Medical Care For Inmates Investigated

Published 4:40 pm Thursday, August 1, 2013

PRINCE EDWARD — Piedmont Regional Jail is one of the least expensive places to house prisoners in the state of Virginia.

But, the jail may have been cutting too many corners when it came to medical care, according to the findings of an investigation conducted by the United States Department of Justice (DOJ).

After learning of a series of deaths at Piedmont Regional Jail, The Civil Rights Division of the DOJ began an investigation. The findings, published in September 2012, are not very flattering.

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The investigation found “reasonable cause to believe that the jail is denying necessary medical and mental health care, and consequently places prisoners at an unreasonable risk of serious harm, in violation of the Constitution.”

The jail has been in negotiations with the DOJ to reach a settlement agreement, which outlines the steps they must take to rectify past deficiencies in their medical care of prisoners. The agreement requires the jail to increase its medical staff and revise and create new medical policies in response to the DOJ’s findings.

The jail board unanimously voted to approve the settlement agreement during their June meeting, according to Chairman James Garnett. The DOJ is expected to sign the agreement soon.

Investigation Findings

Last year’s investigation focused on the medical care prisoners received and whether their right to freedom of worship was being violated.

The DOJ interviewed jail staff and prisoners. They reviewed jail policies, procedures, reports, logs and other “relevant documents and data,” according to the findings.

The investigation concluded that inadequate medical staffing was the chief concern. Not only was there inadequate staffing, but the DOJ claimed that “staff members routinely perform medical services beyond what they are trained and credentialed to do.”

The report continues, “Piedmont’s failure to ensure properly trained and credentialed staffing is to be expected, given its physician’s indifference to such standards: while testifying under oath in March 2012, he stated that he was not aware of the staffing standards mandated by Virginia regarding medical staff at correctional facilities. Our finding is also consistent with the findings of other experts and inspecting bodies, who have made similar findings in recent reviews of Piedmont’s medical services.”

Lack of staffing was also an issue in terms of mental health. At the time of the investigation, the jail did not have a psychiatrist, according to the DOJ, which described the situation as a “gross violation of standard medical practice.”

“At the time of our visit, there were 75 prisoners on mental health medications in the facility, indicating the need for at least 20-40 hours of onsite psychiatric care. The Jail, in contrast, provides none,” states the letter of findings.

The investigation did have some good news. It concluded that the jail was quick to rectify hindrances to prisoner’s freedom of worship. It reported, “During our tour, we identified practices that may have created a substantial burden on the religious exercise of prisoners. The jail immediately made changes in response to our recommendations that resolved the issue.”

The cooperation of jail authorities was noted in both the letter of findings and settlement agreement.

Settlement Agreement

Dr. Edward I. Gordon last served as the jail’s medical director, retiring in March, according to Interim Superintendent Donald L. Hunter.

Since the retirement of Dr. Gordon, the jail has had temporary contracts with local providers to deliver medical care for inmates. Centra Southside Community Hospital, The Woodland, Virginia Baptist Hospital and Crossroads Community Service Board have helped the jail, says Hunter, “to make sure that we had all of the components to take care of our medical department.”

At the time of the investigation last year, the jail only had one physician and two Licensed Professional Nurses (LPN), according to the DOJ.

The agreement will require the jail to have at least one Registered Nurse and six LPNs. More are required if the jail’s inmate population exceeds 600 or health assessments are not completed in a timely manner.

The agreement also includes other medical and mental health requirements, including the establishment of policies and procedures regarding initial intake screening, a chronic care program, comprehensive health assessments, sick call procedures, co-payment fees and medical training for officers.

The jail will need a full time Qualified Mental Health Professional and a Psychiatrist who is on-site at least once a week.

A clinical counselor, who was not a trained or licensed physician, was the only mental health staff person at the time of the investigation, according to DOJ, and only at the jail one day per week.

The jail is also to formulate policies regarding mental health services and suicide prevention.

Finally, the jail is required to develop and implement a quality assurance system meant to “ensure that trends and incidents involving deficiencies in medical and mental health care are identified and corrected in a timely manner.”

All policies will be submitted to the DOJ and an assigned monitor for review and approval.

The jail has publicized a request for proposals for inmate medical, mental health and medical laboratory services, based on the requirements of the settlement agreement. The jail board will then be able to enter into a long-term contract with a medical provider or providers.

Staying within this year’s budget is a concern. Hunter pointed out to The Herald that the medical requirements have not raised the budget of the jail yet. He says a lot depends on the responses to and pricing on the request for proposals.

Increased Revenue?

In the past, the seven counties served by the jail had been able to house their inmates at minimal expense because of the revenue the jail received from housing other prisoners. However, the decline in inmate numbers has meant the counties now have to pay to house their prisoners.

Recently-retired Piedmont Regional Jail Superintendent Ernest Toney told The Herald that because of the investigation the jail did lose some contracts, contributing to the decline of inmates at the jail.

The letter of findings substantiates his comments, noting that U.S. Immigration and Customs Enforcement (ICE) decided to stop housing detainees at the jail after concluding that “the medical practice at Piedmont was below accepted community standards.”

The jail used to house over 300 ICE detainees, according to Toney.

Toney had also told The Herald earlier this year that he expects the number of federal prisoners will increase once negotiations are finalized.

Currently, some of the potential sources of inmates won’t talk to the jail until after the agreement is finalized, says Hunter.

After the agreement is signed by the DOJ, Hunter explained, the jail will approach those potential sources again and hopefully gain more inmates.