By On the occasion of our 20th anniversary
By Gustavo Arellano
By R. Scott Moxley
By Alfonso Delgado
By Courtney Hamilton
By Joel Beers
By Peter Maguire
By Charles Lam
Cells From Hell
One nurse says her futile efforts to improve the women’s infirmary at the Orange County Central Jail Complex have broken her body and haunt her dreams
Black water spills out from the pool in sharp bursts with each wet body that Teresa Matthews slaps down against the cement. The moon hangs like a halogen bulb over the bobbing babies in the water. She dives in and grabs one, maybe two at once, their bodies slippery and limp in her arms. There are more. She can’t get to them before their tiny mouths, pulling for air, succumb to their descent.
“Help me!” she screams. She begins CPR on the ones on the cement. She dives back into the pool.
Matthews jumps out of her sleep, disoriented and sweating. After a moment, she remembers: same dream, different night.
This time, her husband may give her a hug if she’s woken him with her screaming. She will then most likely retreat to the living room, where she’ll sit wide-eyed until the sun creeps over the hills, too afraid, she says, to go back to sleep.
A registered nurse, Matthews used to spend her days treating inmates—perhaps a woman who had gone into early delivery or a man who was on suicide watch—in the Orange County maximum-security central jail system, one of the toughest medical- and mental-health settings for a nurse.
Co-workers remember the 20-year veteran as a caring, no-nonsense nurse who put her patients and fellow nurses before everything else. She had a knack for coolly managing the sickest, wildest, most troubled male and female patients with focus and calm. Today, the former amateur surfer can rarely leave her house because she’s riddled with disease, near-paralysis and fear.
In 2003, she was diagnosed with post-traumatic stress disorder, fatigue and fibromyalgia, a debilitating chronic condition with widespread muscle, ligament and tendon pain. She and her doctors trace the beginning of her illnesses to Matthews’ three-year crusade to try to put an end to the gross inequities she says persist at the Orange County Central Jail Complex when it comes to female-inmate patients. Several nurses—most of whom spoke to the Weekly on condition of anonymity, asking that their names be changed for fear of retaliation—say their concerns with regard to patient safety in the women’s and other medical areas in the jail have fallen on deaf administrative ears.
(Matthews is not Teresa’s real last name; in an effort to preserve her security clearance at the jail, she asked that a pseudonym be used for this story.)
Matthews says that the majority of the 18 years she spent as a nurse within the jail system were good ones. “I loved working in the jail. The nurses were fantastic, and the deputies were amazing.” But the problems started, she says, when she became a senior nurse at the women’s jail and began tackling the county’s Health Care Agency (HCA) administration, trying to make changes she felt were crucial to patient safety.
HCA administrators say they are unaware of any reason for concern in the women’s area. “We’re dealing with an increasing female population, and we’re not hearing any concerns from staff or anyone else,” says Institutional Health Services Director Maureen Robles, who oversees both the correctional medical services and mental-health departments within the jails. “If there ever was a concern, I don’t know what it was, or if that’s relevant if we’re not experiencing that now.”
But what some say is a deep-rooted rift over equipment, staffing and housing between nurses and the HCA was brought to light in 2006 following the death of female inmate Vicki Avila at the women’s jail infirmary. Grand jurors told HCA administrators to improve emergency-nurse training and equipment at county jails. “The nurses didn’t have the machine they needed to use on the inmate. They had to go and borrow it,” says “Karyn,” another jail nurse. “It’s still a huge problem.”
Matthews took a job at the maximum-security jail fresh out of nursing school in the early 1980s. “It was a lot different back then,” she says. “There have been a lot of improvements over the years, but most of them have been made to the men’s jail.”
Matthews worked full-time at the jail for about a year before working for a few years in labor and delivery in Long Beach and in surgery in Fountain Valley, to earn her stripes in other high-pressure medical settings. She returned to the jail soon after and spent the next 15 years there.
In 2000, Matthews was offered a promotion and full-time position as senior nurse at the women’s jail. She accepted. “I had no idea what was going on,” she says after beginning her new post. “I worked at the men’s jail since 1983, so when I went to the women’s jail after my promotion, I was absolutely horrified.”
As senior nurse, Matthews oversaw a small team of nurses who worked in the women’s dispensary, the first “sick call” stop for patients; the women’s infirmary, where the medical and psychiatric patients who needed more attention were observed by a nurse day and night; and a dormitory-like ward, where patients who didn’t require full-time observation were sent to recover.
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 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.
“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.
She emphasizes that medically ill and mentally ill women are placed in individual cells. “We certainly aren’t going to put mentally ill women in with the medically ill women,” Robles says, laughing. Later, when asked about the side-by-side proximity of the cells in the 15-cell cluster, she concedes that the medical and psychiatric patients are “in the same general area.”
Robles says she’s not really sure if patients can hear one another when there’s screaming in the women’s observation area. “Can they hear each other? I don’t know, it’s pretty thick glass,” she says of the windows on the metal cell door. “I don’t know.”
While she has been director, she says, no one has raised concerns about the situation in the unit.
But nurses who spoke to the Weekly disagree. “We had meetings with her. We would speak up and say what was going on. She said, ‘I’ll do something about it,’” says Agbahiwe. “After a while, you don’t speak up anymore because it falls on deaf ears. Or you’re punished somehow. So you just adapt, and when you can’t work anymore, you leave.”
* * *
Matthews, 51, shuffles across her hardwood, living-room floor like an arthritic old woman. She’s barefoot, her right arm in a brace and somewhat limp against her body. A recurring bullet-to-the-chest dream resulted in a torn nerve in her shoulder in 2003, leaving parts of her arm and several of her fingers numb. She calls to her old, black Chihuahua, Sophie, who hobbles around nearby. “Come sit next to me, girl,” she says gently.
She seems brittle. Her left hand trembles. She drags her right leg a little, as she’s adjusting to a new brace. Her waist-length locks are in an upswept bun that seems to balance precariously on her head. She’s 47 pounds lighter than she once was. When she speaks, her voice quivers.
Matthews has been disabled and unable to return to work for five years. Every day, she must lie still for hours because movement is simply too excruciating. She says the fibromyalgia manifests itself as a painful, eerie sensation of her ligaments and muscles pulling without any lubrication. If she leaves the house, she must bring along a wheelchair.
Her sleep is still erratic, bleak and haunted: Sometimes, she is vomiting rivers of decaying corpses—pregnant women and babies. “It must be because of all the babies we lost at the jail,” she says.
There are rape dreams, dreams in which fellow nurses are being injected with HIV, shooting-spree dreams and throat-cutting dreams. “They’re so vivid. I can feel it right here,” she says, running her finger across her neck. “I’ve lost my health, my career, everything. And it’s all because I wasn’t able to fix the women’s jail. If they fix it, I know I’ll get better.”
When she started in her senior post in 2000, she says, the inequities between the men’s and women’s facilities jarred her. “The old EKG machine in the men’s jail was replaced with a brand-new one,” Matthews says. “When I changed over, I noticed they had given the old one to the female jail.” She put in a flurry of requests, beginning with the new EKG machine. She created a supply room, reordered equipment for a proper treatment room and had the area painted.
She brought up her housing concerns for the women “very gently in that first year,” she says, “because you can be let go for anything.”
After that, she decided to begin documenting her conversations with her supervisors with requests in writing. “They were sending me to classes saying that if there are safety hazards, you need to fix them because it’s your responsibility,” she says.
When she finished her probation, she sent her first letter recapping the issues she’d been bringing up for the past year. “I was getting worried,” Matthews says. “I wanted a paper trail. I’d been telling them and telling them about things needing to be fixed, and nothing was getting done.”
She went through the appropriate channels, she says, because she didn’t want to ruffle any feathers. She began with her immediate supervisor, then went up the chain to two more supervisors and to the medical director, Williams. (The HCA denied the Weekly’s request to interview Williams.) “Whenever I would talk to a specific person about it and send a letter, I would cc the other people I had already talked to about it, so that they all knew,” she says. “I kept giving them ways to fix it, and they kept saying, verbally, that they couldn’t afford it.”
She was never given a response in writing, she says. “When they’d say they couldn’t afford it, I’d look for cheaper ways to do it, for temporary solutions.”
She sent letters to supervisors Donna Brecker, Mike Ross and Nicholas Vainas, as well as to Williams. She gave statistics and detailed various temporary and permanent solutions to the problems. Some suggested moving patients from this area to this or that building, and she outlined how to do so effectively. She naively assumed, she says, that by going through the proper chain of command, her supervisors were taking her concerns to OCSD, who would need to work with the HCA to approve any facilities changes.
“All I wanted to do was bring the women’s area up to the same standards of care as the men’s for the female patients and nurses who worked there,” Matthews says. “I used to tell them, ‘Please, please, just fix it, because if you don’t, people are going to sue when this comes out in the news. They’re going to sue for loss of relatives or children or for their right to have an adequate medical area.’”
Months went by, and nothing happened. At another training meeting, Matthews met HCA inspector Sam Love. “He said he was very interested in keeping the place a safe place, and if we had an issue that wasn’t being taken care of by our supervisors, to contact him,” she says.
She wrote to him repeatedly until he finally responded and agreed to come for a visit. On the day he came, in November 2001, medical director Williams was seeing patients, so Love was given a short tour by Matthews and supervisor Brecker. “Three or four patients were screaming. [Love’s] eyes were absolutely huge, like a deer caught in headlights,” Matthews says. She then took him to the glass-protected psychiatric unit in the men’s jail and the quiet men’s infirmary in the separate building.
“He saw a big difference and definitely agreed that it needed to be changed and brought to the same standards as the men’s jail,” she says. Love helped Matthews craft a memo in early 2002, which Matthews then, per Love’s direction, directly delivered it to the sheriff’s lieutenant overseeing the women’s jail at that time, Deana Bergquist. Matthews says she told her supervisors about the memo. Love is no longer an HCA employee; attempts to reach him for this story were unsuccessful.
Matthews says supervisor Vainas told her that the sheriff’s captain overseeing the entire jail complex at that time was furious about Love’s visit.
Not long after, Matthews met with Lieutenant Bergquist. “She seemed to agree with the concerns I had,” she says. Matthews says, however, that she felt pressured by her supervisors to tell Bergquist that everything had been fixed, but she refused to do so.
Vainas, who was the nurse manager at the time and is now retired, says he was familiar with Matthews, but had little direct contact with her. He doesn’t remember her raising any concerns about the women’s facilities. “I really don’t want to comment on any of that,” he says.
OCSD did not approve repeated requests by the Weekly to speak with Bergquist. Requests for comment on whether the jail would consider a new redistribution plan were not responded to by the sheriff’s department. Captain Tim Board, who now oversees the central jail, said that any future facilities changes would need to be approved and most likely paid for by OCSD.
During her tenure, Matthews continued to send letters. One day, she says, she was approached by a deputy who asked if she would be available to help the sheriff’s department out with the female redistribution plan they were working on. “I was shocked,” she says. “I had no idea this was going on; my bosses had never told me.” For months, Matthews worked during her days off, after work and during her vacation on different layouts, plans and schedules for the moving of patients and modifications to their housing areas.
Then, in an abrupt memo sent by a supervisor in October 2002, she was notified that OCSD had put the redistribution plan “on the back burner” because of budgetary constraints. The department had to complete the remodeling of a building at the men’s Theo Lacy Jail in Orange, the e-mail said. The redistribution proposal would be revisited, it said, in three to five years.
“We sometimes say that if you’re a type-A personality and you work hard, then you are not rewarded,” says jail nurse “Karyn.” “That’s the type of people they don’t want around, and Teresa was exactly what they don’t want: someone who wanted to change, who wanted to makes things better.”
Soon after that news, Matthews says, a pregnant inmate who was having early contractions came up to the window and held up a tiny sac of tissue. “‘Nurse,’ she said, ‘I think I just miscarried,’” Matthews recalls. “It was extremely loud in there, the staff nurse had her hands tied, and it made me feel horrible. I often felt very concerned that patients were not going to make it through their pregnancies, and I left a lot of times feeling worthless because I couldn’t do anything about it.”
The usually healthy Matthews was then hit with a series of flu-like bouts she couldn’t shake for months.
* * *
In March 2003, Matthews remembers, her request for a small refrigerator to store diabetic patients’ insulin had been rejected once again. “I was so tired of asking and asking for one that I just went out and bought a used one,” she says. She later learned that the men’s jail would be receiving five new refrigerators. “I was so sick of it.”
One spring morning not long after that, Matthews came in at 4 a.m. for her shift and heard screaming. She went to the infirmary and saw the patient in the window. “I saw that her face was just swollen from having cried and cried so much. She looked at me through the glass and said, ‘I have a migraine headache, and I can’t take it anymore.’” The banging and screeching spilling from the cells on either side of her had kept her up all night.
“I had been in there lots of times when people had been screaming and yelling and things had been very bad, but never had a patient that was medical come up to the door and look me in the eyes and say, ‘I can’t take it anymore.’”
Afterward, Matthews broke out in a cold sweat. The chest pressure that had been creeping up on her during her shifts became stronger. A co-worker told her she looked pale, that she should go home. She eventually went to the doctor, who said she likely had a stress-induced ulcer. He gave her medication, and Matthews went back to work.
By now, the nightmares had begun, and she was sleeping only a few hours a night. In April, when she went back for a checkup, she broke down. “I just cried and cried and cried, and I couldn’t stop,” she says. Her doctor referred her to a string of specialists, psychiatrists and psychologists. She was diagnosed with fibromyalgia and post-traumatic stress disorder, brought on, her doctors concluded, by her work environment.
The county doctor confirmed that her illness was stress-related, and she was approved for Worker’s Compensation benefits. She left her post for what she hoped would be only a short time. It’s been five years. She hasn’t been paid a dime in Worker’s Compensation in two years and is fighting for disability-insurance payments. She’d like to return to work someday, she says, but more than anything, she’d like to know that something will be done about the women’s jail. “Here were are, five years later, and the women are still in the same [infirmary] area. The only thing they’ve changed is the name.”