Dallas Jail-DMN & DOJ Report
11:14 PM CDT on Monday, July 21, 2008
The five-person team visited the jails during the first week in April and documented nagging problems in two 40-page reports filed as part of a federal lawsuit against Dallas County to force improvements in jail health care, sanitation and fire safety.
County commissioners are expected to discuss the report today in a closed session.
Many of the deficiencies noted were first pointed out in a scathing 2006 U.S. Justice Department report that said jail conditions contributed to the death and injury of numerous inmates and placed others at risk of serious harm.
The low marks, while not posing immediate consequences for the county, signal possible trouble in gaining elusive state jail certification. Commissioners say they’re confident the jails will meet all state standards by September.
Among the biggest problems noted in the latest monitoring report filed last week in federal court was that inmates with health problems weren’t seeing doctors fast enough. The report also said that inmates, especially those with chronic diseases, weren’t receiving prompt follow-up care.
Lack of an adequate jail infirmary and mental health facilities was cited among the biggest underlying problems.
Some inmates’ serious medical conditions got worse because the problems weren’t discovered at the initial screening or because inmates weren’t seen fast enough after screening, the report said.
“Many remaining issues relate to the ability to track patients, schedule patients and ensure that medical documents are in the electronic record,” the report said.
In one example cited, an inmate arriving at one of the jails told the medical staff he had a broken finger. A clinician saw the inmate the following day, but he didn’t receive appropriate evaluation and follow-up. The inmate’s diagnosis – a fractured finger – came six weeks later and required surgery to repair a poorly healed bone, the report said.
Another inmate who arrived with a history of tuberculosis was sent to the infirmary for evaluation. But no other clinical notes were found regarding the evaluation.
Few inmates had an examination within 14 days of arrival, the report said.
Commissioner John Wiley Price said he’s pleased with what the county has been able to accomplish in only three years, given what he described as 19 years of neglect.
“It didn’t get this way overnight, and it’s not going to get repaired overnight,” he said. “When you’ve seen where we’ve come from, the report speaks to what we’ve done in a short time.”
Sheriff Lupe Valdez, whose department manages the jails, said in a written statement that since the inspectors’ visit, “we have made significant progress” and moved “beyond the issues that were outlined in the report.”
Allen Clemson, the Commissioners Court administrator, said the quality of care in the jails is “outstanding” and better than any jail in the state.
“There will continually be issues. You’ll never be able to get it to 100 percent,” he said.
County officials signed an agreed order last year with the federal government that spells out what the county must do to improve sanitation and medical and mental health services in its jail system.
As part of that agreement, the county has to pay for several recognized experts in correctional health care to provide periodic monitoring reports on the jails during the next two years.
Mr. Clemson said the county will continue to address the issues the team finds.
The jails have not passed a state inspection since 2003. But Dallas County commissioners have spent more than $110 million on jail improvements. Parkland Memorial Hospital is now providing medical and mental health care, and a new jail tower is under construction.
The inspectors reported that Parkland admissions – an average of 44 per month – could be reduced if the jails had an improved infirmary and better chronic disease management.
County officials have planned for new examination rooms and other medical spaces in the jails to be completed in stages. While some construction projects are under way, a new jail infirmary isn’t scheduled to open for another three years, the report said.
Mr. Clemson said the county still is in the design phase of a planned $47 million infirmary that will have between 300 and 400 beds.
Other problems cited in the monitoring report include:
•Seriously ill inmates returning from the hospital who weren’t seen by a doctor for several days.
•Many patients with chronic illness who are “lost to follow up.”
•Some patients who aren’t getting their medications renewed.
•Lack of a reliable system for logging, tracking and responding to sick calls.
•Multiple problems with the electronic medical record system.
•Lack of working fire safety systems in all five jails.
Another problem noted was inadequate privacy during medical screening. Inspectors said that may have been why only two of 10 HIV-positive inmates reported their condition during the screening.
Mentally ill inmates are inappropriately locked in their cells for 23 hours a day, because of staffing shortages and lack of space for “out-of-cell time,” according to the report.
In the mental health category, other problems reported were a difficulty in tracking patients, lack of privacy, inadequate staffing and a lack of adequate space to conduct mental health evaluations.
The report highlighted several areas of improvement, including jail maintenance response times, the cleanliness of laundry, and a training program to help jail guards recognize and respond to health emergencies.
In addition, there is now excellent leadership of health operations, the jails are on a “steady foundation of funding,” and clinical staffs are of high quality, the report said.
A new federal report says problems remain in Dallas County jails. Among them:
•Difficulty tracking patients’ medical needs.
•Lack of privacy during medical screening.
•Lack of follow-up for inmates returning from the hospital.
•Inadequate fire safety systems in all five jails, including broken or inadequate alarm systems in four jails.
•Slow response to inmate sick calls.
•Use of dirty mattresses that can no longer be cleaned and should be thrown out.
•Improper use of chemical cleaning agents by inmates.
•Lack of dedicated sanitation officers.