COVER STORY : Hard Time : Charges of Poor Medical Care for Inmates Have Plagued the County Jail System for Years. And Treating Prisoners With AIDS Could Further Tax a System That’s Overburdened.

THE THOUGHT OF MICHAEL Vignol hanging by a bedsheet in a Los Angeles County jail cell haunts his mother and his former case worker, both of whom wonder why someone so afraid to die would take his own life.

Sharon Vignol believes that her son, who had AIDS, did not intend to kill himself, but was merely staging the desperate act Feb. 6 to get the attention of jail officials, who he said had not provided him with methadone and antiviral medication for the three weeks after his Jan. 12 arrest. Mark Yurkovich, Michael Vignol’s case worker at a Hollywood methadone clinic, said the 24-year-old may have decided to end his life after he figured that he would die in jail anyway because of a lack of proper care.

“He went into a system that didn’t work,” said Yurkovich, who had treated Vignol with methadone since last year for a longtime cocaine addiction. “I’m not saying the system killed him . . . but (his life) was certainly cut short and the quality of the last few weeks of his life was awful.”

Vignol was among scores of inmates who have complained to county officials and advocacy groups of problems with medical care in the county’s jails. Accusations of substandard delivery of medical care to inmates have plagued the jail system for years, leading to state investigations and lawsuits claiming negligence and, in some cases, wrongful death.

Although officials at the county jails concede that the system’s medical services are not perfect, they contend that they are offering the best care possible in a system that has a staff of 337 doctors and nurses to serve 20,000 inmates in 10 facilities.

“For the overall part, you’re talking about some of the best medical care that’s provided (for the inmates),” said Dr. Orlando Pile, head of communicable diseases for the county jail system. Pile’s division, which has a staff of 10, was formed in 1986 to deal with the increase in communicable infections. It also provides counseling and education on tuberculosis, sexually transmitted diseases and other ailments.

Some inmates have praised the jail system’s medical care, which operates on a budget of about $40 million a year. In fact, Pile said, some inmates have told him that they purposely committed crimes so they could get back into jail hospital wards.

But many inmates say the system is rife with inattentiveness and a simple lack of concern for their medical problems, despite federal laws mandating adequate care for the incarcerated.

A 1992 evaluation by the state Department of Health Services of the Men’s Central Jail near Union Station and the Sybil Brand Institute, a facility for women on the Eastside, revealed that both jails “failed to develop comprehensive plans of care for each patient to meet the patients’ medical, nursing and psychosocial needs.”

The report, which was part of a procedure to license the jail system, also noted that at Sybil Brand patient health care plans “fail to adequately describe the patients’ needs, problems, concerns.”

In one case cited in the report, a woman incarcerated at Sybil Brand on Aug. 15, 1991, received a doctor’s order two days later calling for a daily change of bandages on an injury to her right hip for 30 days. The report said that the first dressing was not changed until Aug. 23, a day after the woman’s wound became infected.

The report also noted that in a survey of 51 medical records at the Men’s Central Jail, the facility’s staff “did not notify the attending physicians of observed changes in condition of patients.” Patients with recent seizures, abnormal lab results, serious infections or nausea and vomiting were not immediately scheduled to see a doctor, the report said.

The jail system has begun to address several of the issues mentioned in the report, said Susan Weekly, director of medical services.

“We continue to try and make changes to improve the care and have done well in the past 10 to 12 months. I’m proud of our progress,” Weekly said.

In 1991 at Men’s Central Jail, more than 300 inquiries regarding the medical status or treatment of inmates were filed with the Sheriff’s Department by inmates, their families or attorneys, Weekly said. Some inquiries complained of medical care or medication that had been denied. Every complaint that is filed is investigated by sheriff’s deputies, said Capt. Dennis Dahlman, commander of Men’s Central Jail since 1990.

Inmate advocates say there are some promising signs.

In the past two years, the number of complaints to the local chapter of the American Civil Liberties Union regarding medical care in the county’s jail system has dropped by about 50%--from the former daily average of 20--as improvements have been implemented, said Lisa Anderson, an ACLU attorney who handles cases regarding medical care in jails and prisons. Anderson has been working closely with county jail officials for the past 18 months.

“Things are coming along. I don’t get nearly as many complaints as I used to. But there’s a long way to go,” Anderson said.

One improvement is the ongoing computerization of inmates’ medical records, said Paul Hoffman, the ACLU’s director of legal services. In addition, the Hacienda-La Puente Unified School District, under a contract with the Los Angeles County Department of Health Services and the Sheriff’s Department, provides case management, counseling and health education for all inmates in the county jail system who are HIV-positive. The school district has been providing basic education and GED classes to inmates since 1973, but decided to expand its services in 1990 when it began AIDS education in county jails, said Don Carmak, a program administrator for the project.

But a host of new problems associated with the rise of AIDS loom, inmates and their advocates say. With basic medical care already the source of complaints, they question whether treating inmates with AIDS will further tax an already overburdened system.

Currently, there are about 80 inmates in the jail system who have tested HIV-positive, and fewer than a dozen have AIDS, said Dr. John Clark, chief physician for the Sheriff’s Department of Medical Services. However, Clark said, as many as 600 inmates might be infected with the AIDS virus but have refused testing or have not disclosed their condition to jail officials. Testing for the AIDS virus is voluntary, unless an incident arises that requires a test.

Since 1987, 31 inmates have died of AIDS. Officials could not say whether any of the deaths were directly related to the quality of medical care in the jail system. But inmates and proponents for better care say that inmates with AIDS suffer under worse conditions and with less dignity than on the outside.

Inmates with HIV or AIDS have accused deputies and medical personnel of callously tossing medication--along with verbal insults--at them, and have put them in isolated cells with limited access to resources.

“When I went in (to jail) and said I was HIV-positive, they kept me in a whole different holding cell and didn’t come near me,” said Audrey Castenada, 26, who served six months at Sybil Brand Institute in 1988-89 for possession of cocaine and heroin.

When she was arrested again in October, 1989, on similar charges, Castenada said, she lied to jail officials about having the virus because she did not want to be treated differently.

In 1990, Richard Thorne, an inmate at the former Hall of Justice Jail and the Men’s Central Jail, chronicled several of his nine-months of incarceration. Thorne wrote that after he was struck by measles he was kept in a cold isolation room for one month without having a shower, a change of clothes or a new bedroll.

Thorne, who had AIDS, wrote that he also waited more than a month to get a prescription for AZT, an AIDS medication. Copies of Thorne’s journal were forwarded to AIDS Project Los Angeles, prompting the organization to become involved in inmate advocacy. Thorne was released from jail in late 1990 and died in San Francisco in 1992.

“I know people (in jail) have to fight very hard to get their medication,” said Mary Lucey, a counselor at Prototypes Crosstraining, a Los Angeles-based training center for counselors of substance abusers and AIDS service providers. “Just getting the medication they need is a living nightmare.”

Inmates say a large part of the problem stems from jailers who ignore requests for treatment.

“The sheriff’s deputies treat me like a dog,” said Joey Coddington Jr., 36, who has AIDS, bronchitis and other ailments. “The deputies act like they don’t want to touch me because I have AIDS or something.”

Weekly, the acting medical services director, acknowledged that some deputies respond poorly to inmates who have the AIDS virus. “What you don’t know, you fear,” she said.

With deputies occasionally getting spit on and having urine or feces thrown at them by inmates who claim they are HIV-positive, that fear is somewhat valid, said Dahlman, the Central Jail commander. Nevertheless, he added, deputies are trained to respond immediately to any inmate’s request for medical care in emergency situations.

“The guys here understand they’re legally liable if they don’t get an inmate . . . medical attention if there’s a problem,” Dahlman said. “The training we give our people is that every complaint should be dealt with immediately.”

Deputies are required to attend training sessions on handling inmates who have the AIDS virus or other communicable diseases. Materials such as surgical masks and gloves and ventilators for mouth-to-mouth resuscitation are distributed, Dahlman said.

Deputies are also faced with the problem of knowing whether an inmate’s medical complaint is valid.

“Sometimes inmates lie, either about being gay or having an illness, so they can be removed from the main jail or put in the hospital and not be harassed” by other inmates, said Joyce Canham, director of public policy for APLA.

Taylor Burke, a case manager who works with AIDS-afflicted inmates through the school district’s program, said another problem rests with inmates’ lack of knowledge in obtaining medication.

“There are complications. There are people who slip through the cracks,” Burke said. “They’re making every effort to serve all of the clientele they have.”

Although many inmates, their families and advocacy groups complain of negligence or improper medical care in the county jail, others have praise.

“The doctors have been excellent. They put me on stabilizing medication immediately,” said Andrew Metoyer, 27, who has been held in the Men’s Central Jail hospital ward since March. Metoyer, who had contagious tuberculosis, pneumonia and bronchitis, discharged himself from a hospital without authorization and returned to his job as a barber in South-Central Los Angeles. He was arrested and charged with endangering the health of others.

“Here you just tell a nurse that you want to be on the line to see the doctor,” Metoyer said. “They respond to everybody here on this floor. . . . They give the medication out like clockwork. I always know what time is because I know the time the nurses come around.”

But for the most part, Metoyer is in the minority, advocates say.

In Michael Vignol’s case, his caseworker said that he tried numerous times to get Vignol the methadone and other medication he needed, all of which were in a small locked box Vignol had with him when he was arrested in Van Nuys on an outstanding warrant for failing to appear in court.

Vignol went from 80 milligrams of methadone a day--the highest legal dosage--to zero, said Yurkovich, a counselor with BAART Comprehensive Health Care & Educational Services. The methadone treatments were vital because the drug stabilized Vignol’s need for cocaine and controlled his temper, Yurkovich said.

“I think it’s inhumane. I think it’s cruel and very insensitive for someone who is incarcerated to be denied medical access,” Yurkovich said. Vignol’s case is an extreme example, Yurkovich said, “but it exemplifies the problems in the county.”

After nearly two weeks in jail, Vignol was prescribed Thorazine, an anti-psychotic medication to which he was allergic, Vignol’s mother said. A few days later, Vignol hanged himself.

Clark, the chief physician for the sheriff’s Medical Services, said he could not comment on specific cases, nor could he comment on why patients are given certain medication.

Clark said jail staff cannot dispense methadone, experimental or other medication to patients unless it is first authorized by a the inmate’s own doctor. Drugs that are used to treat AIDS, such as AZT and DDI, are dispensed according to an inmate’s T-cell count and weight, he said. Doctors must rely on an inmate’s history, a physical assessment and medical background check, Clark said.

Pile, the head of the communicable disease division, said that when inmates are booked, all belongings, including medication, are confiscated “because you’re not sure what’s in those bottles. If the inmates know their medication, they’ll be provided or it’s ordered for them.”

Medical staff in the jails also have to work around inmates’ scheduled court appearances and lawyer visits, which inhibits some medical care, Clark said. “There are so many other things inmates have to do . . . going to the doctor is low on the list,” Clark said.

Nevertheless, “something better has to be done,” said Sharon Vignol.

“Michael was not perfect. He got into trouble and was in jail before. But that doesn’t mean he had to be treated the way he was. Something in the jails, in the prisons too, has got to change.”

‘I Wished I Was Ded’

Richard L. Thorne, an inmate with AIDS, chronicled parts of his nine-month incarceration at the former Hall of Justice Jail and the Men’s Central Jail in 1990. Thorne’s simple writing, full of misspellings, reveals numerous instances of poor treatment. Copies of his journal were forwarded to AIDS Project Los Angeles, which prompted the organization to become involved in inmate advocacy. Thorne was released from jail in late 1990 and died in San Francisco in 1992.

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1.) Thorne twice tells officials he has AIDS upon entering jail. He is asked to “sign all kinds of papers.” A doctor schedules a blood test, but the results are lost. A second test “did not get a nuff.” He’s examined again after a third test and told “that my plasma was very low and they need more blood.” Two days later, he’s seen by another doctor and told he has AIDS.

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2.) After contracting measles, Thorne is placed in isolation. After the fifth day, he asks a deputy if he can take a shower, only to be told that he didn’t need one because he wasn’t going anywhere. Another request for a change in bed rolls and clothes is also denied. Thorne writes: “I’v been here 17 days all by my self with no shower or no close or bed roll (exchange.)”

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3.) Thorne writes about the isolation room being cold, “so cold you had to stay in your planket the hole time or frez to death.”

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4.) Thorne, feverish and shaking from chills, is forced to sit on a bench from 6 p.m. till 7 the next morning, without even an aspirin to bring his fever down or stop the pounding in his head. That night “was hell for me,” Thorne writes. “I wished I was ded.”

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5.) Despite his fever, shakes and stomach cramps that “hert to hell,” Thorne never sees a doctor. He’s told he’s OK and shipped off to court. “So her I am sick and seting in court in cold cells.”