KENT COUNTY, MICHIGAN CONSISTENTLY DENIES MEDICAL TREATMENT TO IT'S INMATES AT THE KENT COUNTY CORRECTIONAL FACILITY* IN GRAND RAPIDS
As a resident of Michigan I can attest to it's scenic beauty and splendor with its Great Lakes, and 1000's of inland lakes. I have also lived in California, Oklahoma, Georgia, Arkansas, and Tennessee. I have also traveled through and visited more than 35 other states in my 56 years of living and Michigan rates number 0ne and always will.
Grand Rapids is equally impressive with it's evolving culture and ethnic diversity. Violent crime is very low and one can feel safe raising a family here enjoying economic prosperity and the many educational opportunities that the city offers.
Grand Rapids is located in Kent County and as a resident and/or a visitor here, anyone subject to incarceration, no matter how short, is subject to a stay at the Kent County Correctional Facility*. The facility is modern and well run, compared to other county jail facilities throughout the country.
It provides physical safety to it's inmate population with its advanced security monitoring systems and well trained jail personnel. The Kent County Correctional Facility was recently featured on msnbc's Lockup-Extended stay and it is an impressive documentary worth viewing. See: http://www.mlive.com/news/grand-rapids/index.ssf/2013/11/msnbcs_lockup_to_feature_kent.html
Unfortunately, this correctional facility's modernization and comforts, though realistically limited, has been provided at the cost of it's inmates medical and health care. It seems that to obtain a modern correctional facility Kent County sacrificed it's inmate medical care and failed to incorporate humane treatment programs that conform to the evolving "contemporary standards of decency" which are guided by "evolving standards of decency that mark the progress of a maturing society."
Regardless if someone is incarcerated for a minor violation of the law or for the most heinous of crimes we as a civilized society, though we may feel otherwise, knowingly cannot encourage and/or condone the blatant disregard of an individuals civil rights guaranteed by the U.S. Constitution and the Bill of rights; especially if the person has not been convicted of any crime, as often is the case of pretrial inmates at the Kent County Correctional Facility.
As a resident of Grand Rapids, a city that was established with the good intentions of it's Christian founders, the makers and administrators of the jail's policies, including Sheriff Lawrence Stelma, Under Sheriff Jon Hess and Captain Randy Demory have all ignored and violated it's Kent County inmates' civil rights in general; especially when it comes to the treatment of substance abuse disorders that these inmates are faced to deal with in jail.
This article specifically addresses it's ongoing failure to provide adequate medical treatment in the jail.
The following news links highlight the some of the inmate deaths over the past few years. See:
1). http://www.mlive.com/sparta/index.ssf/2012/03/family_of_deceased_kent_county.html
2).http://blog.mlive.com/grpress/2008/03/kent_county_jail_inmate_dies_f.htmlhttp://blog.mlive.com/grpress/2008/03/kent_county_jail_inmate_dies_f.html
3).http://www.mlive.com/news/grand-rapids/index.ssf/2013/05/inmates_family_sues_kent_count.html 4).http://www.mlive.com/news/grand-rapids/index.ssf/2010/08/autopsy_shows_kent_county_jail.html
5). http://www.woodtv.com/news/local/grand-rapids/lawsuit-over-kent-county-inmate-death
6).http://www.mlive.com/news/grand-rapids/index.ssf/2010/06/blood_clot_caused_death_of_ken.html
7). http://www.wzzm13.com/news/article/182528/14/Kent-County-inmate-dies This young lady was denied her medication and there appears to be very little in the news about her death; her family wholeheartedly believes the denial of the methadone she received daily for her treatment of a substance abuse disorder was the causative factor in her unnecessary death when the jail denied her the treatment she needed daily.
Certainly, Kent County's inmate deaths are probably not above the national average but the problem should be no less of a concern to us as a society especially when these deaths could have been prevented. Giving all the benefit of doubt to Kent County's well intentions, there remains a pervasive sententious attitude among the jails administrators that inmates with drug problems are criminals and do not deserve treatment and that any suffering they experience in custody is their own fault, including death.
Even though these deaths are evident of a pervasive attitude that avoids preventing death, this same attitude is so pervasive in the daily functions and policies at the Kent County Correction Facility that it extend to their antiquated opposition to the treatment of drug addiction.
Barry McCaffrey, former Director of the White House Office of National Drug Control Policy has taken a strong stand on Methadone Maintenance Treatment and its role in prisons:
“Clearly, one of the most intractable of all drugs to deal with is heroin addiction. We have been willing to marshal the political will and resources to put people behind bars but we have not been able to marshal the political will and resources to provide treatment in prison and for halfway houses on release. We have a failed social policy, and we are going to have to correct it.”
Kent County Correctional Facility has consistently failed the residents of Kent County, both incarcerated and those who have never been involved in the criminal justice system. One might ask: How could this affect me and/or my family? or Why should I care, I don't use drugs nor does the members of my family?
The answer to these questions is easily answered in the100's of federal publications and "statements of purpose" advocating the treatment of drug addiction in the criminal justice system. The following excerpts are from an article from the National Institute of Health, National Institute on Drug abuse:
"Untreated substance abuse adds significant costs to communities, including violent and property crimes, prison expenses, court and criminal costs, emergency room visits, child abuse and neglect, lost child support, foster care and welfare costs, reduced productivity, unemployment, and victimization. The cost to society of drug abuse in 2002 was estimated at $181 billion, $107 billion of which was associated with drug-related crime." See: http://www.drugabuse.gov/publications/drugfacts/treatment-drug-abusers-in-criminal-justice-system
The article continues: "Scientific research since the mid-1970s shows that drug abuse treatment can help many drug abusing offenders change their attitudes, beliefs, and behaviors towards drug abuse, avoid relapse, and successfully remove themselves from a life of substance abuse and crime. It is true that legal pressure might be needed to get a person into treatment and help them stay there. Once in a treatment program, however, even those who are not motivated to change at first can eventually become engaged in a continuing treatment process."
"Untreated substance abusing offenders are more likely to relapse to drug abuse and return to criminal behavior. This can bring about re-arrest and re-incarceration, jeopardizing public health and public safety and taxing criminal justice system resources. Treatment offers the best alternative for interrupting the drug abuse/criminal justice cycle for offenders with drug abuse problems."
Another publication states: "It is estimated that about one-half of State and Federal prisoners abuse or are addicted to drugs, but relatively few receive treatment while incarcerated. Initiating drug abuse treatment in prison and continuing it upon release is vital to both individual recovery and to public health and safety. Various studies have shown that combining prison- and community-based treatment for addicted offenders reduces the risk of both recidivism to drug-related criminal behavior and relapse to drug use—which, in turn, nets huge savings in societal costs. A 2009 study in Baltimore, Maryland, for example, found that opioid-addicted prisoners who started methadone treatment (along with counseling) in prison and then continued it after release had better outcomes (reduced drug use and criminal activity) than those who only received counseling while in prison or those who only started methadone treatment after their release."
This is a concise statement summing up the federal governments position on treating drug addiction in the criminal justice system. See: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2681083/pdf/nihms101882.pdf
"Despite increasing evidence that addiction is a treatable disease of the brain, most individuals do not receive treatment. Involvement in the criminal justice system often results from illegal drug-seeking behavior and participation in illegal activities that reflect, in part, disrupted behavior ensuing from brain changes triggered by repeated drug use. Treating drug-involved offenders provides a unique opportunity to decrease substance abuse and reduce associated criminal behavior. Emerging neuroscience has the potential to transform traditional sanction-oriented public safety approaches by providing new therapeutic strategies against addiction that could be used in the criminal justice system. We summarize relevant neuroscientific findings and evidence-based principles of addiction treatment that, if implemented in the criminal justice system, could help improve public heath and reduce criminal behavior."
The Kent County Correctional Facility fails miserably in any modern, evidence based treatment modalities, addressing the very pervasive drug abuse problems that realistically exist in Grand Rapids, including the surrounding area they service. Unfortunately, the administrators of the jail have rejected any evidence based approaches of treating drug addiction, and have allowed only faith based programs, though limited; only to advocate and proselytize their non-secular principles, such as Alcohol Anonymous (AA) and Narcotic Anonymous (NA), both faith based programs.
Though, well intended, theses programs do not produce viable and lasting results and have failed when they are not combined with realistic goal oriented and evidence based treatments. The following briefly touches on the subject and should be considered:
"A groundbreaking report published last year by the National Center on Addiction and Substance Abuse at Columbia University concluded that “the vast majority of people in need of addiction treatment do not receive anything that approximates evidence-based care.” The report added, “Only a small fraction of individuals receive interventions or treatment consistent with scientific knowledge about what works.” The Columbia report found that most addiction treatment providers are not medical professionals and are not equipped with the knowledge, skills or credentials needed to provide the full range of evidence-based services, including medication and psychosocial therapy. The authors suggested that such insufficient care could be considered “a form of medical malpractice”"
Here the Kent County Correctional Facility has had the perfect opportunity to utilize the services offered by Cherry Street Substance Abuse Services and the Eastern Clinic; these services combined provide approximately 600 opioid addicted patients with state and federally approved Medication Assisted Treatment. These treatment programs have offered treatment since the early 90's and the Kent County Correctional Facility has consistently rejected offers for their treatment assistance to inmates at the facility; a place where it is certainly needed most of all.
Between these two evidence based drug treatment programs Dr. John Campbell, a physician specializing in addictionology, psychiatry, and co-morbid disorders brings to Kent County his expert medical knowledge with 25 plus years of clinical experience, through Cherry Street Services and Dr. Leon Smith, also an experienced addictionologist, brings an equally impressive tract record in the successful treatment of substance abuse disorders, through the Eastern Clinic located in Grand Rapids, Muskegon and Benton Harbor, Michigan.
In February 2011, Donna M. Kuiper, Director of Cherry Street Substance Abuse Services (at the time), presented to the Kent County Correctional Facility administrators a comprehensive plan to involve the facility in evidence based substance abuse services offered to patients who found themselves incarcerated in the jail. These services were offered to the incarcerated patient as part of the Medication Assisted Treatment that Cherry Street Services provided to the patient before their incarceration. Their treatment would have been part of an ongoing comprehensive treatment plan that was initiated prior to their incarceration and already funded, thus not presenting Kent County with any additional financial burden. The presentation lasted several hours and the Kent County Correctional Facility's administrators permanently refused the offer to provide any evidence based substance abuse treatment at the facility.
Considering that the Kent County Correctional Facility's administrators have been aware of the dangers of addiction and of the refusal of it's inmates to access Medication Assisted Treatment for close to 20 years and, then having further clarification of the dangers involved by their blatant denial to treat drug addiction in the jail, would lead one to believe that the administrators are either naive or just do not care. On the other hand, it could be said that their refusal to allow Medication Assisted Treatment in the jail, which results in "pain and suffering" of the incarcerated inmate, encourages if not condones their "pain and suffering" and civil rights violations and infers "deliberate indifference to a serious medical need".
Considering that the Kent County Correctional Facility has consistently rejected any assistance from these drug treatment programs with their expert doctors and staff, and/or any other experts in the field, leads one to believe that Kent County's policy's, practices, and procedures at the jail prohibiting Medication Assisted
Treatment for it's inmate population encourages drug addiction and thus ensures economic security for those employed by the county. After all, using the most conservative figures, reducing drug addiction and crime by just 10% would result in the unemployment of jail guards, food service employees, maintenance workers, also other correctional facility staff, and would reduce the consumption of electricity, water and heat at the jail; resulting the possibility of being able to close an entire section of the facility; thus saving tax dollars!
Granted this is speculative, but since the Kent County Correctional Facility is operating their facility as if there existed no substance abuse issues affecting Kent County and it's residents, as if it is 1950; it is evident that their current position of prohibiting Medication Assisted Treatment for drug addiction does nothing but further the ongoing and pervasive drug problem and criminal activity associated with it here in our community. What could it hurt to incorporate an evidence based, U.S. Department of Justice advocated, state and federally licensed Medication Assisted Treatment program at the Kent County Correctional Facility? Surely, it could not make things worse than they already are! What if it actually reduced substance abuse and crime as our federal government programs and publications claim, would that not be considered "good" as well as beneficial for our community and all involved? Certainly what they have been doing, which is nothing, has not worked. Isn't it time for Kent County to catch up to the 21st century and make a more concerted effort to reduce drug addiction and crime?
The National Institute of Justice, Office of Justice Programs, on their website, http://www.crimesolutions.gov/ProgramDetails.aspx?ID=157, defines Prison-Initiated Methadone Maintenance Treatment, as follows:
"Research has shown that prisoners with heroin addiction are most likely to relapse within 90 days of release (Office of National Drug Control Policy 1999). Thus the primary goal of providing methadone maintenance to prisoners is to engage heroin-addicted offenders in drug abuse treatment before they are released and return to the community. Prison-initiated maintenance therapy offers inmates the opportunity to participate in substance abuse treatment while incarcerated and then provides referrals to community-based treatment programs to encourage their continued treatment during reentry.
"The medication-assisted treatment, called methadone maintenance treatment (MMT), is targeted at individuals with dependence on opioids, including heroin, [Oxycontin], morphine, [and other opiates]. Most facilities providing MMT are community based; there are very few treatment programs available to offenders in jail or prison, despite the higher rates of heroin use among prisoners compared to the general population (Kinlock et al. 2007).
Methadone is a long-acting synthetic opioid analgesic that works as a pharmacologic intervention for patients in drug treatment and detoxification programs. Methadone maintenance helps opioid-addicted patients alleviate withdrawal symptoms, reduce opiate cravings, and bring about a biochemical balance in the body to reduce the illicit use of drugs.
"In addition to administering medication, prisoners participating in methadone maintenance also receive counseling services. Services can include group-based education and discussion on relapse and overdose prevention, cocaine and alcohol abuse, and other reentry issues. Upon release from incarceration, prisoners are advised to report to a community-based facility as soon as possible to continue MMT.
"Prison-initiated methadone maintenance initiates treatment shortly before release from incarceration, to ensure that participants receive a minimum amount of time in treatment (such as 3–6 months) and encourage them to continue the remainder of MMT in the community. The amount of time a prisoner continues to receive methadone will vary. In general, MMT takes a minimum of 12 months, but some heroin-addicted prisoners may require continuous treatment that lasts over a period of several years."
Now I would like to turn to Kent County Correctional Facility's prohibitive policy that does not allow any form of Medication Assisted Treatment at the jail and this includes the use of SUBOXONE (buprenorphine):
"The Drug Addiction Treatment Act of 2000 (DATA 2000), Title XXXV, Section 3502 of the Children’s Health Act of 2000, permits physicians who meet certain qualifications to treat opioid addiction with Schedule III, IV, and V narcotic medications that have been specifically approved by the Food and Drug Administration for that indication. Such medications may be prescribed and dispensed by waived physicians in treatment settings other than the traditional Opioid Treatment Program (methadone clinic) setting.
"Since there is only one narcotic medication approved by the FDA for the treatment of opioid addiction within the Schedules given, DATA 2000 basically refers to the use of buprenorphine for the treatment of opioid addiction. Methadone and LAAM are Schedule II narcotics approved for the same purpose within the highly regulated methadone clinic setting. See: http://en.wikipedia.org/wiki/Drug_Addiction_Treatment_Act, http://www.suboxone.com/, http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm191523.htm
So here we have another medication approved by the U.S. Food and Drug Administration for the treatment of opioid addiction, a successful alternative to methadone, and the Kent County Correctional Facility will not allow its use in their facility; even if the inmate was prescribed the medication prior to his/her incarceration and maintains a valid prescription for SUBOXONE when they become incarcerated.
This denial of another evidence based treatment furthers the assurance that the individual denied his/her medication will certainly relapse upon release from jail into the community. These individuals will be at a heightened risk for drug overdose due to their prolonged abstinence to their drug of choice while incarcerated. Furthermore, since both methadone and Suboxone are oral medications which block the effects of opiates/narcotics thus preventing the injection of heroin, morphine, Oxycontin, and the like; further reducing the transmission of HIV and Hepatitis C and this is highly beneficial in the treatment of substance abuse disorders and would therefore be an additional benefit of advocating treatment at the Kent County Correctional Facility.
Setting aside drug addiction treatment, the Kent County Correctional Facility does not allow any controlled pain medication to be used as well. So if someone has cancer (a very painful condition), chronic back pain/slipped disc, kidney stones, neuropathic pain, migraine or cluster headaches, shingles, Complex Regional Pain Syndrome, sciatica, trigeminal neuralgia, endometriosis, fibromyalgia, pain after an operation, or any other painful condition requiring pain relievers prescribed by a doctor they are out of luck in the Kent County Correctional Facility, due to an administrative policy prohibiting their use. The jail doctor could not administer any of these "prohibited" pain relievers, even if it could be shown that it was medically necessary and warranted, the jail policy would not allow it.
The theory for this denial is that "nobody has ever died from being in pain" and if the experience of incarceration is a painful one then, their belief holds that, in the future the individual "will think twice before breaking the law". Unfortunately, making a drug addict go through a painful withdrawal, without any Medication Assisted Treatment, and/ or denying a pain management patient his medication, is justified in the same manner and is no more effective in the treatment of substance abuse disorders and the prevention of crime than the failed "just say no" campaign of the 80's.
"Medication Assisted Treatment is a well-studied and validated pharmacological therapy for the medical condition known as opioid dependence. The failure to ensure prisoner access to this medical therapy threatens fundamental human rights protections against cruel, inhuman or degrading treatment and rights to health and to life. It also poses serious ethical problems for health care providers, violating basic principles of beneficence and non-maleficence (i.e., do good/do no harm). Governments must take immediate action to ensure access to opioid substitution to prisoners to ensure fulfillment of ethical and human rights obligations."
"The World Health Organization, the United Nations Office on Drugs and Crime and the Joint United Nations Programme on HIV/AIDS have each supported the expansion of MAT because it is an evidence-based therapy that has proven effective for HIV prevention, as well as reducing illicit opioid use and deaths due to overdose, improving uptake and adherence to anti-retroviral treatment for HIV-positive drug users, and that is cost-effective to society (WHO et al., 2004).
"Opioid dependence is a chronic, relapsing neurobiological disease with known, effective medical treatments, specifically methadone and buprenorphine. The refusal to provide these validated medical treatments within correctional settings leads to increases in risk-taking behavior among prisoners and unnecessary harm. In a context where access to medication assisted treatment for opioid dependence may be inadequate for those outside prison, access to treatment for prisoners may rank low on government priorities. But states’ failure to meet treatment needs for all drug users does not relieve them of their obligations to protect the lives and well-being of those in its custody by, among other things, ensuring access to evidence-based drug treatment. Just as correctional systems cannot refuse other medical treatments to prisoners (e.g., diabetes, HIV, etc.) because of the harm it could cause, it is incumbent upon correctional systems to immediately reform their policies and procedures to institute the medical treatment of opioid dependence with the evidenced based use of methadone and/or buprenorphine such that opioid dependent patients can receive the benefits of this well studied and validated medical treatment.
"Physicians practicing in correctional settings are often forced by legal provisions or government policy, as well as prison regulations and practices, to violate this ethical obligation. Physicians are called to improve health outcomes – that is, to do good for patients in their charge and not to do harm. Removing or denying access to a therapy demonstrated to be beneficial for opioid dependent patients constitutes harm -- both direct harm as the individual experiences opioid withdrawal due to the removal of the opioid agonist therapy within the context of corrections, and indirectly in that the removal of the agonist therapy may lead the individual patient to engage in risky practices to placate the symptoms of withdrawal as discussed above. The refusal of correctional systems to allow physicians to provide this evidenced based care violates the commitment to beneficence. This contravention of medical ethics should lead correctional systems to reform their practices around the treatment of opioid dependence."
CONCLUSION
"Opioid dependence is a chronic, relapsing neurobiological disease with known, effective medical treatments, specifically methadone and buprenorphine (Suboxone). The refusal to provide these validated medical treatments within correctional settings leads to increases in risk-taking behavior among prisoners and unnecessary harm. In a context where access to medication assisted treatment for opioid dependence may be inadequate for those outside prison, access to treatment for prisoners may rank low on government priorities. But states’ failure to meet treatment needs for all drug users does not relieve them of their obligations to protect the lives and well-being of those in its custody by, among other things, ensuring access to evidence-based drug treatment. Just as correctional systems cannot refuse other medical treatments to prisoners (e.g., diabetes, HIV, etc.) because of the harm it could cause, it is incumbent upon correctional systems to immediately reform their policies and procedures to institute the medical treatment of opioid dependence with the evidenced based use of methadone and/or buprenorphine such that opioid dependent patients can receive the benefits of this well studied and validated medical treatment." See the complete government publication at:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2366202/
The Kent County policy prohibiting evidence based treatment in the Kent County Correctional Facility is nothing short of violating its inmates constitutional civil rights. Whether you agree or disagree with the treatment of incarcerated inmates for their substance abuse disorders federal law requires and mandates that treatment be implemented. If Kent County comes under federal scrutiny and it is determined that protected federal rights are being violated, all or part of any federal funding Kent County receives could be suspended or lost, as a sanction for theses violations of federal law and constitutionally protected civil rights.
Several county jails throughout the country have run into problems denying evidence based Medication Assisted Treatment and ended up complying with federal law. See all of the following links:
1). http://gritsforbreakfast.blogspot.com/2011/06/2nd-gregg-county-methadone-death-spurs.html
2). http://articles.orlandosentinel.com/2001-08-02/news/0108020292_1_methadone-jail-florida-treatment
3). http://janaburson.wordpress.com/2010/09/04/law-enforcement-behaving-badly/
4). http://www.news-journal.com/news/local/article_50862eb7-54de-5751-ae4a-85dea7691f51.html
5). http://www.texasjailproject.org/tag/withdrawal/
6). http://www.novusdetox.com/methadone-high-dose-risk-detox.php
7). http://excoboard.com/exco/archive.php?ac=t&forumid=60781&date=07-07-2008&t=1473617-1
8). http://methadone.forumotion.net/t867-a-second-methadone-related-death-at-gregg-county-jail
9). http://www.medicalassistedtreatment.org/95211/471119.html
12). http://www.topix.com/forum/county/kent-mi/TR2UICEHR6M8VSB1Q
I hope that this article gives rise to public interest in what its Kent County Authorities are not doing to treat drug addiction and address crime. It is hoped that officials wake up and realize their obligation to address a serious social problem and incorporate humane treatment programs that conform to the evolving "contemporary standards of decency" which are guided by "evolving standards of decency that mark the progress of a maturing society", instead of being stuck in the ideology, fear, and ignorance about drug abuse and addiction that marked the 1950's.
Any comments can be sent to JUSTICE DENIED [email protected]
