Little known about Bucks County inmate monitoring program; unique in Philadelphia region

Posted Aug. 7, 2016

Vallia Valene Karaharisis died in 2013 during heroin withdrawl

Bucks County appears to be one of the few Pennsylvania counties that pays prisoners to monitor sick or suicidal inmates, but little is known about the decades-old program that has been named in a wrongful-death lawsuit involving a female inmate who died during heroin detoxification.

The federal lawsuit prompted this news organization to look into the practice of inmate monitoring, only to find after months of research and interviews that little public information exists about such programs in county prisons in Bucks or elsewhere.

The data that was found shows the practice varies by local laws and agency policies, according to prisoner advocates and trade groups representing prisons. There are no federal standards or guidelines for such monitoring programs, including inmate selection and training.

Bucks County spokesman Christopher Edwards said the county started the inmate monitoring program more than 30 years ago to supplement corrections staff, adding "It's a way of doubling the watch."

The Bucks County Correctional Facility has about 210 corrections officers assigned to oversee roughly 800 prisoners in the men's and women's units. Inmates earn $3 for an eight-hour shift to monitor inmates like Vallia Valene Karaharisis.

The 29-year-old Philadelphia woman was assigned an inmate monitor in September 2013 while she was on what the prison said was routine medical watch for heroin detoxification. She was found unresponsive in her prison cell, roughly four hours after she last spoke to a prison employee, according to prison officials and court documents. An autopsy and toxicology report concluded she experienced “sudden death during heroin withdrawal.”

In a federal civil suit filed last year, Karaharisis’ mother, Loretta Lopez, alleges the use of inmate monitors contributed to her daughter's death. The defendants include Bucks County, the prison and PrimeCare Medical Inc., the county's medical service contractor. Lopez’s attorney, Jonathan Feinberg, declined comment due to the ongoing litigation, as did PrimeCare and Bucks County.

“The lack of monitoring of Ms. Karaharisis’s medical status was due to a policy, practice or custom of correctional and medical staff at BCCF to assign inmates, referred to as ‘babysitters,’ the responsibility to monitor persons undergoing detoxification, notwithstanding the fact that such ‘babysitters’ have no training, medical or otherwise, concerning the risks of detoxification,” the suit alleges.

Karaharisis is one of two inmates who have died at the Bucks County Correctional Facility during heroin detoxification since 2013 while under medical watch and assigned inmate monitoring. She is among seven inmate deaths since 2006, according to county officials. Two of those deaths were suicides, but Edwards could only confirm one of those inmates wasn't considered a suicide risk and wasn't assigned an inmate monitor.

 Did You Know?

Bucks County prison inmates who work in the jail are paid out of the Inmate Welfare Fund, which is independent of the county general fund or prison budget. The fund is made up of a sales commission that vendors who operate the commissary and telephones pay the county.

In response to a Right to Know request this news organization made for general information about the Bucks County inmate monitoring program, the county released some documentation -- including inmate payroll records for one week and inmate pay rates. Prison officials declined to release a copy of the monitoring policy, citing concerns about possible safety threats to inmates and corrections officers. They also have refused to answer additional questions, including ones about how inmate monitors are screened, selected, trained and supervised.

"Disclosure of this policy could lead to manipulation by inmates that could compromise the effectiveness of this policy. Inmates' knowledge and manipulation of this policy could also lead to a compromise of safety and security within the correctional facility and even outside of it," according to the county in its Right to Know response denying the information. Section 708 of the state Right to Know Law Safety allows information requests to be rejected for certain reasons, including "personal or public security."  

Previously, prison officials have said inmate monitors and correction officers are each required to conduct visual checks of inmates who are on medical watch every 15 minutes. Inmates on what was called "acute watch" require constant observation. Inmate monitors are supposed to write down the status of the prisoners they monitor, including their behavior and activity, officials said. It’s unknown exactly what would trigger monitors to call for assistance from staff or whether monitors are responsible for multiple inmates on a medical watch detail.

Records provided by the prison show that inmate monitor appears to be the most popular job at Bucks County prison. During one week in late November last year, inmate monitors accounted for roughly one quarter of the 345 inmate workforce, more than any other job, according to inmate payroll records.

“It’s always been a position of honor for inmates to become 'babysitters.' Cameras could be installed, but, in my humble opinion, eyes and ears are superior,” veteran Lower Bucks defense attorney Ron Elgart said.

Inmate monitoring elsewhere

No other Pennsylvania county in the Philadelphia metro region uses inmate monitors, according to officials.

Lehigh County is the closest prison where inmates are used to monitor other prisoners. That program started in 2002, following a series of inmate suicides and attempted suicides at the prison, which houses roughly 1,000 inmates and employs about 200 corrections officers, said corrections director Edward Sweeney.

Lehigh monitors are used almost exclusively for 24-hour suicide precaution assignments, though the prison’s policy allows them to be used for other types of medical conditions requiring close observation, he said. Monitors aren't used to observe inmates during drug or alcohol detoxification.

The monitors supplement assigned corrections officers, who are expected to perform required inmate medical checks and observations as well, Sweeney added.

"It’s a very cheap belt-and-suspenders approach to the typical just corrections officer (monitor)," Sweeney said. "Knock on wood, we have not had a successful suicide of any inmate who is being subjected to an inmate monitor."

An extra set of eyes isn't the only benefit Sweeney sees to the monitoring program. He believes the experience give inmates the chance to demonstrate responsibility and show empathy.

Potential inmate monitors must demonstrate good conduct in prison, a cooperative attitude, good communication skills and the ability to remain alert for eight hours, since monitors often work the overnight shift, Sweeney said. A treatment supervisor reviews the applications and chooses the monitors. The prison has about 25 monitors, Sweeney said; they earn $3 for an eight-hour shift.

The prison medical staff provides 15 minutes of training before a monitor is assigned to an inmate, the Lehigh prison chief said. Monitors record the assigned inmate’s status every 15 minutes; the sheets are turned in at the end of the shift, Sweeney said. Monitors are encouraged to talk to the inmates they observe and immediately notify staff of any problem or behavioral change, he added.

On the rare occasions when inmate monitors are used for "general" medical purposes, Sweeney said they typically are assigned to elderly or disabled inmates who have mobility problems.

Elsewhere in Pennsylvania, Lackawanna County, in northeastern Pennsylvania, started an inmate monitoring program last year as part of suicide prevention efforts and Luzerne County jail has used inmate monitors as part of its suicide prevention program for more than a decade, according to the Pennsylvania Prison Society, a statewide prisoner advocacy group.

As for the prevalence of inmate monitoring programs in county correctional facilities around the country, Robert Kasabian, executive director of the American Jail Association, said his group doesn't track it or have a list of jails that use the practice. The association is a trade group that represents employees at some of the nation's correctional facilities.

Based on anecdotal evidence, AJA President Wayne Dicky said it appears most inmate monitoring programs are used exclusively for suicide prevention.

For more than a decade, monitors have been used "occasionally" in the Brazos County, Texas, jail where Dicky is an administrator. Generally, he said, they're used a couple times a month on suicide watches to supplement corrections officers. 

"They sit and make observations about what they see. Their only job is, if someone (inmate) is hurting themselves, let someone (staff) know," Dicky said. "The key is those inmates have no decision-making power and they can never have any power over who they are watching."

State and federal prisons

Pennsylvania state prisons train inmates as "certified peer support specialists" to work with other prisoners who are having emotional difficulties or to de-escalate tense situations, according to state prison spokeswoman Susan McNaughton. The peer specialists, who are supervised by prison staff, are used throughout state prisons, including in infirmaries, general housing and mental health units, McNaughton said.

Inmate monitoring, which has been used in federal prisons for more than a decade, has shown some success in preventing suicide, according to a 2005 study, which was the most recent.

As part of the Federal Bureau of Prisons study, a psychologist at a North Carolina federal prison trained inmates to watch their suicidal peers, record log entries at 15-minute intervals and call for assistance during emergencies. The psychologist also gave the observers information about suicidal behaviors, active listening and confidentiality. The inmate observers were instructed that their job was to observe, not counsel.

The study found the length and frequency of suicide watches were reduced when suicidal inmates were observed by their trained peers than when they were observed by corrections officers. While it provided no clear data on the reasons, one researcher suggested time spent with a peer could reduce stress or suicidal inmates sometimes threaten to harm themselves to manipulate corrections staff.

The study also found a drop in suicides and a $300,000 saving in overtime pay in one year at the federal prison. Both were attributed to the inmate monitoring program.

Concerns expressed

Some prisoner advocates and corrections professionals have raised concerns about the effectiveness of inmate monitors in prisons, citing potential problems with inmate access to sensitive health information and a lack of consistent, trained monitors.

“The use of inmate companions for suicide prevention is not used in the majority of correctional facilities throughout the country for obvious reasons, including reliability and potential liability, as well as ethical issues,” said Lindsay Hayes. He's the project director at the National Center on Institutions and Alternatives, an advocacy group for prisoners and others in institutional settings.

"An inmate should never be placed in the position of having to supervise or (have) any other responsibilities over another inmate," Hayes added. 

Despite that, the center has found inmate observers are often being used in suicide prevention programs in prisons where overtime pay is a concern, said Hayes, a national expert on prison suicides and prevention programs. National corrections standards don’t support using inmates to replace staff, he said.

“Perhaps most importantly, inmate companions have little, if any, impact on the reduction of inmate suicides because most inmates commit suicide when they are not on suicide precaution,” Hayes said. “Therefore, because the inmate companion program is often used only when an inmate is placed on suicide precautions, its impact in reducing inmate suicides is negligible.”

Lehigh County’s Sweeney acknowledged that the roughly six inmates who ended their own lives since the inmate monitoring program began there weren't on suicide watch.

Angus Love, executive director of the Pennsylvania Institutional Law Project, an advocacy group, called inmate monitoring a well-intentioned program, but one fraught with potential problems. He said the program carries significant risk, especially in relation to maintaining the strict medical confidentiality required by federal law.

Training and retention are also challenges, said Phyllis Taylor, a volunteer with the Pennsylvania Prison Society who is working with the Pennsylvania Department of Corrections to refine its prison companions program.

Taylor, a former prison nurse and chaplain, said she tried unsuccessfully to introduce an inmate monitoring program in Philadelphia’s prison system. One reason it didn’t work was the high turnover rate as prisoners are bailed out or transferred to state prison, she said, adding that the ideal monitors should be serving sentences of at least 11 months.

"It's extremely hard in a jail setting,” Taylor said. "It's a hugely complicated thing.

Jo Ciavaglia: 215-949-4181; email: jciavaglia@calkins.com; Twitter: @JoCiavaglia