Medical and Medication Problems in the Jails

The nursing staff reviews the sick call Hospital Clinic and VHCC as required by slips and prioritizes them into a triage list of inmates to be seen that day. The Tulare County Sheriff’s Department Detentions Division Policy & Procedure Manual, # A-140 59 × TULARE COUNTY GRAND JURY REPORT 2009-2010 Health Care Manual 90-06 (V) (A) (2) (A- 13. Review of the HHSA grievance logs for M). September, October, November and December 2009, revealed there were

All categories of specialists need to be Sheriff’s Detention Policy Manual to contracted per Health Care Manual. include a mandatory shift briefing prior The following are missing: to assuming duties by incoming medical a. Cardiology staff. b. Gastroenterology c. Neurology 12. Distribute medications as prescribed. d. Pulmonary Disease e. Rheumatology

The Specialists that care for the inmates are located at Tulare Regional Medical

At the Pre-Trial Facility there is a Dentist, 120 medical/medication grievances to treat inmates from all of the jails, from inmates. employed by HHSA.

The three PAs at the jails work four 10 normally distributes medications to hour shifts per week to cover medical inmates and documents when an needs of the inmates. Mondays and inmate is almost or completely out of Fridays are their busiest days, but the medication. schedule calls for only two PAs on those days. 15. When short staffed, a Licensed Vocational Nurse and/or PA help

HHSA implemented a Grievance distribute medication, preventing them Tracking Log. The intent of the log is to from seeing patients. allow tracking of medical grievances from submission to resolution. Review 16. The inmate is supposed to sign a of seven months of the Grievance medical distribution log , per the Health Tracking Log show the log did not Care Manual Policy # 90-05(V)(D), adequately represent the issues however only the Med Tech signs when identified by aggrieved inmates. he/she gives the inmates their medication.

Inmate concerns on the grievance form are reduced to a one line item on the 17. The Sheriff’s Detention Policy Manual # tracking log, while the medical F-625, Medical/Pill Call Services states, practitioner responses are lengthy and “Anyone who brings medications detailed. (prescription and over-the-counter) into the facility are to turn them into the

Grievances forwarded to the medical Intake Officer. All such medications will staff, with medical and non-medical be checked by medical staff to validate issues, are not always redirected to the authenticity. This medication will then responsible authority. be dispensed through pill call in the normal manner.” MEDICATION:

Not all medication is being refilled in a drugs, including prescribed medications, timely manner as prescribed. are confiscated. Prescription medi- cations are held for inmates until they

The Hillman Pharmacy2 had an are released in violation of Sheriff’s automatic prescription refill system. Detention Policy Manual. This system would occasionally fill prescriptions even though inmates had 19. One pregnant inmate’s prenatal been released. This system is no longer vitamins were not provided for a month. in place.

A Medical Technician (Med Tech)

During the current booking process, all

Seizure medication was confiscated from an inmate and was not provided 2Also known as HHSA Pharmacy Ø 60 TULARE COUNTY GRAND JURY REPORT 2009-2010 until after two weeks and three 27. Inmates’ medication is dispensed twice emergency visits to Kaweah Delta a day, including those that are District Hospital. prescribed to be taken three or four times a day. Dosages are increased to

One inmate was on chemotherapy when allow for frequency. incarcerated. The Judge ordered the continuation of chemotherapy. 28. The majority of prescriptions are However, two sessions were missed, antibiotics and pain medications. and the inmate had to file a complaint before the chemotherapy was 29. There is no communication or briefing administered. between medical staff during shift change.

A Med Tech threatened to have an inmate’s need for medication reviewed 30. There are multiple conflicts within and because of disrespectful behavior. between Title 15, the Sheriff’s Detention Policy Manual and the Health Care

The Health Care Manual Policy 95- Manual (e.g. Sheriff’s Detention Policy 01(V)(F) (1, 2 and 3) states, “Unused #F-625 and #F-408). medication should be returned to the HHSA Pharmacy in unit dose containers CONCLUSIONS for disposal. Containers shall not be taken apart and the medications shall It appears as though the term “adequate” as not be removed prior to returning to the referred to in Title 15 regarding health care pharmacy. Any unit dose container no has been defined in Tulare County as “barely longer in use (i.e., inmate released, sufficient or satisfactory” instead of medication discontinued or therapy “sufficient for a specific requirement” completed) must be returned to pharmacy as soon as possible. It is Inmates being offered outside medical preferable to return unit dose services in a limited manner and sick call containers on a daily basis. Out of date slips not being processed timely could lead to medications are to be returned to the long term illnesses and additional financial HHSA Pharmacy on a monthly basis.” burden to the County.

In October 2009, a large box of Not providing a secure accounting of unused ‘salvaged’ medication disappeared from medication leads to theft or lost of BWDF. The contents of the box were medication and is not a fiscally sound unknown, due to the lack of a chain of practice. custody. Threatening to review the need for

The Sheriff’s Detention Policy Manual # medication to control inmates is not part of B300 H(3) states, “The Shift Supervisor the policy. will…prior to release...retrieve all inmate medications and give the inmate, not to Jail policies and procedures not being exceed a two-week supply”. followed are causing significant medical and medication problems within the jail system.

Medication does not always go with the inmate upon their release. 61 × TULARE COUNTY GRAND JURY REPORT 2009-2010