Orange County: Jail health care called inadequate, but some changes underway
Critics of Orange County’s jails fear that not enough action is being taken to improve health care in the wake of a series of recent watchdog reports that raised serious concerns about inmates’ well-being.
A spate of deaths in the past two months — three inmates and fetus of another inmate who was just entering her third trimester — has further raised advocates’ alarm.
One report by the Orange County grand jury in 2018 found that almost half of the inmate deaths in a three-year span could have been preventable. This year’s grand jury panel focused in on deaths tied to hypertension. Both reports recommended several changes to improve care.
But activists with the American Civil Liberties Union of Southern California, which conducted its own investigation into Orange County jails from 2015 to 2017, said they’re still hearing about the same kinds of problems from inmates now that they did a few years ago with care being unaccessible or inadequate.
Officials with the Orange County Sheriff’s Department, which runs county jails, and Health Care Agency, whose Correctional Health Services oversees medical care there, provided some data but did not make anyone available to comment on criticism or talk about what changes are being made.
Statistics do indicate the county is dedicating more resources to inmate medical care now than a few years ago – and it’s about to start renovating one jail and adding two new buildings with space for about 900 new inmates at another. Officials have said the construction should help provide more space to treat a growing number of inmates with mental health issues.
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Inmate deaths
The number of deaths in jails tends to fluctuate by year – Orange County has had between two and 12 every year since at least 2005, with no clear signs of an upward or downward trend. So far this year, four adults and two fetuses have died.
The ACLU and other inmate-rights activists have been staging protests in response to the most recent deaths.
Anthony Aceves, 38, died May 23 at Theo Lacy jail, where he was serving 90 days for a probation violation. His family has already filed a wrongful death claim and has very publicly criticized the Sheriff’s Department for not releasing details about how he died. Aceves had schizophrenia, and relatives are concerned he wasn’t getting the care or medication he needed.
The morning of July 15, 44-year-old Eric Denton, who had entered jail five days earlier on a drug-related charge, was found unresponsive in a cell at Theo Lacy with “no obvious signs of trauma,” sheriff’s officials said. His cause of death is pending.
Then early July 18, deputies found Shikiira Kelly, 37, hanging in her cell; her death appears to be a suicide, officials said. She had been in jail since April on charges of misdemeanor trespassing and violating parole.
On July 27, a 30-year-old woman housed at the Intake Release Center was taken to the hospital with issues related to her pregnancy. Her unborn child, about 27 weeks along, was determined to have died. The fetus’s cause of death is being investigated, officials said. The mother had been in jail for six days for two misdemeanor warrants.
ACLU criticism
For people with health issues who end up in Orange County jail, the problems start at booking, said Daisy Ramirez, the organization’s jails policy and conditions coordinator for Orange County.
“On a fundamental level, the department is doing a very poor job of identifying and assessing medical issues at intake,” she said.
Inmates who reach out to the ACLU for help say that they aren’t getting access to health care they need, or that care is inadequate, especially for chronic illnesses.
“So many people are requesting care, people who end up exiting jail without even getting the care they need,” Ramirez said.
“We’ve heard time and again from people who said that deputies delayed access to care,” she said. “They don’t get any care until they become unconscious or are able to get the attention of a nurse going through a housing module to distribute medication.”
Jail renovation, expansion
Intake is one area that the county plans to improve with its upcoming construction projects, some of which have been in the works since the 1990s.
At the Intake Release Center in Santa Ana, the triage area where all inmates are first processed will be renovated to provide more privacy to inmates being asked questions about their health status. New areas will be added for inmates going through detox – about 100 inmates a day require frequent monitoring, officials said – and substance abuse treatment.
Also, three IRC housing units will get upgrades, with Americans with Disabilities Act-compliant cells and restrooms, plus about 500 new beds for inmates with mental health issues.
The two new buildings will be built at the James Musick Facility in Irvine, which just ended its contract to hold Immigration and Customs Enforcement detainees and transferred its own inmates to other Orange County jails for a planned three-year closure.
In announcing the plans, the Orange County Sheriff’s Department noted that jails had seen a 40% increase in open mental health cases from 2015 to 2018.
That’s true, but an incomplete picture: The same statistics show 2015 was a low point in mental health cases, and the jails actually had a higher percentage of inmates with open cases every year from 2010 to 2013 than in 2018.
Health care resources
The estimated $167 million for the Musick project will come from the state, officials have said.
The county, meanwhile, is dedicating more money in recent years to Correctional Health Services: Its budget rose 17% in the past four years, to about $39 million in fiscal year 2017-18.
And money spent on medication, which rose steadily to about $4.7 million in 2011, then dropped steeply to about $2.9 million in 2012, has rebounded to about $4.1 million in 2018, according to data reported to the state.
Data also shows that the number of inmates being seen by medical staff in Orange County jails has fluctuated similarly to the overall jail population. But jail officials say there’s been a steep increase in transports to emergency rooms and other off-site medical appointments.
Before 2011, when a new state law began sending some convicted felons to county jails instead of state prisons, Orange County averaged about 800 medical transports a year. By 2018, that number rose to more than 2,100.
This article is part of a series on jail health care that was produced as a project for the Data Fellowship, a program of the USC Annenberg Center for Health Journalism.