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Medical Care Within the State Prison System

Most Rhode Islanders are familiar with the large, gray stone building surrounded by a barbed wire fence that sits atop Pontiac Avenue at the former Howard complex in Cranston, now recognized as the Pastore Government Center. It is a part of the state prison system known as the Adult Correctional Facility [ACI]. Within its walls are approximately 3,000 incarcerated inmates who will need some form of medical care during their incarceration.

The healthcare services unit provides medical care under the direction of the medical program director, Jennifer Clarke. Services include medical, mental health, dental and health education and clinical services.

Prisoners’ medical treatment begins at the intake center. A medical intake screen provides a medical history and evaluation. Nursing staff records current and prior illnesses, verifies prescription medications and determines which housing is most appropriate for the inmate, based on medical and mental health needs.

The nursing staff provides daily care to inmates. They assist physicians with treatment, administer medications, monitor inmates for communicable diseases, monitor acute and chronically ill patients and attend to inmates who are at the clinic for sick call. An on call practitioner is available to assist with acute cases that may require a hospital transfer.

Behavioral health services is another important facet of the prison healthcare system. It provides mental health and substance abuse treatment to the inmates. About 20% of the prison population has been diagnosed with a mental illness and between 70% and 80% have a substance abuse history, which correlates with the national average.

Some inmates, upon admission to the intake center, may become psychotic and violent. Often they are detoxing from drug or alcohol abuse and may need to be restrained and sent to the observation and stabilization unit where they meet with a mental health professional who develops an individualized plan of treatment. Once the inmate is stabilized and reevaluated, he is returned to the appropriate population.

For prescribed medications, the healthcare administration contracts with CPS [Contract Pharmacy Services], an out-of-state pharmacy that specializes in providing prescription drugs to correctional facilities throughout the US.

The doctors and nurses use an electronic pharmacy order system to order medications, which are flown by a commercial carrier to RI, picked up at the airport by courier and delivered to each facility six days a week. However, if there is an emergency and medication is required immediately, a local drug store will deliver medications to the door of each facility.

Although the DOC Health Care Services is vast and has many components, it appears well organized and up to the task of providing quality medical care under potentially volatile circumstances to the inmates from their initial incarceration until their discharge.

However, according to a source at the ACI who wishes to remain anonymous, the one weak link may be the discharge planning component of the healthcare system. Once an inmate is scheduled for release, they meet with an assigned discharge planner who will assist them with their discharge goals and establish a discharge plan. It appears that at times the discharge process is slow, or a plan may be almost non-existent and the inmate may be left to fend for himself. Without a long-term plan for continuity of care upon discharge, the potential for the inmate remaining successfully in the community lessens.

The real challenge comes when those inmates being released do not have a home to discharge to or family to assist them upon release and are referred to shelters such as Crossroads and Harrington Hall. The shelters employ social workers who will assist released inmates with finding housing and applying for food stamps, medical care or social security. Inmates who are on medications will, upon discharge, receive a 30-day supply of meds, allowing the shelter staff time to follow up with future prescriptions. Former inmates who have a history of addiction are given a supply of Narcan for emergency purposes, though there is a debate over whether giving narcan ahead of time will encourage drug use or if those who will use drugs will use them with or without having Narcan available.

Inmates who have mental health issues are often referred to agencies such as The Providence Center, which will assist them with scheduling a psychiatric appointment and a primary care doctor who will provide the appropriate medications and provide the necessary medical care. Often times a case manager is assigned to follow them in the community to provide any support needed to help them remain stable.

Over the past several years since the Affordable Care Act went into effect, many past inmates who have entered hospital psychiatric units are often referred to nursing facilities where they receive medical and psychiatric treatment as well as assistance with finding housing, a primary care physician and home care services.

Depending on the patients’ medical insurance, psych residents may remain in the nursing facility if they are homeless until a placement can be found. This situation has been controversial with staff at times because nursing homes are not equipped to deal with the psychiatric behaviors that are often associated with many of the psych diagnoses. Assisting psychiatric residents requires a level of training that is not usually a part of a nursing home environment, creating a tension-filled atmosphere that is taxing on staff. And many patients who require medical treatment are often unable to receive the proper care. Unfortunately, many nursing facilities now have an environment that is more conducive to a psychiatric institution rather than a traditional nursing setting, which is making it difficult to meet the needs of the more traditional resident. However, many who were inmates and are homeless should find some comfort in knowing that there is a place where they can receive assistance and a little security.

 

 

 




Alt-Health: Was it Something You Ate?

lettuceFeeling virtuous, you order a spring greens salad at the new vegan restaurant. After some sparkling mineral water and fruit sorbet, you’re off for a mile-long stroll in the fresh air. What could be healthier? But within hours, you are doubled over with cramps and go racing for the bathroom. Oops! You have just become another unwitting victim of food poisoning.

According to recent CDC studies, each year at least 1 in 6 Americans (48 million people) become sickened by food-borne illnesses. Of these, 128,000 are hospitalized and 3,000 die.

How can this happen in a country with so many regulations and safeguards in place? Because the world is an imperfect place and food contamination can happen at any point as it passes from the field to food handlers to the supermarket shelves. One of the strangest recalls I found online was issued by McCains Foods for Teeter brand frozen hash browns. These had been pulled from stores because they were contaminated with bits of golf balls. How did sports equipment end up in your breakfast? They had been “harvested” in the field along with the potatoes. Just recently, more than 200,000 pounds of  Nathan’s and Curtis hot dogs were recalled after metal pieces were found in the packages. And you may want to consider a rabies shot before perusing the produce: In April 2017, thousands of spring salads were pulled from store shelves after a dead bat turned up in a Fresh Express package sold at a Florida Wal-Mart grocery store.

A beautifully aged steak can reach the supermarket in a state of perfection and then become infested with norovirus by a careless butcher who didn’t wash his hands. A negligent shelf stocker can leave frozen food to thaw in the aisle while he checks his text messages. You aren’t even safe going organic. The warm, moist conditions ideal for growing sprouts is also nirvana for a variety of bacteria. In one study, over 78% of sprouts had levels of dangerous microorganisms too numerous to count, including E. coli.

So, what can you do to protect yourself? The CDC has some common sense suggestions.

Good hygiene: Scrub your hands before and after you handle food, and keep all cooking prep surfaces clean. If you prefer not to use antibacterial disinfectants, a dilute solution of water and chlorine bleach or a combination of hydrogen peroxide and white vinegar work just as well. Be smart — don’t cut raw chicken or other meats on wooden surfaces. Wooden surfaces are porous and suck up bacteria like a sponge.

Cook your food to the proper temperature: Rocky may have swallowed raw eggs for breakfast, but unless you want to risk salmonella, I’d advise scrambling, boiling or frying yours. Do not ever eat rare chicken or pork; it’s like playing Russian roulette with groceries.

Store food properly: You have a refrigerator, use it. Take a cue from the grocery aisles — if it was refrigerated at the store, keep it cold at home. And don’t leave leftovers sitting around at room temperature. Believe it or not, cooked rice can make dangerous leftovers. Not all pathogens are killed in the cooking process and, if left out all night, yesterday’s take-out can become today’s projectile vomitus. Also, be smart about how you store stuff. If you cram raw meats and seafoods next to ready-to-eat food, you risk cross-contamination.

The most common causes of bacterial infection are norovirus, salmonella, E. coli, campylobacter and listeria. However, foods containing undeclared allergens are responsible for more food recalls than any other form of contamination. The largest offenders include milk, eggs, peanuts and wheat. The recalls for these seem to rise every year. In 2015, there were 82 recalls for misplaced milk products; compare this to 101 in 2016. And recalls for mislabeled products containing eggs doubled between 2015 and 2016.

Here’s something else you should do to avoid Montezuma’s Revenge: Check for recall alerts every day. Especially be on the look-out for repeat offenders. Pilgrim’s Pride, one of the largest chicken producers in the country, first issued recalls on April 7, 2016, after discovering that some products had been contaminated with metal, plastic, rubber and wood. They “fixed” the problem, were given a green light and resumed shipping. But on April 26, an additional 4.5 million pounds of chicken products had to pulled. On May 6, another 608,764 pounds were added to the list. Production resumed, only to be halted again on May 19. The total weight of recalled chicken products was over 5.5 million pounds. Yet today, Pilgrim’s Pride is still proudly selling its products to your family and mine. Yay.

The moral of this story? No moral. Just this: Maintaining awareness and using common sense is always going to be your best protection. It’s a dangerous world out there, but it’s a lot safer if you don’t walk over open manholes without bothering to look down. Just sayin’.




Cannabis Recipes: Motif’s Greatest Hits

Important: Remember that items made with cannabis may be illegal in your jurisdiction unless you have proper medical certification, and must always be kept strictly away from children and pets.

Cannabis has been known since ancient times, and some claim that the mysterious קַנַּבּוֹס (“kaneh-bosim,” singular “kaneh-bos”) listed as an ingredient of the holy anointing oil used as a part of priestly ceremonies in the ancient Jewish Temple is a reference to what we know as “cannabis.” The possibility cannot be ruled out, but it’s almost certainly wrong. The coincidental false cognate from the similar-sounding Hebrew and Greek/Latin names proved too tempting to be ignored, inspiring this creatively novel claim in a 1967 book. It was the Sixties, right? We won’t give that recipe – you’re unlikely to need holy anointing oil – but feel free to look it up in Exodus 30:22-24 where modern scholars translate it as “aromatic reed.”

On the other hand, it is a more likely possibility, although hardly certain, that the Hebrew פַּנַּג (“pannag”) of Ezekiel 27:17 was actually cannabis, and that this is the word that eventually became “cannabis” in Greek and “bhanga” in Sanskrit – the latter a neat segue into our first recipe.

From https://motifri.com/carnalcannabis/ Feb 3, 2016 – “Sex and Marijuana: Carnal Cravings and Cannabis Connect,” by Grace Hyde.

Bhang Cannabis Drink

Ingredients:

2 cups water
4 cups warm milk
1/2 to 1 teaspoon rosewater
1oz bud
3/4 to 1 cup sugar
2 tablespoons blanched, chopped almonds
1/8 teaspoon garam masala (blend of black pepper, cardamom, caraway seed, clove, cinnamon, bay leaf, nutmeg, mace, cumin seed, corainder, and saffron – varies between brands)
1/4 teaspoon ginger powder

Instructions:

Bring the water to a boil in a clean teapot.

Remove any stems or seeds from the cannabis, add to the teapot, and cover. Let simmer for approximately 7 minutes.

Strain the water and cannabis through cheesecloth and squeeze the wet cannabis to extract as much water as possible. Save this water.

Place the cannabis in a mortar and add 2 tablespoons warm milk. Slowly but firmly grind the milk and cannabis together.

Put the cannabis through cheesecloth and squeeze out as much milk as you can. Save this milk.

Repeat this process until you have used 1/2 cup (8 tablespoons) of milk. (Save this milk. The cannabis should look pulpy at this point.) Put the cannabis back into the mortar.

Add the chopped almonds and enough warm milk to completely cover the chopped almonds and cannabis.

Grind the mixture in a mortar until a fine paste is formed.

Put this through cheesecloth and squeeze out as much milk as you can. Save this milk also. (Repeat until dry.)

Throw out the dry mass. Combine all the liquids that have been saved (the water and the milk).

Add garam masala, ginger powder, sugar, rosewater, and remaining milk. Stir.

Chill, serve and enjoy.

Note: This drink is VERY potent!! Consume small amounts at a time and wait 45 minutes to an hour for the onset of effects.

From https://motifri.com/these-arent-grandmas-cookies/ Apr 15, 2015 – “These Aren’t Grandma’s Cookies.”

Cannabutter/Cannasugar

Combine an ounce of ground cannabis buds, 1 pound of butter and a cup of water and then let that simmer for roughly four hours. After the cannabis has infused, strain the butter and store it in the fridge for roughly three hours to allow the cannabutter to separate from the water. Once it has separated, poke a hole in the butter, and drain the water underneath the cannabutter. You can also infuse coconut oil with hash or kief by combining the medicinal product with the oil and heating it to 225 degrees Fahrenheit for roughly two hours.

For cannabis sugar, dissolve cannabis hash or kief into alcohol. After it has dissolved in the alcohol, add sugar to the mixture and let it dissolve. Pour the mixture onto a sheet tray and bake it in the oven at 200 degrees Fahrenheit for about an hour to an hour and a half. You will be left with a sheet of sugar and can either break it into smaller pieces or sift it so it becomes a sugary consistency again.

From https://motifri.com/cannakitchen/ Apr 6, 2016 – “In the Canna-Kitchen,” by Grace Hyde.

Dark Chocolate Canna Cake

Makes 12 servings: Use 1 gram of kief or hash (or more if you prefer high potency edibles) hash oil or infused coconut or cooking oil

2 cups sugar
1-3/4 cups all-purpose flour
3/4 cup dark cocoa
1-1/2 teaspoons baking powder
1-1/2 teaspoons baking soda
1 teaspoon salt
2 eggs
1 cup milk
1/2 cup vegetable oil
2 teaspoons vanilla extract
1 cup boiling water

1. Preheat oven to 275°.

2. Grease and flour 2 9” round baking pans.

3. Mix together sugar, flour, cocoa, baking powder, baking soda and salt in large bowl.

4. Warm the vegetable oil and mix with your cannabis concentrate, or substitute infused cooking oil for vegetable oil. Add to batter.

5. Add eggs, milk, and vanilla; beat on medium speed of mixer for 2 minutes.

6. Stir in boiling water while the mixer is running so you don’t scramble the egg. The batter will be very thin.

7. Pour batter into prepared pans.

8. Bake 40-45 minutes, cool, frost and enjoy!

Cupcakes: Makes 30 cupcakes, bake for 30-35 minutes.

cupcakes3Note: The cannabis cooks out at 300°, therefore we must bake it at a slightly lower temperature. Because of this, cooking times need to be adjusted. Be sure to watch your product while it is in the oven, and remove when a toothpick inserted into the middle of the cake comes out clean.

Frosting

1/2 cup (1 stick) butter or margarine
2/3 cup dark cocoa
3 cups powdered sugar
1/3 cup milk
1 teaspoon vanilla extract
Melt butter; stir in cocoa; alternate adding powdered sugar and milk until combined; add vanilla

From https://motifri.com/cannakitchen/ Apr 6, 2016 – “In the Canna-Kitchen,” by Grace Hyde.

Strawberry Banana Raw Cannabis Smoothie

Note: The next recipe is slightly different than that of a typical edible. This recipe calls for raw cannabis, that is, not dried or cured, and preferably cut from the plant within 48 hours. Raw cannabis offers a vast array of health benefits, and some people go so far as to refer to it as a vegetable. Raw cannabis is full of amino acids, omega-3 fatty acids and, most importantly, cannabinoids that haven’t been activated. Before activation, the cannabinoids THCA and CBDA aren’t psychoactive, so you can therefore consume very large quantities at once (recommended 500-1000mgs daily) without psychoactive effects.

Raw cannabis consumption has been extraordinarily promising for those afflicted with autoimmune diseases.

5-7 raw cannabis leaves
1-2 raw cannabis buds (1-2 inches in length) stem removed
1 cup hemp/nut milk of your choice
1 banana, chopped and frozen
2 cups frozen strawberries, sliced
1 tablespoon agave nectar

Add all ingredients to blender; pulse until combined. Take care not to overheat the motor, as heat will activate the cannabinoids and produce a psychoactive product.

From https://motifri.com/cannakitchen/ Apr 6, 2016 – “In the Canna-Kitchen,” by Grace Hyde.

Cheddar Bacon Jalapeno Biscuit

Makes 12 biscuits

6 bacon slices, cooked and chopped
3-3/4 cups bread flour
1-1/2 tablespoons baking powder
1-1/2 teaspoons baking soda
1-1/4 teaspoons salt
1/2 cup (1 stick) chilled unsalted cannabutter, cut into 1/2-inch cubes
2 1/2 cups (packed) coarsely grated sharp cheddar cheese
1 small chopped fresh jalapeno
1-3/4 cups buttermilk

1. Preheat oven to 275°

2. Line sheet tray with parchment paper.

3. Combine flour, baking powder, baking soda, and salt in food processor.

4. Add chilled cannabutter cubes, blend 30 seconds until combined.

5. Transfer to bowl, add cheese, jalapeno, and bacon and combine.

6. Slowly add buttermilk, combining evenly.

7. Drop ½ cup mounds of batter onto prepared baking sheet.

8. Make 25-30 minutes or until tester inserted comes out clean.

9. Enjoy!

From https://motifri.com/summer-edible-recipes/ Jun 16, 2016 – “Summer Edible Recipes,” by Grace Hyde.

Corn, Avocado and Black Bean Salad

Vegetables:

2 cups corn (fresh or thawed frozen)
30 cherry tomatoes, cut in half
1 15 oz. can black beans, rinsed and drained
2 avocados, diced
1 red onion, diced
¼ cup cilantro, chopped

Dressing:

2 T cannabis infused olive oil
1 lemon, juiced
1 tsp. cumin
½ tsp salt
½ tsp black pepper, ground

Prepare all the vegetables and add to a large serving bowl. In a separate bowl, whisk together dressing ingredients. Pour over veggies, let rest for 10 minutes. Serve with chips, on a salad or by itself!

From https://motifri.com/summer-edible-recipes/ Jun 16, 2016 – “Summer Edible Recipes,” by Grace Hyde.

Coconut Mango Slushie

1 cup canned coconut milk (full fat recommended)
3 cups diced mango
3 tablespoons honey
1 cup ice
cannabis coconut oil

slushie3Melt your cannabis coconut oil and combine with coconut milk. Add all ingredients to blender, puree until smooth. Serve and enjoy!

Note: Mango contains high level of the terpene myrcene, which potentiates cannabis, increasing its effects and duration.

From https://motifri.com/summer-edible-recipes/ Jun 16, 2016 – “Summer Edible Recipes,” by Grace Hyde.

S’mores Bar

2 cups graham cracker crumbs
1 stick unsalted cannabutter
6 chocolate bars
10 oz bag mini marshmallows

Pre-heat oven to 275. Grease 8×8” pan (line with parchment paper for easier clean-up). Melt your cannabutter, cool slightly. Combine your cannabutter and graham cracker crumbs in a small bowl. Press your crumb mixture into the bottom of the pan using the back of a spoon or bottom of a cup. Break up and evenly disperse your chocolate on top of the crumb layer. Top with mini marshmallows. Bake in oven for 10-15 minutes or until chocolate is melted and marshmallows are slightly melted. Cool, slice and serve!

Not every recipe Motif has published has been for something you can eat or drink, and we warn you that bath bombs and lubricants are not to be ingested. For details about indications and uses for topicals, it is strongly suggested that you refer to the original articles.

From https://motifri.com/topicals/Apr 20, 2016 – “Cannabis: On Top of Topicals,” by Grace Hyde.

Medicated Bath Bomb Recipe

Ingredients:

1 cup baking soda
½ cup citric acid
½ cup Epsom salt or sea salt
1 tsp water
2 tsp essential oils
3 tsp infused coconut oil, warmed to liquid form

Tools:

2 bowls
whisk
molds (cupcake tray, Easter eggs, bath bomb molds)

Whisk dry ingredients together in a large bowl. Separately, mix liquid ingredients until combined. Slowly pour liquid ingredients into the dry ingredients, making sure to whisk the mixture the whole time. Adding too much liquid will activate the citric acid, and then it won’t fizz when you add it to the bath. Your final mixture should resemble damp sand, and you should be able to clump it together between your fingers. Press your product into the mold, and allow to air dry for 24 to 48 hours. Store in an airtight container.

From https://motifri.com/carnalcannabis/ Feb 3, 2016 – “Sex and Marijuana: Carnal Cravings and Cannabis Connect,” by Grace Hyde.

Homemade Cannabis Lubricant

Ingredients:

1 cup liquid coconut oil (MCT oil) or raw coconut oil*
1 cup trim or bud, or 1 gram hash
1 tablespoon liquid sunflower lecithin

Instructions:

Combine ingredients in crockpot on low/warm setting or in a Magical Butter Machine, set on the “oil” setting.

If using crockpot, cook 3-4 hours stirring frequently.

Strain and cool.

*lubricant made with raw coconut oil will solidify at room temperature, however the heat from your hand will re-liquefy the product; note that oil-based lubricants can weaken latex condoms




How to Cure a Hangover

It happens. You overdid it the night before and now you feel like you’ve been kicked repeatedly in the back of the head by a donkey. Welcome to the wonderful world of hangovers.

First, let’s talk about why you’ve got this plague from hell. One of the main culprits is dehydration, which can happen with even a couple of cocktails if you aren’t careful. Here’s some tips on how to avoid a hangover in the first place.

Pace Yourself. Everyone’s liver, regardless of their weight or size, can process no more than one drink per hour. If you stick to that, you can last out a long evening without getting hammered.

Drink plenty of water while you are knocking back the shots. People don’t think about drinking when they are drinking, because they are drinking. But alcohol doesn’t replenish fluids: Instead, it increases your rate of urination and dehydrates the crap out of you.

Don’t drink on an empty stomach. Some people’s blood sugar level can plummet when they drink, resulting in shakiness, confusion, or even seizures, and the less food there is in your stomach, the faster alcohol is absorbed. Food slows the processing of alcohol. Swallowing 1-2 teaspoons of raw olive oil before you begin imbibing serves the same purpose.

Women are cheap drunks. Although I have known women who could drink any man under the table, the medical fact is that women have less dehydrogenase, the enzyme that breaks down alcohol in the stomach. They can get intoxicated much faster than men. Women also have a higher percentage of body fat and a lower percentage of water, so alcohol concentrates faster in their systems.

Don’t mix medications with alcohol. Certain medications should never be mixed with alcohol. Acetaminophen is the leading cause of liver failure in the US today: When combined with alcohol, the effect on your liver can be deadly. Antidepressants are another dangerous mix. Ask your doctor before combining any pill with booze. If you get the okay, ask how much. Doctors define social use as one to two drinks in an evening, but most college students define social use as drinking all night with a group of buddies.

Take prickly pear extract several hours before you drink. This tip, straight from WebMD, can cut hangover symptoms by about half. The extract seems to curb the inflammation that exacerbates overall malaise.

So, let’s say you managed to get hungover anyway. What can you do to survive the rest of the day without your freakin’ head exploding?

Hair of the Dog. This is a sure-fire remedy, but it’s a temporary and also rather toxic one. Here’s why it works: When you drink, alcohol blocks the release of the brain chemical glutamate, paradoxically causing your brain to make even more of it.

When the booze wears off, your brain unloads a glut of glutamate, triggering symptoms like headache and nausea. Having another drink makes your brain withhold the glutamate again, but this only delays your hangover. Of course, you could just keep on drinking as long as you don’t mind putting your life on hold for the interim.

Pedialyte. A better alternative to water, you’ll find this drink in the baby aisle. Originally developed for dehydrated sick infants, it is super charged with electrolytes, which you lose while drinking at about the same rate as brain cells. Gatorade and other sports drinks probably work as well, but guzzling Pedialyte is a lot funnier.

Sleep it off. If you can remain unconscious long enough, you might luck out and wake up after most of your symptoms have eased off. But watch out: If you sleep too long and drink no water, you can become dangerously dehydrated.

Food. There’s nothing better for a hangover. Some people swear by ramen soup, some by enchiladas, but the weirdest tip I got was from a doctor. His recommendation? The Garbage Plate, voted by health.com as the fattiest food in the state of New York. This greasy spoon delight is a combination of cheeseburger, hamburger, red hots, white hots, Italian sausage, fried chicken, fish, ham, grilled cheese, eggs, and sides of home fries, baked beans, and macaroni salad. Not quite sure why it works, but I suspect that everyone feels better after they puke.




American Life Expectancy Unexpectedly Declines

Life expectancy is a measurement that summarizes almost everything about quality of life in a society, and therefore even tiny increases or decreases are indications of profound changes with deep consequences. In a somewhat shocking discovery, life expectancy declined overall in the United States by 0.1 year from 2014 to 2015, according to the Centers for Disease Control and Prevention (CDC), the federal government agency responsible for compiling and analyzing the relevant statistics. This is the first overall decline for the entire population since 1993, at the height of the AIDS epidemic.

From 2014 to 2015, life expectancy at birth declined for the entire population to 78.8 years, a decrease of 0.1 year; for males to 76.3 years, a decrease of 0.2 years; for females to 81.2 years, a decrease of 0.1 year.

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The decline in life expectancy and corresponding increase in death rates is best understood as the culmination of negative trends within certain subpopulations, particularly non-Hispanic whites. According to the CDC report cited, the age-adjusted death rate for the total population increased 1.2% from 2014 to 2015, but for non-Hispanic white females by 1.6%, for non-Hispanic white males by 1.0%, and for non-Hispanic black males by 0.9%. There was no significant change for non-Hispanic black females, Hispanic males or Hispanic females.

Life expectancies for non-Hispanic whites were flat in both 2012 and 2013 but declined in 2014, according to a 2015 paper published on PNAS, but offsetting increases among Hispanics and non-Hispanic blacks prevented the overall average from falling. “The midlife mortality reversal was confined to white non-Hispanics; black non-Hispanics and Hispanics at midlife, and those aged 65 and above in every racial and ethnic group, continued to see mortality rates fall. This increase for whites was largely accounted for by increasing death rates from drug and alcohol poisonings, suicide, and chronic liver diseases and cirrhosis.”

Disparities correlated with education and race have long been noted, so the data could be viewed as a convergence. A 2012 article in Health Affairs reported that, as of 2008, “US adult men and women with fewer than 12 years of education had life expectancies not much better than those of all adults in the 1950s and 1960s … [and] white US men and women with 16 years or more of schooling had life expectancies far greater than black Americans with fewer than 12 years of education — 14.2 years more for white men than black men, and 10.3 years more for white women than black women.”

Attempts to identify geographic disparities in death rates have encountered serious statistical difficulties, but generally have found wide but consistent variations. A recent study published in the Journal of the American Medical Association in December 2016 observed, “Geographic regions with elevated mortality rates differed among causes: for example, cardiovascular disease mortality tended to be highest along the southern half of the Mississippi River, while mortality rates from self-harm and interpersonal violence were elevated in southwestern counties, and mortality rates from chronic respiratory disease were highest in counties in eastern Kentucky and western West Virginia.”

Death rates in the United States have been in a very long, steady decline, and a 2015 article in the Journal of the American Medical Association described remarkable reductions (age-adjusted) between 1969 and 2013: 42.9% from all causes, 77.0% from stroke, 67.5% from heart disease, 39.8% from unintentional injuries, 17.9% from cancer and 16.5% from diabetes. However, after 2010 (through 2013, the last year of the study), death rates stopped declining and were essentially flat.

In an internal interview, Dr. Jiaquan Xu of the CDC said, “For the total US population, life expectancy decreased … mainly because of increases in mortality from the 13 causes of death among the 15 leading causes of death, such as heart disease, chronic lower respiratory disease, unintentional injuries, stroke, Alzheimer’s disease, diabetes, kidney disease, suicide, septicemia, chronic liver disease, hypertension, Parkinson’s disease and pneumonitis due to solids and liquids.” By comparison, “We haven’t seen the increase in mortality from so many leading causes of death for a long time. The age-adjusted death rates increased significantly for three of 10 leading causes of death in 2014, two in 2013, one in 2012 and five in 2011. It is an unusual year. Again we don’t know why.” However, Dr. Xu said, “We don’t think we have reached a peak in life expectancy…. We also don’t know if the increase in mortality in 2015 will continue in 2016…. But it is too early to say that the mortality in 2016 will go down or continue going up. We will see what happens when the 2016 final file is available.”




Zika virus: Pregnant Women in RI Should Take Precautions

Zika virus infection poses a significant risk in pregnancy as it “is a cause of microcephaly and other severe fetal brain defects” according to the Centers for Disease Control and Prevention (CDC), an agency of the federal government responsible for monitoring and assessing threats to public health. “Microcephaly is a medical condition in which the circumference of the head is smaller than normal because the brain has not developed properly or has stopped growing,” according to the National Institute of Neurological Disorders and Stroke (NINDS), one of several institutes of the National Institutes of Health (NIH). “Some children may have only mild disability, while those with more severe cases may face significant learning disabilities, cognitive delays, or develop other neurological disorders. Many, if not most, cases of Zika microcephaly will be very severe, possibly requiring lifelong intensive care.”

According to the website of the Rhode Island Department of Health (RIDOH), “Zika virus is spread to people through mosquito bites or from sexual contact with an individual who is infected with Zika virus. The species of mosquito that carries Zika virus is not known to be established in Rhode Island at any time of the year. In Rhode Island, Zika virus is considered to be travel-acquired. This means that confirmed cases will be because that person contracted the virus in another area and then returned to Rhode Island.” RIDOH further explains, “The most common symptoms of Zika virus are: fever, rash, joint pain, headache, muscle pain, [and] conjunctivitis (pink eye). Symptoms typically appear within three to 14 days of infection. About one in five people infected with Zika virus become ill [with symptoms].”

RIDOH spokesman Joseph Wendelken told Motif, “As of [last week], there have been 50 cases of Zika virus identified in Rhode Island. All cases had a history of travel to a country where Zika virus is circulating. In addition, only one case of congenital [at birth] Zika virus infection has been identified in an infant. The infant has no birth defects identified.” He continued, “Women who had possible Zika virus exposure through travel or sexual exposure are at risk of passing Zika virus to their partner through sex for 8 weeks after symptom onset [if they have symptoms] or last possible exposure [if they have no symptoms]. Men with possible Zika virus exposure are at risk of passing Zika virus to their partner through sex for 6 months after symptom onset or last possible exposure.”

The risks to a pregnant woman who becomes infected with Zika virus are a matter of scientific uncertainty. An article recently published in the Journal of the American Medical Association provides what is regarded as the best estimate of risk, finding that, in the United States, of 442 completed Zika-infected pregnancies “evidence of a Zika virus-related birth defect, primarily microcephaly with brain abnormalities” was present in 6% overall and in 11% with infection during the first trimester. However, as other researchers pointed out in the New England Journal of Medicine, there could be a large number of pregnant women infected with Zika virus who are never tested and are therefore unaware of their status.

In Rhode Island, according to Wendelken, “More than 500 pregnant women have been offered testing. RIDOH works with reporting obstetricians to ensure that pregnant women who have a history of travel to a country where Zika virus is circulating or sex with a male partner who has a history of travel to one of those countries are tested for Zika virus. Providers are counseling pregnant females to avoid travel and follow safe sex practices (abstinence, condom use) for the remainder of their pregnancy if they have a partner with a recent history of travel to an area where Zika virus is circulating.” RIDOH maintains an infectious disease surveillance unit, its laboratory has developed the capacity to test for Zika virus, and confirmatory testing and consultation in complicated cases is available from the CDC, he said. “Great effort has been made to partner with the ob-gyn community and community health center staff to provide education regarding prevention as well as testing and monitoring during pregnancy, at delivery, and in the newborn period for pregnant women and their infants with potential Zika exposure.”

RIDOH has ramped up a substantial response to the threat since February 2016, Wendelken said, with existing staff reassigned to Zika virus tasks. “A multidisciplinary task force, led by emergency preparedness and response specialists, has been coordinating a multifaceted response. Task force members include maternal and child health services specialists, infectious disease specialists, laboratory specialists, communications staff, maternal and fetal medicine specialists, mosquito control specialists and birth defects surveillance specialists.” Rhode Island has been awarded federal grant funding from the CDC for additional staff and laboratory equipment as well as a public information campaign for arriving travelers at T.F. Green Airport and on the radio, he said.

RIDOH Zika virus information: health.state.ri.us/diseases/mosquitoes/?parm=147




Book review: Taking Charge

Herb Weiss
Herb Weiss

Taking Charge: Collected Stories on Aging Boldly by Herb Weiss, available in paperback and for Amazon Kindle
https://www.amazon.com/dp/0692688706/


After 36 years in journalism Herb Weiss, known for his regular newspaper columns in The Pawtucket Times and The Woonsocket Call, has collected in book form what he regards as some of his best work. An eclectic and highly readable anthology of short pieces, each no longer than a few pages, are grouped under 13 topic headings: Caregiving, Consumer Issues, Employment Scene, Financial Issues, Health and Wellness, Long-Term Care, Mental Health, Pop Culture and Music, Relationships, Retirement and Leisure, Sage Advice for Grandchildren, Spirituality and Helping Others, and Veterans.

taking-charge-large

Weiss’ primary expertise is in aging, and often his articles are usefully specific, such as “When It Is Time to Take Away Mom and Dad’s Car Keys” and “Financially Surviving Your Retirement Years.” Other articles are human-interest stories, such as “Childhood Dream of Becoming a Photographer Becomes Reality” and “Rediscovering Pawtucket’s Red Pollard.” Some are hilariously quirky, such as “Who Was Harry Weathersby Stamps?” about a humorous online obituary written by the daughter of the titular Stamps that eventually attracted over a half million page views.

The choice of articles in the book evinces a strongly optimistic outlook, such as “Healthy Attitude, Lifestyle Are Likely Keys to Living Past 100,” and interest in alternative and metaphysical topics, such as “Hindu Spiritual Leader Heals with Hugs” and “Before ‘Crossing Over,’ Leave a Legacy of Love.” Well-known Rhode Islanders are featured prominently, as in “Richard J. Walton’s Great Adventure in Life and Death” and “Legendary Cowsills Come Home to Be Recognized by Their Own,” about the real-life band who were the inspiration for the fictional “Partridge Family” on television.

In “Attack Stunned Area Vets: Pearl Harbor Survivors Recall Horror of Dec. 7, 1941,” Weiss relates the personal accounts of Leo Lebrun of Woonsocket, Carl Otto of Newport, and Eugene Marchand of North Attleboro who all, for various reasons, witnessed the attack. Weiss writes, “‘The battle went by so fast’ remembered Otto, stressing that his gunnery training allowed him to go into ‘automatic mode’ when preparing the powder charges at his gun battery. That day he clearly remembers looking toward Battleship Row and seeing heavy smoke, intense fire and oil drenched water, with some spots on fire. During the aerial battle, ‘we were credited with downing the first Japanese plane that day,’ Otto proudly recalled.”

According to the book’s “About the Author” section, Weiss in 2016 was appointed by the governor to the Rhode Island Advisory Commission on Aging. He has been honored many times for his writing, receiving the 2003 AARP Rhode Island’s Vision Award, twice (1994, 1999) receiving the American College of Health Care Administrators’ National Award, receiving in 1997 the Distinguished Alumni Award by the Center for Studies in Aging at North Texas State University. Also in 1997, he was selected by the prestigious McKnight’s LTC News to be one of its “100 Most Influential People” in Long-Term Care.

Author’s blog: herbweiss.wordpress.com

Disclaimer: The reviewer assisted the author in editing the book, but did not contribute content.




Healthy Eating, Healthy Wallet

salad-791891_640With prices rising every week, food has become more of a luxury item than a staple. Even government assistance only goes so far; SNAP benefits for an individual are capped at about $195 a month. Those who pay cash really feel the pinch. Healthy eating on a budget? When I began writing this column, I expected it to be a challenge. Surprise! With the right strategies it can be less expensive than what you are doing now.

First, let’s debunk a myth: Healthy eating isn’t about excluding everything but high-priced “all natural” and organic brands. It’s about whole foods, local resources, and cooking with flair; and it can be easier than you think.

Before we even get to what to buy, let’s talk about where to buy it. Twenty dollars at a bargain chain like PriceRite can often buy literally twice what you’ll get for the same cash at Shaw’s, including organics. On the other hand, PriceRite doesn’t take coupons. If you play your sales right you can pick stuff up practically for free at the bigger chain stores. Another tip: If you have a family to feed, consider joining a wholesale club or food co-op. If you shop around, you can save hundreds of dollars a year on food.

Next: Processed, packaged and prepared food is nearly always more expensive than whole food. You should toss these out anyway! Most are loaded with extra sodium, chemicals and refined sugars and the “natural” brands are absurdly overpriced. It is well worth your while to learn some basic cooking skills. With the right recipes, even a novice with a hot plate can whip up a wholesome meal. Just Google what you want, and you’ll have hundreds of quick, easy recipes at your fingertips in minutes.

Nutritional quality versus price: Protein is often the most expensive item on your grocery list, but the most expensive sources aren’t always the healthiest. If red meat is still on your list, let’s compare filet mignon to bargain chuck. Side by side, the tougher cuts are not only cheaper, they also usually have more protein and less fat. Cooking them takes a bit more work, but housewives have been doing it for decades. So can you. While you’re at it, ditch those limp boneless chicken breasts and switch to succulent thighs and whole chicken. And when you are considering seafood, consider this: Pricey lobster and shrimp practically ooze cholesterol while levels are low in the humble tilapia filet. High omega-3s are what you want in seafood, not high prices.

Of course, the most affordable proteins of all are whole grains, legumes and beans. A bag of lentils that goes for $1.79 at Price Rite can be converted into a pot of delicious soup that can be frozen and stretched for days. Grains and legumes are not only a staple for vegetarians; they can serve as high-quality fillers to make meat go further. You can spend less than $15 and get the ingredients to make a chili or stew that’ll last one person 10 meals. The internet is full of new recipes and ideas. But if you want to go full-out vegan, make sure you understand how to balance your amino acids; not all plant proteins are complete. Soy and seitan can stand alone, but you’re gonna need rice if you’re gonna have beans.

We don’t always consider its importance, but the cooking method that you use can be vital to the value of your food. Anyone can leap to healthier eating in a single bound if they stopped frying food. We think of oil as our enemy, but it’s not if we don’t heat it. Eaten raw, the same oil that can clog your arteries and bulge your butt will emulsify stored fat instead.

Time is a problem for many of us, and it can seem so much easier to buy prepared food that requires no further attention than reheating. But with a little planning, you can make big batches of your favorite recipes and freeze or store them to make your own fast food. The first few times you do it, it will be pain in the ass. After you get used to it, cooking can be quite relaxing and fun. It’s a chance to express your creativity and make food just the way you like it.

But more than a grocery list, healthy eating is a way of life. Too many of us gulp and run without really tasting. A long, relaxing meal with companions and laughter is one of the things that makes life worth living. Healthy eating should not be dismal resignation to unseasoned, boring crap. It should be a celebration of one undeniable fact: We may have to give up many of the habits we love because they do us more harm than good … smoking, drinking, sleeping around? … but the one thing we will always get to do is eat.

Salute!




The Health of Health Care in RI

Every year we set out to write about the state of the state’s healthcare industry – from the perspective of all involved. That includes patients, physicians, insurers and hospital systems.

A lot has changed in the field over the last couple of decades and change has been even more intense over the last few years. In the years we’ve been covering this, much of what we’ve reported has been positive. True, healthcare has been a mess, and it’s still a mess. But it’s seemed like technology and policy were catching up with some problem areas, and improvement – or at least optimism – was heavily in evidence the last few years.

Control of costs has been the lingering boogeyman in this process, and no one has come up with a comprehensive proposition for how to do this fairly and effectively. One of the components of Obamacare — that it was built on a gradated implementation (a little more each year) – was an aggressive attempt to pry funding from medical device/equipment manufacturers and pharmaceutical companies. Proponents pointed out that these are elements of the system that are often opportunistically high-profit (and thus flush with potential tax money). Opponents felt that higher taxes on these endeavors would reduce incentive to develop new drugs, devices and treatments. The successful tech innovations produce a lot of return to balance out the majority of attempts, which, because science is a fickle mistress, tend to fail and pull down significant investments with them.

We’ll likely never know which of these outcomes would prove true – this element of Obamacare is the one most clearly and directly targeted by Republicans and the incoming administration, and these provisions will probably be removed before they even fully kick in.

Other elements of Obamacare will be much harder to remove. It seems, from comments made by Trump’s administration and new healthcare czar Tom Price, that the ability to factor in pre-existing conditions and charge or deny coverage because of them will probably not come back. It seems like Republicans would like to keep Medicaid available to people in need (many of their core constituents rely on these services). But they are also pretty determined to remove the requirement that all citizens must have health care – a requirement Obamacare encouraged with rising taxes on anyone who chose not to be insured.

So it looks like the upcoming replacement for Obamacare wants to keep most of the same services, but remove the mechanisms by which Obama sought to pay for them. How will new counter-proposals cover the finances? That, when you boil it down, is what everyone’s nervous about. Reduced services? Higher premiums? New taxes in some other sector? Some actual control of costs?

On the local level, this will probably translate to a tug of war between the state and federal government over who will pay what percentage of coverage costs for patients on Medicaid and other assistance. Rhode Island may be hard-hit in this process, because we have a higher-than-average percentage of our population on Medicaid. But we might also get a boost in bargaining power from the fact that our independently operated exchange has reduced cost-per-capita over its four years of operation, a rare feat that certainly outperforms what was happening with the federal exchange (See sidebar. And we’re talking about HealthSource, not UHIP, here).

This year, Motif reporters had a lot more trouble getting quotes and responses from our usual hospital sources. No one in hospital administration is looking backward and touting their successes this year, perhaps because the entire landscape seems poised for change, and it seems likely to be change that has little relationship to what was or was not working, but rather change driven primarily by politics.

While hospital systems were mostly pleading no comment, Blue Cross Blue Shield pointed out that they were continuing to introduce new tools to help Rhode Islanders manage their health, including an enhanced mobile app, secure mobile messaging and new custom wellness tools as well as numerous smaller outreach improvements (full disclosure – one part of this outreach is that BC/BS also provides sponsored content for Motif in the form of healthy recipes. See “Healthy Habits” on page xxx.) “These innovations are the next steps in BCBSRI’s longstanding philosophy of meeting members where they are to make healthcare easier and more accessible,” says spokesperson Stacy Paterno.

 

HealthSourceRI has shareable success stories galore like this one, provided during our conversation with Director Zachary Sherman:

 

A member of our customer service team shared an anecdote with me this past November that I could not forget. A young woman needed to become her brother’s caretaker after he fell ill with a severe condition. He couldn’t afford all the care he needed because he didn’t have insurance. After thanking our customer service representative for helping her pick the right health plan, she went on to say that not only did having coverage save her brother’s life, but it saved their entire family. The customer has made strides in his recovery, is now back on his feet and has returned to work. This is a great example of the impact of the Affordable Care Act (ACA).”

Similarly, no one we spoke with was eager to look forward, because there’s simply not enough information right now to do that sensibly.

There are a couple of things that are reassuring, though. Even though, at the time of this writing, Congress seems poised to repeal the ACA (Affordable Care Act, aka Obamacare), nothing is going to change immediately. Even the most aggressive Republican proposals (and there are dozens flying about right now without any general consensus) include at least two years of phasing out and phasing in. Remember, healthcare reform was one of Obama’s top priorities coming into office. Its most dramatic elements took four or five years to kick in, and it still isn’t completely realized eight years later. The healthcare industry is a huge beast with many overlapping systems and a bureaucratic momentum that is difficult to turn without concerted long-term effort, whether the people trying to drive know what they’re doing or not.

Turning can happen though, and it will certainly be interesting to see where things go next. But the biggest message for this year seems to be, “Don’t panic.”

“We have a five-year commitment for the levels of expansion that … we expect, and the rate of federal participation (federal funding that covers roughly 90% of Medicaid costs),” explained Senator Josh Miller, head of the Senate’s Health and Human Services Committee in an interview with RI NPR’s Kristin Gourlay. After that, the balance between state and federal funds may change, but Sen. Miller is inclined to believe that the political fallout from cutting off large numbers of Medicaid recipients won’t be worth taking that approach. “There is no scenario that we can anticipate that would drop people who are currently enrolled,” he adds. (hint hint – if grandfathering is a part of a future plan, you may want to make sure your enrollment is up-to-date).

Paterno of Blue Cross Blue Shield of Rhode Island says, “We understand that many of our customers have questions about the impact of the election on their health insurance coverage. Coverage remains in effect for all of our members. We are working with federal and state lawmakers to ensure that all Rhode Islanders have access to high-quality healthcare at a price they can afford.”

 

If you wish to enroll for health insurance before this year’s open enrollment ends on January 31, go to healthsourceri.com, call 1-855-840-4774 Monday through Saturday 8am – 7pm, or visit HealthSource’s Contact Center for in-person assistance at 401 Wampanoag Trail in East Providence. Also, multi-lingual health insurance Navigators are available in every community across the state to help – just call 211 to find one near you.

Sidebar: Key Stats

RI uninsured rate in 2012: 12%

RI uninsured rate now: 4.5%

2017 average premium decrease in RI: .6%

2017 average premium INCREASE nationally: 22%

Average benchmark premium for a 27-year-old in RI: $214

Average benchmark premium for a 27-year-old nationally: $302 ($88 more)

Data courtesy of HealthSourceRI




“Death Sentence:” Good Samaritan Overdose Prevention Act Expires in Political Tiff

samaritan“People are going to die,” said Rebecca McGoldrick, executive director of Protect Families First, describing the consequences of a bizarre political stand-off that, unwanted by anyone and unexpected by everyone, allowed the expiration of Rhode Island’s 2012 “Good Samaritan Overdose Prevention Act” that protected from criminal drug charges those who called for needed medical help, either for themselves or others, during a life-threatening emergency. The law also protected from criminal or civil liability those, including police officers and school staff, who administer life-saving drugs, such as naloxone (brand name Narcan), to treat an overdose.

The 2012 law had a built-in “sunset” provision that caused it to expire after June 30, 2015, unless explicitly renewed. After three years of experience there was nearly unanimous support for the law among legislators as well as public health experts and the medical community, but the renewal process became mired in a dispute about whether to expand the protections of the original law, and the General Assembly simply adjourned without sending either an expanded or an unexpanded renewal to the governor. “No one wanted the bill to die, but politics got in the way,” McGoldrick said. “It’s quite a shame that Rhode Island is the first state to have a ‘Good Samaritan’ law and lose it. I think this is an embarrassment.” She questioned why the law had a sunset provision in the first place, because “the General Assembly proved themselves incompetent to do the job that needs to be done” by renewing any version of the act.

McGoldrick’s group describes itself on the web as a “nonprofit organization that works to raise awareness about the human casualties of America’s destructive war on drugs” and says that she currently serves as a member of the Rhode Island Department of Health’s Overdose Prevention and Rescue Coalition and the Governor’s Council on Behavioral Health’s Prevention Advisory Committee. She singled out Attorney General Peter Kilmartin as “the only person opposed” to the “Good Samaritan” law, saying he “is in disconnect with state and local police” who favor it. On a personal basis, McGoldrick last October in The Providence Journal bluntly said, “Incumbent Kilmartin has opposed the life-saving Good Samaritan Law, which treats drug overdoses as medical emergencies rather than crime scenes. Essentially, Kilmartin would rather a family bury its loved one than encourage people to call 911 in the event of an overdose.” McGoldrick, despite her strong condemnation of Kilmartin, said, “A lot of the blame [for allowing the act to expire] does fall on the General Assembly as a body. They failed the state, and this is a death sentence for a lot of people.”

According to a June 17 report from the Trust for America’s Health at the Robert Wood Johnson Foundation, “Drug overdoses have become the leading cause of injury in 36 states, including Rhode Island, surpassing motor vehicle-related deaths. Nationally, drug overdose deaths have more than doubled in the past 14 years – resulting in 44,000 deaths per year, and half of those deaths (22,000) are related to prescription drugs. Rhode Island ranked seventh highest for drug overdose deaths – at a rate of 19.4 per 100,000 people.”

The move to expand protections under the law was crystallized by the widely publicized case of Veronica Cherwinski who in May 2013 returned from the store to find her 34-year-old boyfriend dead from an overdose. The day after he died, police arrested Cherwinski on an outstanding warrant from a 2010 charge of receiving stolen goods, and she spent over two months in prison. In August, a few months after Cherwinski was released, a friend overdosed while visiting Cherwinski’s Woonsocket apartment and Cherwinski ran downstairs to bang on the door of her landlord to get him to call 911. When police arrived to support medical personnel, they arrested Cherwinski on felony drug charges despite the “Good Samaritan” law. Because she was on probation resulting from the 2010 charge, she was held in prison for 24 days until a violation hearing. Someone on probation can be imprisoned as a violator for associating with people breaking the law, including illicit drug users, although they may not be breaking the law themselves. Cherwinski chose not to contest the violation and was sentenced to 30 days including the 24 days already served, which got her out 6 days later; had she contested the violation, she likely would have served more time in prison even if she won.

Immediately after the probation violation hearing, Cherwinski’s court-appointed lawyer asked the court to dismiss the felony drug charges, citing the “Good Samaritan” law, and a judge agreed. It was reported that, in February 2014, Woonsocket Police asked the attorney general’s office to renew charges against Cherwinski because it was the landlord, not Cherwinski, who had actually telephoned 911 – Cherwinski did not have a telephone – but after press attention that effort was dropped. The Providence Journal reported that on November 7, Cherwinski herself, after repeatedly being sent in and out of prison, died from an overdose at age 33. According to court records, because Cherwinski failed to appear for a hearing on November 21, a bench warrant was issued for her arrest on January 20, 2015; the next day, when the criminal justice system realized she had been dead over two months, the warrant was withdrawn.

The failure of the “Good Samaritan” law to immunize people calling for medical help against not just criminal charges but also probation violation charges was seen as a serious flaw by public health experts and medical professionals, and fixes were proposed simultaneously by Sen. Michael J. McCaffrey in the Senate – S.576 – and by Rep. Robert E. Craven Sr. in the House – H.5416 – that would expand protections to people on probation and also make the act permanent by eliminating the “sunset” provision.

Attorney General Kilmartin in an April 14 letter to the General Assembly objected to both changes, proposing to scale back rather than expand protections by restricting immunity to drug possession offenses only and not to delivery offenses. (In Rhode Island, “delivery” subsumes a wide variety of conduct that would not commonly be understood to constitute drug dealing, such as merely passing a marijuana joint hand to hand or sharing a needle.) “By providing immunity, this law… gives legal protections for those who are selling heroin and operating drug houses that enable heroin use,” Kilmartin wrote. Contradicting the formally stated judgment of the nearly unanimous community of public health professionals, including the RI Medical Society on behalf of itself and 18 other professional societies such as the RI Society of Addiction Medicine, the RI Psychiatric Society, and the RI chapters of the American Pediatric Association and the American College of Emergency Physicians, and also contradicting a separate formal statement by about 40 doctors organized by Josiah D. “Jody” Rich, MD, MPH, the attorney general argued that criminal prosecution of  “Good Samaritans” would be medically beneficial for them: “While I certainly appreciate the notion that the fear of arrest would prevent a person from calling emergency services in an overdose event, we must consider other issues. The immunity provided under this section ensures that there will not be a necessary intervention into the individual’s substance abuse disorder. Some may scoff at this suggestion, but by releasing a person who just suffered an overdose back to the streets; this almost enables the furtherance of the individual’s addiction issues. By having a law enforcement intervention, an individual can be court ordered to seek a substance abuse assessment or treatment as a condition of their bail or probation.”

As a result of Kilmartin’s objections, the Senate agreed to restore the “sunset” provision and extend the life of the act by two years until 2017, but still backed the expansion of protection to people on probation – S.576 Substitute A – and the amended version was passed unanimously, 32-0, on May 21. The House, however,  removed the expanded protections for people on probation and instead only renewed the 2012 law with no change other than to extend its expiration by two years until 2017 – H.5416 Substitute A – which passed unanimously, 71-0, on June 9.

In order for the General Assembly to send a bill to the governor to become law, both the House and Senate must separately pass textually identical versions. Even if both chambers pass similar but slightly different bills, these cannot advance until the differences are negotiated in some sort of compromise: either one chamber must pass unaltered the text that the other passed, or the same modified version must be passed anew by each chamber. Rhode Island has a part-time legislature that in the modern era meets only January through June, so all unfinished business crashed to the ground late on the evening of Thursday, June 25, when the two chambers gave up trying to work out compromises and packed up to go home for the year. The renewal of the “Good Samaritan” law was a casualty of this process. “It’s fair to speculate that had the attorney general not intervened and asked the House to pass the ‘Substitute A’ bill [without the expanded protection for people on probation], we would have a ‘Good Samaritan’ law because that’s why the bill had to go back” to conference between the chambers, McGoldrick said.

The expiration of the “Good Samaritan” act, despite overwhelming unanimous support among legislators for renewing some version of it, has created confusion and crisis. After investing considerable time and money to get naloxone antidote into the hands of police, school teachers, substance abuse counselors and many others likely to come into contact with overdose incidents where seconds could save a life, the law no longer protects them against criminal and civil liability if something goes wrong, such as an adverse or allergic reaction.

McGoldrick said she is seeking an executive order from the governor that would direct police to act as if the old law had not expired, but even that could not constrain the attorney general from filing criminal charges or protect first responders who administer naloxone. “What all of the legislators are missing is that the damage has already been done,” McGoldrick said. “Three years of public health education will be swept away. We had to do a lot of work to build trust in the community, and that has to be redone.”

Amy Kempe, communications officer for Attorney General Peter Kilmartin, said that she was unable to provide substantive comment by press time, but that a statement was being formulated.

Read further content on this subject at http://www.motifri.com/goodsamaritan2015.