Parsons et al v. Ryan et al

Filing 3057

ORDER: Defendants' Motion for Relief from Court Order Re: Termination of Monitoring 2931 is denied. Defendants' Motion for Relief from Court Order Re: HNR Boxes 2932 is denied. Defendants' Motion to Stay 2971 is denied. Plaintiff s' Motion for Status Hearing 2999 is granted. A hearing is set for December 6, 2018, at 1:30 p.m. Defendants' Motion to Modify Order Doc. 2958 3046 is granted. Defendants' monthly compliance reports will be due on the 21st day of each month or on the business day thereafter. IT IS FURTHER ORDERED denying Michael Cohn's pro se Motion for Investigation of Fraudulent Schemes 3044 . Signed by Senior Judge Roslyn O Silver on 11/15/2018. (REK)

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1 WO 2 3 4 5 6 IN THE UNITED STATES DISTRICT COURT 7 FOR THE DISTRICT OF ARIZONA 8 9 Victor Antonio Parsons, et al., Plaintiffs, 10 11 ORDER v. 12 No. CV-12-00601-PHX-ROS Charles L Ryan, et al., 13 Defendants. 14 15 Defendants have moved for relief from two of the Court’s earlier Orders under 16 Federal Rule of Civil Procedure 60(b)(6) and to stay several other Orders. (Docs. 2931, 17 2932, 2971). The Court will deny these motions. The Court will also grant the pending 18 motion to set a status hearing (Doc. 2999) and set a hearing for December 6, 2018, at 19 1:30 p.m. BACKGROUND 20 21 A. 22 In October 2014, after two-and-a-half years of litigation, the parties signed a 23 Stipulation to settle this matter and jointly moved to refer the remainder of this case to 24 Judge Duncan. (Docs. 1185, 1186). After receiving nearly 250 comments from class 25 members, Judge Duncan conducted a Federal Rule of Civil Procedure 23(e) Fairness 26 Hearing in February 2015 and granted the parties’ Motion to Approve Stipulation. 27 (Docs. 1208-1463). 28 The Stipulation Under the Stipulation, Defendants agreed to improve the healthcare provided to 1 inmates. In particular, Defendants agreed that over the course of three years, they would 2 reach a minimum level of compliance regarding 103 healthcare performance measures 3 (PMs) based on national standards for correctional healthcare. Defendants were required 4 to meet or exceed a 75% compliance score during the first year, 80% during the second 5 year, and 85% thereafter. Defendants further agreed to monitor and report on their 6 progress. The Arizona Department of Corrections’ pre-existing Monitoring Bureau was 7 tasked with monitoring Defendants’ efforts on each PM. Because the Stipulation only 8 contained high-level definitions for each PM, the Monitoring Bureau drafted a 9 “Monitoring Guide” for its employees to use. 10 As set out in the Monitoring Guide, every month, for each PM, the Monitoring 11 Bureau reviews a certain number of healthcare records and, applying the standards 12 applicable to that PM, determines whether each record is compliant. As of February 13 2017, if 85% or more of the records reviewed are compliant with the criteria in the 14 Monitoring Guide, ADC is compliant with that PM for that prison for that month. After 15 ADC generates a compliance number, it engages in an informal rebuttal process with its 16 private contractor, Corizon Health, Inc. (Corizon). During that informal process, Corizon 17 has the opportunity to offer additional information or context to explain why a particular 18 PM is actually compliant. At the conclusion of that rebuttal process, ADC enters the 19 compliance information into a spreadsheet called the CGAR report. This CGAR report, 20 generated by the Monitoring Bureau, determines whether each prison facility is 21 complying with the Stipulation’s PMs. 22 B. 23 In February 2016—approximately one year after the Court approved the parties’ 24 stipulation—Plaintiffs filed a motion to compel, seeking production of information they 25 believed necessary to assess Defendants’ compliance with the Stipulation. (Doc. 1506). 26 In April 2016, Plaintiffs filed their first Motion to Enforce the Stipulation involving PMs 27 related to chronic care treatment, inpatient care in prison infirmaries, medication 28 administration, diagnostic testing, access to mental health care, monitoring of Efforts to Compel Compliance with the Stipulation -2- 1 psychotropic medications, access to non-medication treatment, inadequate suicide 2 prevention, and monitoring confinement in isolation for the mentally ill. (Docs. 1506, 3 1576). That filing resulted in the Court spending a tremendous amount of time trying to 4 ascertain why Defendants were unable to comply with the obligations they accepted 5 under the Stipulation. The Court held status conferences in April 2016 and again in May, 6 June, August, September, October, November, and December. (Docs. 1549, 1559, 1582, 7 1619, 1645, 1678, 1708, 1780, 1831). 8 remediation plans for non-compliant PMs, Plaintiffs’ access to Defendants’ new 9 electronic medical records system, and interpretations of key terms in the Stipulation. In 10 the latter half of 2016, the Court also conducted telephonic hearings on discovery 11 disputes, scheduled a prison tour, and addressed allegations of retaliation during the 12 prison tour. (Docs. 1666, 1723, 1734). These conferences covered Defendants’ 13 In late 2016, the parties began presenting disputes for the Court to resolve about 14 how to interpret the data and to assess compliance, including disputes about how to 15 evaluate timing, e.g., whether something done within 30 days means it is done within one 16 month; how to assess compliance when care needs to be provided within a specified 17 number of days; and whether a prisoner is “seen” by a mental health care provider in a 18 group setting or in their cell. (Doc. 1673). The Court also rejected Defendants’ use of 19 partial credit to assess compliance and held that if one part of a prisoner’s file is deficient, 20 it cannot be counted as compliant. (Doc. 1831). 21 In 2017, the Court continued to conduct monthly status hearings, emergent 22 telephonic hearings, and evidentiary hearings. (Docs. 1895, 1933, 1964, 2029, 2061, 23 2124, 2185, 2186, 2205, 2233, 2236, 2245, 2249, 2285, 2313, 2317, 2330, 2403, 2437, 24 2456, 2474, 2526). The frequent of hearings continued in 2018. (Docs. 2560, 2559, 25 2586, 2601, 2658, 2659, 2686, 2700, 2720, 2735, 2757, 2764, 2816, 2843, 2844, 2850, 26 2854, 2860, 2879, 2880, 2882). 27 methodologies used to assess compliance and, therefore, held an evidentiary hearing 28 beginning in March 2017 on how data is collected. The Court also sought clarification about the -3- (Docs. 1964, 1980, 1996). 1 Throughout this time, the motion practice continued apace with the hearings. (Docs. 2 1583, 1673, 1709, 1727, 1745, 1754, 1762, 1833, 1862, 1907, 1910, 1917, 1918, 1951, 3 2030, 2117, 2118, 2119, 2147, 2179, 2225, 2235, 2353, 2382, 2483, 2504, 2551, 2604, 4 2620, 2644, 2789, 2791, 2810, 2833, 2856). In April 2017, the Court informed the 5 parties that it was considering the appointment of a Special Master under Federal Rule of 6 Civil Procedure 53. (Doc. 2029). The Court contemplated that an expert would serve in 7 multiple capacities to oversee the monitoring program and to provide guidance to the 8 Court on what remedial measures would be most effective. Plaintiffs argued that the 9 Court should instead appoint an expert under Federal Rule of Evidence 706. (Docs. 10 2043, 2083). Defendants argued that such an appointment would violate the Stipulation 11 and that “there is no question that this Court is best suited to oversee the monitoring and 12 enforcement of the Stipulation.” (Doc. 2067 at 4:8-9). The Court ordered the parties to 13 meet-and-confer about possible experts for appointment under Rule 706 and then submit 14 names for the Court’s consideration. 15 At the conclusion of this process, the Court appointed Mr. Millar of The Advisory 16 Group as an expert in October 2017. (Docs. 2133, 2236, 2249, 2437, 2483). The Court 17 recognized that the failure to meaningfully comply with the Stipulation was ultimately a 18 matter of staffing, but the Stipulation precluded the Court from ordering that Defendants 19 hire additional staff. Thus, the Court directed Mr. Millar to identify where Defendants 20 failed to meet their own established staffing levels and to identify the underlying cause of 21 that failure. Mr. Millar submitted his final report in June 2018. (Doc. 2880). The Court 22 thereafter ordered Defendants to “file their plan to implement the recommendations 23 contained in the final Advisory Group report.” (Doc. 2904). Defendants submitted a 24 plan and Plaintiffs have challenged that plan as insufficient. (Doc. 2948). 25 26 C. Contempt Proceedings Due to Pervasive Noncompliance with the Stipulation and Errors in the Monitoring Process 27 At the June 2017 Status Hearing, after Defendants’ continued failure to ensure 28 compliance with critical PMs related to delivery of medication, seeing a healthcare -4- 1 provider for routine illness or a specialist, ensuring compliance with emergency room 2 discharge recommendations, acting upon abnormal diagnostic testing, and receiving 3 urgent specialty diagnostic testing, the Court informed the parties that, for certain PMs at 4 certain prisons, “every single failure to comply . . . will result in an order to show cause 5 hearing as to why a $1,000.00 fine should not be imposed.” (Doc. 2124). Following 6 briefing and a hearing, the Court entered findings of fact, conclusions of law, and held 7 Defendants in contempt for December 2017, January 2018, and February 2018 in the 8 amount of $1,445,000. (Doc. 2898). Although some of the PM/locations captured by the 9 contempt proceedings demonstrated improvement, that improvement was neither 10 pervasive nor sustained. (Doc. 2095 at 2). 11 In prior orders, the Court concluded additional expert assistance was needed. In 12 particular, such assistance was needed regarding the monitoring process and for the PMs 13 Defendants repeatedly failed to satisfy. On the monitoring process, evidence—from 14 whistleblower witnesses and internal documents—established that ADC manipulated the 15 monitoring process so that the CGAR Reports showed compliance even when the goals 16 of providing sufficient and appropriate care had not been met. As detailed in the Court’s 17 Order, “the credible evidence before the Court indicates that [Corizon’s electronic 18 medical record system] allows providers to create dishonest and untraceable entries in an 19 inmate’s medical record, that Corizon has manipulated categories of records to comply 20 with the Stipulation’s time frames, and that Corizon has not ensured the integrity of its 21 electronic medical records system.” (Doc. 2900 at 8). 22 Other evidence showed that the Monitoring Bureau reviewed a fluctuating number 23 of records each month and the number of records reviewed may be manipulated to create 24 compliance. Internal emails led to different concerns. One email showed that a member 25 of the monitoring team raised concerns about a specific inmate but did not include him in 26 the CGARs. 27 inmate’s record because it was being reviewed in preparing the CGARs and the fact that 28 it was not included raises a concern that inmate records are artificially excluded from It seems likely the monitoring team only knew about that particular -5- 1 CGARs. A different email showed that a different member of the monitoring team raised 2 concerns about a different inmate, but then counted his case as compliant for the CGARs. 3 (Doc. 2900 at 8-9). 4 category of care in a way that allowed them to take additional time to provide the care 5 and that did not permit an accurate assessment of whether or not there had been 6 compliance with the relevant performance measure.” (Doc. 2900 at 11). Further evidence showed that “Corizon [had] re-categorized a 7 This evidence, combined with Defendants’ “inexplicably inconsistent filings” and 8 inability to explain the Monitoring Guide’s procedures, resulted in the Court concluding 9 that expert assistance is necessary to review Defendants’ monitoring process and confirm 10 that it produces accurate, valid, and reliable information about compliance with the 11 Stipulation. (Doc. 2900). 12 Expert assistance was also necessary because there is a set of PM/locations where 13 the CGAR reports produced by Defendants show long-term non-compliance yet 14 Defendants’ remediation plans had stalled. As detailed in the Court’s Order, for some 15 PM/locations, Defendants had stopped submitting new ideas and have proposed to 16 “continue to utilize the same corrective action plan as set forth in the [previous] update.” 17 (Doc. 2874-1 at 79-80). For other PMs/locations, “Defendants have not even attempted a 18 substantive remedial measure and have simply informed the Court that a new hire will 19 solve the problem” even though the PM/location was already non-compliant when that 20 position had been filled. (Doc. 2905 at 1-2). 21 The Court ordered the parties to submit names for an outside expert who could 22 develop methods, policies, and procedures for Defendants in the performance 23 measures/locations where Defendants have demonstrated persistent non-compliance. 24 (Doc. 2905 at 3). 25 ANALYSIS 26 Since this matter was reassigned, the parties have filed multiple motions and other 27 documents required by Judge Duncan. Defendants seek relief under Rule 60 from two of 28 Judge Duncan’s June 22, 2018 Orders as well as a stay of other orders pending appeal. -6- 1 As for Plaintiffs, they request the Court hold a status hearing. 2 A. 3 Defendants seek relief from the Order denying their Motion to Terminate 4 Monitoring and directing the retention of an expert to evaluate the monitoring process at 5 Defendants’ expense and the Order directing Defendants to reinstall Health Needs 6 Request boxes. (Docs. 2931, 2931). Rule 60(b)(6) permits a court to relieve a party from 7 an order “for any other reason that justifies relief” and is used only “sparingly as an 8 equitable remedy to prevent manifest injustice.” U.S. v. Alpine Land & Reservoir Co., 9 984 F.2d 1047, 1049 (9th Cir. 1993). Motions for Relief Under Rule 60 and Stay Pending Appeal This procedural mechanism is reserved for 10 “extraordinary circumstances” such as a case dismissed because of an attorney’s gross 11 negligence. See, e.g., Lal v. California, 610 F.3d 518, 524 (9th Cir. 2010). Thus, the 12 moving party must be “able to show both injury and circumstances beyond its control 13 prevented timely action to protect its interest.” Gardner v. Martino, 563 F.3d 981, 991 14 (9th Cir. 2009). Here, Defendants’ motions for relief rely entirely on arguments that 15 were presented, considered, and rejected. (Docs. 2931, 2932). Rule 60(b)(6) is not a 16 substitute for a motion for reconsideration or an appeal. Similarly, reassignment of this 17 matter with the Court is not an opportunity for a second bite at the apple. 18 Further, the Court will not grant a stay of the Orders entered on June 23, 2018. 19 Whether to grant a stay pending appeal is guided by an analysis of four factors set forth 20 by the Supreme Court in Nken v. Holder, 556 U.S. 418, 434 (2009): “(1) whether the stay 21 applicant has made a strong showing that he is likely to succeed on the merits; (2) 22 whether the applicant will be irreparably injured absent a stay; (3) whether issuance of 23 the stay will substantially injure the other parties interested in the proceeding; and (4) 24 where the public interest lies.” Lair v. Bullock, 697 F.3d 1200, 1203 (9th Cir. 2012) 25 (quoting Nken, 556 U.S. at 434 (citing Hilton v. Braunskill, 481 U.S. 770, 776 (1987))). 26 Defendants fail to meet a single factor. The Stipulation empowers the Court to 27 employ “any remedy provided by law” to compel Defendants to comply with the 28 Stipulation and all of the Court’s recent decisions—contempt sanctions, solicitation of an -7- 1 expert, and restoring HNR boxes—are squarely within that authority. More than that, 2 Defendants’ interminable noncompliance—which persists to this day—forecloses a 3 finding that a stay of the Court’s June 22, 2018 Orders is appropriate because of the 4 continued harm the class experiences. Defendants’ Motion to Stay will be denied. (Doc. 5 2971). 6 B. 7 In light of the costs incurred and the current procedural posture, the Court has 8 concluded that, instead of two separate experts, one consolidated expert is a more 9 appropriate path forward. The Court will conduct a status hearing with the parties to 10 discuss whether Marc Stern, M.D., should be appointed as the Court’s Rule 706 expert. 11 A copy of Dr. Stern’s curriculum vitae is attached to this Order. Appointment of Expert 12 C. 13 Unsurprisingly, this case has cost the State a lot of money. Under the Stipulation, 14 Defendants agreed to pay Plaintiffs up to $250,000 per calendar year for fees and costs 15 for “work reasonably performed” under the Stipulation. (Doc. 1185, ¶ 44). Through 16 June 30, 2017, Defendants had paid Plaintiffs $645,617.58 pursuant to this provision. 17 (Doc. 2402-1). Cost of this Litigation and Path Forward 18 In November 2017, Plaintiffs informed the Court that Defendants had paid their 19 outside counsel $1,744,543.45 between February 2015 and June 2017. During the first 20 half of 2017, outside counsel invoiced over $100,000/month. (Doc. 2434). Based on the 21 docket, the Court assumes this level of monthly invoicing continued throughout the latter 22 half of 2017 and into 2018. In June 2018, after Plaintiffs submitted Court-directed 23 revisions, the Court granted Plaintiffs’ Motion for Attorneys’ Fees and Costs for the 24 amount of $1,259,991.98 for work through June 30, 2017. (Doc. 2902). 25 This means that, through June 30, 2017, the State had spent over $3.6 million in 26 litigating this matter. Based on billing rates and Plaintiffs’ recent submission, a safe 27 assumption is that close to $2 million more has been spent since then. 28 conservative estimate is that the State has spent well over $5.5 million in attorneys’ fees -8- Thus, a 1 with most of that being spent in the last three years. 2 While Defendants are free to utilize the State’s resources as they wish, at some 3 point their continued insistence that taxpayer money is better spent on assiduously 4 defending their noncompliance with the Stipulation than on efforts towards remedying 5 the fundamental underlying cause of that noncompliance is likely ill-conceived and ill- 6 advised. The Court is disinclined to grinding down the well-worn path of noncompliance 7 and failed remedial measures. It has been four years since the parties adopted the 8 Stipulation and over six years since this litigation commenced. Defendants’ actions raise 9 the distinct miserable possibility that the Stipulation will have to be set aside and the 10 parties instructed to litigate again. See Delay v. Gordon, 475 F.3d 1039, 1044 n.11 11 (2007) (noting “[r]epudiation of a settlement agreement . . . may justify vacating the 12 court’s prior dismissal order [and] return[ing] the parties to the status quo ante”). The 13 parties, but especially Defendants, should carefully contemplate whether they are willing 14 to engage in the good-faith efforts needed to bring Defendants into compliance with the 15 Stipulation. 16 …… 17 …… 18 …… 19 …… 20 …… 21 …… 22 …… 23 …… 24 …… 25 …… 26 …… 27 …… 28 …… -9- 1 2 Accordingly, 3 IT IS ORDERED denying Defendants’ Motion for Relief from Court Order Re: 4 5 6 Termination of Monitoring (Doc. 2931). IT IS FURTHER ORDERED denying Defendants’ Motion for Relief from Court Order Re: HNR Boxes (Doc. 2932). 7 IT IS FURTHER ORDERED denying Defendants’ to Stay (Doc. 2971). 8 IT IS FURTHER ORDERED granting Plaintiffs’ Motion for Status Hearing. 9 (Doc. 2999). A hearing is set for December 6, 2018, at 1:30 p.m. 10 IT IS FURTHER ORDERED granting Defendants’ Motion to Modify Order 11 Doc. 2958 (Doc. 3046). Defendants’ monthly compliance reports will be due on the 21st 12 day of each month or on the business day thereafter. 13 14 15 IT IS FURTHER ORDERED denying Michael Cohn’s pro se Motion for Investigation of Fraudulent Schemes (Doc. 3044). Dated this 15th day of November, 2018. 16 17 18 Honorable Roslyn O. Silver Senior United States District Judge 19 20 21 22 23 24 25 26 27 28 - 10 - MARC F. STERN, M.D., M.P.H., F.A.C.P. November, 2018 1100 Surrey Trace Drive, SE Tumwater, Washington 98501, USA marcstern@live.com +1 (360) 701–6520 SUMMARY OF EXPERIENCE CORRECTIONAL HEALTH CARE CONSULTANT 2009 – PRESENT Consultant in the design, management, and operation of health services in a correctional setting to assist in evaluating, monitoring, or providing evidence-based, cost-effective care consistent with constitutional mandates of quality. Current activities include:  Advisor to various jails in Washington State on patient safety, health systems, and related health care and custody staff activities and operations, and RFP and contract generation (2014 - )  Consultant to Human Rights Watch to evaluate medical care of immigrants in Homeland Security detention (2016 - )  Consultant to the US Department of Justice, Civil Rights Division, Special Litigation Section. Providing investigative support and expert medical services pursuant to complaints regarding care delivered in any US jail, prison, or detention facility. (2010 - ) (no current open cases)  Consultant to Broward County Sheriff to help develop and evaluate responses to a request for proposals (2017 - )  Physician prescriber/trainer for administration of naloxone by law enforcement officers for the Olympia, Tumwater, Lacey, and Evergreen College Police Departments (2017 - )  Consultant to the Civil Rights Enforcement Section, Office of the Attorney General of California, under SB 29, to review the healthcare-related conditions of confinement of detainees confined by Immigration and Customs Enforcement in California facilities (2017 - ) Previous activities include:  Member of monitoring team (medical expert) pursuant to Consent Agreement between US Department of Justice and Miami-Dade County (Unites States of America v Miami-Dade County, et al.) regarding, entre outre, unconstitutional medical care. (2013 - 2016)  Jointly appointed Consultant to the parties in Flynn v Walker (formerly Flynn v Doyle), a class action lawsuit before the US Federal District Court (Eastern District of Wisconsin) regarding Eighth Amendment violations of the health care provided to women at the Taycheedah Correctional Institute. Responsible for monitoring compliance with the medical component of the settlement. (2010 - 2015)  Consultant on “Drug-related Death after Prison Release,” a research grant continuing work with Dr. Ingrid Binswanger, University of Colorado, Denver, examining the causes of, and methods of reducing deaths after release from prison to the community. National Institutes of Health Grant R21 DA031041-01. (2011 - 2016)  Consultant to the US Department of Homeland Security, Office for Civil Rights and Civil Liberties. Providing investigative support and expert medical services pursuant to complaints regarding care received by immigration detainees in the custody of U.S. Immigration and Customs Enforcement. (2009 - 2014)  Special Master for the US Federal District Court (District of Idaho) in Balla v Idaho State Board of Correction, et al., a class action lawsuit alleging Eighth Amendment violations in provision of health care at the Idaho State Correctional Institution. (2011 - 2012)  Facilitator/Consultant to the US Department of Justice, Office of Justice Programs, Bureau of Justice Statistics, providing assistance and input for the development of the first National Survey of Prisoner Health. (2010-2011 )  Project lead and primary author of National Institute of Corrections’ project entitled “Correctional Health Care Executive Curriculum Development,” in collaboration with National Commission on Correctional Health Care. NIC commissioned this curriculum for its use to train executive leaders from jails and prisons across the nation to better manage the health care missions of their facilities. Cooperative Agreement 11AD11GK18, US Department of Justice, National Institute of Corrections. (2011 - 2015 )  Co-teacher, with Jaye Anno, Ph.D., for the National Commission on Correctional Health Care, of the Commission’s standing course, An In-Depth Look at NCCHC’s 2008 Standards for Health Services in Prisons and Jails taught at its national meetings. (2010 - 2013) Marc F. Stern, M.D.           Page 2 Contributor to 2014 Editions of Standards for Health Services in Jails and Standards for Health Services in Prisons, National Commission on Correctional Health Care. (2013) Consultant to the California Department of Corrections and Rehabilitation court-appointed Receiver for medical operations. Projects included: o Assessing the Receiver’s progress in completing its goal of bringing medical care delivered in the Department to a constitutionally mandated level. (2009) o Providing physician leadership to the Telemedicine Program Manager tasked with improving and expanding the statewide use of telemedicine. (2009) Conceived, co-designed, led, and instructed in American College of Correctional Physicians and National Commission on Correctional Health Care’s Medical Directors Boot Camp (now called Leadership Institute), a national training program for new (Track “101”) and more experienced (Track “201”) prison and jail medical directors. (2009 - 2012) Participated as a member of a nine-person Delphi expert consensus panel convened by Rand Corporation to create a set of correctional health care quality standards. (2009) Convened a coalition of jails, Federally Qualified Health Centers, and community mental health centers in ten counties in Washington State to apply for a federal grant to create an electronic network among the participants that will share prescription information for the correctional population as they move among these three venues. (2009 2010) Participated as a clinical expert in comprehensive assessment of Michigan Department of Corrections as part of a team from the National Commission on Correctional Health Care. (2007) Provided consultation to Correctional Medical Services, Inc., St. Louis (now Corizon), on issues related to development of an electronic health record. (2001) Reviewed cases of possible professional misconduct for the Office of Professional Medical Conduct of the New York State Department of Health. (1999 – 2001) Advised Deputy Commissioner, Indiana State Board of Health, on developing plan to reduce morbidity from chronic diseases using available databases. (1992) Provided consultation to Division of General Medicine, University of Nevada at Reno, to help develop a new clinical practice site combining a faculty practice and a supervised resident clinic. (1991) OLYMPIA FREE CLINIC, OLYMPIA, WASHINGTON 2017 - PRESENT Volunteer practitioner providing episodic care at a neighborhood clinic which provides free care to individuals without health insurance until they can find a permanent medical home OLYMPIA UNION GOSPEL MISSION CLINIC, OLYMPIA, WASHINGTON 2009 – 2014 Volunteer practitioner providing primary care at a neighborhood clinic which provides free care to individuals without health insurance until they can find a permanent medical home; my own patient panel within the practice focuses on individuals recently released jail and prison. WASHINGTON STATE DEPARTMENT OF CORRECTIONS 2002 – 2008 Assistant Secretary for Health Services/Health Services Director, 2005 – 2008 Associate Deputy Secretary for Health Care, 2002 – 2005 Responsible for the medical, mental health, chemical dependency (transiently), and dental care of 15,000 offenders in total confinement. Oversaw an annual operating budget of $110 million and 700 health care staff.  As the first incumbent ever in this position, ushered the health services division from an operation of 12 staff in headquarters, providing only consultative services to the Department, to an operation with direct authority and responsibility for all departmental health care staff and budget. As part of new organizational structure, created and filled statewide positions of Directors of Nursing, Medicine, Dental, Behavioral Health, Mental Health, Psychiatry, Pharmacy, Operations, and Utilization Management.  Significantly changed the culture of the practice of correctional health care and the morale of staff by a variety of structural and functional changes, including: ensuring that high ethical standards and excellence in clinical practice were of primordial importance during hiring of professional and supervisory staff; supporting disciplining or career counseling of existing staff where appropriate; implementing an organizational structure such that patient care Marc F. Stern, M.D.     Page 3 decisions were under the final direct authority of a clinician and were designed to ensure that patient needs were met, while respecting and operating within the confines of a custodial system. Improved quality of care by centralizing and standardizing health care operations, including: authoring a new Offender Health Plan defining patient benefits based on the Eighth Amendment, case law, and evidence-based medicine; implementing a novel system of utilization management in medical, dental, and mental health, using the medical staffs as real-time peer reviewers; developing a pharmacy procedures manual and creating a Pharmacy and Therapeutics Committee; achieving initial American Correctional Association accreditation for 13 facilities (all with almost perfect scores on first audit); migrating the eight individual pharmacy databases to a single central database. Blunted the growth in health care spending without compromising quality of care by a number of interventions, including: better coordination and centralization of contracting with external vendors, including new statewide contracts for hospitalization, laboratory, drug purchasing, radiology, physician recruitment, and agency nursing; implementing a statewide formulary; issuing quarterly operational reports at the state and facility levels. Piloted the following projects: direct issuance of over-the-counter medications on demand through inmates stores (commissary), obviating the need for a practitioner visit and prescription; computerized practitioner order entry (CPOE); pill splitting; ER telemedicine. Oversaw the health services team that participated variously in pre-design, design, or build phases of five capital projects to build complete new health units. NEW YORK STATE DEPARTMENT OF CORRECTIONAL SERVICES 2001 – 2002 Regional Medical Director, Northeast Region, 2001 – 2002 Responsible for clinical oversight of medical services for 14,000 offenders in 14 prisons, including one (already) under court monitoring.  Oversaw contract with vendor to manage 60-bed regional infirmary and hospice.  Coordinated activities among the Regional Medical Unit outpatient clinic, the Albany Medical College, and the 13 feeder prisons to provide most of the specialty care for the region.  Worked with contracting specialists and Emergency Departments to improve access and decrease medical out-trips by increasing the proportion of scheduled and emergency services provided by telemedicine.  Provided training, advice, and counseling to practitioners and facility health administrators in the region to improve the quality of care delivered. CORRECTIONAL MEDICAL SERVICES, INC. (now CORIZON) 2000 – 2001 Regional Medical Director, New York Region, 2000 – 2001 Responsible for clinical management of managed care contract with New York State Department of Correctional Services to provide utilization management services for the northeast and northern regions of New York State and supervision of the 60-bed regional infirmary and hospice.  Migrated the utilization approval function from one of an anonymous rule-based “black box” to a collaborative evidence-based decision making process between the vendor and front-line clinicians. MERCY INTERNAL MEDICINE, ALBANY, NEW YORK 1999 – 2000 Neighborhood three-physician internal medicine group practice. Primary Care Physician, 1999 – 2000 (6 months) Provided direct primary care to a panel of community patients during a period of staff shortage. ALBANY COUNTY CORRECTIONAL FACILITY, ALBANY, NEW YORK 1998 – 1999 Acting Facility Medical Director, 1998 – 1999 Directed the medical staff of an 800 bed jail and provided direct patient care following the sudden loss of the Medical Director, pending hiring of a permanent replacement. Coordinated care of jail patients in local hospitals. Provided consultation to the Superintendent on improvements to operation and staffing of medical unit and need for privatization. VETERANS ADMINISTRATION MEDICAL CENTER, ALBANY, NY 1992 – 1998 Marc F. Stern, M.D. Page 4 Assistant Chief, Medical Service, 1995 – 1998 Chief, Section of General Internal Medicine and Emergency Services, 1992 – 1998 Responsible for operation of the general internal medicine clinics and the Emergency Department.  Designed and implemented an organizational and physical plant makeover of the general medicine ambulatory care clinic from an episodic-care driven model with practitioners functioning independently supported by minimal nursing involvement, to a continuity-of-care model with integrated physician/mid-level practitioner/registered nurse/licensed practice nurse/practice manager teams.  Led the design and opening of a new Emergency Department.  As the VA Section Chief of Albany Medical College’s Division of General Internal Medicine, coordinated academic activities of the Division at the VA, including oversight of, and direct teaching in, ambulatory care and inpatient internal medicine rotations for medical students, residents, and fellows. Incorporated medical residents as part of the general internal medicine clinics. Awarded $786,000 Veterans Administration grant (“PRIME I”) over four years for development and operation of educational programs for medicine residents and students in allied health professions (management, pharmacy, social work, physician extenders) wishing to study primary care delivery. ERIE COUNTY HEALTH DEPARTMENT, BUFFALO, NY 1988 – 1990 Director of Sexually Transmitted Diseases (STD) Services, 1989 – 1990 Staff Physician, STD Clinic, 1988 – 1989 Staff Physician, Lackawanna Community Health Center, 1988 – 1990 Provided leadership and patient care services in the evaluation and treatment of STDs. Successfully reorganized the county’s STD services which were suffering from mismanagement and were under public scrutiny. Provided direct patient care services in primary care clinic for underserved neighborhood. UNION OCCUPATIONAL HEALTH CENTER, BUFFALO, NY 1988 – 1990 Staff Physician, 1988 – 1990 Provided direct patient care for the evaluation of occupationally-related health disorders. VETERANS ADMINISTRATION MEDICAL CENTER, BUFFALO, NY 1985 – 1990 Chief Outpatient Medical Section and Primary Care Clinic, 1986 – 1988 VA Section Head, Division of General Internal Medicine, University of Buffalo, 1986 – 1988  Developed and implemented a major restructuring of the general medicine ambulatory care clinic to reduce fragmentation of care by introduction of a continuity-of-care model with a physician/nurse team approach. Medical Director, Anticoagulation Clinic 1986 – 1990 Staff Physician, Emergency Department, 1985 – 1986 FACULTY APPOINTMENTS 2007 – present 1999 – present 1996 – 2002 1992 – 2002 1993 – 1997 1990 – 1992 1985 – 1990 1982 – 1985 Affiliate Assistant Professor, Department of Health Services, School of Public Health, University of Washington Clinical Professor, Fellowship in Applied Public Health (previously Volunteer Faculty, Preventive Medicine Residency), University at Albany School of Public Health Volunteer Faculty, Office of the Dean of Students, University at Albany Associate Clinical/Associate/Assistant Professor of Medicine, Albany Medical College Clinical Associate Faculty, Graduate Program in Nursing, Sage Graduate School Instructor of Medicine, Indiana University Clinical Assistant Professor of Medicine, University of Buffalo Clinical Assistant Instructor of Medicine, University of Buffalo OTHER PROFESSIONAL ACTIVITIES Marc F. Stern, M.D. 2016 – present 2016 – present 2015 – present 2013 – present 2013 – present 2013 – present 2011 – 2012 2010 2010 2010 – present 2009 – present 2007 – present 2007 – present 2005 – present 2004 – 2006 2004 – 2006 2004 2004 2003 – present 2001 – present 2000 – present 1999 – present 1999 1997 – 1998 1996 – 2002 1996 – 2002 1996 1995 – 1998 1995 1994 – 1998 1993 1993 1988 – 1989 Page 5 Chair, Education Committee, Academic Consortium on Criminal Justice Health Member (Prisoner Advocate), Washington State Institutional Review Board Founding Editorial Board Member, Journal for Evidence-based Practice in Correctional Health, Center for Correctional Health Networks, University of Connecticut Member, Conference Planning Committee – Medical/Mental Health Track, American Jail Association Course Faculty, “Health in Prisons” course, Bloomberg School of Public Health, Johns Hopkins University/International Committee of the Red Cross Member (Prisoner Advocate), Institutional Review Board, University of Washington Member, Education Committee, National Commission on Correctional Health Care Recipient, Armond Start Award of Excellence, American College of Correctional Physicians Recipient, (First) Annual Preventive Medicine Faculty Excellence Award, New York State Preventive Medicine Residency Program, University at Albany School of Public Health/New York State Department of Health Member, International Advisory Board, International Journal of Prison Health Member, Editorial Board, Journal of Correctional Health Care Member, National Advisory Committee, COCHS (Community–Oriented Correctional Health Services) Member, Planning Committee, Annual Academic and Health Policy Conference on Correctional Health, University of Massachusetts Medical School and Commonwealth Medicine Correctional Health Program Member, American Correctional Association/Washington Correctional Association Member, Board of Directors, American College of Correctional Physicians Member, Fellow’s Advisory Committee, University of Washington Robert Wood Johnson Clinical Scholar Program Member, External Expert Panel to the Surgeon General on the “Call to Action on Correctional Health Care” Recipient, Excellence in Education Award for excellence in clinical teaching, Family Practice Residency Program, Providence St. Peter Hospital, Olympia, Washington Faculty Instructor, Critical Appraisal of the Literature Course, Family Practice Residency Program, Providence St. Peter Hospital, Olympia, Washington Chair/Co-Chair/Member, Education Committee, American College of Correctional Physicians Member, American College of Correctional Physicians Faculty Instructor, Critical Appraisal of the Literature Course, Preventive Medicine Residency Program, New York State Department of Health/University at Albany School of Public Health Co–Chairperson, Education Subcommittee, Workshop Submission Review Committee, Annual Meeting, Society of General Internal Medicine Northeast US Representative, National Association of VA Ambulatory Managers Faculty Mentor, Journal Club, Internal Medicine Residency Program, Albany Medical College Faculty Advisor and Medical Control, 5 Quad Volunteer Ambulance Service, University at Albany Recipient, Special Recognition for High Quality Workshop Presentation at Annual Meeting, Society of General Internal Medicine Preceptor, MBA Internship, Union College Member, Quality Assurance/Patient Satisfaction Subcommittee, VA National Curriculum Development Committee for Implementation of Primary Care Practices, Veterans Administration Member, Residency Advisory Committee, Preventive Medicine Residency, New York State Department of Health/School of Public Health, University at Albany Chairperson, Dean's Task Force on Primary Care, Albany Medical College Member, Task Group to develop curriculum for Comprehensive Care Case Study Course for Years 1 through 4, Albany Medical College Instructor, Teaching Effectiveness Program for New Housestaff, Graduate Medical Dental Education Consortium of Buffalo Marc F. Stern, M.D. 1987 – 1990 1987 – 1989 1987 – 1988 1987 1986 – 1988 1986 – 1988 1986 1979 – 1980 1973 – 1975 1972 – 1975 1972 – 1975 Page 6 Member, Human Studies Review Committee, School of Allied Health Professions, University of Buffalo Chairman, Subcommittee on Hospital Management Issues and Member, Subcommittee on Teaching of Ad Hoc Committee to Plan Incoming Residents Training Week, Graduate Medical Dental Education Consortium of Buffalo Member, Dean's Ad Hoc Committee to Reorganize "Introduction to Clinical Medicine" Course Preceptor, Nurse Practitioner Training Program, School of Nursing, University of Buffalo Course Coordinator, Simulation Models Section of Physical Diagnosis Course, University of Buffalo Chairman, Service Chiefs' Continuity of Care Task Force, Veterans Administration Medical Center, Buffalo, New York Recipient, Letter of Commendation, House Staff Teaching, University of Buffalo Laboratory Teaching Assistant in Gross Anatomy, Université Libre de Bruxelles, Brussels, Belgium Instructor and Instructor Trainer of First Aid, American National Red Cross Chief of Service or Assistant Chief of Operations, 5 Quad Volunteer Ambulance Service, University at Albany. Emergency Medical Technician Instructor and Course Coordinator, New York State Department of Health, Bureau of Emergency Medical Services EDUCATION University at Albany, College of Arts and Sciences, Albany; B.S., 1975 (Biology) University at Albany, School of Education, Albany; AMST (Albany Math and Science Teachers) Teacher Education Program, 1975 Université Libre de Bruxelles, Faculté de Medecine, Brussels, Belgium; Candidature en Sciences Medicales, 1980 University at Buffalo, School of Medicine, Buffalo; M.D., 1982 University at Buffalo Affiliated Hospitals, Buffalo; Residency in Internal Medicine, 1985 Regenstrief Institute of Indiana University, and Richard L. Roudebush Veterans Administration Medical Center; VA/NIH Fellowship in Primary Care Medicine and Health Services Research, 1992 Indiana University, School of Health, Physical Education, and Recreation, Bloomington; M.P.H., 1992 New York Academy of Medicine, New York; Mini-fellowship Teaching Evidence-Based Medicine, 1999 CERTIFICATION Provisional Teaching Certification for Biology, Chemistry, Physics, Grades 7–12, New York State Department of Education (expired), 1975 Diplomate, National Board of Medical Examiners, 1983 Diplomate, American Board of Internal Medicine, 1985 Fellow, American College of Physicians, 1991 License: Washington (#MD00041843, active); New York (#158327, inactive); Indiana (#01038490, inactive) 2015 – present 2015 – present 2001 – present 2011 – present 2010 – present 2001 – 2004 1996 1990 – 1992 REVIEWER Journal for Evidence-based Practice in Correctional Health PLOS ONE Journal of Correctional Health Care American Journal of Public Health Langeloth Foundation (grants) Journal of General Internal Medicine Abstract Committee, Health Services Research Subcommittee, Annual Meeting, Society of General Internal Medicine Medical Care Marc F. Stern, M.D. Page 7 WORKSHOPS, SEMINARS, PRESENTATIONS, INVITED LECTURES Executive Manager Program in Correctional Health. 4-day training for custody/health care teams from jails and prisons on designing safe and efficient health care systems. National Institute for Corrections Training Facility, Aurora, Colorado, and other venues in Washington State. Periodically, 2014 – present. Medical Ethics in Corrections. Criminal Justice 441 – Professionalism and Ethical Issues in Criminal Justice. University of Washington, Tacoma. Recurring seminar, 2012 – present Medical Aspects of Deaths in ICE Custody. Briefing for U.S. Senate staffers, Human Rights Watch. Washington, D.C. 2018 Jails’ Role in Managing the Opioid Epidemic. Panelist. Washington Association of Sheriffs and Police Chiefs Annual Conference. Spokane, Washington. 2018 Contract Prisons and Contract Health Care: What Do We Know? Behind Bars: Ethics and Human Rights in U.S. Prisons Conference. Center for Bioethics – Harvard Medical School/Human Rights Program – Harvard Law School. Boston, Massachusetts. 2017 Health Care Workers in Prisons. (With Dr. J. Wesley Boyd) Behind Bars: Ethics and Human Rights in U.S. Prisons Conference. Center for Bioethics – Harvard Medical School/Human Rights Program – Harvard Law School. Boston, Massachusetts. 2017 Prisons, Jails and Medical Ethics: Rubber, Meet Road. Grand Rounds. Touro Medical College. New York, New York. 2017 Jail Medical Doesn’t Have to Keep You Up at Night – National Standards, Risks, and Remedies. Washington Association of Counties. SeaTac, Washington. 2017 Prison and Jail Health Care: What do you need to know? Grand Rounds. Providence/St. Peters Medical Center. Olympia, Washington. 2017 Prison Health Leadership Conference. 2-Day workshop. International Corrections and Prisons Association/African Correctional Services Association/Namibian Corrections Service. Omaruru, Namibia. 2016; 2018 What Would YOU Do? Navigating Medical Ethical Dilemmas. Spring Conference. National Commission on Correctional Health Care. Nashville, Tennessee. 2016 Improving Patient Safety. Spring Provider Meeting. Oregon Department of Corrections. Salem, Oregon 2016 A View from the Inside: The Challenges and Opportunities Conducting Cardiovascular Research in Jails and Prisons. Workshop on Cardiovascular Diseases in the Inmate and Released Prison Population. The National Heart, Lung, and Blood Institute. Bethesda, Maryland. 2016 Why it Matters: Advocacy and Policies to Support Health Communities after Incarceration. At the Nexus of Correctional Health and Public Health: Policies and Practice session. Panelist. American Public Health Association Annual Meeting. Chicago, Illinois. 2015 Hot Topics in Correctional Health Care. Presented with Dr. Donald Kern. American Jail Association Annual Meeting. Charlotte, North Carolina. 2015 Turning Sick Call Upside Down. Annual Conference. National Commission on Correctional Health Care. Dallas, Texas, 2015. Diagnostic Maneuvers You May Have Missed in Nursing School. Annual Conference. National Commission on Correctional Health Care. Dallas, Texas. 2015 The Challenges of Hunger Strikes: What Should We Do? What Shouldn’t We Do? Annual Conference. National Commission on Correctional Health Care. Dallas, Texas. 2015 Practical and Ethical Approaches to Managing Hunger Strikes. Annual Practitioners’ Conference. Washington Department of Corrections. Tacoma, Washington. 2015 Contracting for Health Services: Should I, and if so, how? American Jail Association Annual Meeting. Dallas, Texas. 2014 Hunger Strikes: What should the Society of Correctional Physician’s position be? With Allen S, May J, Ritter S. American College of Correctional Physicians (Formerly Society of Correctional Physicians) Annual Meeting. Nashville, Tennessee. 2013 Marc F. Stern, M.D. Page 8 Addressing Conflict between Medical and Security: an Ethics Perspective. International Corrections and Prison Association Annual Meeting. Colorado Springs, Colorado. 2013 Patient Safety and ‘Right Using’ Nurses. Keynote address. Annual Conference. American Correctional Health Services Association. Philadelphia, Pennsylvania. 2013 Patient Safety: Overuse, underuse, and misuse…of nurses. Keynote address. Essentials of Correctional Health Care conference. Salt Lake City, Utah. 2012 The ethics of providing healthcare to prisoners-An International Perspective. Global Health Seminar Series. Department of Global Health, University of Washington, Seattle, Washington. 2012 Recovery, Not Recidivism: Strategies for Helping People Who are Incarcerated. Panelist. NAMI Annual Meeting, Seattle, Washington, 2012 Ethics and HIV Workshop. HIV/AIDS Care in the Correctional Setting Conference, Northwest AIDS Education and Training Center. Salem, Oregon. 2011 Ethics and HIV Workshop. HIV/AIDS Care in the Correctional Setting Conference, Northwest AIDS Education and Training Center. Spokane, Washington. 2011 Patient Safety: Raising the Bar in Correctional Health Care. With Dr. Sharen Barboza. National Commission on Correctional Health Care Mid-Year Meeting, Nashville, Tennessee. 2010 Patient Safety: Raising the Bar in Correctional Health Care. American Correctional Health Services Association, Annual Meeting, Portland, Oregon. 2010 Achieving Quality Care in a Tough Economy. National Commission on Correctional Health Care Mid-Year Meeting, Nashville, Tennessee, 2010 (Co-presented with Rick Morse and Helena Kim, PharmD.) Involuntary Psychotropic Administration: The Harper Solution. With Dr. Bruce Gage. American Correctional Health Services Association, Annual Meeting, Portland, Oregon. 2010 Evidence Based Decision Making for Non-Clinical Correctional Administrators. American Correctional Association 139th Congress, Nashville, Tennessee. 2009 Death Penalty Debate. Panelist. Seattle University School of Law, Seattle, Washington. 2009 The Patient Handoff – From Custody to the Community. Washington Free Clinic Association, Annual Meeting, Olympia, Washington. Lacey, Washington. 2009 Balancing Patient Advocacy with Fiscal Restraint and Patient Litigation. National Commission on Correctional Health Care and American College of Correctional Physicians “Medical Directors Boot Camp,” Seattle, Washington. 2009 Staff Management. National Commission on Correctional Health Care and American College of Correctional Physicians “Medical Directors Boot Camp,” Seattle, Washington. 2009 Management Dilemmas in Corrections: Boots and Bottom Bunks. Annual Meeting, American College of Correctional Physicians, Chicago, Illinois. 2008 Public Health and Correctional Health Care. Masters Program in community–based population focused management – Populations at risk, Washington State University, Spokane, Washington. 2008 Managing the Geriatric Population. Panelist. State Medical Directors’ Meeting, American Corrections Association, Alexandria, Virginia. 2007 I Want to do my own Skin Biopsies. Annual Meeting, American College of Correctional Physicians, New Orleans, Louisiana. 2005 Corrections Quick Topics. Annual Meeting, American College of Correctional Physicians. Austin, Texas. 2003 Evidence Based Medicine in Correctional Health Care. Annual Meeting, National Commission on Correctional Health Care. Austin, Texas. 2003 Evidence Based Medicine. Excellence at Work Conference, Empire State Advantage. Albany, New York. 2002 Evidence Based Medicine, Outcomes Research, and Health Care Organizations. National Clinical Advisory Group, Integrail, Inc., Albany, New York. 2002 Evidence Based Medicine. With Dr. LK Hohmann. The Empire State Advantage, Annual Excellence at Work Conference: Leading and Managing for Organizational Excellence, Albany, New York. 2002 Marc F. Stern, M.D. Page 9 Taking the Mystery out of Evidence Based Medicine: Providing Useful Answers for Clinicians and Patients. Breakfast Series, Institute for the Advancement of Health Care Management, School of Business, University at Albany, Albany, New York. 2001 Diagnosis and Management of Male Erectile Dysfunction – A Goal–Oriented Approach. Society of General Internal Medicine National Meeting, San Francisco, California. 1999 Study Design and Critical Appraisal of the Literature. Graduate Medical Education Lecture Series for all housestaff, Albany Medical College, Albany, New York. 1999 Male Impotence: Its Diagnosis and Treatment in the Era of Sildenafil. 4th Annual CME Day, Alumni Association of the Albany–Hudson Valley Physician Assistant Program, Albany, New York. 1998 Models For Measuring Physician Productivity. Panelist. National Association of VA Ambulatory Managers National Meeting, Memphis, Tennessee. 1997 Introduction to Male Erectile Dysfunction and the Role of Sildenafil in Treatment. Northeast Regional Meeting Pfizer Sales Representatives, Manchester Center, Vermont. 1997 Male Erectile Dysfunction. Topics in Urology, A Seminar for Primary Healthcare Providers, Bassett Healthcare, Cooperstown, New York. 1997 Evaluation and Treatment of the Patient with Impotence: A Practical Primer for General Internists. Society of General Internal Medicine National Meeting, Washington D.C. 1996 Impotence: An Update. Department of Medicine Grand Rounds, Albany Medical College, Albany, New York. 1996 Diabetes for the EMT First–Responder. Five Quad Volunteer Ambulance, University at Albany. Albany, New York. 1996 Impotence: An Approach for Internists. Medicine Grand Rounds, St. Mary's Hospital, Rochester, New York. 1994 Male Impotence. Common Problems in Primary Care Precourse. American College of Physicians National Meeting, Miami, Florida. 1994 Patient Motivation: A Key to Success. Tuberculosis and HIV: A Time for Teamwork. AIDS Program, Bureau of Tuberculosis Control – New York State Department of Health and Albany Medical College, Albany, New York. 1994 Recognizing and Treating Impotence. Department of Medicine Grand Rounds, Albany Medical College, Albany, New York. 1992 Medical Decision Making: A Primer on Decision Analysis. Faculty Research Seminar, Department of Family Practice, Indiana University, Indianapolis, Indiana. 1992 Effective Presentation of Public Health Data. Bureau of Communicable Diseases, Indiana State Board of Health, Indianapolis, Indiana. 1991 Impotence: An Approach for Internists. Housestaff Conference, Department of Medicine, Indiana University, Indianapolis, Indiana. 1991 Using Electronic Databases to Search the Medical Literature. NIH/VA Fellows Program, Indiana University, Indianapolis, Indiana. 1991 Study Designs Used in Epidemiology. Ambulatory Care Block Rotation. Department of Medicine, Indiana University, Indianapolis, Indiana. 1991 Effective Use of Slides in a Short Scientific Presentation. Housestaff Conference, Department of Medicine, Indiana University, Indianapolis, Indiana. 1991 Impotence: A Rational and Practical Approach to Diagnosis and Treatment for the General Internist. Society of General Internal Medicine National Meeting, Washington D.C. 1991 Nirvana and Audio–Visual Aids. With Dr. RM Lubitz. Society of General Internal Medicine, Midwest Regional Meeting, Chicago. 1991 New Perspectives in the Management of Hypercholesterolemia. Medical Staff, West Seneca Developmental Center, West Seneca, New York. 1989 Effective Use of Audio–Visual Aids. Nurse Educators, American Diabetes Association, Western New York Chapter, Buffalo, New York. 1989 Marc F. Stern, M.D. Page 10 Management of Diabetics in the Custodial Care Setting. Medical Staff, West Seneca Developmental Center, West Seneca, New York, 1989 Effective Use of Audio–Visuals in Diabetes Peer and Patient Education. American Association of Diabetic Educators, Western New York Chapter, Buffalo, New York. 1989 Pathophysiology, Diagnosis and Care of Diabetes. Nurse Practitioner Training Program, School of Nursing, University of Buffalo, Buffalo, New York. 1989 Techniques of Large Group Presentations to Medical Audiences – Use of Audio–Visuals. New Housestaff Training Program, Graduate Medical Dental Education Consortium of Buffalo, Buffalo, New York. 1988 PUBLICATIONS/ABSTRACTS Grande L, Stern M. Providing Medication to Treat Opioid Use Disorder in Washington State Jails. Study conducted for Washington State Department of Social and Health Services under Contract 1731-18409. 2018. Stern MF, Newlin N. Epicenter of the Epidemic: Opioids and Jails. American Jails 2018 32(2):16-18 Stern MF. A nurse is a nurse is a nurse…NOT! Guest Editorial, American Jails 2018 32(2):4,68 Wang EA, Redmond N, Dennison Himmelfarb CR, Pettit B, Stern M, Chen J, Shero S, Iturriaga E, Sorlie P, Diez Roux AV. Cardiovascular Disease in Incarcerated Populations. Journal of the American College of Cardiology 2017 69(24):2967-76 Mitchell A, Reichberg T, Randall J, Aziz-Bose R, Ferguson W, Stern M. Criminal Justice Health Digital Curriculum. Poster, Annual Academic and Health Policy Conference on Correctional Health, Atlanta, Georgia, March, 2017 Stern MF. Patient Safety (White Paper). Guidelines, Management Tools, White Papers, National Commission on Correctional Health Care. http://www.ncchc.org/filebin/Resources/Patient-Safety-2016.pdf. June, 2016 Binswanger IA, Stern MF, Yamashita TE, Mueller SR, Baggett TP, Blatchford PJ. Clinical risk factors for death after release from prison in Washington State: a nested case control study. Addiction 2015 Oct 17 Stern MF. Op-Ed on Lethal Injections. The Guardian 2014 Aug 6 Stern MF. American College of Correctional Physicians Calls for Caution Placing Mentally Ill in Segregation: An Important Band-Aid. Guest Editorial. Journal of Correctional Health Care 2014 Apr; 20(2):92-94 Binswanger I, Blatchford PJ, Mueller SR, Stern MF. Mortality After Prison Release: Opioid Overdose and Other Causes of Death, Risk Factors, and Time Trends From 1999 to 2009. Annals of Internal Medicine 2013 Nov; 159(9):592-600 Williams B, Stern MF, Mellow J, Safer M, Greifinger RB. Aging in Correctional Custody: Setting a policy agenda for older prisoner health care. American Journal of Public Health 2012 Aug; 102(8):1475-1481 Binswanger I, Blatchford PJ, Yamashita TE, Stern MF. Drug-Related Risk Factors for Death after Release from Prison: A Nested Case Control Study. Oral Presentation, University of Massachusetts 4th Annual Academic and Health Policy Conference on Correctional Healthcare, Boston, Massachusetts, March, 2011 Binswanger I, Blatchford PJ, Forsyth S, Stern MF, Kinner SA. Death Related to Infectious Disease in Ex-Prisoners: An International Comparative Study. Oral Presentation, University of Massachusetts 4th Annual Academic and Health Policy Conference on Correctional Healthcare, Boston, Massachusetts, March, 2011 Binswanger I, Lindsay R, Stern MF, Blatchford P. Risk Factors for All-Cause, Overdose and Early Deaths after Release from Prison in Washington State Drug and Alcohol Dependence. Drug and Alcohol Dependence Aug 1 2011;117(1):1-6 Stern MF, Greifinger RB, Mellow J. Patient Safety: Moving the Bar in Prison Health Care Standards. American Journal of Public Health November 2010;100(11):2103-2110 Strick LB, Saucerman G, Schlatter C, Newsom L, Stern MF. Implementation of Opt-Out HIV testing in the Washington State Department of Corrections. Poster Presentation, National Commission on Correctional Health Care Annual Meeting, Orlando, Florida, October, 2009 Binswanger IA, Blatchford P, Stern MF. Risk Factors for Death After Release from Prison. Society for General Internal Medicine 32nd Annual Meeting; Miami: Journal of General Internal Medicine; April 2009. p. S164-S95 Stern MF. Force Feeding for Hunger Strikes – One More Step. CorrDocs Winter 2009;12(1):2 Binswanger I, Stern MF, Deyo RA, Heagerty PJ, Cheadle A, Elmore JG, Koepsell TD. Release from Prison – A High Risk of Death for Former Inmates. New England Journal of Medicine 2007 Jan 11;356(2):157–165 Marc F. Stern, M.D. Page 11 Stern MF, Hilliard T, Kelm C, Anderson E. Epidemiology of Hepatitis C Infection in the Washington State Department of Corrections. Poster Presentation, CDC/NIH ad hoc Conference on Management of Hepatitis C in Prisons, San Antonio, Texas, January, 2003 Phelps KR, Stern M, Slingerland A, Heravi M, Strogatz DS, Haqqie SS. Metabolic and skeletal effects of low and high doses of calcium acetate in patients with preterminal chronic renal failure. Am J Nephrol 2002 Sep–Dec;22(5–6):445–54 Goldberg L, Stern MF, Posner DS. Comparative Epidemiology of Erectile Dysfunction in Gay Men. Oral Presentation, International Society for Impotence Research Meeting, Amsterdam, The Netherlands, August 1998. Int J Impot Res. 1998;10(S3):S41 [also presented as oral abstract Annual Meeting, Society for the Study of Impotence, Boston, Massachusetts, October, 1999. Int J Impot Res. 1999;10(S1):S65] Stern MF. Erectile Dysfunction in Older Men. Topics in Geriatric Rehab 12(4):40–52, 1997. [republished in Geriatric Patient Education Resource Manual, Supplement. Aspen Reference Group, Eds. Aspen Publishers, Inc., 1998] Stern MF, Wulfert E, Barada J, Mulchahy JJ, Korenman SG. An Outcomes–Oriented Approach to the Primary Care Evaluation and Management of Erectile Dysfunction. J Clin Outcomes Management 5(2):36–56, 1998 Fihn SD, Callahan CM, Martin D, et al.; for the National Consortium of Anticoagulation Clinics.* The Risk for and Severity of Bleeding Complications in Elderly Patients Treated with Warfarin. Ann Int Med. 1996;124:970–979 Fihn SD, McDonell M, Martin D, et al.; for the Warfarin Optimized Outpatient Follow–up Study Group.* Risk Factors for Complications of Chronic Anticoagulation. Ann Int Med. 1993;118:511–520. (*While involved in the original proposal development and project execution, I was no longer part of the group at the time of this publication) Stern MF, Dittus RS, Birkhead G, Huber R, Schwartz J, Morse D. Cost–Effectiveness of Hepatitis B Immunization Strategies for High Risk People. Oral Presentation, Society of General Internal Medicine National Meeting, Washington, D.C., May 1992. Clin Res 1992 Fihn SD, McDonell MB, Vermes D, Martin D, Kent DL, Henikoff JG, and the Warfarin Outpatient Follow–up Study Group. Optimal Scheduling of Patients Taking Warfarin. A Multicenter Randomized Trial. Oral Presentation, Society of General Internal Medicine National Meeting, Washington, D.C., May 1992. Clin Res 1992 Fihn SD, McDonnell MB, Vermes D, Kent DL, Henikoff JG, and the Warfarin Anticoagulation Study Group. Risk Factors for Complications During Chronic Anticoagulation. Poster Presentation, Society of General Internal Medicine National Meeting, Seattle, May 1991 Pristach CA, Donoghue GD, Sarkin R, Wargula C, Doerr R, Opila D, Stern M, Single G. A Multidisciplinary Program to Improve the Teaching Skills of Incoming Housestaff. Acad Med. 1991;66(3):172–174 Stern MF. Diagnosing Chlamydia trachomatis and Neisseria gonorrhea Infections. (letter) J Gen Intern Med. 1991;6:183 Stern MF, Fitzgerald JF, Dittus RS, Tierney WM, Overhage JM. Office Visits and Outcomes of Care: Does Frequency Matter? Poster Presentation, Society of General Internal Medicine Annual Meeting, Seattle, May 1991. Clin Res 1991;39:610A Stern MF. Cobalamin Deficiency and Red Blood Cell Volume Distribution Width. (letter) Arch Intern Med. 1990;150:910 Stern M, Steinbach B. Hypodermic Needle Embolization to the Heart. NY State J Med. 1990;90(7):368–371 Stern MF, Birkhead G, Huber R, Schwartz J, Morse D. Feasibility of Hepatitis B Immunization in an STD Clinic. Oral Presentation, American Public Health Association Annual Meeting, Atlanta, November 1990 Marc F. Stern, M.D. Page 12 EXPERT TESTIMONY Dockery, et al. v. Hall et al. US District Court for the Southern District of Mississippi Northern Division, 2018 (trial) Benton v. Correct Care Solutions, et al. US District Court for the District of Maryland, 2018 (deposition) Pajas v. County of Monterey, et al. US District Court Northern District of California, 2018 (deposition) Walter v. Correctional Healthcare Companies, et al. US District Court, District of Colorado, 2017 (deposition) Winkler v. Madison County, Kentucky, et al. US District Court, Eastern District of Kentucky, Central Division at Lexington, 2016 (deposition) US v. Miami-Dade County, et al. US District Court, Southern District of Florida, periodically 2014 - 2016 Rosemary Saffioti v. Snohomish County et al. US District Court Western District of Washington at Seattle, 2015 (deposition) Christopher Alsobrook v. Sergeant Alvarado, et al., US District Court, Southern District of Florida, Miami Division, 2014 (deposition) Stefan Woodson v. City of Richmond, Virginia, et al., US District Court, Eastern District of Virginia, Richmond Division, 2013 and 2014 (deposition)

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