Dr. Marc Blatstein Blog, Medical, Preparation, Sentence Mitigation, White-Collar

THE BOP 3-TIER DRUG ‘FORMULARY.’ WILL YOUR MEDICATIONS BE AVAILABLE?

THERE ARE NO GUARANTEES, SO WHAT CAN YOU DO?

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INSPECT YOUR EXPECTATIONS

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YOUR MEDICAL RECORD.

As long as possible before your Presentence Interview, should you need to continue current medical treatments, preparation should start to get copies of all of your records.

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 that includes all medical records, including reports of surgeries (including pathology reports), diagnostic: X-rays, CT, MRI, ultrasounds, EEGs, EKGs, and PET scans (Reports on CD or Thumb Drives). Any and all physician (speciality) office records and notes, including prescriptions.

  • All recent blood tests, prescriptions (Drugs and Medical Devices), hospital records, and treatment plans from their treating physician.
  • To ensure that the patient/inmate receives the appropriate care, it is essential to gather all relevant documentation and contact information for physicians, including their name, phone number, email, and address.
  • It is advisable to prepare thoroughly for The Presentence Interview, especially if there are concerns about medical care from the patient, their attorney, or treating physician. Doing so makes it possible to plan strategically and ensure the patient-inmate receives the necessary care during their time in the BOP. Still, remember, there are no guarantees once incarcerated, so attention to detail at the start is in your long-term interest.

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SAMPLE OF ON-FORMULARY MEDICATIONS, NOT GUARANTEED AVAILABLE.
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  • Whether the specific medications are available either On, or Non-Formulary, then this can be on the record through the PSR, Memorandum, and possibly verified by the judge. Then, if a medication is available (and cheap), it should be provided, not  “arbitrarily changed or reduced.” Unfortunately, this occurred to an inmate where a Federal Judge had to step in and have him released from FCI Florence, in Florence, Colorado, to the nearest hospital as part of a Compassionate Request in court.

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THE BOP CLAIMS TO PROVIDE BASIC MEDICAL CARE TO ALL INMATES.

EVEN WITH COMPREHENSIVE PSI MEDICAL RECORD PREPARATION.

THINGS CAN GO WRONG – AND IF YOU’RE LUCKY…

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An Emergency Motion – THE IMMEDIATE RELEASE OF DEFENDANT BOVIS.

His Story Is Not So Unusual.

When a sentenced defendant is currently grappling with (normal) high blood pressure and is denied access to his prescribed (common, generic) medication, neglect does happen and, in this case, resulted in two Transient Ischemic Attacks (TIAs) on January 28 and February 15, 2025. The Bureau of Prisons’ failure to adhere to existing essential BOP Medical Directives could have led to severe brain damage or even death.

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AT ISSUE: hydroCHLOROthiazide

WHICH IS AVAILABLE ON THE BOP MEDICATION FORMULARY
* hydroCHLOROthiazide 25 MG Tab
* hydroCHLOROthiazide 50 MG Tab (what he came in with)

When the defendant surrendered to the Bureau of Prisons in October, he provided the staff with his medical prescriptions, which included 50 mg of Hydrochlorothiazide, a generic medication that is on the BOP Formulary. However, the BOP did not fill his prescriptions as intended. Instead, they reduced his blood pressure medication to just a quarter of the prescribed dosage, which resulted in “extremely high” blood pressure. Additionally, the prison clinic decided to change (?) his long-time medication to Lisinopril 10 mg.

Lisinopril and Hydrochlorothiazide work in different ways.

Lisinopril constricts blood vessels, whereas Hydrochlorothiazide functions as a diuretic. Side effects of Lisinopril may include a cough, dizziness, and blurred vision (all the signs he had).

After experiencing disorientation, Bovis was denied treatment at the prison medical center. His condition deteriorated, prompting his transfer to a local hospital where he was diagnosed with a Transient Ischemic Attack (TIA). The attending physician at the hospital ordered that Lisinopril be discontinued and that the dosage of Hydrochlorothiazide be restarted at 25 mg.

I personally review all medical records to ensure that the most accurate information is included at the Presentence Interview, which we encourage is provided to the officer one week before the official PSI.

However, none of us can control what the Bureau of Prisons (BOP) will do once our clients arrive under their care.

Between constant contact with the loved ones (with POA), ensuring that the client understands the administrative remedy process, and having the family involved, with counsel when needed, a resolution other than what the BOP may label a natural death is prevented.

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Where a simple, cheap blood pressure medication was arbitrarily replaced with a chemically different medication that resulted in a cascade of systemic medical problems (Strokes, TIA’s, and loss of consciousness), resulting in hospital visits and an eventual Compassionate Release from a judge who found the actions of the BOP medical staff inexcusable.

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NICK BOVIS, COMPASSIONATE RELEASE – MEDICAL ERRORSDownload

There are never guarantees, and going into prison, one must be vigilant. Therefore, don’t assume that you’ll still get medical care in a timely fashion. The assumption may be that you’ll also get the same Medication Formulary Availability they got on the outside, which is likely not the case.

Medications [On-Formulary] availability (~ 3500 different drugs) falls into three categories.

  • 1st) On Formulary -Available: These medications are available for BOP healthcare providers for inmate use. But it still needs to be in your PSR, or you May Not Get It.
  • 2nd) Non-Formulary – If your medication is on this list, your physician should review each of the On-Formulary Medications and explain why they were ineffective for you, as well as how not having this drug would negatively impact your quality of life. Moving forward, these medications require a lengthy preauthorization process: they are not immediately available for your use even when they are in stock. The prescribing BOP physician or other healthcare provider must go through an extensive preauthorization process to obtain permission to provide this to you. That is why your current treating physician’s records are so vital.
  • 3rd)Similar equivalents- When there are no other options, similar or equivalent substitutions are used here. Should a required drug be used where there is no equivalent substitute, this medical problem should be brought up before the sentencing hearing with your physician, and hopefully get the backing of the US Attorney and, finally, the court.
  • JUDGE CAN’T ORDER MEDICATIONS OR TREATMENTS TO BOP.
  • 4th) Not Available. What is your plan?

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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.

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Generics:

  • These are the drugs 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 for the same product, they may differ in color and shape but should be appropriate.

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

If you find 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.

Marc, Dr. Blatstein

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