7 LETTERS TO THE EDITOR Letters from Individuals Who Are

A GUIDE TO ACCESSING MEDICAL CARE: INSIDE AND OUT

Even though the United States spends $8.1 billion on healthcare in prisons, access to adequate care can still be challenging. People with justice involvement have higher rates of cancer, heart disease, traumatic brain injuries, chronic conditions, and infectious diseases, than people in the general population. Among incarcerated people with persistent medical problems, 12.9% in federal facilities, 20.1% in state facilities, and 68.1% in local jails reported receiving no medical examination since incarceration; and following serious injury, 7.7% of people in federal facilities, 12% of people in state facilities, and 24.7% in jails were not attended to by medical personnel. Additionally, every stage of interacting with the criminal justice system can lead to lapses in access to insurance coverage, medication, and medical records, compromising individuals’ ability to be healthy. BY MICAELA LINDER Director of Research The Fortune Society “The following guide provides suggestions for how to navigate some of the challenges you might face trying to access adequate healthcare, both while incarcerated and after release from jail or prison.”

MEDICAL CARE IN JAIL OR PRISON

PREPARING FOR THE APPOINTMENT

DOCUMENTING YOUR SYMPTOMS

It can be difficult to get an appointment with a medical provider while inside. Make the most of your appointments by keeping thorough records of your symptoms prior to the appointment. Use the log below as a template for how to track your symptoms. As much as possible, try and write down your symptoms as soon as you notice them. If you are not able to bring paper into your appointment, review your logs prior to the appointment, and write down important dates and symptoms on the back of your appointment docket.

Date

What day did the symptom occur?

LISTING YOUR PRIORITIES AND QUESTIONS

Sensation

Severity

Location

What did it feel like? Dull, cramping, piercing, sharp, stabbing, throbbing?

From 1 to 10, what is your level of pain (10 = worst)?

Where on your body is the symptom located? Try and be as specific as possible. Is it the right side or the left side? Is it the upper or lower portion of a body part? Is it the whole body part, or just part of it?

Duration

Setting

Medication

What time did the sensation start and how long did it last?

Where were you when you started to experience a symptom or changes in your symptoms?

What medication did you take and what was the dose? If you have been without a medication you regularly take, document how long you have been without your prescription. Make a list of everything you want to discuss in your upcoming appointment to try and ensure you get through as manyof your concerns as possible. Writing out your responses to these questions, or going over them with a friend, can help you remember what to cover during your appointment. • What are the three main reasons you are visiting the doctor? • Do you have any new symptoms you want to discuss? • Do you have any questions from your last visit to the doctor? • Have you experienced any barriers to accessing your medication? • Have you been experiencing any side effects to your medication? • Is there anything difficult or sensitive that you want to talk about with your doctor?

CONNECTING WITH SUPPORT

Going to the doctor can be a difficult and demoralizing process for many people. Before you go into an appointment, consider if there is anyone whom you might call on for support. Most people have very few reliable relationships, and this can be even harder when you are dealing with separation caused by incarceration. If you do not have a person to call on, consider whether there is an organization or group that you might want to be in contact with. Try and let someone know, even if this is just in a letter to yourself, how you are feeling about your upcoming appointment, and any support you hope to receive when you are done.

DURING THE APPOINTMENT

SETTING THE AGENDA WITH THE HEALTHCARE PROVIDER

The more information your medical provider has upfront about what topics you want to cover during the visit, the better. Try and pick your top three priorities (or fewer) prior to going into the appointment, and let your provider know what those are asearly on in theappointment as possible. When setting the agenda for the appointment, try and keep your sentences short and to the point. Below are some example statements: • “I want to cover the results of my blood work and my asthma.” • “I want to talk about the piercing headaches I have been experiencing over the past three months.” • “I would like to discuss the side effects of the medication prescribed to me during our last appointment.”   • “I am concerned about the chest pain I have been experiencing.”

ASKING QUESTIONS

It can be intimidating to ask questions during a medical appointment. Use the following as a guide for questions you might want to ask, depending on the provider’s level of receptivity to questions.

EXAMINATION • What are you looking for during this examination? • What are youlisteningfor by putting the stethoscope to my lungs?

TESTS • Why is this test being performed? • Are there any potential side effects? • When can I expect the results? • What will these results tell you about my health? • What are the follow-up steps after we learn the test results? • Will I need a follow-up appointment? DIAGNOSIS • What may have caused this condition? • Is this condition permanent? • How is this condition treated or managed? • What will be the long-term effects on my life? • Are there any symptoms I should look out for, or ask my friends to look out for, that might be a sign that I need immediate care? MEDICATION • What is the name of the medication? • What does the medication do? • Is this medication addictive? • When and how should I take this medication? • For how long should I take this medication? • What are the potential side effects?If there are side effects, are there any ways we can reduce these? • Will I notice any changes as a result of the medication? If yes, when can I expect to notice these changes? • How effective is this medication? • Is this medication safe to take with the other medication that is prescribed to me?

MEDICAL RECORDS • May I have a copy of my medical record for this appointment, including the results of any tests given?

AFTER THE APPOINTMENT

DOCUMENTING YOUR APPOINTMENT

Keeping your own records of your appointments and tests results can help you see patterns in your health and remember the information a healthcare provider gave you. You can also use the record as documentation. If you had an appointment that was canceled, or if you were unable to get access to an appointment, be sure to record those dates. Use the following as a documentation template:

Date

Provider

What day was the appointment? Or what day was an appointment scheduled for, but then canceled?

What was the name and position of the medical provider?

Tests

What tests were performed?

Results

Diagnosis

Symptoms

Follow-Up

Concerns

Were you given any test results? What were the results?

Did the healthcare provider give you a diagnosis?

Did the provider tell you to monitor any symptoms?

Are there any follow up steps you need to take?

Do you have any issues with the way you were treated?

MAINTAINING YOUR MEDICAL RECORDS

If you would like someone outside of the prison to keep an additional copy of your medical records,fill out Department of Health Form 5032(DOH-532): Instructions for family members (or other nonincarcerated people) filling out a form on your behalf:

Leave the patient signature line blank, unless you are the legal representative (a court-appointed legal guardian; health care agent appointed by a valid health care proxy) and are signing on behalf of theincarcerated person. If not, mail the completed form to theincarcerated personand ask him/ her to sign the form in front of a facility staff member such as a nurse, doctor, ORC, or correction officer, all of whom can sign as the witness to theincarcerated person’ssignature before giving the form to medical staff to be placed in their medical record. A copy of the formshould be provided to the incarcerated person.

Access the form at the following link: https://www.health. ny.gov/forms/doh-5032.pdf

MEDICAL CARE AFTER RELEASE

PAYING FOR MEDICAL CARE • What is Medicaid and who is eligible? • Medicaid is a free health insurance program for people with low income or no income. • How do you apply for Medicaid? • You may be able to apply through the Marketplace. You can find your state marketplace, as well as information on your state’s income threshold for Medicaid eligibility, at this link: https://www.healthcare. gov/marketplace-in-your-state/ • For those applying through New York State: • If you are able to apply through the Marketplace:

Call NY State of Health, The Official Health Plan Marketplace at 1-855-355-5777

• Apply online at NY State of Health, an organized marketplace also known as Obamacare, designed to help people compare and enroll in health insurance coverage: http://nystateofhealth.ny.gov/

• If you need help, anyone who is eligible to apply through the Marketplace can do so with a Certified Assistor or Navigator. Visit https://info.nystateofhealth.ny.gov/ ipanavigatorsitelocations to find one.

• • If you are unable to apply through the Marketplace: • Call the New York State Medicaid Helpline: 1-800-541-2831

Visit your local Social Services Office: https://www.health.ny.gov/health_care/ medicaid/ldss.htm

• For those who must apply through New York City:

• Call the Human Resources Administration (HRA) Medicaid Helpline: 1-888-692-6116

• Visit an HRA Medicaid office: https:// www1.nyc.gov/site/hra/locations/ medicaid-locations.page If you do not meet the income threshold for Medicaid: • You may still be eligible to apply for other healthcare plans through the Marketplace that are partially subsidized by the government. Visit healthcare.gov for more info.

NAVIGATING CONNECTIONS TO MEDICAL CARE

POINT OF REENTRY AND TRANSITION (PORT) LINE • PORTline is a general helpline to assist people recently released from custody in NYC jails with their reentry and transition needs. It is run by the NYC Health + Hospitals Corporation, and can help you get connections to medical care and obtain or fill a prescription, including for Suboxone. • General assistance with reentry and transition can also be obtained through the Correctional Health Services PORTline at (646) 614-1000. QUESTIONS TO CONSIDER WHEN YOU ARE LOOKING FOR A DOCTOR OR CLINIC • Do they accept “walk-in” visits? • Do they accept your health insurance? • Do you have any special concerns and does the doctor have experience treating them? • Is the clinic easy for you to get to? • Are there friends or family members who might have a good doctor you might also want to visit?

It is important for you to be as comfortable as possible during your visits to the doctor, and doctors in the community are often more flexible than doctors on the inside. Below are some options that you might want to use during the appointment, to help make sure that you are getting what you need out of the appointment: • Tell your doctor what you would like to focus on during the appointment. • Tell your doctor what your goals are for your health. • Ask if it is possible for you to shift an item of clothing rather than put on a robe. While this might not always be possible, depending on what the doctor needs to examine, you can always ask. • Ask the doctor to tell you what they are doing and why they are doing it. • End the appointment at any time if you feel uncomfortable.

AFTER THE APPOINTMENT

The following questions can help you evaluate if you would like to keep visiting your doctor. Having an open and trusting relationship with your physician can help your health and well-being. If you do not like your doctor, you have the right to find a differentone who might be better suited. You are the expert on your health, and you deserve someone who respects you and values your insights. • Did the doctor ask about your health goals? • Did the doctor give you a chance to ask questions? • Did it seem like the doctor was listening to you? • Did the doctor give you enough informationabout your diagnosis and/or health plan? • Did the doctor work in collaboration with you, or did the doctorjusttell you what to do? • Did you feel comfortable with the doctor? • Did the doctor seem like someone you couldtalk to? • Was the doctor warm and welcoming, or impatient?

Please use this guide as a starting point to work out what works best for you, and please write to us if you have feedback or suggestions: Micaela Linder, 29-76 Northern Blvd., Long Island City, NY 11101. 