility to adverse outcomes. The current investigation aspired to describe jail census trends before/since the onset of COVID-19 and offer snapshots of temporal changes and context for prevalence estimates of medical/behavioral health conditions in jail detainees from 2019 to 2023. The study relied on data from 18 county and municipal jails nationwide between 2019 and 2023. Each facility held contractual agreements with NaphCare. for the provision of medical/behavioral health services. Data extracted from the EHR were pipelined to an Amazon Web Services (AWS) EC2 SQL instance which allowed developers to extract predefined datapoints needed for the study.

State Roundup

Indiana

To date, five people have died in the Allen County (Fort Wayne) jail in the past year. Of those five deaths, three were suicides. Allen County Sheriff Troy Hershberger says he can’t handle this problem on his own. Sheriff Hershberger says 44 inmates in the jail currently are being treated for acute mental health issues. He says he’s running out of options when it comes to caring for mentally ill inmates. For its mental health treatment, the jail is currently using one outside medical provider to monitor all 44 inmates.

Louisiana

The longtime head of Louisiana's prison system, Jimmy LeBlanc, has resigned for health reasons. Leblanc served for three governors, Republican Bobby Jindal, Democrat John Bel Edwards, and now Republican Jeff Landry. This announcement comes after series of reported by the WBRZ about issues at Elayn Hunt Correctional Center. Among the allegations, rampant drug use and deplorable conditions at the facility and there are other possible issues being investigated.

The resignation of Louisiana's prisons chief amid recent reports on the Elayn Hunt Correctional Center have sparked conversation about what's really going on inside state prisons. Founding member of the East Baton Rouge Parish Prison Reform Coalition Rev. Alexis Anderson says that the alleged problems going on in the facility are widespread. A DOC employee and an inmate in the facility have made claims about alleged drug trafficking and unsanitary living conditions.

Michigan

Several corrections officers, their friends and families, concerned citizens, politicians and union representatives picketed Tuesday at the side of Highway 41 and Superior Avenue in the vicinity of Baraga Correctional Facility. The picketing was one of three planned at Upper Peninsula prisons by the Michigan Corrections Organization union to raise awareness of the low staffing levels in the Michigan Department of Corrections facility and the dangers it creates for corrections officers with an emphasis on mandated double shifts.

Montana

Missoula County this month revoked its consent to hold offenders from state agencies at the local detention center without prior permission, unless the agency agrees to pay the full cost of housing the inmate. The county's action also sends a strong message to the state, primarily the Montana Department of Corrections and the Department of Public Health and Human Services, that they're failing to address the state's growing mental health crisis. Counties across Montana have long held state inmates in local jails, and many of those inmates are supposed to receive treatment for addiction or mental health while in custody.

Nebraska

An inspector general is recommending changes in the Nebraska Department of Correctional Services after reviewing three in-custody suicides. A report details successes and failures made by staff and infrastructure within NDCS in the wake of three suicides between 2021 and 2023. The inmates died by hanging in each incident, but all under different circumstances.

Pennsylvania

Two inmates tested positive this week for Legionnaires’ disease at the State Correctional Institution-Phoenix in Montgomery County. Legionnaires’ disease is a type of pneumonia, and is not spread person-to-person, but instead contracted by breathing in small droplets of water containing legionella bacteria. Last year, an inmate at a Pennsylvania state prison near State College tested positive for Legionnaires’ disease.

“I can’t thank you enough for being here,” Warden Cheryl Steberger told participants as the latest listening session on the new Lancaster County correctional facility. As a part of the new facility there will be a prison’s wellness center will allow much more medical care to be provided on site than is possible at the current County Prison. Among other things, that will reduce the need for frequent outside “med runs” and for correctional officers to guard inmates admitted to local hospitals, factors that are driving significant overtime costs. The hope is that the Medication Assisted Treatment program for substance abuse can be administered on each unit, but that’s still being evaluated.

Washington State

The family of Michael Rowland has sued King County in federal court for $25 million, according to the lawsuit’s tort claim filed with the county. The suit alleges that the county violated Rowland’s civil rights, was negligent in its treatment of him and caused his wrongful death. Rowland was one of five people to die in the downtown Seattle jail in quick succession in the winter and spring of 2022 while the jail struggled with severe understaffing. His death highlights the danger that people in psychiatric distress can face when being funneled into jail systems that provide little support.

Rikers Island

The Rikers Island detainee who died last week was seen by a jail medical professional the day before his death, but was sent back to his housing unit, according to a top city jail official familiar with the case. Anthony Jordan, 63, was found “unresponsive” on the sixth floor inside the North Infirmary Command on Rikers and rushed to Mount Sinai Hospital in Astoria, according to Correction Department. Advocates and former insiders say the events leading up to Jordan’s death point to a potential mishandling of his health needs. They noted that medical staff who work in jails “unfortunately” often treat people like they are faking their pain or discomfort.

San Diego County

California medical regulators have revoked the license of Dr. Carol Ann Gilmore, who was among the many healthcare professionals and sheriff’s deputies under whose watch Elisa Serna died in a San Diego County jail five years ago. She was accused by the medical board of failing to properly treat Serna, who had been arrested on drug and theft charges. Serna had told jail staff that she was addicted to alcohol and heroin but was not placed into department withdrawal protocols. Serna died on the floor of her jail cell five days after she was booked into custody.

Technology

People released from correctional facilities in King County, Washington, over the next three years will be eligible to receive virtual substance abuse support, a company developing the mobile app announced this week. The Washington Department of Corrections and King County, which surrounds Seattle, partnered with the Los Angeles virtual recovery program Igntd to provide substance abuse services for inmates released to and residing in King County. According to Igntd’s Tuesday announcement, users will have 24/7 access to substance-use disorder care, individual and group coaching, support services and case management functions.

Correctional Health Care Vendors

Wellpath

The parents of Bradley S. Hensley, a former inmate at the Henry County Adult Detention Center, filed a lawsuit in federal court alleging their son died while an inmate in 2022 due to negligence. Brad Hensley had been diagnosed with congenital adrenal hyperplasia (CAH), also known as “salt wasting” disorder, according to the filing. The National Institute of Health describes the condition as a hereditary disorder of the adrenal glands, which produce hormones that affect metabolism, blood sugar regulation, blood pressure and other essential functions. “Despite pleas by Brad, his family, fellow detainees, and others,” the filing alleges that the defendants “ignored his distress and refused him the necessary medication and eventual emergent care that he needed.” Employees of the sheriff and Wellpath are named as defendants.

A legislative subcommittee on Monday delayed approval of a $235.5 million medical contract for the Arkansas Department of Corrections after lawmakers voiced concerns about the extent of coverage for inmates and an ongoing dispute over prison bed expansion. The contract presented to the Arkansas Legislative Council’s Review subcommittee represents the first two years of a potential ten-year $1.6 billion contract with Wellpath to provide comprehensive medical, dental, pharmacy and mental health services for inmates and offenders in the custody of the Department of Corrections

Turn Key Health Clinics

A settlement appears near in a federal lawsuit filed by the estate of a mentally ill man who starved to death in the Sebastian County jail in Fort Smith. County Judge Steve Hotz said Thursday that the Sebastian County Quorum Court approved an appropriation of up to $3 million to settle the county’s portion of the lawsuit. In addition to Sebastian County, other defendants are Turn Key Health Clinics LLC, an Oklahoma-based corporation that was contracted to provide physical and mental health care to inmates at the jail.

COCHS Weekly Update Will Not Be Published Next Week
In Observation of Labor Day