Thursday, October 1, 2015

Suit: Bucks prison provides inadequate inmate detox treatment

Posted: Monday, September 28, 2015 
The mother of a Bucks County prison inmate who died during heroin withdrawal in 2013 has filed a wrongful death suit accusing county officials and a private medical contractor of providing inadequate detox treatment despite knowledge her daughter was a heavy drug user.
Loretta Lopez contends that her daughter, Vallia Valene Karaharisis, 29, of Philadelphia, died as a result of the actions — and inactions — of county and PrimeCare Medical Inc. three days after she was admitted to the jail on a probation violation, according to the lawsuit filed in federal court in Philadelphia earlier this month.
Vallia Karaharisis
Karaharisis was incarcerated Sept. 26., 2013, less than three months after PrimeCare took over as the medical service provider at the county prison. Previously the county health department handled inmate medical services. She was found dead in her cell Sept. 29, and an autopsy and a toxicology report found she experienced “sudden death during heroin withdrawal,” according to the suit.
“We can all agree that in 2013 a person with a chronic substance abuse issue should not end up dead while detoxing in a prison,” said attorney Jonathan Feinberg, who represents Lopez. “The fact that Vallia ended up dying three days into her period of incarceration suggests very serious breakdowns in care.”
Todd Haskins, a vice president of operations at PrimeCare Medical Inc., of Harrisburg, declined to comment on the lawsuit. The newspaper was unsuccessful in reaching Bucks County spokesman Chris Edwards for comment. PrimeCare also is contracted to provide medical care at the Montgomery County prison.
In her suit, Lopez alleges that PrimeCare failed to take any action to ensure Karaharisis would be monitored or evaluated while undergoing detox. She contends that medical professionals at the jail failed to adequately assess her daughter.
The suit cited PrimeCare medical documents for Karaharisis as showing no record that vital signs were taken or medical observations “of any kind” were done between Sept. 26 and 29, 2013. It also contends the lack of medical monitoring was the result of a prison policy that used other inmates who lacked medical training or knowledge to monitor inmates on medical watch for drug or alcohol detox.
Karaharisis underwent an intake medical exam conducted by licensed practical nurse Kristin Szuch Hui shortly after arriving at the prison. Hui is also listed as a defendant in the suit. During the exam, Karaharisis told Hui that she was a “heavy” heroin user, injecting up to 20 bags of the drug daily for at least two years, the suit said. 
The information about Karaharisis was recorded in an electronic medical record maintained by PrimeCare that noted the inmate was at risk for heroin detoxification, the suit alleges.
Following the death, prison officials said Karaharisis was under normal medical watch and last spoke to a prison staff member around 4 a.m. the day she died. She had a fever, which is a typical symptom of opiate withdrawal, the prison said.
Opiate withdrawal is generally not considered dangerous for otherwise physically healthy users, according to medical and substance abuse experts. But it can have potentially life-threatening consequences for individuals with chronic medical conditions. There are also risks associated with withdrawal side effects, including dehydration, electrolyte imbalance, neurological arrhythmia and cardiac arrhythmias, according to medical experts.
“Such dangerous medical consequences are particularly likely to be present in persons who are long-term heavy users of heroin like Ms. Karaharisis,” the suit said.
Approximately one-quarter of prisoners entering the Bucks county jail system require detox, PrimeCare estimated. Karaharisis was the first of two Bucks inmates who died during heroin withdrawal in the eight months after PrimeCare took over medical care for Bucks County prison.
Marlene Yarnall, 49, of Bensalem, had a fatal cardiac arrest in March 2014, also the third day of her heroin detox at the prison. Yarnell had heart disease, an enlarged heart and high blood pressure that contributed to her death, according to an autopsy. She also had a heart attack during heroin withdrawal at the prison a year earlier, officials confirmed.
Following Yarnall’s death, the newspaper filed a Pennsylvania Right to Know request to obtain PrimeCare’s medical protocols and drug lists used for inmates undergoing drug or alcohol detoxification at the county jail. The county denied the request, but after an appeal, PrimeCare reached a settlement privately and provided the information.
Those PrimeCare medical protocols include a medical screening on inmates performed by a medical staffer, at least a licensed practical nurse, to determine if an inmate requires a detox protocol. A more comprehensive medical screening is done no longer than 14 days after an inmate is admitted, according to the protocol.
PrimeCare generally does not use narcotic substitute tapers as part of its detox protocol for non-pregnant opiate users. Instead, its standard protocol calls for an antihistamine drug called Vistaril, which reduces activity in the central nervous system, to be administered for 10 days.
Inmates who are medically judged to need a narcotic during detox receive Tylenol 3, which contains acetaminophen and codeine, according to the protocol. Detoxing inmates who cannot be medically managed or who experience “extenuating complications” are transferred to a hospital for treatment, PrimeCare previously said.
Pregnant opiate users are transported to a licensed methadone program until they are stabilized; the methadone maintenance treatment is continued while they are incarcerated because detox is too risky to the inmate and fetus. PrimeCare medical staff administers the methadone, according to the protocol.
Additional drugs may be given to ease withdrawal symptoms including Bentyl for stomach cramps, the anti-nausea drug Zofran, and Pepto-Bismol, according to the protocols.
Other standard opiate taper orders include assigning the inmate to the bottom cell bunk for 30 days, in-person medical checks twice a day that include taking the body temperature, blood pressure, respiration and pulse ox levels. An inmate also sees a physician assistant, certified nurse practitioner or medical doctor the next business day after entering the prison, and again on the third and last day of detox, which generally lasts 10 days.
Last year, PrimeCare added a third medical visit during the 10-day detox treatment period at the Bucks County prison, a change the company claimed was the result of changes in the inmate population, not the two inmate deaths.


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