In Baltimore’s sprawling jail system, those in severe mental health crises languish in solitary confinement, medical care is dysfunctional, and people with disabilities are still not being properly identified or accommodated, even after a deaf man was killed in his cell late last year while being housed with an accused murderer.
Those are among the findings of the latest federal monitor reports on the city’s jail system, which is run by the Maryland Department of Public Safety and Correctional Services and has been under court-ordered oversight for eight years.
Even so, court monitors eyeing the conditions have noted few signs of improvement: The jail has come into compliance on only one out of eight major medical provisions, and remains noncompliant with two of them. To that end, the medical doctor monitoring the progress said in a recent letter that he sees no way the facilities will meet the mandated deadline of June 2024.
Beyond the harsh conditions of the jail, the medical and mental health reports also illuminate bureaucratic dysfunction in granular detail, with no fixes in sight. Upheavals with private vendors have left electronic medical records in disarray, the monitor found.
Bugs in the software make records hard to interpret and error-prone, with recurring oddities such as detainees having multiple medical records and a “widespread problem” of people being falsely marked as deceased when they are in fact alive. Not only does this complicate care for the medical staff, it’s also rendered the records increasingly difficult for the court monitors to decipher.
Corene Kendrick, an attorney with the ACLU National Prison Project, is representing the plaintiffs in a lawsuit challenging medical and mental health care in the jail that led to a settlement in 2016. She said the reports show that the state is unable to get the Baltimore jail system under control.
“It’s very concerning that the medical expert notes he’s been raising these same problems about the failure to have a functional electronic health record for years,” Kendrick said.
At the medical expert’s suggestion, Kendrick said, the plaintiffs asked for a status hearing, which the judge granted half an hour after they filed their request. The corrections department, which does not typically discuss active litigation, did not immediately comment on the reports.
Medications go unadministered, patients go unseen
The problems with the city’s jails start from the moment someone is booked, according to the monitoring report.
Nurses who collect medical information are failing to properly document conditions, including whether someone is on prescriptions, which can be especially dangerous for people who require insulin or blood thinners, as two examples.
Even patients who are sent to the hospital for medical emergencies, such as a diabetic scare, return to the jail only to be lost in the disorderly health care system once again, the monitor noted, using the example of a patient who was not routinely administered insulin.
Nearly six months after 34-year-old Javarick Gantt was killed in his cell while he was housed with an accused murderer, people with disabilities and other medical issues are still not being properly identified and accommodated, the monitor found.
One detainee who had a nerve injury in his leg and used a cane to walk was not provided medical equipment and did not see a doctor for 16 hours, despite the nurse referring the detainee to see one “urgently,” the monitor, Dr. Michael Puisis, said.
In a September tour, Puisis learned that nurses may be feeling pressure to quickly fill out the intake forms because police officers are waiting nearby to hear whether the patient will be accepted or rejected into the facility.
The intake forms themselves are also inadequate, Puisis found, listing numerous deficiencies such as incorrectly describing detainees as “offenders,” despite the fact that they have not yet been convicted of any charges, and not asking about whether someone is experiencing homelessness, among other issues.
The ‘harsh and deprived’ conditions of the mental health unit
After an alarming report last year found that conditions in the Baltimore jail’s mental health unit were among the worst of any prison or jail in the country, the doctor overseeing mental health care recently discussed the concerns with clinical staff, “who were not in disagreement with such findings,” the latest report states.
Despite undergoing acute psychiatric crises, those held in the inpatient mental health unit are kept in solitary confinement, where they are offered only three showers per week and phone usage twice weekly — far more restrictive settings than other parts of the facility.
Since a report from April last year noted a lack of mattresses, those sleeping arrangements have been provided, the mental health monitor said, but the detainees are still kept in highly restrictive settings, wearing suicide smocks as their only clothing.
In March, Dr. Jeffrey L. Metzner interviewed seven inmates in the mental health unit and found that some of the inmates would have met the criteria for nonemergency involuntary medication if they were in a hospital setting. That practice is banned in the jail, he added.
Like the rest of the jail, the mental health unit is dealing with staffing shortages, including vacancies for a full-time psychiatric nurse practitioner and a full-time mental health provider. That, plus the ongoing harsh conditions in the facility and problems with administering medication, means the mental health unit is “far from approximating an inpatient psychiatric hospital environment,” Metzner wrote in his report.
About a third of the patients there are on a waitlist to be transferred to a state psychiatric hospital, the monitor found, an issue that is beyond the jail’s control.
“If the waitlist time was significantly reduced (e.g. less than three weeks), the harm to such patients would be significantly reduced,” the monitor wrote.
