At a tribal jail in Washington state, an inmate with a broken leg banged on his cell door, screaming for pain medication, only to be denied.
Hundreds of miles away, a diabetic man jailed on the Wind River Indian Reservation in Wyoming needed insulin, yet government records say authorities were unable to get any for him.
And jail staff at other reservation lockups on several occasions mistakenly gave inmates the wrong medication.
These episodes, and dozens of others noted in limited detail in 2016 jail incident reports collected by the federal government, underscore what health professionals and jail administrators describe as a deep-seated problem: Scores of federally funded jails on reservations have no in-house nurses or other medical staff, often leaving corrections officers to scramble in emergencies to determine whether to send an inmate to the hospital, or provide basic care themselves — sometimes with unfortunate consequences. Jail data collected by the U.S. Bureau of Indian Affairs from 2017 was not yet available.
“It’s not really safe for really anybody,” said Lynette Bonar, the chief executive of Tuba City Regional Health Care Corporation, a hospital on the Navajo Nation that regularly treats inmates transported from a nearby jail.
She helped form the Arizona Tribal Correctional Healthcare Coalition, an ad-hoc committee of tribal jail and hospital administrators, in response to the situation.
Meanwhile, the Interior Department’s Office of Inspector General urged the BIA in reports spanning more than a decade to tackle the problem, recommending the agency arrange with the Indian Health Service to have nurses keep hours inside some jails.
“You have people that are corrections officers giving people pills,” Bonar said of the tribal jails. “People aren’t really getting health care, and they’re not being screened for communicable diseases.”
The BIA has oversight of some 80 jails from Mississippi to Alaska, holding an estimated 2,500 inmates, according to the most recent federal figures. The largest hold more than 100 inmates, while the smallest house fewer than a dozen.
The BIA manages about a quarter of the jails, and tribes have federal contracts to operate the rest. All rely on Indian Health Service or tribal health clinics to provide care to inmates.
In some instances, local jailers at the facilities or tribes will arrange to have nurses from the clinics treat inmates on site. But such arrangements are made at the local level and dependent on resources of the Indian Health Service, a federal agency under the Department of Health and Human Services, said Nedra Darling, a BIA spokeswoman.
Nationwide, most of the jails do not have the means or an arrangement in place to provide health care in-house, resulting in excessive spending due to the costs of dispatching ambulances to the jails and transporting inmates to hospitals, according to U.S. Sen. John McCain. He sent a letter last fall to federal agencies, including the BIA, seeking to learn standards for medical care for inmates, and how many employees would be needed to ensure the jails have sufficient care.
In an email, Darling said Friday that officials had started exploring solutions two years ago and had begun assessing each detention center’s proximity to clinics, as well as the types of services they provided, to help determine the potential cost of staffing the jails with Public Health Service officers. That assessment is ongoing, she said.
An Associated Press/CJ Project analysis of jail records collected by the BIA found that on average, care was sought four times a week within the jails for reported sexual assaults, fist-fight wounds and ailments ranging from seizures to chest pains. The BIA, however, provided records for fewer than half the jails in response to Freedom of Information Act requests, suggesting the number of times inmates required care may be greater.
In one of the more tragic 2016 cases, officers at the Nisqually Tribe’s jail south of Seattle failed to detect that inmate Andrew Westling, 19, was in dire need of medical care, despite him telling authorities he had a heart problem, according to a lawsuit later filed by his family. Westling, who was not Native American, had been arrested for underage alcohol possession by police in Yelm, which contracts with the Nisqually Tribe to hold suspects, and he died while in custody, according to legal documents. The case was settled last year for an undisclosed amount.
His family’s attorney said health care procedures in the tribal jail facility remained a mystery to him and his team. A spokeswoman for the Nisqually Tribe declined to comment.
The National Congress of American Indians in a resolution last year said tribes with federal contracts to operate jails, many of them already cash-strapped, have started spending more on transporting inmates to and from hospitals. Those trips typically require one or two corrections officers to escort inmates, the Arizona group of tribal health care advocates said.
When that happens, fewer officers are available to supervise the jails.
“You’ve got to pull from small numbers of officers on shift,” said Fernando Castro, deputy director of San Carlos Adult and Juvenile Rehabilitation and Detention Center in Arizona. “Just hold your breath and hope that nothing else serious happens.”
The jail he helps run is on the San Carlos Apache Reservation, in the mountainous desert east of Phoenix. Inside, Castro describes a room designated for people picked up for public intoxication as a “holding area.” He won’t call it a “detox unit,” saying that would suggest there’s medical staff in house to monitor inmates for alcohol withdrawal.
“Whether it’s medical or mental, we just don’t have care on site,” he said.
Bonar, the hospital CEO in Tuba City, said she grew frustrated over the situation in 2013 when the Justice Department completed construction on a $70 million jail in town.
It was among several built with federal stimulus money starting in 2009, complete with an area designed to provide basic care to inmates, she said. Bonar was told, however, there were no federal dollars available for caring for them in house.
“We said, it’s going to be disaster over there one day,” she said.
Soon, those fears were realized.
The year the jail opened, authorities booked an inmate with tuberculosis without a proper screening, triggering an outbreak, she said, and dozens of inmates and staff were tested and treated at the Tuba City hospital, with two corrections officers testing positive for the airborne virus.
Little has changed since, she said.
“It just drops through a crack, and nobody cares,” Bonar said. “They all know they have the problem.”