Jail psychiatrist tries to address medication concerns  

By ANNE GEGGIS
Staff Writer, Daytona Beach News-Journal  June 15, 2007 

DAYTONA BEACH -- Emotions came briefly to a boil Thursday afternoon when the Volusia County Branch jail psychiatrist told a gathering of agency leaders and inmates' relatives that half of all the diagnosed mental illness cases he finds among inmates are not correct. 

Jail psychiatrist David Hager met with about 40 community members to explain his role in keeping jail suicides to a minimum while managing the mental-health needs of the larger prison population.  Hager's methods have been controversial since management of Branch Jail medical services changed in 2005 from Halifax Community Health System to a private contractor, Hager's employer, Prison Health Services.

In the first year of the new contract, costs for drugs, such as antipsychotic and anti-anxiety pills dropped to one-third the cost in the previous year, but public defenders, parents and mental-health advocates say inmates are being denied needed medications -- and potentially being kept from assisting in their own defense.

Hager, who has been in correctional psychiatry for five years, said he's not inclined to give inmates the medicines they say they need because drugs in a correctional facility often are used as currency among inmates. And he views medical records on patients that have a mental-health diagnosis cautiously.

"If they were compliant with the medication and the medication was effective, they would not be in jail," Hager said.  ". . . Unless they are not guilty," said Anne Hanson, a Daytona Beach registered nurse whose 18-year-old son hasn't been given his medications while in county custody.

Hager said most inmates who say they are receiving psychotropic medications -- and have a documented case of mental illness -- are also abusing illegal drugs. That's why he feels the need to observe them off all medications, he explained. Those who are being effectively treated with psychotropic medicines are a rarity in jail, he said. But that assertion drew a protest at the meeting, where audience members were largely silent because questions, at first, had to be directed to Hager in writing. "A lot of us work with the same people, and we don't think they are that rare," said Dan Schafer, assistant public defender.

Hager responded that no one who really needs medications is denied them.
"We're telling you that's happening regularly at your jail," said Richard Domroski of Edgewater, whose son had been at the jail without his medicines for two months after being transferred from a federal facility with his medications.  "I don't see that," Hager said.  "We're not a perfect team -- we're not 100 percent right," he continued. "It's not black and white."

Public Defender James Purdy, who has talked with Hager about his concerns before, said he was glad to hear the psychiatrist agreed that decisions about whether the medicines should be given will be made on a case-by-case basis.
"That's the first time I've heard that," Purdy said.
Janet Miller, president and chief executive officer of the community mental-health agency Act Corp., said she was glad Hager appeared to be willing to talk with people about community resistance to his approach.

But George Griffin, president of the Volusia/Flagler chapter of the American Civil Liberties Union, said his organization likely will file a records request to more fully investigate the complaints about the jail mental-health services he's received. He said he doesn't understand how Hager, who visits the jail twice a week, can better evaluate inmates' psychiatric condition than their private doctors, when an average of 700 inmates come in every week.  "What I am hearing is distrust and disdain for private doctors," Griffin said. "How does he override all these doctors and say that he knows better?" 

Domroski said he wasn't satisfied by Thursday's meeting, either: "It seems to me that he's made up his mind that he's the only one that can diagnose correctly."