When inmates die

The death of Gregory William Townsley, the third inmate to die at Sonoma County Jail in four months, has deepened concerns about inmate medical care even as the jail's provider seeks to renew its contract.

Officers said the 46-year-old transient had been in and out of jail for four years, mainly on drug- and alcohol-related charges, before he was found unresponsive in his bed Monday -- less than 24 hours after his arrest. Emergency responders could not revive Townsley, whose cause of death remains unknown.

Meanwhile, the Marin County Sheriff's Department continues to investigate the July 9 death of Ryan George, a 22-year-old with sickle cell anemia who died six days after being sent back to the jail from Sutter Medical Center.

As with the Townsley case, investigators from the Sonoma County District Attorney's office have joined sheriff's detectives in investigating the June 17 death of 55-year-old Richard Lamont Williamson Jr. He was found unconscious on the floor of his cell less than 24 hours after being arrested. An autopsy revealed coronary artery disease.

"Three deaths in four months speaks volumes," said New York-based attorney Steven Wittels, who is advising the George family and the local NAACP chapter. "They obviously are not giving inmates the proper medical attention they need."

But based on preliminary findings, Sonoma County sheriff's officials say there is no basis for blaming the deaths on "underperformance" by the jail's medical staff.

Nine of the 22 Sonoma County inmates to die in jail since 1997 have abused drugs or alcohol, they reported, a reflection of addiction's prevalence in the nation's jails and inmates' poor underlying health.

More than 70 percent of inmates have histories of substance abuse, and on any given day, 20 to 25 inmates at Sonoma County jails may be at risk of or suffering withdrawal, Assistant Sheriff Linda Suvoy said.

Williamson and Townsley fit that category. Both men were being monitored closely, sheriff's officials said, after they told officers they might suffer from substance abuse withdrawal.

With an average daily population of 1,100 in Sonoma County's two jails and 21,600 bookings a year, deaths are "tragic" but rare, said Dr. Taylor Fithian, president and medical director of California Forensic Medical Group. The Monterey-based contractor provides Sonoma County inmates' treatment.

said Fithian, whose company is the state's largest private provider of correctional health care.

California Forensic Medical Group replaced the jail's previous contractor, St. Louis-based Correctional Medical Services, which drew public criticism after five inmates died in a 16-month span in 1997 and 1998. California Forensic also has contracts in Mendocino, Lake and 20 other counties.

After four companies submitted bids for Sonoma County's upcoming contract, the sheriff's department narrowed contenders to California Forensic and one other. The sheriff expects to submit his recommendation to the Board of Supervisors this fall, Suvoy said.

The firm, which receives $5.3 million annually from the county, signed an eight-year contract in 2000, and within its first year "made numerous improvements in the delivery of health services," according to the Sonoma County grand jury's 2000-'01 report.

By 2005-'06, the grand jury, probing what it described as "substantial cost overruns in jail medical expenses," concluded that "the standard of care in the jail greatly exceeds that of the community."

Those medical services have stood up to scrutiny by the Corrections Standards Authority, which is due to re-inspect the jail in November, and the Institute for Medical Quality, which most recently renewed Sonoma County's two-year accreditation in 2006.

Corrections Standards Authority field representative Don Allen said he last visited Sonoma County in June. In recent years, after questioning inmates, medical staff and correctional officers, Allen said he's found nothing that points to substandard care.

The Institute for Medical Quality has examined the jails' treatment of chemically dependent inmates, their mental health and suicide-prevention practices and other standards l laid out in a 69-page volume.

The institute declined to share Sonoma County's most recent evaluation, referring that request to the sheriff's department.

Administrator Howard Lunche, who oversees corrections health care accreditation for the institute, said the 22 California counties that have received the accreditation either met or exceeded state minimum standards.

"The caveat is, it's not a surprise review," said Lunche, whose nonprofit group, a subsidiary of the California Medical Association, is based in San Francisco. "We're going in on one or two days . . . That doesn't say that on any other given day they didn't do something wrong."

Each Sonoma County inmate is screened for medical and mental health risks at booking, receiving a 13-point questionnaire to identify medications they're on, drug and alcohol habits, tremors or shakes they may experience while sobering up, food allergies and more.

Officers inform an on-site medic of any risk factors, and make regular rounds to check on inmates, with the frequency varying depending on the inmates' condition and where they're housed.

Correctional officers check on inmates at least twice each hour, Suvoy said. Meals and other daily routines allow for additional chances to observe an inmate's condition.

The first 24 to 72 hours after inmates come into jail with a history of drug or alcohol abuse are the most critical, Fithian said.

"We obviously recognize the high risk in this population," Suvoy said. "Our protocols and medical procedures are set up to respond to that."

Yet for many community activists, Townsley's death reinforced convictions that more must be done to protect inmates.

"People are coming in there stating that they're going to be suffering withdrawal, and they're subsequently dying," said Robert Edmonds of Santa Rosa. He is part of a coalition planning an Oct. 22 rally to protest local law enforcement practices.

"They need to do everything they can in order to make sure these people are having their needs met," he said. "Oftentimes, they haven't even been convicted of a crime at the time of their death."

Though Townsley was put on a "withdrawal watch," he did not show signs of withdrawal after he was booked last Sunday, said Elaine Hustedt, vice president of operations and personnel at California Forensic Medical Group.

According to jail records, Townsley was checked twice by a nurse -- once at booking and again six hours later.

"There was nothing that indicated, from a nursing interaction or from the deputies, that he was in trouble," Hustedt said.

"The officers are good . . . They're not going to ignore somebody's cry for help and they're not going to walk by somebody they think might be in trouble," she added. "We can't control everything that happens: Unfortunately people die in the hospital, people die at home, people die in the streets and people die in jail."

Apart from detectives' parallel investigations to determine any criminal liability, the sheriff's department is conducting its own internal, administrative reviews. But it's too soon to say if these latest deaths will prompt any policy changes.

"We're always questioning how we do things and trying to improve," Sheriff Bill Cogbill said. "So when something happens like this, we want to address that."

News Researcher Michele Van Hoeck contributed to this report. You can reach Staff Writer Katy Hillenmeyer at 521-5274 or katy.hillenmeyer@

pressdemocrat.com.