Inmates, Heal Thyselves

The woman, we'll call her Anna, recently left the medical staff at one of the county's jails, and what she saw there shocked her.

Anna makes it clear that administering to inmates is difficult work. Many of the inmates are malingerers who can make life hell for the people who serve them.

But she says that didn't explain the behavior of her co-workers, who seemed to delight in treating inmates badly.

She witnessed nurses tearing up inmates' requests for medical help without reading them. She saw nurses make diagnoses and order medicines without consulting doctors. She saw nurses purposely frustrate inmates by sending back their requests for medical care with more questions, hoping the inmates would simply give up hope of seeing a doctor.

She saw a detention officer bring a man suffering from abdominal pain into a clinic. The man refused to say what was wrong with him, so the detention officer zapped the patient with a stun gun to make him talk.

"None of us could believe it," she says.
She also says that nurses who treated inmates decently were subjected to harassment by other medical staffers as well as detention officers.

Correctional Health Services is a county agency independent of the Sheriff's Office. Theoretically, CHS could defy the sheriff's philosophy that jail--even for pretrial detainees still presumed innocent--should be a place for punishment. But Anna says that at the level of nurse and detention officer, that kind of independence isn't possible.

Another medical employee who left the jails recently agrees. "Basically, we're considered guests in their house. [Detention officers] run the show. I was always cordial with the inmates, but I couldn't be too nice. I couldn't treat them like patients in a hospital. The officers were always there, watching us. So if we were too nice to the inmates, they kicked us out," she says.

Both former staffers claim that the Sheriff's Office regularly banned medical employees from working in the jails, and that often it was for simply treating inmates with respect.

Documents obtained by New Times back up Anna's claims.
Medical records and other documents spanning a period from July to October of last year suggest a pattern of incompetence and neglect. They include records which show that:

* An inmate with a broken jaw complained for 12 days before he was sent to Maricopa Medical Center's emergency room.

* An EKG was ordered for an inmate who hadn't eaten in eight days and who may have had a stroke. The EKG was never done.

* An inmate who reported a rash on his genitals, which could be an indication of several different conditions, was instructed by a nurse to get an antifungal cream. The inmate was not examined by a doctor.

* A 71-year-old inmate with a thyroid condition asked to see a doctor; a doctor's appointment was scheduled for a week later. But 12 days later, he still hadn't been seen, he'd passed out and fallen, and had broken a dental plate.

* In response to an inmate's complaint that she may be coming down with strep throat, her tank order was returned with the annotation "Be specific." A month later, she still had not been seen by a doctor.

* Despite an inmate's assertion that he was allergic to penicillin, it was ordered for him, anyway, resulting in a severe allergic reaction.

* A nurse prescribed medicine for an inmate's chest pains without consulting a doctor, resulting in an admonishing note from the livid physician.

* Inmates who may have been exposed to tuberculosis but who have been moved to other parts of the jail didn't get tested.

Not all detention officers encourage abuse, because other records obtained by New Times include complaints of nurse behavior by detention officers: one officer complained when he saw a nurse throw medications at an inmate. Another complained that a nurse came to work smelling of alcohol.

Another nurse showed up regularly in complaints: that she withheld insulin from a diabetic inmate because he wanted to prick his own finger to perform his blood tests. That she stuck her fingers down another inmate's throat to force him to take medicine. And that she purposely withheld medications, particularly at the 3 a.m. "meds walk."

In another document, Durango Jail's nutritionist C. Jamieson responds to inmate complaints that they are given yogurt past sell-by dates.

"A tart flavor will start to begin as product ages and the consistency may start to breakdown, but it is still edible. . . . Again, as you will note in my response to these grievances, anyone with any concern regarding the expiration or sell-by date need not consume--this is a choice and we will gladly replace (if more are available) any container that someone finds spoiled." (Emphasis not added.)

What Damon Dreckmeier as well as the former staffers say that translated to: eating itself was considered by staff simply a choice that inmates made on their own. They either ate rancid food or didn't eat at all.

Registered nurse Germaine Steudler says she, too, witnessed neglect and incompetence by jail medical staff. That's because she spent time in jail not as an employee, but as an inmate.

New Times published her compelling jail diary last year ("Drear Diary," December 5, 1996).

"They were not practicing nursing appropriately. I do realize that there are a lot of [inmate] scammers. I saw it. But you're still a nurse and you're working with human beings. If you're so callous and hardened, perhaps you need to be out of there.

"I can't tell you how many times I wrote requests about needing medication and not getting it. In one response, a nurse, disregarding the jail doctor's diagnosis [of Steudler's spinal meningitis], responded that it wasn't a life-threatening illness. This was a nurse making that kind of decision.

"The medical care in there is a joke. I've worked emergency rooms for years, and I understand that you get tired of hearing the same old stories, but these [inmates] are still human beings."

Susan Svitak, director of CHS, says that the agency works continuously to improve its services. She notes that Maricopa County's jail clinics have been accredited since 1982, and that CHS has existed as an independent agency since 1992. She reports that just this May, CHS was commended by the National Commission on Correctional Health Care (NCCHC), which stated that CHS "is a very good health care delivery program. It is staffed with excellent people and there is good morale and retention. Staff are competent, cooperative and cheerful although under a heavy work load. The program's organization is superb with top-notch documentation."

It's a far different evaluation than that reached by the Department of Justice's investigator. However, NCCHC's own materials which promote its accreditation process suggest that its investigations are of the feel-good variety: "The survey, which is scheduled only when you feel you are ready, is conducted by health professionals experienced in correctional health care. NCCHC approaches surveys as an educational experience for you and your staff, and we will work with you to help you achieve compliance with the standards."

Svitak notes that jail medical employees serve a huge number of inmates: with a budget of $12 million, CHS serves about 110,000 inmates in a year and 6,700 at any given time in facilities not intended to house more than 4,900. Those inmates make about 83,000 requests for medical services each year.

It's a crush of work to keep up with.
"We're in a difficult environment. We're not totally in control of that environment," she says, explaining why medicine, for example, is handed out at 3 in the morning.

"I'm not going to tell you that we're the Mayo Clinic and we give the best medical care in the world," Svitak says.

She declined to comment on the documents of inmate mistreatment. Instead, she says CHS will attempt to find who leaked them to New Times and prosecute that person.

She says the county has worked hard to decrease the time between an inmate's request for medical care and an examination with a physician. Better handling of those requests is taken very seriously, she says, and it bothers her to hear former staff members say that such requests are purposely mishandled by some nurses.

"If that's true, we'll pick that up and get rid of those people. And in my time here, there has been some staff turnover."

--Tony Ortega

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