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Originally published Friday, December 1, 2006 at 12:00 AM

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Jail health-care troubles put inmates at risk, report says

King County's watchdog is worried that ongoing problems in jail health care are endangering inmates, and it has sent a damning report to...

Seattle Times staff reporter

King County's watchdog is worried that ongoing problems in jail health care are endangering inmates, and it has sent a damning report to Executive Ron Sims and the County Council.

The report from the county ombudsman, sent Wednesday, focuses on medication errors in the jails but also touches on staffing cuts, poor quality assurance and low morale among jail health-care providers. The ombudsman says the county is risking liability because of the problems.

It is the latest in a string of critical reports and inspections involving Jail Health Services. In the past two years, the state Health Department's Board of Pharmacy has failed the jail's pharmacies after two out of four inspections, citing problems ranging from missing narcotics to failure to report "adverse drug events" involving inmates.

The pharmacies' licenses could be suspended, but so far the state has taken no action.

The ombudsman has opened several investigations and, in one instance, accused the city-county public-health department of obstruction.

"While we recognize the extraordinary challenges inherent in providing basic health care in a correctional context, we are concerned that [Jail Health Services] may not be consistently providing inmates with an adequate pharmacy and medication administration system," wrote Jonathan Stier, a senior deputy ombudsman and the office's point man on jail-health issues.

Thursday, Jail Health Services and the Seattle-King County Department of Public Health fired back with an 18-page rebuttal to the most recent Board of Pharmacy inspection, which passed the pharmacy at the Regional Justice Center in Kent, but with the lowest possible score.

The inspection, conducted in October, criticized staffing shortages that had a single pharmacist and two technicians filling as many as 250 prescriptions a day. It also pointed out an ongoing failure to report inmates' adverse reactions to prescribed drugs.

Dr. Ben Sanders, the medical director for Jail Health Services, called the Board of Pharmacy inspection unfair and inaccurate.

"I'm not going to tell you there have not been problems," Sanders said. But the agency has made significant strides in quality assurance and quality improvement, and inmates are receiving adequate and safe care, he said.

Lisa Salmi, the acting executive director of the Board of Pharmacy, defended the inspection and said the board has tried for at least three years to bring the jail's pharmacies into compliance but without success. "We continue to have ongoing concerns relating to those pharmacies," she said.

Stier said the ombudsman's office has seen a steady increase in inmate and staff complaints about medication errors. The office has logged 192 complaints since January 2004 and continues to receive them "at least on a weekly basis," he said.

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Many of the complaints, Stier said, have been resolved with a phone call or other fairly minor involvement.

Others, however, have involved formal investigations that have taken months or even years. One involved an HIV-positive inmate who was repeatedly denied an uninterrupted supply of drugs ordered by his doctor. Another concerned a diabetic inmate who was overdosed on the wrong type of insulin after a chart mix-up. He collapsed and was taken to Harborview Medical Center, where he recovered.

In yet another case, Stier found that nurses gave an inmate the wrong psychiatric medications because they confused his name with that of the inmate who was supposed to get the drugs.

In the case of the HIV-positive inmate, Stier fought the city-county health department for two years to obtain the medication-error report that should have been filled out. At first, the department argued that Stier was not entitled to those reports, according to documents obtained by The Seattle Times. Later, the department admitted they never existed.

The department's refusal "only served to obstruct and delay this investigation," Stier wrote to Jail Health Services in a letter regarding that case.

His letter this week to Sims and the Metropolitan King County Council relied heavily on the work of Board of Pharmacy Inspector Stan Jeppeson, who has twice failed the pharmacies and criticized them over issues ranging from staffing shortages to missing narcotics.

Jeppeson, in turn, has spent time with the jails' nurses and pharmacists, including Anh-Thu Nguyen, who recently quit her job as chief pharmacist at the Regional Justice Center in Kent. In May, Nguyen filed a $1.5 million claim against the county, alleging a hostile work environment.

"On numerous occasions, I have notified my supervisors and manager of conditions within the pharmacy at Kent Regional Justice Center that are not compliant with King County policy and state and federal law," she wrote. "As a result, I have been subjected to retaliation ... ."

Mike Carter: 206-464-3706 or mcarter@seattletimes.com

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