County officials say major improvements have been made in the medical and mental health treatment of prisoners in the Oklahoma County jail, an issue the U.S. Justice Department has identified as a serious problem.
“We've been working with our medical provider and I would say they're very close on a lot of issues already. It took a change, really, of an entire mindset of the agency,” Oklahoma County Sheriff John Whetsel said Friday.
A new medical contractor and revamped assessment and treatment operations at the jail have resolved most of the operational concerns at the jail's medical and mental health facilities, Whetsel said.
Whetsel said the county jail is the largest mental health facility in the state, with about 350 to 400 inmates diagnosed with a mental disorder or on psychotropic medication at any given time.
Florida-based Armor Correctional Health Services Inc. is the new medical provider at the county jail, and likely the most important change the company has made is the retention of a new physician, Dr. Jerry Childs.
Childs, who has 30-plus years of emergency room experience, has stepped up supervision of physician assistants and nursing staff and, along with Armor, has implemented policies that provide better guidance to nursing staff on critical assessments and follow-ups, Whetsel said.
Additionally, Armor installed an electronic medical record system at the jail last year and developed new policies on urgent care assessment and chest pain nursing protocol.
Armor “believes it has resolved the health and mental issues at the jail, but we are awaiting an official response from (Department of Justice),” said Vickie Freeman, the company's vice president of clinical support and operations.
Justice Department officials said in a letter to the county dated March 15 that a failure to address problems with the jail's medical and mental health treatment programs appears to be contributing to significant harm at the jail.
At least three of seven deaths reported at the jail since March 2011 involved serious clinical missteps, including a lack of appropriate assessments and follow-ups and tasks beyond the clinical capabilities of staff, according to the letter.
Remaining issues identified by the Justice Department in the letter include insufficient staffing levels and the facility itself, Whetsel said.
He said 56 of 60 potential civil rights violations identified by the Justice Department in 2007 will no longer be monitored, but funding limits the county's ability to address these final problems.
Maj. Jack Herron, jail administrator, said operational improvements at the jail already have contributed to a decline in violent incidents, the use of force by staff and recidivism in general.
Better partnerships with the state's health care community, as well as cooperation with the local public defender's office and district attorney, has meant better treatment options and lower incarceration rates for inmates with mental health issues, Herron said.
Among other improvements:
• A new inmate monitoring system;
• A “suicide watch” program;
• An inmate classification system;
• A use of force panel review board; and
• Additional health care staff, including the hiring of a full-time psychiatrist.
Herron said the jail also converted a former storage area on the 13th floor into a new waiting room for the jail's medical center.
These improvements make jail staff “better able to monitor and hold people accountable with what's going on,” Herron said.
But there are still obstacles.
The staffing and infrastructure limitations at the jail forbid many of the federal department's health care recommendations from being immediately adopted, Herron said.
Retention is a problem with both correctional officers and health care staff, and there hardly is room to expand the capacity of either mental or physical health treatment programs.
“The jail was not designed with a medical wing in it,” Herron said. “My doctor, I've got him housed in a cell. We really don't have the clinic resources, we don't have the exam rooms — we're just making do with what should have been a housing unit.”
And some of the issues outlined by the Justice Department, particularly those related to mental health treatment, are disputed by Armor and the county.
In a response letter dated April 11, Armor said timeline recommendations for assessing inmates with potential mental health issues are more stringent than the community standard or that of the National Commission on Correctional Health Care.
Also more stringent is the department's recommendation for health care staff-to-inmate ratios, Whetsel said.
“We have more psychiatric staffing at the Oklahoma County jail than any other jail in the state of Oklahoma, or prison for that matter,” he said. “So we're trying to figure out either how to address that from a standpoint of working with Armor or … with Department of Justice to look at what they're trying to hold us to.”
Dr. Stan Ardoin, who retired last November as medical director for the state's Mental Health and Substance Abuse Department, said he believes the sheriff and his staff are headed in the right direction in trying to improve medical and mental health services at the county jail.
Ardoin said the jail's problem, though, is more of a social one than a political or financial one. The community needs to step up and make sure that its incarcerated citizens are taken care of, he said.
“When a patient tells me, ‘I spent 10 days or two months in the Oklahoma County jail,' I shudder with that patient in sympathy,” Ardoin said. “It's not that we need to make a knee-jerk reaction to the Department of Justice, but we need to make it a good jail because we have citizens who go into the jail, many of them with a variety of health problems, and those citizens are going to come out of the jail.”
Whetsel said his department has injected upward of $10 million in capital improvements into the jail since the Justice Department's findings. The county must meet all the requirements by 2014 or risk federal litigation.
In February, county commissioners approved a contract with a Georgia firm that will help develop a concept for a new jail.
A new jail — estimated at more than $300 million — would solve all these problems, said Oklahoma County Commissioner Ray Vaughn.
“But we're moving ahead as fast as we can,” he said. “If the citizens will trust us — and that's a big issue given the response the last time they built a jail — they've got to know we're not going to make the same mistakes that our forefathers did.”