No place for a lady

Despite what we’ve seen of the recent incarceration of reality TV star Khloe Kardashian, genuine concern about women in jail has never really been a priority for the media, the public or their jailers, who are described by LA County’s Special Counsel as sloppy and negligent record keepers at best, and at worst caretakers of a world described simply as “miserable” and “hellish.”

Perhaps because there are only 2,200 female inmates — just more than 11 percent of the county’s average daily number of incarcerated men and women — few others than the county’s own investigators and the ACLU of Southern California have paid much attention to the women’s side of the Sheriff’s Department’s barbed wire fence. That is, absent the typically shallow news coverage of the occasional celebrity visit.

Most people probably well remember the case of Paris Hilton, the hotel heiress caught driving on a license suspended for drunken driving and last year sentenced to 45 days, ultimately doing less than half of that at the Century Regional Detention Facility (CRDF) in Lynwood.

Paris didn’t do the full load, but lessons were clearly learned — if not by Hilton, then the Sheriff’s Department — from all the TV coverage that Paris brought during her stay.

The following month Hilton’s former friend Nicole Richie did exactly 82 minutes of a four-day sentence at CRDF for driving under the influence. Lindsay Lohan was next, serving just one day after being busted for driving drunk and possessing a small amount of cocaine.

Then last week it was the 24-year-old Kardashian’s turn. The daughter of deceased OJ Simpson confidante Robert Kardashian on Friday was supposed to begin a 30-day sentence for violating probation following her own DUI conviction, but ended up serving only 173 minutes.

“It is what it is,” she told the Internet celebrity gossip site TMZ.

And clearly what LA County Jail is to Kardashian and others equipped with lots of money, an army of attorneys and a global audience is no place for a celebrity — and sheriff’s officials seem to agree.

Others aren’t so lucky. The truth is, according to the Special Counsel’s report, LA County Jail is really no place for any woman — especially those with children, those delivering children, or women in need of even the simplest medical attention.

“Prisoners are basically considered subhuman, regardless of if they are in jail or in prison, and then it becomes OK to treat them as less than human,” said Gloria Killian of Pasadena, a onetime state prisoner who  was falsely accused of murder and robbery, set free after serving 16 years and now advocates for women locked up in prisons and jails. Killian read the report and was not surprised by its findings.

“Somehow in our society we have come up with the theory that if you are a prisoner — and usually in jail you are only a suspect, you haven’t been found guilty — you are guilty until proven innocent, not innocent until proven guilty,” Killian said.

No records
The 25th semi-annual report prepared for the county Board of Supervisors by Special Counsel Merrick Bobb and his staff at the Police Assessment Resource Center — the first such report focusing on conditions at the women’s jail — describes conditions akin to an asylum of another time; a place where women are denied such basic dignities as tampons, shackled while giving birth and routinely ignored and sometimes abused by deputies; but also a place where requests for abortions are honored with more efficiency than almost anything else.

While officials have reviewed Bobb’s findings and have already initiated at least one change — an afternoon sick call in which an ill inmate would get to see a medical professional within 24 hours — sheriff’s spokesman Steve Whitmore took umbrage with claims that women have been shackled while delivering.

“It isn’t true,” said Whitmore. “We never shackled an inmate during delivery. When I looked deep into that and went to the people on the line who were [supposed to be doing that], it came back to me that we never shackled anyone during delivery and we never do that. … From time to time a pregnant inmate is facing mental challenges, let’s say, and we have been moved to restrain them by a leather strap, but not during delivery. And that is only done when they prove to be a danger to themselves or the child.”

Bobb’s investigation also included a look at litigation brought against the Sheriff’s Department — $10.8 million in fiscal year 2006-07, with 51 percent of that amount, $5.635 million, paid out in six cases involving deaths or injuries of men in custody.

“Ten million dollars is not to be sneezed at, but given the size of LA County, and given the amount of litigation, and given that in years past it approached $18 million or more … if you put it in context, the thing I was most impressed with and most pleased by was that use of force — that kind of litigation was down, both in number of cases and amounts needed to settle,” Bobb said.

On the other hand, he said, “I was disappointed to see a majority of the payouts in the year that we looked at arose in a custody context, three alleging medical issues and three for failure to protect” inmates while in custody.

While Bobb and his team were quick to praise sheriff’s officials and other jail administrators for some progress (there were 16 fewer lawsuits in 2006-07 than the year before, with a total payout of $15.1 million in 2005-06 and with a downward trend in filings since 2001-02), what they found in the women’s jail from December 2006 to May 2007 was especially disturbing, particularly in how inmates with medical problems were treated by deputies and medical personnel.

Generally speaking, the 141-page document states that the department does “a poor job resolving complaints about medical services.” Specifically, the document states, the department received 214 medical complaints during the time under study, the majority of which centered on treatment delays. Of these, nearly one-third of requested examinations had not been completed at the time of the team’s review. “Only 38 percent of the remaining complaints were completed within a 10-day period,” it states.

“We saw firsthand the dedication of many nurses,” Bobb writes. “Nonetheless, there were areas for improvement, principally because of the dearth of written policies in many important areas, including delivery and birth, and the lack of accountability to ensure treatment within 24 hours,” or 72 hours over the weekend, as required by law.

While it is “a significant accomplishment” for deputies and jail medical staff to properly screen mentally ill patients within a 24- or 72-hour period, “The same does not hold true for women who want to see a doctor or nurse after the screening process has been completed,” the report states.
Like Killian, Mary Tiedeman, jail monitor for the ACLU of Southern California, also wasn’t surprised by what Bobb and his team of investigators found.

When it comes to medical delays, “We see that with the men’s jail as well,” Tiedeman said. Shackling of prisoners while giving birth, however, was “a little disturbing,” she said. “There’s no excuse for not having a policy for that. … Delays in medical care are a real problem that we see all the time; that’s at CRDF and at the men’s facilities.”

Yanking chains
With available records, Bobb and his team learned that of the 31,000 women who come and go through the county jail in a year’s time, 1,400 are pregnant, with as many as 60 pregnant women in jail at any given time. However, the Sheriff’s Department “surprisingly does not keep track of how many women deliver children while in custody, although the department guesses that there are no more than 30 births in a year.”

That’s because “few of the policies and programs relating to pregnancy are reduced to writing,” investigators found. “As a result of this failure to have written policies, we encountered understandable but ultimately unacceptable confusion about actual policies, particularly those relating to the transportation and restraint of women in labor and shackling during delivery,” which is prohibited under state law but, despite Whitmore’s assertions to the contrary, is apparently still practiced by sheriff’s officials, according to Bobb.

“We spoke with a delivery nurse at County USC, where some of the women are taken, and that nurse observed that the women were still attached to the long chains that they use for transportation and otherwise, even in the delivery room. We did not attempt to try to get an exact count because it looked like that would be impossible to do,” Bobb recalled.

The intent of investigators, said Bobb, was to note this practice with anecdotal evidence, but “more to focus the department’s attention on not having a written policy banning shackling, so that it would be clear that whether they are doing it or not, it should not be done. We wanted to draw their attention to the absence of policy.”

While again offering no specific numbers, investigators also found that female inmates seeking abortions got prompt attention from jail authorities and were transported to nearby Planned Parenthood clinics to have those procedures performed. When it came to obtaining abortions, the only complaint investigated by Bobb’s team involved a woman who said her request was ignored for so long that it was no longer possible for her to abort her fetus legally.

But even if they are not pregnant, women inmates requiring attention from a doctor or a nurse have waited weeks — some for months, and some in vain. One woman in unbearable tooth pain wasn’t seen at all after asking a number of times to see a doctor.

Another inmate complained that she “had not seen a doctor since entering the jail over a month ago,” according to the report, “and that her back ailment had gotten worse, to the point that she was now confined to a wheelchair.”

Another inmate cited by the report complained of “abdominal pain, back pain, headaches, and blood spotting and said that although she had had her vaginal discharge tested a month earlier, she still had not received the results.”

After investigating the complaints, Bobb’s team determined that two-thirds of the completed complaints were misclassified by jail personnel.

While Bobb’s report points up numerous examples of subpar care, Killian said it has been widely known that medical care for women in jail has always been extremely poor, but “nothing ever improves over the years. … It’s basically the lack of desire for improvement on the part of the administration.”

Killian said what she read in Bobb’s report “actually reminds me of medieval times when they would take the mentally ill and chain them to the wall. It’s that same lack of empathy or compassion for what people are going through.”

Time for change
One of the reasons why jail medical facilities become overwhelmed is the way prisoners are booked into the jail, a process that in some cases has taken days to complete. Between June 2006 and May 2007, records show that although the average time spent in intake was approximately six hours, “a large number of inmates waited significantly longer,” the report states. “In fact, 5,084 women were in intake for more than 24 hours; 831 of those spent between two and three days in intake; and 27 spent between three and four days.”

The problem was the Lynwood jail facility was originally designed as a reception center, meaning that the booking area was meant to deal with inmates who had already been through the intake process. Its holding cells were not meant to house inmates for significant periods of time, and have only narrow metal benches for inmates to sit on. “Although inmates can sit or lie on the floor, this is obviously hellish, and overcrowding makes this alternative even more difficult or uncomfortable,” the report states.

According to several people interviewed by Bobb’s team, “the miserable condition of the holding cells resulted in an overburdened nurse clinic system.” And the primary reason for that was the fact that everyone seemed to know answering “yes” to one of the three classification questions for medical attention — Are you pregnant? Are you on medication? Are you in need of medical attention? — could result in lengthy stays in those cells.

So instead of facing more delays, those women signed up for a visit to a nurse’s clinic when they were settled in a regular housing area, “increasing wait times for an appointment, delaying needed medical care, and potentially putting other inmates at risk of communicable diseases,” the report states.

Killian holds out little hope that much will change soon. But if the Sheriff’s Department is really serious about changing, “They need to do two things,” Killian said. “They have to change the attitude of the culture. Secondly, there are statewide and, in fact, nationwide standards for jail nursing care. One of the things they need to do is restore the central role of nurses, which happens to include patient advocates, and to ensure statewide and nationwide standards are followed. Until we restore medical professionals to their appropriate roles in both jails and prisons,” she said, “not much is going to change.”

Bobb, however, said past reports and adoption of his office’s previous recommendations for change have led to significant improvements in how the Sheriff’s Department operates. He’s hoping this report will have the same impact.

“What I hope comes out of the report is that the department reads it and takes it in the spirit in which it is offered — which is attempting to improve the department — and implements the recommendations, because I think they are well-founded and will help cure some of the problems and issues that we observed,” he said.

After reading Bobb’s report — and remembering that the LA County Jail system is the largest in the country — Whitmore said “In my view, the Sheriff’s Department is doing a pretty good job.” But, he said, “You can always do better.”