Homeless, poor have new health care, but often don't know
by Susan Abram
Denise Scott shouts angrily over the way America has forgotten her.
"We don't need no more illegals comin' over here!" she screams from a Skid Row sidewalk littered with chicken bones, paper plates and discarded clothes.
"Fix the problems in this country! I need a place to live!"
Christopher Mack, a lead community outreach worker for a health clinic in the heart of Los Angeles' Skid Row, squats next to her. He softly tells her to calm down, to breathe, to remember to see her case worker in the morning about housing.
He also wants to know if she has health insurance.
But Scott, who will turn 61 soon and has lived on Skid Row for 18 months, is in no mood to hear sweet talk. She's bone thin. Her sweater is ripped and riddled with holes. Her clothes and important papers are squashed into various size bags all around her. Tears of frustration drip down her face.
"I'm not a racist," she tells Mack apologetically, "But I can't go to Mexico to get a house and you can't find me a place to live here."
Today is not Scott's day, Mack determines. She is too angry. Despite the fact that she and many others will qualify for health insurance by the end of the year under requirements of the Affordable Care Act, finding a place to live, not health care, is Scott's priority. So Mack will try again another time.
The encounter demonstrates how difficult it can be to provide health coverage to some of the most destitute, even those who qualify for free or subsidized plans. Some of them say that simply trying to survive or find a roof over their heads takes precedence even over caring for their own health.
"Out here, it's about repeated education," said Mack, who has worked the streets of Skid Row 10 years for the JWCH Institute, which runs the Center for Community Health on downtown's 5th Street. "It's about what we in social work call multiple encounters. Where there's a willingness, there are no barriers."
Mack's work is part of what has been an aggressive, three-year outreach campaign by the Los Angeles Department of Health Services to enroll as many of the estimated 390,000 potentially eligible uninsured residents into Healthy Way LA, a no-cost county health insurance that will convert to Medi-Cal in January. Outreach workers from clinics countywide have gone to churches, schools, soup kitchens, homeless shelters and the streets of Skid Row in an effort to find those who qualify.
"The goal is an ambitious one, but we think it is doable given the multitude of incredible partners, internal and external, that we are working with to make it happen," said Amy Luftig Viste, director of community partner programs for the Los Angeles County Department of Health Services.
But the work and the program has had its challenges, she said.
"We have had some difficulties along the way: adequate staff capacity to enroll patients, technological challenges, outreach challenges," Luftig Viste said, but much of that has been remedied by funding that has provided more staff.
"Yes there have been challenges, but we're at 257,000 enrolled — approximately two-thirds of the state's total — so despite the challenges we are proud of our success," she said.
One challenge for DHS is the annual renewal of Healthy Way LA. Many of those who have the insurance didn't know they had to renew it, Luftig Viste said.
"Most recently we have created a redetermination mail-in unit, and are now even calling our patients to confirm that they received their renewal paperwork and if necessary to help them fill it out," she said. "This has improved our redetermination rate significantly, but there is still much work to do to ensure that covered members stay covered."
On Skid Row, for example, a complex knot of homelessness, mental illness and drug or alcohol use, along with a deep distrust of government, makes it difficult for Mack and other outreach workers to help people understand how starting in January, Medi-Cal will have expanded to cover all low-income individuals, ages 19 to 64, who are U.S. citizens or national or legal permanent residents for at least 5 years, and are not pregnant. Those who are pregnant qualify for another insurance.
"Most people come to the clinic already in crisis," Mack said.
And there are other issues. Community clinics are working to expand as all the new patients are coming in. But there are not enough primary care physicians.
"The patients in our system now are being seen, but I don't believe there's enough capacity for the new (patients)," said Al Ballesteros, chief executive officer for the JWCH Institute.
"We are seeking to bring in more primary care providers and looking at new sites," he said. "Definitely, all community centers are in expansion mode. Right now, we have several positions for physicians, but we're competing with large health care systems like Kaiser Permanente."
And yet the goal is to make sure all of the newly insured find a medical home within these clinics to help relieve emergency departments. All too often those who suffer from chronic illnesses such as diabetes, asthma and high blood pressure need support to manage their medications.
On a recent morning, Mack and Juan Rivera, a patient enrollment and eligibility manager with JWCH, walk down crowded 5th street, near the Midnight Mission. Their goal is to invite people into the clinic to enroll in Healthy Way LA. About 35 people a week are enrolled, Rivera said.
"One of the biggest comments I get is nothing is free," Rivera said. "We say this is free. It's based on your income and where you live."
But there are many obstacles for the homeless, including proof of citizenship and ID. Others simply don't know about the Affordable Care Act.
When Mack tells Phillip Evans, an older man with a heart condition who uses a walker, that he qualifies for free health care, Evans places his hand to his chest and bends forward. Sharon Dike, a volunteer with AmeriCares who goes out to Skid Row to bring people to the JWCH Institute clinic, steadies him.
"Whoa," Evans said. "I didn't know anything about that."
Indy police team with community to fight crime
INDIANAPOLIS (AP) — Indianapolis police battling a shortage of officers and a spike in violence are enlisting the help of churches, women's shelters and other community groups to take a holistic approach to reducing crime in the city.
The strategy is designed to keep officers free to respond to emergencies and arrest people and provide those trained to deal with the mentally ill, the poor and teens to help handle other cases.
"Police cannot do by themselves all that needs to be done to address the causes for crime in our community," Public Safety Director Troy Riggs told The Indianapolis Star (http://indy.st/19juZf2). "We cannot arrest our way out of the problem. We need true community partners. The factors are more nuanced and complex than any one police department is capable of handling."
The approach is an expansion of community policing, which traditionally has involved foot patrols, neighborhood watch groups and youth activities at local churches.
Riggs and Police Chief Rick Hite also plan to re-establish an Indianapolis Public Safety Foundation that will raise money to pay for training courses, youth athletic leagues and other programs not covered by the public safety department's $203 million budget.
The ideas, some of which Riggs is borrowing from previous jobs in Louisville, Ky., and Corpus Christi, Texas, could create a model for other departments also facing shortages of money and officers, said Gary Cordner, a professor of criminal justice at Kutztown University in Pennsylvania and a former police chief in Maryland.
"Given the economic situation that many cities are in, we could see more of outreach like this," Cordner said. "Police departments, as they have moved into community policing, have moved away from the, 'Try-to-do-it-all-yourself approach.'
"Administrators are constantly scratching their heads, saying, 'How can we do it better?'" he said. "This is one approach."
Part of the new effort includes expanding programs already established to help officers deal with the mentally ill and teenagers.
IMPD has sent officers to training so they can diffuse run-ins with the mentally ill for the last 10 years. The goal of the training is to reduce the risk that police shoot a mentally ill person or get shot.
Now, the department is teaming with mental health workers to get the mentally ill help before a problem spirals into a tragedy.
Two crisis specialists for Midtown Community Mental Health spend much of their workweek at the IMPD Southwest District.
They go over cases in which a person taken into custody was sent for psychological evaluation and visit camps for the homeless and try to help them get needed services.
"We want to get them help so a dangerous situation doesn't happen in the future, where they can hurt someone or themselves," said Rebekah Bricker, one of the crisis specialists.
The department also is working to reduce friction between police and teens by training officers in ways to communicate with young people.
If the effort does serve as a national model, it won't be the first time.
Indianapolis was one of the first departments to put radios in police cars, the first to assign women to cars and the first to use portable breath tests to catch drunken drivers.
Pennsylvania State Prison's Use of Solitary Confinement Violates Rights of Prisoners Under the Constitution and Americans with Disabilities Act
Today, the Justice Department issued a findings letter detailing the results of its investigation into the use of solitary confinement on prisoners with serious mental illness at the Pennsylvania State Correctional Institution at Cresson in Cambria County, Pa. The department found that Cresson's use of long-term and extreme forms of solitary confinement on prisoners with serious mental illness, many of whom also have intellectual disabilities, violates their rights under the Eighth Amendment to the U.S. Constitution and under the Americans with Disabilities Act (ADA).
Though the Pennsylvania Department of Corrections now intends to close Cresson, many of the prison's problematic policies and practices relating to the use of solitary confinement appear indicative of what is occurring statewide. For this reason, in its findings letter, the department also notified the governor that the department is expanding the investigation to include all prisons in the Pennsylvania Department of Corrections to determine whether these other prisons also engage in the unlawful use of prolonged and extreme isolation of prisoners with serious mental illness and intellectual disabilities. Secretary John Wetzel and his staff at the Department of Corrections have fully cooperated during the course of this investigation and the department looks forward to working collaboratively with them in the coming months.
In addition to finding that Cresson routinely resorts to locking prisoners with serious mental illness in their cells for 22 to 23 hours a day, for months or even years at a time, the department also found that Cresson often denies these prisoners basic necessities and subjects them to harsh and punitive conditions, including excessive uses of force. The department concluded that Cresson's misuse of solitary confinement on prisoners with serious mental illness leads to serious harms, including mental decompensation, clinical depression, psychosis, self-mutilation, and suicide.
The department also found that Cresson came to rely on solitary confinement as a means of warehousing many of its prisoners with serious mental illness because of deficiencies relating to its mental health program. Those systemic deficiencies include a disorganized and fragmented mental health program, marginalization of mental health staff, and disciplinary procedures that result in the punishment of disability-related behaviors and the placement of actively psychotic prisoners into harsh solitary confinement. The department also found an oversight system that does not analyze suicides and other critical data.
“We found that Cresson often permitted its prisoners with serious mental illness or intellectual disabilities to simply languish, decompensate, and harm themselves in solitary confinement for months or years on end under harsh conditions in violation of the Constitution,” said Roy L. Austin Jr., Deputy Assistant Attorney General for the Civil Rights Division. “These practices have serious public safety consequences because many of these individuals are returned to the community. We look forward to continuing to work collaboratively with the Department of Corrections during the expanded investigation to bring an end to these practices.”
“The findings in this case are disturbing and expose a serious disregard for the health and safety of prisoners with serious mental illness,” said David J. Hickton, U.S. Attorney for the Western District of Pennsylvania. “We are dedicated to ensuring that prisoners throughout the Commonwealth are treated humanely and receive the appropriate mental health treatment in an effort to enhance their successful reintegration into the community upon release.”
The department initiated this investigation in December 2011 under the Civil Rights of Institutionalized Persons Act (CRIPA), which prohibits a pattern or practice of deprivation of constitutional rights of individuals confined to state or local government-run correctional facilities. During the course of the investigation, the department made additional findings under the ADA. The investigation also provided information to the department that justified an expanded investigation under CRIPA and the ADA.
The expanded investigation will focus on allegations that prisons throughout the Pennsylvania Department of Corrections subject prisoners with serious mental illness and intellectual disabilities to prolonged periods of isolation under conditions similar to those found at Cresson. Through this investigation the department will seek to determine whether the other prisons in the Commonwealth engage in a pattern or practice of the inappropriate use of prolonged isolation on prisoners with serious mental illness and intellectual disabilities in violation of the Constitution and federal law.
This investigation was conducted by attorneys with the Special Litigation Section of the Justice Department's Civil Rights Division and the U.S. Attorney's Office for the Western District of Pennsylvania. The Civil Rights Division and the U.S. Attorney's Office will be partnering again to conduct the expanded statewide investigation. Additional information about the Civil Rights Division is available on its website at www.justice.gov/crt
Act of Terror Averted
Would-Be Bomber Sentenced in Chicago
A federal judge has sentenced an Illinois man to 23 years in prison for an attempted bombing in 2010 near Chicago's Wrigley Field that was intended to cause mass casualties and paralyze the community.
On that Saturday evening in September, while a concert was taking place at the Chicago Cubs baseball stadium, Sami Samir Hassoun placed a backpack that he thought contained a powerful bomb into a trash can on a nearby crowded street. The device was a fake—supplied by an FBI undercover agent—but had it been real, the effects would have been “horrific,” according to the judge who sentenced Hassoun yesterday.
A Lebanese citizen legally living in Chicago, Hassoun never posed a danger to the public, thanks to an investigation led by our Joint Terrorism Task Force (JTTF) in Chicago. But the 25-year-old would-be terrorist had earlier told an accomplice—who was really an FBI undercover agent—that any casualties from the attack would be the inevitable result of what he termed “revolution.”
Noting that the JTTF consists of Chicago police officers and other federal, state, and local law enforcement personnel in addition to FBI agents, Special Agent Sam Hartman—who served as co-case agent with Chicago Police Detective Angel Lorenzo—explained that “a case like this doesn't have a successful outcome unless everybody pulls together. The JTTF played a key role in this investigation.”
“I am proud of the work done by our investigative team in preventing Hassoun from carrying out his intended act of violence,” said Cory B. Nelson, special agent in charge of our Chicago Field Office. “The FBI remains vigilant in our mission to prevent attacks against Americans.”
We were initially alerted to Hassoun by an informant who warned that Hassoun was hoping to profit from committing extreme acts of violent in Chicago. “He had no qualms about potentially killing lots of people,” Hartman said. “And he wanted money in return.”
Hassoun pled guilty to attempted use of a weapon of mass destruction and attempted use of an explosive device, and he admitted telling a law enforcement informant that he suggested bombing the commercial area surrounding Wrigley Field. The informant later introduced Hassoun to an undercover FBI operative who posed as an accomplice. Hassoun also said he was willing to use a car bomb and to attack Chicago police officers.
On three occasions in August 2010, Hassoun videotaped potential targets around Wrigley Field, focusing on popular bars and restaurants. As he filmed, he commented on the tactical advantages and risks of an attack at the various locations.
On the night of September 18, Hassoun was ready to set his plan in motion. He took a shopping bag and a backpack from our undercover agents that he thought contained a powerful bomb. The agents said the device was surrounded by ball-bearings and that the blast could destroy half a city block. A few minutes after midnight, after he had helped set the device's timer, Hassoun placed the backpack into the trash container on the crowded sidewalk by the stadium.
“Hassoun was an example of the so-called lone offender,” Hartman said. “He had no ties to organized terror groups, but he was clearly a terrorist—and potentially an extreme danger to the public. We were fortunate to have stopped him.”