Physician-public defender collaboration - a new medical-legal partnership

Mr. A., a 45-year-old man with a history of benzodiazepine use disorder, was brought to the hospital after having a grand mal seizure while awaiting trial in the holding cell of a municipal courthouse. After being arrested 3 days earlier, he had been held for 2 days in the police station, where he did not receive any medications. During that period, he developed progressively worsening withdrawal symptoms, including headache, nausea, tremors, and anxiety, culminating in a seizure. He was transferred to a local hospital, admitted to the medical service, and given clonazepam, with a plan for a prolonged taper.

Mr. A. had been hospitalized with seizures from benzodiazepine withdrawal on numerous previous occasions. Each time, he would undergo a relatively brisk clonazepam taper over the course of 1 to 2 weeks and then return to using benzodiazepines almost immediately after discharge. Understanding this pattern, the inpatient medicine team planned a prolonged taper, starting at a total daily dose of 7 mg and tapering by 0.5 mg per week. The clinicians worried, however, that Mr. A. would not be able to continue this taper in the state’s prison system.

Public records showed that the patient had been incarcerated multiple times. Both Mr. A.’s self-report and his medical record indicated that his addiction, coping skills, and ability to lead a fulfilling life had deteriorated with each successive incarceration. It was clear to the medical team that an additional incarceration would be detrimental to Mr. A.’s health.