Special Report: Health and death behind bars

More than 60 Maricopa County jail inmates have died since 2004, many from illnesses that would be treatable in normal medical settings.

The deaths and other health complaints, most of which go unnoticed by the general public and the media, have raised concerns about access to treatment and growing legal liability to county taxpayers. At the same time, county administrators refuse to release documents in support of their claims that conditions have improved or jail consultants are allowed to tour the jails.

Search the list of inmates that died 2004 - 2008 in Maricopa County jails.

If you do not see the data table, click here to view the year-by-year information.

"We really think the medical care is just atrocious," said Debra Hill, an attorney who's representing inmates in a 30-year-old class action lawsuit. "We have asked the court to let us in, and they won't."

Inmates in county jails have died from asthma attacks, pneumonia, infections, diabetes, heart disease and other commonly treated ailments, according to county records. Since 2004, the dead include two newborns and a 17-year-old boy who writhed in pain for six hours before he was seen by medical staff.

Even those on suicide watch have managed to take their lives in the jails, including Stacey Gruenberg, a 42-year-old who overdosed in July on her own psychiatric medication.

Juries have ruled in case after case that the county was at fault. The county has settled other cases to avoid trial, and still more cases are in litigation. Taxpayers have paid out more than $30 million in settlements, verdicts and attorneys' fees since 1993.

"You have a culture of indifference that's grown over the years," said Scottsdale attorney David Don, who's represented the families of five inmates who committed suicide in Maricopa County jails.

"Is (Sheriff Joe) Arpaio giving orders to deny or delay medical care to people? No, but he's creating a culture where this sort of stuff is permitted to happen."

County officials defend health conditions in the jails, saying they've learned from past mistakes and have made substantial improvements in staffing and communications. They say they win lawsuits in inmate death cases that the public never hears about.

"We think the sheriff is running the jails in a very excellent and satisfactory manner," said County Supervisor Don Stapley, R-District 2. "Does he run a country club? No.

"In my opinion, we're doing as good a job as we've ever done right now."

Sheriff's Capt. Paul Chagolla said Correctional Health Services, and not the sheriff's office, is responsible for providing health care to inmates.

"We are responsible for the inmates while they're in our custody," Chagolla said. "But in terms of providing health care, that's not under the authority of the sheriff."

While it's true that Correctional Health Services, a separate county agency, doesn't fall under the sheriff's responsibilities, the clinics are housed in the jails and detention officers are first responders in a health emergency. Attorneys who sue on behalf of inmates routinely name both Arpaio and Correctional Health Services.

SPENDING INCREASES

Even though spending for Correctional Health Services has nearly doubled in the past five years, to $48.8 million this year, county budget documents for fiscal 2006-07 show:

Most inmates didn't receive health assessments within the required 14 days.

Nearly half who asked to see a doctor or nurse were denied.

Treatment was provided to just over one-third of inmates and correctional health employees identified with a communicable disease or serious infection.

About three-fourths of the more than 9,000 people in the jail system haven't been convicted of anything. Many of them haven't even been charged.

Under federal law, inmates have a right to health care. In Maricopa County, that right is backed up by a consent decree stemming from a 30-year-old class action lawsuit over jail conditions for pretrial detainees, as well as a 1999 settlement with the U.S. Department of Justice.

Phoenix attorney Michael Manning believes the sheriff is violating both the settlement agreement and the consent decree and he's asking the Justice Department to get back on the case.

Manning has won several multimillion-dollar settlements against the sheriff's office and Correctional Health Services for inmates and their families, most recently a $2 million payout to the family of Brian Crenshaw, a blind, mentally disabled man who died after suffering a perforated intestine and a broken neck.

Manning sent a 10-page letter to U.S. Attorney General Michael Mukasey last month requesting an investigation into civil rights abuses of jail inmates, alleging that the sheriff's office has destroyed and altered key evidence in Crenshaw's and other cases, ignored dire warnings from jail consultants and is "intentionally running unsafe, unconstitutional and inhumane jails."

"They don't want the public to know about this," Manning said in an interview. "When they get (consultant reports) and they're critical, they destroy them or lock them in their credenzas."

In the letter, he also took county elected officials to task, saying they "continue to disregard the warnings that taxpayers have paid for, and they continue to overlook the dangerous conditions and loss of human lives."

Stapley disputed Manning's claims and said county officials have worked hard to fix problems. He regularly tours the jails and is impressed by what he sees.

"It is blatantly false," he said. "To say that we haven't done anything to improve conditions in the jails is not true."

HISTORY OF CONCERNS

Several studies, the most recent in 2003, deemed the jails unsafe, unconstitutional, inhumane and dangerously understaffed, among other things.

Inmates weren't getting their medications, and health care services violated national accreditation standards, federal court orders and state law, according to a 2003 report by Liebert and Associates, a consultant hired by the county, that warned these problems could cost the county in court.

The county's own 2004 internal audit of Correctional Health Services was unable to measure any key performance standards because data was either missing or inaccurate.

A 2006-07 statistic showed that only 36 percent of inmates got physicals within 14 days as required by law.

But correctional health officials say conditions have improved dramatically since then, thanks in part to additional funding, 106 new clinical positions, higher salaries and new facilities at the Lower Buckeye Jail in south Phoenix, which includes a 264-bed psychiatric unit and a 60-bed infirmary.

Now, more than 90 percent of inmates get physicals within the required 14-day period, said Margaret Green, deputy director for correctional health. She said the record from 2006-07 doesn't reflect the new hires and likely doesn't account for inmates who were in custody for less than two weeks.

"There has been a consistent, concerted effort to attain a higher percentage since we got our new positions," Green said.

There are still vacancies, including openings for physicians, psychiatrists and nurses. But Green and director Betty Adams blame the vacancies on a national shortage of nurses and doctors. In any case, Adams said, nursing slots are filled temporarily using outside nursing registries.

"We're not at all concerned that we've got sick people in the jails who aren't seeing a doctor in the clinic," Adams said.

But a former medical director for Correctional Health Services says people should be concerned.

Dr. Todd Wilcox delivered a scathing resignation letter in February (PDF: Read Dr. Wilcox's resignation letter), saying jail conditions were deteriorating to the point where he feared that remaining as a contract physician would jeopardize his medical license.

Wilcox was hired as a consultant in 2004, served as medical director until February 2006 and then commuted from Salt Lake City to hold orthopedic clinics several times a month.

"My issue is that they were having me defend them in court, and I just can't do that anymore," he said in an interview. "That's one of the reasons they brought me in, was to try to stem the tide on their legal activity. So many of these cases are so egregious."

The county issued a nine-page point-by-point rebuttal to Wilcox's letter, saying he is a disgruntled ex-employee whose contract was terminated. His claims are intended to earn him another consulting contract with the county, Adams said, and are factually inaccurate.

RECORDS KEPT SECRET

The jail's health care facilities are accredited by the National Commission on Correctional Health Care, a voluntary program that accredits more than 500 jails and prisons nationwide. The county has refused to release the commission's reports.

In addition, until just a few months ago, the sheriff's office had been flouting a state law requiring that it annually provide proof of inspection of its health care facilities to state regulators.

Before the 2003 law, county jail health facilities were subject to state regulation and licensing, like hospitals and child care centers. The law exempted them from state regulation, but required they provide proof that the facilities had been inspected by an outside agency, such as the national commission.

A local interfaith group complained, and the state Department of Health Services sent Arpaio a letter in January requesting proof of inspection. Adams' office released a certificate and a two-paragraph letter as proof, but has refused public records requests, including one from the Tribune, to produce the commission's reports or any supporting material.

In fact, Correctional Health Services earned only conditional accreditation in 2006, according to county records, and only earned full accreditation last year "upon further documentation."

County officials point to accreditation as proof their health programs pass constitutional muster. But a federal judge has ruled that the commission's approval isn't synonymous with good care, in part because it relies on written standards and policies, as opposed to actual quality of care and outcomes.

"The fact that they're accredited doesn't mean that they're operating and practicing good medicine," attorney David Don said. "There can still be major, major issues with the medical care."

Attorneys representing plaintiffs in the federal lawsuit, Hart vs. Hill, have requested sanctions against the county for failing to release documents and recently filed their own public records request.

County taxpayers have spent nearly $100,000 since 2006 to defend the sheriff against Hart vs. Hill, filed by hundreds of inmates in 1977 who complained of poor health care, abuse by detention officers and inhumane living conditions. The county settled in 1982 by agreeing to dozens of improvements. County attorneys want the case dismissed, but defense attorneys say most changes have never been implemented.

County lawyers also have successfully prevented the release of thousands of pages of documents and prevented consultant visits to see if the facilities comply with the consent decree. Frustrated with the pace in federal court, attorneys for the inmates turned to the state public records law.

"We've filed a pretty extensive public records request with agencies and boards," attorney Debra Hill said. "I don't think they can just totally ignore us now."

HEALTH CARE IS CRITICAL

Wendy Goetz was asthmatic and a longtime drug user, according to court and county records. Scottsdale police arrested Goetz after neighbors complained about possible drug activity at her apartment and they found drugs in her nightstand. Tempe police picked her up on a warrant in November 2005.

Two days later, she collapsed at Estrella Jail. She told officers she was fine and didn't need medical attention, but her cellmate had to help her walk back to her bunk. She was dead an hour later from an asthma attack, according to an autopsy.

Inmates in Maricopa County jails are, generally speaking, not the healthiest group. Jail medical staff perform initial assessments as inmates are processed into the jails to determine if there are immediate mental or physical health needs.

"Many, many people who are arrested and booked are at very high risk of all kinds of problems," said Dr. Leonardo Garcia-Bunuel, a psychiatrist who's been practicing in Maricopa County jails for more than 30 years. "They may be homeless, drug addicts, in a state of semi-starvation."

Chagolla, the sheriff's spokesman, said taxpayers are providing health care for people who may have had little care on the outside.

"Many of the individuals who come to the jail have neglected their health for years," he said. "All of a sudden they get into the jail and it's you and I, the taxpayers, who now have to foot the bill for their health care."

Ryan Pearson was a healthy young man when he walked into the juvenile pod at Maricopa County's Lower Buckeye Jail.

Brown eyed, tall and slender, he was a junior at Camelback High School, active in Boy Scouts and the junior ROTC program, and a doting big brother.

Ryan also was accused of molesting the 8-year-old daughter of a family friend. His family couldn't afford bail.

Phoenix police arrested him while he was home sick and his mother was at work, and by early September 2006 he'd been in jail, awaiting trial, for nearly a year.

His fellow podmates would say later that Ryan was quiet and liked to read. He mostly kept to himself, and everyone knew him as "Droopy."

Early on Sept. 7, Ryan told detention officers that his stomach hurt and he wanted to see a nurse. According to a sheriff's office report, officers called the nurse at 2:28 a.m. and were told to have him fill out a "tank order" - a request for medical care - and to drink water or clear soda.

About an hour later, officers again called the nurse about Ryan, "due to his throwing up." She suggested another tank order, according to the report.

Several of his podmates recalled hearing Ryan moaning, coughing and gagging throughout the night. One boy told an investigator that Ryan "was told over the intercom by the detention staff to be quiet or he would be written up."

It took more than six hours before Ryan was seen by jail medical staff, and three more before he got to Good Samaritan Medical Center in Phoenix. The emergency surgery he needed to save his life came too late and he died Sept. 9.

The county medical examiner ruled that Ryan's death was from natural causes. He had volvulus, a rare condition where the bowel twists on itself, cutting off blood flow to the body. The symptoms are abdominal pain, nausea and vomiting.

But volvulus is only fatal if it's left untreated, and doctors told his mother Ryan could have been saved if they'd seen him sooner. "They could've done something about it," Rhonda Pearson said. "I don't know what happened in there. I can't get any answers."

Adams and Green, the correctional health care administrators, said they couldn't talk about specific cases because of federal laws that protect patient privacy. But they said that, generally speaking, suicides and other deaths can be difficult, if not impossible, to prevent.

"The cases that the general public doesn't hear about are cases of attempted suicide that don't happen" because staff intervene, Adams said.

A few months after Ryan died, Francisco Oviedo was placed on suicide watch because he said he wanted to kill himself. He was given a "suicide smock," made of material that can't be torn and turned into a noose. But the next day, according to a civil complaint, two doctors issued conflicting orders - one of them discontinuing the suicide watch and the other renewing it. Oviedo was given clothes and bedding. Four days later, he draped toilet paper over the camera in his cell, tore his blanket and used it to hang himself.

Ambrette Spencer was 38 weeks pregnant when she was booked into the Estrella Jail. Two weeks later, she delivered a stillborn baby girl she named Ambria. In court papers, she says that it took hours for jail staff to respond to her complaints of abdominal pain. In response, the county says it took Southwest Ambulance nearly two hours to get Spencer to a hospital. By the time medics got her to Maricopa Medical Center in Phoenix, the baby was dead.

Adams said there will always be fatalities in jail, just as there are on the outside.

"Some of the people who come in, they could have been in the best hospital in the country and still died," Adams said. "We're not going to be able to reduce that number to zero."

Still, attorneys will continue to push the county to prove that the care it provides inmates is constitutional. And families will no doubt continue to sue when their loved ones die.

Rhonda Pearson doesn't have a lawsuit against the county. Just horrifying memories of her oldest son's final hours.

"I ended up pulling the plug on him," she said. "I couldn't see my child suffering like that."