A simple check of inmates’ vital signs as they come into Orange County jail facilities could save their lives, according to a new Orange County Grand Jury report.
The latest findings come after last year’s grand jury found almost half of deaths in Orange County jails could have been prevented through low-cost diagnosis and treatment of medical issues.
And in October, a federal judge found county officials let OC inmates go without psychiatric care for five weeks when their psychiatrist took a leave of absence.
The new report says a simple check for vital signs would help diagnose cardiovascular disease, one of the top 10 leading causes of death in the country.
“Besides saving lives, [a vital signs check] could help reduce the cost to the Orange County taxpayer of having to send inmates to an outside hospital for treatment while at the same time providing potential savings by reducing prospective civil litigation,” the grand jury wrote.
Sheriff Don Barnes disagreed with the grand jury findings in a statement, saying “it does not accurately portray the level of healthcare provided to inmates” in the county jails.
“While OCSD does not provide inmate medical care, we believe the Correctional Health Services staff from the OC Health Care Agency do a great job,” he said, adding that “Intake and triage at the jail is not meant to diagnose and prescribe treatments.”
Instead, Barnes said “inmates are triaged by Correctional Health staff for issues that would restrict their ability to receive medical care at the jail if their needs are acute or exceed the services available.”
Fifteen inmates who died in jail between January 2016 and May 2018 had a history of cardiovascular disease, according to grand jurors, who found that only inmates who identified themselves as at-risk for high-blood pressure would get their vitals checked.
When inmates are booked into the county jail system, they are first screened in the Medical Triage Center of the central jail’s Intake Release Center, which grand jurors describe as a “high-traffic” area averaging 150 inmates per day.
Inmates are screened two at a time with no privacy, and often have abnormal vital signs due to the stress of being handcuffed and booked, and potentially being intoxicated, according to the report. Inmates can also refuse to disclose medical history as well as any medical interventions.
The county could be opening itself up to potential liability lawsuits, according to the report, which cites an “increasing number of inmates, their often poor health status, and the potentially incomplete diagnosing” of them.
“People in custody have a right to medical care and the Sheriff’s Department has an obligation to ensure that folks who need that care get that care. It’s unacceptable for people with medical needs to go untreated and be ignored,” said Daisy Ramirez, the American Civil Liberties Union (ACLU)’s jails project coordinator, in a Wednesday phone interview.
“I’ve heard time and time again from folks who have disclosed that staff have regularly prevented them from accessing that care, and that seeing a nurse or doctor is an uphill battle for folks in the jails,” Ramirez said.
“Inmates are not coming to jail for medical treatment,” Barnes said in his statement. “They are coming because they broke the law.”
“While many inmates require medical care in custody, the jail is not a medical facility. Inmates requiring moderate to severe medical care are sent to the hospital to receive advanced treatment,” he added.
But that current practice could be increasing medical costs to Orange County taxpayers, as inmates “are being transferred to outside hospitals for evaluation of chest pain and more than half are being admitted for care,” according to the grand jury findings.
“Those individuals are now in (Sheriff Barnes’) care,” Ramirez said. “As the Sheriff-Coroner in Orange County, he has an obligation to ensure that medical care is their right to access.”
Among other recommendations made in the report, grand jurors suggested the jails implement “Full Population Assessments,” a practice recognized by the National Commission on Correctional Health Care, in which jail staff conduct hands-on evaluations on all inmates, which includes a review of their screening, medical history, vital signs, height, and weight.
Currently, the county jail system conducts full population assessments on people detained by Immigration and Customs Enforcement (ICE), according to the report. The county jail system can house up to 958 ICE detainees, who receive the assessments as part of their contract with the county.
But that contract was terminated on March 27, according to a press release that announced the agency will transfer all their detainees out of the county jail system by around June 25.
In a report last year, grand jurors wrote “Over the last three years, 44% of custodial deaths in Orange County jails may have been preventable.”
The June 2018 report says dozens of inmate deaths involved jail staff failing to notice and document “obvious health issues,” assigning inmates to cells with people who had contagious diseases, failing to diagnose contagious diseases, and other issues.
“Delays in treatment, failure to identify health threats at intake, failure to diagnose serious mental illness, and lack of timely referral to a healthcare professional have increased the chances that an inmate will not make it out alive,” grand jurors wrote in the 2018 report.
“Modest changes in procedures at a relatively low cost could improve survival rates.”
In their new report, the grand jury said they found inconsistencies between medical reports by jail staff and paramedics who responded to incidents, which appear in DA investigation findings known as custodial death reports.
“Some descriptions of inmate deaths or medical histories were inconsistent with other records describing medical care provided to those inmates,” the grand jury wrote.
Problems in the jails’ health care staff have been brewing well past the last decade. A 2009 county audit of Correctional Health Services, a division of the county Health Care Agency, found that low employee morale, stemming from a lack of accountability in the division’s leadership and low nursing staff levels, had the potential to pose significant problems across the jail system.
The Grand Jury released a report last week that found a failure by sheriff management to have proper training and policies in place enabled the illegal recordings of over 30,000 inmate-attorney phone calls. The grand jury said it did not find management acted with malicious intent nor that criminal trials were jeopardized by the recordings.
Brandon Pho is a Voice of OC intern. Contact him at firstname.lastname@example.org or on Twitter @photherecord.
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