Baltimore City jail remains far from finishing court-mandated overhaul of mental health, medical system, monitors say

The Baltimore City Booking and Intake Center is nowhere close to meeting a court-imposed deadline for making major improvements to the medical and mental health care it provides to people incarcerated in the facility, according to documents filed in federal court on Thursday.

As part of a 2016 settlement of a case the American Civil Liberties Union brought against the state, the Maryland Department of Public Safety and Correctional Services — which operates the city jail —agreed to overhaul its delivery of health care there and make the facility more accessible for people with disabilities.

The state has until June 30, 2024, to meet the goals outlined in the settlement under a deadline imposed last year by federal District Judge Ellen Lipton Hollander, who is overseeing the case in Baltimore’s U.S. District Court.

But as of March, when the court-appointed mental health and medical monitors most recently visited the jail to assess its progress, the facility had only met one of eight goals required by the settlement.

It’s making progress on five other goals, but remains noncompliant on two of them, according to a report by Dr. Michael Puisis, the medical monitor. Reports by Puisis and Dr. Jeffrey Metzner, the mental health monitor, from their March visit to the jail were filed Thursday afternoon in the U.S. District Court for the District of Maryland.

“Given the current status of the program and the rate of progress, it will be difficult and unlikely” for the jail to meet all goals by the 2024 deadline, Puisis wrote in an email last month to ACLU and state lawyers working on the case and Dionne Randolph, the commissioner of pretrial detention and services for Maryland.

He recommended that the people involved in the case meet with Hollander to discuss the jail’s progress.

The Maryland Department of Public Safety and Correctional Services did not respond immediately to an emailed request for comment Thursday afternoon.

The release of the two reports come as LGBTQ+ activists call for an overhaul of state policies on how transgender people are housed in Baltimore corrections facilities. It also comes months after a deaf man was found unresponsive in the city jail. His cellmate has been charged in his death, which was ruled a homicide by strangulation.

Since 2016, according to Puisis’ report, the jail has reached “substantial compliance” on the settlement’s goal on sick calls. People incarcerated in the jail have daily opportunities to ask for health care, and medical professionals usually respond to their requests on a timely basis, Puisis found.

The state corrections department also established a mobile urgent care team, renovated bathrooms accessible to people with disabilities in the building where the infirmary is located and upgraded infirmary beds, among other improvements, Puisis wrote.

But a sticking point in the facility’s progress, Puisis wrote, has been its continued use of an outdated and glitchy medical record system.

The hybrid paper-electronic record system — in place since 2016 with minor modifications, according to Puisis — significantly hampers the ability of the jail’s nurses and doctors to provide the needed health care for people incarcerated at the facility on a timely basis, said David Fathi, director of the ACLU’s National Prison Project and one of the lawyers on the case.

“If you don’t have an accurate understanding of a patient’s medical condition and what treatment the patient has been provided in the past and whether that treatment has been effective or not, you simply can’t provide adequate medical care,” he said.

In Puisis’ most recent visit to the jail, he found that many people incarcerated there were listed as “deceased” in the record system, though they were alive. He also found that many patients had two or three electronic records, each one containing different medical information about them.

Requests for specialty care frequently don’t result in referrals, as in the case of a patient Puisis described in his report who was referred multiple times to receive care from a gastroenterologist or general surgeon, but never got an appointment.

Puisis also described two patients who requested COVID-19 vaccinations multiple times, but never received one, and another with diabetes, who didn’t receive any insulin when he was first incarcerated. The patient’s blood sugar levels rose to 428 — any level over 180 is too high — before he received any insulin, Puisis wrote.

About half a year ago, the state canceled a contract with a company that was working to create a new electronic medical record system for the jail, Puisis wrote. Since then, the Department of Public Safety and Correctional Services has been attempting to upgrade its existing system, instead of getting a new one.

The resulting system is confusing for staff and hindered by software bugs and other errors, Puisis wrote. In the report, he recommended that the state obtain a new electronic medical record system.

The jail’s existing medical record system — and significant staffing shortages — also makes it challenging for staff members to provide mental health care to people incarcerated at the facility, Metzner wrote in his report.

People placed in the jail’s inpatient mental health unit continue to be housed in levels of confinement similar to isolation, Metzner wrote.

The unit’s population, which includes people who are acutely psychotic or suicidal, as well as those who are awaiting transfer to a state forensic hospital, are allowed very limited time out of their cells and must be dressed in suicide smocks. They’re also allowed limited possessions.

This article will be updated.

©2023 Baltimore Sun. Visit baltimoresun.com. Distributed by Tribune Content Agency, LLC.