by KIM HILSENBECK
What happens these days when inmates in the Hays County jail need shots or meds? What if they need a doctor?
Hays County has joined the national wave – at least in part – and has privatized its jail infirmary. A unanimous vote of the commissioner’s court gave the contract to the Tennessee firm, Correct Care Solutions (CCS) for all inmate care.
Jails and prisons in several other states have switched to private management firms, with varying degrees of success. In some prisons and jails, private firms manage the entire facility. In Hays, only the medical portion of the facility is private, while the rest remains under the purview of the Hays County Sheriff’s Office (HCSO).
At the commissioner’s meeting, a CCS representative said all medical unit employees would have to reapply for their positions. In about 96 percent of cases in other facilities, he told the commissioners, current employees were rehired by the firm.
Under the current contract, CCS rehired two part-time and three full-time employees from HCSO. One employee, Adrienne Sparks, resigned as a conscientious objection to privatizing inmate medical care.
Lt. Eric Batch of the support service area of the jail, who is the liaison with CCS medical staff, said CCS also rehired the same medical doctor who was working for HCSO. The doctor comes into the infirmary once a week and is on-call if the nursing or other medical staff has any questions.
Initially, Batch said, there were very few changes that involved process, such as intake screening on new inmates, sick call or med pass, which is shorthand for making medical rounds.
“(CCS) did change up the way they’re doing the meds rounds,” according to Batch. “It’s taking a little longer. They used to organize med pass by location before but now CCS does it alphabetically. When you change something, it’s going to take a little time to learn from what employees used to do. Once they get used to it, the process will be quicker.”
Batch said the main reason an inmate might complain about not getting medication was lack of preparedness.
“The biggest issue,” he said, “was, for example, inmates not coming in from the rec yard in a timely manner or taking a shower instead of receiving meds.”
In some cases, he said, they were slow at getting ready to receive their meds.
“We announce med rounds,” Batch said “Then the inmates get prepared to come into safety vestibule; they get water, their ID and then get in line. If no one else is in line, we close that door and move on to next area. [If they don’t get in line] it’s almost as if they are refusing.”
However, Batch added that medical personnel will make sure if an inmate needs a particular medicine, such as blood pressure or psychotropic drugs, he or she gets it.
“They’ll get it if they’re on the list. We’ll even wake him or her up if we know they need it. We want them to get their medication because if they don’t, then we have other problems.”
Batch said an officer will stand with the medic, who asks inmates to open their mouths and lift their tongues.
“They can find ways to hide it and we’ve done some searches and found some inmates hoarding medication,” he said.
Why would inmates not take needed medication?
It may be the side effects, Batch said, such as feeling nauseous or drowsy.
“But the biggest reason I’ve seen,” Batch said, “is they think they’re better and no longer need the medication. But then once it’s out of their system, the problems start all over.”
The decision to privatize the infirmary, according to Hays County Commissioner Pct. 2 Mark Jones, was to save the county money if possible but also to provide mental health services for inmates. The facility has not had a mental health provider on staff since early 2012 when the previous doctor passed away.
Based on a review of the contract, the services provided by CCS will cost the county about $1.2 million annually – about $317,000 more than the $828,500 allocated for medical expenses in the 2012 budget year.
In February, the Texas Civil Rights Project (TCRP) filed a wrongful death lawsuit against the HCSO on behalf of Diana Riley, whose son, Eric Dykes, died at the Hays County Jail.
Jail personnel found Dykes hanging in his solitary confinement cell March 26, 2011. The lawsuit alleges he threatened to commit suicide and that he was not receiving his medication on a regular basis. Attorneys working on the case said he was bi-polar.
Part of the issue, according to Austin lawyer Michelle Smith with the TCRP, is that Dykes was transferred to the Guadalupe County Jail twice during his 14-month incarceration, which interrupted his medical treatment.
Dykes, who was 25 at the time of his death, spent 14 months in the Hays County Jail as a pre-trial detainee. Arrest and court records show he was booked on charges of aggravated robbery. The lawsuit places the responsibility for his death squarely on the jail supervisors, though the suit also names Sheriff Gary Cutler and other top officials at HCSO.
The HCSO admitted no wrong doing in the case.
A current resident of the Hays County Jail, Justin Dawes, is also bi-polar, according to his wife, San Marcos resident Charis Dawes. She told the Hays Free Press recently that, just like Dykes, her husband is not consistently receiving his medication.
“He’s been in for two months and only received his meds eight times,” she said.
Batch said he has not seen any grievance from Dawes.
Dawes’ wife, Charis, sent a request on June 16 to Texas Gov. Rick Perry to declare the prison system in a state of emergency due to what she called “hellhole conditions” at jails and prisons around Texas. Part of her complaint is the poor and inconsistent treatment of inmates with mental health issues, along with inhumane treatment including roach and rat infestations, abuse by prison guards and overheated facilities.
Healthcare laws prevent the jail staff from releasing information related to an inmate’s medical treatment, but Deputy John Craigmile, who works in the jail division of the HCSO, said the medical staff keeps records of medication dispensation.
In March, nurse and 19-year employee John Cavanaugh in the jail’s infirmary, who was rehired by CCS, said electronic charting took about five years to implement but the jail now has an electronic record of every inmate who needs medication, along with the type, dosage and time it’s administered. Batch confirmed the process.
According to Texas law, jails must provide medical care to inmates. Hays County maintains a 362-bed jail. The facility’s inmate population ranges from 300 to 320 people. About 15 percent of the Hays County Jail’s prisoners are women.
Medical expenses have decreased about five percent in recent years, from $875,200 in the 2010 fiscal year to $830,600 in 2011 and $828,500 last year.
County records show the jail books about 8,000 inmates each year. Not all inmates are convicted of any crimes; some are awaiting trial but cannot post bail, as was the case with Dykes.
Since the implementation of the contract with CCS, Capt. Mark Cumberland, who oversees the Hays County Jail for the HCSO, said he’s very positive about the change.
“It’s very structured, professional and it addresses some of the issues we had very directly,” he said.
When asked about the specific issues, Cumberland said the CCS resolved healthcare issues in the medical unit.
“[The new firm] is more modern, informed and knowledgeable,” he said. “Law enforcement is not the expert at healthcare.”
Batch agreed.
“I like it. We have a higher level of expertise now working in the medical facility. The employees have a wide variety of experience and knowledge,” he said. “We have more qualified people in infirmary now.”
He added that the infirmary can also do many procedures in house since the change.
“Things we used to send inmates to hospital for, we can now do here,” he said. “Things like simple sutures, high blood pressure monitoring and more.”
Batch said doing those procedures in house saves the county money because transporting inmates is expensive.
