Gilad Edelman Photo
At Raymond Rice’s latest checkup, doctors recommended a new glucometer, lower insulin, and a home nurse. Rice appreciated the advice. He appreciated the doctors even more.
“If I hadn’t found them,” he said, “I’d probably be thinking about killing myself again.”
Rice’s statement may sound extreme, but so are the challenges facing Transitions Clinic patients, all of whom, like Rice (pictured above), are recently released from prison and suffer from chronic illness. The clinic plays a potentially crucial role in New Haven’s current “prison reentry” mission — a larger effort to reincorporate the two dozen or so people who leave jail each week back into productive lives in the city.
Research has shown that in the two weeks following release, a former inmate is 12 times as likely to die than the average person. Transitions Clinic is part of a national network that began in San Francisco to intervene during this crucial phase. The New Haven location is housed in the Yale-New Haven Primary Care Center at 789 Howard Ave.
The two-year-old clinic aims to help patients focus on their health issues when they have other concerns — housing, employment, family — that tend to take priority.
“When people come out of prison, they have so many needs to be addressed,” said community health worker Jerry Smart (pictured). He noted that finding work usually comes before attending to health needs. “But if you have a health care issue that’s going to keep you out of work, the job’s not going to help,” Smart said.
Smart, a soft-spoken man who served two years in prison decades ago for drug dealing, is the hub at the center of the clinic’s wheel of patient connections. He helps patients navigate the potentially daunting health care system and assists with the logistics — making appointments, getting prescriptions, arranging transportation — that, though mundane, can prove too much for people fresh out of prison to manage on their own.
“We offer a service we can guarantee,” Smart said. “I can guarantee they’re going to see a doctor within two to three weeks” after being released.
“We want this to be a place that’s safe for them.”
“Call Jerry Any Time”
Raymond Rice (pictured at the top of the story) has benefited from Smart’s outreach. After serving two years for conspiracy to sell cocaine, the middle-aged Rice found himself without permanent housing, unemployed, and facing a daunting list of health problems including diabetes, hypertension, sleep apnea and depression. He had just begun to take care of himself, he said, when he went to prison.
“While in prison, I lost everything I had,” he said, adding that he would be homeless now if not for a former neighbor offering to take him in.
After his release, Rice first went for treatment at Cornell Scott-Hill Health Center.
“I felt like the doctor was rushing me out,” he said. “I just felt like he didn’t have enough time. It felt very detached.” He said that his doctors there would change his prescriptions without notifying him.
His litany of problems, and the lack of satisfactory care, left Rice feeling despondent. “There were days when I wouldn’t get up,” he recalled. “I felt so disgusted, defeated.”
(Told of Rice’s comments, Rob Rioux, Hill Health’s chief of strategic development, said: “That certainly isn’t our standard operating practice. If that’s what happened, we’d want to look into that matter further and address it with the provider. We don’t subscribe to that level of care.”)
Rice’s fate changed following a trip to the emergency room for a cardiac episode. As he was leaving, he happened to bump into Jerry Smart, who asked if he wanted to meet with Dr. Emily Wang, a founder of the Transitions network and the director of the New Haven location. Rice was amazed that Wang came out to the waiting area to meet him.
“She sat and talked to me and listened to my whole story,” he said. “So I took a chance.”
That chance has proved worth taking.
“They’ve done more for me in the two or three months I’ve been coming here than in the nine months that I was going to Hill Health,” Rice said. “They’ve really, really helped me.” He rattled off a list of care and services he’d gotten from Transitions: a cane, a more effective dosage of medication, extensive help applying for welfare benefits and correcting a deficient application.
What seemed to matter most was that he was finally getting enough attention.
“Now I can call Jerry any time,” he said. “I see them respond to each and every thing.”
“The person as a whole”
For Emily Wang (pictured), Rice’s experience demonstrated the impact of a holistic, and intensive, approach to health care for people coming out of prison.
“We really try to think about the person as a whole and all the factors that affect their health,” she said. This individual focus may have wider societal impact.
“About 1,200 people return to New Haven every year, and about 85 percent have a chronic condition” such as diabetes, asthma, hepatitis C or substance dependence, said Wang, who is a professor at the Yale School of Medicine. Of that 85 percent, she added, only 15 percent already have a primary care provider.
Most are uninsured, which means they end up relying on costly emergency room visits in place of primary care. Although the vast majority of the clinic’s patients qualify for Medicaid (especially following the expansion under the Affordable Care Act), Wang said, those benefits are terminated when people go to prison, and many patients lack the time, awareness, or know-how to get them reinstated. The clinic, she said, works hard to get Medicaid reinstated; once it is, it applies retroactively to cover the patient’s previous visits.
A randomized study conducted at the original San Francisco location found a 51 percent reduction in emergency room visits among clinic patients compared to the overall post-release population, Wang said. However, that study found no impact on recidivism. Wang is optimistic that a new, larger study of all 10 of the clinic network’s locations across the country will find a reduction — possibly due to management of drug addiction, which is a prominent factor affecting re-sentencing.
“I can’t think of anything that will influence their health more than keeping them out of prison,” she said.
“Where I Need To Be”
Joanne Cretella knows about the link between drug addiction and prison all too well. She started using PCP, she said, after her high school sweetheart was murdered in 2006. She was 22 at the time. Her dependence increased after a childhood friend and a new boyfriend both died within the year. In 2007, high on the drug, she crashed her car, killing an elderly minister, for which she was eventually convicted of vehicular manslaughter and sentenced to 30 months in prison. While locked up, she was diagnosed with Graves Disease, an autoimmune disorder that affects the thyroid.
Released in 2011, Cretella met Wang at the methadone clinic where she said she got drug tested as a condition of her probation. She has been Wang’s patient ever since, and the two have developed a rapport.
At their latest appointment, on October 31, they reviewed the foods Cretella needs to avoid at breakfast, and discussed the effects of her current prescription.
“I used to be stressed out and irritable, and now I feel totally different, calm,” said Cretella, who was dressed in a Halloween-themed outfit.
“This is the most calm that I’ve seen you in a long time,” Wang replied.
“I’m getting older, I gotta take care of myself,” Cretella said. “Remember when I stopped taking my pills for a few months? I feel a lot better now that I’m doing something for myself.”
The two talked about the stress of her old job, at the Goodwill outlet store in Hamden, and about her promotion to the corporate office.
Cretella, who aspires to apply the lessons of her past by becoming a case manager for returning prisoners, credited Wang and Smart for her improved condition. She described a level of attentiveness and guidance that sounded almost parental.
“I couldn’t really keep appointments, or check when I needed a new prescription,” Cretella said of the months following her release. “They were constantly calling me. They made me understand how important it really was” to deal with her health issue.
Cretella, like Rice, seemed most appreciative of the level of personalized care she gets at the clinic.
“They treat patients like individuals, the same as people who can afford expensive treatment,” she said. “Emily and Jerry have an overall concern for my well-being. I went through a lot, but now I’m getting where I need to be.”