In the wake of a critical state evaluation of the Los Angeles County jail hospital, top jail medical officials said they are working to improve health care for ailing inmates and to boost staffing so they can obtain a state license for the facility.
William Kern, director of medical services for the jail, acknowledged that state and county health officials had identified some legitimate problems with the jail's health care services. He and chief physician John Clark said in interviews this week that the staff is working to upgrade practices in those areas.
Among intended improvements is hiring enough nurses to fill openings that have remained vacant because the jail cannot find people to take the jobs, Kern said.
However, the officials said that some of the problems cited by investigators, such as a lack of patient privacy, could not be addressed because of the need to maintain tight security at the 248-bed hospital.
Kern also refused to comment on allegations by county and state health officials that the jail medical staff violated laws governing the use of physical restraints on patients.
Those concerns were raised after a jail inmate, Carl Bruaw, 49, of Northridge died in July, 1989, from a pulmonary embolism after being strapped to a cot in the medical ward for six days. It was the second time in five years that a county jail inmate suffered a fatal embolism--a blood clot in the lungs that results from immobility--after a prolonged period in restraints.
Investigators from the state Department of Health Services found that during the six days that Bruaw was in restraints, his circulation was rarely checked by hospital staff members, his limbs were not exercised and he did not receive enough food and fluids.
They also found that the jail hospital failed to meet state standards in 11 other areas of patient care, such as maintaining thorough medical records, providing an adequate system for patients to summon nurses and respecting patients' privacy. Some of these concerns had also been raised by county health officials in recent evaluations.
Kern said he could not comment on the use of restraints in the jail or on the Bruaw case because of a wrongful death lawsuit pending against the Sheriff's Department. But he and Dr. Clark defended the quality of medical care provided for inmates at the hospital, saying it was equal to or better than the care in many county hospitals.
"There is no question in my mind that the level of care we provide meets with the community standards, and there are some patient care areas in which we excel the community standards," Clark said.
He admitted that logistic problems involved in moving inmates among the Central Jail, courts and outlying jail facilities sometimes prevented them from receiving prompt medical attention.
Clark said the medical staff members did not always adequately document the care provided to inmates, although he said he hopes the hospital will soon acquire a computer system that will make it easier to keep thorough records.
"We recognize what our problems are and we are working on them," Kern said.
Kern denied that, as some critics have charged, the Sheriff's Department has dragged its feet in obtaining a hospital license. He said the facility has been working toward that goal since a Los Angeles County Superior Court judge ordered it to become licensed more than a decade ago.
"We want to be licensed. We are tired of people looking at us and saying, 'Why aren't you licensed?' " he said.
Understaffing was one of the major problems identified by the state Department of Health Services when it evaluated the jail hospital for a license in 1984, but Kern said he expects staffing to be at the levels required by March, 1991.
Although the medical division received $5 million to fund nursing staff increases over the last five years, he said the hospital--like every other health care facility in the county--has had a problem recruiting nurses because of the industrywide shortage.
Between 24% to 29% of the jail's budgeted nursing positions remain unfilled, Kern said.
"We are in an intensive recruiting campaign locally and around the country," he said. "But we are in competition with a lot of other health care providers."
But Kern said some of the criticisms--particularly those targeting the hospital's physical environment--were inappropriate because they did not account for the jail's special security concerns.
Judging the physical environment of a jail hospital by the standards used to evaluate a private hospital is "like trying to put a square peg in a round hole," Kern said.
For example, Kern said, the facility does not use call buttons--usually at the end of a long cord--because of the risk that inmates would use them not only to summon nurses but to harm themselves or others.
He also said that security considerations prevent the hospital from fulfilling a requirement that patients be given privacy when they use restrooms.