Drug Rehabilitation or Revolving Door?

Drug Rehabilitation or Revolving Door?

BENEDICT CAREY

ROSEBURG, Ore. — Their first love might be the rum or vodka or gin and juice that is going around the bonfire. Or maybe the smoke, the potent marijuana that grows in the misted hills here like moss on a wet stone.

But it hardly matters. Here as elsewhere in the country, some users start early, fall fast and in their reckless prime can swallow, snort, inject or smoke anything available, from crystal meth to prescription pills to heroin and ecstasy. And treatment, if they get it at all, can seem like a joke.

“After the first couple of times I went through, they basically told me that there was nothing they could do,” said Angella, a 17-year-old from the central Oregon city of Bend, who by freshman year in high school was drinking hard liquor every day, smoking pot and sampling a variety of harder drugs. “They were like, ‘Uh, I don’t think so.’ ”

She tried residential programs twice, living away from home for three months each time. In those, she learned how dangerous her habit was, how much pain it was causing others in her life. She worked on strengthening her relationship with her grandparents, with whom she lived. For two months or so afterward she stayed clean.

“Then I went right back,” Angella said in an interview. “After a while, you know, you just start missing your friends.”

Every year, state and federal governments spend more than $15 billion, and insurers at least $5 billion more, on substance-abuse treatment services for some four million people. That amount may soon increase sharply: last year, Congress passed the mental health parity law, which for the first time includes addiction treatment under a federal law requiring that insurers cover mental and physical ailments at equal levels.

Many clinics across the county have waiting lists, and researchers estimate that some 20 million Americans who could benefit from treatment do not get it.

Yet very few rehabilitation programs have the evidence to show that they are effective. The resort-and-spa private clinics generally do not allow outside researchers to verify their published success rates. The publicly supported programs spend their scarce resources on patient care, not costly studies.

And the field has no standard guidelines. Each program has its own philosophy; so, for that matter, do individual counselors. No one knows which approach is best for which patient, because these programs rarely if ever track clients closely after they graduate. Even Alcoholics Anonymous, the best known of all the substance-abuse programs, does not publish data on its participants’ success rate.

“What we have in this country is a washing-machine model of addiction treatment,” said A. Thomas McClellan, chief executive of the nonprofit Treatment Research Institute, based in Philadelphia. “You go to Shady Acres for 30 days, or to some clinic for 60 visits or 60 doses, whatever it is. And then you’re discharged and everyone’s crying and hugging and feeling proud — and you’re supposed to be cured.”

He added: “It doesn’t really matter if you’re a movie star going to some resort by the sea or a homeless person. The system doesn’t work well for what for many people is a chronic, recurring problem.”

In recent years state governments, which cover most of the bill for addiction services, have become increasingly concerned, and some, including Delaware, North Carolina, and Oregon, have sought ways to make the programs more accountable. The experience of Oregon, which has taken the most direct and aggressive action, illustrates both the promise and perils of trying to inject science into addiction treatment.

Evidence-Based Treatments

In 2003 the Oregon Legislature mandated that rehabilitation programs receiving state funds use evidence-based practices — techniques that have proved effective in studies. The law, phased in over several years, was aimed at improving services so that addicts like Angella would not be doomed to a lifetime of rehab, repeating the same kinds of counseling that had failed them in the past — or landing in worse trouble.

“You can get through a lot of programs just by faking it,” said Jennifer Hatton, 25, of Myrtle Creek, Ore., a longtime drinker and drug user who quit two years ago, but only after going to jail and facing the prospect of losing her children. “That’s what did it for me — my kids — and I wish it didn’t have to come to that.”

When practiced faithfully, evidence-based therapies give users their best chance to break a habit. Among the therapies are prescription drugs like naltrexone, for alcohol dependence, and buprenorphine, for addiction to narcotics, which studies find can help people kick their habits.

Another is called the motivational interview, a method intended to harden clients’ commitment upon entering treatment. In M.I., as it is known, the counselor, through skilled questioning, has the addict explain why he or she has a problem, and why it is important to quit, and set goals. Studies find that when clients mark their path in this way — instead of hearing the lecture from a counselor, as in many traditional programs — they stay in treatment longer.

Psychotherapy techniques in which people learn to expect and tolerate restless or low moods are also on the list. So is cognitive behavior therapy, in which addicts learn to question assumptions that reinforce their habits (like “I’ll never make friends who don’t do drugs”) and to engage their nondrug activities and creative interests.

For Angella, this kind of counseling made a difference. She spent several months in a program run by Adapt, an addiction treatment center here in Roseburg, a small city about 175 miles south of Portland.

In treatment, she said, she learned how to “just be with, and feel” bad moods without turning to drink or drugs; and to throw herself into creative projects like collage and painting. The program has helped her reconnect with her father and to enroll in college beginning in January.

“I want to be a teacher, and someone at the program is advising me on that,” she said in an interview. “That’s the plan, to just move out and away from my old life.”

A friend of hers in the program, Alex, a 16-year-old from Roseburg, said that the therapy helped him monitor his own emotional ups and downs, without being swept away by them. The counselors “are always asking about our stress level, our anger, so you become more aware and have a better idea what to do with it,” he said.

Almost 54 percent of Oregon’s $94 million budget for addiction treatment services now goes to programs that deploy evidence-based techniques, according to a state report completed last month. The estimated rate before the mandate was 25 to 30 percent. The state has not yet analyzed the impact of this change on clients.

“Before the mandate, most programs had some evidence-based practices, and since then there has been a lot more interest and awareness of them,” said Traci Rieckmann, a public health researcher at Oregon Health and Science University, who is following the policy implementation with support from the Robert Wood Johnson Foundation and the National Institutes of Health.

Culture Clash

Yet interest and awareness may not translate into good practice, and Dr. Rieckmann says it is not at all clear how many rehabilitation programs claiming to use evidence-based techniques actually do so faithfully. About 400 programs receive state money, and most of them are small, rural outfits that are already stretched to provide counseling, to say nothing of paying for extensive training.

“You’re talking about therapies, like cognitive behavior therapy, that take time to learn,” said John Gardin, the behavioral health and research director at Adapt in Roseburg, who travels the country to teach the skills. “Most places don’t have a person like me to do that training, so they’re getting two to three days of training, if that; and that’s just not enough time to get it.”

In studies looking at hundreds of programs nationwide, researchers have found a similar gap between what programs may want to do and what they’re able to do. “For instance, most programs don’t have an M.D. on staff,” said Aaron Johnson, a sociologist at the University of Georgia who has led many of the studies. “Without that, of course, you can’t prescribe any medications.”

Tim Hartnett, the executive director of a Portland treatment program called CODA Inc., which does its own research on patient outcomes, said that the mandate had raised the level of conversation statewide, but that true reform would mean “an integrated system that tracks clients as they move from residential to outpatient treatment, and that defines clear targets” for what a person should expect from each kind of program.

“Our goal at CODA is to create a system of care that uses evidence-based practices at just the right dose and just the right time,” Mr. Hartnett said. “As with many chronic diseases, figuring out dosage and timing are critical.”

For some addicts, a standard program may not help at all, according to Anne Fletcher, who for her book “Sober For Good” interviewed 222 men and women who had been clean for at least five years. “A lot of these people overcame an alcohol problem on their own, or with the help of an individual therapist,” Ms. Fletcher said.

To complicate matters in Oregon, the state mandate has stirred a kind of culture clash between those who want reform — academic researchers, state officials — and veteran counselors working in the trenches, many of whom have beaten addictions of their own and do not appreciate outsiders telling them how to do their jobs.

“I’m a counselor, and I’d be defensive, too: ‘What do you mean, all this stuff I’ve been doing my entire life is wrong?’ ” said Brian Serna, director of outpatient services at Adapt, who has traveled the state to monitor the use of scientific practices. “So the challenge is to build a bridge between what the science says is effective and what people are already doing.”

One way to do that, some experts now believe, is to combine evidence-based practice with “practice-based evidence” — the results that programs and counselors themselves can document, based on their own work. In 2001 the Delaware Division of Substance Abuse and Mental Health began giving treatment programs incentives, or bonuses, if they met certain benchmarks. The clinics could earn a bonus of up to 5 percent, for instance, if they kept a high percentage of addicts coming in at least weekly and ensured that those clients met their own goals, as measured both by clean urine tests and how well they functioned in everyday life, in school, at work, at home.

By 2006, the state’s rehabilitation programs were operating at 95 percent capacity, up from 50 percent in 2001; and 70 percent of patients were attending regular treatment sessions, up from 53 percent, according to an analysis of the policy published last summer in the journal Health Policy.

“We basically gave them a list of evidence-based practices and told them to pick the ones they wanted to use,” said Jack Kemp, former director of substance abuse services for Delaware, in an interview. “It was up to them to decide what to use.”

For those who are trying not to use, it doesn’t much matter how rehab services are improved — only that it happens in time. “Honestly, you just don’t care how or why something works for you,” said Ms. Hatton, the 25-year-old from Myrtle Creek, Ore. “Just that it does.”

San Quentin warden ends career where he started, 40 years ago

Richard Halstead

Posted: 12/30/2008 05:51:38 PM PST

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Robert Ayers, warden of San Quentin State Prison, ended his career Tuesday where he began as a guard in 1968.

Ayers’ co-workers credit him with returning stability to administration of the state’s oldest prison after a period when wardens there arrived and departed faster than express buses. The heads of nonprofits offering rehabilitative programs at the prison also sing his praises, saying he opened the prison to them in an effort to battle recidivism.

But Ayers’ 40-year career, which includes stints as warden at Lancaster State Prison and Pelican Bay State Prison, has also had its rocky moments. In 2000, he was denied permanent appointment as warden to Pelican Bay, where a female guard filed a lawsuit against him and others, claiming they failed to properly discipline inmates who sexually harassed her.

Gov. Pete Wilson nominated Ayers, who is a Republican, for the warden’s job at Pelican Bay. But Wilson’s successor, Gray Davis, withdrew the nomination. Ayers retired soon after.

“It was a bad political environment at that time,” said Ayers, 61. “I asked myself, ‘Why I am I doing this?’”

Ayers came out of retirement in 2006 to become warden at San Quentin, where he had spent his first 18 years.

“It was very satisfying,” Ayers said. Between the time that Jeanne Woodford left the job in 2004 and Ayers became warden, the prison was headed by at least four different wardens.

Lt. Joe Cello, a training officer at San Quentin, said, “We’d look out the window to

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see who the warden was going to be for the day. It was that bad. We needed stability.”

Ayers said, “When I got here, if the staff saw a procedure that was inconvenient or they didn’t like it, then they just didn’t follow it.”

Ayers changed that.

“I basically let staff know: this is the policy, these are the procedures we have in place to follow to execute that policy, and you’re going to be held accountable,” Ayers said.

Cello said because Ayers made smart decisions and had worked his way up through the ranks, the more than 2,000 people who work at the prison responded well to his direction.

“He’s what we call a warden’s warden, a true leader,” Cello said.

Ayers said something desperately needs to be done about overcrowding in San Quentin’s death row. When he began his career, there were about 100 condemned inmates housed there; today there are 650. But Ayers said there are attractive alternatives to the Department of Corrections and Rehabilitation’s plan to build 768 new cells at San Quentin at a cost of $356 million. One such alternative, he said, is housing the condemned inmates in the California State Prison in Sacramento, commonly known as New Folsom.

“It doesn’t have the infrastructure issues that San Quentin has,” Ayers said.

But given the political resistance such an alternative plan would face, and the time it would take to implement, he said he favors proceeding with plans to expand death row at San Quentin.

Regarding the solution to the other big question facing California’s prison system – how the state will come up with the $7 billion a court-appointed receiver says must be spent to upgrade prison medical facilities – Ayers said he hasn’t a clue.

“Other than sprinkling fairy dust,” he said.

Ayers said construction of a five-story, $146 million medical complex at San Quentin is in full swing and will be finished next year. Robert Sillen, the court-ordered administrator who oversaw California’s prison health-care system for a time, ordered its construction. Ayers said the complex will provide inmates with better access to medical specialists while eliminating the security risk of transferring inmates to outside hospitals.

Ayers expressed frustration that the Department of Corrections has not supplied more funding for rehabilitative efforts at San Quentin, despite promises in 2007 that more funding was in the offing. The heads of nonprofits providing such services at the prison say Ayers has championed their efforts.

“For people who advocate for criminal justice reform, he is a dream,” said Carol Burton, director of the San Rafael nonprofit, Centerforce. “He is program friendly, and he believes in the ability of people to change.”

Burton said Ayers allows more than 65 different nonprofit and faith-based organizations to work with inmates at San Quentin, despite the security problems that such a large presence of volunteers presents.

Jacques Verduin, director of the Insight Prison Project, based in San Rafael, said that in 2007 Ayers had his staff take over a program that Insight was providing, enabling it to involve 400 inmates rather than the 100 it was reaching before. The Stand Up program provides inmates with instruction in anger management, addiction recovery counseling, and parenting, health and life skills.

Verduin said, “He has a wonderful, smack-in-middle, no-nonsense position about it: ‘Look, 95 percent of these guys come out to be your neighbor. How do you want them?’ His standard phrase is, these programs serve public safety and prevent re-victimization.”

His tenure at Pelican Bay was marred by the lawsuit.

In 2003, a jury returned a unanimous verdict that Ayers and other Pelican Bay State Prison officials had prevented Deanna Freitag, a correctional officer at Pelican Bay, from reprimanding male inmates for masturbating in front of her and retaliated against her for complaining about the situation. The verdict was later upheld by the 9th U.S. Circuit Court of Appeals.

In an interview Tuesday, Ayers said the prison is a tough environment for female guards, even though the situation has improved.

“I don’t think it’s anything your typical, average, American little girl dreams of becoming when she grows up – a prison guard,” he said.

But, Ayers said, “I take my hat off to women who do the job. They do make it a better environment.”

Robert Wong, formerly chief deputy warden of the California State Prison in Solano, has been named to serve as acting warden of San Quentin until Gov. Arnold Schwarzenegger selects a permanent replacement for Ayers.

Wong, 49, also served as acting warden of California State Prison in Los Angeles County from June 2006 to February 2007. The warden at San Quentin is paid an annual salary of $129,108.

Violence unabated in juvenile prisons

December 31, 2008

Violence unabated in juvenile prisons

Jordan Schrader

This is the second in a series of stories examining the work of Gov. Mike Easley before he leaves office Jan. 10.

Gov.-elect Bev Perdue will inherit a juvenile-justice system still resisting efforts to shake the violence that has made it a dangerous place for youths and staff alike.

The first 10 months of 2008 saw 331 reports of violent incidents in state juvenile lockups, the Department of Juvenile Justice said. The reports are filed when youths fight, attack each other or staff, or report abuse by staff.

There were 190 incidents reported in 2007. Because of a change in reporting rules, though, the department says the two numbers are too different to be compared, even though a review of the reports filed before and just after the changeover doesn’t show a clear difference.

The state’s youth detention centers had an average daily population of 474 offenders in 2007.

Much is unchanged in the system from 2006, when assaults at the Swannanoa Valley Youth Development Center drew unwelcome headlines for the state.

Top leadership in Raleigh has remained the same through Gov. Mike Easley’s tenure. Youth prisons still lack police or guards, except at Swannanoa. An investigation called for by Easley into claims of cover-up of assaults at Swannanoa has yielded no criminal charges.

But there are signs of change ahead, and one prominent critic sees new accountability at the Swannanoa prison.

“I think everybody got the message that they had to let us know about criminal offenses occurring behind the wall out there,” Buncombe County District Attorney Ron Moore said.

Through his eight years in office — through abuse of youths, assaults on staff and escapes — Easley retained confidence in the state’s first and only juvenile justice secretary. Perdue, though, will find a new leader. Secretary George Sweat retires Dec. 31, 10 days before Easley departs.

“I have no doubt we’ve got this department turned in the right direction,” Sweat said last week.

Sweat cites a reduction in the rate of juvenile crime rate — at its lowest level in the past eight years, he said. He credits law enforcement and the department’s local Juvenile Crime Prevention Councils.

Easley’s drive for state-paid preschool for 4-year-olds will be remembered as another step in preventing crime, he said.

The governor is just as complimentary of Sweat. Easley wasn’t available for an interview, but his office said in an e-mail from spokesman Seth Effron that Sweat “has increased accountability in the agency, made better use of technology, improved facilities and overseen a 68 percent reduction in youth development center commitments since 1998.”

The improved facilities are the most dramatic change on the horizon.

Easley called for new youth development centers — the long-term lockups like Swannanoa that are the juvenile equivalent of prisons — after a 2003 state audit found unsafe conditions at the old centers.

The audit also found workers were unprepared to deal with cases of abuse.

A series of lawsuits in 2002 portrayed Swannanoa as a place where juveniles and some employees routinely sexually abused other youths while state leaders looked the other way. A former Swannanoa counselor, Brian Wayne Harkins, was sentenced to four years in prison on charges of sexual abuse.

Four new centers have opened with five more in the planning stages.

They are intended to provide better security and easier control over juveniles. Their design is aligned with the department’s goal of a “therapeutic environment” that stresses dialogue, not punishment, for youths who act up. Officials also hope to build a new center at a yet-to-be-determined site in Western North Carolina.

It will replace the Swannanoa site, which Sweat said would close at a time yet to be determined. The facility has already shrunk, sharing its campus with a new adult women’s prison.

One violent incident in 2008 took place at a new youth development center, but the rest happened at one of the five older prisons or one of nine short-term lockups, which include Buncombe Regional Juvenile Detention Center.

There were 26 incidents at Swannanoa.

Not all of those incidents are serious ones, Sweat said. A new reporting system is intended to increase transparency by showing all incidents.

“In some of those figures, I’m sure you’re probably talking about pushing and shoving incidents,” he said.

In the first four months after the changeover of systems in September 2007, six incidents at Swannanoa included four that led staff to use pepper spray on youths. Another fight ended with a request for filing of criminal charges, and a sixth involved a punch to the chin.

The attacks appeared similar to those detailed in earlier reports, which were intended to record serious injuries but which ranged from assaults ending in hospitalization to spitting attacks.

Assaults by youths came to the forefront in 2006, after two students severely beat teacher Tom Donohue in a classroom.

Steve Barnett and D’Metriuis Rashaun Hill, both 15 at the time of the assault, are serving time in adult prison. They pleaded guilty in May to assault and conspiracy charges. Barnett, now 17, was sentenced to at least four years in prison. Hill, who is now 18 and whose name is also spelled Demetrius in records, was sentenced to at least five years and 10 months.

Moore complained at the time that Swannanoa left law enforcement in the dark about assaults. But he said he now receives daily incident reports.

He credits the change to departures, including that of former director June Fowler. A new director, James Pronko, took the helm in November.

The Democratic prosecutor said a renewed police presence has also helped. The state heightened security after the Citizen-Times reported in 2006 that just one officer in a depleted police force remained on campus.

Moore has accused juvenile-justice officials from Sweat down of working to keep attacks secret, but he declined to charge anyone based on the results of the State Bureau of Investigation probe Easley ordered into the 2006 attacks.

The information turned over to him by the SBI wouldn’t have allowed him to “go up the food chain” to look for wrongdoing, Moore said.

“I didn’t see the need to arrest some lower level person and let the higher levels escape,” he said.

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On prisons, can U.S. learn from Japan?

Virginia senator thinks so, and he’s taking up fight to overhaul ‘broken’ system

By SANDHYA SOMASHEKHAR Washington Post

Dec. 29, 2008, 11:37PM

WASHINGTON — Somewhere along the meandering career path that led James Webb to the U.S. Senate, he found himself in the frigid interior of a Japanese prison.

A journalist at the time, he was working on an article about Ed Arnett, an American who had spent two years in Fuchu Prison for possession of marijuana. In a January 1984 Parade magazine piece, Webb described the harsh conditions imposed on Arnett, who had frostbite and sometimes labored in solitary confinement making paper bags.

“But, surprisingly, Arnett, home in Omaha, Neb., says he prefers Japan’s legal system to ours,” Webb wrote. “Why? ‘Because it’s fair,’ he said.”

This spring, Webb, D-Va., plans to introduce legislation on a long-standing passion of his: reforming the U.S. prison system. Politicians have failed to address this costly problem for fear of being labeled “soft on crime.”

It is a gamble for Webb, a fiery Democrat from a staunchly law-and-order state. Virginia abolished parole in 1995, and it trails only Texas in the number of people it has executed.

But Webb tends to charge ahead on projects that he has decided are worthy of his time, regardless of how they play.

Webb is a decorated Marine and former Navy secretary who also been a journalist, a novelist and a Hollywood screenwriter. In an interview last week, he said his experience in the military led to his interest in the prison system. He believes it is his experience as a writer that will allow him to articulate a new approach.

“I enjoy grabbing hold of really complex issues and boiling them down in a way that they can be understood by everyone,” he said. “I think you can be a law-and-order leader and still understand that the criminal justice system as we understand it today is broken, unfair … and not locking up the right person in many cases.”

Webb said this spring that he’ll introduce legislation that creates a national panel to recommend ways to overhaul the criminal justice system.

Webb said the United States could learn from the Japanese prison system. In his book, A Time to Fight, he wrote that the Japanese focused less on retribution. Sentences were short, and inmates often left prison with marketable job skills. Webb said the system was modeled on philosophies pioneered by Americans, who he says have since lost their way.

Webb believes he can guide the nation back. “Contrary to so much of today’s political rhetoric,” he wrote, “to do so would be an act not of weakness but of strength.”

BEHIND THE BARS

According to Sen. James Webb, the Pew Center on the States and other groups:

• With 2.3 million people behind bars, the U.S. has imprisoned a higher percentage of its population than any other nation.

• Although the United States has only 5 percent of the world’s population, it has 25 percent of its prison population.

• African-Americans make up 13 percent of the U.S. population but comprise more than half of all prison inmates, compared with one-third two decades ago.

• Today, a black man without a high school diploma has a 60 percent chance of going to prison.

Sacred cow prisons wasting taxpayers money

By Thomas Elias
tdelias@aol. com
Tuesday, December 30, 2008

There is no more sacred a cow in California state government than the prison system, whose population has multiplied by seven since 1980 to a total of about 170,000.

Even while politicians incessantly say theyre looking for every dime of waste, they never finger prisons. They should.

Fear of crime was the initial reason for this untouchable status, which started as Californians imposed a variety of mandatory sentencing rules, including the 1994 three-strikes- youre-out law. These led to building new prisons that quickly became as overcrowded as the old ones, eventually making the prison guards union, the California Correctional Peace Officers Association, the single most powerful special interest in Sacramento.

Sacred cow status usually means that no one looks hard at what youre doing or spending.

Thats how its been for the prison system until very recently, when a federal judge concluded the state on its own would never improve substandard medical care for all those convicts, whose upkeep becomes a public responsibility when the government takes control over them.

Emphasis has been on an $8 billion cost estimate ever since that judge appointed a receiver to bring prison medical care up to where it no longer amounts to cruel and unusual punishment (more on that estimate in an upcoming column).

But the court receiver, McGeorge School of Law professor, J. Clark Kelso, has also discovered phenomenal waste so far unreported elsewhere, mostly because the prisons sacred cow status allowed an absence of oversight.

It turns out that when prisoners become ill or injured today, theyre often taken to local hospitals for treatment. And the state Department of Corrections and Rehabilitation now pretty much pays doctors and hospitals whatever they ask for those services. Plus, the prisons have rarely verified that bills they pay are accurate.

Therefore, Kelso said in an unusually frank hourlong interview the other day, There is a significant likelihood of fraud in the system. He estimated the combination of high payments and overbilling costs the state at least $100 million yearly. It could be much more. The department has no monitoring system in place to be sure services billed are actually delivered, Kelso revealed.

Most serious, the prison system lacks negotiated payment setups like those used by all health insurance companies, which generally pay a fraction of what hospitals and doctors often call usual and customary charges.

The California Hospital Association denies any fraud, with external affairs vice president Jan Emerson saying, Im afraid Mr. Kelso is badly mistaken on that.

Responded Kelso: Ive been around government more than 20 years. Theres always fraud when theres no oversight.

Even the CHA agrees state prisons pay more for services than either insurance companies or Medicare. They have refused to negotiate with most hospitals, Emerson said. This apparent fact is an indictment of decades worth of prison officials.

Plus, Kelso says that whenever a prison doctor recommends that a convict go to an outside hospital, he or she goes. No set standards determine when prisoners should or should not get outside treatment, with costs therefore unlimited. Conditions that one doctor might treat with aspirin can lead another to send patients outside, complete with escorting guards and high costs.

There have been no effective controls on spending and billing, adds Kelso. We think as many as 30 percent to 40 percent of referrals outside could be unnecessary. So he plans to install a system of checks on both costs and outside hospital use by the end of 2009. If it saves $100 million or more, as Kelso guesses, that money would stay in the states general fund for use by schools, parks or wherever legislators decide.

As for what effect losing so much money might have on community hospitals, some of which are only marginally solvent, no one knows. Thats in part because of the startling fact that no one now knows exactly how many prisoners get outside care.

Altogether, this picture is a stunning example of waste and lack of checks on a massive government program.

Which implies its high time to look at some other untouchables associated with the increased prison population and its astronomical costs. The main one of these is the three-strikes law, which demands doubled sentences for second-time felons and 25 years to life for three-time losers, even the nonviolent.

Unless its changed, that law will soon see California prisons operating the worlds largest geriatric hospital system, with many thousands of convicts staying long after theyre a threat to anyone at a cost topping $100,000 per year for a typical inmate with chronic illness.

But even in the current budget morass, neither Gov. Arnold Schwarzenegger nor any state legislative leader has looked to either prison reform or sentencing changes as part of a budget solution.

Thats what we get with sacred cows.

Editorial: Spending this much money on prisons is a real crime

By THE VOICE OF AURORA
The Aurora Sentinel

Published: Sunday, December 28, 2008 11:02 AM MST

Colorado’s current budget woes present a lot of difficult questions that must be resolved with what are sure to be even more difficult answers — all except for one.

It’s unclear yet whether the state will face a relatively painless shortage of about $70 million next year in trying to fund an expected $7.8 billion in needs and services, or whether more dire projects are accurate and Colorado must find a way to trim more than $600 million from it’s budget.

Either way, anyone who’s spent much time watching the creation of the state’s “long bill,” which is the in essence the state’s annual budget, knows that what actually survives the cuts are only the most needed state services. While there may be some ways to squeeze some savings in line items by increasing productivity, for the most part, Colorado runs a lean system. It’s one that’s become too lean in many areas. The state seriously underfunds programs that save Colorado taxpayers in the long run, such as programs to educate Colorado’s poor children and ensure they are mentally and physically well. No study or analysis disputes that funding such programs prevents the government from spending more on those same children later in forms of other social services, corrections or myriad public assistance programs.

And one of the biggest recipients in the state budget for disregarding those tried and true facts is the Colorado Department of Corrections. If you haven’t given the state’s prison department much thought as news of the dismal economy and growing budget shortages hogs the headlines, you should.

Colorado’s prison system accounts for almost 10 percent of the state’s annual budget, a number that has been steadily growing for years. This year, your tax dollars are paying to keep about 24,000 men and women behind bars at the cost of nearly $30,000 a year each. Compare that with the $6,000 or so the state spends on each Colorado child to provide them with a public education.

Here’s the bad-news, good-news: almost half of these men and women are imprisoned because of drug habits, alcoholism, conspiracy or other non-violent offenses. We’re not suggesting that people don’t need to be policed and punished for violating laws, but study after study shows that by first preventing people from becoming mentally ill, drug addicts or alcoholics, taxpayers save big by having those future cell mates be productive, taxpaying citizens.

More to the point in Colorado right now, those non-violent offenders who are being housed in prisons mainly because of mental illness or drug problems are running up huge taxpayer tabs.

Certainly, Colorado will struggle by cutting into almost every aspect of the state budget. The state, however, will only benefit by reducing the number of people it must house each year in prisons.

State officials should look closely at finding treatment programs for those convicted solely of non-violent drug crimes and find inexpensive drug treatment programs for these people who could easily being paying taxes instead of being the recipient of them.

Wyoming sees benefits in new prison garment shop

By MATT JOYCE

Associated Press Writer

Dec 30th, 2008 | RAWLINS, Wyo. — Richard Edwards hunched over a sewing machine and stitched a pocket onto a new shirt, one of many to pass through his hands on a recent workday.

The 64-year-old has become a skilled tailor from his years in the trade — all of which came during his imprisonment at the Wyoming State Penitentiary.

Edwards is one of 27 inmates employed in the prison’s expanded garment factory. The Department of Corrections opened the new 7,800-square- foot shop last month with the goal of putting more inmates to work and making the state’s prison industries self-sustaining.

“It doesn’t matter to me whether I’m in here or not — I’ve always had a need to be productive,” said Edwards, serving two life sentences for a 1996 conviction of second-degree murder. “Because I ain’t ever going to leave here, I’m going to be as productive as I can be until my health won’t let me.”

Corrections officials say they’re committed to providing work opportunities for inmates, both “lifers” like Edwards and shorter-term inmates who will need job skills and a good work ethic to build a new life when they’re released.

“Ninety-seven percent of inmates will eventually return to the streets,” said Michael J. Murphy, warden at the Rawlins prison. “We know that those inmates who are released from prison with a marketable skill and are able to get and keep a job are far less likely to go back to prison than those who don’t have those things. For the others, we need to give them a reason to get up in the morning.”

The Corrections Department started construction on the $4.2 million building in late 2004 and finished in July, spokeswoman Melinda Brazzale said. Along with the garment shop, the 18,000-square- foot building is home to a woodworking shop, which is not yet open, and classroom space.

Garment Supervisor Steve Gibson said his goal is employ up to 60 inmates per shift at the garment factory and to start a second shift within two years.

The new shop is a 10-fold expansion of a smaller garment shop the penitentiary opened in 2006, Gibson said. The shop makes products ranging from bed linens to fleece jackets and kitchen wear. The bulk of its work is clothing for the state’s correctional institutions, and department uniforms. It also does some contract work for private businesses.

Jobs at the garment factory don’t come easily. Gibson said he handles hiring as he would outside of the prison. Employees must have at least a General Equivalency Diploma, which can be earned through classes at the prison. Applicants go through an interview process, and new hires are placed on a 90-day probationary period, he said.

“Because of industries coming in and requiring it, there’s more applications for the education program for inmates to get their GEDs,” Gibson said.

Once they’re hired, the inmates’ pay depends on their skill level. Inmates who work on jobs specifically for state institutions are paid $30 to $90 a month. Inmates who work on contract jobs for private companies make $5.85 to $14 an hour under a federal program called the Prison Industries Enhancement Certification Program.

The inmates receive 20 percent of their pay and 15 percent is placed in a mandatory savings account, Gibson said. The remainder is split among child support payments, fines and restitution, a crime victims’ relief fund and prison operations.

Currently, 37 state and 4 county-based certified correctional industry programs operate in the United States, according to the Bureau of Justice Assistance.

Wyoming corrections officials say the garment shop is part of a larger effort to increase training for prisoners around the state. The state penitentiary is also home to a print shop. At the Wyoming Women’s Center in Lusk, inmates operate a tilapia fish farm and a commercial laundry facility. At the Honor Farm in Riverton, inmates build modular homes for use as part of an affordable housing program.

When it authorized the prison industries program, the Wyoming Legislature set a deadline for the program to become self-sustaining by June 30, 2010. Bil Carter, the DOC’s industries manager, said that means the industries should be supporting their own operations and bringing in enough revenue to cover managers’ pay.

“I’m encouraged,” Carter said. “We’re committed to getting it done.”

At the Rawlins penitentiary, the garment shop is gearing up to make thousands of items to outfit the new state prison in Torrington, which is scheduled to open in 2010. Gibson is working to hire more inmates, and old-timers like Edwards are prepared to teach them how to make clothes.

“When you see somebody accomplish something like that and learn something — that spark of excitement they have — a lot of us old hands can see that, and that makes everything worthwhile,” Edwards said.

States Demand More Evidence that Treatment Works

States Demand More Evidence that Treatment Works

Spending on addiction treatment now tops $20 billion annually and could grow with the passage of the federal parity law, but more funders are pressing treatment programs to move beyond shaky claims of success and prove that they work.

The New York Times reported Dec. 23 that few treatment programs have evidence to prove their effectiveness: private programs generally don’t allow outside evaluation, while publicly funded programs spend their money on providing services, not conducting studies.

Moreover, the addiction treatment field lacks standard measures of success.

“What we have in this country is a washing-machine model of addiction treatment,” said A. Thomas McClellan, CEO of the Treatment Research Institute. “You go to Shady Acres for 30 days, or to some clinic for 60 visits or 60 doses, whatever it is. And then you’re discharged and everyone’s crying and hugging and feeling proud –  and you’re supposed to be cured … It doesn’t really matter if you’re a movie star going to some resort by the sea or a homeless person. The system doesn’t work well for what for many people is a chronic, recurring problem.”

However, states like Oregon, Delaware, and North Carolina are beginning to demand that grantees use evidence-based practices and increase accountability. A 2003 Oregon law, for example, sought to increase use of interventions like naltrexone for alcohol dependence, buprenorphine for opiate addiction, motivational interviewing for incoming treatment patients, and cognitive behavior therapy.

More than half of Oregon’s treatment budget now goes to programs that use evidence-based practices. “Before the mandate, most programs had some evidence-based practices, and since then there has been a lot more interest and awareness of them,” said researcher Traci Rieckmann of Oregon Health and Science University.

However, Rieckmann said that some programs that claim to use evidence-based treatment may not be doing so, or implementing programs correctly. Many smaller programs, for example, don’t have an M.D. on staff, so they can’t prescribe medications like naltrexone. True reform will only come when patients are tracked throughout the treatment process to ensure that goals — clearly defined beforehand — are met, experts said.

The Oregon experience also has resulted in a culture clash between researchers and other backers of standardized interventions and counselors used to doing things their own way. Some experts say that there needs to be a place for “practice-based evidence” as the treatment system is reformed.

“I’m a counselor, and I’d be defensive, too: ‘What do you mean, all this stuff I’ve been doing my entire life is wrong?’ ” said Brian Serna, director of outpatient services at the Adapt treatment program. “So the challenge is to build a bridge between what the science says is effective and what people are already doing.”

San Jose judge runs unique courts for drug-addicted and mentally ill

By Howard Mintz

Mercury News

Posted: 12/29/2008 12:01:00 AM PST

In Santa Clara County Superior Court Judge Stephen Manley’s chaotic courtroom, the bulletin board tells the story.

The thank-you notes. The crayon drawings from grateful children. The Polaroids of former defendants who’ve regained the ability to smile.

They are all telltale signs seldom found elsewhere in the local criminal justice system, where drama and sorrow ordinarily drown out the kind of hope Manley sells inside his courtroom every day. Manley believes in reclamation projects, and he sees hundreds of them each year as he runs one of the most unique courtrooms in California for defendants facing drug addiction and mental illness.

Those defendants, when they succeed in Manley’s program, never forget the judge. And his bulletin board illustrates why he’s become one of the state’s leading judicial experts on rehabilitating convicts instead of cycling them through the prison system.

“I never find it depressing,” said the 67-year-old judge during a recent interview in his chambers. “Every day I see something I haven’t seen before, I see people do something they didn’t think they could do.”

Manley, his signature black patch over his permanently injured left eye, has become a local institution. More than a decade ago, he established groundbreaking specialty courts to serve drug and alcohol-addicted inmates, as well as for those also suffering from mental illness. He has secured millions of dollars in state and federal money to

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spread the programs across California, earning him a special award this fall from Chief Justice Ronald George. He’s about to unveil another special court for veterans, anticipating an influx of defendants suffering unique problems after serving in Iraq and Afghanistan.

He has crisscrossed the state and country, serving as an expert on how to treat defendants stuck in the system because of mental illness and drug abuse. He “graduates” hundreds of defendants each year who succeed in getting their lives in order through drug and mental health treatment, allowing them to avoid more prison time if they meet his rigorous test for success. For addicts facing criminal charges, Manley offers a tough choice — stick with treatment and steer clear of trouble or go back to jail.

“The thing about these courts is Judge Manley having such a huge heart,” said Nona Klippen Hughes, an assistant public defender who supervises lawyers in Manley’s court. “It’s a rare occasion when you have to worry that your client is not going to get the best thing possible.”

On a typical day in Manley’s courtroom, the atmosphere is different from any other corner of the justice system. Ordinary courtroom formalities are nowhere to be found. Defendants chat directly with the judge, who pores over their files with a frequent pause to tell them, “You are doing great!” Each case eventually shifts to a therapy session.

“Alex,” appearing on the judge’s mental health calendar, is getting praise for his treatment program, assuring Manley he’s taking his medication. When he tells the judge he’s playing piano, Manley nearly erupts: “I didn’t know you play the piano!”

As the judge is ready to move to the next case, he points to the ever-present bowl of candy on the defense table. “Have some candy,” he tells Alex. And then the crucial moment for every defendant — everyone in the courtroom, from defendants in county jail garb to sheriffs deputies, applauds, the punctuation mark on any case headed toward success.

“I prosecuted serious offenders most of my career,” said Deputy District Attorney George Chadwick, who sits in the witness box in Manley’s court, serving as the judge’s prosecutorial ear on whether defendants are keeping out of trouble. “I’m very surprised how much I’ve learned about how effective this program is.”

Manley admits he was a “traditional judge” before he launched a drug court in the mid-1990s. An appointee of former Gov. Jerry Brown, he started his career with the usual diet of criminal cases, from routine arraignments to felony trials. But after starting to see the same faces in his court, or in some instances their children, he decided he wanted to get in the business of “changing outcomes.”

He is not, he insists, soft on crime and, in fact, believes jail time is needed to get defendants to buy into treatment to get clean and sober. He initially opposed Proposition 36, which mandates treatment instead of jail for nonviolent first-time drug offenders.

“The idea this is some sort of soft on crime program is nonsense,” Manley said. “It’s harder to do this than go to jail or prison.”

With his courts now herding 1,600 defendants through his programs each year, the judge calls the current budget crunch “an opportunity to be creative.” He sticks to his own mantra, the one he preaches to the dozens of defendants who crowd into his court Thursday afternoons and Friday mornings.

In simple letters, on the courtroom door, a sign reads. “One day at a time.”

a local institution

NAME: Stephen Manley
OCCUPATION: Santa Clara County Superior Court judge
AGE: 67
BACKGROUND: Superior Court judge since 1998. Previously Municipal Court judge, first appointed to the Santa Clara County bench in 1977 by former Gov. Jerry Brown. Staff and directing attorney for Community Legal Services in San Jose from 1966 to 1977.
EDUCATION: Law degree from Stanford University and bachelor”s degree in behavorial sciences from the University of California- Berkeley.
PERSONAL: Palo Alto resident is married with four children. He has been a referee and coach in the Peninsula Soccer League.

Arsenic levels too high in Kern Valley State Prison’s drinking water

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Barbara Davidson / Los Angeles Times

NO CHOICE: Kern Valley State Prison inmates drink tap water. Officials made filtration plans, then scrapped them.

Three years past deadline, California has no solid plan to reduce the arsenic, which has been linked to cancer. Officials spent money to design a filtration plant and then decided not to build it.

By Michael Rothfeld

December 29, 2008

Reporting from Delano — Beside a field of rolling tumbleweed in this remote Central Valley town, the state opened its newest prison in 2005 with a modern design, cutting-edge security features and a serious environmental problem.

The drinking water pumped from two wells at Kern Valley State Prison contained arsenic, a known cause of cancer, in amounts far higher than a federal safety standard soon to take effect.

Yet today, nearly three years after missing the government’s deadline to reduce the arsenic levels, the state has no concrete plans or funding to do so. Officials spent $629,000 to design a filtration system and then decided not to build it, while neglecting to inform staff and inmates that they were consuming contaminated water.

After the prison finally posted notices last April on orders from the state Department of Public Health, the inmates continued drinking the water, under protest.

“We have no choice,” said Larry Tillman, 38, who was serving time for burglary. “We should at the very least receive bottled water, or truck in water from another city.”

Most correctional officers at Kern Valley State Prison take bottled water to work — some say they prefer it anyway — but administrators created a form letter to reject requests for alternative water from some of the 4,800 inmates. The administrators say the health hazard from arsenic, a chemical used in industry and farming, is insignificant, and they promise to filter the water some time in the next few years.

“It’s not that major of an issue,” said Kelly Harrington, the prison’s new warden.

But long-term exposure to arsenic, common in Central Valley communities, has been linked to cancer of the lungs, skin, kidneys, liver and bladder and to other maladies.

The situation, critics say, is emblematic of the short-sighted planning and creeping pace of the mammoth prison bureaucracy as it struggles to house 170,000 of California’s most undesired residents.

The state has placed many of its lockups far from major cities, in rural areas with nothing as far as the eye can see, where they are embraced by residents desperate for jobs and commerce. But officials have sometimes ignored health threats endemic to these regions.

Between 1987 and 1994, the state built four prisons in a part of the Central Valley known as a hotbed of valley fever, a sometimes severe infection that usually affects the lungs. Health experts estimate that the state has spent millions to treat inmates for the disease, spawned by a fungus in desert soil.

In 2007, the year after five inmates died from valley fever, the state proposed expanding five prisons in the Central Valley but later backed off on two of the sites. One proposed expansion site, Pleasant Valley State Prison in Coalinga, had an outbreak that sickened 520 prisoners in 2006. A Fresno County grand jury concluded last year that the prison, built in 1994, should not have been put there.

At the California Institution for Women in Chino, the state has been buying bottled water for prisoners for five years — at a current annual cost of $480,000 — because of nitrate levels that violate federal standards in the water supply to the facility and to the nearby California Institution for Men. Nitrates, which are chemical compounds that often get into soil from fertilizer and manure, can cause a blood disorder in fetuses and infants.

Chino-area municipalities have built systems to filter their own water, and the state hopes to complete a similar project a year from now for both the women’s and men’s prisons. But Chino Mayor Dennis Yates, who says sewage from the men’s prison has long polluted the Santa Ana River, is skeptical of state officials’ competence.

“Even if you do give them money, they don’t do anything,” Yates said. “It’s just a huge, bloated bureaucracy.”

In 2001, four years before Kern Valley prison opened, the U.S. Environmental Protection Agency ordered a reduction in the maximum level of arsenic in drinking water from 50 parts per billion to 10. Water suppliers had until Jan. 23, 2006, to meet the new standard. Recent testing has shown the arsenic level in one prison well at 23 parts per billion and the other at 15.

One day this month, in a low-slung white building with blue doors known as Facility C, prisoners bunking in a crowded gymnasium drank from the water fountain and used water from the sinks to make their soup. Some newcomers said they had not been told about the contamination upon arrival at the prison.

“I just came from an institution where the water was just atrocious, definitely foul,” said Ramon Diaz, 25, who had three years remaining on a sentence for drug dealing. “This to me is like spring water here, and you come to find out that it’s not the way it should be, either.”

Corrections Department officials said they could not explain why a filtration system was not included in the prison’s design because most of the employees who worked on it had since left. Later, the agency developed plans to add a filtration plant. It obtained $2.5 million from lawmakers for that purpose in 2006.

But planners abandoned the idea, electing instead to incorporate the project into an overall prison expansion approved by lawmakers. Flaws in the legislation have postponed the expansion indefinitely.

State project manager Gary Lewis said the filtration plant is in the “conceptual study phase.”

This year the EPA has ordered 11 California water systems to reduce excessive arsenic levels. One was the city of Delano, which serves the North Kern State Prison, a few miles from Kern Valley prison. On Dec. 12, after inquiries by The Times, the state public health department ordered Kern Valley State Prison to come up with a plan by February to comply with the arsenic law.

The prison’s chief medical officer, Dr. Sherry Lopez, said there was no immediate danger from the lockup’s water, based on an e-mail she received in April from a poison-control expert who said arsenic is “much more a regulatory problem than a public health problem.”

“It kind of reassured me and everybody else here that everything is OK,” Lopez said.

But Dr. Gina Solomon, a scientist at the Natural Resources Defense Council, an environmental advocacy group, said that the law is important and that disempowered populations, such as prisoners and poor rural workers, often suffer because of lax enforcement.

“The standard was set for a reason, and the reason is that arsenic is known to cause cancer in humans,” she said. “So the clock is ticking. The longer that people are drinking the water, the higher the risk.”

Many of Kern Valley’s prisoners are serving life terms, but even those with shorter stints are worried.

“It’s definitely a concern for us if there’s an abundance of arsenic in the water and we’re ingesting that,” said Dylan Littlefield, 36, an inmate from Hollywood with five years remaining for attempted robbery and drug dealing. “Who knows if we’re going to be treated properly?”

The healthcare system in the state’s prisons has been turned over to a federal receiver by a judge who said substandard treatment has caused many needless deaths behind bars. The receiver, J. Clark Kelso, was not alerted to the arsenic problem by the state, his top aide said.

“We’re concerned about the potential health risks and we have to look into it,” said John Hagar, the receiver’s chief of staff. “Constructing facilities that are inadequate from the beginning is unfortunately part of a long-standing trend with the Department of Corrections, so I’m not surprised.”