February
28, 2006
Please
Join Us in Albany on March 13th for
MHANYS LEGISLATIVE CONFERENCE
More
information at http://www.mhanys.org/pubpol/conference06.htm
IN
THE NEWS:
Families
Together honors Timothy’s Law advocate.
By Shelley Gebhardt
Legislative Gazette, February 21, 2006
As
an aggressive supporter for Timothy’s Law, Kim Spicciatie
accepted the Advocate of the Year Award presented annually by
Families Together in New York at the group’s luncheon last
Tuesday.
Spicciatie,
who lost her son Christopher about seven months after their health
insurance company denied doctor’s recommendations of inpatient
treatment for mental health and substance abuse, advocates on
behalf of Timothy’s law at PTA meetings and to lawmakers
in Albany.
Timothy’s
Law is named for Timothy O’Clair who took his own life at
age 12 after he had depleted the coverage his health insurance
allowed for treatment of mental health. If passed, the legislation
would require state health insurance companies to provide coverage
for mental health and substance abuse treatment. The bill was
passed in the Assembly for the past three years.
Timothy’s
father, Tom O’Clair, presented the award to Spicciatie whose
stories are all too familiar. Christopher, like Timothy, took
his own life.
Christopher’s
death was due to an overdose of alcohol correlated with the insurance
company’s neglect to provide proper and doctor recommended
substance abuse treatment.
O’Clair
said of Spicciatie, “Kim’s work is in keeping with
the saying that gives me inspiration ‘even the smallest
bird cannot walk upon the sand without leaving a foot print.’
Kim is truly leaving a foot print through her advocacy for change
in the laws in New York.”
Both
Gov. George E. Pataki and Senate Minority Leader David Paterson
were acknowledged at the luncheon for the Leadership Award and
the Legislator of the Year Award, respectfully.
Attention
turns to long-term viability of Part D benefit - Dual eligibles’
advocates see restricted access to medications.
Mental Health Weekly, February 27, 2006
A
mental health client needed to pay two copayments for one antipsychotic
medication, because a shortage of the drug resulted in his normal
quantity being divided into two separate prescriptions.
A physician seeking prior authorizations for a patient was asked
over the phone to furnish two journal citations supporting his
judgment on the drug he sought to prescribe.
Another client with an income of $16,000 was staring at $5,000
in cost-sharing if he wanted to stay on the antipsychotic that
had assisted his recovery.
These actual events, cited by one state director of an association
of community mental health providers, justify growing unrest in
the mental health field about how well the new Medicare Part D
drug benefit will serve the more than 6 million Americans eligible
for both Medicare and Medicaid and now served by Medicare for
prescriptions.
Although most community mental health agencies are still immersed
in short-term barriers to service that the “dual eligible”
population has encountered since the benefit’s Jan. 1 introduction
(see MHW, Jan. 23), many agencies are starting to pay more
attention to longer-term concerns about the benefit’s implementation.
Heading the list of worries are the anticipated actions of the
many private prescription drug plans charged with administering
the new benefit in the states.
Leaders in the mental health community say early evidence points
to a restrictive management of the drug benefit that is widespread
and that threatens access to needed medications for highly vulnerable
beneficiaries.
“Even
though people may find a prescription plan that makes sense for
them, we’re coming up against arbitrary dosing and quantity
limits,” Elizabeth V Earls, president and chief executive
of the Rhode Island Council of Community Mental Health Organizations,
Inc., told MHW.
Earls added, “These plans have no overall investment in
the person’s health care in general. So why should they
care?”
Procedural
challenges
Earls and others say community mental health agencies that are
helping dual eligibles navigate the new benefit’s complexities
face daunting challenges. In Rhode Island, there are about 40
different prescription plans under Part D, with about a dozen
emerging as the market leaders, said Earls, who is also first
vice hair of the board of the National Council for Community Behavioral
Healthcare (NCCBH). For agencies, this means becoming familiar
with an array of restrictions on the plans’ various medication
formularies.
In many community mental health agencies, one-third of more of
clients are in the dual eligible category. The burden of making
sure that these clients can access needed medications has been
falling to community agencies’ entire direct-care staff,
from case managers to physicians to nurses, Earls said.
“Clinicians
are reporting that prior authorization has put everyone through
terrible ordeals,” she said. She added it is disappointing
that while Rhode Island had made good strides in removing barriers
to access to behavioral health care, the introduction of this
prescription benefit nationally has made some of the old conflicts
re-emerge.
Some medical experts around the country have said that based on
the early evidence, the Part D drug plans are behaving even more
restrictively than commercial insurers and their pharmacy benefit
managers traditionally have.
Even though agencies in the service system have tried to establish
a safety net for their clients as problems with the benefit’s
early implementation are ironed out, some clients clearly have
had to go without medications for a period of time, according
to Earls.
Insurance requirements are not the only area of long-term concern
for mental health providers and advocates. Many believe the case
should be made that even the nominal copayments of $1 and $3 per
prescription allowed under Part D pose an unreasonable barrier
for many beneficiaries and should be eliminated. Providers and
advocates say that many of their clients have multiple prescriptions
and simply cannot bear a greater hit on their limited incomes.
In addition, the confusion and barriers that have characterized
the program in its early weeks can have a tangible effect on people
with serious illness. “When any poor person has to go through
a lot of bureaucracy, it diverts a lot of energy and attention
from getting well,” Linda Rosenberg, NCCBH’s president
and chief executive, told MHW.
Prospects
for compensation
Another major question that may take weeks or more to answer revolves
around the degree to which state agencies and providers that have
helped beneficiaries through problems will see compensation from
the federal government for their efforts.
Some but not all states have instituted emergency measures to
ensure that beneficiaries retained access to medications while
program glitches were being worked out. Some states too advantage
of a policy decision enabling them to extend Medicaid coverage
through March 31 for individuals who had been transferred from
Medicaid to Medicare for their prescription drug coverage. It
is unclear at this time whether that deadline may be extended
further.
Rosenberg said that the Centers for Medicare and Medicaid Services
(CMS) has pledged to examine what providers have had to spend
to make sure their clients weren’t falling through cracks
in the system. “For our members, this is still an unfunded
mandate,” she said.
But prospects for seeing providers reimbursed on a wide scale
for their recent activities appear slim at best to many observers.
With the federal government looking at slowing the pace of human-service
spending and increasing the financial burden on beneficiaries
(and with some states appearing eager to follow Washington’s
lead), some find it difficult to envision a plan that would repay
providers for revenue lost as a result of their emergency activities.
“I
can safely say that in Rhode Island we’re not going to see
a dime for the extra work we have done,” Earls said.
Mental
Health Agenda.
Crains Health Pulse, February 23, 2006
Behavioral
health advocates support a three-year COLA rate increase of 2.5%
in the executive budget for community mental health programs.
The proposed hike would mean an influx of as much as $31 million
in each of the next three years. But advocates recently lobbied
Albany lawmakers to urge the administration to develop a permanent
reimbursement method for Article 31 clinics that would accurately
reflect annual inflationary rises in spending. The Coalition of
Voluntary Mental Health Agencies is concerned about the financial
soundness of Article 31 clinics and day treatment programs, whose
base rate was excluded from the governor’s proposed COLA.
The coalition is developing a white paper that will provide an
analysis of historic trends and comparative rate methods with
the theme that reimbursement should be linked to real operational
costs.
Legislators
meet with adult home residents over living conditions, prescription
costs.
By William Eng
Legislative Gazette, February 27, 2006
The
Coalition for Institutionalized Aged and Disabled and the Coalition
for Adult Home Reform met with over 100 residents of adult homes,
to raise awareness on conditions in adult homes statewide.
Michael
Cimino, a 55-year-old resident in a Suffolk County adult home,
like many others who shared their stories, led a normal life before
suffering a series of misfortunes that forced him into an adult
home.
Cimino
was in three car accidents, had two spinal operations, two heart
attacks, open heart surgery and surgery on his colon for what
turned out to be a benign tumor; 45 percent of his heart muscles
died; he was diagnosed with diabetes, suffered a Lithium overdose
due to an oversight by his psychiatrist, was diagnosed with bipolar
disorder and survived an addiction to his pain medication. He
is currently on 17 different medications
Now,
Cimino wants to work toward living on his own. He said, 'We all
need case managers to help us set goals and achieve them. We need
more advocates to represent us and push for us. All we ask is
to be treated as human beings. And being treated as a human being
is a God given right,' he said
Bryan
O'Malley, legislative associate for Assemblyman Richard Gottfried,
D,WF-Manhattan, said, '[Gottfried] feels that adult homes serve
an important role,' and said they should be temporary homes
O'Malley
agreed with adult home residents, who said they needed more well
trained case managers who could help them get out of the homes
and make sure they live a healthy, safe and independent life
Legislators
are addressing other problems as well
For
example, Assemblyman James F. Brennan, D-Brooklyn, announced that
he introduced a bill to provide money for air conditioners in
adult homes.
Brennan
also alleges there have been unreported deaths in adult homes
and the 'Pataki administration has ignored conditions for years
and years.'
Bob
Herz, director of the aging committee for Senator Martin J. Golden,
R,C-Brooklyn, said, 'We will continue to push for $5 million for
[air conditioning].
Gottfriend
also helped pass a law that if a persons medication was denied
under Medicare Part D, they could appeal the case to continue
receiving the medication.
Medicare
Part D, a federal drug plan introduced last year, no longer allows
patients with duel eligibility, people under Medicare and Medicaid,
to have their prescription drugs paid by Medicaid. Now a co-pay
is required and would be set up through a Medicare-approved private
prescription drug plan. However, private drug companies can be
restrictive of medications and co-pays could range from $1 to
$3 per prescription
Adult
home residents receive $150 to $170 a month for personal expenses.
Nursing home residents are exempted from co-pays but assisted
living and adult home residents are not.
Michael
Seereiter, director of public policy for the Mental Health Association
in New York State, said the average resident is on eight to 10
medications and that 600,000 New Yorkers are affected by Medicare
Part D.
Seereiter
said his group's main concern was that adult home residents are
on a fixed income and should not have to plan in another $30.
Need
outweighs supply for child psychiatrists. By Joseph Gerace
Legislative Gazette, February 21, 2006
Albany
County is the home of 15,450 children afflicted with functional
emotional impairments who would probably benefit from the assistance
of a child psychiatrist. But they will have to wait months to
get an appointment; there are just 13 child psychiatrists employed
in the county.
Albany
County Executive Michael Breslin, spoke to a room of mental health
experts at a recent conference dealing with the current drought
of child psychologists in New York State.
“Think
about the brothers and sisters, the teachers and the kids in class
and the children with mental difficulties who lose part of their
life,” Breslin said. “A lot of that is irreversible.”
Representatives
of the New York State Conference of Local Mental Hygiene Directors
and several guest speakers from around the Capital Region held
a public awareness event last Wednesday in support of their Solution
To End Psychiatric Shortages, or STEPS, program.
A
press release from CLMHD stated that of the 62 counties in New
York, 24 do not have a child psychiatrist.
The
number of psychiatrists doesn’t reflect the need of the
populations in many counties. In Westchester County there are
50,071 children with functional emotional disturbances and 22,531
with serious, non-functional, emotional disturbances, with just
130 child psychiatrists.
Rensselaer
County is no better; there are 8,457 children with functional
emotional disturbances and 3,804 children with serious, non-functional,
emotional disturbances and just a single child psychiatrist.
Rensselaer
County’s only child psychiatrist, Dr. Zvi Klopott, spoke
about problems he and counselors around the state are experiencing;
many are forced to turn patients away untreated. According to
Klopott, the best he can do is refer them to another psychiatrist,
and that will prove ineffective as well; patients are simply placed
at the tail end of a six-month waiting list.
He
also warned that although it was possible for parents to receive
medication for their children from a physician, it will often
mask problems “that will re-erupt at a later point.”
Many
speakers suggested solutions to the shortage of psychiatrists,
but a plan of attack common to many of them was collaborating
with the Legislature, governor and other state organizations.
Assemblyman
Peter Rivera, D-Bronx, shared stories about his daughter, who
overcame a diagnosis of attention deficit disorder with determination
and the help of her family. The assemblyman stressed the importance
of listening.
“More
money in the budget is a partial answer,” said Rivera. “We
must go on to identify and collaborate.”
CLMHD
Director of Communications and Special Projects Linda Tremblay
said her number one priority was to find a way to get children
services, “if not through child psychiatrist then through
a pediatrician or a nurse practitioner.”
The
action plan listed in the STEPS program includes working with
the state to enhance existing opportunities and create new state-funded
training and residency for child psychiatrists, developing a manual
on loan forgiveness and programs to assist physicians with economic
relief, and hosting more public events or conferences to raise
public awareness and build support for reform.
“We
have a children and family committee that meets on a monthly basis,”
Tremblay said. “Now they are going to determine what the
next steps are going to be.”
Lethal
oversight in group homes? Some say more supervision could curb
the rash of violence in homes for the mentally ill and disabled.
By Lauren Terrazzano
Long Island Newsday, February 24, 2006
Charles
Psoinas staggered down the stairs in the Garden Place Community
Residence in West Hempstead, bleeding profusely from wounds to
his chest and neck after he was stabbed with a 6-inch pocketknife.
He
made it to the basement, where he found a manager of the 11-resident
home for the psychiatrically disabled. She called 911. Psoinas,
58, a schizophrenic whom family and friends called "Chuckie"
and who loved the group residence that had been his home for about
three years, was pronounced dead shortly afterward.
His
roommate at the state-operated home, Derrick Smith, was charged
with second-degree murder in last month's attack. The trigger
for the violence was seemingly innocuous: According to police,
Smith, 35, had accused Psoinas of telling supervisors that Smith
had been making soup after hours, a violation of the group home's
rules.
It
is among the most recent of several deaths and violent incidents
at group homes for the mentally ill and developmentally disabled
on Long Island and in New York City. While advocates for the population
cringe at potential stereotyping of the residents stemming from
these occurrences, others wonder whether more effective supervision
- higher numbers of better trained staff - is needed.
Not
an isolated occurrence
The
West Hempstead incident isn't an isolated case. In late January,
a mentally disabled woman who lives at a Plainview group home
was assaulted, and an employee of the residence is charged in
the crime. Also last month, a mentally ill man in Chelsea wandered
from his group home and was killed after he sat down on the subway
tracks near 23rd Street. Police said he had liked to play "hide
and seek" in the subway.
In
August, a resident of a Melville group home died of heat exhaustion
after locking himself in a car on a 91-degree day, and in February
2003, a man went missing from a state-affiliated Kings Park facility
and froze to death in the woods. There have been dozens of other
incidents, according to records, though many don't rise to the
level of serious injury or death.
The
West Hempstead killing exposed a telling knowledge gap between
state and local officials, who acknowledge the void, and has raised
issues of supervision among providers.
Jill
Daniels, a spokeswoman for the state Office of Mental Health,
said Psoinas' slaying was the first "critical" incident
at the West Hempstead home reported to the state since it opened
in 1992.
Newsday's
examination of police records told a different story, with law
enforcement a frequent presence at the home.
Since
2001, Nassau police responded 53 times to calls there. While the
majority were so-called "aided" cases, often ambiguous
incidents involving assistance with medical care or resolution
of disputes, at least two were responses to violent incidents
or property damage, according to records. There were nine missing
persons reports filed since 2003, and at least one case of criminal
mischief reported after a window of a car was smashed.
Told
of the lengthy record of police responses to the home, Daniels
said, "Just because the police are called doesn't mean it's
a reportable incident."
Under
state law, homes must report critical incidents to the state,
but criteria vary. They are classified into a variety of categories,
depending on severity, ranging from medication errors to abuse
or neglect or random death. Often, the assessment of an incident's
severity is left to the discretion of group home operators, who
develop their own incident management plans. In such cases, homes
are required to keep internal incident reports except for reportable
deaths, attempted suicides, crimes, or missing clients, among
other categories. Police are not required to report to the state
when they respond to a home.
The
West Hempstead case, however, has prompted some follow-up. The
state's Commission on Quality of Care, a state-funded watchdog
group in Albany, is investigating the alleged assailant's prior
care and treatment around the time of the attack on Psoinas, spokesman
Gary Masline said.
Homes
a humane solution
The
individual group residences, which house anywhere from five to
20 people with a variety of disabilities, began to grow in popularity
in the 1970s and '80s as a more humane alternative to care in
massive psychiatric institutions. The smaller homes were a way
for the mentally ill to live in the community, in the least restrictive
setting - the type of environment called for in New York state
law, advocates said. The state stipulates that one person be on
duty, no matter how many people live in the residence, said Daniels.
Still,
violent incidents in the group homes have been few, given the
thousands who live in them. Currently, close to 3,000 people are
in such residences in Nassau and Suffolk counties, and about 10,000
occupy group homes in New York City. "There's no question
we can find random incidents that are really terrible and tragic,"
said Harvey Rosenthal, director of the New York Association of
Psychiatric Rehabilitation Services in Albany. "But, for
the most part, these are the exceptions."
For
years, Psoinas lived at Pilgrim State Psychiatric Center until
doctors said he was ready to live more independently. By many
accounts, he had managed his schizophrenia quite well with medication,
records and interviews show. Family members said Psoinas had lived
in the well-maintained, white Colonial home and was never happier.
"He
followed the house rules. He was in by curfew. He was a happy,
gentle person who always remembered everyone's birthday,"
said his sister-in-law, Dana Lee of Oyster Bay. He rode his bike
to get his hair cut. He loved shopping at the local flea market.
Smith's
profile was markedly different. A paranoid schizophrenic who at
times had been homeless, he had a history of assaults and had
served time in the Nassau County Jail, police said. In 2001, he
was convicted of felony attempted robbery.
In
1999 and prior, records show Smith had a slew of misdemeanor convictions,
including criminal mischief, resisting arrest and fourth-degree
criminal weapon possession, third-degree assault and criminal
trespass. It is unclear why he and Psoinas were placed as roommates,
given their very different histories. Daniels could not explain
it, though she said that "clinical profiles are considered
to determine compatibility."
More
supervision needed?
Advocates
for the mentally ill fear that incidents such as Psoinas' slaying
will feed a latent stigma against badly needed housing for people
with such disabilities.
"Should
staffing be greater? Absolutely," said Mike Greenfield, director
of the Mental Health Association of Nassau County. "The system
is understaffed and needs staff who are more trained and adequately
compensated for their work."
Lawmakers
need to sit up and take notice of what is an ever more pressing
community predicament, others say.
"There
needs to be a sounding to our state officials that resources are
needed to address the needs of an increasingly complicated group
of people," said Michael Stoltz, chairman of the Suffolk
Coalition of Mental Health Service Providers, who said he is troubled
by the West Hempstead incident. Nearly 1,000 mentally ill people
on Long Island are on a waiting list for community housing, Stoltz
said.
At
some homes, the supervision of residents has been an issue warranting
investigation.
In
August, Luis Rivera, 51, died of heat exhaustion after locking
himself inside a car in the driveway of his group home in Melville.
The Commission on Quality of Care still is investigating.
In
February 2003, Arthur Bartoszewicz, 47, wandered from the grounds
of his Kings Park residence and was found frozen to death in the
woods, naked except for a boot on a sockless right foot. The home
conducted a review of the circumstances leading to Bartoszewicz'
death, but it wasn't examined by the commission.
Lee
said she generally supports the concept of smaller residences
for the mentally disabled - but with an important caveat regarding
the inhabitants' security. "We feel that after all the hard
work he did to live independently," she said of her late
brother-in-law, "he should have been able to be safe in his
own bed."
Warning:
This article contains some explicit language
Cruel
and Unusual? By Ken Picard
Metroland (Capital Region alternative weekly newspaper)
February 23, 2006
Dying
in solitary in a New York prison
Sal
Dagnone is serving 36 years to life for killing a man during a
drunken bar fight 19 years ago. A lot has happened in his life
since then. When he entered prison at 18, Dagnone couldn’t
read or write. He’s since earned a GED, two years of college
credit and paralegal training, and has gotten married. Dagnone
is now being held in Great Meadow Correctional Facility in Comstock,
but his stint behind bars has taken him through almost every maximum-security
prison in the Empire State: Attica, Sing-Sing, Downstate, Shawangunk,
Southport, Clinton, Coxsackie, Sullivan, Elmira.
In
Elmira, Dagnone tried to escape. He used a rope and hook to scale
the roof, and stolen wire cutters to get through a fence before
a guard dog nabbed him. The foiled breakout earned him five years
in disciplinary confinement at Upstate Correctional Facility in
Malone.
After
nearly two decades in prison, Dagnone is still haunted by an incident
he witnessed at Upstate a little over a year ago. For two days
and nights in December 2004, he listened helplessly as a 19-year-old
inmate named Christopher Campos suffered repeated seizures in
a nearby cell. Campos later died in the infirmary because the
prison’s medical staff had assumed he was faking it.
The
snow-covered Adirondacks are the heart of New York state’s
prison country. Clinton, Essex and Franklin counties, collectively
known as the North Country, are home to 10 prisons that employ
more than 3,900 people. The annual payroll exceeds $177 million.
The
small town of Malone, northwest of Plattsburgh, is the site of
three prisons. Together, Bare Hill, Franklin and Upstate correctional
facilities account for more than one-third of the town’s
14,800 residents. Upstate Correctional Facility is New York’s
newest and largest super-max prison. It’s a sprawling complex
of 23 buildings on 70 acres about 10 minutes by car from the Canadian
border.
Upstate
is unique among the 70 prisons operated by the New York State
Department of Correctional Services (DOCS). Hailed at its opening
in July 1999 as a “new concept in disciplinary housing,”
it was designed to hold the worst of the worst. It has a capacity
of 1,500 inmates—300 to work in the prison’s mess
hall, laundry and other services, and 1,200 in disciplinary confinement,
known as the “Special Housing Unit.”
Prisoners
get “SHU time” for a variety of offenses—possession
of contraband, failed drug tests or “dirty urines,”
fighting with other inmates or assaulting staff. SHU prisoners
are locked down 23 hours a day, with just one hour of legally
mandated “recreation” time in an empty outdoor cage
attached to each cell. There are no phones, no clocks, no programs,
no religious congregations and no physical interaction with other
inmates. Except for a limited amount of reading material, headphones
that play staff-selected radio stations, and one allowed visit
per week, inmates in SHU have virtually no contact with the outside
world.
A
10-by-10-foot cell can house one or two inmates. The cell has
no bars, just a concrete floor and three walls, a thick metal
door and a vent that allows in filtered light. Nearly all an inmate’s
activities take place inside his cell, minimizing his contact
with staff and other prisoners. Each cell has a stainless-steel
sink and toilet; staff operate a shower externally. All meals
are served through a “feed-up” slot in the door. On
the rare occasions when an inmate leaves his cell—for court
hearings, meetings with visitors or emergency infirmary calls—he
is typically shackled in leg irons and handcuffed at the waist.
New
York leads the nation in both the number and percentage of inmates
who live in disciplinary confinement, according to the prison
watchdog group Correctional Association of New York. DOCS credits
this approach for its steep decline in inmate offenses. Between
1993 and 2002, DOCS reported a 38-percent drop in inmate-on-staff
assaults. Inmate-on-inmate violence declined 44 percent, contraband
offenses 39 percent. The correctional department’s newsletter,
DOCS Today, summed it up in April 2003: “Upstate
is doing exactly what officials had hoped it would do.”
But
critics of Upstate and similar SHU facilities point to disturbing
problems associated with life “in the box”—notably,
the inmates’ extraordinary amount of idleness, isolation
and neglect. With virtually nothing to do for weeks, months and
sometimes years at a stretch, inmates are essentially warehoused
and rarely receive any treatment or counseling. Many “max
out” their sentences at Upstate and are released directly
back into society with no transitional period following their
time in solitary confinement.
“It’s
essentially a human kennel,” says Stacy Graczyk, an attorney
with Prisoners’ Legal Services of New York in Plattsburgh.
“It does things to people being in there. In the military,
people get special psychological training in case they become
a prisoner of war, to help them tolerate this kind of isolation.
And these are people who already have trouble fitting into society.”
Graczyk,
who provides legal aid to inmates in 16 prisons in northern New
York, first learned of the Campos case in a letter from Dagnone.
The letter, which she found deeply disturbing, echoed many of
the complaints she commonly hears about inmate medical care. At
Upstate, she says, prisoners can find it “extremely difficult”
to get anyone to take their ailments seriously.
“We
see that in the medical and mental health records all the time,
that they’re malingering, they’re faking it, they’re
always complaining,” Graczyk says. “I think it blinds
[the medical staff] to the serious issues that might be there.”
For
example, according to Graczyk, it’s standard procedure at
Upstate for medical exams to be conducted through the door, with
nurses handing out medications, making patient assessments, even
drawing blood and giving shots through the feed-up slot. Not only
does this compromise an inmate’s privacy, she says, but
it also raises serious questions about how medical personnel can
evaluate a patient they can’t see or touch. Graczyk believes
it was this “hands-off” approach to medical care that
cost Campos his life.
Christopher
Campos was born in Mexico and came to the United States when he
was 13, according to his 18-year-old half-brother, Hilario Campos
Jr. Campos spoke very little English, his brother says, so he
often skipped school and fell in with gang members who lived near
their home in Queens.
The
New York State Commission of Correction, the independent state
agency that investigates all inmate deaths, released a report
on Campos’ death in late September. It notes that Campos’
criminal record began at age 16, when he and several others tried
to rob a man. When the victim attempted to flee, he was stabbed
several times and hit with a baseball bat. Campos was convicted
of second-degree assault, menacing behavior and possession of
a weapon. He was sentenced to one to three years in prison.
Campos
entered the correctional system with a known medical history.
During his intake in February 2003, he reported that he suffered
from a seizure disorder that had begun when he was 6, as well
as asthma and tachycardia, for which he was taking medication.
His last reported seizure occurred three days before he entered
prison.
Campos
was sent to Lakeview, a minimum-security prison in Brockton, then
to Washington Correctional Facility in Comstock. There, according
to the Commission report, he “experienced frequent seizures
regularly witnessed by officers.” Although Campos occasionally
refused to take his meds, the report states, he began undergoing
treatment and observation in the neurology department at Albany
Medical Center, where he was a frequent patient for the next year
and a half.
On
July 26, 2004, Campos attacked another inmate with a weapon and
was sentenced to 10 months in SHU at Upstate. He was assigned
to 8 Building, B Block, Cell 26—two cells away from Dagnone.
Campos was alone in his cell.
“I
ain’t gonna lie to you,” says Dagnone, who has seen
his share of correctional facilities. “[Upstate’s]
the worst prison I ever been in.” A clean-cut man with a
boyish face, a friendly demeanor and no-bullshit Brooklyn charm,
Dagnone relates his account of what happened to Campos during
a conversation in the visitors’ hall at the Great Meadow
Correctional Facility in Comstock.
Dagnone
remembers when Campos arrived, he says. He and Campos talked occasionally—though
Campos was two cells away and didn’t speak English well.
A Latino inmate named Julio Perez in the cell between them spoke
Spanish. Perez sometimes translated for Campos when the nurses
came around on sick calls, Dagnone says. Perez wasn’t allowed
out of the cell to translate—he had to shout through the
door.
On
Sept. 21, 2004, Campos was taken to Albany Medical Center, where
it was determined that his seizures were still not controlled
and he needed “long-term” monitoring, according to
the Commission report. On Nov. 20, he was admitted to Albany Medical
Center’s Epilepsy Monitoring Unit and kept under constant
observation until his discharge on Dec. 6. Campos had no seizures
during this time, the report states. However, the attending neurologist
noted in his medical history, “The patient wakes up multiple
times in the night with injury, sometimes tongue biting, sometimes
abrasions all over his head.” Campos’ discharge diagnosis
read “pseudoseizures.”
Pseudoseizures,
as the Commission report explains, are a real and dangerous condition.
Also known as Psychogenic Nonepileptic Seizures, pseudoseizures
are not phony seizures. Rather, they are believed to be “a
psychological defense mechanism induced by stress or episodes
of severe emotional trauma.” Pseudoseizures often accompany
other types of seizures, and are commonly treated with anticonvulsive
drugs.
Campos
was returned to Upstate on Dec. 6 without his prescribed medication
of Carbatrol, an anti-seizure drug, and was admitted to the prison
infirmary for 24 hours of observation. The physician assistant
(identified in the Commission report only as “L.T.”)
noted on his chart that Campos had “missed one dose already
so he may not get today. Will just discontinue.” When she
was later interviewed by state investigators, the physician assistant
“said that she ‘assumed’ that pseudoseizures
were ‘fake seizures.’ ”
On
Dec. 8 and 9, according to the report, Campos refused his meal
trays at breakfast, lunch and dinner and was visited by a nurse
and a social worker. At one point on Dec. 9, a corrections officer
reported that Campos was lying “half under his bed”
and “refused to respond when [the officer] arrived at the
cell.” The report states that the inmate “keeps asking
for meds,” but wasn’t given any. His medical examination
was conducted through the cell window.
Dagnone,
who has never seen the Commission report and wasn’t interviewed
by state investigators, remembers how for two days before Campos
died, he complained about his stomach, called for his meds and
asked that his family be called. Inmates often play games with
guards and medical staff to get attention, Dagnone admits. But
he knew something must be seriously wrong for Campos to refuse
all three meals for two days in a row.
On
Dec. 9, Dagnone says, a guard called the nurse because Campos
appeared to be in serious trouble. “I gotta give credit
where credit is due,” Dagnone says. “[The guards]
tried to get him help.”
Dagnone
remembers that the medical staff showed up at Campos’ cell
but didn’t enter. “They kept yelling at him, ‘Get
off the floor, Campos! Get off the floor! We know you’re
faking it!’ ”
Campos
was left alone. Dagnone claims he didn’t sleep much that
night because of what was going on two cells away. “We could
all hear him banging around and flapping on the concrete . . .
If you’re looking for attention, why do it when no one’s
watching?”
The
Commission report confirms Dagnone’s account. The staff
physician on duty, identified in the report only as “Dr.
E.W.,” claimed that Campos was “difficult to evaluate.”
However, the report also states, “Other medical and correctional
staff in the area did not corroborate Dr. E.W.’s interpretation
of the event. They stated that the physician concluded that Campos
was ‘faking and acting like a child holding his breath.’
”
On
the morning of Dec. 10, 2004, Campos was found lying unconscious
on the floor of his cell. He was brought by stretcher to the prison
infirmary, where he was pronounced dead later that day.
“If
the nurses would have did their job, this never would’ve
happened,” says Dagnone. “He was a young kid with
his whole life ahead of him. And the fucking guy choked to death.
That’s a horrible way to die! You wonder, God forbid I get
sick, these are the people I gotta go to?”
The
Commission’s conclusions about the incident are sharply
critical of the medical care Campos received. The report states
that the staff physician on duty “failed to provide appropriate
intervention, diagnosis and treatment of a gravely ill inmate.”
The physician assistant “arbitrarily discontinued Campos’
medication,” and the nurse assigned to the infirmary “failed
to provide proper nursing intervention.” Investigators also
criticized the practice of conducting patient evaluations through
the window of a cell or infirmary room. All three medical staff
were recommended for “administrative action.”
The
superintendent’s office at Upstate does not release the
names of staff and refers all media inquiries to the DOCS press
office in Albany. DOCS spokesperson Mike Fraser says he cannot
comment on the specifics of the Campos case but only on department
policies and practices as a whole.
“The
incident being raised is certainly a tragedy,” Fraser says.
“But it’s important to know that it’s not representative
of the care that our inmates receive, and it certainly doesn’t
represent the efforts around the state to provide the best possible
care we can to more than 63,000 inmates statewide.”
Fraser
points out that New York state has made tremendous strides in
addressing some of the most serious medical issues in the inmate
population, including a 95 percent drop in AIDS deaths since 1995,
and a 78 percent decline in tuberculosis. “We actually have
a lower TB rate than New York City,” he notes.
Fraser
adds that the Campos incident, while tragic and unfortunate, gives
the correctional system an opportunity to “take a long,
hard look” at its policies and improve care. Recommendations
made by the Commission on Correction are not legally binding.
However, Fraser insists that DOCS takes them “very seriously.”
Fraser
couldn’t say how many members of the Upstate medical staff
speak Spanish. Although an estimated 8 percent of New York inmates
are Spanish-dominant speakers, there’s no requirement in
New York that prisons have Spanish-speaking doctors or nurses
on staff.
When
asked what “administrative action” was taken against
the individuals involved in this case, Fraser explains, “Our
response is to counsel our physicians and staff who were involved
and also to educate them.” None was terminated.
Robert
Gangi is executive director of the Correctional Association of
New York. The prison-watchdog group has unique authority under
state law to inspect prisons and interview inmates. Over the years,
it has issued a number of scathing assessments of inmate health
care.
In
February 2000, the Correctional Association identified a host
of systemic problems plaguing New York prisons, including the
high number of underqualified medical staff, the lack of quality
assurance, and no external government oversight—which means
that prison health-care workers are accountable only to prison
authorities.
The
2000 report also noted the serious shortage of Spanish-speaking
medical personnel. “Spanish-speaking inmates were given
medical information they did not understand, drug prescriptions
they could not read and substandard health care due to the lack
of Spanish-speaking medical staff,” the report states.
During
an inspection of Upstate in January 2001, one inmate told interviewers
that he’d entered the prison with serious medical ailments
and had filed 47 requests to see a doctor but hadn’t received
any treatment. On another visit in August 2002, CA inspectors
found a disabled prisoner who had been transferred from the wheelchair
unit in another prison. At Upstate, his wheelchair was confiscated
for “security reasons.”
“He
was in extreme distress and said that he could barely hoist himself
onto the toilet,” the report reads. “Because of his
disability, he had trouble moving his hands and could not write
a grievance to medical staff. He had spent several weeks at Upstate
living on the floor.”
When
interviewed by phone last week, Gangi said he’d just returned
from a visit to Upstate a day earlier and had heard “a lot
of complaints about medical care.” Gangi wasn’t familiar
with the Campos case, but he said many of the events described
to him from the Commission report are symptomatic of problems
his group has been complaining about for years.
Graczyk
at Prisoners’ Legal Services hears comparable stories from
Upstate. She refutes the DOCS assertion that the Campos case was
an isolated incident. Recently, her office worked with an inmate
there who’d arrived at Upstate with a heart condition. He
had been prescribed self-carry nitroglycerin pills, which were
taken away from him upon arrival. According to Graczyk, the inmate
was told that if he experienced chest pains, he should “bang
on his cell door.” Only after Prisoners’ Legal Services
got involved were the pills returned to him.
“You
hear it all the time. ‘Lock the door and throw away the
key. Who gives a fuck what happens to them?’ ” Graczyk
says. “People think that everyone in prison is a Ted Bundy.
But what about this kid? He’s in there for one to three
for assault second. Did he deserve a death sentence for that?
Obviously not.”
When
Graczyk requested a copy of the videotape of Campos’ cell
from Dec. 9 and 10, 2004, under New York’s Freedom of Information
Law, she was told it wasn’t available. The tape hadn’t
been preserved.
Hilario
Campos Jr. says he learned of his brother’s death when he
arrived home from school on Friday, Dec. 10, 2004. He says someone
from the prison had called and left a message with his parents—in
English. Since they couldn’t understand it well, Hilario
had to call the prison back.
When
reached last week at their home in Camden, N.J., Hilario said
he and his parents didn’t know the Commission of Correction
had issued a report on Christopher’s death. No one had informed
them that the state was conducting an investigation.
“As
a matter of fact,” Hilario says, “they haven’t
even sent us the autopsy results. They only give us the death
certificate.”
Campos
would have turned 21 on Jan. 17, and would have been released
from prison a week later.
Ken
Picard is a staff writer at Seven Days in Burlington, Vt.,
where this story first appeared.
