A 16-year track record of compliance with NCCHC standards for health services is reason enough to feel proud. But staff at the Patrick J. Sullivan Detention Center in Colorado can also take pride in the fact that their health services department is so exceptional that NCCHC accreditation surveyors nominated it for the Commission’s prestigious Facility of the Year Award.

Surveyors visit a great many correctional facilities and get an inside view of their strengths and weaknesses. What makes this county jail stand apart is an overall high quality of care, excellent coordination between two service areas—medical and mental health—that report to different authorities, and close working relationships between health staff and custody staff.

“We are honored by this award,” says Sheriff J. Grayson Robinson. “We understand the benefits of accreditation and are dedicated to the process. This honor is a direct a result of the hard work of the men and women of the sheriff’s office, and those in the health department in particular, to meet and exceed the standards.”

Caseloads, Acuity on the Rise
The Sullivan Detention Center is not unique in terms of many of the challenges it faces: growing populations and patient caseloads, more health problems, tougher health problems.

“The increase in acuity of inmates as they walk in the door is a consistent challenge,” says Elaine Meyer, RN, BSN, MBA, HCM. Although she’s been health services administrator for only about 15 months, she has observed a distinct trend: “Inmates are coming in with acute and chronic medical issues that were not normally seen in the past. We have inmates coming in with trach tubes, on oxygen and with chronic mental health issues.”

The health problems her staff must address deal with run the gamut, but some of the most common conditions are diabetes, chronic obstructive pulmonary disease, bone/muscular/orthopedic problems and cancer.

Mental health problems are also on the rise, says psychiatrist Erwin Mozer, MD, again in terms of patient numbers and severity of illness. “The closure of several mental health facilities in Denver has left a gap that we seem to be filling.” As a consequence he has increased the hours he spends on site from about 10 per week to 14.

Patients generally reach Mozer through the triage system, often sent from the classifications department when an inmate is admitted but also from the consulting psychologist when a patient need is identified.

Solving Problems
Helping to offset the difficulties are the victories. To deal with the handful of juveniles adjudicated as adults, the jail houses them in a dedicated module, assigns specially trained staff to that module and uses health protocols that address juveniles’ special needs.

A review of the medication distribution system revealed widely varying workloads for nurses who handle different housing pods. After a revamp, each nurses’ med pass is more manageable, Meyer reports.

Another problem vanished when the medical director put inmates on notice that special mattresses and T-shirts would no longer be considered medically necessary. “That really cut down on the number of grievances by inmates who wanted these special items,” says Meyer. “They don’t even ask anymore.”

— About the author: Jaime Shimkus is NCCHC’s publications editor. To contact her, e-mail jaimeshimkus@ncchc.org.