County’s Jail Hospital Flaws Cited in Past : Health reviews: Investigators earlier reported infestations and lack of timely care. Medical director tells of efforts to comply.

County officials were warned two years in a row that conditions at the Los Angeles County Jail hospital were unsanitary and that ailing inmates did not receive adequate care in some respects, inspection reports show.

The reports, prepared by inspectors in the Los Angeles County Department of Health Services in 1988 and 1989, show the hospital was infested with cockroaches and rats, that sick jail inmates did not receive timely medical care, and that the medical staff did not confirm that patients received and took their medicine.

The reports indicate that county authorities were aware of some of the deficiencies discovered by state health officials earlier this year when investigators inspected the jail hospital for the first time in six years.

The state investigation--prompted by the death of an inmate who was strapped to a cot in the jail infirmary for six days--found that the facility failed to meet hospital standards in a dozen areas of health care and sanitary practices. Those included aspects of patient care; taking proper precautions to prevent the spread of infection; disposing of dressings, syringes and medical waste properly, and keeping thorough medical records.

County health officials who inspected the jail annually the last two years warned authorities that the facility’s health care services were not up to the standards prescribed by state law for jails, records show.

William Kern, director of medical services for the jail, said that the Sheriff’s Department tries to comply with the state law that regulates health care in jail facilities.

He said, however, that jail officials are not always in accord with the county health officials’ interpretation of the rules.

“We don’t ignore these things,” Kern said. “We do take action. One of the things, though, is that we may not agree with everything that they say. It is our objective to adhere to the (law) but it’s a matter of interpretation. Occasionally we do have a disagreement with what they say.”

The evaluations are prepared by the county health department for the state Board of Corrections, the agency that oversees California’s county jails. But neither agency has the legal authority to enforce their regulations, both county and state officials said.

Instead, authorities try to use “friendly persuasion” to motivate jail supervisors to upgrade conditions, officials said.

John Pederson, deputy director of the Board of Corrections, said the reports can provide powerful evidence for disgruntled inmates who file lawsuits against the Sheriff’s Department for care that they received in the jail hospital.

The reports can be used to prove that jail officials had been informed by a governmental agency of specific problems with their health care services, Pederson said.

In their evaluations, county inspectors also notified jail officials that safeguards to prevent inmates from abusing prescription drugs were inadequate, and that storage areas were so dark that staff members could easily give out the wrong medicine.

Intravenous solutions were prepared in a dirty room, and contaminated waste was stored in the same room where inmates have dental surgery, the evaluators found. In addition, there were no provisions to ensure that patients with medically prescribed diets received the special foods they needed.

The inspectors also criticized the Sheriff’s Department for failing to maintain complete medical records and for failing to send medical records with inmates when they were transferred among the county jail facilities.

Moving inmates without medical records caused excessive delays in their treatment for serious medical problems and sometimes prevented them from receiving medication on time, the inspections found.

Some of the problems had gone uncorrected for several years, the reports said, although they had been outlined to jail officials in previous evaluations.

Blanche Ross, a county health department medical programs consultant who has inspected the jail for several years, said the medical staff has tried to improve the quality of care and sanitary conditions over the last several years.

For example, she said, the medical staff is now testing a new program to ensure that inmates receive their medication all the time.

But Ross said the medical department is hampered by insufficient funding, and demands on the hospital are growing faster than the staff.

“They are attempting to address those issues. It’s a matter of increase in population without a concomitant increase in the medical staff,” she said.

The 248-bed jail hospital provides a wide range of medical services for the more than 21,000 inmates of the central jail and for inmates of jails in the county system.

Inmates are treated in the jail hospital for a variety of serious health problems, including AIDS, hepatitis, diabetes, gunshot wounds and trauma. Patients requiring major surgery are transferred to County-USC Medical Center, but are returned to the jail for post-operative recovery as soon as possible.

The Sheriff’s Department has been under a court order for the last decade to obtain a state license for the hospital, but thus far it has not complied. In order to obtain such a license, the jail will have to correct the deficiencies identified by the state inspectors last week.

State authorities said that they met with county jail officials this week to exchange information and discuss upcoming corrections to the system.