Medication lapse for Harris jail inmates especially long for patients with HIV

Randall Patterson has a compelling story at the Houston Press ("Jail misery," Nov. 19) that demonstrates in human form what the US Justice Department said were unconstitutional flaws in the Harris County jail's healthcare system. He highlights the case of Monte Killian, who became extremely ill after the jail failed to get him AIDS medication in a timely fashion.

In telling Killian's story, though, Randall buried his lede. Deep in the article we find this juicy paragraph:

It turns out that everyone who enters the jail on prescription meds experiences a break in their regimen, and that lapses in HIV treatment tend to be especially long. Dr. Michael Seale, the jail's director of health services, acknowledged the importance of minimizing such delays but said, "You can't go ahead without appropriate information." Thus, the clinic's thorough routine: Instead of confirming an inmate's claim of HIV by simply calling the inmate's doctor, the jail finds it necessary to test the inmate all over again before prescribing medication.

That's the critical piece - the element that makes this a public policy story that potentially affects everybody instead of just something that happened to Monte Killian. In September, the Texas Commission on Jail Standards cited failure to dispense prescription meds as one of the reasons the jail failed inspection, Patterson reports.

There are many situations where for public health reasons you wouldn't want to interrupt somebody's ongoing medication. AIDS patients are certainly one: Jails are unhealthy places and somebody without a natural immune system is in big trouble. And for obvious reasons, you don't want to keep mental health patients off their drugs for too long. For that matter, failure to keep somebody on antibiotics could cause jails to become incubators for antibiotic-resistant infections, which then migrate back to the free world.

That's an important glitch, plus it's a waste of resources to re-test inmates before prescribing medications. It would be quicker, easier and less expensive for everybody to rely on the private docs' diagnosis and prescription regimen until jail docs find reason to dispute it. That would also avoid medication delays that are getting the jail in trouble with the Justice Department and state jail regulators.