PROVIDENCE An assistant public defender, a community health workerand a social caseworker huddled with a man accused of robbery on a recent morning in the hallway at the Licht Judicial Complex.
The group was discussing a possible disposition in the case with Hakim Milton, 41, a towering, slender man breathing with the assistance of a tracheostomy tube, his face etched with trepidation.
Theres always a chance theyre going to send me back. Im a stress head, Milton said.
Unlike the other defendants awaiting court appearances on benches lining the hallway, Milton is accompanied by a team from the Rhode Island Public Defenders office and the Lifespan Transitions Clinic, a program launched in 2018 to help address the myriad needs of people transitioning from prison back into the community.
As a patient at the clinic, Milton is the beneficiary of a novel and emerging approach to criminal justice in Rhode Island: doctors at the Transitions Clinic partnering with the Public Defenders office to bring a health-care perspective to the courts. It is believed to be the first medical-legal collaboration in criminal defense in the nation.
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A social worker at Rhode Island Hospital flagged Milton as being a good candidate for the Transitions Clinic due to his repeated incarcerations, history of cocaine abuse and homelessness, and underlying medical conditions. In 2009, he was diagnosed with multiple sclerosis and a decade later with throat cancer. He relies on atracheostomy tube strapped around his neck and speaks in a faint, raspy voice. He is undergoing chemotherapy.
They felt like I needed someone to help me, said Milton, who made a pattern of walking out on medical treatments in frustration and skipping court dates.
The clinics objective is to interrupt the release-relapse-return cycle of patients like Milton by providing intensive services and support through an interdisciplinary team of doctors and community health workers. Now, that work is partnered with the Public Defenders office to provide a health-care lens to legal advocacy.
Milton grew up surrounded by violence in the Dorchester neighborhood of Boston. Hebegan engaging in petty crime as a teen. He tried cocaine for the first time at 22 while exploring in New Bedford.
Its part of the culture there," he said. "Everyone does it.
He did the drug only occasionally for the first few monthsout of fear hed become a crackhead, and then it took hold. He spent his days robbing drug dealers to get money. He spent the money on drugs.
Eventually, he landed a five-year prison sentence in Massachusetts for armed robbery. Its then that his lifestyle began to give him pause.
I changed enough to be aware of my stupidness, but not enough to change, Milton said.
He came to Rhode Island to be close to his young son, but the boys mother wouldnt let him visit due to his drug use. He slept in the park. He racked up drug-possession, larceny, disorderly conduct and assault charges. He did stints at the Adult Correctional Institutions.
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He says he was feeling helpless in July 2019 when he walked into Star Cleaners on Broad Street with his hand in his pocket. He told a clerk he had AIDS and would poke her with his needle if she didnt empty the register. He grabbed $148 and left.
Providence police tracked him to a nearby liquor store. They tried to place him under arrest. Instead, he resisted and repeatedly grabbed at an officers gun. Officers punched him and doused himwith pepper spray to wrest the gun free.
I tried to make them shoot me, and they didnt, Milton said. He went back to prison.
That case brought Milton to Superior Court on a recent morning. His lawyer, Assistant Public Defender Sarah Potter, presented Superior Court Judge Maureen B. Keough with an email from his treating physician,Dr. M. Catherine Trimbur. It detailed his medical conditions and current treatment, as well as his progress. He is undergoing chemotherapy and is one year in recovery from a substance-use disorder.
The partnership with the clinic gave Potter direct access to Trimbur and informed the courts firsthand about Miltons prognosis and the possible impacts of incarceration. Typically, Potter would have to track providers down, Google medical terms, and then try to interpret it for the courts.
Coming directly from the doctor, it has significantly more weight than me simply saying it, Potter said.
Later that afternoon, Milton admitted to second-degree robbery and larceny for stealing Beats headphones from the Apple Store at Providence Place mall just days before the robbery. In exchange for his no-contest pleas, the state agreed to dismiss resisting arrest and drug charges.He was ordered to pay $1,580 in restitution to Apple and received a seven-year suspended sentence with probation over the states objections.
Assistant Attorney General J. Patrick Youngs spoke of the trauma and fear the clerk at the cleaners continuedto experience. Youngs emphasized that the threat of a needle infected with AIDS made the offense more serious.
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What you did to that woman is inexcusable to me. She really wasnt doing anything other than her job. … And so now she lives with this where shes afraid to go back in the store. I want that to really resonate with you, what you did to her, Keough said.
Keough said she struggled in arriving at the disposition that spared Milton jail time, but that there are other forces at work that made her question what would happen if he returned to the ACI. The medical reports gave her pause.
I think there are penalties that youre suffering right now that are bigger and better than anything I could do. And I dont take pleasure in saying that to you, but its the reality of the situation and why I agreed to do this, Keough said, according to a transcript of the hearing.
She ordered Milton not to return to Star Cleaners or have any contact with the clerk.
Milton recognized that without Trimburs input he would have beenassessed primarily by his criminal record.
They let the courts know my progress. Without knowing my progress, it just didnt matter. I would have been in big-asstrouble if it wasnt for them today, he said.
Milton said he didnt realize his actions would scare the clerk so badly.
I just regret it," he said. "It was so stupid.
Historically, doctors have rarely screened for a patients involvement with the criminal justice system, instead leaving that to lawyers despite the often significant health effects.
Too often, in law and medicine, we have blinders on, Rhode Island Public Defender Lara Montecalvo said.
The partnership between the Transitions Clinic and the Rhode Island Public Defenders office grew in 2019 from a recognition that heading back to prison, probation and parole, and even accruing court fees and fines, had implications on peoples ability to maintain jobs and secure housing; regulate stress and anxiety; and preserve overall health.
Researchers estimate that each year spent behind bars equates to a two-year reduction in life expectancy, meaning that five years in prison drops an individuals expected life span at age 30 by 10 years, according to the Prison Policy Initiative.
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The law in our country is still when someone is convicted of a crime, they go to prison, said Dr. Rahul Vanjani,a physician with the Transitions Clinic, which is a partnership between three Lifespan entities:Rhode Island Hospitals Center for Primary Care, the Lifespan Community Health Institute, and the Center for Health and Justice Transformation.
Substance abuse or mental health treatment plans are interrupted by a return to prison. Not to mention the health impacts of living under constant surveillance in a highly stressful, racialized setting with cortisol, the primary stress hormone, coursing through the body, Vanjani said.
Input from treating clinicians can supply crucial information to lawyers as they advocate for their clients and attempt to delve into the underlying causes of repeated police encounters. Often it is a cycle driven by a substance-use disorder, mental illness, homelessness, or a combination.
Without that perspective, the court is missing an important piece, said James Lawless, social services caseworker supervisor at the state Public Defenders office. We know that incarceration is detrimental to peoples health.
Time spent behind bars also creates barriers to securing stable housing, maintaining or even getting a job, and forging family and community ties, Lawless said.
They are less likely to reoffend if they have stable housing and supports in the community, said Lawless, one of seven social caseworkers in the office.
How many times are you going to do the same thing? Lawless said.He supports the Transitions Clinic model, which focuses on strengthening stability outside of prison through community-based health care, rather than forcing them to rebuild each time they are incarcerated and released.
The clinic has revised its intake process to include asking patients to sign a consent form that allowsdoctors to communicate with social caseworkers at the Public Defenders office, like Lawless. This allows the clinic to reach out if theres a new arrest or alleged probation violation, creating a smooth line of communication.
The caseworkers, in turn, contact the patients assistant public defender. The clinics three doctors can then provide supporting documents, records and insight to assist in resolving the case.
The doctors at the Transitions Clinic dont make recommendations to the court, but rather provide information to better inform sentencing, such as whether from their perspective residential treatment could be preferable to incarceration. They chronicle their patients progress.
The input from the Transitions Clinic to the courts came into play for 58-year-old Theodore Wright in August 2020, when hefound himself once again behind bars. A discharge nurse at the ACI identified Wright as agood candidate for the clinic. His age, history of cocaine abuse and homelessness, underlying medical conditions eye disease, hypertension, cancer and repeated incarcerations were all factored in.
Wrights lawyer, Steven J. DeLuca, who was court-appointed, presented Superior Court Judge Joseph A. Montalbano with paperwork showing that Wright was successfully undergoing outpatient treatment at Anchor Recovery under the oversight of the Transitions Clinic.
They are critical in a lot of cases, DeLuca said of the clinicians'feedback. Incarceration is not going to resolve or address the underlying issue, which is causing the recidivism.
Montalbano agreed to convert the felony assault charge to a misdemeanor simple assault with input from state prosecutors. He gave Wright a one-year suspended sentence with probation under the condition that he continue his treatment at Anchor.
I was convinced that he was doing well, and the victim was OK with it, Montalbano said. My general philosophy in a case like Mr. Wright is to try to give people that opportunity for treatment where appropriate. Its all a give-and-take process.
So far, doctors from the clinic have provided letters to the court in about 30 cases, Lawless said.
They understand that the justice system is a primary stressor in their patients lives, Lawless said.
Vanjani hopes that more doctors and defense lawyers will adopt the Lifespan model that focuses on health outcomes, rather than solely legal ones.
Its really important to have doctors involved, he said.
He and Lawless are spreading the word. In June, they plan to make a presentation via Zoom to the National Legal Aid & Defender Association. They hope to address the Rhode Island Judiciary about the partnership in the coming months.
"Although we are not familiar enough with the Lifespan Transitions Clinic to comment specifically, this Office often considers medical and other issues when making sentencing recommendations," said Kristy dosReis, spokeswoman for Attorney General Peter Neronha."In all cases, we evaluate the individual facts and circumstances and craft sentencing recommendations accordingly."
Anthony Thigpen, a community health worker at the clinic, has made an enormous difference in the lives of Milton and Wright. He accompanies them to court, helps keep their medications and treatment on track, and supports and cajoles them as necessary.
His approach? Love and honesty.
Ive built that rapport with them. They understand we come from a place of no judgment, Thigpen said
Like all three of the clinics community health workers, Thigpen has a criminal history. A former gang member who did eight years in prison for drug trafficking in Massachusetts, he views part of his role as leading by example.
He tells them what they need to hear, not what they want to hear, said Thigpen, a married father who began working at the clinic in 2018.
Hes the one who keeps me going, Milton said.
To Milton, Thigpen is the first person to ever stand by his side.
I didnt want to accept it," he said. "I felt bad asking for stuff.
In time, he learned to trust Thigpens and the clinics support.
Knowing youve got someone in your corner, youre more willing to do the right thing," Milton said. "I know Im never getting railroaded with these guys behind me.
After the court hearing, Thigpen took Milton grocery shopping for food such as yogurt that would slip easily down his throat and returned him to the assisted-living facility in Central Falls, where he lives.
Involvement with the clinic and intensive oversight don't mean there arent hiccups. Milton picked up a shoplifting charge last June, and Wright was charged with domestic simple assault and disorderly conduct charges earlier this month.
We try to practice unconditional love. We try to be malleable, said Vanjani, known as Dr. V, who has worked as a doctor at San Quentin State Prison in California and did his residency at Rikers Island in New York. He and Trimbur are married.
Slip-ups come with the territory for people who have spent their lives in and out of prison and on the streets.
Its part of their lives, unfortunately. Its a blessing that they call me and say, 'I slipped up, Thigpen said. He estimates he has 25 to 30 patients. Fifteen are very active, meaning they are in need of housing and other support. His phone rings nonstop.
Milton, who enjoys playing chess and doing crossword puzzles on the tablet he carries, no longer feels safe in public due to his tracheostomy tube. He texts Thigpen daily, sometimes just to say hes not feeling well. Thigpen will pop by to take him to breakfast.
I know Im not just by myself. Why should I do whatever I want to do? Milton said. I feel like if I mess up, Im wasting their time.
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