Healthcare in the Maricopa County jails has been the subject of a series of lawsuits, studies, and reports that have concluded the same thing: Inmates get grossly inadequate healthcare.
In September 2008, the jails' healthcare system lost its accreditation from the National Commission on Correctional Health Care. It has not been reinstated.
Lauren Gilger
Bertha Oropeza rests at her Phoenix home the day after being released from the hospital.
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In an order issued just last week, U.S. District Court Judge Neil Wake gave a devastating assessment of the conditions: inadequate record-keeping, medication management, staffing and mental health treatment threaten the lives and well-being of thousands of inmates every day.
Saying that the level of healthcare is unconstitutional and puts detainees in real danger, Wake ordered the sheriff and Correctional Health Services, the county agency that administers healthcare in the jails, to fix the problems by the end of this year.
The order came on the heels of a lawsuit that alleged violations of inmates' constitutional rights, and worked its way through the court system for years. The sheriff lost that suit, Graves v. Arpaio, in October 2008. And Wake ruled that the sheriff and the county Board of Supervisors, which runs CHS, must make massive improvements to jail healthcare.
Nearly 18 months later, problems remain.
In fact, Oropeza would likely get no better care today than she did nearly a year ago — despite the court's demand for improvements. She entered jail with one of the most common serious medical conditions doctors and nurses see in the jails: dependence on drugs or alcohol. (In her case, prescribed medication.)
A court-ordered report issued last month assessing improvements — or lack thereof — at the jails, found that nearly 15 percent of patients don't get their medications as prescribed, including those who are carrying them. Oropeza says her prescription medications were in her purse when she was picked up.
But the problem is bigger than that — sometimes patients don't get the right dosage, they have adverse reactions to medications, or face other complications. Many experience withdrawal symptoms that can be "life-threatening or extremely painful," according to the report, which was written by a medical doctor assigned to monitor the jails' progress after Judge Wake's ruling.
"Maricopa County jails are not alone," says Peggy Winter, the associate director of the ACLU's National Prison Project and lead counsel on Graves v. Arpaio. Especially in the largest urban jails, officials inevitably struggle with the overwhelming medical and mental health needs of many detainees, she says.
A big part of the problem in Maricopa County is that doctors don't get timely information because the jails' medical records system is inadequate.
With so many inmates, CHS is likely unable to manage medical records or track inmates with medical needs without an electronic system, the report says. The system now is almost entirely manual, often relying on handwritten records.
CHS Director Betty Adams says her department is working to improve the records system. "If I could wave a magic wand, I would hope for some additional technology," she says.
But that is only one deficiency on a long list of things that need improvement. "I have, like, 16 top priorities," she says.
Deputy Chief Mary Ellen Sheppard of the Sheriff's Office says CHS needs to make better record-keeping its top priority. "It boils down to the lack of a tracking system that measures the care being provided and the quality of that care," she says. "It's hard to fix something that you don't have a handle on."
Hard doesn't begin to describe it.
Fixing all the problems in the jails would be a tall order for any government agency. But in Maricopa County, it's even tougher. Here, the sheriff and members of the Board of Supervisors are embroiled in an endless legal battle over seemingly every aspect of the jails — their healthcare system included.
The Sheriff's Office insists that it should have control over healthcare in the jails it runs. But that duty resides with CHS, which has been running healthcare services in the county's jails for decades.
The dispute ended up in Maricopa County Superior Court last year, with Arpaio attempting to wrest power over CHS from the county Board of Supervisors. He claimed that the board is inept and the Sheriff's Office would do a better job of providing healthcare in the jails.
The judge ruled otherwise, throwing out the case last week.
Arpaio's claims came just when evidence began to show that CHS, though far from being a model of correctional healthcare, is actually improving.
Eric Balaban, a lawyer with the American Civil Liberties Union's National Prison Project who toured the jails in September, says he saw progress.
"There certainly is movement in the right direction," he says. "But they were starting from ground zero."
The court-ordered report released in March also makes it clear that CHS employees are making some improvements: They are doing their best with an inadequate records system; more patients are getting healthcare assessments within two weeks of entering the jail, and those with chronic diseases are getting better care.
But, according to Judge Wake, the only real improvements that have been made are the ones that have cost the county little or no money.