Stanislaus County Men's Jail Medical Care Grand Jury Case # 06-21

All relevant policies and procedures were not followed in providing complainant with necessary and appropriate medical treatment. • According to the County Manual regarding the subject of “Pre-Detention Medical Evaluation/Intake Health Screening Policy”, the arresting officer should have communicated the fact that the complainant had received emergency medical treatment from an emergency medical technician prior to arrest. In this case, the arresting officer’s report was filed the next day indicating evidence of trauma or acute illness. After reviewing booking records, no evidence could be found to confirm that the reception officer was made aware of this information so that he/she could then advise medical personnel of the complainant’s emergency medical treatment prior to booking in the jail. • The complainant did not receive medical treatment in a hospital although jail policy requires that this medical information be transferred and included in an inmate’s medical record. However, the complainant did receive emergency medical treatment from an emergency medical technician and the arresting officer was aware of this treatment. Based upon a comprehensive review of all of the complainant’s jail records, no evidence was found to confirm the booking officer was made aware of this treatment upon receiving the complainant in the jail. The jail policy only requires documented evidence of medical treatment be returned to jail to become part of inmate’s medical record if the arrestee is taken to an emergency treatment center (e.g. hospital.) However, the policy does not include reporting medical treatment if the inmate received treatment outside of a hospital (e.g. ambulance treatment.)8 • CFMG medical staff should have checked complainant’s blood pressure more frequently. Medical records indicate that the complainant had a diagnosis of hypertension (high blood pressure.) According to sworn testimony from the CFMG Regional Registered Nurse, high blood pressure should be monitored closely. In fact, she testified that good medical practice is to check blood pressure every four hours but current practice and procedure in the jail is to check the patient every 12 hours. In this case, jail medical records indicate that the complainant’s blood pressure was only checked approximately every 24 8 Reference to County Manual at . 5 hours. Although the medical screening form was completed correctly in this case, the timeliness of medical follow-up was questionable at best. • Jail personnel failed to follow the Jail Manual that provides when securing property of an arrestee, “prescribed medications belonging to an arrestee will immediately be turned over to medical staff unless otherwise directed by medical personnel.”9 Receiving jail personnel did not follow policy and instead stored the complainant’s nitroglycerin medication without handing over the medication directly to medical staff who could have then consulted with the inmate’s personal doctor about the inmate’s medical needs or allowed the inmate to carry some of his medications with him. • Although policy specifically states that “medical staff must give approval prior to allowing inmates to consume/take medication”,10 this approval could not have happened in this case because medical staff was never made aware that the complainant had nitroglycerin medication or that it was in jail storage with the complainant’s other personal property. Although the medical staff eventually administered nitroglycerin to the complainant, the undue delay could have been avoided had jail staff followed procedure.

The existing jail and medical policies and procedures are not adequate due to the apparent lack of communication and documentation in providing medical treatment to the complainant. • Under sworn testimony, the CGJ found that CFMG medical staff did not receive copies of the arresting officer’s report. As a result, CFMG staff was not informed of the complainant’s prior emergency medical treatment or the complainant’s prescribed medication he carried on his person during the booking process. There is no evidence of timely and direct communication between the arresting officer, booking officer and treating medical staff in order to promptly advise medical staff of the inmate’s subsequent emergency medical treatment or the nitroglycerin medication he carried when he was arrested. • Based on review of both jail records and CFMG medical records, there was no evidence of written or verbal communication between the emergency medical technicians who treated the complainant prior to incarceration and CFMG medical staff in order to provide consistent and appropriate follow-up medical treatment. • Based on review of CFMG medical records and the complainant’s personal medical records, there is no evidence of written or verbal communication between treating medical staff and complainant’s primary care physician. Jail Manual at . Id at 10. 6 • Based on review of the complainant’s booking records, there is no evidence that the Intake Property Form completed by the receiving officer was made available to medical staff to advise medical staff of complainant’s nitroglycerin medication so that they could provide medical treatment accordingly. This information would have also provided the opportunity for medical staff to comply with jail policy to approve that the complainant have access to his own prescribed medication.11 • Jail personnel complied with county policy and jail policy by completing the pre- screening form for additional information and appropriately referred the inmate to the medical department. However, the form is inadequate because it does not prompt the question that inquires whether the inmate has received any medical treatment in the last 24 hours. If this question were included in the screening form, when CFMG medical staff reviewed the referral form, they would be immediately aware of potentially critical medical information to provide appropriate and timely medical treatment to the inmate.

Other Findings: Lack of Quality Medical Treatment • Stanislaus County contracts with CFMG to provide all medical care for all correctional facilities within Stanislaus County. CFMG is responsible for training, supervising and managing its entire medical staff. CFMG medical staff are required to follow their own company policies and procedures; they are also required to follow all county and jail policies and procedures. • CFMG medical staff and the CFMG doctor should have followed-up with their patient (complainant) in a timely manner. Despite medical necessity noted in the records and the complainant’s known chronic medical conditions recorded by medical staff, medical records indicated that the CFMG medical doctor did not conduct a physical examination of the patient. Instead, the CFMG doctor conducted only a file review over 24 hours after the complainant was booked in jail. While the CFMG Physical Assessment form was completed with notations showing a blood pressure of 240/120, forehead and scalp trauma, hypertension and noted his allergy to diabetic medication, the CFMG doctor did not conduct a physical examination or meet the complainant in person. • According to the nurse’s sworn testimony, a diabetic’s blood sugar should be reviewed and monitored closely by medical staff. The complainant’s medical jail records indicate that he was diabetic and noted minimal necessary medical treatment for this condition. Id. 7 • According to jail medical records and sworn testimony from both witnesses interviewed, the complainant received high blood pressure medications but over 24 hours after his arrest. Given the complainant’s high blood pressure condition well documented in the medical records, and current blood pressure condition monitored in jail, the complainant’s personal doctors should have been contacted to determine if blood pressure medication was medically necessary immediately. • Within 2 days of being released from jail, as substantiated by medical records and emergency medical technician (EMT) records, complainant was transported via ambulance and hospitalized to treat an uncontrolled blood pressure condition. According to the complainant’s medical records, his cardiologist stated that the complainant’s unstable angina resulted from his lack of medical treatment while in jail (e.g. not taking his blood pressure medications appropriately.) • According to sworn testimony, new inmates are not automatically placed on prescribed medications due to current circumstances (e.g. if they have used drugs or alcohol prior to arrest). • According to CFMG policy and sworn testimony, patients who require nitroglycerin medication should carry at least 3 nitroglycerin pills on their person. In this case, according to booking records, the complainant’s nitroglycerin pills were removed from his possession upon booking and locked with his personal property to be accessed upon release from jail. Although CFMG medical staff administered nitroglycerin to the complainant, they did so over 30 hours after his arrest, which was unnecessarily delayed and could have been avoided. • According to sworn testimony, some CFMG nursing staff are insensitive to inmate/patient needs and do not listen to legitimate medical complaints or concerns.