The 40,000 men and women held in Baltimore jails each year could receive speedier access to medical care and see improved sanitation conditions under a settlement between state officials and prisoner rights advocates filed Tuesday in federal court.
Over the years, the advocates have documented what they say are dire problems at the Baltimore City Detention Center and the Central Booking and Intake Center: A longtime diabetic died after not receiving insulin. An asthmatic died because jail employees thought he was faking his condition and didn't give him an inhaler. Women with oozing skin infections went without treatment, potentially spreading disease.
"Medical needs have been unmet, and the environment has sickened people," said Wendy Hess, an attorney for the Public Justice Center, which along with the American Civil Liberties Union represents city jail detainees.
Baltimore's pretrial facilities - central booking, where suspects are processed, and the detention center, where they are housed until court appearances - are among the busiest in the country. On a typical day, about 4,000 detainees are behind bars there.
Officials with the Maryland Department of Public Safety and Correctional Services, which oversees the city jails, say they have labored diligently in recent years with federal authorities and rights advocates to make improvements.
"The department began in earnest to take care of these things in the early to mid-2000s," said Rick Binetti, a state prisons spokesman. "We're working hard to come up to speed on where they'd like us to be."
Separately, the U.S. Department of Justice has been monitoring the jails since 2000, when it noted more than 100 categories - including physical and mental health care, special education and crowding - that needed attention.
Binetti said his agency has abided by a Justice Department contract it signed in early 2007, and that it made sense to settle the ACLU lawsuit.
"We have made significant progress on those issues identified by the DOJ as important to the health and safety of the detainees," he said.
The state has plans to build Baltimore detention centers for women and youths who face adult charges in the coming years, new facilities that officials say will alleviate crowding and provide federally required separation from men.
The agreement with the ACLU - reached in a federal case that dates to 1971 - requires the state to give detainees at the city's pretrial facilities quicker and more consistent access to medical care and medications. It also calls for improvements to conditions at the 150-year-old detention center, including better plumbing and eradication of animal infestations.
"None of this is Cadillac care that we're asking for," said Elizabeth Alexander, director of the ACLU's National Prison Project. "This is really an attempt to do the basics with people, to bring the state into constitutional compliance."
Now known as Duvall v. O'Malley, the ACLU case led to a 1993 consent decree, which was reactivated in 2003 when the advocates filed a motion decrying extreme summer heat at the women's lockup. The state agreed to install air conditioning in the building, but dozens of health issues remain unresolved, the advocates said.
U.S. District Judge J. Frederick Motz will review the new settlement and is expected to accept it, but advocates plan to continue suing the state over temperatures in the men's detention center. On a recent August day, the temperature inside reached 90 degrees with 60 percent humidity, according to Hess of the Public Justice Center.
Hess and Alexander say the reforms laid out in the settlement would go a long way toward making the jail safer.
"Medical care was clearly the top crisis issue we were seeing," Hess said. The Public Justice Center represented an elderly woman who collapsed this year from dehydration and lack of medications for her chronic illnesses.
The woman, who did not want to be identified because her criminal case has yet to go to court, described the detention center as "an old, decrepit, rotten building" where temperatures fluctuate wildly and medical needs go unmet for days, if not weeks.
"I understand it is jail. You are incarcerated," she said. "There's only so much the prison can do with its state budget." Still, she said, conditions were "very alarming."
She described some of what she saw - correctional officers responding to women collapsed on the floor by poking them to make sure they were alive, ventilation fans covered in inches of black grime, and rodent and insect infestations treated by midnight sprayings of chemicals atop sleeping women.
The advocates say they do not have a full picture of the problems. Despite a federal judge's order, the state prisons department has never produced an annual list of deaths. There have been three deaths this year and 12 last year, most attributable to natural causes or overdoses, Binetti said. The advocates knew of only eight deaths last year and one this year.