He's put different people in charge and changed and restricted booking procedures. Each new inmate is supposed to undergo medical screening before being booked.
Police aren't supposed to use the jail as a makeshift psychiatric hospital, or detox center, something that's been a national issue for decades, the sheriff said.
“It doesn't solve the problem,” he said. “It's a revolving door.”
One major change, the switch to an electronic medical records system, is scheduled to be completed in September, said Edward DaPra, who's been the jail health services administrator for about 10 months now.
He worked as a mental health professional in the jail for more than three years before that.
The reforms started roughly a year ago, as the jail drew scrutiny for a series of inmate deaths. Several of the deaths led to multimillion-dollar legal claims alleging that inmates died after being denied basic medical care.
Earlier this year, the county paid a $1.3 million settlement to the family of Lyndsey Lason, 27. Lason died slowly in the jail in 2011 as an infection filled her chest with fluid and collapsed her lungs.
With an average daily population of about 1,000 inmates, the jail is basically a small city, DaPra said. Most cities of that size have an outpatient clinic, primary care doctors, nurses and psychologists, he said.
“We're a small city operating in a fishbowl setting, and we need to provide medical care for these individuals,” DaPra said. “Most of these inmates have no preventative care in the community. They've used drugs and alcohol around the clock. They don't have medical insurance. We try to restore them as quickly as possible to medical stability and see them to the end of their term or their court process.”
Roughly 40 percent of people booked into the county jail have histories of addiction, mental illness or both, officials say.
The community heroin epidemic has been a major factor, DaPra said.
In recent weeks, the jail has created an emergency overflow module to house inmates going through withdrawal, to get them out of booking without overwhelming the medical unit, DaPra said. Most inmates coming in with drug problems have been using heroin or heroin mixed with alcohol or other substances.
On some days, more than 50 new inmates are undergoing heroin withdrawal, he said.
Morbidity reviews have been conducted on some of the 10 inmate deaths since 2010, a new process started under Trenary.
Two of the deaths happened this year.
One medical problem identified by reviewing the deaths has been electrolyte deficiency, DaPra said. That can be a symptom of the excessive vomiting associated with drug and alcohol withdrawals.
The medical unit has switched from a red sugar drink, similar to Kool-Aid, to a Gatorade-like drink with electrolytes and vitamins.
Gallons of the orange and blue electrolyte drinks were stacked on a cart in the medical unit on a recent visit to the jail. Notes posted on individual cells told staff which inmates were having withdrawals, and how often they should be checked on.
The 30-minute checks are standard, said a nurse working in the unit.
Once the jail switches to electronic records, more than 1 million pieces of paper will need to be digitized, DaPra said.
Most medical facilities switched to digital records a decade ago, he said.
As it stands, inmate patient files are in manila folders, stacked on shelves.
About half of the people in those files are expected to make return visits to the jail, DaPra said. Inmates aren't always forthcoming about their drug or alcohol use, so having their case history handy can help booking staff make better decisions for placement.
In addition, a metal detector and other more careful screening measures for jail visitors are aimed at keeping more contraband out of the jail, Trenary said. There have been problems with inmates suddenly showing signs of withdrawal days after booking, when drugs and alcohol should be out of their system.
Jail officials also are seeking a new contract for pharmacy services. Inmates often complain about not getting prescription medicine, such as blood-pressure pills or antibiotics for infections, particularly during short stays.
The hope is to find an in-state vendor and change the way medications are organized and distributed, to get prescriptions to inmates within 24 hours, Trenary said. Having an out-of-state vendor can contribute to delays, especially during winter storms.
Inmates with acute medical issues, including mental health problems, may be denied for booking if they need hospital-level care, DaPra said.
Most of the new restrictions primarily involve nonviolent misdemeanor offenders.
Jail staff have been asking the arresting officers to stand by a few minutes to make sure inmates are cleared for booking, DaPra said.
That's different from a long-standing culture of officers leaving once they get their handcuffs back.
There also needs to be more inmate release planning, particularly for the mentally ill, DaPra said. He'd like to see better partnerships with social workers and treatment and transitional housing groups — a way to give newly released inmates a place to go, other than the streets.
Rikki King: 425-339-3449; firstname.lastname@example.org.
- “Kites,” inmate letters requesting medical attention, should now be reviewed by a nurse within 24 hours.
- The sheriff has asked the county council to increase full-time jail nursing staff. The jail has about 17 full-time nurses, and about a dozen temp nurse positions. National experts recommend 40 staff nurses for the jail.
- A doctor now works in the jail three days a week. That likely will become a full-time position.
- Contracts have been cut with cities in neighboring counties and the King and Skagit county sheriff's offices, to keep average populations lower.
- New forms to track the monitoring of inmates under medical watch and new medication procedures for inmates undergoing withdrawal.
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