We have 22 full-time 14 physicians and another 20 to 25 part-time 15 physicians who fill in on an as-needed basis. We 16 also have at the present time 21 physician 17 assistants who assist in the delivery of the 18 health care. 19
It's commonly called "a PA." 22 A physician assistant is a licensed clinical practitioner, called "a mid-level practitioner," who has -- they have certainly legal prescribing practices and diagnostic practices, as outlined in 66 1/25/01 PUBLIC SAFETY - RES. 692 the State of Pennsylvania who are -- who are licensed to practice medicine under the direct supervision of licensed physicians.
Of those 6 physicians that you have, how many of them are 7 psychiatrists, or is that a separate entity that 8 you have? 9
What I just described to you 10 was the medical department only. I'll let 11 Dr. Newkirk tell you about the behavioral health 12 department. 13
I'm sorry. I'm Cassandra 16 Newkirk, and I'm the chief psychiatrist with 17 Prison Services here in Philadelphia. 18 Currently, we have 6.7 full-time 19 equivalents for psychiatrists, which is almost 7 20 full-time -- 21
You have half a body 67 1/25/01 PUBLIC SAFETY - RES. 692 somewhere?
No, I'm sorry. The 0.7 extrapolates to hours based on a 40-hour week. And when I say it's 6.7, we have full-time 6 equivalents, plus it's approximately -- I think it's 32 more hours. So 6 six full-time equivalents and 32 more hours of psychiatric time.
Not at one time. This is the number of staff we have. The way we staff psychiatrists, we have psychiatrists on duty 14 hours a day, 7 days a week. So some physicians, 15 psychiatrists, work full-time and some work 16 part-time. All total per week, I have 6 full-time equivalents plus 32 hours on any given week. That's what I'm staffed for. We also have psychiatrists there Saturday and Sunday in one of our units 16 hours a day, so that's why it comes out to the ratio that it does. If you'd like to, I will continue with my other behavioral health staff at this time.
Sure, go ahead. And how many others? 68 1/25/01 PUBLIC SAFETY - RES. 692
I have one psychologist, who is my program director. I have a full-time port liaison person. I have three clerical staff. I have six case managers who are master's level psychiatric social workers. I have a staff of six bachelor's-level social workers, and we have a lot of -- we have several social workers that work on a part-time basis to fill in the evening and the weekend staffing that we need so that all shifts are staffed. And we also have six psychiatric techs that work between the transitional units and the inpatient behavioral health unit as well.
In your unit -- and this case came up because I knew the family of the person. A few years back, a young Puerto Rican was arrested and he ended up committing suicide. And I was informed later on that there was supposed to be what is called "a suicide watch," that there's an evaluation made of people, and the prison then assigns correctional officers. How do you handle that? And what is the ratio in terms of -- that you put forward per -- in your suicide watch? 69 1/25/01 PUBLIC SAFETY - RES. 692
The beginning of the suicide prevention policy is that an inmate is referred to us by, be it correctional staff health care staff or any other staff for evaluation, and when I say "us," I mean they are referred to behavioral health, and they are seen by a qualified mental health professional, which means either a social worker, a psychiatric social worker, or a psychiatrist. They are assessed for the suicidality at that time. If -- the social worker usually sees a person, sees a person first, and then they're seen by a psychiatrist. If they feel that there's any thought that the inmate may be at risk for suicide, then the psychiatrist orders a suicide watch. We have two kinds of watch, and only two, and that is a continuous watch on our inpatient forensic unit, and that means that they are watched at all times by either our site techs and correctional officers, or we may put the person on a 15-minute watch, meaning that -- and this, again, is on the inpatient unit, meaning that they are checked on at least every 15 minutes. Now, when they are on either one of 70 1/25/01 PUBLIC SAFETY - RES. 692 these watches, they are in cells that are, well, what we call "suicide-proof." There are -- also, any objects or clothing that they could harm themselves with are taken away from them. And the monitoring is documented by officers as well as the treatment staff on the unit. If, by chance, the unit is full, which sometimes it is, we do have suicide cells at the Fromhold Correctional Facility as well. But here, again, it has to be ordered by a psychiatrist. In dire emergencies, any staff member can put someone on suicide watch, but the psychiatrist on call or on duty has to be notified immediately, and the order is given so that everybody is made aware of it.
Has there ever been circumstances in which there have been more prisoners in terms of a suicide watch and the ratio has been to 5, individual to watch 21 individuals on a suicide watch? And. . . 22
You mean one staff member 23 and one corrections officer? 24
One staff member to 25 five. 71 1 1/25/01 PUBLIC SAFETY - RES. 692
Not that I'm aware of. If that is happening, they may be on a 15-minute watch but not a continuous watch. If it's a continuous watch, it's supposed to be one person watching one inmate, and correctional staff at the institution, because we do have to depend on them to do that and have been very accommodating about that when we need a continuous watch.
Approximately, that -- that's 16 just the approximate. Again, I could give you a 17 report back to give you the exact number. 18
Are your nurses full-time and on payroll, or do you hire temporary nurses?
They would all be on -- our 72 1/25/01 PUBLIC SAFETY - RES. 692 employees of PHS, most are full-time and some work on a part-time basis.
Staffing, professional staffing. How many nurses do you have? You have doctors; how many nurses? 10
I thought we just answered -- 11 150. It's 56 RNs and 49 LPNs, plus 6.7 12 psychiatrists and 21 MDs, and 22 PAs. 13
Is there a turnover 14 in terms of nurses and staffing? 15
I can speak directly about 16 physicians. There's always a turnover in terms of 17 people who have decided to either move, for family 18 reasons, or who decided that they want to take on 19 another career path. 20 I can tell you, as the medical 21 director, in the area of Philadelphia, because of 22 your environment and what's happening with managed care in Philadelphia, there is -- I have no 24 problem in terms of recruiting, replacement or to fill positions that have become vacant. 73 1/25/01 PUBLIC SAFETY - RES. 692
I asked a question of Estelle Richman. If Johnny So-and-So, if her son has been arrested and sent to Fromhold, she calls up and says, My son is sick, he's under medication, his medication's here. What happens to that phone call?
That's an interesting question. I'm a clinical physician and I've been in practice for years, and I've always prided 11 myself in having the ability to communicate with 12 patients and patients' families. I don't think 13 there's a day that passes that I don't get a call 14 from a concerned family member. 15 Typically what happens is that I will 16 call each of the facilities, the chief medical 17 officer. I will call their chief medical officer 18 and inform him of the call that I've gotten from the mother, father, brother or sister, whatever, and tell him about the concerns that have been raised. I will get a report back from that clinician, and I usually get these reports back within hours so that I can report back to the family member. Now, part of that, of course, is 74 1/25/01 PUBLIC SAFETY - RES. 692 making sure of the confidentiality issues and making certain that the person calling on the phone is who, in fact, they say they are, and I confirm that with the patient, that the person is requesting information on. That is a part of medicine, is conveying information to people who are concerned about loved ones. If, in fact, there is a medication that they have informed us about, we have a pharmacy provider that we can get any medication known to mankind, with all due speed and in a most expeditious matter. There have been occasions in which I personally have gone to family homes to get prescriptions that either the inmate patient was unaware of or not clear about and that the mother or father cannot read, and will actually pick up their medication to make sure that the person got it. So those things happen on a day-to-day delivery of health care. This is a part of the service that we provide.
If someone is arrested and they are at the Round House, and they 75 1/25/01 PUBLIC SAFETY - RES. 692 suffer from some disease, then they are taken over to the Detention Center, Curran Fromhold -- 'cause that happened very recently. Mr. Santiago, who was a diabetic, and he was transferred. What happened?
What happened in that sort of situation and when the individual does not get the treatment and dies?
Well, Mr. Santiago was a diabetic at the Round House. Then he was transferred to Curran Fromhold, and he didn't get the treatment.
The particular case -- I think it has been stated that the particular case, in talking about the particulars of that particular case, I think that because of confidentiality issues related to his case, things about his medical history that probably should not be made public, and the fact that there is an open suit involving it, that it is best that we not 76 1/25/01 PUBLIC SAFETY - RES. 692 discuss this in this particular form. However, however, in response to the other part of your question, in talking about generalities as to what happens. As a physician, it is vitally important that once a particular entity of illness has been identified in a patient that you be able to follow it up. We have established procedures in place so that when a person who is identified of having an acute illness in the intake facility like PAB, when they are transferred to the PPS facility, that information concerning that particular illness is transferred to the receiving staff at PPS. (Outburst by audience member.)
Please, if you have something to say, you'll have your chance to say it, okay? This hearing, in essence, was -- came about because of the death of Mr. Santiago and the occurrences of others, and we want to make sure that the policies and processes are in place so that those things don't happen, so that when somebody gets arrested and goes through the 77 1/25/01 PUBLIC SAFETY - RES. 692 criminal process, that he is able to survive that process in order to be able to go to court and be able to then have his day in court at that time. And I want you to describe it to me, what happens to a person from the moment he's arrested to the process in which he goes to the Detention Center and Curran Fromhold, and if he happens to be ill with a disease or is in need of medication.
Let's -- your concerns about the maintenance of health of a patient --
I'm going to tell you about the health care linkage, but what I want to make clear is the fact that the concern that you have about the maintenance of a person's well-being and health is the same thing that I have as a clinician and that my staff has. Suffice it to say this: When an individual's identified with having acute medical 78 1/25/01 PUBLIC SAFETY - RES. 692 problems, one or two things could happen immediately. One, that person, if we felt that the acuity of the illness was such that nit needed immediate treatment right now, that person would be referred to the emergency room immediately. Now, assuming a person is at the PAB, Police Administration Building, that is now staffed with RNs who are trained to deal with a wide gamut of medical issues assesses that a person is stable enough to be transferred to the PPS facility, the information that they've obtained on that person is faxed up, called up to the receiving staff at PPS. Policies and procedures are in place so that not only the medical staff but the receiving correctional staff are aware of that and --
You have identified someone that is in need of medication. This person then suffers an attack of some sort, a cardiac arrest, whatever. What goes into place?
If a person's in cardiac arrest, you're going to call code, you're going to transfer the person, 9-1-1-, to the hospital immediately. 79 1/25/01 PUBLIC SAFETY - RES. 692 Let me try to explain it to you this way.
If somebody in a cell block goes into an emergency situation, what happens?
We have doctors on site at the PPS hours a day, 7 days a week. Three 9 facilities are manned with MDs 24/7 to provide 10 acute care, follow-up of chronic care to provide 11 them with -- and to cover or to handle emergent 12 care. 13 Now, if a person suffers a 14 life-threatening situation, as occurs -- 15
Let's say if the medical 18 staff is not there, not on the cell block when it 19 occurs, the correctional staff contacts the 20 medical department. The medical department 21 responds, makes an initial assessment. If that 22 person needs to be 911'd, they're called. Medical 23 staff attempts to stabilize the person until the 24 911 fire rescue can arrive on the scene and then prepare the person to be transferred to the 80 1/25/01 PUBLIC SAFETY - RES. 692 nearest facility, acute care facility. That's in a life-threatening, urgent situation. That's what occurs.
Currently in your population that you have in charge of, what is the percentage of individuals within that population with HIV that are under treatment?
The way I am able to determine, as the medical director, that, the numbers in the population, is to determine how many people are being treated for the disease. Currently, the statistical number is about 3 percent. So that range is somewhere between 200 to 250 people who are actively being cared for HIV disease.
But you don't have -- do you have an idea -- you mean, you have not screened the population to see how many of those individuals within that population are now -- currently have HIV?
That is not something -- a blood test like that is an invasive blood test; that's not something that you can just submit a person who's incarcerated to. Everyone is allowed 81 1/25/01 PUBLIC SAFETY - RES. 692 to and given the opportunity to --
Tuberculosis is absolutely a part of the screening process for every inmate that comes through the jail.
What is the percentage of individuals right now under your care, under this contract, that are suffering from tuberculosis?
Zero. As of today, zero; there is nobody -- there is no patient currently in the PPS jail who has acute tuberculosis.
There's nobody -- I think I can think of no case, as we sit here -- there may be one, but I can think of no case of a person on current -- for drug therapy for acute TB, acute TB. Now, there are other classifications of TB, and then we're talking --
I didn't ask for acute TB; I just said to you, what part of the population has tuberculosis that is under your 82 1/25/01 PUBLIC SAFETY - RES. 692 care right now?
And I'm not trying to -- well, I want to be very direct, 'cause I want you to understand the nature of the disease tuberculosis. I would say, taking all categories of TB, okay, all categories of TB, I would say probably no more than 40 or 50 people are receiving. Those are the people who have what we "call latent tuberculosis," who are on preventative therapy. That would be the greatest number, maybe 40 to 50 at max.
And what is the number of the population that is suffering from diabetes?
Currently, the total diabetic population being treated, if you consider that the largest facility, CFCF, probably has approximately 30, and you take that throughout the population, probably, I would guesstimate a number somewhere between 100 to 150. And, remember, that number could change every day, depending on who comes into the jail.
You say 3 percent of your population is currently identified as HIV 83 1/25/01 PUBLIC SAFETY - RES. 692 positive, right?
Therapy. And we have reports, and as we prepare for this, that the process of them getting their medication, as they described it, the description that has come in to our staff is that it is routinely interrupted. It is -- and I'd like to find out what is the procedure that you have for addressing the timely and continuous arrival of pharmaceuticals to the jail so that the HIV individuals that are suffering from HIV do not -- do not lack their medication on time.
Councilman Ortiz, let me take my time and answer this question for you completely and in all honesty, all honesty. The Philadelphia HIV program that exists today is exemplary. Inmates or patients who come to the jail in Philadelphia who identify themselves as having HIV disease, the first thing to do is to assess them by history and laboratory data, et cetera. If an inmate is known to us and/or can 84 1/25/01 PUBLIC SAFETY - RES. 692 give a clear, concise history of the medications that he or she may be on, can give us the information as to who's caring for them in the community, we will start medications immediately. It makes -- when you think about it medically, it makes no sense to withhold medication, because what you do is propagate disease and illness. We institute therapy immediately. Let me take it a step further. We -- PHS takes the HIV illness so seriously that we have a dedicated infectious disease board certified outstanding clinician in the Philadelphia community, and that's all she does is take care of the HIV population at the PPS. There is no medication that is available in the standard (indiscernible) of medicine today that the inmates at the Philadelphia prison cannot have access to. There is no level of care that they cannot have access to. I would go so far as to say this: I'm not sure who you refer to when you say "they," but the data that I'm giving you is the data that's happening out there. When I say 3 percent, that's 85 1/25/01 PUBLIC SAFETY - RES. 692 what it is; of those people being treated, it's 3 percent. There is no withholding of care. It makes no sense medically to withhold treatment or care. (Outburst by audience member.)
The HIV program has been reviewed, has been monitored, has been evaluated by outside people. And it is -- I mean, it's just bound to be absolutely an excellent program. And here's one of the things what I was concerned about, because the people make statements about the fact that people come to jail and they leave sicker. A recent study showed that the inmates who were leaving prison -- who were in prison or in jail, their compliance with medication is much higher than it is when they're in the community. Now, one of the things I was concerned about is --
When a person leaves the 86 1/25/01 PUBLIC SAFETY - RES. 692 jail --
One of the things that -- I'm a doctor, I'm trained to be a doctor.
And Miss Blondell Reynolds has a question. I know that she --
Good afternoon, everyone. I actually had a series of questions and I wanted to allow my colleague to get through. But did I hear you correctly to say that examining for AIDS is voluntary; is that what you stated?
If a person wishes -- we cannot force a person to take an AIDS test. Where there's counseling available, your (indiscernible) City-sponsored (indiscernible) program is there. For any individual who wishes to have an HIV test, it's made available.
Secondly, you 87 1/25/01 PUBLIC SAFETY - RES. 692 stated that the AIDS program at the prisons has been reviewed. Reviewed by whom?
It's reviewed by the City contract monitor's office. It is-- there are -- Dr. Greifinger reviewed it, he saw it, his report tells you about what he thought about the HIV program.
Greifinger made a report that pointed out a lot of deficiencies.
No, there's two different Greifinger reports. There's a Greifinger report that's concerned mainly about behavioral health, and there's a Greifinger report about the medical 88 1/25/01 PUBLIC SAFETY - RES. 692 services. Now, if you look at the one about the medical services, you'll see that he thought the HIV program was exemplary, and it is.
Allow me, please -- I'm relatively -- months old. That being 11 what it is, my line of questioning is a little 12 different, and forgive me, I do not remember your 13 name, sir.
Good afternoon. Regarding the contract, it is how old, how many years old?
The most recent contract was signed in July of last year. Prior to that time, the Prison Health Services had been under contract with the City since August of 1993 just for medical services, not for mental health.
It's a three-year term, 89 1/25/01 PUBLIC SAFETY - RES. 692 one option year.
Very well. Being African-American and being a female, I'm always curious to the makeup at all levels. The current ethnicity of the current prison population is what?
It's -- I think last time I did a little talk on it. I think it was 81 percent black. Is that about right? Yes, 81 percent black and maybe --
White, Hispanic, Asian and Other. It may not be even that, let me rethink that. Maybe it was about 60 percent 90 1/25/01 PUBLIC SAFETY - RES. 692 African-American and then about percent -- 3
I don't think it's 7 81 percent African-American. 8 Is Mr. Costello here? 9 (No response.) 10
Very well. Of the 11 22 full-time staff, how many of those 12 professionals are of color and how many of them 13 are female? Of the 22 full-time medical 14 department staff. 15
Let's see. Counting myself, 16 there is -- I'd say, 50 percent are -- about 17 50 percent are Afro-American, and we have a 18 substantial -- a well-represented Afro-American 19 females as well as Indian females, Caucasian 20 females. We're -- it's a really good cross-section in terms of the clinical staff.
On the behavioral side, you mentioned that there were seven full-time professionals?
Of those, how many of those are women and how many of them are African-American?
I am the -- I have one African male, I have two Hispanic male psychiatrists. I'm the only woman of any color. And everybody else is white males, for psychiatrists. Now, my master's-level social workers and my bachelor's-level social workers is about 80 percent African-American women. And the rest are white males.
Okay. Finally, there is a City policy -- and I'm asking simply because I don't know -- that those who work in the City should live in the City. Does that policy also apply to the Philadelphia prison system of the professionals that you have, that because they work in the City, they should live in the City? 92 1/25/01 PUBLIC SAFETY - RES. 692 What is the policy? There is no residency requirement?
Yeah, we could get back and give you the exact numbers. Certainly there's City taxes. . .
Okay, I have additional questions. But, again, I'll allow the sponsor of the bill to continue. Thank you very much.
Okay. In terms of the HIV, and you were talking about being exemplary.
One of Greifinger's points that he did make was that the clinical guidelines for the management of HIV and chronic diseases needed to be updated. 93 1/25/01 PUBLIC SAFETY - RES. 692
Dr. Greifinger -- let me just give you a little history about that. Dr. Greifinger -- I came to Philadelphia in January of '99, and Dr. Greifinger did his report and review just two to three months after I arrived here in Philadelphia. I can state with certainty that the HIV guidelines, as reviewed, written, updated have been signed off by Dr. DiAquilante (ph.) as of, I think it's May of 2000. All of the other clinical guidelines are current and up to date. The diabetic guideline is being reviewed by a clinical endocrinologist that I have on staff. An endocrinologist being a person that specializes in endocrine diseases and specifically diabetes. As you may or may not know, the therapy of Type II diabetes is going through a tremendous change, and that's the reason that I invoked that we needed to undo the policies. But you have before you the clinical guidelines for diabetes that are currently in place, as well as the policies and procedures and protocol for the way the diabetes is handled at the PAB.
I know that if I ask 94 1/25/01 PUBLIC SAFETY - RES. 692 you on this -- on an AIDS-related case that happened last year, it's probably under litigation, but an HIV inmate died last year, and one of the allegations of it was that the medication that was needed for his treatment in essence was not given to him, and that that's subject to what Ken said, the litigation aspect of it and so on. But when anyone dies, and I think when these allegations are made, and just like the Santiago case and this other one in terms of HIV in which antifungal drug was not given to this individual, and the allegations were that (indiscernible), it really sounds the alarms for -- that certain things are happening that are not kosher, as they used to say in my old neighborhood in the Lower East side. And so I would like for to you submit to this committee the protocols that you have in terms of medications and HIV and treatment for chronic diseases such as diabetes and other parts. I imagine that they're in writing, are they not?
They are. They are printed up and are readily available. 95 1/25/01 PUBLIC SAFETY - RES. 692
And I imagine that you can send that over to us, to this committee.
You just designate the place where you'd like to receive them and we'll have them to you within hours. 7
Councilman Ortiz, I'd just 12 like to make this one statement. 13
And that is that any 15 medication that a patient needs, they receive. I 16 am committed. I am a physician with many years of 17 practice and experience. I love working in the 18 corrections environment arena. I think I'm very 19 conscientious about what we do, and my staff is 20 conscientious about what they do. And it -- we do 21 not -- it's not a policy of PHS, nor is it 22 something that I would uphold, support the 23 withholding of any medication for a patient. 24
Mr. Catalano, if you may. I know that there are some cases that are in 96 1/25/01 PUBLIC SAFETY - RES. 692 litigation. Are you -- is PH -- is your company under the same type of litigation, or has your company been under the same type of lawsuits in other jurisdictions other than Philadelphia?
Any health care organization from time to time, in the course of business, is subject to malpractice claims in that, and we have experienced --
Okay, that suffices. Do you have any cases in Delaware County or in Delaware?
I'm not aware of whether we do or we don't. I'll have to get back with you on that information.
When an individual is brought into Curran Fromhold and so on and arrested, do all of them go through a medical examination?
When a person is arrested in the City of Philadelphia, there are generally three levels of examination that occur. The first 97 1/25/01 PUBLIC SAFETY - RES. 692 is at the Police Administration Building, the second is at --
At the Police Administration Building, there's an intake screen. When a person reaches either CFCF or the PIC intake, there's another intake evaluation. And within 48 hours, there is a complete physical and medical history and a physical exam done by either a physician's assistant or an MD.
And if something is 20 detected, what happens, what is the process then? 21
It depends on what is 22 detected. If it is something that requires 23 immediate attention, immediate attention is given 24 to it. Let's say, for an example, it's a patient that has hypertension, just for an example, whose 98 1/25/01 PUBLIC SAFETY - RES. 692 blood pressure is taken, the blood pressure is elevated but not severely elevated, that person is then referred to one of the chronic-care physicians, where he's followed up by an MD. In the State, in Pennsylvania, in Philadelphia, the chronic-cares clinics would be like your going to your doctor, and that's where all the variety and the various kinds of issues related to medicine occur, except for HIV, which is something that is held out and cut out. So those people would be referred to those clinics and then they would be followed up as necessary.
Do you try to secure medical records once you have diagnosed someone that needs treatment?
There's two ways that we do. One, if the patient is willing to give the name of the provider and/or hospitals that we've been at, we then get written authorization from the patient, send it to that provider and/or hospital to obtain the information. Now, another thing that happens, and 99 1/25/01 PUBLIC SAFETY - RES. 692 this happens with a fair degree of regularity, if there's an issue that we want to know now, the person's been in the hospital recently, I need that information. Then what we do is, we get the person to sign a release of authorization, fax it to the hospital, and then the clinician can talk to the medical records department over the phone to get certain vital information.
What is the process that functions between the mental health and your -- in terms of when the treatment needs to be coordinated?
I'll just speak quickly about the medical part, and I'll let her speak about the behavioral part. That to me is the beauty of the Philadelphia health care system. Having a single vendor now allows me to readily have quick access to my behavioral health peers in terms of handling patients. It's no longer having to go through a third party that may or may not be willing to be forthright in terms of giving information. What it also means is that when the behavioral health, the mental health department 100 1/25/01 PUBLIC SAFETY - RES. 692 needs information, the access is very quick in getting it from the physicians who have provided the medical care. So that to me -- and this is something that's ongoing and developing as we're getting into it. One of the great things that we've developed is this monthly meeting between behavioral health and medicine in which we sit down and talk about cases that we have in common and talk about their presentations from the medical side and from the behavioral health side and in terms of raising the level of knowledge from both disciplines, and, of course, improving the care for the inmate patient.
One of the other primary things that has happened is the medical records and the mental health records are combined so there's one medical record. So whenever a psychiatrist or any other medical professional or nurses gets a record, you get the whole record. So everybody knows if there's an identified problem so it sensitizes the staff. We also do cross consultations. The psychiatrists and other professionals may ask for 101 1/25/01 PUBLIC SAFETY - RES. 692 medical referrals, and it's no problem. The medical staff may ask for mental health problems and it's no problem. Dr. Orr and my offices are together, we go to all of the executive meetings together. There is even a further integration of behavioral health along with prison administration in terms of there is very open communications between prison, the Philadelphia prison system social work staff, as well as the administration, as well as the medical staff.
I asked Estelle Richman about the prison guards and the prison staff. Do you deal directly in terms of training with the prison staff in terms of being able to notify you and for any indication of suicidal tendencies, paranoid aspects? And do you oversee the training of the prison guards along those lines?
I don't oversee the training. We work directly with the Training Academy, which does the training for the prison officers. And my program director, who is a clinical psychologist, actually does a lot of the training for the correctional officers as it 102 1/25/01 PUBLIC SAFETY - RES. 692 relates to the behavioral health issues, and they are trained in the basics, looking for abnormal behaviors, anything out of the ordinary. And I totally agree with Ms. Richmond, they have been trained to refer more not less, so we do get a lot of referral that probably may not have been needed to be referred, but that's okay. But we also use that as a training mechanism on a one-by-one basis to then pick up the phone, call the officers who referred it and say, you know, well, maybe next time, that one could have waited. But we would much rather have more than less, and that's exactly what's happening.
To whom does a prison guard go to notify about the behavior of one of the inmates?
One of the first things that's sort of been in place for a long time is something that's called "a 783 form," which is a part of the mental health statute here in the State of Pennsylvania. And they fill out the form, which is a referral for transport for emergency services, and they will --
The prison guards 103 1/25/01 PUBLIC SAFETY - RES. 692 fill it out?
Yes, they actually fill that out themselves. And what that does is, they then immediately transport the person to our triage area, which is basically a psychiatric crisis center, and they are brought over to that service for evaluation. They call before they come so that we know that they are coming.
No, that's the general referral form that anyone can fill out. The 783 has a little 783 down in the -- I think it's in the left-hand corner at the bottom of the page, it will say "783." But the referral form they can use as well, it doesn't matter. The officers may fill out that form as well. They can also call the behavioral staff within their facility. We have social workers assigned to each of the five main --
They fill out the 104 1/25/01 PUBLIC SAFETY - RES. 692 form, and where does that form go to?
Well, the form comes with the inmate and the officer over to the triage area, or if they're being seen in their facility, because we do have social workers assigned to each facility, it may be on another floor, the form comes with the inmate. It may be faxed before --
They remove the inmate from the population and send them on with the form?
Well, usually the inmates usually get taken off of the housing units and taken to -- it may be down the hall or on another floor to the behavioral office staff, but the officers escort them to that unit so they can be seen. If it's a dire emergency, they can call, and we will go to where they are, but the majority of them are brought down to us because they're usually double-bumped or more than one per cell, so it provides for some confidentiality of 105 1/25/01 PUBLIC SAFETY - RES. 692 the evaluation.
Okay. We will submit to you, Mr. Catalano, some other questions in writing, and then you can submit 'em back to us. Is that okay? 'Cause the time is running, and we have some other folks that --
Okay. Thank you very much. Donnie Moore? Please stick around for a few minutes, okay, so that. . . (Witness comes forward.)
My name is Donnie Moore. I'm currently the President of the Department of Human Services, which is the correctional --
My name is Donnie Moore. I'm currently the President of the Department of Human Services. I represent all correctional officers in the City of Philadelphia. 106 1/25/01 PUBLIC SAFETY - RES. 692
I'm here because of the impact that the officers feel of the medical plan within the Philadelphia prison, but I'd like to also say that I've been an officer for nine years. I was an intake officer, so when the inmates first come into the jail --