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The Problem of Aging Prisoners

Posted by Edmond Geary on 03-04-2012

Elderly prisoners, both male and female, are the most rapidly growing group in American  prisons.  Staff in the prisons are facing increasing difficulties in providing these prisoners
appropriate housing and medical care.  Because of their higher rates of illness and physical and mental impairments, older prisoners incur medical costs three to nine times as high as those for younger prisoners.

Some reports put the number of convicted state and federal prisoners who are 65 or older at growing between 2007 and 2010 at 94 times the rate of the overall prison population.  The number of sentenced prisoners 55 years or older grew at six times the rate of the overall prison population between 1995 and 2010.  Commentators have reminded us that prisons were never designed to be geriatric facilities, and they simply do not have adequate facilities for the aged prisoners.  Yet prisons are operating what amounts to old age homes behind bars.

Many of today’s prisoners will not get out of prison, thanks to the trend toward long sentences, until they are very old.  Some, of course, will never get out, but they will live longer than prisoners in earlier years.  Nearly one in ten prisoners in state prisons, more precisely 9.6 percent,  is serving a life sentence. An additional 11.2 percent of state prisoners have sentences longer than 20 years.

A study of twenty prisons of 20 prisons in nine states interviewed prison officials, corrections and gerontology experts, and the prisoners. The study found officials scrambling to respond to the needs and vulnerabilities of the older prisoners.

Yet even with these added burdens, the prisons are experiencing shrinking budgets.
They have other obstacles in old prison architecture that is not designed for common age-related disabilities.   Prison officials also must deal with limited medical staff and medical facilities, lack of planning and a paucity of support from elected officials.  And prison officials must deal with all these issues in the context of meeting the press of day-to-day operations.

Serving time in prison can be hard for anyone, but it is particularly challenging for the growing number of older prisoners who are frail, have mobility, hearing, and vision impairments, and are suffering chronic, disabling, and terminal illnesses or diminishing cognitive capacities.

Prison facilities, rules, and customs were created with younger inmates in mind, and they can pose special hardships for older inmates. Walking a long distance to the dining hall, climbing up to a top bunk, or even standing for count can be virtually impossible for some older prisoners. Incontinence and dementia present special problems.  Prisons with high proportions of elderly prisoners have reported staff behavior has had to adapt to the realities of aging bodies and minds.  For instance, staff who work with the elderly know it makes no sense to yell at a prisoner who doesn’t understand what is being yelled.  Older prisoners have to be given more leeway when it comes to enforcing the rules.

Unless there is some moderation to the policies that tout being especially “tough on crime,” the number of aging prisoners will continue to grow.   These policies include long mandatory minimum sentences, increasing life sentences, and reduced opportunities for parole. These policies keeps many older prisoners remain incarcerated even though they are too old and infirm to threaten public safety if released.

A collection of statistics gives some particularity to these descriptions:  One in ten state prisoners is serving a life sentence;  fifteen percent of state prisoners age 61 or older have been in prison more than 20 years;  Eleven percent of federal prisoners age 51 or older are serving sentences ranging from 30 years to life, and there is no federal parole; in Florida, the 16 percent of the prison population 50 years or over accounts for 40.1 percent of all episodes of medical care and 47.9 percent of all hospital days.

Some ideas for addressing these issues including a review of sentencing and release policies to determine which could be modified to reduce the growing population of older prisoners without risking public safety.  Knowledgeable critics have proposed other ideas as well including developing a comprehensive plans for housing, medical care, and programs for the current and projected populations of older prisoners and modifying prison rules that impose unnecessary hardship on older inmates.


Texas Spent $247K on Medicine While Suing Drug Maker

NBC 5 Investigation
By Shane Allen
|  Tuesday, Feb 28, 2012  |  Updated 6:39 PM CST

The state won a $158 million settlement last month from a pharmaceutical company that the Texas attorney general said promoted an antipsychotic drug for uses not yet approved by federal regulators.

Attorney General Greg Abbott said Johnson & Johnson marketed Risperdal as the drug of choice for children and the elderly for schizophrenia and dementia even though the Food and Drug Administration had not approved its use in children or the elderly.

Yet while the state was suing J&J, the Texas Youth Commission, one of the state's largest purchasers of pharmaceuticals, prescribed it nearly 3,000 times to youth in the Texas prison system, according to financial documents uncovered by NBC 5.

The state's lawsuit, which was filed in 2006, said the state excessively paid pharmacies that dispensed prescriptions for Medicaid patients for a range of unapproved uses.

"Johnson & Johnson's scheme to profit from the Medicaid program by overstating the safety and effectiveness of an expensive drug and improperly influencing officials ended up costing taxpayers millions of dollars," Abbott said in a statement after the settlement was reached.

"As part of the agreed settlement with the state of Texas, we do not admit liability or fault," said Teresa Mueller, a spokeswoman for J&J subsidiary Janssen Pharmaceuticals Inc.

In response to the attorney general's accusations that J&J schemed to profit from Medicaid, the company said it "is committed to ethical business practices and has policies in place to ensure its products are only promoted for their FDA-approved indications."

In 2007, a year after the lawsuit was filed, the FDA approved the drug for use in children and the elderly, but the state of Texas said it felt the financial damage had already been done.

The University of Texas Medical Branch, which is in charge of all medical care within the state's prison systems, spent $247,666.87 buying Risperdal between 2006 and 2007.

TYC spokesman Jim Hurley said Risperdal was never really deemed unsafe for use but just did not have FDA approval.

"Many drugs are often used in this manner," he said. "In fact, the FDA has some interesting figures about atypical drug use among patients 13-17 [years of age] nationwide. Apparently there was a 25 percent increase in these antipsychotics, and most were not [FDA] approved."

After speaking with the youth commission's medical director, Hurley said: "It's common that a number of medicines have value outside of their packaging."

Hurley cited data from the FDA's Center for Drug Evaluation and Research that said 26 percent of the Risperdal dispensed between 2004 and 2008 was for pediatric patients nationwide. He said the practice is commonly accepted within the medical community.

TYC deferred further comment to the University of Texas Medical Branch.

UTMB spokesman Raul Reyes said it would not comment on the issue.

"We'll let the lawsuit and the data speak for itself," he said by telephone.

Tom Kelley, spokesman for the Texas Attorney General's Office, released the following statement:

"Our Civil Medicaid Fraud office was not investigating whether any residents in these facilities were Medicaid-eligible, nor were we ever alleging that Risperdal was a 'bad' drug (doctors may prescribe it at their discretion). Our lawsuit focused on the fact that J&J had been overwhelmingly overselling this expensive drug as superior to conventional drugs, when it was not, and downplaying its side effects.

And in addition, the Texas criminal justice system's pharmacy expenditures are not paid for by Medicaid. UTMB provides the medical care for TDCJ, so perhaps you are focused on the criminal justice system. Those are not Medicaid dollars.

The whole point of this is that pharmaceutical manufacturers may NOT urge physicians to prescribe their products (that's called "off-label marketing" and it's unlawful). Physicians, however, may prescribe such medications as they think is warranted in an individual case. Our lawsuit was, in part, to make them cease all the off-label marketing they'd been doing, among other things."


When prison illness becomes a death sentence

Two in every five inmates in US prisons have a chronic medical condition. Terrell Griswold, due for release last year, was one

Sadhbh Walshe, Thursday 16 February 2012 17.17 GMT

Terrell Griswold, who died, aged 26, while serving a three-year sentence in Bent County Correctional Facility, Colorado.
On 28 October 2010, Lagalia Afola received a phone call from the Bent County Correctional Facility, a private prison operated by the Correctional Corporation of America (CCA), informing her that her 26-year-old son, Terrell Griswold, was dead. Terrell was serving a three-year sentence for burglary and was due to be released in early 2011. Sadly for him, and for his grieving family, he never made it home.

The autopsy report stated that Terrell died as a result of "hypertensive cardiovascular disease" and that he had a clinical history of hypertension, for which he refused to take medication. His mother found this conclusion hard to accept and, after months of persistent enquiry, was finally provided with at least some of her son's medical records. Upon reviewing the records, she discovered that her son had been suffering from a blockage in his prostrate that prevented him from urinating properly, causing chronic kidney damage, and which, she believes, ultimately contributed to his abrupt demise.

This blockage in Terrell's prostrate was discovered on 3 December 2009 by Dr David Oba, an attending physician at the CCA prison. The doctor noted at the time that inmate Griswold reported having had problems passing urine for the past two months:

"He has the urge to void but sometimes is unable to void at all, other times he has a very weak stream but is able to void."

The doctor also noted that he had discussed with the patient that "he may have a chronic sub-acute prostatitis", which he planned to treat with a 30-day cycle of ciprofloxacin (Cipro). If there was no improvement he wrote that "he may need an eval [sic] with cystoscope with urology."

According to the records seen (PDF), Terrell was never treated by an urologist during his entire stay at the CCA facility, and it appears he did not receive the Cipro for almost six months. On 27 January 2010, Terrell had a follow-up visit with a nurse. The nurse's report of the visit reads as follows:

"I/M (inmate) to medical to discuss non-compliance re: HCTZ & Lisinopril. (Both drugs were to treat hypertension and high blood pressure). Per I/M he has the meds in cell but states he forgets to take meds. I/M agrees to take meds as ordered."

She goes on to write: "I/M also reports he never received Cipro for his urinary problem." She reviews his charts and confirms that the Cipro was never ordered. Following this visit, there are several "Refusal of Treatment Medical Release Forms" dated 5, 13 and 24 February, 10 and 15 March, which appear to have been completed on Inmate Griswold's behalf but which he "refused to sign".

There appears to be no record of any visits with the medical team regarding his urinary complaint for several months. His next visit with a nurse (other than to deal with an issue regarding a swollen knee), according to the records I reviewed (PDF), was on 16 August 2010. The nurse notes again that "I/M non-compliant re: medication regimen. Last pick up 5/14/10." This note is somewhat at odds with Terrell's monthly medication records, which list all the medications he is taking each month. In May, June and July, the listed medications include HCTZ, Lisinopril and Cipro. If what the nurse stated on 16 August 2010 was true, that Griswold had not picked up his medications since 14 May 2010, then why did the records list all these medications (including Cipro) for the intervening months?

Whatever the explanation, it is clear from what followed is that Terrell Griswold's urinary complaint never went away.

Close to midnight on 22 October 2010, Terrell declared a medical self-emergency (PDF) and was taken from his cell to the prison clinic. He complained of "diarrhea, dizziness, tingling in his fingers and feet, has an odd smell in nose like bleach or ammonia, feels like his throat is closing up, has acid reflux when awake and pain in epigrastic area." He did not see a doctor because the doctor was not there; but the doctor did prescribe Bactrim, an antibiotic used to treat infections, over the phone. The nurse noted on her report that inmate Griswold was instructed to take his meds as ordered, told to follow up in 24-48 hours if no better, and was sent back to his cell. She ticked the box that said "no acute distress".

On 24 October 2010, Griswold got to see the doctor. But according to the records, the doctor performed no tests, did not take a blood pressure reading, and simply wrote the words "UTI" (urinary tract infection) in the assessment section. During this period, Terrell's cellmate later reported that he was making frequent attempts to urinate.

Three days later, on 27 October 2010, Griswold began vomiting in his cell and was sent to the nurse at 7.30pm. The nurse informed her patient that his antibiotic was making him sick. She ordered him to return to his cell and wrote: "He did not show any outward signs of distress that would have warranted he needed emergency treatment."

Eleven hours later, at 6.30am, Terrell Griswold was found slumped over his toilet bowl, lifeless. His condition finally warranted emergency treatment (pdf) and the full capacity of the CCA's medical team kicked in; CPR was administered, the patient was rushed to hospital, where he was pronounced dead at 7.24am. It was noted on his death certificate that his bladder was full of urine.

When a prisoner is deprived of their liberty by the state, they cannot provide themselves with food, water or medical care. For this reason, the state has to assume the responsibility for meeting those basic needs. A private prison that is run for profit has the same obligation to meet these basic needs; otherwise, the prisoner would be deprived of life, a violation of their most basic constitutional rights.

I asked Steve Owen, the senior director of public affairs for the CCA, if he felt that Terrell Griswold had been provided with adequate medical care. He would not comment on Griswold's specific case, citing privacy reasons, but he sent a fact sheet (pdf), which, he said, "summarizes both the scope and commitment to quality inmate healthcare services that our company provide and to which our government partners hold us accountable."

The fact sheet claims, among other things, that every CCA facility is equipped with a fully-staffed, state-of-the-art medical clinic, which is available for inmate access 24/7; that all care-related decisions are made solely on a medical basis, entirely independent of impact on CCA profits. It also states that CCA facilities utilize an innovative computer program that automates medical records, pill call and pharmacy services, which reduces paperwork and wait times.

Lagalia Afola wrote to Dr Leon Kelly, the coroner who performed her son's autopsy, detailing her objection to his initial conclusion that her son had died of "hypertensive cardiovascular disease". When he reviewed the new information, the coroner issued a revised autopsy (pdf), listing obstructive uropathy as one of the causes of death. Dr Kelly told me that he believed the successive urinary episodes led to kidney failure, which "certainly contributed to [Terrell's] sudden cardiac death".

At this point, however, the cause of death is of less concern to Mrs Afola than the fact of it. "My son was sentenced to three years for burglary," she said. "It was not supposed to be a death sentence."

According to bureau of justice statistics (pdf), around 4,000 inmates died in prison and jails (both public and private) in 2009; and over half of those deaths were illness-related. A comprehensive nationwide survey on the health and healthcare of US prisoners carried out by Harvard Medical School researchers (pdf) found that over 40% of US inmates were suffering from a chronic medical condition, a far higher rate than other Americans of similar age. Of these sick inmates, over 20% in state prisons, 68% in jails and 13.9% in federal prisons had not seen a doctor or nurse since incarceration.

One of the authors of the study, Dr Andrew Wilper, told me they did not include private prisons in their study because, to the best of his knowledge, there was no data available. In his view, he added, "the private prisons like it that way."

Interested parties can write to:

Sadhbh Walshe
PO box 1466
New York, NY 10150

Or send an email to:

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Exonerated Texas man's grave gets permanent tribute


    * Texas executes man caught years after crime by DNA
      Fri, Jan 27 2012

By Marice Richter

FORT WORTH, Texas | Sun Feb 12, 2012 7:02pm EST

FORT WORTH, Texas (Reuters) - The first person in the United States to be exonerated posthumously on the basis of DNA evidence received a lasting tribute in his home state of Texas this week.

State officials and the family of the late Tim Cole unveiled the first Texas historical marker dedicated to an exonerated convict, located in a Fort Worth cemetery a few feet from the grave where Cole was buried in 1999.

Governor Rick Perry issued Texas' first posthumous pardon to Cole in 2010, over a decade after he died from complications from an asthma attack while serving time in prison for a rape he did not commit.

"We finally have something visual that people can see to remember Tim," Cory Session, Cole's brother, told Reuters. "We are very pleased and grateful that Tim's life and legacy will not be forgotten."

Post-conviction DNA testing has exonerated nearly 290 people in the United States since 1989, including 17 death row inmates, according the Innocence Project, which works to reverse wrongful convictions. It says that witness misidentification was a factor in nearly 75 percent of cases.

Of the DNA exonerations nationwide, over 40 have been in Texas, more than in any other U.S. state.

The Texas marker tells the story of how Cole was convicted in 1986 of raping a fellow student at Texas Tech University and was sentenced to 25 years in prison. An Army veteran, Cole served more than 13 years in prison, steadfastly insisting he did not commit the crime.

He turned down a plea bargain before his trial and a parole opportunity because he refused to admit guilt.

His family's continued efforts to clear his name were boosted by the Innocence Project of Texas, which received a letter in 2007 from an inmate confessing to the crime that Cole was convicted of committing.

Preserved DNA evidence confirmed that Jerry Wayne Johnson - not Cole - committed the rape. The victim of the attack, Michele Mallin, had identified Cole as her attacker in a photo and physical lineup but later joined efforts to bring him justice, said Gary Udashen, president of the Innocence Project of Texas.

The legal maneuvers to clear Cole's name were successful, and in 2009 he was cleared in court of the crime "to a 100 percent moral, legal and factual certainty," the marker reads.

"Tim Cole's case is extremely significant and has made a real difference in the bringing justice to those falsely convicted in Texas," Udashen said.

The case prompted passage of two laws, including the Tim Cole Compensation Act, passed by the Texas Legislature in 2009, which provides compensation to those wrongly imprisoned.

The legislature also created the Timothy Cole Advisory Panel on Wrongful Convictions to help prevent future such convictions in Texas.

The marker was the result of a two-year effort by Cole's family.

"I was driving my daughter through another cemetery to visit a grave when we saw a historical marker," said Session, policy director for the Innocence Project. "I decided right then that's what I wanted for Tim."

(Reporting By Marice Richter; Editing by Corrie MacLaggan and Cynthia Johnston)

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My Way News

More than 300 killed in Honduras prison fire

Feb 15, 12:14 PM (ET)


TEGUCIGALPA, Honduras (AP) - Trapped inmates screamed from their cells as a fire swept through a Honduran prison, killing at least 300 inmates in the world's deadliest prison fire in at least a century, authorities said Wednesday.

Some 475 people escaped from the prison in the town of Comayagua and 356 are missing and presumed dead, said Hector Ivan Mejia, a spokesman for the Honduras Security Ministry. He said 21 people had been injured.

Dozens were trapped behind bars as prison authorities tried to find the keys, officials said. Honduran authorities said the fire had been started by a prisoner who set his mattress ablaze in his cell.
Outraged relatives of dead inmates tried to storm the gates of the prison Wednesday morning to recover the remains of their loves ones, witnesses told The Associated Press. The crowds were driven back by police officers firing tear gas.

Channel 5 television showed dozens of inmates' relatives hurling rocks at officers.
The prison housed people convicted of serious crimes such as homicide and armed robbery, Danilo Orellana, director of the national prison system, told The Associated Press.

"We want to see the body," said Juan Martinez, whose son was reported dead. "We'll be here until we get to do that."

Survivors told investigators that an inmate had lit fire to his bedding, Orellana said.
"Some of his cellmates said that he screamed: 'We will all die here!' And in five minutes everything burned," Orellana said. He did not identify the man or speculate about his motivation. Leonel Silva, fire chief in Comayagua, a town 90 miles (140 kilometers) north of the capital, confirmed Orellana's account to reporters on the scene.

Honduras' overcrowded and dilapidated prisons have been hit by a string of deadly riots and fires in recent years. A 2004 prison fire killed more than 100 incarcerated gang members in a state prison north of the capital. A fire a year earlier at a nearby facility killed 70 gang members. In 1994, a fire sparked by an overheated refrigerator motor in an overcrowded Honduras prison killed 103 people.
Honduran authorities have repeatedly pledged to improve conditions but human rights groups say little has been done.

The country of 7.6 million people is a major transit route for drugs headed from South America to the United States and has one of the world's highest rates of violent crime.
The U.S. State Department has criticized Honduras for "harsh prison conditions" and violence against detainees.

"This is a problem that's existed for a long time and the solutions haven't been applied, but now we have to do something even though we don't have the money," Security Minister Pompeyo Bonilla told reporters.

Comayagua fire department spokesman Josue Garcia said he saw "horrific" scenes while trying to put out the fire, saying inmates rioted in attempts to escape. He said "some 100 prisoners were burned to death or suffocated in their cells."

"We couldn't get them out because we didn't have the keys and couldn't find the guards who had them," Garcia said.

Rescuers carried shirtless, semi-conscious prisoners from the facility by their arms and legs. One hauled a victim away from the fire by piggyback.

A prisoner identified as Silverio Aguilar told HRN Radio that someone started screaming, "Fire! fire!" and the prisoners called for help.

"For a while, nobody listened. But after a few minutes, which seemed like an eternity, a guard appeared with keys and let us out," he said.

He said there had been 60 prisoners packed into his cell.

At 10:20 a.m., the first U.S. support was on its way to the prison from their base at Soto Cano Air Base, about 15 minutes away.

"We're driving there right now to provide assistance to emergency responders on the ground," said U.S. Military Staff Sgt. Bryan Franks. Franks said smoke was no longer visible above the city, and that his team included four vehicles made up of a 10-man medical team, a security forces element and firefighters.

Hundreds of relatives rushed to Santa Teresa Hospital in Comayagua state to learn the fate of their loved ones, Silva said.

Lucy Marder, chief of forensic medicine for the prosecutor's office, said she believed the death toll would rise and it would take at least three months to identify victims, some burned beyond recognition, because DNA tests will be required.

Honduras has 24 prisons, 23 for men or mixed populations, and one exclusively for women. In December the total prison population was 11,846 of which 411 were women.

In 2010, a fire in an El Salvador prison killed 16 inmates and injured another 22, while a Chile prison fire left 81 people dead.
Martha Mendoza and Michael Weissenstein in Mexico City contributed.

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