Despite body scans and other preventative efforts, fentanyl-induced deaths on rise in Ariz. jail
"Everything we have done is done for a purpose to try to keep that horrific drug out of our facility," Sheriff Chris Nanos said
By Nicole Ludden
The Arizona Daily Star
TUCSON, Ariz. — On Feb. 2, a corrections officer at the Pima County jail went to deliver Sylvestre Miguel Inzunza's breakfast, but found the inmate unresponsive in his bed.
The officer noticed he was "cold to the touch," according to an incident report from the Pima County Sheriff's Department, which runs the jail.
Corrections officers and medical staffers attempted lifesaving measures until the Tucson Fire Department arrived. Inzunza, 18, was "beyond savable," the report said, and was declared dead at 5:26 a.m.
Inzunza was the second inmate to die at the jail in 2022, after last year's 10 reported deaths that marked a decade-high number of annual deaths at the facility.
Including the two deaths this year, five of the deaths were attributed to drug overdoses, with the most recent four caused by fentanyl, according to the Pima County Medical Examiner. Fentanyl is a highly addictive drug that's nearly 100 times more potent than morphine, according to the DEA.
Three of the deaths resulted from medical complications, three from COVID-19, and one from suicide, according to the medical examiner's findings. Of the 12 inmates, eight were people of color.
In 2021, the average daily inmate population at the jail was 1,621. Last week, it was 1,678, according to the Sheriff's Department.
The deaths have drawn scrutiny on the jail and its policies from local advocates and family members of the deceased demanding answers.
Frances Guzman, whose son Cruz Patiño Jr. III died at the jail in August, has attended three protests in front of the facility since November with other family members of those who've died at the jail. They are trying to bring wider attention to the deaths.
"I'm doing these steps to have a little bit of peace because I'm never going to get closure," Guzman said. "I'm climbing the steps, and when I see another death, I'm right back to step one. I see these families crying, these friends crying for the same thing that my family's crying for. It's an ongoing thing."
The Pima County Board of Supervisors is set to discuss fentanyl-related overdoses at the jail with Sheriff Chris Nanos at its March 1 meeting, particularly, "The status of any internal or external investigations into how fentanyl is making it into the inmate population," the agenda says.
"One death is bad, right? We know that. One death is horrible. But my goodness, to sit there and say the sheriff is doing nothing about it is wrong," Nanos said. "Everything we have done is done for a purpose to try to keep that horrific drug out of our facility."
From January 2021 to Feb. 2, 2022, the jail had 26 emergency-room send-outs for possible overdoses, according to a memo from Paula Perrera, the county's behavioral health director. Narcan was administered in 22 of those cases, and 19 cases required multiple doses of the drug designed to reverse opioid overdoses.
Nanos said every corrections officer overseeing a pod has been given access to Narcan in the last month.
Inzunza's death, which was ruled a fatal overdose, was the latest to happen at the jail, less than three weeks after another fentanyl-induced death.
It's unclear from records why Inzunza was in jail. He appeared in court — out of custody — one week before at a case management conference for 2021 charges of resisting arrest and a minor carrying a firearm, according to court records. He was also facing charges of armed and aggravated robbery and aggravated assault with a deadly weapon in connection with a 2020 incident.
On Jan. 10, Pedro Xavier Martinez Palacios Jr. was transferred to St. Mary's Hospital, according to records from the Sheriff's Department. Four days later, he was declared brain-dead.
The incident report details a conversation with Palacios' cellmate, who told jail personnel that Palacios had taken eight "Mexican blue" pills — which are counterfeit oxycodone pills containing varying amounts of fentanyl — over the course of three days.
The cellmate said a third inmate who left the jail before Palacios' death brought in fentanyl pills by hiding them in his body and supplied the drugs to him and Palacios.
After running out of the fentanyl supply the third inmate had left behind, the cellmate told investigators Palacios suffered from severe withdrawal symptoms, including "throwing up to the point of dry heaving" and that "he couldn't unclench his hands."
"I'm like, just ... drink some water, and you'll be, like, you'll be all right," Palacios' cellmate told investigators, according to the report. "And then uh, the COs told him the same thing, just drink some water, and you'll be fine."
The cellmate told investigators Palacios took a shower the morning of Jan. 10, and the cellmate proceeded to do the same. Before he undressed, the cellmate said, he saw Palacios being placed on a gurney.
Palacios, who was previously convicted of felony aggravated assault, had been booked into the jail at the time of his death in connection with felony charges of auto theft, burglary and fleeing from law enforcement, according to court records.
Visitations not allowed
From July 2020 to July 2021, fentanyl-related deaths have increased by 59% in Pima County, according to a report from the county Health Department, which also says fentanyl is the leading cause of death for youth in Pima County.
The county's behavioral health unit is charged with overseeing the contracts for privatized correctional health care companies that provide medical services to inmates in the jail.
Perrera, who has headed the behavioral health department since 2018, says the deaths at the jail are reflective of those in the community.
"Fentanyl is a serious problem nationwide, but particularly here in Tucson, we're just so close to the border," she said. "People in the community are, you know, addicted to fentanyl and they use fentanyl and they're bringing it with them inside the jail."
Nanos said every inmate undergoes a body scan when booked into the jail, which detects anomalies and potential contraband hidden on or within a body. The jail uses a canine specialized in sniffing out fentanyl, he said, and doesn't allow in-person visitations or physical mail, with inmates attending most court hearings virtually.
Some inmates swallow bags of pills to excrete them once they're inside the jail in attempts to evade security procedures.
"But it is a tiny pill and sometimes people are going to get that by us," Nanos said. "We are doing everything we can to keep that nasty drug out of there. But it is tough. It is not an easy thing to stop from coming into your jails."
Despite the department's efforts, fentanyl is finding its way into the jail.
In Palacios' case, sheriff's personnel reviewed the body scan of the cellmate who allegedly provided him with fentanyl and found "a circular anomaly ... in (the inmate's) abdomen, but it was unclear what it was."
Nanos said the body scanning machine detects anomalies inside a person's body and provides a percentage as a threshold for when further inspection is needed. He said the scan detected the abnormality, but it didn't reach the threshold needed to issue a warrant for further inspection.
"We will go through that machine and see the ones we've missed and say, could we lower that standard to say, 'OK, we need to wake up when they hit 70%? Not 80%?' I don't know. It's a guessing game," Nanos said.
The sheriff said the corrections workers who conduct the body scans are "adjusting to that technology."
"So we have COs who are trained to be corrections officers, looking at a machine's X-ray vision, doing the best they can to say, I think there's something here," Nanos said.
The jail is also short-staffed, leaving corrections workers to take on longer shifts and experience burnout faster. As of last week, the jail was short-staffed by 104 corrections officers, five corrections sergeants and two corrections lieutenants.
Nanos said increasing staffing "could have an impact" on decreasing the number of deaths in the jail.
"I've got staff, for example, doing rounds every 20 minutes. What if I have enough that can do rounds every 10 minutes? Maybe they'd catch some of this," he said. "I think your morale kind of picks up a little bit, because you're not feeling like you're stuck there for so many hours in the day. And once morale's up you're giving a better effort."
Nanos said his department is in discussions to build a 30-bed unit for inmates detoxing from drugs and is considering buying a hand scanner that could detect drug residue on inmates' hands when they're booked into the jail. For now, however, those are just ideas.
In reality, Nanos said the jail he oversees isn't a place for those struggling with addiction.
"I know there are some really, really bad people who exist, and they belong in that jail," Nanos said. "But there are a lot of people who are in that jail because they do drugs. I don't like you doing drugs. But I don't know that is the place for you."
Pima County Public Defender Joel Feinman, who represents many of the inmates in the jail, is joining family members of the deceased in attempts to bring attention to the facility's deaths.
His office, however, lacks the power to keep people out of the jail, he said. That's an authority granted to the judges who put them there.
"All we can do is represent our clients to the best of our ability and bring attention to issues and demand that society pay attention to how our clients are marginalized and mistreated," Feinman said.
Many inmates — including Palacios, according to sheriff's reports — enter the facility detoxing from drugs they took on the outside and lack access to proper care for the often dangerous withdrawal process.
"The idea that if you are unlucky enough to have a substance abuse problem, and you get arrested for a low-level offense, then you have to roll the dice with your life and potentially die in the Pima County jail as a result of substandard medical care. I mean, I find that just deeply offensive," Feinman said.
In Perrera's memo addressed to acting County Administrator Jan Lesher, the behavioral health department director wrote: "We speculate that the lack of methadone as a treatment option may be a contributing factor for some of the overdoses within the jail population."
According to Perrera, inmates with opioid use disorder — where withdrawal can be life-threatening and cause symptoms such as nausea, diarrhea and insomnia — used to be able to access methadone if they had taken it outside the facility. Methadone is commonly used to treat opioid use disorder by reducing withdrawal symptoms and cravings.
But on Dec. 1, the county stopped working with its former methadone provider, Community Medical Services. Perrera said the change came after officials found the company was starting people on methadone even if they weren't provided it on the outside, going against the jail's policy and causing "some adverse events."
The jail also ended its contract with its former medical provider Centurion in August, switching to another privatized correctional health care company, NaphCare. Perrera said the Centurion contract ended because the company was violating its contract by refusing to "engage and provide court-ordered evaluation and treatment services," on an involuntary basis.
Now, after nearly three months without methadone treatment in the jail, Pima County has obtained a preliminary license from the Substance Abuse and Mental Health Services Administration, or SAMHSA, to continue providing methadone to inmates.
Perrera expects the first shipments of methadone to arrive next week. The preliminary license won't become permanent, however, until SAMHSA conducts a survey at the jail to ensure compliance with rules and regulations.
But even with the return of the opioid withdrawal medication, only those who were already receiving methadone outside the facility can participate in the program.
"In the current contract with NaphCare, I don't have the staffing in there that it would take to have a full-blown MAT (medically assisted treatment) services program," Perrera said.
In her memo to Lesher, Perrera said the county's "long-standing policy" is "that individuals in our detention facilities should have the same or better access to quality care as they would outside."
"I think we are certainly much closer today than we were when I took over this position," Perrera said when asked if the jail is living up to that policy.
"Do we have everything that we could ever want? No, but we are way closer and we are continuing to move forward to having the right staff and the right staffing mix," she said. "So it's hard to say that today things are exactly the way that I want them to be. They aren't."
(c)2022 The Arizona Daily Star (Tucson, Ariz.)