Five key sources for investigating the health care crisis in California jails

Published on
September 20, 2019

A criminal justice reform measure intended to relieve a health care crisis caused by overcrowding in California’s state prisons has helped improve conditions there.

The 2011 law, usually called Assembly Bill 109 or realignment, accomplished that by keeping many inmates in county jails rather than sending them to state prisons. But did it really solve anything, or did it just shift the problems to the counties? And in counties that have been sued since then over their health care, could data show whether federal court settlements are improving conditions?

My news organization, the Southern California News Group, has 11 daily newspapers in four counties. Jails in three of those counties — Los Angeles, Riverside and San Bernardino — have come under orders since 2015 to fix some combination of mental health care, medical health care and use-of-force policies.

The fourth, Orange County, was investigated by the U.S. Department of Justice in 2014 but not sued over health care. But a 2018 report by the Orange County grand jury found that almost half of deaths in the county jails there could have been preventable if care had been better.

In reporting out my project on health care in those four county jail systems for the 2018 Data Fellowship, I found some good news: Lawyers overseeing the three court settlements said changes are being made for the better, even if the jails still have a long way to go to be in compliance. The less good news: There was virtually no hard data to back that up.

Still, data available from the state and requested from the counties helped illustrate the challenges that jail administrators face and what they’re doing to improve, while lawsuits and interviews provided insight into the human toll of inadequate health care.

Here are five key sources I used that might help others wanting to look into similar issues, as well as some of the caveats I found in working with them.

Jail Profile Survey: California has been collecting data from jails for decades. The Board of State and Community Corrections, established after realignment in 2012, now maintains that data. The Jail Profile Survey contains a wealth of information, including how many inmates in each jail and county system are: charged with felonies or misdemeanors; sentenced or unsentenced; male or female; receiving mental health care or psych medication; seen at sick call by a physician, dentist or off-site medical appointment; released due to lack of housing capacity; among other metrics, all reported monthly. Jails report a few other metrics quarterly: number of inmate assaults against staff (though you’ll find a lot of skepticism about these numbers), money spent on medication and the average length of sentence for inmates released that quarter. All of that is available going back to 2002 (provided your county reported it), and some if it is available back to 1995. The database appears to be updated quarterly. (A drawback is that a county may change how it decides to report a particular metric and so you’ll see a large vertical drop or jump, and officials may not be able to explain what changed.)

In-custody deaths: The California Department of Justice has a data portal that includes a database of in-custody deaths reported by all law enforcement agencies going back to 2005. Although agencies are supposed to notify the DOJ within a relatively short time frame of any in-custody death, the database is only updated once a year, around June. It holds information including the deceased’s age, gender and race, what they’d been arrested for, whose custody they were in, and their manner and mode of death. A big limitation is that it doesn’t include names. Another is that some agencies don’t provide updates, so if the death was still under investigation when it was reported, the database may still list the manner and mode as “under investigation” years later, which means it’s almost impossible to say whether any particular kind of death is happening more or less frequently now than before. And in cross-checking the DOJ database against information I received from counties, I found plenty of errors such as dates of death being a day off or ages being a year off. Also, when I checked with Los Angeles County about whether the number of suicides per year was correct, the database turned out to be wrong in several years.

To get the deceased’s names and other information, you can request the notification letters that the custodial agency sent to the DOJ. There are several possible sources for more complete narratives about what happened — find out who investigates your county’s in-custody deaths and how, then request any final reports they write. I did not request the full coroner-autopsy reports because about 50 inmates per year die in the four counties I was reporting on, and asking for even five years’ worth would have would have meant I’d still be reading them all now. But I found that district attorneys’ offices that investigate whether there was any criminal negligence provide pretty good summaries of the medical facts.

(Side note: One attorney I spoke to cautioned against comparing jail death rates to rates in the general population because their risk factors are so different. Not a lot of people in jails are dying of old age. Not many car crashes or gunshots either. But mental illness and substance abuse are overrepresented in jail populations.)

Grand jury reports: In California, all counties have a civil grand jury, watchdog panels whose members serve one-year terms investigating local agencies and writing reports with nonbinding recommendations. Each year, one of each grand jury’s investigations is supposed to involve the prisons or jails in their county. I found some great details relating to health care and the effects of realignment in these reports. The one on in-custody deaths in Orange County led me to the person who led off my project’s main story, though it took a little detective work to actually identify that person (and luck that his attorney and mother were willing to talk to me).

Lawsuits: I’d thought when I started working on the project that lawsuits might be one of my best ways to put human faces on the main issues I was going to write about. That was true to some extent, but not quite in the way I’d expected. A few months before starting this project, I’d requested data from all four county sheriffs on all claims and lawsuits that had resulted in payouts. I considered putting in another request for all open or closed cases specifically related to jail health care, but didn’t for two reasons. One, it had taken a very long time to get satisfactory responses the first time around, and two, many cases involved multiple issues — a person might claim they were wrongly arrested, then were subjected to excessive force, then didn’t receive the health care they needed for the injuries that resulted — and I suspected cases like that wouldn’t end up in the responses I would have received. Instead, I did a little fishing in PACER and county court systems and found some additional open cases. However, none of the plaintiffs or attorneys in any of those cases were willing to talk to me. The lawsuits I ended up highlighting were by the families of someone I found through Orange County’s grand jury report, and someone whose death we had reported on before but not since the suit was filed. The DOJ and Prison Law Office lawsuits also provided invaluable details about general conditions.

Other data and public information requests: I’d hoped I’d be able to get information from the counties on what kinds of illnesses they treat and how it’s changed over the years. I was not successful. Most were able to tell be about their current population — how many had mental illness or substance abuse issues, how many were on dialysis, how many had HIV/AIDS or cancer, etc. But no one could give comparable numbers from before realignment took effect. Attorneys I talked to recommended asking for staffing and budget numbers — understaffing is one of the biggest indicators of a dysfunctional system, so seeing if those numbers have gone up or down can help tell the story. They also recommended asking for any reports produced by consultants who were hired to evaluate the jails, and for applications for any grants the county sought related to jail health care, in which officials have to be frank about what problems they’re trying to solve with that grant money.

Read Nikie Johnson's fellowship stories here.