Thursday, November 19, 2009

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.


Anonymous said...

Is racial prejudice involved in this delay of HIV treatment? To illustrate the point, consider statistics for just one city - Chicago.

"While Black people make up 35% of Chicago’s population, they make up 54% of known HIV cases."

Data from other cities would likely show a pattern similar to that found in Chicago.

Gritsforbreakfast said...

The fellow in this story was white, FWIW.

Anonymous said...

Bexar County does the same thing. A few years back I had to do 60 days and I brought my anti-depressants with me when I surrendered myself. They threw out a 30 day supply (or some guard took them home) and told me I had to see the doctor.

He was a decent guy and explained to me how things worked but he couldn't give me the same meds I was taking for cost reasons. He gave me something else that just made me sleep all day. Hell, I didn't care.

Anonymous said...

More waste of taxpayer monies...this is typical of most all county jails nationwide...ah the great healthcare in jail & prisons!! Makes me SICK!!

Anonymous said...

A disgrace. I bet there are kickbacks or federal funding for the 'confirmation tests.'

Anonymous said...

Another cause for concern is the impact of medication interruption for those taking anti-psychotic meds - the ability of those people to communicate with counsel and help prepare their defense is often affected by them being given the wrong medication, or too little, or too much, or none of the medication they need. As a capital habeas lawyer I always obtain my client's jail prescription records to see just how drugged they were during trial. It's also a big issue when the client's demeanor is affected by medication i.e. the wooden stare of the over-medicated client is all too easily interpreted by the jury as lack of empathy or remorse.

Anonymous said...

My husband was there recently. I called the medical unit because I had not been in contact with him for several days and wanted to make sure that he was receiving his medication for high blood pressure.

When I did finally talk to a human voice, they explained that there was only one pharmacist for the over 12,000 inmates and it takes some time for medications to be filled.

It was seven days before he began receiving his medication. I don't know what lasting affect going on and off this type of medication has on someone but this has left me wondering. I'm grateful that he did not die in the interim.

How could they possibly have only one pharmacist?

Anonymous said...

Harris county took my mentally ill grandson off his meds. Changed what he was on because of the cost (they said) he was on ssi and medicaid. When he couldn't cope without meds they just hand cuffed him and three of them went in and beat him and then took his visits away until the bruises didn't show.