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‘The highest risk population’

Every day, a dedicated medical staff at the county jail fights to keep the inmates healthy

BY ABRAHAM HYATT
PHOTOS BY CRISTOPHER GARDNER

NURSE’S NOTES
Over the course of her shift at the county jail, nurse Jean Nolan’s duties will vary. She’ll assist a doctor while he examines a patient, ensure that the doctor’s orders are carried out, check vital signs, and change bandages. And in the case of a medical emergency, she’ll be one of the first medical responders on scene.

On a Tuesday morning, Dr. Robert Latta is talking to a patient who's been peeing a lot.
"Nineteen times in a 24-hour period. It's been getting worse the past few months," John* said. "I'm getting no sleep because I'm up every hour."

John is a small man with short hair, a graying ragged beard, and slouched shoulders. His faded orange jail outfit is too big for him and he's rolled up the pant legs. He keeps his hands folded in his lap as he sits on the examining table.

Latta asks John questions about his medical history as a nurse takes the inmate's blood pressure and pulse. She's seen John several times here in the county jail's sick bay, and she jumps in occasionally to add information about John's high pulse and blood pressure.

"Do you think you're going to be here for just a few days?" Latta asks him.

"No. I'll be here at least until the tenth of June."

The doctor looks down at John's chart and flips through several pages. How long have you had a problem with your blood pressure? he asks.

"He's been here many times," the nurse interjects. "There's also [another] chart."

"What I'm interested in knowing is what degree of treatment [you can get]," Latta says to John. "When you're here, you're going to get treated, but when you're outside ."

"This is going to be my last time. I'm intent. I'm getting into a program," John said.

"Where you can get some medical care?" Latta asks.

* * *

Every day there are between 400 and 500 inmates in the San Luis Obispo County Jail. That adds up to between 12,000 and 14,000 inmates a year. Some stays are only a four-hour trip to the drunk tank and some stays last more than a year.

Every day, about 30 of the jail's inmates are also the medical staff's patients. For the most part, the staff has no idea what an inmate is in jail for. They simply know the patient's health history and the issues they present to doctors and nurses.

And those issues are unlike what the rest of the county's medical community deals with. Because of the large amount of inmates who engage in high-risk behaviors, many of them have health problems associated with substance abuse, HIV/AIDS, Hepatitis C, and antibiotic-resistant infections.

D.J. Andersen is the correctional nurse supervisor at the jail. "What we have in here is everybody," she said. "This is the highest risk population."

Andersen's been working at the jail since it first opened in the early 1970s. Back then, the average population was about 80 inmates a day and Andersen worked 20 hours a week, mainly by herself. Now she oversees a staff of 17.

Only a fraction of that staff is made up of doctors. The rest are part- and full-time nurses who do the majority of work with the patients. Nurses assist the doctor during the morning sick call but they run the afternoon sick call themselves. They dispense thousands of medications to hundreds of patients. They change bandages, test blood sugar levels, treat detoxing inmates, and handle tens of thousands of mundane and serious medical problems every year.

As the years have passed, inmates' health problems have changed. At any given time, if Andersen takes the problems of the surrounding community and magnifies them by 10, those are the health problems she and staff deal with in the jail: common colds, alcoholism, methamphetamine use.

New medications - especially in the psychiatric realm - and advancements in medicine have made her and her staff more efficient as time's gone by. Another form of support has been Sheriff Pat Hedges.

The jail's medical staff doesn't work for the sheriff's department; they're county employees. Andersen said that while the medical and jail staff in many other California counties has an adversarial relationship, San Luis Obispo is the exact opposite.

In fact, she describes Hedges as the most supportive sheriff she's ever worked with. According to her, the sheriff goes to bat for them at Board of Supervisors meetings, he's supportive when it comes to funding, and he's supportive of mental health and medical programs.

Hedges' corrections officers are also a key part of the equation. As she talked about her staff's relationship with the sheriff's department, Andersen listed one fact that embodied their rapport: Since the jail opened, a nurse has never been injured by an inmate.

Even with that kind of protection, the nurses and doctors are always on guard.

"You can't ever become comfortable," Andersen said. "You have to always be thinking of the risks."

 

THE PILL HOUSE
When nurse Bullock brings an inmate’s pill to his or her cell, the routine is the same: Check the face on the ID bracelet to the face on the inmate. Hand out the pills and a glass of water. Check to make sure the inmate has swallowed the pills. Move onto the next cell.

When inmates have a medical problem, an officer takes them from their cell and leads them down concrete corridors to Stahl Hall.

It's a large well-lighted room with wood accents, blue doors, and clean carpets. There's a faded wildlife poster on the wall and a benched sitting area in the middle for patients. Correctional officers in khaki-colored shirts and dark green pants make small talk with each other as they stand watch over the patients. Occasionally, they banter with an inmate in a professional tone.

Around that center space are offices for mental health workers, a room ringed with medical-record filing cabinets - they keep every inmate's medical records for seven years - and an examination room that looks like every other doctor's office in the world: skeleton and muscle diagrams on the wall, a blood pressure cuff, pressboard cabinets, an examination table.

Sitting on the exam table is Jane*. She has an infection on her foot and a sore on her abdomen. She's dressed in a women's-prison cadmium-red outfit. On top of that she has on a yellow protective gown and she's wearing rubber gloves. The reason: MRSA or methicillin-resistant Staphylococcus aureus - one of the medical staff's biggest concerns.

Over time, germs like Staphylococcus have mutated and developed a resistance to antibiotics like those in the penicillin family. To treat an MRSA infection, specialized antibiotics are needed. Until the wound is healed, there's a high risk that the super bugs could be passed on to someone else.

Those resistant germs are very common in jails and San Luis Obispo is no different. Dr. Latta also works at an urgent care facility where, over the past three years, he's seen two MRSA infections. At the jail, between 60-70 percent of all infections are caused by MRSA.

Latta said there are many theories but no proof as to why the germs like institutional facilities. In fact, the San Luis jail has started a study to see if its MRSA cases come from bacteria inside or outside the facility. Either way, they represent a high risk to anyone who comes in contact with them.

When an inmate arrives at the jail with an open sore or a draining wound, the jail staff promptly puts in them in isolation. A laboratory tests the wound to see if it contains MRSA, and the inmate stays in isolation until the results come back.

Jane's results have not come back from the lab, so Jane is still in isolation.

Latta talks with her about how her infections have been healing, and a nurse changes the bandage that protects her foot. Latta also explains to Jane why she's still in isolation and how it's protecting the other inmates and jail staff.

"I have to go to court tomorrow, do I have to wear this?" Jane asks, pulling at her yellow gown.

"Let me ask. I think you do," the nurse says.

"Because I have two courts tomorrow. I have my normal court and I have my drug court."

"Let me go ask," the nurse repeats.

* * *

Patients come and patients go back to their cells. One with a broken foot that's not quite healed. One with diabetes. One with a swollen lump on his head.

Latta explains in simple language why the men and women are in pain. He discuses medication and more exercise. He asks if they have any questions. With his white hair, precise way of speaking, and grandfatherly presence, he seems very small next to the tattooed inmates.

This Tuesday morning's problems are just a slice of what the medical staff deals with. Several weeks ago, a new inmate fell off his bunk and had a heart attack. The nurses saved his life. There are also alcoholics in withdrawal and inmates looking for narcotic medications.

For those going through withdrawal, nursing supervisor Andersen said there are support programs. For the patients who are constantly asking for prescription narcotics, the staff tries to teach them to be responsible for themselves and their own health care.

"Part of [it] is to be proactive and do [their] stretching exercises so that you don't have back pain," Andersen said, referencing a common complaint given by narcotic-drug-seeking patients.

Another issue at the jail is the drastic increase in the number of pregnant women. In the 2000-2001 fiscal year, there were 35. By the beginning of May 2004, there had already been 60 and this fiscal year hasn't even ended. On average there are between seven to 10 pregnant women in the jail at any given time.

Latta said the biggest difference between working in jail and in private practice is the amount and severity of those various issues. To start with, he's never met most of his patients before. He can't do a comprehensive examination. Latta said he knows a patient might have unseen problems, but he has to find the biggest ones and focus on them.

He referenced John, the inmate with the high blood pressure and the frequent urination. John is homeless. Latta and other members of the medical staff feel that the care he receives at the jail is vastly superior to anything he's had in decades. In fact, it's probably saving his life.

"You see people who come in here who really have had no care at all. They're street people, have had problems with alcohol or drugs, or whatever reason. They come here and we try to figure out what's going on," Latta said.

* * *

One of Latta's last patients of the day is Jim* - an insulin-dependent diabetic with a quiet voice.

He and Latta discus his exercise, his carbohydrate intake, how his blood-sugar level has been dropping. The nurse teases him about how he used to be scared to give himself an insulin shot.

Through the visit Latta talks about ways for the patient to keep his blood sugar levels stabilized in the future. But before he starts, he raises the question he asks all the patients he's trying to craft long-term care for.

"Are you out of here pretty soon or are you in for a while?"

Jim looks down at the floor and then at the opposite wall.

"I'm in for a while," he says.

 

* Names have been changed to protect patient confidentiality.

 

Staff Writer Abraham Hyatt can be reached at ahyatt@newtimesslo.com.

 



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