“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.

“Oh, heavens, it’s chaos and mayhem in there,” says jail nurse “Olivia” about the women’s medical-observation unit.

“They are very loud,” she says of the psychiatric patients. “The medical patients are affected by it. I don’t see any way around it.”

Walking through the unit on a recent tour, conversation bounces off the concrete walls, doors and ceiling in a thousand tiny echoes. On this day, the nine patients in the unit are sedate, and the area seems uneventful. “We can hear way back in our offices if they’re yelling,” says a deputy giving the tour. She gives a short demonstration: Locked inside a cell, she pounds on the door and puts her face up to the small window. “Can you hear me now?” she screams. Her single voice sounds like 10.

“That’s what they do,” another deputy says. “They scream and pound like that.”

Which is exactly the problem, according to “Lucy,” another nurse who works at the jail. “If there are a bunch of people screaming, and there’s a patient who looks like they’re sleeping through the window, you could very easily think they’re comfortable lying there. You can’t tell who’s buzzing for help when you have people screaming throughout the day. It’s insane.”

“It was just horrible,” says Uchenna Agbahiwe, a former nurse who quit after 10 years at the jail. “I wanted to preserve my sanity. The auditory levels are deplorable. When the medically ill patients are put into their cells, other patients are screaming, cussing, yelling. The medical patients, they beg you, ‘Can you change our housing? Can you send us to regular housing? Please!’ But you can’t send them back because they still need to be under observation.

“How can anyone heal in that situation?” she asks. “Nurses are stressed out. Nurses are leaving. The way we are treated by the administration—they don’t care. You tell them what your needs are, but they don’t care.”

*     *     *

The HCA’s Institutional Health Services division administers all medical and mental-health services throughout the five county jails. The 2007-08 budget for Correctional Medical Services was $36.8 million; for Correctional Mental Health, an additional $14 million. The HCA doesn’t budget separately for male and female expenditures, according to spokesperson Deanne Thompson. Every nurse, doctor and psychiatrist who works in the jail is employed or contracted by the agency, which also works closely with the Orange County Sheriff’s Department (OCSD), which oversees security and patient facilities for the jail system’s sickest patients.

The HCA’s Robles, who has overseen medical and mental-health services for four years, says she cannot comment on anything that happened before she became director. HCA rejected the Weekly’s requests to speak with HCA Director Julie Paulson and Correctional Medical Services Medical Director Dr. Ernest Williams, both of whom were in those positions during Matthews’ tenure.

“We provide an ambulatory or home-health level of care,” says Robles. It’s the equivalent, she says, of someone who has been discharged home and has a relative around to help take care of them. “That’s about the level of care we provide. . . . These are not infirmaries,” she says, referring to what the designated medical areas were once called before she changed their names last year.

Some nurses say the change in name denigrates the level of care that is actually provided at the jail. “She should come in when we have our seizure patients,” says Olivia. “The reason Maureen wanted to rename the unit was so that she would not have to staff it with a registered nurse, which California code mandates in an infirmary setting, and only staff it with a licensed vocational nurse to cut costs. But the RNs and LVNs fought it because we knew we needed someone with the proper training for what we do.”

Robles says the layout of the jail determines how male and female patients are housed. When asked if there is a ward area in the women’s jail where the medically ill women could be housed, she says there is, but that currently they’re not housed there. “We’re having discussions to see if that will be an option,” she says, because the female population is on the rise. But, she adds, those discussions have not yet been brought to the sheriff’s department.

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