'It's A Prison. It's Punishing Addicts': Calls To Reform Civil Commitments Increase

Standing inside the county jail in Ludlow, Hampden County Sheriff Nick Cocchi is clearly proud of his jail's newest wing.

"This here is our Section 35 civil commitment — quote, unquote — 'wing,' " he says, unlocking a set of doors to lead this reporter on a tour. "Now, I want you to know that it's not wet. That's how clean the place is."

As the state reviews how it involuntarily commits people to addiction treatment under a state law called Section 35, Cocchi has opened this part of his jail for men who have been civilly committed. He's done this despite public calls from some who have been civilly committed to stop sending people into correctional institutions for drug and alcohol treatment.

The July inception of the sheriff's wing marked the opening of the first Section 35 facility in western Massachusetts. It's designed to hold up to 96 men.

Beyond the indeed shiny, linoleum-floored hallway is the unit's main common area.

"... We got the TV, we got ping pong, we got some games," Cocchi says, pointing around the room. "It's like a rec[reation] room."

Dozens of men sit at metal tables and on gray, homogenized sofas without arms. Surrounding them are two levels of doors to what here are called bedrooms.

"The doors are open," says Cocchi. "They can come and go."

It's clear that these "bedrooms" used to be numbered, padlocked cells.

"Yep. What we've done is we've changed the whole way we do business here," Cocchi says.

'This Is A Civil Matter'

Business in this wing is addiction treatment. The men have not committed crimes. Each of them was sent to this jail by a judge who determined their substance use was dangerous.

"This is a very dangerous, acute sick, and I would say not-so-well-behaved population," he says. "Section 35s are people who really didn't put their hands up themselves. It's a family member, a first responder, a medical doctor that is saying, if they don't receive treatment, they're going to potentially harm themselves or somebody in the community.

"And this population really doesn't carry insurance, all of 'em," Cocchi adds. "I'm the sheriff, I serve everybody."

The sheriff talks easily with the men, listening to their comments and complaints — most of them about the food. So, he makes an announcement:

"You're getting pizza — and don't go talking around to nobody, because nobody else is getting it but you guys," Cocchi says to applause.

"Yeah. That will get everybody's spirit up ... pizza," laughs Scott Dzialo. The 53-year-old has been in Ludlow for almost a month. The average stay is 17 to 44 days, depending on a man's further treatment plan.

Typically a person is "sectioned" — as it's commonly called — when a loved one asks a judge to civilly commit. But in Dzialo's case, it was the police who came to his house.

"I was sitting in my house, in my living room," he says. "I went to shake the officer's hand and a handcuff went on me, and then he put my other hand behind my back, and he said, 'You're going to the courthouse.' I said, 'Am I under arrest?' And he said, 'No, this is civil matter.' "

Police are among those who can ask the court to commit someone to treatment. Then, if a judge agrees, the judge decides where to send the person.

Civil Commitments Are Under Review

There are three facilities in Massachusetts for civilly committed men — only one is run by the Department of Public Health. This one in Ludlow and one that opened last year in Plymouth are run by corrections officials.

Dzialo has never been incarcerated before. Initially, he was angry that he was put in a jail.

"You've got steel beds, concrete walls. You've got guards that watch you 24/7. That's as close to prison as I can think of," he says.

But, Dzialo says he now thinks being locked up has helped him.

"I didn't think so at first," he says. "I'm like, 'Why did they do this to me?' I was like, 'Poor me.' But, be real, I put myself here."

Sheriff Cocchi says treatment in his jail focuses on personal responsibility. He says those prescribed the addiction medication suboxone can continue to take them throughout their stay there.

His staff consulted with addiction professionals, Cocchi says, to design the treatment program, and it's run by mental health correctional workers currently on staff. He says that makes it less expensive than other programs and cheaper than incarceration. He estimates the annual cost is about $46,000 per person.

Plus, Cocchi says there are several reasons why he should take this on: he has a secure facility, and he has the room. His inmate count is down by about half from a decade ago.

The death of a patient in the hours-long ride from a court in western Massachusetts to one of the Section 35 treatment centers in eastern Massachusetts is what he says prompted him to open this wing. Almost 3,000 men went through the program in three months, and already, the sheriff is thinking about expanding.

"There is nothing worse than going around in the community and being asked to continue to help, and I can tell you and report out that we're helping the men, but I'm not helping the women yet. That's not OK," he says. "So we are going to keep working with the Baker administration, as well as our legislative delegation, and we are going to implement something for the women of western Massachusetts — and we're going to do it in short order."

That might be tough. A new law passed in response to a lawsuit prohibits the state from sending women to correctional settings when they're committed to treatment. Some lawmakers say the sheriff is not exempt.

"I'm shocked and horrified to hear that anyone is considering breaking that law," says state Rep. Ruth Balser. She plans to file legislation next month that would also prohibit the civil commitment of men to correctional facilities.

Balser, a Newton Democrat, is a member of the state's new Section 35 commission, which is reviewing the civil commitment process. At a commission meeting this month, members got an earful from people who have been sectioned. Most complained about correctional facilities and whether they have standards of care similar to those facilities overseen by the Department of Public Health.

Thirty-two-year-old Zachary Wallace talked about the month he spent this fall at the 250-bed Massachusetts Alcohol and Substance Abuse Center (MASAC) in Plymouth. It's run by the Department of Correction (DOC). Some of his time there, he says, was spent in segregation — or "the hole."

“When I was there, there were at least 10 fights. There’s a lot of physical violence going on there,” Wallace says. “A lot of people are in a prison mentality. When I was there, I was beat up by two people the first day I was there, and then I went to the hole unit, which is a cell with no toilet, no running water."

Wallace has been sectioned before. But he has no complaints about his previous commitment at the Men's Addiction Treatment Center (MATC) in Brockton, which is run by the Department of Public Health. Plymouth, he says, is completely different.

“It's a prison. It's punishing addicts for being addicts,” Wallace says. “I believe it's a disease, and they should treat it.”

Almost 3,000 men have been committed to MASAC since it opened in May of 2017.

Thirty-six-year-old Joel Kergaravat was sent to Plymouth in June. He says he was not allowed to continue to take his prescribed psychiatric medication there, and urged the commission to close MASAC down.

"I went to groups from one to three hours a day," Kergaravat says. "The rest of the time I was locked in a cell. These are human beings. Get rid of MASAC, please."

But Denise Bohan, who sectioned her son a half-dozen times, says the process could be improved, but, for her, it was the only option.

"I would do it again," Bohan says. "You can't sit there and watch your first-born do drugs and not do anything. It might be the only thing that will save his life."

In an emailed response, DOC says it does not have segregation — but “security cells” and "short-term placements" may occur. It also says it investigates any incidents of misconduct and its mission is to promote public safety by providing a "safe, secure and structured treatment environment."

Unlike Ludlow, DOC in Plymouth contracts with the private vendor Wellpath for treatment, and provides a minimum of 20 hours of substance use disorder programming each week. DOC offers the addiction medication vivitrol and says men are not denied prescribed psychiatric medication, but they may be prescribed different medications based on their needs. The annual cost is far more than Ludlow — almost $77,000 for each person committed.

Almost 3,000 lineal feet of fencing has been installed around the minimum security prison since it became MASAC. The annual budget for Plymouth is more than $12 million, and the Baker administration has promised more funds for it to expand.

“... there is a role for involuntary treatment for a small subset of individuals. I think it should be a clinical treatment process and not a court process.”

Health and Human Services Secretary Marylou Sudders

Health and Human Services Secretary Marylou Sudders says correctional facilities are used because Section 35 is a court process. But, she questions that.

“Is that the process that we want to get someone into treatment for addictions?” she asks. “I happen to believe that there is a role for involuntary treatment for a small subset of individuals. I think it should be a clinical treatment process and not a court process.”

And for now — amid an opioid epidemic that claims almost 2,000 lives in overdoses a year — Section 35 is widely used. More than 6,500 people were civilly committed in the last fiscal year, according to the Department of Public Health.

Sheriff Cocchi says the need is great for secure, locked facilities that he says save lives. Plus, he says, Ludlow and the step-down program he runs in Springfield are run more like medical facilities, than correctional facilities.

"It's medical treatment — period," Cocchi says. "The men are not treated like inmates, they're treated like clients. I'm responsible to the people of Hampden and their families who are in dire need of help for this senseless loss of life through drug and alcohol addiction."

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