An intake officer, so when they first come into the jail, they come to my unit. Okay, for nine years -- and I worked at the Philadelphia Industrial Correctional Center in the receiving room. But my concerns are that my officers are made to do medication, my officers are made to give inmates medication at certain areas. My officers are made to give -- at 600, my officers are made to give out medication, and that is not their job.
Hold it, hold it. When you say "medication," what do you mean?
I'm saying whatever medications these inmates take at 600 -- there are 107 1/25/01 PUBLIC SAFETY - RES. 692 189 inmates at 600 University Avenue. My officers -- there is no medical staff on duty at 600 at all. Ridge Avenue, there is no medical staff on duty. There are inmates in there at all. My 6 officers are made to give out that medication. 7
We've been told that 8 the medical staff is available and on duty 24 9 hours a day. 10
There is no medical staff 11 at this area, in this area. There are 189 inmates 12 at 600. There's no medical staff there. 13 When the medication is given out, my 14 officers have a basket in Center Control they 15 roll up the basket with medication in it, and the 16 inmates have to come get their medication. That's 17 at 600. They do a similar thing at Ridge Avenue. 18 If something happens to an inmate at 19 600 or Ridge Avenue, they have to make a phone call. There's no medical treatment there at either site. Or at the cannery, there's none around the clock at the cannery. There's certain facilities where they are not supplied medical staff. And when they come into the receiving 108 1/25/01 PUBLIC SAFETY - RES. 692 room, when the inmates come -- and that's Curran Fromhold, they come into it. And they stated about the medical records coming with them. We have a different type of inmates, we have a lot of inmates that have mental problems. And we just had a recent inmate that came to the jail, that came to the jail from the hospital, and he was violent, he got violent. Our job is to restrain them. We restrained him. This inmate right now is in Jefferson Hospital on life support because he was -- he was treated by health service wings, and now he's in the hospital.
When he came in, he was given something to calm him down, and when the officers had to grab him and the officers almost got hurt working with him. He was treated and he was rushed to the emergency ward at Jefferson. That's all I know of him.
Was there a suicide watch put on? 109 1/25/01 PUBLIC SAFETY - RES. 692
Was there a suicide watch? He never made it out of the receiving room. He made it from the receiving room to PHSG to the emergency -- he had just came into the jail. His name is Cal York.
I cannot answer that. When they go to the receiving room, there's the -- the doctors do not come into the receiving room. PAs or nurses come down there. Their first initial -- their initial thing they do is, they call them as a group, they ask us if anyone is taking any serious medication of any kind or diabetes, they ask that. And then they will come back after the initial and they get washed up and they get their personal effect. Hours later, they will come back, and I'm at Curran Fromhold, they will do an intake. Where I worked at, at PICC, the nurse comes down and does a individual intake on each person, asks them -- and writes this information down. These are the ones that I'm aware of. And I have witnessed as a correction officer in my 110 1/25/01 PUBLIC SAFETY - RES. 692 years at PIC five deaths. I have witnessed two deaths on my intake unit alone.
From wrong -- from, well, the two that was on my unit, at the intake unit, they had just came into the jail, and it was detoxing.
What period of time did these deaths occur, during the last year, two years, three years?
They've occurred in the last -- between the last three to five years, from that.
And what was the cause of death of the other three? Two were from detox.
One of 'em, and it was recently, she recently died from an overdose, and 111 1/25/01 PUBLIC SAFETY - RES. 692 she was in there, and someone gave her the wrong drugs in the jail.
No, I don't know if it was a prescribed drug or not. I know she OD'd. I do not know the reason why the other two died, but I know there was five deaths that I'm very much aware of.
One went into cardiac arrest in medical, 'cause I was ordered -- I was ordered, as an officer, I was ordered to report to medical with a Scott air pack, and they put a Scott air pack on a person that wasn't breathing 'cause they asked me how to work it. My biggest worry is about sui -- they talked about suicide watches. Currently right now, they have one officer would watch up to four to five to six suicide watches. It came out from the press room in writing about suicide watches. And two years ago before, this new system was put in it, was a one-on-one. When an inmate goes to the health service wing and when we 783 a inmate 112 1/25/01 PUBLIC SAFETY - RES. 692 and they don't have a bed, it was one-on-one. Recently, they decided, they said -- recently now, it's two, three, four, five. I've seen eight inmates on one officer, suicide watch.
Define "recently." And you say "new system." A new system when?
Within the last two years, 'cause I've only been -- just like you, I've only been the president of this local for nine months. I was in the jail before then. When I was in the jail, we've had five inmates on one, eight inmates on one, ten inmates on one officer to openly observe one inmate. One officer was there to observe all of those inmates.
One officer for eight, one officer for five, one officer for three. That's just what I've observed myself, that's what I've observed.
And what might be some of the reasons why -- why there is not a greater breakdown, one-on-one? Could it be that an employee did not show up? Could it be that 113 1/25/01 PUBLIC SAFETY - RES. 692 there aren't adequate employees to cover the --
You know, that's not what we've been told. You've been here, and that's not what we've been told during the last few hours.
I don't work for the City, I work for members. I'm telling you this is what happens. That's who I work for. Now, I may have to go back there in three years, but I work for the members of Local 159, and I've seen it, I've been there, I've done it. (Applause.)
I'm very concerned in terms of the prison guards dispensing medication and giving medication. Who gives you those instructions?
Who gives us those 114 1/25/01 PUBLIC SAFETY - RES. 692 instructions?
Define management? Management is defined as from a sergeant, captain, lieutenant, commissioner, deputy commissioner, warden. That's defined as management.
Versus -- well, yes, versus the medical division. We get our instructions from management, so --
There is no one in the medical division that sits down with the prison guards to tell them about these medications that they're dispensing?
I have ten years in the Philadelphia prison system. I've never sat down with a person, never, and I worked the unit where they first come in and are doing detox and everything else.
In the treatment of 115 1/25/01 PUBLIC SAFETY - RES. 692 inmates, as when they're suffering from one of the diseases that we've been talking about, one of the chronic diseases and so on, what has been the process that you observed in the prison in terms of how they acquire the medical services that they need?
There have been times on intake units where they didn't have the EZT for the inmates. There have been times when they didn't have this medication and they didn't get it till it came in. When an inmate comes into the receiving room, if that inmate brings his medication with him, that medication is taken. That inmate does not get any medication until he is seen by a doctor, and that may take two to three days, no 18 matter what the medication is.
Medication is taken and then not replaced until three or four days?
No inmate can get any medication in the jail that I worked at, in the jail I worked at. In PICC, when an inmate walks into that receiving room, whatever they have is taken away from them and it is duly noted, but 116 1/25/01 PUBLIC SAFETY - RES. 692 they will not receive any medication until they are seen by a physician and somebody prescribes it.
Sometimes it takes over two days, so it takes one and two and three days, sometimes it takes as long as that. I've seen it take that.
And through that period of time, they're without medication?
Through that period of time, they are without medication. At times, they would give them a -- they can go to the medication line and give them a Tylenol.
Let's take -- you want specifics? Why don't you direct me. 117 1/25/01 PUBLIC SAFETY - RES. 692
Look, you know, he has put forward certain things that need to be responded to.
Let's make just a general statement so that the arena's clear. He's not been in the facility for nine months; is that correct?
We have taken over the behavioral Health Department as of July. So I guess maybe some issues -- that may speak to some issues.
Are there any circumstance in which prison guards dispense medication to the inmates? 118 1/25/01 PUBLIC SAFETY - RES. 692
The Ridge Avenue project is not a part of our -- I'm not aware of certainly the medical staff requiring guards to dispense medication. Mr. Fry, the administrative assistant, my regional administrator, may be able to give more about that, but I'm not aware of a doctor writing an order for guards to give anybody medication.
I don't think they're supposed to; I'm just saying, are you aware that prison guards are dispensing medication.
You can come up; we cannot do this like this. (Witness comes forward.)
Mr. Moore, do not leave, please sit at the table. Identify yourself for the record 119 1/25/01 PUBLIC SAFETY - RES. 692 please.
My name is Rodney Fry, and I'm the Regional Manager for Prison Health Services. At 600 University Avenue and at Ridge Avenue, these are work release inmates. These are inmates who go out to work during the day or evening shift or night shift, and they have other privileges that the inmates do not have at State Road. If they have medical conditions and need prescription medications, those are evaluated by a physician, an order is written, and we have what you call "a keep-on person" protocol and a policy and procedure in place. Those medications are sent to either 600 University Avenue or to Ridge Avenue. They are placed in a secured cart with the individual inmates' identifiers. And at certain times throughout the day, the inmate is allowed access to his medication. The officer only brings out the cart to maintain security. The inmate would then get his own medication and self-administer his medication, just as if he were at home. 120 1/25/01 PUBLIC SAFETY - RES. 692 The administrator for ASD, which is a part of maintaining and overseeing 600 University Avenue and Ridge, she goes down once a week or every two weeks to review the medications, check for compliance of the patient. And we do have a process in place by protocol and procedure to renew and reorder medications as needed.
But the prison guards are not at any time supposed to give or distribute medication?
That is correct. The officers have never been directed to administer medications.
And they don't do it there and they don't do it at Curran Fromhold.
So part of the discrepancy lies in the fact that we're dealing with two different sites, correct? Hello?
We are dealing with buildings 121 1/25/01 PUBLIC SAFETY - RES. 692 that are a part of the Philadelphia prison system but they are not located on State Road with the five major facilities. They are work release programs that are on Ridge Avenue and 600 University. And because of the more flow in and out of the jail and the work release and the minimal charges, they are treated a little differently than those at State Road. There are no direct medical personnel at 600 University Avenue or Ridge, but if the inmate does have need of care, they are brought to the alternative special-need detention central unit where they can be treated by a physician or a physician's assistant. If it is an emergent need felt by the patient or the officers, they are allowed to go to the emergency room, and several do go to the emergency room or access outside care while they are working.
That is very, very helpful. Mr. Moore, do you have a counterpart at the location where the medical director is located?
Oh, first off, at University, first off, it is supposed to be a pre-release. But on the third floor of University Avenue is a general population of inmates that stay around the clock. They do not go to work, are general population at University Avenue.
And so the follow-up question becomes, the general population on the third floor where you are, are they of the same classification as the inmates you deal with where the procedures are different?
We do have a screening process in place on who would be eligible to go to 600 University if they are not in the work release program. We try to send inmates who are not on medication or who do not have pending consults or who do not need continuous care. Sometimes, because of what's available 123 1/25/01 PUBLIC SAFETY - RES. 692 for a minimal security inmate, we may have inmates, as he said, in general population who fit the qualification to go to 600 University Avenue, but they would still be under the same auspices of work release and self-medicate when we supply their medications and have them available.
Excuse me. Throughout the prison system, there's a medication time, there's a medication time for everyone to come to get their medication. And the process in the jails is, a nurse dispenses the medication and the officer stands by and makes sure the inmate takes the medication. At University Avenue, when they call medication, the officer has to roll out the cart, sit the cart there, and watch the inmate get their medication, with no nursing staff. Even the general population, they have to call medication, they come from the third floor to get their medication.
And that is the process of self-administration. Just as if you were on blood pressure medication at home, you're being treated 124 1/25/01 PUBLIC SAFETY - RES. 692 as a responsible adult to open your medication bottle, check and make sure you have the right pill at the right time of the day, get a glass of water, and swallow it.
Doctor, Mr. Moore said that all medication is taken at intake, and then that inmate may go for one, two or even three days without any medication until he or she is examined and then prescribed that medication. What protocols are in place if a person cannot wait two or three days for that medication to be taken?
The intake facility -- the intake facility in a jail is a unique environment. Why? It's tantamount to being an emergency room. There are people who are right off the street, who may or may not have problems, who may or may not need immediate intervention. What happens is, when the corrections officers who are manning the intake facility are made aware of an inmate of a medical problem, the procedures are in place for that corrections officer to contact medical. Medical can then assess the inmate, and it will generally be done 125 1/25/01 PUBLIC SAFETY - RES. 692 by nurses, and then determine whether or not the person needs medication. If a person needs anything and they need to have it immediately, the thing is, if they're in the screening process of corrections and have not gotten to their medical screening procedure, that is facilitated, and the inmate is brought the medicine quicker so that they can make initial assessment so that the person can be seen either by a nurse or by a PA or by an MD to start medication.
I am not aware of any intentional delay of any inmate to get his or her medication.
If there a protocol in place to be able to cure that immediately? Is that true? That's what you just said.
There is a -- there is procedures in place for Corrections to notify -- I don't expect Corrections to make those calls if medicine is necessary or not, but if it's brought to their attention, there are procedures in place 126 1/25/01 PUBLIC SAFETY - RES. 692 to notify nursing, and then nursing will then do what is deemed appropriate.
Excuse me. In the intake at the jail that I'm talking about, when the nurses come down, they get the medications that the inmates get, they see the medications that they in the receiving room, they see the medication. From the receiving room, the inmate is brought to the intake unit, where I am at. Several times, I've called medical, and I understand what you're saying and stuff, but you're not there. I've called medical, I've told them about this inmate such and such and such and such, and I'm told that he has to wait to see the doctor, he has to wait to see the doctor. And I've called several times. I've logged it, it's a matter of record in the log books, 'cause we have to log it in every time it happens. It's a matter of record in the log books. This is what happens at the intake at PIC, sir.
In all due respect to the officer, what he may not understand is that when you have notified that nurse of a problem, she may 127 1/25/01 PUBLIC SAFETY - RES. 692 have made an assessment of this person on this particular medication, may have eyeballed the person and determined that this can, in fact, wait until the person is seen by a mid-level practitioner or a physician. The medical judgment already has already been involved. You may not understand it and you may be -- the officer may be unsatisfied with that decision that occurred, but a medical judgment and a decision has been made.
The protocol that you have in place does not permit that to happen.
The protocol is pretty steadfast. I mean, there's issues, things may occur, things may occur.
I just want it for the record that it doesn't happen, right?
The protocol is there. I would like to say that I think -- I would like to say that I think that it probably does not happen. I certainly -- you know, I'm not aware of 128 1/25/01 PUBLIC SAFETY - RES. 692 any ongoing problem of issues of that occurring.
And also, I would like to make you clear, sir, that it is the policy of the Philadelphia prison system to take all personal belongings when they come in and to lock them up, and that would include medication. If we need to get access to knowing what those medications are because the patient is unclear, we have worked cooperatively with correctional staff to at least get the names of those medications. If you come in and the intake nurse is identified to you that you are on medication, if it is a prescription drug, he or she then notifies the physician. We can't get a verbal order without the patient seeing the physician at that time. And as Mr. Moore has alluded to, it may take two or three days before they physically see the physician. But there has been contact by nursing professionals, two physician professionals, and an order has been obtained and medication administration has began.
Mr. Moore, do you 129 1/25/01 PUBLIC SAFETY - RES. 692 have anything else?
I'm only here on the impact of the concern of my officers and how it impacts on my officers. The suicide, which is the suicide watch, and how they do it, the suicide watch, and my officers -- and I still say, no matter how you call it, they give medication out. They have -- they are the ones that pull it out, they are the ones that make sure the inmate takes the medication. They are given -- of the two, that medication is given in the jails by the nurse, and officers are making sure they take it.
All right. Thank you. Aisha Russell, Nona Gorman, James Graham, William Shands, and Jonathan Jackson. (Witnesses come forward.) (Applause.)
You can submit your statement and -- but I would like first to get really to the -- to the --
Your statements, you know, can be submitted for the record, but I would 130 1/25/01 PUBLIC SAFETY - RES. 692 like to get immediately into what we were looking for. And so if you can give us that, we can then begin. Identify yourself for the record, please.
My name is Aisha Russell. I'm a member of ACT UP Philadelphia, which is an AIDS activist group that's been in existence for the last years in Philadelphia. 11 We fight for an end to the AIDS crisis, using 12 protest tactics. Also, I direct a program called 13 "Project Teach Outside," which is an HIV education program targeted toward positive inmates who are recently released from both State institutions and from county jails. Finally, I'm a former intake advocate at the AIDS Law Project of Pennsylvania, which, as you may know, is a nonprofit, public interest law firm for poor people with AIDS. And actually, in order to get to the bolts, as you said, and nuts, why don't we start with testimony from someone who's recently released from PIC. Unfortunately, William Shands, an ex-inmate who's living with AIDS, and Jonathon 131 1/25/01 PUBLIC SAFETY - RES. 692 Jackson an ex-inmate who's living with AIDS both could not be here today; however, I hope to be able to, in a truant fashion, submit their written testimony regarding their lengthy stays and the medical neglect that they experienced and witnessed.
However, Tracy Ann Franks recently was released from PIC and can speak about the quality of her medical care during that time, which is something that's (indiscernible) from the testimony that's been submitted so far.
I just did that, you must not have heard. It's Tracy Ann Franks. I was arrested on August 1st this summer, during the Republican National Convention, and I was brought by a police process to the Round House. Upon reaching the Round House, I did deny 132 1/25/01 PUBLIC SAFETY - RES. 692 my name, I did withhold my name, but I immediately gave all of my medical information during the intake. And I was brought to the nurse, who, again, did a medical intake. I told that nurse that I was hypoglycemic and that I was prone to precipitous perilous drops in my blood sugar level. These drops generally mean I go into convulsions. I have spent two years of my life in and out of hospitals for this condition. This condition is very easily treated. It means I have to eat -- that is all it means -- about every six hours. " So, she was right. I mean, they didn't do anything about it. For three days, I didn't get any food. However, the other inmates, the other women who were in the Round House actually did not eat at all to pass on their sandwiches and 133 1/25/01 PUBLIC SAFETY - RES. 692 the little bit of food was given to me, and that was how I avoided this medical emergency. Three days later, a doctor was finally brought into the Round House. And upon talking to me, he ordered that my blood sugar level be checked regularly and that if it dropped below 80, I'd be given food and medical attention. After that doctor came, I was only in the Round House for one more day. And during that day, I did have my blood sugar level checked regularly, and it hovered right around 80. I was receiving food, like I said, from the other women in the Round House. After I was arraigned and I was moved from the Round House to PIC, those regular checks of my blood sugar level stopped. During the week I was in PIC, my blood sugar level was checked three times. One of those times, my blood sugar level was 32. I am not sure if you're aware of what that means, but that's a life-threatening situation. Now, there was still absolutely nothing in place to deal with that. So the nurse took from her own lunch some juice and an apple and 134 1/25/01 PUBLIC SAFETY - RES. 692 gave that to me 'cause she understood what it means when somebody has a blood sugar level of 32. However, there was no systemic response. The next day, I was brought to see a doctor, who ordered that I get nightly snacks in order to supplement my diet so that this would not occur again. And, again, he checked my blood sugar level, and it was again very low; I think it was in the 50s -- not as low as the day before. So I have this order, this very nice thing on paper that says I'm going to get this extra food, and this should take care of things. The entire time I was in PIC -- I was in PIC for a week -- I never received a single one of these nightly snacks. When I asked a corrections officer why that was so, she explained to me that it generally took about a month for special dietary needs to be processed. A month. This is something that's a very serious medical condition if it gets to that point, and I survived because a corrections officer gave me an extra cold pack because women gave up their food and, you know, and another corrections officer, when I was moved to ASD also gave me food out of 135 1/25/01 PUBLIC SAFETY - RES. 692 her lunch. So I did receive this kind of ad hoc dietary supplement, which meant I avoided any serious medical condition. I still lost pounds in 12 days. I 6 was released from ASD weighing 86 pounds. And 7 this is a really simple medical condition, one 8 that requires almost nothing. If this -- if 9 something as simply as hypoglycemia can't be 10 treated during a 12-day stay in Philadelphia jail, 11 I wonder what hope we have for more serious 12 medical conditions.
Hello. I'm James Graham. I used to work as a prison case manager for Action AIDS, which is an AIDS service organization. I worked in this position from March 30, 1999 to July 26, 2000. My client population were HIV-positive prisoners in the Philadelphia prison system. I worked with them while they were incarcerated in the Philadelphia prison system until six months after their release either from the Philadelphia prison system or from a drug 136 1/25/01 PUBLIC SAFETY - RES. 692 treatment facility, or until they were transferred to a State or a federal prison. My job was to link my clients to the services they needed to live with HIV, especially medical care. While I cannot refer to my clients specifically by name without their permission because of confidentiality, I would like to talk about experiences my clients had with their medical treatment by Prison Health Services and consistent and clear trends I noted while working there. Also, because all of my clients suffered lapses in medication, I cannot comprehensively list each lapse without spending a couple of days testifying, but I will mention some significant cases, and plus also mention that basically lapses in medication were things experienced by pretty much all of my clients; none of my clients managed to avoid lapses in their treatment. Firstly, there was the delay in medications when they first came in. When a person is arrested in Philadelphia who is HIV-positive and is receiving medication, or 137 1/25/01 PUBLIC SAFETY - RES. 692 anybody who is receiving medication, they can generally expect on average about a two- to three-week delay before receiving any of those medications. Now, basically, when Dr. Orr described how they then assess that inmate if they say they're HIV-positive, for one thing, the inmate will probably not get to tell their condition to anyone who will listen to them for the first three days. And then this starts a process by which they then have to get tested again for HIV. And for some reason, this HIV test, when it's administered in the Philadelphia prison system, tends to take about two weeks to come back. Then they have to see the infectious diseases doctor and be rediagnosed. Now, in many of these cases, these are people who are being treated on the outside, quite often by a public health clinic here in Philadelphia. This information is usually made aware to Prison Health Services but it has never been my experience where Prison Health Services has ever contacted this outside provider. In a few cases, where I was dealing 138 1/25/01 PUBLIC SAFETY - RES. 692 with a client who was a client at Action AIDS on the outside, who was arrested and then had their case manager come and tell me, "My client was arrested this morning," and I would get right on it, I was sometimes able to get them medications within two to three days. But this is in a very exceptional case. This is my taking the records to Prison Health Services, handing them to a doctor, usually one of the doctors or nurses I knew who would actually do something, and then my following up and being very persistent about calling to see if they got their medication. And this is something that I was only able to do a few times with my only clients. And only one out of every ten HIV-positive inmates in the Philadelphia prison system is receiving case management at all, only one in ten has somebody out there whose job is to actually kind of troubleshoot and try to do things like this. And in most cases, my clients wouldn't even get case management until they'd already been in the system for about a month or two months. So, you know, the vast majority of HIV-positive inmates are coming in and not getting 139 1/25/01 PUBLIC SAFETY - RES. 692 any treatment for two to three weeks. And this is happening whether or not they are able to come up with this information. On the outside, they're able to --
Yes, you haven't been told that. That -- because basically, the system that Dr. Orr --
I imagine you have documentation to, you know, ascertain this.
I can go back -- and right now, unfortunately, we weren't able to get specific releases from my former clients, but that is something that we are working on. So I can provide specific documentation. Needless to say, I can't release documentation about a specific client.
But I'm working on that, 140 1/25/01 PUBLIC SAFETY - RES. 692 and I'm getting that together. But in my experience, basically the system that Dr. Orr described is a system that I never saw. PHS was never proactive in getting people's records. In fact, actually, even when the records are basically handed right to them by a case manager, it was like pulling teeth to get them to actually follow up on it. Now, there are certain individuals who work for PHS who take their job responsibly, but that's pretty much an individual commitment. It seemed as though that there was no systemic way of dealing with this, it was no one's job. And basically, if anybody did contact an individual doctor, it was usually a matter of that individual nurse or doctor going above and beyond the call of duty and doing that. And, you know, there was no 19 system there in place. The general attitude that was taken by PHS was that the inmate was lying if they told them of any medical need. Now, I can understand, given the population and also given the fact that even if an inmate does know their medical condition, they may not know specifically what 141 1/25/01 PUBLIC SAFETY - RES. 692 medications they're taking. PHS would not check on these -- on what the inmate told them. They would basically assume the inmate is lying so, therefore, we don't have to check this. And so inmates -- again, you know, we are dealing about two to three weeks before an inmate would get treated.
So medication -- I asked a question before that made -- maybe a few hours ago --
-- about medication and the pharmaceuticals not being handled in a prompt manner. I asked that of Dr. Estelle Richman and so on. And I think that was one of the critiques that was given in the previous report that was formally given to the Health Department, but that was supposed to have been taken care of and resolved so that medication is timely, timely given to those inmates that need it.
Well, as of my -- as of July 26th, when I stopped working there, this delay was still going on. And also, there were 142 1/25/01 PUBLIC SAFETY - RES. 692 lapses in medication, even after a person had been prescribed medication. Quite often, the medications were left up to the COs to dispense, or the CO would have to release an inmate from their cell, and due to staff demands, wouldn't be able to get to that inmate.
Is there an incidental case, one case here maybe, you know, one --
Again, all of my clients reported lapses in medication. It is very common; it is the rule rather than the exception at the Philadelphia prison system that there will be lapses in your medication.
Okay. Now, you know, in addition to some of these incidental lapses in medication that may be caused by an inmate not being released from their cell in time or for some reason the dose not being available, there were also shortages that occurred. During the summer of 1999, the Detention Center for about two weeks ran out of Sustiva, which is an extremely common HIV drug -- 143 1/25/01 PUBLIC SAFETY - RES. 692 in fact, probably one of the most common HIV drugs. And there was a total shortage. Nobody received any Sustiva for about two weeks. And I cannot see how any responsible medical system in a prison or outside a prison runs out of a very common medication for as long as two weeks so that no one gets this. I also want to skip to the importance of taking these medications consistently. Now, HIV medication, anti-retro viral therapy, works on suppressing the virus, and basically you just keep having to knock the virus down, knock the virus down, knock the virus down. And so if you miss a few doses here and there, which may not be significant for other medications, it can have a real impact with HIV treatment, because if the level of the drug drops down below a certain level, it ceases to really shut down the viral replication. And so it's present in the system enough to kind of provide an evolutionary factor in the reproduction of the HIV. The HIV begins to develop drug-resistant strains. And once a drug-resistant strain has mutated and developed 144 1/25/01 PUBLIC SAFETY - RES. 692 within the body, then it begins to replace the regular HIV, what's called "wild strain HIV," which is not drug-resistant. And the person then begins to then have that treatment regiment fail. So basically, an entire class of drugs become unusable for them. And they -- you know, and their chances of being successfully treated for HIV goes down. So the impact of this might not take place right away. But by getting that regimen taking away from them, then that means that, you know, that their life expectancy could be shortened because they now have a class of drugs that don't treat them. Secondly, they now have a drug-resistant strain of HIV in their body, which, if they spread to other people, they have now spread a drug-resistant strain to other people. And the significance of this can't be underestimated. In the Russian prison system, there was a shortage of anti-tuberculosis drugs that took place, and the Russian prison system basically started giving people half dosages of the drugs. 145 1/25/01 PUBLIC SAFETY - RES. 692 And they did this because of an overall shortage. What ended up developing in Russia and what Russia is now dealing with is a plague of drug-resistant TB, which can't be treated by the conventional treatment. And while HIV doesn't spread quite as quickly, if the Philadelphia prison system, through these lapses, begins to develop drug-resistant strains of HIV, we might be seeing a similar phenomena not affecting not just the inmate population but the entire population here in Philadelphia of a form of HIV that cannot be treated by current drugs. So I just wanted to kind of emphasize the significance of these lapses, you know, because you might not see the impact right away but the impact will be felt, and it is significant.
To sort of change the tone a bit, while I was responsible for intake at an agency that, unlike the agency that Jamie talks about, did not have in any way any funding to 146 1/25/01 PUBLIC SAFETY - RES. 692 solicit calls or contact from inmates with HIV, still got a substantial number of desperate calls from family and from friends -- I'm referring to the AIDS Law Project of Pennsylvania -- incredibly concerned about the health care status of their loved ones. In some cases, it was doctors and nurses who had heard that their health care -- that their patients in fact had been arrested and they were quite concerned about whether or not they were receiving their medication, they were concerned, because in the past, they knew of lapses of care after having been educated by their patients when they return to clinic. In one such case, an inmate was admitted to an institution, one of the Philadelphia county jails -- I can't remember which one -- and was taking secondary prophylaxis for cryptococcal meningitis in the form of Fluconizol or Diflucan, which is a common medication that's often given for yeast infections chronically, I'm not a medical doctor. However, in this case, despite the intervention of an HIV specialist health-care provider -- in this case, it was a register nurse 147 1/25/01 PUBLIC SAFETY - RES. 692 practitioner who diligently faxed in a list of each and every medication that this extremely immune-compromised patient was on, in addition to the dosages required of each of the medication. And I followed up by a call to the medical director, and I was told Diflucan's not in stock, we don't have it. And in this case, it's not a situation where you see the impact later on, where there's evolutionary factors that might end up in the development, or will end up, let's say, in the development of drug-resistant HIV, long after the patient has been released, let's say, from a jail. We're talking about development of a fatal brain infection that, if not treated, will kill somebody. So this chronic secondary prophylaxis that this inmate had been taken before he was an inmate was denied him until the shipment arrived. This is something that's different from the lapses that people were talking about that are more a result of gaps in care that are a part of transferring from the Round House to a facility that are as important and need to be addressed by 148 1/25/01 PUBLIC SAFETY - RES. 692 Prison Health Services. But this seems to me like a gap that happens all the time, that's remained unaddressed, that was brought up in the Greifinger report, that was brought up in reports that preceded it, and that remains a clear denial of care for prisoners with HIV and other chronic conditions like diabetes, like hypertension. We need to see a plan from the City and from Prison Health Services to close this gap because inmates are dying. And that's the truth.
It will require that plan. And this is not going to be the end of the hearings, but we will follow up. I'm going to sit down and go through the testimony that's been given here today and develop a series of questions for the next one that's coming up. The situation you describe, Mr. Graham, is -- and you as a caseworker, is one that concerns me. And I hope that the doctor and people from PHS have listened. You contradict in essence a lot of statements that were made before. And that that is worrisome. And we have to be able, as a Council, to begin looking into 149 1/25/01 PUBLIC SAFETY - RES. 692 what -- where the truth lies and where is it that we go from here. I would like you to give to this committee all of the documentation that you have available. We -- I would like to share that with my colleagues on the committee because we would like to formally come out with a full report for the approval of this Council. And we also -- as Blondell Reynolds left, she said there were a lot of questions here that have been raised that we have to look into as we go into the budget process of the City, which is coming up in the next few weeks, and as part of what we are looking into. We are also requesting that a full audit of the health program be instituted and that that will be done in the most expeditious manner possible so that, hopefully, we may be able to have it before we finish our final report. So if you can -- any information that can be documented, that is not just hearsay, we would like to be able to have that so that we can share it with the colleagues in City Council.
I just want to say that I can work on trying to compile that over the next 150 1/25/01 PUBLIC SAFETY - RES. 692 few weeks. Again, I have to get permission from my former clients.
And, you know, we can protect the confidentiality of anyone.
To be clear, as well, they are clients who are not in litigation, who are ex-inmates representing themselves as citizens of Philadelphia.
Okay, yes indeed. Thank you. Anything else? You go ahead.
Is this working? Hi. My name is Nina Gorman. I was working as a case manager, social worker with a agency contracted with the prison to provide medical advocacy and discharge planning for HIV-positive and AIDS inmates. Similarly, nearly all of the 100 clients I serviced for the one-year period between August '99 and October of 2000 told me that they 151 1/25/01 PUBLIC SAFETY - RES. 692 went without medications on intake. A few of them experienced heroin withdrawal or methadone withdrawal. One or two experienced benzodiazepine withdrawal on intake. And I had another that experienced the fear of withdrawing from Clonopin and benzodiazepine several times during a stay at the prison. When I would try to advocate for him getting his Clonopin, I went all the way up to the chief medical officer of the House of Corrections, and I was told by him Clonopin is not a seizure medicine, a statement which demonstrates clearly his lack of competence and demonstrates how he does not know the class of drugs, that Clonopin is a benzodiazepine --
). He told me that it's not a seizure medicine, which demonstrates that he does not know it's a benzodiazepine, or he does not 152 1/25/01 PUBLIC SAFETY - RES. 692 know that benzodiazepine withdrawal is so dangerous that it precipitates seizures, which can kill somebody. I advocated many times for this client and other clients that were on benzodiazepine because the prison has no protocol for benzodiazepine withdrawal. Five of clients had PCP pneumonia while in prison. Most of them had this -- had symptoms of it on intake. A few of them told Prison Health Services they were HIV-positive, two of them did not because they said they feared confidentiality breakage, because on the intake line, when they had to go through the intake interview, there was a line of inmates that were waiting there that could -- that were in full hearing distance of what was discussed. Two of these inmates nearly died, having to go to outside hospitals because the prison is not equipped to hospitalize them properly. A few others were placed in the hospital infirmary. And when I say "properly," it wasn't able to give them whatever services they needed. A few of them were hospitalized in the hospital infirmary. 153 1/25/01 PUBLIC SAFETY - RES. 692 One of these was ordered a test, a heart culture, by Dr. ), who was an infectious disease specialist at the time. The prison declined to give this. Dr. Pepe told me this herself in person. She was very outraged about it. This client ended up in the hospital and almost died from the heart infection. Unfortunately, all of my clients told me they missed their medications on transfer -- at least all the ones that I spoke to about being transferred. They were told the reason for this was that there records were delayed, or that the infectious disease specialist was not available for consult with the chronic-care doctor. On one transfer, I saw the chronic-care doctor, Dr. ), change the medications of a client, which is drastically against protocol for any HIV standards for dealing with HIV and AIDS clients, and this was an AIDS patient. The reason being for drug-resistant strains being a risk. I also had a few of my clients tell me that their treating doctors on the outside had informed them that they are on their last or 154 1/25/01 PUBLIC SAFETY - RES. 692 second-to-last combination of HIV drugs before they would have used up all of their combinations, because of drug resistance, which can develop. From what I've been told doctors, it even appeared as small as several months, in less than a year, a client can potentially go through all of the possible combinations within a number of years and have nothing else to keep them alive. And so I have clients very frightened, having gone through intake. One in PIC had no medication for over a month and he was told he was on his last combination. Certainly on discharge, most of my clients that were discharged went without all of their medications or had a medication missing often. Several of them did get some medications, especially towards -- I saw an improvement in the summer, with more discharge medications being provided. But typically, they would be missing one, or would only have gotten two or three doses. When I asked Prison Health Services about protocol, or my agency asked them about protocol for discharge medications, we were told 155 1/25/01 PUBLIC SAFETY - RES. 692 sometimes they're supposed to get a few doses in a prescription, other times we were told they're supposed to get three days' medication, other times two days' medication. When we asked for these policies in writing for intake discharge and transfer protocol, we were told that Prison Health Systems, nor prison management is willing to dispense any protocol in writing, and they would continue to refuse to do so.
Probably the most frustrating part of my job was seeing clients with AIDS-related disorders, all of which, if left untreated with the antibiotics they needed or with getting disruptions in HIV medications could be life-threatening within a period of weeks. Diagnosis such as kidney failure and MAI infection, Karposi's sarcoma --
Are you going to submit that to us, what you have written?
All right, I'll wrap it 156 1/25/01 PUBLIC SAFETY - RES. 692 up.
I'd like you to submit it so that we can begin looking at. . .
I'll wrap it up. Okay, I can echo to the lack of emergency protocol, that it's up to the discretion of untrained and nonmedical CO staff to bring clients up. I had two clients with seizure disorders that I went up the chain of command in Prison Health Services to the chief medical officer, who refused to do anything to deal with the situations. One of those clients ended up with Dilantin toxicity. They refused to even provide a --
If you can begin being specific when you give it to us in terms of who you talked to and so on up the line and so on.
Okay. I talked to Bob Holmes, nursing case manager. I talked to a person that he directed me to that was the head of nursing in Prison Health Services -- I believe her name was Rose. I'm not certain -- you know, I know her by face. Who else did I talk to? I talked to 157 1/25/01 PUBLIC SAFETY - RES. 692 the nursing administrator. I can't remember her name, but I can get her name for you. Thompson, I believe her name was. I can find out her name. They all refused to evaluate the client for seizures or to move them closer to the infirmary to get them any kind of assessment, and he later was discharged and told that he was over-medicated on Dilantin. I don't know if that was connected with the seizures or not. When I would call Prison Medical to advocate for clients, I typically would either not be able to get through on the phone at all, was told to leave a message for the chief medical officers, who didn't pick up their phone or call me back at all. Or when they did call me back, it was several days later. When I talked to Dr. Orr himself, he told that me only checks his machine every few days. So there could be no assurances for that. Okay, so I'll, you know, wrap it up. So I would urge a system of accountability and a protocol in place for emergencies and also to deal with surgery delays. I had a client that had his airway obstructed and his esophagus obstructed 158 1/25/01 PUBLIC SAFETY - RES. 692 simultaneously. I saw notes for this by the ENT doctor. I saw his -- the ENT doctor's notes listed as urgent for him to have a biopsy and him to have surgery. I saw those notes repeatedly ignored for months, and I saw them later written over by someone to change the dates. And that's, you know, basically it. And, you know, I'd also urge some system of accountability that would involve, you know, getting consistent prisoner input, because Prison Health Services and prison management can say what they want to say based on what they've witnessed or haven't witnessed, and there's no way, you know, of verifying this, but these issues of lack of medicines for life-threatening illnesses, delays, medication lapses are common knowledge for prisoners in the Philadelphia prison system.
And I'll also gather 159 1/25/01 PUBLIC SAFETY - RES. 692 documentation of some of my former clients. I'm no longer with the agency; I left because of the conflict over this issue.
I think no one here today has said that giving health care in a jail or in a system of jails is easy. Certainly, populations come and go, and there's a lot of fluctuation and a lot of problems that can arise. But that's why taxpayers pay taxes, so that a vendor can be contracted with that can with be relied upon to meet the needs of this, basically this population of over 7,000 people that has multiple illnesses. The Philadelphia jail system has the greatest concentration of HIV in Philadelphia. And these are basic problems that we know how to treat, we know how to address on the outside. It should be as treatable on the inside.
They said that only -- they were only treating around 3 percent of HIV-positive individuals in the prison. In your estimation -- an d I know that and I -- 'cause we 160 1/25/01 PUBLIC SAFETY - RES. 692 deal with the privacy legislation. What is in your estimation, and I know you do a lot of work, what is the population of HIV, in your estimation, in the Philadelphia prisons?
Based on a -- I'm going to tell you the source of this so -- anyway, so as to what limitations of the source there are, but based on conversations I've had with (indiscernible) Garcia, who is the head social worker for the ACO Office AIDS, Activities Coordination Office, within the Philadelphia prison system, it was his estimate that the number of HIV-positive inmates in the Philadelphia prison system, known to the prison, was a little under 10 percent. And that was the -- and that figure also seemed to be confirmed by estimations of other people.
Condoms are available. However, how to get these condoms is not widespread knowledge. Also another area that --
They're available at the request or they're available -- 161 1/25/01 PUBLIC SAFETY - RES. 692
They're available at the request. One thing that could be improved on is to make where this could be requested more common knowledge because I knew about it because I was the case manager, and I told my clients about it, but it was not common knowledge, and the majority of inmates are not really aware that these are available, but they are available; it's just a matter of getting the word out there.
And also, even though there may only be 2 or 300 inmates that are receiving treatment for HIV via -- on medication, Dr. DeQuilante (ph.), the current infectious disease specialist, told me herself that her caseload is over 700. And she also -- we've also had conversations over medication lapses frequently, and she's told me there's nothing she can do about it.
Good evening, Councilman 162 1/25/01 PUBLIC SAFETY - RES. 692 Ortiz, Mr. Alvarez, and everyone in Council. I'm going to be real short and brief. I'm Knesset David Klein, Prisoner Rights Advocate, and I'm with the Pennsylvania Prison Society. The Pennsylvania Prison Society is promoting humane justice and a restorative correctional system and a rational approach to criminal justice issues since 1787. I'm just going to read one case that I have, but before I get there, the Pennsylvania Prison Society strives to assist prisoners and their families during periods of confinement and integration of the community, urge policy-makers to avoid politicizing criminal justice issue, and recognizing the value of a restorative approach to corrections, a system that seeks to repair the damage of the victims, offenders, and society as a whole, and to keep the public informed of criminal justice developments affecting the public's ability to deal constructively with the crimes, monitoring State and county prisons, and provides programming and support for the needs of prisoners and their families. Councilman Ortiz and Mr. Alvarez and 163 1/25/01 PUBLIC SAFETY - RES. 692 those that are in City Council, I'd like you to hear this -- the doctor made a statement about the calls that they get and the chain of command and getting the calls out to family members. Prison Society has been around for about 200-some years, and basically, we get a lot of impact, a lot of the calls because families members can't assess the system, they can't get into the prison, they can't get the calls, the calls don't go through, so they call us. Mr. Clinton Driver. Richard Driver called about his son, Clinton Driver, who was incarcerated at the Detention Center. Richard said Clinton was shot in the head on June 5, 2000 and has to have surgery done at the University of Pennsylvania. Clinton is blind in the right eye and is starting to go blind in the left one. Richard said they removed part of Clinton's skull during the operation, but they haven't replaced it. Richard said they still have the piece that was removed in the freezer at the University of Penn. Richard said they were talking about putting a plate in his head. Mr. Driver has been seen by medical for 164 1/25/01 PUBLIC SAFETY - RES. 692 his eye site but has been denied to go back to the University of Penn, where the doctors were supposed to put this skull back in, in place. So because of so many cases and incidents, Mr. Driver isn't even hardly seeing, and this University of Penn still has his skull. And as I was saying, we get numerous calls from Prison Society about these issues, and they aren't handled. We have to go up there and we have to investigate or see what is happening. And I would just like to say that they aren't -- they weren't following the protocol as they said about getting the phone calls, they don't receive those calls, they can't receive those calls. The outside organizations such as the Prison Society, AIDS Law Project, whatever, they receive these calls, and we have to find a way to get in. And I would like to say that I worked with Mr. Graham for about a year in prison rights advocacy and legal aid for the Institutional Law Project, where we worked for the City and State. And if Mr. Graham --
These phone calls 165 1/25/01 PUBLIC SAFETY - RES. 692 are about medical attention, medical services?
And you relay them to the medical services of the prison?