Man dies in jail after being denied prescription

[birchswing]

I unfortunately knew which class of drug before reading the article because death by benzodiazepine withdrawal in US jails happens often enough that I see about five news articles on it a year (without looking for them). How many times it actually happens is likely far greater:

http://www.newnownext.com/texas-gay...police-refuse-to-give-him-medication/07/2015/

This seems like something the APA or some other civil society organization could take on as an issue to better educate doctors in jails.

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[st2205]

This seems like something the APA or some other civil society organization could take on as an issue to better educate doctors in jails.

Or better educate providers on not giving benzos in high enough doses to cause complicated withdrawal, or at least not giving benzos to people who consume enough alcohol/benzos to go into complicated withdrawal.

 

[birchswing]

Or better educate providers on not giving benzos in high enough doses to cause complicated withdrawal, or at least not giving benzos to people who consume enough alcohol/benzos to go into complicated withdrawal.

I agree. But killing someone is in orders of magnitude worse than creating benzodiazepine dependence, even as bad as the latter is. A responsible doctor wouldn't cause a patient to die regardless of the mistakes of previous doctors.

But the two sort of go together anyway. If you're aware of why not to prescribe medication in a certain way, you'd be aware of what would happen when it's suddenly stopped.

 

[Ceke2002]

As much as I have a metric eff tonne of sympathy for the family (and empathy for what this poor guy must have gone through before his untimely death), I do think this is a much more complex situation than first meets the eye. You have possible poor prescribing practices, potential misuse of the medication, a prison system where they probably get umpteen dozen inmates through a day all crowing about how 'you just got to give me my medication, Doc, I need my Xanax/Klonazepam/Rohypnol/insert whatever other benzo is on the list' and then the Doctor checks the patient's medical records and finds out the patient is prescribed 4 mgs of Xanax a day when in fact he's been taking three times that amount. Not saying that's what happened in this case, just that there is a culture in place there and a Doctors decision to treat may be influenced by that culture (and by the same token you also don't want a Doctor who's going to just believe whatever a patient tells him, because they want to get high so they lie about being on a higher dosage of benzos than what they really are, because then you just end up creating the risk that you're going to have someone who enters the prison system and ends up leaving with a worse pill problem than what they first presented with).

 

[whopper]

I work in a jail. Anyone we even suspect of being on alcohol or benzos goes through a benzo withdrawal protocol with them getting some benzos and weaned off of them over the course of about a week.

The only way I could see a defense for the jail is if the guy couldn't communicate he was on benzos. That doesn't seem to be what happened in the article but I've seen several times on the news things being reported in a misleading manner including circumstances I was involved in.

E.g. onetime I did not discharge a patient, the court did against my recommendation. The guy was dangerous. The news reported that the hospital (didn't mention me) discharged him despite that he was dangerous. They didn't report that the doc (me) argued the guy should be kept it.

And the hospital and I weren't allowed to correct the news cause it would've violated HIPAA.

I have seen several jails give lousy care but I can't say this really was the case here cause I don't fully trust the article. I wouldn't be surprised if it were true cause I've seen horror cases in jail but I don't know if this is the case here.

 

[heyjack70]

It will be interesting to see if the lawsuit goes to trial. Our local jail pulls similar nonsense. For example, someone gets admitted to the psych hospital directly from jail because the are on psych meds and are suicidal. BTW the jail does not have a psychiatrist. They barely have a primary care NP part time. Patient is treated for bipolar depression with lithium and seroquel in the hospital and stabilizes. Go to transfer them back and the jail says "we can't provide seroquel". Well why not? It's not on our formulary. Well too bad. You have an obligation to provide ongoing necessary medical care to the inmate and not doing so when you know you should is willfully disregarding his needs. And it's not just seroquel. If someone is on sustenna or clozaril they don't have those either. I've talked to the manager of the "medical department" who is an LPN and she has no idea what she is doing. Most times a patient on psych meds gets arrested and is taken cold turkey off everything. Not by a doctor stopping the medication, the jail just doesn't provide medical care until they're bad enough to transfer to the hospital.

 

[Ceke2002]

So what's the underlying issue here then? Obviously some of the jails are getting things way wrong in terms of even basic medical care for inmates, so is it a systemic type thing that's come about from the environment itself, or is it privatisation issues and companies putting profits before safety by cutting costs and corners, or is it a general attitude of 'don't do the crime if you can't do the time' type situation?

 

[birchswing]

So what's the underlying issue here then? Obviously some of the jails are getting things way wrong in terms of even basic medical care for inmates, so is it a systemic type thing that's come about from the environment itself, or is it privatisation issues and companies putting profits before safety by cutting costs and corners, or is it a general attitude of 'don't do the crime if you can't do the time' type situation?

Jails in the US are an abomination in general. We have a system that is punitive, and even with having one of the highest incarceration rates in the world, the general attitude in the US is that prisoners get what they deserve. To put it in perspective, in the Americas there are 35 independent nations. The US and St. Kitts & Nevis (a very small island) are the only countries that actively use the death penalty. People openly talk about hoping that prisoners are raped or "taken care of'' by other inmates. And we use solitary confinement, which many IOs consider torture. Some of it's privatized, but the biggest issue is the culture we have. As far as the doctors, I can't speak to why a prison doctor could miss a case of acute benzo withdrawal but it happens with some regularity. In a country where prisoners are treated humanely, an issue like this might be noticed. In the US, this won't be on many people's radar. I can guarantee you people like some of my relatives (with their prolific rantings on Facebook) would see this case and say, "Got what he deserved" (along with some expletives), even if they've themselves abused drugs or had DUIs. Doesn't make a lot of sense. It's a cowboy justice mentality in a country with a lot of cowboy outlaws.

 

[shan564]

As much as I have a metric eff tonne of sympathy for the family (and empathy for what this poor guy must have gone through before his untimely death), I do think this is a much more complex situation than first meets the eye. You have possible poor prescribing practices, potential misuse of the medication, a prison system where they probably get umpteen dozen inmates through a day all crowing about how 'you just got to give me my medication, Doc, I need my Xanax/Klonazepam/Rohypnol/insert whatever other benzo is on the list' and then the Doctor checks the patient's medical records and finds out the patient is prescribed 4 mgs of Xanax a day when in fact he's been taking three times that amount. Not saying that's what happened in this case, just that there is a culture in place there and a Doctors decision to treat may be influenced by that culture (and by the same token you also don't want a Doctor who's going to just believe whatever a patient tells him, because they want to get high so they lie about being on a higher dosage of benzos than what they really are, because then you just end up creating the risk that you're going to have someone who enters the prison system and ends up leaving with a worse pill problem than what they first presented with).

I work in a jail. Anyone we even suspect of being on alcohol or benzos goes through a benzo withdrawal protocol with them getting some benzos and weaned off of them over the course of about a week.

The only way I could see a defense for the jail is if the guy couldn't communicate he was on benzos. That doesn't seem to be what happened in the article but I've seen several times on the news things being reported in a misleading manner including circumstances I was involved in.

E.g. onetime I did not discharge a patient, the court did against my recommendation. The guy was dangerous. The news reported that the hospital (didn't mention me) discharged him despite that he was dangerous. They didn't report that the doc (me) argued the guy should be kept it.

And the hospital and I weren't allowed to correct the news cause it would've violated HIPAA.

I have seen several jails give lousy care but I can't say this really was the case here cause I don't fully trust the article. I wouldn't be surprised if it were true cause I've seen horror cases in jail but I don't know if this is the case here.

+2. These are the first thoughts that came to my mind too.

 

[Wilf]

Jails in the US are an abomination in general. We have a system that is punitive, and even with having one of the highest incarceration rates in the world, the general attitude in the US is that prisoners get what they deserve. To put it in perspective, in the Americas there are 35 independent nations. The US and St. Kitts & Nevis (a very small island) are the only countries that actively use the death penalty. People openly talk about hoping that prisoners are raped or "taken care of'' by other inmates. And we use solitary confinement, which many IOs consider torture. Some of it's privatized, but the biggest issue is the culture we have. As far as the doctors, I can't speak to why a prison doctor could miss a case of acute benzo withdrawal but it happens with some regularity. In a country where prisoners are treated humanely, an issue like this might be noticed. In the US, this won't be on many people's radar. I can guarantee you people like some of my relatives (with their prolific rantings on Facebook) would see this case and say, "Got what he deserved" (along with some expletives), even if they've themselves abused drugs or had DUIs. Doesn't make a lot of sense. It's a cowboy justice mentality in a country with a lot of cowboy outlaws.

Perhaps you would feel differently if one of your family members or spouse was murdered, killed by a drunk driver, raped, robbed at gun point, assaulted to the point of hospitalization, had drugs sold to them causing dependence, etc.

 

[birchswing]

Perhaps you would feel differently if one of your family members or spouse was murdered, killed by a drunk driver, raped, robbed at gun point, assaulted to the point of hospitalization, had drugs sold to them causing dependence, etc.

I likely would feel different. But: 1) Some of those feelings are through societal conditioning and would change as our default response changes (as an example, when corporal punishment became illegal in Sweden around the 1960s most were opposed to making it illegal and thought you couldn't raise children without hitting them; after it became normalized to not hit children, the percentage in favor of the ban skyrocketed—action preceded feeling). In short, feelings follow norms to some extent. 2) It's not a good idea to base our expectation of human rights on how we might feel in a moment of great vulnerability.

 

[PikminOC]

Drinking while on Xanax. Whoa!

 

[NickNaylor]

Drinking while on Xanax. Whoa!

Sometimes you just gotta get turnt.

 

[Doctor Bagel]

Drinking while on Xanax. Whoa!

I'm surprised that you're surprised that someone prescribed Xanax would have bad judgment.

On this case, we don't have enough information to know what really happened. If you were covering a jail and knew someone had a prescription for Xanax, you probably should have withdrawal on your mind. You should probably also have alcohol withdrawal on your mind for everyone, especially someone who is in for a DUI. A withdrawal protocol perhaps with an anticonvulsant would have been reasonable. You know, though, that makes me wonder -- is CIWA a routine part of jail stays? Maybe it should be, but jeez, that's a high effort thing.

About what happened, it is easy to miss things in all kinds of settings. As a doctor, it's a reminder to be careful where you work. Places with chaotic systems can lead you to making more mistakes. Do you want to take on that liability? It's easy to feel outraged, but it's possible this was a really easy to make mistake for an overworked doctor in a screwed up system with limited supports.

On another note, I suspect this guy should not have been prescribed Xanax. Being in jail for a DUI suggests an alcohol use disorder. Yeah, yeah, yeah, I know there are those unlucky people who drove drunk for the one time in their life and got caught -- I hear this story every day -- but it's usually not true. I wonder if he was one of those people who was getting 6 mg qday or something crazy like that.

 

[Psychoanalysis]

I work in a jail. Anyone we even suspect of being on alcohol or benzos goes through a benzo withdrawal protocol with them getting some benzos and weaned off of them over the course of about a week.

The only way I could see a defense for the jail is if the guy couldn't communicate he was on benzos. That doesn't seem to be what happened in the article but I've seen several times on the news things being reported in a misleading manner including circumstances I was involved in.

E.g. onetime I did not discharge a patient, the court did against my recommendation. The guy was dangerous. The news reported that the hospital (didn't mention me) discharged him despite that he was dangerous. They didn't report that the doc (me) argued the guy should be kept it.

And the hospital and I weren't allowed to correct the news cause it would've violated HIPAA.

I have seen several jails give lousy care but I can't say this really was the case here cause I don't fully trust the article. I wouldn't be surprised if it were true cause I've seen horror cases in jail but I don't know if this is the case here.

*big sigh, and a face palm*. I don't know how you put up with all of this. I have been following you for some time, and I am usually in awe at how patient you seem to be.

 

[Ceke2002]

Drinking while on Xanax. Whoa!

Pfft, amateur. Back in my day I shot Heroin with Xanax and still managed to work 10 hours a night at a strip club.

Yeah, I was really going places.

 

[Ceke2002]

*big sigh, and a face palm*. I don't know how you put up with all of this. I have been following you for some time, and I am usually in awe at how patient you seem to be.

^^^This.

 

[birchswing]

I'm surprised that you're surprised that someone prescribed Xanax would have bad judgment.

On this case, we don't have enough information to know what really happened. If you were covering a jail and knew someone had a prescription for Xanax, you probably should have withdrawal on your mind. You should probably also have alcohol withdrawal on your mind for everyone, especially someone who is in for a DUI. A withdrawal protocol perhaps with an anticonvulsant would have been reasonable. You know, though, that makes me wonder -- is CIWA a routine part of jail stays? Maybe it should be, but jeez, that's a high effort thing.

About what happened, it is easy to miss things in all kinds of settings. As a doctor, it's a reminder to be careful where you work. Places with chaotic systems can lead you to making more mistakes. Do you want to take on that liability? It's easy to feel outraged, but it's possible this was a really easy to make mistake for an overworked doctor in a screwed up system with limited supports.

On another note, I suspect this guy should not have been prescribed Xanax. Being in jail for a DUI suggests an alcohol use disorder. Yeah, yeah, yeah, I know there are those unlucky people who drove drunk for the one time in their life and got caught -- I hear this story every day -- but it's usually not true. I wonder if he was one of those people who was getting 6 mg qday or something crazy like that.

I don't say this to be seem outrageous but because it shifted my perspective. In the last year, I found out about two people I know who have had DUIs--the only two people in my entire life I've known to have had DUIs. The first was my previous psychiatrist who abruptly stopped seeing me. He had been prescribing himself Ambien and was been arrested for DUI (prescriptions and alcohol). He was sentenced to 30 days in jail and fled the country and has lost his medical license. The second was a dean at the university I attend who oversees "medical contracts" with students. They usually involve mental health issues, and the short of it is that if you leave this university on medical leave and come back, you have to come back on a medical contract. My university has been in national papers a good deal lately over a disportioncate number of suicides and what some say (and I would agree) is a cultural problem at the administrative level regarding how mental health is handled. I left the college because of a disability, but on returning I have been treated like a criminal in an almost Kafkaesque like system. It's very intimidating because they are basically in liability mode and want you to open up about everything in your personal life, even if the reason you left had nothing to do with a propensity for suicide. This woman was basically an interrogator into any possible self-destructive behavior. And then she was recently arrested for drunk driving, which makes my life easier because she's on administrative leave and I don't have to meet with her.

Even though these were both authority figures in my life I didn't particularly care for, I have been able to work on having empathy for them.

Anyhow, this tangentially relates to the population you were describing with DUIs. The irony with my psychiatrist is that I have been on benzodiazepines since I was 15, never have had a sip of alcohol in my life, and I don't drive due to anxiety. I asked him, since my father was pushing me to drive, whether it was safe to drive on benzodiazepines and he told me that I was safer driving on benzodiazepines than not due to my anxiety. And it turned out he was the one mixing a benzo-like drug and alcohol and driving.

As I said, I do have empathy, but everyone has a story.

 

[PikminOC]

Pfft, amateur. Back in my day I shot Heroin with Xanax and still managed to work 10 hours a night at a strip club.

Yeah, I was really going places.

I can't have my name on any of those bottles of Xanax!

 

[Ceke2002]

I can't have my name on any of those bottles of Xanax!

You know I don't actually ever remember travelling to another hemisphere to get a script for Xanax

 

[Mass Effect]

then the Doctor checks the patient's medical records and finds out the patient is prescribed 4 mgs of Xanax a day when in fact he's been taking three times that amount. Not saying that's what happened in this case, just that there is a culture in place there and a Doctors decision to treat may be influenced by that culture (and by the same token you also don't want a Doctor who's going to just believe whatever a patient tells him, because they want to get high so they lie about being on a higher dosage of benzos than what they really are, because then you just end up creating the risk that you're going to have someone who enters the prison system and ends up leaving with a worse pill problem than what they first presented with).

This does not explain what happened here. If there's any suspicion that someone is taking a benzo, even if they shouldn't be, they are put on withdrawal protocol. The doctor at the jail dropped the ball here.

As for the article, I'm trying to figure out why it matters that the man was gay. Is his sexual orientation seriously headline worthy when it appears to have nothing to do with the story?

 

[Member 1337]

As for the article, I'm trying to figure out why it matters that the man was gay. Is his sexual orientation seriously headline worthy when it appears to have nothing to do with the story?

Serious? I'm not implying anything here, but there may be a correlation between provocative headlines and getting clickies, likes, pokes, retweets, fwd's, improved hit metrics, opinions and comments. Texas has a horribad reputation when it comes to progressively taking care of its gay citizens... like, Google "Texas" "Gay" and "Violence" and see what pops up on your feeling luckies... you may see something about a 2016 presidential candidate. Then ask yourself how much more interesting a conspiracy theory is from a normal sick person having a normal seizure while in jail... and try not to jump to any uncomfortable conclusions.

 

[Ceke2002]

This does not explain what happened here. If there's any suspicion that someone is taking a benzo, even if they shouldn't be, they are put on withdrawal protocol. The doctor at the jail dropped the ball here.

As for the article, I'm trying to figure out why it matters that the man was gay. Is his sexual orientation seriously headline worthy when it appears to have nothing to do with the story?

Of course it doesn't explain what happened in this case, which is why I said that I wasn't saying 'this is what happened here'. I was just trying to give an example of how it 'might' happen, as in how a Doctor in this situation could drop the ball like that. Sorry if I didn't quite explain myself properly.