Medical care for approximately 10,000 prisoners in the Maricopa County jail system is an abject failure. That may explain why the Arizona county, which is the fourth largest in the nation, has had to pay over $13 million in jury awards, settlements and legal fees in lawsuits involving prisoners’ deaths and injuries due to medical neglect over the last decade. The county has also paid $250,000 to consultants to help identify solutions to the jail’s problematic health care services. [See: PLN, March 2009, p.34]
The major causes of the breakdown in medical treatment have been identified as poor record keeping and understaffing, with attendant overworking of the jail system’s health care personnel. Maricopa County operates six detention facilities, including its infamous tent city, under the direction of also-infamous Sheriff Joe Arpaio.
In the early 1990s, then-Sheriff Tom Agnos asked the Maricopa County Board of Supervisors to create Correctional Health Services (CHS) to assume responsibility over the medical care needs of prisoners in the jail system. By the time Betty Adams took over as director of CHS in 2007, the agency had gone through four other directors in the past ten years. By all accounts, health care at the jail is improving under Adams’ leadership. However, by all accounts that is not enough. Maricopa County ignored the warning signs for too long and corrective measures have been too little, too late.
In 1996, the U.S. Department of Justice (DOJ) warned the county that the medical care in its jails was below minimum constitutional requirements. In 1999 the county signed an agreement with the DOJ to improve the level of care. Outside consultants hired in 1998, 2000 and 2003 found substandard health care services and recommended hiring more staff, increasing retention rates and changing to an electronic records system. In February 2006, the jail’s medical care system was placed on probation by the National Commission on Correctional Health Care (NCCHC) after a routine review uncovered major deficiencies. In September 2008, NCCHC threatened to withdraw the jail’s accreditation. Accreditation was formally withdrawn in January 2009.
The problems are deadly serious. For example, Deborah Braillard was arrested for suspected drug possession and booked into the Maricopa County jail on January 1, 2005. She went in and out of consciousness and writhed in pain for the next five days. Guards did not take her to the infirmary. After Braillard slipped into a coma she was transferred to a hospital, where she died three weeks later.
Because she was a drug user, jail staff had assumed her symptoms were due to detoxing. In fact, Braillard was an insulin-dependent diabetic, which was noted in her medical records from her previous jail stays. The records were handwritten on paper and stored in a huge warehouse; thus, they were not readily accessible to intake or medical personnel.
Although a jail officer had sent a fax regarding Braillard’s diabetic condition to the facility where she was sent after being booked, CHS employees denied receiving it. “Nobody in health care uses faxes to communicate with. That’s just absurd,” said Dr. Todd Wilcox, a former CHS medical director, noting there is no way to verify a fax is received and read by appropriate medical staff in a timely manner.
An electronic medical records system might have saved Braillard’s life. Such a system “is paramount for Maricopa County to move forward,” said national prisoner health care expert Jacqueline Moore. “Large jail systems just can’t continue the paper chase of finding and filing medical records. [Electronic record keeping] mitigates risks. There’s less room for error.”
In 2003, Dallas County, Texas switched its jail medical records over to an electronic system. According to Sharon Phillips, who supervises prisoner health care for the 6,000-bed Dallas County jail system, the improvements were immediate and there were long-term cost savings.
Oddly, in 2005, the Maricopa County Board of Supervisors took bids to install an electronic medical records system at the jail. In 2007 they signed a $5 million contract with Atlanta-based Business Computer Applications, Inc. to purchase a system, and paid a $218,000 deposit. County officials then put the project on hold, initially claiming they had discovered the software was inadequate and later saying they lacked the funds to pay for the system. CHS director Betty Adams is now looking into joining with the Maricopa Integrated Health System – the county’s public health care provider – and the Maricopa Medical Center to install an electronic records system that is estimated to cost $83 million over the next ten years.
CHS has hired more than 200 employees since 2004, and presently has over 450 full-time staff members. Despite this improvement, NCCHC noted there was still severe understaffing, even though part-time employees were being used to cover some vacant full-time positions. Wilcox stated in a 2008 deposition that county administrators would approve new positions but not fund them, so no one could be hired.
“This is the game that Office of Management and Budget play,” said Wilcox. “The whole time I was medical director, I would have [staff] allocations, but I would have no authorization to hire my allocations.” This resulted in understaffing, which in turn led to substandard medical care for prisoners.
Sandi Wilson, who heads the Office of Management and Budget, apparently agreed. “The biggest issue is budget driving policy decisions,” she said. “Policy, even if it’s not the most cost efficient, should drive decisions, not budget.”
So what does Betty Adams think about the crisis in CHS? “We don’t feel like we’re in a crisis,” she remarked. “We feel like there’s been a huge distraction in the last six months. All of that was brought on by people that don’t like us. We feel like we’re humming right along.”
All of those pesky medical neglect lawsuits the county has lost, and the revocation of the jail’s health care accreditation from the NCCHC, have been caused by people who simply don’t like CHS or the Sheriff’s Department? With that attitude, it is certain that little will change in regard to the medical care crisis in Maricopa County’s jail system. For the record, neither Deborah Braillard nor her family, which filed suit against the county over her death, are “humming right along.”
Sources: Arizona Republic, Phoenix New Times
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