Jail nurses bring compassion to tough job

From The Portland Business Journal, October 18, 1998

Nurse Chris Olson still remembers the suicide victim’s face like it was yesterday.

It was a slow Sunday and the man was in a holding cell at the Multnomah County Detention Center in downtown Portland. “All of a sudden they screamed for a nurse,” recounts Olson, who was working medical reception that day. The man had hung himself. She and other workers tried desperately to resuscitate him, to no avail.

“When I just looked at him, I knew it was hopeless,” recalls Olson, a veteran nurse who started her position at the Detention Center in 1997. “It was really very scary,” she says. “It was traumatizing.”

The man had come into the jail earlier that day and seemed fine. To this day, she can’t think of anything that could have been done differently.

“I still think about it all the time,” she adds.

Welcome to jail nursing. It’s not a job for the faint of heart.

Imagine having a career where you interact with known murderers, child abusers, rapists and thieves. Where many of your “clients” have mental health disorders, drug and alcohol addictions, or both. Where communicable diseases, such as tuberculosis, pose serious threats to your own health. Where you have to be let through several locked doors just to get to the job. Where your conversations and actions are monitored, and your safety is in the hands of sheriff’s deputies who must oversee dozens of inmates simultaneously.

Nurse Barbara Lieuallen faces that reality every day.

It’s Sept. 29, and Lieuallen is doing her rounds at the Detention Center, located inside the Justice Center at Southwest Third Avenue.

She’s one of a handful of nurses and three physicians working day shift on a 24-hour medical schedule in the jail. No matter how heinous their crimes, Lieuallen is ready to see inmates. She’ll look them in the eye, offer them compassion, medication and medical expertise.

“We provide a safety net for the very bottom of the barrel,” says Lieuallen. “Somebody has to do it. I have a strong spiritual need to do it.”

“Their behavior gets so institutionalized you forget,” says nurse Brooks Plowden, who also does rounds at the jail. “They’re not in here for very nice things. The biggest creep in the world in terms of his charges can be the most charming and engaging here.”

As long as the inmates are cooperative and treat them with respect, the nurses can overlook their charges–in fact they find they must, so they can focus on the issues at hand–good medical care.

“You can’t look so much at the larger picture,” says Plowden. “We depend a lot on each other, going into the lions’ dens.”

9 a.m.: Facing the lions

Three carts line up in the narrow, white hallway at the jail.

They look like industrial airline food carts, but instead of food they hold dozens of pill vials, wound dressings and first aid supplies. Their drawers are tinted sea-green, luring the eye from the overwhelming gray and white environment.

Three nurses check their medical supplies in the jail pharmacy, edging around one another in a well-rehearsed dance. Drugs are a major part of the health care program. The county spends an estimated $2,000 every other week, just for the antidepressant Prozac, according to a corrections health nurse.

The six drawers in each cart are checked and then checked again. Each nurse flips through her clipboard assignments.

Then it’s time for medical rounds to begin. Dozens of the 676 inmates at the downtown jail need some type of medical attention or ongoing prescription.

Lieuallen checks the bulletin board for the current patient roster: nine people being watched for heroin withdrawal, four isolated for possible tuberculosis, one man on intravenous antibiotics for a severe kidney infection and nine pregnant women–all high risk. Two inmates on “suicide watch,” one of whom tried to hang himself with a blanket the day before. And that’s just a partial list.

Lieuallen fidgets a bit, maybe because she’s been assigned to treat some of the rowdiest units of male inmates at the jail.

“Did you draw the short straw?” jokes Sgt. Robert Camp, a sheriff’s worker who is escorting Lieuallen on her rounds. Corrections health is under the auspices of the county health department, not the sheriff’s office, but deputies protect the health care workers.

“I definitely want (a guard) with me in 7A,” says Lieuallen, referring to a ward of particularly testy inmates. It’s not common, but a year ago a nurse was slammed against a wall by an irate inmate after she refused to give him narcotics.

The cart trio rolls down a narrow hall, veers right and stops in front of institutional chrome elevators, too marred to see a reflection.

One of the nurses mumbles something about how easy it would be to get lost in the maze of hallways. Each hall is blocked by locked doors, controlled by sheriff’s workers hidden behind darkened glass offices. They also monitor the cameras that keep watch on the passages.

Lieuallen pauses before each hall door to wait for someone to flip the switch. She goes through two more sets of locked glass doors before she reaches the guard station.

“Welcome to 7 Alpha,” booms Deputy Roderick Lightner Sr., sounding like a character out of an Alien movie. Only a handful of the 64 inmates in 7A are outside their cells. Most remain locked in until Lightner jabs some release buttons on his control panel for ones who need medication or are seeking treatment. Inmates in this unit don’t expect release soon, and tension is thick. There are a few catcalls and mumbled comments.

The deputy watches the nurse, but spends time scanning the floor, occasionally raising his voice to chastise an inmate who’s shouting for more food or trying to draw attention to himself. Visitors tend to get prisoners stirred up and Lightner doesn’t want any problems. A few men push their faces against the 4-inch wide window in their wooden doors to get a better angle to watch Lieuallen.

Lightner’s station has mostly bare counter tops, save a purple Holy Bible, a 1998 standard diary and a Scrabble game. His demeanor is that of someone who doesn’t allow clutter, just as he doesn’t permit misbehavior. “It takes a certain amount of tolerance,” says Lightner, a 10-year-veteran of the sheriff’s department. “Not everybody can do it.”

An inmate with a shaved head hustles up to Lieuallen. Both speak in hushed tones. At one point the nurse leaves the station enclosure to get a better look at the inmate’s feet. She jots some notes in a file and he shuffles away.

Lieuallen says the inmate claims he had surgery for flat feet and is angling to get a downstairs cell so he won’t have to trudge up the white-grated stars to the second level.

An older man is next in queue. He wants to know whether his family has brought in his eye glasses. They haven’t. “Are you going to be in jail long?” asks Lieuallen. Another three to five days, at least, he says, adding, “Getting behind on my reading.”

The next man approaches, silent as he shows Lieuallen his wristband, which gives his inmate number. She looks up the chart, puts a few pills in a paper cup and watches him swallow them down with water to ensure that he actually downs the medicine. Some inmates save up pills to barter with other inmates or sometimes end up taking a lethal dose.

“Johnny you have a call,” shouts Lightner, hailing a balding man as he snaps his console to unlock the door. The inmate pads by, headed toward a phone in the direction Lightner indicates.

Johnny returns from his attorney’s call. His father has just died. He gets Lightner’s permission to make a call.

Another prisoner asks the nurse to be switched to a bottom bunk because of his seizure disorder.

Typically those kinds of disorders are noted and accounted for when prisoners go through their admission questionnaire, Lieuallen explains. Everyone must answer a series of questions and be observed by a medical triage before they ever get near a cell. If they stay longer than two days, the jail mandates testing for tuberculosis. But sometimes folks don’t disclose everything.

Sgt. Camp notes that changes, even if made for health concerns, can disrupt the jail pecking order. “Everything is in the here and now; they don’t understand consequences.” Inmates fight over even the most insignificant details, like who eats first or who walks first. Like children.

9:49 a.m.: The “predators”

Lieuallen rolls into the next unit, a divided room overseen by Deputy Elliott Ness. Some of the jail’s most unsavory characters–child molesters and rapists–are housed here. But tension doesn’t seem to be present and Ness jokes with the inmates as they line up at the nurses’ station.

“You’ve got to watch where you house people,” says Sgt. Camp. “Child molesters, rapists are at the bottom of the ranks. Most of these people are predators. They exploit people. They associate niceness with weakness. If you do something nice for them they think they have something over on you. It’s a totally different mentality.”

Sgt. Camp says these inmates are housed together for their own safety. Other inmates have kids and families on the outside and don’t take kindly to child molesters. Inmates who are testifying against others also are placed in this unit, he adds.

Several inmates are walking around. TVs are blasting in both common areas and there’s a hum of conversation. Two men in unit C are playing chess.

Prisoners queue up to see the nurse. They know the routine. If they’re taking pills, they come with a small cup of water to swallow it down.

Paul, one of the prisoners, downs a cupful of meds with water. He says he has been satisfied with the jail health care services, but he’s sour on the fact that his Medicaid plan won’t cover his antidepressants and anti-anxiety meds in jail.

He’s facing charges that he abused his son, says Paul, whose last name is withheld on request by the jail. He’s accused of beating his child and withholding food. Enough to depress anyone. He denies the charges, but had plead guilty to some misdemeanors because he’d gotten involved in some other trouble related to his drug addiction.


“I guess when I was on the drugs I was pretty cranky,” he adds. His sentencing was slated for mid-October. If he’s found guilty, he’ll get 13 years. He says he’ll surely file an appeal.

Another chubby-cheeked man with a crew cut echoes that assessment of health care. “Actually it’s pretty good,” he notes. The man takes four prescriptions a month, a $20 hit. But the medicine, including anti-psychotics, has helped him squelch inner demons that earlier prompted him to try to hang himself. “I hear voices,” he says. He sees a jail psychiatrist twice monthly. Another $10.

Was it an interruption in his medicine that prompted some behavior that got him arrested? That’s a much-cited pattern for an increasing number of mentally ill folks in jail. “No,” he shakes his head, his eyes suddenly going vacant. “I got myself in here.” He volunteers nothing more and moves away.

The man was a child molester, Sgt. Camp explains, his victims including several Russian children.

Only a few prisoners line up to see Lieuallen on the right wing of the unit. One prisoner needs a different request form. She examines one man’s throat with a light and makes some chart notes to get him some pain medicine. An older man gets a bit heated when he’s asking Lieuallen for regular shoes to wear because the jail-issued, plastic sandals hurt with his gout condition.

Lieuallen doesn’t let the discussion escalate. She promises to check on his request and firmly ends the conversation. Getting regular shoes in jail is a big deal, she explains later, because it’s considered a privilege that the lieutenant in charge doesn’t often allow.

By 10:30 a.m. Lieuallen is wheeling back to the fourth floor and drops off her cart. She heads to the 10-unit infirmary. En route she calls out “Hi honey” to one inmate. Lieuallen says the woman is mentally ill, alcoholic and homeless, and is chronically in and out of the jail. Lieuallen explains that the nurses discovered the woman had a severe mental illness during one of her earlier visits after she’d detoxed the alcohol.

A lot of Lieuallen’s clients are repeat visitors, many of whom are harmless if they can stay on their medications or off the narcotics.

“People arrested on methamphetamines are the worst,” says Lieuallen. “They’ve been up straight for 48 to 70 hours. It’s like looking at an animal being electrocuted. Little petite woman have this incredible strength. They’re thin, they don’t eat, their teeth are destroyed. They don’t take care of their kids. As a nurse, it’s hard to see this in people you care about.”

Lieuallen recalls a genial, educated Central African teacher jailed here a few years ago as a political refugee. He needed regular kidney dialysis, a service the jail contracts out in the community. He was deported at his home country’s request, only to die a short while later because he couldn’t get the medical attention he needed.

Lieuallen stops in a locked mental ward unit. There’s a fan facing out from the guard’s station. Sometimes it can be a bit smelly. Deputy Rick Wallace encourages inmates to take a couple showers a week, cajoling and occasionally forcing prisoners into the tile-lined room. More than five years ago, when the prison allowed smoking, he recalled, cigarettes provided a good incentive. Now, he’s able to bribe a lot of them with coffee.

10:55 a.m. Next Stop: The Hole

Near the mental unit, Lieuallen stops by a special area known simply as “The Hole.”

The Hole is a grimy, locked hallway with 10 individually locked cells–something akin to a kennel for the worst of the bad dogs. The small cell windows to the outside are frosted, furthering the isolation.

Depending on behavior, inmates may get only 15 minutes a day, and sometimes even less, outside the cell.

And when they do get out, they are allowed only to pace the locked hall, barren except for a shower and a wall phone. Occasionally the prisoners rip the phone off the wall and hit each other with it, Lieullen says.

Earlier in the day one prisoner had rubbed feces on the wall. Hair stubble remains on the floor where another had gotten a haircut. The ceiling is yellowed with water stains.

No one needs medical attention in The Hole today, but when they do, says Lieuallen, transactions are done through the door’s food delivery opening. The quiet casts an eerie mood.

One inmate looks out as Wallace illustrates a sliding cover that can blacken out even the modest window in the door.

To one wants to stay in The Hole for long.

11:10 a.m.: Back to the future

Lieuallen returns to the medical unit, heading into a work room/break room. That’s one of the few places in the jail besides the restrooms where workers aren’t on camera or near listening devices.

She sits down to talk with some of the other nurses, debriefing the day or talking about the world outside. There may be files to check. They have to prep for the next round that will come right after lunch.

Most days, Lieuallen and the other nurses make sure they get outside the jail for lunch and fresh air.

Explains Lieuallen, “Everyone has to get outside; it’s just too weird.”