Jail bite: Inmates get ill, you pay

In 1988, a King County jail inmate named Calvin Hammer got in a fight, and the bones in his face were broken.

Fourteen years later, that may be one reason the county is closing its parks.

Hammer's injuries, the mishandling of his treatment and a subsequent court settlement have led to stringent controls over medical services provided King County jail inmates — and much higher costs.

The cost of jail health care comes to about $15.9 million this year. With the cost of running medical programs at the North Rehabilitation Facility in Seattle and the Cedar Hills Addiction Treatment Center in Maple Valley included, the county's cost for correctional-health-and-rehabilitation services comes to $22.5 million this year.

That's more than the $18 million a year it costs to run county parks, which the county is trying to keep open.

Taxpayers are paying the medical expenses for some of the sickest people in the community, those suffering everything from kidney failure to tooth decay brought on by methamphetamine use.

"Think about who these people are — homeless, mentally ill, drug using — with one or two infectious diseases, with nutritional stress and all that," said Dr. Alonzo Plough, director of Public Health — Seattle & King County, which runs medical services for the county jails.

Providing expensive medical care to inmates is not a problem unique to King County. The state of Washington spends about $60.2 million a year on medical care for about 15,000 inmates in the state prison system.

Snohomish County uses a system of both contracted services and in-house staff to provide medical services for an average daily population of 1,040 inmates at five sites, said a jail spokesman. The estimated cost is more than $1.5 million of the jail's $22 million-a-year budget.

A 1976 Supreme Court ruling established a constitutional standard for inmate health care, essentially guaranteeing that inmates have to be provided adequate medical care, though there's little agreement on what's adequate.

But for King County, standards are set by a settlement approved by a federal judge who ruled on the case of Calvin Hammer.

In 1988, Hammer was a 28-year-old with a criminal history that included drug possession, burglary and auto theft.

On July 25, 1988, he got in the fight in the jail and the bones in his face were broken. He was supposed to go to Harborview Medical Center for an appointment early in August but missed it because no one was available to take him.

Three weeks passed.

"During this time, the broken face bones had partially healed, which necessitated re-cutting the bone in order to reset the fractures and involved unnecessary pain and suffering for plaintiff Hammer," federal records relate.

First filed in King County Superior Court, Hammer's lawsuit was moved to federal court in Seattle. The class-action filing sought minimum standards for custodial and health-care staffing.

Testimony detailed widespread problems in jail operations, including obtaining medical treatment.

Glen Lirman, a public-health nurse assigned to the jail, testified about how inmates' medical appointments often were canceled because there weren't enough officers available to take them. Medical screening wasn't done for days, rounds were canceled and contagious diseases spread through the jail, Lirman said.

The Hammer case continued through the courts for some 10 years. In June 1998, a settlement was reached under the approval of U.S. District Court Judge Barbara Rothstein.

The agreement covers everything from staffing to the number of beds and conditions for driving prisoners to medical appointments. It specifies the number of corrections officers and their assigned positions on each floor for each shift seven days a week. It requires peer review by faculty members of the University of Washington who are not part of the Seattle-King County health department. The county must keep nine categories of records, including dental and psychiatric-care charts. One stipulation was that the jail obtain accreditation by the Chicago-based National Commission on Correctional Health Care (NCCHC).

King County has complied with the orders. On Feb. 22, for example, County Executive Ron Sims noted that the county jails had been accredited by the Chicago commission.

"There are only 60 other large jails throughout the country that have been able to operate under compliance with all 68 standards to improve the quality of health care provided in jails, prisons and juvenile confinement facilities," Sims noted.

Settlement's implications

But the deeper implications of the Hammer settlement had been laid out in an internal county memo in March 2001.

"If we were to lose our accreditation, the ACLU could bring an action to enforce the terms of the agreement. Presumably the ACLU would seek damages, attorney's fees and an order requiring King County to gain accreditation. This might also entail some sort of supervision by the court."

In other words, the county follows the settlement or a federal court could take over the jails.

The jails, which operate in downtown Seattle and Kent, and where the average inmate stay is 18 days, are, in part, a major hospital, with some 140 doctors, nurses and other health-care professionals taking care of the medical needs of about 2,700 prisoners every day.

"Most people estimate the downtown King County jail is either the second- or third-largest psychiatric in-patient facility in the state of Washington," said Plough of Public Health.

Medical operations in a year include 68,000 annual clinical-nursing visits (187 a day, seven days a week), 22,000 clinical-provider visits by doctors and other staff, 21,000 mental-health visits (an average of 60 a day), 2,268 dental treatments and more than 12,000 health assessments.

"We have people on dialysis," Plough said. "We have an arrangement with Harborview to provide daily dialysis to people with kidney failure. This is a very sick group. That becomes our obligation, to provide this care when they're in jail. We don't have any choice. It's all mandated."

Plough says that, if anything, the problems are worse than in 1988, with twice as many inmates and the onset of ailments such as those caused by methamphetamine use, which destroys dental enamel, and other new diseases.

"Individuals who are addicted to meth come in with essentially eroding teeth," he said. "So we are essentially doing extractions and pain management.

"You have double, triple, quadruple-diagnosed people. We'll have people who are mentally ill, substance-abusing, TB- and HIV-positive. Those are not unusual profiles for us to be treating," he said.

There's also little or no help in paying for such expensive treatment. Most of the inmates don't have medical insurance.

"Federal health insurance, Medicaid, is not designed to pay for services for people who are incarcerated," Plough said. "I think no one would argue that the jail is not the best common pathway for these health problems, but it has by default become so."

Mattresses still on the floor

A visit today to the Seattle jail's medical facilities on the sixth and seventh floors finds a place that looks much the same as in 1990 photographs that were part of the Hammer lawsuit (no photographs were allowed on the recent visit).

Inmates still sleep on mattresses on the infirmary floor. Conditions remain about as crowded as they were 14 years ago.

In the pharmacy, for example, five people work in a space about 8-feet-by-15-feet to fill some 300 prescriptions a day.

"It gets smaller every day," said Liz Burzloff, a pharmacist working at a computer screen among piles of cardboard supply boxes.

In other areas, thousands of dog-eared medical files are stacked along walls, obviously thumbed through countless times and representing the medical histories of thousands of inmates, most of whom are frequent jail visitors — 58 percent of the jail's 60,000 annual bookings are of repeat offenders.

Twenty-three inmates were in the infirmary areas that day, five lying on mattresses in one room. That's partly because it's nearly impossible to provide normal hospital beds; they're usually destroyed through vandalism or by inmates trying to make them into weapons.

There were 164 inmates in psychiatric housing, an area designed for 125.

In another section, two nurses were giving insulin shots to diabetic inmates, a cost that wouldn't be needed outside the jail, but inmates can't have needles.

Adam Thorp, a corrections officer, was about halfway through his shift of looking through a glass panel into a room about 20 feet by 20 feet with 18 people inside — that's the suicide watch.

Officials say they're doing as much as possible to reduce costs and still meet the requirements of the Hammer settlement.

They're trying to devise plans to reduce the average inmate populations, which have doubled since the 1980s. Developing a jail master plan is part of those efforts, but draft plans note that there isn't any agreement on who should be in jail, with inmates varying from drug offenders to people with suspended driver's licenses.

"We're trying to do what makes sense anyway," said Bette Pine, interim director of correctional health and rehabilitation services. "We're looking at every aspect we know of for cost containment."

But Pine wonders if some of the proposed cuts will simply lead to greater problems later, as more sick people end up in jail.

"Sometimes, if you scrimp on things, you end up paying more down the road," she said.

And Harborview Medical Center officials worry that the budget restrictions will lead to problems there, as other programs collapse and Harborview is left to cope with the remnants.

The plaintiff's story

Calvin Hammer was last reported living in North Seattle but has since moved away. Fred Diamondstone, Hammer's attorney in the lawsuit, says he has lost track of him but remembers that he became something of a "success story," straightening out his life and getting a job running an oil-change business.

But a warrant was issued for his arrest after he got a speeding ticket in Cowlitz County in 1995, and court records indicate he filed for bankruptcy in Arizona in 1998.

Peyton Whitely: 206-464-2259 or at pwhitely@seattletimes.com