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Old 02-27-2005, 09:01 PM
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Default Report faults inmate health care at jail

Report faults inmate health care at jail
Undetected illnesses, excess costs, risks to public cited in study
By JAMES M. O'NEILL / The Dallas Morning News

A new study of health conditions at the Dallas County Jail says lapses in medical care worsen inmates' health, pose risks to jailers and the public, and cost county taxpayers unnecessary emergency medical expenses.
The report indicates severe systemic problems, including the way inmates with illnesses are screened; the potentially dangerous way they are housed; a serious shortage of medical and jail staff; and a virtually non-existent process to identify inmates with tuberculosis, a problem that poses risks to the public.
About 90,000 people were incarcerated in the jail during 2004.
The 52-page report includes 38 specific recommendations and suggests that the county review its contract with the University of Texas Medical Branch, which has handled health care at the jail since October 2003.
UTMB, which also handles health services for many state prisons, comes under particular scrutiny for its staffing decisions in the report, which notes that as a general practice, UTMB has reduced the number of higher-level trained staff members in favor of less-trained staffers – and has proposed reducing their number further.

UTMB officials said that although they had not seen the report, they welcomed the study. They produced their own report to the county late last year, contending that staffing and funding issues were a major concern. Dr. Steven Bowers, UTMB's medical director at the jail, manages 17,000 inmates in nine facilities in Dallas and elsewhere for UTMB.
"How much of his time can realistically be devoted to the Dallas County Jail?" the report asks. "He is managing facilities other than the Dallas County facilities even though his full time position is funded through the county contract."
Other UTMB jail staffers also are used to staff non-county jails.
"Given the lack of staffing at the jail, this practice should be
prohibited by contract language," the report states, "but it is not."
Though the county received the report on Feb. 1, officials have yet to make it public. The Dallas Morning News obtained a copy Tuesday.
The report, funded by the Meadows Foundation, was requested by County Judge Margaret Keliher, partly as a response to the near-death of James Mims, a mentally ill inmate whose psychiatric medications had been withheld for two months.
It was produced by Health Management Associates and written by Dr. Michael Puisis, a specialist in correctional health who is former medical director of Cook County jail in Chicago. He was also regional medical director for New Mexico's corrections system and has been a national consultant.
Dr. Puisis spent eight days at the jail, reviewed documents and medical records, interviewed UTMB and jail staffers, and interviewed officials from other agencies that are involved in jail health.
Pat Terrell, who oversaw the report for Health Management Associates, said she had been told by the county not to comment publicly about the report.
Under review County Administrator Allen Clemson said the report is being reviewed by the district attorney's office, as well as the private law firm of Figari and Davenport, which the county commissioners hired Tuesday, to ensure that the report doesn't pose legal risks to the county in a civil lawsuit filed in December by Mr. Mims' family.
As a result, officials of UTMB and Parkland Hospital, as well as Sheriff Lupe Valdez, have not seen the report. Attorney David Finn, who is suing the county on behalf of Mr. Mims' mother, said he has not seen the report. But he said he hopes it breaks a pattern of investigations followed by ineffective reforms.
"It reminds me of Groundhog Day," Mr. Finn said, referring to a 1993 film in which a character experiences the worst day of his life over and over. "When is somebody going to step in and do something?"
"It's terrible. It's shocking," Commissioner Maurine Dickey said of the report. "If we don't use this as a call to action, we are very remiss." Ms. Keliher said the report "has highlighted that we have to address health care in the jail. Whether we stay with UTMB or do something different, the court will address the issue." She said the county will ask the consultants who produced the report for help in making changes.
Dr. Ben Raimer, chief physician executive of correctional health care services for UTMB, said the university has lost $500,000 a year through the contract with current staff levels.
Jack Smith, UTMB's director of operations, said UTMB has suggested a 40 percent staff increase – about 53 full-time positions – to improve the jail health-care situation. Owen Murray, UTMB's medical director, said that would obviously require a significant increase in funding by the county.
Problems occur from the time inmates are booked, the report indicates.
Normally, new arrivals at a jail should be screened and receive a
physical exam to weed out emergency or chronic conditions. Such
screening is typically performed by nurses or other health-care workers.
But in the Dallas County Jail, regular jail staff members conduct the screening.
"There are no medical policies governing how officers screen, and
officers receive no training to screen," the report states.
Problems undetected as a result, the report estimates, screening officials miss at least 35 percent of detainees with health problems, and as many as 25 people a day go through intake without having their mental illness identified.
Once housed, some mental health patients are sent by chance to closed observation cells that are completely out of sight of the corridors, a "dangerous practice," according to the report.
Some are kept in 23-hour-per-day lockup, without stimulation, similar to the isolation in a super-max prison, which has been known to lead to psychotic behavior. "To use these types of arrangements for known
psychotic inmates can only make treatment more difficult and may prolong their disease or increase the severity of symptoms," the report said.
The report notes that the jail's tuberculosis screening program "is basically non-existent." This "results in the jail being a focus of amplification of tuberculosis spread both within the jail as well as into the community at large."
The doctor in charge of TB in the jail "has no experience in managing patients with tuberculosis, and he has so much else to do that he actually spends very little time managing people with tuberculosis."
The report also points out that frequent delays in medication for
inmates with chronic illness result in many unnecessary hospital visits – trips that ultimately cost county taxpayers.

•The medical staff, not the jail staff, should perform initial health screenings.
•A crisis stabilization unit should be established for housing
suicidal and severely disturbed mental patients, and admission to the unit should be by a licensed psychologist or psychiatrist.
•An infirmary should be established with unimpeded examinations of inmates, and daily rounds should be conducted by physicians and nurses.
•An infection-control program should be established against contagious and infectious diseases.
•The facility's hygiene should be significantly improved to thwart antibiotic-resistant staph aureus, an important and emerging pathogen.
•All patients should be seen with a medical record in hand.
•Pharmacy services should be evaluated, and prescriptions should be
delivered within two days.
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