10

Street
Post Office Box 11
Columbia South Carolina
Re: South Carolina Department of Corrections
Camille Graham Correctional Institution
Dear Mr. Westbrook
During August 23, 24, 20 I 0, we site visited the Camille Graham Correctional Institution along
with Steve Martin, Esq., Alan Pogue, and Steve Carter. We received a tour of general population
housing units, programming areas (e.g. educational building, gym, dining area etc.), medical unit
and the Special Management Unit (SMU).
The total inmate count during August 23, 20 I 0 was 562 inmates, \vhich included 124 Reception
and Evaluation (R&E) inmates, 41 Special Management Unit inmates and 76 inmates in the Blue
Ridge housing units.
During the moming of August 23, 2010, \ve toured the physical plant of the Camille Graham
Correctional Institution. We visited the following units:
1. administration building,
medical building,
3. library/gymnasium,
4. Whitney housing units (A&B),
5. Blue Ridge housing units (C&D),

Institution

not a mental

with a count
had bunked
There were
camera cells located in Blue Ridge D.
cubicles. The count was

llV,*JH"li:.

Seventy-five (75)
were enrolled in programs within the educational building (primarily
word processing! computer skills). The Apparel workshop currently employed 65 inmates (nonpaying jobs) and had a capacity of 79 inmates. Inmates worked four lO-hour days per week. The
welding program has a capacity
15 inmates and we were informed that the shop has had 11 to
15 inmates for the past eight months.
R&E inmates went to the dining hall three times per day and had access to the gym on a 5-day
per week basis and had access to showers on a 3 times per week basis. There were 2 tiers with 24
cells on each side of the housing unit for a total of 96 cells. It was common for many of these
double bunked designed cells to be triple bunked with one inmate on the Hoor. It generally took
7 days tor R&E inmates to receive a PIN number tor telephone purposes. They did not have
access to a radio or TV.
There were 4 crisis cells for oved10w purposes located in the R&E. SMU overflow inmates were
also housed on the lower tier of R&E. A correctional of1icer and a supervisor staffed the R&E
unit along with one CO in the control booth, who also staffed the SMU portion of the building.
to be between 30-45
The average length of stay in the R&E unit was reported by Major
days.
The SMU side of the building was also two tiers with a total of96 cells. Four of these cells were
also camera cells that were used for crisis intervention purposes. Two COs and one supervisor
this unit along with the previously referenced CO in the control booth. Inmates did not
on this unit.
to the recreational area was 5 times per
10
at
same

Site
Re: Camille Graham
3 8

Institution

frequently run out
when
inmates ,."'r'Ar1r~rt
restriction
including
are taken
They also have no visitation, no telephone access,
no canteen
except for personal items.
or nine of these inmates reported they had previous or current
dHlLgnOSt~S of PTSD, however none have had a group focused on the treatment and management
ofPTSD.
Another group interview was conducted with five women from the Shock Boot Camp. This
Boot Camp was described as a 90-day to 10-month program tor young women between the ages
of 17 to
as a Youth Offender program. These women reported that they have clinical
counselors who may talk with them one time per month. They all reported they felt a need to
have a mental health counselor as all five were on the mental health caseload and were
prescribed medication by Dr.
These inmates reported diagnoses of schizoaffective
disorder, bipolar, schizophrenic, PTSD, post-partum depression, and depression. They reported
they are in no mental health groups. They also reported they have treatment plans that include
their getting their GEDs and participating in NA or AA groups. These treatment plans were
signed by the inmates. They report there are no treatment team meetings where they are able to
discuss their treatment plans with statf prior to or after their development. They also reported
there is a lack of confidentiality as officers tell each other about the comments or issues that are
raised by these women in the Shock Boot Camp program.
Psychiatric coverage has been provided by
M.D. She is on site for eight hours
every Thursday and an additional two days (12 hours per day) per month tor a total of 56 hours
of psychiatric coverage (i.e., 0.35 FTE) per month. The mental health caseload was over 200
inmates at Graham CI and did not include caseload inmates treated by Dr.
at Graham
CI who are from Leath CI.
Appendix I

inmates in

Special Management

at

1.
2,
3,
4,

lack of participation by the psychiatrist the treatment team
lack routine participation by the psychiatrist in crisis cell management of inmates,
access problems to the psychiatrist by inmates, and
lack of timely follow-up clinical contacts by the psychiatrist.

The use of crisis cells in the SMU and R & E housing units are very problematic and directly
contribute to the following issues:
1, lack of a therapeutic milieu in the crisis cells,
2, lack of meaningful crisis interventions (Le" therapy/counseling), and
3, creation of a punitive environment in response to inmates experiencing a mental
health crisis,
4, The custody officer starting in the SMU and R&E appears to be inadequate. A
correctional otlicer and supervisor staff the R&E unit along with one CO in the
control booth who also staif the SMU portion of the building, There are cameras
utilized for observation in the CI cells which are monitored by a single correctional
officer in the control booth. This is inadequate monitoring.

These problems are exacerbated by the following:
1. excessive property restrictions (e,g" lack of a mattress),
clinical "interventions" performed at the cell front resulting in lack of confidentiality,
3, the punitive
inherent in the SMU setting, and
a treatment team concept.

without

ill

inmates with a mental
a severe
that is associated with
treatment available is essentially limited to medication management
a mental health clinician at the cellfront. Many of the mental health case load
social skill deficits,
management issues and cognitive distortions
that require a
structured psychosocial rehabilitation approach tor etlective management,
which is not accomplished via cell front monitoring. It is not very surprising that some of these
inmates have had extended stays in the SMU despite initially having short sentences in the SMU
related to these deticits and the punitive milieu of the SMU.
The treatment plans were very generic in nature and did not appear to have been individualized
or modified based on the inmate's clinical presentation. The paucity of positive reinforcements
and abundance of negative reinforcements have contributed to a very poor treatment milieu
within the SMU.
In addition, there appeared to be very little coordination and communication
between the psychiatrists and the other mental health clinicians as evidenced by the following
testimony given by
M.D.:

Q. Do you provide individual therapy to your patients?
A. I would say that I do provide supportive therapy for some of my patients, yes.

Q. All right. And how is that ditlerent from their individual therapy provided by
counselors?
A. I don't know. I don't know exactly what they do.
In addition, there appears to be an overemphasis by the clinical staff on focusing solely on an
inmate's personality disorder in contrast to recognizing other Axis I issues such as posttraumatic
stress disorder, afIective disorders and psychotic disorders. Some initial Axis I disorders
appeared to have been "dropped" by the psychiatrist without adequate documentation re: the
rationale tor such a

Site Assessment
Re: Camille Graham Correctional Institution
Page 6 of8

Please contact us if you have questions re: this report.
Sincereiy.

Jeffrey L. Metzner, M.D.

Raymond F. Patterson, M.D.

PLT.ll02

Site
Re:

Appendix I

Institution

Appendix II

Percentage

in General Population and in Segregation at Graham
2007-2009 1
% Mlof

TotalIMs in

MIIMs in

% Mlof

Total

Seg

Seg

Total

45%
48%
_.42%
46%
45%
45%
42%

22
18
15
23
31
28
19
21
31
16
37
39
32
23
29
27
28
39
40
48
28

9
8
9

41%

44%
42%
45%

13
16
18

11
11
17
6
23
21
15

11
15

13
15
21
23
25
15

t~,§eg

440/0
60%
56%
52%
64%
58%
52%
55%
37%
62%
54%
47%
48%
52%
48%
54%
54%
57%
52%
54%

the number of MI in total population were taken from 6875-000-009 thm 028. The total number of imnates
were taken from 6875-000-167.

Appendix II
Camille Graham Correctional Institution
Inmate Interviews

1. Inmate I
Inmate 1 was a 20-year-old woman who has been incarcerated in SCDC for about one year
related to a homicide conviction (her 6 month old daughter). She was diagnosed by Dr.
as having a postpartum depression.
This was her second placement in the SMU. Her first placement was for an alleged assault
which resulted in a 30 day stay. After being released for three days she was transferred back to
SMU for 10 days due to having a new tattoo.
Inmate 1 indicated that she has seen Dr.
on about three or four occaSIOns for
medication management. She has been prescribed lithium for about 2.5 months following
unsuccessful trials of Zoloft, Celexa and BuSpar. She reported having blood drawn for the first
three weeks following initiation of lithium. Inmate 1 stated that none of these medications have
helped her mood swings. Periodically tee ling very good with racing thoughts was described
although other manic symptoms did not appear to be present.
This inmate indicated that she has an assigned counselor but has only met with the counselor on
one occasion during her time in the SMU. Her first counselor no longer works at Graham CL
This inmate will return to Blue Ridge C following discharge from the SMU. She stated that a
variety of different group therapies were available within that unit. She has participated in the
past in dream group.
There was not a history
13

mental health treatment prior to her arrest
to Clnr",,'?'"

t>Vi',pnt

for a brief period

Appendix II

Remeron

to

She was

to Dr.
as

Dr.

a mental health counselor noted that she was medication
During September
noncompliant. The plan was to see her in 90 days or as needed. Inmate 1 was again seen by Dr.
,during November 1,2009. Zoloft was discontinued and BuSpar started.
A treatment team summary note was written during December 11, 2009. The psychiatrist did not
attend this meeting.
Dr.
again saw this inmate during December 31, 2009. A trial of Celexa was started
and BuSpar apparently discontinued.
During February 22, 2010 this inmate was placed on crisis intervention status related to suicidal
thinking. She was noncompliant with medications. During February 25, 2010, while still on
crisis cell status, she was referred to the psychiatrist.
evaluated this inmate two days later.
Dr.
recommended for release from crisis intervention by
2010.
During March 1 L 2010 Dr.
disorder NOS with borderline features.

Celexa was discontinued. She was
CCC IV, during March 1,

indicated that this inmate's diagnosis was personality

This inmate askcd to be removed from the mental health roster during June 7, 2010. A referral to
the psychiatrist was made at that time.
lithium was initiated during June 10,2010.

11

Inmates

2. Inmate 2
Inmate 2 is a 29-year-old separated African American woman who
been incarcerated for the
third time in SCDC for the past three years. She spent her first two years of incarceration at
Leath CI and has been at Graham CI for the past nine months related to, according to this inmate,
a separation petition from a correctional officer who had been assaulted by this inmate via
spitting.

This inmate's tIve-year sentence for breach of trust will be maxed out during July 1, 2011. She
reported that she has SMU time through 2012. Related to her SMU time, she has lost canteen,
visitation and telephone privileges through 2020. Inmate 2 will be living with her mother and
four children (ages five, six, to, 14 years) upon her release. It was unclear to her the current
status of her relationship with her husband, who is a father of two of her children.
Mental health treatment was reported by Inmate 2 to have primarily consisted of medication
management for "panic attacks, problems sleeping [and] nightmares." Medication trials of
Triavil, Wellbutrin, Vistaril, Remeron, and Seroquel were reported by Inmate 2. She stated that
Remeron had been helpful but was discontinued after she was found to be hoarding pills. Inmate
2 is currently prescribed Haldol, which was described as not being helpful.
This inmate received an additional one year sentence in SMU related to a hoarding charge as
well as loss of visitation and telephone privileges as previously described. She stated that the
warden from Leath CI told the warden at Graham CI not to suspend any of her SMU sentence.
Inmate 2
told
Dr.
that
will only receive medications that are
in liquid form. Inmate 2 complained that other inmates with similar hoarding charges

was

to

most

10 treatment plan
NOS
as well as a personality disorder NOS vvith antisocial and borderline
The interventions described were generic nature.
The AMR of this inmate was reviewed, which provided a different history than obtained from
her. An October 1 2009 progress note indicated that this inmate made it very clear that she
wanted to be transferred from Leath CI due to her difficulties with Sgt.
The mental health
counselor thought she would function better at Graham CI. Follovving transfer to Graham CI,
she requested a mental health counselor be assigned to her during November 16,2009. She was
initially seen by
HSC I during November 23, 2009. Her presentation was
consistent with a depressive disorder NOS and an anxiety disorder NOS.
Dr.
initially evaluated this inmate during December 3, 2009. She was diagnosed as
having a personality disorder NOS with antisocial and borderline features (severe) and a
depressive disorder NOS. Medications prescribed included Remeron, BuSpar and Triavil.
A January 11, 2010 SMU review note indicated that this inmate was excited that she had been
able to call her mother and children on Christmas day, which was the tirst time she had talked
with them in 2.5 years.
During January 14, 2010 Inmate 2 was found to be hoarding medications. The registered nurse
indicated that all her medications would be discontinued. Five days later this inmate was
requesting to be placed back on psychotropic medications. She was subsequently referred to the
during January 20, 2010. She was again referred to the psychiatrist
psychiatrist by Ms. .
for similar reasons during Febmary 1, 2010.

I

of

as
10 and

was noted to

medication compliant

Her report that security would not allow reduction of her disciplinary time was accurate.

Assessment: There were several problematic aspects of the treatment provided to this inmate
which included the following:
1. a generic treatment plan,
lack of attendance by the psychiatrist at the treatment team meeting,
3. untimely responses to referrals to the psychiatrist,
4. lack of timely psychiatric follow-up,
5. apparent discontinuation of medication by a nurse without an physician order, and
6. lack of referral to the psychiatrist related to medication noncompliance.

It is very concerning that this inmate is scheduled to be discharged from the SMU back to the
streets and that her phone calls and visitation privileges have been lost The impact on her
relationship with her children appears to be of little concern to relevant decision makers in this
context It is concerning that the treatment plan does not include the potential for regaining such
privileges based on her behavior.

3. Inmate 3
Inmate 3 is a 23-year-old single African-American woman who has been incarcerated since 2008
and is currently serving a 30 year sentence. She has been in the SMU for 11 months with her
SMU sentence
during September
2010. Her initial sentence to SMU was for 90 days
related to
an inmate. She
received subsequent SMU time related to threatening an

to

11

as

<"'"'l"'~J'-l,'U

p,erSOntlllt

borderline

severe.
were

Inmate 3 has had at least
intervention placements
past six months. She
indicated that she does not receive a mattress when housed in a crisis intervention cell.
The hard copy of this inmate's health care record was reviewed. It appears that
to Graham CI during March 26, 2008.

was admitted

Treatment plans (6/15/09, 12/03/09, 6/0911 0) were identical. For example, the approaches
related to her symptoms of PTSD (which was not diagnosed) indicated the following:
"counseling monthly, quarterly or as needed, quarterly psych evaluations or as needed,
medication, if needed, monitoring of medication record, attending Anger Management Group
and Impulse Control, Social Skills (West) once released from lockup.
The above approach was for the following problem: "inmate reports experiencing nightmares,
tlashbacks and the voice of the victim related to her crime, recurring thoughts and anger about
childhood sexual abuse."
Records from Palmetto Health Richland were present in the chart. Diagnoses during 1999
included substance-abuse, adjustment disorder with disturbance of mood and conduct and rule
out conduct disorder. Similar diagnoses were made during 2002.
The AMR of this inmate was reviewed.
N.P. evaluated this inmate during April
1 2008. She was prescribed Thorazine for psychosis and Celexa for depression. Her
differential diagnosis included chronic PTSD and psychosis NOS versus schizophrenia. She was
noted
the mental health counselor tour days later to be noncompliant with medications.

lIlI

of Inmates

were noted to

NOS,

disorder and

was
by
Brown during June 18, 2008. Dr.
2008 that her record review confirmed the presence of a personality
June
2008
referred this inmate to Dr.
during July
medication review at the patient's request.
She was seen by Dr. '
during Janet July 26, 2008. She reported the presence of auditory
and visual hallucinations. She was diagnosed as having a severe personality disorder and
malingering psychotic symptoms. Low-dose psychotropic medications vvere prescribed for
anger control purposes.
Dr.
again saw this inmate during October 12, 2008. Her diagnosis was unchanged.
She increased Navane to 4 mg po t.i.d.
This inmate was being followed on a fairly regular basis by her mental health clinician. During
March 2009 she was referred to the psychiatrist.
She was placed on crisis cell status during April 2, 2009.
She was reminded b y , HSC I during May 18, 2009 that "the psychiatrist wants
her to be seen by the psychologist prior to writing another prescription. II
During July 1
four days.
Ms.

2009 she was placed on crisis cell status. She remained on this status for at least

again initiated a psychiatric evaluation during October 2009 related to symptoms
during October 21, 2009. A trial
this inmate. She vvas tinally seen by Dr.
During November 16, 2009 this inmate refused her medications. As in

111

Appendix II
Interviews
8

3
been seen on
20 I O. During
17,
H U H U •• ' -

different mental health clinicians

May

Assessment: There are various problems associated with the treatment of this inmate that
included an inadequate treatment plan, lack of a structured treatment program for an inmate with
an apparent severe personality disorder, untimely assessments by the psychiatrist and lack of
adequate input into the treatment plan by the psychiatrist.

4. Inmate 4
Inmate 4 was a 28 year old, single Caucasian woman, whose current incarceration in SCDC has
been since 2006 although she has had prior incarceration since 1998. She is currently serving
three life sentences without the chance of parole.
Inmate 4 has been in the SMU since June 15,2010 related to striking an inmate and threatening a
public employee. She has a five-month sentence in the SMU.
A long history of mental health treatment related to poor impulse control and significant anger
was described by this inmate. She also reported having "suicidal and homicidal tendencies" with
many crisis intervention placements. Crisis placements in the SMU were characterized by
having no mattress, a smock that did not fit and daily contact with the mental health counselor.
A past history of psychiatric hospitalizations was described, which has included multiple
placements at Just Care.
a bipolar personality disorder. She sees

1

disorder (i.e. borderline
medication
an outpatient
which has now expired. Her medications \'.'ere subsequently discontinued
medications and was assessed to not meet the criteria for forced
because
was
at that time.
medications at that time.
inmate was also refusing to meet with Dr. '
Inmate 4 indicated that she does not like Dr.

because "she treats me like a dog."

She was working on a cleaning detair in the dorm prior to her SMU placement.
Assessment: The lack of a structured therapeutic program for this inmate was very problematic,
as was the absence of the psychiatrist in treatment planning meetings and lack of the
psychiatrist's participation in the crisis cell management of this inmate.

5. (nmate 5
Inmate 5 was a 27-year-old single Caucasian woman who has been incarcerated for the past nine
years. Her current SMU placement has recently ended after 45 days related to tighting with
another inmate.
She had been housed in Blue Ridge C for about one year prior to her current SMU placement.
She indicated that she was very comfortable in Blue Ridge because she was able to isolate
herself: which is much more ditlicult in other housing units. However, she will not be
transferred back to Blue Ridge due to a shortage of beds.
Current medications include BuSpar, Zoloft and Tegretol for a long-standing seizure disorder.
She indicated that Dr.
had discontinued her Tegretol about 12 months ago due to
reported abuse of this medication by other inmates but not specitic to Inmate 5.

1114

Appendix II

Dr.

were June 15,

10

Ms.
indicated that counseling
would occur
and as needed.
ditTerential diagnosis ofPTSD was not included in any of the notes reviewed.

The

Assessment: The lack of a structured therapeutic program for this inmate \vas problematic as
was the apparent lack of consideration re: PTSD. Also problematic was this inmate's poor acces
to the psychiatrist.

6. Inmate 6
Inmate 6 was a 25-year-old single African-American woman who has been incarcerated since
2006. She was serving a 14 year sentence. She has been in the SMU tor 18 months. Inmate 6
reported that her disciplinary time was accumulated at Leath Correctional Institution.
Medications include BuSpar, Trilafon and Remeron. She reported that she receives these
medications for treatment of a bipolar disorder. Inmate 6 described a past history of psychiatric
hospitalizations.
She sees her counselor at the cell front on a weekly basis and has been unable to meet with her in
a private setting.
This inmate reported a history of periodically experiencing auditory hallucinations.
This inmate's AMR was briet1y reviewed. An August 2, 2010 progress note indicated a
diagnosis of personality disorder with antisocial features (severe).
The most recent appointment with Dr.
was dated June 17,
10. Medications at that
included Remeron, perphenazine and BuSpar. Tegretol had been stopped related to a low

7. Inmate 7
7

us

due

sees
not meet with a mental

Dr.
health counselor.
There was a history of multiple psychiatric hospitalizations in the
of 16 were reported by this inmate.
the

Tactile hallucinations

The AMR of this inmate was reviewed. An August 6, 2009 social health services system note
indicated diagnoses of bipolar disorder by history, antisocial personality disorder, anxiety, and
panic attacks. A variety of psychotropic medications taken by this inmate was identified by
nursing staff during August 10,2009. She was seen for mental health assessment two days later.
Diagnostic impression was manic depression NOS by history, anxiety disorder NOS by history
and antisocial personality disorder by history. She was referred for psychiatric assessment by
HSC r.
Ms.
August 16, 2009 assessment included bipolar disorder, anxiety disorder NOS,
PTSD, chronic and alcohol dependence in remission. Appropriate laboratory studies were
ordered. Prescribed medications included nortriptyline, sertraline and Geodon.
. there was no
A November 4, 2009 mental health clinician's note indicated that per Dr.
Axis I diagnosis. Axis II diagnosis was personality disorder NOS with borderline features
(severe).
A November 6, 2009 stafling note indicated that this inmate was a YOA and would be
transitioning back to the YOIP, which meant that she would not be receiving any mental health
at Graham CI.

o

to

11

Inmates

A

depressed
Dr.

This inmate was participating in a parenting group during April 20 I O.
seen by Dr.
Inmate 7 \vas
was noted at the time.

during June 17, 2010. Possible delusional thinking

Assessment: The documentation by Dr.
relevant to the change in her diagnosL of
bipolar disorder to personality disorder with antisocial features was lacking. There was a
discrepancy in the history reported by this inmate as compared to the history in the AMR
relevant to the length of stay in the crisis celL The nature of the treatment received in the crisis
cell was of signiticant concern as was the apparent lack of treatment related to her brother's
suicide following her crisis cell placement.

8. Inmate 8
Inmate 8 was a 26 year old single Caucasian woman who has been in SCDC for about eight
years. She was serving a 20 year sentence. She has been in the SMU since August 11, 2010
related to a 90 day sentence due to tattoo paraphernalia and a drug charge related to Tegretol.

Mental health treatment has consisted of BuSpar for anxiety and intrequent meetings with her
counselor.
during
The AMR of this inmate \vas reviewed. This inmate was first seen by Dr.
March 1 L 2007. The differential diagnosis was mood disorder NOS and personality disorder
Risperdal was started, BuSpar continued and Seroquel discontinued.

care.

11

9. Inmate 9

in the SMU and has
SMU.
reported having another 30-90 days left in
This inmate previously had been in the SIU program.
for potential transfer to the Blue Ridge housing unit.

is awaiting a psychological evaluation

Medications included lithium and Trilafon for a reported bipolar disorder. Inmate 9 stated that
she infrequently sees her mental health counselor in the SMU and only sees her at the cellfront.
There was a past history of prior psychiatric hospitalizations.
I, HSC I for
The AMR of this inmate was revie\ved. She was initially referred by
psychiatric examination during March
2010 after becoming out of control during an initial
mental health assessment. She was again seen by Ms.
during March 4, 2010 with
another psychiatrist referral initiated.

Risperdal and lithium were started during the evening of March 10, 2010.
Dr.
initially evaluated this inmate during March 11,2010. She was assessed to have a
borderline personality disorder (severe) and adjustment disorder.
This inmate was pepper sprayed during March 13, 2010 after attempting to jump off of the top
bunk. She subsequently was placed on crisis intervention status during March 1 2010 for
attempting to harm herself
10. Risperdal was discontinued and

1

infonnation relevant to property restrictions and the nature of

It is very likely that this inmate would not do well
a shock treatment program and could
benefit from a structured residential level of care program.

to. Inmate 10
Inmate 10 \vas a 34-year-old divorced, Caucasian woman who has been incarcerated fc)r the third
10. She was in her 30 th day of a 45-day SMU sentence related to threatening
time since July
an inmate. She remains on R&E status.
This inmate recently \vas started on Paxil. She stated that it took about three weeks for her to be
seen despite repeated sick call requests.
The AMR of this inmate was reviewed. This inmate received an initial mental health assessment
during July 19, 2010.
Initial diagnostic impression was depressive disorder NOS and
polysubstance dependence. A referral to the psychiatrist was initiated.
Dr.
initially evaluated this inmate during July 24, 2010. Dr.
impression was consistent with the July 19, 2010 assessment. Paxil was restarted.

diagnostic

This inmate has had no further mental health contacts.

Assessment: There appeared to be access problems for mental health servIces based on
infonnation provided by this inmate. This inmate also reported that it took several days to
receive her first dose of Paxil after it was initially ordered by Dr. I

I L Inmate II

not

Inmates

disorder

This inmate was seen at the cellfront by her mental health counselor for a 30 day SMU
review during June
2010. The plan was to see her as needed.
She was again seen by Dr.

Leath)

during July 7, 2010. A trial ofProzac was initiated.

Assessment: Access issues re: mental health counseling appeared to be present as well as issues
re: the quality of the services being provided.

12. Inmate 12
Inmate 12 is an 18-year-old single African-American \voman who has been incarcerated for the
past one year. She originally was sentenced to SMU for three months after threatening an officer
but has subsequently picked up several other charges with one charge pending. She was going
on her fourth month in the SMU and reports that she is not doing well.

Medications include Remeron and BuSpar, which were reported by Inmate 12 to not be working.
She stated that she is not prescribed a medication for ADHD because it was reportedly a drug of
abuse within the correctional system. She also reported that she only sees her mental health
counselor when in a crisis cell because she was told that she "is not mental health." Inmate 12
stated that her mental health counselor also refused to refer her to the psychiatrist for similar
reasons.
The AMR of this inmate was reviewed. This inmate was placed in a crisis cell during August 10,
2010 after trying to hang herselt: She reported being seen by a mental health clinician during
two
that
was in a
cell. She indicated she was very cold in the cell
related to the restricted property.

13. Inmate 13
1

Medications

LJU",~H""

and Seroquel for an apparent bipolar
her
health

fIer AMR was
An August
10 mental health assessment
, HSC I was
reviewed. Her presentation was consistent with the differential diagnosis of the depressive
disorder NOS and a bipolar disorder NOS. She was referred to the psychiatrist. Inmate 13 has
not yet been seen by the psychiatrist. She was currently not receiving any medications.
Assessment: This inmate has not received a timely evaluation by the psychiatrist and currently
was not receiving an appropriate level of mental health care.

14.Inmate 14
Inmate 14 is a 46-year-old female that has been incarcerated at Graham since July 2010. She
reported she has been diagnosed as having schizophrenia and has been prescribed Thorazine for
the past 10 years which was changed to Haldol and Cogentin for the past six months. The
inmate reported that she has seen her counselor, Ms.
twice since her incarceration
including one to two weeks prior to the interview on 8/23/10 and on 8/23110. She reported she
one week after she was incarcerated but has not seen her since. She
has seen Dr.
reported she is currently prescribed Haldol but does not know the dosage. She does not know
her level of care. She reports she is not engaged in any groups but has been told she will be
placed in a discharged planning group on 8/24/10. She reported that she has sent in a sick slip
for discharge planning as she expects to be released from prison "soon". She described the
mental health services as "real good".

This inmate was housed in the ICS Building but again could not state her level of care.
has not received consistent mental health contacts from the mental

1

sees her counselor,
90
and if Ms.
to see her in a
period
time.
indicating a q three month appointment
reported that it "didn't use to be that way was 90
with the psychiatrist, however the inmate stated "it changed in the last year". She added that
unless the patient is put on crises status and stripped out "butt naked". I asked her if that had
ever occurred to her and she reported that the last time she was placed in a crises bed \vas in the
1990s for approximately six months. She stated she then went to the SMU and from there to the
Cooper Building because she has medical problems but was also suicidal and paranoid.
,.",..",,..,,,rl

that

She reported she has been taking Risperdal Consta 37.5 mg every two \veeks, Invega 9 mg every
mg every morning, and Buspar 15 mg bid. She also reported that she
morning, EtTexor ER
takes Amantadine twice a day and Wellbutrin 200 mg twice a day. The inmate states that this
combination is working "pretty good" for her and that her Risperdal Consta was decreased from
50 mg to 37.5 mg because of her "neck pulling to the right", and Invega was added.
When asked how she has been adjusting, this inmate reported "they take care of me because they
know I can be a problem". She stated she was a LPN prior to her life sentence and that at the
time of her killing her children, she had told her primary care doctor that she intended to kill
herself and her kids. The inmate added "I'm a little bit paranoid about rattling their cage don't
want to be sent to Leath." The inmate added that she trusted Dr.
now but didn't at first
before she was receiving injections of medication. She reported she would go five or six days
past when she should get the injection and "all hell would break loose".
The inmate added "we have no PRN meds around here - people in Blue Ridge need them but
don't
them so some of us live in fear." She continued that the morning meds are given
between 6:30 7:00, there's a 12 o'clock pill line for inmates who are on medication three times
per day, and a 4:30 pill line the afternoon tor p.m. medications.

of Inmates

was on a
list tor a depression group. During
same time period, her medications were changed
because she appeared to have been having some difficulties however there is no indication that
the medication changes were discussed by a multidisciplinary treatment team.
Assessment: This inmate's care and treatment are inadequate as she has been a long-term
resident in the SCDC that continues to struggle with a number of issues related to her instant
otIense. Further she has had periods of depression and crises, and reports that she is fearful of
reporting these feelings to staff because she expects the response to be to place her in a crises cell
rather than to have her evaluated by the mental health staff
Further. despite there being changes in the inmate's psychotropic medications by the psychiatrist.
there does not appear to be any meaningful collaboration between the psychiatrist and the
counseling staff with the inmate to develop an appropriate treatment plan given her long-term
incarceration and ongoing mental health problems.

16. Inmate 16
Inmate 16 is a 23-year-old woman who reports she has been housed at Graham for two years and
one month. She is currently in the Blue Ridge, C Side Dormitory. When asked about her mental
health care she reported "I vvas area but I took myself off medications, now outpatient". When
asked about her level of care regarding the L system, she replied she didn't know what I was
talking about. She went on to state she believes her counselor "whose an idiot," and went on to
state that "these counselors are "pay check" counselors, continuing "all they're here for."
She reported her diagnosis as ~'borderline schizophrenia". She stated that she has been Depakote
for the
two months because that is the only medication that helps her. She further stated that
I

Appendix II
of

was

on

as well as
1/ I
Initially she was
bipolar disorder
history. The
the problem indicated childhood
depressive thoughts and symptoms with
objectives
for her to verbally identify sources of her depressed mood, developed cognitive
patterns in three months with the approaches being one-to-one counseling per SCDC policies and
monitoring medications weekly by the counselor. She was also noted to have a history of serious
injurious behavior (SIB) and drug addiction with an objective to continue to resolve
childhood/family issues, and refer to the Positive Thinking group with a counselor to meet with
her. There \\:as a handwTitten line on 2/27/09 indicating "treatment plan update, continue as
written". This was the only statement regarding her treatment planning being reviewed at that
time. On 6/5/09 the bipolar disorder by history was dropped from the diagnosis and she was
considered to have borderline personality disorder only. Despite the change, the objectives and
the approaches were identical and remain such for the treatment plan of 6/11/10.
Assessment: This inmate's care and treatment are inadequate. Her treatment plans do not
include the psychiatrist meeting with the counselors or providing any documented input
regarding the treatment plan objectives. The inmate's diagnosis was changed and the objectives
and staff approaches remained the same even when the inmate had some difficulties in
maintaining her mental health stability. The treatment plans are generic and do not reflect any
considerations of the inmate's changing psychodynamics and conditions.

17-21. Inmates 17-21
These inmates were interviewed as a group as they all are participants in the Youth Otlender
Program (Shock Boot Camp) and housed in the Shock Dormitory. I interviewed them as a group
and reviewed their records individually.

1

ftU'Ft!H>nrc

of

sentence.
was horrified to find out
successfully completed the r....r".,.., .....
All five women reported that they have been prescribed medications by Dr.
and they
see Dr.
approximately once every three months. These inmates reported they have no
mental health groups.
also reported they have treatment plans and the treatment plans are
provided to them by their counselors. There are no treatment team meetings with Dr.
and the counselors simultaneously.
Four of the five inmates reported they have never signed any consent for medications although
all five inmates are prescribed medications by Dr.
The inmates reported as part of their program they work part-time and also attend school unless
they already have their OED. They reported however that outside of those activities, there is
"nothing to do".
When I asked them about other programmatic activities or assistance from the counselors, the
inmates replied "no help from the counselors". They reported they don't feel they can talk to the
ofticers and that they simply talk with each other and other inmates because there is no
confidentiality in what they may say to the ofticers.
I reviewed the medical records of all five of these inmates and will describe them below.
17. Inmate 17
This 26-year-old inmate received a medical screening on 19/10. It was noted on the screening
that she had been prescribed Haldol, had a suicide attempt two years prior to admission, was
hearing voices in her
currently, and was pregnant. There was no treatment plan provided in
medical record nor was there any documentation in the Automated Medical Record (AMR)

Appendix II
Interviews
21

Inmates

have been prescribed
as selt:mutilation.
inmate was seen in the mental health clinic on 411
0 and prescribed Cclexa based on
diagnoses of depressive disorder NOS and borderline personality disorder. The medication was
prescribed for a 180-day period by Dr.
Although the inmate had been admitted to the
Shock Dormitory Youth Otfender program on 2/19/1 0, her first encounter with mental health
staff was as noted above, almost two months after her admission.
Assessment: This inmate's care and treatment were inadequate. It was almost two months after
admission before she was evaluated by the psychiatrist despite her history of depression, suicidal
ideation, selt:injurious behavior and crack cocaine addiction. Further, neither the AMR nor the
medical record indicates any treatment plan being developed for this inmate and certainly not
collaboration between the psychiatrist, clinical counseling statT and medical with regard to
managing her pregnancy, hypertension, post-partum adjustment and mental health issues.
Despite her very significant to serious co-morbidity, she was diagnosed \vith schizoaftective
disorder by history, pregnancy and her stressors were considered "incarceration" with a OAF of
75 and a recommendation for outpatient mental health.

18. Inmate 18
This inmate was a 19-year-old woman whose medical record was reviewed. A medical
screening on 10/2911 0 indicated that she was pregnant and reported no mental health history or
mental health problems. The MAR however indicates that she was prescribed Remeron 15 q day
from
0 1
0 and there were multiple
dosages or refusals documented on the
MARs. She was also prescribed
200
bid from
0~
1111.

19. Inmate 19

15

care and treatment were inadequate in that it took an inordinately
to
psychiatrist, despite her presenting complains
aet)re~;Slc.n and treatment with anti-depressant medications.

20. Inmate 20
woman whose medical screening on 5/27/10 indicated PTSD,
This
was a
and she was prescribed SeroqueL She also was noted to have a history
VH~'UU.U disorder,
hs was ordered as well as Celexa 20 mg hs
of suicide attempts. On 5/27/10 Seroquel XL 400
either medication. There was no treatment plan documented in the
with no
me'UIc,al record of this inmate.
and was noted to have medical
Albuterol

Inmates

Am?>.-r,,,,

and
and

Assessment:
inmate's care
treatment are inadequate
that
to
been
to adj ustment medications to treat her symptoms, no
documentation in the record beyond the initial assessment and referral by a mental health
form of treatment.
counselor that counselors were following this inmate and providing
There was also no treatment plan in the record reviewed.

21. Inmate 21
This inmate was a 26-year-old woman who was also a partIcIpant in the Youth Ot1ender
program. A medical screening of
111 0 indicated that she was diagnosed with bipolar disorder
and receiving Trazodone. There was no treatment plan in the record.
Her medications at the time of this review included Buspar, Navane, and Remeron with orders
tor Buspar and Remeron tor a six-month period.
Assessment: This inmate's care and treatment are inadequate. There is no evidence in the
medical records reviewed that she had a treatment plan or any collaborative eftorts for treatment
planning by the psychiatrist and counseling staff. Further her medication orders far exceeded the
three-month limitations as dictated by policy.

22. Inmate 22
This inmate was a participant in the Youth Oftender program however was not interviewed
during the course of the site visit. Her medical record was reviewed and a medical screening of
1 10 identified diagnoses of ADHD, bipolar disorder, depression and "Terrets" which I
interpreted to being Tourettes Syndrome.
She was also reported to have been receiving
Lithium, Concerta, Albuterol and other medications, and had a past psychiatric
not to

1

Appendix II
Re:

of

medications as well as medications
not receive a
stabilizing medication (Lithium) or an antipsychotic (Risperdal)
she was
admitted. Shortly
the prescription of these medications, she required crises intervention for
approximately tour days. Subsequently, medications were ordered for a six-month period in
violation of standard policies and procedures.

23. Inmate 23
This inmate was a 49-year-old woman who was requested to attend a group interview however
she refused. Her medical record was subsequently reviewed and a medical screening of 9118/99
reported a diagnosis of manic depression. She was classified at the M-2 area mental health level
of care in 1999.
A review of her most recent treatment plan of 11112/09 indicated the statT assessment of the
problem was that she was "doing better" and that she was compliant with medication and
treatment. The objectives were for her to take her medications for the next 180 days and
verbalize her feelings. The approaches were for the counselor to review the MARs and to
provide one-to-one counseling. Her diagnosis on Axis I at that time was "N/A", and diagnosis
on Axis II was personality disorder, borderline. Axis IV stressor was a life sentence and no
family and the Axis V global assessment of functioning was 70.
Despite the above diagnoses, she was prescribed Risperdal, Buspar and Celexa as well as
medications for hypertension and diabetes.
Her psychotropic medications \vere to be
administered at hs, i.e. hour of sleep; however they appear to have been administered at 5 p.m. I
was unable to locate any consent forms for these medications in her medical record.

admission, her treatment plans did not
substantive changes in the approaches which
included one-to-one monthly
with the counselor, several groups and medication. Her
global adaptive functioning remained at 67 prior to and after her admission to the mental health
observation unit. Her last treatment plan in the record was 111 10 and she was therefore
missing two treatment plans based on her level of care.

Assessment: This inmate's care and treatment were inadequate. This inmate's care and
treatment do not appear to be based on her changing symptoms and particularly her having been
admitted to mental health observation because of suicidal ideation.

25. Inmate 25
This inmate was a 46-year-old woman who had a medical screening on 7/23/08 which revealed a
history of depression. [requested an interview with her however she was out on a medical run
and therefore could not be interviewed. The medical screening also indicated she was taking
Zyprexa and Vistaril and identified her as having depressed and anxious symptoms. Review of
her record indicated a treatment plan dated 511311 0 with diagnoses of obsessive compulsive
disorder (OCD), pyromania, and borderline personality disorder.
Her global adaptive
functioning was 70. The staff approach to the problem (SAP) essentially restated the criteria for
a diagnosis of OeD and pyromania. The objective was to decrease those symptoms and for the
inmate to attend appointments. The approach was for one-to-one counseling, medication and for
the inmate to identify conflicts, have medication compliance and provide feedback to control her
actions. This plan was signed by the supervisor only and not by the inmate. A previous
treatment plan from 1119/10 was essentially identical to the treatment plan of 511311 0 with the
exception of the approach including her referral to an impulse control group. There was no
indication that the inmate
that group in the medical record or in the treatment plan
0,
1
contract

1

Appendix II
Interviews
of

Inmates

26. Inmate 26

as per medical
however indicated
health problems.
9/30/09, 1/1
and
reviewed and indicated a diagnosis of schizophrenia undifferentiated type and antisocial
personality disorder. The SAP, objectives and approaches were essentially the same for these
70. However, there was some dit1erence noted in the
treatment plans and indicated a GAF
treatment plan of 5/13/10 which indicated that the inmate had been given forced medications and
no GAF score was recorded. It was noted she had auditory and visual hallucinations and that she
was assaultive. The inmate's medications included Invega, Citalopram, Haldol and Amantadine.
Assessment: Based on the review of the record, it is unclear as to this inmate's overall
functioning. Although she was given a GAF of 70 indicating that she had mild or inconsistent
symptoms of mental illness, it was noted that she was being given forced medications because of
auditory and visual hallucinations as well as being assaultive. The symptoms seemed
inconsistent with her overall assigned global assessment of functioning.

27. Inmate 27
This inmate was a 47-year-old woman who was interviewed. She reported that she had been at
Leath for tive years prior to her transfer to Graham nearly four years ago. She reported she was
transferred because there had been a chaplain at Leath who was reportedly "molesting girls".
She reported that she has been receiving mental health treatment since she was 14 years old and
that currently her medications include Paxil 60 mg per day. She reported that she sees Dr.
every three months but that she has never signed a consent form for PaxiL
When I asked about her symptoms she stated she had "mood swings - from the change in life"
and stated that because SCDC medical statf do not prescribe Premarin, Dr.
prescribed
Paxil
her. She added however "['m not depressed".

I
reported that
was a
a phase I substance
When I asked about her
stated it was "really a joke" and that the group leader essentially talked all about herself and did
not provide
handouts or homework
the inmates to work on.
I reviewed this inmate's records which indicated a medical screening dated 7/24/02 at Leath
where she was admitted and was reported as a "cutter" with scars on her arms but that under the
general appearance section of the medical screening no evidence of trauma was noted.
Treatment plans of9/12/08, 5/1109, 1112/09, and 5/19/10 were reviewed. The diagnosis recorded
was depressive disorder NOS. The treatment plan of9/12/08 was signed by the supervisor only
but not the counselor or the inmate. She was also diagnosed with personality disorder NOS with
borderline features. Her GAF was noted as 75. The staff approach to the problem identified
depressive symptoms, incarceration, unresolved grief and self·mutilating behavior as well as a
history of drug and alcohol abuse. The objectives were for the inmate to recognize and cope
with depression in six months, take her medications and decrease her desire to use drugs. The
approaches were one-to-one counseling every three months, and taking medication. The
counselor was to monitor her medication on a weekly basis. Treatment plan updates of 5/1/09
and 1112/09 indicated little to no depression and on 5/19/10 no depression but also indicated the
inmate wanted to open up to her counselor about her past. Despite these notations, there was no
change in the treatment plan, no increase in individual sessions with the counselor, and
antidepressant medications continued.
Assessment: This inmate's care and treatment are inadequate. She reports that she has
significant medical problems and concerns however they have not been addressed in a
multidisciplinary treatment plan including mental health and medical staff. Her symptoms of
depression
to the record
essentially resolved however her request to the
to be able to talk about her
and problems that she has experienced did not result in
or to
v V ' l U h , ... nJ1

1

placed in
intervention at Camille Graham and
homicidaL She has subsequently
with
medications
and
two
receiving her medications. She reports she has seen Dr.
twice
during calendar
20 10, approximately once
three months, however
believes this
been changed to every six months and that her medication is now ordered for a
month period. She reports
has never signed a consent form for medications.
and she reported that she was "great for
The inmate reported that her counselor is Ms.
me". The inmate reported that she has never had a treatment team meeting that included the
psychiatrist and counselor with her at anytime during her incarceration at Graham. She reported
that she has had "classes" in anger management and positive thinking and has seen a number of
videos during these classes and then added "but nothing done to help you deal with your own
issues." When I asked what she meant by that she stated that the classes are not tailored to
discuss any of the inmate's individual issues and that the counselor don't appear to be able to
help them with their individual problems. The inmate stated that she works out and that helps
her because she has seasonal affective disorder and in the winter time there is "nothing they do
for you."
The inmate reported she is in no groups currently and there are no groups there specific for her
problems. The inmate added that she has had serious problems with medical services and
reported that in 2005 she had an accident where she fell on the sidewalk, injuring her face, had
trouble walking after that, and had multiple bumps and bruises. She stated she went to medical
to clean herself up and actually had a medical appointment the following day but there were no
x-rays or any other diagnostic tests. She reported that she would not make any appointments
away from the institution including such things as mammograms because she's afraid that she
would fall again. She implied that such appointments had been attempted for her but that she
had not kept them because she is afraid that she would fall and not receive medical services.
mental health care is inadequate in that it is not individualized, does
that
been

11

Appendix II
Interviews of Inmates

that
movements in both hands that could

in the
plant.
representative of tardive

The inmate reported that she has taken Geodon, Tramadol, Zoloft, Trileptal, RisperdaI and
in the past and that she has been taking Paxil as prescribed by Dr.
whom she
"zaps" in her head if she
sees every three months. She reports the Paxil is helpful and she
misses her Paxil.
The inmate reported that she sees her counselor every two to three months unless she
to her
office and peeks in. She stated she went to see her counselor after she had cut herself really
badly as self-mutilation and was in a crises cell for 11 days. She reports she didn't see the
counselor at all during that 11 day period and added they don't treat self-mutilation here." She
then stated she has "lots of scars" and displayed scars on both arms as well as carvings on her
legs saying "loser" and "hated". She reported that she had told Dr.
: about her scars and
Dr.
told her that the staff "look at it like tattoos here ~ they don't treat me for it and
sometimes I get frustrated and [ cut too deep. "
When I asked the inmate if she had ever seen a treatment team since being at SCDC, she
reported 'no' but she is very familiar with treatment teams from California. She added she has
never had one at SCDC. She also reported that she had been in a crises intervention cell for
cutting herself two months ago, was discharged she was discharged to a dorn1itory setting even
though she has a diagnosis of social anxiety disorder. She reported that in the past she has
attempted to hang herself as \vell as taking overdoses and is currently anxious that she may
attempt to harm herself further at some point in the future. She reported that she asked her
counselor about possible halfway houses that she could be discharged to four months ago and
that her counselor has not
her any information. She did state that she was able to get some
information from
chaplain.

I

30. Inmate 30
Inmate 30 was a 33-year-old woman who reports she has been at Graham since 2004 having
spent two and one-half years at Leath prior to transfer. The inmate reported she was first treated
for mental illness at
10 for depression. The inmate stated that she believes she is "area
mental health" but did not have any knowledge of the L system level of classification. The
inmate reported she is currently prescribed Remeron 45 mg each evening and that there have
been approximately four times since January 2010 that the staff have not had her medication.
She reported that this generally lasted four to five days before she received the medication after
the staff has run out.
The inmate reported that she sees her counselor approximately two times per month or whenever
she is called. She reported that she has been trying to get into an anger management group as
well as group about medications and some others but that she has not been able to. She stated
that she had had an anger management group before and it was helpful to her.
The inmate stated that she did have a treatment team meeting "one time" with the counselor and
other counselors but she could not remember if Dr.
attended that meeting. She stated
that she was told by the counselors that if she went otT her medications she'd go back to lockup
and they "argued me down saying it does help when I keep telling them it doesn't help." She
stated she has been in lockup more than 20 times and when I asked her why she said it's because
the statT say that she has threatened them and added "I don't", as well as for disrespect and being
out of place. She stated that she is always put in a crises cell but never because of threats to hurt
herself. She
that
did try to hang herself once, approximately one year
and
to cut
a

of lnmates

and impulse {'Ar,t"A
hospitalization once
evidence of
In addition to the above ~.~.",u,~

""LTD.,."'"

Assessment: This inmate's mental health care appears to be inadequate. Despite her reports of
depression and suicidal ideation, as well as her having been in lockup multiple times tor
extended periods of time, she has not had multidisciplinary treatment planning and the treatment
has not been focused on helping her reduce her impulse control problems, improve her
depression, and assist her with controlling her anger which appears to be a major contributant to
her disciplinary infractions.

31. Inmate 31
This inmate was a 22-year-old woman who reported she had been incarcerated at Graham for the
past five years. This inmate reported she tirst received mental health treatment at age 13 tor
depression and then manic depression. She reported she has been prescribed Zoloft and
Depakote and subsequently Seroquel. She reported that she stopped taking Depakote and
subsequently stopped taking Seroquel approximately two months ago because the Seroquel was
being crushed. She reported that she has been taking Tegretol for approximately one year. The
inmate stated that she has not signed any consent forms tor these medications.
I asked the inmate if she was attending any groups and she reported no mental health groups
because "I don't like them." When I asked why she reported that she doesn't go to groups
because the staff don't really talk to inmates about their medicines and how they are supposed to
work and the staff do not try to help them. She reported they should have treatment teams here
like she had at horne prior to incarceration.
She elaborated that she has never had a treatment plan since incarceration and stated "this ain't
~ I
library
\von't tell

1

at the

32. Inmate 32
Inmate
was a 50-year-old woman who reported that she has been in Graham since November
2008. She reported she first went to a mental health clinic in 1991 or 1992 because of anxiety
and depression. She reported further that she has been treated with Abilify, Depakote, Klonopin,
and Vistaril but that she currently is not taking any medications. She reported that her last
medications
months ago consisted of Depakote and VistariL
When I asked about groups she reported she currently has no groups and had been placed on
group restriction for six months because she made a three-way phone calL She reported that she
had been placed previously in a substance abuse class even though she has no substance abuse
problems.
When I asked about the three-way phone call the inmate stated that another inmate had
appendicitis and medical did nothing so that she called the other inmate's mother and set up an
illegal three-way phone call, which resulted in her restriction.
I asked the inmate about any treatment team meetings and she stated "absolutely not they don't
do that here." I then asked her about her opinions regarding the mental health program and she
stated it is "very very poor". She stated she has never been in crises intervention and never been
in lockup and reported that she has had no suicidal ideation since she has been at Graham.
I reviewed the inmate's records and they indicate she was in a depression group until they
concluded in May 2010. She reported that she had received her certificate tor good participation
in the group. Additional notes in the record indicate that she was begun on Buspar by an
internist however the psychiatrist discontinued the Buspar, writing that there was no indication
the

1

of

those

not

reported
she had "lupus" but that medical was having
suffered from this medical illness.

Assessment:
inmate' s mental health treatment appear to be inadequate. The record
demonstrates that she has suffered from symptoms of anxiety and depression prior to and since
her incarceration. There is a clear lack of multidisciplinary treatment planning as the inmate was
started on an anxiolytic medication, Buspar, by a non-psychiatrist which was subsequently
discontinued by the psychiatrist with the psychiatrist noting no indication for the medication.
There is nothing in the record to indicate that there was any collaboration between the mental
health and medical staffs about this inmate's overall treatment needs despite her having reported
"lupus", dizziness, nausea, vomiting and other symptoms. At one point she was given a
wheelchair because of her reported symptoms and yet there was again no documentation of
collaboration via multidisciplinary treatment planning to assist this inmate in her overall
treatment needs.

33-41. Inmates 33-41
A group of nine inmates were interviewed to obtain information about their care and treatment at
Graham. These inmates were selected trom a roster \vhich indicated they were all at the L-2
(reS) level of care.
The inmates reported they didn't have any knowledge of the new classification system and gave
their levels of care as res, area of mental health or outpatient. Six of the nine inmates had been
at Graham for more than one year and the other three had been at Graham for tive, six and ten
months respectively. The inmates asked a question was Blue Ridge D an IeS program to which
I could not answer. When I
those who believed they were on the IeS level of care what
that
they reported they see a counselor once per month but there were no other
""r\Art",,; that
on Blue
D but

Appendix II
Re: Interviews of

did not
to

would need to

the
that
they are having
symptoms
and
are
interactions with other inmates, they wondered why they could not
outside for a
time out or into their cells to
away from the environment. They suggested they would even
be willing to
into a holding cell to calm down but that staff would not allow that to happen
and the alternative is to place them in c.I. The inmates reported that when they have been in
crises and asked to see a counselor they have been told that the counselor couldn't see them
particularly if it was on a weekend. Another inmate reported that she told her counselor that she
because her medications had been changed and they vvere not
needed to talk to Dr.
working for her, so she started refusing medications, and this inmate reported that she was told
by the counselor that they would just "put me down, that's just wanting to get high to get
medication". The inmate reported that she finally saw Dr.
after several weeks and that
her medications were changed again.
Another inmate reported that she had a crisis and essentially broke down and asked an oUicer if
she would call a counselor and the counselor told the officer to ask this inmate what was wrong
and did not see the inmate herself for two weeks. By contrast another inmate reported that her
counselor would see her if she needed to as long as it was not on a weekend or holiday because
there is no mental health statT present in the facility at that time.
All the inmates reported they see the psychiatrist every three months however fIve of nine
reported that their medications had run out and that it usually takes from three to seven days and
up to two weeks to actually have the medication restored.
Three of the inmates reported their beliefs that the otlicers need training because when the
otlicers see the inmates laughing or socializing with each other they send them to their rooms
rather than allow them to have that kind of interaction. When I asked about group therapies,
the nine inmates reported they were in groups currently and
of the nine reported they
they

Inmates

reported that they
not had any multidisciplinary treatment planning but are
has decided about them. I reviewed the
told by the counselors what the "treatment
34,
and the records were consistent with other records
medical records of inmates
described in this report for the lack of multidisciplinary treatment planning, mental health
counselor contacts that do not appear to focus on the diagnoses or the symptoms reported by the
patients. It was also no evidence in the records that consent forms were signed for medications
that were prescribed for these women. Lastly, the references to group therapy and largely to do
with whether or not inmates attended groups did not give specific information about how the
groups were helpful in addressing the mental illnesses that these inmates presented with.
Assessment: These inmate's care and treatment appear to be inadequate particularly if they are
considered to be at the Ies level of care. Discussion with the inmates as well as review of their
records does not indicate there is any significant ditIerence in the treatment services provided to
them at the res level of care as compared with inmates in area of mental health level of care, the
L-2 for Ies versus L-3 tor area mental health or L-4 tor outpatient were unknown to these
inmates and the services described by the inmates and the documentation in the records do not
indicate any significant increases or enhances in treatment.
Of great concern is the practice of imposing restrictions on inmates who have been in lockup
after their lockup time has been concluded as described by these and other inmates during the
course of this site visit. It is clinically contraindicated and potentially extremely detrimental to
have such restrictions placed on women with or without mental illness that prohibit them from
having contacts with their tamilies particularly their children. It is not helpful and indeed
damaging to women with mental illness to be unable to have such communications with their
families and outside social support systems. This is a practice that has no clinical justification
and should be stopped immediately.

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