Disability Rights NC is pushing for more rigorous oversight and stronger enforcement mechanisms to ensure that inmates, jail staff are safe.

by Rachel Crumpler, North Carolina Health News
January 13, 2023

Missed supervision rounds. Overcrowded facilities. Skipped fire drills. 

State inspectors with the NC Department of Health and Human Services’ Division of Health Service Regulation routinely found these issues and more while evaluating the state’s 109 jails for compliance with the minimum operating and safety standards.

Inspection failures are not rare occurrences, according to a Disability Rights NC investigation into the safety of North Carolina jails and the effectiveness of state oversight released in December.

“Not only were we seeing a lot of these violations in these jails, we were seeing really no consequences for the jails that kept failing these inspections for the same reason, creating really dangerous situations again and again,” said Luke Woollard, a Disability Rights NC attorney.

Disability Rights NC analyzed more than 600 inspection reports from 2017 to 2019 and found that inspectors cited over half the state’s 109 jails for repeated failures in supervision, overcrowding, fire safety and construction/sanitation issues. Forty-one jails failed every inspection over the review period — often for the same problem over and over. 

Jails are operated by their local county government and elected sheriff, while prisons are managed by a state agency, the Department of Adult Correction. Jails also mostly confine people who have been charged with but not convicted of a crime.

The findings astonished Woollard — particularly the inaction around resolving violations.

Closer look at jail inspection failures:

• 86% or 324 inspection failures were due to construction/sanitation issues
• 38% or 143 inspection failures were for supervision issues
• 29% or 110 inspection failures were due to overcrowding
• 20% or 76 inspection failures were for fire safety issues
• 4.8% or 18 inspection failures were for having inadequate health plans 

Disability Rights NC said in its report that the state’s “deeply flawed and dangerous jail regulatory system” allows jails to operate despite these chronic inspection failures. 

In some facilities, persisting problems resulted in consequences as serious as in-custody deaths.

An increasing number of people are dying every year in North Carolina jails, according to Disability Rights NC. A record 56 people died in 2020 from untreated medical conditions, suicide, or substance abuse-related causes, according to another report released by the organization in March. 

For the sake of the nearly 20,000 people awaiting trial or serving low-level sentences in North Carolina jails at any given time, Disability Rights NC is pushing for more rigorous oversight and stronger enforcement mechanisms to ensure that jails are safe.

“You should at a very baseline minimum know that going into this facility you will get care and be safe and not be at risk of dying,” Woollard said.

Chronic problems persist

A three-person team at the North Carolina Department of Health and Human Services’ Division of Health Service Regulation conducts biannual inspections of North Carolina jails. The team also investigates complaints and in-custody deaths. It’s a large workload for a small team, with the length of time needed to conduct an inspection varying based on the size of the jail and the number of deficiencies found.

Despite a strained staff, Woollard said inspectors are doing their jobs and identifying serious problems.

However, many problems aren’t getting corrected.

In 211 instances, a facility failed an inspection for the same reason it failed its previous inspection, according to the Disability Rights NC investigation. From 2017 to 2019, approximately 59 percent of the state’s 109 jails had a chronic problem.

In contrast to the high number of jails that repeatedly fail safety inspections statewide, 15 facilities passed all inspections and an additional 13 failed just one inspection, promptly fixing an identified problem.

A DHHS spokesperson said ensuring the health and safety of detainees in local jails requires sufficient local staff and resources, but inspectors frequently hear from jail officials struggling to recruit and train the necessary staff. This comes on top of frequent shortfalls in jails’ budgets.  

Alicia Stemper, public information officer of the Orange County Sheriff’s Office, also said old jail facilities can pose problems for compliance. For years, inspectors cited the old Orange County jail — first built in 1925 — for inadequacies in its kitchen, medical and laundry facilities. She said many of the issues were impossible or inordinately expensive to repair. Moving into a new facility in April allowed the jail to avoid these types of problems.

Woollard said repeated failures lead to dangerous environments for incarcerated individuals and jail staff. 

“The problems are not getting fixed, and that is especially concerning to me when you have a facility where you see that inspection after inspection — and then you have a death, and you have the same problems that occurred in that death investigation,” Woollard said.

For example, four people died in Rowan County Detention Center from 2017 to 2020. Inspectors cited the jail for missing supervision rounds and overcrowding during inspections during that period. Death investigations found the same failures at play. 

“That is a heartbreaking illustration of how not having a powerful enough regulatory system really does affect people’s lives and … safety in facilities,” Woollard said.

Regulatory process

State regulators require jails to submit plans to correct any deficiencies found during inspections. 

Disability Rights NC’s investigation found that the Division of Health Service Regulation approves the majority of the plans of correction, though the deficiencies often go uncorrected.

In 119 of the 211 instances when a facility failed an inspection for the same reason it failed previous inspections, Disability Rights NC found that state regulators had accepted the sheriff’s initial insufficient plan of correction only to have the jail fail the next inspection for the same reason. 

When consequences do not follow, Woollard said the plans of correction are largely ineffective.

“Clearly from the results that we’re seeing, and also just from just thinking about it in terms of an incentive structure, it is not really effective in getting jails to comply with these really bare minimum safety standards that are in the Jail Rules,” he said.

If a jail’s conditions are deemed dangerous to staff or to those in custody, the only enforcement mechanism available is for the DHHS secretary to close the jail or force corrective action. And closure is a lengthy, often impractical option. 

That’s why Disability Rights NC is calling on the General Assembly to strengthen the Division of Health Service Regulation’s ability to regulate jails and to increase transparency in the inspection process. 

Recommendations

Woollard said intermediary enforcement powers, including fines and the ability to require immediate corrective action, are needed to improve the effectiveness of jail regulation. 

State inspectors of hospitals, group homes and adult care homes have these tools at their disposal, and Disability Rights NC is calling for the same to be extended to jail regulators. 

A DHHS spokesperson noted that, unlike hospitals and adult care homes in North Carolina, jails are not licensed by the state.

Lauren Brinkley-Rubinstein, a professor in the Department of Population Health Sciences at Duke University School of Medicine who studies the criminal legal system, said jails should be regulated in the same way as other facilities.

“To me, it seems like there should be very similar regulations across all types of health care providers,” she said. “If we see that a nursing facility is engaging in subpar quality care, there are real tangible impacts relevant to their livelihood that impacts their ability to exist, and we don’t see the same thing in the context of jails. 

“There’s no good explanation for why, other than a real deprioritization or dehumanization of that population.” 

Disability Rights NC also called for additional jail inspectors. 

House Bill 841, proposed in 2021, would have added two jail inspectors and a facility compliance consultant to the Division of Health Service Regulation, allowing for improved follow-up and technical assistance. The bill did not pass.

A DHHS spokesperson said the department has advocated for additional staffing, resources and support for jail inspections to ensure the health and safety of those incarcerated. The spokesperson added that the governor’s budget for 2022–23 included additional funding and positions for this important work.

Brinkley-Rubinstein said it’s clear the jail regulatory system needs to be strengthened.

“We’ve seen over and over that there are no consequences for continually violating standards of care,” she said. “There needs to be change in the way that we do things relevant to oversight and keeping facilities accountable. That probably needs to happen at the legislation level.”

This article first appeared on North Carolina Health News and is republished here under a Creative Commons license.

North Carolina Health News is an independent, non-partisan, not-for-profit, statewide news organization dedicated to covering all things health care in North Carolina. Visit NCHN at northcarolinahealthnews.org.