Archive for the ‘Law Enforcement Behaving Badly’ Category

Inmate Dies From Withdrawal, FBI will investigate

aaaaaaaaaades

An interesting article from this week’s issue of Alcoholism & Drug Abuse Weekly caught my eye today. On page 4 is the article, “Video of jail drug-withdrawal death leads to FBI inquiry.” This seized my attention, since I view the awful treatment of U.S. prisoners as one of our nation’s biggest moral failings. I get particularly agitated when patients enrolled in medication-assisted treatment for addiction are denied access to medical care.

This story is heart-wrenching.

In June of 2014, David Stojcevski , 32 years old, was jailed in the Macomb County, Michigan, jail for thirty days for failure to pay a traffic ticket. He was denied access to his usual medications; news sources said he was being prescribed methadone, Klonopin, and Xanax for the treatment of addiction. No mention was made of whether he was a patient of an opioid treatment program.

David died seventeen days into his thirty day sentence. His autopsy listed the cause of death as “Acute withdrawal from chronic benzodiazepine, methadone, and opiate medication,” and also mentioned seizures and dehydration as contributing factors.

A jail nurse, noting his medical condition upon intake to the jail, recommended he be sent to a medical detox unit, but her recommendations were not heeded. Instead, when Mr. Stojcevski began behaving in unusual ways, he was sent to a mental health cell, where he was monitored with video around the clock. He was supposed to have personnel checking on him every fifteen minutes. Apparently his withdrawal symptoms were so severe he declined meals and lost 50 pounds within these eleven days. He had what appear to be seizures as he lay on the jail floor dying.

Understandably, David’s family was livid. In order to illustrate the jail’s indifference to their son’s suffering, they posted all 240 hours of the video monitoring on the internet, where it went viral. David’s family is seeking to change the way prisoners on medications are treated, to avoid senseless deaths like David’s. They have also filed a wrongful death lawsuit against the county and against Correct Care Solutions, the company which was supposed to have provided medical care to prisoners in the county jail.

I have often heard my patients describe the callous indifference jailers have toward them as they withdrawal from legally prescribed medication, but it’s quite another thing to actually watch this man die slowly. I only saw a few clips from the local news program above, and was horrified. It does not take any medical knowledge to see how this man was suffering. He became thinner, wasn’t eating, and didn’t get off the jail floor for the last two days of his life. At the very end, he has some agonal respirations, what looks to me like seizure activity, and then becomes still.

Then jail personnel crowd into his cell.

Too little, too late. He’s already dead and can’t be revived.

Some of the frames were televised on the area’s local news segment and can be seen here: http://www.clickondetroit.com/news/man-jailed-for-ticket-dies-in-custody/35452790
Be warned this segment is not for the faint of heart.

This man died from a treatable condition, opioid and benzodiazepine withdrawal.

An addiction expert interviewed by the area’s local television statement called the treatment of this man “unconscionable.”

I could quibble about the appropriateness of prescribing two benzodiazepines to a person with addiction in the first place, but since that’s not the point of this blog post, that’s all I’ll say about that.

Just yesterday, local TV news said the ACLU had filed a request for a formal Justice Department investigation of the Macomb County jail, saying prisoners are having their civil rights violated by the actions at the jail. The ACLU has also asked for an investigation into the judge’s decision to imprison David after he was unable to pay his traffic ticket, creating what was in essence a “debtor’s prison.”

A representative of the ACLU said anyone watching the video could deduce there was “Something systemically wrong at the Macomb County Jail.”

Recently, the Justice Department in Washington, D.C. contacted the FBI, asking them to investigate this case for evidence of criminal behavior on the part of Macomb County jail staff.

Macomb County officials steadfastly maintain they did nothing wrong, have nothing to hide, and welcome investigations into David Stojcevski’s death.

What I saw on this video clip appears criminal to me. The neglect, the reckless disregard for the wellbeing of another human is a far more serious crime than David’s traffic ticket. Every person who worked in that jail who turned a blind eye to the dying man belongs on the other side of the bars.

I am grateful to David’s family for their decision to post this painful video. That had to be a hard decision, but David’s graphic suffering causes more impact than written descriptions. I wonder if the ACLU, Justice Department, and FBI would have gotten involved had his family not publicized David’s gradual death, and had it not gone viral.

This behavior on the part of law enforcement is stupid, inhumane, and egregious. Do these law enforcement personnel have no shame, no basic human decency? Are we in a third world country where prisoners have no rights?

I will follow this story and give updates when possible.

I’d love to see the FBI investigate, and I hope criminal charges are filed. I hope the family sues and wins millions of dollars. I hope something can finally change in county jails across the nation, so that people who are incarcerated are no longer denied medical care.

Opioid Addicts in Indiana Contract HIV

aaaaaaaaaaaaindianaThe New York Times ran an article 5/5/15 about a small town in rural Indiana that is facing a relative epidemic of new cases of HIV.

Austin, Indiana, a town of only 4200, has more than 140 people just diagnosed with HIV. The town is struggling to understand what to do about this epidemic, since the area has had a low HIV rate in the past.

The new cases of HIV were intravenous opioid addicts, and Opana was specifically mentioned by the opioid addicts in the article.

As in many small towns, needle exchange has been met with resistance from citizens who feel giving free needles to addicts only serves to encourage them to use more drugs.

Fortunately, the Indiana governor has authorized a needle exchange program for the area where addicts were sometimes using the same needle as many as three hundred times. Unfortunately, the needle exchange is not being run according to best practices. People must sign up for the service. Obviously, many opioid addicts who could benefit from free new needles are hesitant to register with anyone, due to the shame and stigma associated with addiction in this country.

To add to the difficulty, local police still arrest any addict found with needles, unless they are enrolled with the needle exchange. In other words, if one addict signs up for needle exchange and distributes these new needles to other drug users, those users could still get arrested if the police find their needles. Police say they are doing this to force addicts to register with the needle exchange.

We already know, from decades of studies, that actions like these by the police erode trust in the whole needle exchange program. Studies show needle exchange works best when people aren’t asked to register, and are allowed to procure free needles for other people who won’t come to a needle exchange. These type programs are very effective at halting the spread of HIV

The article only tangentially mentions treatment; it says some intravenous drug users have gone to a residential treatment center about 30 miles away, and others remain on a waiting list.

Sadly, no mention is made of medication-assisted treatment of opioid addiction with buprenorphine and methadone.

I did my own research: residents of Austin can drive to an opioid addiction treatment center less than a half hour away, in Charlestown, Indiana Also, there are at least two OTPs in Louisville,, only a few minutes farther, in Kentucky.

I hope someone is telling all the opioid addicts about this option. We know that after an opioid-addicted person enters medication-assisted treatment, the risk of contracting HIV drops at least three-fold. Thankfully HIV can now be treated, and is more like a chronic disease than the death sentence it was twenty-five years ago, but wouldn’t it be better to prevent HIV in the first place?

I fear Austin, Indiana is a harbinger of things to come in other small towns in our nation. Let’s stop with the politics, and get patients into medication-assisted treatment. Let’s do unrestricted needle exchange, and let’s hand out naloxone kits!

Criminally Pregnant In Tennessee, Part II

pregnant caucasian woman portrait attached with handcuffs isolated studio on white background

Today my guest blogger Dr. Fedup weighs in on my last entry, “Criminally Pregnant,” with his own unique point of view. He gives counterpoints to my arguments, as he feels Tennessee’s law is a good idea. I’ll let him explain his reasoning. His political leanings are somewhat right of center, as you will read.

“I applaud Tennessee’s new law, which makes it a crime to expose a pre-born baby (I don’t believe in using that word fetus, since life begins at conception) to drugs. Too many babies are born with neonatal abstinence syndrome, so obviously Tennessee has grown too soft on crime for this to be happening.

“Bill number 1391, already passed by the state’s legislature, needs only the governor’s signature to become law. In short, this bill says a mother can be prosecuted for “an assaultive offense or homicide if she illegally takes a narcotic drug while pregnant and the child is born addicted, is harmed, or dies because of the drug.”

“Their governor, Bill Haslam, goofed last year when he passed that Safe Harbor Law, which eliminated criminal charges for pregnant women who went into treatment. This new law corrects and cancels that law. Some people have said that’s inconsistent, and not enough time passed since the Safe Harbor Law to see if it was going to work or not.

“I say it’s OK to be inconsistent so long as you are putting people in jail.

“There’s nothing in the new bill to prevent pregnant, opioid addicted women who are in methadone or buprenorphine programs from being prosecuted as well, though bill 1391 does say, “Illegally take a narcotic drug while pregnant.” Women who enter such treatments have already taken illegal narcotics while pregnant, or they wouldn’t need treatment.

“My only problem with the new bill, SB 1391, is that it doesn’t go far enough. We should put the drug addict babies in jail, too.

“Think about it. You know those little suckers enjoyed the drugs they were getting through the placenta, and they need to be punished for that. They’re born addicts. Start punishing them right out of the womb. That way, the state can teach them right from wrong as they grow up, right there in the prison system, like we do with all other inmates in Tennessee jails.

“Some people criticize my idea. Some people say we already put too many people in jail. But I say if U.S. history teaches us anything, it’s that taxpayers are always happy to spend more money on jails.

“We must be willing to incarcerate more people, because U.S. citizens are more evil and criminal than people in other parts of the world. They must be, because we put more people in jail per capita than anywhere else. Circular logic? I don’t care, as long as it puts bad people in jail.

“It was a happy day when the U.S. could finally brag that we incarcerate more people per capita, than even Russia or Rwanda. We’re Number One! We put 716 people out of 100,000 into jails or prisons, and Russia only puts 484 out of 100,000 in prisons. We’re beating them almost two to one! [1]

“Lots of bleeding heart liberals will complain about how Tennessee jails aren’t set up for infants. I say we can fix that. After all, aren’t play pens just jail cells, only prettier? These addict babies don’t deserve anything too pretty, and they’ll get used to the bars soon enough.

“No measure is too severe if it will fix the drug problem. My critics point to all the information collected since the 1950’s which indicates incarcerating addicts does nothing to help addiction rates. But I’m telling you that this new send-an-addict-baby-to-jail program will work.

“While we are on the topic of evil pregnant women who harm their babies, let’s discuss nicotine addiction. There’s more medical evidence to show tobacco smoking harms babies than there is to show cocaine harms babies. Let’s put all those mothers who smoke into jail, too, since they are intentionally harming their pre-borns.

“Then let’s take this train of thought to its logical conclusion. In the latest issue of the Journal of the American Medical Association, there was a great article about the harm maternal obesity does to the fetus. This article reviewed all of the studies of how obesity affects fetal death and infant death. The conclusion was, “Even modest increases in maternal BMI were associated with increased risk of fetal death, stillbirth, and neonatal, perinatal, and infant death.” [2]

“Sounds to me like it’s time to build jails for the fatties, too. Because the state of Tennessee believes that jail time corrects bad behavior.

1. http://en.wikipedia.org/wiki/List_of_countries_by_incarceration_rate
2. Aune, et al, “Maternal Body Mass Index and the Risk of Fetal Death, Stillbirth, and Infant Death: a Systematic Review and Meta-analysis,” JAMA, 2014; 311(15):1536-1546.