By Andrea J. Cabral
Sheriff, Suffolk County Sheriff’s Department
January 4, 2004

Thousands of men and women are committed to the Suffolk County Jail each year, and each receives the best possible medical care available. The Jail, located at 200 Nashua St. in Boston, processed more than 13,000 pre–trial detainees—men and women arrested—in 2003. Providing medical and mental health care for each of these individuals is a daily challenge for the health care professionals and the uniformed staff of the Jail. Some detainees only stay at the jail for a few hours; others are housed for several months or, in some cases, years. The Jail must provide a wide range of medical care to these detainees, including general medical attention, substance abuse counseling, psychiatric services, orthopedics and dentistry.

In the last two fiscal years, budget cuts to human service agencies have been drastic. The absence of substance abuse and mental health resources, and the resulting unavailability of alternative placements for defendants presenting with these problems, results in significantly higher bail commitments. In these circumstances, the Jail becomes a de facto detoxification, mental health and primary medical care facility for pre–trial detainees in Suffolk County.

The Jail’s medical/psychiatric unit has room for 22 detainees and is always operating at full capacity. During the last six months of 2003, we have seen a dramatic rise in the number of detainees who have mental health issues. The number of people seen by mental health practitioners rose from 2,757 in 2002 to 5,406 in 2003, an increase of 96 percent. In the first 10 months of 2002, there were 34 people committed to state mental health facilities. During one three week period in 2003, there were seven inmates with mental health issues committed to state mental health facilities. This year, 15 percent of the men and 36 percent of the women housed at the Jail were seen by medical staff and determined to have major mental health illnesses.

Another significant medical challenge faced by the professional staff at the Jail is substance abuse. More than 60 percent of the detainees reported injecting or inhaling drugs in the month prior to their incarceration. The number of inmates actively detoxing from drugs and alcohol has skyrocketed over the past year. In 2003, the Jail treated 1,124 men and women who were in stages of detoxification, an increase of 109 percent from 2002. Not coincidentally, the vast majority (80 percent) of inmates with mental issues also have substance abuse problems.

As the population increases, the Jail must also deal with increases in chronic illness. Approximately 18 percent of the detainees have asthma and 8 percent have cardiovascular disease. Diabetes is seen in 8 percent of detainees and more than 30 percent have bone or joint problems. The amount of chronic illness among detainees resulted in nearly 4,297 inmates being seen at sick call by the physician. We are required to treat every detainee, and for security and financial reasons most of the treatment is done at the Jail, though 703 detainees were transported to outside medical facilities for treatment in 2003, up from 685 in 2002.

Sexually transmitted disease is one of the most daunting problems facing our medical staff at the Jail. The rate of HIV infection among inmates is eight times that of the general population. In 2001, the jail treated 453 cases of chlaymidia. One alarming fact is that nearly 10 percent of the syphilis cases reported in Massachusetts in 2001 were from people held at the Nashua Street Jail.

Treating detainees with these and other illnesses, while necessary, is costly and time consuming and has a significant impact on our budget during these lean fiscal times. The Department alone cannot solve the problems caused by the dramatic increase in the number of men and women committed to the Jail. We recognize the need to comprehensively collaborate with social and psychiatric service agencies and access other criminal justice resources to effectively meet these unprecedented challenges.

We continue to explore ways to improve and broaden clinical programming and treatment, with the hope of providing stabilization in the lives of those in our custody. Our goal is the ultimate reward of a healthier population, reduced recidivism, safer communities and the enhanced public safety. I am committed to providing innovative leadership that balances our operational needs and fiscal limitations against our obligation to provide quality medical care to the men and women committed to our custody.