In Arpaio's Jails, the Most Basic Healthcare is No Better Despite Years of Lawsuits and Investigations
by Lauren Gilger
Phoenix New Times
Thursday, Apr 15 2010
But after 10 hours in Maricopa County's Fourth Avenue jail, Oropeza was unconscious, in cardiogenic shock with acute kidney failure at Good Samaritan Hospital. Meanwhile, no one at the jail could tell her family where she was. "She's been released" was their refrain.
Oropeza, 45, had been straightforward with jail personnel about needing medication, which is reflected in jail and hospital records, as well as in Oropeza's recollection.
When she was arrested, she tells New Times, she clearly remembers telling the officer who took her purse that she would need to take her pills again in an hour.
He told her to wait until she got to the jail.
As Maricopa County Sheriff Joe Arpaio's guards took her through the intake process "they asked me when I last took it, and I told them," Oropeza says. "I'm thinking, 'Okay, they're gonna give me my medication.'"
They didn't, so she tried again, telling the guard checking her into the jail that she needed her pills.
"Well, you don't need them right now," he told her. "It's your own fault. What do you think this is, a hospital?"
Oropeza's medical history is summarized in Good Samaritan Hospital records, released by Oropeza to New Times: She was in a car accident in west Phoenix in 2005 that left her disabled and with chronic back and leg pain.
Oropeza says she spent a month in a coma and five months in the hospital after she was thrown from the passenger's side of a car. Her hip "came completely out of socket," she says, and she suffered extensive head trauma after hitting the pavement.
She regularly takes the painkillers morphine and oxycodone as well as the muscle relaxant carisoprodal, according to hospital records.
Jail employees definitely knew about her condition, county records show. At 9:49 a.m. — about the time Oropeza was booked into the jail — a note was entered in her file recording that she was on medication for chronic pain in her legs and back due to a car accident.
Still, she didn't get help.
Oropeza knew what would happen next: The pain in her legs would come back, her stomach would reject anything in it, her muscles would seize up, and her lungs would tighten.
"If I don't take my medication, then I get a withdrawal right away," she says.
She had no power to stop it from coming. It did.
In the first holding cell, waiting to be fingerprinted, Oropeza asked for a bag to throw up in. A guard handed her one.
She sat on the concrete floor in the corner of the cell, vomiting into the bag until it was full, unable to move as the pain in her legs crept back and the painkillers wore off.
When she asked for a second bag, a guard told her to use the trash can on the other side of the cell. But she couldn't get up to walk over to it.
"Just don't throw up on the floor," he told her.
She was struggling to breathe and still throwing up when another woman in the cell began to kick the door to get the guard's attention. Oropeza, afraid of angering the guard, begged her not to.
"No," the woman said. "You need help. You need help now."
When the guard finally came, he walked Oropeza down a long hall and told another guard on duty there to "take her down to medical," Oropeza remembers.
Standing at the end of the hall with the new guard, Oropeza felt increasingly dizzy. She grabbed a nearby chair because she felt like she was going to faint.
"Don't touch that chair," the guard yelled.
"You don't need nothing to hold on to. You just stand there," Oropeza remembers him saying.
She asked him whether she could hold onto the wall. He told her no.
"All you're doing is putting on a show to get out of here. We get it all the time," he said.
When he took her out of the hallway, it was to yet another cell — this one right outside the medical unit, where she could see the nurses through a window.
Oropeza begged the nurses for help, miming that she couldn't breathe. She says Arpaio's guard just laughed at her. The nurses didn't come.
By about 1:30 p.m., after at least three hours of vomiting and dry heaving in a cement jail cell, Arpaio's guards finally turned her over to Correctional Health Services, the medical unit of the jail, according to records.
She was handcuffed to a gurney. When she complained of being cold, "they threw paper over me," she says.
At a few minutes before 7 p.m. on June 2, CHS staff called an ambulance to come for Bertha Oropeza. It arrived at 7:30 p.m., according to records, a full six hours after she had entered the medical unit
Healthcare in the Maricopa County jails has been the subject of a series of lawsuits, studies, and reports that have concluded the same thing: Inmates get grossly inadequate healthcare.
In September 2008, the jails' healthcare system lost its accreditation from the National Commission on Correctional Health Care. It has not been reinstated.
In an order issued just last week, U.S. District Court Judge Neil Wake gave a devastating assessment of the conditions: inadequate record-keeping, medication management, staffing and mental health treatment threaten the lives and well-being of thousands of inmates every day.
Saying that the level of healthcare is unconstitutional and puts detainees in real danger, Wake ordered the sheriff and Correctional Health Services, the county agency that administers healthcare in the jails, to fix the problems by the end of this year.
The order came on the heels of a lawsuit that alleged violations of inmates' constitutional rights, and worked its way through the court system for years. The sheriff lost that suit, Graves v. Arpaio, in October 2008. And Wake ruled that the sheriff and the county Board of Supervisors, which runs CHS, must make massive improvements to jail healthcare.
Nearly 18 months later, problems remain.
In fact, Oropeza would likely get no better care today than she did nearly a year ago — despite the court's demand for improvements. She entered jail with one of the most common serious medical conditions doctors and nurses see in the jails: dependence on drugs or alcohol. (In her case, prescribed medication.)
A court-ordered report issued last month assessing improvements — or lack thereof — at the jails, found that nearly 15 percent of patients don't get their medications as prescribed, including those who are carrying them. Oropeza says her prescription medications were in her purse when she was picked up.
But the problem is bigger than that — sometimes patients don't get the right dosage, they have adverse reactions to medications, or face other complications. Many experience withdrawal symptoms that can be "life-threatening or extremely painful," according to the report, which was written by a medical doctor assigned to monitor the jails' progress after Judge Wake's ruling.
"Maricopa County jails are not alone," says Peggy Winter, the associate director of the ACLU's National Prison Project and lead counsel on Graves v. Arpaio. Especially in the largest urban jails, officials inevitably struggle with the overwhelming medical and mental health needs of many detainees, she says.
A big part of the problem in Maricopa County is that doctors don't get timely information because the jails' medical records system is inadequate.
With so many inmates, CHS is likely unable to manage medical records or track inmates with medical needs without an electronic system, the report says. The system now is almost entirely manual, often relying on handwritten records.
CHS Director Betty Adams says her department is working to improve the records system. "If I could wave a magic wand, I would hope for some additional technology," she says.
But that is only one deficiency on a long list of things that need improvement. "I have, like, 16 top priorities," she says.
Deputy Chief Mary Ellen Sheppard of the Sheriff's Office says CHS needs to make better record-keeping its top priority. "It boils down to the lack of a tracking system that measures the care being provided and the quality of that care," she says. "It's hard to fix something that you don't have a handle on."
Hard doesn't begin to describe it.
Fixing all the problems in the jails would be a tall order for any government agency. But in Maricopa County, it's even tougher. Here, the sheriff and members of the Board of Supervisors are embroiled in an endless legal battle over seemingly every aspect of the jails — their healthcare system included.
The Sheriff's Office insists that it should have control over healthcare in the jails it runs. But that duty resides with CHS, which has been running healthcare services in the county's jails for decades.
The dispute ended up in Maricopa County Superior Court last year, with Arpaio attempting to wrest power over CHS from the county Board of Supervisors. He claimed that the board is inept and the Sheriff's Office would do a better job of providing healthcare in the jails.
The judge ruled otherwise, throwing out the case last week.
Arpaio's claims came just when evidence began to show that CHS, though far from being a model of correctional healthcare, is actually improving.
Eric Balaban, a lawyer with the American Civil Liberties Union's National Prison Project who toured the jails in September, says he saw progress.
"There certainly is movement in the right direction," he says. "But they were starting from ground zero."
The court-ordered report released in March also makes it clear that CHS employees are making some improvements: They are doing their best with an inadequate records system; more patients are getting healthcare assessments within two weeks of entering the jail, and those with chronic diseases are getting better care.
But, according to Judge Wake, the only real improvements that have been made are the ones that have cost the county little or no money.
CHS is a huge operation, with a $49 million annual budget. Imagine a constant stream of potential new patients — hundreds every day — each of whom is more than likely to be addicted to drugs or alcohol and less than likely to have seen a doctor in the past year.
On any given day, there are about 9,000 inmates in the Maricopa County jails, according to the U.S. Department of Justice. According to CHS documents, 130,000 people were admitted into the jails last year alone. The jails take in 350 new inmates on an average day.
That means CHS has about $6.39 to spend on each inmate's healthcare per day, according to the March report.
Now, imagine trying to take care of that constant stream of patients, while they are being processed and packed into concrete cells, in poor shape and facing worse conditions.
Add a healthcare system that has been plagued by problems for years, and you've got the Maricopa County jails. It's a dangerous situation for medically fragile inmates.
"We're talking about life and death here," says Winter. "So a jail stay for some offense that may be very minor, and for which you might not even have been convicted, can result in a life sentence or some terrible lifelong injury because you didn't get the access to care that you should have."
Before her eight-day stay at Good Sam, Bertha Oropeza had spent just 10 hours in jail.
Her condition that first night didn't seem critical, according to medical records. She must have appeared to be just another narcotics-addicted inmate from Fourth Avenue.
But one day later, Oropeza was rushed to the ICU, intubated, and treated for cardiogenic shock, a life-threatening condition that occurs right before your heart fails completely.
Doctors inserted a balloon pump in her throat to keep her breathing. Her kidneys failed, and she stopped producing urine because of dehydration, according to medical records.
It wasn't until close to midnight on the day she was arrested that her family tracked her down at the hospital.
"We were really worried," Bertha's eldest daughter, Blanca Oropeza, says. "And then we find out her heart's crashing and that she might not make it through the night."
Two days later, Oropeza was out of danger. It was a surprise.
"The heart doctor told us she had a 40 percent chance of living through the night," Blanca says.
Both CHS and Good Samaritan records cite withdrawal from pain medications as possible causes of her near-death. But, at least one thing wasn't the cause: Oropeza's "social history," as doctors call it.
Medical records show that she smokes a pack of cigarettes each day and smokes marijuana — the very offense that landed her in jail.
But the records state: "Social History: Noncontributory."
In other words, it wasn't anything Oropeza had done to herself that brought her so close to death.
Oropeza plans to file a lawsuit against the county but doesn't know where to begin.
"The thing is, if I wouldn't have been in jail and something like that would have happened to me, I would have started straight to the hospital," she says.
"I could have been dead."
In fact, the court-ordered report released this month makes that even more apparent. "The Fourth Avenue jail intake facility is not medically suitable," the doctor writes, for people "prone to instability due to complex acute or chronic diseases" or "those with significant physical or functional disabilities."
Clearly, the Fourth Avenue jail intake facility was not medically suitable for Bertha Oropeza.
...
In September 2008, the jails' healthcare system lost its accreditation from the National Commission on Correctional Health Care. It has not been reinstated.
In an order issued just last week, U.S. District Court Judge Neil Wake gave a devastating assessment of the conditions: inadequate record-keeping, medication management, staffing and mental health treatment threaten the lives and well-being of thousands of inmates every day.
Saying that the level of healthcare is unconstitutional and puts detainees in real danger, Wake ordered the sheriff and Correctional Health Services, the county agency that administers healthcare in the jails, to fix the problems by the end of this year.
The order came on the heels of a lawsuit that alleged violations of inmates' constitutional rights, and worked its way through the court system for years. The sheriff lost that suit, Graves v. Arpaio, in October 2008. And Wake ruled that the sheriff and the county Board of Supervisors, which runs CHS, must make massive improvements to jail healthcare.
Nearly 18 months later, problems remain.
In fact, Oropeza would likely get no better care today than she did nearly a year ago — despite the court's demand for improvements. She entered jail with one of the most common serious medical conditions doctors and nurses see in the jails: dependence on drugs or alcohol. (In her case, prescribed medication.)
A court-ordered report issued last month assessing improvements — or lack thereof — at the jails, found that nearly 15 percent of patients don't get their medications as prescribed, including those who are carrying them. Oropeza says her prescription medications were in her purse when she was picked up.
But the problem is bigger than that — sometimes patients don't get the right dosage, they have adverse reactions to medications, or face other complications. Many experience withdrawal symptoms that can be "life-threatening or extremely painful," according to the report, which was written by a medical doctor assigned to monitor the jails' progress after Judge Wake's ruling.
"Maricopa County jails are not alone," says Peggy Winter, the associate director of the ACLU's National Prison Project and lead counsel on Graves v. Arpaio. Especially in the largest urban jails, officials inevitably struggle with the overwhelming medical and mental health needs of many detainees, she says.
A big part of the problem in Maricopa County is that doctors don't get timely information because the jails' medical records system is inadequate.
With so many inmates, CHS is likely unable to manage medical records or track inmates with medical needs without an electronic system, the report says. The system now is almost entirely manual, often relying on handwritten records.
CHS Director Betty Adams says her department is working to improve the records system. "If I could wave a magic wand, I would hope for some additional technology," she says.
But that is only one deficiency on a long list of things that need improvement. "I have, like, 16 top priorities," she says.
Deputy Chief Mary Ellen Sheppard of the Sheriff's Office says CHS needs to make better record-keeping its top priority. "It boils down to the lack of a tracking system that measures the care being provided and the quality of that care," she says. "It's hard to fix something that you don't have a handle on."
Hard doesn't begin to describe it.
Fixing all the problems in the jails would be a tall order for any government agency. But in Maricopa County, it's even tougher. Here, the sheriff and members of the Board of Supervisors are embroiled in an endless legal battle over seemingly every aspect of the jails — their healthcare system included.
The Sheriff's Office insists that it should have control over healthcare in the jails it runs. But that duty resides with CHS, which has been running healthcare services in the county's jails for decades.
The dispute ended up in Maricopa County Superior Court last year, with Arpaio attempting to wrest power over CHS from the county Board of Supervisors. He claimed that the board is inept and the Sheriff's Office would do a better job of providing healthcare in the jails.
The judge ruled otherwise, throwing out the case last week.
Arpaio's claims came just when evidence began to show that CHS, though far from being a model of correctional healthcare, is actually improving.
Eric Balaban, a lawyer with the American Civil Liberties Union's National Prison Project who toured the jails in September, says he saw progress.
"There certainly is movement in the right direction," he says. "But they were starting from ground zero."
The court-ordered report released in March also makes it clear that CHS employees are making some improvements: They are doing their best with an inadequate records system; more patients are getting healthcare assessments within two weeks of entering the jail, and those with chronic diseases are getting better care.
But, according to Judge Wake, the only real improvements that have been made are the ones that have cost the county little or no money.
CHS is a huge operation, with a $49 million annual budget. Imagine a constant stream of potential new patients — hundreds every day — each of whom is more than likely to be addicted to drugs or alcohol and less than likely to have seen a doctor in the past year.
On any given day, there are about 9,000 inmates in the Maricopa County jails, according to the U.S. Department of Justice. According to CHS documents, 130,000 people were admitted into the jails last year alone. The jails take in 350 new inmates on an average day.
That means CHS has about $6.39 to spend on each inmate's healthcare per day, according to the March report.
Now, imagine trying to take care of that constant stream of patients, while they are being processed and packed into concrete cells, in poor shape and facing worse conditions.
Add a healthcare system that has been plagued by problems for years, and you've got the Maricopa County jails. It's a dangerous situation for medically fragile inmates.
"We're talking about life and death here," says Winter. "So a jail stay for some offense that may be very minor, and for which you might not even have been convicted, can result in a life sentence or some terrible lifelong injury because you didn't get the access to care that you should have."
Before her eight-day stay at Good Sam, Bertha Oropeza had spent just 10 hours in jail.
Her condition that first night didn't seem critical, according to medical records. She must have appeared to be just another narcotics-addicted inmate from Fourth Avenue.
But one day later, Oropeza was rushed to the ICU, intubated, and treated for cardiogenic shock, a life-threatening condition that occurs right before your heart fails completely.
Doctors inserted a balloon pump in her throat to keep her breathing. Her kidneys failed, and she stopped producing urine because of dehydration, according to medical records.
It wasn't until close to midnight on the day she was arrested that her family tracked her down at the hospital.
"We were really worried," Bertha's eldest daughter, Blanca Oropeza, says. "And then we find out her heart's crashing and that she might not make it through the night."
Two days later, Oropeza was out of danger. It was a surprise.
"The heart doctor told us she had a 40 percent chance of living through the night," Blanca says.
Both CHS and Good Samaritan records cite withdrawal from pain medications as possible causes of her near-death. But, at least one thing wasn't the cause: Oropeza's "social history," as doctors call it.
Medical records show that she smokes a pack of cigarettes each day and smokes marijuana — the very offense that landed her in jail.
But the records state: "Social History: Noncontributory."
In other words, it wasn't anything Oropeza had done to herself that brought her so close to death.
Oropeza plans to file a lawsuit against the county but doesn't know where to begin.
"The thing is, if I wouldn't have been in jail and something like that would have happened to me, I would have started straight to the hospital," she says.
"I could have been dead."
In fact, the court-ordered report released this month makes that even more apparent. "The Fourth Avenue jail intake facility is not medically suitable," the doctor writes, for people "prone to instability due to complex acute or chronic diseases" or "those with significant physical or functional disabilities."
Clearly, the Fourth Avenue jail intake facility was not medically suitable for Bertha Oropeza.
...
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