The summer of 2023 was an extraordinarily deadly time in Multnomah County’s two jails. Between May and August, six inmates died in county custody—a body count higher than in the previous five years combined.
During that three-month period, county doctors were raising alarms about conditions inside the jails, WW has learned.
By July, all three of the jails’ physicians had quit, including their longtime medical director. Two of them sent resignation letters that voiced concerns about short staffing and patient safety, but declined to elaborate on their fears when reached by WW.
But the third, Dr. Elaine Marcus, was willing to tell her story, which is supported by current and former staffers who wish to remain anonymous. She says the county struggled for eight months to replace its jail medical director, who agreed to stick around for a while “on call” and finally quit in frustration.
When Marcus retired in July, she was the last physician left working in Multnomah County’s jails and, she says, the situation was spinning out of control.
“They didn’t have enough providers and they didn’t have leadership,” she says. “Of course things were going to go wrong.”
The lack of physicians was compounded by a shortage of specialized health care providers, who prescribe psychiatric medications for inmates who demonstrate mental illness—nearly a third of the jail population. For a few weeks over the summer, there wasn’t a single psychiatric nurse practitioner left working in the buildings, staff tells WW.
The county scrambled to hire a single replacement from a staffing agency, but she was quickly overwhelmed, staff says. As a result, medical appointments became scarce and wait times to see a doctor sometimes extended to more than a month.
Meanwhile, there’s been such a shortage of frontline nurses that those who remain are often required to work 16-hour double shifts, a practice the state prohibits at public and private hospitals.
No one is alleging that errors in patient care led to inmate deaths. But, jail staff say, the facilities haven’t felt safe.
Jail conditions are the responsibility of Sheriff Nicole Morrissey O’Donnell. But jail doctors are hired and fired by the Multnomah County Health Department, overseen by County Chair Jessica Vega Pederson.
In a statement to WW, Vega Pederson conceded the staffing problem is real. “Corrections Health is a challenging place to work and definitely needs additional staff,” she said, offering a laundry list of initiatives she’s supporting to increase staff, including budget increases, pay raises and retention bonuses.
“I will continue to focus efforts across the county to support this team.”
In a separate statement, the county health department also acknowledged the problem. “Corrections Health agrees that the more staff and resources we have to serve our clients, the more we can do to help them and keep people healthy,” it reads, in part. “But we also know that the work our employees continue to do every day saves lives.”
Jails are not hospitals. But they are forced to act like them.
The people who arrive at their doors often come with traumatic injuries or chronic, untreated conditions. In Portland, more than 30% of people in jail have mental health issues.
So, Multnomah County has built medical clinics in its jails and hired teams of nurses and clinicians to staff them. It’s a difficult and often thankless job—entry-level nurses are currently paid nearly $5 less per hour than their counterparts at some Providence hospitals, says Kevin Mealy, a spokesman for their union.
But it is also a crucial one, and employees tell WW they take pride in doing it.
In Portland, like elsewhere in the country, jails are the health care provider of last resort. For many people, their only contact with a doctor is after they’re arrested.
None of this comes cheap. Portland’s jails treat over 36,000 people every year. Federal insurance programs like Medicaid do not cover people in jail, and so local authorities must come up with the money themselves.
Many, including Clackamas and Washington counties, outsource the job to for-profit companies that are frequently accused of providing substandard care. But not Multnomah, which delegates the task to its health department, spending $31.5 million a year to do it.
The pandemic has caused health care staffing shortages nationwide, and Multnomah County is no exception. By 2022, Corrections Health was struggling to hire staff across its organizational chart.
It was dealing with “chronic vacancies” among frontline nurses, director Myque Obiero told county commissioners. Last fiscal year, 24% of corrections nursing positions were vacant.
A recent survey of nearly 40 corrections nurses by their union found only 20% were satisfied with their jobs. Their biggest concern: short staffing.
The resulting delays in care, they said, were a safety issue—and mandatory overtime had become the new normal rather than the exception. This fiscal year, the county estimates it will have mandated that nurses work overtime 600 times.
It’s a vicious cycle. As nurses burn out, the county requires more mandatory overtime, which in turn makes it more difficult to recruit replacements.
Meanwhile, the county was also struggling to find a new medical director.
The position was held by Dr. Michael Seale, who was hired in 2015 after previously overseeing jail health care in Houston. Seale was known as a tireless worker: someone who’d pick up the phone at 2 am to answer a tough medical question or take on a shift when no one else was available.
But the workload took a toll, and Seale planned to retire at the end of the year.
For the better part of a year, the county hunted for a replacement. In February, a promising candidate was rejected after making it through two rounds of interviews when the candidate turned out not to have the necessary credentials. The county hired a new recruitment agency and started the process over.
Seale gamely stuck around “on call,” until May 30, when a colleague abruptly resigned.
That colleague, Dr. Angelina Platas, wrote in her resignation email that she was “heartbroken” to leave but she had no choice.
“I cannot continue working for Corrections Health while feeling that the patients we serve are not treated as if they deserve the highest quality medical care available,” she wrote.
That same day, Seale sent his own resignation letter, citing the lack of “customary provider staffing” resulting from Platas’ exit. “I cannot put my license at further risk,” he wrote.
Neither physician was willing to speak to WW to elaborate on their concerns.
In its statement to WW, the county says there’s “a variety of reasons” it’s difficult to hire clinicians, pointing specifically to the problem of telework. “Many providers could work for systems that allowed telework for virtual and telehealth visits,” the county says, an option that’s “not appropriate” in jails.
By June, Dr. Elaine Marcus was the only physician left, at least in Multnomah County’s two jails, she says.
Marcus, a graduate of NYU’s medical school, was working as a family medicine doctor for Providence when she became disillusioned with corporate medicine. Working in corrections and treating some of Portland’s most vulnerable people, she says, felt more important—and more interesting.
But with Seale on his way out, she says, “it was getting scarier and scarier.” As her retirement loomed, she couldn’t wait to leave.
It wasn’t just the leadership vacuum or the lack of physicians, she says.
During a series of Zoom meetings early this year, staff realized every one of the jail’s psychiatric nurse practitioners, who prescribe the antidepressants and antipsychotic medications so crucial to managing inmates’ mental illnesses, were leaving that spring.
“There was a stretch of time when there was nobody to review patient care or prescribe medications,” Marcus says.
The county hired a replacement from a staffing agency in May, but she quickly became “overwhelmed,” Marcus says.
The replacement lasted only a few months, during which the wait for inmates to get medication got longer and longer—more than a month in some cases, Dr. Marcus and other jail staff told WW.
The lack of mental health prescribers made everyone else’s job more difficult. As inmates’ mental health deteriorated, they became increasingly agitated, anxious and more difficult to treat.
Deputies had to step in to Marcus’ office more often to intervene, she says. Beginning in May, patients were referred to her office who needed prescriptions for psychiatric drugs she didn’t feel sufficiently trained to administer.
Marcus retired in July. The county hired a new medical director, a former Providence surgeon, in August.
The county says it has been “aggressively” recruiting more staff and has health care providers on call, if needed. It has hired 10 providers since 2022, and is currently interviewing more. “Finding providers who want to work in corrections and are a good fit for our employees, environment and population is not easy,” it said in a statement.
The county recently added 19 nursing positions to its latest budget in hopes of reducing mandatory overtime.
But it’s done little to address immediate concerns and only one of the positions has so far been filled. The vacancy rate now stands at 42%.
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