I was told I have to wait to go see a doctor. A month and a half later, I eventually seen a doctor.
You put in a sick-call request and it took a month and a half for you to see a doctor?
Correct. I mean, I was even thinking about hitting a CO so I could get into the infirmary so the COs would beat me up so I could get some medication so I could sleep at night. I was starting to think about that; that's how bad the pain was. Nobody understands back pain unless they've been through it, or knows somebody that has 68 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 been through back pain.
No. I wish somebody, you know, that has gone through back pain can realize it's not easy to stand up in the middle of the night and there's no heat and --
Does it comfort you that the City administration says that they're going to get into discussions about this? Do you have confidence that this will be fixed?
I do not see anything being resolved at any time shortly because of the resistance to talk about it. I know it's not even in the contract for penalties; I heard that earlier.
To me, it's surprising that we have City Solicitors and it seems like our City Solicitors, instead of protecting the taxpayer, are protecting the company that has contracted to provide services. Kind of odd, kind of odd.
It is odd. I hope and pray that all the inmates that are there get the medication they need, 'cause 69 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 I know when I was there, they were not always getting it.
My name is Nina Gorman. I'm formerly a social worker with the Philadelphia Linkage Program, and I'm now with the Prisoner Health Advocacy Project. I work as a social worker. About a year and a half ago, I quit my job in October of 2001 because of the medical neglect I witnessed at Philadelphia County prisons. I gave testimony previously and I'm mostly here to introduce two inmates -- or two ex-inmates, ex-prisoners: Anthony Hightower and also James Nelson, who experienced medical neglect. But also, I work as a volunteer for an organization --
That is being taken care of, by the way. There's very little medical neglect, I mean. Dr. Greifinger says that there is, but we're taking care of that.
I know. I saw terrible things. In addition to the testimony to the 70 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 testimony I gave before about --
I know, someday, someday we hope. You know, I had one client that went without dialysis three times 'cause he had to pick between going to court or taking his dialysis 'cause there's no protocol for that. I had several seizure patients who were not able to get seizure medications or assessments for their seizure disorder, one of which went two weeks with problems with recurring seizures, and they found out later that they had given them so much Dilantin that his system was toxic. I've seen several records of inmates where the only medication they received for severe beatings by guards was Tylenol. And I've also -- Anthony Hightower can tell you about both the mental health and the physical neglect medical neglect, as well as Mr. James Nelson.
Mr. James Nelson might be 71 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 able to testify quicker 'cause his case is quicker. And Anthony Hightower has much more detail.
My name is James Nelson. And I was arrested July of 2001, and I was taken to 55th and Pine. They permitted me to make a phone call, but I did not receive anybody, so I was there for seven days without my medication. I was supposed to take it --
I have a bladder condition. I'm supposed to take my medicine three times a day, and if I don't take my medicine and if I fall asleep, I --
No, I didn't go to intake. I told them my problem, and nobody would listen.
Could I just clarify for a second. He's talking from the time of his arrest, and I understand from Miss Asia Russell from ACT-UP 72 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 that PHS is responsible for health care from the time of arrest through intake at CFCF, so Mr. Nelson may not be terminology of intake, which means, from the time he got into CFCF, I believe, right?
Yes. Well, I was there, like I say, for seven days, and I told them that I needed my medicine three times a day and --
Oh, yeah. Well, they took me one day to get my medicine once I got there, but before there, I was at 55th and Pine for seven days, and I didn't receive no medicine.
Yes. On the seventh day, they took me -- up at 55th and Pine, they took me up to the emergency room at -- I've forgotten the hospital now. But, anyway, on the seventh day, they did give me some medicine, but that next day, they took me up to CFCF, and it took me one day to get medicine up there. 73 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 But for the seven days, anytime, I fell asleep, I urinated on myself. So for seven days, I didn't take a bath and, you know, I was smelling like urine. And in addition to that, the place was crowded. I mean, it was standing room only, and the rest room with the commode, I mean, it has -- it's deplorable there, you know, and it's feces piled up around the bowl in there.
Well, in intake, they ask you whether you have any, you know, medical problems and so forth, and I told 'em, but it took one day before I got my medicine up there, and after one day, they gave it to me. But, still, I urinated on myself that first night I was up there because they didn't give me my medicine. They gave it to me the next day, and like a couple days, I was out.
My name's Anthony Hightower. 74 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 I was arrested on December of 2000. Upon my entry into prison -- well, I'm just going to read from this because -- I had this drawn up because... I have two serious terminal illnesses: AIDS and hepatitis C, which is chronic liver disease. I'm also a diabetic, and I take insulin. I have had a few serious bouts of depression. I would like to address a number of problems I saw with medical care and mental-health care with Prison Health Care when I was incarcerated. One of the first major problems was not enough staffing and poorly trained staff for intake and chronic care, for infectious disease clinic, for mental health. Poor staffing is obvious at intake. Must wait two to three days before a doctor examines you. Cannot get medication for serious disorders like diabetes, asthma, HIV/AIDS at intake, even if you have a file with them already. Poor staffing also obvious at chronic care clinic. Must wait one to three days for sick call. Escort to medical is always available, even in emergencies or the CO will tell that you that 75 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 medical is too busy to see you, even in an emergency. I know asthmatic inmates who are refused access to medical. They cannot keep their inhalers with them, so if they can't get to medical, they can die. Medical chronic care staff does not recognize major disorders of AIDS and HIV. Example: Dr. (indiscernible), chief medical officer of the House of Corrections, could not diagnose my rash, which, this rash is borne around the whole prison. I mean, I seen a guy that got this rash; it got so bad that it looked like his skin just came off his body. And I don't know, it's something, I believe, that has to do with the showers; they are old and mildewy; it's a fungus that is in them showers 'cause that's where I started getting it at on my body. It's all on my body and it --
Yeah. And my cellmate, I had a cellmate, Fante McDade, who died from medical neglect. He went to medical from July the 4th to July the 13th, complaining over and over again of nausea, vomiting, and bad abdominal pain. 76 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 All PHS did was tell him to take a Tylenol or take a shower and drink water. After a week and a half and getting no treatment, he was dead. This was very upsetting to the inmates and me. Infectious disease also has poor staffing. When infectious disease doctor is out, no 8 one covers for her, has no replacement if sick or on vacation. She went away for four weeks, four weeks, and nobody could see her. You know, she told us that a Dr. Pepe would cover for her only in extreme emergencies, but who's to say what an emergency is? I mean, that's -- nurses up there, I don't believe they know what an emergency is. Infectious -- infectious -- wait a minute. Even when she is in, I have to wait to see her for months. Even when I'm sick, I cannot get to see her for a month or more. And even Dr. (indiscernible) would not call her to consult her on me when he doesn't have the training to treat me. This is a serious problem if you have HIV, because if fewer -- pneumonias could come on you quickly and can kill you without the right treatment. When I do see Dr. , she would not tell 77 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 me what my diagnosis is. I mean, I'm in -- like my stomach is blowing up, and after eight months, I had to discontinue all medications because my body had become all bloated with meds and stuff, and my liver is, like, real damaged. And she put me off for months and months for trying to go get a biopsy of my liver. You know, she just kept running me around in circles, telling me that, you know, we're going to stop this, we're going to do this test, we're going to do this test. But in the end, I had over 12 months in the system, and she say, okay, well, I think you got a legitimate -- you can get the biopsy. And two weeks later, she reneged on me and said, no, you don't need a biopsy. You know, all I would see is like, you know, it seemed like, you know, they're in it just for a profit. You know, I was a guy that, you know, I made a point to try to know who the other HIV and AIDS people were in the jail, and I kind of, like, you know, like, touched based with 'em, you know? A lot of 'em are scared, you know, because you know, a lot of 'em's not going to do a lot of time, and they don't want to make any waves. 78 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 You know, I got friends up there, who had HIV. C. You know, Dr. D. will tell them, oh, put 'em in the back over there. You know, I heard her tell 'em to put 'em in the back, you know, 'cause his condition had got so bad. They drag they feet on it so long that he was close to death. You know, she -- she -- she lies to us, she don't tell you the truth about you diagnosis, you know. Prison Health Services, you know, they have her, you know, they tell her to handle certain cases, you know, and, you know, at all costs, cut costs, cut it, you know, because if you going to die or not. And I have been trying for months to get a diagnosis biopsy for my hepatitis to see how bad my liver is damaged or if I could go back on my HIV meds. The doctor took me off them because my liver is bad. Now I have been afraid for months that I would die without my AIDS medicine. Medicine or without treatment or even a diagnosis of my liver, even though my labs showed my liver is bad and I have had bad stomach pains for months. 79 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 You know, I've had this rash nearly two weeks, and I have not been able to see her or get any diagnosis treatment, even though I went to sick call times -- how many times for a rash. I went around about four or five times. I was only recently -- Okay, delays in insured referrals and medication is a second major problem and common in cases that I noticed.
Delays at intake during my incarceration and on discharge. Even though I was known to the prison system, I still had to wait to get my meds for over a week. Both times, I went through intake in the past two years. Even diabetics wait for they insulin at intake, and while incarcerated, get none at intake; get it later while incarcerated, about two or three hours. (Indiscernible) red flag system. The system has some good points, in my opinion. Some folks get meds who need them, but are too tired or sick to wait in line for them. It's helpful for some HIV patients and those with serious disorders like diabetes, but if you get red-flagged, they will come back and take you up to medical and you can avoid the long lines, which is help when you feel 80 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 sick. That's why a lot of the guys, you know, they would rather be red-flagged because those lines, man, it's just -- those med lines, it's just terrible up there. You know, it's no control up there at all. And another good point about (indiscernible) is that they have stopped giving as many write-ups refusing meds. Since they don't have enough space to lock inputs, they punished for refusing meds. The system has bad points too. If you refuse your meds for whatever reason, you have to fill out a refusal form, and when you do, you can often get a write-up. You get a write-up, even if you have bad side effects. A write-up goes against your record, it keeps you from getting paroled. And If you are real sick from the meds, you have to take them anyway. I saw one guy with bad sweats who was really having a hard time. Point two: If you refuse the meds because they make you sick with side effects, you can't get a referral to be able to be checked by the doctor about the meds. If you ask for a referral form, you are told the only way you'll get one is if 81 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 you go back to the end of the line. The line is so long -- about 150, 200 people -- that no one wants to bother, especially if you have HIV or are sick.
Yeah. It is terrible, man. The medication line also takes place because it is a security risk. I saw one mental health patient at HOC ask for his meds three times, and a seven-foot CO beat him down to the floor. Then it took -- then it takes you --
(Addressing City personnel) I hope you are taking notes; you should investigate all these things.
Then it takes you a few days to see a doctor anyway, even if you do fill out the referral form or if you go on sick call. Sick call takes one to three days. The red flags encourage many people to take meds who don't need them. Maybe some inmates depended on them and are not trying to improve themselves, especially the mental-health patients and drug addicts, who, in my opinion, should be 82 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 getting treatment, not just doped up and then thrown out there when they get released. You know, it seems like these psychiatrists is working for the drug companies. He's dispensing all these Sinequans and all these mental-health drugs to people that don't need 'em. You know, it's a common thing now. They take the cigarettes out of the jail; now all they have to do to pass the time now is to take Sinequans and stay up all day and all night. And then when they want to crash, they take these Sinequans and stuff and it's, like, out of control. Half of the jail is on mental-health medications. Some mental-health patients get stuck in there for months and years longer than they are sentenced because they are too doped up to know what's going on. You know, you got a guy in there for two or three years, man, who don't even know where they at, because the psych give them all this stuff that they want. Sometimes they are so tired of medications, when they are all doped up, which is illegal. It's mostly guys who are on mental-health drugs when they go to court. They 83 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 don't know what's going on down there. All they do is take the deals and stuff that they offer them and, you know, they really don't know what's going on, and their attorney doesn't really, you know, consult with them, or they don't really, you know, advise them because they were in a state of, I don't know, you know, after a while, that medication just make you just happy-go-lucky. All right, I'm going down here to when you first try to see a psychiatrist, you see someone, a clerical kind of a person -- I'm not sure of her credentials. She just takes down what you say and doesn't tell you anything or show that she cares. It's a lot different than when Hahnemann was there and bad social workers. They don't have the money for counseling, they say.
He's going to wrap it up and tell you about his experience when he was on suicide watch.
Well, I was stripped of all my clothes, and I was put on this blue thing, like a straight jacket type, but it was real heavy, like a Velcro type of thing. And they take everything else from you, and they walked me 84 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 barefooted -- it was in December -- out to the van to take me to D.C. And then they walked me from D.C. receiving room all the way to the hospital the same way, and then they put me in a room with nothing in it -- no sheets, no nothing. And I was in there for three days.
And I was freezing, freezing -- no clothes, no nothing but that Velcro thing. And --
I don't think so. You know, every now and then, I would see like a orderly type of guy; he would peep in there, you know, but that wasn't like an hour, an hour -- or it wasn't a CO or --
They're supposed to have somebody in front of that cell hours. 21
No, no, don't -- yeah, 22 because, you know, I did some time in the Bucks 23 County prison and -- 24
I visited the other day, and they told me they have somebody for 24 85 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 hours standing in front and looking at the inmate.
No. I did time in the Bucks County prison system, and that was my job, to sit at somebody's door. We had three shifts around the clock watching that person. They don't do that in this county, they don't do it here. And you be lucky if they look in on you once. As long as you don't make no noise, they don't care. You don't make no noise, you could probably be dying in there.
Thank you. Thank you very much. You heard the testimony of the City. I don't think you're very happy with that, right?
Thank you. PHS representatives, will you come forward. Frank Rizzo is here.
I apologize for being late -- there were a lot of things going on today. 86 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 But I know I had a conversation with you, and I apologize if it's been covered, but has the -- Mr. Chairman, has the issue about the valuables been dealt with on how they --
No, that's going to be another hearing that they're going to have.
Okay. I wanted to make sure that we eventually get to that. But thank you for having these hearings, and --
But, you know, we'll probably get as many answers when we hold the hearings on those as we're getting on these, okay?
Well, again, I appreciate the hearings, I think they're important, and I'll be waiting for the continuing hearing, the additional hearings. Thank you.
Thank you, Frank. Thank you, guys. PHS. (PHS witnesses come 87 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 forward.)
Good afternoon and I apologize. I know that you came from Tennessee, right?
The state that gave George Bush to us. State your name, please, for the record.
Can you describe the positions you hold at PHS, please, each of you.
I'm based out of Brentwood, Tennessee, and I'm the Chief Operating Officer of PHS.
I'm the Regional Medical Director for Personnel Services at the Philadelphia prisons.
I'm the Regional Behavioral Health Medical Director for the Philadelphia prison system.
You're the regional director? 88 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598
I'm the Regional Manager for Prison Health Services in Philadelphia. My name's Robert Taylor.
And you're the -- who's the director of the current program at our prison system, you are?
Okay. Dr. Greifinger says that PHS is functioning in a crisis mode. Can you tell me, what's your understanding of that in his report?
The City Solicitor tells me that I can answer generalities; however, to 89 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 comment specifically on --
You know, this sounds like the mafia before the Congress here. The fifth, the fifth; it seems like we're taking the fifth here. It sounds like you have either something to hide or something not to report. All I'm asking is, are you performing? He says -- Dr. Greifinger says: "The regional vice president and the medical director have been unable to mount coherent efforts to remedy deficiencies that have been aberrant throughout the term of this contract." Throughout the term of this contract. What are those deficiencies that you have been unable to correct? State 'em for the record as you understand 'em. You refuse to answer on the grounds that it might intend to incriminate you?
Absolutely not. I refuse to answer on the advice of my attorney, who has told me that I'm not allowed to comment on specifics of the Greifinger report.
Well, if you can't -- you know, I wish the City Solicitor -- you know, you represent us; you don't represent them. 90 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598
Okay? Remember that, okay? You cannot testify as to -- why, why? Tell me why you think you cannot tell me what are your deficiencies to fulfill your contract. And if you cannot testify, tell us why we should give you another $28 million contract.
I can answer the first part of your question; I'm answering the question the way I am on the advice of my lawyer. As to the second part of your question, I have no comment.
So I guess if I ask you about the problems at intake, you will not be able to answer that either, right? 'Cause it's not -- I want some specifics, okay? If I ask you about what are what are the current staffing, you know, vacancies that you have and give me the categories for those, can you answer that?
You don't know what 91 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 staffing -- you're running the program, but you don't know what staffing vacancies you have?
I don't know on a day-to-day basis; I would defer that to the regional manager.
Okay, Regional Manager, do you know what staffing vacancies you have?
We are currently actively recruiting positions for six registered nurses region-wide and one licensed practical nurse region-wide, as well as three nurse managers across the entire complex.
The behavioral health staff vacancies are three master's-level social workers; they're being filled now with people working overtime. And one drug and alcohol 92 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 counselor.
One of the problems that Dr. Greifinger had identified before in the previous report to this was about the suicide watch. A week ago, somebody committed suicide, and it seems that as of this day, we still don't have a comprehensive suicide prevention program. Tell me, what does PHS provide in terms of suicide prevention program?
We have a comprehensive suicide prevention program. Just because we have one does not mean that we are able to present one hundred percent of the completed suicides; unfortunately, that's going to happen.
Give me the policy, give me the program, because Dr. Patterson seems to disagree with you that you have a comprehensive suicide-prevention program.
Dr. Patterson -- and I have not seen his report; I have a synopsis of his report and I'm in the process of responding to that. 93 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 We do have a comprehensive suicide policy now. Anyone who says that they are thinking about suicide, they are evaluated as --
Like they're going to come to you and say, "Hey, I'm going to kill myself."
They tell officers, who immediately notify Behavioral Health, and we either go see them or they are brought to the --
I'm not at liberty to talk about that case because it's still under investigation.
Well, I was over there not too long ago, and I took a little trip, and at that time, they talked to me about a 94 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 methadone program.
The methadone program is -- we are waiting on the final approval from the Center of Substance Abuse Treatment. All other provisional approvals have been given, so we're just waiting on the word from CSAT.
We do not know. The City's expert who has been working with us, Dr. John Carroll, is following up on that and has made personal contact with people that he knows at CSAT. We had a meeting on this with PPS officials as well as City officials and PHS Staff last week, and they were -- CSAT was still unable to give him a date for us to get up and running, but our part is done.
Before it had been reported, one of the reports by Dr. Patterson, that over 95 percent of the inmates were taking psychotropic medications.
And now it is currently -- it says: "While this over-medication has been reviewed, Dr. Patterson still knows that it's currently approximately percent higher than 8 he would expect." 9 Why? What's the problem? Why the 10 over-use of this? It says it's 50 percent higher, 11 and this is a report of a month ago. 12
I'm not familiar with what 13 you're talking about, the statistics that you're 14 talking about. 15
They come in and they evaluate your program, they write a report, and the City doesn't give you a report to tell you what you're doing wrong so you could correct it? You 96 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 don't have the report?
I do not have the report. I've been given the recommendations and I am responding to those. And so what you're saying is --
You should get the report so you can find out what it is so that you can actually -- what did you write in answer to the report?
We are in the process of responding because we must respond to what we are given by the City as a part of the monitoring process.
I would like a copy of that, of your responses to the report.
City Solicitor, I would like a copy of those answers to the report, and I would like the answers to other reports that they have had. 97 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 City Solicitor, you hearing me?
Okay. In your contract, do you have any penalties for non-compliance and so on?
It's my belief that there is a clause in the contract that does state --
It's to be assessed and to be determined by the City of Philadelphia.
It seems that you have been -- according to this report, you have been in noncompliance in several areas for over -- for the -- according to Dr. Greifinger, for the duration of the contract. 98 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 Have you ever been given anything in writing, except these reports, from the administration that says that you are not complying with such-and-such, please fix it? Have you ever been given anything in writing by the administration of your noncompliance with the contract?
The City. I mean, you work for the City of Philadelphia.
Has anyone in the City of Philadelphia -- because, obviously, when somebody dies, they make a phone call to the D.A. Has anyone ever written to you a letter, other than the report that Dr. Greifinger gives you, you know, saying you're in noncompliance?
From Mr. Gill's office, we do receive letters of noncompliance.
Could you please forward those letters to me? I'd like to see what monitoring is taking place.
And then based on the letters we forward, the action plans to Mr. Gill's 99 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 office for his --
You send them to whoever it is, and I'd like to see what you have been told that you're non-complying and what you have done to take care of those issues. You know, Dr. Greifinger -- and I'd like to go down Dr. Greifinger's report. It says that -- he reported -- he reported in '99 -- he reported in '99 that the contractual requirements for the screening of inmates for gonorrhoea and chlamydia were not being met. PHS, he says, began a system in October; however, as of this date, only 30 percent of men are being screened. I mean, this is 1999. We're in the year 2002. You were made aware of something that is going on that is really a public-health issue and a public-policy one that has to be taken care of, because once they leave -- and only 30 percent, as of this date, are being done?
I have testified before that I cannot, or will not, answer any questions 100 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 specific to those reports. However, I am told that Dr. Greifinger and Dr. Patterson will be here in the future, at which time we may discuss those.
You can't tell me why you haven't been able to fulfill that contractual obligation? You can't say? And it has taken, you know, from '99 to this year?
Mr. Ortiz, I am advised by my attorney not to answer these questions.
Have you been asked by Mr. Gill in writing, saying to you in a letter that you have a requirement to screen inmates for gonorrhoea and chlamydia, you are supposed to meet this requirement, I expect you to do it by such-and-such a timeline; have you gotten a letter on that issue? (No immediate verbal response.)
This is a contractual obligation that is not being met over a three-year period, and I want to know if there's any correspondence from the City telling you that you're not meeting this contractual obligation, what are you doing to fix it? Have you done that? Have you 101 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 received that sort of notice?
I think Mr. Taylor answered that question, that we have received --
No, no, I'm asking very specifically about this obligation that has been brought to your attention by previous reports, reports as early as 1999, and the year 2002 of the day March 20th of this report, that contractual obligation still has not been taken care of. Have you gotten notice as to why you have not met it and what you're doing to fix it?
You specifically asked if Tim Gill had communicated to me in writing --
By contract, it should be a hundred percent of men being screened. Why is it only 30 percent when you were notified in 1999?
My attorney's asked that I be allowed five minutes to discuss this with him in private.
Thank you. I appreciate it. 102 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 (Break taken.) (Proceedings resume.) - - -
The suggestion in the report that the Committee on Gonorrhoea Screening is less than 100 percent at one time was very true. Getting the program started was very difficult, we had difficulty with logistics and collection. However now, through a great deal of cooperation with Corrections, we now, at CFCF, for the male intake, collect 99.9 percent of the urines. I don't want to say 100 because nothing is absolute, but we are collecting as close to 100 percent as I anticipate we'll be able to. We've had no refusals that I'm aware of. At PIC, where we do our female intake, that program runs at nearly 100 percent as well.
I'm going to ask you some questions, I'm going to ask you whether you agree or not. In mental health care, it says that there's little progress on the implementation of quality management tools and programs for mental-health care. More than 20 percent of the 103 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 inmates at PPS have prescribed psychotropic medication. That is approximately percent higher 4 than expected. Considering the demographics of the 5 inmates and epidemiology of serious mental illness 6 among jail inmates, any excess prescription is 7 harmful to the patients. 8 And in addition, there are cost 9 implications. A one-third reduction in the use of 10 psychotropic medication could save PHS more than 11 $500,000. 12 Is that the current condition that is 13 going on? Is that the way it's been implemented? 14
The current statistics are 15 that we have approximately 20 percent of our inmates on psychotropic medications. That 20 percent is about the national average for jails; it is less for prisons. And Dr. Greifinger and I disagree on the national standard for that. But, yes, we do have approximately 20 percent. Many of our inmates who initially come into our jail are also coming off of street drugs, and they are displaying psychiatric symptoms, which is why we have such a high proportion of people at 104 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 the front door, or at least within the first several weeks, on psychotropic medication. As time goes on, some of those people are taken off because the symptoms go away, because the withdrawal from the substances go away, and of course, a lot of people do stay on the medications. One of the things that we do is as much as we can, when inmates come in on certain psychotropic medications, we continue them on the same medications if we can verify. So we are practicing what is being practiced as the community standard of care here in the City of Philadelphia. And one of the things that makes this system different than a lot of other jail systems is that some of the purest heroin in the country is here in the City of Philadelphia, so we have people coming in who are on a multiplicity of addictive substances along with their mental illnesses, and when we first see them, it takes us quite a while to figure out what we are looking at, and it is a very complex issue.
So you don't agree that it's 50 percent higher than expected?
15 or 50 percent? 105 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598
I don't agree that it's 50 percent higher than other jails because, as I said, in jail systems around the country, it runs between and percent to see people on 7 psychotropic medications. 8
Dr. Greifinger and 9 Dr. Patterson, they both agree that the current 10 screening in terms of suicide prevention, that the 11 current screening tool is defective. 12 What are you doing about that? Do you 13 agree with that? 14
With the input of 15 Dr. Greifinger and Dr. Patterson, a new medical 16 intake screen that had several more mental health 17 questions on it was implemented on April 23rd -- I'm 18 sorry, on March 23rd, and so the new screen did go 19 in with the input from both of the experts, along 20 with PPS staff, the management information systems staff, and Prison Health Services staff. So we have corrected that issue.
Right, with the input of 106 5/8/02 PUB. HEALTH/PUB. SAFETY RES. 010598 both experts.
Since the time that that -- that report was based on their reviews in early March.
Something went wrong. Nothing went wrong? A person died and nothing went wrong? You're shaking your head; nothing went wrong?