Dual loyalty is an omnipresent feature of correctional health. As part of a human rights quality improvement committee, and utilizing the unique advantage of a fully integrated electronic health record system, we undertook an assessment... more
Dual loyalty is an omnipresent feature of correctional health. As part of a human rights quality improvement committee, and utilizing the unique advantage of a fully integrated electronic health record system, we undertook an assessment of dual loyalty in the New York City jail system. The evaluation revealed significant concerns about the extent to which the mental health service is involved in assessments that are part of the punishment process of the security apparatus. As a result, dual loyalty training was developed and delivered to all types of health staff in the jail system via anonymous survey. Six clinical scenarios were presented in this training and staff members were asked to indicate whether they had encountered similar circumstances and how they would respond. Staff responses to the survey raised concerns about the frequency with which they are pressured or asked to put aside their primary goal of patient care for the interests of the security mission. The online trai...
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Since 2004, 65 detainees are acknowledged to have died in Immigration and Customs Enforcement(I.C.E.) custody but little is known about the circumstances surrounding these deaths. Immigration detention is the fastest growing form of... more
Since 2004, 65 detainees are acknowledged to have died in Immigration and Customs Enforcement(I.C.E.) custody but little is known about the circumstances surrounding these deaths. Immigration detention is the fastest growing form of incarceration in the United States, involving the detention of over 200,000 people annually and approximately 30,000 at any one time. We have reviewed relevant information provided to the United States Congress and the United Nations Special Rapporteur on the Human Rights of Migrants in an effort to better characterize these deaths. In only twenty cases was significant medical information available. Six deaths occurred after medication was withheld during detention, including the following cases; a-death from myocardial infarction in a detainee with known renal disease whose antihypertensive medication was withheld, b-death of a detainee with AIDS from meningitis/pneumonia whose prophylactic dapsone was stopped and c-death involving seizure in a known ep...
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Research Interests: Demography, Adolescent, Prisons, Humans, New York City, and 5 moreFemale, Male, Mental Disorders, Adult, and Age Factors
The criminal justice system creates particular challenges for persons with HIV and Hepatitis C, many of whom have a history of injection drug use. The case of Scott Ortiz, taken from public trial and sentencing transcripts, reveals the... more
The criminal justice system creates particular challenges for persons with HIV and Hepatitis C, many of whom have a history of injection drug use. The case of Scott Ortiz, taken from public trial and sentencing transcripts, reveals the manner in which incarceration may delay learning of important health problems such as Hepatitis C infection. In addition, the case of Mr. Ortiz suggests the bias in sentencing that a former injection drug user may face. Collaboration between the Montefiore Medical Center residency in Social Medicine and a Bronx legal services agency, Bronx Defenders, yielded the discovery that a decade after diagnosis with HIV and after long term incarceration, Mr. Ortiz was infected with Hepatitis C. Mr. Ortiz only became aware of his advanced Hepatitis C and liver damage during his trial. The second important aspect of this case centers on the justification for lengthy sentence for a burglary conviction. The presiding Judge in Mr. Ortiz's case acknowledged that ...
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Research Interests:
Research Interests: Primary Care, Mental Health, Africa, Risk assessment, Humans, and 16 moreNew York City, United States, Male, Young Adult, Mental Disorders, Mental health services, Mental Health Care, Immigrant, African Americans, Middle Aged, Adult, Public health systems and services research, Sex Factors, Age Factors, Risk Assessment, and Community Based Organization
Research Interests: Mental Health, Health Care, Africa, Female Circumcision, Health insurance, and 15 moreCommunicable Diseases, Humans, African American, Infectious Disease, Chronic Disease, United States, Female, Risk factors, Prevalence, Health Problems, Health Care System, Public health systems and services research, Risk Factors, Coronary Artery Disease, and Insurance Coverage
Immigration detention is the fastest-growing form of incarceration in the U.S. Numerous reports by advocacy groups and detainees themselves have alleged substandard medical care for detainees. We have undertaken an analysis of the health... more
Immigration detention is the fastest-growing form of incarceration in the U.S. Numerous reports by advocacy groups and detainees themselves have alleged substandard medical care for detainees. We have undertaken an analysis of the health plan that regulates reimbursement of much of detainee health care. We conclude that this plan may place detainees at risk of receiving inadequate care, particularly if they have chronic medical problems or would benefit from routine health screening exams. We present several concrete measures that could immediately improve the level of medical care afforded to this vulnerable population.
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The lack of transparency in immigration detention in the United States has contributed to serious concerns about the fate of immigrants who are detained in the United States and require medical care. In particular, deficiencies in initial... more
The lack of transparency in immigration detention in the United States has contributed to serious concerns about the fate of immigrants who are detained in the United States and require medical care. In particular, deficiencies in initial screening, chronic disease management (including referral to outside care), and pain management of detainees have been identified by numerous governmental and nongovernmental groups.
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The jail-involved population-people with a history of arrest in the previous year-has high rates of illness, which leads to high costs for society. A significant percentage of jail-involved people are estimated to become newly eligible... more
The jail-involved population-people with a history of arrest in the previous year-has high rates of illness, which leads to high costs for society. A significant percentage of jail-involved people are estimated to become newly eligible for coverage through the Affordable Care Act's expansion of Medicaid, including coverage of substance abuse treatment and mental health care. In this article we explore the need to break down the current policy silos between health care and criminal justice, to benefit both sectors and reduce unnecessary costs resulting from lack of coordination. To draw attention to the hidden costs of the current system, we review three case studies, from Washington State, Los Angeles County in California, and New York City. Each case study addresses different aspects of care needed by or provided to the jail-involved population, including mental health and substance abuse, emergency care, and coordination of care transitions. Ultimately, bending the cost curve for health care and criminal justice will require greater integration of the two systems.
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Research Interests:
The detention of immigrants in the United States is a rapidly expanding endeavor with serious health consequences for the detainees. This detainee population represents non-criminal immigrants who are detained because of a visa violation... more
The detention of immigrants in the United States is a rapidly expanding endeavor with serious health consequences for the detainees. This detainee population represents non-criminal immigrants who are detained because of a visa violation or other immigration issue but who are not charged with any crime and do not enter the criminal justice system. HIV-positive detainees are especially vulnerable to lapses in proper medical care, and press reports have highlighted deaths and adverse medical outcomes among HIV-positive detainees. We have examined reports on detainee health issues published by numerous groups and conducted our own analysis of the health plan used to govern much of the specialty care for detainees who are HIV positive. We conclude that the system of immigration detention in the US fails to adequately screen detainees for HIV and delivers a substandard level of medical care to those with HIV. We provide several specific recommendations for improving screening and medical...
