How Bad is the Dallas County Jail? The Dallas Morning News Articles & Editorials Tell the Story

For the past 15 years the Dallas Morning News has published articles and editorials that paint an awful picture of the Dallas County Jail, particularly relating to the care that mentally ill persons receive. But little, if anything has changed.
The same finger pointing and buck passing year after year after year.
Is it asking too much to demand real leadership from our county officials?

Hope you enjoy this sample of news and editorials. I think you'll see a very disturbing pattern.

David Finn





06/23/05
DAY: Thursday
PAPER: THE DALLAS MORNING NEWS
SECTION: METRO
EDITION: WEST
PAGE: 1B
HEAD: Officials stand by sheriff on jail care Dallas: Some say claims that
Valdez isn't doing enough are hypocritical
BYLINE: JAMES M. O'NEILL
CREDIT: Staff Writer
ART: PHOTO(S): Sheriff Lupe Valdez's policies are aimed at better care, a
spokesman says.
TEXT:
Dallas County Sheriff Lupe Valdez has quietly done more to improve health care at the jail than Commissioner Kenneth Mayfield's attacks suggest, department officials said Wednesday.
And Sheriff Valdez chose not to proceed with some changes because the department either doesn't have the money or she decided some current procedures work better, said Sgt. Don Peritz, the department spokesman.
Meanwhile, Democrats turned Mr. Mayfield's criticisms of the Democratic sheriff on their head, calling him a hypocrite.
Mr. Mayfield, a Republican who chairs a committee to fix health-care problems at the jail, earlier this week asked why Sheriff Valdez, six months into her job, had not moved quickly to improve inmate health care. Jail health care has become a serious liability for commissioners and has put some inmates in life-threatening conditions, according to a recent study.
Commissioner John Wiley Price, the lone Democrat on the Commissioners Court, said Wednesday of Mr. Mayfield: "All of a sudden he becomes the person of social concern. He hadn't shown any concern in the past 10 years. He's late to the game as usual."
And a new political coalition designed to promote Democratic candidates across North Texas also weighed in.
"Mayfield has been part of the problems for the last 10 years and to come out swinging at Sheriff Valdez is hypocritical," said Russell Langley, co-founder of the Texas Values in Action Coalition. "Mayfield is worrying about his own re-election next year and is trying to find someone to scapegoat for his failed leadership."
Mr. Mayfield brushed the attacks aside. "Those people are uninformed and don't know how things work," he said. "There are things that don't have to do with providing more money that she can implement now to be sure people in the jail are treated with dignity and not harmed."
Mr. Mayfield had questioned why the sheriff did not accept the Mental Health Association's free offer to train jail guards to identify and handle mentally ill inmates.
According to Darryl Thomas, the department's chief financial officer, it would still cost about $400,000 in overtime to free up detention officers for a 16-hour training program.
Sgt. Peritz said Sheriff Valdez welcomes training offers, but she must remain fiscally responsible, and the overtime cost would have to come from somewhere. He said she hopes to create a position to write grant proposals for just such projects, if the commissioners will approve the post. The commissioners control the sheriff's budget.
Mr. Mayfield also questioned why the sheriff had not improved inmates' ability to communicate directly with medical staff to request aid by providing boxes for their requests that medical staff would check. Currently, inmates must pass requests to the jail guards first.
Sgt. Peritz said the sheriff's staff studied the issue, and concluded that, given the shortage of medical staff at the jail, there was no guarantee they'd be able to collect the requests in a timely manner. Having inmates hand them to jail guards who could pass them on was judged more efficient, he said.
Sgt. Peritz also said the sheriff instituted a new policy giving supervisors authority to send inmates directly to the hospital when they looked to be in medical distress without first getting approval up the chain of command.
He said the sheriff also instituted a policy in which jail guards made visual checks on each cell every 15 minutes to identify medical emergencies. In the past, the checks could be spaced 30 minutes apart or longer.
E-mail joneill@dallasnews.com
06/22/05
DAY: Wednesday
PAPER: THE DALLAS MORNING NEWS
SECTION: METRO
EDITION: SECOND
PAGE: 1B
HEAD: Valdez faulted on care at jail Dallas: Mayfield wants more done;
sheriff cites new policies, staff needs
BYLINE: JAMES M. O'NEILL
CREDIT: Staff Writer
ART: PHOTO(S): 1. Commissioner Kenneth Mayfield criticized 2. Sheriff
Lupe Valdez, who wants to add management positions.
TEXT:
Dallas County Commissioner Kenneth Mayfield on Tuesday challenged Sheriff Lupe Valdez, asking why she has not done more to improve health care in the jail, a crisis that has put the county on the defensive for months.
Mr. Mayfield raised the issue during discussion of the sheriff's proposal to add two top management posts in the Sheriff's Department.
Mr. Mayfield, chairman of a committee to improve jail health care, also said in an interview Monday that Sheriff Valdez could do more to fix the problems, which are posing sometimes life-threatening health risks to inmates, according to a recent study.
"I haven't seen a lot of movement," he said.
Sheriff Valdez said she has established policies to have guards check on inmates every 15 minutes, improved the way inmates submit medical requests and created a committee to pick a company to analyze the department.
Mr. Mayfield cited a lack of progress on altering policies that pose a liability to the county, bettering the system for inmate requests and training jail staff to handle the mentally ill.
"She could have been doing all these things. I'm pretty disappointed they haven't happened," Mr. Mayfield said.
He said the sheriff has not acted on an offer by the Mental Health Association's Vivian Lawrence to train jail guards on how to identify and handle mentally ill inmates.
Ms. Lawrence said she has offered to provide the training for free, at a time and place the sheriff deemed convenient.
"I have not heard back from her office," she said. "The offer has been out there for a while, but it has not been accepted."
At Tuesday's meeting, Mr. Mayfield asked, "In the treatment of prisoners, which is a huge liability we have, what's in place now to ensure that prisoners are treated with dignity and respect?"
Sheriff Valdez said she has made policy changes to improve oversight of inmates' health but also shot back that without more staff, none of the changes would make a difference.
"If we don't have the people there to follow through with the new policies," she said, "it's just not going to happen."
Commissioner Maurine Dickey came to the sheriff's defense. "These are management tools the sheriff needs to proceed," Mrs. Dickey said. "We need to give Sheriff Valdez the tools she needs without giving her a hard time on every tool she asks for."
Mrs. Dickey also gently chastised the commissioners, noting that their overarching concerns about keeping costs down had led the county into trouble in the past.
"Let's not predicate every decision on the Commissioners Court with, 'Does it save money?'" Mrs. Dickey said. "That's how we got into the ditch in the first place. We need to look at value as well."
Sheriff Valdez had until now enjoyed a relatively benign relationship with the commissioners.
But she has been in office nearly six months, and in that time the commissioners have come under intense criticism for the jail health care crisis, which prompted several pending lawsuits.
Mr. Mayfield, in the interview, said the sheriff could have ordered that paper forms, or kites, which inmates use to request medical help, be put in locked boxes for medical staffers to pick up directly. Currently, inmates must hand the kites to jail guards, who are supposed to pass them along.
Many other counties use locked boxes for kites to ensure that they get directly to medical staff and are not lost.
Mr. Mayfield also said the sheriff should be reviewing policies that pose potential liability for the county, including the policy to shut water off in the cells of often mentally ill inmates who stop up the toilets in their cells. He said the policy never made clear how long the water should be turned off. The county is facing a federal lawsuit involving James Mims, a mentally ill inmate who nearly died last year after water in his cell was shut off for two weeks.
The sheriff has created a committee to pick one of four companies to conduct an analysis of the department and how to streamline and improve operations.
E-mail joneill@dallasnews.com

05/29/05
DAY: Sunday
PAPER: THE DALLAS MORNING NEWS
SECTION: NEWS
EDITION: SECOND
PAGE: 1A
HEAD: Glitches at jail swallowed up inmates Exclusive: County never knew
how many were stuck long past release dates - or still are
BYLINE: JAMES M. O'NEILL
CREDIT: Staff Writer
ART: PHOTO(S): (MONA REEDER/Staff Photographer) Scott Williams was
arrested on a DWI charge in February, a dicey time at the jail. He hoped to be out the next day, but, denied his medications, he endured "a week of
hell," he says. CHART(S): SERVING THEIR TIME, AND THEN SOME.
TEXT:
It was as if Scott Williams had vanished into a black hole.
Shortly after his rush-hour fender-bender on Central Expressway, he made a cellphone call from the back of a police car. In a voice laced with agitation, he told his partner, Rodney Russell, that he had been drinking, that he had rear-ended a Jeep and that he was headed to the Dallas County Jail on a DWI charge.
Mr. Williams thought he would quickly be released - as soon as Mr. Russell could learn from the jail how much bail to post.
But Mr. Williams' arrest occurred on Friday, Feb. 4, during the most chaotic week the county jail has likely ever seen.
"I expected to be out the next day, for sure," Mr. Williams said. "But it turned into a week of hell."
Just days before his arrest, on Jan. 31, the county had launched a new computer system for the jail.
The Adult Information System, or AIS, which has cost $3 million in federal grant money, was designed to make book-in and law enforcement work more efficient. Someday it might do that.
Instead, the system's launch caused a staggering backlog of defendants waiting for book-in the week of Mr. Williams' arrest.
In addition, lists of new inmates produced by the county's old mainframe could no longer be produced, wreaking havoc with court officials' ability to know who was in jail and to set inmates' court dates.
Jail clerks - some poorly trained - also had trouble with the new system.
The passel of problems caused scores of people, including Mr. Williams, to languish in the jail for weeks and months too long.
Through interviews with court officials, defendants and others, and after reviewing data in the new system and in court documents, The Dallas Morning News has identified at least 40 cases in which defendants were imprisoned too long after the launch of AIS. Some officials say the total number is far higher.
"These cases are just a small representation of the chaos we experienced," District Court Judge Vic Cunningham said.
In the four months since the crisis began, the county has never tried to determine how many people were affected. As a result, some who might have been located and released remained imprisoned far too long.
For instance, one inmate was booked in Feb. 8, but the courts learned of him only when he managed to get a message to a judge 56 days later. In many cases, court officials discovered someone's imprisonment only because family members alerted them.
"It comes down to a tremendous failure by the county. It's outrageous," said Michael Linz of the American Civil Liberties Union of Texas. "But it's not unusual for the county to think of these folks as just people in jail - the weak and powerless - and to ignore them."
Mr. Linz said those held too long could have the basis for a civil rights lawsuit against the county.
"Ordinarily, the government's not permitted to hold you without cause," he said. "Dallas has been notoriously deficient in taking care of basic human liberties."
To date, Dallas County has no idea whether people who should have been released are still in the jail. One court accidentally discovered a defendant still imprisoned as recently as May 12 even though it had told the jail to release him 34 days earlier. The court learned he was still imprisoned only when he failed to show up for a court appointment, and his attorney called his family to ask why. They said he was still in jail.
News analysis
To gauge the extent of the problem, The News looked at the cases of 50 defendants booked in at the jail over about four hours on the evening of Feb. 1. At least one in seven appears to have been imprisoned too long.
"It is unimaginable that people could languish for days and weeks beyond their release date. It's outrageous," former county criminal court Judge David Finn said.
The sweeping problems affected all kinds of people. Some had long criminal records; others had no prior offenses. Some are homeless, and some hold prestigious white-collar jobs.
Many were locked away for minor infractions, and for some, charges were dropped. One woman had her charges dismissed by a grand jury on Feb. 22 but wasn't released until 36 days later - only after she got word to her lawyer.

Defense lawyers were surprised by the computer problems, saying they had come to trust the old system and never felt a need to check if their clients were actually released on time.
"Things came to a standstill. We couldn't get our clients brought down to court because the jail couldn't find them," said Kenda Culpepper, who sits on the board of the Dallas Criminal Defense Lawyers Association.
When Ms. Culpepper heard one of her clients was held a month too long, she called the court and got him released.
"What about the people stuck in there who didn't have a lawyer to advocate for them?" she said. "People without access to family or a lawyer were just stuck. Their rights were violated. It's unforgivable.
"There was a problem with the whole thing that the county has to acknowledge. For them not to - that's pure arrogance."
County Commissioner Mike Cantrell, who spearheaded the project, said AIS is solid and functions as intended. The big problem occurred when mainframe reports for the courts were cut off.
"There were issues with the old mainframe when it started, there are issues with this new system, and there will be issues with whatever replaces AIS in the future," he said. "There are always going to be instances that pop up out of the norm."
He said his responsibility is to Dallas County taxpayers and indicated he isn't inclined to issue an apology to those held too long.
"I don't want to be callous," he said. "But something like that has to go through the district attorney's office."
Instead of conducting an audit to discover how many people were held too long, Mr. Cantrell and others said they have focused on fixing the immediate problems.
'A perfect storm'
The same week the computer problems started, commissioners received a scathing report on health care in the jail. It noted that many inmates with physical and mental illnesses were not receiving their prescribed medication.
Mr. Finn said the jail's poor health care, compounded by the computer problems, created "a perfect storm."
"It puts the mentally ill in a bad position," he said. "They feel absolutely lost in the jail, and that's scary." He said drugs for mental illness can cause serious side effects when suddenly withdrawn.
The confluence of computer problems and health care woes proved toxic for Scott Williams.
Mr. Williams has fought depression and anxiety for years. His prescription medications have not always worked, and doctors have had to tinker with the mix. In August, he spiraled downward, so Mr. Russell got him into a treatment program. Doctors finally hit on a combination of four drugs that seemed to stabilize him.
But early this year, a close friend died. And on the night of Feb. 4, Mr. Williams, who has had a drinking problem since experiencing childhood sexual abuse, bought some alcohol. He took it to his apartment on Turtle Creek Boulevard and had a few drinks. When Mr. Russell came home and took a nap, Mr. Williams decided to go get new water for his tropical fish tank. He took Mr. Russell's car and accidentally rammed the Jeep.
Mr. Williams, 36, said that when he arrived at the jail, he told the staff and the nurse on duty about his medications.
He was placed in a holding cell designed for 63 people but which at that point was crammed with several hundred. "People were literally laying on top of each other," he wrote after being released.
He remained there Friday night, Saturday and into Sunday, expecting to be bailed out. He refused to eat the moldy baloney sandwiches the jail gave out, and a guard put him on suicide watch.
Early on Monday, Feb. 7, he said, he was taken to a suicide cell, stripped naked and left on the floor, freezing and shaking. He said he could already feel withdrawal symptoms from the lack of medication.
Later that morning, after a doctor lifted the suicide watch, Mr. Williams was transferred to a cell he said was strewn with glass, while the floor, sink and toilet were smeared with feces. He started to yell at the guards to move him. "I needed my medication and was going hysterical in a world of hell," he wrote later.
Monday night, he said, he started to shake uncontrollably.
By Wednesday, he was wondering if he had been abandoned.
Defending AIS
Mr. Cantrell defends the work of InfoIntegration, the fledgling company that created AIS. Asked if anything should have been handled differently, he said, "Nothing on the development side."
Mr. Cantrell blames the bulk of problems on two things. There were clerical errors among jail staff. And Atos Origin, the company that has a five-year, $53 million contract to handle the county's old mainframe, failed to ready the old system to collect data from AIS so it could still produce key reports for the courts.
When that occurred, officials decided it would be faster to rebuild the reports using AIS rather than adjusting the mainframe. Mr. Cantrell said InfoIntegration had to shift key resources away from fine-tuning AIS to develop the court reports through the new system.
Yet court officials say the reports produced by AIS are inaccurate. Numerous defendants were left off the lists - forcing them to remain imprisoned until they were discovered days or weeks later, often by chance.
On March 1, Tonya Brenneman, president of InfoIntegration, told commissioners it would take two more weeks to clear up major issues afflicting the system. That day, Mr. Cantrell rejected suggestions to hire a larger computer firm to help.
He says the county did not have money to hire another company because the project was funded strictly with federal grant dollars, and they were allocated for development of the system. "Another company couldn't do anything more than InfoIntegration because of the limited amount of money available," he said.
But 12 weeks after Ms. Brenneman's assurances, serious problems persist. As recently as May 17, Robert Clines, the county's new technology director, said dozens of problems with the court reports are still "significantly impacting those courts."
Judge Cunningham said the daily reports listing new defendants used to be seven pages long when produced by the old system. Reports now are only four pages - a signal that people are missing from the lists.
"It's getting better," he said, "but there's still a long way to go."
A recent report by Mr. Clines indicates that blame should be spread among Atos for cutting off the court reports, the county for providing scant oversight and InfoIntegration for failing to properly test the system.
Stacks of case folders continue to pile up on court clerks' desks because the information they need to assign court dates or issue warrants is missing from AIS.
Court staffers have turned to satire to express their frustration, circulating a "Top 10" list of what the initials "AIS" really stand for. One
example: "Anyone Incarcerated Stays."
Jail staffers complained that AIS would assign the same book-in number to multiple defendants and list inmates in one cell when they were in another.
And the system's sluggish performance early on frustrated clerks during book-in. In some cases, the same charge is listed for a defendant five or six times, a sign of an impatient clerk repeatedly hitting the "enter" button.
As a result, the AIS system indicates there are 3,000 more inmates in the jail than there really are, said Sgt. Don Peritz, the Sheriff's Department spokesman.
"Our people are understaffed and overworked to the point of burnout," Sgt. Peritz said. He said Sheriff Lupe Valdez has assigned a full-time deputy to manually check the status of inmates to reduce the chance that people are imprisoned for too long.
Forgotten in system
While Scott Williams was deteriorating in jail, Rodney Russell, his partner, grew anxious on the outside.
On Saturday, the day after Mr. Williams' arrest, Mr. Russell approached the jail's information desk to ask about Mr. Williams' status. A jail employee couldn't find him in the system. "They had no clue whether he was even booked in," Mr. Russell said.
Mr. Russell returned on Sunday and Monday, with the same results. On Tuesday and Wednesday, officials were able to locate Mr. Williams in the system, but Mr. Russell said they gave conflicting information about what bail would cost.
On Wednesday, Mr. Russell was able to see Mr. Williams in the jail. The visit only confirmed his worst fears - Mr. Williams clearly was not taking any medication.
"He was dazed and confused. He told me he hadn't slept since Friday," Mr. Russell said.
On Thursday morning, because of medical staff intervention, guards brought Mr. Williams to court. Given his condition, County Criminal Court Judge Lisa Fox issued a personal recognizance bond so he could be released immediately. Even so, he remained in jail.
On Friday morning, Dr. Gary Neller, a jail psychiatrist, saw Mr. Williams for a second time. "Off all four medications since being locked up," he wrote in Mr. Williams' medical file. "Patient doesn't recognize me as his doctor and refuses all jail medication."
Mr. Williams was finally released that Friday.
He said he still has nightmares about the experience. "I felt like a sick animal that had been kicked to the side of the road," he said.
For Mr. Russell, his partner's release provided only fleeting relief. "This experience has set us back with his meds - everything we had just accomplished," Mr. Russell said.
He is still amazed his partner was unnecessarily imprisoned for a week. "We couldn't believe this was happening in a big city like Dallas," Mr. Russell said.
"Maybe a one-horse town. But Dallas?"
E-mail joneill@dallasnews.com
05/03/05
DAY: Tuesday
PAPER: THE DALLAS MORNING NEWS
SECTION: METRO
EDITION: SECOND
PAGE: 1B
HEAD: Interim jail fix sought County weighs stopgap hires as it pursues
final remedy for health crisis
BYLINE: JAMES M. O'NEILL
CREDIT: Staff Writer
TEXT:
Facing pressure to move quickly and fix the health-care crisis at the Dallas County Jail, county commissioners say they are trying to identify extra nursing or other medical positions they can add soon as a stopgap.
The commissioners are waiting for a detailed analysis from a jail health committee to identify what procedures and new positions are needed to solve an array of problems identified in a report that commissioners received on Feb. 1.
Since that report, they have created a committee to study the issue further and hired a national expert on correctional health to advise them. But they have yet to add a single new position at the jail, despite several studies clearly documenting the need.
Commissioners have talked about moving quickly, if carefully. But health-care advocates have grown weary of the wait, especially given that inmates and former inmates say one of the most serious problems is still occurring - inmates with medical conditions often do not receive their prescribed medications. That can trigger more serious medical problems.
The county faces several lawsuits related to jail health care.
Commissioner Kenneth Mayfield, chairman of the new jail health committee, said the commissioners have not added any new positions because "we wanted to wait to see what we could do to move quickly on policies and procedures, and then look to address extra positions. If we have to add more positions, we'll add them."
But he also questioned how the county could quickly fill extra positions when the University of Texas Medical Branch, which runs jail health care, already has trouble filling vacancies.
"The court is ready to do whatever we need to fix the problem. Throwing money at it is not the answer," Commissioner Mike Cantrell said, if it is done without first analyzing the needs. "We need a long-term fix, and if we can do something short-term as well, that's what we'd want to do."
As for the reports that many inmates still are not getting their medications, Mr. Cantrell said, "There's absolutely no reason for it still to be happening."
The commissioners say money is not a hurdle to adding positions quickly. The county's annual budget includes a fund to address emergencies that might occur in a budget year. The $36 million fund has yet to be tapped, and the fiscal year ends Sept. 30.
During the Commissioners Court meeting April 26, David Kellogg of the Mental Health Association of Dallas voiced the frustrations that mental health advocates have had with the county's pace.
"As the Feb. 1 report makes clear, there's currently a life-threatening situation in the jail," Mr. Kellogg told the commissioners. "It makes sense to push UTMB to address these life-threatening issues now.
"I want to emphasize a need for immediate attention," he said.
Commissioner Maurine Dickey agreed. "Even though we may not have all the results of the committee's study for months, we must do something now," she said.
Last week UTMB lifted its own restriction on the number of vacancies it can fill on a short-term basis with people from temporary agencies. That might help UTMB fill seven vacant nursing positions.
"Lifting the cap will help fill existing positions, but we're in an emergency situation, and we need to go forward with adding additional positions," Commissioner John Wiley Price said.
He is pushing a suggestion to add 10 floating nursing positions at least as a stopgap until the commissioners' jail health committee hammers out more specifically the jail's staffing needs.
And Allen Clemson, Commissioners Court administrator, said he was trying to sit with county officials and UTMB to identify which new positions all sides could agree were vital and then move to create them without delay.
UTMB in December came out with its own analysis of the health-care staffing needs at the jail and urged 53 new positions. County Judge Margaret Keliher said the most pressing issue is how to fix the jail's intake procedures. A solution there will help solve the bulk of the jail-health problems.
The Feb. 1 report noted that jail guards with no medical training handle all medical screening at intake, rather than trained medical professionals. As a result, many inmates' health problems are missed. In addition, the county has a poor system to screen for tuberculosis at intake.
E-mail joneill@dallasnews.com
04/26/05
DAY: Tuesday
PAPER: THE DALLAS MORNING NEWS
SECTION: METRO
EDITION: SECOND
PAGE: 7B
HEAD: County nurse shortage might pose risk at jail Effort to boost inmate
health care hampered by seven vacancies
BYLINE: JAMES M. O'NEILL
CREDIT: Staff Writer
TEXT:
Even as Dallas County considers increasing its medical staff to boost alarmingly poor health care at the jail, current nursing positions go unfilled, posing potential risks to inmates.
The seriousness of the shortage was highlighted over the weekend when several nurses missed their shifts and the jail's entire west tower went a night shift without a nurse on duty.
Dr. Steven Bowers, director of medical care at the jail, said Monday that there are seven nursing vacancies, three of them in the juvenile area.
He said the University of Texas Medical Branch, which oversees jail health care, has raised a self-imposed limit on the number of medical staff positions that can be filled through temporary agencies, which should alleviate the nursing shortage on a short-term basis.
But filling the positions full time remains a major hurdle, he said. Not only is there a national nursing shortage, but jail positions are a hard sell.
In addition, recent studies outlining the serious health problems in the jail, combined with rumblings from county commissioners about not renewing UTMB's contract, make it even harder for UTMB to attract full-time nursing staff members, said Kristin Branham, the county's liaison with UTMB.
That said, county officials are pressing to increase the number of medical staff positions quickly. During Monday's meeting of Sheriff's Department and county officials, Ms. Branham suggested that the county could create 10 floating nurse positions. But she said UTMB wouldn't add positions without extra county funding.
E-mail joneill@dallasnews.com
04/16/05
DAY: Saturday
PAPER: THE DALLAS MORNING NEWS
SECTION: METRO
EDITION: SECOND
PAGE: 1B
HEAD: No changes yet in health care at jail County still studying medical
improvements for its inmates
BYLINE: JAMES M. O'NEILL
CREDIT: Staff Writer
TEXT:
Two-and-a-half months after Dallas County received a scathing report outlining life-threatening problems with health care at the jail, county officials have hired no extra medical or jail staff, made no policy changes, purchased no new medical equipment and made no physical jail improvements.
"Despite the report, all the publicity, and our lawsuit, they haven't changed a thing," said Laurence Priddy, a lawyer who brought suit against the county in the case of a mentally ill man who died in jail.
Such criticism clearly was on the minds of county commissioners Friday, as they gathered with an array of medical and jail officials for the first meeting of a new committee to fix jail health care.
Commissioner Kenneth Mayfield, the committee chairman, kept pushing to identify changes that could be made quickly.
"We've had a lot of talks. I want to get started on some action," he said.
And Commissioner John Wiley Price argued that there is clear evidence the jail's medical team is seriously understaffed, so the county should quickly beef up the team.
But Mr. Mayfield was frustrated to learn it will take two to three months for subcommittees to plan solutions and estimate costs.
Under the direction of Dr. Michael Puisis, a national expert on correctional health, separate groups will look at mental health, physical health, tuberculosis screening, and nursing requirements.
"I would like to have been done yesterday," Mr. Mayfield said after the meeting.
He said the county has been slowed by its own lawyers, who caution about what the commissioners can say in public because of several lawsuits, including Mr. Priddy's.
That concern also was voiced Friday. Commissioners Court Administrator Allen Clemson reminded the committee that, given the lawsuits, "we need to talk about the future and not past history."
Mr. Mayfield, a lawyer himself, said, "Right, not specifics, but we have to look at the past to address the future."
Advocates for the mentally ill said they were distressed that it will take three more months to craft a plan.
"We're very concerned in the delay of needed reforms, because obviously people have died in the jail," said David Kellogg of the Mental Health Association.
The University of Texas Medical Branch, which the county hired in 2002 to run jail health care, has said it needs 53 more positions to improve care. Dr. Puisis, in his own report, also noted serious staffing shortages. Given that, Mr. Price said, the county should move quickly to increase staffing.
"You're probably right," Dr. Puisis said. "I'm not sure how to address that. But you're right, they do have a need that's not being met. To say the county needs an emergency allotment of medical staff would be prudent."
One issue that remains a dangerous problem is the long delay in providing medication to mentally ill inmates.
That was clear Thursday in the county's mental health divert court, designed to direct mentally ill people into a constructive program to help keep them on their medication rather than sticking them in jail for minor offenses.
The program requires people to stay on their prescribed medications and refrain from non-prescribed medication, such as marijuana, which disrupts the benefits of the prescribed medications. To ensure this, the court conducts random drug tests.
Two people in the program who tested positive for nonprescriptive drugs spent a week in jail as punishment. When they were released Thursday, District Judge Susan Hawk asked if they had been given their prescriptive medication for mental illness while in the jail. Both said they had received nothing.
And a third mentally ill inmate, entering the program for the first time, told the judge she had not received her medication at all during 42 days in jail.
"The issue continues to fester," Mr. Kellogg said after Friday's meeting. "Hopefully, nothing tragic will happen before the county decides to do something. There's been no substantive improvement."
Mr. Mayfield said getting medications to mentally ill inmates "should be a no-brainer. That's been a problem for a long time, and it is a big liability issue."
"It makes me tear my hair out," he said after the meeting. "I am very frustrated by that. We need some action. To me, three months before we get a plan is two months too long. We have not made any progress."
E-mail joneill@dallasnews.com
04/10/05
DAY: Sunday
PAPER: THE DALLAS MORNING NEWS
SECTION: METRO
EDITION: SECOND
PAGE: 1B
HEAD: County sues UTMB over jail health care Early suit against county
indicates lapses before contract
BYLINE: JAMES M. O'NEILL
CREDIT: Staff Writer
TEXT:
Dallas County has filed suit against the University of Texas Medical Branch over the alleged medical neglect of former inmate James Mims, in a bid to deflect blame from the county as well as possible financial damages.
But a separate suit involving alleged neglect of another former inmate, which the county settled for $50,000 in February, potentially bolsters the argument of Mr. Mims' lawyers that his experience was part of a pattern of poor health care at the jail stretching back well before UTMB.
A Sheriff's Department investigation found that Mr. Mims, a mentally ill man who had been sent to the jail from a state hospital for a 2004 court hearing, did not receive his medication for two months while in jail, and that the water in his cell was turned off for two weeks, causing his health to deteriorate significantly.
In a civil rights suit filed in U.S. District Court last December, Mr. Mims' lawyers ask the court to intervene with an injunction forcing the county to improve jail health care.
In response, the county on Friday filed its suit against UTMB, which it had hired in late 2002 to run jail health care. The county argues that if any of the claims in the Mims case "are found to have merit, UTMB was negligent in allowing the conditions ... to exist."
But Mark Haney, a lawyer for Mr. Mims, said he didn't think the county could file such a suit, because the state, and by extension UTMB, has immunity from such suits.
UTMB spokeswoman Marsha Canright said the university never waived its immunity - only the Legislature can do that.
The county's lawyer, Ernest E. Figari Jr., countered that UTMB did indeed waive its immunity when it signed the county contract.
Dr. Ben Raimer, chief physician executive of correctional health care for UTMB, said: "I didn't expect we'd be drawn into this. If other people had a problem with the way we were delivering care, I would have thought they would tell us before this."
Clue: a low rate
Mr. Haney equated the unusually low-priced contract agreement between Dallas County and UTMB - it calls for the county to pay UTMB $5.69 per day per inmate for care - with "putting a Band-Aid on an open gash."
"As the county, you can't close your eyes and sign a contract with a rate this low and argue you did not exhibit deliberate indifference to the constitutional rights of inmates to receive adequate health care," Mr. Haney said. "They were and have been aware of the problems at the jail for a long time."
Alan Clemson, administrator for the Dallas County Commissioners Court, declined to comment on the contract, citing the Mims lawsuit.
In a separate case the county settled in February, the jail medical director said delays in care that endanger inmates' health were common, even before UTMB took over jail health care.
That case involved former inmate Michael Austin, who had suffered a workplace accident in 2000 that severed four fingers from his left hand. Emergency surgery at Parkland Memorial Hospital saved three fingers, and he visited Parkland for follow-up visits. The fingers healed well.
Court documents said Mr. Austin was scheduled for a checkup on Jan. 29, 2001, but was arrested the previous day. During the arrest, his fingers were reinjured. His lawyer stated in a court filing that Mr. Austin, then 34, told jail officials about his hand at book-in. A jail doctor saw him on Feb. 3 and prescribed a drug to treat infection. Another jail doctor became aware of the problem when reviewing Mr. Austin's charts on Feb. 9, documents said.

Despite his repeated requests for aid, he was not sent to Parkland until March 28 - two months after the fingers were reinjured, court documents said. There, an X-ray indicated the bone was infected. Portions of two fingers had to be amputated.
The Parkland surgeon instructed that Mr. Austin would require medication to control the pain and to "please ensure that he receives these medications while in jail," according to court documents. Mr. Austin's criminal judge also stressed that Mr. Austin needed care for the hand. But his lawyer alleged that he received no pain medication on 79 days from April 19 through August 2001, documents said. He filed at least a dozen requests for the medication.
Delay in therapy
In addition, the jail failed to send Mr. Austin for prescribed occupational therapy until Aug. 2, four months after surgery, the documents said.
"Mr. Austin had a serious medical need. This was obvious to the staff at the jail," Dr. Robert B. Greifinger, an expert witness who reviewed Mr. Austin's medical records, concluded in a report to the court. "His pain was ignored, his physician's orders were ignored. ... The jail and the staff ... were deliberately indifferent to Mr. Austin's serious medical condition.
"Because of the failure to meet the standard of care," he wrote, "Mr. Austin suffered pain and had his fingers amputated. In my opinion, this amounts to cruel and unusual punishment."
This all occurred in 2001. UTMB did not take over jail health care until late 2002.
"It shows there's a longstanding problem here, not a UTMB problem," Dr. Raimer said.
Mr. Haney agreed. "This isn't something that came up overnight," he said. "I don't think the county can point the finger at UTMB and say the jail's health care problems are all their fault. The county commissioners had known for years that care at the jail was not adequate."
The county settled the Austin case for $50,000 in February, and both sides signed an agreement not to discuss the case.
Mr. Figari, who did not represent the county in that case, said he was unfamiliar with it and couldn't comment.
Perhaps the part of the Austin case most relevant to the larger argument the Mims lawyers make about a longstanding pattern of poor medical care at the jail is the testimony of Dr. Steven Bowers.
Recently outspoken
Dr. Bowers has been medical director at the jail since 1994, both when the county oversaw jail health care directly and under UTMB. In recent weeks, he has spoken out publicly of the need for more medical staff at the jail and about the physical conditions that impede care.
During a deposition in the Austin case, David B. Joeckel Jr., Mr. Austin's lawyer, asked Dr. Bowers if the delays in treating Mr. Austin were typical of medical care at the jail. Dr. Bowers answered yes.
Mr. Joeckel: "Was the two-month delay in Mr. Austin not being seen at Parkland ... and the reason for that delay consistent with the common practices at the jail in 2001?"
Dr. Bowers: "Yes."
Mr. Joeckel: "How about the delay in Mr. Austin being sent to Parkland ... for occupational therapy ... was that consistent with the common practices in the jail in 2001?"
Dr. Bowers: "Yes."
Mr. Joeckel: "And the things we've just gone through with respect to the common practices of the jail, the way in which Mr. Austin was treated is the way many prisoners are treated ... correct?"
Dr. Bowers: "Yes."
E-mail joneill@dallasnews.com
04/08/05
DAY: Friday
PAPER: THE DALLAS MORNING NEWS
SECTION: METRO
EDITION: COLLIN COUNTY
PAGE: 11B
HEAD: Dallas asked to hire 5 for jail TB testing Medical unit's request
derided as battle over health care continues
BYLINE: JAMES M. O'NEILL
CREDIT: Staff Writer
TEXT:
Dallas County has received a request from the University of Texas Medical Branch to approve five extra positions at the jail to beef up tuberculosis screening for inmates, a month after the state cited the county jail for an ineffective TB screening program.
But given the current dispute between county commissioners and UTMB over the way the university has provided jail health care, it is not likely the medical branch's request will be acted on.
Commissioner Kenneth Mayfield, chairman of a new committee to review health care problems at the jail, scoffed at the medical branch's request, which would cost an estimated $278,000 a year. He said UTMB was supposed to provide proper TB screening all along, under the county's contract with the university that began in late 2002.
"They've already raised some serious legal issues that we plan to look at further," Mr. Mayfield said.
He said that, if anything, the county would call on its health department to provide TB screening at the jail - and then charge UTMB for those services.
The conflict is the latest in a worsening relationship between the county and UTMB over jail health care.
The county has drawn intense criticism over the condition of jail health care in recent months, especially after a civil rights suit was filed in December. The suit was filed by the family of James Mims, a former inmate who was mentally ill and who failed to receive his medication for two months while in jail. The county also turned off water in his cell, worsening his medical condition.
Then in February, the county received a scathing report on jail health conditions from a consultant that it had hired to conduct a study of the jail. The report cited sweeping problems, including a serious shortage of medical and jail staff and major physical limitations in the facility that hamper proper care. Conditions are so bad, the report concluded, they are sometimes life-threatening to inmates. Several inmates have died after allegedly improper care.
The report also concluded that "the Dallas County Jail TB screening program is basically nonexistent." That poses a general public health risk, because inmates could catch TB inside the confined jail setting and then, once released, spread it to the public.
In March the Texas Commission on Jail Standards inspected the jail and gave the county a failing grade, also noting the TB issue.
County commissioners began talking about purchasing a chest X-ray machine to ensure that all new inmates were screened for TB and that results could be acted on immediately. But they found they could not move so quickly, as county staff began to research how many machines to buy, where they should be located and who would read the X-rays. The jail also needs structural adjustments to house such machines.
Meanwhile, the UTMB contract comes up for renewal in the fall.
In that context, UTMB on March 30 sent a letter to the county requesting the five extra positions to start immediate TB testing of inmates at in-take, using a skin test that takes three days to show results.
"It would be a good step for public health in Dallas County," said Dr. Ben Raimer, chief physician executive of correctional health care for UTMB.
He said that because so many inmates spend very few days in the jail before release on bail, UTMB would provide instructions on getting medical help outside jail for those leaving before their results are known.
UTMB tests only those inmates who remain in the jail after three days.
E-mail joneill@dallasnews.com
03/23/05
DAY: Wednesday
PAPER: THE DALLAS MORNING NEWS
SECTION: METRO
EDITION: SECOND
PAGE: 1B
HEAD: County judge added to jail panel after all GOP commissioners mend
fences; Price left out, so lawsuit stands
BYLINE: JAMES M. O'NEILL
CREDIT: Staff Writer
TEXT:
Facing public outcry and a pending lawsuit, Dallas County commissioners reversed themselves Tuesday, dropping Commissioner Maurine Dickey from a new jail health committee and adding County Judge Margaret Keliher.
The makeup of the committee, designed to address widespread problems with health-care delivery at the county jail, came under sharp criticism last week. An initial proposal had Kenneth Mayfield and Mrs. Dickey as the Commissioners Court representatives, leaving off Ms. Keliher, who had secured the money to pay for a study highlighting serious jail health-care problems.
The snub to Ms. Keliher reflected a recent clash between her and the commissioners over her leadership style. And they complained that she failed to hold meetings for the last year as chair of a separate committee to oversee performance of the University of Texas Medical Branch, which provides health care at the jail.
Commissioner Mike Cantrell said after Tuesday's vote that adding Ms. Keliher to the new committee signaled a thawing in the working relationship between the three Republican commissioners and Ms. Keliher.
"Yes, there is communication taking place now with the judge, and that's a positive sign," he said.
The commissioners also added a spot for a representative of the county's juvenile department, a gesture of accommodation to Commissioner John Wiley Price, who had raised concerns about the matter. But Mr. Price was not added to the committee, which still irked him.
Mr. Price had complained last week that Mr. Cantrell, Mrs. Dickey and Mr. Mayfield had met privately to hash out the makeup of the new committee without input from Mr. Price or Ms. Keliher, and he filed a lawsuit Friday alleging that his fellow commissioners violated the state open-meetings law.

The three have strongly denied wrongdoing.
Mr. Price said he appreciated the gesture by the commissioners but had not decided to drop his suit.
"It doesn't mean they still didn't violate the open-meetings act," he said. "It remains a sad commentary that it has taken litigation to get us to this point."
Later Tuesday, after talking with his lawyer, Mr. Price said the commissioners' actions only strengthen his contention that they purposely acted behind closed doors to make sure that he would not be on the jail committee. "I'm still excluded," he said. "It has only strengthened my case."
April hearing
A hearing in the case has been set for April 15. If the courts find the commissioners in violation of the open-meetings law, all action regarding the new committee might be voided, and the commissioners would have to start anew.
At Tuesday's meeting, Mr. Mayfield called Mr. Price's allegations "baseless and without merit, and they won't cause problems with the committee. They were wholly outrageous and had no basis in fact, and everyone knows that."
Before commissioners approved the new committee, Mrs. Dickey proposed an amendment, withdrawing her name and inserting Ms. Keliher's in its place.
Mrs. Dickey said later that she withdrew her name because she had spoken with Ms. Keliher about the matter, and Ms. Keliher "is extremely interested in this issue and has a lot of good ideas about it, and she's a veteran of this court, and I'd certainly rather delegate that responsibility to her." She said she has committed to reach out to Ms. Keliher and work with her on the issue.
Mr. Cantrell's amendment also added a second position on the committee for a mental health advocate, ensuring that both Mental Health Associates of Dallas and the Dallas chapter of the National Association of Mental Illness are included on the committee.
Panel's task
The new jail health committee will review 38 recommendations made in a recent study that cited sweeping problems with the delivery of health care in the county jail. It will also look at whether to retain UTMB to provide health services. The commissioners have been sharply critical of UTMB's performance.
The commissioners' focus on jail health was spurred by a federal lawsuit filed in December against the county by the family of James Mims, a former inmate who is mentally ill and did not receive his medication for two months while in jail.
The family of another former inmate filed a separate suit last week against the county, alleging that he died in jail last summer because he was not given medication to treat his heart disease.
The commissioners Tuesday addressed other jail issues:
*They approved a $3.7 million contract to have HKS Inc. design a four-story, 2,304-bed medium-security addition to the jail. The addition will replace the Kays Jail, which must be torn down for a new bridge across the Trinity River. The addition would cost about $55 million.
*They approved allocating up to $60,000 for HKS to study ways to create a more comprehensive medical services facility within the jail to improve health care.
*They approved up to $90,000 for HKS to study how to improve the intake area at the jail, which was cited in a state inspection because it is designed to hold 63 inmates but routinely holds up to 350. The jail health study also advocated improving medical screening at intake to better diagnose inmates with tuberculosis and other medical conditions.
*They received an update on plans to improve TB screening. County administrator Allen Clemson said that before purchasing an X-ray machine for such screening, the county must decide how many to purchase, where the machines will be located, how to prepare the space, who will run the machines and read the images, and which inmates will be screened.
E-mail joneill@dallasnews.com
03/20/05
DAY: Sunday
PAPER: THE DALLAS MORNING NEWS
SECTION: METRO
EDITION: SECOND
PAGE: 1B
HEAD: Parkland weighs role in jail care President says county must commit
funds, change attitudes
BYLINE: JAMES M. O'NEILL
CREDIT: Staff Writer
ART: PHOTO(S): Dr. Ron Anderson. CHART(S): What They're Saying
TEXT:
As Dallas County commissioners grapple with severe health care problems at the county jail, it looks increasingly likely that they will turn to Parkland Memorial Hospital to play a key role, whether to run the health programs outright or provide significant oversight for whoever does.
Parkland administrators stand ready to take on whatever role the county desires - but with some significant caveats.
Dr. Ron Anderson, Parkland's president and CEO, said Parkland could develop a creative approach to jail health, turning it into an opportunity to address some larger public health concerns.
But he said that Parkland cannot absorb jail health care into its own budget, and that the hospital would not take on oversight without a real commitment from county commissioners for wholesale changes in attitude and in staff and funding levels.
"There needs to be a change in culture here, from the Commissioners Court to the jail staff," Dr. Anderson said in an interview. "We can't play around the edges. And that means actually doing the work and putting the doctors in there."
Dr. Anderson said he understands that commissioners have shown a reluctance to spend more than the minimum on health care at the jail.
"They don't want to spend more money," Dr. Anderson conceded, "but I think they understand now that they must."
Dr. Steven Bowers, the jail's medical director, said Friday that he advised Dr. Anderson that without more resources from the county, Parkland would be no more successful in providing health care at the jail than the University of Texas Medical Branch, which the county hired late in 2002.
"I told him that if he did not get increased staff and funds, he was doomed to fail and would be just another name at the top," Dr. Bowers said. "He'd just have a horrible experience."
"They're facing it one way or another," Dr. Bowers said of the commissioners' need to increase staff and spending on jail health. "Either they make the changes on their own or they can dally and end up with a federal court order."
County commissioners have been pressed to take a hard look at health care in the jail after a lawsuit was filed in U.S. District Court last December by the family of James Mims, a former inmate who is mentally ill and almost died in custody because he did not receive his medication for two months.
In February, an independent study found serious systemic staff and facilities problems with jail health care, conditions that worsened inmates' health and in some cases were life-threatening.
Debate has focused on whether to retain UTMB, whose contract is up for renewal this fall.
Dr. Anderson said that if UTMB stayed on, Parkland should be given greater authority to provide oversight and to conduct routine and spot audits of care. He said the current contract language gives the hospital no authority to intervene. In fact, he said, Parkland has been unable to obtain financial data from UTMB, which has called such data proprietary.
Commissioner Mike Cantrell agreed on the need for strong oversight. "It boils down to having a party that is responsible and accountable," he said.
"You would need Parkland to do the monitoring, not a committee of the Commissioners Court," Dr. Anderson said. "That would never work."
Finding solutions
If the commissioners turned to Parkland to run the jail's health care, Dr. Anderson said, he would need a chance to develop an appropriate plan.
"Don't just give the jail to me - give me time to put together a thoughtful business plan," Dr. Anderson said. "If we were involved, we'd want it done right. We'd have to look at the issue in a totally different light."
He said Dr. Michael Puisis, a national expert on correctional health and the author of the recent study on the jail's health problems, has already offered to bring a team of people to help set up a new care plan.
Finding quality staff is always a problem in jail health care, Dr. Anderson said. But he had several suggestions for improving staff at the jail.
First, he said the University of Texas Southwestern Medical School, which helps to staff Parkland, might want to step up and assist at the jail. He said the chair of psychiatry, Dr. Eric Nestler, has an interest in getting his residents exposed to forensic psychiatry, and they might spend time working at the jail.
Dr. Bowers said that for years he has been asking that UT Southwestern send its interns and residents to the jail as part of their regular rotation. He said it would be a productive way to increase jail health staff at minimal cost to the county.
Dr. Anderson also said the county could reach out to the National Health Service Corps - doctors who are paying off their medical school loans by working in settings such as jails. He said some of the staff at Parkland's array of community clinics might also be willing to work a shift a week for extra pay at the jail.
Community resources
And he said there were great opportunities to pull in other entities to help create a web of coverage for inmates, both while in jail and after they re-enter the general population.
He said the county's Health and Human Services Department, for instance, could take over screening of inmates for tuberculosis, a lapse under UTMB, according to the recent jail study.
Zachary Thompson, the county's health director, said that before UTMB took over, the county had increased its TB testing in the jail and that it was in good shape.
"We definitely want to help out," he said. "We can bring our TB testing program back into the jail because it's definitely a public health concern. ... We'd just have to have the staffing and budget to do it in the jail again."
Dr. Anderson said that while the commissioners right now are concerned about the jail's influence in spreading TB to the broader community, proper screening at the jail can also be a way to attack another public health issue - the spread of sexually transmitted diseases.
Dr. Anderson said other entities could also get involved.
"If we get the jail, I'd want a fundamental change in attitude and to fund mental health enough to do case management," he said. "We could team up with the Mental Health Association of Dallas and other advocacy groups so that this wasn't just seen as a Parkland problem to solve."
He said that if done correctly, by pulling in resources from the community, the county could ultimately use the jail to treat patients who otherwise might slip through the cracks in Parkland.
"There's definitely a public health opportunity here at the jail," he said.
E-mail joneill@dallasnews.com
03/19/05
DAY: Saturday
PAPER: THE DALLAS MORNING NEWS
SECTION: METRO
EDITION: SECOND
PAGE: 1B
HEAD: Suit filed over jail committee Price targets 3 fellow commissioners,
alleges open-meetings violation
BYLINE: JAMES M. O'NEILL
CREDIT: Staff Writer
ART: PHOTO(S): John Wiley Price says his colleagues tried to exclude him.

TEXT:
Dallas County Commissioner John Wiley Price filed a lawsuit Friday against three fellow commissioners, alleging they violated the state's open-meetings law by working privately to decide who should sit on a new jail health care committee.
Mr. Price asks in the suit that the court declare the commissioners' actions void and that they be prohibited from sitting on any jail health committee formed in the future.
The three commissioners cited in the suit have said they did not violate the law, nor did they meet together to discuss the committee's makeup.
The new committee, which was on the agenda for discussion at a Commissioners Court meeting on Tuesday, would analyze the recommendations made in a study on jail health problems and determine whether the county should retain the University of Texas Medical Branch as the provider for health care in the jail.
State District Judge David Evans has set an April 15 hearing date on the issue.
William Brewer, Mr. Price's attorney, said the filing would not keep the commissioners from voting to establish the new committee Tuesday.
But he said that if the judge rules for Mr. Price, all the commissioners' decisions about the committee and its makeup would be voided.
"This is an unusual case," said Mr. Brewer, whose law firm has handled other open-meetings cases. "Typically it takes more digging" to find evidence to support the claims.
"This is not what good and open government is all about," Mr. Brewer said. "These individuals have shown a hostility to their obligation."
Commissioner Mike Cantrell said Friday that he asked that the committee structure be placed on Tuesday's meeting agenda for discussion precisely "so we could have that transparent decision-making process take place."
He said he was "surprised and somewhat disappointed" by the suit.
"We need cooperation right now, not litigation. We need teamwork to address these issues. We need to be tough on the issues, not on each other. Delay is not an option. We need to move forward on these issues," Mr. Cantrell said.
Commissioner Maurine Dickey said Friday that she has worked on state and local public boards since 1995 and is "richly aware of the Open Meetings Act."
"I'm not going to do anything to hurt my credibility or do anything to violate the spirit or letter of that law," she said.
"Mr. Price has consistently orchestrated childish events aimed at me throughout my first 80 days in office, and I have chosen not to comment. I expected at some point he would manufacture an excuse to file a suit of some kind."
She dismissed the suit as "pettiness."
"I intend to do my job and forge ahead," she said.
Commissioner Kenneth Mayfield did not return calls Friday.
The jail health committee proposal called for a panel of 12, with Mr. Mayfield as chairman and Ms. Dickey as vice chairwoman.
Mr. Price alleges that Mr. Mayfield, Ms. Dickey and Mr. Cantrell met privately as a quorum to hash out how the committee would look and which commissioners would sit on it.
"In an effort to exclude the views of the Commissioners Court's lone Democrat, John Wiley Price ... defendants made important legislative decisions in secret meetings held behind closed doors," the suit alleges.
It says the commissioners' actions "were specifically designed to deny Commissioner Price, the public, and media the opportunity to observe and participate in this process."
The law notes that even if elected officials meet privately to discuss public business in groups smaller than a quorum as a way to circumvent the law, they are still in violation.
Mr. Price also suggested that their efforts to set the committee makeup ahead of public discussion and designate the commissioners who would sit on the panel were a "convenient way to keep someone's point of view out of the process."
Mr. Price said that his peers tried a similar tactic in 2002 when they left him off a committee set up to oversee the jail health performance of UTMB, which the county hired that year to provide health care in the jail. Mr. Price was the lone commissioner who voted against awarding the contract to UTMB.
But the committee included a designee from the county juvenile board, of which Mr. Price is a member. That board named Mr. Price as its designee to the UTMB oversight committee.
E-mail joneill@dallasnews.com
03/17/05
DAY: Thursday
PAPER: THE DALLAS MORNING NEWS
SECTION: METRO
EDITION: SECOND
PAGE: 3B
HEAD: Heart patient's family sues, says jail didn't give medical care
Lawsuit says man asked nurses and staff for his medication, then died
BYLINE: JAMES M. O'NEILL
CREDIT: Staff Writer
TEXT:
The family of a 51-year-old Dallas man says he died last summer in the Dallas County Jail because of a lack of proper medical care, according to a lawsuit filed in U.S. District Court on Wednesday. The suit asks that the court order Dallas County to improve medical conditions in the jail.
The suit alleges that Frank Nelson Palo Jr., who was held at the jail from July 3 to 10, was not provided the medication that had been prescribed to treat his hypertensive cardiovascular disease. As a result, the suit says, he suffered a heart attack and died while in custody.
County officials said Wednesday that they had no comment on the suit, but they said that they were moving to correct problems in jail health care.
Paul Rich, the Palo family's attorney, said Mr. Palo had told jail officials about his condition when he arrived, asked for his medication and even contacted his sister from the jail to say he wasn't receiving his medication.
He "repeatedly asked nurses and officers for his heart medicine, but was either rebuffed or ignored," the lawsuit states. "Mr. Palo called Kathy Palo numerous times, informing her that he was not getting the medicine he needed and that he was scared."
The lawsuit alleges that the county "had a duty, but failed to implement policies, practices and procedures that respected his constitutional rights to adequate medical care and treatment." That negligence, the complaint argues, caused Mr. Palo "unwarranted and excruciating mental anguish and death."
"The primary thrust of this suit is to place the burden on the proper authorities to bring the jail system into compliance," Mr. Rich said.
He said that although the issues surrounding proper treatment of jail inmates "is unpopular politically, as a society we have a responsibility. Unfortunately, Mr. Palo lost his life due to the lack of adequate care by the county and the Sheriff's Department, as exemplified by the stories that have run recently in the newspaper."
The county is already dealing with a lawsuit filed in December by the family of James Mims, a mentally ill inmate who wasn't given his medication for two months last year, according to an internal report by the Sheriff's Department. The lawsuit was joined by attorneys representing Clarence Lee Grant Jr., who died in the jail in 2003, allegedly because of mistreatment.
Last month, The Dallas Morning News obtained a copy of a county report that outlines sweeping staff and facilities problems that prevented proper delivery of health care in the jail. The report, produced by a national expert on correctional health, said the health care problems exacerbated inmates' health problems and in some cases were life-threatening.
The report still has not been made public by county officials, who cite legal concerns involving the Mims case.
In response to the study, county commissioners have moved to set up an advisory committee to review the report's recommendations and whether to retain the University of Texas Medical Branch, which the commissioners hired late in 2002 to handle jail health care. The commissioners are expected to vote Tuesday to establish the committee, which will include Sheriff Lupe Valdez and community advocates for mental and medical health. Commissioner Kenneth Mayfield is expected to be chairman of the committee.
"I can't comment on litigation and say anything that might be used by the other side," Mr. Mayfield said. But he added, "We're creating this committee, and we're going to be taking care of these problems in the jail, hopefully. And hopefully we'll get cooperation. Whatever policies are in place that are keeping people from getting their medication need to be corrected."
E-mail joneill@dallasnews.com
03/15/05
DAY: Tuesday
PAPER: THE DALLAS MORNING NEWS
SECTION: METRO
EDITION: SECOND
PAGE: 1B
HEAD: Judge may be left on outside looking in at jail health panel
Proposal would exclude Keliher from 12-member group as dispute grows
BYLINE: JAMES M. O'NEILL
CREDIT: Staff Writer
TEXT:
Dallas County commissioners are moving to set up a new committee to tackle severe health care problems at the county jail, but Republican commissioners appear ready to prevent County Judge Margaret Keliher from taking a leadership role on the issue.
Ms. Keliher helped bring the jail health problems to the spotlight with a recent study that outlined sweeping problems with inmate medical care. And she helped establish a divert court to ensure that some mentally ill inmates serve time in community programs rather than in the jail.
But today, commissioners will debate a proposal that would put Commissioners Kenneth Mayfield and Maurine Dickey on the jail health committee, not Ms. Keliher.
The move echoes a maneuver by the commissioners last week when they named Mr. Mayfield and Mrs. Dickey - and not Ms. Keliher - as liaisons to a blue-ribbon panel on Parkland Memorial Hospital's facilities needs, though Ms. Keliher, a fellow Republican, was involved in authorizing a study of Parkland and its needs.
Mrs. Dickey said Monday that the jail health problems are a serious concern and that the commissioners need to move swiftly to address them. She noted that for the last two years Ms. Keliher headed up a committee that was to provide oversight of the jail's health programs and particularly the county's contract with the University of Texas Medical Branch to run those programs. But the committee, after meeting for several months, has not met in more than a year.
"She's had two years" to address jail health issues, Mrs. Dickey said. "Maybe she might want some others to look at it now. I'm not here to assign blame. I'm just trying to solve the problems."
Ms. Keliher has said she stopped having the meetings because the group kept receiving glowing reports from UTMB about how the jail health programs were functioning. In December, UTMB produced its own study that determined a need for 53 more medical staff positions to improve health care at the jail.
Ms. Keliher said it is obvious she thinks the new committee is very important, because she "thought the jail health issue was important to take up in the first place. I think I've done a lot to address these issues and will continue to stay involved."
Shutting Ms. Keliher out of the new jail health committee is the latest in a growing feud between three Republican commissioners and Ms. Keliher over her leadership style.
The proposal the commissioners are set to discuss today would create a 12-member committee to look at how to implement 38 recommendations made in the jail health study, which was produced by Dr. Michael Puisis, a national expert on correctional health.
Valdez part of panel
The committee would include Sheriff Lupe Valdez; two other members of the Sheriff's Department with oversight of the jail and support services; Dr. James Baker, the CEO of MetroCare Services, the largest provider of indigent mental health care in Dallas; two representatives from Parkland Memorial Hospital; a representative from the county's health and human services department; and two community advocates, representing mental health and medical health.
Mr. Mayfield would act as chairman and Mrs. Dickey as vice chairwoman. The bylaws wouldn't require a quorum for a meeting to occur if Mr. Mayfield or Mrs. Dickey were there.
Mrs. Dickey said the commissioners might want to include Dr. Puisis on the committee.
She said the group might consider expanding the jail's medical facilities so that some routine medical procedures could take place in the jail, rather than incurring the expense of transporting inmates to Parkland and having to pay round-the-clock guard coverage of inmates there.
Ms. Keliher said she has suggested expanding the medical facilities at the jail for that reason.
Expanded facilities?
Mrs. Dickey also said the county might consider expanding the medical facilities so they could take federal and state prisoners from the surrounding region and provide medical care on a fee-for-service basis, bringing in revenue to the county and saving the state and federal governments the cost of flying inmates to a medical facility in Galveston, which they do now.
The commissioners also will consider plans today to build a four-story tower at the jail to replace the Kays Jail, a satellite facility that will be torn down to make way for one of the Calatrava bridges of the Trinity River project. Ms. Keliher said that addition might provide the county a chance to include a new medical facility in the jail.
In addition, the basement and first floor of the jail's existing North Tower were never finished and remain vacant, and could be a possible location for expanding medical facilities, said Dan Savage, the county's assistant administrator for operations. The space also could provide a solution to the needs of the jail's cramped intake areas, where prisoners are first booked in and screened for medical conditions, Mr. Savage said.
A recent state inspection cited serious problems with the jail's intake area. And the jail health study highlighted a lack of proper screening for tuberculosis and other medical conditions during the intake process.
E-mail joneill@dallasnews.com
03/09/05
DAY: Wednesday
PAPER: THE DALLAS MORNING NEWS
SECTION: METRO
EDITION: SECOND
PAGE: 1B
HEAD: Screening for TB at jail delayed
BYLINE: James M. O'Neill
COLUMN: UPDATE
TEXT:
Dallas County commissioners will have to wait an extra week to tackle the lack of tuberculosis screening at the county jail.
The staff did not compile material on purchasing a chest X-ray machine in time for Tuesday's meeting.
County Administrator Allen Clemson said he'd have something on the agenda next Tuesday. A recent report noted the public health threat by not adequately screening inmates for TB.
"Commissioner Ken Mayfield and I feel this TB machine needs to get on the agenda now," Commissioner Maurine Dickey said. "There's no excuse not to do it. This jail health issue is a crisis."
James M. O'Neill
03/08/05
DAY: Tuesday
PAPER: THE DALLAS MORNING NEWS
SECTION: NEWS
EDITION: SECOND
PAGE: 2A
HEAD: Bexar jail's advances could point way for Dallas County
BYLINE: JAMES M. O'NEILL
CREDIT: Staff Writer
TEXT:
Bexar County's improvement of its jail operations after the threat of federal oversight in the 1970s could provide some ideas for Dallas County officials to consider in confronting recent criticism of heath care for jail inmates.
In his 52-page report on the Dallas County Jail's health care programs, Dr. Michael Puisis, a national expert on correctional facility heath care, noted that new arrestees in Dallas are booked by jail staffers who lack health care training. As a result, medical conditions in 35 percent of inmates go undetected.
Michael Provost, medical director of Bexar County's jail, said nurses are stationed at the booking area and conduct medical screening on every new inmate.
Dr. Puisis also noted that in Dallas County, inmates who want to request medical attention must obtain a form, or "kite," from jail guards. After filling them out, the inmates return the kites to the guards, who are supposed to pass them on to medical staff.
Dr. Puisis wrote that the lack of a secure transfer of medical requests directly to the medical staff means "inmates may be requesting care via kites that health care staff do not always receive."
Bexar County's jail provides a locked box outside each cell unit for inmates to file medical requests. Medical staffers check each box and bring them to the nursing staff, which prioritizes the requests.
Bexar County's jail officials also don't face the problem of maintaining enough jail guards to assist the medical staff because the facility is designed to be more efficient. Because most inmates are in jail on minor offenses, the county set up the jail so that inmates can go down a secured hall and into an elevator that takes them to the health clinic. Guards don't escort the prisoners but observe them on TV monitors.
In addition, each inmate living area has a physical exam room within 10 feet of the cells.
"The inmates don't have far to go for medical exams," Dr. Provost said.
E-mail joneill@dallasnews.com
03/08/05
DAY: Tuesday
PAPER: THE DALLAS MORNING NEWS
SECTION: NEWS
EDITION: FIRST
PAGE: 1A
HEAD: Underfunding has left jail's health care in poor shape County blames
contractor, but years of records point to overstretched staffing
BYLINE: JAMES M. O'NEILL
CREDIT: Staff Writer
ART: CHART(S): COMPARISON OF URBAN COUNTY JAILS IN TEXAS.
TEXT:
Dallas County commissioners have made a whipping boy in the last week out of the University of Texas Medical Branch, blaming it for serious problems with health care in the county jail.
But myriad audits and budget requests over the years highlighted staffing problems long before UTMB came on the scene. And a comparison of the jail's staffing, funding and facility with those of other urban county jails in Texas shows that Dallas County's does indeed lag far behind in health care services.
UTMB's own assessment that the 146-member county jail medical team needs to grow by 53 positions - nearly 40 percent - rings true to health care advocates. They say commissioners' penny-pinching has driven the county's jail programs into the ground.
"We've always thought there needed to be substantially more money invested into the jail's health services," said David Kellogg, public policy director for the Mental Health Association of Greater Dallas. "It certainly has never been as high a priority for the commissioners as it should. They've not been willing to put up the appropriate money, and as a result there have been chronic problems."
Commission lays blame
That hasn't kept commissioners from blasting UTMB after a recent study detailed sweeping problems in the jail's health program, including problems that increase the medical risks to inmates.
The county contracted with UTMB in late 2002 to handle the jail's health services. Previously, the county itself handled jail health care.
Typical were the comments of Commissioner Kenneth Mayfield, who said last
week: "UTMB has done a terrible job. They came to us and said they could improve care and save money, and they've done exactly the opposite."
Commissioner Mike Cantrell, while acknowledging the need for more staff, scoffed at UTMB's assessment in December that it needs 53 more positions.
"When they competed for the contract, they said they were proposing what they thought was adequate staffing based on accrediting bodies' recommendations," he said. "It's disingenuous for them to come in later and start saying they need more staff. That's an excuse. That should have been brought out a long time ago."
County commissioners have known for years about problems with the staffing levels in the jail's health programs.
In 1998, for instance, a report on the jail's psychiatric services said that the number of available nurses was inadequate and that some nurses would record administering medication that was never given, "perhaps because they are assigned too many tasks."
It also suggested increasing salary levels to help recruit and retain medical staff.
A 2001 study of conditions in the county's George Allen Detention Center by the U.S. Department of Justice noted that intake health screening was conducted on only 10 percent to 20 percent of the incoming inmates, that health appraisals were not routinely performed and that "a sufficient number of qualified mental health professionals are not available to perform timely assessments." It noted that urgent suicide assessments were conducted by nurses because mental health staff was not always available.
Dallas commissioners have been proudly frugal over the years, managing to keep the tax rate virtually unchanged for nearly a decade. In fact, the tax rate is lower today than it was in 1996.
But others warn that the frugality has cost the county more in the long term. Buffeted by the recent jail health study and last week's failing grade from the Texas Commission on Jail Standards, by week's end Dallas commissioners had started to voice a willingness to spend more on the jail's health care staffing and facilities, whether or not they retain UTMB.
The Bexar County jail in San Antonio may provide a valuable lesson. In the 1970s, it faced federal oversight after a class-action suit brought by inmates over poor jail conditions, including health care. The federal court prodded the county to action.
Today, Bexar spends $8.75 per inmate on health care each day - well above the $5.69 that Dallas County spends. Bexar's 185 medical staff members treat a 4,000-inmate jail population. Dallas County has 39 fewer health care positions and nearly 3,000 more inmates.
In the Houston area, Harris County, which also faced federal oversight after a 1970s case, improved its jail health staff as well.
Over the years, Dallas commissioners have provided more health care staff but not everything that health directors said they needed. For instance, in fiscal 2000, the commissioners approved 11 new nurse positions and a new physician position. But in 2001, they added three nurses, not the five requested, and one psychiatric nurse instead of the three requested.
Dallas jail officials and medical experts say that even if commissioners increased the jail's medical staff, only half the problem would be solved. The recent report on jail health care and state jail inspectors pointed out that there are too few guards available to escort nurses and medical staff when treating inmates and to escort inmates from cells to clinics or the infirmary for treatment.
Bowles' view
Jim Bowles, the former sheriff who left office Dec. 31, made requests year after year for more jail guard positions devoted specifically to escorting medical staff. But commissioners routinely turned down those requests.
And for the last two years, the Texas jail standards commission has flagged Dallas County for failing to maintain the state-mandated ratio of one jailer for every 48 inmates. The commission has noted that the violations stem in part from jailers leaving their floor to escort inmates for medical care.
Mr. Bowles said he could not fill vacancies because the county's salary scale for jail guards remained uncompetitive with other city and county jails in the region. UTMB has also found it hard to fill vacancies on the health care side because of a less competitive salary structure.
"I wasn't trying to dress my staff in tuxedos, and I wasn't trying to serve the inmates filet mignon," Mr. Bowles said in an interview last week. "But they are human beings, and our responsibility is to care for them in a humane way."
And while county commissioners said they could provide little oversight of the jail because they were not given regular access, Mr. Bowles refuted that claim.
"I begged them to come in and look at the jail," he said. "They said they didn't have time. But that is their biggest responsibility in running the county."
He said that when he asked for more staff, former Commissioner Jim Jackson once told him: "Sheriff, I can absorb a million-dollar lawsuit now and then a lot easier than I can your budget extravagancies."
Mr. Jackson, now a state representative, said he doesn't recall saying that. He also declined to comment on the commissioners' history of handling staffing and financing at the jail.
"That's the current commissioners' problem," he said.
In fact, the county does face a lawsuit, filed in December by the family of James Mims, a mentally ill former inmate. The suit, filed in U.S. District Court, alleges long-standing abuse and neglect in the jail, and that the mistreatment also led to the death of inmate Clarence Lee Grant Jr. in 2003. In addition to seeking monetary damages, the suit asks for a court injunction to prevent further abuse.
"Because of lawsuits, the county will end up spending more money than they would have if they had put adequate resources into the health programs in the first place," said Mr. Kellogg of the Mental Health Association of Greater Dallas.
Susan Hays, Dallas County Democratic Party chairwoman, said: "The Republicans want to starve things, and that doesn't save you money. It costs you money in the long run."
E-mail joneill@dallasnews.com
03/05/05
DAY: Saturday
PAPER: THE DALLAS MORNING NEWS
SECTION: NEWS
EDITION: SECOND
PAGE: 1A
HEAD: County ready to spend for jail Commissioners plan to meet next week
to go over solutions
BYLINE: JAMES M. O'NEILL
CREDIT: Staff Writer
ART: PHOTO(S): 1. Mike Cantrell warns against a Band-Aid fix. 2. Margaret
Keliher wants to address staffing.
TEXT:
Dallas County commissioners say they now realize they must spend more money to improve health care at the county jail, no matter whom they put in charge of the program.
And they expect to discuss on Tuesday specific ideas to correct problems outlined in two recent studies of jail conditions.
County Judge Margaret Keliher said the commissioners first plan to tackle deficient tuberculosis screening for inmates, dangerously poor services and conditions for mentally ill prisoners, and an overhaul of the jail's intake section, where people are booked and screened for illnesses.
She also said the county must address clearly documented staffing shortages among health care workers at the jail.
Some of the proposals will be big-ticket items, and the commissioners have historically spent too little on jail health care, community health care advocates say.
But the commissioners gave signals late this week that they are prepared to increase spending on the issue.
"We'll change what needs to be changed," Commissioner Kenneth Mayfield said.

Commissioner Mike Cantrell said he agreed "100 percent" that changing oversight of the health programs without addressing staffing shortages and physical deficiencies would merely leave the county with the same problems.
Commissioner Maurine Dickey said the county's practice of trying to spend as little as possible clearly doesn't work. Spending more on high-quality care upfront provides longer-term benefits and fewer problems and is more cost-effective, she said.
"We're going to have to put money into it," Mrs. Dickey said. "Let's do it now and not wait until we're forced to by some outside party."
Other jails in Texas, including the Bexar County Jail in San Antonio, have come under federal court orders over the years to improve inmate health care. Dallas County was suedin December by the family of a mentally ill former inmate, James Mims, alleging long-standing abuse and neglect at the jail.
A 52-page study of health issues in the jail, produced by national correctional health expert Dr. Michael Puisis last month, noted that when people are booked into the Lew Sterrett Justice Center, staff members with no medical training do the initial medical screening.
As a result, as many as 35 percent of inmates with medical conditions are not identified, and 25 or so people a day go through booking procedures without their mental illness identified. Dr. Puisis indicated that in many other jails, health care workers participate in the booking process to accurately gauge inmates' medical needs.
This week, inspectors from the Texas Commission on Jail Standards found the intake section poorly designed to handle the flood of people being booked.
They said the facility is designed to hold 63 inmates, but as many as 350 often are housed there. The jail books about 90,000 people a year.
"We are going to do a much better job at intake," Ms. Keliher said. She said a better system of screening inmates for illness upfront would help ensure that better medical care is provided in the jail.
Ms. Keliher also said she wants to see if the county's new jail computer system can be linked to a database of mentally ill patients under care in the regional NorthStar system, which oversees mental health care providers for seven North Texas counties, including Dallas.
If jail officials could access that system, they would have a head start gaining information about newly arriving inmates with a history of mental illness.
Ms. Keliher and Mr. Cantrell mentioned the possibility of somehow including mentally ill inmates in the NorthStar system, but even regional mental health care providers in the community have seen cuts in contributions from the state and county in recent years, including MetroCare Services, the largest provider in Dallas.
The Puisis study and this week's jail standards inspection both noted a lack of screening at the jail for tuberculosis, a deficiency that has ramifications for the public. Mr. Mayfield said the county will be looking at buying a chest X-ray machine to screen inmates and provide immediate results.
The Harris County Jail in Houston has used a chest X-ray machine to screen for TB for more than a decade, said Dr. Michael Seale, the jail medical director there.
Commissioners said they also are inclined not to renew the jail health contract with the University of Texas Medical Branch at Galveston, which has handled the Dallas County Jail's medical care since late 2002.
Commissioner John Wiley Price said he thought the responsibility should be transferred to Parkland Memorial Hospital, although Dr. Ron Anderson, the hospital's president and CEO, noted that his staff has no experience with the correctional health care. Dr. Anderson said Parkland would step in to manage the programs if asked.
Mr. Cantrell said Parkland might pick up the regular health care at the jail and MetroCare might handle mental health services.
The University of Texas Southwestern Medical Center at Dallas also has expressed an interest in the situation.
Dr. Paul Mohl, UT Southwestern's vice chairman for education in psychiatry, said officials have been in talks with Parkland and MetroCare and have an "interest in helping to improve things." But, he said, "we want to see if the county commissioners will be willing to adequately fund health care at the jail."
Ms. Keliher said she is not yet ready to write off UTMB. But she said that whoever takes over health care perhaps should assess whether care for mentally ill inmates should be handled by a separate entity.
Mrs. Dickey said the commissioners should reach out to include Sheriff Lupe Valdez in discussions. The sheriff overseesthe jail, but she has made no public comment about the facility's health care problems.
E-mail joneill@dallasnews.com
03/04/05
DAY: Friday
PAPER: THE DALLAS MORNING NEWS
SECTION: NEWS
EDITION: SECOND
PAGE: 1A
HEAD: Jail fails surprise review State inspectors cite trouble with
staffing, health care, fire safety
BYLINE: JAMES M. O'NEILL
CREDIT: Staff Writer
ART: CHART(S): KEY FINDINGS
TEXT:
State inspectors gave the Dallas County Jail a failing grade Thursday after a three-day surprise visit, noting staff shortages, fire-safety issues and problems with health-care delivery.
It was the county's second failing grade from the Texas Commission on Jail Standards in two years.
The state report echoes key findings in a recent study of the jail's health programs, which found sweeping problems with the delivery of health care because of staff shortages and facility shortcomings.
County commissioners said Thursday that they were moving forward with recommendations on how to fix the health care problems. One thing they can take quick action on, Commissioner Kenneth Mayfield said, is buying a chest X-ray machine to improve screening for tuberculosis, a problem cited by state inspectors and the jail-health study.
The lack of screening poses a health risk to the public because inmates who go untested and untreated can spread TB once they are released, health advocates say.
"This is a crisis, an emergency," Commissioner Maurine Dickey said. "The TB machine is one thing we can fix now, so let's do it. I totally support that."
The county must respond to the failed jail inspection with a plan to remedy the problems. If the county doesn't show progress, the state commission could order it to make immediate changes, possibly by capping inmate population by floor, said Sgt. Don Peritz, a Sheriff's Department spokesman. That would force the county to reopen the mothballed Decker jail facility until the problems are fixed at the main jail, the Lew Sterrett Justice Center.
A majority of commissioners said they were disinclined to renew the county's jail health-care contract with the University of Texas Medical Branch, which the county hired in late 2002. The contract is up for renewal this fall.
Several UTMB officials traveled to Dallas on Thursday to meet with County Judge Margaret Keliher. They said later that she left the door open but made no commitment to renew the contract or supply the 53 extra medical staff members that UTMB says it needs to ensure proper health care in the jail.
Ms. Keliher said in an interview, "We're going to have to address the staffing issue whether we do it through UTMB or someone else."
Dr. Ben Raimer, chief physician executive of correctional health care for UTMB, said he hopes the commissioners "take into consideration all the facts and the status of the jail today compared with two years ago." UTMB has argued that it inherited many problems and made significant improvements.
He added: "If the commissioners don't want us there, we don't want to be there. We want to be there by invitation."
Mrs. Dickey, Mr. Mayfield and Commissioner John Wiley Price said Thursday that they would not favor renewing UTMB's contract. Ms. Keliher said last week that she was "dissatisfied" with UTMB's performance but said Thursday that she was not yet prepared to say UTMB has to go.
Mr. Mayfield said the county had retained Dr. Michael Puisis, a nationally respected expert on correctional health care, to advise them on how to plan for making jail health improvements.
Mr. Mayfield said Dr. Puisis is talking with some of the regional players in chronic and mental health care, including Parkland Memorial Hospital, the University of Texas Southwestern Medical Center and MetroCare.
Dr. Puisis recently penned a 52-page study of the county's jail health care, detailing a long list of problems that actually exacerbate health problems for inmates, pose health risks and generate unnecessary expenses. The report was completed Feb. 1, but the county has yet to make it public. The Dallas Morning News obtained a copy last week.
One of the concerns Dr. Puisis highlighted was a lack of inmate screening for tuberculosis. He noted that the county uses a skin test on some, but not all, inmates, and the lag time for test results means many inmates get released before knowing they have TB.
He noted that the Cook County Jail in Chicago gives all new inmates a chest X-ray to detect active TB immediately.
The new inspection by the Texas Commission on Jail Standards, concluded Thursday, noted several major problems with the jail's structure as well as inadequate guard staffing.
Sgt. Peritz said Sheriff Lupe Valdez, at a conference in Washington, had been briefed on the failed inspection and expressed concern.
The inspection report noted that the area where people are booked into jail was designed to accommodate 63 inmates but currently holds up to 350 at one time. It also notes staffing shortages throughout the facility, failing to keep the state required ratio of one guard for every 48 inmates.
The state inspectors also reported that inmates who ask for medical care are not being seen within the 72 hours required in the medical policies outlined by UTMB. On average, inmates are being treated or seen six days after requesting care.
Dr. Steven Bowers, the jail's medical director, said he was surprised the average was that low.
"At times it has been more like two weeks," he said. "Until we get more staff, it isn't going to change much."
The state inspectors also wrote that "inmates are not being tested for tuberculosis on or before the seventh day of confinement," as required by the state. Dr. Bowers said the state wants the TB screening team up to compliance by a week from today.
Other problems the state cited include an inadequate smoke-management system in the jail, a faulty intercom system that prevents two-way communication from cells to jail staff, and a lack of fire-resistant mattress covers.
The staffing shortages, as well as the smoke and intercom systems, were also cited in last year's state inspection.
County Administrator Allen Clemson said that the state had signed off on a plan to reconfigure the jail's intake section to accommodate more people but that inspectors reversed themselves during this week's visit. He also said the county would look at the staffing numbers and add more if needed.
Mr. Clemson said the county has already outfitted a demonstration cell with a new smoke detection and removal system, which the state inspectors viewed and approved, and which the county plans to install shortly. He also said the county has awarded a bid contract to fix the intercom system.
E-mail joneill@dallasnews.com
KEY FINDINGS
Jail's intake area, designed for 63 inmates, now holds up to 350 at one time. Inmates who request medical care wait on average six days to be treated or seen. Inmates are not tested for tuberculosis in a timely fashion. The smoke detection and management system fails requirements. The intercom system doesn't provide adequate two-way communication between cells and jail staff. Fire resistant mattress covers are not used.

03/01/05
DAY: Tuesday
PAPER: THE DALLAS MORNING NEWS
SECTION: NEWS
EDITION: SECOND
PAGE: 1A
HEAD: Jail harbors staph that defies drugs Exclusive: County says it lacks
resources to contain infection spread by inmates, staff to public
BYLINE: JAMES M. O'NEILL
CREDIT: Staff Writer
ART: CHART(S): WHAT IT IS.
TEXT:
Dallas County Jail health officials treated nearly 700 cases of a drug-resistant and potentially dangerous staph infection during a recent three-month period and warn that limited resources are thwarting efforts to prevent further spread of the bacterium in the community.
For more than a decade, jail health officials have been battling, with little success, thousands of cases of boils and sores on inmates caused by methicillin-resistant Staphylococcus aureus, or MRSA. From November through January, health workers at the jail treated 682 confirmed or suspected cases of MRSA.
"It remains a big problem here," Dr. Steven P. Bowers, the jail's medical director, said Monday.
In addition to inmates, the infection afflicts the jail staff and their families. Since February 2002, Dallas County's employee health clinic has treated 123 cases among Sheriff's Department staff members.
The infection can be spread through physical contact or contact with surfaces touched by infected people. Once confined to hospitals, it is cropping up in the general public nationwide as well as jails across the country.
The Dallas County Jail, because it confines people who might come into contact with those infected and because of its generally unsanitary conditions, has become a haven for the bacterium.
Texas has become a hot spot for MRSA outbreaks, a researcher with the Centers for Disease Control and Prevention said in December. Parkland Memorial Hospital has seen a steady rise in infections since 2000, handling 364 cases that year, compared with 1,233 in 2004.
For the most part, MRSA manifests itself as a skin boil. In some cases it can attack internal organs, and without proper draining and treatment, it can be deadly.
"It's alarming to see the numbers growing," said Rita Espinoza, a state health department epidemiologist. She said many people blame overuse and misuse of antibiotics for the increase, fueling the bacterium's swift transformation to resist front-line antibiotics.
"The concern is that as it resists more and more antibiotics, we'll eventually have no treatment at all," Dr. Bowers said.
Stemming growth
Jails across the country have been grappling with MRSA for several years. Los Angeles, with the largest county jail in the nation, first identified the problem in 2002. It saw MRSA cases increase from 921 that year to 2,480 in 2004.
When the number of cases doubled at Florida's Palm Beach County Jail in 2004, county health officials there threatened to take the jail and its private medical provider to court if the outbreak wasn't controlled.
Los Angeles officials instituted more stringent measures to counter the outbreak, requiring inmates who enter the jail with a boil or sore to be isolated and tested. Those who test positive for MRSA are further isolated and treated with aggressive antibiotics.
Dallas County Jail officials have adopted measures to stem the wave of infections. But without more stringent measures, such as those used in Los Angeles, the number of cases is not likely to decline, Dr. Bowers said. He said that because the problem is spreading through the general community, many of the 250 or so booked into the jail each day have the infection when they arrive.
Normally, the jail staff washes down cell walls, floors and other surfaces twice a week. But eight months ago, in a bid to quell the staph infections, jail officials added a third washing each week, with bleach and water, said Sheriff's Department Chief Deputy Edgar L. McMillan Jr. He said employees have also been issued latex gloves, and workers and inmates have been given antibacterial soap.
Health officials also created a video for inmates outlining how to reduce their risk of getting the bacterium.
Dr. Bowers said the measures help a bit but are not likely to make a big dent in cases.
"The only way to significantly diminish the cases is to follow the example of Los Angeles County," he said.
But the Dallas jail's staffing shortages and space limitations, which make it difficult to isolate and screen suspected MRSA carriers, make the Los Angeles strategy virtually impossible to carry out, he said.
Another complication is the Dallas jail's lack of cleanliness.
"That's a very big issue," Dr. Bowers said. "And the Sheriff's Department personnel are doing everything they can with the resources they currently have. But attention has not been paid to the needs of this institution."
Monitoring outbreaks
There is no requirement to report MRSA cases, so the state has no statistics on outbreaks. But many health officials are concerned about the surprisingly swift spread of the bacterium through the general population, and the Texas Department of State Health Services convened a conference on the issue last fall.
When Dr. Bowers first started working at the jail in 1990, he noticed cases in which inmates complained of spider bites. Inmates caught spiders and gave them to the staff, and some assumed that the culprits were brown recluse or black widow spiders. Suspicious, Dr. Bowers asked for help. An entomologist from the Texas A&M University extension service conducted a detailed study of the facility in 2001. He found no evidence of brown recluse spiders, black widows or any other vector that would have caused the wounds.
After starting to culture the wounds, Dr. Bowers' staff detected a pattern of MRSA. "It became obvious that spider bites were not the culprit," Dr. Bowers said. With help from Parkland Hospital's infectious disease control unit, the county wrote recommendations for combating the infections in December 2001.
In 1995, Dr. Bowers' 13-month-old son developed an abscess in the lung, which in retrospect the physician concluded was a case of MRSA.
"I probably took it home with me from the jail, even that far back in time," he said.
E-mail joneill@dallasnews.com
03/01/05
DAY: Tuesday
PAPER: THE DALLAS MORNING NEWS
SECTION: NEWS
EDITION: SECOND
PAGE: 11A
HEAD: State inspectors pay surprise visit to facility Weeklong exam of
jail planned after it failed checkup last year
BYLINE: JAMES M. O'NEILL
CREDIT: Staff Writer
TEXT:
Dallas County Jail officials received a surprise visit Monday from state inspectors, who plan to spend about a week reviewing the jail's operations and whether it meets state guidelines.
The visit from the Texas State Commission on Jail Standards is the first since the county jail failed an inspection in April 2004 and comes after an independent study found worsening and widespread health problems in the jail.
The jail's failed inspection was the first time in 21 years the county facility had not passed state scrutiny.
County officials had been expecting the state inspectors this time, but not for several weeks.
Last time, the state faulted some jail safety equipment, including an intercom system and smoke filtration technology in the west tower. County Administrator Allen Clemson said the county has awarded a bid contract to fix the filtration situation and has outfitted a pod of cells with the new smoke detection and evacuation system, which the state can inspect. He said that when tested, the system worked well.
He said the county also has blueprints in hand to show the state how it will fix the intercom system.
Staffing problems were also a concern in last year's inspection. The jail did not always abide by the state requirement of having one guard on duty for every 48 inmates.
Staffing shortages were also a focus of the recent health study, produced by an outside consultant at County Judge Margaret Keliher's request.
The report found that health care was not adequate and sometimes increased inmates' illnesses because of a shortage of medical staff to handle patients and a lack of jail guards to escort inmates for health exams and treatment.
E-mail joneill@dallasnews.com
02/28/05
DAY: Monday
PAPER: THE DALLAS MORNING NEWS
SECTION: NEWS
EDITION: SECOND
PAGE: 1A
HEAD: Jail woes pinned on county Commissioners defend health oversight,
say staffing complaint new
BYLINE: JAMES M. O'NEILL
CREDIT: Staff Writer
TEXT:
The widespread and worsening health problems in the Dallas County jail, outlined in a new report, stem from years of inaction by county commissioners who neglected to increase spending and staffing to ensure basic care, health advocates and medical officials say.
They also say commissioners didn't provide adequate oversight of health conditions in the jail after awarding a contract to the University of Texas Medical Branch in late 2002 to handle the jail's health programs.
"It's all about money and tax rates. That thinking still dominates the Commissioners Court," said Mike Katz, past president of the National Alliance of Mental Illness' Dallas chapter. "We've always felt the jail's health care programs were understaffed."
The new report on jail health outlines sweeping problems in both the physical jail space and staffing levels, as well as systemic issues that often exacerbate inmates' illnesses and even pose life-threatening risks. The report was funded by the Meadows Foundation and produced by Health Management Associates. The county received the report Feb. 1, but officials have not made it public. The Dallas Morning News obtained a copy last week.
County Judge Margaret Keliher, who requested the independent report, said she was "dissatisfied with UTMB's performance."
But she defended the commissioners' oversight, saying UTMB did not report staffing problems until its own study was released in December. Others say the problems existed well before UTMB took over.
Many of the problems stem from severe understaffing of both health care employees and the jail guards who escort inmates for medical services. Because of the huge demand for medical care and the lack of staff, patients seeking medical care sometimes aren't seen by nurses for six weeks, the study said. Currently, UTMB has 146 budgeted medical staff positions for the jail, but there are nine vacancies. Temporary nurses fill at least five of those positions.
"The problems UTMB inherited have been here for many years. It's been very frustrating," said Dr. Steven P. Bowers, the jail's medical director, who has worked at the jail since 1993. "The number of medical staff has been grossly deficient. The psych staff was in total disarray. They inherited a terrible record system and old medical equipment. The Sheriff's Department has been understaffed for years as well, and that impacts us on the health side greatly."
UTMB study
Dr. Bowers added that, despite his repeated requests over the years for the county to conduct a thorough analysis of the jail's medical staffing needs, UTMB was the first to actually do it.
The university concluded in its December report that the county needed to spend another $2.7 million a year to hire 53 additional health staff, a 40 percent increase over current staffing levels. By contrast, two years earlier UTMB had said it could provide the same level of care as the county had without increasing staff, and it even promised about $600,000 a year in reduced costs.
Ms. Keliher said the UTMB study was the first time she had heard any complaints about staffing needs. Commissioner John Wiley Price said commissioners had been responsive to county requests for improved staffing prior to UTMB's involvement and that the jail had passed certification inspections by the state every year until last year.
And Commissioner Mike Cantrell said that the very fact the commissioners hired UTMB to manage the jail showed their responsiveness to try to improve the situation.
"It's very easy to point fingers at the Commissioners Court, but we rely on other people to run the jail," Mr. Cantrell said. "It's not a place we can walk into on a moment's notice. That's been a frustration on my part - we're the outsider looking in. The sheriff runs the jail, and the former sheriff knew what was going on there."
Former Sheriff Jim Bowles lost in a primary last year and left office Dec. 31.
Mr. Cantrell said that, as a result of the new study, "you'll see this court make substantial changes in the jail."
Health care experts suggest that UTMB either underbid the contract or failed to judge accurately the costs of health care at a jail, since its primary experience had been providing care in state prisons, which have a more stable population.
The UTMB study noted that the jail had seen "significant increases in the numbers of chronically ill inmates who need numerous medications," and that "pharmacy expenses are increasing dramatically."
UTMB also said it was "compelled to increase the salary levels of health care workers twice in the past two years in order to attract staff," and that a shift differential was instituted for nursing personnel to encourage staff to work evening, night and weekend shifts.
The university estimated that it had lost $500,000 a year on the contract since it began. In 2004, the county paid UTMB $13.5 million to handle a jail population of about 6,600. Its contract is up for renewal this fall.
Dr. Owen Murray, medical director of correctional health care services for UTMB, said the university does not want to abandon its program in the Dallas jail. "We've certainly learned lessons there," he said. "UTMB sees itself as dedicated to doing correctional health care."
Default provider
Nationally, ill-equipped jails have become the default health-care providers for growing numbers of mentally ill Americans. The trend started decades ago, with the transfer of many mentally ill patients from psychiatric institutions, which had their own problems, to programs in the community. But federal and state budget cuts have hurt many of the community programs, and mentally ill people began showing up on the streets, committing minor violations that landed them repeatedly in jail.
Health advocates say that people often ignore problems in the jail and resist paying higher taxes to fix what they believe has no impact on their lives.
"But these people are your concern," said Vivian Lawrence, criminal justice specialist with the Mental Health Association of Greater Dallas. "Up to 20 percent of people in the U.S. have some form of mental illness, and they are related to someone out in the community. It's not a matter of, 'This issue isn't about us.' It is about us."
She said the money comes out of taxpayers' pockets either way. If the government tries to get by on the cheap, health service ends up deteriorating in the jail, and mentally ill inmates make more trips back to jail and to emergency rooms - added costs that taxpayers must bear.
Problems in the past
In Dallas, the pattern of neglect has stretched back years.
Betty Culbreath, former director of the county's Department of Health and Human Services, said that when her department ran the jail's health program in the 1990s, she repeatedly clashed with county commissioners, asking for more staff and getting rebuffed.
In a 2001 report, the Texas Commission on Jail Standards said that statewide "there is little public support for increased jail spending. While the county sheriff is responsible for operating the jail, the county commissioners court is responsible for providing the financial resources necessary to maintain that operation. As a result, the sheriff is often unable to effect those decisions necessary for the proper operation of the institution."
In a 2002 investigation, the Morning News revealed how mentally ill inmates at the county jail were routinely getting only cursory psychiatric exams and often went without anti-psychotic drugs needed to control behavior.
But when commissioners moved to address the problem, much of their public debate focused on how to maintain care at existing levels, not improve it, and how the new contract with UTMB would save taxpayers money. After the contract was awarded, an oversight committee of three commissioners, medical representatives and health care advocates initially met monthly, then quarterly, but it has not met in about a year.
"The county commissioners decided this issue was not worth their trouble. They abrogated their responsibility for oversight," said David Kellogg, public policy director of the Dallas mental health association. "They had this committee and just pulled the plug on it."
Mr. Kellogg's complaint about the commissioners' lack of oversight echoes concerns voiced in 2002 by Mr. Price, the only one who voted against granting the jail health contract to UTMB.
Mr. Price argued at the time that the three-year contract did not include performance measures to judge the quality of health care and asked, "How many contracts do we let without having expectations?"
E-mail joneill@dallasnews.com
02/27/05
DAY: Sunday
PAPER: THE DALLAS MORNING NEWS
SECTION: METRO
EDITION: SECOND
PAGE: 1B
HEAD: Study: Conditions worsen jail illnesses Inadequate infirmary,
'crude' dental unit among listed problems
BYLINE: JAMES M. O'NEILL
CREDIT: Staff Writer
TEXT:
The physical conditions in the Dallas County Jail exacerbate illnesses among inmates and "are so unsafe for some persons that they are life-threatening," a new study of the jail's health programs says.
The study, requested by county officials, argues that although serious shortages in medical and guard staff add to the difficulties, many of the dangerous problems stem from the dire physical conditions in which inmates are housed and treated.
These include cellblocks that allow only verbal communication and not physical examinations of patients by medical staff, an infirmary whose cells are "physically separated from the nursing station by a winding maze of corridors," and a "crude" dental unit for tooth extractions outfitted with no sink and only hand tools.
The study also suggests that the majority of inmates held in suicide prevention cells are not likely to be suicidal but merely are there for punishment or because they're intoxicated.
The physical conditions and staffing situation are so severe that most staff members have "a survival mentality" and "see their main purpose as trying to address the emergency of the day rather than being engaged in a health care program," the study said.
The conditions and poor health care cause some inmates to return to the community and potentially infect others with tuberculosis, sexually transmitted diseases and other illnesses. Or, in the case of inmates with mental illness, the lack of consistent medical care and medication, combined with the dangerous housing conditions, causes them to be released with their conditions untreated, which leads them often to repeat the behavior that sent them to jail in the first place, setting up a revolving door at the jail.
About 90,000 people were incarcerated in the county's Lew Sterrett Justice Center in 2004. Since winning a contract in 2002, the University of Texas Medical Branch has handled the jail's medical care.
Needs highlighted
The report was funded by the Meadows Foundation and requested by County Judge Margaret Keliher, who said the results have "highlighted that we have to address health care in the jail."
She said that in the case of mentally ill inmates, efforts must be made to find alternatives to jail, such as the DIVERT court program, which directs arrestees into special care programs in the community instead of the jail.
Though the county received the report Feb. 1, officials have yet to make it public. The Dallas Morning News obtained a copy Tuesday.
The study was produced by Health Management Associates and written by Dr. Michael Puisis, a specialist in correctional health who has held top medical positions with Cook County Hospital in Chicago and New Mexico's corrections system. Dr. Puisis, who spent eight days at the jail documenting the problems, said he could not comment without permission from the county.
Physical barriers
UTMB officials agreed with the major finding of the report, arguing that the physical barriers of the jail facility make it harder for health staff to provide adequate care.
"The Dallas County Jail is an older structure with significant plant limitations. We'd be supportive of any changes that would allow us greater access to and visibility of patients," said Dr. Owen Murray, medical director of correctional health care services for UTMB.
In his report, Dr. Puisis noted that despite being so understaffed, the jail employees "work extremely hard in a very challenging environment with a dedication I found admirable. I hope they are able ... to separate the criticisms of the program from their clinical dedication to their work."
Dr. Murray agreed that the physical conditions in the jail, along with a dearth of jail guards to escort medical staff, have deeply affected morale among the health-care staff. He said there is "a great deal of frustration and anxiety" among workers, and noted that a recent UTMB audit of staffing needs recommends that the county add about 50 positions to the jail health staff.
Conditions deteriorate
There are "significant physical barriers to inmates' access to mental health and medical care in the Dallas County Jail," the report said. "Housing arrangements ... actually promote deterioration" of medical conditions.
For inmates housed in closed behavior-observation cells, "treatment is further worsened because clinical staff are not permitted any contact except verbal contact with the inmate through the food port," a small opening in the cell door to pass food into the cell. If a clinician wants to evaluate the patient outside the cell, a second jail guard must be present, and since they are so hard to come by, "inmates are rarely, if ever, examined out of the cell."
The "extreme forced physical isolation" of mentally ill inmates placed in closed observation cells "harms them. ... It appears that the primary clinical consideration is prevention of suicide. Therapy is not a priority."

Infirmary lacking
The report sharply criticizes the jail's infirmary. It describes the industry standard for jail infirmaries as a designated area where inmates are within sight and sound of a health professional and managed by a registered nurse 24 hours a day.
But the Dallas jail infirmary is a "complex maze of 19 separate housing units, almost all of which are out of sight or sound of nurses. ... Nurses cannot look into any single cell unit from their station. Most of the cells are physically separated from the nursing station by a winding maze of corridors."
In addition, patient-inmates place "kites," or requests for care, rather than nurses checking on them daily, as is the practice in a typical infirmary. "The level of services is minimal," the report said.
The dental unit, meanwhile, "consists of a single chair and light, both ... in poor repair," the report said. "The room is not clean. The only procedure performed is extractions. There is no sink, no equipment except hand tools, and no receptacle for the patient to expectorate. ... The dentist works with rudimentary tools and equipment. This situation is very crude."
E-mail joneill@dallasnews.com
02/24/05
DAY: Thursday
PAPER: THE DALLAS MORNING NEWS
SECTION: NEWS
EDITION: SECOND
PAGE: 1A
HEAD: Report: Jail puts county at risk for TB Study cites lack of inmate
screening, reporting of cases
BYLINE: JAMES M. O'NEILL
CREDIT: Staff Writer
ART: CHART(S): (Knight Ridder Newspapers) HOW TUBERCULOSIS SPREADS
TEXT:
The lack of screening for tuberculosis at the Dallas County Jail poses a health risk to the community and leaves the county far behind many other major jails across the country in TB prevention, a new study says.
The report on jail health conditions also notes that the county failed to report tuberculosis cases to the state for much of 2004, violating state law. And when reports were finally made, the number of positive test results
- 1 percent - was so low as to be "simply not credible."
"The Dallas County Jail TB screening program is basically nonexistent," said the report, produced by Health Management Associates at the county's request. As a result, it said, the jail acts as a key agent for spreading TB, not only among inmates and jail staff, but also among the population at large as inmates get released.
That testing is virtually nonexistent "is a great concern to us from a public health standpoint," said Zachary Thompson, the county's health department director. "It's a very controllable disease if cases are identified and people are given their medication. But if they're not even being tested, that does impact the overall Dallas community."
Dr. Ron Anderson, president and CEO at Parkland Memorial Hospital, agreed. "If the jail were screening for tuberculosis, there's no question it can help the larger community. If someone gets out of the jail with an untreated case of TB, he could spread it to others."
In 2004, about 90,000 people spent time in the Dallas County Jail, often for brief stints. If inmates contract TB in the jail, without proper treatment they can easily spread it to jail employees, other inmates, and the general public once released.
"We are going to revamp the way we do TB testing at the jail," said County Judge Margaret Keliher, who secured a grant from the Meadows Foundation to pay for the jail health study. "This is a huge issue for us. That's why we asked HMA to look at the infectious disease program at the jail in the first place."
Last year, 249 confirmed cases of TB were reported to the Dallas County Department of Health and Human Services. Fourteen cases were reported in January of this year, compared with seven in January 2003.
Other problems
In addition to the TB issue, the 52-page report lays out sweeping problems with the jail's health-care program, which worsen inmates' health, pose risks to jail staff and the public, and result in easily avoided emergency room visits that cost county taxpayers.
Though the county received the report on Feb. 1, officials have yet to make it public. The Dallas Morning News obtained a copy Tuesday.
The study was written by Dr. Michael Puisis, a specialist in correctional health who has been a medical director for the Cook County jail in Chicago and for the New Mexico corrections system.
The report notes that when Dallas County's own health department was responsible for jail health care, 13 staff members were assigned to the TB program to screen for active TB disease. But under the University of Texas Medical Branch, which the county hired to run jail health care in 2002, staffing was recently reduced to four, the report states.
Mr. Thompson said that when health department officials handled health care at the jail, they had a team of TB screeners in place at the intake area 24 hours a day, seven days a week, who conducted 2,000 to 3,000 skin tests a month. He said those who bailed out quickly were given a phone number to contact the county health department to get their test read, in order to ensure continued care once released.
To screen for active disease, UTMB performs some skin testing, "but does not do this for all inmates and delays the process so that ... many persons are discharged before the test can be applied, read, or followed up on," the report said. "Also, there appear to be errors either in recorded skin test results or in performance of this test."
State law requires that new inmates get screened for TB within seven days of incarceration.
There are two basic ways to test for TB - a skin test and a chest X-ray. The skin test is cheaper but takes 72 hours to read the result. The report says that using the skin-test method has been known to delay detection by up to two weeks. But many inmates spend less than two weeks in the jail.
X-rays for all
As a result, some large jail systems have chosen to screen all new inmates with a chest radiograph. The Cook County jail in Chicago, the Los Angeles County jail and Houston's Harris County jail all use chest X-rays, according to the report. It noted that the Cook County jail cut the time for TB diagnosis from 17 days to two days using the chest X-ray method and the number of people identified with contagious TB tripled.
A chest film can help immediately identify an inmate with TB, and jail officials could then promptly put them in isolation.
"It's more expensive, absolutely, but is it a better approach? Absolutely," Dr. Anderson said.
Mr. Thompson said skin-test supplies can be obtained for free from the state, while the chest X-ray machines can cost $10,000 to $50,000.
Some jails also have links to databases compiled by local health departments listing people with known active TB cases, so that they can be identified when they are booked into the jail. The report notes that New York jail facilities have such a link with the city's health department TB database.
Letter from state
In October 2004, the Texas Department of State Health Services sent a letter to jail officials complaining that the jail had not been reporting cases of tuberculosis, as required under state safety codes.
The jail then started reporting TB statistics.
"Despite not knowing the number of active tuberculosis that occurred before October of 2004, the jail did report TB skin test data for the past year," the report said. The positive test results were only 1 percent of the total, a result that, the report says, "is simply not credible." It says a rate of at least 15 percent would be expected.
The study said that despite the low numbers UTMB reported to the state, TB "remains a major problem at the jail." From January to October 2004, Parkland Hospital reported 83 cases of TB, with 19 having been inmates at the jail at some point and seven others being admitted directly from the jail when diagnosed.
E-mail joneill@dallasnews.com
02/23/05
DAY: Wednesday
PAPER: THE DALLAS MORNING NEWS
SECTION: NEWS
EDITION: SECOND
PAGE: 1A
HEAD: Jail's health system faulted Undetected illnesses, excess costs,
risks to public cited in study
BYLINE: JAMES M. O'NEILL
CREDIT: Staff Writer
ART: CHART(S): 1. KEY RECOMMENDATIONS. 2. CASE STUDIES.
TEXT:
A new study of health conditions at the Dallas County Jail says lapses in medical care worsen inmates' health, pose risks to jailers and the public, and cost county taxpayers unnecessary emergency medical expenses.
The report indicates severe systemic problems, including the way inmates with illnesses are screened; the potentially dangerous way they are housed; a serious shortage of medical and jail staff; and a virtually non-existent process to identify inmates with tuberculosis, a problem that poses risks to the public.
About 90,000 people were incarcerated in the jail during 2004.
The 52-page report includes 38 specific recommendations and suggests that the county review its contract with the University of Texas Medical Branch, which has handled health care at the jail since October 2003.
UTMB, which also handles health services for many state prisons, comes under particular scrutiny in the report for its staffing decisions. The report notes that as a general practice, UTMB has reduced the number of higher-level trained staff members in favor of less-trained staffers - and has proposed reducing their number further.
UTMB officials said that although they had not seen the report, they welcomed the study. They produced their own report to the county late last year, contending that staffing and funding issues were a major concern.
Dr. Steven Bowers, UTMB's medical director at the jail, manages 17,000 inmates in nine facilities in Dallas and elsewhere for UTMB.
"How much of his time can realistically be devoted to the Dallas County Jail?" the report asks. "He is managing facilities other than the Dallas County facilities even though his full-time position is funded through the county contract."
Other UTMB jail staffers also are used to staff noncounty jails.
"Given the lack of staffing at the jail, this practice should be prohibited by contract language," the report states, "but it is not."
Though the county received the report on Feb. 1, officials have yet to make it public. The Dallas Morning News obtained a copy Tuesday.
The report, funded by the Meadows Foundation, was requested by County Judge Margaret Keliher, partly as a response to the near-death of James Mims, a mentally ill inmate whose psychiatric medications had been withheld for two months.
It was produced by Health Management Associates and written by Dr. Michael Puisis, a specialist in correctional health who is former medical director of the Cook County Jail in Chicago. He was also regional medical director for New Mexico's corrections system and has been a national consultant.
Dr. Puisis spent eight days at the jail, reviewed documents and medical records, interviewed UTMB and jail staffers, and interviewed officials from other agencies that are involved in jail health.
Pat Terrell, who oversaw the report for Health Management Associates, said she had been told by the county not to comment publicly about the report.
Under review
County Administrator Allen Clemson said the report is being reviewed by the district attorney's office, as well as the private law firm of Figari and Davenport, which the county commissioners hired Tuesday to ensure that the report doesn't pose legal risks to the county in a lawsuit filed in December by Mr. Mims' family.
As a result, officials of UTMB and Parkland Memorial Hospital, as well as Sheriff Lupe Valdez, have not seen the report.
Attorney David Finn, who is suing the county on behalf of Mr. Mims' mother, said he has not seen the report. But he said he hopes it breaks a pattern of investigations followed by ineffective reforms.
"It reminds me of Groundhog Day," Mr. Finn said, referring to a 1993 film in which a character experiences the worst day of his life over and over. "When is somebody going to step in and do something?"
"It's terrible. It's shocking," Commissioner Maurine Dickey said of the report. "If we don't use this as a call to action, we are very remiss."
Ms. Keliher said the report "has highlighted that we have to address health care in the jail. Whether we stay with UTMB or do something different, the court will address the issue." She said the county will ask the consultants who produced the report for help in making changes.
Dr. Ben Raimer, chief physician executive of correctional health care services for UTMB, said the university has lost $500,000 a year through the contract with current staff levels.
Jack Smith, UTMB's director of operations, said UTMB has suggested a 40 percent staff increase - about 53 full-time positions - to improve the jail health-care situation. Owen Murray, UTMB's medical director, said that would obviously require a significant increase in funding by the county.
Problems occur from the time inmates are booked, the report indicates. Normally, new arrivals at a jail should be screened and receive a physical exam to weed out emergency or chronic conditions. Such screening is typically performed by nurses or other health-care workers. But in the Dallas County Jail, regular jail staff members conduct the screening.
"There are no medical policies governing how officers screen, and officers receive no training to screen," the report states.
Problems undetected
As a result, the report estimates, screening officials miss at least 35 percent of detainees with health problems, and as many as 25 people a day go through intake without having their mental illness identified.
Once housed, some mental health patients are sent by chance to closed observation cells that are completely out of sight of the corridors, a "dangerous practice," according to the report.
Some are kept in 23-hour-per-day lockup, without stimulation, similar to the isolation in a super-max prison, which has been known to lead to psychotic behavior. "To use these types of arrangements for known psychotic inmates can only make treatment more difficult and may prolong their disease or increase the severity of symptoms," the report said.
The report notes that the jail's tuberculosis screening program "is basically non-existent." This "results in the jail being a focus of amplification of tuberculosis spread both within the jail as well as into the community at large."
The doctor in charge of TB in the jail "has no experience in managing patients with tuberculosis, and he has so much else to do that he actually spends very little time managing people with tuberculosis."
The report also points out that frequent delays in medication for inmates with chronic illness result in many unnecessary hospital visits - trips that ultimately cost county taxpayers.
E-mail joneill@dallasnews.com
12/31/04
DAY: Friday
PAPER: THE DALLAS MORNING NEWS
SECTION: METRO
EDITION: SECOND
PAGE: 1B
HEAD: Lawsuit: Mentally ill abused at jail Action alleges mistreatment of
Mims, 2 other former inmates
BYLINE: JAMES M. O'NEILL
CREDIT: Staff Writer
TEXT:
Lawyers for James Monroe Mims and two other mentally ill former inmates - one of whom died in jail - filed suit in U.S. District Court on Thursday, alleging long-standing abuse and neglect at the Dallas County jail.
In Mr. Mims' case, an investigation by the Sheriff's Department found that he wasn't given his medicine for two months and that water in his cell was turned off for two weeks.
The suit includes allegations of mistreatment toward two other mentally ill inmates and alleges that the mistreatment led to the death of inmate Clarence Lee Grant Jr. in 2003.
"The systematic abuse of mentally ill prisoners has been going on for years," said David Finn, the lawyer for Mr. Mims' family. "It's outrageous, and it needs to end."
Sheriff's Department spokesman Sgt. Don Peritz said the department does not comment on pending litigation.
The suit is unrelated to any criminal charges that could be brought after an FBI investigation of the Mims case.
After an investigation by The Dallas Morning News in 2002 outlined a series of cases in which mentally ill inmates were denied medication and otherwise mistreated, Dallas County commissioners moved to fix the problem by contracting with the University of Texas Medical Branch at Galveston to handle all medical services at the jail.
But Mr. Finn said Thursday that the changes did not fix the problems.
"If anything," he said, "they've gotten worse."
All three cases cited in the suit filed Thursday occurred after UTMB took over medical services at the jail.
The suit alleges that Mr. Grant, 51, suffered from paranoid schizophrenia.
He had been arrested and charged with setting fire to his family's home. He was found incompetent to stand trial and transferred to Vernon State Hospital, where he received treatment for the schizophrenia, hypertension and seizure disorders.
On Feb. 4, 2003, Mr. Grant was transferred to Dallas County jail for a hearing. The hospital provided medical care instructions and a 14-day supply of medications he had been receiving.
Medications confiscated
The suit alleges that during his booking, Dallas County jail officials confiscated his medications and did not provide replacements within the first 24 hours of his arrival.
The suit alleges that he did not receive any medicine for five days. It states that when his sister, Lucille Ralston, visited him in jail Feb. 19, she "was horrified by his condition - he was weak, disheveled, and could barely talk. Ms. Ralston immediately informed the guard of Grant's condition."
On Feb. 21, the suit said, a jail officer saw Mr. Grant sitting in his cell, weaving from side to side. The officer knocked three times on the glass of the jail cell and asked Mr. Grant whether he wanted to see a nurse.
"Although Mr. Grant moved each time he heard the knock, he failed to provide a verbal response to the officer's question," the suit reads. When the officer consulted with a nurse, "he was informed to note it as a refusal to see the nurse."
Mr. Grant died in his cell that day, the suit alleges, "from lack of proper medical attention."
Kennedy Nickerson is a 38-year-old who also suffers from paranoid schizophrenia. Mr. Nickerson was found incompetent to stand trial in June 2003 and sent to Kerrville State Hospital for treatment. He was sent to the jail June 15, 2003, for court proceedings.
In medical documentation that accompanied him, the hospital staff indicated that Mr. Nickerson was unable to care for himself and needed sufficient and appropriate discharge plans.
On June 19, the suit alleges, Mr. Nickerson was released from the jail "to the street with no medication, no follow-up arrangements, and no notice to his family."
On June 24, Mr. Nickerson was found lying on the street, still without medication. He was transported to Baylor University Medical Center and was "dehydrated, suffering from a fever of 108 degrees, and having seizures."
Mr. Mims arrived at Parkland Memorial Hospital in April from the jail suffering from dehydration, seizures and pressure sores.
'Deliberate, callous'
The suit argues that the county, the Sheriff's Department and the county hospital district, which hired UTMB, exhibited "deliberate, callous and conscious indifference" to the three inmates' civil rights by denying proper medical treatment.
Besides seeking monetary damages, the suit asks for a court injunction to prevent further abuse. That could result in a judge laying out steps the Sheriff's Department must follow or appointing an ombudsman to oversee health issues at the jail.
Joining the suit is Advocacy Inc., a federally financed, state-appointed nonprofit designed to protect the legal rights of people with disabilities.
Laurence Priddy, the agency's lawyer, said it appears that hiring UTMB did not improve jail treatment of mentally ill inmates.
"We think the problem is still endemic to the jail," he said. "In fact, there really seems to be a level of indifference there."
E-mail joneill@dallasnews.com
12/07/04
DAY: Tuesday
PAPER: THE DALLAS MORNING NEWS
SECTION: METRO
EDITION: COLLIN COUNTY
PAGE: 5B
HEAD: Near death of inmate spurs study of Dallas County jail Nonprofit
grant to pay for report on how the mentally ill are treated
BYLINE: JAMES M. O'NEILL
CREDIT: Staff Writer
CORRECT: CORRECTIONS, CLARIFICATIONS: An article in Tuesday's Metro
section and articles on Sept. 10, 14, 15 and 23 incorrectly summarized one part of the case of James Mims, a mentally ill inmate in the Dallas County jail. An internal investigation found that the jail's medical staff, overseen by the University of Texas Medical Branch, neglected to provide psychiatric medicines to Mr. Mims for two months, not the jailers. The investigation also found that jailers had cut off his water for 13 days. A two-part series about Mr. Mims last month summarized the case properly.
(Ran: Thursday, December 09, 2004)
TEXT:
Dallas County commissioners are set to launch today a study of how well mentally ill inmates are treated in the county jail, three months after it was revealed that a mentally ill inmate nearly died while in jail.
The Meadows Foundation has agreed to provide a $53,000 grant to pay for the study by Health Management Associates, a consulting group based in Lansing, Mich., that recently finished a sweeping report on problems at Parkland Memorial Hospital.
The HMA study will take about six weeks and is expected to look at the jail intake process and how quickly and accurately mental illness and suicide risks are detected among those being booked. It will also determine how detainees are directed into care after it is clear that they are mentally ill.
The study also will evaluate how well the jail's intake staff can diagnose detainees' conditions; review suicide and attempted suicide rates within the county's jails; observe the housing accommodations of mentally ill patients; and evaluate the effectiveness and appropriateness of psychotropic drug use among detainees.
County Judge Margaret Keliher said she approached the Meadows Foundation for the grant in part because of the case of James Monroe Mims, who was rushed to Parkland on April 9 after jail trusties found him on his cell floor, semiconscious and incoherent.
The Dallas Morning News reported in September that an internal Sheriff's Department investigation concluded that jailers had cut off water to Mr. Mims for at least 13 days and withheld his psychiatric medications for two months.
The new study "is wonderful news and long overdue," said David Finn, Mr. Mims' family lawyer. "Hopefully, this leads to the kinds of reforms and changes the public has been demanding for a long time."
Ms. Keliher also said she asked for the study because it has become clear from the experiences of the county's new mental health divert court that though proper services might be in place for mentally ill inmates, "unfortunately, a lot of times the left hand doesn't know what the right hand is doing."
The divert court, which began in August, has handled nearly 60 cases. Those who are arrested on nonviolent charges and are within the government-financed NorthSTAR mental health services system are diverted at booking to a separate court, run by Judge Kristin Wade. Many are homeless, and their charges stem from that. For instance, many are charged with criminal trespassing or burglary because they were found sleeping in a building, Ms. Keliher said.
Instead of being housed in the county jails, these patients are sent to Homeward Bound's Dallas facility on 10th Street, where they stay for several days as their caseworkers check in on them and try to contact family members and arrange for more permanent housing.
E-mail joneill@dallasnews.com
03/24/05
DAY: Thursday
PAPER: THE DALLAS MORNING NEWS
SECTION: METRO
EDITION: SECOND
PAGE: 3B
HEAD: County wants publication of study blocked Court asked to order News
to stop printing details of jail report
BYLINE: REESE DUNKLIN
CREDIT: Staff Writer
TEXT:
Dallas County has asked a judge to block The Dallas Morning News from continuing to publish details of a recent study that found sweeping problems at the troubled county jail.
In a petition filed in district court this month against The News and parent company Belo Corp., the county argued that the jail study was confidential and its release unauthorized. The county also said that the document was exempt under the state's Public Information Act.
Further disclosure of the study, the county said, would hurt its defense in a federal lawsuit filed last year by the family of James M. Mims, a mentally ill inmate who nearly died at the county jail after water to his cell was cut off for almost two weeks.
The county had asked a private firm to examine the Mims case as part of a broader, ongoing review of the jail's health-care programs. The firm's study, completed Feb. 1 but not made public by the county, cited several health-care risks, including the lack of inmate screening for tuberculosis.
The News published the findings of the 52-page report Feb. 23 and posted a copy of the study on its Web site.
Ernest Figari Jr., a Dallas lawyer representing the county in the matter, declined to comment Wednesday. In its petition, the county seeks a permanent injunction against The News and wants a judge to order the newspaper to return the study.
Russ Coleman, general counsel of Belo Corp., said The News isn't prevented from reporting on the document simply because the county considers it confidential.
"The report contains critical information for area citizens," Mr. Coleman said. "The report was made under a consulting contract approved by the Commissioners Court and involves a public facility and public health."
The county's action against the newspaper is the latest turn in the crisis at the county jail. Conditions there have come under intense scrutiny after news of Mr. Mims' case and a recent surprise inspection by the Texas Commission on Jail Standards, which gave the county failing marks. The state found problems with fire safety and health care, as well as staffing shortages.
County commissioners this week finalized the makeup of a committee that will examine solutions for the jail. The panel had a controversial start, as commissioners bickered over who would represent them on it.
The fight escalated when Commissioner John Wiley Price sued some of his colleagues, alleging that they violated the state's Open Meetings Act by privately discussing the committee without him or County Judge Margaret Keliher.
E-mail rdunklin@dallasnews.com
09/23/04
DAY: Thursday
PAPER: THE DALLAS MORNING NEWS
SECTION: EDITORIALS
EDITION: SECOND
PAGE: 26A
HEAD: Cruel and Unusual Inmate's ordeal tests Dallas jail accountability

COLUMN: EDITORIALS
CORRECT: CORRECTIONS, CLARIFICATIONS: An article in Tuesday's Metro
section and articles on Sept. 10, 14, 15 and 23 incorrectly summarized one part of the case of James Mims, a mentally ill inmate in the Dallas County jail. An internal investigation found that the jail's medical staff, overseen by the University of Texas Medical Branch, neglected to provide psychiatric medicines to Mr. Mims for two months, not the jailers. The investigation also found that jailers had cut off his water for 13 days. A two-part series about Mr. Mims last month summarized the case properly.
(Ran: Thursday, December 09, 2004)
TEXT:
It's not easy to violate the constitutional rights of prisoners when it comes to medical care. The standard enunciated by the U.S. Supreme Court says that jails and prisons mete out cruel and unusual punishment only if they show "deliberate indifference to serious medical needs of prisoners" resulting in the "unnecessary and wanton infliction of pain."
We're not constitutional scholars, but even words as strong as those don't sound out of place in describing what happened to James Monroe Mims in the Dallas County Jail.
Mr. Mims, accused of attempted murder but unable to stand trial because he is profoundly psychotic, nearly died after jailers failed to give him prescribed medications for two months and shut off the water in his cell for nearly two weeks.
Such treatment is incomprehensible and inexcusable, if not criminal - especially because county officials have known for more than a decade that mental health care in the jail was a problem. In 1993, 1998 and 2002, panels of experts were assembled to prescribe cures for a system that, in the words of the 1998 study, did not provide even a "minimally adequate standard of psychiatric care."
The latest strategy, adopted in 2002 after The Dallas Morning News and WFAA-TV (Channel 8) exposed widespread neglect of mentally ill inmates, was to contract all medical care in the jail to the University of Texas Medical Branch at Galveston. One rationale for hiring UTMB was to create greater accountability. How county officials deal with Mr. Mims' case will determine whether accountability is real or just empty management-speak.
Even before the Mims atrocity, Dallas County Judge Margaret Keliher had angered some mental health professionals and advocates, who accuse her of rebuffing their efforts to monitor or augment the mental health services provided to inmates. She argues that there's no need for external oversight because the county employs a liaison to see that mentally ill inmates receive adequate care in the jail, as well as services from mental health agencies when they're released. The problem in this case, she insists, is that the liaison never learned that Mr. Mims had been transferred to the jail from Terrell State Hospital.
The ultimate solution, she said, might be to change the law so that a person such as Mr. Mims, who has been involuntarily committed to a mental institution, can undergo the required annual judicial review of his commitment at or near the hospital, rather than being hauled back to the county where his case arose. That makes sense to us. But in the meantime, what steps is the county taking to prevent this outrage from happening again?
09/15/04
DAY: Wednesday
PAPER: THE DALLAS MORNING NEWS
SECTION: METRO
EDITION: SECOND
PAGE: 8B
HEAD: Mentally ill man's ordeal spurs outcry to improve care at jail
BYLINE: FRANK TREJO
CREDIT: Staff Writer
CORRECT: CORRECTIONS, CLARIFICATIONS: An article in Tuesday's Metro
section and articles on Sept. 10, 14, 15 and 23 incorrectly summarized one part of the case of James Mims, a mentally ill inmate in the Dallas County jail. An internal investigation found that the jail's medical staff, overseen by the University of Texas Medical Branch, neglected to provide psychiatric medicines to Mr. Mims for two months, not the jailers. The investigation also found that jailers had cut off his water for 13 days. A two-part series about Mr. Mims last month summarized the case properly.
(Ran: Thursday, December 09, 2004)
TEXT:
Outraged advocates urged Dallas County officials Tuesday to change the way the county jail cares for mentally ill inmates.
The calls follow recent reports that a 53-year-old man nearly died this year when jailers cut off his drinking water and denied him psychiatric medications.
"I am appalled that any human being, whether in your institution or anywhere else, is denied medical treatment, food and water and other basic needs," said Pam Armstrong, executive director of the Dallas chapter of the National Association for the Mentally Ill.
Ms. Armstrong and several other speakers were prompted by reports about James Monroe Mims, who had been transferred to the jail from a state hospital in Terrell. According to an internal investigation by the Sheriff's Department, Mr. Mims was rushed to Parkland Memorial Hospital on April 9 after jail trusties found him on the floor of his cell, semiconscious and soaked in waste.
According to the investigators, jailers had cut off drinking water to Mr. Mims' cell for at least 13 days and had denied him his psychiatric medications for two months. Family members have said Mr. Mims spent three months in Parkland, including one month in intensive care.
None of the commissioners responded directly to the advocates' comments at Tuesday's weekly Commissioner's Court meeting.
Afterward, County Judge Margaret Keliher and Commissioner John Wiley Price said they could not discuss specifics of Mr. Mims' case because of the possibility of pending litigation.
"I don't think that anyone can say that what happened here is not upsetting," Ms. Keliher said, adding that she has always been concerned about the care of the mentally ill in the jail. "All I can say is that this court will be looking at the quality of care in the jail."
Mr. Mims' case comes less than two years after county officials approved a contract with the University of Texas Medical Branch in Galveston to provide medical and psychiatric care to jail inmates. That change came amid criticism that inmates were not getting their medications and were receiving little or no psychiatric monitoring.
Vivian Lawrence, a criminal justice specialist with the Mental Health Association of Greater Dallas, reminded commissioners Tuesday that when the UTMB contract was signed in 2002, advocates urged the establishment of an independent task force of mental health professionals to evaluate treatment and practices in the jail.
E-mail ftrejo@dallasnews.com
04/17/04
DAY: Saturday
PAPER: THE DALLAS MORNING NEWS
SECTION: METRO
EDITION: SECOND
PAGE: 1B
HEAD: County jail fails inspection Holding cell, staffing problems will be
corrected, officials say
BYLINE: DAVE MICHAELS
CREDIT: Staff Writer
TEXT:
The Dallas County Sheriff's Department failed its annual inspection this week, the first time in 21 years the jail has not passed the state's scrutiny.
In a preliminary report issued Friday, the Texas Commission on Jail Standards cited overcrowded holding cells, staffing shortages and some medical deficiencies.
The notice of noncompliance does not have immediate consequences, state officials said. If Sheriff Jim Bowles makes recommended changes, his jail will eventually be certified.
But jail commanders were clearly disappointed by the report and vowed to correct the problems.
"Bottom line: It will be fixed," Chief Deputy Edgar McMillan said. "Any violation is a grave violation."
County commissioners were forgiving. They said the violations are mostly technical and argued that the health and safety of inmates are not in jeopardy.
"I don't consider this a black mark against our jail," Dallas County Judge Margaret Keliher said. "We have technical ... violations that need to be corrected."
Among the problems cited by state inspectors was overcrowding in the intake processing, an area where new inmates are searched and fingerprinted. On the day the inspectors visited, the intake area was holding 107 inmates instead of the allowed 43, the report said.
Commanders said the excess was temporary and resulted from a Dallas police sting operation and a rush of state prisoners who returned for trial testimony.
The report faulted some equipment, including an intercom system and smoke filtration technology in the west tower. The intercom has an alert button that inmates can use, but its two-way voice feature was not working properly, Inspector Mark Wilson said.
That could be a problem if an inmate were unable to use the alert button, Mr. Wilson said. County officials said the intercom system would be repaired.
Inspectors admonished the jail for not keeping health screening forms for all inmates. Commanders said that all inmates received medical attention but that some forms were not in the proper file.
Inspectors also noted staffing problems. The jail did not always maintain the legal staffing ratio, which requires one officer for every 48 inmates. Typically, inspectors said, the jail fell out of compliance because an officer left to transfer an inmate and was not replaced.
Commissioner John Wiley Price said the staffing shortage should not be blamed on Sheriff Bowles. Commissioners abolished overtime for detention officers last year, he noted, and they should perhaps pay for more positions.
Inspectors could return within 30 days if Sheriff Bowles requests them. Otherwise, Mr. Wilson said, they will return within 180 days.
The Texas Commission on Jail Standards enforces minimum standards of construction, maintenance and operation of county jails. Its inspectors say 36 Texas jails are out of compliance, including those in Bexar, Cameron, Smith and Webb counties.
If a county jail continues to fail inspections, the full board of the commission - whose chairman is Dallas County Commissioner Jim Jackson - could pass an order requiring it to comply with state standards. The commission can also sue a county that refuses to comply.
Terry Julian, the commission's executive director, said he thinks Dallas County will quickly correct its shortcomings.
"They have always been responsive in the past, and we anticipate no problems this year," Mr. Julian said.
E-mail dmichaels@dallasnews.com
03/05/04
DAY: Friday
PAPER: THE DALLAS MORNING NEWS
SECTION: METRO
EDITION: SECOND
PAGE: 1B
HEAD: Inmates may pay for doctor visits Sheriff orders study of jail
health plan; rival says he keeps stalling
BYLINE: DAVE MICHAELS
CREDIT: Staff Writer
ART: PHOTO(S): Jim Bowles
TEXT:
Dallas County wants to start charging inmates for health care they receive in jail, a practice that is legal but has languished in bureaucratic limbo for several years.
Now the proposal is on everyone's priority list, as Sheriff Jim Bowles says he's ordered a committee to study it and one of his Republican primary opponents accuses the sheriff of continuing to sit on the issue.
Sheriff Bowles went public Wednesday with his desire to institute a co-payment from inmates who could afford it. The program could generate $750,000 a year, the sheriff said.
The sheriff said the system could be implemented by September or October, after a new courthouse computer system goes online.
Danny Chandler, one of his opponents in the Republican primary, said the computer system has little to do with the co-pay, which could cost between $3 and $5 each time an inmate asks to see a doctor.
Mr. Chandler, a former chief deputy in the Sheriff's Department, released records Thursday that showed the department considered the idea as early as 2000.
"It is just something used as a stalling technique rather than dealing with the issue," Mr. Chandler said. "He needs to step up, take a leadership role and push this over the top."
County officials said the co-payments would apply only to doctor visits initiated by inmates. Inmates with a serious illness or medical condition, such as cancer or diabetes, would not be asked to absorb the co-pay.
Sheriff Bowles and Mr. Chandler are opponents in Tuesday's Republican primary. Sheriff's Capt. Larry Locke and Deputy Leonard Bueber also are running. Four Democratic candidates - Sam Allen, Jim Foster, Chuck Munoz and Lupe Valdez - are seeking their party's nomination.
Deflecting criticism
Sheriff Bowles brushed off Mr. Chandler's criticism, saying his former aide does not understand the workings of jail health care.
Most important, the sheriff argued, is that he couldn't force inmates to pay for health care.
So while inmates have money to buy products from the jail commissary, the Sheriff's Department cannot deduct money from their accounts without the inmates' consent, Sheriff Bowles said.
Over the years, the department has struggled to devise a consent form in concert with Parkland Memorial Hospital, which arranges for the treatment of inmates, jail officials said. The entities have disagreed over who should deal with the form because reading it to inmates, and getting them to sign it, would require dedicated staff.
The department, according to Sheriff Bowles, does not have the staff to handle that task.
In 2000, when Mr. Chandler proposed the co-payment as a way to funnel savings to raises for deputies and jailers, the sheriff disagreed that it could be done.
The law mandates that revenue from the co-payments would have gone to the hospital district, Sheriff Bowles said.
"It appears ... Mr. Chandler didn't understand the law at that time, and he still doesn't understand it," Sheriff Bowles said.
But Mr. Chandler said the revenue would offset some of the county's cost, freeing up funds for raises and other initiatives.
"Whether it comes from his pocket or Parkland's pocket, it still comes out of the taxpayers' pocket," Mr. Chandler said, adding that Sheriff Bowles "has lost sight of that."
Ties to vendor
Mr. Chandler and his supporters also accused Sheriff Bowles of hindering the proposal out of loyalty to his commissary contractor.
If inmates agreed to the co-payments, the money would come from an account they use to buy commissary goods. The sheriff's relationship with Jack Madera, the jail commissary contractor, is the subject of a four-month investigation by a special prosecutor.
"If commissary sales would halt until they implemented a co-payment system for health care, I have every faith and confidence it would happen very quickly," Mr. Chandler said.
Sheriff Bowles said the commissary has no relation to the health care issue.

The sheriff said he does not want to use the commissary's computer system because it is not tied to mainframe systems that keep track of inmates. A computer system that is still under development would keep better track of inmate medical costs, he said.
"I am an innovator when it comes to finding ways to achieve income," the sheriff said.
E-mail dmichaels@dallasnews.com
02/13/03
DAY: Thursday
PAPER: THE DALLAS MORNING NEWS
SECTION: NEWS
EDITION: SECOND
PAGE: 1A
HEAD: A 20-year cycle of mania, jail Without costly drugs, mentally ill
woman has been in and out of lockup for shoplifting
BYLINE: TIM WYATT
CREDIT: Staff Writer
ART: PHOTO(S): 1. (Henley family) For a time Denise Henley was on a
steady drug regimen for bipolar disorder and enjoyed last Easter with husband Perry and grandson Zane Jacobs Jr. Soon after, things began to unravel. 2. (MEI-CHUN JAU/Staff Photographer) Construction worker Perry Henley, with his wife's dog Ziggy, has been unemployed since April. He has relentlessly pursued help - and peace of mind - for his wife of 26 years. She is serving nine months for shoplifting and could be released in May.
CHART(S): 1. CRIMINAL RECORD 2. SEVEN DRUGS, FOUR CONDITIONS
TEXT:
Perry Henley waits for his wife to get out of jail and worries how to keep her out of trouble once she gets home.
For the last 20 years, a seemingly never-ending string of petty theft convictions from towns across North Texas has Denise Henley pegged as a career shoplifter. She has been caught stealing items such as sunglasses, cigarettes and toothpaste.
But the reason behind about 30 arrests and more than a dozen convictions doesn't show up in police reports and court files kept on the 45-year-old grandmother. Her problem? She can't afford the prescribed medications that control her manic episodes and keep her out of jail.
And neither can the health-care agencies that provide treatment for the poor.
For Mrs. Henley, the last two years have been a tormenting journey through overlapping bureaucracies that have a say in whether she stays medicated on a costly drug regimen for her bipolar disorder or is left to cope on her own. More times than not, she has been labeled a "frequent flier" in psychiatric wards and lands in prison or jail, the de facto care system for poor Texans who are mentally ill.
David Kellogg, director of public policy for the Mental Health Association of Greater Dallas, called Mrs. Henley's ordeal "the perfect symptom of our failure to plan community mental health services."
"We have people falling through the system every day," he said. "And there's a very limited tolerance for reducing culpability as a result of mental illness."
Mr. Kellogg said there's no steady care in sight for Mrs. Henley and others like her. Plans to create a diversionary court in Dallas County with federal grant money to deal with mentally ill offenders may cover only nonviolent, misdemeanor-level cases.
"This is the result of a long-term failure that started decades ago," Mr. Kellogg said. "And the community health system is a patchwork of services."
When Mrs. Henley is out of jail on parole, the public health-care system cannot afford the most expensive of her prescriptions. Her dosage of Zyprexa alone costs $700 to $1,000 each month, her medical records show. Without the anti-psychotic drug, her manic episodes spiral out of control, her husband said. Other, less-expensive drugs don't work for her, he said.
Likewise, when she's in jail, the state prison system can't afford to maintain her medications at a level that keeps her rapidly cycling manic swings in check. Mr. Henley said his wife's prescriptions have been altered, changed, interrupted or substituted to suit budgetary restraints rather than her medical needs.
Texas prisons can afford the newest anti-psychotic drugs for only about one in six of more than 16,000 mentally ill inmates statewide, according to a study by the Criminal Justice Policy Council.
The same study shows that slightly more than half the people receiving indigent mental health care through state programs get those same drugs.
That's little consolation to Mr. Henley, a construction worker unemployed since April who has called and begged and pestered officials for the last year to help get his wife of 26 years some peace of mind.
"Except for a few caring folks here and there, it seems like everyone wants to wash their hands of Denise," he said. "The hospitals, insurance plans, welfare, the police, the courts, even the prison system. If we had $1,300 to $1,500 a month to buy her pills, we wouldn't be living this nightmare right now."
A history of torment
Mrs. Henley's history of mental illness goes back to her teenage years with a diagnosis of manic-depression, now called bipolar disorder.
On and off for the last 30 years, she has struggled with the wild euphoria of a manic episode when she stops taking her prescriptions because of side effects that leave her dazed and confused, according to her husband.
Two years ago, after being paroled from a three-year prison stint for theft, Mrs. Henley decided to deal with her illness and maintain a steady drug regimen, her husband said. Her medical records show that doctors were working in early 2001 to find the right blend of anti-psychotic drugs. During that time, she was arrested twice for shoplifting.
By fall, she was introduced to a steady dose of Zyprexa, and doctors, caseworkers and her family noticed a dramatic change.
"For the first time in years I recognized the old Denise," Mr. Henley said. "She was back in so many ways. She took charge of our Christmas that year, and we had a great time. It was just amazing. There were no side effects."
The Henleys walked a delicate line, using Medicaid and the county's indigent HMO-style health plan to pay for doctor care and prescriptions. She averaged seven different pills for her mental illness, hormone therapy for a pituitary gland problem and gout.
Last March, everything began to unravel, and neither Mrs. Henley nor the public health system was able to react quickly enough to prevent what would follow.
Exhausting Medicaid
Medicaid assistance for her hormone therapy reached its limit. Their managed health care plan - under the umbrella of NorthSTAR - was unable to subsidize all her medications. Mr. Henley watched his wife ration out Zyprexa and other prescriptions to buy some time.
"You tell me what's worse," he said. "Her hormone levels out of whack or her mania. It was a tossup, really, as far as her mental state was concerned."
When Mr. Henley was laid off in April, his wife's Social Security disability benefits increased to about $550 a month. But it still wasn't enough to pay for her prescriptions, which were coming from psychiatrists as well as her regular doctor.
"We had doctors writing prescriptions for this and that, but one plan wouldn't cover this drug or that, and another doctor wasn't certified with this plan or that plan," Mr. Henley recalled. "Denise was in the dark about it all, and she was slipping. Neither of us knew what to do or where to go."

On June 18, Mr. Henley got a call from Parkland Memorial Hospital asking him to come pick up his wife.
She had been caught shoplifting again, had unraveled into a psychotic hysteria and was sedated at Parkland's psychiatric emergency room. Three weeks later it happened again. Mrs. Henley landed in Green Oaks Hospital in lieu of the Richardson city jail. Charges and an arrest warrant followed in August.
A most manic person
Psychiatrist Judi Stonedale described Mrs. Henley as "one of the more manic people I've ever interviewed" during testimony in a December trial.
"She's been on everything under the sun," she told a judge. "And she's had problems with every medication she's been on."
Even with an increased dosage of Zyprexa from the jail's psychiatric unit - about three times what she was prescribed through her HMO - Mrs. Henley was a fragile patient prone to uncontrollable tremors and constant edginess in the noisy concrete and steel hallways of the jail, Dr. Stonedale testified.
But the doctor couldn't offer the judge definitive proof that Mrs. Henley's mental illness clouded her ability to distinguish right from wrong when she strolled out of a grocery store without paying for about $80 worth of goods.

Like most criminal cases, Mrs. Henley's insanity defense was virtually impossible to prove.
"A lot of people think the insanity defense is always a ploy to walk away from a crime," defense attorney Robert Burns said. "With a record like hers, everyone assumes she's a habitual criminal, and that's a shame.
"It's also a shame that psychiatric hospitals are so underfunded that they can't handle people like Denise."
State District Judge Mark Nancarrow took less than a minute to return a guilty verdict in the two-hour trial. He sentenced Mrs. Henley to nine months in jail - less than half of the maximum penalty she faced. With four months credit for time served, she could be released in May.
"At least in the jail she's going to get what she needs," Mr. Henley said. "Now I just need to find a way to pay for pills when she gets out."
At risk again
Joe Lovelace of the National Association of the Mentally Ill said uninterrupted care for most mentally ill prisoners isn't likely.
"Now that she's in the prison system, they're going to apply their rules to her treatment," Mr. Lovelace said. "Each bureaucracy she passes through will typically start her over from square one.
"She's viewed as a run-of-the-mill, repeat offender, but prison isn't going to solve her problem. Still, nowhere she ends up will there be sufficient funding to deal with her medical problem."
Mr. Lovelace said Texas doesn't treat the mentally ill to keep them out of jails and prisons, adding that expensive drugs such as Zyprexa cut into the profits of managed-care systems contracted to provide medical care for prisoners and the poor.
Mr. Henley has written and called anyone who would listen to keep his wife on the drug regimen begun in the county jail. Mr. Burns filed an appeal to the December conviction in an effort to prevent her transfer to Gatesville and possible interruption of her medication.
But Mrs. Henley ended up on a prison bus in early January. Her first letters to her husband described a weeklong break from medication, followed by a cutback on her Zyprexa.
Prison officials transferred Mrs. Henley back to Dallas and the Dawson State Jail near downtown in late January. She was moved to the Dallas County jail last week, and the psychiatric unit restarted her old drug regimen once again.
Dr. Tony Fabelo, director of the Criminal Justice Policy Council, said the state's prison system has received millions of dollars to help cover the additional costs of treating mentally ill inmates, but that doesn't mean every inmate who might need top-of-the-line anti-psychotics such as Zyprexa will get it.
"Have things improved? Certainly," Dr. Fabelo said. "But does that mean every inmate gets the exact same drugs prescribed on the outside? Not yet, anyway."
Mr. Henley said he has tried to understand the complexities of sparse budgets and costly drugs, but the last two years have left him exhausted and frustrated.
"Maybe I'm wrong about this, but it all seems to fall back on the mental health system in Texas," he said.
"Because the criminal justice system still thinks that when she comes home from jail this time, everything will be different, that she will have learned her lesson.
"I'm telling you, Denise needs her pills - not more jail time," Mr. Henley said. "And there's no telling how many others like her are out there facing the same thing."
E-mail twyatt@dallasnews.com
01/08/03
DAY: Wednesday
PAPER: THE DALLAS MORNING NEWS
SECTION: METRO
EDITION: SECOND
PAGE: 21A
HEAD: Questions surround death of inmate at county jail Mother wants
answers, says he was addicted to crack but healthy
BYLINE: ED HOUSEWRIGHT
CREDIT: Staff Writer
ART: PHOTO(S): Ricky Spicer
TEXT:
Ricky Spicer grew up knowing the dangers of drug use.
His mother, Helen Spicer, served time in prison on drug charges and started a residential drug-treatment program after being released.
Nevertheless, Mr. Spicer developed an addiction to crack cocaine that led to several arrests and stints in the Dallas County jail system, Ms. Spicer said.
Her son was back in jail, awaiting transfer to a state-run drug program, when he died Dec. 28, Ms. Spicer and county officials said.
No one seems to know why. Mr. Spicer, who worked in his uncle's restaurant in Lancaster, turned 24 on Dec. 21. He was on medication for depression but had no major health problems, his mother said.
The county autopsy has not been completed. Neither has a private autopsy.
"He was a very good young man," said Ms. Spicer, 55, whose nonprofit drug treatment program, Johnnie's Manor, receives county financing. "That's why it's so hard to accept. I'm trying to hold up. It's very hard."
Ms. Spicer has hired an attorney to investigate the circumstances surrounding the death.
County Commissioner John Wiley Price said Tuesday that he, too, was asking questions.
"It concerns me," Mr. Price said. "We're still trying to get answers. We've got to figure out if ... jail officials acted properly."
Sheriff's spokesman Sgt. Don Peritz said jail employees acted appropriately. Mr. Spicer, who had been in jail for six weeks, complained of breathing problems the night of Dec. 27, Sgt. Peritz said.
"We took him to the nurse station immediately," he said. "They observed him and made the decision to transport him to Parkland" Memorial Hospital.
Mr. Spicer arrived at Parkland at 2:17 a.m. Dec. 28 and wasn't responsive, according to hospital records. He was pronounced dead at 3:29 a.m. that day, records show.
He became the 16th person to die in the Dallas County jail system in 2002, and the 65th since 1996, according to the Texas Commission on Jail Standards.
On Sunday, a 55-year-old disabled woman hanged herself in her jail cell, becoming the first in-custody death this year.
At their weekly meeting Tuesday, county commissioners approved the payment of $300,000 to the family of a 46-year-old woman who died eight days after being admitted to the jail on drug charges in 1999.
Ruth Neiss repeatedly complained of chest pains and shortness of breath, according to a lawsuit filed over her death. She was seen six times by a nurse but was never examined by a doctor, before dying at Parkland hospital, the lawsuit says.
Her mother and daughter said that Ms. Neiss was in reasonably good health and that her death - from a staph infection in her lungs - could have been prevented with better medical care.
County officials have defended the treatment she received.
Janet Ferguson, chief of the civil section of the district attorney's office, declined to comment on the settlement Tuesday.
County Administrator Allen Clemson said $300,000 is a "substantial claim" but not the largest lawsuit settlement approved by commissioners. He declined to comment further.
Previously, sheriff's officials have said that most jail deaths are from natural causes and cannot be prevented. About 100,000 inmates pass through the Dallas County jail system each year - many in poor health because of years of substance abuse and lack of regular medical care, Sgt. Peritz said.

Former Dallas City Council member Al Lipscomb, a friend of the Spicer family, told county commissioners Tuesday that Mr. Spicer's death should be investigated.
"People go in alive and come out dead," Mr. Lipscomb said in an interview. "It doesn't make sense. Who is going to be next if that cavalier attitude is practiced?"
Ms. Spicer said family members of other inmates have told her that her son was seen vomiting blood and had complained of being ill for almost a week before he was seen by a nurse.
Sgt. Peritz said he had no record of Mr. Spicer vomiting blood or making earlier complaints of feeling ill.
"The whole thing is a sad, sad situation," said attorney Fred Time, who represented Ms. Spicer in her legal problems and has been retained to look into her son's death. "He was a sweet, kind, loving young man. I've known him since he was a boy.
"He never gave anybody any trouble. His trouble was himself."
Staff writer Dave Michaels contributed to this report.
01/07/03
DAY: Tuesday
PAPER: THE DALLAS MORNING NEWS
SECTION: METRO
EDITION: SECOND
PAGE: 13A
HEAD: Disabled inmate hangs self in Dallas County jail It's 1st in-custody
death at the facility this year; there were 16 in 2002
BYLINE: TIM WYATT
CREDIT: Staff Writer
ART: PHOTO(S): Merna Argovitz Kann.
TEXT:
A 55-year-old disabled woman hanged herself in her jail cell Sunday night. It was the first in-custody death of the year at the Dallas County jail.
Merna Argovitz Kann, who used a wheelchair and was serving a six-month term for a misdemeanor theft conviction, took off her jail jumper, tied it around her neck and around shelving in her cell, and hanged herself, according to the Dallas County Sheriff's Department.
Sheriff's spokesman Sgt. Don Peritz said a jailer discovered Ms. Kann's body at 10:15 p.m. Sunday in her single cell in the north tower of Lew Sterrett Justice Center. Jail logs show that she was last seen alive 30 minutes before a jailer called paramedics.
Ms. Kann was taken to Parkland Memorial Hospital, where she was pronounced dead an hour later.
Though Ms. Kann's apparent suicide was the jail's first in-custody death this year, Sgt. Peritz said, there were 16 in 2002, with the last two resulting from inmate medical problems Dec. 10 and 28. Sheriff's records show that more than 95,000 people were booked into the jail last year, with the average daily prisoner population exceeding 7,000, Sgt. Peritz said.
Sheriff's investigators are studying whether jailers properly followed procedures in monitoring and caring for Ms. Kann.
Sgt. Peritz said the Richardson woman was not listed as suicidal when she checked into jail Jan. 1 to begin serving her sentence. A judge convicted Ms. Kann in December for theft under $50, the latest of a string of petty theft and drug convictions dating to 1982.
"It's really unfortunate that this would happen to anyone," Sgt. Peritz said. "But with so many people being processed through here, it's going to happen now and then."
Deandra Grant, who defended Ms. Kann on numerous occasions in the last four years, said her client was a "difficult person who also had a lot of medical problems."
"Still, I was surprised by the news of her suicide," Ms. Grant said. "Merna told me she wouldn't survive her jail sentence, but she was talking about her health problems, not hinting at suicide."
Arrest reports show that most of Ms. Kann's crimes were petty and rarely involved her using a wheelchair, prompting authorities to question how serious her disabilities were.
Including Ms. Kann, eight people have committed suicide while in jail custody in the last five years.
Last fall, the families of two mentally ill prisoners who committed suicide while in custody sued the county, alleging that the jail's psychiatric unit failed to properly medicate and care for the two, a 36-year-old Dallas woman with bipolar disorder and a 27-year-old Richardson man with schizophrenia.
Sgt. Peritz and Ms. Grant said Ms. Kann did not have a history of mental illness.
E-mail twyatt@dallasnews.com
11/29/02
DAY: Friday
PAPER: THE DALLAS MORNING NEWS
SECTION: METRO
EDITION: SECOND
PAGE: 37A
HEAD: Inmate health falls to school Jail turns over medical
responsibilities to improve care, cut costs
BYLINE: ED HOUSEWRIGHT
CREDIT: Staff Writer
TEXT:
Inmates may not immediately notice, but a major change begins Sunday in health care delivery in the Dallas County jail system.
County officials are privatizing medical and mental health care to the 7,000 inmates in an effort to improve services and save money.
The University of Texas Medical Branch at Galveston has received a three-year contract to operate a managed-care system, taking over from the county Health and Human Services Department. The transition has been planned for more than a year, but it comes against a backdrop of mounting criticism by mental health advocates.
In July, The Dallas Morning News and WFAA-TV (Channel 8) reported that mentally ill inmates routinely undergo only cursory psychiatric exams and often go without anti-psychotic drugs needed to control behavior. Several weeks later, Rita Moss, the psychiatrist in charge of jail mental health, resigned. She blamed "media lies and blatant misrepresentations" and defended her care.
A change in jail health care is long overdue, said David Kellogg, public policy director for the Mental Health Association of Greater Dallas. But he said he was not sure that the medical school is the answer. He and other advocates worry that the school might cut care to save money.
"We are very skeptical and are going to monitor the situation closely," Mr. Kellogg said. "We can only hope that it's going to be an improvement."
The medical school, a not-for-profit provider, serves 150,000 Texas prison inmates and 5,200 federal prisoners. But it has never overseen health care in a county jail, where inmates stay shorter periods and the turnover is much greater. Each day, about 500 inmates enter and leave the Dallas County jail system.
Leon Clements, chief administrative officer of the school, said many parallels exist between health care delivery in a large prison and a smaller county jail. He said the medical school has spent months preparing for its job in Dallas County and will not reduce care. Doing so, he said, could make inmate health problems worse and more costly to treat.
"Are we going to make everybody happy?" Mr. Clements said. "I think the answer to that is no. We're going to give it a good shot. We've done a heck of a lot of research.
"I think for the first time we have a fully staffed psychiatric operation there."
Most of the 148 jail employees who worked for the county Health and Human Services Department have gone to work for the University of Texas Medical Branch, he said. Under the contract, the medical school must maintain the current staffing for at least six months.
County officials have estimated that the contract with the school could save $681,344 in the first year through improved efficiency. The medical school says it will treat more inmates in the jail - instead of transferring them to Parkland Memorial Hospital - and use its centralized pharmacy in Huntsville that serves inmates.
The school also will computerize inmate medical records. Paper files sometimes get misplaced as inmates transfer within the jail system with the current system, officials said.
Mr. Clements said the medical school has a stellar record serving state prison inmates. But officials with the Prison and Jail Accountability Project of the American Civil Liberties Union disagree. They testified before county commissioners in September - shortly before the school contract was approved - and said they have received many complaints about inadequate care.
Locally, an 11-member advisory committee will be appointed to monitor Dallas County jail health care and oversee the contract. The committee will include three members of the commissioners court, two Parkland officials, two doctors and a Sheriff's Department representative.
No advocate
Mr. Kellogg said he's upset that a mental health advocate would not be on the committee.
"As previously discussed, MHA Mental Health Association of Greater Dallas believes that an independent mental health advocate must serve on the advisory committee in order to more fully protect the interests of people living with mental illness in the Dallas County Jail," Mr. Kellogg wrote to County Judge Margaret Keliher.
Ms. Keliher, who will be on the advisory committee, said the advocates' interests will be represented by Melissa Cahill, chief psychologist for the Dallas County Community Supervision and Corrections Department, commonly known as the probation department. Dr. Cahill is the chairman of an organization of service providers and advocates.
Ms. Keliher said commissioners decided not to appoint a mental health advocate to the advisory committee because there are many other interest groups to consider.
"I don't know where you would draw the line on which advocacy groups should be on the committee," Ms. Keliher said. "What about the women's health groups? The meetings are open. They're all allowed to come and participate."

Mr. Kellogg said he's also concerned that the medical school won't provide the newest and best anti-psychotic medication to inmates because of cost.
Medication decisions
County officials and treatment providers have debated whether it's proper to start inmates on the latest medications in jail if they can't afford them - or insurance won't cover them - when they are released.
Mr. Clements said medication decisions would be made on a case-by-case basis.
"To say that we're going to give all generics is wrong," he said. "To say we're going to always rely on the latest and greatest drugs is wrong. We're going to treat them appropriately."
E-mail ehousewright@dallasnews.com
Inmate care at the Dallas County Jail was the subject of an investigation by The Dallas Morning News and WFAA-TV (Channel 8). Read the background, watch the video and link to online exclusive interviews with the parties involved, on the Local News page.
10/14/02
DAY: Monday
PAPER: THE DALLAS MORNING NEWS
SECTION: METRO
EDITION: SECOND
PAGE: 21A
HEAD: Jailhouse deaths spur lawsuits against county 63 have died in seven
years; commissioner not alarmed at level
BYLINE: ED HOUSEWRIGHT
CREDIT: Staff Writer
ART: PHOTO(S): Ruth Neiss. CHART(S): JAIL DEATHS.
TEXT:
Ruth Neiss' last address was the Dallas County Jail.
Ms. Neiss, 46, suddenly collapsed and died eight days after being admitted to the jail on drug charges in 1999.
Her mother and daughter say that she was in reasonably good health and that her death - from a staph infection in her lungs - could have been prevented with better medical care. They are suing Dallas County.
"It shocks me that someone could go in and die a matter of days later," said Ms. Neiss' daughter, Heather Slade, 26, of Albuquerque, N.M.
Ms. Neiss is among 63 people who have died in the Dallas County jail system in the last seven years - an average of nine deaths per year, according to the Texas Commission on Jail Standards. The total is less than in Harris County, which had nearly the same annual jail population but had 112 deaths in the same period, figures show. Seven of the Dallas County deaths from 1996 to the present were suicides, including the most recent death in the jail. On July 26, Murdock McLeod hanged himself in a single cell in the jail's psychiatric unit five days after arriving from Terrell State Hospital, becoming the seventh jail death this year, according to the Sheriff's Department. Other causes of death included heart attack, pneumonia, AIDS, emphysema and aneurysm, autopsies show.
County officials say most jail deaths are from natural causes and cannot be prevented. More than 100,000 inmates pass through the jail system each year
- many in poor health because of years of substance abuse, hard living and lack of regular medical care, Sheriff's Department spokesman Sgt. Don Peritz said. The inmates who died in the past seven years ranged in age from 19 to 70.
Last month, county commissioners made a major change in jail health care, approving a three-year contract with the University of Texas Medical Branch at Galveston. The medical school, which serves 150,000 state prisoners, will take over from the county Health and Human Services Department and Parkland Health & Hospital System about Nov. 1.
Commissioners say the medical school will improve care by treating more patients in the jail instead of at Parkland, developing a computerized medical record system and using a centralized pharmacy that serves the state prison system.
The decision to switch to the medical school was not related to the number of jail deaths or recent questions raised about the level of psychiatric care received by inmates, commissioners said.
"It has never risen to the level that it's alarmed me," commissioner Mike Cantrell said. "I've never seen anything happening - or been notified by the sheriff - that we're contributing to deaths."
Sgt. Peritz said each jail death is thoroughly investigated.
"I think a lot of them are health-related and unavoidable," he said.
However, the Mental Health Association of Greater Dallas is concerned about the number of deaths, particularly suicides, said David Kellogg, public policy director.
"I don't see how any suicide is unavoidable," he said. "When the state takes responsibility for a person by incarceration, they have an obligation to do everything they can to prevent suicide. Part of that is screening for mental health risk factors. The other part is maintaining a secure environment."
Other suits pending
In addition to the Neiss lawsuit, which was filed in September 2000, three other suits are pending against Dallas County over inmate deaths, each alleging poor medical care. One prisoner was a 33-year-old man who died in 1998 after collapsing in his cell and striking his head on the floor. A 19-year-old man died of meningitis in 1999. A 52-year-old man died of a heart attack in 1999.
Officials with the American Civil Liberties' Prison and Jail Accountability Project say it's often difficult to get accurate information on inmate deaths.
"We only know basically what they want us to know," said Yolanda Torres, litigation director. "They have access to the prisoners, the bodies, the records. I think corrections people are concerned about keeping what goes on behind prison walls, behind prison walls."
Statewide, county jails have a hard time finding qualified doctors and nurses, said Terry Julian, executive director of the Texas Commission on Jail Standards, which inspects jails.
"You've got to be dedicated to work inside a jail, locked up just like inmates, and listen to some of the concerns inmates have," Mr. Julian said. "Sometimes it becomes a game with the inmates to see if they can find a doctor who will buy their symptoms, if you will, and provide drugs for them. How much care is adequate - that's the bottom line. Sheriffs have to be cognizant ... not to let someone go that really needs proper medical care."
Ms. Neiss' mother, Barbra Bell, says the doctor who supervised her daughter's treatment should never have been hired.
Dr. Brandt McCorkle, an osteopath, had his state medical license suspended from 1993 to 1995 because of drug and alcohol abuse, county records show. His first employer after having his license reinstated: Dallas County.
Six months before Ms. Neiss died in 1999, a supervisor feared that Dr. McCorkle might have begun drinking again.
"In addition to calling in sick very frequently ... I have received multiple complaints from the nursing staff considering his physical appearance, performance, and overall medical care provided to the inmates," Dr. Steven Bowers, jail medical director, wrote to the Texas State Board of Medical Examiners.
Two years after Ms. Neiss died, Dr. McCorkle was fired for his handling of another inmate health problem that resulted in the inmate's death, Dr. Bowers wrote to the board of medical examiners.
Dr. McCorkle, who works in the El Paso County jail and is a defendant in the Neiss lawsuit, declined to comment.
Slow response alleged
According to the suit, the jail medical staff didn't respond quickly enough to Ms. Neiss' repeated complaints of chest pains and shortness of breath. After entering the jail Dec. 13, 1999, Ms. Neiss saw a nurse six times before she died Dec. 21 at Parkland hospital but was never examined by a doctor, the suit says. Ms. Neiss had a documented history of asthma and heart problems.
In a deposition taken for trial, Dr. McCorkle said he reviewed an EKG performed by a nurse and saw no problems with Ms. Neiss' heart. He said he did not order further tests or examine Ms. Neiss to determine the cause of her chest pain and shortness of breath. The breathing problems were a sign of the staph infection in her lungs, the lawsuit says.
Problem 'undetectable'
"Something went wrong with her," Dr. McCorkle said in the deposition. "I'm saying it may have been undetectable until the acute event."
Ms. Slade said she struggles to accept her mother's death. She gave birth to a baby girl two weeks before her mother died. Her mother never got to see her first grandchild.
"She had talked to her once and was planning to come see her and stay for a while," Ms. Slade said. "She was very excited. My mom was a very loving and caring person."
Staff writer Tim Wyatt contributed to this report.
E-mail ehousewright@dallasnews.com
09/18/02
DAY: Wednesday
PAPER: THE DALLAS MORNING NEWS
SECTION: METRO
EDITION: SECOND
PAGE: 21A
HEAD: A new era for inmate care County OKs contract with medical school

BYLINE: ED HOUSEWRIGHT
CREDIT: Staff Writer
TEXT:
Dallas County commissioners voted 4-1 Tuesday to contract with the University of Texas Medical Branch at Galveston to provide jail health care, despite opposition from inmate advocates who criticized the medical school's record.
Commissioner John Wiley Price cast the dissenting vote, arguing that the three-year contract does not list performance measures to judge the quality of health care. Other commissioners responded that an advisory committee of county officials and medical experts would establish and monitor treatment standards.
"How many contracts do we let without having expectations?'' Mr. Price asked.
Supporters say that the medical school, which serves 150,000 state prison inmates, will provide better jail health care - physical and mental - at a lower price. It will take over around Nov. 1.
Currently, the county Health and Human Services Department and Parkland Health & Hospital System treat the jail's 7,000 inmates at a cost of about $14 million a year. Officials support the move, saying the medical school has developed expertise in inmate care. The medical school should save the county $681,344 in jail health costs in the first year, county administrator Allen Clemson has said.
The commissioners' decision to contract with the medical school was harshly criticized Tuesday by representatives of the ACLU and Amnesty International and a mother whose 19-year-old son is receiving psychiatric care in prison.
Yolanda Torres of the ACLU's Prison and Jail Accountability Project said the medical school has a "dismal" record of providing medical care for prisoners. The group has received many complaints from inmates and their families about apathetic care, inadequate treatment and improper distribution of patient medication, she said.
"I think the UTMB presence in the Dallas County jail system will exacerbate any existing problems," Ms. Torres said.
No medical school representatives attended the meeting. Previously, they have assured commissioners that the medical school, a not-for-profit provider, would not shortchange care to save money. Under the contract, it must maintain current staffing - 148 employees - for at least six months.
"I'm not going to get into a shouting match with anybody," Leon Clements, the medical school's chief administrative officer, said Tuesday. "We let our results do the talking. We have an excellent record in the prison system."
He said that the medical school has achieved accreditation from the American Correctional Association. The county has not been accredited by the organization.
Commissioners who voted for the contract told critics that they would keep a close eye on the medical school's performance.
"There will be aggressive monitoring," Commissioner Mike Cantrell said.
Commissioner Jim Jackson said it's not surprising that some people would criticize the medical school's record in the prison system, given that it serves 150,000 inmates.
"Everybody is kind of piling on UTMB without looking at anything that might be better," Mr. Jackson said. "No system in the world is going to be without complaints."
The county and UTMB were in contract talks before Aug. 1, when The Dallas Morning News and WFAA-TV (Channel 8) reported that mentally ill prisoners routinely undergo only cursory psychiatric exams and often go without anti-psychotic drugs needed to control their behavior. Dr. Rita Moss, the psychiatrist in charge of jail mental health, resigned earlier this month. She blamed "media lies and blatant misrepresentations" and defended her care.
Mr. Clemson said UTMB will treat more inmates in jail instead of incurring the expense of transferring them to Parkland Memorial Hospital, he said. The medical school also will save money by using a centralized pharmacy in Huntsville that serves the prison system, and it will computerize inmate medical records, he said.
Besides serving state prisoners, the University of Texas Medical Branch at Galveston provides health care to 5,200 federal inmates and 3,900 juvenile offenders throughout the state.
E-mail ehousewright@dallasnews.com On DallasNews.com
The care of mentally ill inmates at the Dallas County jail was the subject of a recent investigation by The Dallas Morning News and WFAA-TV (Channel 8). Read the reports and watch the video, on the Local News page.
09/17/02
DAY: Tuesday
PAPER: THE DALLAS MORNING NEWS
SECTION: EDITORIALS
EDITION: SECOND
PAGE: 16A
HEAD: Mental Health Care Jail conditions must be upgraded
COLUMN: EDITORIALS
TEXT:
Should the Dallas County Commissioners Court allow the University of Texas Medical Branch at Galveston to administer mental health services at Dallas County jails? Yes, but the court needs to put some firm parameters around the school's work when the issue comes up for a vote today.
Recent reports by both The Dallas Morning News and WFAA-TV have detailed the serious problems that face mentally ill prisoners. If you did not know better, you would think you were looking into scenes from a gulag. A prisoner plucks his eye out. Another dies after eating coffee grounds and human feces. And a third hangs himself. Need we say more?
The change must be done right, however. UTMB has run health services, including mental health care, at state prisons. But its work has not always been problem-free.
The Mental Health Association of Greater Dallas advocates that the new contract stipulate that:
*Qualified personnel give inmates a mental health screening within 24 hours of intake.
*A psychiatrist examine an inmate in need of mental health care within seven days.
*Inmates receive treatment and medicine immediately upon intake if they suffer from acute psychosis or withdrawal.
*Inmates receive medication within 24 hours of prescription.
These requests are all correct. And the last one is especially important. Some Dallas County inmates have suffered needlessly by not receiving their medicines promptly.
The association also correctly proposes that UTMB provide "new generation" medicines to inmates. Inmates need access to them, even though they cost more than older medicines. As Dr. Joel Feiner of the University of Texas Southwestern Medical Center at Dallas says, the decision needs to be based on science, not money.
Three other changes also must be built into the contract:
*An outside panel of mental health experts should be given access to Dallas County patients on a regular basis to determine the quality of care.
*That panel should be part of the six-month review of UTMB's work.
*Commissioners should allow an independent ombudsman to work within the Dallas County jail to ensure UTMB delivers quality mental health care.
With the Dallas County jail in need of urgent reform, UTMB deserves a chance to improve the level of care. But it must be done right. And monitored. The residents of Dallas County have a vested interest in making sure that mentally ill inmates receive decent care so they don't offend again.
09/16/02
DAY: Monday
PAPER: THE DALLAS MORNING NEWS
SECTION: NEWS
EDITION: SECOND
PAGE: 1A
HEAD: Med school poised to take over county jail health care Inmate
advocates say money will be saved at expense of treatment
BYLINE: ED HOUSEWRIGHT
CREDIT: Staff Writer
ART: CHART(S): KEY PROVISIONS.
TEXT:
The turnstile at the Dallas County Jail never stops.
Each day, an average of 500 inmates book in, 500 book out.
Legal problems aren't their only concern. Many arrive with a multitude of ailments - physical and mental - often made worse by years of substance abuse and hard living.
Taxpayers pick up the ever-increasing health care bill - about $14 million a year.
Looking for a way to cap soaring costs, county commissioners plan to approve a three-year contract Tuesday with the University of Texas Medical Branch at Galveston. The medical school, which provides health care to 150,000 state prison inmates, will operate a managed care system in Dallas County starting around Nov. 1.
With improved efficiency, the medical school should save the county $681,344 in jail health care costs in the first year of the contract, said county administrator Allen Clemson. The school will also be able to treat more patients in the jail, save money through revised pharmaceutical procedures and improve recordkeeping.
Currently, the county Health and Human Services Department and Parkland Health and Hospital System treat the jail's 7,000 inmates. Officials applaud the shift in responsibility to the medical school.
"These people have experience in correctional health and a proven record," said Nina McIntosh, vice president of ambulatory care for Parkland. "Jail health is a very different field. It's very challenging. It takes some level of expertise and understanding of that environment to provide the most appropriate care."
Inmate advocacy groups, however, worry that jail health care - which they say is already lacking - may deteriorate further in the name of saving money.
"UTMB's performance in the individual prison units has been mixed at best," said Meredith Rountree, director of the American Civil Liberties Union's Prison and Jail Accountability Project in Austin. "There is erratic and often very poor care. There are very strong concerns about failure to diagnose properly, failure to medicate, denial of access to appropriate specialists and arbitrary decisions by untrained and unsophisticated staff."

She spoke at the commissioners' meeting Tuesday, along with several local mental health advocates. Recently, they have intensified their criticism of psychiatric care in the jail system - saying mentally ill inmates are sometimes denied proper medication and treatment.
"It should be obvious to all that jail psychiatric services are in a state of turmoil," Mike Katz of the National Alliance for the Mentally Ill told commissioners. "The county is looking to managed care to solve a financial problem or at least inhibit the growth in spending. It is clear that managed care is not a resounding success in any segment of the American experience."

He said county officials are saving money "at the expense of people who are ill, many of whom are in jail due to the failed mental health system that exists in our abundant community."
Defending quality
Officials with the University of Texas Medical Branch, which was chosen by a state committee in 1993 to provide prison health care, say they will offer quality treatment in Lew Sterrett Justice Center and other county jails. The medical school, a not-for-profit provider, does not shortchange care to save money, said Leon Clements, chief administrative officer.
"UTMB has a vested interest in providing the patient with the best possible health care we can," he said. "If we don't solve a patient's problem before it gets to be a big problem, we're going to pay for the big problem.
"There's a medical peer review process in place for all our contracts, and that peer review system is very active."
The medical school will be able to treat more patients in the jail instead of incurring the expense of transferring them to Parkland Memorial Hospital, Mr. Clemson said. The medical school also will save money by using a centralized pharmacy that it operates in Huntsville for the state prison system, he said.
It also promises to establish an electronic medical record system within a year. Currently, paper medical files sometimes get misplaced as inmates are transferred within the jail system, officials said.
The Galveston school has met the standards necessary to receive accreditation from the American Correctional Association. The organization governs "administrative and fiscal controls, staff training and development, physical plant, safety and emergency procedures, sanitation, food service, rules and discipline," according to its literature.
Currently, Dallas County's jail health care system is not accredited.
Besides serving 150,000 state prison inmates, the medical branch provides health care to 5,200 federal inmates and 3,900 juvenile offenders throughout Texas, Mr. Clements said.
"We're very happy with the contract with UTMB," said Pamela Ward, spokeswoman for the Texas Youth Commission, which operates the juvenile correction system. "Medicine is not one of our core expertise areas. We feel like moving to this has really brought quality care for our youth and has saved the state money.
"A kid in Corsicana is going to get the same quality of care and oversight as a kid in Gainesville."
Critics, however, complain that the county's 18-page contract with the medical school does not establish specific performance measures. Under the contract, the medical school must keep the same number of health care workers - 148 - for six months. After that, the number of employees may be reduced with approval from Parkland and county officials.
Some advocates are worried that the medical school may change the staff makeup to save money - using fewer doctors and nurses and more medical technicians.
"That's absolutely false," said Mr. Clements. "This is a physician-driven organization."
He said inmates often receive better health care than the public.
"The prison population is the only population in the United States that's guaranteed health care," Mr. Clements said. "Is the average blue-collar worker able to walk in and see his physician or dentist or nurse to get a free prescription drug anytime he wants?"
County jails around the state struggle to provide quality health care while curtailing costs, said Marcus Kenter, executive director of the Texas Jail Association, which represents 900 jail employees.
"It's becoming a bigger issue," he said. "Our jails are full of folks now who are unstable and mentally challenged. Our jailers and sheriffs, as skilled as they are, are not prepared for some of the types of individuals they're having to deal with."
Other counties
Dallas-area counties provide jail health care in different ways. Tarrant County, for instance, uses the county hospital district, JPS Health System, said county spokesman Marc Flake.
Collin County has hired Correctional Medical Services, a private firm in St. Louis. More companies are now contracting with counties to provide inmate care.
"With health care costs and prison populations increasing, state, county and city corrections agencies face the increasingly difficult challenge of providing inmates with quality health care services within existing budgets," according to literature from Correctional Managed Services.
Collin County Sheriff Terry Box said he's glad the county is no longer responsible for providing health care.
"Back when we were doing it, we never knew how much it was going to cost for sure," he said. "When you contract it out, you can budget closer to what you're going to spend."
E-mail ehousewright@dallasnews.com
09/16/02
DAY: Monday
PAPER: THE DALLAS MORNING NEWS
SECTION: NEWS
EDITION: SECOND
PAGE: 10A
HEAD: KEY PROVISIONS
TEXT:
Dallas County commissioners plan to contract Tuesday with the University of Texas Medical Branch at Galveston to provide health care - physical and mental - to the jail's 7,000 inmates.
Key provisions of the three-year managed care contract:
*Save the county $681,344 in first year.
*Develop an electronic medical record system.
*Use a centralized pharmacy in Huntsville that serves the state prison system.
*Provide more care in the jail, instead of transferring inmates to Parkland Memorial Hospital.
*Achieve medical accreditation from the American Correctional Association.
*Maintain staff size of 148 for at least six months.
SOURCES: Dallas County; University of Texas Medical Branch at Galveston
09/05/02
DAY: Thursday
PAPER: THE DALLAS MORNING NEWS
SECTION: METRO
EDITION: SECOND
PAGE: 19A
HEAD: Doctor at jail resigns Mental-health chief cites 'media lies' about
county inmates' care
BYLINE: ED HOUSEWRIGHT
CREDIT: Staff Writer
TEXT:
The psychiatrist in charge of mental health care for the Dallas County jail system has resigned, citing recent news stories that she said unfairly criticized inmate care.
"The media lies and blatant misrepresentations have compromised my safety and irreparably damaged the doctor-patient relationship," Dr. Rita Moss wrote in a resignation letter to her supervisor at the Health and Human Services Department.
Dr. Moss has been on indefinite medical leave because of stress since early last month, when The Dallas Morning News and WFAA-TV (Channel 8) reported that mentally ill prisoners routinely undergo only cursory psychiatric exams and often go without anti-psychotic drugs to control their behavior.
WFAA also reported that Dr. Moss, who has a private psychiatric practice, left early without working full days at the jail.
Dr. Moss' resignation letter, dated Friday, said her last day would be Sept. 13, although she is not expected back before then. She did not return a call seeking comment Wednesday.
"I think it's a shame," said Dr. Karine Lancaster, medical director for the Health and Human Services Department, who received Dr. Moss' resignation letter. "She was doing a good job."
Another jail psychiatrist, Dr. Gonzalo Aillon, also has been on indefinite leave because of stress associated with the news stories, Dr. Lancaster said. WFAA reported that Dr. Aillon didn't put in full days at the jail. He, too, has a private psychiatric practice.
Dr. Aillon, reached at his office, would not say whether he planned to return to his county job.
"I don't have anything to say," he said.
Betty Culbreath-Lister, director of the Health and Human Services Department, said she didn't think Dr. Aillon would be back.
"He's gone," she said. "He went on vacation and said he's not coming back."
Ms. Culbreath-Lister and Dr. Lancaster have defended the quality of mental health care in the jail. But with the loss of Dr. Moss and Dr. Aillon, the county is now down to one full-time and two part-time psychiatrists, they said.
"People aren't going to get the care they need," Dr. Lancaster said.
With the recent negative publicity, it will be difficult to find psychiatrists to work in the jail, she said.
"It's not so easy for people to walk in and think they're going to be held up to the spotlight," Dr. Lancaster said.
Dallas County commissioners, who set the budget for the Health and Human Services Department, have said that jail mental health care is adequate, despite harsh criticism from some mental health advocates.
However, commissioners appear to be on the verge of awarding a contract for all jail health care - mental and physical - to the University of Texas Medical Branch at Galveston.
Commissioners are scheduled to receive a briefing on the proposed contract on Tuesday and vote on it Sept. 17, said county administrator Allen Clemson.

The Galveston medical branch, which provides care to about 145,000 state prison inmates, could improve treatment in the county jail system and save up to $900,000 a year, Mr. Clemson said. Commissioners began to look at privatizing jail health care more than a year ago, before recent news stories.
"Outsourcing is something we've promoted over the last few years for savings, efficiency and better service," County Commissioner Jim Jackson said.
On Friday, several mental health advocates plan to review the proposed three-year contract with officials from the county, the medical branch and Parkland Health & Hospital System. The medical branch could begin providing care in the jail around Nov. 1.
"There are a number of outstanding issues we're concerned about, particularly the question of the prescription formulary," said David Kellogg, public policy director for the Mental Health Association of Greater Dallas. "We, obviously, are very concerned about what has been allowed to happen at the Dallas County Jail in terms of psychiatric services and the complete failure of oversight."
Some advocates and county employees have questioned whether the medical branch can provide better care than the Health and Human Services Department. For instance, the branch has never served county jails, which have a much higher turnover of inmates than state prisons.
"We don't see any significant problems," said Leon Clements, chief administrative officer for the medical branch. "I think it'll be a very high quality product."
E-mail ehousewright@dallasnews.com
09/01/02
DAY: Sunday
PAPER: THE DALLAS MORNING NEWS
SECTION: VIEWPOINTS
EDITION: SECOND
PAGE: 5J
HEAD: Jails cope poorly with the mentally ill
BYLINE: RAMAN GILL, DAVID FINN
COLUMN: RAMAN GILL & DAVID FINN
TEXT:
Rosa Alejo went into the Dallas County jail on a probation violation and came out in a casket. Ms. Alejo, who was afflicted with bipolar disorder, became psychotic after the jail mental health staff didn't administer her regular regimen of medicine. Her descent into psychosis was documented in jail records and came to a horrific end when she apparently choked to death on a mouthful of coffee grounds.
Ms. Alejo's story is tragic in and of itself, but even more tragic is the fact that hers isn't an isolated incident. The Dallas Morning News and WFAA-TV (Channel 8) recently have reported that people with mental illness in the Dallas County jail get only cursory mental health exams and often are denied their medications. That should evoke alarm and concern in anyone who cares about fairness and justice.
There are ways to improve the plight of people with mental illness. The first, and most obvious, is to keep them out of jail. Some have suggested a diversion program, which would help police identify offenders with mental illness and send those people to treatment facilities instead of jail.
Treatment is critical; it is the lack of treatment, in fact, that gets many people with mental illness into trouble in the first place. Certain crimes, like misdemeanor assault and criminal trespass, are referred to in the mental health community as mental health crimes because they often are a result not of any mean-spirited criminal behavior but of untreated mental illness.
We also can make sure that jailed inmates suffering from mental illness get qualified counsel in a timely manner. A committed and caring criminal defense attorney can go a long way toward curbing the impact of abuses like those recently set out in the media by following up on mental health issues and by working to ensure that jail staff provide any necessary medication.
The Texas Fair Defense Act, a comprehensive new law designed to ensure the prompt appointment of qualified attorneys to poor people accused of crime, is a great first step toward improving the representation of people with mental illness in jail because many of those inmates are represented by appointed lawyers.
Even while we know quality legal representation and mental health treatment can help get and keep people with mental illness out of jail, we are coming up on a legislative session in which money is tight. That means the creation of more mental health facilities and additional state funding for indigent defense might be tough to sell.
We have to remind our county officials and legislators that treating mental illness instead of ignoring it is cost-effective. Jails are expensive, and many people with untreated mental illness circulate through the jail system over and over again on misdemeanor charges.
We also must remind them that treating people with mental illness in jail is good for the public at large. The county jail is near popular clubs and restaurants in Dallas. Most people dining in Deep Ellum or the West End would rather come across a person recently released from jail who received quality mental health treatment than someone who is in a psychotic state because he didn't receive his medication in jail. Running into a person with untreated mental illness who is hallucinating or paranoid makes most people feel uncomfortable and sometimes unsafe, even if there is no real threat to them.
More to the point, we must tell our local and state officials that what happened to Ms. Alejo was wrong and that the inhumane treatment of anyone, but especially of the most vulnerable citizens in our society, must be stopped. We have to tell them that creating mental health facilities and improving indigent defense should be priorities this next legislative session, even during these tight budgetary times.
Raman Gill is an attorney fellow at Texas Appleseed, a public interest law center that has produced a handbook for attorneys to help them better represent their clients with mental illness in the criminal justice system. The handbook can be downloaded for free at www.appleseeds.net/tx. David Finn, a former assistant U.S. attorney and Dallas County criminal court judge, now is in private practice.
08/20/02
DAY: Tuesday
PAPER: THE DALLAS MORNING NEWS
SECTION: EDITORIALS
EDITION: SECOND
PAGE: 14A
HEAD: Get Going County jail needs serious psychiatric reforms
COLUMN: EDITORIALS
TEXT:
This much is certain: The Dallas jail system has a mental health problem. Anyone who thinks otherwise, including any county commissioner, is wrong, plain wrong. Anytime a county jail has mentally ill prisoners hanging themselves or plucking out their eyeballs, the situation clearly needs repair. Believe it or not, those tragedies have occurred this month in the Dallas County jail.
The most important reform involves improving a system of community care for mental patients so they don't end up behind bars. Or when they do, they go to an alternative facility where they receive necessary attention. Both options are in the best interest of the patient/offender and Dallas County residents.
One simple place to start is making sure the jail has ready access to a mental patient's records. University of Texas Southwestern Medical Center at Dallas Professor Joel Feiner argues with good reason that North Texas health professionals should be able to use computer networks to speedily get medical information to the jail's mental health staff in order to appropriately treat an offender.
Next, the county needs a jail diversion program for mental health offenders. The National Sheriffs' Association helps communities establish such programs. They determine whether law enforcement officials are properly trained to identify a suspect's mental health problems. They work with community leaders to assess housing options for offenders. And they define a receiving point for anyone with a mental illness who is arrested. Now, such offenders go straight to the Dallas County jail, which is a recipe for the disastrous treatment this newspaper and WFAA-TV have reported on recently.
County Commissioner Ken Mayfield has expressed interest in creating a diversion program for Dallas County. So should Sheriff Jim Bowles. His push could help the county establish a program with the right conditions for mentally ill offenders.
Beyond these reforms, the Dallas County jail needs an ombudsman to track and intervene in the treatment of prisoners who need psychiatric attention. Tim Simmons of the Mental Health Association of Greater Dallas plans to submit an ombudsman proposal to county commissioners, perhaps by week's end. We encourage the commissioners to promptly approve the initiative. An independent voice within the jail could help the county improve its treatment of mentally ill offenders.
Surely, a county of Dallas' stature recognizes that neither it nor its prisoners benefit from deplorable mental health care. When all sides are losing, then the moment has arrived for serious reform. Dallas County clearly has reached such a moment.
08/19/02
DAY: Monday
PAPER: THE DALLAS MORNING NEWS
SECTION: NEWS
EDITION: SECOND
PAGE: 1A
HEAD: Advocates press for changes at jail Mental health officials dispute
county's line that care is adequate
BYLINE: TIM WYATT
CREDIT: Staff Writer
ART: CHART(S): HOW TO GET HELP.
TEXT:
Statements by Dallas County officials that all is well in the jail's psychiatric unit are drawing criticism from mental health officials and more accounts of neglect and mistreatment of mentally ill prisoners.
Dozens of current and former inmates, their families and mental health workers dispute statements by county commissioners and the director of Health and Human Services that psychiatric care in the jail is adequate.
"I'm sorry, but the commissioners are wrong," said Cliff Gay, who suffers from bipolar disorder and volunteers to counsel mentally ill people who are released on probation in Dallas County. "I don't think they know just how extensive the problems are in the jail."
An investigation by The Dallas Morning News and WFAA-TV (Channel 8) earlier this month found that mentally ill prisoners routinely undergo cursory psychiatric exams of two minutes or less and can languish for weeks without anti-psychotic drugs.
Two inmate cases cited - a 36-year-old psychotic woman who died after swallowing toxic amounts of ground coffee and a 32-year-old man who was accused of faking mental illness after swallowing 133 plastic spoon handles
- were deemed to be "very isolated cases" by Dallas County Health Department director Betty Culbreath-Lister, who oversees the jail's psychiatric unit.
Among the more than two dozen accounts of problems told to The News after the county's response were:
*A mother who said she had to fight to get her daughter, who suffers from bipolar disorder, committed to a mental hospital after the jail's psychiatric staff would not administer badly needed anti-psychotic medicine.

*Another mother who said her terminally ill son, also suffering from bipolar disorder, wasn't given more than 20 different medications prescribed to stabilize a wide array of physical and mental problems.
*An attorney who said he had his client transferred to a federal jail in another county after a federal court order failed to sway Dallas County jail doctors to change their prescription for the woman, who was suffering serious side effects from anti-psychotic drugs.
In response to the latest accounts, County Judge Lee Jackson said, "I still believe that the physical and mental health care being provided in our jail system is better than it's been at any time I've been county judge."
Ms. Lister, who did not return phone calls for comment this week, originally described the psychiatric unit as well-funded but dysfunctional. She later said that the unit provides adequate care to mentally ill prisoners.
Ombudsman suggested
Tim Simmons, director of the Mental Health Association of Greater Dallas, said his organization offered last week to pay for an independent ombudsman
- or mediator - to resolve complaints about the lack of proper care or delivery of medicine.
Although commissioners have reconvened a task force of mental health care professionals to examine treatment at the jail, an independent go-between with full access to prisoners, their records and the jail may be the solution for the county, Mr. Simmons said.
"This position wouldn't be to go in and ruin someone's medical career or violate a patient's confidence. It's about getting people the treatment they need," Mr. Simmons said.
Mr. Jackson said an ombudsman is a "very good idea." Dallas County Sheriff Jim Bowles said he might support such a position.
Dr. Rita Moss, head of the jail's psychiatric unit, went on indefinite medical leave two weeks ago because of stress associated with recent criticism, county officials said. Whether Dr. Moss will return to work at the Dallas County Health and Human Services Department was unclear.
Mr. Jackson also said he supports a proposed contract with the University of Texas Medical Branch at Galveston to take over responsibility for medical and psychiatric health care in the jail system. Commissioners could vote on the contract in the coming weeks.
"That contract will allow us to have a more clear accountability. It will allow them to improve the medical staff perhaps more than we've been able to because we have had some vacancies at times that have been difficult to fill," he said.
Sheriff's records show prisoners have filed more than 90 grievances since January about the lack of care in the jail's psychiatric unit. Citing patient-doctor confidentiality rules, officials denied The News access to information about the resolution of the complaints.
The county is facing a civil rights lawsuit filed by Paul Skelton, the inmate who swallowed the plastic spoon handles.
Within the last two weeks, jail incident reports show that one mentally ill inmate hanged himself in his cell and another pulled his eye out during a psychotic episode. Both men had long histories of mental illness. The sheriff's office has not released results of investigations into the incidents, but there has been no indication that the psychiatric staff was at fault.
Substitute drugs
In the case involving the inmate who was transferred to a federal facility, defense attorney Clint Broden said his mentally ill client, facing federal criminal charges last fall, was sent to the county jail by the U.S. Marshal's Service because it contained a psychiatric unit. When the woman arrived at jail, her medicine regimen was stopped, he said.
Doctors then prescribed substitute drugs, which caused panic attacks, tremors and sleeplessness, Mr. Broden said.
"A letter from her psychiatrist of 10 years and a court order from a federal judge wouldn't budge" jail doctors, Mr. Broden said.
After months of wrangling, he got his client transferred to a federal medical facility in Fort Worth, where her original drugs were restarted and her mental condition "was the difference between night and day," he said.
A nurse who has worked inside the Dallas County Jail psychiatric unit said supervisors were so lax about monitoring some shifts that she saw bags of expensive anti-psychotic prescriptions earmarked for inmates littering the psychiatric nurse station. The nurse asked not to be named because she is concerned about retaliation by county officials.
She also said other concerned workers frequently complained to their bosses
- even to Ms. Culbreath-Lister - but that nothing was done.
Dallas County officials have refused to respond to questions about care of specific inmates, citing confidentiality rules.
In two other cases, Christina Mendez and Carol Pendley said their adult children were too psychotic from lack of medication to complain on their own.
Ms. Mendez's 22-year-old daughter, Angel, landed in the Dallas County Jail in March on charges of misdemeanor assault. Her mother said she languished there without anti-psychotic medication for almost four months.
She said when she read accounts in The News two weeks ago about psychiatric care in the jail, she thought she was reading about her daughter.
"Everything was correct," Ms. Mendez said. "I've seen all of that first-hand with my daughter."
Ms. Mendez said she sent lists of her daughter's medications to the psychiatric staff on four occasions. The staff said they never received the lists, she said.
Ms. Mendez said she pleaded with and badgered jail and court officials for four months, after repeated calls to the department went unreturned and conflicting stories from nurses and jail officials about why her daughter wasn't getting medicine. She finally got her daughter a competency hearing so that she could be committed to Terrell State Hospital.
The other mother, Carol Pendley, said her 43-year-old son, Steve, was jailed on a misdemeanor assault charge last summer. She said her son also is in the end stages of liver failure, most likely a result of years of self-medication with alcohol and drugs.
When Mesquite police arrested him in a manic state in July 2001, Ms. Pendley said, he was booked into jail with a grocery sack of more than 20 prescriptions to help him with the complications of liver failure and control the chemical imbalance in his brain.
Ms. Pendley said it was clear days after his arrival in the jail that her terminally ill son's condition had worsened.
"When he came through the door to talk to me, his privates were exposed through a jumpsuit that was too small, and there were feces smeared on his back," she said. "The next 12 days, I watched him deteriorate mentally and physically. He was turning yellow and had no idea what was going on."
Ms. Pendley said she learned that the only medication her son was receiving was one that made his bowels move. At the end of two weeks, Ms. Pendley said, she persuaded officials to send her son to Parkland Memorial Hospital, where she hoped doctors would commit him to a mental hospital.
They did.
After seven days of intensive care to lower toxic ammonia levels in his body, Ms. Pendley took an inventory of the grocery sack of medications released with her son from the jail.
"We counted the pills in the bottles and virtually no medications were missing," she said. "It was obvious they had not been giving him his medications.
"When someone says these kinds of stories are isolated incidents, I say that's ridiculous. We know better than that."
Complaints
An advocacy group says its federal mandate to help resolve problems related to psychiatric care of prisoners in Texas jails has been successful. However, the group says few people know of Advocacy Inc., and jailers aren't required to inform prisoners about it.
Lawrence Priddy, a caseworker in Advocacy Inc.'s Dallas office, said that his group gets "periodic" calls to intervene but does not keep records on the number of complaints received from Dallas County jail inmates.
"But I will say we're not satisfied with the care provided mentally ill prisoners," he said. "They're treated as if their mental illness is a manifestation of their criminality, rather than their criminality being a manifestation of their mental illness."
Complaints registered with the nonprofit organization from Dallas County inmates usually center on undelivered medicine and lack of access to doctors in jails, he said.
Advocacy Inc. investigator Nestor Presas said authorities have always cooperated when complaints are received.
"The inmates who complain to us are obviously focused enough to try to protect their mental state," he said. "But keep in mind the people that are most vulnerable aren't going to call us because they're already psychotic."
Mr. Presas said he believes that the incidents being reported by families and attorneys of prisoners in the psychiatric unit are legitimate claims.
"I'm not satisfied with the explanation that everything is all right in the jail and that these are simply isolated instances," he said.
Staff writers Holly Becka, Jennifer Emily and Ed Housewright contributed to this report.
E-mail twyatt@dallasnews.com HOW TO GET HELP
Advocacy Inc. is a federally mandated organization whose caseworkers can investigate claims of prisoners not getting medications or proper treatment in Texas jails.
The North Texas regional office is at 1420 W. Mockingbird Lane, Suite 450, Dallas, TX 75247. Contact the group at 214-630-0916 or www.advocacyinc.org.
08/11/02
DAY: Sunday
PAPER: THE DALLAS MORNING NEWS
SECTION: EDITORIALS
EDITION: SECOND
PAGE: 3J
HEAD: JAILHOUSE MENTAL ILLNESS
COLUMN: LETTERS
ART: PHOTO(S): A Dallas County inmate.
TEXT:
I'm horrified
Re: "Mentally ill prisoners often go unmedicated - Jail's medical director denies hasty exams, lack of treatment," Aug. 1.
I have never cried upon reading a newspaper article before. But I was so appalled, horrified and deeply ashamed as I read the circumstances under which our mentally ill prisoners are living at the Dallas County Jail. How could treachery be happening right down the road from my North Dallas home?
I feel that I have been a good citizen, contributing to the community, in the seven years I have lived in Dallas. I was a docent at the Dallas Museum of Art for four years and I am a provisional member of the Junior League of Dallas.
I am also bipolar/manic depressive, call it what you will. I am not socially inept, or odd. I simply have a biological illness no less treatable than asthma or heart disease.
I am only too aware of every violent criminal attempting to use this illness as a ticket to freedom. However, the situation at our jail as reported in The Dallas Morning News is beyond deplorable. I am sickened. I am horrified. My tax dollars supply the pay for a person who withholds a patient's medication? Allows an inmate to wallow in her own filth for days on end? I shed tears for those workers with cold indignant hearts who can turn a back on such suffering and pain.
Tell me, please, whom do I call? Whose door do I knock on? To whom do I write? My God, somebody has got to do something.
Tammy Taylor-Roubik,
Dallas
Inexcusable supervision
Re: "Mentally ill prisoners often go unmedicated," Aug. 1.
What kind of director is it who says of the departments under her supervision that: "If they don't do their job, it's on them, not on me"?
Betty Culbreath-Lister is not trustworthy enough to hold her position. It is her job to ensure that departments reporting to her do their jobs. She is accountable for this. This is true of any management position, and to have the person directing the Health and Human Services Department for the county hold this attitude is beyond mind-boggling.
Her charter is to care for the county residents, including those incarcerated. To blow off her responsibility in this manner is inexcusable.
Renee Hetter, Richardson
My friend suffers
Re: "Jail's doctor taking time off - She endured stress from criticisms of care of mentally ill, officials say," Aug. 7.
If it didn't make me so angry, I would laugh at the good doctor's inability to handle criticism.
My friend was in the Dallas County facility for two months in 2000. During that time, he was placed on the appropriate medications for bipolar disorder and received care that was adequate considering the huge number of people who pass through.
However, he managed to have another stay there from April to May 2002. This time was much different. He made requests for medical attention and I called to request that he receive the medications he needed. Even with his medical records there from the previous stay, we couldn't get anyone to see him for evaluation or prescribe the medications they knew he needed. Bipolar disorder does not go away. There is no excuse for blatant abuse in this case.
When he came out this time, he was a different person ... completely out of control and unable to help it because the medication required to keep him chemically balanced had been taken away.
Now he is back in there again. If they do not give his medication to him, he'll never have a chance of staying out.
Dr. Rita Moss should feel extreme stress and shame for such undeniable disregard for people's lives. Several of us are suffering from this one case of abuse. I'm wondering how many more families have been ruined this way.
E.Y. Chapman, Irving The big picture
Re: "Mentally ill prisoners often go unmedicated," Aug. 1.
I found Tim Wyatt's article on psychiatric treatment in the Dallas County Jail a welcome piece of coverage. However, I think that readers, before jumping to the conclusion that Dr. Rita Moss and her staff are incompetent and don't care, should keep in mind the following:
1) A psychiatrist is only as effective as the system in which he operates. A state system committed to cost containment first, second and third puts constraints on what skills the psychiatrist can use and the degree to which they can be used. Superbly trained and highly motivated psychiatrists can be rendered useless - or even harmful - in certain settings.
2) Cost containment is the rage, and many states have turned to for-profit managed care organizations to handle financing of their mental health operations. In such arrangements treatments get diluted, needed medications are withheld (or postponed), individual sessions get shortened, and there is a pressure toward speed as opposed to thoroughness.
3) In one state, Michigan, as more state hospitals were shut down, mental patients began showing up in increased numbers in the prison system. Treatment conditions were abysmal. It took a federal court injunction to ensure adequate treatment.
4) Texas ranks in the bottom end (48th a few years ago) when it comes to money spent per capita for mental illness issues. This is a lot lower than even Michigan.
Mental illness is a matter we all wish would go away. Our public policies reflect a belief that it has gone away because we fund it as if it were a minor problem that can be treated with five-minute evaluations and medications that are out of date. The official rhetoric does not say this, but the behavior - the policies - do.
It would be a mistake to resolve this issue by kicking aside Dr. Moss and her staff as the culprits. It would be an even worse mistake to forget this matter when we go to the voting booths in November.
David Hershey, M.D.,
psychiatrist, Dallas
08/07/02
DAY: Wednesday
PAPER: THE DALLAS MORNING NEWS
SECTION: NEWS
EDITION: SECOND
PAGE: 1A
HEAD: Jail's doctor taking time off She endured stress from criticisms of
care of mentally ill, officials say
BYLINE: ED HOUSEWRIGHT
CREDIT: Staff Writer
TEXT:
The psychiatrist in charge of mental health care for Dallas County jail inmates is on indefinite medical leave because of stress associated with recent criticism, three county officials said Tuesday.
It's unclear whether Dr. Rita Moss will return to work at the Dallas County Health and Human Services Department, said the officials, who asked not to be identified.
Before taking time off, Dr. Moss asked to give up her title as medical director and become a staff psychiatrist with no management duties, officials said. That request was not acted upon before she went on leave.
Last week, The Dallas Morning News and WFAA-TV (Channel 8) reported that mentally ill prisoners routinely undergo only cursory psychiatric exams and often go without anti-psychotic drugs to control their behavior. WFAA reported that Dr. Moss, who also has a private psychiatric practice, did not work full days at the jail.
Dr. Moss' supervisor defended her Tuesday, saying patient care had not been compromised.
Dr. Moss could not be reached for comment Tuesday. The telephone at her private office had a voice message that called the news stories "vicious lies and slander."
"If ... you had planned to leave a threatening or unwelcome message, please be informed that ... the Dallas Police Department will be monitoring all such calls," according to the recorded message. "If you are someone who knows the truth and is giving a message of support, your message is very welcomed."
On Tuesday, the director of the Health and Human Services Department voiced support for Dr. Moss. Betty Culbreath-Lister said she investigated the doctor's work schedule and found that she rarely left work early.
"That happened on isolated occasions," Ms. Culbreath-Lister said. "I found no compromise in patient care."
Also Tuesday, county commissioners had a closed-door meeting with Ms. Culbreath-Lister for more than an hour to discuss mental health care in the jail. Afterward, commissioners said they were satisfied with the care.
"From everything I can determine, the quality of psychiatric care in the Dallas County jail is as good or better now than it has been in the 15 years that I've been county judge," County Judge Lee Jackson said. "There are areas of fine-tuning and improvement possible, but the system overall is working far better."
An investigation by The News and WFAA found that a 36-year-old woman with bipolar disorder died after swallowing her own feces and toxic amounts of ground coffee. She was found in her cell with no pulse in March.
In another incident, a 32-year-old severely depressed inmate swallowed 133 plastic spoon handles and was kept in a chilly isolation cell for nearly a month because doctors thought he was faking mental illness, despite six suicide attempts, according to his attorney.
The investigation also found that since January, inmates have filed more than 90 grievances against the jail's psychiatric department. Most are pleas to see a psychiatrist or complaints that drug regimens were cut off or delayed for as long as three weeks.
Commissioners' support
"It is unfortunate that some attorneys, in advocating for their clients, have presented only a part of the story, and they've given a very misleading impression about the attitude of Dallas County to health care in the jail," Mr. Jackson said.
Ms. Culbreath-Lister said she was pleased that commissioners listened to her account of psychiatric care.
"I explained the system to them, and I think they're comfortable with the management," she said. "We're going to try to do a better job on everything we do, but the system is not going to change."
County Commissioner Mike Cantrell, who served on a jail mental health task force five years ago, said he was reassured about the quality of care after meeting with Ms. Culbreath-Lister.
"I think we're right on target with where we need to be," Mr. Cantrell said.

However, a local mental health advocate said he remained alarmed at psychiatric care within the jail.
"I don't think they have a procedure for ensuring that people are evaluated and put on meds quickly," said Tim Simmons, executive director of the Mental Health Association of Greater Dallas. "The proof really comes from people who have been in jail. I've heard enough to convince me there are problems there."
Despite commissioners' support of Ms. Culbreath-Lister, they are strongly considering a proposal to turn over mental and physical care in the jail to the University of Texas Medical Branch at Galveston.
Officials with the medical school, which serves 140,000 inmates in the state prison system, told commissioners at a briefing Tuesday that they probably would increase the number of medical providers if they are chosen to oversee jail health care.
Possible outside contract
Commissioners said they could approve a contract with UTMB this month to start service Oct. 1.
"I'm hoping this moves forward fast," Commissioner Jim Jackson said. "I think because of their extensive work in prisons, their protocol probably fits our need."
Commissioners emphasized that they have considered privatizing jail health care for more than a year, long before the recent publicized incidents. They said that if they do contract with UTMB, it's not an indication of dissatisfaction with the Health and Human Services Department.
Ms. Culbreath-Lister said she wouldn't mind giving up jail health care responsibilities.
"We have too many other public health issues," she said.
In June, more than 1,300 of the 7,000 Dallas County jail inmates - almost one in five - were receiving some sort of psychiatric care. Most have received diagnoses of - or say they suffer from - depression, bipolar disorder or schizophrenia.
The stories by The News and WFAA said some psychiatric exams lasted less than two minutes - a practice that mental health experts say makes it impossible to determine whether an inmate could harm himself or others.
On Tuesday, the severely depressed inmate who swallowed 133 plastic spoon handles filed a lawsuit in federal court against Sheriff Jim Bowles, Dr. Moss and jail nurse Rene Funk.
The inmate, Paul Skelton, alleges in the suit that he was denied proper psychiatric care and forced to sleep naked on a concrete cell floor. He has been in the jail since August 2001 and has bipolar disorder and seizures, according to the lawsuit.
"As a result of the failure of the Defendants ... Mr. Skelton's mental disability has grown worse," the lawsuit alleges. "He has responded with even violent behavior, in one instance obtaining a weapon and threatening to kill himself."
Sheriff Bowles said Tuesday that he could not comment on pending litigation. He has said that though he's ultimately responsible for all inmates, he's powerless to administer medical care.
Ms. Funk could not be reached for comment.
Staff writer Jennifer Emily contributed to this report.
E-mail ehousewright@dallasnews.com
08/04/02
DAY: Sunday
PAPER: THE DALLAS MORNING NEWS
SECTION: EDITORIALS
EDITION: SECOND
PAGE: 2J
HEAD: No Excuse Dallas jail needs mental health reforms - now
COLUMN: EDITORIALS
TEXT:
The Dallas County jail clearly is not the place for anyone with a mental health problem. This newspaper and WFAA-TV (Channel 8) reported vividly last week on the horrid situation that prisoners with mental health problems encounter at the jail. We need not repeat all of them, other than to say they are cruel and inhumane. No medicine. Sitting naked in jails. Dying after eating coffee grounds and human feces. Third World prisoners could expect more.
The nation's 10th-largest county certainly can treat offenders with mental illnesses better. And Dallas County has a vested interest in doing so. Without adequate care, mentally ill prisoners are likely to commit more crimes after they leave jail.
The reforms must be direct and at several levels.
First, the Dallas County Commissioners Court, plus the Dallas sheriff's office, must continue to embrace the effort by the Mental Health Association of Greater Dallas and other advocacy groups to establish a visiting committee in the Dallas jail. If given regular access to prisoners, outside experts could ensure that prisoners with mental illnesses receive adequate care, including their medicine. The jail now has mental health workers, but they obviously need review. When inmates like Rosa Alejo are found dead in the shower with a mouthful of coffee grounds, something is wrong. Very wrong.
The county must let this committee do its work, no matter the findings. Commissioners Ken Mayfield and John Wylie Price especially should throw blocks for the committee. The two have spoken out on mental health matters.
Second, the commissioners must assess what works. The visiting committee, state District Judge John Creuzot notes, could help through discovering what treatments matter. The commissioners then could glean whether additional resources would help - and, if so, where.
Third, Mr. Mayfield and advocacy groups must quicken their pace on establishing a jail diversion program for mentally ill offenders. Local foundations should consider this initiative a worthy investment, too.
Tim Simmons of the Mental Health Association of Greater Dallas says that a coalition is working with Mr. Mayfield to establish a program that places mentally ill offenders in either short-term or long-term housing. Specialty providers would treat offenders there, much as they do in programs in Houston, Fort Worth and Memphis. This could deter crime more than a lock-and-key mentality does.
Fourth, mental health workers across Dallas should consider the jail as part of the community's system of care. With 20 percent of offenders receiving psychiatric attention, caregivers cannot afford to consider the jail a separate entity. The University of Texas Southwestern Medical Center at Dallas' Dr. Joel Feiner explains that a simple tool like encouraging providers to ensure the jail's psychiatric staff has speedy access to medical information could prevent some problems.
No one wins under a flawed system of inmate mental health care. Not the mentally disturbed offenders. Not the community. Not even their victims. No one. Dallas County leaders must move more quickly and effectively to correct this situation. Now.
08/02/02
DAY: Friday
PAPER: THE DALLAS MORNING NEWS
SECTION: METRO
EDITION: SECOND
PAGE: 37A
HEAD: Local activists deplore jail care Official defends mental health
actions; county plans to meet with her
BYLINE: ED HOUSEWRIGHT
CREDIT: Staff Writer
TEXT:
Local mental health advocates said Thursday that psychiatric care of Dallas County jail inmates is grossly inadequate, and they called for immediate action.
The advocates were responding to an investigation by The Dallas Morning News and WFAA-TV (Channel 8) that found mentally ill prisoners routinely undergo only cursory psychiatric exams and often go without anti-psychotic drugs needed to control their behavior.
"I'm appalled," said David Mitchell, president of the Dallas chapter of the National Alliance for the Mentally Ill. "No doubt it's a lot worse than I thought. It's got to be straightened out."
On Tuesday, Dallas County commissioners plan to meet in closed session with the director of the county Health and Human Services Department to discuss jail mental health treatment.
The director, Betty Culbreath-Lister, said Thursday that care was adequate.
"Anything could be better if you just write a blank check," she said. "In some instances, maybe some people have fallen through the cracks. But I think they get adequate care. It's unfortunate that they don't get as good of care on the street as they do in the jail."
She called two inmate cases cited in The News' and WFAA's investigation "very isolated incidents."
In one, a 36-year-old woman with bipolar disorder swallowed her own feces and toxic amounts of ground coffee. She was found in her cell with no pulse in March.
In the other case, a 32-year-old severely depressed inmate swallowed 133 plastic spoon handles and was kept in a chilly isolation cell for nearly a month because doctors thought he was faking mental illness, despite six suicide attempts, according to his attorney.
Ms. Culbreath-Lister said she would investigate allegations in a WFAA report that Dr. Rita Moss, medical director for the jail's 35-person mental health staff, didn't work full days at the jail. Dr. Moss also has a private psychiatric practice.
Ms. Culbreath-Lister said she would make sure that no mental-health staff members were leaving early.
"If, after my investigation, I find that there's been some misuse of county time, I will take whatever action is appropriate," she said. "The only way I would know if the accounts were accurate would be to have the exempt staff punch a timecard."
In June, more than 1,300 of the 7,000 inmates in the Dallas County Jail - almost one in five - were receiving some sort of psychiatric care. Most have received diagnoses of - or say they suffer from - depression, bipolar disorder or schizophrenia.
County Commissioner Mike Cantrell said he was alarmed by the findings of The News and WFAA. The news stories reported that some psychiatric exams lasted fewer than two minutes - a practice that mental health experts say makes it impossible to determine whether an inmate could harm himself or others.
"We need to get to the bottom of all the facts," Mr. Cantrell said. "A prudent course for the commissioners court is to look at what's been alleged in the news and get an explanation from our management at Health and Human Services."
Tim Simmons, executive director of the Mental Health Association of Greater Dallas, said that a task force of psychiatrists and advocates will begin meeting next month to study ways to improve jail care. A similar task force in 1997 recommended major changes, many of which were implemented.
"Since we've had continued problems in this area, I believe it's in everyone's best interests to have an ombudsman-type position that is independent from the county and the jail," Mr. Simmons said. "They would be there to resolve complaints. We'd be happy to fund it, I believe so firmly in this."
Earlier this year, Dallas County administrators began studying the possibility of privatizing mental health care of inmates.
On Tuesday, commissioners will consider a proposal by the University of Texas Medical Branch at Galveston to take over both mental and physical care within the jail.
The medical school serves 140,000 inmates in the state prison system, said county administrator Allen Clemson. He said the school could possibly provide better care at lower prices.
"I think they bring a very professional approach to this industry," Mr. Clemson said.
After a briefing Tuesday, they could approve a contract with UTMB later this month to start service Oct. 1, Mr. Clemson said.
"They have a track record that's supposed to be extremely good," Mr. Cantrell said. "I'm very much in favor of privatizing the jail physical and mental health."
E-mail ehousewright@dallasnews.com
08/01/02
DAY: Thursday
PAPER: THE DALLAS MORNING NEWS
SECTION: NEWS
EDITION: SECOND
PAGE: 1A
HEAD: Mentally ill prisoners often go unmedicated Jail's medical director
denies hasty exams, lack of treatment
BYLINE: TIM WYATT
CREDIT: Staff Writer
ART: PHOTO(S): (Dallas County Sheriff's Department) Only after Parkland
doctors diagnosed Paul Skelton's mental illness, after nine months in jail,
was he properly medicated.
TEXT:
Mentally ill prisoners in the Dallas County jail routinely undergo only cursory psychiatric exams and often go days or weeks without the anti-psychotic drugs needed to control their behavior, an investigation by The Dallas Morning News and WFAA-TV (Channel 8) has found.
Some exams last less than two minutes - a practice that mental health experts say makes it impossible to determine whether an inmate could harm himself or others.
The family of one inmate with bipolar disorder said the jail's psychiatric unit failed to protect the woman from swallowing her own feces and toxic amounts of ground coffee. She was found in her cell with no pulse in March and pronounced dead at a hospital.
The attorney for a severely depressed prisoner said his client, who swallowed 133 plastic spoon handles, was kept in a chilly isolation cell for nearly a month as punishment because doctors thought he was faking mental illness despite six suicide attempts.
Accounts by inmates, their families, criminal court judges and mental health advocates - backed by jail records obtained by The News and WFAA - found that psychiatric patients behind bars often have medicine withheld or are left naked in cells.
"The danger in prisoners going unmedicated is that you never know what their behavior is going to be. They could kill you and never really be aware of it," County Criminal Court Judge Jim Pruitt said.
Dr. Rita Moss, medical director for the 35-person mental health staff, told WFAA that her department provides excellent care to inmates despite "not enough doctors and too many people who need treatment."
She refused an interview request from The News and referred questions to her supervisor, Dallas County Health and Human Services director Betty Culbreath-Lister.
Ms. Culbreath-Lister described the jail's psychiatric staff as a "dysfunctional" group that has yet to forward a single written complaint to her about any lack of care or mistreatment of prisoners.
"I've given them everything they've asked for in the way of money and resources," Ms. Culbreath-Lister said. "If they don't do their job, it's on them, not on me."
Dallas County Sheriff Jim Bowles said that though he's ultimately responsible for all inmates, he's powerless to administer medical care.
Inmates may be referred to the jail's psychiatric unit by disclosing their mental problems when they are booked, if counselors notice unusual behavior or if they have a documented history of mental problems.
Since January, inmates have filed more than 90 grievances against the jail's psychiatric department. Most are pleas to see a psychiatrist or complaints that drug regimens were cut off or delayed for as long as three weeks.
Social worker Jolie Edery, who said she resigned from her job at the jail in June out of frustration over the treatment of prisoners, said she regularly saw bags of undelivered medicine at nurse stations. She said she rarely saw doctors at the jail except during twice-weekly clinics and constantly consoled mentally ill inmates who complained about not getting medication.
Ms. Edery said problem prisoners were punished by being denied prescribed medicine or put in isolation.
"What's going on in there is simply inhumane," she said. "I found the treatment of the inmates shocking and horrifying. And I believe people in there are at serious risk whether they're clinically depressed or acutely psychotic."
Dr. Moss told WFAA that she would not discuss any specific cases involving mentally ill inmates.
Reforms ignored
Despite increased staffing and the allocation of more money by county commissioners to improve treatment, key reforms suggested in 1992 and 1997 to protect mentally ill inmates and improve their care have been ignored or discarded, some advocates say.
Dr. Joel Feiner, a co-author of the 1997 study who teaches psychiatry at the University of Texas Southwestern Medical Center at Dallas, said it's clear that many of the recommended changes never went into full effect or were set aside. A task force again has been formed to look into the problems, he said.
"Our recommendations were not outrageous; they were benchmarked recommendations," Dr. Feiner said. "Obviously, we're concerned about that, and it's one of the reasons why a task force has been reconstituted."
The recommendations said doctors should spend more time with patients and the county should increase staff in the psychiatric unit and institute a better screening system to identify mentally ill inmates as they are booked into jail.
In June, more than 1,300 of the 7,000 prisoners in the Dallas County jail - almost one in five - were receiving some sort of psychiatric care. Most have received diagnoses of or say they suffer from depression, bipolar disorder or schizophrenia.
The number of mentally ill inmates is higher than in 1997, when a task force of prominent psychiatrists recommended that commissioners add more medical staff members to a jail that had become the largest mental illness facility in North Texas.
The commissioners, having heard a steady call for reform since 1992, complied after mental health advocates documented reports of prisoner mistreatment and neglect similar to those being made now.
Last year, the pharmacy bill for treating mentally ill prisoners was $1.9 million - 86 percent of the pharmacy's total budget.
This year, the 35-member psychiatric unit's payroll came to more than $3.5 million.
That includes salaries for two full-time psychiatrists, four part-time doctors, a psychologist and specially trained psychiatric nurses. A third full-time psychiatrist position is open.
Mental health advocates are asking the county to monitor the treatment that inmates receive and to make sure it's comparable to what they would get for any other kind of illness.
"There's an attitude that once somebody gets in jail, they are less deserving in some way than somebody who's not," Dr. Feiner said. "But here we are dealing with biological illnesses ... no different in that regard than hypertension, diabetes, heart disease, cancer or AIDS."
One of the key recommendations in 1997 focused on giving inmates better care by increasing the time that doctors spend evaluating inmates from five minutes to 20 minutes.
State District Judge John Cruezot said he learned during a meeting in late May with Dr. Moss that doctors weren't coming close to meeting that goal.
Dr. Moss "indicated that occasionally she spends three or four minutes with a patient," Judge Creuzot said. "But most of the people she sees - the vast majority of people - she spends about a minute evaluating."
Dr. Moss denied telling the judge that she diagnoses patients' conditions in one or two minutes.
"That would be most unusual," she told WFAA. "It takes longer than that to do the paperwork."
Medication disrupted
Family members, inmates and advocates say a lack of proper medication is a huge problem in the jail.
Members of Rosa Alejo's family said the disruption of her longtime medication regimen contributed to her death in March. Jailed in February for violating probation on felony drug possession, the 36-year-old woman with bipolar disorder told counselors of her illness and listed the medications she had been taking for the last 10 years.
Ten days later, Ms. Alejo told relatives that she was still without her regular medicine and was scared something would to happen to her. Within five days of her arrest, jailers began documenting Ms. Alejo's mental deterioration.
Jailers noted that she began pulling her hair, pounding her head against the window of her single cell in the psychiatric unit and screaming for her medication.
They soon saw her eating toilet paper, pushing her own waste out her cell door and smearing it on the glass. She then started eating her own waste and bags of coffee grounds. Ms. Alejo also was seen standing under the shower in her cell with her mouth open to let water pour down her throat.
Each time jailers notified members of the psychiatric staff, they responded with injections to temporarily calm her, according to jail records.
Her brother, Rocky Alejo, said that when he visited his sister after two weeks in jail, she told him: "Rocky, these people don't care. They think I'm some crazy woman in here."
On March 5, jailers found Ms. Alejo face down in the shower with no pulse, her mouth full of the ground coffee. In her chart earlier that day, a doctor had written, "Return to clinic in two weeks." She had been scheduled for a court competency hearing the next day.
An autopsy called the death an accident. Mr. Alejo bristles at that.
"They knew what medications she took, they knew when she needed her medication," he said. "They just didn't follow up, and that's why she passed away. We feel they killed her."
Dr. Moss declined to comment on any specific case, citing rules on doctor-patient confidentiality.
Problems in court
Judge Pruitt said he has encountered problems with unmedicated prisoners awaiting trial in his court.
He said he twice had to declare incompetent a woman facing misdemeanor charges. She was sent to Terrell State Hospital for treatment because the jail's psychiatric staff was unable or unwilling to keep her medicated, the judge said.
After apologizing to the woman's family for her condition in the second incompetency finding, the judge turned to the psychiatric staff.
"I told them I wasn't going to apologize to the family again," Judge Pruitt said. "And if I heard of someone else in my court not getting their medications, someone was going to jail."
Judge Pruitt also said prisoners were being blamed for refusing their medicine even if they were asleep or in court when nurses brought it around.

The judge said things changed when he threatened to subpoena each nurse to testify about an inmate's refusal to take medication.
"All of a sudden I didn't have one person complaining they had been passed over for medication," he said.
Judge Pruitt said he doesn't know whether the psychiatric staff is "overwhelmed or just doesn't care."
"But if you don't care about these people, and it's not your calling, you need to go do something else," he said.
'Suicide by cop'
Paul Skelton's history of manic behavior and suicide attempts goes back further than his six most recent tries to kill himself while in the Dallas County jail.
Within two months of being arrested in August 2001 on parole violations, the 32-year-old truck driver who had no history of violent crimes faced attempted capital murder charges. He tried to kill a jail guard watching him as he was being treated for an injury suffered during an epileptic seizure.
Mr. Skelton said the idea was to commit what's commonly called "suicide by cop." He hoped that by trying to take the guard's gun, the guard would respond by killing him.
To this day, however, jail records obtained by Mr. Skelton's lawyer, David Finn, say he displays "no evidence of psychiatric problems."
The Parkland Memorial Hospital emergency room psychiatric team disagreed after he was admitted for gallbladder surgery in May. A radiologist at Parkland spotted a bizarre image while scanning Mr. Skelton for the surgery. The CAT scan showed he had swallowed 133 plastic spoon handles.
Doctors there then determined that Mr. Skelton was mildly psychotic and suffered from bipolar disorder and depression. Only after that diagnosis - nine months into his jail stay - was he given anti-psychotic drugs.
When he was returned to the jail in June, he was put back in a single cell naked, his surgical wound open and packed with gauze. The unchanged dressing on his wound reeked, he looked gaunt, and he was shaking from sitting naked in a frigid cell on suicide watch, his mother said.
When Mr. Finn, a former county criminal court judge, began requesting his client's jail psychiatric records to prepare for trial, Mr. Skelton's anxiety medication was increased and he became more lucid.
Still, Dr. Moss' instructions were to keep him on suicide watch for the remainder of his incarceration in Dallas County with a "paper drape only."
Mr. Skelton, saying he was clear-headed for the first time in months, pleaded guilty last week to a lesser charge of aggravated assault and received a 15-year prison term. Mr. Finn said he thinks a jury would have acquitted Mr. Skelton if it were shown the lack of care he received when he first arrived in jail.
Mr. Skelton said he agreed to the plea bargain because he didn't want to take a chance on a life sentence and he wanted out of the jail's mental unit.
"This is cruel and unusual punishment," Mr. Finn said. "It's also something prohibited by Texas jail standards and something that civilized society shouldn't be doing."
Staff writer Holly Becka contributed to this report.
E-mail twyatt@dallasnews.com
03/15/01
DAY: Thursday
PAPER: THE DALLAS MORNING NEWS
SECTION: METRO
EDITION: THIRD
PAGE: 21A
HEAD: Meningitis vaccine given to prisoners Dallas County inmate who died
Tuesday might have had disease
BYLINE: Jennifer Emily
CREDIT: Staff Writer
ART: PHOTO(S): Solomon Moore ... died Tuesday; officials think he may
have had meningitis.
TEXT:
Dallas County jail and health department officials provided antibiotics and vaccines Wednesday for prisoners who came into contact with an inmate whose death may have been caused by meningococcal meningitis.
The inmate, Solomon L. Moore, 24, died late Tuesday at Parkland Memorial Hospital.
About 23 inmates housed in the West Tower of Lew Sterrett Justice Center were given the antibiotic and isolated from other inmates, said Investigator Don Peritz Jr., a Sheriff's Department spokesman.
Mr. Moore's fatal illness would be the first meningitis case at the jail, said Dr. Karine Lancaster, medical director for Dallas County Health and Human Services.
Mr. Moore was in his cell Tuesday when he complained of a fever and rash, she said.
He died about 11 p.m. Tuesday at Parkland.
If meningitis is confirmed as the cause of Mr. Moore's death, it would be the first fatality in Dallas County this year blamed on the disease. There have been 12 confirmed cases of meningococcal disease in the county this year, Dr. Lancaster said. In 2000, there were 30 cases.
The type of meningitis thought to have caused Mr. Moore's death is the same kind linked to 41 cases, including four deaths, in late 2000 and early 2001 near Houston.
Mr. Moore was booked into Lew Sterrett on Jan. 2 from Vernon State Hospital on a warrant for possession of a controlled substance, Investigator Peritz said.
Dr. Lancaster said that Mr. Moore could not have contracted the disease at the hospital, because the incubation period is between two and 10 days.
About 10 to 15 percent of the population carry the bacterium, Neisseria meningitidis, in their mouths and throats without getting sick.
Meningitis is an infection of the spinal cord fluid and the fluid that surrounds the brain, according to the federal Centers for Disease Control and Prevention.
Meningococcal meningitis is a particularly severe form of the disease that is caused by bacteria and can be treated with antibiotics if it is caught early enough.
Nationally, the CDC records about 2,000 cases of meningitis each year.
About 10 percent of patients die despite receiving antibiotics early in the illness.
Of those who survive, an additional 10 percent suffer severe aftereffects, including mental retardation, hearing loss and loss of limbs.
Viral meningitis is less severe and resolves itself without specific treatment. A spinal tap can determine the type of meningitis.
The bacteria are spread through kissing, coughing or prolonged contact, Dr. Lancaster said.
"It's common in recruit camps and college dorms because people are housed so close together," Dr. Lancaster said.
01/10/99
DAY: Sunday
PAPER: THE DALLAS MORNING NEWS
SECTION: NEWS
EDITION: HOME FINAL
PAGE: 27A
LENGTH: 23
HEAD: County aims to keep mentally ill out of jail New workers will try to
prevent repeat offenses
BYLINE: Ed Housewright
CREDIT: Staff Writer of The Dallas Morning News
ART: PHOTO(S): (The Dallas Morning News: Russell Bronson) Michael
Mohammed and Jubal Shaw are inmates in Lew Sterrett Justice Center's behavioral observation unit. They could be aided by an increased jail
psychiatric services budget.
TEXT:
Michael Mohammed is what county mental health officials call a "frequent flier."
Mr. Mohammed, who suffers from paranoid schizophrenia, says he's been booked into Lew Sterrett Justice Center up to 20 times in the last nine years, mostly for minor offenses.
This month, Dallas County Commissioners began a $650,000 effort to curtail the costly visits by Mr. Mohammed and many other mentally ill inmates on charges such as disorderly conduct and criminal trespassing.
Commissioners doubled the number of jail psychiatrists to four and added two counselors, two social workers and an additional psychiatric nurse to try to stabilize prisoners while in custody. In addition, Mental Health Mental Retardation officials will work with inmates after release to make sure they stay on anti-psychotic medication and keep their appointments at MHMR clinics.
Commissioners approved the 107 percent increase in spending on jail psychiatric services after a critical task force report last summer. Seven local psychiatrists said that "basic resources must be increased to permit a minimally adequate standard of psychiatric care." Commissioners said that spending more on mental health services may lower the county's expense of jailing the mentally ill.
"I think it's going to make a tremendous difference," County Commissioner Mike Cantrell said of the changes. "By spending money on some of these people, like caseworkers and psychiatric counselors, hopefully we're going to be able to break the cycle on some individuals as well as move them through the system quicker."
Dr. Ken Arfa, the jail psychiatric director, said the changes would allow doctors to spend more time with mentally ill inmates and communicate better with their families. The jail psychiatric staff sees about 700 mentally ill inmates a month, he said.
Patient endorsement
Mr. Mohammed, who has been at Lew Sterrett for four months this time, said jail mental health services help him and he would welcome follow-up by MHMR once he's released. He's assigned to a special area for the mentally ill, who often are more disruptive than other inmates and more likely to commit suicide, jail officials said.
"I definitely need help, and I'm getting it now, but I need it continued," said Mr. Mohammed, 47. "Sometimes I feel I'm becoming normal, and I think I don't need my medication. But this time I know for a fact I need to stay on my medication."
Another inmate also said he's benefited from anti-psychotic medication in jail and thinks he can remain stable with monitoring.
"I have come a long way," said Jubal Shaw, 24. "I was having unusual thoughts and mind functioning. I was kind of confused. Hopefully, I'll get out and get back into the ballgame and into the work force."
Across the country, jails now house many mentally ill people. Often, they have been released from state psychiatric hospitals as part of an ongoing trend to deinstitutionalize the mentally ill, experts say.
They frequently become homeless and fight drug and alcohol abuse as well as their mental illness, Dr. Arfa said. Soon they begin a cycle of arrest and re-arrest for petty crimes.
While in jail, many mentally ill inmates show great improvement with new anti-psychotic medications and regular visits with jail psychiatrists, Dr. Arfa said. However, once they're released, they often have no support system, get off their medication and relapse.
Now, an MHMR team led by a psychiatrist will intensely monitor 40 people who frequently come and go from Lew Sterrett. Most commonly, mentally ill inmates are men in their 20s and 30s, Dr. Arfa said.
"We will help stabilize their housing and their compliance with treatment and really try to change the pattern of the illness," said Dr. Conway McDanald , medical director of Dallas County MHMR. "Ultimately, we'd like to get these people as far along in life as possible, and a job would be the ultimate. Probably most of the people we start with are not going to be ready to be employed."
Jailers' burdens
A Sheriff's Department report describes the problems that mentally ill inmates often present to jailers.
"There is rarely any warning when these inmates might go into a physical or emotional tirade," it says. "Their demeanor is often unaffected by a spray of pepper mace. . . . Every time an officer goes into a tank he has another officer with him. . . . At times some of these inmates are not allowed access to running water because they tend to flood their cells, tanks, or hallways."
On a recent visit, several jailers were mopping up a cell that had been intentionally flooded by mentally ill inmates.
In one area for the mentally ill, several inmates sat on tables and watched cartoons on TV. One man had stripped off his jail jumpsuit and was walking around barefooted in boxer shorts.
In the women's area, one inmate walked unsteadily and was led around a cell by another inmate. The woman, a "frequent flier," has almost daily seizures, a jail official said.
The Mental Health Association of Greater Dallas, which first complained about the level of psychiatric services in 1992, supports the county's plan to improve care, said Tim Simmons, public policy director.
"As a rule, these aren't folks who go out and maliciously commit crimes," Mr. Simmons said. "They are people with mental illness who are having a lot of different problems. If we're ever going to stop this cycle of repeat offenders, we're going to have to deal with the fact that they have mental illness."

08/05/98
DAY: Wednesday
PAPER: THE DALLAS MORNING NEWS
SECTION: EDITORIALS
EDITION: HOME FINAL
PAGE: 22A
LENGTH: 10
HEAD: Jail Mental Health Report confirms previously acknowledged
inadequacies
COLUMN: EDITORIALS
TEXT:
In 1992, mental health advocates stood on the steps of the county's largest jail and decried the dismal services available to mentally ill inmates. Hundreds of prisoners were booked daily, and as many as 10 percent of them were mentally ill. Yet the county provided only 22 hours of psychiatric and psychological services per week in the jails.
Services have improved _ some. The county jails have the equivalent of one full-time and one three-quarter-time psychiatrist. Inmates are screened for mental illness during intake.
These steps, while important, are inadequate. A panel of independent psychiatrists, appointed by Dallas County Judge Lee Jackson and familiar with public mental health systems, recently found that the jail mental health staff remains severely overburdened. Jail psychiatrists carry caseloads of 300 to 400 inmates. There is only one jail nurse dedicated solely to psychiatric care.
There are other problems. Mentally ill inmates sometimes go naked because jailers don't have or won't distribute paper gowns. Caseworkers have so many other duties they don't have time to line up services that might prevent inmates with mental illness from being re-arrested. Inefficient handling of prescriptions means the jail staff throws away leftover prescriptions _ a process that wasted $38,000 in medications in one month.
The panel's 16-page report contains more than two dozen carefully considered suggestions. Increased staffing would be expensive _ though the county will recoup some money by preventing hospitalizations and re-arrests of minor offenders with mental illness.
Long-term improvement also requires administrative change. Right now, the county hospital district pays for jail health services, but its administrators don't have the freedom to select who provides the care. Dallas County Health and Human Services Department employees staff the jail.

That isn't the right fit. The county Mental Health and Mental Retardation system would be a more logical group to provide jail mental health. These staff members have more expertise handling indigent, chronically mentally ill people, including offenders, and a greater awareness of related community services.
It is realistic to expect adequate psychiatric care in jail. County commissioners must decide that it's important _ and the U.S. Justice Department says decent mental health care in jail is important _ and then give the county hospital district the support and freedom to improve it.
08/01/98
DAY: Saturday
PAPER: THE DALLAS MORNING NEWS
SECTION: NEWS
EDITION: HOME FINAL
PAGE: 35A
LENGTH: 19
HEAD: Dallas jail lacks staff to treat mentally ill, panel finds Facility
doesn't meet minimum standards, doctor says
BYLINE: Laura Beil
CREDIT: Public Health Writer of The Dallas Morning News
TEXT:
Most mentally ill inmates at the Dallas County Jail don't receive even a "minimally adequate standard of care," largely because the jail psychiatric staff is spread too thin, an independent team of doctors has found.
The load of a full-time psychiatrist in the Dallas County Jail exceeds 300 to 400 inmates and allows only about five to 10 minutes for an initial evaluation, according to a report sent to County Judge Lee Jackson in July.
The Lew Sterrett Justice Center "does not in any way meet national minimum standards for what should be in a jail," said Dr. Barry Mills, a forensic psychiatrist in Fort Worth who served on a task force Mr. Jackson assembled last fall.
While praising the work of doctors and nurses at the jail, Dr. Mills said "they just don't have anywhere near the staff they need to do what they need to do."
Mr. Jackson said that the county is still evaluating the report and that it is not yet clear how many of its suggestions will be followed. He formed the panel after patient advocates approached him with concerns about the treatment of mentally ill inmates. The seven-member committee was headed by Dr. Douglas Crowder of the University of Texas Southwestern Medical Center at Dallas.
Among the task force's 28 suggestions were recommendations that the county add at least two more psychiatrists, effectively doubling the number of doctors; four more registered psychiatric nurses; and four master's-level social workers to the jail health staff.
"In general, the committee found that . . . jail psychiatrist Ken Arfa and his staff have responded rather heroically to the inordinate demands placed on them by massive numbers of psychiatric patients who are incarcerated," the report stated in part. "Nevertheless, however competent the psychiatric staff may be, basic resources must be increased in order to permit a minimally adequate standard of psychiatric care to be delivered to inmates."

Even the recommended staffing increases, the report said, would still leave caseloads "far above what the U.S. Department of Justice consultants recommended as the maximum for a jail psychiatrist" during an investigation last fall of the Los Angeles County Jail.
Dr. Crowder said that in addition to improving care after arrest, inmates need better care after release. Many are set free - frequently just after midnight, when their release date arrives - but are not offered ample treatment in the community, he said. Back on the street, these patients often commit petty crimes and find themselves in jail again.
"If I were going to pick one area for improvement, I would pick the after-care, the social component," Dr. Crowder said. Without good treatment in neighborhoods, "you're going to be patching things up for the moment."
Mr. Jackson said he has sent the document to administrators at Parkland Health & Hospital System.
"It's best if they're the ones to recommend a plan," he said of Parkland officials, because they are medical experts and fund the jail health program. While some of the report's recommendations affect the budgets of other county agencies, most would fall on Parkland.
"On its face, it all appears to be perfectly reasonable," Karen Cawley, Parkland's chief of clinical operations, said of the task force report. She is now calculating the cost, a figure that she predicted "isn't going to be cheap."
"We're going to make every effort to implement them," she said of the recommendations.
While Parkland pays the bill for jail health services, the county's Health and Human Services Department operates the program and makes the staffing decisions. Betty Culbreath, director of Health and Human Services, said she has not yet seen a copy of the report.
Patient advocates who pushed for the investigation said they are pleased to see the results.
"It definitely confirmed our fears," said Clare Hudspeth, executive director of the Mental Health Association of Greater Dallas. "I would publicly applaud Judge Jackson for appointing the blue-ribbon panel that he appointed."
In addition to Dr. Mills and Dr. Crowder, the task force was made up of area psychiatrists Kenneth Dekleva, Mitchell Dunn, Joel Feiner, Saundra Gilfillan and Conway McDanald.
"We are eager to see if we can't get some funding changes to implement some of the recommendations," Ms. Hudspeth said. "The revolving door of people in the criminal justice system is very costly in economic terms and in human terms."

11/04/97
PAPER: THE DALLAS MORNING NEWS
SECTION: NEWS
EDITION: HOME FINAL
PAGE: 1A
LENGTH: 48
HEAD: LOCKED IN, LOCKED OUT Patient advocates, county officials often
clash over the level of mental health care necessary in jails
BYLINE: Laura Beil
CREDIT: Public Health Writer of The Dallas Morning News
SERIES: ILLNESS IN THE SYSTEM
ART: PHOTO(S): (1-5 DMN: Andy Scott) 1. Mark Hayes takes a cigarette
break in the activity room on the psychiatric floor of the Tarrant County jail. Mr. Hayes, who is serving a nine-month sentence for delivery of a controlled substance, is being treated for schizophrenia. This is his fifth trip through the criminal justice system. 2. Inmates carry out their daily routines in the section of the Dallas County jail reserved for mentally ill prisoners. "It's a very depressing situation, " said Northwestern University researcher Linda Teplin, who has studied the incarcerated mentally ill for two decades. "Jails were never designed to be mental hospitals." 3. Randy Ainsworth receives his daily dose of medication from nurse Cynthia Simms at the Tarrant County jail. Mr. Ainsworth, who is serving a sentence for aggravated assault, suffers from depression. 4. From left foreground: Psychiatrist John Stafford, psychologist Mike Hepler and charge nurse Dorothy Williams discuss the case of Kenny Thomas (right) at Houston's Harris County Jail. Mr. Thomas is undergoing treatment for dementia caused by HIV and is serving a three-month sentence for burglary. The jail offers group activities and counseling sessions for inmates.5. A Houston jail inmate prays along with Bobby Cox (kneeling), associate chaplain of the Harris County Jail, during a worship service in the area of the lockup
reserved for the mentally ill.
TEXT:
Third of four parts
The largest mental institution in the region dominates a corner of Industrial Boulevard just outside downtown Dallas. Most people know it as the county jail.
On a given day, as many as 750 mentally ill people, twice the population of the nearest state hospital, are wards of the Dallas County Sheriff's Department.
"It's a very depressing situation," said Northwestern University researcher Linda Teplin, who has studied the incarcerated mentally ill for two decades. "Jails were never designed to be mental hospitals."
Yet that is just what they are becoming. In Dallas and other cities, many people with mental illness, often virtually invisible to the rest of the world, end up getting regular treatment from a jail cell. And as the overall number of inmates rises, the quality of jail care in Dallas and other cities can become an explosive subject.
Advocates complain that many officials ignore the needs and vulnerability of the mentally ill in their care. And jail authorities often say they have been overloaded with people who would be better served elsewhere, and that they are blamed for locking up those they have no power to release.
Many jails across the United States have been hit with lawsuits and federal investigations to improve conditions. And even when official action isn't taken, patient advocates and county officials often clash over the level of mental health care necessary in what is, in the end, a correctional center and not a hospital.
Often the disagreements occur over screening as well as treatment programs. Mental illnesses can go unnoticed in a busy jail, and many medical professionals say the mentally ill will become lost if no one looks for them. Dr. Teplin's studies of the Cook County Department of Corrections in Chicago have found that only about 37 percent of men and 24 percent of women with serious mental illnesses receive treatment in jail.
Such complaints are heard in Dallas as well. "They didn't give me no medicine the whole time I was down there," contended Ronnie Harris, a Dallas man with schizophrenia who spent three weeks in the Lew Sterrett Justice Center this summer on a criminal trespass charge. He said he slept under his bunk, feeling safer tucked into a personal hideout.
Yet for other reasons, Mr. Harris said he didn't mind blending in with the general population. Advocates say that when jail authorities do recognize the mentally ill, sometimes those patients fall victim to stigma and abuse. In Los Angeles County, home to the nation's largest jail system, mentally ill inmates must wear specially colored jumpsuits. Federal investigators reported this year that they heard numerous accounts of "kicks, punches, beatings and sexual assaults" by Los Angeles deputies and other inmates.
Mental health advocates in Dallas have leveled their share of criticism at local authorities. In 1992, the Mental Health Association of Greater Dallas convened a news conference outside the jail, blasting staffing levels and what it called an insensitivity to patients' welfare. In 1995, a multi-agency task force report about mentally ill inmates in Dallas County pointed out that on Thursdays alone, when the jail has a regularly scheduled clinic, more than 100 patients file through.
But things are better than they used to be, advocates say.
"We have more resources there," said Jill Ferrell, executive director of the mental health association. She says, however, that her organization still hears pleas for help from inmates, their families and their attorneys, who say patients do not get adequate care.
For example, she said, she and her colleagues had been assured that the jail had enough personnel to monitor inmates as they take their medicine. Yet last year, a man committed suicide by secretly stockpiling his anti-depressant medication until he had enough to kill himself in one swallow. In September, another man attempted suicide with the same strategy, by reportedly taking 84 anti-depressant pills at once.
Advocates such as Ms. Ferrell often compare the Dallas facility to the Harris County Jail in Houston. With an inmate population ranging near or above that of Dallas County, it has a full-time psychiatric staff more than six times as large. The Harris jail offers group activities and counseling sessions for inmates.
"I'd like to think we are a leader in the forensic standard," said Walter Rowe of the Mental Health/Mental Retardation Authority of Harris County and head of the jail mental health program.
The Dallas County jail's full-time psychiatric staff has fewer than 12 people. However, Dallas County officials say that they are satisfied with the level of psychiatric care and that critics are making unrealistic demands to satisfy their own agendas.
"Everybody in the jail is checked on if they have a medical problem," said Betty Culbreath, director of Dallas County Health and Human Services, which runs the jail medical program. She said that, given the limitations of a jail and the fact that patients stay a relatively short time, psychiatrists can do little beyond making certain that patients get their medicine.
"It ain't no magic that you can do by seeing a psychiatrist," Ms. Culbreath said. "You ain't in Timberlawn."
Jail psychiatrists, she said, "are there strictly to keep them stable and monitor their medicine and make sure they got it, or prescribe it if they come to jail without it."
So far, all of Ms. Culbreath's recent requests for staff increases have been honored by Parkland hospital, which pays for jail health care but does not oversee it. "If there are significant concerns, we would be willing to work with the county to address them," said Parkland's chief executive officer, Dr. Ron Anderson. "We take seriously what some of the advocates have said."
However, he added: "I think it needs a more comprehensive view. I think a community problem needs to be fixed in the community."
Ms. Culbreath said that Dallas inmates should not expect weekly counseling sessions, as if the jail could operate on the level of a regular psychiatrist's office. "There's no way they can possibly do that."
The Houston jail, she said, offers more because it has been forced to do so. In the 1970s, federal authorities ordered the Harris County sheriff to improve all medical care there.
However, Harris County's Mr. Rowe maintained that the federal action affects all correctional facilities, not just Harris County's, and the extra measures that have been taken are out of concern for "the lives that have been put in our hands."
Tarrant County Corrections Center in Fort Worth, with a full-time mental health staff of nine, offers group sessions and some counseling to its 200 to 300 mentally ill inmates, said Ramey Heddins, who manages the jail care program for Tarrant County Mental Health/Mental Retardation.
"When you spend 45 minutes to an hour with a person, you're not just dispensing medicines," he said. "We're not trying to replace the psychiatric services in the county," he said, but rather to tend to the population in their care.
Agreement over the quality of jail care might be easier to find if experts had specific recommendations about staff and services. The American Psychiatric Association has issued extensive guidelines for correctional health care but points out that "staffing levels are virtually impossible to set with any objective formula or standard that has general applicability."
In their investigation of the Los Angeles County Jail, authorities from the U.S. Department of Justice said a jail psychiatrist should not have a patient load exceeding 75 to 100 inmates. One full-time and two part-time psychiatrists at the Dallas jail care for a patient load that earlier this fall totaled 750 mentally ill inmates, with 410 of them in the jail's designated observation wards. Two part-time medical residents and a part-time psychologist also circulate through the jail.
Federal investigators in Los Angeles said that one of the most troubling aspects of the jail there was the fact that some mentally ill inmates were in lockdown for all but one hour of the day without access to many activities available to other inmates.
On a psychiatric floor of the Tarrant County Jail, the least stable mentally ill inmates are let out three at a time to a recreation area, where they can stretch their legs, get some coffee and watch television. On another side of the room, inmates in better health are released six at a time. In other areas, inmates mingle throughout the day, both with each other and with guards.
Because the mentally ill are so often repeat customers, the deputies know many inmates by name. It is an odd role, one of the officers says, to be custodians of people largely because they are abandoned by everyone else.
"This is the result," said guard John Beaman. "They wind up here."
He motions to one cell door.
"That guy over there, he's mentally retarded," Mr. Beaman said. "Why the hell is he in jail?"
Probably for something trivial, experts say. Most people with mental impairments are arrested for petty crimes, such as trespassing or urinating in public. Research also has found that about two-thirds of them have substance-abuse problems.
But it is difficult to say whether good treatment in jail keeps patients from getting arrested again, said Dr. Hank Steadman of Policy Research Associates in Delmar, N.Y.
Dr. Steadman, a national expert on jail health care, said communities should not try to repair an eroding mental health system by shoring up care in the jail. Nevertheless, services for people in jail should have "a higher standard than someone who is free in the community," he said, because jailed people are deprived of freedom.
Often standards aren't set at all, said Dr. J. Douglas Crowder, a forensic psychiatrist at the University of Texas Southwestern Medical Center at Dallas.
"It's not a conscious decision," said Dr. Crowder, who supervises the psychiatric residents at the Dallas jail. "We'd do better if there were a conscious decision."
Ms. Culbreath of the Dallas County health department said she doubts whether there is a push for serious study to find out whether the level of care in the jail actually helps patients stabilize when they are back out in the community.
"They're not even interested in outcome," she said of mental health advocates. "All they're interested in is whining about what they don't have."
But Ms. Ferrell of the mental health association said that studies of jail psychiatric services are scant from of a lack of research money, not a lack of interest. When it comes to publicly funded projects, she said, inmates are "a population that's hard to get sympathy for."
Ms. Culbreath and others say that the only long-term solution is to keep the mentally ill from landing in jail in the first place.
"We should do better with our mentally ill citizens while they're out here," she said, "not wait until they get in the jail."
11/02/97
PAPER: THE DALLAS MORNING NEWS
SECTION: NEWS
EDITION: HOME FINAL
PAGE: 1A
LENGTH: 61
HEAD: A HOLDING PATTERN Criminal justice system - with jails caught in
middle - have become custodians of the mentally ill
BYLINE: Laura Beil
CREDIT: Public Health Writer of The Dallas Morning News
SERIES: ILLNESS IN THE SYSTEM
ART: PHOTO(S): (1. - 6. DMN: Andy Scott) 1. Some of the more than 400
mentally ill inmates at the Lew Sterrett Justice Center who stay on designated observation floors line up in their cells. The Dallas County lockup has more psychiatric bed space than the nearest state mental hospital in Terrell. 2. Richard Peraza of Fort Worth peers out of his high-security containment cell at the Tarrant County Jail. Mr. Peraza, jailed on assault charges, says he hears voices. Doctors say that the stress of confinement alone can tighten the grip of illness, and that a mental impairment can leave a person vulnerable to abuse. 3. Mark Hayes is serving a nine-month sentence for delivery of a controlled substance in a section of the Tarrant County Jail reserved for the mentally ill. Mr. Hayes is being treated for schizophrenia. 4. Associate Chaplain Bobby Cox leads a group worship service at Houston's Harris County jail. The jail, which was the target of a lawsuit in the 1970s to improve its overall medical care, has more than 80 people on its psychiatric staff to care for a comparable number of inmates. 5. Kenny Thomas, who spends his time in the Harris County jail's area for the mentally ill, is serving a three-month sentence for burglary. Mr. Thomas is being treated for dementia resulting from HIV, the virus that causes AIDS. 6. Dr. Michael Pittman, psychiatrist at Dallas' Lew Sterrett Justice Center, meets with a prisoner to discuss his condition and monitor his treatment. Debate continues over the quality of mental health care expected in a law enforcement center. Dallas County has a full-time psychiatric staff of fewer
than 12. CHART(S): Illness in the System.
TEXT:
.
First of four parts One Saturday in September, Chuck Woodruff got arrested outside Parkland hospital. Security officers complained he was panhandling and reeked of alcohol, so he was booked into the county jail.
It was his 19th arrest.
The 35-year-old Dallas man was given a bunk, along with the medicines that lift him from a suicidal despair. Like many of the several hundred mentally ill people incarcerated with him, Mr. Woodruff is as familiar with jailers as he is with doctors.
County jails, built as houses for criminals, have reluctantly become depots for the mentally ill. National surveys estimate that nearly 700,000 people with diagnosed mental illnesses are taken to jail each year, more than nine times the number found in public mental hospitals at any one time.
"We are the biggest mental hospital around," Dr. Ken Arfa, the psychiatrist at the Dallas County jail, said wryly. On any given day, his staff monitors about 750 inmates known to be mentally ill. More than 400 of them stay on designated observation floors, giving Lew Sterrett Justice Center more psychiatric bed space than the nearest state mental hospital.
Incarceration of the mentally ill has become especially visible in Texas, which has imprisoned a larger percentage of its total population than any other state - larger, even, than any Western democracy. Between 1988 and 1994, the last year for which Justice Department figures are available, Dallas County's jail population rose faster than any other county's in the United States. And a 1995 study, from a coalition led by the Mental Health Association of Greater Dallas, found that about 15 percent of local inmates are known clients of the state's public mental health services.
The problem touches every tier of law enforcement, from patrol cops to judges. Many cities, such as Memphis, Tenn., and Los Angeles, have trained special squads of police just to respond to calls involving people with mental illness. In Dallas, the court system has seven probation officers with entire caseloads of offenders who are either mentally ill or retarded. Jails, meanwhile, are in the middle, and have silently become custodians of the mentally ill.
But jails were not made to be hospitals, and patients do not want to be inmates. Doctors say that the stress of confinement itself can tighten the grip of illness, and that a mental impairment can leave a person vulnerable to abuse from inmates and even jail staff. Dallas inmates have told patient advocates that they are afraid to take their medicine in jail, fearful that it might leave them so drowsy that someone could steal their meals.
Incarceration drains not only patient health but the criminal justice till as well. Dallas County budget officials say feeding and housing a prisoner costs $33 per day. And, health experts say, mentally ill inmates remain in jail longer than other suspects because they are less likely to qualify for bail. Seriously ill offenders who are found incompetent first undergo treatment to restore them to health and then are returned to jail to await trial. The mental health association study noted that patients often end up spending a longer time locked away than if they had just served any sentence resulting from a guilty verdict.
The situation does not surprise public health officials. Patients have been eased out of state hospitals for more than two decades, encouraged to seek help in their own neighborhoods. The flaw in that plan, health experts say, was that society was not financially or psychologically prepared to embrace the mentally ill. Texas, for instance, consistently ranks in the bottom 10 of the 50 states for spending on mental health services.
"Deinstitutionalization of seriously ill individuals has been the largest failed social experiment in 20th-century America," psychiatrist E. Fuller Torrey of the National Institute of Mental Health wrote in the American Journal of Public Health in 1995. "It failed not because the vast majority of released individuals cannot live in the community, but because we did not ensure that they receive the medications and after-care that they need to do so successfully."
As a result, multitudes of patients descend into homelessness and hopelessness - and, routinely, into the hands of police officers, jailers and judges.
"I think it's a horrendous thing," said researcher Linda Teplin of Northwestern University Medical School in Chicago. "We didn't anticipate for mentally ill people to get arrested instead of treatment."
Despite well-publicized accounts of violent acts committed by mentally ill offenders, doctors believe most of these inmates are arrested for minor offenses such as creating public disturbances, trespassing, urinating in public or committing petty theft.
All but three of Mr. Woodruff's 18 other arrests have been for criminal trespassing, often at Parkland.
"I was wrong for being there under the influence," he said in September from behind the hazy glass of a jail visitor's booth, "but I was trying to get some medicine."
He hesitates a moment, trying to explain why so many mentally ill brethren share cellblocks with him. "I think because they're misunderstood," he said.

Researchers for the National Alliance for the Mentally Ill reported in 1992 that 29 percent of the jails they surveyed nationwide held mentally ill people without any criminal charges at all, simply because they were deemed psychiatric emergencies with no other place to go. The survey - of 1,391 local jails that responded to a mailed questionnaire - found, for example, that in Kentucky, 81 percent of jail officials said they hold mentally ill people without charges.
Local psychiatrist Barry Mills calls most mentally ill inmates "Big Gulp cases," snatched up by the criminal justice system because they help themselves at the 7-Eleven without paying. Still others are picked up for drug possession, apparently seeking haven from their illness in an illegal high.
"I've had patients who served 10- to 20-year sentences because they got busted with a $10 rock of cocaine," said Dr. Kenneth Dekleva, who provides psychiatric care for the Tarrant County Corrections Center.
Easy access to a wider selection of illicit drugs has amplified this problem in recent years, said Judi Regina, director of the Maine Sheriffs' Association's Mental Health Initiative. Studies suggest that about two-thirds of people with mental illness also have a substance abuse problem, making them especially difficult to manage. These patients often find they cannot get into drug and alcohol treatment programs because they are mentally ill, psychiatrists say, and they cannot get help for their illness because they are addicts.
And they are prime targets for a public with a strong anti-crime and anti-drug sentiment. "Social policy has changed," Ms. Regina said. "We're very much a country into locking people up right now."
Drug crimes have particularly heavy punishments, health experts note, so the mentally ill often wind up prisoners of the war on drugs.
"This is fraught with a great deal of political difficulty," said Dr. J. Douglas Crowder of the University of Texas Southwestern Medical Center at Dallas. "If you treat these people better, you'll make people think you're coddling criminals. . . .
"That is political suicide, to appear soft on crime."
The mentally ill also do not command a great deal of political sympathy, Ms. Regina said. With their unusual behavior and unpredictability, untreated mentally ill people can make those around them feel threatened. Many patients, in fact, have been abandoned by their weary families. As a result, she said, they "go into the big black hole of the community, which is the jail."
And as the agents who must deliver them there, many police departments have established specially trained teams that are versed in mental health statutes and in dealing with people whose thinking is disturbed. Usually, these officers can offer more than just a ride to jail.
"This population was being `criminalized,' if you will, because of a lack of resources in the mental health system," said Detective Walter DeCuir, who is in charge of the Los Angeles Police Department's mental evaluation unit.
But Detective DeCuir and other officers say they are nevertheless law enforcement officers, not armed social workers, and that they do still escort mentally ill people to jail. Yet, unlike many other officers on the force, most of those working with a mental health unit tend to use arrest as a rare option. A study of the Los Angeles unit, which responds to about 56,000 calls a year, found that those officers took people to jail 2 percent of the time.
In Texas, Galveston County has a long-established mental health unit in which a unique team of sheriff's deputies answers calls thought to involve a person with mental illness, whether it's a drifter sidling up to passing cars or a person barricaded in his house. As in Los Angeles, misdemeanor offenders are usually driven to outpatient clinics, private hospitals, emergency rooms or back to their families.
"In Galveston, people with mental illness don't go to jail," said Capt. B.T. Joseph, who heads the five-deputy unit. The program was formed in 1975 out of concern over a high number of jail suicides. In the last 10 years, only one person - an 18-year-old arrested on a sexual assault charge - has killed himself in the jail, records show.
But in many urban centers, such as Dallas, people with mental illness do go to jail. This has meant that jails, which were never meant or equipped to be hospitals, are increasingly scrutinized for their quality of mental health care. Many have fallen under federal orders to improve conditions. For instance, in September, the U.S. Department of Justice excoriated the Los Angeles County Jail, the largest jail system in the nation, for unconstitutional conditions and "a deliberate indifference to inmates' serious mental health needs."
Among the many problems cited, investigators stated that "the number of inmates in need of mental health care overwhelms available staff resources."

Dallas has not escaped similar complaints. In 1992, mental health advocates held a news conference on the steps of the county jail to demand improved psychiatric care for inmates. At the time, jail critics said, only one part-time psychiatrist and one part-time psychologist were expected to care for perhaps hundreds of mentally ill inmates, and patients would often have to wait weeks to get medicine.
Since then, the Dallas County Department of Health and Human Services, which runs the jail health care service, has increased staff, and Parkland Health and Hospital System has installed a jail pharmacy.
Yet debate continues over the quality of mental health care expected in a law enforcement center. For example, Dallas County has a full-time psychiatric staff of fewer than 12. The Harris County jail in Houston, which was the target of a lawsuit in the 1970s to improve its overall medical care, has more than 80 people on its psychiatric staff to care for an inmate population that ranges near that of the Dallas jail.
"They have a mental hospital; they don't have a jail," Betty Culbreath, director of the county health department, said about the Houston jail. "Why would we make that jail a state hospital when we got a state hospital down there with four dormitories boarded up?
"My main point is that we need to do better with our folks" while they are still in the community, she said.
Those who convened the 1992 news conference say they are pleased that the Dallas jail has boosted staff but that the efforts fall short. This summer, Jill Ferrell, executive director of the Mental Health Association of Greater Dallas, told county commissioners that the jail "doesn't have the medical personnel, the support personnel, the clerical help or the space to do an adequate job" of caring for the mentally ill.
But the level of care that should be provided in a jail is not an easy equation to work out, national experts say.
"The jail should be a jail," said Dr. Hank Steadman, president of Policy Research Associates in Delmar, N.Y., one of the nation's foremost authorities on the mentally ill in the criminal justice system. While stressing that people should receive treatment for their illness, "you shouldn't try to fix a broken-down community mental health system by providing services in the jail," he said.
Areas of the country credited with reducing the number of mentally ill people incarcerated, such as Maine, say they have all had to overcome one
obstacle: deciding who is responsible for the problem.
"We really need to look at this issue and say, `We are in this together,' " said Ms. Regina of the Maine Sheriffs' Association. "The finger-pointing is phenomenal.
"The significant difference we've made in Maine is community collaboration."

However, Dr. Steadman says that many states will continue to arrest and convict large numbers of mentally ill people because they see their welfare as a problem only for law enforcement, or only for the mental health system, and not as a mutual concern. The typical view of the jail, he said, is as a "stand-alone physical plant."
Since his arrest at Parkland in September, Mr. Woodruff has been released from jail and is part of a county mental health program designed to help disentangle him from the criminal justice system. He is trying to gain living skills and lose his dependence on alcohol. He vows never to be arrested again.
"I wasn't taking medicine like I should," he said about his previous run-ins with police. He says he now has a "feeling of contentment. I used to have a feeling of hopelessness. I would exist from one day to the next."
But people like Mr. Woodruff will not see their illnesses stabilized without support from the people around them, UT Southwestern's Dr. Crowder said. "It's up to all of us to make this difference," he said. "I don't know what's going to happen. It all depends on how enlightened and courageous people are."
04/15/97
PAPER: THE DALLAS MORNING NEWS
SECTION: NEWS
EDITION: HOME FINAL
PAGE: 18A
LENGTH: 12
HEAD: Trial starts in class-action suit on jail conditions Inmate
testifies he saw rats, roaches, human waste in '93
BYLINE: Tracy Everbach
CREDIT: Staff Writer of The Dallas Morning News
TEXT:
.
Rats, roaches and raw sewage were Frederick V. Canady's bedmates as he slept on a mattress on the floor of Dallas County's Old Jail in 1993, the inmate testified Monday at the start of a class-action lawsuit over jail conditions.
In the crowded jail, which at that time had too many inmates and not enough beds, "rats crawled all over me and bit on me," Mr. Canady said. "I was forced to sleep around human waste."
Mr. Canady, serving a state prison sentence for a drug charge, and 55 other inmates or former inmates are testifying in the federal lawsuit. It's being tried in a state courtroom because of its proximity to the jail.
Dallas County Assistant District Attorney Peter Harlan, who is representing the county and Sheriff Jim Bowles, repeatedly asserted during cross-examinations of witnesses Monday that jail officials violated no one's rights and that jail conditions in 1993 and 1994 were safe and sanitary.
The civil rights case, filed by an inmate on a handwritten form, had been dismissed about four years ago. But the inmate, Joe Davis Miller Jr., appealed to the 5th U.S. Circuit Court of Appeals, which sent the case back to Dallas for trial. Mr. Miller said he was badly beaten by gang members while in the jail and jail officials failed to help him.
Ed Cloutman, the attorney appointed to represent the inmates, successfully asked for it to be certified as a class-action lawsuit.
In 1993, the county jails were designed to house about 6,600 prisoners but at times held nearly 10,000. County officials then blamed the crowding on the state prison system's refusal to accept new prisoners because of its own crowding. Thousands of state prisoners were housed in the county jails.
The backlog of inmates ended in 1995 after the state built more prisons and accepted more prisoners, and the county renovated a local warehouse into a jail.
The inmates who testified Monday described problems with medical care, sanitation, food, safety and security in the jail system.
Larry Ricky Allen, in jail for eight months during 1993, said he was appalled by dirty conditions in the medical ward.
Mr. Allen, who has been diagnosed with AIDS, said he was exposed to tuberculosis patients, lived with dirty bathroom and cell conditions, was served frozen food, slept on the floor and was humiliated by guards. He said he had to complain several times before inmates were issued cleaning supplies.
"No one would come into the tank unless someone was gasping for breath, about to die," said Mr. Allen of the medical staff. He is serving state prison time on a drug charge.
Mr. Allen said when he complained to jail officials about conditions and wrote a letter to the Dallas County Health Department, he was transferred to a single cell, with no access to people, televisions or newspapers.
The case, before U.S. Magistrate Judge Jeff Kaplan, is expected to continue through next week in Auxiliary Court 4 in the Frank Crowley Courts Building.

11/27/95
PAPER: THE DALLAS MORNING NEWS
SECTION: NEWS
EDITION: HOME FINAL
PAGE: 13A
LENGTH: 22
HEAD: Study criticizes jailing of mentally ill, retarded 2-year inquiry by
local officials finds need for better screening, other changes in system

BYLINE: Tracy Everbach
CREDIT: Staff Writer of The Dallas Morning News
TEXT:
Hundreds of mentally ill and mentally retarded people in Dallas County are thrown in jail rather than placed in mental health programs, a recent study of the county's criminal justice system concludes.
The study by mental health, law enforcement, court and government officials recommends dozens of changes to help people with mental health problems and save money on costly incarceration.
"We discovered that the criminal justice system in this community is the backup for the mental health system," said Christine Siegfried, public policy specialist for the Mental Health Association of Greater Dallas, which sponsored the two-year study.
"The criminal justice system is full of people with mental illness and mental retardation."
Some people with mental health problems are arrested and taken to jail repeatedly for minor offenses such as trespassing and public intoxication, the study found.
"This impacts fiscally and impacts public safety," said Jill Ferrell, executive director of the Mental Health Association. "If you can get offenders into appropriate treatment, they are not likely to offend again."
The study makes long-range and short-range recommendations. Three identified as most pressing are:
* Training for attorneys, judges, probation officers, jail workers and court managers about the mental health system and about the mentally ill and retarded. It also recommends training for mental health workers about the criminal justice system.
* Better screening for mentally ill and retarded people who are booked into Dallas County jails. Screening is not done 24 hours a day, so some people with mental health problems pass through the system without being identified or treated.
* Improving coordination between the court system and state hospitals.
The study said there are dozens of people in state mental hospitals who had been charged with crimes and found incompetent to stand trial. The study found that the court system and district attorney's office failed to keep track of them or to follow up on their cases. Some people occupied state hospital beds for more time than necessary.
"We found one man who had been at Terrell State Hospital for seven years on a charge of unauthorized use of a motor vehicle," Ms. Siegfried said. Under Texas law, the punishment on that state jail felony charge is 180 days to two years in prison. Before 1994, the punishment was two to 10 years in prison.
The district attorney's office apparently lost track of the man's case after he was ruled incompetent, Ms. Siegfried said. After the researchers found him, prosecutors dropped the case and the man was discharged to a community mental health program.
Such programs are critical to prevent people from repeating offenses, the study emphasizes. More than 20,000 mentally ill adults in Dallas County receive no treatment, the study found, and 3,000 to 4,000 of them are homeless.
Leon Evans, director of Dallas County's Mental Health and Mental Retardation Center, said teamwork among agencies is essential.
"It costs a lot of money to incarcerate people, and many of those people could be better served in the community with services the Mental Health Association has identified" in the study, he said. Dallas County MHMR intends to use the study as a guide, he said.
A major problem is money.
The study found that there's not enough money to help everyone who needs mental health assistance.
"We are looking for community services as alternatives to incarceration - we want to have it as part of the solution - and the services aren't there," Ms. Siegfried said.
"The biggest need is for supervised housing for offenders with mental health problems."
However, some of the study's recommendations "won't cost a dime," she said. "We are asking people to change the way they do business."
The study praises the county and city for beginning programs that single out and help inmates with mental health problems and for training police officers to recognize mentally ill and retarded people.
A jail psychiatric services staff of nine, with six full-time employees, must serve about 1,200 inmates a month. Mentally ill and retarded people are scattered throughout the four-jail system rather than housed in a consolidated unit where they might be better served, the study notes.
Ms. Ferrell and Ms. Siegfried said that in June 1994 they toured a women's psychiatric unit in the George L. Allen Sr. Jail downtown, which was overcrowded at the time. It "looked like a mental institution from the '50s," Ms. Siegfried said.
"It had single cells that were small, metal cagelike things," Ms. Ferrell said. "You felt like you were in a submarine."
Women were "lying in their beds with a glazed look," she said, except one woman who was screaming.
The two said that since their tour, the jail population has dropped, and many women have been moved to better facilities in the newer Lew Sterrett North Jail Tower on Industrial Boulevard.
"Our concern is that the jail population is headed back up," Ms. Siegfried said. "That puts the mentally ill/mentally retarded offender at risk."
11/13/95
PAPER: THE DALLAS MORNING NEWS
SECTION: VIEWPOINTS
EDITION: HOME FINAL
PAGE: 13A
LENGTH: 16
HEAD: Jail is the wrong place for mentally impaired people
BYLINE: Philip Seib
COLUMN: PHILIP SEIB
TEXT:
Survey the population of the Dallas County jail on any given day, and you will find about 900 mentally ill and mentally retarded inmates. That is more than twice the number housed in the nearest state mental hospital.
Many are charged with minor crimes such as trespassing, disorderly conduct and petty theft. One in four is homeless. More than half have substance abuse problems. Many are jailed repeatedly for committing the same kind of offense.
These people are criminals in the sense that they have broken the law. But a strong argument can be made that they should not be locked up like everyone else in the criminal justice system. Their `criminal intent" is the product of an impaired brain. Jailing them does not provide rehabilitation or even deterrence; it is merely punitive warehousing.
A crime by a mentally impaired person is, however, still a crime. These people need to be taken off the streets before they commit further offenses, hurting others or themselves. How to do that remains one of society's most daunting moral challenges.
A communitywide task force organized by the Mental Health Association of Greater Dallas has done an impressively comprehensive study of the mentally impaired in Dallas County's criminal justice system. It traces the process from arrest to jail to courtroom and emphasizes how screening and diverting these people might help them be treated more efficiently and humanely.
This report is not a sappy do-gooders' guide. In presenting a five-year plan for systemic improvements, it makes cogent points about the inordinate amounts of money and time spent trying to fit mentally impaired inmates into a process that is not suited for them. They are dealt with so ineffectually that their recidivism rate is about 60 percent. That means still more dollars and hours.
Diverting mentally ill and mentally retarded offenders is the key to reform. As the report notes, incarceration poses special risks for these people, including victimization by other inmates, mental deterioration and suicide. Their jail stays should be minimal, and they should be moved into supervised care that protects them and the public.
State law mandates transferring mentally impaired inmates `to the nearest appropriate mental health or mental retardation facility." But too often the mental impairment goes undiagnosed by law enforcement or corrections personnel. Also, as the task force report points out, `the biggest deterrent to diversion in Dallas County is the lack of community services to divert people to."
This gets to the issue underlying all these matters: the extent to which voters and elected officials are willlng to provide care to those who cannot care for themselves. This is particularly difficult when the people involved are engaged in behavior that if not truly criminal is at least offensively anti-social. Consider how you would react if a raving street person lurched up to you. Would you say, `This person is obviously ill and needs help," or `Get him away from me, and lock him up"?
Answering that is made harder by the failure of civic leaders to address the moral and policy issues of dealing with mentally impaired people. This is one reason Texas ranks 48th in the nation in per capita funding for mental health care and 37th in funding for mental retardation services. It is a reason thousands of mentally ill and mentally retarded men and women bounce back and forth between Dallas County streets and the Dallas County jail.
The new task force report offers a blueprint for building a humane and effective system of care. But this plan will become a reality only if the public decides that mentally impaired people do not belong in jail.
Philip Seib is a contributing columnist to Viewpoints
04/26/95
PAPER: THE DALLAS MORNING NEWS
SECTION: NEWS
EDITION: STATE
PAGE: 34A
LENGTH: 7
HEAD: County to hire more jail nurses Board cites increased demand,
tentatively OK's plan to add part-time staff
BYLINE: Tracy Everbach
CREDIT: Staff Writer of The Dallas Morning News
TEXT:
Resignations, illnesses, the recent death of a nurse and increased demands for inmate care have prompted Dallas County commissioners to hire more jail nurses.
Commissioners tentatively approved a plan Tuesday to add five licensed vocational nurses to the jail intake division, creating a pool of part-time nurses to fill in for employees on vacation or ill.
The cost for the rest of the fiscal year would be $58,400 for the five nurses' salaries and $35,000 for budgeted overtime pay.
A formal approval on the plan is expected next week.
Jail nursing director Barbara Stacey on Tuesday told commissioners about her staffing problems, partly caused by more ill nurses than usual. One nurse died of an illness last week, she said.
Ms. Stacey attributed the increased illnesses to stress.
She noted that nurses' jobs have become increasingly complex due to complicated inmate illnesses, such as AIDS; the opening of a seventh jail and central jail kitchen; and problems last year with jail overcrowding.
County jails have 11 vacant nursing positions, with two more set to open by May 1 because of resignations, according to a report by the Dallas County Personnel Civil Service Department.
In January, some nursing supervisors filed a complaint with the Dallas County Health Department saying that the jail medical director, Dr. Steven Bowers, had undermined their jobs and hurt inmate care.
Several nurses since have resigned, according to county officials.
The personnel report noted that absenteeism had been unusually high in March and April, citing worker's compensation, vacation, compensatory time and sick leave.
In addition to recommending filling the five positions, the personnel report suggested using the nursing pool "whenever possible, in lieu of compensatory time or overtime" for full-time employees.
01/06/95
PAPER: THE DALLAS MORNING NEWS
SECTION: NEWS
EDITION: HOME FINAL
PAGE: 30A
LENGTH: 12
HEAD: Dallas jail nursing supervisors file complaint, say jobs are
undermined
BYLINE: Tracy Everbach
CREDIT: Staff Writer of The Dallas Morning News
TEXT:
Some nursing supervisors in the Dallas County jails have filed a grievance with the county health department complaining that their jobs are being undermined and inmate care is suffering.
The nurses have complained to Health Department director Randy Farris and county commissioners that jail medical director Steven Bowers is "dictatorial."
They allege that Dr. Bowers has tried to humiliate them and has instituted policies that will hurt inmate care. He has been jail medical director for one year.
Dr. Bowers said Thursday that he could not discuss the matter and referred a request for an interview to Dr. Farris, who said it would be inappropriate for him to talk about the dispute.
"This is more than likely going to go to the civil service commission," he said. "It's real confusing, and it's going to have to have some resolution."

Dallas County Commissioner John Wiley Price said some nurses called his office last week, asking to air their complaints at this week's Commissioners Court meeting. He said he told them to "come on down."
Some nurses said they backed out at the last minute because Dr. Bowers told one nurse that anyone who appeared before the commissioners would be barred from the jails.
Mr. Price said he has asked Dr. Farris to report to him "about what's really going on."
The commissioner said any of the nurses who want to speak before commissioners may do so.
County Administrator Allen Clemson said the nurses' grievance is scheduled to be heard at the next meeting of the Dallas County Civil Service Commission.
The nurses wrote their complaints in December after Dr. Bowers announced he was instituting a policy to transfer nursing supervisors to different assignments every four months. That program began Tuesday.
In their complaints, the nurses said they felt the transfers were in retaliation for past challenges to Dr. Bowers' decisions.
The nurses also alleged that inmates will be hurt by the transfers because constant change will disrupt the continuity of care.
"In my opinion, the dictatorial leadership we now have is causing an excessive amount of mental abuse for reasons that are not fully understood," wrote nursing supervisor Joan Bonner, a licensed vocational nurse, in a Dec. 21 letter to commissioners.
"The humiliations, intimidations and harassments are too abundant to discuss in a typed letter," she continued.
Another supervisor, Nancy Phelps, wrote that she has worked for Dallas County 151/2 years, mainly in psychiatric care. As of Tuesday, she was assigned to work with pregnant women in their last trimester or with pregnancy complications.
"Each of the nursing supervisors has become specialized in certain areas of medicine/nursing," wrote Ms. Phelps, a licensed vocational nurse, in a letter to the director of jail nurses. "To put that nurse in another area will decrease the level of care to the inmate and also increase the county's liability."
07/23/94
PAPER: THE DALLAS MORNING NEWS
SECTION: NEWS
EDITION: HOME FINAL
PAGE: 33A
LENGTH: 18
HEAD: County jail TB screening inadequate, state reports
BYLINE: Tracy Everbach
CREDIT: Staff Writer of The Dallas Morning News
TEXT:
Inmates in the Dallas County jail system are not adequately protected from tuberculosis, the Texas Department of Health concluded in a study released this month.
After a May review, a nurse consultant and environmental quality specialist for the state found that the county jail TB screening program is understaffed, with two staff nurse positions primarily responsible for screening inmates.
Friday, the county Health Department's director, Dr. Randy Farris, disputed the findings. He said the review was unfair and that the reviewers "didn't understand what they were looking at."
The review concluded that if screening methods are not improved, especially among HIV-positive inmates, "the likelihood of a future outbreak in the jail is increased."
Dr. Farris said that expanding the jail tuberculosis screening program is his top priority for the next fiscal year, which begins in October. He has asked county commissioners to fund three new nurse positions and one clerk position at a cost of $96,949. But the county personnel office has not recommended establishing those positions.
Tuberculosis is a contagious lung disease that can be spread through the air. The disease is more infectious in a confined area where people are exposed to it for long periods. Most strains can be treated with medicine, but some cannot and can be fatal.
In June 1993, Dallas County implemented the jail TB testing and treatment program, with a goal of testing each inmate jailed for 14 days or longer. The program was financed through a $217,000 grant.
When the county Health Department applied for the federal grant, the jail population was about 5,500, Dr. Farris said. But the population ballooned last year to about 9,500 because of state prison crowding. Not all of those inmates could be tested.
"It's no secret that testing is only being done in three of the jails," the Lew Sterrett Justice Center, the George L. Allen Sr. Jail and the "old jail" in the county Records Building, Dr. Farris said.
"My first priority in 1995 funding is to get additional resources for the other three jails," he said.
The inmates currently being tested include those in jail infirmaries and those who are HIV positive, he said.
About 12,000 people are booked into Dallas County jails each month, but only about 3,600 stay longer than three days.
Since the screening program started, health officials have found 18 cases of active TB. The ill people were identified not only through the screening program but also through examination by jail health workers in response to inmate complaints.
Dr. Farris said 18 is not an excessive number for the Dallas County jail population. It's "what you expect in a high-risk population," he said.
Particularly at risk for TB are alcoholics and other substance abusers, people with poor nutrition and those infected with HIV, the virus that causes AIDS.
In Dallas County, inmates identified as having tuberculosis are tracked on a computer that also records the names of other inmates with whom they come in contact.
The state Health Department review mentioned one inmate who tested positive for active TB after being housed with HIV-positive inmates. The review said that "the jail staff may have omitted half of the potential contacts to this case," and added that "the staff available to conduct a contact investigation is not adequate."
Dr. Farris said state reviewers were not even aware of the computer records. He wrote in a response to the report, "A thorough investigation around this inmate was performed using a computer program. . . . No cases of tuberculosis have been found in inmates who had been in contact with the patient. Also, the jail staff has been tested."
Dr. Farris said an inmate identified as having active TB is placed alone in a cell and given medicine to reduce the chances of spreading the disease.
But the state review said that even in such cases, the jail ventilation system may not be sufficient to prevent the spread of TB.
Dr. Jody Meador, TB controller of Orange County, Calif., said Friday that "It's not just a matter of putting an inmate in a cell by himself. You have to have environmental control. It must be ventilated to the outside."
The state review noted that Dallas County commissioners recently approved renovations to vent air from 12 isolation cells to the outside.
05/18/94
PAPER: THE DALLAS MORNING NEWS
SECTION: NEWS
EDITION: HOME FINAL
PAGE: 29A
LENGTH: 11
HEAD: County jail commander defends inmate conditions Lawsuit alleges
unsanitary facilities for women
BYLINE: Tracy Everbach
CREDIT: Staff Writer of The Dallas Morning News
TEXT:
Dallas County jails are overcrowded but not dirty, unhealthy or lacking in medical care or nutrition, the county's jail commander testified Tuesday.
"I don't think we're violating rights," said Chief Deputy Bob Knowles of the Dallas County Sheriff's Department.
His testimony came as a hearing resumed in a federal lawsuit over treatment of women inmates in the Dallas County jails. The defendants - including Dallas County, its sheriff, the Texas Department of Criminal Justice and other state agencies - began presenting their side of the case.
The plaintiffs presented testimony and evidence three weeks ago.
Chief Knowles said Dallas County jails are holding about 5,000 inmates who are ready to go to state prison, but the state won't accept them because it says it has no room for them.
The county jails were built to house 6,600 inmates but now hold about 9,500, the jail commander said.
Despite the crowded conditions and the fact that many inmates must sleep on mattresses on floors, the Sheriff's Department has been able to maintain clean and safe conditions, he testified.
Previous testimony in the case alleged that the three jails where women are held are filthy, infested with rats and roaches, installed with poor sewage and lacking in medical care and nutrition.
Chief Knowles said Monday that inmates receive cleaning supplies on a regular basis; cells are exterminated for pests and vermin twice a month, and kitchens weekly; meals are nutritionally balanced; and kitchens are sanitary and approved by the Dallas County Health Department.
The plaintiffs allege in their lawsuit that women inmates are forced to spend twice as much time as men in the county jails' unsafe and unhealthful conditions, partly because the state criminal justice system does not allow women to be admitted to state prison or paroled as quickly as men.
The plaintiffs are asking U.S. District Judge Joe Kendall to certify the 1,500 women inmates in the jail as a class, to appoint an expert or master to assess conditions in the jails, to order the county and state to improve policies regarding women and to establish a fund for emergency care of women.
Judge Kendall hinted Monday that he was considering granting the request to appoint an expert to look at the jails. He interrupted Chief Knowles' testimony, saying, "We've had prisoners saying there's rats and (meals are) bologna and Kool-Aid, and then we've got Chief Knowles here saying, `While it's not the Hyatt, it's not the Bastille.' It kind of sounds to me like we need an expert, and you're proving it."
Testimony is expected to continue Wednesday.
03/15/94
PAPER: THE DALLAS MORNING NEWS
SECTION: NEWS
EDITION: HOME FINAL
PAGE: 19A
LENGTH: 34
HEAD: Jails lack basic care, inmates say County defends work, cites state
inspections
BYLINE: Tracy Everbach
CREDIT: Staff Writer of The Dallas Morning News
TEXT:
An inmate is bitten on the head by a rat and gets ointment to treat it. Another says he and his cellmates have been infected with tuberculosis because another inmate wasn't tested. A third complains about outbreaks of scabies and lice.
These are just some of the complaints by inmates in the Dallas County Jail system, a system so overwhelmed that it often fails to provide proper medical care, according to inmates, lawyers, civil rights advocates and others.
County officials defend the health and medical care in the jail and note that Dallas County has passed every inspection in the past decade by the Texas Commission on Jail Standards.
The Dallas County Health Department, which handles medical care for the jail system, is doing everything it can, according to Dallas County commissioners and the department director, Dr. Randy Farris. But with the massive overcrowding, county officials said, the department can do only so much.
About 9,200 inmates are crammed into five jails built to accommodate about 6,600, in part because two-thirds of the inmates are awaiting transfer to state prison. The state isn't accepting them because of limits on its prison capacity.
Many jail inmates sleep on the floor, on mats 18 inches apart. Rats join them.
Chad Lane Riley, who is being held for violating his probation on a car burglary charge, has seen the rodents. And felt them.
"I guess it crawled on my mattress and I rolled over and scared it," the inmate wrote in a letter describing his rat bite at the Allen Jail on Commerce Street. "I went to see the nurse about being bit on my head. My head had swollen up and turned red. The nurse said, and I quote, `Oh, that's nothing. I'll give you some cream.'
"Ointment cream for a rat bite: Do these people know what they are doing over here?"
The Health Department has assigned three full-time physicians, one part-time obstetrician-gynecologist and 70 full-time nurses to handle the medical needs of the more than 9,000 jail inmates, said Dr. Farris, a physician. Anyone who is seriously ill or needs medical attention that the jail staff can't provide is taken to Parkland Memorial Hospital.
Dr. Farris, who has been highly praised by Dallas County commissioners during his two years at the helm of the Health Department, said the county has arranged a "reflex" system to hire more staff as the number of inmates increases.
"We have taken a pro-active approach," he said.
However, he said, it's difficult to recruit and keep health professionals to work in the jails.
"We don't have people beating down the door for positions," Dr. Farris said. "Many people are reluctant, skeptical. They have fears for their personal safety."
County Commissioner John Wiley Price, who served 24 days in Lew Sterrett Justice Center last fall for breaking a woman's windshield wiper during a protest, said he believes the county provides adequate health care to inmates. But he's also concerned about the health of jail detention and medical workers.
"When I saw employees come by my cell handling inmates with rubber gloves and masks, I got concerned for our employees," he said. "You can't say you can have that many people packed in the jails and not have problems."
Said Mr. Price's colleague, Nancy Judy: "As the population grows, people are becoming less and less happy at the conditions. Communication is difficult, and tempers seem to run high. There is stress on the detention staff and on the medical personnel."
The five Dallas County jails are Lew Sterrett on Industrial Boulevard; the adjacent, new Sterrett North Tower Jail; the Decker Correctional Center on Stemmons Freeway, a former hotel converted into a jail; the Allen Jail above the George L. Allen Sr. Courthouse on Commerce Street; and the old jail in the Dallas County Records Building.
Under Texas law, the sheriff is charged with running the jails, the Health Department handles medical care and county commissioners control the budget.

Dallas County Sheriff Jim Bowles said that on advice from his attorneys in a federal class-action lawsuit filed in January by femaleinmates, he could not discuss medical and health conditions in the county jails.
The sheriff is a defendant in the suit, which alleges that the rights of 1,500 female inmates have been violated by unconstitutional jail conditions. It demands that a federal judge order the state and county to rectify the situation.
All inmates who are booked into the jail receive a screening document to inform the medical staff of any medical problems, prescriptions or scheduled appointments, Dr. Farris said. The staff evaluates the information and distributes medicine to those who need it, puts the seriously ill in jail infirmaries and takes those who need more attention to Parkland, he said.
There is a nine-member mental health staff, including a full-time psychiatrist, to screen inmates for mental illness and to provide therapy.
Once in jail, inmates may request to see a physician by filling out a report.
Not all complaints require immediate medical attention. But some inmates and lawyers say the system is so overloaded that some inmates aren't getting the treatment they need.
"It's been my observation, going up into the jail, that if there is something major wrong, you're taken care of," said Douglas Skemp, a Dallas criminal defense lawyer. "But if you just have some problems and need medication, you're not."
Inmate Robert D. Robinson, who is being held for violating his parole on a theft conviction, said in a letter that he is "witnessing abhorrent conditions in the system."
"Lack of basic necessities, soap, clean jumpers, sheets. The jail on Government Center (Allen Jail) has an outbreak of scabies. . . . My cellmate has syphilis, has not received any medical attention. Whether the medical staff is short-handed or lacks concern, I don't know."
Some inmates complain that they have been exposed to tuberculosis, a lung disease that is particularly contagious in a confined environment. It is spread through the air by coughs and sneezes.
Inmate Chris Gray said he and his cellmates have been exposed to "lice, scabies, strep throat, hepatitis and TB. Active TB! Eight of us came in clean and now must take TB meds for six months."
He said he's being held on a parole violation on a theft charge in a tank that's designed for 24 men but routinely holds 40 to 50.
"Twenty-four bunks, one shower, six toilets, three phones," he said. "At least 20 men sleep on mats on the floor."
Eight months ago, Dallas County implemented a tuberculosis testing and treatment program for jail inmates financed through a $217,000 federal grant from the Centers for Disease Control and Prevention.
The commissioners are expected to approve continuing that program at their weekly meeting Tuesday.
The Legislature passed a bill last summer requiring jail and prison inmates to be tested for TB on or before their 14th day of confinement.
But that hasn't helped the thousands of inmates who came into the jail before the program started.
Mr. Price said that the county is doing the best it can to meet what he called "very idealistic" federal mandates on TB testing.
Prescriptions rarely are refilled on time, said Mr. Gray, who takes medicine for high blood pressure and curvature of the spine.
Dr. Farris acknowledged that there have been some glitches in the medicine-distribution system. But he said the Health Department is constantly taking steps to improve it, including a new pharmacy inside the North Jail Tower that opened last week. Previously, medicine came from Parkland.
Dozens of requests for medical attention turn out to be frivolous, making it more difficult for the medical staff to respond to complaints, officials say.
"In any medical setting, you have people coming in complaining about this little ache, that little ache," Dr. Farris said. "After you've seen a few, you can tell what's real and what's not. The only caveat is, when in doubt, send them out."
03/06/94
PAPER: THE DALLAS MORNING NEWS
SECTION: NEWS
EDITION: HOME FINAL
PAGE: 31A
LENGTH: 28
HEAD: Women inmates decry county jail conditions Lawsuit asks judge to
order better treatment
BYLINE: Tracy Everbach
CREDIT: Staff Writer of The Dallas Morning News
TEXT:
Wanda Maria Maciumba vividly remembers giving birth to twins in October while incarcerated in a Dallas County jail.
She particularly recalls the rats in the infirmary, the cold, the cramps and the shackles.
"When I figured out I was in labor, I told the nurse," she wrote in a letter from the jail, where she remains without her children. "I waited 45 minutes for the transport officer. A foot was coming out by the time I got to the hospital. . . . They shackled my feet and hands while I was in labor."
Ms. Maciumba, 30, is one of 1,500 women in the county jail system who are plaintiffs in a federal class-action lawsuit filed in January against county and state officials. It alleges unequal treatment compared with men and horrendous health and medical conditions in violation of women's rights.
Last week, the lawyer who filed the case asked a federal judge to issue an injunction against the defendants, demanding that they take specific steps to remedy the situation.
If not, lawyer Ruth Kollman argues, the women's "mental and physical conditions will continue to irreparably deteriorate, even to the point of death."
The problem, according to a 90-page brief she filed this week in U.S. District Judge A. Joe Fish's court, is that women are serving longer sentences than men for the same or similar crimes.
The reasons, she alleges, are multifaceted. The outcome, she says, is that women spend an excessive amount of time under dangerous and unsanitary conditions in a "woefully overextended Dallas County jail system."
Dallas County jails are equipped to hold about 6,600 inmates but currently house 9,700. About 6,000 of those inmates are ready to go to state prison, but the state won't accept them because its jails are filled to a capacity it won't exceed.
Dallas County jail conditions, Ms. Kollman said Friday, "are like a Third World country. It's embarrassing."
In the brief, the lawyer quotes affidavits from inmates who tell of sleeping on mattresses on the concrete floors, rats and roaches, "green bologna," "mice drippings," mold, mildew, lice, pestilence and lack of sanitary napkins.
The defendants include the Dallas County commissioners, the sheriff and pretrial release services; the Texas Department of Criminal Justice and its director, James Collins; the state Jail Standards Commission; the state Board of Criminal Justice; and the Texas Board of Pardons and Paroles.
County Judge Lee Jackson said Friday that he had not seen the court documents and could not comment.
Sheriff Jim Bowles referred queries to Assistant District Attorney Peter Harlan, who declined to comment, citing his office's policy not to discuss pending litigation. In court filings, he denied that the Dallas County defendants have discriminated against women or violated their constitutional rights.
The state defendants declined to comment on the litigation. The Department of Criminal Justice referred calls to state Assistant Attorney General John Worley, who could not be reached.
The injunction asks that Judge Fish order the defendants to change certain policies, set up a fund for emergency care of the women, appoint a master to report on and monitor jail conditions and make an immediate inspection and videotape of jail conditions.
The defendants, Ms. Kollman alleged, are wasting time and energy by accusing each other of causing the jail problems.
"The state prisoners have been deserted in appalling conditions by bureaucrats charged with their care who squabble over accountability instead of working together to seek solutions."
Ms. Kollman said she reviewed state and county statistics and discovered that the state failed to allocate sufficient prison beds for women and was providing no beds for parole violators, as it was for men.
The state provides only 6 percent of its bed space to women, while about 10 percent of all people sentenced to prison in Texas urban counties are women, according to statistics.
Before last year, the state was allocating 3 to 4 percent of its beds to women, she noted.
Consequently, women who would be entitled to receive "good time" credits on their sentences in prison aren't getting it because they're in the county jail.
As part of her study, Ms. Kollman compared case histories of a man and woman arrested at the same time and convicted as co-conspirators for the same crime. The man was transferred to state prison 41 days after sentencing. The woman is awaiting transfer after one year. The average wait for women is 18 months, compared with six months for men.
In her research, Ms. Kollman discovered at least two women she thinks are being illegally detained because they have served the maximum time the state prison system may hold them. But they remain in the county jail.
"It may be that these two women are the only two who have reached their eligibility date, but I jolly well doubt it," she said Friday.
The request for an injunction demands that those women be released immediately.
The jail conditions are bad and only getting worse, the court documents allege.
Sheriff Bowles has said that with overcrowding, it is virtually impossible to exterminate rodents and insects because there is no place to move the inmates.
One woman quoted in the lawsuit described how she and her cellmates have "had to chase rats out of our room who were feeding on the hair of inmates sleeping on the floor."
Another said: "People stuff their ears with toilet paper for fear roaches might crawl in."
A woman inmate noted that "there are rodents not only stalking the catwalks, but they have been found dead and decaying in the mattresses that they give us to sleep on . . . we are told to just live with it!"
Said another woman: "The showers and walls were covered with mold and fungus, and we were not given proper cleaning supplies."
Most of the women in Dallas County jails are not violent offenders, Ms. Kollman said. Many are being held on technical violations of parole and probation.
Ms. Maciumba, the mother of the twins, has been in jail since July. She received eight years' probation for cocaine possession, but when she failed to show up for scheduled appointments, she received a three-year prison sentence. She doesn't know when she'll get out of jail.
"Most of the public doesn't think that pregnant women with two- and three-year sentences ought to be sleeping on the floor, getting chewed on by rats," Ms. Kollman said. "I'm asking Judge Fish to order the parole board to release these women."
01/12/94
PAPER: THE DALLAS MORNING NEWS
SECTION: NEWS
EDITION: HOME FINAL
PAGE: 27A
LENGTH: 25
HEAD: Women inmates file bias suit over conditions at county jail
BYLINE: Tracy Everbach
CREDIT: Staff Writer of The Dallas Morning News
CORRECT: CORRECTIONS, CLARIFICATIONS: On Page 31A of Wednesday's
Metropolitan section, a story misidentified plantiffs in a federal lawsuit complaining about conditions for women in Dallas County theft over $100,000 is Diane Lynn Hopper. The plantiff who is suffering from breast cancer is
Wanda Diane Nash Smith. (Ran: Thursday, January 13, 1994)
TEXT:
A class-action lawsuit filed Tuesday alleges that the Dallas County jail system discriminates against female inmates by subjecting them at a higher rate than men to cruel and unusual punishment.
The suit, filed in U.S. District Court in Dallas, says that women are held longer in the overcrowded county jail system, which subjects them to unconstitutional, unsanitary, unhealthful conditions and inadequate medical treatment.
Dallas lawyer Ruth Kollman filed the lawsuit on behalf of the 750 women incarcerated in Dallas County jails.
"Each member of the class has been and is confined in vermin-ridden, unsanitary, health-hazardous conditions for a disparately longer period of time than similarly situated men," the suit says.
Named as defendants are the Dallas County Commissioners Court, the Dallas County sheriff, the county Pretrial Release Services and the county Community Supervision and Corrections Department. Also named as defendants are the Texas Department of Criminal Justice and its director, James Collins, the state Jail Standards Commission, the Texas Board of Criminal Justice and the Texas Board of Pardons and Paroles.
The suit asks U.S. District Judge A. Joe Fish to issue restraining orders against the defendants, ordering them to remedy unequal treatment and overcrowded conditions for women in the Dallas County jails. It also asks the judge to order the defendants to pay $100 to each female inmate for each day in jail and pay sufficient funds to provide adequate diet, medical care and sanitary facilities.
Ms. Kollman said she met with Dallas County Sheriff Jim Bowles before filing suit and believes he is "doing the best he can" to try to resolve the women's problems.
"In his personal capacity, he's not deliberately inflicting injury on anyone, but institutionally he is," Ms. Kollman said.
Sheriff Bowles has publicly decried conditions in his jail and blamed them in part on the state's failure to accept convicted inmates into its overcrowded prison system. Of 9,700 inmates in Dallas County jails, about 6,000 should be in state prison. The county jails are designed to hold 6,600 inmates.
The sheriff declined comment on the class-action lawsuit Tuesday, citing a department policy against discussing pending litigation. However, he said the case "was just a matter of time. It doesn't surprise me that someone would take issue with it."
Dallas County Judge Lee Jackson, who heads the Commissioners Court, did not return telephone calls Tuesday.
David Nunnellee, a Texas Department of Criminal Justice spokesman, declined comment on the allegations on behalf of his department; its director, Mr. Collins; and the Board of Pardons and Paroles.
Jack Crump, director of the Jail Standards Commission, declined comment because he had not seen the lawsuit.
The lawsuit notes several areas in which women receive disparate treatment in the county jails. It says women are not released on their own recognizance through pretrial services in the same proportion that men are. And female inmates and state prisoners are confined longer than men while awaiting transfer to community drug treatment and other programs, according to the lawsuit.
Jim Mills, assistant director of Dallas County Community Supervision and Corrections, said Tuesday that his department is studying the issue of female offenders and recently increased bed space for women in the county's drug treatment center in Wilmer.
"We're doing what we can," he said.
The suit also alleges that female state prisoners are held longer in county jails awaiting transfer to prison.
Women state prisoners serve an average of 18 months in Dallas County jails, three times longer than men, the suit says. Because women aren't getting to state prison as quickly, they are not being paroled as early as men convicted of similar crimes, the suit says.
"Women simply don't get out of the system as quickly as men do," Ms. Kollman said.
In the grossly overcrowded Dallas County jails, women are deprived of medical and other treatment they could receive in state prisons, she said.
One of the lawsuit's named plaintiffs, Diane Lynn Hopper, is serving a 35-year sentence for theft over $100,000. While awaiting transfer to state prison for four months, she found a lump in her breast.
She was not examined for three months, the suit says, and the lump was malignant. She had surgery, and a county physician ordered chemotherapy and radiation therapy.
But "because of her inadequate diet, her blood level has not been high enough for her to tolerate the therapy," the suit says. "She was scheduled to be tested again on Jan. 7, 1994, to determine if she could tolerate a chemotherapy session. No one took her to the doctor."
Women do not receive needed medication, and prescription medicines are permitted to run out before refills are ordered, the suit says. Special diets aren't provided. "Bologna and wieners are staples of the jail menu," according to the suit. Fresh fruit has not been distributed for weeks, and fresh vegetables are never distributed.
Women who have contagious conditions are not segregated from other women with medical problems. "As examples, pregnant women occupy beds in the Government Center Infirmary next to women who have the flu or other conditions," the suit says. "Inmates with body lice and crabs are neither treated nor segregated from other women inmates." Tuberculosis is present, and the overcrowding "greatly increases the potential for an epidemic within the jail and guard population."
Unsanitary conditions prevail, the suit alleges. Rats have invaded the jail system, and poison cannot be distributed because there is nowhere to move inmates while exterminating.
"By inflicting punishment beyond that reasonably required to imprison and punish the county prisoners, the conditions are inconsistent with the right to be free from cruel and unusual punishment" guaranteed by the Constitution, the lawsuit says.
11/22/93
PAPER: THE DALLAS MORNING NEWS
SECTION: NEWS
EDITION: HOME FINAL
PAGE: 15A
LENGTH: 26
HEAD: Psychiatrist aids ailing inmates County official says mentally ill
often locked up
BYLINE: Tracy Everbach
CREDIT: Staff Writer of The Dallas Morning News
ART: PHOTO(S): Dr. Ken Arfa is the psychiatric medical director of the
Dallas County jails. Ten to 15 percent of county inmates are believed to suffer a mental illness. (The Dallas Morning News: Pat Davison) CHART(S): (State ed. p. 18A) Kenneth S. Arfa. ; PHOTO LOCATION: NR(C) (cf 65861).

TEXT:
Dr. Ken Arfa spends his days behind bars.
As the new psychiatric medical director for the Dallas County jail system, Dr. Arfa is incarcerated daily - but it's all part of his job diagnosing, treating and counseling inmates.
About 10 to 15 percent of the estimated 9,400 Dallas County inmates are believed to suffer some form of mental illness. Dr. Arfa said many mentally ill people repeatedly are arrested and locked up, often for minor skirmishes with the law such as trespassing or disorderly conduct.
"For a person whose mind is fragmented, this (incarceration), I assume, is true hell," said the 40-year-old psychiatrist.
He's pondered the issue, especially in relation to his family history.
"I think a lot about what people who were war refugees must have felt when they were incarcerated and didn't know why," Dr. Arfa said.
"My father's parents and the rest of his family were wiped out by the Nazis. It makes you aware of what people go through and how caring people can make a difference in their quality of life."
Dr. Arfa's job was created this year, when Dallas County commissioners approved $500,000 in the county's 1994 budget for a jail mental health program. The doctor, who began work about two months ago, is the first of a nine-member staff hired to develop the new program.
The man who chose him for the task, Dallas County Health Department Director Randy Farris, said he's impressed by Dr. Arfa's enthusiasm.
"He's very excited about the prospect of being part of a growing program," Dr. Farris said. Jail mental health services need to be expanded, he said, especially because of the increase in the number of county jail inmates.
Until this year, there was little screening or treatment for mentally ill Dallas County inmates. Recently the Texas Department of Mental Health and Mental Retardation began checking all people booked into the jail to determine whether they have received mental health services from the state.
Dr. Arfa and his staff screen inmates for suicide risk and for severe mental illness, including schizophrenia and manic depression. They also provide therapy to inmates who request to see a psychiatrist or are referred by MHMR, their families, the jail staff or other inmates.
The psychiatrist had wanted a job like this for a long time, he said. In fact, he had been calling Dallas County Health Department officials regularly to check whether there were such an opening.
"If I had to write what I wanted to do, this was it," Dr. Arfa said last week from the Lew Sterrett Justice Center in Dallas. "This is an area where there's so much potential for growth. There's a lot of community support here to improve mental health services."
Mike Faenza, executive director of the Mental Health Association of Greater Dallas, said his group and others, including religious organizations, "worked very hard to get the political support to create Dr. Arfa's position."
But, he said, "I worry that there is not at all enough of Dr. Arfa to go around, with conservatively 1,000 people in jail with major mental illness."

Dr. Arfa already has encountered some compelling situations: from an inmate who had lost touch with reality and was banging his head against the wall of a cell, to a woman who was confused about her incarceration and depressed about being separated from her children.
The New York native didn't decide to enter the psychiatric field until he was in his late 20s. In fact, it's his second career.
After earning a bachelor's degree from City University of New York-Queens College in 1975, and a master's degree in journalism from Northwestern University in 1976, he began a journalism career.
During the next five years, he founded a backpacking magazine called NOON - National Outdoor Outfitters News, worked as a desk editor for ABC News in Chicago and was a reporter for two Dallas radio stations, KAFM-FM and KAAM-AM.
But something was missing. "I was feeling unfulfilled," he recalled.
His wife, Judy, a certified public accountant, encouraged him to try medical school, although "I had no science courses - I found them intimidating."
He took premedicine classes at the University of Houston, and to his surprise, earned straight A's. Later, in medical school at the University of Texas Southwestern Medical Center at Dallas, he interned at the chaotic Parkland Memorial Hospital emergency room. Working with people in crisis drew him to psychiatry.
"You would have people who attempted to commit suicide, street people who wanted a warm place to stay and families who would show up with a `patient'
- as the family called them - and a suitcase, wanting to check them in."
Working there "brought in my journalism skills," he said. "I had to deal with deadlines. I had a patient. I had to get information quickly and make a decision on them."
During a four-year medical residency at Timberlawn Hospital in Far East Dallas, Dr. Arfa became interested in forensic psychiatry - a practice connected with both civil and criminal aspects of the law.
After working for about a year as Texas medical director of a large health maintenance organization's mental health program, he and his wife moved to Houston to be near her ailing mother. A psychiatrist friend there urged him to consult with inmates at the Harris County Jail.
"I saw that the people being treated there were not the Hannibal Lecter types of extreme antisocial behavior," he said, referring to the psychopathic villain in the book and movie Silence of the Lambs. "A lot were chronic mental patients who a few years ago would have been in institutions."
But a move in recent years away from institutionalization has resulted in more mentally ill people on the streets. About 30 percent of homeless people are estimated to have some mental illness.
"There are probably more beds for mentally ill people in this jail than in any nearby psychiatric institution," Dr. Arfa said. "It's sad. It's something for society to think about: the problem of mentally ill people returning to jail."
08/29/93
PAPER: THE DALLAS MORNING NEWS
SECTION: EDITORIALS
EDITION: HOME FINAL
PAGE: 2J
LENGTH: 8
HEAD: MENTALLY IMPAIRED County officials should approve jail proposal
COLUMN: EDITORIALS
TEXT:
Dallas County commissioners are reviewing a $400,000 plan to improve mental health services for the hundreds of county jail inmates who may be mentally impaired. It is a modest proposal at best. But its approval would show that the county has become serious about addressing a human need that has long been neglected.
By screening prisoners, the Dallas County Mental Health and Mental Retardation Center has found that as many as 16 percent of the county's inmates have a documented history of mental impairment. Without specialized care and treatment, those individuals may not be able to break their cycle of lawbreaking behavior.
That is what makes the county's proposed services so promising. About three-fourths of the money would go toward linking mentally impaired inmates with community services that can help them lead more productive lives. The new caseworkers would try to divert minor offenders from jail and assist other inmates upon release.
The rest of the money would allow the county to continue building the nucleus of a staff of mental health professionals within the jail itself. The expanded psychiatric staff, together with the opening of a pharmacy inside the jail, should do much to improve the care and treatment of mentally ill inmates.
Studies have shown that the recidivism rate among mentally impaired offenders can be as high as 60 percent. Diversion programs, proper treatment while in jail and good linkage to out-of-jail services upon release can interrupt this pattern of lawbreaking. That benefits both the individual and society.
Eventually, Dallas County will need to hire additional psychiatrists, nurses and mental health caseworkers if it is to fulfill its responsibility of providing appropriate health care to all inmates. But this year's budget proposal is a hopeful beginning that deserves the county commissioners' strong backing.
08/08/93
PAPER: THE DALLAS MORNING NEWS
SECTION: NEWS
EDITION: HOME FINAL
PAGE: 37A
LENGTH: 23
HEAD: County may boost jail service Mental health plan would aid inmates

BYLINE: Anne Belli Gesalman
CREDIT: Staff Writer of The Dallas Morning News
ART: PHOTO(S): Lee Jackson (Ran in Bulldog edition, page 39A); PHOTO
LOCATION: Jackson, Lee.
TEXT:
It's been three years, but Jannell Fultz is still disturbed by her son's four-month stay in a Dallas County jail.
The man, who suffers from manic depression, was booked into Lew Sterrett Justice Center after a scuffle with police at the Salvation Army. Mrs. Fultz said her son had stopped taking the medication he needs to control his illness.
When he landed in jail, his condition went from bad to worse, the Arkansas woman said. Even though she had provided ample documentation of her son's mental history, Mrs. Fultz said, the 22-year-old was in jail for more than a month before he began receiving his medicine.
A state judge eventually dismissed the first-degree felony charge against him, and he was released from jail. Now he has a job and is living on his own.
But Mrs. Fultz hasn't forgotten what her son looked like when she visited him at Lew Sterrett - thin, barefoot, dirty and clearly in a manic state.
"There is a very big difference between a criminal and a sick person," Mrs. Fultz said. "A person who is sick needs their medication and someone who is sensitive to them."
At the time, the estimated hundreds of mentally ill and mentally retarded inmates housed in Dallas County jails were served by one part-time psychiatrist and one part-time psychologist. Since then, little has changed, although a full-time psychiatric nurse was hired this year.
But Dallas County Commissioners this month are considering several new proposals that would significantly improve services to the mentally disabled behind bars. If approved, the $500,000 in new services would be included in the county's fiscal 1994 budget, which takes effect Oct. 1.
"If what's in front of the county commissioners this summer is actually funded, it will represent a great step forward," said Michael Faenza, executive director of the Mental Health Association of Greater Dallas. "It will mean humane and effective treatment of people with mental illness and mental retardation."
Commissioners are guarded when asked whether they'll approve the increased services. But they acknowledge the seriousness of the jail mental health issue, and they note that the proposals are on a short list of important items that they will try to include in next year's budget.
"It is just logical to treat this population in a meaningful way," said County Commissioner Nancy Judy, who has led a task force to study jail mental health services. "I am optimistic that we will improve the services."

For years, Mr. Faenza and other advocates have criticized the treatment of the mentally impaired in jail. They have said county officials should do more to identify such inmates, hire full-time professionals to treat them and link them with outside services when they are released so they don't end up in jail again.
In the spring, the Dallas County Mental Health and Mental Retardation Center began screening all jail inmates to determine which ones previously received services through the Texas MHMR system. Each day, the agency hands county jail officials a list of inmates believed to be mentally ill or mentally retarded.
Don Gilbert, executive director of MHMR, said that list routinely shows that hundreds of inmates have a documented history of mental impairment.
But without increased staffing, jail officials have been limited in their response to that list, said Dr. Randy Farris, Dallas County's health director.
That's why he has asked commissioners to approve the hiring of a full-time psychiatrist, two more psychiatric nurses and a mental health caseworker.
Commissioners have approved the hiring of the psychiatrist and agreed to increase the salary of that post a few weeks ago. Dr. Farris said he expects to fill that position within three weeks.
Commissioners will consider approving the nurse and caseworker positions this month, Dr. Farris said, along with a proposal by Dallas County MHMR to help move nonviolent mentally ill and retarded inmates out of the jail when appropriate.
The proposal - which represents $300,000 of the $500,000 total - calls for the hiring of eight case managers and one secretary to help identify those mentally disabled inmates who are in jail for minor offenses, then arrange for their release and treatment in outside agencies.
If approved, the new services would enhance other recent changes in the way the local criminal justice system handles mentally disabled inmates, county officials said.
Among them is an expedited system for bringing those inmates to court for competency trials. Two months ago, Dallas County Chief Magistrate Boyd Patterson opened a separate courtroom to conduct such trials so that mentally ill and retarded inmates wouldn't have to wait for openings on the busy state district court dockets.
Assistant Chief Bob Knowles, chief of detentions at the Dallas County Sheriff's Department, said he favors efforts to move mentally disabled inmates out of the jail more quickly when possible.
"They need a place that can provide the proper help they deserve," he said.
County Budget Officer Philip Scheps said commissioners will discuss the jail mental health proposals in more detail during a budget workshop later this month.
County Judge Lee Jackson said he was not ready to say whether he would approve the requests.
"But jail mental health is on a very short list, and there are not that many other areas in the county which are going to receive much consideration for new or expanded services," Mr. Jackson said.
05/23/93
PAPER: THE DALLAS MORNING NEWS
SECTION: EDITORIALS
EDITION: HOME FINAL
PAGE: 2J
LENGTH: 10
HEAD: MENTALLY ILL Agency should take over jail psychiatric services
COLUMN: EDITORIALS
TEXT:
More than a year has past since community leaders first called attention to the dearth of psychiatric services for Dallas County jail inmates. Yet, despite the public outcry, very few substantive improvements in care have been made by county officials. The one full-time psychiatrist who had been promised hasn't even been hired yet. Will it take a class-action lawsuit, or some jail tragedy, for Dallas County to finally get serious about providing adequate services? This community would not deny health care to jail inmates. Why, then, is there such a reluctance to extend the appropriate psychiatric care?
The need to do better should be more obvious than ever. Since mid-March, the Dallas County Mental Health and Mental Retardation Center has screened all inmates as they enter the jail to determine whether they have been in the state mental health and mental retardation system. The numbers are alarming. As many as 16 percent of the inmates have been cared for at either a state hospital or a community mental health center. And mental health officials point out that the real incidence of mental illness may be higher, since the screening does not identify inmates who have received private care or none at all.
Up to now, the county Health Department has overseen the few mental health services available in the county jails. But maybe it is time for the county to put another agency in charge, an agency with more expertise and experience in helping the mentally ill -- namely, the Dallas County Mental Health and Mental Retardation Center. The switch would make sense. Many of the mentally ill inmates have been the center's clients before they got into jail, and many probably will be clients again when they leave. Allowing the center to care for them while they were behind bars would provide some continuity.
Granted, making such a change is not, by itself, the answer to the underfunding of psychiatric services at the jails. The mental health center has no pot of gold to offer; the county still would maintain financial responsibility. But the cooperation that would be engendered between the county and the mental health center as a result of this working arrangement could be beneficial in finding a satisfactory long-term solution. Other large counties in Texas have called on the expertise of their community mental health centers to help care for jail inmates; such a partnership might work just as well here.
12/16/92
PAPER: THE DALLAS MORNING NEWS
SECTION: NEWS
EDITION: HOME FINAL
PAGE: 27A
LENGTH: 13
HEAD: Funds backed for inmate care But some say county plan for mentally
ill, retarded falls short
BYLINE: Anne Belli
CREDIT: Staff Writer of The Dallas Morning News
ART: CHART(S): Jail mental health care; (DMN)
TEXT:
Dallas County commissioners tentatively agreed Tuesday to spend $200,000 to improve treatment of mentally ill and mentally retarded inmates, hundreds of whom are in jail receiving little or no specialized care.
But, while grateful for the improvements, some mental health advocates warned that the steps still fell far short of what was needed to treat mentally impaired inmates humanely.
"I'm disappointed there is not a more sincere attempt to approach the level of need,' said Michael Faenza, executive director of the Mental Health Association of Greater Dallas. Mr. Faenza was part of a task force that this summer proposed about $700,000 in improved mental health services to county inmates.
Commissioners acknowledged that the need might be greater than the improvements. But they quickly noted that the county was having its toughest year financially in recent memory.
"I understand the frustrations,' Commissioner Jim Jackson said of the advocates' complaints. "But there are a lot of frustrations right now.'
County health department officials estimate that of the roughly 6,000 inmates in jail on any given day, at least 12 percent are seriously mentally ill or mentally retarded.
In the spring, a group of mental health advocates publicly decried the inmates' treatment, saying that hundreds of mentally impaired people were being warehoused in the county jails receiving little treatment, such as accurate diagnoses and medication.
Then, as now, only one part-time psychiatrist, one part-time psychologist and a case worker provide treatment to mentally ill and mentally retarded inmates.
During the summer, a task force headed by Commissioner Nancy Judy, and including more than a dozen county officials and advocates, debated the problem. During the county's budget talks, the task force recommended hiring several new health care personnel, as well as other measures.
Officials had hoped that the $700,000 proposal would be paid largely by a state grant expected to be awarded to Dallas County. But when county officials learned late last month that the grant was not awarded, County Health Department Director Randy Farris, a member of the task force, was asked by commissioners to pare down the proposal.
Specifically, Dr. Farris recommended Tuesday that the county hire an additional full-time psychiatrist and one psychiatric nurse, as well as establish a part-time magistrate court to speed competency hearings.
He also noted that Parkland Memorial Hospital plans to open a pharmacy at the Lew Sterrett Justice Center by March. That would allow psychiatric patients to receive medication quicker and more consistently, he said.
Dr. Farris also noted that the Dallas County Mental Health and Mental Retardation Center planned to begin screening inmates soon for histories of mental illness and mental retardation as they are booked into jail.
"I think anything that increases services has to be seen as a positive step,' Don Gilbert, executive director of Dallas County MHMR, said of the commissioners' action Tuesday.
"Clearly we do need more,' he said. "But the reality is that this is a difficult time for government in general.'
12/01/92
PAPER: THE DALLAS MORNING NEWS
SECTION: EDITORIALS
EDITION: HOME FINAL
PAGE: 16A
LENGTH: 9
HEAD: JAIL SERVICES Dallas County should fund mental health plan
COLUMN: EDITORIALS
TEXT:
Dallas County needs to follow through on its plan to improve the care of jail inmates who are seriously mentally ill. Although county officials have learned that they won't be receiving an anticipated state grant that would have helped pay for the mental health project, they must not let that disappointing news delay those crucially important services.
At the moment, the county jails' mental health services -- essentially, one part-time psychiatrist, one part-time psychologist and one full-time caseworker -- are grossly inadequate to meet the needs of the hundreds of inmates who are seriously ill. Many go unrecognized and untreated.
Earlier this year, a county task force worked hard to develop a plan for hiring additional mental health professionals to improve care. Ultimately, the county needs to create a complete psychiatric unit within the jails, as well as divert non-violent offenders into community treatment programs. But the task force's proposal was a good beginning.
Now, with no state funds forthcoming, even that modest plan is in doubt.
Still, there are compelling reasons for county officials not to give up. Aside from the obvious inhumanity of allowing mentally ill individuals to languish behind bars without appropriate treatment, Dallas County conceivably could face a costly class-action lawsuit if it shows no financial commitment to improve the jail's psychiatric services soon.
County officials are trying to identify alternative sources of funding. But if all else fails, they should consider using some of the county's cash reserves to get the project moving. True, these are tough times for the county. Yet the fact that the services probably wouldn't begin until halfway through the budget year would blunt their financial impact.
In addition, a better system of care for mentally ill inmates might well lead to a smaller jail population over time -- and produce savings for taxpayers. When the county task force made its recommendations last summer, hopes were high that this problem finally was on its way to being solved. It would be terrible if those hopes now were dashed.
11/07/92
PAPER: THE DALLAS MORNING NEWS
SECTION: VIEWPOINTS
EDITION: HOME FINAL
PAGE: 29A
LENGTH: 13
HEAD: Mentally ill are trapped in our jails
BYLINE: Patricia Wilson
COLUMN: PATRICIA WILSON
TEXT:
I stood in the room of my 13-year-old son and read a handout he had been given in American history class. It contained excerpts of the testimony given by Dorothea Dix in 1843 to the Massachusetts legislators in which she appealed to them to reform the care of the mentally ill people who were often housed in jails.
I thought, "Nothing has changed.'
In 1992, in Dallas, the mentally ill are still often housed in the county jail. A man with a previously diagnosed major mental illness was held for months while there was a hospital bed waiting for him out of state; people dependent upon medication to behave rationally are held for weeks without medication until they decompensate to the point where they are unfit to stand trial, then are sent to Terrell State Hospital to re-stabilize and repeat the cycle back to county jail.
A mentally ill homeless man was in the county jail awaiting trial because he ate Twinkies off the shelf of the 7-Eleven and was too confused to pay for them. A delusional, suicidal young man was stripped naked and locked in a bare cell for days because the jailers had no other means to protect him from himself.
Some local legal professionals say these things could not happen, that the system does not keep misdemeanant and mentally ill people in jail. For months, the county said there were very few mentally ill offenders in the jail; however, a recent Dallas County Mental Health ental Retardation Board study found 702 people in the jail on a single day in March who had received services from the Texas mental health etardation system.
The Texas Council for Mentally Impaired Offenders states that between 15 and 20 percent of those charged with a misdemeanor offense have a diagnosable mental illness.
A person suffering from mental illness who ends up in Lew Sterrett must think he has gone to hell. To a mentally ill person, what is real is what is going on in his mind, and that is the part that his illness affects.
Imagine the horror of a mentally ill person experiencing delusions or persecution and paranoia or sliding into the deep abyss of major depression surrounded by the terrifying environment of a cell in the county jail. The jailers would not leave an inmate with a broken leg screaming in pain, but they unknowingly leave mentally ill inmates in comparable mental anguish and emotional suffering.
A recent survey by the Public Citizen Health Research Group, a national health advocacy group, said that 7.2 percent of jail inmates were seriously mentally ill and faced no criminal charges, and an earlier report issued jointly with the National Alliance for the Mentally ill stated that, "The largest mental institution in the national is the Los Angeles County Jail, which has 3,600 inmates with serious mental illness in the population of 24,000.'
In Dorothea Dix's time, mentally ill people were called insane, lunatics, feeble minded or even witches. The nomenclature has changed. Is it not time that the treatment changes also?
Patricia N. Wilson is a former member of the Dallas County Mental Health ental Retardation Board and member of the Mental Health Association of Greater Dallas.
08/21/92
PAPER: THE DALLAS MORNING NEWS
SECTION: EDITORIALS
EDITION: HOME FINAL
PAGE: 26A
LENGTH: 9
HEAD: JAIL SERVICES Dallas County should fund mental health plan
COLUMN: EDITORIALS
TEXT:
Despite tight finances this year, Dallas County needs to get started on improving the care of jail inmates who are seriously mentally ill. Until appropriate help is provided, many of the mentally ill will continue to pass through the criminal justice system. Not only is that cycle of arrest, incarceration and re-arrest unjust to them, it is a waste of tax dollars.
The jails' existing mental health services -- essentially, one part-time psychiatrist and one part-time psychologist -- are grossly inadequate to meet the needs of the hundreds of inmates who are seriously ill. Many go unrecognized and untreated. As a first step toward improving care, the county commissioners are looking at a plan that would help identify the mentally ill as they enter jail. The proposal also calls for hiring two full-time psychiatrists, one full-time psychologist, eight nurses and two case workers.
County Commissioner Nancy Judy is to be commended for pursuing this important issue in the face of the county's tight budget. The easy thing would have been to say the county doesn't have the funds and to postpone consideration until next year. Instead, the commissioner has been working hard to see how the $750,000 proposal can be included in the 1992-93 budget. A couple of possibilities exist: (1) obtaining a state criminal justice grant, or (2) beginning the initiative at mid-year, thereby halving the first year's costs.
Obviously, the county should go after whatever grant money may be available. But if those outside funds are not forthcoming, the county still should improve the jails' mental health services this year -- with its own money if necessary. Aside from the inhumanity of allowing hundreds of mentally ill individuals to languish behind bars without appropriate treatment, there is the very real possibility of a costly class-action lawsuit being brought against Dallas County if the jails' psychiatric services are not expanded soon.
Over the next several years, the county will need to look at creating a complete psychiatric unit within the jails, as well as diverting mentally ill offenders who are non-violent into community treatment programs. But the limited proposal now before the county commissioners is a good beginning, given today's financial constraints. It deserves to be adopted.
07/14/92
PAPER: THE DALLAS MORNING NEWS
SECTION: NEWS
EDITION: HOME FINAL
PAGE: 24A
LENGTH: 15
HEAD: $5.4 million sought to aid mentally ill Commissioners note budget is
already strapped
BYLINE: Anne Belli
CREDIT: Staff Writer of The Dallas Morning News
ART: PHOTO(S): Lee Jackson . . . "This may be one if those areas where we
may be simply debating whether 1993 is the year to increase service; " (This photo ran in the State edition on page 17A) ; PHOTO LOCATION: Jackson, Lee.

TEXT:
Dallas County commissioners were asked Monday to add $5.4 million to next year's budget to serve severely mentally ill jail inmates, children and other county residents.
But the proposals got a lukewarm response from commissioners, who are facing the grimmest county budget picture in recent years.
County Judge Lee Jackson noted that the county already was considering a 20 percent tax increase that doesn't even include funding for new programs such as jail mental health care.
"This may be one of those areas where we may be simply debating whether 1993 is the year to increase services,' Mr. Jackson said. "No one is eager about a 20 percent tax hike.'
County budget officers last week proposed a 19 percent tax increase to cover the sale of about $215 million in bonds, high costs associated with the opening of the huge new North Jail Tower and to make up for a decline in property values.
By Monday morning the proposed tax increase had moved up to 20 percent to adjust for new calculations.
In one of the proposals, the county's health director asked commissioners to hire two full-time psychiatrists, one psychologist, eight psychiatric nurses and two case workers to treat mentally ill jail inmates.
Dr. Randy Farris, director of the health department, said that about 12 percent of the county's 6,000 inmates were believed to be seriously mentally ill. Yet the county provides only one part-time psychiatrist, one part-time psychologist and one full-time case worker to treat hundreds of inmates.
The new positions would cost the county $714,382, budget documents show.
Also, the Dallas County Mental Health and Mental Retardation Center asked commissioners to include an additional $43,000 in its budget to operate a computer system that would check incoming inmates for a history of mental illness.
Within 24 hours after an inmate is jailed, the system would check to see whether the inmate had ever received services through any MHMR agency statewide, said Dallas County MHMR executive director Don Gilbert.
Both proposals are byproducts of a task force set up four months ago to examine jail mental health. The task force, chaired by Commissioner Nancy Judy, included Dr. Farris, Mr. Gilbert, sheriff's department officials and mental health advocates.
Also Monday, Mr. Gilbert asked commissioners to budget an additional $4.4 million next year for increased services to severely mentally ill children, and to continue $87,000 in funding for MHMR's Mobile Crisis Intervention Team. The team makes "house calls' to Dallas County residents in mental health emergencies.
Mr. Gilbert also urged the court to increase its budget for the operation of the new Dallas Psychiatric Intensive Care Unit by $300,000. The county has included $2.8 million in next year's budget to run the unit, formerly the Mental Diagnostic Center. Five people died at the center last year, causing it to be shut down from October until March while MHMR made state-ordered improvements.
After the budget hearing, Mr. Gilbert said he was cautiously optimistic that commissioners would grant his agency's requests. "They didn't throw us out,' he said.
In another budget hearing Monday, the Sheriff's Department urged commissioners to continue funding its Drug Intervention Unit next year. The narcotics unit has been cut from the county's preliminary budget. But Dallas sheriff's Capt. Danny Chandler said the unit had more than justified its $325,000 annual cost in making big drug busts.
The unit, established in 1990, has seized millions of dollars in cars, homes, drugs, weapons and cash, Capt. Chandler said. He presented a slide show detailing the unit's major busts.
06/07/92
PAPER: THE DALLAS MORNING NEWS
SECTION: SUNDAY READER
EDITION: HOME FINAL
PAGE: 2J
LENGTH: 13
HEAD: MENTALLY ILL Dallas County must improve jail services
COLUMN: EDITORIALS
TEXT:
A recent estimate that at least 10 percent of Dallas County jail inmates are seriously mentally ill underscores the importance of county officials' developing an appropriate system of care for those individuals. Until adequate help is provided, many of the mentally ill will continue to pass through the criminal justice system. Not only is that cycle of arrest, incarceration and re-arrest unjust to them, it also is a waste of tax dollars.
As surprisingly high as that estimate may be to some county officials who at first tried to downplay the lack of proper care in the jail, the number actually may be much larger. Although 707 of the county's 5,851 inmates were identified as receiving services through the state mental health and mental retardation system, there likely are many other mentally ill inmates who have been treated in the private sector or who haven't gotten any help at all.
At the initiative of Dallas County Commissioner Nancy Judy, county health and mental health authorities are drafting recommendations on what additional services should be provided. There is much that county officials could learn from looking at similarly sized jails, such as those in Phoenix and San Diego, where mental health services are readily available through the criminal justice system. But at minimum, Dallas County's plans for reform must:
Do more to identify mentally ill people as they enter jail.
Divert minor or non-violent offenders into community treatment programs.
Provide serious offenders with more intensive care while in jail.
Link up mentally ill inmates with community treatment services upon release.

Although state funds may be available for diverting the county's minor or non-violent mentally ill offenders into treatment programs, identifying funding sources for the other initiatives could be more difficult. Still, the county's tight finances must not be used as an excuse for either postponing reform or making short shrift of the recommendations. There are compelling reasons for the county commissioners' thoroughly addressing the jail issue during their budget deliberations this summer.
Aside from the obvious inhumanity of allowing mentally ill individuals to languish behind bars without appropriate treatment, there is the very real possibility of a costly class-action lawsuit being brought against Dallas County if the jail's psychiatric services do not improve soon. A better system of care for the county's mentally ill inmates might well lead to a smaller jail population over time -- and produce savings for taxpayers.
The close attention being paid to this issue by Don Gilbert, the new director of the Dallas County Mental Health and Mental Retardation Center, is to be applauded. But his research and analysis, and Commissioner Judy's interest in the matter, are only a beginning. If funding is to be found for the long-overdue jail improvements, broader support will have to be expressed by the community. Now more than ever, the families of mentally ill people must speak up and be heard.
05/30/92
PAPER: THE DALLAS MORNING NEWS
SECTION: NEWS
EDITION: HOME FINAL
PAGE: 34A
LENGTH: 15
HEAD: Mental help for inmates studied Panel to submit ideas after survey
finds that 10% in jail need services
BYLINE: Anne Belli
CREDIT: Staff Writer of The Dallas Morning News
TEXT:
Alarmed by new estimates that at least 10 percent of county jail inmates are seriously mentally ill, Dallas County officials are working to improve services for those inmates.
A committee of officials from the county health and sheriff's departments, the Dallas County Mental Health and Mental Retardation Center, and a mental health advocacy group plans to submit specific service recommendations to county commissioners by June 11, officials said.
That would be three months after a group of mental health advocates gathered outside the county's largest jail to decry what they called inhumane treatment of mentally ill inmates.
The critics said hundreds of mentally ill inmates are neglected routinely in county jails, where one psychiatrist and one psychologist work a total of 22 hours a week. Sheriff's Department officials defended their services and denied that any inmates were being mistreated.
Since then, however, MHMR Executive Director Don Gilbert and jail officials have tried to determine how many inmates suffer from a severe mental illness or mental retardation. Dallas County Commissioner Nancy Judy, who has worked with county health officials on the issue since summer, encouraged the additional efforts.
After comparing a list of inmates with a list of clients served by MHMR offices in Texas, the officials found that 707 of 5,851 inmates had received mental health or mental retardation services. Most of those 707 -- or about 10 percent of the total inmate population -- were mentally ill.
About 400 of the clients were from Dallas County; more than 250 had been patients at state hospitals.
"I'm very pleased to see that here is concrete data as to what is the problem of mental illness in the criminal justice system,' said Michael Faenza, executive director of the Mental Health Association of Greater Dallas. "On the other hand, how sad it is that there are so many people incarcerated with mental illness.'
Mr. Gilbert agreed. "There is just a whole lot of need,' he said.
He noted that the number of mentally ill inmates might be significantly higher because the MHMR system treats only those with the most serious diagnoses, such as schizophrenia and severe manic depression.
"You don't qualify to receive services unless you are chronically mentally ill,' he said.
County Health Director Randolph Farris, who is helping develop the recommendations, said his department had been concerned about mental health services to inmates since June. "This is something we have been looking into for almost a year,' he said.
Mr. Gilbert said the committee was reviewing mental health services in jails throughout the state and country. He said its recommendations probably would include plans to:
* Divert some mentally ill people convicted of misdemeanors from jail to outside mental health agencies.
* Better screen incoming inmates for mental illness, perhaps by checking to see whether they have ever received services through the MHMR system.
* Improve services to more serious offenders who must remain in jail.
* Link mentally ill inmates with outside agencies when they are released.
Mr. Gilbert acknowledged that all those plans would require significant spending at a time when county government is facing a grim financial year.
But Mr. Faenza said the improvements could result in cost savings because they would cut down on the number of mentally ill inmates housed in county jails.
"You have to invest in rational plans to be able to save money,' he said.
04/04/92
PAPER: THE DALLAS MORNING NEWS
SECTION: NEWS
EDITION: HOME FINAL
PAGE: 35A
LENGTH: 15
HEAD: TB tests urged for inmates Action would slow spread of disease,
official says
BYLINE: Laura Beil
CREDIT: Staff Writer of The Dallas Morning News
ART: CHART(S): TB On The Rise (DMN)
TEXT:
Faced with a marked increase in tuberculosis cases, the Dallas County Health Department wants to test county jail inmates for the potentially deadly lung disease.
Detention commander Bob Knowles said the tests are essential because "TB seems to be coming back strongly in jails and penitentiaries.' He said the tests would reduce the spread of tuberculosis among inmates and the jail staff.
No one knows how many county prisoners suffer from TB. But prisoners are considered especially at risk to contract the disease because large numbers of them are housed in a common area. The disease is spread through the air by coughs and sneezes.
Officials say they don't know when the tests will begin because they are awaiting word on a federal grant that would pay for the tests.
Not all prisoners will be tested because the majority are released on bail within three days. A tuberculosis skin test must be examined within 48 to 72 hours.
"If we tested everybody that came in, 72 hours later, 80 percent of those people would be gone,' Mr. Knowles said.
The health department will test only prisoners who have been in jail for seven days because they are less likely to be released on bail, officials said. Mr. Knowles predicted that about 2,000 prisoners will be tested each month. About 10,000 to 12,000 inmates are booked into the county's four jails every month.
Infected prisoners will be treated immediately with antibiotics, officials said. According to Dr. Charles Haley, county epidemiologist, infected prisoners will be medically isolated for the first five days of treatment. When their coughing ceases, the danger of passing infection on will be reduced and isolation will no longer be necessary.
Health department policy is to test only prisoners who exhibit TB symptoms
-- a raspy cough or night sweats.
Other Texas counties routinely test for tuberculosis, including Harris and Bexar counties. The Texas Department of Criminal Justice also tests all new state prisoners.
Until the mid-1980s, tuberculosis was thought to no longer be a public health threat, thanks to antibiotic treatments developed in the 1950s.
But some strains of the disease now appearing are resistant to antibiotics.
The disease began a resurgence in recent years, with steady increases reported nationally since 1985. In Dallas County, the growth of TB cases has become apparent in the past three years, said Charla Edwards, the county's TB program manager. In 1991, 301 new cases were reported, compared with 284 in 1990 and 262 in 1989.
The problem has been more dramatic within the city, Ms. Edwards said. In 1990, 15.4 new cases were reported for every 100,000 county residents. In the city of Dallas, 21.4 cases were reported for every 100,000 people.
National figures released Thursday by the federal Centers for Disease Control showed that the number of cases in 1991 increased by 2.3 percent, to 26,283 cases. From 1989 to 1990, new cases rose by 9.4 percent, the biggest increase ever. The disease peaked in 1953, when 84,000 new cases were reported.
The county health department has requested $220,000 from the CDC for the inmate tests. The money would be used to hire four nurses and to buy an X-ray machine and a computer system to keep track of tested inmates. The county's health director, Dr. Randolph Farris, said he expects to hear from the CDC about the request in two or three weeks.
Given the number of prisoners admitted to county jails and the re-emergence of tuberculosis as a national health threat, Dr. Farris said the grant probably will come through.
04/02/92
PAPER: THE DALLAS MORNING NEWS
SECTION: EDITORIALS
EDITION: HOME FINAL
PAGE: 26A
LENGTH: 9
HEAD: COUNTY JAILS Officials begin to address mental illness issue
COLUMN: Editorials
TEXT:
Dallas County officials have made a good start in evaluating the problems that mentally ill people face in the county jails. Most notably, the efforts by Don Gilbert, the new executive director of the Mental Health and Mental Retardation Center, to get a better flx on the number of mentally ill inmates in Dallas County should help resolve a longstanding debate over just how pervasive the problems are. Estimates of the number of emotionally ill inmates have varied widely. In order to be as accurate as possible, Mr. Gilbert will need to identify not only the people who have received mental health services but also those who may be eligible for help.
Sheriff Jim Bowles is ultimately responsible for the care of jail inmates, and his new willingness to sit down and talk with residents concerned about the mentally ill is welcome. The sheriff can continue to show his good faith in this emerging planning effort by following through on a recommendation made by mental health leaders and asking the National Institute of Corrections to do an outside evaluation of the Dallas County jails' mental health services. Such a review would be an excellent way to take Mr. Gilbert's census study a step further.
The highly recognized institute, which is a part of the Justice Department, has assisted urban jails throughout the country in drafting plans for improving mental health services. In the case of Los Angeles County, the Institute of Corrections sent three consultants, who spent several days visiting the jails and interviewing employees to find out what else might be done for emotionally ill inmates. The end result was a series of independent recommendations for reform. The service is provided at no charge to the local community. All that is needed is for Sheriff Bowles to request the expert advice.
Finally, a communitywide task force should be appointed by County Judge Lee Jackson to review the feasibility of the institute's recommendations and to identify possible funding sources for whatever improvements might be made. As long as a cooperative spirit prevails among county policy-makers, much can be accomplished. Mental illness is, by itself, no crime. Those who suffer from it deserve the community's attention.
04/01/92
PAPER: THE DALLAS MORNING NEWS
SECTION: NEWS
EDITION: HOME FINAL
PAGE: 32A
LENGTH: 13
HEAD: County agencies study inmate neglect charges Groups counting number
of mentally ill
BYLINE: Anne Belli
CREDIT: Staff Writer of The Dallas Morning News
TEXT:
Several county agencies are trying to determine whether there is merit to charges made last month that mentally ill inmates are being neglected in Dallas County jails.
For starters, the Dallas County Mental Health and Mental Retardation Center, with the help of the county health and sheriff's departments, is conducting a computer study to see how many current inmates have received services from an MHMR agency statewide.
However, those who match up probably would only account for a portion of the mentally ill inmates and wouldn't include those who never received MHMR services, said Dallas County MHMR Executive Director Don Gilbert.
To get a more accurate projection of the number of mentally ill inmates, officials will compare Dallas County's jail population with that of Harris County, where mentally ill inmates are tracked closely, Mr. Gilbert said.
"To say now that we don't have enough services or we have the right amount of services assumes we know how many mentally ill inmates there are, and we don't,' said Mr. Gilbert, adding that the issue is one of the first he has tackled since starting his job March 1.
Representatives of several advocacy groups for the mentally ill gathered March 2 outside Lew Sterrett Justice Center to decry what they called inhumane treatment of emotionally troubled inmates.
They said they had been trying for more than a year to get basic information about jail services from the Sheriff's Department but were denied the data. They also called for an outside review of the problem by the National Institute of Corrections, a federal agency that conducts such reviews for free.
Mr. Gilbert said that within a month he hopes to have a refined estimate of how many inmates in county jails are mentally ill. After that, county officials will be able to better determine whether services to them fall short, he said.
County Commissioner Nancy Judy, who is working closely with other officials on the issue, said during the Commissioners Court meeting Tuesday that she is pleased with the recent efforts. She also said she believes the Sheriff's Department does a much better job caring for the mentally ill than the advocates claim.
"It's not as bad a picture as some would like to paint,' she said.
But Commissioner John Wiley Price said he favors the outside review by the federal agency and wouldn't trust an internal assessment.
"My concern is the bureaucracy,' he said. "It's like the fox watching the henhouse . . . We're talking about people who are sick. I don't have the same comfort level with us looking at this as you do.'
But Mrs. Judy said she had faith in MHMR, which is not currently responsible for providing services to mentally ill inmates and, she believes, therefore, would be objective.
"I have confidence in the integrity of the people with whom we're working,' she said.
Michael Faenza, executive director of the Mental Health Association of Greater Dallas, which led last month's rally, said he was encouraged by the county's recent steps.
"Don Gilbert and MHMR are determined to take a hard look at the service need, and I think they are approaching that very seriously,' Mr. Faenza said.
03/09/92
PAPER: THE DALLAS MORNING NEWS
SECTION: EDITORIALS
EDITION: HOME FINAL
PAGE: 12A
LENGTH: 27
HEAD: MENTALLY ILL County jails must provide better services
COLUMN: EDITORIALS
ART: ILLUSTRATION
TEXT:
"Two hundred years ago, we locked mentally ill people up in jails because we didn't know what else to do with them. Well, not much has changed. Jails have once again become mental institutions."
-- The Rev. Jerry Hill, Episcopal Diocese of Dallas
Dallas County's jails, already overcrowded, have turned into de facto mental wards because of a shortage of public psychiatric services in the community. Estimates vary, but even conservatively speaking, hundreds of mentally or emotionally ill people may be behind bars on any day.
Many clearly don't belong there. They are there mainly because we have neglected them. We have failed to give them the treatment they need. Unable to function, they eventually commit a petty offense, like trespassing or disturbing the peace, and fall into the hands of the law.
Our jails never were meant to become mental institutions. Yet, because of our overburdened public mental health system, that is what they are -- the shelters of last resort for the mentally and emotionally ill. Sometimes, the police will put them in jail just to get them off the streets.
Of course, just as we have neglected to treat mentally ill people outside the jail, we neglect them once inside. Dallas County jail officials do a poor job of identifying the mentally ill when they arrive. Many inmates with serious disorders never are spotted and thus never are helped.
Even those who are identified and placed in the behavioral observation unit receive little professional attention. The part-time psychiatrist and part-time psychologist employed by the county can spend only a few minutes with each patient. Medication can be difficult to obtain, too.
Allowing the Dallas County jails to become a warehouse for the community's mentally ill has been cruel and inhumane. Because of their bizarre behavior, mentally ill inmates often are placed in solitary confinement. They also are easily preyed upon and manipulated by other prisoners.
Without specialized treatment, many of the mentally ill become trapped in the judicial system. When they finally do get out, they rarely are hooked up to community mental health services. It then becomes only a matter of time before they commit another petty offense and repeat the cycle.
This pattern of arrest, incarceration and release not only is unjust; it is a huge waste of taxpayer dollars. At a time when the county finds itself inundated with state inmates, it should be doing everything possible to reduce the jail population where appropriate.
The Mental Health Association of Greater Dallas has raised the issue of better care for the mentally ill in the Dallas County jails for more than a year. Yet Sheriff Jim Bowles has shown little interest in working with community leaders to see what improvements could be made.
That attitude must change.
Although County Commissioner Nancy Judy has tried to gather information on the issue, her efforts are only a start. A communitywide task force, made up of law enforcement officials and mental health leaders, should be appointed by County Judge Lee Jackson and given the mandate of drafting real reforms:
* More attention must be paid to identifying mentally ill people as they enter jail.f-b A mental health specialist now screens all inmates referred to her by the county's jails. That is an impossible task for one individual, considering the number of people booked each day.
By contrast, Harris County has five mental health specialists doing its screening. A larger unit here would be much better able to identify mentally ill people who otherwise might not be recognized and thus never receive needed counseling and treatment, like homeless individuals.
* Mentally ill offenders with minor or non-violent crimes should be diverted into community treatment programs rather than incarcerated.f-b A good model is Project Action in Harris County. Only 1 years old, it already has placed 250 offenders in counseling and treatment programs.
Project Action is showing that, with the right care and support, the mentally ill are able to stay out of the criminal justice system. The results have been impressive so far. The Harris County pilot program has reduced the recidivism rate of its users from about 60 percent to only 4 percent.
* Mentally ill inmates who have committed serious offenses should receive better care while in jail.f-b The courts have ruled that prisoners must have "reasonable access" to health services. It is difficult to imagine that providing only 10 hours per week of psychiatric time to Dallas County's 5,000-plus inmates constitutes "reasonable access."
People whose offenses require them to be incarcerated must not be denied medical treatment just because their illness happens to be neurological in nature. Jail systems in other cities realize this. Harris County has a full-fledged psychiatric unit inside its jail.
* Mentally ill people being discharged from the jails should be linked up with community treatment services.f-b There is now little coordination. As a result, many individuals get into trouble again and return to jail, where they take up beds that could be used for violent offenders.
Keeping the mentally ill out of jail is in the county taxpayer's interest. Medicaid will pay for rehabilitation services as long as someone is not behind bars. Supplemental Security Income payments also are available. When someone is in jail, though, that state and federal help vanishes.
As a first step toward achieving those four goals, Sheriff Bowles should call on the National Institute of Corrections for its expertise. The institute, which is part of the Justice Department, has helped other counties plan and design the mental health services in their jails.
The Dallas County task force then should help identify possible ways to fund the improvements. Community justice assistance dollars, funds from the Texas Council on Mentally Impaired Offenders, state mental health money and county dollars are all sources that might be tapped.
This community has worked well on past mental health planning efforts, such as last year's successful campaign to secure state funding for a 30-bed public psychiatric hospital. That same broad-based cooperation now must be applied to the jail problem.
Mental illness is no crime. Those who suffer from it in our community deserve humane and effective treatment.
03/03/92
PAPER: THE DALLAS MORNING NEWS
SECTION: NEWS
EDITION: HOME FINAL
PAGE: 16A
LENGTH: 19
HEAD: Care of mentally ill inmates protested Those at rally urge study of
county jail
BYLINE: Anne Belli
CREDIT: Staff Writer of The Dallas Morning News
ART: PHOTO(S): Mike Faenza of the Mental Health Association of Greater
Dallas addresses the news media Monday outside the Lew Sterrett Justice Center as part of a group portesting treatment of mentally ill inmates.
(DMN: Erich Schlegel); PHOTO LOCATION: Faenza, Mike (cf 51370).
TEXT:
Mental health advocates gathered outside the county's largest jail Monday morning to decry what they called inhumane treatment of mentally ill inmates.
Yards away from the entrance to the Lew Sterrett Justice Center, advocates blasted the Dallas County Sheriff's Department, saying mentally ill inmates are not screened adequately and do not receive basic treatment and medication.
They called for an independent study of the issue by the National Institute of Corrections, a federal agency.
"The fact that you have people in our jails that become so psychotic that they are eating their feces and drinking their urine is unconscionable,' said Mike Faenza, executive director of the Mental Health Association of Greater Dallas.
Mr. Faenza said family members of mentally ill inmates have recounted several such incidents at Lew Sterrett.
Sheriff's officials said Monday that they are aware of such incidents, but most have involved inmates who were faking mental illness.
"We see a lot of folks doing this to try and help out their criminal charge,' said Deputy Chief Bob Knowles, detention commander at Lew Sterrett.

John Weddle, the department's legal adviser, staunchly denied that the jail has neglected mentally ill inmates. He said Lew Sterrett regularly passes state jail inspections.
"We are doing everything that the sheriff has the authority to do,' he said.

He said the department contracts with a psychologist and psychiatrist to evaluate inmates and prescribe medication. It also has established a behavioral observation unit on the third floor of Lew Sterrett, where mentally ill inmates are watched and, if necessary, placed in solitary confinement for their own protection.
"Anything beyond that is nice, but it is not something the sheriff has the responsibility to do,' Mr. Weddle said. "We are a holding facility and that's what we do. . . . We don't have the statutory authority to be treating people.'
Mr. Weddle spoke during an impromptu news conference minutes after the mental health advocates had departed.
In addition to Mr. Faenza, the advocates included Dr. Ron Anderson, chief executive officer of Parkland Memorial Hospital; the Rev. Jerry Hill, director of the Austin Street Shelter; the Rev. Matt English, director of North Dallas Shared Ministries; Michael Peterson, president-elect of the Mental Health Association; and about a dozen other civic leaders and concerned citizens.
They estimated that, based on national trends, 25 percent of Dallas County inmates -- or about 1,000 -- are mentally ill.
Dr. Anderson commended the efforts of the psychologist and psychiatrist who work with the inmates a total of about 22 hours a week. But he said that is not enough.
"I am aware that there are a few very competent people working hard to provide services to people with mental illness in our Dallas County jails,' Dr. Anderson said, speaking as an advocate, not as a Parkland official.
"However, jails in other cities are doing more to provide better services and to divert mentally ill people from the jail system.'
He and others pointed to the Harris County jail system, where the Texas Department of Mental Health and Mental Retardation operates a full-service mental health jail ward under a contract with the county.
"It's a pretty extensive process,' said Maj. Mike Quinn, who oversees the ward for the Harris County Sheriff's Department.
Mr. Peterson said that for 18 months, the Mental Health Association has requested a tour of Lew Sterrett's observation unit but has been denied access.
Because association members haven't been able to see the unit firsthand, they said they still aren't aware of the Sheriff's Department policies regarding mentally ill inmates.
Dallas psychologist Richard L. Fulbright said he recently was evaluating an inmate for a private attorney when he heard a man in the behavioral observation unit screaming for hours.
"There was a guy up there that just kept screaming and screaming and obviously had not been medicated,' he said.
County Commissioner Nancy Judy said she has formed a task force of county officials to evaluate the handling of such inmates. But she said the group is still "in the discovery phase,' and she could not say whether services fall short.
"The question is: Are these people getting adequate treatment in the jail setting?' Mrs. Judy said.
Mr. Faenza said later Monday that Sheriff's Department officials have agreed to meet with him soon to discuss the issue further.
11/26/89
PAPER: THE DALLAS MORNING NEWS
SECTION: NEWS
EDITION: HOME FINAL
PAGE: 33A
LENGTH: 10
HEAD: Where did blame start in jail death?
BYLINE: Steve Blow
COLUMN: STEVE BLOW
TEXT:
Two letters arrived last week concerning Mike Houston's death in the Dallas County jail. Two very different letters, yet equally haunting.
Mike died Oct. 29 -- one day after his 36th birthday and after several days of pleading for medical help.
The first letter was forwarded to me by Mike's parents, Leslie and Vivian Houston of Richardson. It was written by one of Mike's cellmates after he read of Mike's death in an earlier column.
"I feel the need to tell you the truth of what has happened to Mike as I believe a great injustice has been done,' wrote Scott McCausland. Cellmate's-eye view
" . . . Around 1 p.m. Mike got a severe headache. He would scream out loud in great pain that made me very nervous.
"I called the guard and told him Mike needed to see a doctor immediately, that he was very sick. After a few minutes they came and got him. In about five minutes, he was brought back to our tank. He told me that they did nothing for him, not even would they give him an aspirin.
"Mike came back to our room and lay down. It was obvious that he was in pain. He told me constantly that it felt like something was bursting inside of his head.
"About one hour later Mike was getting worse. We made several attempts to get the guards to help him. . . . Across the speaker one guard said, "Sure, we'll do something for him. We'll put a bullet through his head.'
"Mike was in a delirious state of mind. He was very confused. He had no idea where he was or what he was doing. He would spit on himself and he urinated on himself. He would say things that made no sense.
"We again called the nurse. We told her that Mike said he felt like something busted in his head and he felt like liquid was sloshing around in his head.
"Again they handcuffed him and made him walk, but soon realized that he could not, and they brought a wheelchair and took him away. We all prayed he was getting the medical attention he needed, but as we found out in today's newspaper, they did nothing for him.'
Mike was taken from the group jail cell on Oct. 21 and placed in an observation cell. And there he died eight days later.
According to the autopsy report, Mike died of a brain hemorrhage "due to blunt impact of head.' An accidental death, the report said.
Guards saw Mike hit his head in the midst of a delirium on Oct. 20. Knowing that he was a heroin addict, they attributed his actions to drug withdrawal.

And jail medical personnel from the county health department apparently continued to make that assumption while Mike slowly died. Drugs: Father of the man
The second letter came from Kelly Dykes of Plano, a friend of Mike's family. "Something more needs to be said about Mike's life and death,' he wrote.
"Mike wrote in his last letter to his parents, "I'm so sorry about all this. I know I wasn't raised this way.'
"Mike had every opportunity to become a solid member of society. Mike's parents, Leslie and Vivian Houston, happily married for 39 years, are openly affectionate and caring people. The Houston clan is a large family. Mike was the youngest of four children, with three older sisters with families of their own. The family is very supportive of each other. . . .
"Mike had the advantage of looks, family, middle-class environment and educational opportunities. He should have had a good, productive life, but as he himself said in that last letter, he had made a mess of his life. Why?

"At 14, he experimented with sniffing glue, which led to pot, speed and eventually to heroin addiction. Those who knew Mike remember a kind soul who made them laugh. But drugs ruined a basically good man's life.
"Mike Houston should have been given adequate medical treatment while in jail. If his pleas for help had been listened to, he would probably be alive today. The truly tragic thing is that drugs are the reason he was in this situation and drugs finally put Mike in harm's way.
"Mike Houston has left behind a loving family, a handsome 11-year-old son and friends who will miss him. But if only one parent, child or any individual can realize the curse that drugs had on Mike's life and be swayed from using them, then maybe his passing could seem less tragic.'
09/19/89
PAPER: THE DALLAS MORNING NEWS
SECTION: NEWS
EDITION: HOME FINAL
PAGE: 17A
LENGTH: 6
HEAD: County jail tour policy needed, Price says
BYLINE: Lawrence E. Young
CREDIT: Staff Writer of The Dallas Morning News
ART: PHOTO(S): (State Ed., P. 18A) John Wiley Price; PHOTO LOCATION:
Price, John Wiley.
TEXT:
Dallas County Commissioner John Wiley Price wants the Sheriff's Department to establish a formal policy on jail visits by commissioners.
Mr. Price made the request Monday during a Commissioners Court meeting. He said Sheriff's Department officials prevented him from conducting a personal investigation into overcrowding and health conditions inside county jails Sunday evening.
At least two other commissioners -- Jim Jackson and Chris Semos -- said they have toured jails without any problems.
"I've received numerous complaints from some inmates and defense attorneys about what they consider deplorable conditions in some county jails,' Mr. Price said. "I wanted to see for myself.'
In a telephone interview after the meeting, Sheriff Jim Bowles said he didn't believe a formal policy was necessary. Sheriff Bowles said his staff routinely takes commissioners on tours of the county's four jails upon request.
He said he had no knowledge about the apparent difficulties Mr. Price experienced Sunday.
"There is no policy or law that addresses the issue of commissioners visiting the jail,' Sheriff Bowles said. "But any time any commissioner has asked to look at the jails we've escorted them through.
"If someone has information about some kind of problem, we would be more than happy to check it out.'
Dr. Gordon Green, the county's director of public health, said any time jail overcrowding occurs, the potential exists for transmission of communicable disease among inmates.
The county's system is certified for 3,750 inmates. On Monday, 5,955 prisoners were packed into the four jails.
Recently a bacterial infection caused an epidemic among inmates in Harris County's jail system.
Dr. Green said he was unaware of any such problems in Dallas County.
Sheriff Bowles said the jails passed state inspection for the sixth consecutive year in August. About a month before the state conducted its investigation, he said, the county and city health departments inspected the jails.
"We got a clean bill of health,' the sheriff said.
Mr. Price remains skeptical of conditions in the jails, despite assurances from Sheriff Bowles.
"I am not saying it ought to look like the (Loews) Anatole (hotel),' Mr. Price said. "But anybody can be polished up for (state) inspection.'
"I want to be able to pop up there at any time. I don't want anybody to have notice.'
02/23/05
DAY: Wednesday
PAPER: THE DALLAS MORNING NEWS
SECTION: NEWS
EDITION: SECOND
PAGE: 14A
HEAD: Mom says neglect changed inmate
BYLINE: RANDY LEE LOFTIS
CREDIT: Staff Writer
ART: PHOTO(S): (FILE 2004/Family photo) James Mims was hospitalized in
May after going without medication and water while in jail.
TEXT:
A mother tries to get her son to open his eyes. But since his near-death in April on the floor of his cell in the Dallas County Jail, James Mims prefers darkness.
"He said, 'Why should I open them when I'm going to see the same thing?'" Cleo McGee, Mr. Mims' mother, said Tuesday. "It hurt me to my heart."
Mr. Mims is the mentally ill man whose case helped trigger a consultant's investigation of medical and psychiatric care at the county jail. Mr. Mims almost died after he was denied psychiatric medications for two months and had no water in his cell for 13 days.
He recovered during three months at Parkland Memorial Hospital and was returned to Terrell State Hospital, the psychiatric hospital that is his permanent home. He has been in state hospitals since 1978, when he was declared mentally incompetent to stand trial in the shooting of two Dallas police officers.
His legs were "hard as a rock" when he returned from Parkland, Ms. McGee said. He can stand now, she said, but refuses. Instead, he uses a wheelchair.
Ms. McGee is suing the county over her son's treatment. She said the consultant's report, which describes a badly flawed system in which many inmates go without needed care, is long overdue.
But as angry as she is over the lack of treatment that her son received in the county jail, she said, the case revealed problems larger than one inmate's fate.
"It's unbelievable," Ms. McGee said. "Everybody's not a hardened criminal. Some are, but some are not. But they treat them all like dogs."
E-mail rloftis@dallasnews.com
11/19/04
DAY: Friday
PAPER: THE DALLAS MORNING NEWS
SECTION: NEWS
EDITION: SECOND
PAGE: 1A
HEAD: How the state failed James Mims Doctors, jailers at nearly every
turn didn't help mentally ill inmate; it almost killed him
BYLINE: RANDY LEE LOFTIS
CREDIT: Staff Writer
ART: PHOTO(S): 1. (BARBARA DAVIDSON/Staff Photographer) Doctors didn't
find Cleo McGee until three weeks after her mentally ill son, James Mims, was taken to Parkland Memorial Hospital from the Dallas County jail. 2. (Courtesy Photo) A relative photographed James Mims at Parkland a month after he arrived. Doctors said he wouldn't live, but he later returned to
Terrell State Hospital. CHART(S): AN INMATE'S DOWNFALL
TEXT:
The second of two parts
"I am the commander commander. I was freed before the slaves were freed. I am a doctor, an FBI agent, a CIA agent and sheriff."
James Mims, at Parkland, June 17, 2004
The late Dallas psychiatrist James Grigson was a vigorous defender of the death penalty and a frequent expert witness for prosecutors seeking to expose defendants faking mental illness. Lawyers called him "Dr. Death."
In 1991, however, he was a defense witness. Since their first meeting 13 years earlier, James Mims had gotten worse, Dr. Grigson said. He would never be mentally competent; he would remain a threat to himself and others.
Dr. Grigson's was one in an unbroken chain of psychiatric conclusions.
In 1992, a state psychiatrist wrote that Mr. Mims claimed he wasn't mentally ill. Then the patient would "shout and argue with imaginary people, shoving paper in his ears and dancing in ritual movements prior to eating and bathing."
In 1995, Mr. Mims told Dr. Michael Pittman, a court-appointed psychiatrist, that he had a jillion dollars, used to be a "general general" but was promoted to "colonel colonel," had invented the jet airplane and nuclear power and was a government agent who had built Children's Medical Center.
"He also stated that he had formerly been 'jet-black' but 'they,' perhaps a woman named Sparky, had taken his black away from him."
Two years later, he told another doctor that someone had stolen his color and his height from him. Year to year, the assessments were the same, though hints of frustration with the system's inability to deal with Mr. Mims became clear.
In January, the head forensic psychiatrist at Terrell State Hospital, Dr. Mitchell F. Dunn, wrote that years of drugs and group therapy had not healed Mr. Mims; he needed to stay in the hospital, for his own and society's welfare.
"If not hospitalized, he likely would not take medicine and would gain access to weapons," Dr. Dunn wrote.
His colleague, Dr. Quynh Nguyen, agreed that jail was the wrong place for Mr. Mims, who "continues to require the monitoring, treatment and structure of inpatient hospitalization at this time."
The doctors knew that Mr. Mims' return to Dallas County for his annual criminal competency hearing was coming. They tried to get him to sign a document waiving his right to a hearing, which they hoped would spare him a stay in the jail.
"The people at Terrell did not really want him to come back to Dallas because they knew every time, he came back a wreck," said his sister, Cookie McGee. "So they tried to get us to have him sign a paper where he wouldn't have to go."
Mr. Mims thought it was a trick. He wouldn't sign.
"The patient remains grossly psychotic and inappropriate for return to court at this time."
- Dr. Quynh Nguyen, June 28, 1994
District Judge Faith Johnson signed the latest bench warrant for Mr. Mims' court appearance on Feb. 2 at the request of the district attorney's office. What follows comes from a sheriff's office internal investigation.
Nurse Debra Beneke checked Mr. Mims on his arrival at the county jail on Feb. 9 and found him incoherent. She recommended an observation cell and sent paperwork to the psychiatric staff.
She also noted that he had psychiatric medications from Terrell: quetiapine and clonazepam, antipsychotic and antiseizure. Dr. Dunn had written the prescriptions that day.
The nurse put the medicine in his property envelope. Jail procedure is that jail doctors reissue identical prescriptions.
It never happened.
By Feb. 11, jail records showed, a note appeared from nurse Linda Mooney to Dr. Gary Neller, a Rockwall psychiatrist who works at the jail, telling him that Mr. Mims' psychiatric records had been scanned into his medical chart.
But Dr. Neller never saw Mr. Mims. At least three times, investigators wrote, the psychiatric staff was told that a severely psychotic inmate needed attention. There's no record of a response.
Cathy Judd, a physician's assistant, first told investigators that she "vaguely remembered" being taken to see a mentally ill inmate. She heard the name Mims but didn't see him face to face. Days later, she told investigators that she never saw him, didn't know if Dr. Neller had, and didn't know if any more records existed.
Only on April 15, six days after Mr. Mims was taken to Parkland Memorial Hospital nearly dead, a note from Dr. Neller appeared in the records. It said he would complete his evaluation of Mr. Mims when he returned from the hospital.
Dr. Neller told investigators he tries to see new psychiatric inmates within a couple of days, but "sometimes some can slip through the cracks." At least twice, he said, he tried to see Mr. Mims, but the inmate refused. The doctor said he'd check his records to verify the dates.
Dr. Neller never provided any such records, investigators wrote. But he did tell them he was "displeased with the chronically under-funded programs that they had to work with. Stated that I the investigator needed to ask the right questions, and he could not help me out any more than this because he needed his job."
Dr. Neller declined to comment for this story. Dr. Joe Oliver, head psychiatrist at the jail, did not respond to an interview request.
The Mims case left plenty of room for finger-pointing. Sometime after Mr. Mims was rushed to Parkland, a jail shift supervisor stepped into the psychiatric office. He mentioned Mr. Mims to Sue Griffin, the head psychiatric nurse.
Jailers have to take the initiative and tell us about these cases, Ms. Griffin told him. Earlier, she said, Mr. Mims' paperwork had gotten lost; he had "slipped through the cracks."
The supervisor, Senior Sgt. Gregory Porter, passed her suggestion to his officers. "All became very upset," he told investigators. "All of the officers stated emphatically to me that they had mentioned Mr. Mims to members of the psych staff on several occasions."
Water cut off
The lack of psychiatric care alone didn't nearly kill Mr. Mims. Lack of water did.
Jailers told investigators that Mr. Mims mumbled and paced or sat motionless on his mattress. He also soaked his bedclothes in the toilet and wrapped them around him, and he flooded his cell, they said. Jail logs didn't back that up.
Around 4:15 a.m. March 28, the jail staff cut off the water to Mr. Mims' cell. For the next 13 days, Mr. Mims had no water; he was too mentally ill to ask for it.
By the time other inmates called for help April 9, he was on the floor, crashing medically.
Sara Clemente, associate unit manager at Parkland's intensive care unit, told investigators that Parkland notified state Adult Protective Services about the abuse and neglect of Mr. Mims. APS later told investigators it had no record of a call.
Parkland officials declined to comment, citing Mr. Mims' privacy right.
Although the jail's psychiatrists never saw Mr. Mims, others did. Dr. Pittman and Dr. Lisa Clayton, both court-appointed, saw him on April 1, his fourth day without water. Neither reported a water problem.
They wrote that they reviewed his jail files and were told he was refusing medications - impossible because investigators found the jail never issued him any medications. The doctors didn't reveal who told them about the medicines.
Both psychiatrists found Mr. Mims already in miserable shape.
"As his psychiatric condition was manifest and because of the stench," Dr. Pittman wrote, "I elected to terminate the interview. ... His grooming was poor and the stench around his cell was overpowering."
Dr. Pittman and Dr. Clayton did not respond to interview requests.
As near to death as Mr. Mims was on April 9, no one notified his family. Cleo McGee said she didn't learn until April 30 that her son was at Parkland. A doctor there called, she said, after he finally tracked her down; she's not sure how.
Parkland asked for family contacts, she said, but the jail said it didn't have any. If the jail had called Terrell or checked its own visitor logs, it would have found his mother's name and address.
By the time she got there, her son, who is now 54, had had strokes and a tracheotomy and didn't even know her. The doctor spoke of an infection in the heart, threatening the brain. He probably would die. She should consider hospice for a dignified death.
"And I said, 'What do you mean?' I could not send my son to any hospice, and I just found him today. ... He said, 'He's in a bad condition; he seems like he might pass.'"
Weeks later, his physical recovery was phenomenal. One day a doctor said he opened his eyes some. Finally, his mother knew he would live.
"He saw me in the door and said, 'Cleo!' He let me know he knew who I was.
"Those doctors and nurses, they did a wonderful job. Because that child was dead."
Evidence for reforms
So what becomes of James Mims and others trapped between hospital and jail?
The American Psychiatric Association has pressed hard for jail and prison mental-health reform. Evidence for their case abounds: Two years ago, The Dallas Morning News revealed example after example of Dallas County jail inmates not getting their psychiatric medicines or much treatment at all.
The result was a psychiatrist's resignation and a change from a county-run jail medical system to one run by the University of Texas Medical Branch at Galveston.
UTMB also runs the medical and psychiatric services for all state prisons in the state's eastern half. Texas Tech does the job in West Texas.
Dallas County commissioners, who hired UTMB, aren't commenting, citing a possible lawsuit by Mr. Mims' family. No suit has been filed.
But Commissioner Kenneth Mayfield, a former prosecutor and current president of the National Association of Counties, told a U.S. Senate committee in 2002 how jail can set back a mental patient and how important it is not to use the criminal justice system as a substitute for psychiatric care.
"The need for collaboration between criminal justice and health and human services agencies at the local level cannot be overemphasized," he said. "The challenge is to create a seamless web of comprehensive services."
Cookie McGee believes the system will never say enough, it's over, even if it must wheel an 80-year-old defendant into the jail someday. Because her brother shot two cops.
For James Mims himself, there is only time that he cannot measure. Cleo McGee has visited her son over the years when she dared trust her old truck to get her there; last month, she took him a birthday cake. She found him talking nonstop, still in a wheelchair, but with his legs no longer blue-black from his jail injuries.
Occasionally during his lost years, he has asked for a hospital job, washing cars and such. He's been in crafts classes, leatherwork and wood, although his mother says he's not fond of "being in school."
But on her piano stands a wooden plaque in the shape of a heart, painted red. He made it for his long-lost wife, Cleo McGee said, but he sent it to his mother instead.
His words are carved in the heart.
YOU
LOVE
ME
I
LOVE
YOU
SAYS
MIMS
E-mail rloftis@dallasnews.com
11/18/04
DAY: Thursday
PAPER: THE DALLAS MORNING NEWS
SECTION: NEWS
EDITION: SECOND
PAGE: 1A
HEAD: A life of mental illness, a brush with death in jail County inmate
denied water for 2 weeks 'fell through the cracks'
BYLINE: RANDY LEE LOFTIS
CREDIT: Staff Writer
ART: PHOTO(S): (Barbara Davidson/Staff Photographer) 1. Cleo McGee holds
a photo of her mentally ill son, James Mims, who was hospitalized this year after nearly dying in the Dallas County jail. 2. The News covered the arrest of James Mims in the editions of Aug. 22, 1978, a day after two Dallas
police officers were shot.
TEXT:
The first of two parts
The Friday night nurses knew gunshot wounds, overdoses, car wrecks. But this man was different.
He had the symptoms of someone lost in the desert for two weeks, found just hours before his last dry gasp.
Sodium levels sky-high. Thick, toxic gunk in his blood quickly choking him to death. Kidneys shut down, exhausted.
His clothes smelled of sewage. Sores on his side spoke of days lying in virtual paralysis. He was semiconscious and incoherent.
A nurse spoke to the man who had come with him in the ambulance. How long has he been like this? The man said he didn't know.
This is ridiculous, a supervising nurse said: a case of abuse and neglect, a matter for investigators.
The patient was an inmate from the Dallas County jail. His name was James Mims. He was 53 years old. Those who saw him at Parkland Memorial Hospital's emergency room the night of April 9 knew nothing more about him.
They didn't know about the man who agonized because he thought his height and color and even his son's name were stolen from him.
They didn't know about the others who had crossed his path: the brave and cheerful policeman whose smile Mr. Mims took away one summer afternoon, or the little boy who should have been scared but wasn't.
They didn't know that this vestige of a man had once been strong, defiant and dangerous, the stuff of front-page headlines and gut-wrenching photographs in the Dallas papers and top stories on the local news. Or that he was at the center of one of the longest, saddest tales in the history of Texas justice and was about to become the center of a scandal.
And, most important, they didn't know that James Mims had been found, very nearly dead after being denied water for two weeks, on the floor of cell F, tank 3P3, West Tower, Lew Sterrett Justice Center.
*
Mr. Mims was not a criminal, at least not in the formal view of the law. He stands accused of very serious crimes: trying to kill two Dallas police officers. But that was 26 years ago. He has never been tried because he was
- is - profoundly mentally ill: "grossly psychotic," a psychiatrist wrote a decade ago.
Every doctor who has ever seen him, including those appointed by the courts, has said he belongs in a state mental hospital, not in jail. He has been in one state hospital or another without break since the last days of summer 1978.
That is, almost without break. Because the charges remain, a Dallas County judge signs a yearly warrant for Mr. Mims to appear in court, and deputies drive east to Terrell State Hospital, a complex of one-story brick buildings amid nice lawns where Mr. Mims and nearly 300 other patients live.
The deputies take him to Dallas County's high-rise jail at Industrial and Commerce, where he changes from patient to prisoner. There he waits until a judge declares him incompetent to stand trial. Then deputies return him to the hospital, his psychiatric condition invariably worse for his time in jail.
Mr. Mims isn't the only disturbed person to land in the Dallas County jail with bad result. Two years ago, The Dallas Morning News revealed case after case of psychiatric inmates who weren't getting much treatment.
That brought a management shake-up and promises of reform. But the matter of James Mims seems to indicate that serious problems persist.
Mims, James Monroe. DOB 10/02/50. F-7808282, aggravated assault with a deadly weapon. F-7808283, attempted capital murder in the second degree. F-7808284, attempted capital murder in the second degree.
F means felony. 78 means 1978; 08 means August. The other numbers mean these were the 282nd, 283rd and 284th felony cases filed in Dallas County that month.
On that Monday afternoon, in a little apartment not far from Love Field, Mr. Mims, then 27, pointed a shotgun at his front door and fired. Outside, trying to rescue Mr. Mims' son, were Dallas police Officer Donald S. Ortega, 32, and Sgt. Alfred M. Cessna, 41.
The pellets went through the door, hitting Officer Ortega in the forearm and Sgt. Cessna in the face.
That Mr. Mims did it is undisputed: His mother says so, his sister; every piece of evidence says so. A grand jury indicted him within days.
But doctors declared him deeply ill, schizophrenic. He couldn't stand trial.

The state sent him to Rusk State Hospital, then Texas' maximum-security psychiatric hospital. Since then, he has also been in state hospitals in Vernon, Kerrville and Terrell, sometimes declared "manifestly dangerous," sometimes not.
His annual hearings are rubber stamps. No one objects or argues: neither the assistant public defender nor the assistant district attorney who happen to have drawn that year's duty. The judge - for years it has been District Court Judge Faith Johnson - signs the orders to keep him hospitalized for another 12 months.
"They want to punish him all his life," said Mr. Mims' sister, Carmen "Cookie" McGee. "That's what they intend to do because he shot two police officers. They're saying, 'We are never going to let you get past this.'"
The county's chief prosecutor disagrees.
"We don't dismiss cases in which a violent crime occurred," said Rachel Horton, spokeswoman for District Attorney Bill Hill. "If we do that, we're basically risking that person getting out."
Senior Cpl. Glenn White, president of the Dallas Police Association, said an injured officer, or a slain officer's family, wants justice and public safety - whether that's prison for a guilty person or hospitalization for a mentally ill one.
"We all know how dangerous this job is," he said. "Everybody goes to work every day hoping they don't get hurt."
"I kissed a girl and she sucked all my breath out."
- James Mims, Dec. 12, 1991, quoted in a psychiatrist's notes
On Oct. 10, 1969, eight days after he turned 19, James Mims stood in Dallas County Criminal District Court No. 5 and was convicted of statutory rape.
Details are lost. A single line in a newspaper story about the 1978 police shooting said the assault happened at gunpoint. His sister said it was a misunderstanding involving a relationship with a 15-year-old white girl; Mr. Mims is black. As a sex-crime victim, the girl wasn't publicly named.
James got five years and served three, from Dec. 9, 1969, to Dec. 12, 1972. He went in, his mother said, thoughtful and outgoing; he had worked at a restaurant, a furniture store, a bakery and a mattress company. He wanted to take air-conditioning repair classes.
He also was a father: a boy, 2 years old when he went to prison; and a girl, born about the time he went away. James and Thelma, a year older, married around the time he went to prison but separated after he got out.
James had first showed signs of illness in prison. Then came the day in 1973 when Cleo McGee took her son to buy clothes at Sanger's department store. He went into the dressing room and didn't come out.
"Somebody went in to look," she said. "He was just in a catatonic condition. And that's when it started."
The diagnosis was schizophrenia. He got medication at a clinic but no other treatment, his mother said. The clinic would check him if things got bad - when he would seem stricken, immobile, mumbling.
Twice his mother had him committed. At Terrell, a psychiatrist later testified, doctors tried group therapy and drugs and finally electric shocks. Shock treatments helped, but only for a while.
"James Monroe Mims ... did intentionally and knowingly use a deadly weapon,
to-wit: a shotgun ..."
- 1978 indictment
Unable to hold a job, in August 1978 James was living on disability in the Metropole Apartments on Roper Street. Thelma and the children were five miles away in the vast West Dallas public-housing complex.
His son, Bernard, then 10, did not bear James' last name. James grew to believe that enemies had taken it. He would make them give it back.
About 4 p.m. on Aug. 21, he drove to Thelma's apartment, where Bernard was watching a toddler half-sister while their mother worked. James wore a straw hat, a yellow shirt, gray slacks and an ammunition belt. He carried a shotgun.
He took Bernard and ran red lights all the way back to his place. Once inside, he offered his son a beer. The boy declined; his grandmother had told him alcohol was bad.
A neighbor called police. Word also got to Thelma, working at a Burger King at Preston Road and Royal Lane. She had no car, so she hitchhiked to James' apartment.
His sister Cookie McGee, then 20, also heard. She went to his door.
"I said, 'James, are you in there?' He said, 'Get away from the door; just get away from the door.' So that's when I came back and called my mother and told her that he was at home.
"And then I asked, 'So do you want me to call the police or what?' She said, 'Well, I guess you better go ahead.'"
Cookie McGee said she warned the officers that her brother might have a shotgun. She looked for it in his car. It was gone.
"As I was coming back, I heard the shot - boom."
Dozens of officers had converged on the scene, including Officer Ortega, who had been five minutes from going off duty when the call came.
Sgt. Cessna, a nine-year veteran with a master's degree in psychology, also came. Tired of desk jobs, he had gotten street duty just three months earlier.
Officer Ortega's partner went around back. Officer Ortega and Sgt. Cessna went to the front.
The shot through the door hit Officer Ortega in the left forearm. A newspaper photograph from that day shows him standing, being helped by a supervisor.
The shot hit Sgt. Cessna in the right side of his face.
A photograph shows him on the ground, surrounded by colleagues, his face butchered. Parkland surgeons could not save his right eye. Officials later denied reports of brain damage.
Officer Ortega went on to work in homicide and auto theft and retired after 25 years. Now 58, he lives in an Atlanta suburb, where he's active in a community soccer league. He declined to be interviewed for this story.
Sgt. Cessna went on disability, officers who knew him said. One said the shot seemed to take more than his eye.
Assistant Chief Ron Waldrop regarded Sgt. Cessna as an extraordinarily dedicated officer.
"He was one of those guys who was always positive and got along with everybody," Chief Waldrop said. "He didn't just blend into the crowd. He was entertaining, very jovial.
"The injury was just devastating."
Sgt. Cessna, now 67, moved from Anna to Alvin, near Houston. Telephone messages and a letter from The News for this story brought no response.
Thelma Mims, 54, and Bernard Carroll, 36, her son with Mr. Mims, still live in Dallas, but repeated efforts to contact them were unsuccessful. Her West Dallas apartment is long gone, torn down for new public housing. Mr. Mims' apartment near Love Field remains, renovated and renamed, with well-kept greenery and iron gates.
Cleo McGee said her grandson should have been terrified that day, but he wasn't. That day, he told a reporter why.
"I was on the floor in the kitchen when the shooting stopped," he said. "I heard him say he was going out. He said, 'Don't hurt my boy.'
"He turned to me and put his gun against the wall. He looked at me and said: 'The only reason I'm doing this is for you. I didn't want you to get hurt.'"

*
On Feb. 9, 2004, deputies brought Mr. Mims from Terrell State Hospital to Dallas for his annual hearing. But the Feb. 10 hearing didn't happen; court records don't say why. Instead, he spent two months in jail with no psychiatric care.
He also spent at least 13 days with no water after the jail staff cut off the water to his cell. Sheriff's investigators never confirmed why.
After going to Parkland on April 9 - the account of his arrival there comes from a sheriff's office internal investigation - he spent a month in intensive care and three more in recovery. Doctors thought he would die. His mother and sister said he would live.
They were right. By late June, he had recovered. Recalls his mother: "I said it's like he's a newborn baby, come back fresh and new."
But doctors saw that he was still gravely disturbed. Mr. Mims' hearing finally took place on July 1: quick, pro-forma proceedings that found "clear and convincing evidence" of continued psychosis. Eleven days later, the county took him from Parkland back to Terrell, where he remains.
When he came back, doctors there told his mother, he wouldn't open his eyes
- "like he was defending himself from the world," Cleo McGee said.
The FBI is investigating how a man in the care and custody of Dallas County could almost die of thirst like a prisoner in a medieval dungeon.
"Obviously, what happened here was a failure of the system," said Ms. Horton, the district attorney's spokeswoman. "There was no reason for him to sit in the jail so long."
Judge Johnson didn't return phone calls seeking comment. Neither did Pamela Segura-Muhammad, Mr. Mims' most recent public defender.
Sheriff Jim Bowles, a lame duck, isn't talking. Neither are officials at the University of Texas Medical Branch at Galveston, which took over the jail's medical and psychiatric care two years ago, after The News revealed the jail's problems.
Neither are the jail doctors, psychiatrists and nurses who were supposed to make sure that Mr. Mims got his medications and didn't die alone on the cold, urine-soaked floor of his cell. A psychiatrist and a nurse explained it to sheriff's office internal investigators this way:
James Mims simply "fell through the cracks."
E-mail rloftis@dallasnews.com
09/10/04
DAY: Friday
PAPER: THE DALLAS MORNING NEWS
SECTION: METRO
EDITION: SECOND
PAGE: 1B
HEAD: Mentally ill inmate nearly dies County jail withheld water, medicine
from suspect
BYLINE: RANDY LEE LOFTIS
CREDIT: Staff Writer
ART: PHOTO(S): 1. (BARBARA DAVIDSON/Staff Photographer Cleo McGee of
Dallas said that at one point, she refused a doctor's suggestion to put her son in hospice care to die. 2. James Monroe Mims, 53, was at Parkland Memorial Hospital for three months. Accused of attempted murder of police officers, he had been in a Dallas County jail cell, where water had been
shut off for 13 days.
CORRECT: CORRECTIONS, CLARIFICATIONS: An article in Tuesday's Metro
section and articles on Sept. 10, 14, 15 and 23 incorrectly summarized one part of the case of James Mims, a mentally ill inmate in the Dallas County jail. An internal investigation found that the jail's medical staff, overseen by the University of Texas Medical Branch, neglected to provide psychiatric medicines to Mr. Mims for two months, not the jailers. The investigation also found that jailers had cut off his water for 13 days. A two-part series about Mr. Mims last month summarized the case properly.
(Ran: Thursday, December 09, 2004)
TEXT:
A mentally ill inmate in the Dallas County jail nearly died in April after jailers cut off his drinking water for at least 13 days and denied him his psychiatric medications for two months, an internal investigation by the Sheriff's Department found.
James Monroe Mims, 53, was rushed to Parkland Memorial Hospital on April 9 after jail trusties found him on the floor of his cell, semiconscious, incoherent and soaked in his own waste, investigators wrote in their report.

At Parkland, emergency room nurses immediately saw that Mr. Mims was critically ill, suffering from severe dehydration and kidney failure. He had pressure sores on his shoulder, back and hip, indicating that he had been lying unaided for a long period of time, nurses told investigators.
Mr. Mims spent three months in Parkland, the first of those months in intensive care, before doctors pulled him through, family members said. His mother, Cleo McGee of Dallas, said that before her son's recovery, a doctor advised her to consider hospice care because he was expected to die.
"I said, 'No, my son will live,'" Ms. McGee said.
Sgt. Don Peritz, spokesman for Sheriff Jim Bowles and the Sheriff's Department, said he could not comment because of a potential lawsuit by Mr. Mims' family. Mr. Mims has returned to the state hospital in Terrell.
The family's attorney, David Finn, described the case as an outrage and said he wants Dallas County District Attorney Bill Hill to convene a grand jury to investigate.
"If somebody denied water to a horse or a dog for two weeks, they'd be prosecuted," said Mr. Finn, who lost the 2002 Republican primary for district attorney to Mr. Hill. "This is sickening."
Mr. Hill's spokeswoman, Rachel Horton, said the district attorney's office would consider an investigation if Mr. Finn requested one. She said he apparently had not done so by Thursday.
Mr. Mims was charged in 1978 with two counts of attempted murder in the shooting of two Dallas police officers during a domestic standoff. He was declared mentally incompetent to stand trial, however, and has been in state mental hospitals since.
Dallas County judges and juries have repeatedly found him mentally ill and incompetent to stand trial. It was another such hearing that caused deputies to return him to Dallas from a state hospital in Terrell on Feb. 9.
>From then until April 9, investigators wrote, Mr. Mims never received
>the
anti-psychotic and anti-seizure medications that the mental hospital had sent with him.
The jail's psychiatric staff never saw him, despite what jail employees said were repeated referrals from jailers, investigators wrote.
For at least 13 days, Mr. Mims had no water because the jail had cut off water to his cell, and he was too mentally unstable to demand water, investigators wrote. It was the lack of water that nearly killed Mr. Mims, Parkland nurses told sheriff's investigators.
Jail employees said they cut off Mr. Mims' water because he had flooded his cell, but jail records did not support those assertions, investigators wrote. At the time, the jail had no policy limiting how long an inmate could go without water or documenting how long the water had been cut off, they wrote.
The jail has since changed its water policies, investigators said.
Mr. Mims' hospitalization came less than two years after a head psychiatrist at the jail resigned amid disclosures that inmates were not getting their medications and were receiving little or no psychiatric monitoring.
County officials responded by approving a contract with the University of Texas Medical Branch in Galveston to provide medical and psychiatric care to jail inmates. Current medical and psychiatric staff members are employees of UTMB.
E-mail rloftis@dallasnews.com