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COVER STORY : Hard Time : Charges of Poor Medical Care for Inmates Have Plagued the County Jail System for Years. And Treating Prisoners With AIDS Could Further Tax a System That's Overburdened.

April 25, 1993|LUCILLE RENWICK

THE THOUGHT OF MICHAEL Vignol hanging by a bedsheet in a Los Angeles County jail cell haunts his mother and his former case worker, both of whom wonder why someone so afraid to die would take his own life.

Sharon Vignol believes that her son, who had AIDS, did not intend to kill himself, but was merely staging the desperate act Feb. 6 to get the attention of jail officials, who he said had not provided him with methadone and antiviral medication for the three weeks after his Jan. 12 arrest. Mark Yurkovich, Michael Vignol's case worker at a Hollywood methadone clinic, said the 24-year-old may have decided to end his life after he figured that he would die in jail anyway because of a lack of proper care.

"He went into a system that didn't work," said Yurkovich, who had treated Vignol with methadone since last year for a longtime cocaine addiction. "I'm not saying the system killed him . . . but (his life) was certainly cut short and the quality of the last few weeks of his life was awful."

Vignol was among scores of inmates who have complained to county officials and advocacy groups of problems with medical care in the county's jails. Accusations of substandard delivery of medical care to inmates have plagued the jail system for years, leading to state investigations and lawsuits claiming negligence and, in some cases, wrongful death.

Although officials at the county jails concede that the system's medical services are not perfect, they contend that they are offering the best care possible in a system that has a staff of 337 doctors and nurses to serve 20,000 inmates in 10 facilities.

"For the overall part, you're talking about some of the best medical care that's provided (for the inmates)," said Dr. Orlando Pile, head of communicable diseases for the county jail system. Pile's division, which has a staff of 10, was formed in 1986 to deal with the increase in communicable infections. It also provides counseling and education on tuberculosis, sexually transmitted diseases and other ailments.

Some inmates have praised the jail system's medical care, which operates on a budget of about $40 million a year. In fact, Pile said, some inmates have told him that they purposely committed crimes so they could get back into jail hospital wards.

But many inmates say the system is rife with inattentiveness and a simple lack of concern for their medical problems, despite federal laws mandating adequate care for the incarcerated.

A 1992 evaluation by the state Department of Health Services of the Men's Central Jail near Union Station and the Sybil Brand Institute, a facility for women on the Eastside, revealed that both jails "failed to develop comprehensive plans of care for each patient to meet the patients' medical, nursing and psychosocial needs."

The report, which was part of a procedure to license the jail system, also noted that at Sybil Brand patient health care plans "fail to adequately describe the patients' needs, problems, concerns."

In one case cited in the report, a woman incarcerated at Sybil Brand on Aug. 15, 1991, received a doctor's order two days later calling for a daily change of bandages on an injury to her right hip for 30 days. The report said that the first dressing was not changed until Aug. 23, a day after the woman's wound became infected.

The report also noted that in a survey of 51 medical records at the Men's Central Jail, the facility's staff "did not notify the attending physicians of observed changes in condition of patients." Patients with recent seizures, abnormal lab results, serious infections or nausea and vomiting were not immediately scheduled to see a doctor, the report said.

The jail system has begun to address several of the issues mentioned in the report, said Susan Weekly, director of medical services.

"We continue to try and make changes to improve the care and have done well in the past 10 to 12 months. I'm proud of our progress," Weekly said.

In 1991 at Men's Central Jail, more than 300 inquiries regarding the medical status or treatment of inmates were filed with the Sheriff's Department by inmates, their families or attorneys, Weekly said. Some inquiries complained of medical care or medication that had been denied. Every complaint that is filed is investigated by sheriff's deputies, said Capt. Dennis Dahlman, commander of Men's Central Jail since 1990.

Inmate advocates say there are some promising signs.

In the past two years, the number of complaints to the local chapter of the American Civil Liberties Union regarding medical care in the county's jail system has dropped by about 50%--from the former daily average of 20--as improvements have been implemented, said Lisa Anderson, an ACLU attorney who handles cases regarding medical care in jails and prisons. Anderson has been working closely with county jail officials for the past 18 months.

"Things are coming along. I don't get nearly as many complaints as I used to. But there's a long way to go," Anderson said.

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