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Medications 💊 For Indigent Inmate/Patient | AVAILABLE AT THE COMMISSARY, (OTC)

OVER-THE-COUNTER (OTC) MEDICATION AVAILABLE THROUGH THE COMMISSARY

Ammonium lactate lotion/cream

  1. Requests to improve the appearance of the skin will be disapproved.
  2. Indigent Patient AND treatment is medically necessary. Orders are limited to 30 days in duration when approved on the basis of indigent status alone. If renewed, the indigent status will be reassessed.

 

Analgesics Topical – capsaicin cream, diclofenac 1% (Voltaren®), salicylate/menthol (Bengay®)

  1. A failed 30-day trial of oral NSAIDs or NSAIDs is contraindicated AND
  2. Documented improvement in functional status (required for renewals) OR
  3. Indigent Patient AND treatment is medically necessary. Orders are limited to 30 days in duration when approved on the basis of indigent status alone. If renewed, the indigent status will be reassessed.
  4. Diclofenac gel 3% will not be approved without sufficient justification as to why 1% cannot be used.

Artificial tears – solution and ointment (various OTC formulations)

1. Initiated by an optometrist or ophthalmologist with ongoing evaluation and

2. Failure of commissary alternatives or Indigent Patients AND treatment is medically necessary. Orders are limited to 30 days.

 

Benzoyl peroxide washes/soaps

  1. Chronic cystic scarring acne and/or causing secondary bacterial infections OR
  2. Indigent Patient – treatment is medically necessary. Orders are limited to 30 days in duration when approved on the basis of indigent status alone. If renewed, indigent status will be reassessed.

Bismuth Subsalicylate (Pepto Bismol®)

  1. Indigent Patient: treatment is medically necessary AND has failed OTC Indigent program alternatives. Orders are limited to 30 days in duration.

Calcium carbonate (Tums®)

  1. Indigent Patient: treatment is medically necessary AND has failed OTC Indigent program alternatives. Orders are limited to 30 days in duration.

Carbamide peroxide 6.5% ear drops (Debrox®)

  1. Indigent Patient – treatment is medically necessary. Orders are limited to 10 days in duration when approved on the basis of indigent status alone. If renewed, indigent status will be reassessed.

Coal Tar shampoo/gel/solution

  1. Documented failure of OTC commissary selenium or coal tar shampoo OR
  2. Indigent Patient, treatment medically necessary AND has failed OTC Indigent Program alternatives (ex: Selenium 1% Shampoo). Orders are limited to 30 days in duration when approved on the basis of indigent status alone. If renewed, indigent status will be reassessed
  3. For Psoriasis, lesions interfere with function.
  4. For Psoriasis: Psoriasis affects >10% of BSA (refer patients to the commissary for mild psoriasis) OR crucial body areas (hands, feet, fact, etc.)
    • Selenium shampoo/lotion
    • Documented failure of OTC commissary selenium or coal tar shampoo OR
    • The patient is indigent, treatment medically necessary, AND has failed OTC Indigent Program alternatives (ex: Selenium Shampoo 1%Shampoo). Orders are limited to 30 days in duration when approved based on indigent status alone. If renewed, the indigent status will be reassessed.

Hemorrhoidal cream/ointment- (Preparation H®, Anusol ®, others), dibucaine ointment

  1. Pending hemorrhoid surgery or 30 days (or less) post-hemorrhoid surgery OR
  2. For indigent Patients, treatment is medically necessary. Orders are limited to 30 days in duration when approved based on indigent status alone. If renewed, the indigent status will be reassessed.

Loperamide (Immodium®)

  1. For Indigent Patients, treatment is medically necessary. OTC has failed Indigent program alternatives. Orders are limited to 30 days in duration.

Magnesium/aluminum/simethicone-containing products (Maalox®/Mylanta®/Gaviscon®, Milk of Magnesia®, etc.)

  1. For Indigent Patients, treatment is medically necessary. OTC has failed Indigent program alternatives. Orders are limited to 30 days in duration.

Moisturizers topical (all formulations except Vitamin A&D)

  1. Failed a 30-day trial of two commissary moisturizers OR
  2. Indigent Patients, and treatment are medically necessary. Orders are limited to 30 days in duration when approved based on indigent status alone. If renewed, the indigent status will be reassessed.

Naphazoline-pheniramine Ophthalmic drops (Visine-A®, Opcon A®)

  1. Initiated by an optometrist or ophthalmologist with ongoing evaluation and
  2. Failure of commissary alternatives or
  3. Indigent Patients, and treatment are medically necessary. Orders are limited to 3 days.

Simethicone tablets/capsules (Gas-X®)

  1. Indigent Patients, and treatment are medically necessary. Orders are limited to 30 days in duration when approved based on indigent status alone. If renewed, the indigent status will be reassessed.

Sunscreens (various formulations)

  1. Prescribed an essential medication causing documented photosensitivity OR
  2. For indigent Patients, treatment is medically necessary. Orders are limited to 30 days in duration when approved based on indigent status alone. If renewed, the indigent status will be reassessed.
  3. Requests due to the unavailability of protective clothing will be disapproved.
  4. Approvals will be for SPF 30 products only.

Vitamin A&D Ointment

  1. Diabetes with Neuropathy OR
  2. Circulatory disorder evidenced by the absence of pedal pulses and/or extremity hair loss due to poor circulation or abnormal monofilament exam demonstrating loss of sensation OR
  3. Indigent Patients, and treatments are medically necessary. Orders are limited to 30 days in duration when approved based on indigent status alone. If renewed, the indigent status will be reassessed.

Witch hazel & glycerin pads topical (Tucks® Pads)

  1. Pending hemorrhoid surgery or 30 days (or less) post-hemorrhoid surgery OR
  2. Indigent Patients, AND treatment are medically necessary. Orders are limited to 30 days in duration when approved based on indigent status alone. If renewed, the indigent status will be reassessed.

The administration of that dose must be recorded on a Medication Administration Record (MAR’s) by the employee.

Risk Evaluation and Mitigation Strategies (REMS)

VETERANS: ALTERNATIVES TO PROSECUTION AND INCARCERATION

 Justice-Involved Veterans

SENTENCING LAW AND POLICY, September 6, 2023

Council on Criminal Justice releases new policy roadmap encouraging alternatives to prosecution and incarceration for justice-involved veterans.

 

The policy framework offers alternative sentencing for veterans, taking into account their service and potential impact on their criminal behavior. These options include pretrial supervision and probation, replacing imprisonment and criminal records. These evidence-based practices are implemented in problem-solving courts and community supervision. The Commission also encourages laws that allow veterans to apply for record expungement.

“Once ensnared by the system, veterans often present a complex set of needs and risk factors that are distinctive from those characteristics of civilians without a military background.”

The American Legislative Exchange Council adopted the Veterans Justice Act as a model policy. State legislatures will receive an updated framework to address the issue. Recommendations were released in March, with more coming next year. The Commission includes military and criminal justice leaders and is dedicated to helping veterans transition smoothly to civilian life.

 

Improve Definition and Identification of Veterans Involved in the Criminal Justice System

“Studies show that when asked about their status by law enforcement, many former service members are hesitant to identify as veterans.”
Recommendation: Federal, state, and local criminal justice agencies and courts should improve processes for identifying veterans in the criminal justice system and adopt a uniform definition of “military veteran” for use in those processes.

 

Create a Continuum of Alternatives to Prosecution and Incarceration for Justice-Involved Veterans

“America, in turn, has a responsibility to manage all veterans in a fashion that honors their service and helps them address the multiple challenges that service can create.”

Twelve states have created post-conviction statutory schemes, separate from VTCs, that recognize veteran status as a mitigating factor in sentencing.

 

 

Establish a National Center on Veterans Justice to Improve Justice-Involved Veterans Programs through Research and Coordination

“The Commission finds that the lack of coordination between programs for justice-involved veterans results in the duplication of efforts, a lack of proper program evaluation, and an inability to disseminate best practices.”

 

 


Provides Unconditional Love Inside, along with skills to take with them on the outside.


Suicide Among Justice-Involved Veterans: Understanding Risk and Meeting Needs

The Council on Criminal Justice is a beacon of hope in a world that desperately needs solutions to our criminal justice problems. They are dedicated to advancing our understanding of the policy choices that impact our nation and building consensus on solutions that will enhance safety and justice for all. This independent and nonpartisan organization invites people to become members and contribute to its think tank, which serves as a center of gravity and an incubator of policy and leadership for the criminal justice field.

The Council is a catalyst for progress, using facts, evidence, and fundamental principles of justice to drive change. They believe a fair and effective criminal justice system is essential to democracy and a core measure of our nation’s well-being. With their tireless dedication to justice, the Council on Criminal Justice is leading the way toward a brighter future for all of us.


THE VETERANS JUSTICE ACT, 7/27/2023

This policy presents alternative sentencing choices for American veterans who are accused of certain crimes and acknowledges their contribution to the nation and the possibility that their criminal conduct may stem from their military service. These choices comprise employing pretrial supervision and probation instead of a criminal record or imprisonment and are based on proven techniques for efficient supervision and restoration.

You are Federally Indicted – What To Do First?

You are Federally Indicted – What To Do First?

You need a Federal Criminal Defense Attorney specializing in White-Collar Defense.

Together, You Decide on Your Strategy: Trial or plea, as 98% of cases do. Here, you need an attorney who specializes in Mitigating Your Sentence.

  • If Prison is inevitable, start preparing for your Presentence Interview and Personal Narrative – ASAP.

Presentence Interview Preparation is Next, and it Controls Your Life.

Probation Officers conduct the Presentence Interview (PSI) and write the official Presentence Report (PSR) to the Judge and Court.

In reading how attorneys prepare for the PSI, I side with those who believe in being proactive and drafting their own memorandum that contains the information needed for the PSR and providing it to the Probation Officers before the Presentence Interview – Getting Your Message On The Record.

Why being Proactive with your Presentence Interview is best, is because this is the beginning of your Presentence Report (PSR)

  • Probation officers are very busy and appreciate having some of the work already completed.
  • It allows the legal team to get Your message into the record.

The Presentence Report (PSR), Controls Your Life :

In the trial, you will need a Trial Attorney in whom you have confidence.

  • They will review with you the strength of your case.
  • The US Attorney simultaneously makes it more difficult for you if you lose,
  • with the penalty resulting in more jail time.
  • But if you and your attorney are confident and in the right, then stay strong!

Has ‘2’ outcomes that I am aware of:

  1. You win, are proven innocent, and go home.
  2. You are found guilty, then back to preparation for your Presentence Interview.
  • Preceded by the Presentence Interview (PSI) and Presentence Report (PSR): Next, and it Controls Your Life.

DrMB@PPRSUS.com

A 30+ YEAR CAREER AND REPUTATION 👉 MY STORY

As criminal defense attorneys, you’re on the other side of the bench; this is my firsthand perspective.

In 2006, I was convicted of a felony and served a 1-year, 1-day sentence for Mail Fraud for my Medical-Surgical Suites billing before officially certified that I owned. While there was no Medicare or Medicaid Fraud, this was a terrible, embarrassing, and humbling self-inflicted experience.

In 2010, I was grateful to have my license to practice reinstated in full, which was good for my soul. Several years later, I realized several things,

1st) In addition to being a terrible and terrified client, in the end, I was unprepared for everything related to the Law, Sentencing, and what to expect once inside Federal Prison.

2nd) Judges understand that crimes don’t occur in a vacuum – they want to understand the why and what happened that caused the breaking of the law and hear that explanation from the person they are about to sentence while having Remorse for the Victims and Accepting Responsibility.

3rd) When is the best time to provide this?
Provide to the Probation Officer 1-2 Weeks before The Presentence Interview in a well-organized format, this includes,
Copies of all:
1. Personal Identification
2. Biographerical Background Information

Well Written;
1. Personal NARRATIVE
2. RELEASE Plan
3. Previously Reviewed: FSA SPARC-13 Assessment Survey and PATTERN SCORE
4. ALLOCUTION

Marc
Dr. Blatstein
Published, Co-Author
1. The Federal Lawyer, 2021, The Critical Role of The Presentence Report
2. ABA, 2022, Dementia

Entering The BOP, Ease Your Client’s Medication Fears

BOP generic medications

Entering The BOP, Ease Your Client’s Medication Fears

To someone enters prison for the first time, they assume that they will still get medical care. The assumption may be that they will also get the same medications that they got on the outside, which is likely not the case.

Medication availability (~ 3000 different drugs), falls into 3 categories.

  • 1st) On Formulary -Available: These medications are available for BOP healthcare providers for inmate use.
  • 2nd) Non-Formulary -These require a lengthy Preauthorization Process-: These medications while they are stocked, they are not immediately available for your use. The prescribing BOP Physician or other healthcare provider needs to go through a lengthy Pre-authorization process to get permission to provide this to you.
  • 3rd) Similar equivalents- When there are no other options, here similar or equivalent substitutions are used. Should the need for a required drug be used where there is no equivalent substitute; this medical problem should be brought up before the sentencing hearing, and hopefully get the backing of the US Attorney, and finally the court.

Examples of medication confusion;

  • Cholesterol Control: PCSK9 Inhibitors vs. Statins. Statins are a popular treatment that has been available since the 1980s. PCSK9 inhibitors, on the other hand, are a new type of cholesterol drug. They were approved by the Food and Drug Administration in 2015.
  • But these Cholesterol generics look very different (see heading photo), and may not look like what the defendant has been taking – adding to their stress level.

Generics:

  • These are the drug of choice for the BOP as they are cheaper than brand-name medications.
  • It may be beneficial to inform your client ahead of time that, while they’ll be taking a generic medication since there are many manufacturers who each produce similar generic drugs that may differ in color and shape; they should be appropriate.

Nobody likes surprises, especially if they are entering prison for the first time.

Pregnant In State Prisons

Pregnant In State Prisons

As a follow-up to my previous issue, today we discuss the concerns of pregnancy in state prisons. Here too, they have the constitutional right to obtain appropriate medical care. The extent prison policies address pregnancy-related services is another moral indicator of how state-run facilities or agencies provide care to the women in their custody.

If you like what you are reading, send it to friends, ask them to subscribe using the button above, and consider engaging us.

It seems to this author as we have 50 individual states, each with its own individual policies as to whether or not a pregnant inmate gets the required prenatal and postpartum care, it appears that the care they get depends on the state in which they live. Not Very Good Odds!

50-state survey of state prison systems shows that some failed to meet even basic standards of care for expectant mothers.

No alt text provided for this image

Dr. Carolyn Sufrin M.D., Ph.D., A.M. at John Hopkins School of Medicine’s School of Public Health, has a series that studies pregnancy prevalence and outcomes in U.S. jails, prisons, and youth facilities. Together with The Prison Policy Initiative, she points out that;

Dr. Sufrin founded JailcareFinding the Safety Net for Women Behind Bars.

“Jailcare is a moving and galvanizing story of pregnant women in jail and those responsible for their health, it is essential reading for anyone who cares about women, children, and justice.” Piper Kerman, author of Orange is The New Black.

  • Dr. Sufrin Contact numbers: 410-550-0337 (Appointment Phone: 443-997-0400).

STATES, Funding, and The Second Chance Act

The Bureau of Justice Assistance is the agency that administers the Second Chance Act. As such, they conduct low-cost outreach by highlighting grantee successes, that;

  1. reminds states of available funding,
  2. provides technical assistance with state applications.
  3. So remember, April is Second Chance Month – there are a few days left!

These funds allow prison nurseries to be developed by states, tribal or local prosecutors, too;

  1. establish or expand demonstration programs,
  2. reduce recidivism,
  3. improve reentry into the community,
  4. support Pregnant Incarcerated Mothers and Infants Together Programs.

No alt text provided for this image

Some Positive News: States With Onsite Prison Nurseries.

California

SHIELDS for Families’ Tamar Village Program: provides comprehensive family-centered substance abuse treatment services to mothers re-entering the community from the criminal justice system.

Services included:

  • Educational groups (health and nutrition, HIV/AIDS, life skills, relapse prevention for addiction).
  • Parenting and child development classes.
  • Therapeutic groups (trauma, grief and loss, domestic violence, sexual abuse, women’s issues, and relationships).
  • There is also an on-site child development center for children ages 0-5 and a youth program for children ages 6-18.

 Illinois

  • Illinois Department of Corrections: Focuses on the Needs of Pregnant and Parenting Inmates.

Decatur Correctional Center called “Moms and Babies” started a prison nursery program initiated in 2007. The program includes an Infant Development Center, and each of the five prisons for women in Illinois includes;

  • A child-friendly visitation area where mothers can read with their children, watch videos or play on the floor.
  • Family activities range from; day camps, video visiting, and holiday activities for mothers and children.
  • Parenting programs are offered to all inmates, no matter their security level.

Indiana

I) Family Preservation Program includes individual and family counseling to begin healing trauma caused by histories of addiction, poverty, and mental, physical, and sexual abuse.

Indiana Women’s PrisonFamily Preservation Program, started in 1996.

Women typically come to prison from underserved communities;

II) Women’s Prison in Indianapolis for Low-level offenders

III) WOMEN BEHIND BARS: LIFE AND DEATH IN INDIANA  S1 E1

Women Behind Bars: Maximum Security

Maryland

Maryland Correctional Institute for Women (MCIW).

The Baltimore Doula Project currently provides doula support to pregnant women, info@baltimoredoulaproject.org

Missouri 

  • The Center for Women in Transition is a St. Louis organization that provides wraparound services for women reentering the community from jail or prison.
  • They support The Correctional Center Nursery Programs which allow women who give birth while incarcerated the chance to stay with their newborns in prison for up to 18 months.

New York Opened, in 1930

Bedford Hills Correctional Facility for Women includes the longest-standing continuous prison nursery in the country.

Oregon

Coffee Creek Correctional Facility Parenting Inside Out (PIO) program’s curriculum offers interactive skill-building on child and adult development, parenting skills, and effective communication through letters, calls, and visits (page 31).

Pennsylvania

 I) SCI Muncy with doula services, that provide people with physical, emotional, and educational support during pregnancy and childbirth. They have been linked to better birth outcomes by lowering the likelihood of birth complications and helping to treat postpartum depression.

  • Gerria Coffee is the founder of Williamsport-based Genesis Birth Services. 1307 Park Ave, Williamsport, PA 17701, Phone(717) 970-3009, George Little, Acting Pa. Secretary of Corrections 717.728.4109.
  • “To have a program where someone is there for them when they are giving birth, it’s immeasurable,” Coffee said. She’s held women’s hands during birth, cut umbilical cords, and provided encouragement during labor. “All of those are priceless experiences and experiences that anyone who is giving birth deserves.”

II) Maternity Care Coalition’s MOMobile works within Philadelphia’s Riverside Correctional Facility, where it delivers the education and support women need to prepare for reintegration with their families and communities.

  • The in-prison component is coupled with individual case management for up to one year after release, helping newly-released parents form strong ties to their communities and positive relationships with their children.
  • MOMobile staff has attended 34 births since the start of a doula program in May 2008. The program teaches parenting skills, mother-child bonding, and positive discipline skills, which has the potential to result in substantial community-wide benefits if expanded to serve a greater percentage of incarcerated mothers having served over 300 women.

I thank you for reading with me. On a lighter note, to you moms

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In closing, I believe that the responsibility for a client’s Mental and Physical Health should be safeguarded to protect them from themselves and others, …while providing a safe environment for the duration of their incarceration (for them and their newborn). Ultimately this is the responsibility of the Court, Defense Team, and The Respective State Authority.

If this was helpful, please share it with your colleagues. With more to follow, should you have any questions, are interested in engaging my services (getting your message on the record – is best done before the PSI, and also could support your BOP placement request), or have any suggestions for future topics, I am easy to reach, and thank you for your time.

No alt text provided for this image

Marc, Dr. Blatstein

Copyright © 2021-2022 Physician Presentence Report Service, LLC, (PPRS Disclaimer)

How Prepared – Really, is Your Client For Their First Day In The BOP?

How Prepared – Really, is Your Client For Their First Day In The BOP?

The Sentencing Hearing. While this phase of your client’s defense has reached its apparent conclusion, practically speaking, some defendants may still be unprepared for their 1st day in the BOP. They naturally are nervous, terrified, and anxious, but some, after arrival find themselves faced with a series of events that could result in off-the-chart-anxiety, and even medical harm, most of which could have all been avoided.

Each client is different, and as such will handle prison life, and all of its nuances in their own way, some better than others. I emphasize the importance of minimizing some of the unnecessary stresses that can be avoided. With just a little bit of effort and time, your client and their family will be grateful for that bit of understanding regarding what they are about to encounter.

Being allowed to self-surrender can be a significant relief. For others, they are taken right into custody.

For those lucky enough to self-surrender, this is still a terrifying experience, but we all adjust over time. But if you’re surrendering to a satellite prison camp, these are adjacent to higher security facilities, and therefore you must first present yourself there, and not the satellite camp. And in case you ask – with higher security comes long guns and a “more secure and overall tense” atmosphere. I mention this because Federal Prison Camps (FPC), do not have adjacent higher secure facilities, as they are free-standing.

Once you present yourself, only to learn that your court’s orders have not yet arrived, you likely will find yourself placed in a single cell, asking why? If you were never claustrophobic – you could be now. Should this be your first time in any sort of prison or even being handcuffed – this can be terrifying. I know this to be so because unfortunately, it happened to me. I’m willing to share my experience – so give me a call, which includes my license being fully restored.

For your client’s well-being, verify that the required court intake paperwork has been received by the BOP facility – before your client’s arrival. While BOP Policy states that single secure cells used in these cases cannot be ‘isolation cells’ for > 23 hours/day, as a new person presenting to a camp, being surprised and isolated in a single secure cell for just ’30 minutes’, was horrifying enough, thank you! Then with staff shortages, don’t hold your breath regarding the frequency of staff stopping by.

Reasons, why a single secure cell could be used: 1) court intake orders were not received, 2) Medical (contagious, ie. COVID -2020) or Inmate Safety, 3) lack of bed space. Each of these issues may have been anticipated by legal before the defendants’ arrival and considered before the PSI. Rest assured, if they were given a heads-up that a single cell may be in their future, most clients would have seriously questioned, why.

Colette Peters, Director of The Federal BOP. There is great anticipation regarding Dir. Peters’s ability to make significant changes within the BOP, but only time will tell. The BOP is a very large conglomerate, and change does not happen overnight.

The federal system, while having more oversight, is held to a higher standard and is supposed to pay greater attention to healthcare and programming needs. While these may not be what we are used to on the outside, compared with some individual state prisons (which is pushing the bar Very Low), and county jails (also Much Lower) around the nation, the hope is that with Director Peters, the BOP will fare much better.

A program that excels: There are bright spots among state facilities though, among them is a program called: The Last Mile which prepares and educates inmates for release and helps get them to find good-paying jobs through their partners.

BOP Visitor Form

BOP TRULINCS Email

Sample BOP Commissary List

BOP MEDICAL INTAKE SCREENING UPON ARRIVAL

Sample BOP INMATE ADMISSION & ORIENTATION HANDBOOK

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Opinion. I believe that the responsibility for a client’s Mental and Physical Health should be safeguarded to protect them from themselves and others, …while providing a safe environment for the duration of their incarceration. Ultimately this is the responsibility of the Court, Defense Team, and BOP.

If this was helpful, please share it with your colleagues. With more to follow, should you have any questions, are interested in engaging my services (getting your message on the record – is best done before the PSI, and also could support your BOP placement request), or have any suggestions for future topics, I am easy to reach, and thank you for your time.

No alt text provided for this image

Marc, Dr. Blatstein

  • PPRSUS.com
  • info@PPRSUS.com
  • Voice: 240-888-7778
  • For more information on the BOP: www.bop.gov
  • Watch our 50+ minute PowerPoint Presentation, (of CLE Quality), which can be time adjusted to meet your needs.
  • As seen on LinkedIn

Copyright © 2021-2022 Physician Presentence Report Service, LLC, (PPRS Disclaimer)

Steel Toe Safety Boots In Prisons – Not Always The Best Choice

Steel Toe Safety Boots In Prisons | NIH: Shear-Reducing Insoles Prevent Foot Ulceration

Medicine is both an art and a science. While the implementation of steel-toe safety boots protects the institution and the majority of persons incarcerated, there is a significant, albeit small part of their population that may be harmed – however rare that may be.

As The Bureau states in their Program Statement 6031.01, Patient Care, (Page 58), they are responsible for providing one pair of safety shoes to each inmate, suitable for their job assignment. They would make custom shoes or orthotic devices available if needed that would have to be, medically necessary to accommodate a significant foot deformity or decrease the chance of injury to feet with impaired sensation.

The caveat here is that in a large bureaucratic institution, the patient/inmate may have to either pay their co-pay to be seen immediately for an unscheduled visit or wait for staff to provide a referral – either way, once prescribed, the wait time can be expected to be at best – “a while.”

The headline image I have chosen was for several reasons. To start, safety boots with a steel-toe box will provide protection, but in my opinion, after 30+ years of practicing in this space, I believe that there are other forces of concern. To start, the inner sole at the inside bottom of the boot has to have significant padding to cushion (or protect) the foot from shear forces, that over time could wear down the skin’s protective padding. The boots in 2006, had none.

No alt text provided for this image

Additionally, with correct insoles, biomechanical support would be of additional long-term benefit. When I was in a BOP facility years ago, there was nothing like this available, and I was left to figure out the protection and biomechanical issues on my own.

The medicare prescription shoe P6031.04 is referencing:

o   HCPCS code A5500 for diabetics only, custom preparation, and supply of off-the-shelf depth-inlay shoe manufactured to accommodate a multi-density insert(s), per shoe as maintained by CMS

o   ICD-10 Codes for Orthotic/Prosthetic — Diabetic Shoe

Then there is the steel toe, and while available in widths, new boots being what they are, take time to break in. During that period, a person’s toe that is rubbing against the hard, leather-steel binding, is a recipe for potential problems, no matter how rare. Then, with wear, the foot through the normal gait process over time, again no matter how rare, could rub against the steel toe box.

No alt text provided for this image

The patient/inmate does not have to be an out-of-control Diabetic, they could be a pre-diabetic, have Peripheral Vascular Disease (PVD), or Raynaud’s (which I still have), just to mention a few. Therefore, for those few who slip between the CARE LEVEL cracks, there may be some that need to get a toe or two amputated due to infections. But here is where Murphy’s Law presents itself, (where one amputation turns into multiple, more aggressive procedures) – some of which could have been avoided, with a little prevention.

I present several cases from NIH:

I) Intermediate-term outcome of primary digit amputations in patients with diabetes mellitus who have forefoot sepsis requiring hospitalization had presumed adequate circulatory status.

Outcome.

  • Out of 92 patients with 97 forefoot infections, twenty-two had foot amputations.
  • Pre-op, all had presumed adequate forefoot perfusion (assumed good blood flow to their feet), as determined by noninvasive methods, was studied.

II) Midfoot amputations expand limb salvage rates for diabetic foot infections

Outcome.

  • If surgery is indicated, these are likely options.
  • Transtarsal amputations (removes even more of the foot – below the ankle) salvaged over half of nonhealing Transmetatarsal, Amputation (TMA)

III) Shear-reducing insoles to prevent foot ulceration in high-risk diabetic patients

Outcome.

  • These results suggest that a shear-reducing insole is more effective than traditional insoles in preventing foot ulcers in high-risk persons, including those with diabetes.

Prevention In Medicine Is a Core Value


I believe that the responsibility for a client’s Mental and Physical Health should be safeguarded to protect them from themselves and others, …while providing a safe environment for the duration of their incarceration. Ultimately this is the responsibility of the Court, Defense Team, and BOP.

If you found this helpful, please subscribe and share it with your colleagues. With more to follow, should you have any questions, are interested in engaging my services, or have any suggestions for future topics, I am easy to reach, and thank you for your time.

No alt text provided for this image

Marc, Dr. Blatstein

  • PPRSUS.com
  • info@PPRSUS.com
  • Voice: 240-888-7778
  • Getting Your Message on the Record
  • Drafting a well-thought-out Personal Narrative
  • For more information on the BOP: www.bop.gov
  • My license to practice was restored in 2010
  • Seen on LinkedIn

Watch our 50+ minute PowerPoint Presentation, (of CLE Quality), which can be time adjusted to meet your needs.

Published by

Dr. M. Blatstein

Status is online
FEDERAL SENTENCE MITIGATION: PERSONAL NARRATIVE | PRESENTENCE INTERVIEW PREP. | ALLOCUTION | REENTRY PLANNING | RDAP | HEALTHCARE | MEDICATION AVAILABILITY | BOP PLACEMENT – I answer 👇 and personally return 📳 My calls.
In this issue of my newsletter series, I review the use of Safety Steel-Toe Shoes. If you find this helpful, please subscribe, share it with your colleagues, and consider engaging my services. 

FACING A FEDERAL INDICTMENT – WHAT DO YOU DO?

THE DOJ HAS A 98% CONVICTION RATE 

INDICTED AND FACING PRISON IS TERRIFYING

NOW IS NOT THE TIME TO GIVE UP

William H. McRaven, rising through the ranks to become commander of the Pentagon’s Joint Special Operations Command, was credited for organizing and overseeing the execution of Operation Neptune’s Spear, the special ops raid on Osama bin Laden on May 2, 2011. Admiral McRaven’s experiences and challenges hold true whether in those challenging times of warfare as a member of SEAL Team Six or to those of us facing Federal Indictments and a temporary stay in Prison.

His 10 Lessons to Live By, inspired by leaders like Mandela, to a young girl in Pakistan, Malala, should leave you with hope. Take 15 Minutes and watch this video; it may Change Your Paradigm on Life To NEVER GIVE UP.”

#10. NEVER GIVE UP

Did the FBI  wake you at 6 a.m. this morning with their warrant?

Yes, which of these below applies to you?

      • Were you involved in PPP or other Loan Frauds?
      • As a physician, was encountering the FBI unexpected?
      • Have you heard any rumors about the authorities asking questions?
      • You’ve worked in business or government, where things suddenly changed?
      • Are you dealing with federal charges after all the hard work you put into building your business?
      • Were issues related to legal or illegal drugs, alcohol, gambling, or ‘others’ involved in your charge?
      • ‘First,’ you need Legal Representation – we are not Lawyers.

It’s decision time: do you go to Trial or Plea?

  • Trials are expensive and involve hours of discovery, not counting the trial itself. At hundreds to thousands of dollars per hour – the DOJ still has a 98% Conviction Rate, so you may want to ask your attorney how many cases like yours they have taken to trial and won. Unfortunately, our justice system is far from perfect, and feeling that you are innocent may not be enough. That said – if your case is strong – go to trial. All is not lost, even if you lose.
  • A Plea will save you money and possibly help at sentencing because it will save your attorney billable hours, and the prosecutor wouldn’t have to spend as much time preparing for a trial. Whether you elect to go to Trial or Plea, what you do next will impact your future.
  • Your Presentence Interview, in addition to everything else – needs to include your Story (Autobiography) or Personal Narrative, a Release Plan, and Allocution, which is where you speak with your judge. Why? Because judges have been interviewed, and they want to hear from you, the defendant, for many reasons,

1st) They want to believe that you’ve accepted responsibility for your actions.
2nd) Have remorse for the pain you have inflicted on your victims.
3rd) They understand that crimes do not happen in a vacuum – and want to learn what happened in your life that brought you to this point where you broke the law.
4th) What is your plan not to return to their courtroom?
5th) Were there other ramifications, such as losing your professional license to practice in a career that you love or
6th) Have you always provided community service or volunteered in your community – doing what?


Attorneys know the law, but the nuances of navigating through Federal Prison aren’t part of a traditional legal defense. Are You Now Ready To Start? 

Give me a call, 240.888.7778 – I personally answer and return all calls.

Sentencing Mitigation requires a unique set of knowledge and skills that are of interest to both a) those facing Prison, as well and b) those who are responsible for preparing you to reenter society as Law Abiding Citizens – ‘Your STAKEHOLDERS.’


PREPARATION: WHAT YOU SHOULD KNOW, STEPS #1-4,

1st YOUR DEFENSE
2nd YOUR PRESENTENCE REPORT (PSR): PHYSICIAN ASSISTED
3rd, YOUR NARRATIVE, RELEASE PLAN, AND ALLOCUTION
4th AT SENTENCING

 

1st YOUR DEFENSE 

  • Finding an experienced criminal defense lawyer is crucial when dealing with federal charges. The Department of Justice has a high conviction rate, so deciding on going to trial or plea should be carefully considered with your attorney. If the decision is “Trial,” ask your attorney how many cases they have taken to trial – and won. Remember, the DOJ has a 98% Conviction Rate, meaning they usually don’t lose.
  • Properly preparing for your presentence interview is your next step and is critical for your future. Have you thought about what it entails?

 

2nd YOUR PRESENTENCE REPORT (PSR): PHYSICIAN ASSISTED

a) YOUR PRESENTENCE INTERVIEW (PSI) – IS THAT IMPORTANT: Here, all your Personal Identification and Biographical Background information (proofread for accuracy) is provided to your Probation Officer. It is recommended that you include Your Personal NARRATIVE and Release Plan. WHY?


 

YOUR NARRATIVE INCLUDED IN YOUR PRESENTENCE REPORT – WILL HELP HUMANIZE YOU TO YOUR JUDGE.

Michael Santos interviews Federal Judge Mark Bennett on the importance of including Your Personal NARRATIVE in Your Presentence Report.


    • Everything should be provided to your Probation Officer 1-2 weeks before your Interview. This will result in a less stressful interview day as the Officer already knows your background and can take their time to get to know you personally. Asking any remaining questions they may have, they may come away with a more positive view of who you are.
    • The Probation Officer next drafts your OFFICIAL PRESENTENCE REPORT.

b) THE PRESENTENCE REPORT CONTROLS YOUR FUTURE – IT INCLUDES YOUR:
(1)MEDICATIONS: should is important, and attention should be paid to the BOP Generic Drug List (Formulary) for availability – because this is All There Is. You do not want to learn this after you surrender.  Non-Formulary or Not Available medications must be addressed by reviewing the online BOP medication list with your physician before your Presentence Interview. Should the need arise, these issues should be addressed before your interview date.

(2) MEDICAL: This, too, is important, as a recent article noted 1 IN 4 INMATE DEATHS HAPPENED IN THE SAME PRISON. WHY?  Being proactive includes obtaining a comprehensive medical history long before the Presentence Interview, and you set foot in prison. Or, October 10, 2022, Judge Holds Federal Bureau of Prisons in Contempt for Allowing Man To Waste Away From Untreated Cancer.

    • When it comes to providing medical care to individuals with unique medical conditions while in the Bureau of Prisons (BOP), it is crucial to have a comprehensive medical history prepared and documented before your Interview date that includes all medical records. This includes reports of surgeries (including pathology reports), diagnostic X-rays, CT, MRI, ultrasounds, EEGs, EKGs, and PET scans (Reports and tests on CD or Flash Drives). All recent blood tests, prescriptions (Drugs and Medical Devices), hospital records, and treatment plans from their treating physician.

To ensure that the patient receives the appropriate care, it is essential to gather all relevant information, documentation, and contact information for your current treating physicians, including their name, phone number, email, and address.

    • It is advisable to prepare thoroughly for The Presentence Interview, especially if there are any concerns about medical care from the patient, their attorney, or treating physician. Doing this in advance makes it possible to plan strategically and ensure that the patient/defendant receives the necessary care during their time in the BOP.
    • I’ll keep adding: No Guarantees because there are none regarding all aspects of your life once incarcerated. Your best defense is being as best prepared at the beginning as you can, including appointing someone you trust with Power of Attorney.
    • Why? If you ever need a second opinion while in prison, first, this could take up to 36 months if this is even allowed. Second, the Clinical Director of your facility is not required to follow the Specialist’s Recommendations regarding your medical care. Having your Past Medical History included could make the difference. Again, no guarantees, but you have The Administrative Remedy Process to fall back on as your next step.

(3) SENTENCING: This is your first opportunity to meet and speak with your Judge. By this point, the Judge already knows all about you from your INDICTMENT and likely has a sentence in mind. Your only hope of changing their mind is by helping your Judge understand Who You Are – and this can be done by writing your NARRATIVE, ALLOCUTION, and RELEASE PLAN and including them in your Presentence Report under seal. Along with your Personal Identification and Biographical Background information that was provided to your Probation Officer 1-2 weeks before your Presentence Interview, be prepared to have your conversation with the judge.

c) MAKING YOUR BOP PLACEMENT REQUEST is a 3-step simple process. Our BOP Packet is provided to your defense counsel for presentation to the court and includes the Programs Supporting Your Placement Request, Example 👉 FPC Alderson.

d) AS A LICENSED PROVIDER, I have 30+ years of personal experience in healthcare as well as with how medical care is delivered in prison due to my felony conviction in 2006 when I was incarcerated. With the support of colleagues, my medical license was reinstated in 2010, and several years later, I transitioned from patient care, taking what I have learned to provide Preparation and Knowledge to those facing the reality of federal prison.

    • My goal is to help ease any concerns that may arise for individuals and their families experiencing these life-changing events. Although I am no longer directly involved in patient care, I remain committed to positively impacting those I interact with. At the same time, it’s important to keep in mind that the BOP holds the final decision-making power in this process, and therefore, neither I nor any attorney, consultant, or other mitigation expert can guarantee any specific outcomes from their or my recommendations.

 

3rd, YOUR NARRATIVE, RELEASE PLAN, AND ALLOCUTION

  • Navigating through Federal Prison is not usually part of a traditional legal defense. This requires a unique set of knowledge and skills that are needed after the guilty verdict or plea and are of interest to your Judge at sentencing. The NARRATIVE, ALLOCUTIONand RELEASE PLAN are of interest to your judge and other STAKEHOLDERS you haven’t yet met. ARE YOU PREPARED?

 

4th AT SENTENCING

  • In addition to your legal defense, are you prepared to meet your Judge, and if so, what are you planning to say? Have you read your attorney’s Sentencing Memorandum? Is your NARRATIVE and a Few Character Letters attached? Are you and your legal team prepared to make the 3-point BOP Placement Request?

Contact me if you need recommendations for attorneys who practice Federal Criminal Defense and have experience in Federal Court. These should be attorneys with experience in cases like yours and are also empathetic to the stresses you are going through.


 

This video is for you. If you received a Target letter invitation to speak to a Grand Jury, you need Legal Representation. For a federal crime, it is best to have an attorney who practices federal criminal defense, having had cases similar to yours, and practices in federal court. After that, hopefully, you will have time for follow-up questions to see if he/she is the best fit for you.

  1. Federal Judge Mark Bennett (YouTube above) highlights the significance of incorporating your personal account or Narrative into your Presentence Report. This will enable the court to understand your background and the factors that led you to commit the offense. Taking responsibility for your actions, expressing regret for the harm you caused, and speaking humbly from the heart are all imperative during your court appearance.

    Your Judge Already Knows 
    The DOJ wants you in Jail.
    The Prosecutor wants to convict you.
    Your Attorney is paid to keep you out of prison.
    Judges Also Know That Crimes Aren’t Committed In A Vacuum.
    This is Your Opportunity to Help Your Judge Understand Who You Are

    Federal Judge Mark Bennett (YouTube above) highlights the significance of incorporating your personal account or Narrative into your Presentence Report. This will enable the court to understand your background and the factors that led you to commit the offense. Taking responsibility for your actions, expressing regret for the harm you caused, and speaking humbly from the heart are all imperative during your court appearance. Listen to my video, and help your judge understand who you are while challenging the DOJ INDICTMENT with your Personal NARRATIVE  included in your Presentence Report.

    What have you planned to say as you stand at your sentencing hearing, anticipating your conversation with your Judge?

     

    Speaking from the heart could influence the courts and impact your sentence – for the BETTER. On the other hand, if you are not prepared, it may be best not to say anything.


    DO YOU FEEL PREPARED FOR YOUR PRESENTENCE INTERVIEW? HAVE YOU PICKED THE RIGHT ATTORNEY – FOR YOU? ARE YOU COMFORTABLE (NERVOUS IS OK) TO SPEAK WITH YOUR JUDGE AT SENTENCING?

     

    For a personal, one-on-one call to discuss your legal issue, or that of a loved one, call me; I personally answer and return all of my calls (240.888.7778). Marc Blatstein

    We are not Attorneys; you need Legal Representation.


    No one can guarantee results, as the outcome at the end of the day rests with your attorney, the Judge, and The Federal Bureau of Prisons. Once inside, as in life, there will be staff genuinely caring about you and their job, while others look at you as a number. The only person who can control Your Reactions and Emotions  Is You.


    Don’t let this be a missed opportunity!

    PPRSUS is here to help.