Mustafa Willis was 24 in 2010. He was walking down the street, having a snack. He sees a police car coming down the street toward him. The police jump out and arrest him. Mustafa finds out eventually that they've arrested him for illegal possession of a firearm -- one found in a car.
The system is supposed to allow Mustafa to go home and start preparing his case. So we have the bail system in which the defendant can go home if they pay 10%, in this case $5,000, of the bail amount. But Mustafa, like so many other people, couldn't quickly come up with $5,000. And so he stayed in jail.The story, as told on Planet Money, continues. Mustafa stayed in jail for weeks, and then months. Finally, after three months, the judge lowered bail to $30K and his family was able to make bail.
Once he was home, Mustafa tracked down a video showing that the gun wasn't his at all and once he presented the evidence, the case was immediately dismissed.
However, the impact of the case on Mustafa is permanent. He owes the $3,000 regardless. He lost his job and missed his cousin's funeral. Roseanne Scotty, a lawyer, says, "one of the things that most people in jail have in common is that they're poor. So for these individuals, having $1,000 bail or $2,500 may as well be $1 million dollars."
The idea of bail is that it helps decide who is able to go free while awaiting trial and who needs to stay in jail until trial. Some people shouldn't be allowed to post bail -- for instance the king pin of a large mafia organization -- but these are the people that are most able to post bail.
In fact the average length of time that a defendant stays in jail awaiting trial is 314 days. And 40% of people in jail are there because they lack the nominal amount of bail (for instance, amounts under $5,000) needed to be released. Of course, innocent people being in jail for months costs the state huge amounts of money and can ruin lives.
In 2013, Scotty's organization put out a report about this. So many times, a report like that might be read and then ultimately ignored. But this time, that's not what happened. The Chief Justice of the New Jersey Supreme Court called defenders, prosecutors, and other people from across the system into chambers to discuss the report. He told them that something needed to change with the bail system. And they worked and worked until they came up with a plan to replace the bail system.
The plan they came up with uses "big data" to calculate a defendant's likelihood of committing another crime. It creates a 6-point scale (with 1 being least likely to commit another crime) and 6 being most likely. People ranked lower should be released, while people ranked higher wouldn't be. Mustafa rated a 1.
Shockingly, the new system has now been incorporated across New Jersey and the bail system has completely been done away with. A fundamentally unjust part of the system has been changed, and it's because these people came together -- across partisan lines, to change it.
The medical system is broken in some of the same ways as the US justice system. Well-meaning people are working within a largely miraculous, but hugely broken system -- and it's very difficult to make changes.
So I thought the episode highlighted three really surprising things about this project that I think are crucial for a medical setting.
3 things that medicine can learn from New Jersey's bail project:
- Be willing to change approaches even if “we’ve always done it that way.”
The bail system is literally the way that the justice system has always done things and it is enshrined in the state constitution. It would certainly be easy to believe that it could never change, or be improved, and yet it was. There are so many things in medicine that we do because we've always done them that way, even when there are better options. (This is one of the main objections to iClickCare that we hear, in fact: "I just don't think our staff will change how they do things.") But New Jersey's experience shows that real, substantial change can be made, quickly. And that the whole system is better for it.
- Look at — and use — the data.
In New Jersey's case, Scotty lookd at the data to see whether the bail system was working at all, and what pre-trial jail stays looked like. The data brought the issue into relief and that was what caused the Chief Justice of the New Jersey Supreme Court to demand change. Further, it's big data that is fueling the new ranking system they're using. Decades ago, it's likely that neither set of data would have been available. But now that the data is available, I believe we have a responsibility to use it. The data shows that medical collaboration and telemedicine dramatically decrease costs, readmissions, length of stay, and improve outcomes. It's time for the medical community to start looking at the data and adapting our practice accordingly.
- Work together, collaboratively, even if not everyone on the team has exactly the same experience or motivations.
It was facinating to me that in the bail changes, it was a group of people with all kinds of motivations who came together to change the system. They had all kinds of reasons to not work together, but they put those aside to work toward a common goal. This kind of collaboration is crucial in medicine. We don't have to agree on everything, but we do have to work together for the patient.
We certainly applaud every single person who took part in this bail initiative. And we hope that the medical community can draw inspiration from their success.
The data shows that hybrid store-and-forward telemedicine is a powerful tool to improve outcomes. Learn more about it here: