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SEPTEMBER/OCTOBER 2015 VOL. 24 NO.5

Drug TestingInhouse Vs.Outsourced

Latest Trends:Education, Technology & Reentry

AGING INMATEPOPULATIONSA SPECIAL REPORT

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22

The Pulse

Dementia in theIncarcerated: Ready or Not?

Lab Services Prove Vital:Inhouse Vs. Outsourced

Dispensing Medications:Policies & Procedures

Aging Inmate Care: A Special Report

Education, Technology & Reentry: Tying It All Together

Ad Index

SEPTEMBER/OCTOBER 2015

48

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CORRECTIONSFORUM

Publisher & Executive EditorThomas S. Kapinos

Assistant PublisherJennifer A. Kapinos

West Northeast

Editor-in-ChiefDonna Rogers

Contributing EditorsMichael Grohs, Kelly Mason, Bill Schiffner, G.F. Guercio

Art DirectorJamie Stroud

CORRECTIONS FORUM (ISSN10729275)

is published bi-monthly by:

Criminal Justice Media, Inc 565 Pier Avenue

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MISSOURI GOV. COMMUTESDEATH SENTENCE

Kimber Edwards, who was con-victed of hiring someone to kill hisex-wife in 2000, had his death sen-tence commuted by Missouri Gov.Jay Nixon on Oct. 2, after a news-paper reported that the murderernow says he acted alone, Reuterssaid.

Edwards had been scheduled todie on Oct. 6 for his involvementin the death of Kimberly Cantrell.

In a statement, Nixon, a Democ-rat, said he was convinced that theevidence supports the decision toconvict Edwards of first-degree mur-der, and that Edwards will remainin prison for the rest of his life.

"This is a step not taken lightly,and only after significant consid-eration of the totality of the cir-cumstances," Nixon said.

Orthell Wilson, who had saidEdwards hired him to kill Cantrell,has recently recanted his state-ment, telling a reporter that hehad acted alone, according to theSt. Louis Post-Dispatch.

Edwards confessed to the crime,but said at his trial and ever sincethat he was innocent, the newspa-per said. His lawyers say Edwardshad a form of autism that couldhave made him vulnerable to ag-gressive interrogation techniques,and led to a false confession, thenewspaper said.

Elsewhere on Oct 2, the Okla-

homa Court of Criminal Appealsgranted a state request to halt threeupcoming executions so it can ex-amine a drug mix-up discoveredabout two hours before inmateRichard Glossip was to have beenput to death earlier that week.

Oklahoma Attorney GeneralScott Pruitt filed the request onThursday so the state could exam-ine what went wrong with its exe-cution protocols. Glossip's plannedexecution had received global at-tention with his case raising ques-tions about whether the state maybe executing an innocent man andabout the drug combination Okla-homa plans to use in its lethal in-jection mix, reported Reuters.

Oklahoma revised its death

4 CORRECTIONS FORUM • SEPTEMBER/OCTOBER 2015 VISIT US AT WWW.CORRECTIONSFORUM.NET

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chamber protocols after a flawed ex-ecution last year when medical staffdid not properly place an IV line onmurderer Clayton Lockett, who wasseen twisting in pain on the gurney.He died about 45 minutes after theprocedure began because of an accu-mulation of lethal injection chemi-cals that had built up in his tissue.

A total of 22 people have beenexecuted in the United States so farthis year, including six in Missouri,according to the Death Penalty In-formation Center.

TRIPLE MURDERER ALFREDO PRIETO IS EXECUTED IN VIRGINIA

The Washington Post reported Al-fredo Rolando Prieto, convicted of

two murders in Fairfax County,one in California and linked byDNA and ballistics to six more, wasexecuted by lethal injection Oct 1at the Greensville CorrectionalCenter.

Prieto, 49, said: “I would like tosay thanks to all my lawyers, all mysupporters and all my family mem-bers. Get this over with.”

The short statement representedjust about the only words Prietohas ever said publicly since he wascaught 25 years ago. He neverspoke to detectives investigatinghis crimes, did not testify duringany of his four trials and nevergave an interview. In one hearingin Fairfax in 2010, he told a judgethat “I was using a lot of drugs. I

was drinking” at the time of hisNorthern Virginia crimes in 1988.

Prieto’s death was witnessed byDeidre Raver of Yorktown, N.Y.,the sister of Rachael A. Raver, whowas 22 when she was shot in theback in a vacant lot near Reston.She had watched Prieto fatallyshoot her boyfriend, Warren H.Fulton III, in the back while on hisknees, law enforcement authoritieshave said. Investigators believethat Raver ran but that Prietochased her down, shot her andraped her as she lay dying.

“Today ends a long and painfulordeal for my family,” DeidreRaver said, “that has haunted usfor over 26 years. I speak on behalfof my sister, Rachael Angelica, whowill have the last word after all....”

It was the first execution in Vir-ginia since January 2013 and thefirst by lethal injection since August2011. Prieto’s attorneys tried a lateappeal for a stay by challenging oneof the three drugs used to executehim, which Virginia obtained fromTexas in August. But U.S. DistrictJudge Henry Hudson denied the re-quest for a postponement.

Prieto had spent the last quar-ter-century of his life behind bars.Prior to that, he did a two-yearstint as a teenager for a drive-byshooting in California. And in be-tween those two prison stays, po-lice believe, he fatally shot fourpeople—raping two of them—inVirginia, then returned to Califor-nia and shot and killed five people,also raping two of them.

In seeking to persuade a Fairfaxjury to impose a death sentence onhim, Fairfax Commonwealth’s At-torney Raymond F. Morrogh said in2010, “Anyone who would commitcrimes this dastardly, amoral andinhuman is someone who poses athreat to society.” CF



Case Study

A.C., an 82-year-old male withdiabetes, hypertension and coro-nary artery disease, was a first-time offender who entered thecorrectional system at anadvanced aged. Since his incar-ceration, he was also diagnosedwith dementia after cliniciansobserved that he was having diffi-culties in remembering.

While this case raises severalchallenges around delivery of opti-

mal care in patients with demen-tia, incarceration adds anotherlayer of complexity. For the pur-pose of this article we will focus onthe following challenges:

(1) aging population in cus-tody

(2) dementia and incarceration

Aging population in custodyBaby boomers (over 71 million

people born between 1946 and1964) are now aging into seniorcitizens and this, coupled with anincrease in life expectancy due to

advances in medicine, has result-ed in a growing number of peo-ple with longer lifespans. Greaternumbers of senior citizens arenow living with one or morechronic disease conditions.Correspondingly, there is higherprevalence of chronic diseaseconditions in jails and prisons.(Binswanger, I., Krueger, P., &Steiner, J., 2009)

Aggressive management ofchronic medical diseases by exist-ing health care delivery in pris-ons and jails and longer incarcer-


BY PARUL MISTRY, MD, MA, AND LEONORA MUHAMMAD, DNP, RN, CCHP

Dementia in the Incarcerated

Ready or Not?

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ation periods have led to a disproportionate increasein older inmates. In addition, a number of olderprisoners are sex offenders who pose a perceivedthreat to alternative housing solutions like skilledcare or assisted living facilities. Reports from various

groups have projected that the number of prisonersaged 55 or older is growing at a higher rate than theoverall prison population. Ronald Aday, a professorof aging studies and author of Aging Prisoners: Crisisin American Corrections, predicts that by 2020, 16%percent of those serving life sentences will be in thisage group (Aday, R., 2003). The American CivilLiberties Union published a report in 2012 statingthat in 1981 there were 8,853 state and federal pris-oners aged 55 and older; by 2030 this number willbe almost 400,000, amounting to over one-third ofprisoners in the United States.

Most jails and prisons do a great job in providingcare for chronic conditions; however, the questionis, are they equipped to care for this debilitated pop-ulation, not only from a physical perspective, butalso in offering emotional support, mental healthservices and additional help where needed? Whilebetter understanding of geriatric needs has led to thecreation of community programs to provide supportfor patients with dementia, similar measures havenot, for the most part, been brought into correction-al facilities. How do we as a society want to treat ourincarcerated elderly? And how do we prepare for theincreased number of them who are projected to bebehind bars in the next 15 years? (Fellner, J., 2012)

Dementia and incarceration

Dementia Awarenessand Evaluation

According to the Alzheimer’s Association, demen-tia is a term that describes a condition that developswhen nerve cells die or no longer function normal-ly, causing changes in memory, behavior and the

VISIT US AT WWW.CORRECTIONSFORUM.NET CORRECTIONS FORUM • SEPTEMBER/OCTOBER 2015 9

One inmate reads to another in the Buddy Program.


ability to think clearly. Dementiacan be related to Alzheimer’s, ormany other conditions. Whileage may be one of the causes,other conditions that can con-tribute to dementia include vas-cular dementia, dementia relatedto Parkinson’s disease anddementia from chronic alcoholabuse.

Many inmates have pre-incar-ceration risk factors that furtherpredispose them to developingdementia at a younger age com-pared to the general population.Some of these risk factors include

inadequate access to health care,drug and alcohol abuse, traumat-ic brain injury, smoking andHIV/AIDS. Limited social andintellectual stimulation duringincarceration may accelerate thedevelopment of dementia.Inmates with dementia may goundiagnosed due to the struc-tured prison life, and minimalrequirements to make indepen-dent decisions. Some prisonerswith dementia may be with-drawn and this “quiet behavior”may be rewarded by the correc-tions system. As the disease pro-gresses, an inmate may get agitat-ed, hostile or may be unable tocope with everyday activities; thisbehavior may be punished due tolack of understanding on the partof corrections officers. Inmateswith dementia may also be vic-tims to the bullying behavior of

other inmates. All these factorsraise the question regarding thesafety, physical and mental well-being of elderly inmates withdementia.

Initial evaluation of olderinmates should include assess-ment for dementia. Testing withrecall and other methods are sim-ple techniques that can be usedto assess for cognitive impair-ment. This enables a betterunderstanding of the person’shealth status by clinical and cor-rectional staff and also provides abaseline from which to assess as

the person ages. Understandingof an inmate’s cognitive capacitywill also assist in making deci-sions regarding placing them inappropriate housing units.

In the case of inmate A.C.noted above, observation of hisdifficulty in remembering andinability to function in the gener-al population were factors thatled to his diagnosis of dementia.

Training forcorrectionalstaff

Caring for patients withdementia requires special com-munication skills, compassionand respect. While these skills aregenerally a part of themedical/mental health expecta-tion, officers should also be well-versed in the behaviors that an

inmate with dementia can dis-play. They should receive specialtraining on other methods ofinteraction and options for anynecessary intervention before theinmate is punished.

Dementia training must beprovided to all officers, not onlyin the corrections system but alsoin the field (Schoenly, L., 2012).Understanding the psychologicaland behavioral symptoms ofdementia and the effect the con-dition can have on those diag-nosed will allow for higher vigi-lance in detecting progression ofthe disease so appropriate andtimely care can be delivered.

Adapting the prison environment

Simple changes in environ-ment may facilitate indepen-dence in inmates with dementia.Colored cell doors, pictures andcalendars will definitely assist inmaintaining orientation and cop-ing. Handrails and non-slipperyfloors, placing older inmates onlower bunks, in-housing unitsclose to dining halls, and givingthem more time to respond toactivities related to a drill per-formed by custody may allowthis population to continue tofunction independently whilemaintaining their dignity(Schoenly, L., 2012).

Memory units and specializedprograms

Often correctional facility limi-tations leave clinicians no choicebut to put patients like A.C. in aninfirmary with medically illpatients. Not only does this cre-ate problems with cost-effectiveuse of infirmary beds, but it alsoputs undue pressure on infirmarystaff to shift the focus of carefrom medical to supportive, cre-ating conflicting priorities. Inaddition, the level of acuity andfrequent change in inmate popu-lation at the infirmary can only


A Corizon programmatches up inmateswith dementia withhealthy inmates.


contribute to confusion forpatient with dementia.

Some facilities have set upprograms and enhanced careunits to provide care to thesepatients outside of an infirmarysetting. These programs offerdaily monitoring by a nurse,periodic monitoring by a mentalhealth professional and activitiesprovided by activity coordina-tors. Modification of housingfrom bunk beds to side-by-sidebeds can assist with safety (Hill,M., 2007).

In some programs, screenedand trained offenders can pro-vide support for people withdementia. In a companion pro-gram or “buddy program” selectoffenders are identified to betrained and serve as companionsto those patients who are bedrid-den, debilitated, agitated andconfused or with other memoryimpairments. These companionssit with the patients, interactand read to them, and provideother activity support. They mayalso help with activities of dailyliving, taking them to medica-tion and clinic appointmentsand walking with them(Missouri Department ofCorrections, 2015).

A.C. has been assigned a Daily

Living Assistant (DLA) who takeshim to the medical unit for hismedications and appointmentsand assists him with activities ofdaily living. Programs like theseoffer A.C. and other offenderslike him the benefit of beinghoused close to medical serviceswhile being able to more fullyparticipate in socialization andrecreation.

While these specialized unitsare a great example, they are fewand far between. We as a nationneed to take measures on a largescale to manage this challengethat is right at our doorstep.There is a need to expandMemory Care Units or geriatriccare units within correctionalfacilities.

Conclusion While there are no clear num-

bers on how many people withdementia exist in the prison sys-tem, the projected increase in theaging population indicates thatthese conditions will continue torise. A collaborative approachbetween policy, research andhealth care delivery teams willensure that this vulnerable groupis protected. Many inmates withlife sentences depend on thesocial support of fellow inmatesin similar situations, and specialcare units are a way to create thisenvironment. As family supportwanes, over time these special-ized units become “home” andthe fellow inmates become theirfamily.

While there is no data on therisk of recidivism in individualswith dementia, aggressive behav-ior should not be the sole reasonfor continued incarceration inthese individuals; a path of com-passionate release should be con-sidered where appropriate.

As for A.C., he can be foundsitting and visiting, playing cardsor doing puzzles with otheroffenders assigned to his unitwho are now his family, as hispersonal support system on theoutside has declined.

Dr. Parul Mistry is the ChiefMedical Information Officer forCorizon Health. Dr. LeonoraMuhammad is Corizon Health’sRegional Clinical Services Managerfor the Western Region.


A doctor offers treatment to an older inmate. The American Civil Liberties Unionpredicts that by 2030 the number of inmates 55 and older will be almost 400,000,amounting to over one-third of prisoners in the United States.


Over 50 percent of inmatescurrently in federal prisonsare there for drug offenses,according to data releasedby the Federal Bureau ofPrisons in 2014. That per-centage has risen fairly con-sistently over decades,jumping up from 16 per-cent in 1970.

As the number of people con-victed of these drug offenses con-tinues to rise, random drug test-ing of inmates has become com-monplace. This has led to theneed for faster and more accuratedrug testing procedures in correc-tional facilities across the coun-try either being outsourced orperformed in house. Althoughurine testing is still considered apredominant method to detectdrug and alcohol use, saliva test-ing as well as other methods arestarting to gain ground because


BY BILL SCHIFFNER, CONTRIBUTING EDITOR

Lab ServicesProve Vital

Both inhouse andoutsourcing drugtesting contributes to a comprehensiveprogram for facilities.

Forensic Source specializesin products for forensicsprofessionals, includingnarcotics identification.

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of their convenience. “A comprehensive drug test

program extends well beyondrapid qualitative testing many cor-rectional institutions have avail-able within their own facilities,”comments Richard Williams,director of Product Development,eLab Solutions, Huntsville, Ala.“Indeed, many of these rapid,high-volume screening systemshave our software controllingtheir immunoassay instruments.These local laboratory systemsprovide the first line of defense inthe release of criminal offenders,continual monitoring of parolees,and accountability for recoveringdrug court participants. From aninstitutional, behavioral, and eco-nomic perspective this testing iscritical to the success of theirintended mission.”

Williams adds that beyond theeffectiveness of these systems, theservices of outside sophisticatedlaboratories are just as important.“These labs provide unprecedent-ed accuracy using state-of-the-arttesting methodologies and ultra-sensitive instrumentation, deliv-ering quantitative results for notonly suspected drug positives buttheir metabolites as well. Thesemetabolites are often detectablefor days after their parent drughas disappeared. The result isindisputable legal evidence thatprovides a safety net for the insti-

tution’s local testing process.”“Accurate and timely results

are a critical component for deci-sion makers in the criminal jus-tice system,” points out KathyRuzich, manager, GlobalMarketing Communication atThermo Fisher Scientific,Fremont, Calif. “Whether partici-pating in a drug court program ortesting/monitoring inmates dur-ing incarceration, judges, proba-tion agents, parole officers andothers use the results of drugscreening tests as one of their keycomponents in determining thenext steps in judicial review, or atcritical decision points in childcustody cases. Running tests in alab environment using standard-ized protocols and with properlymaintained equipment helps toensure fairness and compliancewith any program,” she adds.

Best PracticesRuzich furthers that most labo-

ratories will set guidelines andgood laboratory practices toensure the instruments are work-ing correctly and tests being per-formed follow the proper instruc-tions for use. “Through the crimi-nal justice system, we can offer atotal solution for compliance,from collection to confirmation,with collection devices, instru-mentation, reagents, quality con-trols, and client management

software. To maximize the integri-ty of the system, specimen validi-ty tests can be performed on col-lected samples to ensure that theyhave not been adulterated.”

Jackie Pirone, director market-ing SAT and IR, OraSureTechnologies, Bethlehem, Pa.,adds that lab services such as theaccuracy of the drug test, confir-mation testing, expert testimony,timely reporting of results and thechain of custody are all vital to acomprehensive drug testing pro-gram. “Additionally, labs can testfor a wide variety of drugs at vary-ing cutoff levels which allows forgreater flexibility for drug testingprograms. With the availability ofnewer drugs such as Spice, K2 andBath Salts, it is critical that drug-testing programs be able to keepup with the trends. Because labscan adjust their testing based ontheir clients needs, you can besure you are getting the most outof your drug testing program.”

Providing TotalSolutions

Ruzich says that they are ableto provide a total solution to lab-oratories, including the screeninginstrument, reagents, qualitycontrols and software tools cus-tom designed to efficiently runyour drug screening lab.“Thermo Fisher Scientific can


Combat the use of additives and adulterants to mask controlled substances in urine sampleswith the Thermo Scientific DRI Indiko pH-Detect Specimen Validity Test. Liquid and ready-to-use, these tests can be performed on a variety of general chemistry analyzers.


also support your need for confir-mation equipment. We haveworked extensively with correc-tion facilities on both the countyand state level, and have empow-ered drug courts and problemsolving courts in state after stateto take control of their testingand compliance procedures. Ourexperienced field technical ser-vice staff is there to help com-plete the instrument installationand will ensure your staff is prop-erly trained to run these drugtests, and our technical servicehotline call center available isavailable to answer any questions24 hours a day, 7 days a week.”

Other Testing OptionsBesides testing urine and saliva

there are other emerging options.Michelle Lach, associate brandmanager, United States DrugTesting Laboratories, Inc.(USDTL), Des Plaines, Ill., reportsthat USDTL offers a wide array ofdrug testing assays to fit the par-ticular needs of the collector and

donor. “By offering multiple win-dows of detection and multiplespecimens for collection there aremore opportunities available forservices. The testing services arecompletely contingent on whatthe collector is trying to test for.”

She points out that assays thatuse specimens such as oral fluid,blood and urine, can detect drugsand alcohol currently or veryrecently in the donor’s system,where as assays such as hair andfingernail can test for heavy usein the previous months.

She adds that additionally, labsgo through rigorous certificationprocedures to make sure they arefollowing proper protocol.“USDTL, for example, is accredit-ed by numerous bodies such asthe College of AmericanPathologists (CAP) and is in thefinal stages of ISO 17025 accredi-tation, through the internationalorganization of standardization.”

Lach says they provide drugtesting laboratory services, special-izing in alternate specimen testing

such as fingernail testing, whichhas all of the benefits of hair drugtesting, without the risk of adul-teration. “Clipping hair and fin-gernails prior to collection doesnot prevent the drug test fromshowing signs of ingestion, it sim-ply delays collection. Whatever isin the hair and fingernail when itwas clipped, will still be in thehair or fingernail in 1-2 weekswhen it grows back out.”

Outsourcing VersusOnsite Services

Ruzich says that depending onyour testing volume and otherfactors, agencies have a choice tooutsource or bring in house. Dothey set up their own lab or dothey send out their samples toanother regional type lab? “Thebenefit of the send outs is that thelabor burden on the actual agencyis minor, ensuring samples col-lected are properly sent out. Thebenefits to establishing an onsitelab, however, may far outweighthe send outs,” she says.


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“With an onsite lab, the courtcan experience a turnaround timefor client samples that can bemeasured in minutes instead ofdays, which in turn can help intime sensitive situations. Forexample, using the ThermoScientific Indiko or Indiko Pluscan provide the screening resultsin less than 15 minutes. Thisintuitive, bench top system is sim-ple to use and provides accurateresults, and can help to reducerepeat testing, providing an addi-tional cost savings. Agencies thattake the steps to set up an onsitelaboratory usually see significantcost savings over the total price ofthe send out testing when freightcosts and lost productivity time isaccounted for. Additionally, themultiple options for customizingand digitizing the laboratory solu-tion means that the software auto-mates and helps to keep track ofyour clients in the system, sup-porting your random testingneeds, and maintaining client his-torical test results for the decision

makers to review,” Ruzichexplains.

“Contrarily, correctional facili-ties outsourcing substances to alaboratory service to analyze con-traband confiscated is cumber-some and can challenge resourceslike time and budget,” says T.Allen Miller, product manager/Forensics, The Safariland Group,Ontario, Calif. “Often, illicit dugsseized by correctional officers aresmall amounts compared to streetbusts. Considering the position ofthe majority of the inmates andtheir current sentences, expendingmuch needed funds in order toprovide a disciplinary sentence toany particular inmate may notjustify the cost associated with theresult. A system that utilizes ourpresumptive tests to deal with theincident of contraband onsite,and the internal hearings associat-ed with those results, are accurateand can protect against costlyinvestments whether personnelhours or the hard costs of labfees,” Miller adds.

Outsourcing OptionsWilliams of eLab says that

every agency’s build versus buysituation is unique. “Outside labsare an essential part of a compre-hensive drug testing program.The decision of an institution toinvest in its own screening sys-tem or send its samples elsewhereincludes consideration of internalstaffing budget and qualified per-sonnel availability, sample vol-ume, turnaround time, and tar-geted drugs of abuse. And in thelight of new technologies andscreening techniques may needreevaluating on a periodic basisby every agency.”

He reports that where the agen-cies are large and spread acrosswide areas, technology solutionsmay also play a part in this deci-sion. “For example, the ArkansasCommunity Corrections agencyused eLab’s QuikLIMS software toplace 30 remote test sites acrossthe state, all tied to a centralizedsystem in Little Rock, controllingall of the instruments and relay-



ing their results directly into the state's ElectronicOffender Management Information System,” heexplains.

Kelli Mogush, senior marketing manager atSiemens, Global Marketing Syva Drug TestingDiagnostics, Malvern, Pa., says onsite testing allowsfacilities to get accurate results quickly. “All of ourproducts are designed to be as turnkey and easy touse as possible, and with our consultative approach,we are confident onsite testing can be conducted ina way that reliably enhances their drug testing andrehabilitation programs. Implementing a drug test-ing program directly at the facility allows them toavoid safety issues that could arise while waiting foran outside lab result (11 minutes versus days). Thiscan be done easily, without adding additional man-power and can actually save costs.”

Lach says outsourcing laboratory services can pro-vide better information and more options thanusing an in house lab or dip-stick drug testing. “Labssuch as USDTL offer state-of-the-art instrumenta-tion, strict chain of custody protocols for evidentiarypurposes, as well as expert review and confirmationson all reported positives.”

Pirone adds that since lab personnel are trained toperform the test and an instrument interprets theresults, there is no “second guessing” like might bepossible with point of care or instant tests.“Sometimes it can be difficult to read the line on a


USDTL offers a wide array of drug testing assays to fitthe particular needs of the collector and donor.


point of care test and knowwhether the result is negative orpositive. With lab based testing,the instrument takes the guess-work out, preserving the integrityof the result. And with a neutralthird party performing the test-ing, you know the result will beunbiased.”

“Also, by not having correc-tions staff perform the testing,this frees them up to continuetheir everyday job responsibilitiesand duties,” she concludes.

Outsourcing & OnsiteTesting Equipment

Here’s a sampling of some ofthe latest equipment and labtesting services for the correc-tions market.

AnalyzersThermo Scientific Indiko or

Indiko Plus, their benchtop clini-cal and specialty chemistry ana-lyzers, are fully automated forperforming immunoassay drug

screening tests. Both are consid-ered to be flexible systems whichare fully self-contained and donot require any external hook-ups to water systems. They offer avery intuitive user interface andare set up to maximize load upand walk-away convenience. www.thermoscientific.com, 1.800.232.3342

Oral Fluid DrugTesting System

OraSure’s Intercept Oral FluidDrug Testing System was the firstFDA-cleared in-vitro diagnosticlaboratory-based oral fluid drugtesting system, and is the onlyone that is FDA cleared for detec-tion of nine commonly abuseddrugs, including marijuana,cocaine, opiates, PCP, ampheta-

mines, methamphetamine, barbi-turates, methadone and benzodi-azepines. http://www.orasure.com, 1.800.869.3538

Web-Based Call SystemCall2test is a randomized, web-

based, call-in system for drug andalcohol testing and probationreporting. The system can beconfigured in less than 60 sec-onds, is fully automated, and can

be used by courts of any size. Byutilizing existing Interactive voiceresponse technologies, call2test isable to provide service at a lowcost per offender.

call2test.com, 1.888.972.9166

Drug Testing SolutionsUS Diagnostics drug testing

products are engineered to giveusers the quickest and clearest-reading results available and areeasy for clinicians to store, han-dle and administer. From correc-tions facility to drug courts, theycan provide the best on-site test-ing products to conform to afacilities needs.http://usdiagnostics.com, 1.888.669.4337

Drug Testing SystemThe Siemens Viva-E System

provides a complete menu ofgold standard EMIT assays for fastanalysis of drugs of abuse, thera-

peutic drugs and immunosup-pressants, as well as sample valid-ity testing on a single bench topanalyzer. It is designed for low-to mid-volume labs, treatmentcenters, transplant managementcenters, criminal justice facilities,and industrial facilities.

http://usa.healthcare.siemens.com,1.800.242.3233

New SoftwareIntroduced at NADCP 2015,

QuikCase will be a new offeringin the Case Management spacefor Drug Courts and similar pro-grams. Features include: seamlessintegration with QuikLIMS drugtesting management system,resource and client scheduling,assessment of the customer's drugtesting menu relative to the aggre-

gated occurrence of detecteddrugs of abuse in their geography,random drug test scheduling, andcomprehensive reporting. In addi-tion, QuikCase can accommodateprogram administration of multi-ple court types like Family Court,Heroin Court, and Veterans Courtamong multiple jurisdictions suchas Municipal, District, andCounty Courts.

www.elabsolutions.com, 1.866.990.3522

20 CORRECTIONS FORUM • JULY/AUGUST 2015 VISIT US AT WWW.CORRECTIONSFORUM.NET



BY MICHAEL GROHS, CONTRIBUTING EDITOR

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tudies show thatinmates are biolog-ically older thantheir chronologicalage, often by more

than a decade. They also tend tohave more health issues than thegeneral community. Infectiousdiseases such as hepatitis, addic-tion, diabetes, coronary disease,and other chronic maladies areprevalent in many inmates. Thenthere is the matter of mentalhealth. A 2014 report by theTreatment Advocacy Center stat-ed that not only is the number ofinmates with mental healthissues growing, the severity of theillnesses is on the rise as well. Thenumbers are staggering. In 2012,the report says, there were356,268 inmates with severemental illness—more than thepopulation of Tampa. In compar-ison, there were only 35,000patients in state psychiatrichospitals.

Medicating all of theseconditions is a majorchallenge for correc-tional facilities andrequires considerableplanning, policies, andprocedures. SaysMartha Ingram, RN,CCHP, CPHQ directorof Quality Management& Performance Improve-ment at Wexford HealthSources: “Facilities are look-ing for the most efficientmethod of medication adminis-tration to limit the amount oftime that custody personnel aretied up with each medication dis-tribution.” Becky Luethy, RN,director, Operations Develop-ment, Centurion, LLC, adds thatfacilities are looking for “systemsthat are intuitive, efficient, andsimple. Popular today are elec-tronic medication administrationrecord (eMAR) systems, whichallow staff who administer med-ications to do so accurately andefficiently.” (There are severalsuch systems on the market man-ufactured by organizations suchas CorrecTek, AssistMed and

Diamond.)Naturally, there are difficulties

when it comes to distributinginmate medication, especiallywhen it is a particularly largepopulation. Many factors thatcan be a challenge, says BeckyPinney, MSN, CCHP-RN, VPBusiness Operations & FacilityPerformance at Corizon Health,are “officer availability, patienceon the part of patients who growweary of lines, little time forproper documentation, andensuring that patients are actual-ly consuming the medications vs.‘cheeking’ them.” There are alsoconcerns about interruptions inthe availability of medicationsfrom the manufacturer as well asthe correctional environment

itself, which

is in its way, organized chaos.Often, says Luethy, administra-tion occurs in the cellblock wherenoise and crowds of offenderscan be a distraction, and offend-ers sometimes approach thehealth care professional with

medical questions unrelated tothe task at hand.

One issue, Ingram furthers,includes the continuity of med-ication upon an inmate’s arrivalat the facility. “This is especiallytroublesome for the initial book-ing of detainees in jails.” As shestates, inmates rarely come tofacilities with their medicationon their person. “They are typi-cally not good historians, and donot always know the name of themedication prescribed or thedosage.”

Ingram explains that amongthe most important considera-tions of medication distributionis that “the medication is accu-rately given to each person anddocumented appropriately.”Good medical practice, she fur-thers, requires that there are “nointerruptions of life-sustainingmedications, or those needed to

maintain therapeutic blood lev-els for serious health condi-tions.” She furthers thatevery medication needs tobe verified with the physi-cian or pharmacy beforeit can be administered.If the medical personnelare unable to verify themedications, the inmateoften must wait until a

physician can meet withhim or her and receive an

order for the prescription.“This is a very time-consuming

and labor-intensive mission.”Protocol and policy requires

training. Corizon’s medicationmanagement protocols trainnurses to manage the numerouschallenges as effectively as possi-ble so as not to hinder delivery.They also maintain awarenessthat when volume is as high as itis in a correctional facility, inven-tory and refills can be a chal-lenge. Says Pinney, “We providealternative sources for medica-tions to alleviate or minimizedelays until full inventory can berestored.” One method ofaddressing this challenge mightbe the use of automatic dispens-ing units (ADUs). Says Luethy,


S

Good medical practice, says MarthaIngram at Wexford, requires thatthere are “no interruptions of life-sus-taining medications, or those neededto maintain therapeutic blood levelsfor serious health conditions.”


“Centurion uses an automaticdispensing unit in one of ourcontracts where we maintain alicensed pharmacy. Advantagesinclude having medications readyto provide to offender patientswhen new orders are receivedfrom the provider—we don’thave to wait until the next day toreceive them from our pharmacypartner.” There is an issue,though. Ingram notes, “Whileautomatic dispensing units areseen as a safer form of medicationadministration, there are fewcounty and state governmentsthat have the funding availableto provide automatic dispensersystems for their correctionalhealth care services.”

A primary concern with med-ication, naturally, is ensuringthat the correct inmate gets theproper medication and actuallytakes it. One consideration cor-rectional facilities have that tradi-tional medical providers do not isthat in correctional facilities, asthe California Department ofCorrections and Rehabilitation’sDivision of Correctional HealthCare Services Inmate MedicalServices Volume IV states, medica-tion distribution requires collabo-ration between health care andcustody staff and that “at thetime of medication administra-tion, licensed nursing staff shallensure that the right patientreceives the right medicationand right dose , by the rightroute, at the right time. In addi-tion, nursing staff shall ensurethat each patient's MedicationAdministration Record (MAR)includes the right documenta-tion.” To put some scale to thetask, in 2011, the population ofCDCR inmates was 287,444;more than the population ofNewark, N.J. Many need to bemedicated every day, and thatrequires a profound sense of orga-nization.

The policy at CDCR regardingpatient medication is straightfor-ward. “The CaliforniaDepartment of Corrections andRehabilitation (CDCR) shall pro-

vide medications to patients in atimely manner, in accordancewith state and federal laws.” Theprocedure to ensure these goalsare met are clearly described inthe manual and include proce-dures such as how licensed nurs-ing staff must compare the med-ication’s label with the MAR aswell as check the MAR for aller-gies before distribution. Licensednursing staff shall also verify thatthe medication order is currentand that the medication has notexpired. The practitioner mustalso verify the patient’s name andCDCR number before administer-ing the medication and details ofadministration such as the routeand administration site “shall

also be recorded on the back ofthe MAR if a medication isadministered by injection.” Amedication error report must becompleted for any deviation fromthe procedure. There is a specificform for licensed staff to notifythe prescriber of suspicion thatthe patient is not taking the med-ication.

Hoarding and “cheeking” med-ication is a serious concern andsomething providers need tohave a policy to monitor. On thatnote, says Luethy, Centurionpartners with their colleagues inthe facility to establish policiesand procedures in dissuade andavoid hoarding and cheekingmedications with the intent to


CDCR’ s health care policystates: At the time of medica-tion administration, licensed

nursing staff shall ensure thatthe right patientreceives the right medicationand right dose,

by the right route, atthe right time.


avoid taking them or to sellthem. “We are also very mindfulof the use and misuse of abusablemedications in prison, and wehave policies for strict controlson those medications.” For exam-ple, abusable medications arenever distributed as “Keep onPerson” medications. Whilemalingerers are a nuisance, saysLuethy, they are usually wellknown to the staff and they cre-ate individual treatment plans forthose who malinger. Those plansfocus on the root cause of themalingering, and often they areable to meet their patients’ needsin other ways “so malingering iskept to a minimum.”

CDCR’s policy in regards tomalingerers and hoarders in casesinvolving security or safety issuesin which medication manage-ment is compromised, such ashoarding or selling medications,is the inmate will be referred tothe health care manager and theappropriate associate warden ordesignee for resolution.

While malingerers are certainlyan issue when it comes to med-ication protocol, Pinney pointsout that, “It is critical thatproviders make good clinicaljudgments without bias about thepatient. Clinicians must notbecome apathetic or jump to con-clusions, but base decisions onindividual assessment and dis-cernment of the presenting con-ditions. If meds are needed, theyshould be ordered. If not, theclinician should provide educa-tion to the patient about othertreatment approaches.” One tac-tic, she states, is that “it takesteamwork between custody andnursing at the point of adminis-tration to avoid patients hoard-ing and/or selling medications.The team must carefully considerKOP meds, and must commit toperiodic checks and discussionsat chronic care encounters toreevaluate the appropriateness ofthe process for each patient.”

One policy to address this sortof medication misuse, says

Ingram, is to ensure that adminis-tration is orderly and thatinmates are not allowed to crowdaround the window or medica-tion cart, that they arrive one at atime, and that they remain quietto prevent unnecessary distrac-tions for the nursing staff admin-istering the medications. (TheInmate Handbook for theMonroe County, Fla., Sheriff’sOffice clearly states, “Duringmedication, inmates will line upin a single file line and remainQUIET.”)

Ingram furthers, “Protocolshould require that inmatesalways present their identifica-tion to the nurse to ensure themedication is administered to thecorrect inmate. In an ideal situa-tion, the inmate must go to a spe-cific location and is directly giventhe medication by the responsi-ble nurse after providing appro-priate identification. The inmatethen takes the medication andsteps to the side, and the accom-panying officer performs the



mouth check. This scenario keepsthe medication administrationmoving at an appropriate pace,and provides another level ofsecurity to impede the inmates’ability to hide, hoard, and thentraffic the medications received.”

Other policies Centurionadheres to, says Luethy, reflectNCCHC standards and includepolicies in regards to “account-ing of medications, administra-tion of medications, dispensing

of medications, disposal of med-ications, distribution of medica-tions, use of over-the-countermedications, procurement ofmedications, refusal of medica-tions, and others.”

Ingram points out that poli-cies, procedures, and protocolsregarding medication administra-tion depend on a variety of fac-tors including the size, layoutand security level of the facility.A few of those issues that can be

addressed in the institution’spolicies and procedures includeensuring the provision on ade-quate supply of stock medicationthat can be utilized on an interimbasis. There should also be theavailability of a local back-uppharmacy for urgent medicationneeds that are not carried instock. Facilities should also havea formulary system that “pro-vides access to regularly pre-scribed medications, along with acomprehensive procedure thatenables the use of non-formularymedications when medicallyindicated.”

Facilities should also adhere toa “patient-specific system” (thatis to say sealed pre-packagedunit dose) because that will pro-vide for increased accuracy inpatient medication administra-tion. One such provider isPennsylvania based MediDose/EPS. Bob Braverman ofMediDose notes that one issuethat arises is “shrinkage in thepipes,” a term used to refer tothe disappearance of medica-tions in transit. Using such asystem can help avoid thatbecause the packages are tamperresistant and MediDose offers asoftware package to help thepharmacy label medications aswell as print bar codes andgraphics.

Ingram furthers that facilitiesshould also adopt “protocols thataddress and allow for proper con-tinuity of medication uponintake (jails) as well as continuedadministration for prescriptionsscheduled to expire.”



The saying may be thattime stands still inprison, but thatcouldn’t further fromthe truth. In a way itspeeds up. “Many

inmates,” says Bill Sessa, informa-tion officer at the CaliforniaDepartment of Corrections andRehabilitation (CDCR), “are oldermedically than they are chronolog-ically, often because of poor nutri-tion and drug or alcohol use beforethey came to prison.” (Studies havefound that age difference to bebetween 10 and 15 years.)

According to the Administra-tion on Aging, in 2013 the U.S.population aged 65 and oldernumbered nearly 45 million. By2060 that figure will double. Thesilver tsunami is deluging the cor-rectional environment just as fastas it is the community. Accordingto 2013 data from the FederalBureau of Prisons (BOP), inmatesaged 50 and older were the fastestgrowing segment of the inmatepopulation. Between 2009 and2013 that population increased25%. During that same period,the data show, the inmate popu-


BY MICHAEL GROHS, CONTRIBUTING EDITOR

AGINGINMATECARE: A SPECIAL REPORT

HOW PRISONSARE DEALINGWITH THE RISINGELDERLY POPU-LATIONS, SPIRAL-ING HEALTH CARE TREAT-MENT, AND LEGAL RAMIFICATIONS.

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lation under 50 decreased by 1%.There was also a nearly 30%decrease in the number ofinmates under 29 years old.Simply put, the inmate popula-tion is getting older. Not onlythat, says Dr. John Wilson, Ph.D.,vice president of ClinicalDevelopment, MHM Services,Inc. “The aging inmate popula-tion is not just driven by inmatesgrowing old inside correctionalfacilities. There has been anuptick in older individuals beingarrested.” In May 2015, theOffice of the Inspector General(OIG) at the U.S. Department ofJustice (DOJ) released the studyThe Impact of an Aging InmatePopulation on the Federal Bureau ofPrison. Among the findings werethat aging inmates were morecostly to incarcerate thanyounger ones, mostly due toincreased medical needs andaccommodation considerations.On that note, Dr. Wilson fur-thers, “The price tag is sendingstate budgets reeling. The cost of

incarcerating geriatric individualsis two to three times the cost ofincarcerating younger offenders.”As the saying goes, time and tidewait for no one.

Dr. Kurt Johnson, MD, region-al medical director, CorizonHealth, Wyoming DOC, notesthat challenges include“polypharmacy [use of five ormore medications], prolongedexposure to heat/lack of air con-ditioning, fall risks, inexperi-enced or under-trained officers,providers and/or nurses withregards to providing care, andsecurity to this population.”Other concerns are the lack ofgeriatric housing units in thisrapidly growing population, andvictimization of elderly patients.“We are also challenged withaddressing the behavioral chal-lenges of the demented patient,care for the bed-ridden, specialnutritional requirements, and theappropriate use of resources inmeeting their many needs.”

As Dr. Steve Krebs, the former

chief medical officer of Denver-based Correctional HeathPartners points out, “Prisons werenot designed for elderly prisonerswith geriatric needs.” Olderinmates need assistance in trans-portation, and facilities may needto retrofit bathroom and showerfacilities. Dr. Wilson furthers,“Installing hand rails, wideningcell doors for wheelchairs, andproviding the multiple interven-tions that are required for thispopulation is expensive.” It canalso put other inmates at risk.“To take one example, a wheel-chair can be disassembled andmade into multiple weapons.”Dr. Krebs also mentions thatthings like crutches can be usedas weapons, and needles for dia-betics can be both a weapon anda commodity. There may also bethe need for hands-on physicalassistance.

Out of ReachUpper bunks can become an

impossible barrier for older



inmates to negotiate, so occupan-cy can become an issue.According to the OIG report, theBOP operated at 36% over capaci-ty, and the lack of lower bunkshas affected inmates in severalways. During the OIG’s visit toone facility, they noticed thatsome bunks did not have laddersor steps, and the aged inmate hadto climb on desks and chairs toreach the upper bunk. The lack oflower bunks has also caused prob-lems in retrofitting facilities. Onesupervisor of education told theOIG that her facility was unableto accommodate all of those whorequired a lower bunk and had toadd beds to a room not designedfor housing. The OIG also foundthat some cells had been retrofit-ted from “two-man cubes” tothree, in which the bottom twobunks were classified as “lower.”Further, inmates with a history ofhigh blood pressure or seizureswho receive middle bunks couldcreate a liability for the facility ifthe inmate were to fall. Finally,the lack of lower bunks requiresstaff to reassign them by reorga-nizing bed assignments, whichcan create tension among theinmates being reassigned.

The distance between cells andchow halls and pill lines isbecoming an issue, says Dr.Wilson. An easy journey for a 30-year-old, may not be for an 80-year-old. Dr. Krebs says that evenclothing can become an issue. Azipped jumpsuit for an inmatewith two bad shoulders can beimpossible to put on. “Imaginean inmate with severe arthritislacing up a state boot.”

Legal RamificationsThere are also legal matters

such as ADA compliance and pri-vacy matters in regards to assis-tance that is traditionally provid-ed by the family. There is thematter of mandates of “norelease” or a crime that makesrelease an issue such as sexoffenders and where to put them.Legislatively they are considered

a predator, and they cannot sim-ply be placed in an assisted-livingor nursing facility. Says Dr. Krebs,at 30 years old the sentencemight be appropriate. By 90, thethreat might be “washed out,”but legislatively they are still con-sidered just as dangerous. “Thereis literally no place for us torehab these people.” Further-more, Dr. Wilson points out,there is the consideration of aninmate who is 80 and has beenlocked up continuously since hewas 30 and has developed severesigns of Alzheimer’s. “His abilityto recognize others, his surround-ings, and even the fact that he isincarcerated may no longer bereliable. Is it ethical to continueto punish someone who nolonger knows he’s being pun-ished?”

Rising Costs inCaring for theAging

The biggest challenge, manyagree, is, and will continue to be,medical needs. Dr. Neil A. Fisher,MD, CCHP, corporate medicaldirector, Quality Management &Pharmacy at Wexford HealthServices, notes that as the num-ber of aging inmates increases,many county and state govern-ments are not fully prepared forthe exponential increase in med-ical costs. “There is an increasein medical conditions and alsodisabilities among aging inmates,and the need for chronic careclinics, follow-up care, and phar-maceuticals drive costs up signifi-cantly per inmate.” There arenumerous conditions to considerincluding heart disease, diabetes,cancer, COPD, dementia, renalfailure, and sleep apnea, andoften these conditions must betested and treated at off-site facil-ities. “With the higher rates of ill-ness, county and state govern-ments need to prepare forincreased costs in pharmaceuti-cals, laboratory work, x-rays,MRIs, CT scans, and an increased

frequency of off-site care.” Forexample, says Dr. Fisher, “A geri-atric inmate who has cancer willneed to have a plethora of testscompleted that are often off-site(i.e. biopsies, CT scans, PET/bonescans), and pharmaceutical treat-ment, chemotherapy, and radia-tion therapy. In addition, thisinmate will need to be in specialhousing due to fragility and secu-rity reasons. While these servicesand accommodations are neces-sary and reasonable, they are alsoexpensive.”

What Is BeingDone?

CDCR’s Sessa points out thatCalifornia has been under a courtorder to provide a “constitution-al” level of medical care toinmates. One step that has beentaken to ensure that this happensis a state-of-the-art medical facili-ty in Stockton. The CaliforniaHealth Care Facility housesinmates who have acute healthcare needs as well as some withserious mental health issues. Ithas an advanced system for stor-ing and dispensing medications.At the time it was being built, itwas the largest municipal con-struction project in the countrycoming in at a price tag of $900million. (It opened in June 2013.)It is not, says Sessa, a hospital.Inmates who require surgery aretaken to a hospital in Stocktonand treated in a wing that hasbeen revamped as part of thehealth care facility construction.All of the inmates assigned to theCalifornia Health Care Facilityhave long-term and acute healthcare needs, for which the facilityis staffed to treat. He also pointsout that by housing thoseinmates in the Stockton facility,medical clinics in each prison arefreed up, which improves theday-to-day health care needs foreveryone else.

CDCR also has hospice pro-grams at the California Men’sColony (CMC) in San LuisObispo and in the California



Medical Facility in Vacaville.Also at CMC is the “Gold CoatProgram,” in which able-bodiedinmates assist those who havedementia with daily tasks. Thissort of assistance is seeminglybecoming more and more of alogical tactic and one recom-mended in the OIG Report,though it found that some facili-ties had inmate companion pro-grams, but there was little consis-tent oversight and implementa-tion varied from facility to facili-ty. (Their recommendation forthe BOP is to “develop nationalguidelines for the availability andpurpose on inmate companionprograms.”)

Dr. Fisher also notes that manyother counties and states areestablishing geriatric and hospice

units and providing a secure loca-tion staffed with personnel whoare trained in such type of care.Others are creating educationalprograms for all medical and cor-rectional staff regarding securityfor elderly inmates and ensuringthat everyone is aware of the spe-cific safety concerns surroundingthat population. “We are also see-ing more facilities providingonsite testing including ultra-sounds, MRIs, and CT scans.Whether they utilize mobile ser-vices companies or decide tobuild their own in-house serviceareas, they are seeing this as a fea-sible solution to preventing toomany elderly inmates going off-site for tests.”

The Wyoming DOC, says Dr.Johnson, offers a geriatric unit

that has numerous special accom-modations such as adequate cli-mate control, space for wheel-chair access and safe maneuver-ing around the unit and the twohospice cells, and a private areadirectly outside the unit where aninmate “can walk, tend to a veg-etable garden, sit in the sun, andeat their lunches.” (No otherinmates have access to this area.)There is also a fully-equippedmedical exam room nearby withaccess to EMRs [electric medicalrecords], which reduces the needfor transport to the medicaldepartment. The Wyoming DOCalso staffs the unit with officerswho have been screened and aresensitive to the older inmate pop-ulation’s needs and are able todiscern security concerns from


There are numerousconditions to considerincluding heart dis-ease, diabetes, cancer,COPD, dementia, renalfailure, and sleepapnea, and oftenthese conditions mustbe tested and treatedat off-site facilities.


behavioral issues presented bythe older population, so the offi-cers will respond accordingly ona situation-by-situation basis.

Training is a word often men-tioned among those in the field.Dr. Fisher suggests that one tacticis to ensure that all cliniciansshould be trained in geriatric andend-of-life care. Dr. Johnsonnotes that the Wyoming DOCprovides ongoing medical educa-tion to primary care providersand nurses such as familiaritywith the Beers List, which is theAmerican Geriatric Society’s listof potentially inappropriate med-ications for the elderly and whythey are on the list.“Polypharmacy is particularlydangerous in this population.We foster an awareness of andaction plans to prevent or fixoverprescribing.” There is also theadmonition against using chronicindwelling catheters and avoid-ing the use of bed restraintsamongst this population. TheOIG recommends furtheringtraining so that all staff aretrained to identify signs of agingand assist in communicatingwith aging inmates.

Dr. Wilson points out thatmost correctional facilities arestruggling to find solutions.Many are looking hard at activat-ing or strengthening what haslong been a dormant option:medical furlough and other com-passionate release policies (TheOIG recommended doing this asone of their suggestions in theirstudy.) “There are challengeswith these policies, as no one hasa crystal ball, and estimating lifeexpectancies with precision ismostly a grim art.”

What Should Be Done?

Dr. Krebs points out that staffare aware of the issues. It is morea matter of funding and legisla-tive changes. Facilities requirespace and mental care capital.“The corrections world needs tosay what they would do to pro-

vide a facility and to do so in asecure environment.” Anotherissue that is often not addressed,says Dr. Fisher, is the need foradditional correctional officers totransport the inmates to multiplespecialist appointments.

One point of concern, says Dr.Johnson, is looking to the futureand being able to have the capac-ity to provide adequate staffingand geriatric housing when thegeriatric prison population trulyexplodes. “Currently we aremeeting the needs of the elderlydespite these numbers havingincreased significantly in the pasttwo years. Nevertheless, thisincrease hasn’t represented anexplosion yet. In anticipation ofan increase in inmate popula-tions, empty shell units werebuilt as part of construction in2010. One or more of these shellunits will most certainly be con-verted into geriatric units as thebaby-boomer generation contin-ues to age.”

Dr. Wilson points outs out thatstaffing is also one of the primaryissues to address. “There is a sig-nificant shortage of healthcareprofessionals specializing ingerontology.” This shortage, hesays, is being felt in the communi-ty and will only worsen. “It willnegatively impact correctional sys-tems’ ability to provide the stan-dard of care. These specialistsfocus on maximizing the qualityof life and managing the totalityof the individual’s medical condi-tions, not necessarily on maximiz-ing specialized treatments for spe-

cific diseases. Treatment for aginginmates needs to be provided in aholistic, integrated manner— notin silos by specialists who don’ttalk with each other. We need cor-rectional gerontologists.”

Dr. Johnson has also beenthinking about the matter.“There will need to be somethought given to the answers tothis challenge. Perhaps therecould be a joint effort by the state(DOC, Medicaid, DOH) to con-tract with existing nursing homesso that there is a landing spot forthese patients. Or perhaps anRFP could be submitted so that avendor contracts with the state tobuild and run such a facility. Orit may be more feasible to simplyadd on to an existing prison.These are questions we should beanswering now so that we areprepared when the anticipatedincrease in elderly patients getsinto full swing.”

The fact of the matter is, saysDr. Wilson, “We are reaping whatwe have sown.” The aging popula-tion, healthcare costs and demo-graphics were not likely consid-ered when mandatory minimumsentences and harsh sentencinglaws were enacted. Correctionalofficers are not trained as nursingassistants, and most of them don’twant to be. They are being askedto manage patients rather thaninmates. Says Dr. Wilson, “Nowonder that one disoriented anddemented inmate told us, ‘This isthe worst nursing home I’ve everbeen in.’”


“PRISONS ARE NOTDESIGNED AS NURSINGHOMES, BUT THAT IS WHATTHEY ARE BECOMING.”

– Dr. John Wilson, Ph.D., vice president of Clinical Development, MHM Services, Inc.


THE LONG LAZY DAYSof summer have come to a close.As the September days growshorter and nights grow cooler,many students return to theirstudies, and by October mosthave delved deeply into theirnew curriculums. Some correc-tions departments have also seenthe benefits of education—andthis fall inmates are no exceptionin their quest for knowledge.

The U.S. Department ofEducation (ED) is backing themup with a new study calledEducational Technology inCorrections, 2015 published inJune that emphasizes the benefitsof advanced technology forinmates and reports the availabil-ity of it for those incarcerated—which remains low. In addition,it highlights a few exampleswhere technology is a successfulpart of the corrections experi-ence.

At the same time, more correc-tions agencies are conductingresearch into how academic andvocational training have impact-ed recidivism. As you will seebelow, they are beginning to diptheir toes into some innovative

vocational reentry programs. First, however, let’s begin with

the report from the ED. It citedthe 2014 RAND Corporationstudy (sponsored by the Bureauof Justice Assistance) that foundthat incarcerated individuals whoreceived general education andvocational training were signifi-cantly less likely to return toprison after release and more like-ly to find employment than theirpeers who not did not receivesuch opportunities.

The RAND Report found thatcorrections education has a sig-nificant impact on post-releaserecidivism. It found that, “onaverage, inmates who participat-ed in correctional education pro-grams had 43 percent lower oddsof recidivating than inmates whodid not…. This translates into areduction in the risk of recidivat-ing of 13 percentage points forthose who participate in correc-tional education programs versusthose who do not.”

Education was also shown toimprove inmates’ chances ofobtaining employment afterrelease, and employment hasbeen shown to have a positive


BY DONNA ROGERS, EDITOR-IN-CHIEF

EDUCATION,TECHNOLOGY AND REENTRYCORRECTIONS PROGRAMS THAT TIE IT ALL TOGETHER.

Female offenders in the BuildingMaintenance classroom at Indiana’sRockville Correctional Facility learncarpentry, basic plumbing, electricaland framing.

S-O 15 p40-45 reentry_master template 10/4/15 8:12 PM

impact on recidivism rates. Theodds of obtaining employmentpost-release among inmates whoparticipated in either academic orvocational correctional educationwas 13 percent higher than theodds for those who did not par-ticipate. In addition, it was foundthat “those who participated invocational training were 28 per-cent more likely to be employedafter release from prison thanthose who did not receive suchtraining.”

RAND researchers concludedthat prison education programswere cost-effective. But the studyalso documented a cautionarytale within the good news: accessto education in correctional insti-tutions was limited, and signifi-cant knowledge gaps existedregarding the nuances of educa-tional program effectiveness inthe correctional context.

INMATES ‘LEFT BEHIND’ INUSE OF TECHNOLOGY

The National EducationTechnology Plan, developed in2010 by the ED, underscores thenecessity of advanced technolo-gies to support all student learn-ing. Yet, it reports: “As states, dis-tricts, higher education institu-tions, and other educationproviders implement these plans,education programs in correc-tional facilities are being leftbehind.” It states: “For example,according to a 2013 survey ofstate correctional education direc-tors, although most states offerstudents limited use of computersin their prisons, less than halfreported that one or more oftheir prisons provided studentswith off-line access to Internetcontent and even fewer allowedrestricted Internet access (Davis etal. 2014).”

OBJECTIONS TOTECHNOLOGY

The report notes that the pri-mary concern about adoptingeducational technology in correc-

tions is the potential for securitybreaches, though the lack of fund-ing to purchase, implement andmaintain equipment is anotherreason that hinders its use.

While the objections are wellfounded, the report goes on tooutline numerous case examplesof departments that have found away to overcome the concerns. Itincludes a section on how theOhio Department of Rehabilita-tion and Correction in 2005implemented a policy to allowrestricted Internet access, and anappendix contains the policy forothers to consider.

In the ED report, BrantChoate, former director ofInmate Education Programs withthe Los Angeles County Sheriff’sDepartment (he is now superin-tendent of California’s Office ofCorrectional Education), made acase for inmate technology edu-cation. He said if correctionalagencies are serious about prepar-ing incarcerated individuals forrelease, they cannot ignore tech-nological advances, including theInternet, occurring outside thefacility walls.

As noted, the Rand Reportfound education on the whole,whether academic or vocational,extremely promising. It did notfind a statistical difference as towhich is best suited to post releasesuccess, though those in the fieldreport studies are under way.

INDIANA TRANSITIONALEMPLOYMENT PROGRAM

A transitional employmentprogram for 25 inmates beingreleased to the Indianapolis met-ropolitan area during the next 12months has just been initiated bythe Indiana Department ofCorrections (IDOC). The agree-ment is with Goodwill Industriesof Central Indiana, Inc., an orga-nization under the umbrella ofthe United Way with a history ofproviding employment for peoplewhose options have been limitedby disability, a criminal history,low education level or other sig-

nificant barrier. Using donor andcommunity funding of about$400,000 annually, GoodwillIndustries' Retail Divisionemploys nearly 2,000 people.

According to John Nally, Ed.D.,director of education with theIDOC, participants will be paid$7.25/hr. to begin, with payincreases up to $8.00 per hourbased on program milestones, andwill work four days per week, for32 or 40 hours; and spend one dayper week (six hours) in classroomtraining. This training will includeinstruction in: Microsoft Word,Powerpoint and Excel; reading(participant must be at 8th gradelevel by graduation), math (mustbe at 5th grade level by gradua-tion) and career planning.

To be considered for the pro-gram, each participant must com-plete or acquire (or be ready to,immediately upon graduation),the following:○ Housing: a participant must

have a “secure home,” definedas living with family, a supportgroup, or a transitional home.A participant must have a per-manent address. A shelter isnot considered a permanentaddress.

○ Medical Care: a participantmust acquire a primary carephysician or primary facility,and acquire medical insurance.

○ Financial Skills: a participantmust have acquired an under-standing of financial planning,and must complete a personalbudget. Each participant mustobtain a personal checking orsavings account or obtain apersonal pay card account anddemonstrate the ability to keepit balanced.

○ Support System: a participantmust obtain a ParticipantChampion from outside theProgram, approved byGoodwill, whom they meetwith regularly.

○ Full-Time Employment: uponthe completion of the program,a participant must obtain full-time employment (at least 30hours). The employment could

42 CORRECTIONS FORUM • JULY/AUGUST 2015 VISIT US AT WWW.CORRECTIONSFORUM.NET


be at Goodwill or with an outside employer, includ-ing one of Goodwill’s many employer partners. Dr. Nally along with Susan Lockwood, Ed.D.,

director of Juvenile Education for the IDOC, con-ducted a comprehensive study that followedinmates released from Indiana state prisons over fiveyears with strong results toward education, particu-larly vocational training. The study showed thatrecidivism was greatly reduced based on the offend-er participating educational programs. “The studyfound the recidivism rate is 29.7 percent amongoffenders who participated in a variety of correction-al education programs,” Nally said in an email.“Conversely, the recidivism rate reached 67.8 per-cent among individuals who declined to participatein any correctional education programs.”

Dr. Nally has said he doesn’t think it serves soci-ety well to exclude citizens from a formal educationprogram. A citizen, he believes, regardless of “wherethey sleep at night” should still be able to get aneducation.

INDIANA CALL CENTER PROGRAMTo carry out that mission, the IDOC has an array

of reentry plans. One is a joint-partnership withTeleverde (http://www.televerde.com/) for a call cen-ter at the Rockville Correctional Facility (female).The current number of inmates employed throughthe joint partnership is 37 with an agreed upon goal


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Availability of Technology inCorrections Education, 2013


of 150 individuals gainfullyemployed while incarcerated.Inmates will be paid on a climb-ing scale based on their length ofemployment, i.e., $1/hr fortrainees, up to $2.50/hr. after twoyears.

Among the learning outcomesof the Televerde call center train-ing are: honing communicationsskills, discerning customer needs,becoming knowledgeable in web-based customer service, manag-ing stressful situations and propertime management skills—allreadily transferred to the outsidebusiness world. Graduates willearn a certification from theInternational Business TrainingAssociation.

Unfortunately, Dr. Nally notes,inmates are not meeting the basicstandards to be considered for thetraining. Televerde had 30 appli-cants in May but 17 did not passthe pre-employment assessment.“To increase the probability ofemployment within the call cen-ter, we will provide access to aWorkINdiana on-site program,”he says. This partnership, in con-junction with Oakland CityUniversity, provides offenderswho failed the pre-employmentassessment with a six-week, 15-hour classroom and distancelearning skills class. Among the

remedial topics covered are basictyping, locating information andinterviewing skills.

Technology skills and postrelease follow-up are also part ofthe call center plan. “Beyond thelearning outcomes, the trainingwill be combined with computertraining and/or employabilityskills training, to add depth,” Dr.Nally explains. “Completers willalso qualify for post-release sup-port through the H.I.R.E. program.

Mobile devices are the newwave, and the ED report discussesseveral providers, among them isInnertainment Delivery Systems(IDS), a tech-enabled Nashvillecompany supporting contentdelivery for users within secureenvironments (www.ids615.com).The company, which was found-ed in 2009 when they began sup-plying counties with MP4devices, began producing educa-tional tablets in 2011. It nowoffers both proprietary cus-tomized hardware and softwaresolutions, which are specificallyfor jail and prison use, accordingto Dr. Turner Nashe, president.The company produces 4-, 7-,and 10-inch tablets, which can beeither wifi enabled and non-wifienabled for the most securerequirements. IDS reports 50installations, including the

California Department ofCorrections and Rehabilitation.

We generally partner withDOCs, counties, and theirschools (K12 through post sec-ondary), notes Dr. Nashe. “Weoffer curriculum and content oneverything from primary, sec-ondary, and post-secondaryschools. We also offer ABE, ESL,religion, life skills, vocational,substance abuse. We provide over45,000 titles of content across allprogram needs.

“Everything we sell was bornout of customer need,” he fur-thers. “We began trying to showthat electronics, under the rightcircumstance, could be a forcemultiplier when used in an edu-cational setting. We have spentthe last six years developing newand secure technologies to meetthe needs of budget-strapped jailand prison administrators aroundthe country. This increased accessto a mobile learning environ-ment, we hope, will lead toincreased quality of life andemployability upon release,” con-cludes Nashe.

REENTRY TOOLS& TECHNOLOGY

PROVEN BEHAVIORAL TOOL

Moral Reconation Therapy—MRT—has been employed indrug court treatment programssince the mid-1990s. The cogni-tive-behavioral program wasdeveloped by CorrectionalCounseling Inc. and is used forsubstance abuse treatment andfor criminal justice offendersacross the U.S.

A recent study provided a com-prehensive review of 56 recidi-vism outcome studies publishedin journals, independent programevaluations, and technical reportsover the past two decades, report-ing on the effects of MRT in drugcourt operations. Seven of thepublished studies of adult courtsincluded recidivism data with a


Graduates of Indiana DOC’s Televerde inmate call center certification program, which aids in honing communications and customer service skills.


comparison between groups thatutilized MRT and groups that didnot. Six of these seven studiesshowed that MRT treatment inadult courts led to lower recidi-vism. The average recidivismreduction rate of the MRT treat-ment group in all seven studieswas 21.6%, which comparesfavorably to the 10%-15% recidi-vism reduction rate of other drugcourts. Comparable studies wereconducted for juvenile court,family courts, wellness court andveterans courts.

www.ccimrt.com, [email protected] or901.360.1564

ONLINE JOB SEARCHES

Some 2,000 inmates in FultonCounty jail in Atlanta have beengiven access to JobView tablets ina pilot program, according toWSB-TV, Atlanta. With thesemobile devices inmates get limit-ed access to the cyber world andcommand tablets can be used tocontrol them.

Anything we can use to getinmates to follow institutionrules without having to use forceand without having to be coer-cive, I think is a good tool, saidjail commander Colonel MarkAdger. We can extend to theinmates the opportunity to enter-tain themselves productively, headded.

In the pilot, Securus has giventhe jail the tablets at no chargefor inmates who rent them for$20 per month.

Among the programs loadedon the tablets is a solution calledJOBview 2ndChance, which hasno keyboard or connection to theInternet, and it allows inmates tosearch through current job list-ings that are updated daily.Because staff often have the onusto find job listings for offenders,they had been faced with theneed to bring handwritten list-ings or newspaper clippings forinmates to peruse for jobs, and“they are always out of date,”notes Ryan Solberg, vice presi-

dent of the Minneapolis compa-ny which developed the solution.“This can provide somethingmuch closer to what they willactually see on the outside.”

The solution is used by correc-tional facilities, probation offices,halfway houses and other reentrylocations.www.jobview.com, [email protected]

or 1.866.562.8439.

S.F. TABLET PILOTSome San Francisco jail

inmates are now in possession ofcomputer tablets they can use todo homework, read novels andprepare for their criminal cases,according to NBCbay area.com.

The tablets were distributed inOctober 2014 to more than 100inmates as part of a two-year,$275,000 pilot program.

The inmates will have access tofour secure websites, including alaw library and a digital book site.They can also use a calculator, aneducation application and an edu-cation curriculum developed bythe jail's Five Keys Charter School.

Inmate Dennis Jones, an armyveteran, has been in and out ofthe prison system for more than adecade. He is hoping the comput-er tablet can help him break thenegative cycle and help him earnhis high school diploma.

San Francisco Sheriff RossMirkarimi said the tablets couldhelp make sure inmates don'treturn to jail. "This is really cut-ting edge,'' he told a group ofsheriff's deputies and charterschool teachers receiving tablettraining. "Historically, there'sbeen resistance, if not prohibi-tions, on allowing technologyinto the living quarters ofinmates.''

New York-based AmericanPrison Data Systems developedthe tablets. The company alsoprovides the devices to juvenilejails in Kansas and Indiana andan adult prison system inMaryland, CEO Chris Grewe said.

http://apdscorporate.com,[email protected] or

646.592.1072.


Page No.

Alcolock, USA .........................17

ASSA .........................................6

Black Creek Integrated

Systems Corp. ....................29

Bob Barker..............................47

Corizon .....................................7

Correctional Counseling ........43

Correctional Medical Care .....27

Diamond Drugs Inc. ...............25

Endur ID Incorporated ...........28

Infax........................................31

Institutional Eye Care.............46

Jinny Corp.................................4

Keefe Group ...........................48

Mars........................................35

Medi-Dose Company ........23,41

MHM Correctional

Services, Inc..........................2

Microtronic US .......................32

Morse Watchmans, Inc. .........37

NaphCare .................................9

NCIC Inmate Telephone

Services...............................39

OraLine, Inc. ...........................18

OraSure Technologies, Inc. ....19

Point Blank Industries ..............5

StunCuff Enterprises, Inc. ........4

Thermo Fisher Scientific.........15

Time Keeping Systems, Inc. ...33

Tribridge.................................11

TrinityServices Group, Inc......21

Wexford Health Sources ........13

This advertisers index is provided as a service to our readers only. The publisher does not assume

liability for errors or omissions.

A D I N D E X


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