Death Sentence

The feds throw the book at King County's jail as inmate fatalities skyrocket.

A few months after two inmates in the downtown King County Jail committed suicide in 2005--one by overdosing on hoarded jail medications, the other by hanging himself with a TV cord--County Executive Ron Sims pronounced jail medical care "efficient and well-managed." The deaths weren't made public at the time; they were revealed months later by Seattle Weekly. But Sims did publicize what he called a "prestigious" performance review his jail had received from a national correctional health care group, giving KCJ high marks for inmate care. By December 2006, jail health officials had reclassified their services as "medically sound," even though inmate complaints, medical errors, and deaths were on the rise. Flash forward to two weeks ago, when U.S. Department of Justice investigators handed in their own performance review, determining that the two 2005 suicides—and at least three other deaths since then—were preventable. In a blistering report, the feds said King County Jail conditions had become so unsafe and abusive in the past three years that inmates' civil rights were being violated. Asked last week how the jail could achieve a "prestigious" rating in 2005 and be "sound" in 2006, yet now be accused of deadly medical breakdowns and other failures dating back through those years, Sims would not comment. James Apa, a spokesperson for Public Health–Seattle & King County, says the county is still trying to decipher the medical significance of the new DOJ study. It "doesn't assess our performance against specified standards," claims Apa, "so we're going to be working with them in the upcoming months to understand their analyses." The federal findings confirm a series of reports by the Weekly that revealed unreported jail deaths, disease outbreaks, and medical mistakes. The DOJ report cites the Weekly as one of the sources of its findings. (See "Dead-End Jail," Sept. 21, 2005, and "Contagion in the Jail," Dec. 7, 2005, among others). After studying the new federal findings in private for nine days, county officials released the DOJ report on Nov. 21. While they conceded that there were problems that needed fixing, county leaders suggested the troubles were old news, in what seemed an echo of denials from previous years. As Sims appointees Reed Holtgeerts, director of Adult and Juvenile Corrections, and David Fleming, head of Public Health, put it in a joint statement, the federal review was critical of "past practices" in the jail, and many of those issues have since been resolved. Except the "past" was barely a few months ago: It was just August when a DOJ inspection team made its second trip to the jail this year and found more of the harmful conditions the team discovered on an initial visit in March. Inspectors were so concerned with ongoing violations that, in August, they quietly issued an urgent notification to Sims that people were still unnecessarily dying in his jail. Along with "preventable" deaths, DOJ inspectors found that inmate abuse was "routine" and overall jail operations had "serious" deficiencies. If remedial measures aren't made by Dec. 31, the DOJ says in its 27-page review, the county can expect to be taken to court by the federal government and forced to comply. The jail made mistakes even while federal inspectors were in the building looking for them. In March, an inmate on suicide watch somehow obtained and swallowed multiple medications while the DOJ experts were on the same floor. "Disturbingly," recounts Rena Comisac, acting head of the DOJ Civil Rights Division, "despite the unfolding emergency, security staff did not call for medical help for a crucial eight minutes after the inmate had swallowed the medications." It took another seven minutes before a nurse arrived with a medical crash cart, Comisac says in the new DOJ report, and it was 25 minutes after the suicide attempt that fire department medics arrived. Though the woman survived, Comisac calls it a "life-threatening example" of the jail's failure to provide adequate emergency care, leaving inmates at "grave risk of harm." In August, an inmate suffering from shortness of breath and a lump on his neck had been misdiagnosed the day before the DOJ team's return. A subsequent "physical exam by our consultants," Comisac reports, "revealed that the inmate required urgent evaluation at an acute care hospital to rule out the risk of sudden death from obstruction in his trachea." The inmate wasn't alone. The contingent reviewed the medical records of seven prisoners and found six were wrongly classified and required prompt medical attention. Abuse also was a major concern, the DOJ report found. Dangerous and painful inmate-controlling measures such as pepper spray and hair holds, for example, were sometimes employed on defenseless mentally ill or developmentally disabled prisoners. In one case, which the feds termed "inexplicable," a mentally distressed prisoner was restrained by a hair hold (yanking the hair forcefully to dominate the inmate) even though she was locked into a wheelchair by leg and waist restraints. Noting that three custodial officers were accused (and later convicted) of having sex with inmates and that internal investigations had reached an "abnormally high" number, the feds said self-investigation techniques must be improved to assure inmates are safe from an "alarming" misconduct trend. Holtgeerts and Fleming say they "have recently taken steps to review our policies and increase training for staff in the use of force." They've also stepped up training and policy changes, and tightened internal investigation procedures. Some corrections officers have campaigned for those changes, and their union, the Corrections Guild, says it has long been seeking staffing increases and "repeatedly asked the administration for a greater commitment to training." But it's the risk of contagion and dying that has inspectors most worried, citing the constant threat of MRSA and incidents of flesh-eating-disease deaths, as revealed by the Weekly. The "most egregious" example of "systemic" failure was the repeated preventable deaths of inmates, Comisac says. At least two inmate deaths resulted from inadequate medical care, and three suicides in the past three years could have been prevented, DOJ found. One of the inmates, an alcoholic, had been sent to Harborview suffering from seizures and skin infections. He then was returned to the jail and waited for 30 hours before he was given a necessary antibiotic. He was later seen by a doctor but, despite a tender abdomen and "highly unstable" vital signs, was returned to the inmate population. By the third day, he was doubled over with abdominal pain. After waiting seven hours to be seen again, he was sent to the hospital, where he died of an apparently perforated gastric ulcer. He was one of five inmates who died in 2006 from a variety of causes. The jail averaged one death a year from 2000 through 2002, yet has since averaged five. So far in 2007, six inmates have died, the most of any year this decade. The DOJ report indicates the county may have shown "deliberate indifference" to the welfare of inmates by denying such conditions exist or by delaying their resolution. The report cites the 1997 Civil Rights of Institutionalized Persons Act and case law in making a case for a constitutional court challenge. But, says a conciliatory DOJ spokesperson, Jodi Bobb, "The Department of Justice is optimistic that we can reach common ground with the county on implementing the necessary reform measures." Sims says that the county "will be able to correct any identified concerns in a cooperative spirit" with the feds and avoid a lawsuit. But he denies that conditions amount to civil rights violations, arguing the jail is "constitutionally sound" today. Apparently, "medically sound" is nolonger the operative term.

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