Current Litigation trends

Detention setting healthcare lawsuits began in earnest in the 1990s. Usually these cases focused on one aspect of care such as medical care or mental health care. In California the Department of Corrections and Rehabilitation (CDCR) was sued in the early 1990's for inadequate mental health care. What started as a class action mental health lawsuit progressed to a lawsuit about disability accommodations, and then for providing unlicensed care, and then medical care and then dental care. Some of these CDCR lawsuits continue today.

So how does state prison problems affect the county jail systems today?

With a growing county jail population leading to overcrowding and other issues, county jails became the next target for healthcare litigation. Jails are seeing longer sentences, aging populations and increased demand for services. At the same community mental health services are limited so many mentally ill persons end up in the county jail.

Current Challenges

Today's jails face a tremendous challenge to provide necessary healthcare that they did not plan for years ago when facilities were designed and built.

Some of these challenges are:

Inmates have longer sentences with fewer deferrals of care.
The population is older with greater health challenges and chronic diseases such as COPD, back pain, Diabetes, Hepatitis C, AIDS and heart disease.
Nationally, 20-40% of the jail population has a severe mental illness that requires treatment.
Older facilities do not have the right kind of beds, not enough treatment spaces or good access to out of doors space for recreation and out of cell time.
Many inmates have untreated dental issues
Older facilities did not plan for growth in healthcare services.
Community services (acute mental health, acute hospitals) is limited or not available.
Delays in Competency hearings
Difficulties recruiting trained staff
Inexperience with healthcare planning for new facilities
Inexperience with healthcare lawsuits.

Current Best Practices

Counties today must carefully consider these challenges and the risks of litigation when planning for their next detention project. What was once the standard in jail design is now shifting to provide additional design for necessary services for their population. Careful consideration, consultation with healthcare staff and experts in the field will best assist counties to build what they need now and for the future. This type of planning may also reduce the chance of litigation and increase positive outcomes including reduction of recidivism.

The latest trends in jail design are moving towards specialized housing for certain types of healthcare conditions. Such as medical units and behavioral health units. From the health and hospital design literature many studies now show that environment affects behavior and healing.

Here are a few building design elements that are now considered best practice in detention healthcare planning for new and renovated facilities.

Cells arranged so there is a view to nature with good natural light
Building flexible space for future changes
Planning for multiple levels of care units for mentally ill inmates (from acute needs to GP) so that as they improve the environment can be less restrictive
Planning for adequate treatment space for groups, individual contacts and recreation
Access to outside air and sunlight
Use of color and textures to create a therapeutic environment