COCHS WEEKLY UPDATE: March 26, 2024


Highlighted Stories

Editor's Note
This week's highlighted stories discuss MOUD in corrections and take differing perspectives on its efficacy. A JAMA study concludes that MOUD has nominal efficacy with males and less efficacy with females. In contrast to that, the article from Albuquerque reports on an auditor's findings at the Metropolitan Detention Center in that jurisdiction. Even though the facility was required to provide MOUD to incarcerated individuals, this care reached very few of the eligible detainees. The JAMA study and the article from Albuquerque raises many questions. In the JAMA study, what role if any did the self-selected sample of people impact the outcome? In Bernalillo County, we see a familiar scenario where mandated treatment was not delivered. Is this a case of correctional intransigence or just system chaos? In both cases were there bureaucratic hurdles in qualifying for methadone or buprenorphine?

As was discussed in last week's Editor's Note, the Department of Justice has now come out with a position that correctional facilities must provide medically assisted treatment to individuals with a substance use disorder at the point of incarceration under their ADA rights. It is a powerful combination, the DOJ policy with the recent Medicaid 1115 waivers and the funding that Medicaid entails. The impact of these levers being used will hopefully require better responses to mandated care and much needed further investigation of outcomes.

MOUD
JAMA: Prison Buprenorphine Implementation and Postrelease Opioid Use Disorder Outcomes
In this study of 225 adults incarcerated and released from prisons in Massachusetts, when buprenorphine treatment began to be offered during incarceration (previously only naltrexone was available), postrelease buprenorphine receipt in the community increased, accompanied by a smaller decrease in naltrexone receipt. When stratified by sex, there was a small decrease in postrelease all-cause mortality in the male cohort (and a decrease in postrelease opioid overdose in the female cohort that was not statistically significant).

Albuquerque Journal: Audit of inmate health care at Bernalillo County jail found a ‘lot of work’ to be done
A November audit of the Bernalillo County jail’s medical care found improvements but also identified roadblocks in providing "timely and adequate health care" to inmates. Currently, the inmates are not receiving the standard of care they require in a timely and dependable manner,” according to the report. UNMH, the new health care provider, reported up to 700 people in withdrawals are booked into MDC every month — with 140 at the facility on any given day — but they have only treated 67 people with Suboxone since starting the medication in December. This is in direct violation of a December 2022 court order, from a decades long settlement agreement, that directs the jail’s health care provider, UNMH, to treat everyone in withdrawal with Suboxone or methadone.

Seattle Times: Fentanyl crisis descends on jail in a small WA town short on treatment
Small jails in rural areas of Washington State, lack a key tool in fighting the crisis. While an influx of state money is poised to help more jails provide medications to treat opioid use disorder, there have historically been significant barriers, including costs and a shortage of health care providers. This year, state legislators agreed to add nearly $7.4 million to the state’s budget to maintain and grow a program that pays for the medications in jails. Lawmakers also passed a bill requiring jails to inform people who are being released from custody of treatment options. Washington has been working to try to fill that gap through a state Health Care Authority program that provides money to jails to cover the cost of the medications.




Mental Health

Marshall Project: They’re Not Cops. They Don’t Have Guns. But They’re Responding to More 911 Calls.
People experiencing mental or behavioral health crises and addiction have often been subject to police use of force, arrest and incarceration. But there are some efforts around the country to change that. One of the most common new approaches — and one that has rapidly gained traction since 2020 — are civilian co-responder programs, in which behavioral health specialists, often social workers, show up to certain emergency calls alongside police. These can include situations like suicide threats, drug overdoses, and psychiatric episodes.

Public News Service: Criminal Justice Month: Alternatives to incarceration for mental health issues
March is National Criminal Justice Month and advocacy groups are drawing attention to how people with mental illness are overrepresented in jails and prisons. According to the Prison Policy Initiative, 43% of people in state prisons and 44% of people in local jails have been diagnosed with a mental health disorder. John Mitchell, mental health court judge in Kootenai County (ID), said about half of the people in his caseload have some sort of mental health diagnosis, but noted jail does little to change their behavior.

Queens Daily Eagle: Rikers sees higher rates of mental health and violent felony charges, report finds
Two distinct populations on Rikers Island grew more than any other over the past decade – detainees diagnosed with mental health issues and those facing violent felony charges, a new report found. In a study issued by the Independent Budget Office on Tuesday, the IBO said that no other groups saw the same explosion in population on Rikers Island over the past 10 years – which the report described as an “immensely volatile period” – than those needing mental health treatment and those facing some of the most extreme charges.

KLFY: Lafayette Parish Sheriff’s Office says mental illness plays a factor in jail overcrowding
Captain John Mowell with the Lafayette Parish Sheriff’s Office said due to the limited number of beds at a mental health facility, inmates who are classified as mentally ill, are housed in parish jails, which contributes the jail being overcrowded. Because of the lack of resources and housing for the inmates classified with mental health issues, there is nowhere to place them other than the parish jails.

centralmaine.com: Maine wants to keep housing some criminal defendants with mental illness in prison
In 2021, the Legislature temporarily granted the Department of Health and Human Services the power to transfer certain violent criminal defendants who have been ruled incompetent to stand trial from psychiatric hospitals to the Maine State Prison. Between Oct. 18, 2021, and Dec. 15, 2023, Maine courts issued 130 orders of incompetence, according to a report DHHS and the Department of Corrections issued this January. Out of those, only four were moved to the state prison’s psychiatric ward under the 2021 law.

WTAE: Allegheny County promises more mental health support, less use of force at its jail
The Allegheny County jail could significantly increase its mental health staffing and provide more training about use of force and restraint under a proposed settlement. The agreement, which still requires a judge's approval, would resolve a class action that accused the jail in Pittsburgh of offering inadequate treatment and medication for inmates with mental health disabilities, and often punishing them with extended solitary confinement or excessive force. Mental health care — from intake to medication, counseling and suicide prevention — was “either non-existent or wholly deficient” when the lawsuit was filed in 2020.

Steamboat Pilot: Routt offers ‘model’ jail based behavioral health services
At the Routt County Detention Center, (CO), many detainees or inmates are dealing with mental health conditions or substance abuse issues, officials say. However, about 30-40% of those in custody chose to take advantage of the Jail Based Behavioral Services, according to Sgt. Joe Boyle, JBBS project manager. Those behavioral health services expanded around 2017 assisted by funding through the Colorado Behavioral Health Administration. The incarcerated population can take advantage of substance abuse disorder group therapy, Bible study, meditation class or virtual visit with a CareMind Health therapist. Sometimes as an inmate is being released, Sgt Boyle takes down a list of their sizes and immediate needs, and goes on a shopping trip to Walmart for supplies for people who need basics such as clean clothes, boots, a sleeping bag and tent.




Food & Water

The Hill: Drinking water in US prisons may contain dangerous levels of ‘forever chemicals’: Study
Nearly half of American prisons are located downstream from water sources that are likely contaminated with cancer-linked "forever chemicals," a new study has found. Due to insufficient water quality testing in and around such sites, officials have only found that 5 percent of U.S. carceral institutions are situated in watersheds that definitively contain these toxic compounds, according. But tens of thousands of people are incarcerated at those facilities — and presumptive sources of exposure were found near many more sites. When it comes to toxins like forever chemicals, also known as PFAS, incarcerated populations are of particular concern because they have minimal ability to reduce their exposures.

Guardian: Rat fur, arsenic and copper: the dangerous ingredients lacing US prison water
Across the country, formerly or currently incarcerated people recount choking down water that tastes and smells of sewage or sulfur, that emerges hot or discolored from taps or contains visible sediment. And they were forced to drink it because they couldn’t afford bottles from the commissary or because bottled water was not made available to them. These reports are bolstered by research and investigations that have found toxic heavy metals, PFAS "forever chemical"”, the insecticide DDT, coal ash, bacteria and the radioactive gas radon in the water systems of many US corrections facilities. In theory, the federal Safe Drinking Water Act protects the right to clean water for everyone, including incarcerated people. Yet this and “other basic necessities are routinely denied” to people serving time in prisons and jails.

Washington Post: Minnesota penalizes county jail for depriving inmate of food and water for more than 2 days
The Minnesota Department of Corrections has penalized a county jail for depriving an inmate of food and water for more than two days as punishment after he smeared feces in his cell and refused to clean it up. The department ordered the Otter Tail County Jail in Fergus Falls to transfer all current inmates to new facilities. The jail will be allowed to keep new inmates no more than 72 hours, excluding holidays and weekends, until the state agency approves.




Suicide

WUNC: Formerly incarcerated at higher risk of suicide — even years after prison release, study finds
A study to evaluate the suicide risk of people released from North Carolina prisons. It is also the most in-depth look at the subject, analyzing data over nearly two decades. The report analyzed data from 2000 to 2020 from the N.C. Department of Adult Correction and death records from the Vital Records Unit of the North Carolina Division of Public Health to identify patterns in suicide rates among formerly incarcerated people. The analysis revealed that white and Hispanic people had more elevated suicide mortality rates after incarceration compared to Black people. Suicide deaths among formerly incarcerated white people were nine times higher than those of formerly incarcerated Black people.




Aging

FindLaw: What Will States Do With America's Aging Prison Population?
While prisoners have a right to healthcare, prisons often don’t have the resources to provide it. Gerontological nurses, with their expertise in caring for older adults and knowledge of health care systems, are positioned to play a crucial role in improving care for this vulnerable population. But correctional facilities often lack sufficient knowledgeable staff. When these nurses have too high of a patient load, they may fail to recognize or manage aging-related health issues.




Skin Cancer

Dermatology Times: Advocating for Mohs Surgery in Prison Populations
Vulnerable populations such as the prison population should have access to Mohs surgery to prevent the increased risk of morbidity and mortality from skin cancer. (Mohs surgery is a type of skin cancer treatment that removes the visible tumor and a thin layer of surrounding skin.) There are various barriers that cause the inmate population to have an increased risk of skin cancer. Extended exposure to sunlight without appropriate sunscreen or sun protective clothes can increase the risk of skin cancer. While in outdoor spaces, patients in prison may have decreased access to sunscreen. For the prison population, it is difficult to access dermatologic care and patients have delays in getting in to see a dermatologist.




HIV

The Land: He’s 23 and in an Ohio Prison for Exposing Someone to HIV – Even Though He Couldn’t Transmit the Virus
Prosecutors charged Caymir Weaver with felonious assault for not notifying his partner of his HIV status. He faced up to eight years in prison. It didn’t matter that there was “little to no risk” of transmitting the virus or that Weaver’s partner tested negative. But he was scared, so he took a plea deal. Prosecutors agreed not to argue for prison. Across the country, there’s a push to repeal or update the types of laws that put Weaver in prison. Most of the laws were put on the books decades ago, fueled by fear and absent scientific understanding about how the virus is transmitted, and long before advances in HIV treatments.




Dental Care

Innocence Project: Injustice Beyond Bars: How Poor Oral Health Care in Prison Continues to Burden Wrongfully Convicted People
Rodney Roberts found himself facing a dental nightmare when he was wrongfully incarcerated for 18 years. Mr. Roberts describes the prison dental clinic as a “butcher shop,” recounting the "cruel and unusual" experience of having three teeth pulled for common cavities. The BOP's policy on prison dental services corroborates that claim. It states that "dental care will be conservative, providing necessary treatment for the greatest number of inmates within available resources." This limited approach to dental care even takes place on the state level. For example, the Florida Department of Corrections’ dental policy considers procedures such as crowns, bridges, and implants to be elective dental care, and the wait to see a dentist can be up to two years.




Cannabis

Reuters: No one should go to jail for 'smoking weed,' VP Harris says at White House
U.S. Vice President Kamala Harris said "nobody should have to go to jail for smoking weed," as she met to discuss the topic with rapper Fat Joe and others pardoned for marijuana convictions. Harris added that "far too many people have been sent to jail for simple marijuana possession." The Department of Health and Human Services last year recommended that cannabis be reclassified from its current treatment as a "Schedule I" to a Schedule III drug with a moderate potential for causing addiction.




State Roundup

California
CalMatters: California jails are holding thousands fewer people, but far more are dying in them
People are dying in custody at record rates across California. They’re dying in big jails and small jails, in red counties and blue counties, in rural holding cells and downtown mega-complexes. They’re dying from suicide, drug overdoses and the catch-all term natural causes. Gov. Gavin Newsom pledged almost five years ago that the state would take a stronger hand to prevent deaths in the 57 jail systems run by California county sheriffs. In every year since, more people have died in California jails than when Newsom made that pledge — hitting a high of 215 in 2022. Tulare, San Diego, Kern, Riverside and San Bernardino counties’ jails set records.

CalMatters: Who can fix California’s troubled jails? This board is gaining new power to review deaths
California’s county-run jails have a crisis on their hands with overdoses and suicides claiming dozens of lives every year. This year, for the first time, a state agency that oversees conditions in the locally run lockups is gaining authority through a new state law to demand information from sheriffs and review those deaths. California created the Board of State and Community Corrections in 2011. Now, advocates for jail inmates want the board to take a more active role in addressing conditions inside the lockups.

Iowa
Des Moines Register: Iowa county jails are failing to comply with law on inmate medical billing, ombudsman says
Responding to what it says has been years of uneven compliance, the Iowa Office of Ombudsman is calling on the state’s county jails to follow the law on charging prisoners for health care and room and board. The ombudsman in a report found that several county jails in Iowa have been collecting money from inmates for health care costs before they were convicted and without a court order. The report said that violates an Iowa law on the books since 2006.

Louisiana
Washington Post: My brother isn’t permitted to read his own story. That’s a remnant of slavery.
My brother Bobby is not allowed to read the Black history that he is integrally a part of, a history that is presented in a book that he, himself, helped write. For nearly 25 years, my brother has been behind bars in the Louisiana State Penitentiary in Angola, the largest maximum-security prison in the nation. “Of Greed and Glory: In Pursuit of Freedom For All,” recounts his story, in the context of the larger story of America’s “peculiar institution” of slavery and its contemporary iteration as America’s mass incarceration system. Prison administrators, like those at the Louisiana corrections department, argue that censorship is necessary “for rehabilitation and the maintenance of safety and security.”

North Carolina
Governing: Deaths Decline in N.C. Jails but Remain Historically High
Jail deaths in North Carolina dropped significantly last year, the first reduction in seven years. But investigations of the deaths — whether they are deemed suicides, overdoses or deaths from natural causes — continue to reveal supervision failures. As in past years, investigators found them in more than a third of all deaths. The N.C. Department of Health and Human Services reported 46 “in custody” inmate deaths in the jails for 2023, based on reports submitted by county sheriffs as required by law.

Texas
KERA: Uninsured inmates will no longer foot the bill for ambulance rides under new MedStar, JPS agreement
Some inmates at Tarrant County’s jails will no longer be charged for emergency ambulance rides, after the county’s hospital district approved a reimbursement agreement with MedStar. For more than a decade, uninsured people incarcerated in Tarrant County were expected to foot the bill if they needed to be transported to a hospital. But the EMS provider responsible for those transports, MedStar, reported abysmal collection rates; the average payment MedStar collected from uninsured Tarrant County Corrections Center patients in 2022 was $2.36. Most bills were eventually written off as charity care.




Correctional Health Care Vendors

Wellpath
WECT: Brunswick Co. Commissioners approve agreement with Wellpath for inmate healthcare
Brunswick County Commissioners voted at their meeting on March 18 to keep the same company in charge of providing healthcare to jail inmates. Commissioners voted 4-1 to approve a new $2.1 million agreement with Wellpath LLC., a company that has faced accusations of providing inadequate care at facilities across the country. 12 Senators signed a letter in December raising serious concerns about Wellpath’s operations.

Santa Barbara Independent: Santa Barbara County Jail Sees Big Spike in Medical Grievances
The number of medical- and mental-health-related grievances filed by inmates in the Santa Barbara County Jail increased by more than 50 percent a month in 2023 over the monthly average established over the five preceding years. Nearly 13 percent of the grievances involved lack of access to what’s known as Medication Assisted Treatment (MAT). That acronym refers to methadone treatment for individuals addicted to opiates, a program launched only in the last year. Contributing to grievances were staff shortages both among custody officers working for the County Sheriff’s Office and for medical personnel hired by Wellpath, the private contracting firm hired by the county to provide health care in the jail. During the same period, county jail officers also made grievance forms more available to inmates.