Opinion ID: 4531499
Heading Depth: 3
Heading Rank: 3

Heading: The KOP Policy

Text: The Jail’s KOP Policy has been in effect, subject to revisions, since 1998. The Jail adopted the standards formulated by the National Commission of Correctional Healthcare. As revised in 2012, it provided: It is the policy of Wayne County Jail Health Services (WCJHS) that R.N.’s/L.P.N.’s [sic] shall distribute non restricted medications for the Self Medication Program to patient/inmates in the general population and medical special housing so that they can store and administer their own medications. All psychotropic medications for patients/inmates will be nurse dispensed regardless of the location of the inmate. Inmate/patients who reside on the mental health unit will be excepted from the Self Medication Program and as such all medications to Mental Health Unit patients will be Nurse administered. WCJHS reserves the right to restrict self administration privileges to any inmate if necessary, to assure the safety and security of the patient, other inmates or the institution. A current drug list will be posted in all medication books and clinical areas at all times. (Emphasis added.) Thus, as of 2012, only patients housed on the mental health unit are excluded from participating in the KOP program. Five categories of medications were on the “Nurse Administered Medications” list. These included: (1) tuberculosis medications, (2) miscellaneous drugs—including Catapres but not Verapamil, (3) psychotropic antidepressant medications, (4) psychotropic antipsychotic No. 19-1992 Andrews v. Wayne Cty., Mich. Page 7 medications, and (5) antiretroviral medications. The Jail had identified these drugs as having “an abuse potential” or “warrant[ing] close monitoring for patient/inmate compliance.” The drugs on the list were “restricted to individual dose administration.” Medical Director Thomas Clafton, M.D.,2 explained that medicines “known to be abused by inmates” made it to the list. The blood pressure medication Catapres was listed under the “miscellaneous” category “because it’s sedating, it’s a sleeper. The inmates know that they can take a bunch of that and it will make them go to sleep.” Dr. Keith Dlugokinski, Ph.D., the Director of Jail Health Services, also knew that Catapres had “some value on the trade market in the jail” because it has “sedating components” and “sleep is . . . a valuable commodity in the jail.” Verapamil, although also “an anti-hypertensive,” was not on the list because it would not have the same effect. Prior to the 2012 version, the KOP precluded any inmate on psychotropic medication from participating in the self-administration program.3 Thus, had White arrived at the Jail in 2009 instead of 2014, she would not have been permitted to keep any drugs with her, because she was taking two psychotropic medications, Klonopin and Lexapro. Under the 2012 KOP Policy, White was allowed to participate in the program because she had not been placed on the mental health unit. Not long after White’s death, the KOP Policy was amended to add Verapamil to the “miscellaneous” drug category. 2 Dr. Clafton no longer works for the Jail. 3 The 2009 KOP Policy stated: It is the policy of the Wayne County Jail Health Services (WCJHS) that R.N.’s/L.P.N.’s [sic] will distribute non restricted medications for the Self Medication Program to responsible patients/inmates in the general population only to carry and administer their own medications. The self medication program is restricted to patients/inmates who do not receive any psychotropic medications inclusive of the present restricted drug list. All psychotic [sic] medications for patients/inmates will be nurse dispensed regardless of his/her location. A current drug list will be posted in all medication books and clinical areas at all times. (Emphasis added) No. 19-1992 Andrews v. Wayne Cty., Mich. Page 8