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Fresno County Jail forces cheap meds

Jul 9, 2009 | Pablo Lopez | The Fresno Bee

Fresno County Jail's health manager has found a way to cut drug costs by $70,000 a month or more, winning praise from corrections officials around the state.

But critics say his method -- forcing some mentally ill inmates to switch to cheaper medications -- is shortsighted because it causes needless mental breakdowns and adds legal and health-care costs over the long term.

And if inmates decline the new drugs, the jail gives them nothing. As a result, many have become unstable and been confined to isolation cells for months or years, according to defense attorneys and mental-health advocates.

"What they're doing in the jail is inhumane," Fresno defense lawyer Kimberly Hall said. "It's been going on forever, and it will continue until someone sues them."

Jail officials, however, cite a study that the jail's health manager and psychiatrist conducted in 2007 on the effect of withholding two expensive psychotropic drugs, Seroquel and Wellbutrin. They concluded that switching the drugs or withholding them didn't harm the patients.

Cabinets in the Fresno County jail infirmary are stocked with various medications including some for depression and anxiety. George "Bud" Laird, the county's correctional health manager, makes the medical decisions at the Fresno County Jail.

Deputy Sgt. R. Osborn stands near isolation cells in Fresno County Jail. Two high-profile former inmates, Marcus Wesson and Ramadan Abdullah, were housed in them.

But that flies in the face of the conventional understanding of how to treat mental illness, critics say.

Finding a medication that works for a patient is a highly individualized matter of trial and error, and once a physician determines what works for a person, any sudden change can be disastrous, doctors say.

"In my professional opinion, withholding medicine is putting people at risk," said John Madsen, secretary of the California Association of Alcoholism and Drug Abuse Counselors.

Medical decisions at jail

George "Bud" Laird, the county's correctional health manager, makes the medical decisions at the jail. He's not a physician, but he has a doctorate in psychology from the University of Waterloo in Ontario, Canada.

Laird has worked with the criminally insane at Atascadero state prison hospital and at Corcoran State Prison's "super max" unit, which houses inmates who are too violent to be in the general population. He said he has been trained in hostage negotiations and has worked in hospital burn and intensive care units.

He helps the San Francisco nonprofit Institute for Medical Quality review the medical practices of county detention facilities statewide for certification.

Laird said he stopped dispensing Seroquel and Wellbutrin except in special cases in part because he believes inmates were faking mental illness to get them. Seroquel -- prescribed for patients with schizophrenia and bipolar disorder -- is known among inmates as "baby heroin" because of its effects, he said. Wellbutrin, an antidepressant that inmates call "Welbys," can be crushed and snorted to achieve a rush similar to speed, he said.

Laird, 63, has been in charge of the jail's medical staff for three years and oversees a budget of $13 million. Of the 3,000 inmates, about 275 require medical attention on any given day, he said.

Laird said he's not sure how many of those are classified as mentally ill. But the number has declined by dozens since he became health manager.

When Laird took over, about 350 inmates per month received psychotropic medication, he said. Fresno County was spending about $85,000 a month on those drugs, he said. Now it's about $15,000 a month, he said. And last month, the county spent only $7,000 on psychotropic drugs, Laird said.

One issue, he said, is that some inmates pretend to have mental illness and don't really need psychotropic drugs. Those inmates do things like banging their heads on walls or spreading feces on themselves, he said.

"Honestly, have you ever seen a mentally ill person do that?" Laird said.

Another issue is that those inmates who do need drugs can get by with less-expensive drugs.

Study found no harm

The study by Laird and jail psychiatrist Dr. Pratap Narayan concluded that inmates weren't harmed when they didn't get the medicine of their choice. There was no increase in crisis calls, suicides, transfers to padded safety cells or emergency placement in psychiatric units, Laird said.

"Our goal was not to save money," Laird said. "Our goal is to treat inmates appropriately. ... We don't let inmates choose their medication."

Cabinets in the Fresno County jail infirmary are stocked with various medications including some for depression and anxiety. George "Bud" Laird, the county's correctional health manager, makes the medical decisions at the Fresno County Jail.

Deputy Sgt. R. Osborn stands near isolation cells in Fresno County Jail. Two high-profile former inmates, Marcus Wesson and Ramadan Abdullah, were housed in them.

But Madsen said withholding drugs from inmates who need them is not the way to deal with inmates who abuse psychotropic drugs. "I think he is setting himself up for some real problems," Madsen said of Laird's policy.

Nevertheless, Laird's approach appears to be catching on. For example, Laird's study helped persuade San Bernardino County to ban Seroquel and Wellbutrin except in special cases.

"We are real believers of Dr. Laird's research," said Terry Fillman, health services supervisor for the San Bernardino County sheriff's detention facilities. Since cutting out Seroquel and Wellbutrin, San Bernardino has saved money and cut drug abuse inside the jail, he said.

"The benefits are outstanding," Fillman said. "I'm sure other counties will soon follow suit."

Randall Hagar, government-affairs director of the California Psychiatric Association, said a similar policy is in place in the state prison system. He said the association has voiced its concerns to state prison officials, because any time medicine is switched, there's a risk of the patient relapsing.

"Sure, pharmacy costs go down, but the cost to the system goes up," Hagar said.

Those costs include more than just added medical expenses. When inmates become incompetent, it also delays court proceedings and drives up legal costs, critics say.

Jailed lawyer rejects offer of new medication

The human toll is attracting increasing attention in Fresno's legal community, in part because of the case of Scott Kinney, a once-successful lawyer whose mental illness has spiraled out of control since his arrest on domestic violence charges.

For years, Kinney took Lithium to control bipolar and maniac disorders, said his mother, Marion Kinney.

When he was arrested in December, jail staff was provided with proof that he had been taking Lithium, Marion Kinney said. But the staff offered Kinney Zoloft instead.

Kinney refused the Zoloft, became unstable and ended up in an isolation cell, said attorney Hall, one of Scott Kinney's friends. Kinney is now in a state prison hospital trying to restore his sanity, she said.

"These are sick people who need their meds," Hall said. "Instead, [jail officials] want them to rot in jail."

Scott Kinney is the son of prominent Fresno attorney Ernest Kinney, who died last year. Ernest Kinney was manic and also took Lithium, his wife said.

Hall said she began investigating the jail's medical practices after she learned of Scott Kinney's situation. Since then, she said, other defense attorneys have provided her with details of other allegations of mistreatment.

Inmate faces isolation

A check of local court records show few lawsuits against Laird and his staff.

But Jovonne Perrin, whose son is in the downtown jail, said Laird is doing a disservice by withholding drugs.

Perrin said that her son, Johnathon Settle, suffers from schizophrenia and has an anti-social behavior disorder. Fresno police arrested him in September 2006 on suspicion of killing his 62-year-old aunt, Rita Cordrey.

Perrin said her son will have a difficult time proving his innocence, because he has been in an isolation cell for nearly three years, except for a brief time he spent in a state prison hospital.

She said state prison hospital staffers gave her son Risperdal, and his condition improved.

But when he returned to the Fresno jail, the staffers offered him Zyprexia, which he refused to take, she said. Risperdal and Zyprexia are both anti-psychotic medications.

During a recent court appearance, Settle had a big bump on his head and one of his ears looked mangled. His mother said he has been banging his head on his cell's walls and used a phone in the jail visiting room to bust open his ear because he hears a buzzing sound.

"My son is crazy, but he won't admit it," Perrin said. "It doesn't help when they don't give him the right medicine."

Cabinets in the Fresno County jail infirmary are stocked with various medications including some for depression and anxiety. George "Bud" Laird, the county's correctional health manager, makes the medical decisions at the Fresno County Jail.

Deputy Sgt. R. Osborn stands near isolation cells in Fresno County Jail. Two high-profile former inmates, Marcus Wesson and Ramadan Abdullah, were housed in them.

Settle, 27, will soon have a competency hearing to determine whether he should return to the state prison hospital or stand trial on the murder charge, said attorney Scott Baly, who is defending Settle.

Laird said every sick inmate receives proper medication after being screened by medical doctors.

Laird said that a few judges have sent the jail medical staff court orders that specify what type of medication an inmate should receive. But he said he has personally reminded these judges that they don't have the legal authority to prescribe medicine and can only order a medical evaluation for the inmate.

The screening is necessary, Laird said, because inmates often fake illnesses to get stoned, sell the drugs to other inmates, delay court proceedings or to get into one of the 37 beds in the quiet confines of jail's medical ward, where female nurses tend to them.

"I wouldn't say it's bad behavior," Laird said. "I think it's logical behavior. Everyone would like to improve their living conditions."