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Following procedure, Shook filled out an Inmate Request Form, writing that his medication had not come. He deposited the form in the locked box labeled "medical" at the entrance of the cell block. The forms are distributed daily, but Shook says he never received an answer even though he wrote daily requests. His medication just appeared one day on the medicine cart that is wheeled around each floor by a nurse. Shook didn't know if he should take the pills again; starting and interrupting an HIV regimen repeatedly can cause more damage than taking no drugs at all. When he decided to take them again, he noticed new side effects immediately: nausea, fever and diarrhea.
"I'm not saying it never happens. I'm not excusing it," Carvajal says. "But this is the system, and it works. It's very professional. It's a top-quality program."
In 1972 Lawrence R. Alberti filed a lawsuit against Harris County, claiming that overcrowded and poor conditions at Harris County Jail amounted to cruel and unusual punishment forbidden by the U.S. Constitution. The case, which later became a class-action suit, took 23 years to run its course. The settlement of the Alberti case recommended that medical services be outsourced to a professional service provider. Harris County used to employ its own physicians and health care staff, but in 1990 it contracted with the UT Health Science Center for physicians. UT provides four full-time primary care faculty members, including the medical director, as well as two full-time nurse practitioners and various on-site specialists. At any given time, there are one to three infectious-disease fellows rotating through the jail clinic who specialize in HIV management.
The most recent agreement stipulates that Harris County will pay UT $200,000 each month for its services. In addition, the sheriff's budget also includes roughly $2.4 million for medical services and drugs. This figure does not include the salaries of nurses and ancillary staff who are employed by the sheriff's department.
Finding people to work in a lockup setting can be a challenge. Harris County Jail has been short on nurses; however, all of Houston has suffered from a years-long nursing shortage, Seale says, and the jail is no worse off than any other Houston facility. (Seale was unable to provide a specific number of unfilled positions.) Still, he admits that jail is not a desirable place to work.
"In our situation it's doubly difficult, because for one, when you're a nurse or a doctor, you don't think of jail being a practice," Seale says. "I think what we've found is many of the people who work in correctional facilities really buy into it as almost a Peace Corps issue or a decision to provide care to the underserved."
"I think Dr. Seale does a wonderful job over there," says Dr. Grace Chao, a former medical director for the Texas Department of Criminal Justice hospital who once spent a month at Harris County Jail on a public health residency. "It's a very, very tough job he has. It's very difficult because the turnover is so huge, you just can't catch them and hold them long enough to do a whole lot."
Harris County Jail is one of only 12 detention facilities in Texas (out of 240 county jails, many private facilities and several INS detention centers) accredited by the National Committee on Correctional Health Care, based in Chicago. Since 1970, the private nongovernmental association has offered a voluntary accreditation program based on national standards. Harris County Jail has met that standard for more than five years, says Edward Harrison, the correctional health care group's president.
The jail also gets a thumbs-up from Terry Julian, executive director of the Texas Commission on Jail Standards, a state agency that conducts annual inspections.
"We're very pleased with them. If you could go down there to look and see what they do, it's just mind-boggling, to see the number of inmates that need to be taken to all the things they do They are doing a superior job of taking care of inmates. I know they're on the cutting edge of technology as far as a large jail is concerned," Julian says.
However, according to records obtained by the Press through the Texas Public Information Act, at least 38 complaints concerning medical care, discrimination and harassment have been filed with the commission against the Harris County Jail since January 2000. Most of the complaints dealt with allegations of assaults on inmates -- either by other prisoners or by guards -- or the withholding of medication or legal services from inmates by jail staff. The complaints seemed to range in severity as well as veracity. For example, one inmate claimed that he was sexually assaulted by another inmate, but a physical examination of the reporting inmate revealed no evidence of an assault. Another set of correspondence to the commission indicates that inmate Garard Natiello was, however, wrongfully denied access to the jail law library. In June 2000 George Brown, director of the library, wrote to the commission stating that "this matter has been investigated and it was found that Mr. Natiello is now attending Law Library and his grievance is resolved."