Riverside County: Jails rebound from shocking lack of resources
When an expert on correctional health care toured Riverside County’s jails in 2015, he found a shocking situation:
For the past two years, one lone physician had been on staff to serve a system that booked almost 60,000 inmates a year and housed an average of 3,700 people per day in five jails spread across a 7,300-square-mile county.
Inmates could still be sent to area hospitals for care, but the system was so overwhelmed that many resorted to asking the judge in their criminal case to order medical care. More than 150 court orders per month were being issued, a number that Dr. Scott Allen called “extraordinary.”
The report Allen wrote was part of the settlement of a class-action lawsuit that has been bringing about transformational changes in how Riverside County cares for its sick inmates.
The county is now under a court order called a consent decree that requires it to improve medical and mental health care. Allen and an expert in mental health, Dr. Bruce Gage, are monitoring progress – although unlike their initial reports, the ones they’ve filed since are not public.
“What Riverside County has been doing to fix things has been to build systems from the ground up,” said Sara Norman, an attorney with the nonprofit Prison Law Office, which filed the lawsuit. “They’ve really done the work … to change the way they ordinarily do things.
“It’s been very heartening,” she said, “even though they’re nowhere near done.”
‘Cruel and inhumane’
Deep budget cuts during the recession devastated the Riverside County jails’ medical staff. A grand jury found that the system went from 158 registered nurses and 11 physicians in 2007 to 47 nurses and three physicians in 2011. Two of those three doctors then quit in the face of their increased workload, Allen wrote.
Allen also found “programmatic deficiencies and institutional barriers” in the system. He noted that a 2011 law known as AB109 or realignment, which began sending some convicted felons with multiyear sentences to county jails instead of state prisons, created even more challenges.
The Prison Law Office said the result was “cruel and inhumane deficits in medical and mental health care” that placed inmates at serious risk of harm.
Their lawsuit contained page after page of allegations of failures: inmates missing or being suddenly taken off medication, waiting months or years to be seen by specialists including when cancer was suspected, receiving no documented psychiatric help despite multiple suicide attempts.
Norman said that although the county took a hostile stance initially, officials became very collaborative once the settlement was reached.
Today, the health care staff speaks about wanting to not just come into compliance with the court order but go beyond its requirements.
“We plan to blow it out of the water and do much better,” said Dr. Matt Chang, head of behavioral health for the county.
In 2018, Riverside County’s correctional health services became the first jail medical system in California to achieve national accreditation through the National Commission on Correctional Health Care, officials said.
Restructuring jail health care
While the Sheriff’s Department runs the jails, medical and mental health care are managed by the county’s public health and behavioral health departments. A major change in recent years has been integrating all of those departments’ records to coordinate care both inside and upon release from jail.
“We’re restructuring how we view correctional health,” said Dr. Mike Mesisca, the county’s medical director for correctional health. Jails are now seen as one piece in a larger picture of public health.
Meanwhile, the budgets for the jail health agencies have jumped from a combined $17 million at their low point in 2011 to $62 million in 2018. The majority of the increase has gone toward salaries as the county staffs back up.
The county has also been trying to provide the physical space needed to improve care. A new medical clinic opened early this year at the jail near Banning, and a new jail in Indio that just finished construction was designed with the requirements of the court order in mind.
More clinical space and staff means fewer inmates have to be transported off-site for care, a huge savings in time as well as sheriff’s resources, as each inmate has to be escorted by two deputies.
Much has changed in the jails as well. At intake, nurses rather than deputies now do health screenings before inmates are booked, and triage everyone based on their needs.
Requests for medical care are now dropped into locked boxes that are checked twice a day, rather than sent through deputies, who were sometimes accused of blocking access to care. And some inmates whose security or mental health classification has kept them mostly locked in their cells now get more time out of them.
In the mental health housing units, and the Sheriff’s Department has instituted a “core team” strategy, where deputies communicate every day with the clinicians. They get extra training and aren’t moved around between units like most guards are, which officials say helps build trust.
Norman lauded the strategy.
“They’re handpicking the deputies, trying to ensure it’s a team approach,” she said. “It’s still early but really promising.”
Complaints persist
Despite her praise for the county’s work, Norman didn’t have an estimate for how much longer it might be until the jails come into compliance with the court settlement.
Meanwhile, inmates continue to complain about – and file lawsuits over – the care they receive.
Michelle Delahanty, the wife of one inmate who participated in a hunger strike in January, said her husband had been diagnosed with high blood pressure in jail but wasn’t getting medication. She said one of his friends had gotten his jaw broken in a fight and wasn’t getting the care he needed, despite putting in request after request.
This summer, a small number of women also went on a hunger strike. Two of them said that a woman in a nearby cell who had mental health issues tried to hang herself in mid-July. Both claimed that prior to the suicide attempt, the woman would frequently self-mutilate, but she wasn’t placed in a safety cell.
Sheriff’s officials said they weren’t able to comment on specific medical cases, or to confirm whether a suicide attempt took place.
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.