Knock LA

No fresh air. No soap or water. No room to social distance, no proper PPE, and no real enforcement of COVID-19 safety protocols. This is the reality incarcerated patients face during COVID-19 at the nation’s largest mental health facility: The Twin Towers Correctional Facility in Los Angeles County. The jail sits on the edge of Chinatown and is comprised of two buildings, a medical services building and a medical jail ward. When COVID-19 swept through the country in early 2020, human rights advocates rang every alarm to warn the most densely populated jail system in the country what was at stake if Los Angeles County did not take drastic steps to mitigate the crisis of a deadly virus within overcrowded jails. Not only were those drastic steps not taken, but the search to find out who is responsible for bottom-lining the conditions of the jail are like wading through a pile of “we’re doing the best we can” style bureaucratic muck. What happens when the “best” results in nearly 4,300 positive COVID-19 cases across the Los Angeles County Jail system?

Three entities work in conjunction to operate the Twin Towers Correctional Facility: The Los Angeles County Sheriff’s Department (LASD), the Los Angeles County Department of Health Services (LADHS, or just DHS) and Correctional Health Services (CHS). The Sheriff’s Department oversees operations regarding the incarcerated, as they do with other jails in Los Angeles County. LADHS operates the medical side of the jail, so the Twin Towers Correctional Facility is classified as a hospital and is obligated to run at the same capacity as any other County hospital. The glaring issue, however, is that the jail is not a hospital. Twin Towers Correctional Facility is already operating at well over 100% capacity, and a jail lacks the germ control that a hospital has.

The healthcare facilities within the jail, known as Correctional Health Services, are technically under the umbrella of LADHS. These three branches—LASD, LADHS, and CHS, are supposed to work together to create a safe environment for the incarcerated and the staff always, but especially now.

Ahmanise Sanati, the Mental Health Clinical Supervisor for the Twin Towers Correctional Facility, reached out to Knock LA concerned for her fellow colleagues and the incarcerated population she works with as a social worker. 

“We’re operating in squalor,” she told Knock LA in an interview in December 2020, 10 months into the pandemic. “It’s arguably the case we’re bringing the virus into the facility or taking it into our homes. The inmates cannot socially distance. We cannot socially distance. We don’t have windows, we don’t have ventilation.” 

In speaking with Sanati and her colleagues, it became clear that taking the necessary steps to make the Twin Towers a safe place to be during COVID-19 was not the priority of LASD, LADHS, nor CHS. “There just seems to be a lack of communication among the three entities that are kind of at work in [the] jail,” a psychiatric social worker who wished to remain anonymous told Knock LA . “I think the primary problem has just been administration not really understanding what the conditions are like in the jail, and what it’s like for someone with severe and persistent mental illness to be stuck in their cell 24/7, and not really being given proper masks so that they can come out of their cell and talk to their clinicians in a way that’s safe.”

This same source mentioned she’s been conducting her sessions with her patients through the glass of their cells, rather than meeting face to face as they normally do. This, she described, is largely for the patient’s safety, as it’s rare to see an incarcerated person within the facility wearing proper PPE. This type of practice is obviously not ideal, as normally a mental health provider would want to seek privacy in order to build trust and rapport with their patients.

Sanati confirmed that incarcerated people had access to masks, but they were often cloth masks and they were responsible for washing them themselves—a difficult task considering those incarcerated don’t have consistent access to basic necessities like clean water and soap. Water access is also sometimes turned off for one cell, and because of the layout of the jail that almost always affects multiple cells. 

Even though the Twin Towers is a medical facility and jail all in one, the medical staff don’t technically have jurisdiction over the daily safety of the incarcerated people. That responsibility falls to the Sheriff’s Department. So, while Sanati and her colleagues have been advocating for proper PPE and safer conditions for their patients, at the end of the day, is it LASD’s responsibility.

This is particularly troubling, considering multiple employees of Twin Towers who wished to remain anonymous all relayed that the LASD deputies are inconsistent with mask wearing, and they are not regularly providing proper PPE for the incarcerated population to their knowledge. “It really seemed like a lot of the deputies were hesitant to wear masks,” the same psychiatric social worker from earlier explained. “We’ve been battling just to get them to wear masks,” another shared. This is not just a case of personal experience, as the LA County Inspector General determined the sheriff deputies do not wear their masks as required.

Another employee of the facility said that the incarcerated have not only tried to get the deputies to wear their masks but are also taking it upon themselves to stay as safe as possible in what feels like impossible conditions. “If you’re quarantined or isolated, you can’t go to court, which pushes things back,” the source said. More incarcerated people are working together to wear masks (if they have them) and distance — a tough task in a crowded jail.

As far as COVID-19 testing, an employee explained, “the only time that inmates are tested is when they enter the facility. So you have 5,000 people at any given time in that facility with only a handful knowing what their status is….and no safety enforcement happening.” The LASD website vaguely notes “since May 1, 2020, CHS has conducted tests to identify asymptomatic inmates.” Sanati remembers a large round of testing for everyone in the facility including staff in June. When an employee reached out to DHS through their general help email, Dr. Michael Bolaris, the Medical Director of the COVID-19 Response for DHS responded, “Mass testing to truly identify people who are infected in the workplace would require 2-3x weekly testing.  Tests are accurate at the time we collect them.  To truly exclude everyone infections from the workplace, routine short interval screening would be required with highly sensitive and expensive tests.  You can imagine this is a challenge to complete even with unlimited resources.”

Knock reached out to a resident within the LA County hospital system and he corroborated that there “simply isn’t enough infrastructure to test us regularly.” As Twin Towers falls under the scope of DHS, which controls the County hospitals as well, the regulations for mass testing are probably the same for both County jails and County hospitals. Yet hospitals have air filtration systems to keep patients and employees safe. Jails don’t.

Even still, employees at Twin Towers have access to free COVID-19 tests provided at one of the many testing sites in Los Angeles. If an employee feels sick, they can seek out a test on their own, easily. When an incarcerated person feels sick, they do not have the agency to go to a testing site. They have to advocate for a test—something that some incarcerated folx don’t do, not because they don’t want to keep themselves and others safe, but because the protocol for a positive test is isolation. In isolation, you’re stripped of the limited privileges you have while incarcerated, such as time outside or use of the phone. As mentioned earlier, the isolation is for quarantine purposes, but what often ends up happening is people miss their court dates while in isolation.

When asked about the safety precautions taken in the jail to reduce the spread of COVID-19, an incarcerated mental health patient relayed to Knock through an anonymous source “[Social distancing] is not happening,” and he didn’t feel like there was any effort to enact this. He and two other patients confirmed they had been given one N95 mask—one mask for a pandemic that has now lasted over a year. When asked if there were any extra efforts to keep the jail clean, the incarcerated patient said “No,” and pointed to feces on the wall that wasn’t his.

He said the conditions were worse in Men’s Central Jail, a separate correctional facility located on the same property, than the high observation intake area within Twin Towers. According to this patient, the LASD deputies at Men’s Central Jail make the incarcerated people clean up messes like this themselves.

He did mention they were given soap in their “fish kit,” which is a small hygiene kit given to incarcerated people, but also noted he wasn’t allowed to have his fish kit in the high observation area. This means people in this area of Twin Towers Correctional Facility have no access to soap. No one has made hand sanitizer available for the incarcerated, either. Washing your hands becomes quite difficult when you have nothing with which to do it.

In order to better understand why jails and prisons in the United States should be a priority in discussions around COVID-19 safety, we have to first consider the infrastructure of jails and prisons themselves. It should not be a surprise to anyone that jails and prisons are hotbeds of COVID-19, as jails and prisons are not designed with people in mind. Science journalist for The Atlantic Ed Yong explains, “In response to the global energy crisis of the 1970s, architects made structures more energy-efficient by sealing them off from outdoor air, reducing ventilation rates. Pollutants and pathogens built up indoors.” In making jails and prisons more energy efficient, we inadvertently made them the perfect breeding ground for disease. 

But the lack of proper ventilation is not the only thing that puts jails and prisons at higher risk for outbreaks of a virus like COVID-19. Infectious disease specialist Dr. Joseph A. Bick notes in a 2007 article that “crowding, delays in medical evaluation and treatment, rationed access to soap, water, and clean laundry” and “insufficient infection-control expertise”  are all contributing factors in making correctional facilities particularly dangerous from an infection control standpoint. In fact, these are all things staff members of the Twin Towers Correctional Facility have noted as particularly troubling issues. 

One of the other largest contributing factors is the transient nature of jails and prisons. Rita Rubin writes for the JAMA Network that “When it comes to the highly infectious virus that causes COVID-19, what happens in correctional facilities does not stay in correctional facilities, because staff members as well as incarcerated individuals come and go.” This means that jails and prisons are not only threatening for employees or incarcerated individuals, but also every person who comes into contact with someone who has spent time in a correctional facility. 

In a recent epidemiological model report released by the ACLU, it was noted that jails are particularly dangerous vectors for infection because they have a much higher turnaround than prisons. “Jails are revolving doors for incarceration and face 10.7 million admissions a year,” the report states. The average length someone spends in jail is 25 days, according to the US Department of Justice. “As a result of the constant movement between jails and the broader community, our jails will act as vectors for the COVID-19 pandemic in our communities,” the ACLU report says. 

When you consider the makeup of who lives in Los Angeles County versus who gets put behind bars, you’re looking at a higher number of people who have health conditions that would make COVID-19 more dangerous, like asthma. There’s also a disproportionate percentage of incarcerated Black and Latinx men—in 2019 Los Angeles County Jail system racial demographics were 53% Latinx, 29% Black and 15% white even though Black people only make up 9% of Los Angeles County’s population. This, unfortunately, is not unique to Los Angeles County, but this does mean that the County’s response to COVID-19 in jails and prisons is undoubtedly an issue of racial justice. 

Based on the knowledge—which predates the coronavirus—that jails and prisons are petri dishes and a public health nightmare during a global pandemic, it’s no secret jails and prisons are prime breeding ground for disease. And yet, now over a year into the pandemic, LA County has yet to see a focused effort to prevent mass spread and mass death for one of its most vulnerable populations.

Governor Gavin Newsom approved the early release of thousands of incarcerated people on multiple occasions over the spring and summer of 2020, but the majority of them had sentences ending mere months later. California also “blocked the transfer of county jail inmates to prison” as reported in March by the LA Times. While this might have ultimately lowered the prison populations, it increased jail populations, a harrowing realization when you remember LA County Jails are already operating at well over 100% capacity. 

A January 2021 study from UCLA Law showed that “people are actually spending more time in LA County Jails than before the pandemic.” The study notes that the “failure of the Sheriff’s Department to minimize exposure in the jails” led to repeated quarantine, which in turn caused many people to miss their court dates.

Sanati has not given up. In fact, she’s contacted pretty much every department or individual she can think of who might have some power to help the life threatening situation. While some of her advocacy has yielded results, such as a letter to the California Health and Human Services Agency that was directly followed by a mask mandate, even she is not sure where the buck stops when it comes to who is responsible.

She’s not the only one who has attempted to shine a spotlight on the dismal conditions at the Twin Towers Correctional Facility and other correctional facilities around California. In fact, the past year has been a litany of complaints, fines and lawsuits, with little action in return from the County.

Let’s take a trip down memory lane: 

April 2020:

The National Association of Criminal Defense Lawyers, California Attorneys for Criminal Justice, and the Youth Justice Coalition submit a petition for writ of mandate to Governor Newsom and Attorney General Xavier Becerra. The petition details that “key measures to prevent the spread of COVID-19 are impossible in correctional facilities,” due to the very cramped, unventilated nature of jails, and notes the only way to slow the spread is through severe jail population reduction. 

This occurs just as abolitionist advocacy groups Dignity & Power Now, the Youth Justice Coalition, and nine incarcerated individuals sue LASD “for failure to adequately protect the lives and safety of people incarcerated within Los Angeles County jail system from COVID-19,” as their April press release states.

June 2020

The ACLU and Prison Policy release a study grading each state’s response to COVID-19 in jails and prisons. California receives a glowing F+.  

August 2020:

The LA County Inspector General announces that the Los Angeles Sheriff’s Department are not consistently wearing their masks — a troubling conclusion considering LASD issued their own mask mandate on April 15, and LASD staff come into direct contact with incarcerated people daily. 

September 2020

The Sheriff Civilian Oversight Commission releases a report stating LASD needs to do much more to help curb the spread of COVID-19 in LA County Jails, citing specific problems like insufficient testing, inconsistent use of masks, lack of cleaning supplies, and insufficient physical distancing.

November 2020

Cal/OSHA fines the Los Angeles County Department of Health Services $71,555 for multiple violations from the Correctional Health Services staff at Twin Towers Correctional Facility, including failure to immediately report a work related injury (read: COVID-19). 

The same month, court-appointed jail monitor Richard Drooyan announces at an LA County Board of Supervisors meeting that the LA County Jails do not have adequate supplies or staff to be safely operating at their current capacity. 

December 2020:

The LA Times publishes an Op-Ed urging LA County to immediately depopulate jails.

That’s a lot of noise for a particular issue, especially knowing advocacy groups have been screaming solutions from the rooftops. Early on in the coronavirus crisis, organizations like the Prison Policy Initiative released simple steps states could take to mitigate the virus. Those steps included reducing the number of people in jails and prisons, eliminating unnecessary face-to-face interactions, strengthening correctional health services by, for example, boosting paid sick leave for staff, and making phone calls free and accessible so those experiencing a global pandemic in the most dangerous places in the country don’t have to do so in isolation.

Sanati was the only mental health staff member who felt comfortable giving statements on the record, citing “fear of retaliation” as a reason her colleagues wished to remain anonymous. The fear isn’t baseless either—back in August, former LA County CEO Sachi Hamai won a $1.5 million settlement and private security from LA County after experiencing ’severe and pervasive harassment, defamation, malicious prosecution, and hostility’ by Sheriff Alex Villanueva. “It’s a difficult task to do work there when you’re working in the ‘Sheriff’s House,’ as they call it, with a different mission [from LASD],” an anonymous source added.

It’s not as if CHS or LADHS was bending over backwards to address the situation either. An anonymous psychiatric social worker told Knock:

“There was no communication, whether it was from administration [Correctional Health Services] or our program manager… even middle management wasn’t communicating with us until we said, ‘Hey, what do you want us to do.’ And I just find that completely insane especially when it’s already crowded in there. The conditions are terrible already. And now we have a pandemic on our hands. I think the least you could do for the clinicians is to say ‘hey, how are we going to continue providing care for the most mentally ill people in the country?’”

The main ask from the mental health employees is for CHS to allow the staff to telework for as much of their jobs is realistic. From April to October, staff had the option to telework for 50% of their jobs. In October, that telework guideline was arbitrarily revoked for most of the staff, and then reinstated at 30% for some staff members at the beginning of December. Sanati emphasized that much of the department’s jobs could be done remotely; meeting with patients is one thing, but much of the work is paperwork and notes that does not require the employee to be in their offices.

Offices, it’s worth noting, that don’t have any windows. Another anonymous source told Knock “there’s no access to fresh air flow. To this day, there’s still no changes that have been made in the office from a safety perspective.” Dr. Tim Belavich, interim director of Correctional Health Services, remarked in an interview with Daily News in November that “plexiglass has been installed in clinical and office areas of the Inmate Reception Center and other areas of the jail to prevent spread of the coronavirus.” “Other areas of the jail” clearly does not include the offices used by the mental health staff. 

Keep in mind the conditions described by Sanati, her colleagues and the incarcerated only really cover the Twin Towers Correctional Facility, and not the conditions of Men’s Central Jail. An anonymous employee mentioned things are so bad at Men’s Central Jail (for more reasons than just the threat of COVID-19) that it’s not uncommon for people to report false suicidal ideations so they are transferred to Twin Towers. “There have been plumbing issues [at Men’s Central Jail], and as a result feces has been floating in parts of the jail, in addition to the extreme exposure to germs,” the employee told Knock. They said it’s a “common type of dilemma” for the men to seek the mental health services at Twin Towers, where the conditions are already unacceptable, so they can escape what they’re experiencing at Men’s Central Jail. 

At this point in the pandemic, the only thing saving the incarcerated population is access to vaccines. In Los Angeles, all incarcerated people became eligible for the vaccine on March 15. It is unclear what percentage of those incarcerated at Twin Towers have received a dose, although many of the mental health staff members received it a few months ago due to their eligibility as healthcare workers. 

But waiting a year for a vaccine to be ready is not a plan. DHS, CHS, and LASD failed in their duty to make swift and bold moves to protect their own employees and one of the County’s most vulnerable populations. Where was Dr. Christina Ghaly (Director of DHS), or Dr. Timothy Belavich, or Sheriff Alex Villanueva, throughout this crisis? Why wasn’t there an immediate call for the maximum amount of telehealth possible, a release of a significant amount of incarcerated people, or proper PPE provided to every single person in the jail? For the psychiatric social worker who chose to remain anonymous, it could have to do with a cultural perception of jails and the people inside them: “If you happen to be a person who has a booking number, you’re automatically put at the bottom of the food chain, you know. And I think the county treats the inmates that way, and then I think we end up [getting put down there too] as the people that work with them.”

Dr. Ghaly could not be reached for comment for this story, and Dr. Belavich and LASD both did not provide comment.