In a medical error, an estimated 15 people incarcerated at Northwest State Correctional Facility in St. Albans received codeine and Tylenol on July 23 rather than buprenorphine to treat their opioid use disorder, according to a memo from the Vermont Department of Corrections health services division.
The July 27 email, written by Brenda Shattuck, director of nursing for the department, was sent to the Office of the Defender General, as well as the individuals affected by the error.
“If you feel you have been impacted by this event, please reach out to medical by completing a sick call slip with your concerns,” Shattuck wrote. “We are putting safety measures in place to prevent this from happening in the future.”
The department relies on a private contractor, Wellpath, to provide health care services in its prisons.
In an email, corrections spokesperson Haley Sommer said that “inquiries regarding corrective action on behalf of Wellpath, the frequency of errors, and any negative health effects would be better directed towards Wellpath.” She added that Wellpath had, per the request of the department, conducted a “corrective action plan.”
The error came to light when a correctional officer noticed the problem and “immediately notified our comprehensive health services provider Wellpath,” Sommer wrote.
Wellpath did not respond to questions on Wednesday regarding the medication error.
Jonathan Elwell, a member of the prison reform advocacy group Vermont Just Justice, brought the error to light during testimony before the Legislature’s Joint Justice Oversight Committee hearing on Tuesday.
The hearing highlighted medical care inside Vermont’s prisons, which has faced increased scrutiny since the death of David Mitchell at Southern State Correctional Facility in Springfield last April. Wellpath took over health care in Vermont’s prisons on July 1.
In recent weeks, Just Justice advocates have collected stories from incarcerated people and their families, some of which they shared with legislators.
“We felt that if Vermonters and our legislators knew what people experienced, they would demand change,” Meg McCarthy, a Just Justice member, said during the hearing.
Matthew Valerio, Vermont’s defender general, said it’s not uncommon to hear about medication mix-ups in prison — though it is unusual to hear about them from the department.
“In my 22 years this is the first time that DOC has acknowledged a medication error like this,” Valerio wrote in an email. “We are occasionally notified by particular inmates that they have not received the correct meds, or that they have not received any meds. It probably happens once or twice a month for particular individuals across the state.”
The mix-up occurred when incarcerated individuals went to receive medication to treat their opioid use disorder. Subutex, the medication the affected individuals were supposed to receive, contains buprenorphine and works to help stem cravings for opioids by activating similar receptors. Codeine, the medication the individuals received in error, is itself a pain-relieving opioid that is sometimes abused.
According to C. Frederick Lord, CEO and medical director of Connecticut Valley Addiction Recovery in Windsor, taking codeine — a “full agonist opioid” — on top of buprenorphine would not cause physical harm.
“One might question whether that might ‘trigger’ someone’s craving for opioids but, honestly, codeine is such a wimpy opioid, one has to ingest more than a therapeutic dose to get the opioid effect,” Lord wrote in an email. “Taking buprenorphine with a full agonist on board can precipitate opioid withdrawal. However, one dose of codeine given (presumably) 24 hours beforehand is not very likely to produce enough mu receptor occupancy for that to happen.”
That said, Lord said withdrawal might occur because codeine might not be as potent as a patient’s regularly prescribed buprenorphine, thus creating a “deficit.”
Commissioner talks prison health care
Nick Deml, Vermont Department of Corrections commissioner, also appeared before the justice oversight committee to discuss the health care challenges faced by his department and its health contractor.
He didn’t address the medication error, but said the accounts Just Justice had compiled are “really instructive to us charting our path to a better place.”
“We look like a prison but we are in fact a hospital system, a nursing system,” Deml said.
Despite a decrease in Vermont’s prison population, more incarcerated people have chronic conditions, according to Deml. Nearly 60% of those incarcerated in the state receive medication to treat opioid use disorder, he said.
Pressures on the state’s broader health care system have also affected the care provided to people in Vermont’s prisons. The department houses “close to 30” people who would be moved to nursing homes or hospice care if there were available beds, Deml said.
And in the last three months, the Department of Corrections has sent incarcerated people to hospitals in Connecticut, Massachusetts, New Hampshire and New York due to a lack of beds in Vermont, the commissioner said.
With scrutiny facing corrections’ health contractor Wellpath, Deml also addressed the idea of the department taking over health care for the people it houses.
Such a system would cost between $80 million and $100 million per year, Deml said, though he did not have calculations on hand to explain that estimate. Currently, the state pays more than $33 million per year to Wellpath for health services.