Medical staffing is one of the top problems at the Jackson County jail

When prisoners are booked into the Wyandotte County and Johnson County jails, a nurse is right there alongside the booking officer to assess their physical and mental health.

Johnson County Sheriff Frank Denning considers this kind of screening so important that his department docks the health care contractor for the jail $250 for each prisoner who isn’t seen within two hours of booking.

“We have prevented overdose deaths,” he told The Star. “We’ve prevented the potential for suicide, and then we’ve been able to diagnose their immediate medical needs so that appropriate intervention could take place as soon as possible.”

By contrast, there are no nurses screening fresh arrivals at Jackson County’s jail. Prisoners fill out a 10-question medical assessment form, and no one with medical training checks to see if the answers to those questions match up with the appearance and behavior of the person who was arrested.

“There is screening in place. However, it’s ineffective,” said Lisa Pelofsky, a former Kansas City police commissioner and one of the five members of a task force reviewing procedures at the Jackson County Detention Center.

County Executive Mike Sanders formed the group in late August after the FBI began investigating the use of excessive force by guards against jail inmates. Its task was to evaluate the procedures and culture of the institution where that alleged brutality occurred, and it will issue its report this coming week.

[Read more: Attorney says Jackson County jail guards were slow to admit July injuries to inmate]

Some of the jail’s shortcomings were, according to one member, so “blindingly obvious” that 60 days were plenty of time for the task force to complete its work. Among the top recommendations: Raise the pay of and better train corrections officers, who jail officials admit are overworked and underpaid by industry standards.

But other concerns raised were less obvious at the outset and for some task force members troubling, task force members told The Star.

The report is expected to question the adequacy of the health care system within the jail, and the newspaper’s own reporting amplified that, especially regarding staffing levels at the facility.

The number of medical personnel serving inmates at the Jackson County jail is below what industry best practices recommend, the county’s own medical provider acknowledges.

Up to five nurses are on duty at the jail at any one time to answer the needs of roughly 900 prisoners, according to a representative of the private company that the county contracts with to provide nurses, doctors and other health professionals.

When asked by task force member Karen Curls whether that was an adequate number, Teresa Mathis of Tennessee-based Correct Care Solutions didn’t answer with a yes or a no.

“I’m not saying that’s an adequate number,” Mathis testified. “That’s the contract we have with Jackson County.”

Neither would officials at Correct Care’s corporate office say in response to a reporter’s question what an adequate staffing level should be for a jail the size of Jackson County’s.

“Facility layout, number of facilities and on-site processes greatly affect staffing levels, so comparisons based strictly on numbers are not meaningful,” spokeswoman Karla West wrote in an email.

But in contract renewal talks now underway, Correct Care is asking for a 24 percent increase in number of staff, from 23.35 full-time-equivalent positions to 28.95.

[Read more: Higher pay for Jackson County jail guards could save tax dollars, official says]

That would bring the staffing level in Jackson County closer to what Correct Care provides across the state line at the Johnson County Detention Center, The Star determined by comparing the two contracts.

Based on guaranteed staffing minimums and the average daily population, there is one medical staffer for every 22.73 inmates at Johnson County’s two jail facilities.

At the Jackson County jail, the ratio is one for every 34.45, at best.

Curls, a social sciences professor at Metropolitan Community College-Penn Valley, was the only task force member who did not respond to requests for comment. She was among those voicing the most concerns about medical staffing levels during task force meetings.

“This seems extremely disproportionate as it relates to the possible services that we need,” she said at one hearing.

The quality of care did not come in for much criticism. But the lack of a nurse at booking could leave prisoners vulnerable.

In Wyandotte County and Johnson County, a registered nurse or a licensed practical nurse is on duty 24 hours a day to evaluate every prisoner at booking.

The nurse takes prisoners’ temperature and blood pressure. The nurse asks them a series of questions about their physical and mental health. Do they take medication? When did they last consume drugs or alcohol? Are they feeling suicidal? Nurses judge whether they are getting truthful answers to those questions.

“The upshot is they are able to see red flags right away,” said deputy Kelli Bailiff, spokeswoman for the Wyandotte County sheriff’s department, which runs that county’s jail.

In Jackson County, task force members raised concerns, both during meetings and in later interviews, about whether prisoners with mental problems are getting adequate care due to that lack of screening. Some also focused on whether prisoners were getting proper medication and say that needs more study because testimony was inconclusive.

“My whole thinking is we have to do a lot better with this mental health thing,” chairman Alvin Brooks said in an interview.

Prisoner lawsuits

Procedures for transporting inmates with health issues or disabilities were little discussed by the task force but are the subject of two federal lawsuits filed in 2015.

One that received a lot of news coverage in October concerned a pregnant woman who was transferred in shackles from the county jail to a state facility to serve a sentence on felony charges.

At the time, she was in labor. The doctor that saw her at Truman Medical Center when guards brought her in for evaluation said she was too far along to travel safely, according to the lawsuit.

But Jackson County guards drove her 200 miles to the Women’s Eastern Reception, Diagnostic and Correctional Center in Vandalia, Mo., where she was rushed to the hospital and gave birth to a son.

“I was scared. I was hurting,” Megon Riedel said in an interview at the time her lawsuit was filed in October. “I don’t want somebody else to go through what I had to go through.”

The Star found another case in the files that, until now, hadn’t made the news. It concerns double amputee Gary P. Jones Sr., who is serving a 10-year sentence on drug charges in state prison. Jones’ legs had been removed.

While at the Jackson County jail two years ago, Jones claims in his lawsuit, county corrections officers dropped him while removing him from a van that didn’t have a wheelchair lift.

He claims to have had back problems ever since that day when he was being transported from the jail to a hearing in Independence.

Doug Bonney, a lawyer for the American Civil Liberties Union, looked into the case but does not represent Jones. He said the corrections officer who dropped Jones either didn’t know the county had vans with wheelchair lifts available or “they were too lazy to move some other vans around to get the properly equipped van out.”

Neither reflects well on how corrections officers are trained, he said.

The county does not comment on pending litigation, a spokesman said.

Call for accreditation

There are no state laws governing the operation of local jails in Missouri. So the Missouri Sheriffs’ Association is now developing a set of minimum standards to fill that gap, which association spokesman Kevin Merritt said exists due to what he calls “deliberate indifference” on the part of the state legislature.

But there are national groups that set out best practices and accredit jails that meet standards regarding things like workers’ pay, training, medical services for prisoners and the like.

From 1986 to 1996, the Jackson County Detention Center was accredited by the American Correctional Association. The then Jackson County executive, Kathryn Shields, allowed that to lapse for reasons unknown while she was in office.

Shields, now a Kansas City councilwoman, did not respond to requests for comment, and the jail administrator at the time has died. A spokesman for Sanders said he did not know why his boss didn’t seek accreditation when he took office in 2007.

“One lesson learned is that when you penny-pinch, you pay later,” said task force member William Eckhardt, a law professor at the University of Missouri-Kansas City who is best known as the chief prosecutor in the Vietnam-era My Lai Massacre case.

Indeed, accreditation costs money in terms of fees to the accrediting body and the time and expense it takes to do internal assessments and meet standards.

[Read more: Jackson County jail guards are underpaid, undertrained and overworked]

Denning in Johnson County said being unaccredited does not mean your jail is substandard, as long as management holds itself to national standards.

“The need to spend that money to get a new accreditation plaque to hang on your wall, I didn’t think was necessary,” he said.

However, the task force believes that the investment would have paid dividends in Jackson County. Had some outside group been keeping an eye on the jail, guards might have been paid better, the FBI might not have had to step in and Sanders might not have needed to appoint a special task force.

“I think accreditation keeps everybody on their toes,” said task force member John Fierro, president of the Mattie Rhodes Center.

Joe Piccinini, acting head of the Jackson County department of corrections since spring, has said he and previous administrators have tried to live up to industry standards but admittedly did not subject the jail to outside review.

One benefit of accreditation for any institution, be it a jail or a university, Eckhardt said, is that it helps the officials who run those institutions when it comes to finding money to keep standards high.

“You have the clout to go to the money people and say, ‘If you want to keep us accredited, then you’re going to have to help us correct this,’ ” he said.

In this case, the “money people” are the nine members of the Jackson County Legislature.

Brooks trusts that they will find the task force report helpful in making decisions on how to improve the jail and avoid future investigations and lawsuits.

“I think it will be a good road map,” Brooks said.

This story was originally published October 31, 2015 at 7:29 PM with the headline "Medical staffing is one of the top problems at the Jackson County jail."