How drunk is too drunk?
That’s the question jail and medical personnel face before booking intoxicated individuals, and it is one La Plata County jail officials face often.
A statistical study published by the U.S. Department of Justice shows there were 925 deaths related to intoxication in county and municipal jails from 2000 to 2013. These numbers include instances when authorities transport individuals to a hospital and they die en route or while receiving medical treatment.
Between 2012 and 2013, jail deaths related to drug or alcohol intoxication increased by 23 percent, from 57 deaths to 70.
The problem has hit Montezuma County, which has seen three alcohol-related, in-custody deaths in the county jail in the past two years.
According to La Plata County sheriff’s and coroner’s offices, these deaths aren’t happening here. Neither had record of an in-custody death related to alcohol intoxication, and the jail credits its in-house medical staff and partnerships with Mercy Regional Medical Center and Axis Health System in avoiding these fatalities.
But that is not to undermine what officials call a pressing problem with alcohol in La Plata County. Last year, local health and law enforcement agencies reported an uptick in people coming in with dangerously high blood-alcohol concentrations (BAC).
Little has changed, according to jail personnel.
“We have a lot of inmates come in that are intoxicated,” La Plata County Sheriff’s Office Lt. Mitch Higgins said. “The majority, I would say. If we had to guess, 7 out of 10.”
By policy, the jail does not book intoxicated people who are incoherent and thus incapable of understanding the charges, officials said. And if dangerously drunk, they must receive screening from a medical doctor and are monitored afterward in the holding cell until sober.
The jail initially appointed a medical staff in 1994, which has grown over the past 20 years to four registered nurses and one licensed practical nurse.
There is at least one nurse on duty between 7 a.m. and 1 a.m. During that six-hour period when there is no nursing staff on duty, the detention sergeant or another deputy decides if the individual is a danger to himself or herself. If so, the agency that brought him or her into the jail transports the individual to the hospital.
Protocol in La Plata County is to give drunken intakes a breath test. If they register 0.3 or higher, they are directed to Mercy Regional Medical Center to receive a screening from a medical doctor.
But both jail and health officials agree – 0.3 BAC should not be a hard and fast number.
“It’s just one element of the equation of safety,” said Jack McManus, medical director of emergency services at Mercy Regional Medical Center. “We see people who drink every day, all day, and a BAC over the limit doesn’t concern me, where someone naive to alcohol with basic intoxication is concerning, because they’re not used to it. The level is just one variable in figuring out whether they’re at risk.”
Depending on when the individual had his or her last drink, the BAC could continue to spike until it peaks, or go down.
“If they come in and have a 0.28 and spiking, we call to transport them,” said Cpt. Larry Foukas, who oversees the county’s detention division.
Possible head trauma or other injuries sustained are factors in determining whether a medical screening is necessary, and McManus said the hospital errs on the side of too careful, particularly when it comes to testing for head injuries.
Drunken people can be a daily, if not multiple times daily, occurrence, McManus said. But in his 15 years, he has not seen any in-custody patient deaths as a result of alcohol.
The BAC limitation can be a deceptive and volatile figure to deal with, and it has recently resulted in death in the Montezuma County correctional system.
Last week, complications of chronic alcohol abuse were determined the cause of death for a woman found dead in October in a Montezuma County jail cell. She had been booked the day before with a 0.289 BAC – just shy of the 0.3 threshold calling for medical clearance. Her death brought the alcohol-related, in-custody death count to three in Montezuma County in just the past two years.
Montezuma County jail officials promised to consider lowering the BAC limitation and establish a detox center – something La Plata County has.
Axis Health System provides services to the jail for inmates dealing with substance abuse and withdrawal. Higgins said about five Axis personnel come to the jail almost daily to meet with inmates. It’s the individuals who are not part of the system, and are simply being held temporarily at the jail to detox, who are the most vulnerable, McManus said.
Foukas said detoxing individuals who have received medical clearance are placed in a mirrored holding cell where officers can have constant visual contact. Drunken detainees are checked every 15 to 30 minutes and typically administered another breathalyzer to see if their BAC is going up or down.
Demographics and age groups vary, but across the board, jail and hospital staff see it as a problem.
“It seems like we’re seeing more young and severe alcoholics than ever before, which is just tragic when you see someone in their early 30s or late 20s with advanced alcohol complications and signs of liver disease,” McManus said. “I think we’re seeing a rise in severe alcoholism and withdrawal in all emergency departments, not just Mercy.”
jpace@durangoherald.com