In sickness, in health and in jail
By DEBORAH O'NEIL
Around the corner from a medical ward where 15 inmates are crammed in a space built for six, Pinellas County Jail physician Dr. Tim Bailey is treating the achy and infected during Monday morning sick call.
He will see 30 men this morning in a sliver of a room converted from a supply closet to an examination space.
A diabetic comes in with a blood sugar level far too high.
One inmate has a dog bite on his leg and another has a bruise on his face.
One man who had heart surgery is refusing to take his medication.
Down the hall, the jail medical staff is monitoring an alcoholic who doesn't know where he is as he enters his fourth week of alcohol withdrawal. At the other end of Bravo, the jail's medical wing, the staff has ruled out tuberculosis in another inmate.
Serious illness, disease and injury among the 2,700 inmates a day at the Pinellas County Jail is alarmingly routine. For some very poor inmates, the medical care they receive at the jail is the only care they have had in years. Some inmates are there because they have been sentenced to serve time; others are awaiting trial.
For Sheriff Everett Rice, treating them amounts to a $10.3-million annual medical program with 144 employees.
"I don't think people realize how much of an indigent population we have in here," Bailey said.
Jail officials say the number of inmates needing medical and psychiatric attention grows annually. However, they say, the jail facility was not designed to accommodate the complex medical issues that are an everyday reality.
To deal with the challenge, county officials are starting a project that is not likely to elicit much enthusiasm in the community. Plans are under way for a $30-million jail medical building that will expand and consolidate the medical space. The building will be paid for with Penny for Pinellas dollars and built on the jail campus in 2003 and 2004.
Whether the county should invest so much in inmate health care is debatable.
"It's not a popular thing, tax dollars having to be spent on medical needs at the jail," Rice concedes. "But they're human beings and we have to attend to their needs."
Even Pinellas County commissioners have questions.
"My concern is I don't want to see us getting into the hospital business," Commissioner Barbara Sheen Todd said at a recent meeting.
About 20 percent of the country's 3,300 jails have full-time medical services like Pinellas. The rest typically have a nurse or doctor who is on call or visits at certain times, said Scott Chavez, vice president of the National Commission on Correctional Health Care. How much care is delivered is left to government leaders who set jail budgets.
"Jails don't have an opportunity to have a flow of revenue,' he said. "What they get is what they get."
One serious case of AIDS can dramatically drive up costs, he said. Pinellas already has spent nearly $200,000 on AIDS medications this year. Locking people up costs money.
"If you want safety you have to pay for it," Chavez said.
Sick and injured
Bailey and a cadre of 77 nurses treat inmates amid constant banging, clanging, shouting and the dizzying smell of chemical cleaners.
There are other unpleasantries. On a tour, one inmate is standing at the bars, brazenly gripping his crotch. Many areas of the jail have mobile screens that nurses use to protect themselves from flying feces, urine and spit.
Victoria Scotti, a registered nurse and the jail's administrator for inmate health care, said no amount of pep talking can prepare new nurses for what they see.
"I tell them you're either going to love it or hate it," she said. "You can tell by the look on their faces if they're ones who are going to stay."
On top of all that, the medical staff must figure out when an inmate is lying for attention or drugs. One man, Bailey said, pretended for months he was paralyzed from the waist down.
"He wasn't," Bailey said. "He actually peed on himself several times to make his point."
Antics aside, Bailey says more often than not, inmates truly are sick. The degree of sickness in the Pinellas jail is not unusual, experts say. Inmate populations typically are indigent people who do not have access to health care.
"There are a lot of serious illnesses, much of which tend to be undiagnosed and untreated," said Dr. Joel Nitzkin of New Orleans, a consultant in public and correctional health. "They are difficult to manage in the jail environment."
In the year since Bailey joined the jail, he has seen an inmate with lung cancer, stroke victims and people missing limbs who must use wheelchairs. In fact, the jail has retrofitted some areas for the disabled.
There are hundreds of people at the jail with hepatitis C -- Bailey estimates 35 percent of the jail population carries the viral disease of the liver.
There are junkies coming off drugs, alcoholics going through withdrawals, broken arms, legs and jaws and all the routine flus and bugs.
In the last fiscal year, 224 pregnant women were booked into the jail and many were high risk pregnancies because of drug or alcohol abuse. The jail has a pregnancy protocol to provide the female inmates with prenatal care.
Some people get sick or sicker while they are at the jail.
"People deteriorate in here," Bailey said. "There's no doubt about it. How long can you take it in this place? A lot of people don't have the makeup to handle it."
The medical staff also tends to psychiatric patients, who are closely watched.
In all, inmates logged 157,000 visits with the jail's medical and psychiatric staff from October 2000 through September 2001. If trends continue, the jail will likely surpass that number in the coming fiscal year.
In Pinellas, jail officials say anyone sick enough to be in a hospital is sent there. The rest must be cared for while incarcerated. The jail has 186 beds for ill and psychiatric inmates spread in various wings. They all are usually filled.
The medical B-wing was built to house 44 inmates. It was renovated in 1995 and 1996 to meet immediate needs, said Carl Barron, director of general services for the county.
One day last week, B-wing had 70 inmates. One ward for six inmates had 12. Another the same size had 15. They squeeze the men in by laying portable plastic beds on the floors.
"We just step over people," Scotti said. "It's one of those places we never say, "Oh we're full.' We do what we have to do."
Nurses have to sit on the floor to insert IVs because cell bunks sit so low to the floor. Inmates with health emergencies are dragged on mattresses into the hall because cells are too small for medical response teams.
The infirmary, with its six hospital beds, is usually full. And so are the jail's three isolation rooms where inmates with suspected or diagnosed communicable diseases are held. The isolation rooms don't have hospital beds because the doorways are too narrow and the rooms are too small for the beds to fit.
"We don't have enough facilities to handle all the sick people there," Rice said. "We've got people scattered in different areas of the jail."
The jail's "new clinic" is a 6-year-old cramped hall with four examination rooms, a dental room and a trauma room for emergencies. Nurses do physicals, medical histories and other routine medical procedures there 24 hours a day.
"We've totally outgrown this clinic," Scotti says as visitors try to maneuver out of the way in the small area.
Lack of space is also an issue when it comes to supplies and medical records storage. Medical supplies are tucked in closets all over the jail because there is no space for a central supply room, Scotti said. One inmate bathroom in the female barracks is overflowing with wheelchairs and other medical equipment.
The records room is filled ceiling to floor with medical records that must be kept for seven years. Some inmates' medical files are two and three volumes thick.
How the new building will be equipped and designed is yet to be determined. Experts will consult with the medical staff to create a building that fits the needs and stays within the $30-million budget.
But the medical staff certainly knows what it would like to have: 350 beds total; a 75-bed infirmary; 120 beds for male psychiatric patients; plenty of storage and supply space; a larger clinic; a medications room for nurses to prepare to dispense treatments and more isolation rooms.
"If we had proper space, proper layout, we could be more productive," Scotti says.
* * *
224: Pregnant women at jail in last fiscal year
272: HIV positive inmates in last fiscal year
328: Average number of medications stocked
$614,000: Amount spent on medications, January-September
$194,300: Amount spent on AIDS medications
610: Number of male inmates admitted to medical wing in October
1,007: Number of doctor visits in October
6,336: Number of nurse sick call visits in October
899: Number of inmates on medication in October
144: Number of medical staffers
$7.2-million: Annual cost of medical salaries
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