Prison care for mentally ill criticized

The Federal Detention Center in Honolulu has come under criticism for the way it handles the medication for incoming mentally troubled inmates and the lack of a psychiatrist on the staff.

Dr. Daryl Matthews, a Honolulu psychiatrist, said detainees at the Guantanamo Bay Naval Base have more access to psychiatric services than the center's inmates.

A center spokeswoman said the Honolulu facility will be hiring a part-time psychiatrist.

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The Federal Detention Center here falls below the standard of medical care in the way it switches prescribed drugs for incoming mentally troubled inmates, according to a Honolulu mental health expert.

Psychiatrist Dr. Daryl Matthews said the switches, made without a psychiatric evaluation of the prisoner, and the lack of a staff psychiatrist are a "major problem" that warrants a review by federal authorities.

Matthews, who was assigned to help evaluate mental health services at the Guantanamo Bay detention center for suspected terrorists, said detainees there had better access to psychiatric services than federal inmates in Honolulu.

"It gives me shivers," he says.

Elizabeth Ammons, the center's public information officer, said Friday the facility is in the process of hiring a part-time psychiatrist, but could not say when that would happen.

The center, located near Honolulu Airport, houses more than 640 federal and state inmates.

Its practices were disclosed at a federal court hearing Dec. 6 on the revocation of the supervisory release for convicted bank robber James Breitenbucher. He is accused of violating the conditions of his release, including stealing a bottle of vodka.

Matthews was hired by Breitenbucher's lawyer, federal 1st Assistant Public Defender Alexander Silvert, to testify about the practices.

Breitenbucher has been diagnosed as bipolar and had two prescription medications when he entered the center on Sept. 27, according to the testimony.

One was for the antidepressant Paxil, but because it is not on the Bureau of Prisons' preferred list of drugs, the prison switched the medication to another antidepressant, Prozac. Paxil is on the list but is not a preferred drug.

The switch was made even though Breitenbucher was not evaluated by a psychiatrist or a person with a background in psychiatry, according to the testimony.

Breitenbucher stopped taking Prozac after several days because he feared he would have a negative reaction as he experienced in the past. Silvert contended his client's condition deteriorated without antidepressants.

Dr. Leonardo Giron, the center's clinical director, who is not a psychiatrist, testified he did not see Breitenbucher, but approved the switch based on the bureau's list policy.

Giron acknowledged that the center did not have a doctor trained in psychiatry to provide services to inmates at the center, although the center can consult with its chief psychiatrist on the mainland. Giron said the center had a psychiatrist here on a contract that expired Oct. 1.

Matthews, 60, has been named to court-appointed state mental health panels to evaluate defendants in hundreds of cases. He also ran the University of Hawaii Medical School's training in forensic psychiatry from 2000 to 2006.

He testified the switch to Prozac from Paxil was "below the standard of care" in medical practice.

Matthews said there is no medical reason for the switch and that the prison did not get information about Breitenbucher's past history with Prozac.

Asked what he thought of Giron's testimony that others had their medication switched from Paxil to Prozac, Matthews testified, "I was stunned to hear that."

Matthews said Paxil and Prozac come from the same family of drugs but are "completely" different and cannot be switched without medical reasons.

Assistant U.S. Attorney Darren Ching asked U.S. District Judge Susan Oki Mollway to revoke Breitenbucher's release and sentence him to a prison term because of his past illegal drug use and failure to deal his mental problems. Silvert sought to have Breitenbucher transferred to a drug and mental health treatment facility.

After hearing the testimony, Mollway allowed Breitenbucher to be transferred to a drug and mental treatment center and held off ruling on the revocation until another hearing March 31.

Ching referred questions about the center last week to the facility officials, who did not address whether any changes have been made to the prison practice or whether they believe Breitenbucher was correctly treated.

"Inmates with perceived immediate medical/dental/mental heath needs are referred to the appropriate health care staff for evaluation," Ammons, the center's public affairs officer, said in a written response.

She said each federal prison must use the bureau's list of drugs to ensure "high quality, cost-effective drug therapy."

Silvert said last week that Breitenbucher is not unique. The defense lawyer said he knows of four or five inmates who had their prescribed medication changed in the last six months because of the prison's preferred list.

"This is certainly something that should be examined and the policy changed," he said.

Matthews affirmed his testimony last week and said he could not believe that an institution would switch drugs without a medical reason.

"It's a very dangerous practice," he said.

Matthews went to Guantanamo in 2003 at the request of the Army Medical Command as part of a team to evaluate mental health services.

Matthews said one of the problems of not having mental health experts is that when inmates flare up or show signs of mental disturbances, they are placed in isolation for safety purposes. "It has the real potential of making that person's mental situation worse," he said. "That's seen all the time in Hawaii and elsewhere."

In 2005 the Justice Department launched an investigation into the Oahu Community Correctional Center's treatment of inmates with mental illnesses. The probe was based on the federal law seeking to protect prisoners' civil rights.

Attorney General Mark Bennett said the state is close to wrapping up negotiations with the Justice Department, and he expects that they will reach an agreement soon.

Matthews said he finds it ironic that the state came under investigation, because he believes the state prison is doing a better job of providing mental health services.