California prison mental health care workers are practicing “defensive medicine” and overmedicating their patients with psychotropic medications. Fear of triggering a lawsuit or federal court order drives the practice, admits a former top prison official.

An Associated Press report found spending on psychotropic drugs in California prisons greatly exceeds that of other large prison systems. According to the APs figures, nearly 20% of the $144.5 million California spent on all prison pharmaceuticals in 2012 went for anti-psychotic drugs.

The mental health care system in California prisons has been under federal court oversight for two decades. In 2009, J. Clark Kelso, the federal court-appointed receiver, raised the alarm on the excess use of psychotropic drugs. He found that in 2008 anti-psychotic drugs accounted for 34 percent of all prison pharmaceutical spending.

 “Why are all these people on meds?” asked Kelso. “A lot of it, I think, we overprescribe on mental health. Anybody who comes in on mental health [referrals], we put on a psychotropic.”

Of the nearly 133,000 prisoners in California, more than 32,000 receive mental health care. Fear drives most of them to be treated with drugs.

 “One of the concerns that our staff always have, if we take someone off the caseload because we don’t think they ought be on there anymore, and anything goes wrong, then we get clobbered,” said Sharon Aungst, former chief deputy secretary for the California Department of Corrections and Rehabilitation (CDOCR) Division of Health Care Services. “So we are playing defensive medicine quite a bit, and it’s so much safer for our staff, because they’re risk averse, to keep them on the caseload and continue to treat even if we’re not so sure that’s absolutely necessary.”

In at least one case, the “risk averse” method of overmedicating prisoners resulted in causing exactly what it was intended to prevent: a death and a lawsuit.

Prisoner Joseph Sullivan, 26, was found hanging by a bed sheet at Chuckawalla Valley State Prison. He had been prescribed the psychotropic drug, Olanzapine, which goes by the trade name Zyprexa. An autopsy showed Sullivan had nearly double the maximum therapeutic amount of Zyprexa in his system. According to the autopsy, the combination Zyprexa, high temperatures, and isolation in his prison cell probably drove him “to hopelessness and despair.”

 “Joseph was put on psychotropic drugs for no good reason” said Sullivan family attorney, David Springfield. Fellow prisoners and a medical expert said that Sullivan exhibit no sign of suicidal ideation prior to taking the drug. Three years after his death in 2009, his family won a lawsuit in his death that resulted in a $475,000 settlement.

Overprescribing of medication became so rampant in California, that in 2011 the state legislature passed a bill that prevents prisoners be prescribed psychotropic without their informed consent. That same year, attorney Ken Karan won a court order that prevented the forced administration of psychotropic drugs to his prisoner client.

 “My feeling is that being used as a disciplinary measure, as a way to control people who are not institutional type of people,” said Karan. “One way to make them comply is to pump them up with dangerous drugs.”

Whatever the real purpose may be, the facts show California prisons administer psychotropic drugs at a higher level than other state prison systems. Pharmaceutical drugs spending on psychotropic drugs were 34% in 2008 and about 26% in 2009-2011. It dropped to about 19% in 2011-2012.

By comparison, when California spending was 26%, New York spent 17% of its drug budget on psychotropic. Texas and Florida follow California at the top of the list for the largest prison systems, but they spend only 6% and 3%, respectively, on psychotropic in 2012-2013.

A 2012 report by California’s Legislative Analysts’ Office found that the state spent about $1,500 annually on psychotropic drugs for each prisoner receiving mental health care. Meanwhile, Florida, Georgia, New Jersey, Ohio, and Pennsylvania averaged about $610 annually per prisoner.

Despite these facts, California prison officials still deny there is a problem. “While we do not have data to support the assertion of over-prescribing as an indication of defensive medicine, it is a possibility that we must guard against with appropriate checks and balances,” wrote CDOCR chief psychiatrist Dr. Karen Higgins in an email.

Source: Associated Press

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