Monday, October 31, 2016

Overdose death raises questions for Bristol Township sober house run by property company

Tom and Jessica Blackburn lost daughter Victoria Exner last year
Posted: Oct 30, 2016

When Victoria Exner moved into a sober home on Ironwood Road in Bristol Township last year, the only thing that struck her family as strange was the name they wrote on money orders for her rent: Official House Buyers LLC.
It wasn't until months after Exner died of a fatal cocaine overdose there that her Buckingham family learned the house was owned and operated by a business that flips real estate and allows practices at its sober house — such as co-ed living — that some addiction management experts warn can put residents at risk for relapse.
As the first anniversary of Exner's Nov. 3, 2015, death approaches, her parents are questioning why a company that buys and sells houses is running a home for recovering substance abusers.
“It’s ridiculous,” her stepfather, Tom Blackburn, said during a recent interview.
But not unheard of. At least four other real estate-related companies are landlords for a minimum of 13 confirmed recovery residences in Bucks County, though some appear to rent the properties to third parties that operate the recovery/sober houses, according to county property records and a database this news organization compiled of Bucks County recovery houses.
For local and state lawmakers and addiction specialists, the Ironwood Road home highlights the need for outside oversight and minimum operating standards to govern a lucrative, unregulated and fast-growing segment of the housing industry. Recovery and sober living residences are supposed to provide a structured, safe and drug-free environment that supports individuals seeking long-term sobriety. Their residents are protected from discrimination under federal housing and disability laws.
The Pennsylvania Alliance of Recovery Residences calls it “highly unusual” for a real estate-related business to run a recovery residence. PARR is a state affiliate of the National Association of Recovery Residences, a nonprofit group that promotes peer evaluation and oversight of recovery residences and sets minimum health, safety and operation standards. 
PARR Executive Director Fred Way expressed skepticism about the effectiveness of a recovery residence operator with no professional training or education in drug treatment or addiction management.
“How many in-house meetings are they doing? What kind of life skills (training) is going on in the house?” Way asked. “Is it another house that people are labeling it a recovery house that technically is not?”
The Ironwood Road house is the first — and only — “sober living house” owned by Official House Buyers LLC, a Bristol Township property company, according to Jonathan Geftman, who identified himself as an owner and manager of the company. He described the sober house as a transitional residence for individuals who have been sober for at least six months.
Before moving in, residents must pass a drug test, complete an application process and provide references, Geftman said. Residents are expected to “self-police” their behaviors, complete assigned household chores and submit to regular random drug testing, but there are no rules or expectations other than those, Geftman said.
“It’s not a place where you clock in or clock out,” he added. “It’s not a jail. I think clocking in and clocking out with this type of home could be offensive to the residents.”
A house manager oversees daily operations, but it’s not a live-in position. The manager and other staff members visit the house throughout the day to monitor activity, Geftman said. The manager, who Geftman hired, came “highly recommended” from another long-term recovery house operator, according to Geftman, who said the manager has nine years of experience managing recovery and sober living homes and is a trained first responder.
Sober homes are considered the last stop on the recovery residence continuum for people who have with been sober for a sustained period of time and who are self-sufficient or close to it, according to Way. Individuals typically progress to sober living homes after staying in a recovery house, which is a more structured aftercare residence that is designed to provide intense supervision, emotional support and job and life skills building following drug treatment or prison. A typical recovery house stay is at least three months, but NARR has no similar minimum standard for sober living homes.

Jessica Schieber Blackburn and Thomas Blackburn hold a photo of their late daughter, Victoria Exner, 29, who died of a drug overdose.
Tracie Van Auken / For the Courier Times
“Individuals should have some clean time under their belt if they are going into a sober living home, no doubt,” Way said. “They have the freedom to go and come because they have earned that.”
While residents of sober houses have earned more independence, structure is still important, according to NARR, which recommends -- at a minimum -- random drug screenings, in-house meetings and encouraging residents to attend self-help meetings such as Narcotics Anonymous or Alcoholics Anonymous. Some state affiliates, like PARR, require sober living homes that seek their certification to implement certain rules, including minimal curfews and requirements that residents attend some outside self-help meetings, Way said.
Official House Buyers LLC purchased the formerly vacant home in the 100 block of Ironwood Road for $135,000 in May 2015 with the intention of opening a sober house, Geftman said. The house is in the Indian Creek section of Levittown, where at least eight other recovery residences are located, according to township records.
The business applied to Bristol Township’s Department of Licenses and Inspections to open a “sober living facility” with 10 bedrooms and shared common areas in June 2015, and passed the township-required inspection in late August with approval for up to 12 occupants, township property records show. The first tenants — who are charged an average of $160 a week — moved in on Sept. 1, 2015, Geftman said, adding the company has no plans to open additional recovery residences.

Flowers from the funeral of Victoria Exner sit in the living room at the home of Jessica Schieber Blackburn and Thomas Blackburn in Buckingham. Exner died after being found unresponsive at a sober living home in Bristol Township.
Tracie Van Auken / For the Courier Times
“It seemed like a productive use of the property,” he said. “It also seemed like a good idea to be in a position to have a quality property for people to have a second chance and shelter.”
According to her family, Exner had struggled with opiate addiction since high school. By the time she arrived at Ironwood Road, she had been in and out of detox and rehabs and had lived in two other recovery houses in less than a year, her mother, Jessica Schieber Blackburn, said.
Schieber Blackburn said she contacted at least a dozen recovery residences in an unsuccessful search of a bed for her daughter before someone gave her the phone number for the Ironwood Road house. It was the first house that had an immediate opening, she said.
When they visited, Schieber Blackburn said the home appeared to be well-maintained and clean, and residents were drug tested. But what she said they they didn't know was that the home was co-ed and the manager didn't live there. Schieber Blackburn said her daughter didn't tell her if she filled out a rental application or received other paperwork before she entered the house.
“It looked just like all the other (recovery) homes,” Schieber Blackburn added. “I thought the people running the house were the owners.”
Schieber Blackburn said she was surprised when her daughter asked her to write a money order for the rent, addressing it to what sounded like a business. “I thought it was strange, but I didn’t question it,” she said. "Shame on me."
After all, she said, Exner appeared to be on the path to maintaining her sobriety this time. She worked as a house cleaner and waitress. Most of the time, she paid her rent without her parents' help. She attended Narcotics Anonymous meetings and was sober for six months, her family said, a milestone commemorated in the colored NA key chains her mom has kept.
The Blackburns insisted Exner lived at Ironwood Road at least starting in September and showed the money order receipts they said proved it.  Geftman, though, said his records show she lived there three weeks.
“She was really so proud of herself and we were proud of her,” Schieber Blackburn said.

Victoria Exner, 29, died in late 2015 after she was found unresponsive at a new recovery home in Bristol Township.
Tracie Van Auken / For the Courier Times
“She looked great,” Tom Blackburn added. “She was her old happy self.”
Word-of-mouth referrals like the Blackburns described are what Official House Buyers relies on, Geftman said. The company doesn't work with drug treatment providers, a frequent referral source for recovery residences, he said.
Prospective residents fill out a one-page screening application that includes questions about 12-step meeting attendance in the previous month and whether the person has a 12-step sponsor, as well as emergency contact and sponsor information, Geftman said. He declined to provide this news organization with a copy of the application, which he said was supplied to him by another long-term recovery house.
And while the house is co-ed, men and women don't share bedrooms, Geftman said. Aside from one fight after which both participants were evicted, no problems have occurred with the co-ed living arrangement, he said. Residents are given week-to-week leases and someone who's removed for failing to follow house rules gets unused rent refunded, he said.
“We don’t want these people to be homeless,” he added.
Tenants typically stay at Ironwood Road for an average of six to nine months, Geftman said.
He described the house’s drug testing policy as random, explaining that some tests are done on back-to-back days while others are done weekly. He said all resident information, including the drug test logs are maintained, though he declined to say where the information is stored. Officials House Buyers doesn't supply Narcan – the opiate overdose reversal drug – to the house, he added.
“The hope and aspiration is the people who are occupants will ultimately be renting their own apartments rather than live in a shared facility,” Geftman added. “Official house Buyers is proud that many occupants of Ironwood have made commitments to themselves and have improved their lives and those in their lives.”
Not long after the house opened, state Rep. Tina Davis, D-141, Bristol Township, visited the house, Geftman said. A “mutual acquaintance” suggested Geftman contact Davis because she wanted to see the conditions there. Geftman declined to provide the acquaintance’s name. During her visit, Geftman said, Davis complimented the house, telling him that it was not only well organized, but “superior” to other recovery houses she had seen.
Davis has a different recollection of the meeting.
“I was getting tons of complaints from neighbors (about the home)," she said. “I didn’t consider them a recovery house.”

Jessica Schieber Blackburn and Thomas Blackburn stand next to the orchid which they named after daughter Victoria Exner, who died of a drug overdose after being found unresponsive at the sober living house where she was residing. 

The state lawmaker, who has proposed legislation for voluntary recovery and sober house certification, agreed the house appeared to be well-maintained, but she said she observed only the common areas, not the locked bedrooms. She expressed concerns to Geftman about the house accepting men and women and its application form, which Davis said didn’t contain questions about sobriety or drug use.
During the visit, Davis said she suggested the house join the Bucks County Recovery House Association, a local network of private recovery house owners and operators that practice peer-monitoring and oversight of member homes and are a PARR affiliate. Geftman said he considered joining, but hasn’t applied. He declined to say why.
Bucks County Emergency Dispatch records show police responded to six calls at the house during the three months after it opened. So far this year, police have responded to six calls, including a domestic disturbance, an unwanted person, a threat and an abandoned 911 call, according to county records. Police have also made 11 offender checks — when probation and parole officers visit an offender at home or work — at the home since September 2015, according to dispatch records.
Among the 911 calls at the house last year, two reported cardiopulmonary arrest and active seizures on Nov. 2, 2015, the day Exner was found unconscious in her bedroom. Two days later, police responded to the report of a second overdose/poisoning and cardiac arrest at the house, records show, but no additional information was noted.
Available township records show at least six people moved in and out of the home the first month it was open. Five left after six days, according to letters that Official House Buyers submitted to the township listing tenant names for earned-income tax purposes. Additional letters listing tenants included the dates residents left the house, but not when they entered, so it’s unknown how long they stayed. The most recent tenant list was submitted in March, according to an October review of township records for the property.
PARR’s Way said some of the administrative and operational practices described by Geftman and the turnover noted in the available records were questionable.
A high resident turnover rate can be a red flag for recovery and sober houses that suggests poor management, he said. NARR standards also strongly discourage co-ed recovery houses. During the first year of sobriety, addiction management professionals advocate avoiding sexual and romantic relationships, which are seen as distracting and disruptive and place individuals at risk for relapse, Way explained. PARR and NARR standards bar managers from working in opposite-sex homes, he added.
The combination of a co-ed home and lack of an on-site manager and unpredictable supervision raises a potential “major” red flag for resident safety, according to Way.
While it’s common for recovery house operators to require residents make weekly rent payments, they typically have month-to-month leases, Way said. He’s never heard of week-to-week agreements. Any house rules or guidelines also should be provided to residents in writing, including refund policies and penalties for late payments or non-payments, he added.
“Everything should be in writing,” Way added. “They should be keeping records of the urine testing, and the chore list should be hung up in the house where any visitor can see it. It’s easy to say what you have; it’s harder to produce what you have.”
Of the 21 fatal drug overdoses in Bristol Township last year, Exner was the only one at a confirmed sober or recovery residence, according to police.
The Philadelphia Medical Examiner autopsy report confirmed Exner's death was drug-related. It’s the only official record the family has detailing her death, and came after Exner was taken to a hospital after her overdose and declared brain dead.
Bristol Township police haven't returned Schieber Blackburn's calls and won’t release the incident report, citing state law that protects materials that are part of a criminal investigation, she said. This news organization was unsuccessful in reaching Bristol Township police Lt. Terry Hughes for comment on any police investigation. The family's attorney, Keith Williams, who was hired to find out more details about Exner's death, said the Bucks County District Attorney's Office told him police found no evidence of a crime.
Much of what the family says it knows about what happened before and after Exner's body was found is bits and pieces of third-hand information, Schieber Blackburn said, like how paramedics worked on Exner for 45 minutes until they heard a faint heartbeat and took her to the hospital.
Her daughter’s Narcotics Anonymous sponsor notified the family about the overdose, Schieber Blackburn said. The only person with Official House Buyers who contacted the family after the overdose was the house manager. He wanted to know if he could pack up Exner’s belongings so her room could be rented, Schieber Blackburn said.
The call came before the family had the life support machines disconnected, she said.
Not all of Exner’s belongings at the home were returned and neither was the balance of the rent they paid, Schieber Blackburn said, noting her daughter had no will.
Geftman responded that any property, including unused rent, that belonged to Exner would have to be passed to her estate. “It happens to be the law of the land,” he added.

Jessica Schieber Blackburn and Thomas Blackburn hold a photo of their daughter, Victoria Exner, 29, at their home in Buckingham Township on Thursday, Sept. 15, 2016. Exner died after being found unresponsive at a new recovery home in Bristol Township.
Tracie Van Auken / For the Courier Times
"What 29-year-old is thinking of getting a will," Schieber Blackburn said. "I am insulted. It's adding insult to injury."
Geftman declined to comment on the death, beyond calling it “tragic” and saying he wanted to respect the family’s privacy. He said he hasn't contacted the family.
Meanwhile, Schieber Blackburn believes she was misled. She said she wouldn't have let her daughter live at the Ironwood home if she had known a real estate flipping company operated it and that it had few rules and minimal supervision.
“That blew us away,” she said. “My understanding was this is where people that are addicted go to get structure in their life."
Jo Ciavaglia: 215-949-4181; email:; Twitter: @JoCiavaglia

Friday, October 28, 2016

Pennsylvania 38th state to make non-lethal strangulation a standalone crime

Posted: Oct. 26, 2016
Pennsylvania has become the latest state to pass a law that will make it easier to prosecute crimes involving non-lethal strangulation, a form of domestic violence that is increasingly reported among victims, according to victim advocates and law enforcement officials.
Gov. Tom Wolf signed into law Wednesday a bill that makes choking someone a standalone crime like robbery or murder — a move that plucked it out of the myriad offenses that fall under the umbrella of simple or aggravated assault charges. The legislation also makes it a potential felony under certain circumstances.
Specifically, the law states that it’s a crime to “intentionally or knowingly” impede another person’s breathing or circulation by applying pressure to the person’s throat or neck or blocking someone’s nose or mouth.
The new offense is graded as a second-degree misdemeanor, but could rise to a second-degree felony if it is committed in conjunction with sexual violence or the victim is a care-dependent person or a household member. It becomes a first-degree felony offense if the victim has an active protection from abuse order, an instrument of crime is used or the defendant has a previous strangulation conviction. Under the old law, strangulation could be charged as a summary offense up to a felony, but the latter was often difficult to make stick, according to prosecutors.
Pennsylvania is the 38th state to pass a law carving out strangulation as a separate criminal offense.
“By making strangulation a felony, the law will more appropriately reflect the gravity and potentially deadly nature of this offense," said David Arnold Jr., president of the Pennsylvania District Attorneys Association, an organization that supported the bill.
Bucks County District Attorney Matt Weintraub said prosecuting alleged strangulation as an aggravated assault, which carries harsher penalties than simple assault, can be difficult because typically the charge requires the victim to lose a body part or suffer a protracted injury.
“With strangulation, the victim may have been near death, but suffered no permanent injury — that may lead us to only prosecute for simple assault,” Weintraub said. “This (law) is going to allow us to better protect our victims of domestic violence.” 
Non-lethal strangulation — better known as choking — has become more common in domestic abuse cases in the United States over the last decade, according to national data. But its seriousness historically has been minimized by the legal, law enforcement and medical communities since most victims survive, domestic violence experts say.
Studies suggest that strangulation is often a predictor for homicide and repeated strangulation can lead to other serious health problems, abuse experts say. But within the context of domestic violence, strangulation has been systematically investigated by criminology researchers only in the last 15 years, according to a study released earlier this year.
One of the first studies to examine it in 2001 found that 68 percent of the 62 women in a Dallas women’s shelter reported being strangled by an abusive partner on average of 5.3 times. A 2008 study in the Journal of Emergency Medicine suggested that the risks of an attempted homicide increase about sevenfold for women who have been strangled by their partner. The study also found that nearly half of all individuals murdered in domestic assaults and 45 percent of victims of attempted murder had been strangled by a partner in the previous year.
In Pennsylvania, most domestic violence murder victims are shot or stabbed, but strangulation is the third-most frequent cause of death, according to data from the Pennsylvania Coalition Against Domestic Violence.  Among the 113 domestic-violence related murders in the state last year, eight people were strangled to death compared to 61 shot and 33 stabbed, according to the Pennsylvania Coalition Against Domestic Violence’s annual report.
“I do believe — and we learned in advocating on this bill — people in general do not understand how dangerous choking or strangling someone is,” said Peg Dierkers, the coalition's executive director.
As little as 10 seconds of pressure on the carotid arteries in the neck is enough to deprive the brain of oxygen and cause someone to lose consciousness, according to the National Family Justice Center's CEO Gael Strack, a national expert on domestic violence and strangulation. If the pressure continues, brain death can occur in as quickly as five minutes, said the Family Justice Center Alliance. But even if the pressure is released — and consciousness regained — the person might experience serious, potentially fatal, injuries. Swollen vocal cords can block breathing and lead to death hours or days later. Repeated incidents of strangulation can cause permanent artery and blood vessel damage that can result in an increased risk of early stroke, according to Strack.
Strangulation has been on the PCADV's radar for at least four years, when it was the main topic of an educational conference with the Pennsylvania Chiefs of Police Association to develop an officer training program; the same year the coalition launched its Lethal Assessment Protocol in domestic violence calls.
Under the protocol, police officers are encouraged to ask suspected domestic violence victims a series of questions designed to gauge their likelihood of being killed by a partner and connect them with services immediately. About 200 of the state’s 1,200 police departments — close to 20 percent — participate in the LAP, including Abington, Upper Moreland, Telford and 12 others in Montgomery County.
Since the coalition implemented the LAP, roughly half of 9,966 Pennsylvania domestic violence victims screened under the protocol since 2012 reported they have been choked or strangled by an alleged abuser, Dierkers said. Last year alone, 1,794 Pennsylvania victims — 53 percent of those screened — claimed they previously were choked by an abuser, according to the coalition’s database.
Montgomery County domestic violence victims reporting past choking incidents involving a partner jumped from 37.5 percent (15 out of 40 screened) in 2012 to 45 percent (106 out of 236 screened) last year, according to the coalition’s data.
Bucks County does not participate in the coalition’s program, but has its own domestic violence assessment protocol, which includes 11 questions that were common issues identified as factors in domestic-related homicides in the county, according to Linda Thomas, director of institutional advocacy for A Woman’s Place, the county’s domestic violence service provider and women’s shelter. About half of the county's 42 police departments use the protocol, Thomas said, though she is working to expand the number.
Thomas did not have any Bucks County data available for the frequency of reports of strangulation or choking among domestic violence victims, but she called it a “very common factor.” She added that victims sometimes don’t recognize the seriousness of the act.
“Often they refer to it as choking, and we try to inform them and educate them to the seriousness of the situation and tell them it’s actually strangulation,” Thomas said.
Law enforcement agencies now can begin working on special training to identify evidence of strangulation, Thomas said.
Among the challenges with charging and prosecuting non-lethal strangulation has been the injuries might not be immediately obvious. Strangulation often presents with subtle signs initially, such as redness or scratches around the neck or chest, bloodshot eyes, dizziness, vomiting or loss of consciousness. Hours or days later, bruises also can form around the neck.
A 1995 study found that in half of the strangling cases, people have no immediate signs of external injury, and 35 percent of the time the injuries are too minor for police to photograph. Without signs of external injury, proving felony assault is difficult for prosecutors. Proving attempted murder is also tough, since prosecutors have to prove the defendant intended to kill — not scare or control — the victim, experts say.

Jo Ciavaglia: 215-949-4181; email:; Twitter: @JoCiavaglia

Wednesday, October 26, 2016

Court documents in wrongful death suit give insight into inmate monitors at Bucks County prison

Vallia Karaharisis died of complications from heroin withdrawal
Posted: Oct 23, 2016
As a Bucks County prisoner placed on medical watch, Vallia Valene Karaharisis should have been checked on 64 times — once every seven to eight minutes by a fellow inmate or a guard — during the overnight hours of Sept. 28, 2013.
Instead, written records suggest she was observed only 13 times over roughly 10 hours, an apparent violation of the prison's Watch and Observation policy. The last contact she allegedly had with a guard came nearly four hours before she was found dead as a result of complications from sudden heroin withdrawal. But there is no record that a conversation took place during that contact, according to testimony. 
Those and other details contained in deposition testimony and recent court documents involving a lawsuit filed by Karaharisis' mother last year suggests that lax oversight existed in a Bucks County prison program that pays inmates to watch over other inmates who are sick, suicidal or a security issue. Those documents provide details the county previously denied this news organization in a Right to Know request about the program
“The prison had a custom of noncompliance with the (inmate watch) policy and failed to provide adequate supervision and training regarding the policy,” according to attorney Jonathan Feinberg, who represents Karaharisis' mother, Loretta Lopez.
Bucks County is one of only a handful of prisons or detention centers in Pennsylvania — and the only one in the Philadelphia region — that uses inmate monitors to help watch over sick and suicidal inmates to ensure that they get help as quickly as possible if their condition deteriorates. No federal standards exist for such monitoring programs, and the little data that is available shows the practice varies widely depending on local jurisdictions and agency policies. The closest county jail to Bucks County using inmate monitors is Lehigh County, but those inmates do not watch prisoners detoxing from drugs or alcohol.
Bucks County has acknowledged in related court documents that corrections staff and inmate monitors failed to properly follow watch procedure during the shifts immediately before Karaharisis, who was jailed on a probation violation, was found dead. However, they deny the lapses reflected widespread failure to follow the protocol, any lack of adequate corrections officer training, or that the delayed monitoring contributed to her death.  
A medical assistant conducting detox check rounds discovered Karaharisis dead at 8:15 a.m. on Sept. 29, 2013. She was in rigor mortis, cold to the touch, and her hands, fingers and legs above her calf were blue, according to testimony from medical staff and corrections officers.  In humans, the onset of rigor mortis generally occurs 4 to 6 hours after death and reaches maximum stiffness after 12 hours, according to Dr. David Fowler, Maryland's chief medical examiner and president of the National Association of Medical Examiners.
“Not only is there a complete lack of evidence to demonstrate that Karaharisis was in ‘medical distress’ during the overnight shift of Sept. 28, 2013, the conduct of the individual county defendants in failing to monitor Karaharisis every 15 minutes, instead of every 30 minutes, does not constitute deliberate indifference to her serious illness," the county said in an Oct. 6 motion to dismiss the lawsuit. The suit names the county, three corrections officers and PrimeCare Medical Inc., the prison's medical services provider, as defendants.
Yet hundreds of pages of deposition testimony from corrections officers, prison employees and inmates contained in a court motion opposing the county’s request to dismiss the lawsuit provide new insight into the inmate monitoring protocol, including:
  • While the county has used inmate monitors, who are paid $3 for an eight-hour shift and often referred as "babysitters" by prison employees, for at least 30 years, according to a county official, a lieutenant assigned to the prison’s officer training division testified that the watch and observation procedures weren't written until 2003.
  • One of Karaharisis’ cellmates, who testified that she worked as an inmate monitor, stated she believed the inmate monitors — not the corrections officers — observed inmates on watch protocol. County policy requires both to make observations.
  • Corrections employees testified they were aware that inmate monitors sometimes incorrectly filled out monitoring forms, which are used to communicate with corrections staff about the updated needs of an inmate in mental or medical distress.
  • Corrections officers and senior prison staff testified they did not know what happened to the completed inmate monitor forms after they were forwarded to the corrections mental health unit.
  • None of the corrections officers responsible for Karaharisis during the shifts before her death were disciplined or retrained on the watch protocols after her death, according to testimony including from the officers involved. The suit also alleges that a lack of consequences for officers who didn't follow watch protocol was not unusual.
  • Superior officers failed to flag Karaharisis' inmate monitor forms as out of compliance with county policy and procedure. Supervisors are responsible for reviewing the forms after they are turned in by corrections officers.
In an emailed response to this new organization, Bucks County Commissioner Diane Marseglia said inmate monitoring policies were in place prior to 2003. She declined further comment on the case, and other county officials could not be reached for comment.  
Karaharisis, 29, of Philadelphia, was the first of two prison inmates to die while under medical watch and assigned inmate monitoring since 2013. Six months after her death, Marlene Yarnall, 49, of Bensalem, also died of cardiac arrest in March 2014, during heroin detoxification three days after she was incarcerated on a probation violation. Yarnall’s family has also filed a federal wrongful death suit, which is still winding its way through the federal system.
The Karaharsis suit contends that had the county properly trained and supervised inmate monitors and corrections officers to follow the county protocol, the severity of her daughter's medical distress would have been noticed and she would have received prompt medical intervention. It also alleges that PrimeCare employees failed to follow company detox protocol, and provide Karaharisis adequate medical care and supervision.
Prison employees testified in depositions that case managers at the prison are responsible for selecting inmate monitors and reviewing the written job instructions with them before they are assigned a watch shift, Deputy Warden Lillian Budd testified. Inmate monitors are not formally trained to oversee other inmates on watch. 
Inmate monitors are generally assigned to observe up to eight inmates during a regular watch shift. The job requires them to observe and record the behavior of the inmates they watch on a form using the codes that include eating, sleeping, toilet, shower, talking, in the cell, out of the cell and “other," Budd said.
The regular watch protocol calls for inmates to be observed every 15 minutes, but watch tours are supposed to be staggered so that an inmate is actually observed every seven to eight minutes by an inmate monitor or a corrections officer, according to Budd’s testimony. Both inmate monitors and corrections officers are supposed to record each observation on the inmate monitor forms, and the officer initials both observations, Budd testified.  
Inmate monitors and corrections officers fill out separate forms and must use new forms for each shift under a change implemented last year, according to testimony. In 2013, though, monitors and correction officers used the same monitor form, which contained 64 spaces for observations, according to a training supervisor's testimony. Corrections staff also now sign inmates’ monitor forms every 15 minutes, whereas before it was sometimes signed sporadically throughout a shift, according to testimony. 
However, in its Oct. 6 motion, the county denied the watch policy requires observations to be “noted and initialed on the inmate monitor form every 7-8 minutes.” The county also denied that regular watch procedures require that correction officers write their observations of inmates on the form; rather, they are required only to initial the form that includes the notations from the inmate monitor. 
The inmate monitor assigned to Karaharisis for the 10 p.m. to 6 a.m. shift starting Sept. 28 testified Karaharisis appeared to be experiencing what she considered a “normal” detox when she observed her early in the shift, describing her as “up and down getting sick.”
The monitor testified she made observations at 1 a.m. and 2 a.m. She added that Karaharisis stated she was not “OK,” but she also did not want a corrections officer called. At 2 a.m., after Karaharisis said she still wasn't "OK," the monitor said she brought Karaharisis water because she worried she was dehydrated and appeared to be "progressively getting a little bit worse," she said. 
Around 2:15 a.m. on Sep. 29, 2013, the monitor testified, she checked on Karaharisis, who appeared to be sleeping in bed with her body facing the wall. One of Karaharisis’ cellmates also testified that she believed Karaharisis was in her bed around 2 a.m. 
The monitor also testified that, when she worked overnight on a regular inmate watch, the locked cell doors prevented her from observing an inmate up close. Instead she pressed her face against the cell window with her hands cupped around her face to observe an inmate. Another option was to turn on the cell lights, but she was reluctant to do because it upset sleeping cellmates. 
“I have 20/20 vision. I can see into the cell, but it’s not a clear picture,” she added. “I can see outlines of bodies in a bed, but you know, I could not tell you what they were doing. ... I don’t understand the whole process, because how am I supposed to know if somebody is breathing?”
For the remainder of the shift, the monitor testified that every time she checked on Karaharisis, the inmate was in the same position facing the wall.  
But the monitor's testimony contradicts what was written on the inmate monitor form she turned in, according to testimony. The sheet contained only eight identical entries that Karaharsis was asleep the entire eight hours starting at 10 p.m., according to deposition testimony. The monitor also testified it wasn’t the first time she failed to write down observations. 
“I would check on (inmates) obviously, but I would never write down what they’re doing if they’re sleeping,” she said. 
Other deposition testimony suggests that incorrect or incomplete inmate monitor forms were not an anomaly.
Frank Bochenek, described in court documents as a prison “chief investigator,” testified that he saw “multiple” inmate monitor forms that were incomplete or contained only eight recorded observations during an eight-hour shift rather than the combined 64 checks required from both inmate monitors and correction officers.
“I’m going to say not all of (the monitor sheets) were filled out on every line. Some of them would be filled out in this type of format showing one entry with a line down, (indicating the behavior didn’t change),” Bochenek said, according to deposition testimony.
Corrections officer Rebecca Mitchell, who worked the 6 a.m. to 2 p.m. shift on Sept. 29, 2013, on Karaharisis’ cellblock, testified that she was aware that inmate monitors sometimes filled out monitor forms at the start of their shifts with “predicted” observations. 
“If they see them inside the cell, they assume that’s … where they (are) at, like, for the next 15 minutes and they will write it down even though they didn’t get up to observe the inmate at that time,” Mitchell testified. “I’m not going to say all the time (it happens). You might have some that we call lazy, that don’t want to do the whole thing. But then there’s some that’s on all the time. So we stress to them, this is what your job duties are.”
Two of the three corrections officers on duty when Karaharisis died testified that they observed inmates on regular watch protocol every 30 minutes; one testified that she knew the protocol required an officer or inmate monitor to stagger tours so observations were done every seven to eight minutes. All three officers testified that they did not know they were required to write down their observations. 
Corrections officer Kristin Spadaro acknowledged in her testimony that the inmate monitor form for Karaharisis that she approved had only eight written entries and she initialed under “staff” portion of the form only five times. But she insisted that Karaharisis was observed more often than that overnight on Sept. 28-29. The county contends that an activity log shows Spadaro and other officers toured the module at least 15 times throughout the night.
Spadaro testified that she spoke to Karaharisis around 4 or 4:30 a.m. on Sept. 29 while doing her inmate watch tour and Karaharisis had no complaints. “I’m good. I’m still breathing,” she allegedly said, according to the officer's testimony.
According to court documents, though, Spadaro did not write on the inmate monitor sheet that the conversation took place.
Feinberg, the attorney representing Karaharisis' mother, alleges the conversation wasn't documented because it never took place. 
"Had Spadaro actually monitored Ms. Karaharisis every 15 minutes as required by BCCF's Watch and Observation protocol, she would have seen these symptoms of Ms. Karaharisis' serious medical need and could have called for medical intervention," Feinberg wrote in court documents. "While Spadaro claims to have spoken with Karaharisis at approximately 4 a.m. or 4:30 a.m., her claim is belied by both documentary and testimonial evidence." 

Tuesday, October 18, 2016

Some millennials reluctant to outgrow their pediatricians

Posted Oct. 16, 2016

These days, Kathleen Kurtz feels less self-conscious when she visits her doctor.

Now that the 31-year-old Northampton woman is a mom of three, she fits right in at the pediatrician's office, where both she and her children are patients.
She isn’t the oldest patient at the practice, either. The oldest is 35.
Kurtz is an unusual example of a small, but some believe growing, number of young adults who haven't outgrown their childhood doctor.

Kathleen Kurtz, 31, of Northampton is a mom of three, so she fits right in at the pediatrician's office, where both she and her children are patients. Kurtz is an unusual example of a small, but some believe growing, number of young adults who haven't outgrown their pediatricians.
Kathleen Kurtz with her son Thomas during a recent interview.
Jo Ciavaglia/Staff
Pediatric office visits among those 19 and older jumped from fewer than 1 million in 2002 to 2.4 million by 2012, according to the Annual National Ambulatory Medical Care Survey. But there is debate within the medical community whether the increase is a real trend, or reflects more visits by young adults with special needs who tend to stick with their pediatricians longer.
Some suspect the rise is related to the implementation of the Affordable Care Act, which allows young adults to be covered under their parents’ health insurance plans until age 26. The change alone has added 6 million people between ages 19 and 25 to insurance rolls since 2010, according to the U.S. Department of Health and Human Services.
Some in the medical community express concern about whether pediatricians should be treating young adults, and when the transition to an adult doctor should occur. When young adults such as Kurtz are asked why they've stuck with their pediatrician, continuity of care is one reason that's given, along with convenience, same-day appointments and comfort levels.
“I just feel comfortable with him. It’s easy to go to him. He’s available whenever I need him. I can be seen right away,” Kurtz said. “I’m actually nervous about when he retires.”

Kurtz has been seeing Dr. Isaac Abir at his practice in the Richboro section of Northampton since she was an infant. When she was diagnosed with thyroid cancer at age 24, Abir was very involved in her care. He recommended her surgeon and other specialists, and reviewed her scans and other treatment records. In recent years, she sees him mostly only when she is sick or for her annual flu shot.
In her 20s, Kurtz admits that she felt self-conscious sitting in the waiting room, with its walls of handmade crayon artwork, a laundry basket brimming with children’s books and giant baby bottle.
“Before I had kids I felt uncomfortable sitting in the waiting area because I’m obviously older,” she said. “But now that I have kids I feel I have an excuse to go to him because I don’t feel as odd when I’m there.”
Research has found that people between the ages of 18 and 34 have historically shunned doctors until they have a medical need, and so-called millennials in their 20s are more likely than other age groups to use retail clinics and emergency rooms rather than visiting a doctor's office. Yet recent data suggests young adults who still see their pediatricians are bucking those trends.
A study by the American Academy of Pediatrics found pediatrician visits among those between 19 and 28 grew by slightly less than 1 percent between 2007 and 2012. The study, which is still being finalized, was done using National Ambulatory Medical Care Survey data prepared for Got Transition/Center for Health Care Transition Improvement. The organization is a national resource center run by the National Alliance to Advance Adolescent Health.
Patients ages 18 and older accounted for nearly 7 percent of pediatrician visits in 2012-13, according to the National Ambulatory Medical Care Survey.

Dr. Heidi Weinroth of Cooper University Pediatrics in Moorestown, Burlington County, talks with patient Bridget Fynan, 20, of Delran
Dr. Heidi Weinroth and colleagues in Cooper University Pediatrics in Moorestown, New Jersey, typically see patients until they graduate from college. She estimates fewer than 10 percent of patients in her medical practice are in their 20s, but their reluctance to leave doesn’t surprise her.
With more young adults living at home longer and attending college closer to home, it makes sense to them to stay with a doctor they know and trust, she said. Weinroth added that she is careful not to overstep her medical bounds and refers young adult patients to specialists as needed.
But for general health issues, she said he finds the combination of continuity of care and the longtime doctor-patient relationship makes patients more receptive to talking frankly about their health issues.
“You bond with your pediatrician differently. We know them as well as they know us. These patients have had the same doctor for all their lives, literally,” she said. “Most of us haven’t seen our doctor 10 times. It’s no wonder they don’t want to leave us.”
Not every doctor wants to keep seeing patients into adulthood.
For example, most pediatric practices associated with Grand View Health in West Rockhill don't allow patients to remain in their practice after age 22, health system spokeswoman Susan Ferarri said. Many pediatric practices see age 22 as “really a stretch,” Ferarri said.
While the medical community agrees the relationship between pediatricians and patients is special, experts generally believe it shouldn't last too far into adulthood.
The Institute of Medicine and the National Research Council recently released a report that found that ages 18 to 26 represent a critical developmental period, and that group should be treated as a distinct subpopulation for medical reasons. Among the report’s recommendations for improving health care for this age range is transitioning from pediatric to adult medical and behavioral health care.
Got Transition encourages pediatric practices to set age-out policies so the deadline is known far in advance, said spokesman Daniel Beck. As early as ages 12 or 14, parents should start thinking about transitioning their child to an adult-focused doctor, he said, adding that his group believes the transition should be done between ages 18 and 21.
“We understand it’s a new (doctor) and trust needs to be formed, but it’s certainly something that needs to be happening,” Beck said.
While pediatric office visits by young adults are growing, Dr. Patience White, co-director of Got Transition, suspects a large number of those visits are by young adults with chronic illnesses who require more frequent medical care than their healthier peers.
“Change is hard, and for those with special needs, it’s especially hard,” said White, a professor emeritus of medicine and pediatrics at the George Washington University School of Medicine and Health Sciences in Washington, D.C.
Some pediatricians agreed that the transition to an adult-focused doctor can be difficult for patients with special needs such as Attention Deficit Hyperactivity Disorder or asthma. Frequently, a new doctor will want to start over to reaffirm the original diagnosis or adjust medications, which she said can be time-consuming.
But that's another reason the transition from pediatric to adult-focused health care is critical, said Dr. Katie McPeak, medical director of the Center for the Urban Child at St. Christopher’s Hospital in Philadelphia. St. Christopher's treats patients until age 21. McPeak recommends a two- or three-year transitional planning period, starting at age 15, for patients with chronic conditions.
"You are just prolonging the inevitable,” she added. “We can’t keep kids forever.”
Most pediatricians aren't credentialed to treat patients after age 21 and that can make it difficult to get an insurance company to cover the visit, McPeak said. Pediatricians also aren't necessarily skilled in substance abuse management and also may not be trained in sexual health and women's health issues, she said.
For those looking to delay the transition, a compromise could be a doctor board-certified in pediatrics and adolescent medicine since those specialties require additional training in behavioral and sexual health, White and McPeak said. Abir, Kurtz's pediatrician, fits into this category. He has extra training and experience in adolescent and adult medicine, and formerly was medical director for a residential center for children and adults with mental and physical disabilities.
Abir enjoys treating adults and children, but decided on the latter when he opened his solo pediatric and adolescent medicine practice in 1970.
He sees no reason to move his longtime patients to adult-focused practice once they turn 21, though he doesn’t accept new young adult patients. Abir believes the lifelong connection with patients is mutually medically beneficial.
“I have their whole history of life,” he said. “It’s like they are family.”
Jo Ciavaglia: 215-949-4181; email:; Twitter: @JoCiavaglia