The U.S. Department of Justice's civil rights division has found that conditions at the Baltimore City Detention Center violate the constitutional rights of inmates and appear to have played a role in the deaths of several prisoners, some of whom received little or no medical attention for chronic health problems.
Chief among the findings in the Justice Department's report is that the state-run detention center - parts of which were built in 1803 - has a poorly run system of health care and suicide prevention that often takes days to assess an inmate's medical needs. In some cases, the problems proved deadly, according to the report, which gives state officials 49 days from Aug. 13, when the report was issued, to propose solutions.
"We find that persons confined suffer harm or the risk of serious harm," the report concluded, citing several examples of jail suicides, heart-attack deaths and fatal asthma spasms that federal authorities deemed "preventable if the inmates' conditions had been properly treated."
The report was made public yesterday, when state officials released it.
Stuart O. Simms, chief of the Maryland Department of Public Safety and Correctional Services, which oversees the detention center, acknowledged yesterday that the jail faces serious problems. He said he has begun to speak with health care administrators for advice and help in delivering better care at the jail, which each year admits more than 43,000 inmates.
"We have collectively become the largest emergency room in the state," Simms said. "Our arrest population has some of the most severe health problems in the country. We're faced with a community health issue."
Justice officials visited the detention center and the city's Central Booking and Intake Center several times in 2000. Among the deaths that they document in their report:
A 29-year-old woman who hanged herself with a paper gown Aug. 16. She had tried to kill herself the same way the day before but failed and was ordered on a suicide watch in which she would not receive the gown. Despite that, she was given the paper gown rather than the smock typically provided to suicidal prisoners.
A male inmate who died of natural causes Nov. 22 after collapsing in his cell at central booking. Although his cellmate tried to get corrections officers' attention, CPR was not performed on the man for several minutes.
A man who died May 19 of hypertension and cardiovascular disease a day-and-a-half after being jailed. The man, who had a long history of medical problems, was not given a medical screening though he had needle tracks on his arms, and cocaine and other drugs in his system that should have raised concern that he was going through withdrawal.
A heroin-addicted man who died July 18 after being in custody 24 hours and who had told an officer during a medical screening that he was on medication for high-blood pressure. He was never seen by one of the jail's health professionals and died of cardiovascular problems likely aggravated by his detoxification from drugs.
A man who died of an asthma attack Dec. 2 after having last received medical attention 19 days before, when he was put on intravenous fluids because of severe breathing problems and other health concerns. He died struggling to use an asthma inhaler that failed to work because of overuse.
A mentally ill 41-year-old inmate who committed suicide Dec. 18. The inmate was never referred to a mental health professional at the jail for evaluation, and was taken off a suicide watch by a nurse who apparently did not perform a suicide assessment.
"These and other completed suicides illustrate lapses in the suicide prevention system and also reflect the systemic mental health delivery problems such as inadequate access to care," the Justice Department report states. "The booking screen process does not sufficiently identify those who need medical attention or observation, nor sufficiently trigger medical care when needed."
The inmates' names are not provided in the Justice Department report, and state public safety officials said yesterday that they weren't able to track down the names.
Leonard A. Sipes Jr., a spokesman for Public Safety and Correctional Services, said state officials are trying to come up with solutions to the problems, many of which he said are attributable to a lack of funds and poor conditions inside the jail. One option would be to replace the antiquated jail building - at a cost of about $100 million, he said.
Another option would be to form a partnership with a hospital or health system that would take over aspects of the jail's health care. Sipes pointed to statistics that show that Baltimore correctional facilities have one of the highest rates of intake for people with AIDS and tuberculosis.
"We're talking here about an amazing degree of medical problems that has overwhelmed our existing capacity," Sipes said. "We are dealing with a very sick population. We're going to use the Justice Department's report as a road map for change, but people have to understand that prisons and jails are not medical institutions and hospitals. Are we supposed to become the public health hospital for the city of Baltimore?"
State officials also pointed to Department of Justice statistics that show that though Maryland has a high number of inmates with health problems, the state's correctional system has a lower death rate than the national average.
Sipes said part of the problem at the jail is the large number of inmates incarcerated on minor charges. Such inmates are good candidates for alternative-sentencing programs rather than jail, Sipes said.
"Does it really make any sense for the state to keep someone locked up on $500 bail, just to incur $20,000 in medical costs?" Sipes said.
Seven deaths this year
State figures show that 19 people died in the city detention center in 1999; 12 died in 2000; 12 died in 2001; and seven have died so far this year. Among the most recent deaths is that of James E. Huddleston, a Baltimore man who died of heat-related causes June 29. A state medical examiner determined that Huddleston had a temperature of 107.4 degrees when he died.
Overheated conditions have troubled city jail officials much of the summer, particularly in the women's detention center, where temperatures have hit 110 degrees. The overheated conditions and a lawsuit filed on behalf of inmates prompted a federal judge to sign an order this month requiring state officials to provide air conditioning for 210 detainees in the facility by today.
The Justice Department report outlines other problems at the detention center, including improper fire safety precautions, failure to provide exercise and educational opportunities, and filthy, roach-infested conditions.
"Insects are a major problem," the report states. "Dead roaches and droppings were prevalent in the commissary area ... we also found roach droppings, spiders and gnats in residence areas."
State and Justice Department officials will discuss possible remedies during the next month.
The impetus for the Justice Department report was a 1999 investigation by New York-based Human Rights Watch, an international human rights group. It found that hundreds of children were jailed in appalling conditions in Maryland, including the city detention center.
Michael Bochenek, chief counsel to Human Rights Watch, said yesterday that he contacted the Justice Department in late 1999 and asked it to consider an investigation in Baltimore. Officials there agreed.
Bochenek said he vividly remembers the problems he saw during visits to Baltimore jails.
"What was quickly apparent was that the city detention center is an archaic, decaying facility," Bochenek said. "It's ancient. There are many difficulties in housing inmates in humane conditions in a building that is that decrepit."