By Aakanksha Patel and Alexander Ramirez
WOODLAND, CA – A few weeks ago, the Yolo County Superior Court made a finding that the Yolo County Jail was making reasonable accommodations for Alfred Narayan who has a number of medical conditions that impair his life.
These conditions include fall risk, Post Traumatic Stress Syndrome (PTSD), rheumatoid arthritis, TBI (Traumatic Brain Injury), chronic sinusitis, and COPD (Chronic obstructive pulmonary disease) with asthma.
The hearing ended with promises that specialists would be added to his care, and the medical facility be there in case of any emergency.
The court met again this week to get an update on whether those promises are being fulfilled.
Private Defense Attorney Jennifer Schieck argued that Narayan was not receiving adequate medical attention in the Yolo County Jail and that his custody sentence should be reduced. She called therapist Dr. April Hayes to testify about progress prior to and during custody. Dr. Hayes has been certified with a Ph.D. in the psychology of trauma.
Narayan was referred to her seven to eight years ago from the Veterans Affairs department. He was injured in Iraq in 2004—his convoy was hit by three Improvised Explosive Devices. He was at point blank, in direct line of one of those.
He was airlifted and sent to Germany, and then Washington State for treatment, not expected to live. It took years to recover and start walking again with medical treatment. When he was struggling psychologically years ago, he was referred to Dr. Hayes.
To elaborate on the struggles Narayan faces due, Dr. Hayes described the different triggers he faces in jail.
The primary trigger is confinement. She mentioned that “it feels like you cannot get out, the walls are coming in, no safety.” Because of this, Narayan develops a fight or flight response. He needs to move but when he cannot, he starts fighting and hurting themself.
Another trigger is pain. It is a trigger because it is so intensely painful, that he cannot think straight. “It feels like the end of the world,” she says.
The third one is loud noise. Jail is a noisy place. Any door that opens or closes is metal and it vibrates throughout the whole building. She mentions that she had been visiting him every week since he had been in jail, and she has heard people screaming at other inmates.
She was deeply concerned about his long-term medical condition. When asked to elaborate on his declining condition, Dr. Hayes got emotional and had to take time to gain her composure.
When asked if she was all right by judge Dave Rosenberg, she replied, “It’s just been overwhelming to see him like that. I’ve seen him for so long and he’s done so well, and we had pre-planned for him to be there regarding his PTSD…He had it down pretty well. Now, he has declined so much that he is getting confused.”
As a concluding statement, Dr. Hayes gave her professional opinion regarding what would happen if were to remain in custody.
She explained that even if he were to get out now, he has already declined to a degree where it is going to take a lot of work to get him back up. Her latest concern is that he has complained of not being able to urinate which means his body is refusing to cooperate. She has no idea how long it will take to become normal again.
Deputy District Attorney Rachel Raymond cross-examined the doctor on whether she has any relationship with Narayan outside of the professional sphere. Dr. Hayes declined to answer but he was a part of the veteran’s group in her office.
When asked whether she often gets emotional or attached when dealing with patients, she asserted that she is an emotional person. “Working with people over the years, you get to know them very well,” she said, adding that she was not particularly attached to Mr. Narayan. She had great respect for him, but she treats all her patients the same, she said.
Assistant County Counsel Ronald Martinez asked Dr. Hayes whether she was aware if his decline was affecting his mobility in any way. She said that he had fluctuating mobility and whenever she has seen him, he has been in pain, wheezing. From what he tells her, he lays in his bed most of the time.
After Hayes stepped down from the stand, medical staff from the facility gave their point of view on facility policies and their treatment toward Narayan.
The first staff member went over the “plan of care” for the patient, and commented, “We don’t make promises, we provide a plan of care that is dynamic and continuously changing. Mostly due to the patient’s response to it.”
Narayan’s plan included pain medications that included narcotics, and he has been receiving steroidal medicine and muscle relaxers that are staggered throughout the day. The medical staff added that when they give Narayan his medicine throughout the day, his mobility has in fact been improving.
“He gets quickly from his bunk, and he, you know, grabs his water, and then he knows he kind of only has our ear for just a brief time and he actually is able to speak in complete paragraphs without stopping just so let us know what his needs are and how to meet them.”
A medicine that was brought up often in the case was albuterol, which could be used to treat Narayan’s breathing fits, but as the medical staff explained, this medicine is only administered as needed since it increases a patient’s anxiety exponentially.
It’s a “rescue medication” for when a patient is wheezing or needs immediate oxygen in their body.
Although Narayan has been completing physical therapy, he still reports moderate breakthrough pain and a back brace that is on constantly. He may also have a walker but does not need it on some occasions even though he is considered a fall risk.
After all this, the medical staff reaffirmed that their plan is going as intended for Narayan to keep him comfortable and not lose mobility as he serves his time.
After the last hearing, the medical staff asked Narayan if there were any accommodations they could make for him, which ended with an officer giving him a new pair of shoes and more support for his mattress. After they asked him again later, there were no significant complaints that Narayan had.
Schieck continued to ask Judge Rosenberg if she had the ability to question the witnesses, and although Rosenberg corrected Schieck by saying the medical staff weren’t witnesses but instead just here giving an update on the medical facility treatment, he allowed her to question them.
Schieck asked about the response rate for emergencies like wheezing or difficulty breathing. One of the staff in court said it only takes less than a minute, and they “get to medical emergencies quite quickly in the jail.”
If that’s the case, then Schieck questions why there was a two and half hour response time situation just on June 8 when Narayan couldn’t breathe, and they promised him they would see him soon. Two and a half hours later, staff just told Narayan, “Hey, you’re doing okay?”
Staff were aware of this incident.
“Needless to say, I was very unpleasant in my counseling of the staff, and it has not happened since. That is an unacceptable time, and I simply cannot answer it any other way,” said the officer.
When Schieck relayed that Narayan said that these incidents happen often, with no responses from the staff sometimes, medical staff in court did not have a reply to this statement.
Narayan still requires consistent breathing treatment, yet they don’t administer his albuterol anymore. Staff affirmed that albuterol is still available to Narayan, but due to its side effects is only used for emergencies.
If Narayan needed to go to the hospital, the staff would be able to send him there.
In closing statements, Schieck argued that by the facility taking Narayan off of specific medication, they subjected him to cruel and unusual pain because of his PTSD that he was subjected to defending his country.
On the opposition, they argued that the judge is making accommodations for Narayan even against the opinion of the DA, and he doesn’t have much longer in jail. He is to be released in October.
After closing statements, Judge Rosenberg acknowledged Narayan’s bravery fighting for his country but did not agree that his treatment at jail is evidence of cruel and unusual punishment.
“I continue to find that the jail is, and continues to find reasonable accommodations to Mr. Narayan’s condition,” he said, ruling that Narayan will continue to serve his time until his release in October.
Aakanksha Patel is a fourth year student studying Communications and Public Affairs at UCLA. She is from San Jose, California.
Alexander Ramirez is a third-year Political Science major at the University of California, Davis. He hopes to hone his writing skills in preparation for the inevitable time of graduation.
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