Inmate health in St. Louis County: Is jail getting best care?
Confronted with a medical provider under fire, jail administrators open up about health care challenges and why standing put ought to be an option.
DULUTH — Until recently, the St. Louis County Jail had enjoyed its time in the shadows.
“We don’t like making the news,” Jail Administrator Jessica Pete said. “We’re the quiet part of the Sheriff’s Office.”
But the jail’s contract with a for-profit medical provider put the St. Louis County Jail under a spotlight this month, when the County Board voted 4-3 to maintain its existing contract with MEnD Correctional Care unless directed to an alternative by Sheriff Ross Litman.
MEnD is under fire throughout the Midwest after its founder and medical director, Dr. Todd Leonard, had his medical license indefinitely suspended by the state in January.
Leonard’s license was suspended following the 2018 death of 27-year-old Hardel Sherrell, who died in the Beltrami County Jail in Bemidji. Jail and MEnD staff were found to have ignored Sherrell’s pleas for help in the days preceding his death, and that county has since ended its relationship with MEnD.
But local jail officials say inmates aren’t at risk of substandard or neglectful care.
“That’s not a possibility here,” said Erich Stabs, a 20-year veteran and interim captain of security at the St. Louis County Jail. “If somebody is having an issue, we bring it forward. Our staff has never had an issue bringing it forward.”
The News Tribune met with jail administrators last week to discuss MEnD, and medical practices within the jail. During a tour of the jail, there were 188 inmates. Some were observed working in the kitchen, on their way to earning extra phone cards. Others were mingling in common spaces within units. One full unit featured 47 new inmates, one to a cell as they each completed 14 days in quarantine — a measure used to prevent the spread of COVID-19.
"Quarantining takes up a lot of space," Pete said. "You have to take one person away from everybody else."
A staff member inside a unit was observed wearing full personal protective equipment as the jail was getting over its first outbreak of COVID-19 — an illustration of both how well the jail had performed until now, and how fast and effectively the omicron variant spread in January.
“In two years, we hadn’t had an outbreak,” Pete said. “All of a sudden, one-third of our staff and one-third of our inmates were completely positive within a few days of each other.”
The News Tribune had been informed of the outbreak by an inmate and his spouse, saying he was being isolated in an intake cell with other COVID-19-positive inmates — sleeping on mattresses on the floor.
Sheriff Ross Litman confirmed the unusual situation.
“The situation in the jail right now is not idyllic, because of the pandemic,” Litman said when asked about the inmate’s complaints. “You can imagine how challenging that is.”
Jail administrators spoke with candor about the pandemic and jail medical practices, and sought to protect the county’s relationship with MEnD in the face of public criticism, including from the Duluth branch of the NAACP and the Minnesota Nurses Association, who have called on the county to move on from MEnD.
But jail administrators say MEnD has helped them build a medication-assisted treatment program for people addicted to opioids. MEnD's nurse practitioners and doctors have sought proper waivers to provide the treatment, and the MEnD staff on-site features one nurse whose sole function is to deliver the treatment.
“We started small and now we are up to, on average, 35 people who are actively on the program,” Pete said. “We have a waiting list of about 20 other people, only because we have to figure out how to staff it. It’s time-intensive.”
The county’s program is so effective, program administrators have spoken about it at industry conferences. When an inmate leaves the program, a navigator helps find a provider in the community to ensure the person a clean transition.
“You have to have a prescriber who is willing to prescribe (medication-assisted treatment),” Pete said. “So, one of my biggest concerns is if I find a new company, are they going to provide this MAT service? They don’t have to if they don’t want to get the waiver. I want that requirement for anybody who is looking to come in and fill the contract.”
A 19-year veteran at the jail, Pete described Dr. Leonard’s role as mostly administrative now, and said that MEnD's on-site staff are valued parts of the local team. During the tour of the jail, multiple nurses conducted business in a medical office, which contained a secure room with a viewing monitor used by inmates for telehealth consultations.
“I hear the community; I hear them yelling, because they don't know or understand what goes on in here," Pete said. "But it's the people who work here for MEnD that, to me, represent MEnD. ... People forget these are community members — these are people that live and, in many cases, grew up in our community."
The jail administrators explained processes from health emergencies to the health screenings that occur during booking procedures. They described a culture of humane treatment, and told how, at any point, a jail staff member can call for an inmate to be seen at a local hospital and cleared by an emergency room doctor prior to returning to jail.
"'If in doubt, send them out,'" Stabs said, reciting a piece of wisdom shared in training. "Nobody critiques how you're handling medical issues. If you say, 'I'm sending them out,' it's as easy as that."
The jail features some medical equipment, including a newly acquired full-body scanner to help locate contraband like weapons and packaged drugs an inmate may have swallowed or hidden.
“The one thing we’re not here is a hospital,” said Brandon Hartwick, captain of operations. “If you have that level of care needed, we can’t provide that here.”
Hartwick spoke about the work of the corrections and medical personnel during a time when jail care is being publicly questioned.
“We know what we do here,” Hartwick said. “We’re in the people business. We are passionate about what we do. It’s just not something that’s shown or reflected in the community.”
Hartwick and the others described difficult situations. There was the time a couple of months ago when he used Narcan to save an overdosing addict.
“This person was a color blue I didn’t know existed on a human being,” Hartwick said. “And there we were, myself administering Narcan and bringing this person back to a level of consciousness where they’re finally able to answer questions and get EMS rolling and get them to a hospital.”
There was a recent suicide attempt where an inmate leaped two stories from a mezzanine to the ground floor.
“He broke several bones in his body, and luckily he’s OK and made it through,” Pete said. “He’s not going to be allowed near a tier ever again while he’s in custody, because I don’t trust him anymore.”
That person didn’t display signals jail personnel are attuned to observing, they said. By law, staff are required to observe the well-being of inmates at least every 30 minutes. They’re familiar with signs of distress or anxiety which accompany a medical or mental health issue.
Pete described the jail as a microcosm of community.
"You’re going to have people that pass away, and you’re going to have people that give birth," she said. "We’ve had both in here."
Every incident, such as the suicidal jumper, has to be reported to the state Department of Corrections and investigated internally, reviewing to determine if something needs to be done differently.
“There wasn’t anything we could have done to prevent it,” Pete said.
“Sometimes, if they are determined, they are not going to give you those signs,” Hartwick added.
Regarding the county’s contract with MEnD, which has been in place since Essentia Health opted out of jail health care in 2012, Litman is expected to bring a recommendation to the County Board sometime this year.
“I have no problem looking outside MEnD,” Pete said. “There could be something that is bigger and better and provides different services I’ve never thought of.”
But until then, Pete and the others support MEnD and the status quo.
“They’re in a very weird mode,” Pete said of the MEnD staff working while their contract is under scrutiny. “I’ve had to reassure them we’re doing our due diligence, and that I’ll let them know anything the moment I do.”