Matthews noticed immediate disparities between the way male and female patients were housed and what was available to them. Although the men’s medical-services division had its own set of problems, she says, what she found at the women’s jail was a medical area in a state of total neglect.

Most troubling to Matthews was the case of the jail’s most vulnerable women: Both the medical and psychiatric patients were—and continue to be—housed right next to each other in the same cluster of cement jail cells, a setup, Matthews says, that was abolished decades ago in the men’s jail. Such housing, she says, creates an unsafe, unhealthy and potentially life-threatening environment for the inmates and even the nurses.

“The standards of care were so much lower for the women,” she says. “There weren’t the same safety amenities as there were in the men’s jails. . . . The cells where they housed the sickest females patients would never be used for the same population in the men’s jail.”

The Orange County Central Jail Complex houses more than 800 women
Jeanne Rice
The Orange County Central Jail Complex houses more than 800 women
Aaron McKinney

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The view from the row of quaint, historic Santa Ana homes on Shelton Street near Sixth and Flower streets is of the hulking, almost-windowless Orange County Central Jail Complex. Three buildings, connected by a labyrinth of internal tunnels, house an average of 3,000 male and female inmates. Every inmate who is booked sees a nurse, who screens him or her for any dental, medical or psychiatric services at the central jail. Last year, the average daily inmate population for the whole system was around 5,600 men and about 900 women. The majority of women are housed at the central jail. The newest building, known as the Intake/Release Center, was built 20 years ago; the two older buildings are 40 years old.

Male psychiatric patients are housed in the newer Intake/Release center, which is designed in “pods” rather than linear rows of cells characteristic of older jails. The unit, designed especially for the housing of psychiatric patients, was built with layer upon layer of thick, tall glass walls. Nurses sit in a central station with deputies stationed directly above them, about 25 feet from inmate cells.

It’s easy to see into the inmate cells, which have floor-to-ceiling glass doors and windows, from both the medical and deputy stations. Although the area is bustling with nurse and deputy activity, the pounding and calling out by the psychiatric patients who are housed on two floors of cells is visible but not audible. The beds in the cells are a single concrete block, with a pad on them, so patients can’t hide under them. If a patient needs to be attended to immediately, a deputy is on hand to enter the cell with a nurse, since she cannot attend to an inmate alone. Deputies have the ability to speak with patients through a push-button system from their stations. Nurses don’t speak directly with the patients unless they go in to administer medication.

Down a long, white, concrete tunnel, the jail’s sickest men are housed in another building. The Medical Observation Unit in the men’s jail is a quiet, dorm-like setting with 18 railed beds and one hospital bed, reserved for the medical patients who require constant observation—perhaps recovering from surgery, or going through alcohol or drug withdrawal. A staff nurse observes the patients through a station with large glass windows on all sides. Nurses go in periodically and make bedside rounds. No psychiatric patients are housed in the ward.

Although they share the same name, the Medical Observation Unit at the women’s jail is a far cry from both the men’s medical and mental-health units. The major difference, which Matthews contends raises the most patient-safety red flags, is that in the women’s area, bothmedical and psychiatric patients are housed in one of 15, side-by-side concrete cells. The cells have large metal doors, each with a small glass window, which nurses say is often smeared with bodily fluids by the mentally ill patients. The nurse sitting at the station about five feet away cannot see directly inside to observe either the sick patient or the psychiatric patient like the nurses in the men’s units. There is no hospital bed with special amenities available to the women. There is only one nurse and no deputy stationed in the unit. In order to speak with a patient, a nurse must address her through a small, metal-mesh door. In order to attend to a patient, she must call in a deputy, who will unlock the door and go in with her. Although both nurses and deputies make rounds every 15 minutes or so, Matthews says it takes only a few minutes for someone suffering a medical emergency to lose consciousness.

“You need to be able to see your patients,” she says. “And you need to be able to hear them, which you can’t do if people are screaming and pounding on the cells around you.”

Because the door is metal, the walls and ceiling concrete, and the building old, Matthews says, everything, including the piercing cries of psychiatric patients, can be heard by the nurses and the medical patients surrounding those cells. Unlike the men’s psychiatric unit, there are no high ceilings or layers of glass separating those prone to potentially manic and violent outbreaks, behavior that is common among some of the sickest psychiatric patients, from the nurses and medically ill patients only a few feet away.

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