Grand Jurors Assail Jails’ Medical Care

Decrying the level of health care in the San Diego County jails as “primitive” and “very poor,” the grand jury on Thursday called for the medical services program for inmates to be removed from the Sheriff’s Department and transferred to the county Health Services Department.

In two separate reports, the grand jury also blasted the Sheriff’s Department for specifically providing inadequate care for women and mentally ill prisoners, for not having an acceptable process to review inmate deaths and for not seeking and obtaining proper medical accreditation, as done by other correctional facilities in the state.

The two reports are the latest salvo from the grand jury, which in March sharply chastised Sheriff John Duffy and his staff because of widespread assaults on inmates by deputies.

“This is another one that unfortunately the Sheriff’s Department is not going to look good in,” grand jury foreman Armistead B. Smith said of his panel’s reports issued Thursday.

He also defended the toughness of the grand jury’s conclusions, saying the panel hopes that “some constructive good” will come from its recommendations.

“We’ve tried to call it the way we’ve seen it,” he said. “And the conclusions we drew were that health and medical care being provided in the jails is very poor.”

Duffy could not be reached for comment Thursday. His staff said he was in Washington, D.C., where he is scheduled to testify today as a representative of the National Sheriffs’ Assn. before a Senate subcommittee reviewing a ban on the sale and use of semi-automatic assault weapons.

Robert Jones, the jail’s medical services administrator, also could not be reached for comment.

Susan Golding, chairman of the county Board of Supervisors, said she will propose the creation of a public-private task force to evaluate the grand jury’s recommendations. That committee, Golding added, should report back to the supervisors within several months on the feasibility of the grand jury’s proposals.

“The real question is whether the problems are the result of the structure or supervision and management,” she said.

“When you see that medical care in jails . . . is being done well by sheriffs in other counties, you have to say that the structure may not be the problem. But we need to take a closer look at these ideas before making any switches.”

Betty Wheeler, legal director of the local ACLU, which has sued the county over inadequate medical treatment of inmates, said the report by the grand jury was long overdue.

“Clearly, the problems the grand jury identified are pervasive,” she said. “These are problems that are systemic.”

Wheeler said the American Civil Liberties Union has received many letters and phone calls from inmates complaining of improper health care.

“I hear a lot of those voices when I get phone calls and in the mail I get,” she said. “We should remember that these are real people who have suffered a lot because of the problems with medical care in the jails.”

The grand jury pointed out that medical services for county inmates had been supervised by the health department, until it was transferred to the sheriff in 1974. The panel also noted that detention facilities in San Francisco, Santa Clara, Sacramento, Fresno and Orange counties are staffed with medical units supervised by the outside health departments.

The San Diego County Health Department does provide medical care for the Probation Department.

“The jury found its clinic to be staffed with knowledgeable, efficient professionals,” the grand jury said of the Probation Department facility. “Medical policies and procedures are organized and current. Inmate medical charts are reviewed after every clinic.”

Not so in the county jails, the grand jury said, where there are eight vacancies for registered nurses, one for a nurse practitioner and two for part-time physicians.

“There are two part-time physicians and one part-time dentist for almost 4,000 inmates,” the report said. “Three facilities lack 24-hour nursing coverage, thereby forcing deputies to make medical decisions.”

By comparison, the physician-inmate ratio in the Angeles County jail is one physician per 1,300 inmates, and the National Commission on Correctional Health Care recommends one physician for every 700 inmates.

The grand jury report said that, although the current medical program in San Diego County jails is not accredited, the commission advised the panel that accreditation “would set adequate medical standards and greatly reduce health and liability risks.”

The report found several areas in which the medical program was deficient, most strikingly in the daily services provided inmates.

“Examinations by the physician are often perfunctory,” the report said.

“Standard health procedures are not always followed. Jury members observed medical staff did not always use gloves when drawing blood even when testing for AIDS.

“Occasionally, staff members did not change the paper on the exam table and did not always wash their hands after a ‘hands-on’ examination.”

The report said deputies are required to perform clinical functions, such as dispensing prescription medication and assessing medical conditions of inmates.

“There are occasions when no medical staff members are on duty,” the grand jury said, “and it is the deputy who makes the decision whether or not to transport an inmate to a hospital.”

The grand jury said audits of the jail medical program have been conducted by a Health Department sanitarian rather than a medical team, and that individual patient records are kept on 5-by-8 inch note cards, rather than file folders.

Also, the panel said, some patient records are “subject to loss” and “some drug cabinets are left unlocked during non-clinic hours.”

And, the report said, “some clinics lack basic equipment such as microscopes, centrifuges and gurneys.”

Beyond the problems with staffing and equipment, the grand jury found a critical need for an on-site, in-patient, psychiatric unit for 10% of the female inmates at the Las Colinas Dention Facility, where medical care was found to be “primitive.”

In describing how a mentally ill female patient is often handled if she poses a danger to herself or others, the report said:

“After her clothing is removed, she is placed in a safety cell. Occasionally, she is given a paper suit or a paper blanket. The walls, ceiling and floor of the cell are textured with a rubber-like material. A drain in the center of the empty cell serves as a toilet.

“If the inmate becomes violent, she is chained at the waist, legs and arms to prevent injury to herself.”

Because the County Mental Health facility is frequently filled to capacity, the inmate remains at the jail, where she “is often the victim of other inmates or may be the aggressor, causing stress and personal risk to the staff.”