Prisons and Jails are unprepared; COVID-19

COVID- 19 in Prisons and Jails are unprepared and may now be forced to recommend, in some cases alternative diversion sentences and/or home confinement.
I can only believe that the PSR could play a significant roll in this process.

Six feet apart, unlikely

6' apart, unlikely

COVID-19 in Prisons (Federal, State) and  Jails, like Cruise Ships, unfortunately, act as perfect breeding grounds for any kind of virus and especially one that currently has no treatment protocols.
John Hopkins has a Live Interactive Dashboard
Provides Current Reported Cases of COVID-19. Use our interactive web-based map to track cases of the virus around the world

UpToDate/Coronavirus disease 2019 (COVID-19)


Recent Press Releases:
September 2020

Visitation beginning to restart.

June 3, 2020 (Marshall Project)

How Prisons in Each State Are Restricting Visits Due to Coronavirus


June 3, 2020 (Marshall Project)

Jails Are Coronavirus Hotbeds. How Many People Should Be Released To Slow The Spread?

May 15, 2020 (Marshall Project)

For Mentally Ill Defendants, Coronavirus Means Few Safe Options

While their mental health deteriorates, some are stuck in jail as hospitals are decreasing admissions to prevent the spread of infections

April 17, 2020                                                                                           

Inadequate access to medical care poses a severe threat to a population that is already more vulnerable to coronavirus: there are about 10,000 people over 60 in federal custody, and about a third have pre-existing conditions. Photograph: Jonny Weeks/The Guardian

In prisons and jails across the deep south, coronavirus threatens to overwhelm

chronically underfunded, understaffed and overpopulated facilities

Mar 21, 2020;

Forbes; Can US Prisons React Fast Enough To COVID-19? By Walter Pavlo


March 22, 2020; 

Assistant U.S. Attorney Tanya Hajjar –  – wrote that no inmates at the Metropolitan Detention Center (MDC) in Brooklyn, NY or any other federal facility had tested positive for the coronavirus. What she failed to mention is that the BOP was not doing any testing of prisoners. ByJ.J. O’Hara



At least 38 people in New York City jails have contracted the virus. Associated Press

First federal prisoner, in Brooklyn, tests positive for COVID-19. Associated Press

Florida beaches covered with 1000’s on spring break, 2020.
All of this while COVID-19 is spreading across our country and the world. As a growing number of state governors urged all of us to Shelter in Place, in Florida, their beaches were covered with 1000’s on spring break.
You ask why and I have no idea. But these revelers are now on their way home to spread the virus throughout their families, friends and fellow workers’ personal space. Yet another vector.
The spread of COVID-19 from these beaches will ultimately whether direct or indirectly impact our society and prison system.
The Marshall Project, 3-19-2020

‘Those 55 and older are a growing share of the people in prisons. They’re also the most at risk as coronavirus spreads.’ By WEIHUA LI and NICOLE LEWIS

Couple this with the unprecedented delay of the federal government to act in any manner to assist state governors since January 2020, COVID-19 has exploded across the country exponentially! These same prisons and jails are already overcrowded, resulting in a healthcare disaster ready to get out of control.

Marshall Project: Jails are perfect incubators for COVID-19.” By Cary Aspinwall, Keri Blakinger, Abbie VanSickle and Christie Thompson

ICE Now could be another vector waiting to explode, impacting immigrants and ICE officers alike. While ICE claims to “have a plan”, the horse has already left the barn.


#covid19 #Covid19Prison #covidBOP

Federal Sentencing, COVID-19 and Compassionate Release

(1) Federal Sentencing in the age of COVID-19; for drug crimes from the U.S. National Library of Medicine – Evidenced Based Diversion Sentencing (a step by step process clearly explained).

  • This is critical as prisons are perfect petri dish incubators for contagions to multiply as in the cruise ship; e.g., Diamond Princess.
  • With ~600K inmates released each year with no current treatments available;
(2) Compassionate Release  /COVID19; while to my understanding it’s been difficult-impossible to get in past years, with COVID19, these examples just appear cruel:
  • People with severe obesity (body mass index [BMI] of 40 or higher).
  • People with diabetes.
  • People with chronic kidney disease undergoing dialysis.
  • People with liver disease.
  • I recommend the website UpToDate, an excellent resource tool for clinicians, hospitals, and hospital systems.

(3) 5-15-2020; Halfway House photos show no 6′ social distancing or masks being used.


BOP/ COVID-19 / Hydroxychloroquine / The Science

4-7-2020 (Marshall Project)

BOP buys $60,000 worth of hydroxychloroquine, the un

White House economic adviser Peter Navarro reportedly clashed with the National Institute of Infectious Diseases director Dr. Anthony Fauci over the efficacy of hydroxychloroquine as a coronavirus treatment.

proven COVID-19 treatment drug;

Many Trump-friendly pundits, however, are convinced of the drug’s effectiveness, most notably those on Fox News shows from which the president is known to take policy cues.


Malaria (not recommended for the treatment of complicated malaria.)

Lupus Erythematosus

Rheumatoid Arthritis: the treatment of acute and chronic RA  in adults.

Common side effects of Hydroxychloroquine include:


Clinical Effectiveness COVID-19 Resources Available to All

UpToDate (Medical Experts for Physicians)

Clinical Effectiveness COVID-19 Resources


Coronavirus disease 2019 (COVID-19): Management in adults


I) Hydroxychloroquine/chloroquine— 

There are insufficient data thus far to know whether hydroxychloroquine or chloroquine has a role in the treatment of COVID-19. For this reason, we strongly recommend that patients should be referred to a clinical trial whenever possible.

If hydroxychloroquine or chloroquine is used outside of a clinical trial, the potential for adverse effects should be carefully assessed. (See “Coronavirus disease 2019 (COVID-19): Arrhythmias and conduction system disease”, section on ‘Monitoring for QT prolongation’.)


Ia) Azithromycin and hydroxychloroquine –

We do not routinely use azithromycin in combination with hydroxychloroquine for treating COVID-19. Although one study suggested the use of azithromycin in combination with hydroxychloroquine was associated with more rapid resolution of virus detection than hydroxychloroquine alone [62], this result should be interpreted with caution…


II) Remdesivir (Testing canceled,, not because the drug wasn’t working, but because it proved too difficult to enroll the required number of patients. (Endpoints News))

…is a novel nucleotide analogue that has activity against SARS-CoV-2 in vitro [43] and related coronaviruses (including SARS and MERS-CoV) both in vitro and in animal studies [44]. Several randomized trials are underway to evaluate the efficacy of remdesivir for moderate or severe COVID-19 [45].

IIa) The WHO is launching a trial to further evaluate:

…remdesivirhydroxychloroquine/chloroquine, and lopinavir-ritonavir with and without interferon beta [76]. Various other antiviral and immunomodulating agents are in various stages of evaluation for COVID-19. A registry of international clinical trials can be found on the WHO website and at


III) Convalescent plasma — 

In the United States, the Food and Drug Administration (FDA) is accepting investigational new drug applications for use of convalescent plasma for patients with severe or life-threatening COVID-19 [50]; pathways for use through these applications include clinical trials, expanded access programs, and emergency individual use.


IV) Tocilizumab

…is an interleukin (IL)-6 receptor inhibitor used for rheumatic diseases and cytokine release syndrome. Elevated IL-6 levels have been described in patients with severe COVID-19, and case reports have described good outcomes with tocilizumab [66-69].

Federal Prison Placement Preparation

Incorporate these federal prison placement data points:

Federal prison placement includes Medical and Mental Healthcare needs to be implemented through the BOP CARE LEVELS I-IV Structure

Psychological Treatment

  • I) Brave Program A first-timer young male offender 32 years of age or younger, facing a sentence of 60 months or more
  • II) Challenge Program A male inmate facing a high-security penitentiary with a current diagnosis of either: Mood, Anxiety, Schizophrenia, Delusion and/or a Substance-induced Psychotic Disorders
  • III) Mental Health Step Down A male or female who lacks the skills to function in a general population prison setting and is willing to work with Psychiatry Services.
  • IV) Resolve A male or female with a current diagnosis of a mental illness related to physical, mental and/or intimate domestic violence or traumatic PTSD
  •  V) Skills A significant functional impairment due to intellectual disabilities, neurological and/or remarkable social skills deficits such as Autism Spectrum Disorder, Obsessive Compulsive Disorder, Epilepsy, Alzheimer’s, Parkinson’s or Traumatic Brain Injuries (TBIs) to mention just a few.
  •  VI) Stages  A male inmate with a serious mental illness and a primary diagnostic of Borderline Personality Disorder, along with a history of unfavorable institutional adjustment.
  • VIIa) Sex Offender Non-Residential Single Sex Crime, or first time Internet Sex Offense
  • VIIb) Sex Offender Residential Multiple sex crimes.
  • VIIc) Butner’s Commitment and Treatment Program for Sexually Dangerous Persons, Page 12Is considered for sexually dangerous persons with the possibility of criminal recidivism
  • VIII) Female Integrated Treatment Is a female with substance abuse (RDAP Eligibility Possible), trauma-related disorders, and other mental illnesses. (FIT) Program

Medication availability falls into 3 tiers:

  1. On the BOP Formulary (available).
  2. Non-Formulary; these require a lengthy preauthorization process.
  3. Last: these are just not available. While similar medications are substituted, how is their efficacy verified?

Security Requirements

  1. Offense Level vs Criminal History Calculation
  2. Criminal History Calculation
  • +3 points for each prior sentence > 1 Year + 1 Month.
  • +2 points for each prior sentence > 60 days, not counted above.
  • +1 point for each prior sentence, <= 60 days not counted above; for up to a maximum of 4 points in this category.
  • +2 points for each revocation that has a new charge or occurs under federal supervision.
  • + 1 point for each prior sentence resulting from a conviction of a crime of violence that did not receive any points as noted above because such sentence was treated as a single sentence, up to a total of 3 points for this subsection.

The BOP and Prison Security Level Placement

  1. (Program Statement P5100.08, Chapter 4: Pages 5-13 and Chapter 5: Pages 12-13)

Helpful articles in preparation for the sentencing hearing;

  1. Judges are interested in placement recommendations; By Alan Ellis, • THE FEDERAL LAWYER • September 2017
  2. When recommending a facility placement; BY ALICIA VASQUEZ AND TODD BUSSERT, How Federal Prisoners Are Placed, Published in Criminal Justice, Volume 31, Number 1, Spring 2016. © 2016 by the American Bar Association
The Presentence Report – A Medical, Medication, and Security Requirement Referral

As found in my LinkedIn 2/29/2020 post

A Broad Overview Outline of the Federal Sentencing and Placement Process

1st: Federal Defendants once indicted, >80% likely will be sentenced to federal prison

2nd: The defendant’s 1st appearance in court

  • ~80%, can result in either a plea or verdict of guilty
  • Between the Defendants 1stand, 2nd court appearance; a resume or CV of the defendant’s background is developed: called the Presentence Report (PSR).
  • The PSR is where the Defense Team Can make a Placement Request, while documenting the defendant’s medical, criminal, work & education histories, etc.

3rd: The defendants 2nd court appearance is for the Sentencing Hearing

  • The details of sentencing are not taught in most law schools
  • Judges determine the length of time the defendant is imprisoned
  • Judges can also make a placement request to the BOP

4th: The BOP determines placement

  • Some of the factors that affect placement (BOP Policy Statement P5100.08 (Chapter 4 Pages 5-13 and Chapter 5 Pages 12-13):
    • Judges recommendations
    • Public Safety Factor (PSF) Variables
      • Accepting Responsibility
      • Age
      • Criminal History
      • Education Level
      • Legal Release Residence
    • Management Variables; Pre-determined Security levels
      • Disruptive Group-confirmed member
      • Greatest Offense Severity #
      • Greatest Severity Offense
      • Prison Disturbance
      • Serious escape
      • Serious Telephone Abuse
      • Sex Offender
      • The threat to Government Officials
    • Medical CARE LEVELS I-IV Structure
    • Mental Healthcare CARE LEVELS I-IV Structure
    • Psychology Treatment Programs
    • Medication Availability
      • On Formulary, or available
      • Non-Formulary requires a lengthy preapproval process
      • Or Just Not Available, where a similar substitute may be implemented

BOP Psychology Programs and Mental Healthcare   240-888-7778

PSR/Sentencing and Placement Preparation: BOP Mental Healthcare Programs

If your client has replied ‘Yes’ to the questions (I- IX) below, one of these 9 BOP Mental Healthcare Programs may provide the best mental illness placement option for your client.

RDAP eligibility and an overview are covered in section VIII.

I) Is your client a first-timer young male offender 32 years of age or younger, facing a sentence of 60 months or more?

  • If yes, would your client be interested in participating in a program that teaches how to create a smoother adjustment to federal Prison?
  • Will they be sentenced to a medium-security facility?
  • If all three answers are yes, this program may help □;
Brave Program- Facility Locations:
    • FCI Victorville, CA-Medium
    • FCI Beckley, WV-Medium

II) Is your client a male inmate in (or facing) a high-security penitentiary setting with a history of substance abuse/dependence or a major mental illness as evidenced by a current diagnosis of a Psychotic Disorder that may include; Mood, Anxiety, Schizophrenia, Delusion and/or a Substance-induced Psychotic Disorder?

  • If the answers are yes, this program may help □;
Challenge Program – Facility Locations:
    • USP Big Sandy, KY-High
    • USP Hazelton, WV-High
    • USP Lee, VA-High
    • USP McCreary, KY-High
    • USP Allenwood,PA-High
    • USP Canaan, PA-High
    • USP Beaumont, TX-High
    • USP Coleman I, FL-High
    • USP Coleman II, FL-High
    • USP Pollock, LA-High
    • USP Tucson, AZ-High
    • USP Atwater, CA-High
    • USP Terre Haute, IN-High
    • USP Coleman I, FL (H)
    • USP Coleman II, FL (H)

III) Is your client a male or female with a serious mental illness, but who does not require inpatient treatment?

  • Do they lack the skills to function in a general population prison setting?
  • Would they be interested in a mental healthcare program that works closely with Psychiatry Services to ensure they receive appropriate medication and have the opportunity to build a positive relationship with the treating psychiatrist?
  • If your answers are yes, this program may help: □;
Mental Health Step Down Program- Facility Locations:
    • FCI Butner, NC-Medium
    • USP Atlanta, GA-High

* Male inmates with a primary diagnosis of Borderline Personality Disorder are referred to the STAGES Program

IV) Is your client a male or female with a history of mental illness related to physical, mental, intimate domestic violence or traumatic PTSD?

  • Would your client be interested in a mental healthcare program that focuses on the development of personal resilience, effective coping skills, emotional self-regulation, and healthy interpersonal relationships?
  • If both answers are yes, this program may help: □;
Resolve Program- Facility Locations:
    • FPC Alderson, WV-Minimum (F)
    • SFF Hazelton, WV -Low (F)
    • SCP Lexington, KY-Minimum (F)
    • SCP Greenville, IL-Minimum (F)
    • FCI Aliceville, AL-Low (F)
    • SCP Coleman, FL-Minimum (F)
    • SCP Marianna, FL-Minimum (F)
    • FCI Tallahassee, FL-Low (F)
    • FCI Dublin, CA-Low (F)
    • SCP Victorville, CA-Minimum (F)
    • ADX Florence, CO-Maximum (M)
    • FCI Waseca, MN-Low (F)
    • FCI Danbury, CT-Low (M)
    • SCP Danbury, CT-Minimum (F)
    • FSL Danbury, CT-Low (F) (Activating)
    • FFPC Bryan, TX-Minimum (F)
    • FMC Carswell, TX-Adm. (F)

V) Does your client have a significant functional impairment due to intellectual disabilities, neurological deficits, and/or remarkable social skills deficits?

  • For example, do any of these apply to your client: Autism Spectrum Disorder, Obsessive- Compulsive Disorder, Epilepsy, Alzheimer’s, Parkinson’s or Traumatic brain injuries (TBIs) to mention just a few?
  • Would your client be interested in improving their institutional adjustment and likelihood for successful community reentry?
  • If your answers are yes, this program may help: □;
Skills Program- Facility Locations:
    • FCI Coleman, FL-Medium
    • FCI Danbury, CT-Low


New Drug Improves Empathy And Social Skills In People With Autism; 2 May 2019, 7:00 am EDT By Rina Doctor Tech Times

Dental care is tough to find for people with autism
Inmate patients (who need specified dental procedures) with autism and other developmental disorders require general anesthesia for non-routine dental work. Most dentists are not equipped to provide it, and insurers will not cover general anesthesia for root canals.

VI) Is your client a male inmate (or facing prison) with serious mental illnesses and a primary diagnosis of Borderline Personality Disorder, along with a history of unfavorable institutional adjustment linked to this disorder?

  • Would they be willing to volunteer for this mental healthcare program?
  • If both answers are yes, this program may help: □;
Stages Program- Facility Locations:
    • FCI Terre Haute, IN-Medium
    • USP Florence, CO-High (Effective 9/ 2014)

VII) Sex Offender Conviction(s)

VIIa) Sex Offender Treatment Program: Nonresidential (SOTP -NR)

  • Is your client considered a low to moderate risk sexual offender?
  • Does your client have a history of a single-sex crime; or are they serving a sentence for first time Internet Sex Offense?
  • If both answers are yes, this program may help: □;
SOTP-NR Program- Facility Locations:
    • FCI Petersburg- Medium
    • FCI Englewood,CO-Low
    • USP Marion, IL-Medium
    • FCI Elkton, OH-Low
    • FMC Carswell, TX-Med. Ctr.(Females)
    • FCI Seagoville, TX-Low
    • FCI Marianna, FL-Medium
    • USP Tucson, AZ-High

VIIb) Sex Offender Treatment Program: Residential (SOTP -R)

  • Is your client considered a high-risk sex offender?
  • Does your client have a history of multiple sex crimes (re-offense sex offender), extensive non- sexual criminal histories, and/or a high level of sexual deviancy or hyper-sexuality?
  • Does their criminal history include; rape, sodomy, incest, carnal knowledge, transportation with coercion, a force for commercial purposes or sexual exploitation of children, unlawful sexual conduct with a minor, and/or internet pornography?
  • If your answers are yes, this mental healthcare program may help: □;
SOTP-Residential Program– Facility Locations:
    • USP Marion, IL-Medium
    • High FMC Devens, MA-Med. Ctr.

VIIc) New: Commitment and Treatment Program for Sexually Dangerous Person’s.

  • Is your client a candidate for psychological treatment, implementation of a behavior management plan, and coordination of a multidisciplinary treatment team?
  • Can your client be considered sexually dangerous with the possibility of criminal recidivism?
  • If both answers are yes, this program may help □;
Butner ‘New’ Commitment and Treatment Program – Facility Location:
    • FCC Butner, NC

To verify RDAP eligibility, in addition to drug and alcohol abuse, prescription medications along with other medications available over the counter are also included.

According to the American Bar Association: there must be a verifiable, documented pattern of substance abuse or dependence within the 12-month period preceding arrest.

IX) NEW: The Female Integrated Treatment (FIT) Program

  • Is your client a candidate for cognitive-behavioral treatment for females with substance use disorders, mental illness, and trauma-related disorders to female inmates?
  • Would your client also qualify for RDAP and those treatment plans which would also address substance use in this residential program may qualify for the early release benefit associated with RDAP?
  • If your answer is yes, this program may help □;
FIT Locations:
    • FSL Danbury, CT-Low – The New (FIT) Program


A Medical Resource


An evidence-based clinical decision support resource (one of many), that is authored and peer-reviewed exclusively by physicians who are recognized experts in their medical specialties.

Healthcare in the Federal Bureau of Prisons (BOP)


Federal PSR / Sentencing Preparation 



I.              Medical CARE LEVELS I-IV

How and where inmates are placed according to their medical and mental healthcare needs is via the BOP’s CARE LEVEL I-IV structure.

  • Medical CARE LEVEL I [under 70, healthy, needing limited to no medical contact].
    • Inmates are generally healthy, but may have limited medical needs that can be easily managed by clinician evaluations every 6 months and are located approximately one hour or more from community medical centers.
    • Inmates are less than 70 years of age.
    • Examples: mild asthma or diet-controlled diabetes not requiring medications.
      • FCI Manchester, Medium [Includes Satellite Camp], KY.
      • FCI Three Rivers, Medium [Includes Satellite], TX.
      • FCI Bennettsville, Medium [Includes: Satellite Camp], SC.
      • FCI Williamsburg, Medium [Includes Satellite Camp], SC.
      • FCI Herlong Medium [Includes Satellite Camp], CA.
      • FPC Yankton, SD.
      • FCI McKean, Medium [Includes Satellite Camp], PA.
      • USP Atwater, [Includes Satellite Camp], CA.
      • FCI Oxford Medium [Includes Satellite], WI.
      • USP Big Sandy, [Includes Satellite Camp], KY.
      • FCI Ray Brook,[Includes Detention Ctr], NY.
      • USP Lee,[Includes Satellite Camp], VA.
      • FCI Safford ‘Low’, AZ.
      • USP Pollock,[Includes Satellite Camp], LA.
      • FCI Sandstone Low, MN.
      • USP Yazoo City , Yazoo City FCC[Low-Med] MS.


  • Medical CARE LEVEL II [the majority of BOP facilities, overall healthy with routine medical visits)
    • Inmates are stable outpatients who require at least quarterly clinician evaluations and are located within one hour of major regional medical centers.
    • Can be managed in chronic care clinics, including mental healthcare issues.
    • Examples: medication controlled diabetes, epilepsy and emphysema.

For those inmates with Medical (and Mental Healthcare) Care Levels 3 and 4, the designation decision will be made by The Office of Medical Determinations and Transportation (OMDT).

Example of CARE LEVEL III Requirements

e.g.: Psychiatric Out Patient, Unable to perform their Activities of Daily Living (ADL)

Example of CARE LEVEL IV Requirements

e.g.: Dialysis, or needing inpatient hospital care; 24/7

  • Medical CARE LEVEL III [outpatient care or unable to perform ADL]
    • Inmates are fragile outpatients who require frequent clinical contacts to prevent re-hospitalization, and may be located within Level IV institutions.
    • May require assistance with activities of daily living, but does not need daily nursing care.
    • Examples: cancer in remission less than a year, advanced HIV disease, severe mental illness in remission and on medication, severe congestive heart failure, end-stage liver disease.
    • Designation is done by BOP’s Office of Medical Determinations and Transportation (OMDT).
      • FCC Butner (other than Low, FMC) NC.
      • USP Terre Haute (Minimum, Medium & High) IA.
      • USP Tucson FCC (Female); AZ.
      • FCI Terminal Island (Low) CA.
      • FCI, Med, USP: Allenwood, Pa.
      • FCI Tucson,[Medium w/Detention Ctr] AZ.
  • Medical CARE LEVEL IV [Hospitalization required]
    • Functioning is severely impaired.
    • Requires 24-hour skilled nursing care or assistance.
    • Examples: cancer on active treatment, dialysis, quadriplegia, stroke or head injury patients, major surgical patients, acute psychiatric illness requiring inpatient treatment, high-risk pregnancy.
    • Requesting a CARE LEVEL IV placement should be carefully considered as the inmates there are of all security levels, including both violent and non-violent offenders.
    • There are seven Federal Medical Centers (A brief overview)
      • FMC Butner (North Carolina); the cancer center for the BOP, provides inpatient mental healthcare and houses all security levels.
      • FMC Carswell (Texas); the only facility just for women.
      • FMC Devens (Massachusetts); provides dialysis, one of several facilities that provide a residential sex offender program, along with inpatient mental healthcare.
      • FMC Forth Worth (Texas)
      • FMC Lexington (Kentucky); for lower security inmates.
      • FMC Rochester (Minnesota); contracted with the Mayo Clinic providing all levels of complex medical care along with inpatient mental healthcare.
      • FMC, Springfield (Missouri); higher security, dialysis and inpatient mental healthcare services.

II         Mental Healthcare (MH) – CARE LEVELS I-IV

(Location Levels I-IV are the same as above)

Unfortunately, in general the BOP is not equipped to provide any meaningful treatment for the following underlying disorders, several examples:

□ Post-traumatic stress disorder

□ Major depressive

□ Bipolar

□ (Eye Movement Desensitization and Reprocessing) for treatment of PTSD is not available.

As medical staffing differs from one facility to another, and if the care by chance is available within the BOP; this  may necessitate a transfer to a facility further away from their home.

*Alan Ellis and J. Michael Henderson (July 19, 2018); How To Do Time- Part IV.

  • MH CARE LEVEL I[under 70, healthy with limited medical visits]
    • No Remarkable Issues, no significant level of functional impairment.
    • No history of regular Mental Illness Interventions, seeking help should there be a returning episode.
  • MH CARE LEVEL II [the majority of BOP facilities, overall healthy with routine medical visits)
    • ‘Routine and/or Infrequent Crisis Oriented Outpatient’ Care.
    • Treatments Controlled with medication.
    • May require suicide watch or brief observation.

For those inmates with Medical (and Mental Healthcare) Care Levels 3 and 4, the designation decision will be made by The Office of Medical Determinations and Transportation (OMDT).

  • MH CARE LEVEL III [outpatient care, not able to perform ADL]
    • ‘More Severe Outpatient’ or Residential Mental Healthcare.
    • May require weekly mental healthcare visits or Residential Psychology Treatments.
  • MH CARE LEVEL IV [Hospitalization required]
    • ‘Inpatient’ Psychiatrist Monitored, includes those who are:
      • Gravely disabled and cannot function in general population as in MH Care Level III.
      • Has a current or recent historical need for inpatient psychiatric care.
      • Requires psychotropic medication control may require MH Care Level IV.
      • Requesting a CARE LEVEL IV placement should be carefully considered as the inmates there are of all security levels that includes both violent and non-violent offenders.


UpToDate – A Medical Resource

An evidence-based clinical decision support resource that is authored and peer-reviewed exclusively by physicians who are recognized experts in their medical specialties.

Probation Officers: their impact on the PSR and final prison placement

Probation officers representing the court will:

  • Receive and evaluate pre-sentence investigation requests.
  • Identify and pursue leads to obtain evidence.
  • Gather and document evidence by interviewing involved parties, obtaining statements, reviewing and analyzing records and files, etc.
  • Gather criminal history, police reports, victim impact statements, criminal complaints and information and review prior to interview with offender.
  • Inform crime victims of their rights.
  • Assist the victim advocates in coordinating victim requests for offender information; victim issues such as recovery from injury, financial losses, or victim mediation; preparation of victim impact statements and reports; communicate offender progress and victim assistance to various local, state, and federal officials, and to treatment staff.
  • Conduct offender criminal history checks, warrant inquiries, and driver’s license abstract checks.
  • Compile and maintain history and case records.
  • Inform offenders of their rights, responsibilities, and purposes of the pre-sentence investigation process.
  • Interview offenders required by the courts to have a pre-sentence investigation completed.
  • Utilize PSI interview guide and the Criminogenic Domains of Criminal History, Education/Employment, Financial, Family/Marital, Accommodation, Leisure/Recreation, Companions, Alcohol/Drug, Emotional/Personal, and Attitude/Orientation.
  • Complete various extensive assessment tools to gauge offender risk and needs.
  • Collect PSI fees.
  • Coordinate investigations with other law enforcement agencies, regulatory agencies, and other relevant entities.
  • Confirm information gathered during interview.
  • Communicate with the appropriate Department of Corrections and Rehabilitation staff, other state agencies, related organizations, other entities, volunteers, and the public to provide information, referral services, technical advice and consultation regarding PSI.
  • Communicate with Courts, attorneys, law enforcement, and other agencies involved in a court-ordered pre-sentence investigation.
  • Document interview and investigation.
  • Prepare investigative reports and recommend administrative, legal, and/or sentencing action.
  • Present evidence to prosecutors, legal staff, or courts.
  • Prepare and present testimony as required for legal proceedings or administrative hearings.
  • Report offender compliance with the presentence investigation to courts.
  • Summarize information gathered during investigation and interview into the pre-sentence format.
  • Make sentencing recommendations based on sentencing guidelines and a thorough analysis of criminal history, medical and mental healthcare history allowing for continuity of care, medication availability, offender risks, resources, and evidence-based practices.
  • Ensure the report is distributed according to Applicable Code standards.
  • Monitor programs for compliance with state and federal laws compliance.
  • Gather, compile, and maintain statistics for required and requested reports.
  • Investigate and confirm the information on offender release plans or interstate compact investigations. Maintain working knowledge of the Department of Correction and Rehabilitation (DOCR) programs and community bases programs that are available for offenders.

Note: The duties of probation officers listed above are not intended to be all-inclusive.

BOP BRAVE Program – For Those New To Federal Prison

BOP BRAVE Program is a 6 month program designed to facilitate favorable initial adjustment to incarceration – for young males new to federal prison, serving their first sentence in a medium facility.  Photo Credit: The Marshall Project


BOP Brave Program – Admission Criteria:

I- Designed for medium security male inmates.

II- The inmate is 32 years old or younger.

III- They will be serving a sentence of 60 months or more, and is their 1st time in the BOP.

IV- The program is assigned at the beginning of their sentence.

The responsibility for your client’s mental and physical health should be safe guarded in order to protect them from themselves (and others), while providing a safe environment for the duration of their incarceration.

This should be the responsibility of legal council, the court and BOP.


The BRAVE Program is located at the following federal prison facilities: * 240.888.7778

  Federal PSR/Sentencing Preparation Software

BOP Challenge Program – Addressing Mental Illness Disorder

Photo Credit: The Marshall Project

  The BOP Challenge Program focuses on mental illness/psychotic disorders and if included in a complete PSR, could affect your client’s prison placement.

Psychotic disorders make up a group of serious mental illness disorders that affect the mind. Psychotic disorders makes it hard for someone to think clearly, make good judgments, respond emotionally, communicate effectively, understand reality, and behave appropriately.

When severe,those with mental illness disorders  have trouble staying in touch with reality.


BOP Challenge Program Admission Criteria

I) The BOP Challenge Program is for high security inmates in penitentiary settings with substance abuse problems, and/or mental illness disorders.

The inmate must meet one of the following criteria:

  • Has a history of substance abuse/dependence or,
  • Has a major mental illness as evidenced by a current diagnosis of a;
    1. Psychotic disorder
    2. Mood disorder
    3. Anxiety disorder
    4. Personality disorder

The responsibility for your client’s mental and physical health should be safe guarded in order to protect them from themselves (and others), while providing a safe environment for the duration of their incarceration.

This should be the responsibility of legal council, the court and BOP.


Below is an overview of the BOP Challenge Programs ‘types and symptoms’ of psychotic disorders along with an itemized list of BOP ‘Formulary’ and ‘Non-Formulary’ medications currently available to treat these disorders.


A)   Types and Symptoms

I- Schizophrenia

Note: Clozapine is the only FDA-approved medication for treating schizophrenia that is resistant to other treatments. It’s also indicated for decreasing suicidal behaviors in those with schizophrenia who are at risk.

II-    Schizophreniform, a Mental Illness Disorder

  • Includes symptoms of schizophrenia.
  • The symptoms last for a shorter time: between 1 and 6 months.
    • Medication* and Psychotherapy —to help the patient manage everyday problems related to the disorder.
      • Clozapine (Clozaril®) – On Formulary
      • Olanzapine (Zyprexa®)– On Formulary
      • Quetiapine (Seroquel®)– Non Formulary
      • Risperidone (Risperdal®)– On Formulary
      • Ziprasidone (Geodon®)– On Formulary

III- Brief Psychotic Disorder

IV- Delusional Disorder

  • The key symptom is having a delusion (a false, fixed belief) involving a real-life situation that could be true, but isn’t; such as being followed, being plotted against, or having a delusion. The delusion lasts for at least 1 month. Symptoms may include;
    • Cold, detached manner with the inability to express emotion.
    • Confused thinking;
      • Disorganized or incoherent speech.
      • Loss of interest in activities.
      • Loss of interest in personal hygiene.
      • Mood swings or other mood symptoms, such as depression or mania.
      • Problems at school or work and with relationships.
      • Slowed or unusual movements.
      • Strange, possibly dangerous behavior.
    • The primary typical medications* used;
    • Atypical antipsychotics* have fewer movement-related side effects;
    • Other medications*:
      • Antidepressants might be used to treat depression, which often happens in people with delusional disorders.
      • Psychotherapy can also be helpful, along with medications, as a way to help people better manage and cope with the stresses related to their delusional beliefs and its impact in their lives.
      • Sedatives and antidepressants might also be used to treat anxiety or mood symptoms, if they happen with a delusional disorder.
      • Tranquilizers might be used if the person has a very high level of anxiety or problems sleeping.

V- Shared Psychotic Disorder (also called folie à deux)

  • Here one person in a relationship has a delusion, and the other person in the relationship adopts that same delusion.
  • Diagnosing is difficult.

VI- Substance-Induced Psychotic Disorder

  • This condition is caused by the use of or withdrawal from drugs, such as hallucinogens or crack cocaine that cause hallucinations, delusions, or confused speech.
  • The hallucinations and delusions displayed should be in excess of those that typically accompany simple substance intoxication or withdrawal, although the patient could also be intoxicated and/or going through withdrawal.
  • Some precipitating substances:
  • Treatments
    • A calm environment.
    • Often a benzodiazepine or antipsychotics in most substance-induced psychoses, stopping the substance and giving an anxiolytic (eg., a benzodiazepine [Not Available]) or an antipsychotic drug can be effective.
    • Psychosis due to:
      • dopamine-stimulating drugs such as amphetamine; an antipsychotic drug could be used here.
      • For drugs such as LSD, quiet observation may be all that is needed.
    • For substances with actions that do not involve dopamine, observation may be all that is needed, or possibly an anxiolytic may help.

VII- Psychotic Disorders due to other medical conditions;

  • Hallucinations, delusions, or other symptoms may happen because of another illness that affects brain function, such as a head injury or brain tumor.

VIII- Paraphrenia: (Symptoms similar to schizophrenia).

  • It starts late in life in the elderly.
    • Generally has a much better prognosis than other psychotic disorders.
    • Antispsychotic medication can be helpful.
    • Paraphrenia sometimes co-occurs with depression and anxiety.

IX- Mood Disorder

  • Depression [Slide Show] ; can be emotionally crippling.
  • Bipolar disorder also known as manic depression.
    • Can cause risky behavior, even suicidal.
    • Can cause periods ranging from overly happy and energized, to other periods feeling very sad, hopeless, and sluggish.
    • Symptoms of mania (“the highs”):
      • Angry, and hostile.
      • Becoming more impulsive.
      • Drug and alcohol abuse.
      • Excessive happiness, hopefulness, and excitement.
      • Increased energy and less need for sleep.
      • Making grand and unrealistic plans.
      • Rapid speech and poor concentration.
      • Restlessness.
      • Showing poor judgment.
      • Sudden changes from being joyful to being irritable.
      • Unusually high sex drive.
    • Symptoms of (“the lows”):
      • Appetite changes that make them lose or gain weight.
      • Attempting suicide.
      • Feelings of hopelessness or worthlessness.
      • Insomnia.
      • Irritability.
      • Loss of energy.
      • Needing more sleep.
      • Sadness.
      • Thoughts of death or suicide.
      • Trouble concentrating.
      • Trouble making decisions.
      • Uncontrollable crying.
B) Other possible treatment medications*
C- Note: Psychotherapy, or “talk therapy,” is recommended.


BOP  Challenge Facility Penitentiary (USP) Locations:

Allenwood, PA-High

Atwater, CA-High

Beaumont, TX-High

Big Sandy KY-High

Cannan, PA-High

Coleman I, FL-High

Coleman II, FL-High

Hazelton, WV-High

Lee, VA-High

McCreary, KY-High

Pollock, LA-High

Terre Haute, IN-High

Tucson, AZ-High


* Medication availability:
  • On Formulary – These are available.
  • Non-Formulary – These medications require a lengthy review process.  It is prudent to document these at the sentencing hearing, and through their PSR.

PSR / Sentencing Preparation Software

240.888.7778 *



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