By Daniel Berti
The Virginian-Pilot
NORFOLK, Va. — The Norfolk City Jail’s psychiatrist resigned last week amid what he described as rampant prescription drug abuse fueled by the excessive distribution of medications to inmates.
Dr. Matthew Sachs, a contractor for the jail’s third-party health provider, Wellpath, resigned April 29 after six months on the job.
Before Sachs became the jail’s contractor, more than one-third of the inmate population was medicated, according to emails between Sachs and Wellpath. But in his brief stint, Sachs cut the number of medicated inmates nearly in half. When they complained, Sachs said the sheriff’s office responded by demanding he dramatically ramp up his weekly inmate consultations — a signal to Sachs that the jail wanted him to dole out prescriptions at the previous pace.
In an interview this week, Sachs said the sheriff’s office demanded he begin meeting a quota that, in essence, would require inmate psychiatric appointments fall under 10 minutes. At that length, he said, meetings would violate psychiatric standards by not allowing enough time for an accurate diagnosis or to determine what medication was needed.
“This was so off the standard of care in the mental health field,” Sachs told The Pilot. “It was unethical and dangerous.”
The Norfolk Sheriff’s Office denied it made any requests to Sachs for more inmate psychiatric appointments, though Sachs has a recording of a conversation with a high-ranking jail official that contradicts the denial. The sheriff’s office declined to respond to additional questions from The Pilot.
The jail’s former psychiatrist could not be reached for comment.
Sachs, 42, who runs a private practice in Virginia Beach, said he took the job at Norfolk City Jail because he wanted to help underserved people. It was a contract job, for nine hours a week, run through Wellpath.
Sachs owns post-graduate degrees from Harvard University, Virginia Commonwealth University and the University of Massachusetts-Amherst.
After starting at the jail in November, Sachs discovered what he described as “a massive problem” with prescription drug abuse.
At the time, more than 300 patients were on psychiatric medication, according to emails. For comparison, the jail had an average of 784 inmates between October and April, according to Jamie Bastas, the jail’s spokesperson.
The most commonly abused medications were prescription antidepressant, anti-anxiety and antipsychotic drugs, Sachs said.
The antipsychotic drug Zyprexa, antidepressant Remeron and Buspar, a drug for anxiety, had been “prescribed at very high (numbers)” by the previous psychiatrist, Sachs informed the sheriff’s office in a Dec. 7 email.
He said nurses and guards alerted him “constantly” that inmates were being caught hoarding, crushing and abusing their prescribed medications — drugs that he said produce “a tremendous high” if snorted or ingested at a high dose.
Sachs appears to have sharply reduced the number of psychiatric drugs prescribed to inmates in his first four months on the job. By being more stringent about medications, the number of inmates on psychiatric drugs dropped to 187 by February, emails show.
“The nurses are happy,” but the “inmates hate it,” Melissa Peppenhorst, Sachs’ supervisor with Wellpath, wrote him in an email. The jail’s previous psychiatrist “conditioned everyone to expect Buspar, Atarax, Hydroxyzine and Remeron to treat sleep and anxiety.”
In the same email, Peppenhorst also said some jail workers did not understand why inmates who were feeling anxious “can’t have something to take the edge off.”
“Jail is hard, I get that, but I can’t medicate the entire jail,” Sachs replied.
Sachs’ approach triggered “an influx of complaints” from inmates and their families, according to emails between Sachs and Peppenhorst.
“The largest complaint from family members is that patients are not receiving medication that they are accustomed to having while at ( Norfolk City Jail),” Peppenhorst told Sachs in an April 21 email.
The jail’s supervisors, according to Sachs, cared primarily about one thing: They wanted the complaints to go away.
Through Wellpath, the sheriff’s office demanded, with little explanation, that he more than double his weekly appointments, Sachs said.
Peppenhorst told Sachs in a Feb. 21 email that the sheriff’s office wanted him to see a minimum of 50 inmates per week in the nine hours he was contracted to work. Until that point, Sachs said he met with between 15 and 20 patients per week.
Peppenhorst told Sachs in the email that the office’s desire for more appointments was based on the schedule of the jail’s previous psychiatrist, who saw between 50 and 60 patients per week, she said.
The sheriff’s office “stated that their expectation is 50 per week based on that,” Peppenhorst said.
Though the sheriff’s office denied it made any demands for increased psychiatric appointments, Sachs secretly recorded an April 28 conversation with sheriff’s office Chief of Staff Wayne Handley. The Pilot provided the recording to the sheriff’s office, which did not dispute that Handley was the staffer on the tape.
During the meeting, Sachs told Handley the quota could put inmates’ lives at risk, and would be a liability for both himself and the jail.
“You want me to go fast. But I won’t do it at risk of a misdiagnosis,” Sachs said. “That will lead to malpractice.”
Handley ended the meeting by telling Sachs: “From the ( Norfolk Sheriff Office)’s perspective, I need more patients seen. We need the complaints to stop.”
Sachs said he interpreted this request to mean Handley wanted him to give inmates the prescriptions they were asking for to end the complaints.
Sachs submitted his resignation to Wellpath via email a day later.
“The options to continue working in the same conditions, which the chief confirmed would be the case, would have resulted in disastrous consequences for me, and possibly the Norfolk City Jail,” Sachs said in the email.
Sachs provided a handful of emails and jail incident reports that detail instances in which inmates were caught hoarding, abusing or selling prescription drugs in the jail.
For instance, on March 1, jail staff wrote that they found “crushed” Buspar, an anti-anxiety drug, hidden in a sock in an inmate’s cell. According to the report, the inmate was prescribed the medication twice daily. They estimated that the amount of crushed Buspar found in his cell was about five days’ worth of his medication.
In an email, a jail mental health worker asked Sachs to discontinue an inmate’s prescription to Zyprexa, the antipsychotic used to treat schizophrenia, after receiving complaints that she had been “hoarding and sharing her Zyprexa with other inmates,” and “crushing it up.”
Sachs told The Pilot those incidents were “just the tip of the iceberg.”
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