TRAVERSE CITY — Accounts of how, when and why inmates receive medications inside Grand Traverse County’s jail are sparse, but what’s available paints a concerning picture for mental health professionals.

Accusations that unmedicated patients wait days to see a nurse, some mental health medications are withheld entirely and others are swapped out suddenly arrived in flurries of posts from former inmates and family on “Abuse at the Grand Traverse County Jail,” a Facebook page created to spur reform within the aged jail’s concrete walls.

And their treatment behind bars — before conviction and after — falls far from best practice, said Dr. Pamela Herringshaw, a seasoned psychologist at Old Town Psychological.

“It could be a real tipping point for those types of individuals, for someone who is attempting to cope with depression — if they previously had suicidal thinking … they might follow through on that,” she said of patients switched or cut off from medications. “That person could potentially be dangerous to themselves or dangerous to others.”

Dr. Sander Weckstein, a northern Michigan psychiatrist with more than 25 years in the field, agrees.

Changing medications on patients — particularly those on psychotropics for depression, anxiety or bipolar disorder, for example — requires a thoughtful approach, he said.

“It’s not a simple, easy question,” Weckstein said. “The best framework is to do it really slowly and thoughtfully, and making sure that while you’re doing that they’re being closely monitored and have additional coping strategies.”

It’s a problem that impacts many people who pass through the county’s jail — almost a quarter of defendants whose cases move through Judge Thomas Power’s 13th Circuit courtroom have significant mental health issues, he said.

Private health contractor Wellpath — the nation’s largest health provider to jails, with 300,000 incarcerated patients in 34 states — provides Grand Traverse County jail’s medical services.

Nationwide, the company has been named in hundreds of lawsuits, according to reports from the Associated Press, CNN and other outlets, under both Wellpath and the company’s previous name, Correct Care Solutions.

Multiple local Wellpath officials did not return calls for comment. A message to a corporate office was returned, but officials were not available Friday to talk.

Grand Traverse County has seen two inmate suicides under the company’s watch — Alan Halloway in 2017 and Marilyn Palmer in early 2018 — along with more than 51 attempts between 2011 and 2018. Both deaths yielded settlements from county taxpayer-funded coffers.

Practices outlined by the company during an Oct. 2 presentation to county commissioners revealed a gap of local oversight of the company’s in-jail practices — Sheriff Tom Bensley told the board overseeing the jail medical team “wasn’t his job.”

Dr. Ann Kuenker, who did not return calls for comment Friday, oversees the jail’s medical team. She splits her time otherwise between the Elk Rapids Skin and Laser Clinic, where she specializes in advising patients on the Ideal Protein diet and using an UltraSlim-brand laser to dissolve fat and tighten skin, and the Traverse City Vein Center, where she handles varicose and spider vein treatment.

A staffing matrix shows Kuenker, a doctor of osteopathic medicine or DO, clocks one hour per week in the jail each Monday and is otherwise on call. Jail Administrator Capt. Chris Barsheff said he believes Dr. Kuenker interacts primarily with her staff, and doesn’t see inmates herself.

Her team includes a nurse practitioner who works two three-hour shifts in the jail per week, a psychiatrist Bensley said works off site for two hours per week, a team of five nurses who rotate day and night shifts, and two other staffers the matrix lists as LPN/EMTs.

Those nurses are responsible for reviewing each patient with a medical condition or on medication. Bensley said those reviews are supposed to occur within 24 hours of intake. Former inmates have provided conflicting reports.

Psychiatrists are the best-situated professionals to handle mental health treatment and medication in that realm, Dr. Weckstein said. In his practice, every new patient or discussion of changing medication comes with a thorough verbal and physical assessment. Dr. Herringshaw, who as a psychologist isn’t qualified to prescribe, works closely with Old Town’s prescribers to best build treatment plans — a vital partnership, she said.

“If it’s a psychotropic medication, I think it’s essential,” she said.

Counseling and other mental health services in the jail come through a contract with Community Mental Health.

But CMH CEO Karl Kovacs said those services come in silos.

“They’re two separate contracts and two different areas of responsibility,” he said. “Coordination is something we’ll be working toward, but right now, those services are distinct. Medication issues are the responsibility of Wellpath.”

LIMITING RESOURCES

Wellpath staff work off a formulary — a prescribing guide that limits which medications doctors can and will dole out. Deviations from that formula can be pursued at the discretion of medical staff, but need approval from Wellpath Regional Director Adeyemi Fatoki, who oversees operations in dozens of jails through multiple states, Barsheff said.

Wellpath Operations Manager Elaine Kaiser said last month that it doesn’t all come down to that formulary — she said not all psychotropics doctors prescribe are necessary in a jail setting.

“They may say, ‘Well, you know, this person is anxious, let me give them a little something to help them through difficult times.’ Well, that may not be something they’re going to be needing in the jail,” Kaiser said during her presentation before commissioners.

Dr. Weckstein contends a formulary can create troubling gaps, because medications targeting the same condition aren’t necessarily interchangeable.

“There could be one person who could have a good response in relation to their anxiety, let’s say, with one of those medications, and a non-good response to another,” he said. “There (are) some thoughtful, educated trials to figure out what works best for a particular person.”

It gets exponentially more complicated when a patient is medicated to treat multiple conditions — drug interactions are a major concern. And many common psychological conditions, like anxiety disorders and ADHD, for example are commonly comorbid, increasing treatment complexity.

Many people with the substance abuse disorders also occur alongside mental health conditions.

Patients cut off from medications can revert to untreated states, Dr. Herringshaw said — meaning a risk of seizures, risk of symptom reemergence and other withdrawal symptoms.

“Someone could become suicidal, one could begin having panic attacks, someone could begin having hallucinations again,” she said. “There are physical withdrawal effects and very heavy-duty psychological withdrawal effects.”

But some argue a more selective approach to medications isn’t all negative. Power said a selective approach is vital in the jail — without it, staff run risks of inmates trading or hoarding medications, which can create a dangerous situation.

“I think the jail has to have some control about what medications are coming into the jail,” Power said. “If someone has a script for narcotic painkillers, that doesn’t mean you should give it to them.”

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