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To confirm that a person has an illness, and to ascertain how far the disease has progressed, the jail diagnoses patients from scratch. Nurses draw blood for lab work, which is completed in-house. Patients must wait for the results and consult with a doctor, who writes a new prescription. Medication is dispensed from the jail pharmacy, which charges a $3 handling fee per bottle. Even those used to taking their medication daily must wait at least a week for lab results before getting their first dose.
Of the eight inmates interviewed for this story, six took medication daily, and all of those complained of a wait anywhere from seven to 21 days, from the time they first entered the jail. Four others wrote letters stating they also had not received drugs for HIV or mental illnesses in a timely manner.
John Phillips, who took ten different medications, says 21 days passed before he received his drugs. Phillips was charged with aggravated assault with a deadly weapon, the weapon being his HIV-infected blood (even though the virus can't live outside the body). Phillips had been suffering from hallucinations caused by one of his HIV drugs, Sustiva, when he left his mother's house to walk the dog. Officers found him climbing the rafters of a Montrose building and accused him of smearing his bloody hands on them. When he arrived at the jail, he didn't know his name and thought hidden radioactive cameras were taking his picture. He couldn't afford bail and eventually was found not guilty by reason of temporary insanity after sitting in jail for nine months.
Jerry Schwartz, a schoolteacher who has been HIV-positive since 1983, served 60 days for violating his probation, and says it took five days before he was even called for blood work and 11 days before he received his drugs.
"For someone who's been told, 'Don't miss a dose,' 11 days got me panicking," says Schwartz, who asked that his real name not be used.
With HIV drugs, it is crucial not to miss a single dose in order to maintain levels of medication in the bloodstream, says Steven Walker, executive director of the Donald R. Watkins Memorial Foundation, a nonprofit AIDS clinic for indigent people.
"Because the HIV virus mutates so rapidly, if people miss a single dose of medication, it can result in resistance," he says. And that's bad news not just for the patient but for everyone, because stronger strains of HIV will get passed around.
"If the person infects someone else, the person who is infected is also drug-resistant," he explains.
Seale acknowledges that someone could become drug-resistant in the week it takes to complete the jail's lab work, but says tests are necessary to make an accurate assessment. "There is no cookbook prescription for HIV medication. It's all individualized for the patient to meet his or her needs," he says.
Raul Carvajal, who directs the HIV and substance abuse counseling programs in the jail, insists, "It's impossible not to lose a week People complain, but I don't know how to do it differently. If I said, 'I have a problem,' would you give me the medication just on my word?" Sometimes inmates are mistaken about having HIV or lie about it, he says. Confirming HIV takes two tests, the ELISA and Western Blot.
"Sometimes they assume they have HIV because they went to some place and they might have had one ELISA and never come back, but it was a false positive There is also a very small percentage of people who think that if they're HIV-positive they're going to get some privileges."
Once in a while, inmates can receive medication faster if the jail obtains medical records from the patient's outside physician, Seale says. But the inmate must sign a release, and not all doctors return phone calls, so shuffling paperwork from one place to another can take just as long. Also, the intake nurse can refer an inmate with urgent needs to a physician right away who might administer a dose of medication at that time. "Occasionally when a doctor is very comfortable with the history and very secure that the patient knows what he's talking about, we might initiate medication at that initial visit," Seale says.
However, none of the inmates interviewed for this story say those options were made available to them. In fact, Shook, Phillips and Schwartz had worried relatives who tried desperately to find ways to get medication to them. They informed the inmates' lawyers of the situation, tried to contact physicians and even medical staff at the jail. Jo Shook, Shook's mother, and a family friend even called the office of Texas Senator Mario Gallegos for help.
Some of the HIV specialists who work at the county jail also work at the county's Thomas Street Clinic, where Shook and Phillips had been receiving care. In fact, Shook eventually saw the same doctor inside the jail that he had seen at Thomas Street, yet his medical records were not made available to the jail.
When he finally received the pills, Shook suffered from another weeklong lapse when his refills did not come.