L.A. County Jail Infirmary Substandard, State Finds : Law enforcement: Inspection prompted by death of inmate lists misuse of restraints among violations.

State investigators have determined that the Los Angeles County Jail infirmary, the largest in California, has not followed acceptable medical practices for the use of physical restraints on mentally ill patients.

The state Department of Health Services also reported to the county in a letter earlier this month that the infirmary failed to meet minimum hospital standards in 11 other areas of patient care.

Those included taking precautions to prevent the spread of infection; disposing of dressings, syringes, and other medical waste properly; keeping thorough medical records, and providing ways for patients in distress to summon medical help, state officials said.

William Kern, director of medical services for the jail, said Friday that the Los Angeles County Sheriff’s Department believes the state’s findings include “a number of inaccuracies.” He declined to elaborate, but said he plans to meet with state health officials next week to discuss the conclusions.

State health department inspectors toured the jail infirmary in April, their first inspection of the facilities in about six years. The inspection was prompted by the death of Carl Bruaw, a 49-year-old real estate agent from Northridge who suffered a fatal pulmonary embolism in the infirmary after being strapped to a cot for six days.

Pulmonary embolisms--blood clots that travel to the lungs--are often caused by prolonged immobility. Bruaw, who was serving a one-year misdemeanor sentence for assaulting a police officer, was the second person in five years to suffer a fatal pulmonary embolism in the infirmary after being restrained for an extended period.

The Federal Bureau of Investigation is also investigating Bruaw’s medical treatment and his death to determine whether the jail medical staff violated the inmate’s civil rights by keeping him in restraints for so long, an FBI spokesman confirmed Friday.

The Los Angeles County Jail infirmary treats the basic health problems of more than 21,000 inmates countywide, including more than 3,600 diagnosed as having serious mental illnesses. Inmates who require surgery are transferred to County-USC Hospital.

State officials charged with overseeing county jails say that loopholes in regulatory laws leave them virtually powerless to compel sheriff’s departments to correct deficiencies in care.

In Los Angeles County, state officials said they hope the Sheriff’s Department will voluntarily improve conditions at the medical ward.

Bruaw’s widow, Joyce Amiri, filed a civil rights and wrongful death lawsuit against the county, charging that her husband should not have been placed in restraints because he was passive and depressed, rather than aggressive and hostile.

Amiri said her husband was arrested Aug. 2, 1988, in his Northridge neighborhood after pushing a police officer who asked him why he was outdoors in his underwear while walking his dog. Bruaw was behaving erratically because he was having a nervous breakdown, she said.

Months later, after he was sent to the infirmary, the suit charged, jail medical personnel failed to follow the federal and state regulations governing the care of patients in restraints.

State regulations for licensed hospitals specify that a mental patient may be placed in restraints only as a last resort, when the patient is threatening himself or others. Regulations also state that the patient must be allowed to exercise his limbs at regular intervals.

Although the health department letter to Kern stated that the jail had not followed current standards of practice for using restraints, it did not provide details of the violations nor did it mandate corrective measures.

Paul Keller, a regional administrator for the state health department, said that in the absence of power to enforce changes, state health officials have scheduled meetings with jail medical officials to discuss the problems and possible solutions.

“We’d like to maintain an open relationship,” Keller said. “There is no point in us puffing out our chest, and the county puffing up theirs.”

State health officials said the Sheriff’s Department has requested an application to become a licensed jail medical facility, but has delayed filing it because state agencies are still developing standards for jail hospitals.

In 1974, the state Health and Safety Code was altered to require jails to obtain state licenses and thus submit to periodic, unannounced inspections.

Six years later, in 1980, the American Civil Liberties Union complained that the jail was dragging its feet in obeying the new state requirement, and a Los Angeles Superior Court judge ordered the Sheriff’s Department to obtain the license for the jail infirmary.

Ten years after that court order, the jail medical ward still does not have such a license.

For its part, the county has complained that the standards the infirmary must meet to be licensed, including providing windows that open to the outside, are more appropriate for regular hospitals.

As a result, state agencies are now attempting to come up with standards specifically for correctional facilities.

“They are working on getting the facility licensed,” said Jacqueline A. Lincer, district administrator for the health department’s Licensing and Certification Division. “We are working with them.”

Until that time, the jail will continue to operate without state regulation of any aspect of the infirmary’s medical care, state officials said.

The state Board of Corrections, charged with overseeing the state’s county jails, has minimum standards that jail medical wards must meet, but those standards are only advisory, said Jack Pederson, deputy director of the board’s Jail Standards and Operations Division.