When M.K. arrived at the D.C. Jail around the start of 2022, his HIV was undetectable — meaning the virus was suppressed to the point where it couldn’t be transmitted to others. This was thanks to a decade of using the HIV medication Biktarvy, according to his attorneys.

But M.K. has missed more doses in the past 16 months or so than in his previous 10 years put together because staff at the jail have failed to consistently provide him his medication, his lawyers say. Once, during a search of his cell, they say staff “threw his Biktarvy on the floor and stepped on it, rendering it unusable.”

Missing this medication has consequences: In addition to raising one’s viral load, repeatedly missing doses of HIV medication can decrease its efficacy long term, allowing the virus to develop resistance to the drug. By September, M.K. once again had a measurable viral load of HIV, according to his attorneys.

M.K. (referred to in the lawsuit by a pseudonym for his privacy and safety) is one of several people whose experiences are detailed in a new class action lawsuit against the D.C. Department of Corrections filed Monday by the Washington Lawyers’ Committee, a legal nonprofit focused on civil rights litigation. The lawsuit alleges that DOC is “deliberately indifferent” to its constitutional obligation to provide people with adequate medical care, arguing that medical care at the jail is “systematically dysfunctional.”

The result, the suit alleges, is that people with serious medical conditions routinely miss doses of life-saving medication and are forced to wait months or years for urgent medical care. In multiple cases, the suit says, medical staff at the jail failed to schedule necessary follow-up appointments until they were months past due, or canceled appointments last minute without explanation. One plaintiff with congestive heart failure claims that jail staff routinely deprive him of his medications. Another plaintiff who needs catheters in order to urinate claims that jail staff insist that he reuse old ones, using only his cell’s sink to clean them.

“The level of indifference — and the widespread amount of indifference… is mind boggling,” said Jacqueline Kutnik-Bauder, Deputy Legal Director at the Washington Lawyers’ Committee.

The suit aims for a court order to fix the jail’s system of delivering health care, as well as ongoing monitoring and enforcement to ensure the jail follows through. It also asks D.C. to pay damages and attorney’s fees to some of the plaintiffs.

DOC declined to comment on the allegations in the suit, citing its policy of not responding to inquiries about active litigation.

Residents of the jail — particularly those with complex health conditions — are entirely at the mercy of DOC and its medical contractor, Unity Health Care, to manage their health care needs. While they’re detained, they can’t obtain or manage their medications, schedule doctor’s appointments, seek specialists, access medical supplies, or even see a doctor without permission and an escort.

The suit describes, in rare detail, instances of extreme medical neglect spanning a variety of health conditions — from a resident who tore his ACL while in the jail but had his post-surgery physical therapy routinely canceled or delayed, to a man who went months with abscessed and rotting teeth.

For one plaintiff, they argue, medical delays have been life-threatening.

The plaintiff, referred to in the filing as “V.C.,” has been diagnosed with congestive heart failure, according to his lawyers. They say he must take nine medications every day or risk debilitating chest pains, shortness of breath, and an increased risk of death. The suit alleges that jail staff failed to provide V.C. his medications “on at least nineteen occasions, sometimes for a few hours and sometimes for multiple days at a time.” According to the suit, the problems persisted despite V.C. filing sick call slips and grievances with staff, and despite his attorneys reaching out to DOC.

“Because of Defendant’s deliberate indifference,” the suit says, “V.C. suffered unnecessary and debilitating chest pains, shortness of breath, risk of heart failure, and severe anxiety over whether his heart could fail completely.”

Another plaintiff in the suit, B.L., needs to use catheters in order to urinate because of long-term damage from a gunshot wound. According to the suit, jail staff not only won’t regularly provide him new catheters but often give him catheters that are too large and routinely fail to provide him with enough sanitizing wipes and lubricant to insert them safely and comfortably. As a result, his lawyers say, B.L. is at risk for infection, bleeding, and scarring. He limits his fluid intake so he has to urinate less often, the suit says.

These are not his only problems with medical care: B.L. also requires specialty care for two concerning health issues — blood in his stool, and an abnormal mass in one of his testicles that emergency room staff identified in January of 2022. The suit says it took jail staff a year to bring him to a urology specialist and that B.L. still does not have answers about the cause of the bleeding and whether his mass is cancerous.

The suit also details delays in vision care for plaintiffs. One man, referred to in the complaint as L.S., is blind in one eye and requires lubricating eye drops and glasses to see out of the other.

The suit argues that because of failures at the jail, L.S. hasn’t been provided enough drops or had functioning glasses with the correct prescription since his broke more than two years ago. Sometimes, the suit says, he goes months without being able to see, regularly bumping into people and objects. Given the dangers this presents, he often stays confined to his cell.

DOC officials and patients’ medical records offer a variety of reasons for missed medication, missed appointments, and other medical delays, according to the suit. In one case, DOC officials said errors in their electronic pharmacy system led to a resident missing medication. Another time, they said they failed to transfer that patient’s medication over when he switched housing units. Other times, the suit says, the jail fails to deliver people their medication if they miss “pill call” (when staff pass out medication in the housing units) because of legal visits or court appearances.

Other times, the problems appear to be linked to staffing — in M.K.’s case, the suit says he had 13 appointments canceled because there wasn’t sufficient staff to provide an escort.

The suit argues that these problems with medical care aren’t limited to the plaintiffs they name in their complaint and are instead systemic at the jail — which is why they’re asking for a judge to certify their suit as a class action case. They argue that numerous others at the jail — most of whom are being detained pre-trial and haven’t been convicted of a crime — are deprived of medical care.

The suit also argues that the current widespread problems with medical care at the jail are part of a decades-long history of failures.

As part of a pair of lawsuits against the jail that led to more than 30 years of court oversight, District Court judge William B. Bryant seized control of medical and mental health care at the facility in 1995. He said the jail’s failure to abide by his orders to screen and treat people detained at the jail for tuberculosis “could very well result in an epidemic in the entire city.”

Complaints about medical care have persisted since then. More recently, residents of the D.C. Jail filed a class action lawsuit against the facility over its handling of the COVID-19 pandemic, ending in a settlement where DOC agreed to submit to a series of inspections. In 2021, complaints from Jan. 6 defendants about medical care in the jail brought more attention to the treatment of residents in the facility. Those complaints led to an inspection and memo by the U.S. Marshals Service that alleged a litany of failures at the jail — including unsanitary conditions and punitive denial of food and water to residents. DOC officials largely denied the Marshals Service’s allegations, but local advocates said they weren’t surprised by the contents of the memo. They pointed out that people detained at the jail — most of whom are Black and from D.C. — have complained about poor treatment at the facility for years.