Breakdowns in medical care, including treatment errors by physicians and nurses, have contributed to the deaths of at least 14 inmates since 1999, a Times investigation found.
Understaffing has contributed to an array of medical problems in the nation's largest jail system, a review of court files, autopsy reports, jail records and other documents shows.
Broken bones have gone untreated. Illnesses have been overlooked. Inmates have waited days, or weeks, for exams they're supposed to receive within 24 hours of making a request. Twenty percent of inmates who ask to see a doctor are released from jail without ever being examined, officials acknowledge.
In a confidential report, a consultant said an additional 720 jail medical workers were needed to meet minimum state treatment standards. At the time, the work force stood at about 980.
"The county incurs significant liability for continuing a system of care that clearly is not working," the consultant said in the 2004 report to the Los Angeles County Board of Supervisors.
Spurred by those findings, officials began to bolster the ranks of doctors and nurses. But the system remains several hundred medical workers short.
Jody Kent, a court-sanctioned monitor who for three years walked the county's cellblocks documenting complaints for the American Civil Liberties Union, said she frequently saw inmates suffering.
She said inmates showed her what seemed to be gaping wounds from staph infections, broken bones and bulging hernias.
"I basically saw grown men crying because they were in such pain," Kent said.
Sheriff's Lt. Stephen Smith, who oversees the jail system's medical services bureau, said tending to sick prisoners is fraught with complications. He said some inmates conceal medical problems from their jailers, while others feign illness. Thousands are mentally ill.
"We face unique challenges, and we do the best we can," Smith said. "These are difficult, angry, messed-up people. We try to treat people with the respect, not that they necessarily deserve, but that human decency demands."
Smith cited recent improvements in the quality of care: Medical records have been computerized, allowing for better tracking of doctors' orders, and distribution of prescription drugs has been automated, reducing medication errors. He said the department plans to launch a "telemedicine" program that will expand the reach of doctors by allowing them to remotely diagnose and treat inmates via computer and teleconference.
Smith acknowledged, however, that staffing shortages still exist and "bad outcomes" occur.
Pamela Wimberley was serving a 30-day sentence for forging a prescription. On the morning of Feb. 10, 2003, she awoke in her cell in the Twin Towers jail downtown with a headache and fever. A nurse who examined her noted that Wimberley's blood pressure was up and her pulse was racing.
A doctor was informed over the phone, and he noted that Wimberley was diabetic and at risk of developing a respiratory infection. He ordered blood and urine tests to determine if that's what she had.
The order was never put in writing, however, and the tests were never done.
Instead, Wimberley was given a pain reliever and sent back to her cell.