Sacramento jail failing in health care for inmates, with report citing ‘filthy’ areas
One inmate in his late 30s was booked into the Sacramento County Main Jail in February and told a nurse doing intake screening that he had consumed a gallon of liquor every day for two years straight. But no one placed him on alcohol withdrawal treatment and 30 hours later he had a seizure and died.
Another was a man in his late 50s with heart failure who went into the jail in March and had a doctor decide to discontinue his heart medications without actually seeing the patient. “I need my Entresto, I will die without it,” the inmate told one doctor, then saw his health deteriorate until he died within two months.
A third inmate asked for help because he had “blood sepsis” and an infection affecting his heart valves, but was scheduled for a routine sick call and died of septic shock and a heart condition within two weeks.
These are some of the examples described in a damning new report on the state of health care inside Sacramento County’s jail system, which is described as having medical treatment areas that are “cluttered, dirty, and in many cases filthy,” a chronic shortage of nurses and doctors and an overcrowding problem so severe that the Main Jail has twice as many inmates as it was originally designed to hold.
“Access to care is a fundamental and essential element to any correctional health care program,” the 101-page report filed in federal court Tuesday says. “However, the access to care program at Sacramento County Jail is broken.
“Patients do not receive timely access to care for their health serious medical needs, resulting in preventable harm to patients.”
Report part of 2020 settlement
The report was compiled by court-appointed monitors working to assure the county is moving toward compliance with a 2018 federal consent decree in the Mays v. Sacramento County lawsuit to improve conditions in the jails, but found a series of problems that include delays in getting seriously-ill inmates treated, “callous” treatment of inmates by some medical staff and possible falsification of records.
“A common practice among the providers is to include a statement at the end of their notes which reads: ‘Patient was counseled about medical conditions and management. Patient verbalize understanding and consents to current management,’” the report says.
“The presence of the same spelling and grammar mistakes in every instance makes it clear that this is an auto-populated macro rather than an accurate description of exactly what aspects of the patient’s condition and treatment plan were discussed. The practice of providers cutting and pasting notes risks documenting history and physical examinations and education that have not been conducted and, in some cases, simply amounts to falsification of medical records.”
The county issued a statement conceding officials can do better but added that efforts are being made to come into compliance with the requirements under the consent decree.
“The county will be reviewing the report in detail to determine how the report can aid the county in achieving full compliance with the Mays consent decree,” the county statement said. “The county believes it is important to note that the county has been within at least partial compliance of many areas of the 2020 Mays consent decree.
“In fact the report filed today notes many areas where the county is in full compliance with portions of the consent decree,” the county’s statement continued. “Because this report is limited to medical services, it does not address the progress the county has made in decreasing jail bed contracts by other agencies, increasing pre-trial and collaborative courts programs, expanding re-entry programs, creating and expanding mental health intensive outpatient programs, and adding a new contractor for placement of individuals on conservatorships.”
The county added it “continues to do the work necessary to achieve full compliance across all parts of the consent decree. In the next several weeks, the county will be issuing its plans to reduce the jail population and to address the deficiencies in the jail facilities.”
Doctors not seeing inmates
Among the problems identified in the report is the fact that doctors often do not actually see the patients they are trying to diagnose and treat, the report found.
“A major concern is that medical providers too often practice remote control medicine,” the report said. “Providers commonly order tests and medications without seeing the patients to discuss the treatment plan and changes to their medical regimen. They often do not communicate test results with patients timely, if at all.”
And part of the issue stems from a lack of enough custody staff to escort health care providers to see inmates, the report found.
“There were many instances in which custody informed providers and nurses that they were not permitted to see patients due to lack of escorts, ‘behavioral issues,’ or because unspecified activities were taking place in the housing unit,” the report found. “This is obstructing access to care and should not occur.
“While it is understood that custody is responsible for safety and security of the institution, it is the role of custody to facilitate appointments taking place, not prevent them. When behavioral issues are a factor, mental health staff need to be consulted.”
The findings are contained in the third monitoring report issued under the Mays consent decree that stems from a 2018 federal lawsuit on behalf of Lorenzo Mays and several other inmates who challenged the access to medical and mental health care, use of solitary confinement and violations of federal law requiring proper access for inmates with disabilities.