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February 28, 2006

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MHANYS' LEGISLATIVE DAY
MARCH 13, 2006

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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.

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