Officials adjust to new law for drunk prisoners

Some drunk prisoners who refuse to participate in medical tests to meet the Pettis County Jail's fit-for-confinement policy are not booked into the jail.

Instead, those arrested by Sedalia police officers are either released to sober adults, or watched for hours by an officer. County deputies take prisoners to the hospital to be examined, even if they refuse.

Sheriff Kevin Bond and Police Chief John DeGonia say they are working together to solve problems that have risen from the jail's fit-for-confinement policy.

A state law, which went into effect last year, allows jails to require medical clearance from "a physician or competent medical personnel" if prisoners are unconscious, seriously ill or injured or "seriously impaired" by alcohol or drugs.

"As administrators ... we have an obligation to ensure that the citizens are protected, whether that's the individual citizens that are coming through our facility or society at-large, by protecting the county (from liability)," Bond said.

How it works
Here's how it works at the Pettis County Jail: A person who appears to be drunk is asked to take a portable Breathalyzer test when he or she is brought into the jail. The jail requires medical clearance if the person has a blood alcohol content higher than .25 percent. Bond said he set the threshold based on medical documentation from the jail's physician and correctional medical providers.

The judgment of jail staff and the arresting officer help decide whether a person needs clearance from medical personnel to meet confinement standard, if that person refuses a Breathalyzer or is below .25 percent.

"Just because a person refuses to blow is not an indicator that they automatically need to seek treatment," Bond said. "It is that totality of circumstances when looking at that."

Jailers take into account the person's level of consciousness, behavior, speech and whether he is able to walk without assistance. The arresting officer is obligated to have the prisoner checked, at the prisoner's expense, to meet the confinement standards, according to the state law.

Sedalia Police Cmdr. David Woolery said, "The problem for us is a lot of people we arrest are intoxicated, and many over .25 (percent blood alcohol content)."

Woolery said if the prisoner is unconscious, injured or ill "it's our responsibility to take them to the hospital because they're not fit." He said he understands the sheriff's need to protect the jail from liability, but the policy is impractical when it comes to walking, talking drunks.

Sedalia attorney Robert W. Russell said the policy "puts the arresting officer into a heck of a box."

A person who is unconscious is unable to give consent and therefore, officers can seek medical treatment on behalf of the prisoner.

"You get into a completely different discussion when that person is conscious," Russell said. "Everything is dependent on the circumstances, on what condition the person is in when they're brought to the jail."

Officers take conscious, drunk prisoners to the hospital when asked by jailers and the prisoners agree to treatment, Woolery said. But, officers have few choices when a prisoner can walk and talk and refuses a medical exam, he said.

"We either keep them under observation, or get a competent adult to come and get them, which isn't a situation we're comfortable with, either, but we don't have any other options," Woolery said.

Those outcomes are undesirable because many of those who fail to meet the jail's requirements are violent, Woolery said. Officers arrested the prisoners for a reason, be it domestic violence, fighting or driving while intoxicated, he said.

"If they get back into that, or create another situation, it's just not a good idea," Woolery said.

A danger to their health
Sam Hargrave, the jail administrator, said intoxicated prisoners are among the most dangerous of health risks because of alcohol poisoning and the difficulty in detecting it.

Other county jails in Missouri have similar policies to those here. Some jails have a full-time medical staff. At others, jailers isolate drunks and monitor them carefully to catch medical problems.

Bond and Hargrave take the position that a drunk person is unable to exercise sound judgment in whether he needs medical treatment. Hargrave says prisoners have the "right" to refuse a Breathalyzer and to say what they want.
"That doesn't necessarily mean we will follow what they want, if there's concern for the health and safety of that inmate, that's going to win over on that," he said.

Hargrave said "a person who is highly intoxicated is a danger to himself and to others and he needs to be seen." Those who are drunk and drive are making irrational decisions and are unable to make rational judgments about their health too, he said.

"I'd say the arresting officer, if he's concerned about the well-being of the individual, he will take them to the hospital to be seen, even if they don't want to go," Hargrave said.

Bond and Hargrave liken it to when a person is suicidal.

"That person has no right to refuse because we're concerned about (that person's) welfare," Hargrave said.
Bond said prisoners can be forced to go to the hospital.

"We approach it from the standpoint, state law allows us, that if a person appears they don't fit medical confinement standards, it becomes the arresting agency's responsibility to get that fitness for confinement standards," he said.

A prisoner's rights
However, Russell said the state law can't trump Fourth Amendment rights against unlawful searches and seizures or Fifth Amendment protections against self incrimination.

State law "doesn't necessarily give the sheriff the right to force someone to be seen by a physician," Russell said.

Hargrave said jailers are not concerned about the prisoner's desires to keep parents from knowing of their arrest or fears that going to the hospital may jeopardize their criminal case.

"There is a great liability accepting someone into the jail who is not medically fit for confinement," he said. "I hope the citizens of Pettis County are concerned about that too. We'd really be doing somebody wrong if we didn't see that they were OK."

Bothwell Regional Health Center chief nursing officer Debra Howser said any patient who refuses treatment at the hospital is read a form and told of the health risks associated with leaving. A patient is allowed to leave after signing a "refusal for treatment form."

Howser said the hospital treats patients brought by officers to the emergency department the same as any other patient.

"We don't do exams just to say someone is" fit for confinement, she said.

Officers are at risk of civil liability if they force a prisoner to be examined, in some cases, Russell said. Nurses and doctors are at the same risk if they force an examination or possibly if they make the wrong call that the prisoner is suitable for jail.

"That's why you see a lot of hospitals refusing to do these things," Russell said.

Howser said the hospital assumes the same liability it would for any patient treated in the emergency department who later has a bad outcome.

Last year, two drunk inmates on separate occasions were taken to the hospital to get medical clearance. Each had been in a vehicle accident, but neither complained of pain at the jail. Bond said both had lacerated livers that required treatment.

"Had those people been in our facility and waited until they started complaining ... we don't know what the outcome would have been on that, but certainly, the quicker they can get to medical treatment the better off it is," Bond said.

An isolated problem
Bond contends that problems meeting the confinement standards are isolated to a few prisoners.

"We're not having every inmate come through like that. ... Most of the inmates we have come through, it's not an issue," he said. "The person is able to walk in on their own, they're able to talk, they know (the day of the week)."

Woolery said from Feb. 28 to March 19, four prisoners failed to meet the jail's fit for confinement standards and refused the examination at the hospital. He began requesting documentation of such instances March 2.

Woolery said he is unaware of any prisoner arrested by Sedalia officers being admitted to the hospital after a medical exam.

Tale of two arrests
Hargrave described a recent situation following the arrest by a Pettis County deputy that shows how the policy is supposed to work.

A woman was arrested with a blood alcohol content of .27 percent. The deputy told the woman he was going to take her to the hospital to be checked as a matter of policy and procedure, and "she didn't want to go," Hargrave said. The deputy took the woman despite her wishes, a doctor said she was medically fit to be in jail and she was brought back to the jail.

"That arresting officer did his job," Hargrave said. "He had concern for her, as well as the correctional officers, that she was OK. Nobody was let out of jail; we don't want anybody let out of jail. ... If they break the law, they should be in jail, but that doesn't mean we're not concerned about their safety and welfare and want them checked out."

In contrast, Sedalia officers detailed these events in a report from an incident March 1.

A woman was arrested on charges of obstruction and failure to obey officers. She appeared to be drunk. Once at the jail, the woman "functioned very well physically but was uncooperative by way of her attitude." Officers described her as "mobile, agile and articulate with no slurring the entire time, although she remained loud and hostile."

Officers began paperwork to book the woman into the jail and the woman continued to yell and threaten officers. The woman refused the portable breath test and the jailers told officers they would have to take the woman to the hospital to be examined.

She refused to be examined, and jailers told city officers she could be cleared if a doctor looked at her and said she was OK. An officer called the hospital, where an emergency room doctor said he wouldn't make a medical diagnosis without physically checking the woman.

Two Sedalia officers were in the sally port of the jail discussing what to do with the woman who was not allowed in the jail without the medical exam, which she refused. A jailer escorted the woman into the sally port and released her there with the officers. She began yelling, pointing and getting so close to the officers they had to push her away. A deputy helped the officers by handcuffing the woman to a wall in the sally port. The woman was released to a relative.

Bond said jailers in this situation suspected the woman was also on drugs and exhibiting "bizarre" behavior. He later talked to a family member who said the woman had also taken medication that shouldn't be mixed with alcohol.