SPANISH FORK Utah County Jail inmate Marcos Flores got his tooth filled recently, but something went wrong and now it's infected. Tuesday afternoon he sat handcuffed to a bench in the medical unit, waiting to see the dentist.
"It's good," the inmate said of health services in jail. "But you gotta wait another week if they don't do it right."
Each day, nurses visit the jail's housing pods, pushing a medicine cart like vendors at a baseball game, handing out pills approved by the jail's doctors and psychiatrists.
On an average day, 30 percent of inmates are receiving treatment or counseling for mental health issues or depression. Others, like Flores, are getting cavities filled or receiving medicine for high blood pressure or a lingering cough.
"I think the public's opinion is that we provide the low minimum health care, which isn't true," said Dale Bench, health services director at the Utah County Jail. "People feel that when they come to jail, what they did (will) determine how they are treated. That's not the way it works."
Inmates occasionally complain about treatment, but medical privacy rules prevent Bench from responding.
In 4th District Court on May 12, defense attorney Greg Skordas told a judge that his client, David Ragsdale, was losing weight because he wasn't getting his medicines in jail. Ragsdale is charged with aggravated murder, accused of gunning down his wife, Kristy, in an LDS parking lot in Lehi in January.
Because of HIPAA or the Health Insurance Portability and Accountability Act Bench can't comment about Ragsdale's situation. Utah County Sheriff's Lt. Dennis Harris could only say that Ragsdale was receiving the appropriate care.
The medical facilities
The Spanish Fork-based jail has been accredited since 1994 by the National Commission on Correctional Health Care, which requires performance one step above state and federal correctional requirements.
"We just don't do the bare minimum," said Bench, who is also an RN and used to work in the emergency room at the Utah Valley Regional Medical Center.
Accreditation means jail officials treat inmates quicker, provide mental health care, send released inmates home with the remaining carefully prescribed medicines, schedule follow-up mental health appointments and prepare for inspections every two years.
The Salt Lake County Metro Jail is also NCCHC-accredited, and most other Utah jails try to adhere to those standards even if they don't have the expensive accreditation, Bench said.
At the Utah County Jail, there are 14 full-time nurses, two part-time nurses and contracted doctors and psychiatrists who come in several times each week to meet with inmates.
A dentist and hygienist, who also work on contract, perform dental care in an office similar to those used by the general public, except in this clinic, patients are handcuffed to the chairs.
"We see everything it's like an ER," said Alan, health services supervisor at the jail. "Cold, cough, fever, flu, trauma," he said. "Just about everything but gunshot wounds. It's a cross-section of the public that has the same needs as the public, but they haven't been seeking the care."
Alan asked that his last name not be used because he's received several death threats from inmates who didn't agree with his medical decisions.
Many of the jail inmates have been homeless, without insurance or addicted to drugs factors that take a huge toll on their bodies, Alan said.
"In many cases, they receive better care (here) than they have in their adult life," Alan said.
Care in cuffs
In the booking area nurse's office, a handcuffed Juan Jesus Jimenez pointed to his waist above the left pelvic bone and explained to nurse Alan Harris that he'd been in pain for a while but it comes and goes.
Harris asked some questions, poked and prodded, then told Jimenez they would do a blood test and a urine analysis to check for kidney stones or an infection.
"Oh, it's good," Jimenez said when asked about the health care in jail. "I put in to see the dentist 'cause I broke a tooth and they pulled it out. But then I put in to see the doctor and I got sent to the dentist."
A paperwork glitch meant Jimenez received another dentist visit before he actually got to see the nurse Tuesday.
"It's cheaper," he said of jail care. "It (would have) cost me $50 to pull the tooth, but it only cost $10 (here)."
The jail charges a monthly $3 co-pay for prescription medicines, $10 for dental care co-pays, $3 for a nurse visit and $10 to see the doctor.
Mental-health assessments and treatments are free, to encourage inmates to ask for help.
Each new inmate is interviewed, then given a medical exam by a nurse who notifies deputies if the person appears depressed or suicidal. If so, they're placed in a special housing unit.
The greatest risk of suicide comes within the first 72 hours, which is why medical staff become involved quickly.
"We don't want to let someone slip through the cracks that should have been talked to, but didn't want to," Bench said. Mental-health issues are a growing concern and take about 50 percent of jail medical resources, Bench said.
Nurses also verify each inmate's prescription history with their primary physician, but the jail-contracted psychiatrists make the final call, handing out what is needed, not necessarily what is requested.
"It's so easy to do doctor shopping," said Ralph Olsen, clinical supervisor of behavioral sciences at the jail. "We still see dozens and dozens (of inmates) who have 15 different doctors all up and down the Wasatch Front prescribing simultaneously."
With that background, many inmates come to jail with an air of "entitlement," thinking they deserve numerous prescriptions, said licensed clinical social work Derek Timms. "They all but demand it."
But despite those demanding attitudes, the complaints and frustrations, some inmates realize Bench is there to help them and express appreciation for the help."We're advocates for the inmates," said Bench, who emphasizes he's a nurse, not an officer. "When people commit a crime, I may have an opinion about that, but I don't let it affect how I do my job."