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The full count is 66 nurses and three full-time doctors, a doctor for every tour of duty. But Culbreath also admits there are aspects of care, especially for a paraplegic, that necessarily suffer because the jail is a jail.
"There are probably things we should be doing for them that we can't do," she admits. "We can't give paraplegics [overhead] bars [to lift themselves with], because they use them for weapons. We can't give them slide boards [for help getting in and out of bed], because they use them for weapons."
She insists her staff at the jail does the best it can under the circumstances.
But according to Kevin Young's jail medical chart, obtained by the Dallas Observer, the fact is that his physical condition began to grow startlingly worse from the moment he entered the jail. Five days after the initial April 19 examination, the sore at the base of his spine had grown to a baseball-sized abscess; the other sores had worsened and were draining, and he had to be manually "de-impacted" of hardened stool that he had been unable to pass.
In the weeks ahead, Young's chart is filled with notations indicating that he had refused to come to the nursing station for changes of his dressings and had refused to sign a medical refusal form. None of the refusal forms attached to the copy of the medical chart obtained by the Observer bears his signature. Culbreath says her staff has other documentation to show that he refused.
Young's version of what was going on during that period is different. He says that he was lying on a bunk in his own waste and putrescence, deeply depressed, sick, perhaps on occasion unable to summon the strength or will to haul himself into his chair and down to the nursing station.
"They would just call and say I was supposed to report down there, and I might not have made it every time," Young says. "But I never refused no medicine, and I never refused to have my dressings changed."
In fact, the chart shows that he did get himself to the nurses every few days to ask for help evacuating his bowels. Urination, in the meantime, had developed into another issue.
When Young went back to jail, his chart shows that he was fitted with a "straight catheter" to allow urine to pass from his bladder to a bag. Culbreath and her staff say that he later demanded to have the permanent catheter removed. She says she can't imagine why anyone would voluntarily give up a permanent catheter in exchange for the alternative -- a messy process in which Young had to stick a catheter up his own penis every time he needed to urinate. While Young did not have sensation in his penis, he says the catheter often brought up blood, which he found emotionally distressing because of the damage he knew he was doing with the catheter.
"Why would he do that?" Culbreath asks. "I don't know."
Young says the answer is that he wouldn't volunteer for self-catheterization -- no one would. He says he was never offered a permanent catheter. "If they would have offered me that, I would have taken it."
Later entries in the chart confirm that he was using the "in-and-out" self-catheterization method, inserting it himself each time. The problem with that technique, he says, was that the jail would agree to provide him with only one catheter at a time.
"It says right on the package, 'for single use only.' It says it's not sterile after that," he says.
Young says -- and his chart confirms -- that he was instructed to wash out the catheter in his cell and use it again. He says, and the chart seems to confirm, that he was soon also plagued with a urinary-tract infection.
During the months of May and June, Young's grandmother Francis Young and his aunt Doris Mitchell spoke to him regularly on the telephone. Young's chart from May and early June is filled with optimistic notations by the jail's medical staff remarking how well his wounds from the bedsores are doing. The chart also contains complaints from the staff about his personal hygiene and references to the need for more regular showering.
Young says he can get out of his bed and into his chair by himself, but can't get from one chair to another by himself. Therefore he can't get out of his own chair by himself and into the shower chair. The only way he could shower was to shower in his wheelchair.
"Then the chair would be wet like for the rest of the day, and I would have to sit in it," he says.
During that same period, his aunt and grandmother were growing alarmed by what he had to say to them on the telephone every day -- that he was literally rotting away, that he was too sick to eat and that he was not receiving any kind of consistent medical care or medication.
On June 30, in spite of all the notations of success on the medical chart, Young was sent to Parkland Medical Hospital with runaway infected sores so raw and large that they required surgery. On July 1, he was already back at the jail, but now the notations on the chart were notably less cheerful. Parkland still had not provided the jail with any paperwork on what they had done for him. He came back with open surgical wounds and foul-smelling running sores, according to the chart.
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