Various Topics on Diabetes

..anutja..

Here is an article from the Los Angeles Times
Sunday June 20, 2004
-----------------------------------------------------------------
THE STATE

Ailing Inmate Was Free but Never Made It Home

By Sue Fox, Times Staff Writer

When Gustavo Ortega was released from the downtown Los Angeles County Jail in the middle of the
night, he did not go far.

An insulin-dependent diabetic, he had just had part of his right foot amputated. Walking was a
struggle, so he apparently sank onto a bench in a jailhouse lobby and waited.

A few miles away on the Eastside, his family had no idea that the 50-year-old Ortega - whose memory
was so spotty he sometimes forgot his own phone number - was free. When his brother Mike went to
visit him the next day, he was shocked to learn that his frail brother had been released.

"Released to whom?" Mike Ortega asked.

"To the streets," he said the guard replied.

"I said, 'To the streets? How is that possible?' He was sick. He just had an amputation."

The Ortegas, a close-knit family of seven children and their elderly mother, spent the next two days
combing downtown for Gustavo, who had been serving time for several misdemeanors. They checked
Chinatown and Olvera Street, the hills of Echo Park and homeless shelters on skid row.

They canv***ed the grounds of the Twin Towers jail but did not think to look inside the nearby
Inmate Reception Center, where prisoners are admitted and released.

Three days after Ortega's release, sheriff's deputies found him there, where it appears he may have
been the whole time. He was so weak he could barely move. He asked, "Can you please give me a ride
home?" deputies later told his family.

Instead, paramedics rushed him to the hospital, where he died of coronary artery disease, with
diabetes, chronic renal failure and hypertension as contributing factors.

Ortega's death April 5 came at a difficult time for the county's jail system, which is run by the
Sheriff's Department. Budget cuts have stretched jailers thin, and security lapses have become so
common that five inmates have been killed in jail since October.

The department said it followed procedure in releasing Ortega, but officials expressed regret that
he seemed to have slipped through the cracks of a huge, often impersonal system that takes in and
releases up to 800 inmates a day.

"It's a tragedy if we didn't observe him and the public saw him and didn't do anything," said
Sheriff's Capt. Anthony Argott, who oversees the reception center. "This poor guy needed help."

Argott said deputies could have overlooked Ortega because the center is often crowded and some
people linger there for many hours.

"We're not trying to get people out and make the lobby pristine. Deputies change shifts, and they
may have never noticed this guy," Argott said. "Nobody's listening, but I must say we have a severe,
and I must say again, a severe shortage of personnel."

Ortega's family recently asked the Board of Supervisors to investigate his death, triggering an
inquiry by the Office of Independent Review, a civilian oversight agency that monitors the Sheriff's
Department."We need to see what, if anything, the Sheriff's Department did," said Michael Gennaco,
the former federal prosecutor who heads the oversight agency. "Certainly there are issues of
standards of care, everything from the way he was ***essed with regard to any mental health issues
to cl***ification and treatment while he was in custody.

"Once he's released, that is something of a gray area," Gennaco added.

Ortega's sad sojourn through the county's courts, jails and hospitals began March 1, when he was
arrested for drinking at Whittier Boulevard and Spence Street, about three blocks from the house he
shared with his siblings and their mother.

He pleaded no contest and was convicted two days later. Ortega, a father of two who loved to sing
and play guitar, would remain in jail for a month until his release just before he died.

The county is required to conduct mental health screenings of all new inmates. Despite what his
family called a history of disorientation and memory problems that kept him from working, Ortega was
not cl***ified as a mental-observation inmate.

"There's no indication that he complained of any mental health problems during his incarceration,
nor was he referred to mental health by medical services," said Dr. Thomas Klotz, the jail's chief
psychiatrist.

In jail, Ortega's diabetes caused his feet to swell. His brothers and sisters think he may have
forgotten to take off his shoes to relieve the pressure. Diabetics can be at risk of amputation when
circulation to their extremities fails.

Ortega was sent to the jail ward at County-USC Medical Center, where members of his family said they
tried to visit him nearly every day. Sometimes they were allowed to see him - resting calmly in a
wheelchair - in the visiting area, they said, but other days they were told he was bedridden and
could not come out.

They weren't allowed into his hospital room and could not speak to his doctor, they said, even when
Ortega told them that part of his foot, including his toes, would be amputated.

"They would always tell us the same thing, that he was an adult and it was between the doctor and
the patient," Mike Ortega said. "They said the doctors wouldn't make phone calls to the family."

A month after his arrest, Ortega was taken from the jail ward back to court. He had two outstanding
misdemeanor charges from 2001: driving with a suspended license and having no proof of car
insurance. He was convicted April 1 of driving without a license and sentenced to one day in jail
but given credit for time served.

Just before 2 a.m. the next day, he was released.

Sheriff's Capt. Rod Penner, who oversees the jail's medical services bureau, said the medical staff
followed the proper protocol.

"He was medically cleared by a physician prior to his release," Penner said. "He indicated that he
had family coming to pick him up and that he had a doctor out in the community."

Penner says that if inmates are ambulatory, they are permitted to leave. Only rarely does the jail
transfer an inmate directly to a hospital upon release.

After receiving his medical clearance, Ortega was processed by custody staff at the reception
center. Jailers gave him a pair of crutches, Penner said.

Once Ortega was released, he was on his own.

He did not call his family, and no one else did either.

The lobby where Ortega was found is a grimy, busy way station, open 24 hours a day and often filled
with dozens of people waiting to pick up an inmate's property or deposit money so they can buy
snacks at the jail canteen.

There are rows of cashiers behind gl*** partitions, and a sheriff's deputy keeps an eye on things
from an information booth.

The air is thick with cellphone chatter, the clink of change in soda machines and the drone of two
television sets.

While his family searched the streets, Ortega apparently languished in the center on a rock-hard
bench. It is not known whether he ever left the second-floor lobby, but his family suspects that he
stayed put.

Without medicine or steady meals he grew weaker.

On April 5, two deputies appeared at the family home to tell them that Ortega had been found and
taken back to County-USC.

Ortega's sister Rosalinda recalled one deputy telling them that when they discovered her brother in
the jailhouse lobby, someone said: "This guy's been lying here for three days."

She got to see him briefly before he died. He was rail-thin, his eyes sunken. "Ay, hermano," she
asked, "where have you been?"

He shrugged slightly, she said, whispering that he was cold.

She watched through tears as doctors tried to revive him. Later, after he died, she looked through
the possessions he had when deputies found him. There was no insulin, just some clothes, a dollar
bill and two slices of bread.

Ortega's family buried him two months ago at a Montebello cemetery.

Now they want some answers.

"The one thing I just cannot understand is: How can they just let somebody stay in their facility,
in plain view, for three days?" Mike Ortega said. "It was total negligence."