[V]ermont prisoners have been harmed by “unsafe and unacceptable patient care” due to inadequate implementation of a new law expanding addiction treatment behind bars, according to a complaint filed with the state Board of Medical Practice.
Vermonters for Criminal Justice Reform has filed the complaint against Dr. Steven Fisher, who is medical director for Centurion, a contractor that provides health care in the state’s prisons.
The Burlington-based prisoners-rights group argues that, by denying inmates access to treatment they are entitled to under a law passed earlier this year, Fisher is “abandoning his patients.”
State officials have argued that they are implementing the law, and they say Centurion is adhering to nationally accepted prison health care policy. But Tom Dalton, the reform group’s executive director, says numerous inmates are going without treatment they need to stay alive.
“It’s not something I take lightly,” Dalton said about the complaint filed against Fisher. “But the stakes are very high here.”
Fisher could not be reached for comment. Spokespersons for Centurion and its two parent companies did not answer questions about the matter on Monday, and Centurion previously has not responded to inquiries from VTDigger.org.
The debate centers on Act 176, which was signed by Gov. Phil Scott in May and took effect July 1.
Advocates like Dalton have argued that the expansion of medication assisted treatment for inmate opioid addiction wasn’t happening fast enough, putting inmates at risk for overdose upon release and undermining the state’s efforts to fight the opioid epidemic.
Act 176 aimed to rectify that by allowing inmates to begin receiving medication assisted treatment behind bars, even if they hadn’t been receiving those medications prior to their arrest. The statute says new inmates must be screened for substance use disorder within 24 hours of entering a prison.
The law also eliminated a 120-day limit on medication assisted treatment. Instead, inmates are now able to receive that treatment for “for as long as medically necessary.”
Additionally, the statute opened the door for current inmates to request addiction screening. If it’s deemed medically necessary, those inmates should “receive the medication as soon as possible.”
That provision has proven to be controversial.
The Department of Corrections has said new inmates are being screened for addiction and inducted into treatment as needed. But for those inmates who have been in the system for a while, officials say Centurion is following a national corrections policy that says starting longer-term inmates on addiction treatment becomes medically necessary only within 30 days of release from prison.
The department also has acknowledged a long wait list – about 500 inmates at the end of August – for those who have requested screenings.
Those issues have attracted scrutiny from lawmakers and now have spurred the reform group’s medical board complaint. Dalton said he filed the complaint based on state officials’ contention that it is the medical providers’ decision – not a department policy – to deny treatment to some inmates.
Dalton wrote that Fisher “has failed to respond to requests for screening, assessment and treatment in a timely way for patients in need of immediate treatment and care.” He also says Centurion has “systematically limited (treatment) access” to a narrow 14- to 30-day window before an inmate’s “exact, confirmed release date” – a date many inmates don’t get until it’s too late to meet the contractor’s treatment requirements.
This practice is “not evidence-based,” Dalton wrote, and it has “resulted in harm to patients while incarcerated and after release from incarceration.”
The complaint cites two examples. One inmate who was denied treatment “continued to use illicit opioids while incarcerated and has been subject to disciplinary action and other harm,” while another inmate “was released untreated and began using non-prescribed opioids within 24 hours of release.”
The risk of fatal overdose, Dalton wrote, “is up to 10 times higher soon after release from incarceration than for the same individual weeks or months later, and 100 times higher than the general population.”
Given the urgency of the situation, Dalton wrote, the Board of Medical Practice should “investigate and address these concerns on an urgent and expedited basis.”
While a complainant like Vermonters for Criminal Justice Reform is not prohibited from disclosing such allegations, the medical board’s investigations are confidential. In a description of the process, officials wrote that “the board will not publicly disclose the investigation absent charges or a stipulated order.”
Those kinds of outcomes are rare. According to an analysis on the medical board’s website, the board averaged 197 investigations annually between 2011 and 2015. “The average number of cases resulting in discipline or surrender of license was just under nine,” officials wrote.
While notification of a board investigation is “disturbing, unsettling or just plain annoying” for physicians, “the reality is that the likelihood of a public action is quite low,” board officials wrote.
The board is obligated, however, to investigate all complaints filed against a medical licensee. The board relies on the statutory definition of unprofessional medical conduct.
Investigations usually last two to 12 months but can take longer if there is a contested hearing, board documents show.
Whatever the outcome of his complaint against Fisher, Dalton says he will continue to press the matter.
“I’ve been really open with (state officials) that, for me, fully implementing this law is so important, I’m going to do whatever it takes to make sure that happens,” he said.
