12 years later, jail dispute continues
By IAN DEMSKY
The News Tribune
TACOMA — More than 12 years after a legal settlement over inadequate medical care at the Pierce County jail, county officials and a lawyer for inmates are still debating how much further medical care at the facility needs to improve.
 Pierce County officials say that under the legal settlement the National Commission on Correctional Health Care standards “should be considered as guidelines,” not requirements. (AP Photo/Rich Pedroncelli, File) |
The most recent court-ordered review, which was filed in August, found the county jail still did not meet national standards in 18 areas including adequate staffing, management of chronic diseases and mental health screenings.
The attorney representing the inmates argued in federal court filings in January that the county is not only failing to abide by the judgment, but the longstanding issues with medical care may even be contributing to deaths at the facility.
The county has challenged many of the monitor’s findings and the lawyer’s contentions. Officials pointed out that under the legal settlement the National Commission on Correctional Health Care standards “should be considered as guidelines,” not requirements. The standards would need to be met for accreditation by the commission, but the county is obligated neither to seek nor obtain that designation.
The two sides were not able to come to an agreement about how to proceed during mediation talks in December and now Seattle attorney Fred Diamondstone, who represents the inmates, is asking the court to intervene.
“The parties are at an impasse on the current issue of necessary health staff at the jail,” he wrote in court filings.
More staff needed?
In 1996, Pierce County settled a class action lawsuit brought by inmates alleging unconstitutional conditions at the jail. A monitor was appointed by the court to make sure the county improved to meet the requirements. Monitor Dr. Joe Goldenson filed his most recent report in August, detailing his findings from a June inspection.
In it, he says he believes the jail needs to hire six additional nurses and two mental health staffers. County officials disagreed, saying those staffing levels were based on responses to hypothetical questions, such as “How many nurses would it take to screen every person coming into the jail?” - which is unnecessary.
“Current staffing levels are fully adequate to provide necessary medical services for inmates,” jail health services manager Vince Goldsmith wrote to Goldenson on Jan. 7. “I have spoken to my staff and they agree that we do not need the proposed new positions to meet the conditions of the court order.”
Staffing increases are part of the Sheriff’s Department’s five-year plan, which is on hold because of the economic downturn, Goldsmith wrote.
Goldenson, who heads jail health services for the San Francisco Department of Public Health, also noted mental health services were not always provided in a timely manner, nor was there a policy in place that required staff to respond to mental health requests from inmates.
For example, he wrote that an inmate with a history of suicidal thoughts submitted a note to staff, known as a “kite,” on June 3 stating, “meds - seizures making it impossible to control emotions - put in several kites.” He wrote another kite six days later asking why his kites weren’t being answered.
“I need help badly,” he wrote. As of Goldenson’s visit on June 12, the inmate has still not received a response, nor had his kites been posted on a board for follow-up.
Jail officials responded that a review of their records found the inmate was screened upon booking and no mental health issues were found. He had been seen by medical staff 10 times and the behavior log “is not reflective of someone suffering depression.” The inmate was given self-help information to address his complaints of sleeplessness and anxiety.
“This does not rise to the level of serious as observed by a lay person let alone the medical professionals who saw him repeatedly during his stay,” mental health manager Judy Snow wrote to Goldenson.
The jail had also taken steps to better prioritize response to kites.
“We do not believe we are taking shortcuts . . . rather, we are attempting to be as efficient as possible while providing [an] appropriate level of care,” Snow wrote. A more comprehensive assessment “will show that we are meeting all requirements of the consent decree and there is no rationale for requiring the additional mental health staff referenced in the report.”
Leval of care questioned
After mediation failed, inmate advocate Diamondstone asked the court to allow him to question jail and correctional health care staff to help demonstrate the extent to which the county was complying with the recommendations of the monitors and abiding by the 1996 judgment.
The county is “failing to provide the minimally accepted level of heath care, including mental health care and dental health care,” he wrote in court documents filed last month.
In recent weeks the jail has started providing dental care more often, Diamondstone said in a recent interview.
Among the biggest remaining issues that Diamondstone raised are staffing levels, adequate access to care and treatment for chronic diseases.
Eight inmate deaths from 2006 to 2008 “all raise questions about access and/or adequacy of health care,” Diamondstone wrote, though he does not detail each case. He questions Pierce County’s recent practice of reviewing jail deaths internally instead of having reviews done by an outside party not involved with the inmate’s medical care.
In one 2006 death, he wrote, jail physician Miguel Balderrama “suggested that law enforcement had not provided full information about suicide potential at the time of booking.” However, records show the arresting officers wrote “SUICIDE WATCH” across the top of his intake form and made other notations that he was at risk. (That case is now the subject of a separate federal lawsuit.)
Goldenson’s latest report did not find problems with the inmate deaths or subsequent reviews.
In the past, the jail had only an outside doctor perform reviews before there was a physician on staff, said county prosecutor Doug Vanscoy who is representing the county in the case.
“The NCCHC standards were revised last year to provide that an outside physician conducts such a review when the jail physician was directly providing care to the person who died, and the County will comply with that standard,” Vanscoy wrote in an e-mail to The News Tribune.
Vanscoy did not want to comment directly on Diamondstone’s allegations because the county is still working on its response for the court.
Not up to standard
Here’s a list of 18 national standards that a court-appointed monitor found were not being met at the Pierce County jail during his latest review:
Access to care; policies and procedures; continuous quality improvement program; staffing plan; clinic space, equipment and supplies; receiving screening; health assessment; mental health screening and evaluation; oral care; nonemergency medical requests; segregation of inmates; continuity of care; special treatment plans; management of chronic disease; suicide prevention program; health record format and contents; emergency psychotropic medication; right to refuse treatment.
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