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The jail is seeing an 'unprecedented' number of inmate deaths this year, after four have died in five months.

PMG PHOTO: JAIME VALDEZ - A Washington County Jail deputy tries to calm an inmate in the medical observation unit, who began hitting his head against the door during a tour of the facility in July.

Despite numerous medical procedures built into the daily operations of the Washington County Jail, four people have died there in the past five months.

A look at the jail's medical facilities and policies shows that while the health of adults in custody is taken seriously, there are areas where some might fall through the cracks and where the very nature of the detention system contributes to a lack of adequate medical care.

One of the four deceased inmates hadn't even been there a full day before she was found unresponsive, and another didn't get through the booking process before deputies found him not breathing in the general intake room.

Details remain scarce as to just how these four people died or whether their deaths could have been prevented.

The Washington County Sheriff's Office, which operates the jail, maintains that it meets or exceeds all the medical standards required by Oregon law. The facility has been granted the required certifications and regularly passes its inspections by state and local agencies. PMG PHOTO: JAIME VALDEZ  - Lt. Vance Stimler (right) and Sgt. Brandon Toney (left) stand in the special needs unit of the Washington County Jail, where inmates with the greatest medical and mental health needs are housed.

Medical and intake procedures

Everyone who's booked at the jail gets a medical screening and mental health evaluation. Depending on their physical and mental state, jail staff will check on them regularly while they wait in the booking area.

The initial medical triage, when a person is first processed at the jail, is mainly to go over big physical ailments. They determine early on how frequently someone needs to be checked on by jail staff. PMG PHOTO: JAIME VALDEZ  - One of the medical exam rooms at the Washington County Jail, where privately contracted medical staff see to the health needs of inmates.

If someone has an acute physical ailment or is under the influence of drugs or alcohol, they may get checked on more frequently. Those who have COVID-19 or have a recent known exposure are immediately taken to separate holding cells off of the main intake room.

Every inmate — officially described in Oregon law as an adult in custody (AIC) — gets checked on by jail staff at least once every hour, the Washington County Sheriff's Office said.

Still, Ronald Ferguson, 51, died while awaiting his formal booking on June 1.

The press release from the Washington County Sheriff's Office says he was found in a chair in the booking area, though deputies on-site at the jail said they couldn't confirm that or answer any questions related to the open investigations into these deaths at the jail.

If inmates have recently taken drugs, they are supposed to get checked on at least once every 15 minutes.

Still, Crystal Leuenberger, 35, died at the jail on May 24 — less than 24 hours after she'd been booked.

Court records show Leuenberger had a history of drug possession charges, including a conviction for possessing methamphetamine in 2016. An anonymous acquaintance told Pamplin Media Group that friends believed Leuenberger was continuing to abuse drugs up until her death, although no toxicology report has been released in her case.

If inmates are experiencing suicidal thoughts, they are also supposed to get checked on more frequently. Lt. Vance Stimler says there are at least four different occasions during the booking process when inmates are asked about thoughts of self-harm or suicide.

If an inmate is suicidal, they are moved to a special unit where they can be kept under closer observation. Just as the jail has medical staff who can make appointments to see inmates, there are also counselors who can treat and analyze inmates. PMG PHOTO: JAIME VALDEZ - Adults in custody watch TV in the general intake area, awaiting their formal booking into the jail. One of the four inmates who have died this year was found unresponsive in this intake area in June.

Still, the Washington County Sheriff's Office recently reported that Fabian Hernandez, 31, was found unresponsive in his cell after an attempted suicide on Aug. 17.

The first inmate who died in the jail this year was 23-year-old Bryce Bybee, who was found unresponsive in his cell on April 17. No details have emerged on his case yet, although court records indicate that a judge had ordered Bybee to be transferred to the Oregon State Hospital earlier that month. He was awaiting transfer when he died, and a backlog at the state hospital meant he was waiting beyond the court-mandated deadline for his transfer.

The Oregon State Medical Examiner's Office says that it still has no update on any of the jail deaths while it is awaiting toxicology results and other tests.

The built-in checks during the intake process deal with what happens when someone first arrives at the jail. But jail staff are limited in what they can do by how much an inmate tells them, and there are many reasons why those being booked into jail might not be forthcoming with medical information.

"It's all contingent on them cooperating with us, and being able to cooperate with us," said Sgt. Brandon Toney. "But if they aren't cognizant enough or cooperative enough for us to make those determinations, then we really can't force them."

While jail staff can confirm an inmate's medication and prescribe more to them as needed, inmates must consent to be treated. By law, jail staff cannot medicate them by force.

On the flip side, deputies say they also must balance the need for inmate safety with the need to not let people skirt their time in lockup or get preferential treatment without legitimate reasons. PMG PHOTO: JAIME VALDEZ  - Inmates can also receive dental cleanings and other kinds of care at the jail.

Stimler said that if people know that they will be placed in the hospital instead of in jail for certain ailments, they have an incentive to lie and say they've just swallowed drugs, that they've just hit their head or some other reason why they need to be transported elsewhere or kept in a separate area than with the general population.

Mental health in jails

The inmates with the greatest level of medical and psychiatric need are all housed in the Special Needs Unit. While it's still a secure facility, inmates there can move about a bit more freely than those in the general population housing units. The space is designed to reduce the stress of the jail environment and therefore reduce the likelihood of an episode.

"People with some sort of mental illness are more likely to be preyed upon in jail, so we try to accommodate them more because of that," said Stimler.

There is a separate area for those who are considered to be actively experiencing a medical or psychiatric crisis.

Called the medical observation unit (MOU), it's typically used for inmates who are on suicide watch, those who are detoxing, or those who might pose a threat to themselves or others in the general population.

When Pamplin Media Group toured the jail in late July, one inmate in the MOU said he wanted his lunch, and he began banging his head on the door when he was told it wasn't mealtime. Two separate deputies spoke to the inmate to try and calm him down, but no medical staff was called to the area.

"It's not unlike a child's temper tantrum," Stimler said. "If they aren't hurting themselves or someone else, you kind of have to just let them tire themselves out."

After a few minutes of banging his head against the door, the inmate started kicking the door instead.

While officials maintain that its purpose is inmate safety, some critics say the MOU is akin to solitary confinement, which can do more harm than good for people with mental health problems.

"In the jail's solitary confinement, or MOU — whatever they want to call it — you don't have a window," said Chris Doud, a mental health professional who works in Portland.

Doud was previously detained at the jail back in 2009 and housed in the MOU for a time.

"I couldn't see the sky," Doud recalled. "The lights were always dim. There wasn't really treatment of any kind. They just kind of sedated me."

Doud has been working with Disability Rights Oregon, a group that has championed jail and prison reform regarding those with mental illnesses, on legislation that seeks to regulate this kind of solitary confinement.

Doud was arrested after he was found with a pill bottle of suboxone, a narcotic that's used to ween addicts off of opiates.

"All addicts know you can't get high off of it if you're still using heroin," Doud said.

Doud says he was using suboxone to try and curb withdrawals, but he didn't have a prescription. Doud said he couldn't remember where he got it, just that he had a few pills in a bottle when he was pulled over during a traffic stop in Beaverton.

Doud said his treatment in the jail, coupled with his withdrawal symptoms, resulted in all kinds of physical and mental issues. He lost weight and had psychotic episodes that made him non-verbal, unable to respond to jail deputies, medical staff or even loved ones who came to visit him.

He attributed his worsening condition to the indifference of the jail staff and the harsh conditions of the MOU, which is supposed to be for the safety of inmates, not for punishment.

But the Washington County Sheriff's Office says that it strives for a positive relationship between jail staff and inmates.

"If you treat people like they're constantly a threat, they will be on edge," said Stimler. "If you treat them like they're OK, they'll behave. … The majority of the people in jail aren't bad people, they just make bad decisions."

As for the conditions in the MOU, the Sheriff's Office says there aren't really alternatives in a jail setting.

"Jail is confinement by its design," Sgt. Daniel DiPietro said in an email. "If an AIC is determined to be a danger to themselves or others, we have to keep them away from other AICs. (The) safety of all AICs is very important." PMG PHOTO: JAIME VALDEZ - An example of the cells inside the Washington County Jail. Each are single occupancy, which the building was designed for when it was built back in the 1990's.

He also added that there are other experts on-hand to deal with mental health issues.

"We do work with our mental health staff to address the needs of the people that are incarcerated in the jail," DiPietro said. "This is also one of the reasons for direct supervision, to reduce the stress associated with being in jail."

While the county says it has made greater strides toward more accountability for its medical services provider, there is still a history of neglect and corner-cutting when it comes to health services for inmates.

A 2014 audit of the jail's medical services, then provided by Corizon Health, revealed cost-cutting measures that were saving the company money at the expense of taxpayer dollars and the health of inmates.

Doud was detained while Corizon was contracted by the county.

However, deaths remain at "unprecedented" levels this year, according to Sheriff Pat Garrett, as the county is in its first year of a five-year contract with a new jail medical services provider, NaphCare.

NaphCare did not return numerous requests for comment from Pamplin Media Group. All five Washington County commissioners, who ultimately decide on the health provider with which the jail contracts, also did not return requests for comment.

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