A Phoenix Fire Department ambulance outside Maricopa County’s Watkins Jail. Maricopa County Sheriff’s Office Diane Smith. James Deak according to the complaint in the suit, did not provide Esquivel treatment for the resulting abscess. The infection then spread from his foot. He was hospitalized “repeatedly,” after being released, and has “undergone surgical amputations and skin graft procedures,” the complaint alleged. It appears Esquivel was never charged with a crime. In legal pleadings, attorneys for the county denied any negligence had caused his injuries, and claimed that staff had acted in accordance with policy. Last year, though, the suit was settled for an undis- closed amount. Two other recent lawsuits raised similar claims. One, filed in April in Maricopa County Superior Court, alleges that a man who was clearly ill was not provided medical care for a serious bacte- rial infection and a rare, life-threatening form of Valley fever — until he was found unconscious in his cell. He was in a coma for two weeks as a result. The other lawsuit, from 2020, docu- ments the March 2019 case of a man with a heart infection who was given only Tylenol and a “big glass of water” for his symptoms. After a month without treat- ment, he died in jail. The county has not yet filed a response in court to claims in the first lawsuit. In the second lawsuit, the county did not contest most of the claims by the man’s family about his death, though it denied liability. In fall 2021, all parties mutually agreed to dismiss the case. Details about a settlement are unclear from federal court records. Calbert Gillett, a spokesperson for the sheriff’s office, wrote that the agency would not comment on pending litigation. Gillett did not reply to other questions for this story, including questions about lawsuits that have been settled. Phoenix Fire Department data shows that emergency services responded 28 times so far this year to the 200 block of Fourth Avenue, where the Fourth Avenue Jail is located. Five times, the fire depart- ment was called for a hanging, three times because someone was unconscious, and twice to treat someone who had stopped breathing. These calls are common, years of fire department data show. No other year for which data is available, back to 2014, indicated there were more than two or three calls for a hanging in the same period, however. According to documents and multiple sources within MCSO and CHS, the quality of health care has worsened further since the onset of the pandemic in 2020. This is hardly a surprise. Over the last two years, the county jails have suffered from serious understaffing, as New Times has previously reported. Prior reports by New Times showed that the jails had implemented new emer- gency protocols as a result of the under- staffing. People in custody say that lockdowns, resulting from too few deten- tion officers on shift, are frequent. These lockdowns are referenced in the new documents obtained by New Times. On two occasions, the lockdowns prevented medications from being distributed, audi- tors found. The understaffing has taken a toll on correctional health as well. “The project team considers Maricopa County to be operating under crisis stan- dards of care at the time of our assess- ment,” the consultants wrote of this understaffing. “While the county has been aggressively working to mitigate any effect these shortages will have on opera- tions ... there is only so much CHS can do given these exceptional challenges.” Over the last year, 400 out of Correctional Health Services’ 512 total positions have typically been filled at any given time. According to the most recent figures provided by the county, 394 posi- tions at CHS are currently filled. That’s approximately a 23 percent vacancy rate, a slight improvement over the vacancy level the consultants identified at the end of November, which was around 26 percent. Last October, Maricopa County commissioned a “workplace environment assessment” of CHS, in response to “growing concerns regarding staff levels and reports of missed medication passes,” the county said. Chandler-based govern- ment consulting firm 65th North Group was contracted to carry out the assessment. The resulting report, which was released on February 13, focused, in large part, on coping with severe understaffing. It provided several dozen recommenda- tions for how to improve operations, including restructuring CHS’s leadership, upping employee pay, and formalizing protocols for reporting failures in health care. The report also provides a window into how seriously CHS’s operations have been impacted. “Nobody, Not Even the Critical Ones, Got Done” On May 3, 2021, Diane Smith submitted a grievance to the medical staff at the Estrella Jail, the county women’s jail where Smith is in custody. “No medications for the evening were administered to any inmate in A-300,” wrote Smith, a former nurse, referring to the section of the jail where Smith stayed. Smith, 53, faces murder charges in the shooting of her husband, who she claims she believed was an intruder. She has not yet gone to trial. In her complaint, Smith detailed “alarming side effects” she experienced from missing her heart and blood pres- sure medication. “Several inmates are stating that they alerted guards throughout the night of the situation, but it was not remedied,” she wrote. “This infraction needs to be reported to the state.” The grievance, according to the mate- rials Smith provided to New Times, was closed with only a brief note apologizing for “any perceived unsatisfactory patient care” and a promise to bring the issue to a supervisor. New Times provided the grievance number and other documentation of the complaint to the county, which said it could not comment on details of care for any particular patient. Federal law prevents health providers from disclosing health information without a patient’s consent. The county isn’t required, according to the consultants, to report such failures to the state. But because of how muddled internal reporting is around these prac- tices, it’s not clear whether the missed medication that night was even brought to the attention of CHS leadership. Bohn claims that county leadership became aware of the broader medication issues in early October. But Smith had submitted her complaint about the issue five months earlier. In the jails, patients with prescriptions receive medication twice a day, in the morning and evening. This is called, collo- quially, “med pass.” The process is often lengthy: Nurses must deliver medication to hundreds of people, and often are required to ensure that people take the medicine, checking the insides of their cheeks or crushing the pills in water and watching them drink. Smith’s account aligns with what consultants discovered in their investiga- tion of health services in the jails. Understaffing has grown so severe, according to the report, that med passes are frequently missed, sometimes for “up to three days in a row.” “Numerous clinical staff reported in interviews that they have missed medica- tion passes on several occasions,” >> p 14 13 phoenixnewtimes.com | CONTENTS | FEEDBACK | OPINION | NEWS | FEATURE | NIGHT+DAY | CULTURE | FILM | CAFE | MUSIC | PHOENIX NEW TIMES JUNE 2ND– JUNE 8TH, 2022
