TWIN FALLS • Health care for inmates at the Twin Falls County Jail has prompted so many complaints that a county district judge vowed Wednesday to take on the issue and provide a written order with guidance for the jail’s medical staff.
Judge Randy Stoker made his decision during a hearing for inmate Teddy Gene Escamilla, who says he has received inadequate treatment for HIV, Hepatitis C and liver failure.
“As far as I know, no district judge has ever addressed the issue of the level of appropriate medical treatment expected under the law at the Twin Falls County Jail for inmates,” Stoker said. “And yet we are constantly in here hearing complaints about the jail in bond hearings.”
Stoker had ordered Escamilla’s attorney, Dan Brown, to investigate the case and look into filing
a petition for a writ of habeas
That gives an inmate the chance to show the judge he is
being detained illegally.
On Nov. 27, Brown filed the writ, in which Escamilla says the jail is not providing adequate medical care, thus violating his 8th Amendment right against cruel and unusual punishment.
Brown said the jail’s staff has shown deliberate indifference to Escamilla’s health and has failed to respond to his known medical problems.
The jail intentionally delayed Escamilla’s access to care and interfered with his treatment once a doctor prescribed medication, Brown said.
The jail took weeks to get Escamilla’s HIV medication after his Oct. 14 arrest on a charge of driving under the influence, the lawyer said.
Escamilla didn’t have his medication when he arrived at the jail. He testified that he wasn’t allowed to bring it. Two weeks later, his wife brought some of his medicine in, but the jail declined to accept it.
HIV is considered a chronic illness but can become life-threatening if a person is not taking antiviral medication, testified Mary Jensen, a registered nurse and program manager for South Central Public Health District.
If a person is off their antiviral medication for a while, though, HIV can mutate and become resistant to that medicine, Jensen said. So lab work must be done to see if the medication still works for the person.
Because jail staff believed Escamilla was not taking his medication properly, an HIV specialist in Boise wanted new lab work, she said.
Brown noted that other inmates may be at risk from Escamilla’s ongoing nose bleed and bleeding from deep cracks in his feet.
“I fear greatly for other people in that jail,” he said.
Jail head nurse Lou Probasco said “universal precautions” — such as hand-washing and wearing gloves — are taken with inmates who have any infectious disease. All jail staff are trained how to deal with biohazards, he said.
HIV-positive inmates aren’t separated from other prisoners unless they bleed or have other symptoms that could endanger someone, Probasco said.
But Idaho’s jail standard says an inmate with a contagious disease should be isolated and seen by a doctor within 24 hours, Brown noted.
Probasco said most HIV-positive people don’t have symptoms that warrant being isolated.
Stoker questioned that practice, saying it seemed the jail was interpreting the standards differently than he would.
Probasco said the subject has been discussed at many jail medical conferences, and the consensus is that HIV-positive inmates should not be isolated unless they show symptoms.
He noted that HIV medication is difficult to get in Twin Falls County.
Probasco gave this account of glitches that delayed Escamilla’s treatment:
• Escamilla was reluctant to talk to jail medical staff, was unreliable about his medical history, and arrived at the jail under the influence of alcohol and seemingly confused and disoriented, so the staff wasn’t certain about his status. Probasco said he contacted the University of Virginia Medical Center, which had treated Escamilla for HIV, and got a medical history within 48 hours.
• The earliest appointment with the HIV specialist at the Wellness Center in Boise — the closest available — was on Oct 29. Escamilla received some medications delivered Nov. 1, but not the antiviral HIV medicine. Center staff said the doctor still was reviewing lab work, and the HIV medication had not been prescribed.
• “It took quite a while to get the lab work,” Probasco said. He called the Wellness Center daily and was asked several times for more information and documents. On Nov. 19, he was told the prescriptions should arrive soon. But the next day, the center requested more test results.
• On Nov. 26, more than six weeks after Escamilla was booked into jail, the anti-viral medication arrived, and the patient restarted his regimen. A few days later, though, the center advised that Escamilla should only take one of the four antiviral medications sent, Probasco said.
Stoker asked Probasco if he is satisfied with the Wellness Center’s services.
The company could move more quickly, the nurse said, but it is the only service in the state.
Stoker suggested Escamilla meet face to face with the jail’s doctor, Joseph Ippolito, and make sure he has a follow-up appointment with the HIV specialist in Boise.
Failure to do so would be “irresponsible” and could be considered failure to respond to Escamilla’s medical condition, the judge said.
Probasco said Escamilla will have another appointment with the HIV specialist this month to see if his medications are working properly.
Defense lawyer Brown asked Jensen why the HIV medication could not be prescribed and filled locally. Jensen said Idaho does not fund strong support of HIV patients.
Brown asked: What if Escamilla had been taking his medication regularly? What if he had his medicine with him? What if Escamilla’s wife brought the medicine earlier?
If Escamilla had been taking his medicine without interruption, Jensen said, she would have recommended that he keep taking it in jail.
“I think that would be in his best interest, yes,” she said, but the jail has restrictions.
Brown asked that Escamilla also be allowed to see a doctor about chronic pain due to an old injury and possibly get back on prescription pain medication.
The jail is careful with prescribing pain medication, Probasco previously told the Times-News, but gives ibuprofen or Tylenol to inmates complaining of pain.
Escamilla could be evaluated for his pain, but a judge shouldn’t order pain medication for him, deputy prosecutor Jennifer Bergin said.
“It wasn’t the primary issue that he was having pain,” Bergin said.
Communication between jail medical staff and inmates seems to be an ongoing problem, Stoker said.
He said he hadn’t found that the jail is being deliberately indifferent, which is required in order for a judge to intervene.
“I don’t find that,” Stoker said. “Could it be better? Yep. Should it be better? Probably.”
At the end of the three-hour hearing, Stoker said it appeared that many points in the original petition to the court are now immaterial.
“I don’t think it’s a coincidence that medical staff has seen him and medications arrived since the petition was filed,” Brown said.
Bergin said the timing of treatment didn’t have anything to do with the petition. Escamilla got his medication Nov. 26, and the petition was filed Nov. 27, she said.
Bergin asked that the case be dismissed.
Stoker declined to do so, instead opting to write an opinion that will give guidance to jail medical staff.