Dallas Observer Slams Jail
Cell Disease
Being sick in Dallas County's troubled jail can be a death sentence
By MATT PULLE,DALLAS OBSERVER
Published: Thursday, September 15, 2005
Four days into his short stint at Dallas County's jail at the Lew Sterrett Justice Center, Mark McLeod talked with his public defender about a plea agreement that could set him free the next afternoon. The attorney remembers that her new client talked slowly as his wide, dark eyes offered a faint glimpse into his troubled mind, but she wouldn't think anything of it until a tearful Friday morning when she saw an 8-by-10-inch color photograph of the bright-eyed young man at his grandmother's home.
On July 25, 2002, public defender Julie Doucet spent hours with McLeod reviewing the plea and trying to complete the final details of the agreement with the District Attorney's Office. Now they were waiting on his brother, Michael, to accept a deal on a misdemeanor assault charge stemming from a shoving match the brothers had in their grandmother's kitchen. It could have been brushed off as a spat between siblings, but Mark had been acting differently lately, and no one knew why. That's why the police were called.
Now the District Attorney's Office was trying to contact Michael and resolve the case, but they couldn't get in touch with him. Doucet also called her client's brother. Finally, early on a Friday morning, she reached Michael. When they finished talking, she drove to the grandmother's home in Richardson, her eyes welling with tears.
Just a few years earlier, Mark McLeod's life was promising. A graduate of Texas Tech University with a degree in journalism, he had plans to become a newspaper reporter. But while his family knew that McLeod was a little different, nobody knew the extent of his troubles until after he was arrested for assaulting his brother. On November 28, 2000, nearly a month after the shoving match, McLeod was diagnosed with catatonic schizophrenia. Two days later, a jury found him incompetent to stand trial, and he was sent to Terrell State Hospital, a mental health facility in neighboring Kaufman County.
It took 19 months of rigorous treatment for doctors and staff to stabilize McLeod. He had a few setbacks, including a fight or two with some of the other residents, but toward the end of his stay he was doing well. On July 22, 2002, more than a year and a half after he was first arrested, he was discharged from Terrell and sent to Sterrett while he awaited the resolution of his charges. That day he called his grandmother, with whom he had lived since he was 5. He sounded ordinary and hopeful. He planned to return home.
Schizophrenia is a disease of the brain; its symptoms are terrifying and numerous, most notably including paranoia and auditory hallucinations. It can't be cured, but through a rigorous treatment plan, many of the disease's sufferers can lead peaceful, productive lives; the doctors at Terrell hoped that this would be their young patient's fate.
The discharge records from Terrell were clear: McLeod was to receive 32 milligrams of Trilafon four times daily. If he did not receive his medication, the discharge notes warned, "symptoms of schizophrenia, paranoid type will recur..."
Five days after Mark McLeod was released from Terrell into Sterrett, Doucet finally got in touch with his brother. She figured he would agree to a plea deal and within hours, McLeod would return home.
"He told me 'I just got back from the morgue,'" Doucet recalls. "I almost went off the deep end."
Hours earlier Mark McLeod, just 27 years old and staring at a second chance at a normal life, hanged himself in his cell.
McLeod's autopsy records, released by his civil attorney, David Finn, show that he had no trace of Trilafon in his body. Finn's notes also document that a day before McLeod killed himself, he told the medical staff that he was hearing voices, but he was not placed on suicide watch. Instead, he remained alone in a closed cell.
After visiting with McLeod's grandmother, a heartbroken Doucet headed immediately to Sterrett. A secret source gave her a list of four inmates who lived on his pod, and she and another attorney planned to talk to them to piece together clues about how her client spent his last night. The sheriff's office, however, wouldn't give her access, claiming that she did not have the authority to interview McLeod's neighboring inmates since she was not their attorney of record.
"I wish I could have talked to the four inmates. I would have asked them, 'Did you hear anything, was he angry, was he talking to people, did he ask for help, was he calling for the guards, did the guards say anything to him?'" Doucet says. "But the Dallas County Sheriff's Department put their foot down, and I will never get over that."
Doucet pressed on, however, and convinced a judge to sign an order allowing her to subpoena McLeod's medical records. Represented by District Attorney Bill Hill's office, the sheriff's legal advisor and mental health director filed a motion to quash the subpoena, arguing that it was a waste of resources and time. Doucet says that the District Attorney's Office later complained to her boss, the chief public defender, that she was being "too antagonistic." Meanwhile, McLeod's civil attorneys ultimately withdrew their lawsuit because it would have been difficult to prove that the mentally ill inmate did not refuse his meds, even though a refusal should have caused jail staff to at least put him on suicide watch or contact Terrell.
McLeod's death and the county's response were far from unique. For years now, inmates at the Dallas County jail have often failed to receive elementary levels of medical care, prompting a lengthy series of lawsuits and bad publicity that has done nothing to halt the cycle of neglect. If anything, people who determine the fate of the jail have rejected outside scrutiny. Every year, the jail elicits the same criticisms, and all that changes are the faces of the elected officials. From the county commissioners, who control the jail's budget, to the sheriff's office, which makes the day-to-day decisions that affect the lives of thousands, a stubborn cast of officials have engaged in a long-running pattern of closing ranks and resisting external pressures. Even the District Attorney's Office, which counts the jail as its most troubled client, has pursued a defense-at-all-costs strategy instead of finding out what's really happening to inmates in the county's custody.
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It was a textbook Lew Sterrett death: a troubled inmate suffers dramatic deterioration amid guards and a neglectful medical staff. Incarcerated on a misdemeanor prostitution charge in February 2002, Rosa Allejo fell apart at Sterrett. Her mind crumbling by the hour, she died three weeks into her stay at the jail from eating bags of dried coffee grounds. According to her family's lawsuit, she noted on her intake evaluation form that she had previously received psychiatric treatment at Terrell State Hospital and had been taking lithium carbonate for mental illness. Within a week, though, Allejo became a wreck.
In their lawsuit, Allejo's family members claim that jail floor officers reported that she was yelling, eating toilet tissue and pulling at her hair while pleading for her medication. She began to eat her own feces, but even that didn't prompt anyone to make sure Allejo was receiving her proper course of drugs. Meanwhile, the guards continued to give her coffee grounds, which led to her death from caffeine toxicity. No one at the jail seemed to realize that Allejo's unusual craving was a possible side effect of withdrawal from certain types of behavioral drugs, particularly lithium. Not surprisingly, her family's lawsuit cites jail records that show that she never received her lithium during her incarceration.
Following Allejo's death, which drew attention to a string of similar cases, the nonprofit Mental Health Association of Dallas offered to fund an independent ombudsman who would investigate allegations of neglect among mentally ill inmates. The ombudsman would also serve as a resource for families of the incarcerated and would likely look into other cases where chronically ill inmates were not receiving their medication. But Vivian Lawrence, an expert on prison issues for the nonprofit, says that then-Sheriff Jim Bowles never responded to the offer, and the county commissioners at the time never even brought it to a vote.
"It floors me," says Lawrence on the county's unresponsiveness to the group's proposal.
This year, the Mental Health Association has offered to train the jail's detention officers, free of charge. Citing overtime costs, Sheriff Lupe Valdez's office has declined the offer.
"This has been going on for so long, you can't say there is any one commissioner responsible for this," Lawrence says of the jail's entrenched problems. "You can't necessarily blame the sheriff, since we have a new sheriff. I just think there is a culture at the jail where they just say, 'We have done this so long, and we're not going to change.'"
In 1998, four years before the deaths of Mark McLeod and Rosa Allejo, a panel of health experts analyzed mental health issues at the jail, including why some inmates were not receiving their medications. Seven years after the panel looked at the jail, an outside consultant employed by the county studied the jail and again criticized how mentally ill inmates are treated.
"If you look at the 1998 report and the report the current consultant did in February of this year, there are a lot of the same recommendations," Lawrence says.
First-term County Judge Margaret Keliher has taken steps to tackle the long-term defects that have plagued the jail. Over the objections of some of her colleagues, she has pushed for the county to hire enough detention officers to meet state standards and institute structural changes that include revamping the jail's flawed intake procedures. Her office has also helped guide a fledgling but promising mental health diversion program that tracks nonviolent mentally ill inmates and places them out of jail and into a program of coordinated care.
Perhaps most important, Keliher not only pushed for the 2005 consultant's report on Sterrett, she secured private funding to pay for it.
But Keliher, along with the rest of the commissioners court, has gone to federal court to suppress that same report, which is being cited in an inmate lawsuit against the county. The report is a blow-by-blow account of the jail's inept health care system, blaming the facility's medical providers as well as its guards. After the report was concluded, The Dallas Morning News asked for a copy, but the District Attorney's Office denied the paper's request.
Regardless, Morning News reporter Jim O'Neill obtained a confidential copy of the report and wrote about it in detail. That prompted the commissioners court's outside counsel, the corporate law firm of Figari & Davenport, to send a letter to the paper demanding that they cease writing about and immediately return the report. The Morning News wasn't exactly intimidated; its response was to post the so-called confidential report on its Web site. Then in July, Figari & Davenport failed to convince a federal magistrate that plaintiffs in an inmate lawsuit couldn't cite the report as evidence that the pattern of poor care at the jail led to their client's death. The law firm appealed that decision and lost. For their efforts, Figari & Davenport has been paid more than $100,000 by the county.
Lost in all the legal wrangling is the fate of the man who inspired it all, James Mims. A mentally ill inmate, Mims suffered renal failure and wound up in Parkland Memorial Hospital in grave condition last year after guards turned off the water in his cell when Mims flooded it. The sheriff's own investigators found that the guards who turned off the water did not properly report their action up the chain of command, although none of them were formally disciplined. Nor did any of them realize that he wasn't drinking any water. Meanwhile, internal investigators cited the jail's medical provider, the University of Texas Branch at Galveston, for failing to give Mims the psychiatric medicine he needed, which contributed to his bizarre behavior. Investigators also blamed the jail's psychiatric department for not giving him an evaluation, even though the medical department referred him three times.
Keliher declined to comment on the specifics of the commissioners court's legal strategy, except to say that they have an obligation to protect taxpayer dollars. Suppressing a damning consultant's report might stymie the plaintiffs' extraction of a large settlement from the county, of course, but that raises a philosophical question: Should the commissioners court be playing hardball to protect taxpayer dollars or should it be looking to settle a case where its own sheriff's department has corroborated many of the lawsuit's allegations?
On any given day, there are more than 7,000 inmates in Dallas County's jail system, whose main facility, Lew Sterrett Justice Center, is located on Industrial Boulevard in the shadow of downtown's skyline. Making sure that the inmates are safe and that the sick are receiving care is a logistical nightmare. It's also a grueling job for everyone who works there. Unruly, deranged inmates will throw feces at guards, provoke fights and take part in vandalism such as clogging up toilets and overflowing sinks. Salaries for detention officers begin at $27,000, which is less than Tarrant and other neighboring counties pay. Still, employees who have worked at the jail say that most of the guards, though certainly not all, exercise remarkable restraint and good judgment.
For the poor and sick, who may not receive any medical care at all in the community, incarceration often means the best health care of their lives. But the problems at the jail that incite lawsuits and headlines seem to be more entrenched than episodic, particularly the issue of how guards and medical staff respond to chronically ill inmates. Independent observers, including judges and doctors, corroborate that ill and healthy inmates alike are failing to receive medications or enduring long periods of neglect while in custody; even the state's own correctional facility watchdog confirms the jail's deficiencies.
"We have found more complaints from the Dallas County jail about the medical care, and we have found more incidents arising from the inmates at Dallas County than any other big county jail in Texas," says Terry Julian, the executive director of the Texas Commission on Jail Standards.
Last year, Sterrett failed inspection with the commission, in part because it was short on staff and neglected to perform adequate health screenings of its inmates. It failed again in 2005, having been found in violation of at least 10 state standards, including staff shortages, incomplete tuberculosis testing and a lack of prompt care for sick inmates. State standards require that county jails have at least one corrections officer per 48 inmates; in recent unannounced state inspections, the jail has fallen just short of that for "significant periods of time," according to inspectors. While the Dallas County commissioners are finally taking steps to correct some of the jail's nagging problems, including hiring enough detention officers to meet state standards, they're only beginning to address the institutional defects that have been allowed to linger and grow for years.
"The jail did not fall out of compliance overnight," says Julian, who credits the current commissioners for finally tackling one of the fundamental problems with the place, lack of money. "Dallas County was certified for many, many years. It was a facility we could all be proud of. But now, over the last couple years, it has declined. We're seeing more inmates and more of them have medical needs that are not being met."
To a degree, some of the county's problems can be traced to funding. Until this year, a tax-averse commissioners court would typically ask the sheriff's office to reduce its operating budget, and the sheriff would cut staff. Sheriff's office employees say the commissioners exacerbated the problem by pressuring them to freeze overtime pay last year, which they say led to the low staffing ratios that caused the jail to fail inspection. This year, the county will likely fund a budget increase that would allow the sheriff's office to hire at least 70 jailers, although the department originally hoped for up to 400. The county's budget office maintains that the 70 new positions should still be enough for the jail system to meet state standards.
As the Texas Commission on Jail Standards and others single out Dallas County for a range of problems, it's hardly surprising to find that it spends considerably less money on its jail than its closest peer, Harris County, even after accounting for a smaller inmate population. Last year, Dallas County budgeted $77 million for its jails, including operating costs, food and health care. Harris County, which has around 2,500 more inmates than its North Texas counterpart, allocated $135.9 million for jail expenses. But Dallas County is hardly the only big county jail in Texas with problems. Both the Harris County and Bexar County (San Antonio) jails have also failed inspections recently.
In many of the lawsuits filed against the jail, sick inmates allege that guards continually fail to respond to serious health needs. Advocates, who say that problems of health care at Lew Sterrett go back at least 20 years, say that while all jails could be beter, Dallas County's is one of the worst. Lanny Priddy is an attorney for the North Texas Region of Advocacy Inc., which monitors jail conditions throughout the region including Fort Worth, Denton, Tyler and Texarkana.
"We find that the Dallas jail generates more complaints about medical and mental health conditions than all the other jails in the region put together," he writes in an e-mail. "Whether considered on the basis of complaints per capita or in terms of absolute numbers of complaints, the Dallas jail presents by far the greatest problem in the region with regard to jail medical and mental health care."
Not all of the jail's problems can be easily traced to a lack of funding. Attorney Tona Trollinger, who has a seriously ill client at Sterrett, says the jail's problems are also rooted in the attitudes of some of the people who work there. "They get doctors who just want to work 9-to-5 jobs. Everybody just gets jaded," she says. "The staff is so acerbic. They get complaints from so many inmates who are not sick that when someone really is in pain, they can't tell if that's real."
Some of Dallas County's problems stem from years of bad management, poor funding and a dysfunctional relationship between the two county offices responsible for the fate of the jail. Ex-Sheriff Jim Bowles feuded with many of the county commissioners over budgets and staffing, and the relationship between the sheriff and the commissioners became so acrimonious that as the jail endured bad press and explosive lawsuits, some of the commissioners felt as though they couldn't even trust what the sheriff was telling them about his facility.
In an August interview, Dallas County Commissioner Mike Cantrell showed the depth of distrust when he explained why they had to enlist the support of an outside consultant to study Sterrett. "We had a sheriff who would not allow us access to the jail," he explained incredulously.
Bowles refused to be interviewed for this story, and the three commissioners who served with Bowles, Mike Cantrell, Kenneth Mayfield and John Wiley Price, did not respond to repeated requests for comment.
Sheriff Lupe Valdez, elected last year in a surprise victory for the openly gay Democrat, has instituted several modest departmental changes. Still, while many lawyers and judges had high hopes for Valdez upon her election, particularly given the polarizing last few years of her predecessor's two-decade tenure, problems continue, including yet another case where a guard inexplicably turned off an inmate's water. That incident was almost identical to what happened to James Mims last year. Although captains had been authorized to turn off water in an inmate's cell if it had been reported up the chain of command, Valdez writes in an e-mail that she has now ordered that "there will be no water turned-off within any of our jail facilities. Period."
Valdez also says that jail employees have been ordered to be more attentive to sick inmates. She says that jailers now have to take any inmate who appears ill or even just complains of being ill to a nurses' station for immediate examination. Over the years, ailing inmates have complained that nobody took their pleas for medical care seriously, in part because so many of their peers fake illnesses for attention. Now, under Valdez's orders, guards can't pick and choose which inmates they believe.
Arguably cast as the biggest villain in ongoing conflict over the jail has been its medical provider, the University of Texas Medical Branch at Galveston. County commissioners in particular criticized UTMB after reviewing the detailed and critical report submitted by the county's outside consultant earlier this year. Conducted by Dr. Michael Puisis, the former medical director of the Cook County Jail in Chicago, and funded by Health Management Associates, the report sharply criticized how the jail monitors its most disturbed inmates, noting it is "only a matter of chance" whether a severely disturbed psychotic individual is assigned to a cell where he could be monitored versus a cell where he is hidden from view. He also reported that the jail's suicide cells recklessly shut out the inmate from nearly all human contact, which can result in psychotic behavior.
Although he was at the facility for only a week, Puisis also discovered one inmate who died after the jail's medical staff failed to diagnose his chronic illnesses--the report doesn't say what sort of illness--for more than six weeks. Another inmate who had been on medication for tuberculosis before he came to the jail and had obvious symptoms of the contagious disease was inexplicably kept in the general population. The inmate did not have a physical examination for the first four months of his incarceration. Overall, the doctor characterized the UTMB's monitoring of chronically ill inmates as "poor to non-existent," resulting in excessive hospitalizations.
"I'm disappointed in their performance," Keliher says of UTMB. "They were used to prisons instead of jails, and in all fairness, they probably underbid and understaffed it."
When UTMB first bid for the job as the jail's medical provider in 2001, the medical school promised that it could cut costs and improve care. Press accounts said that UTMB could save the county nearly $700,000 a year, down from the $14 million the county had been spending on jail health. Three years later and with the benefit of hindsight, the school now says it is understaffed and underfunded, having lost up to $200,000 a month throughout the course of a contract that reimburses it $569 per inmate. Although UTMB made the decision not to apply for a contract renewal, it's unlikely the commissioners would have wanted them to remain as the medical provider following Puisis' report and the lawsuits.
Dr. Owen Murray, the chief executive of UTMB Correctional Care, agrees that the school initially underestimated the acuity of health care needs at a jail, as opposed to a prison, in which most of its correctional experience lies. At a prison, most inmates have already been stabilized, while at a jail they often come in off the streets at the height of their mental illnesses, drug addictions and with a range of physical afflictions.
"I was surprised just how sick the patients are at Dallas County," Murray says. "You have three times the rate of diabetes in the jail as you do in prison and twice the rate of hypertension."
Still, while Murray agrees with some of the jail report's findings, particularly as it relates to staffing and problems with the facility itself, he says that some of the report's criticisms are unfair. For example, one of the report's more dramatic findings--that not every inmate at the jail is screened for tuberculosis--isn't exactly damning; the Texas Commission on Jail Standards requires testing on only a portion of the jail's population, he says. Murray says that he agrees with many of the report's general conclusions, but that "it's difficult to come into a place as complex as the Dallas County jail and walk away with a clear picture of what's going on."
Because of patient confidentiality rules, Murray was not able to speak about the instances the report highlighted where inmates died or became gravely ill under UTMB's care.
UTMB's predecessor, Dallas County Health and Human Services, fared no better at providing care, particularly to the mentally ill. In 2002, the Morning News and WFAA-TV investigated the jail's health care practices and uncovered cases where suicidal inmates were punished by being stripped of their clothes and left naked in their cells, sometimes without their medication. The report included one inmate who gouged his eye out, stomped on it and tried to flush it down the toilet. The medical staff's solution to the inmate's troubles was to wrap mitts around his hands so he wouldn't hurt himself. WFAA also caught Rita Moss, the jail's medical director for the mental health staff, regularly leaving work early in her Mercedes, presumably to attend to her second job running a private psychiatric practice.
Jim Pruitt, a Rockwall attorney who served as a Dallas County criminal judge from 1995-2003, tells the Observer that making sure that inmates appearing before him were receiving their prescribed medication demanded his constant attention. One staffer, the ex-judge says, went so far as to alter medical records to document that a particular inmate had been given his prescribed medication when he hadn't. That staffer was later fired. Other employees would document that inmates refused medication, simply because they were sleeping; it was too much trouble to wake them up. Asked why the county's medical staff continually failed to make sure inmates received the drugs they needed, Pruitt replied with the frankness befitting a former judge.
"They were damn lazy."
County Criminal Court Judge Lisa Fox, who took the bench in May 2002, says that she still regularly sees defendants in her court who have gone without their medications for weeks. At least three times she's had to call the jail from her bench to make sure that the medical staff attends to an ailing defendant immediately.
"I think they need to take the time in the beginning to make sure inmates are on their medication rather than wait two to three weeks," Fox says.
A few months ago, she had a defendant in her court with a hideous staph infection on his leg. She ordered him to be taken to Parkland Hospital immediately.
"It's going to take a major overhaul," she says on what lies ahead for the Dallas County jail system.
Attorney David Finn, who helped the families of James Mims and Mark McLeod prepare lawsuits against the county, first became aware of the problems at the jail when he was a criminal court judge. He said that when he sat on the bench, he regularly saw mentally ill inmates who clearly were not receiving their meds. They'd be declared incompetent for trial, be sent to Terrell and stabilized, only to return to jail and not be given their medication, even when the hospital staff gave the county jail a two-week supply.
"Hundreds of thousands of dollars in meds are just getting flushed down the toilet," he says. "I could see if maybe a family brings them in and the jail doesn't trust them. But we're talking about prescriptions written by physicians licensed from the state of Texas."
Finn regularly receives letters from inmates detailing their lack of care at the jail. He also regularly visits the jail, talks to employees who work there and hears a never-ending parade of families detail how their loved ones are languishing in the custody of the county.
"If you have a loved one at the jail and they're sick, you have to make it a full-time job to keep them alive."
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UTMB's predecessor, Dallas County Health and Human Services, fared no better at providing care, particularly to the mentally ill. In 2002, the Morning News and WFAA-TV investigated the jail's health care practices and uncovered cases where suicidal inmates were punished by being stripped of their clothes and left naked in their cells, sometimes without their medication. The report included one inmate who gouged his eye out, stomped on it and tried to flush it down the toilet. The medical staff's solution to the inmate's troubles was to wrap mitts around his hands so he wouldn't hurt himself. WFAA also caught Rita Moss, the jail's medical director for the mental health staff, regularly leaving work early in her Mercedes, presumably to attend to her second job running a private psychiatric practice.
Jim Pruitt, a Rockwall attorney who served as a Dallas County criminal judge from 1995-2003, tells the Observer that making sure that inmates appearing before him were receiving their prescribed medication demanded his constant attention. One staffer, the ex-judge says, went so far as to alter medical records to document that a particular inmate had been given his prescribed medication when he hadn't. That staffer was later fired. Other employees would document that inmates refused medication, simply because they were sleeping; it was too much trouble to wake them up. Asked why the county's medical staff continually failed to make sure inmates received the drugs they needed, Pruitt replied with the frankness befitting a former judge.
"They were damn lazy."
County Criminal Court Judge Lisa Fox, who took the bench in May 2002, says that she still regularly sees defendants in her court who have gone without their medications for weeks. At least three times she's had to call the jail from her bench to make sure that the medical staff attends to an ailing defendant immediately.
"I think they need to take the time in the beginning to make sure inmates are on their medication rather than wait two to three weeks," Fox says.
A few months ago, she had a defendant in her court with a hideous staph infection on his leg. She ordered him to be taken to Parkland Hospital immediately.
"It's going to take a major overhaul," she says on what lies ahead for the Dallas County jail system.
Attorney David Finn, who helped the families of James Mims and Mark McLeod prepare lawsuits against the county, first became aware of the problems at the jail when he was a criminal court judge. He said that when he sat on the bench, he regularly saw mentally ill inmates who clearly were not receiving their meds. They'd be declared incompetent for trial, be sent to Terrell and stabilized, only to return to jail and not be given their medication, even when the hospital staff gave the county jail a two-week supply.
"Hundreds of thousands of dollars in meds are just getting flushed down the toilet," he says. "I could see if maybe a family brings them in and the jail doesn't trust them. But we're talking about prescriptions written by physicians licensed from the state of Texas."
Finn regularly receives letters from inmates detailing their lack of care at the jail. He also regularly visits the jail, talks to employees who work there and hears a never-ending parade of families detail how their loved ones are languishing in the custody of the county.
"If you have a loved one at the jail and they're sick, you have to make it a full-time job to keep them alive."
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That's exactly how Donald and Shirley Scott felt as they watched their son nearly lose his life at the jail last year. Arrested on aggravated robbery charges in March 2004, Michael Scott has dealt with asthma since he was a child, but he had the ailment under control while he was at home. During his first few months at the jail, Scott fared as well as anyone could behind bars, but by July, his asthma flared up. Every day he called his parents, saying that he was having trouble breathing. The guards, he added, weren't taking him seriously.
So Scott's parents called the jail's infirmary, and the nurses gave him the standard treatment for asthmatics.
But the Scotts say that the jail's treatment plan did not relieve any of his symptoms. On August 2, he was rushed by ambulance to Parkland after he again had trouble breathing. He was stabilized and returned to the jail. On September 3, he once again struggled to breathe. He was taken to Parkland a second time, and his doctors prescribed him a new regimen of drugs to strengthen his lungs, but his parents say that when he returned to the jail, he was only given a standard inhaler, which is for someone with mild asthma. Their son's condition became much worse.
Parkland and UTMB officials acknowledge that they each have different lists of preferred drugs and that sometimes this discrepancy creates a conflict. When Parkland takes over managing medical care at the jail later this year, it should be a lot easier to coordinate care. But that's of little consolation to the Scotts.
They say that when their son returned to the jail after his first three trips to Parkland, he didn't improve. His inhaler was providing little relief. On the morning of September 14, 2004, he called his dad after a sleepless night and said he couldn't breathe. His heart was beating rapidly. That day he was sent to Parkland and doctors hooked him up to a respirator. When his parents arrived at the hospital, they were stunned to see their son connected to a series of tubes, his eyes closed and his once-lean body puffed up and bloated.
"The doctors couldn't guarantee us he was going to live," says Donald Scott, from his home in Arlington.
Scott's parents provided the Observer with Parkland records that show that he spent 10 days at the hospital, September 14 to 24. The records also show that he made six other visits to Parkland from August to November of 2004. For nearly a week, Scott was on life support. They also had photographs of their son attached to a respirator.
"The doctor told us the bill he accumulated in intensive care was a lot more expensive to the county than the medication he should have been getting," Donald Scott says.
And yet, he says that when his son returned to the jail, he still was not receiving his prescribed medication. Michael Scott would tell his dad during their regular phone calls that he still was having trouble breathing. Finally, he went back to Parkland in a scheduled outpatient appointment and a pulmonologist took it upon herself to make sure that Scott received the exact round of drugs that he needed. The 21-year-old, who would later plead guilty to aggravated robbery charges, never had any problems receiving his medication during the rest of his stay at Dallas County.
Still, Shirley Scott says that after her son went on life support, his speech was slurred for months. He had trouble walking for weeks and doctors say that he could be at risk for memory loss. His parents say that even today, nearly a year after he fell sick, he seems to talk more slowly.
Jerry Wayne Mooney may also never be the same after his three years at the jail that seemed to bring out the worst in the guards and medical staff. (See "We Hate Your Guts," July 28, 2005). After a shootout with Irving police, Mooney spent a month at Parkland, recovering from nearly a dozen bullet wounds. The gunshots left Mooney's abdominal muscles shredded, allowing his intestines to push into his belly and form a sac of wrinkled gray skin that flopped over his waist. Doctors also performed a colostomy and later in his discharge instructions stated that nurses needed to change his colostomy bags regularly.
When he was discharged into the jail, he was placed in solitary confinement, supposedly for his own protection since he had to carry his colostomy bag. But Mooney and his family say that he spent 62 days in solitary confinement, and nurses failed to change his bags for as long as 11 days.
"I was put in solitary confinement and left to rot," Mooney says. "They didn't change my bandages, and I got a staph infection for five weeks before they did anything about it."
Even worse, Mooney got a hernia stemming from his stomach surgery, and the jail's medical staff failed to provide him with abdominal support binders. As a result, his family says, the hernia gradually continued to grow and now looks like a bowling ball striking a bedsheet. Doctors at Parkland initially thought they could correct his distended abdomen, but the jail staff failed to bring him to a scheduled surgery last year, after a computer error inexplicably released him from jail. His family believes that when Mooney later returned to Lew Sterrett, he was handed a new booking number which caused him to be lost in the computer system when the date came for him to be brought to Parkland.
As Mooney was awaiting trial on his charges, his family and his attorneys had to press the jail staff constantly to make sure he wasn't falling through the facility's considerable cracks. One of his two lawyers, Tona Trollinger, says they needed five separate court orders to ensure that he was receiving his medication, among other basic health care needs. She continually called the jail to make sure they gave him colostomy bags and that he was taken to his scheduled appointments at Parkland.
"The quality of care is abysmal," says Trollinger, a former law professor. "They knew that his attorneys were watching him, and they still haven't been giving him quality medical care. They don't give him colostomy bags; the administration of the medication is erratic; they don't allow him to see a doctor when he asks."
Trollinger says the guards have been especially disappointing, complaining whenever they're asked to check up on Mooney.
Today, after being incarcerated at the jail for three years, he says that were it not for his attorneys and his family hounding the jail staff, "he would have been left for dead."
Scott Williams says he would have faced the same fate were it not for a criminal court judge. In February, he ended up at the jail after being arrested for DUI. Thanks to a failed tracking system that prompted more embarrassing headlines for the jail, Williams stayed there for a week, unaccounted for by a malfunctioning computer program. The Dallas Morning News ran a front-page story on Williams and other inmates who languished in the jail for days and weeks after the facility's new computer program failed to keep tabs on inmates.
Being a family paper, the Morning News did not detail the conditions of the jail as recalled by Williams and other inmates. Williams says that inmates wrote their names in shit on the walls, and a water fountain was the waste receptacle of choice for one inmate with diarrhea.
"There was shit on the toilets. When I'm talking shit, I'm talking an inch of shit," he says. "I just squatted over it and pushed and tried to aim as best I could."
Williams says that because he wasn't eating sandwiches provided to him, he was forced to strip naked and move to a suicide cell. He shivered for 12 hours, lying on the floor without a blanket, trying to avoid shattered glass on the floor of his cell. Because he hadn't been receiving his medicine for depression and anxiety, he suffered through an agonizing withdrawal. At night, he'd hear inmates who weren't receiving their prescribed drugs bang noisily on their cells in protest.
"I was in hell, buddy," says Williams, who, on top of it all, is HIV-positive. Fortunately for Williams, when he appeared before Criminal Court Judge Lisa Fox, she could tell he had been to hell and back, and she gave him a personal recognizance bond that should have released him immediately. Other defendants who had been neglected have come into her court, and lawyers and advocates alike have credited her for making sure the defendants receive care if they need it.
"[Williams] wasn't getting his medication," she says. "I believed he was suffering and that he didn't need to be in jail."
Fox says that even though the personal recognizance bond should have had Williams out of the jail immediately in the custody of his mother, he wound up staying an extra day. That's because Williams says he showed a guard a pink slip of paper that said he was to be released in the custody of his mother, but the guard wasn't impressed. "'Fuck Judge Fox; she didn't call my mama, so why the fuck should I give a shit what she says?'" Williams says the guard told him.
A few months later, Williams and his partner were at their Turtle Creek apartment watching a show on the History Channel about concentration camps. Williams instantly compared what he saw to his own experiences at Dallas County. Still overwhelmed by what he endured, he became agitated and turned to his partner and said, "I would have rather been there."
David Finn
Being sick in Dallas County's troubled jail can be a death sentence
By MATT PULLE,DALLAS OBSERVER
Published: Thursday, September 15, 2005
Four days into his short stint at Dallas County's jail at the Lew Sterrett Justice Center, Mark McLeod talked with his public defender about a plea agreement that could set him free the next afternoon. The attorney remembers that her new client talked slowly as his wide, dark eyes offered a faint glimpse into his troubled mind, but she wouldn't think anything of it until a tearful Friday morning when she saw an 8-by-10-inch color photograph of the bright-eyed young man at his grandmother's home.
On July 25, 2002, public defender Julie Doucet spent hours with McLeod reviewing the plea and trying to complete the final details of the agreement with the District Attorney's Office. Now they were waiting on his brother, Michael, to accept a deal on a misdemeanor assault charge stemming from a shoving match the brothers had in their grandmother's kitchen. It could have been brushed off as a spat between siblings, but Mark had been acting differently lately, and no one knew why. That's why the police were called.
Now the District Attorney's Office was trying to contact Michael and resolve the case, but they couldn't get in touch with him. Doucet also called her client's brother. Finally, early on a Friday morning, she reached Michael. When they finished talking, she drove to the grandmother's home in Richardson, her eyes welling with tears.
Just a few years earlier, Mark McLeod's life was promising. A graduate of Texas Tech University with a degree in journalism, he had plans to become a newspaper reporter. But while his family knew that McLeod was a little different, nobody knew the extent of his troubles until after he was arrested for assaulting his brother. On November 28, 2000, nearly a month after the shoving match, McLeod was diagnosed with catatonic schizophrenia. Two days later, a jury found him incompetent to stand trial, and he was sent to Terrell State Hospital, a mental health facility in neighboring Kaufman County.
It took 19 months of rigorous treatment for doctors and staff to stabilize McLeod. He had a few setbacks, including a fight or two with some of the other residents, but toward the end of his stay he was doing well. On July 22, 2002, more than a year and a half after he was first arrested, he was discharged from Terrell and sent to Sterrett while he awaited the resolution of his charges. That day he called his grandmother, with whom he had lived since he was 5. He sounded ordinary and hopeful. He planned to return home.
Schizophrenia is a disease of the brain; its symptoms are terrifying and numerous, most notably including paranoia and auditory hallucinations. It can't be cured, but through a rigorous treatment plan, many of the disease's sufferers can lead peaceful, productive lives; the doctors at Terrell hoped that this would be their young patient's fate.
The discharge records from Terrell were clear: McLeod was to receive 32 milligrams of Trilafon four times daily. If he did not receive his medication, the discharge notes warned, "symptoms of schizophrenia, paranoid type will recur..."
Five days after Mark McLeod was released from Terrell into Sterrett, Doucet finally got in touch with his brother. She figured he would agree to a plea deal and within hours, McLeod would return home.
"He told me 'I just got back from the morgue,'" Doucet recalls. "I almost went off the deep end."
Hours earlier Mark McLeod, just 27 years old and staring at a second chance at a normal life, hanged himself in his cell.
McLeod's autopsy records, released by his civil attorney, David Finn, show that he had no trace of Trilafon in his body. Finn's notes also document that a day before McLeod killed himself, he told the medical staff that he was hearing voices, but he was not placed on suicide watch. Instead, he remained alone in a closed cell.
After visiting with McLeod's grandmother, a heartbroken Doucet headed immediately to Sterrett. A secret source gave her a list of four inmates who lived on his pod, and she and another attorney planned to talk to them to piece together clues about how her client spent his last night. The sheriff's office, however, wouldn't give her access, claiming that she did not have the authority to interview McLeod's neighboring inmates since she was not their attorney of record.
"I wish I could have talked to the four inmates. I would have asked them, 'Did you hear anything, was he angry, was he talking to people, did he ask for help, was he calling for the guards, did the guards say anything to him?'" Doucet says. "But the Dallas County Sheriff's Department put their foot down, and I will never get over that."
Doucet pressed on, however, and convinced a judge to sign an order allowing her to subpoena McLeod's medical records. Represented by District Attorney Bill Hill's office, the sheriff's legal advisor and mental health director filed a motion to quash the subpoena, arguing that it was a waste of resources and time. Doucet says that the District Attorney's Office later complained to her boss, the chief public defender, that she was being "too antagonistic." Meanwhile, McLeod's civil attorneys ultimately withdrew their lawsuit because it would have been difficult to prove that the mentally ill inmate did not refuse his meds, even though a refusal should have caused jail staff to at least put him on suicide watch or contact Terrell.
McLeod's death and the county's response were far from unique. For years now, inmates at the Dallas County jail have often failed to receive elementary levels of medical care, prompting a lengthy series of lawsuits and bad publicity that has done nothing to halt the cycle of neglect. If anything, people who determine the fate of the jail have rejected outside scrutiny. Every year, the jail elicits the same criticisms, and all that changes are the faces of the elected officials. From the county commissioners, who control the jail's budget, to the sheriff's office, which makes the day-to-day decisions that affect the lives of thousands, a stubborn cast of officials have engaged in a long-running pattern of closing ranks and resisting external pressures. Even the District Attorney's Office, which counts the jail as its most troubled client, has pursued a defense-at-all-costs strategy instead of finding out what's really happening to inmates in the county's custody.
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It was a textbook Lew Sterrett death: a troubled inmate suffers dramatic deterioration amid guards and a neglectful medical staff. Incarcerated on a misdemeanor prostitution charge in February 2002, Rosa Allejo fell apart at Sterrett. Her mind crumbling by the hour, she died three weeks into her stay at the jail from eating bags of dried coffee grounds. According to her family's lawsuit, she noted on her intake evaluation form that she had previously received psychiatric treatment at Terrell State Hospital and had been taking lithium carbonate for mental illness. Within a week, though, Allejo became a wreck.
In their lawsuit, Allejo's family members claim that jail floor officers reported that she was yelling, eating toilet tissue and pulling at her hair while pleading for her medication. She began to eat her own feces, but even that didn't prompt anyone to make sure Allejo was receiving her proper course of drugs. Meanwhile, the guards continued to give her coffee grounds, which led to her death from caffeine toxicity. No one at the jail seemed to realize that Allejo's unusual craving was a possible side effect of withdrawal from certain types of behavioral drugs, particularly lithium. Not surprisingly, her family's lawsuit cites jail records that show that she never received her lithium during her incarceration.
Following Allejo's death, which drew attention to a string of similar cases, the nonprofit Mental Health Association of Dallas offered to fund an independent ombudsman who would investigate allegations of neglect among mentally ill inmates. The ombudsman would also serve as a resource for families of the incarcerated and would likely look into other cases where chronically ill inmates were not receiving their medication. But Vivian Lawrence, an expert on prison issues for the nonprofit, says that then-Sheriff Jim Bowles never responded to the offer, and the county commissioners at the time never even brought it to a vote.
"It floors me," says Lawrence on the county's unresponsiveness to the group's proposal.
This year, the Mental Health Association has offered to train the jail's detention officers, free of charge. Citing overtime costs, Sheriff Lupe Valdez's office has declined the offer.
"This has been going on for so long, you can't say there is any one commissioner responsible for this," Lawrence says of the jail's entrenched problems. "You can't necessarily blame the sheriff, since we have a new sheriff. I just think there is a culture at the jail where they just say, 'We have done this so long, and we're not going to change.'"
In 1998, four years before the deaths of Mark McLeod and Rosa Allejo, a panel of health experts analyzed mental health issues at the jail, including why some inmates were not receiving their medications. Seven years after the panel looked at the jail, an outside consultant employed by the county studied the jail and again criticized how mentally ill inmates are treated.
"If you look at the 1998 report and the report the current consultant did in February of this year, there are a lot of the same recommendations," Lawrence says.
First-term County Judge Margaret Keliher has taken steps to tackle the long-term defects that have plagued the jail. Over the objections of some of her colleagues, she has pushed for the county to hire enough detention officers to meet state standards and institute structural changes that include revamping the jail's flawed intake procedures. Her office has also helped guide a fledgling but promising mental health diversion program that tracks nonviolent mentally ill inmates and places them out of jail and into a program of coordinated care.
Perhaps most important, Keliher not only pushed for the 2005 consultant's report on Sterrett, she secured private funding to pay for it.
But Keliher, along with the rest of the commissioners court, has gone to federal court to suppress that same report, which is being cited in an inmate lawsuit against the county. The report is a blow-by-blow account of the jail's inept health care system, blaming the facility's medical providers as well as its guards. After the report was concluded, The Dallas Morning News asked for a copy, but the District Attorney's Office denied the paper's request.
Regardless, Morning News reporter Jim O'Neill obtained a confidential copy of the report and wrote about it in detail. That prompted the commissioners court's outside counsel, the corporate law firm of Figari & Davenport, to send a letter to the paper demanding that they cease writing about and immediately return the report. The Morning News wasn't exactly intimidated; its response was to post the so-called confidential report on its Web site. Then in July, Figari & Davenport failed to convince a federal magistrate that plaintiffs in an inmate lawsuit couldn't cite the report as evidence that the pattern of poor care at the jail led to their client's death. The law firm appealed that decision and lost. For their efforts, Figari & Davenport has been paid more than $100,000 by the county.
Lost in all the legal wrangling is the fate of the man who inspired it all, James Mims. A mentally ill inmate, Mims suffered renal failure and wound up in Parkland Memorial Hospital in grave condition last year after guards turned off the water in his cell when Mims flooded it. The sheriff's own investigators found that the guards who turned off the water did not properly report their action up the chain of command, although none of them were formally disciplined. Nor did any of them realize that he wasn't drinking any water. Meanwhile, internal investigators cited the jail's medical provider, the University of Texas Branch at Galveston, for failing to give Mims the psychiatric medicine he needed, which contributed to his bizarre behavior. Investigators also blamed the jail's psychiatric department for not giving him an evaluation, even though the medical department referred him three times.
Keliher declined to comment on the specifics of the commissioners court's legal strategy, except to say that they have an obligation to protect taxpayer dollars. Suppressing a damning consultant's report might stymie the plaintiffs' extraction of a large settlement from the county, of course, but that raises a philosophical question: Should the commissioners court be playing hardball to protect taxpayer dollars or should it be looking to settle a case where its own sheriff's department has corroborated many of the lawsuit's allegations?
On any given day, there are more than 7,000 inmates in Dallas County's jail system, whose main facility, Lew Sterrett Justice Center, is located on Industrial Boulevard in the shadow of downtown's skyline. Making sure that the inmates are safe and that the sick are receiving care is a logistical nightmare. It's also a grueling job for everyone who works there. Unruly, deranged inmates will throw feces at guards, provoke fights and take part in vandalism such as clogging up toilets and overflowing sinks. Salaries for detention officers begin at $27,000, which is less than Tarrant and other neighboring counties pay. Still, employees who have worked at the jail say that most of the guards, though certainly not all, exercise remarkable restraint and good judgment.
For the poor and sick, who may not receive any medical care at all in the community, incarceration often means the best health care of their lives. But the problems at the jail that incite lawsuits and headlines seem to be more entrenched than episodic, particularly the issue of how guards and medical staff respond to chronically ill inmates. Independent observers, including judges and doctors, corroborate that ill and healthy inmates alike are failing to receive medications or enduring long periods of neglect while in custody; even the state's own correctional facility watchdog confirms the jail's deficiencies.
"We have found more complaints from the Dallas County jail about the medical care, and we have found more incidents arising from the inmates at Dallas County than any other big county jail in Texas," says Terry Julian, the executive director of the Texas Commission on Jail Standards.
Last year, Sterrett failed inspection with the commission, in part because it was short on staff and neglected to perform adequate health screenings of its inmates. It failed again in 2005, having been found in violation of at least 10 state standards, including staff shortages, incomplete tuberculosis testing and a lack of prompt care for sick inmates. State standards require that county jails have at least one corrections officer per 48 inmates; in recent unannounced state inspections, the jail has fallen just short of that for "significant periods of time," according to inspectors. While the Dallas County commissioners are finally taking steps to correct some of the jail's nagging problems, including hiring enough detention officers to meet state standards, they're only beginning to address the institutional defects that have been allowed to linger and grow for years.
"The jail did not fall out of compliance overnight," says Julian, who credits the current commissioners for finally tackling one of the fundamental problems with the place, lack of money. "Dallas County was certified for many, many years. It was a facility we could all be proud of. But now, over the last couple years, it has declined. We're seeing more inmates and more of them have medical needs that are not being met."
To a degree, some of the county's problems can be traced to funding. Until this year, a tax-averse commissioners court would typically ask the sheriff's office to reduce its operating budget, and the sheriff would cut staff. Sheriff's office employees say the commissioners exacerbated the problem by pressuring them to freeze overtime pay last year, which they say led to the low staffing ratios that caused the jail to fail inspection. This year, the county will likely fund a budget increase that would allow the sheriff's office to hire at least 70 jailers, although the department originally hoped for up to 400. The county's budget office maintains that the 70 new positions should still be enough for the jail system to meet state standards.
As the Texas Commission on Jail Standards and others single out Dallas County for a range of problems, it's hardly surprising to find that it spends considerably less money on its jail than its closest peer, Harris County, even after accounting for a smaller inmate population. Last year, Dallas County budgeted $77 million for its jails, including operating costs, food and health care. Harris County, which has around 2,500 more inmates than its North Texas counterpart, allocated $135.9 million for jail expenses. But Dallas County is hardly the only big county jail in Texas with problems. Both the Harris County and Bexar County (San Antonio) jails have also failed inspections recently.
In many of the lawsuits filed against the jail, sick inmates allege that guards continually fail to respond to serious health needs. Advocates, who say that problems of health care at Lew Sterrett go back at least 20 years, say that while all jails could be beter, Dallas County's is one of the worst. Lanny Priddy is an attorney for the North Texas Region of Advocacy Inc., which monitors jail conditions throughout the region including Fort Worth, Denton, Tyler and Texarkana.
"We find that the Dallas jail generates more complaints about medical and mental health conditions than all the other jails in the region put together," he writes in an e-mail. "Whether considered on the basis of complaints per capita or in terms of absolute numbers of complaints, the Dallas jail presents by far the greatest problem in the region with regard to jail medical and mental health care."
Not all of the jail's problems can be easily traced to a lack of funding. Attorney Tona Trollinger, who has a seriously ill client at Sterrett, says the jail's problems are also rooted in the attitudes of some of the people who work there. "They get doctors who just want to work 9-to-5 jobs. Everybody just gets jaded," she says. "The staff is so acerbic. They get complaints from so many inmates who are not sick that when someone really is in pain, they can't tell if that's real."
Some of Dallas County's problems stem from years of bad management, poor funding and a dysfunctional relationship between the two county offices responsible for the fate of the jail. Ex-Sheriff Jim Bowles feuded with many of the county commissioners over budgets and staffing, and the relationship between the sheriff and the commissioners became so acrimonious that as the jail endured bad press and explosive lawsuits, some of the commissioners felt as though they couldn't even trust what the sheriff was telling them about his facility.
In an August interview, Dallas County Commissioner Mike Cantrell showed the depth of distrust when he explained why they had to enlist the support of an outside consultant to study Sterrett. "We had a sheriff who would not allow us access to the jail," he explained incredulously.
Bowles refused to be interviewed for this story, and the three commissioners who served with Bowles, Mike Cantrell, Kenneth Mayfield and John Wiley Price, did not respond to repeated requests for comment.
Sheriff Lupe Valdez, elected last year in a surprise victory for the openly gay Democrat, has instituted several modest departmental changes. Still, while many lawyers and judges had high hopes for Valdez upon her election, particularly given the polarizing last few years of her predecessor's two-decade tenure, problems continue, including yet another case where a guard inexplicably turned off an inmate's water. That incident was almost identical to what happened to James Mims last year. Although captains had been authorized to turn off water in an inmate's cell if it had been reported up the chain of command, Valdez writes in an e-mail that she has now ordered that "there will be no water turned-off within any of our jail facilities. Period."
Valdez also says that jail employees have been ordered to be more attentive to sick inmates. She says that jailers now have to take any inmate who appears ill or even just complains of being ill to a nurses' station for immediate examination. Over the years, ailing inmates have complained that nobody took their pleas for medical care seriously, in part because so many of their peers fake illnesses for attention. Now, under Valdez's orders, guards can't pick and choose which inmates they believe.
Arguably cast as the biggest villain in ongoing conflict over the jail has been its medical provider, the University of Texas Medical Branch at Galveston. County commissioners in particular criticized UTMB after reviewing the detailed and critical report submitted by the county's outside consultant earlier this year. Conducted by Dr. Michael Puisis, the former medical director of the Cook County Jail in Chicago, and funded by Health Management Associates, the report sharply criticized how the jail monitors its most disturbed inmates, noting it is "only a matter of chance" whether a severely disturbed psychotic individual is assigned to a cell where he could be monitored versus a cell where he is hidden from view. He also reported that the jail's suicide cells recklessly shut out the inmate from nearly all human contact, which can result in psychotic behavior.
Although he was at the facility for only a week, Puisis also discovered one inmate who died after the jail's medical staff failed to diagnose his chronic illnesses--the report doesn't say what sort of illness--for more than six weeks. Another inmate who had been on medication for tuberculosis before he came to the jail and had obvious symptoms of the contagious disease was inexplicably kept in the general population. The inmate did not have a physical examination for the first four months of his incarceration. Overall, the doctor characterized the UTMB's monitoring of chronically ill inmates as "poor to non-existent," resulting in excessive hospitalizations.
"I'm disappointed in their performance," Keliher says of UTMB. "They were used to prisons instead of jails, and in all fairness, they probably underbid and understaffed it."
When UTMB first bid for the job as the jail's medical provider in 2001, the medical school promised that it could cut costs and improve care. Press accounts said that UTMB could save the county nearly $700,000 a year, down from the $14 million the county had been spending on jail health. Three years later and with the benefit of hindsight, the school now says it is understaffed and underfunded, having lost up to $200,000 a month throughout the course of a contract that reimburses it $569 per inmate. Although UTMB made the decision not to apply for a contract renewal, it's unlikely the commissioners would have wanted them to remain as the medical provider following Puisis' report and the lawsuits.
Dr. Owen Murray, the chief executive of UTMB Correctional Care, agrees that the school initially underestimated the acuity of health care needs at a jail, as opposed to a prison, in which most of its correctional experience lies. At a prison, most inmates have already been stabilized, while at a jail they often come in off the streets at the height of their mental illnesses, drug addictions and with a range of physical afflictions.
"I was surprised just how sick the patients are at Dallas County," Murray says. "You have three times the rate of diabetes in the jail as you do in prison and twice the rate of hypertension."
Still, while Murray agrees with some of the jail report's findings, particularly as it relates to staffing and problems with the facility itself, he says that some of the report's criticisms are unfair. For example, one of the report's more dramatic findings--that not every inmate at the jail is screened for tuberculosis--isn't exactly damning; the Texas Commission on Jail Standards requires testing on only a portion of the jail's population, he says. Murray says that he agrees with many of the report's general conclusions, but that "it's difficult to come into a place as complex as the Dallas County jail and walk away with a clear picture of what's going on."
Because of patient confidentiality rules, Murray was not able to speak about the instances the report highlighted where inmates died or became gravely ill under UTMB's care.
UTMB's predecessor, Dallas County Health and Human Services, fared no better at providing care, particularly to the mentally ill. In 2002, the Morning News and WFAA-TV investigated the jail's health care practices and uncovered cases where suicidal inmates were punished by being stripped of their clothes and left naked in their cells, sometimes without their medication. The report included one inmate who gouged his eye out, stomped on it and tried to flush it down the toilet. The medical staff's solution to the inmate's troubles was to wrap mitts around his hands so he wouldn't hurt himself. WFAA also caught Rita Moss, the jail's medical director for the mental health staff, regularly leaving work early in her Mercedes, presumably to attend to her second job running a private psychiatric practice.
Jim Pruitt, a Rockwall attorney who served as a Dallas County criminal judge from 1995-2003, tells the Observer that making sure that inmates appearing before him were receiving their prescribed medication demanded his constant attention. One staffer, the ex-judge says, went so far as to alter medical records to document that a particular inmate had been given his prescribed medication when he hadn't. That staffer was later fired. Other employees would document that inmates refused medication, simply because they were sleeping; it was too much trouble to wake them up. Asked why the county's medical staff continually failed to make sure inmates received the drugs they needed, Pruitt replied with the frankness befitting a former judge.
"They were damn lazy."
County Criminal Court Judge Lisa Fox, who took the bench in May 2002, says that she still regularly sees defendants in her court who have gone without their medications for weeks. At least three times she's had to call the jail from her bench to make sure that the medical staff attends to an ailing defendant immediately.
"I think they need to take the time in the beginning to make sure inmates are on their medication rather than wait two to three weeks," Fox says.
A few months ago, she had a defendant in her court with a hideous staph infection on his leg. She ordered him to be taken to Parkland Hospital immediately.
"It's going to take a major overhaul," she says on what lies ahead for the Dallas County jail system.
Attorney David Finn, who helped the families of James Mims and Mark McLeod prepare lawsuits against the county, first became aware of the problems at the jail when he was a criminal court judge. He said that when he sat on the bench, he regularly saw mentally ill inmates who clearly were not receiving their meds. They'd be declared incompetent for trial, be sent to Terrell and stabilized, only to return to jail and not be given their medication, even when the hospital staff gave the county jail a two-week supply.
"Hundreds of thousands of dollars in meds are just getting flushed down the toilet," he says. "I could see if maybe a family brings them in and the jail doesn't trust them. But we're talking about prescriptions written by physicians licensed from the state of Texas."
Finn regularly receives letters from inmates detailing their lack of care at the jail. He also regularly visits the jail, talks to employees who work there and hears a never-ending parade of families detail how their loved ones are languishing in the custody of the county.
"If you have a loved one at the jail and they're sick, you have to make it a full-time job to keep them alive."
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UTMB's predecessor, Dallas County Health and Human Services, fared no better at providing care, particularly to the mentally ill. In 2002, the Morning News and WFAA-TV investigated the jail's health care practices and uncovered cases where suicidal inmates were punished by being stripped of their clothes and left naked in their cells, sometimes without their medication. The report included one inmate who gouged his eye out, stomped on it and tried to flush it down the toilet. The medical staff's solution to the inmate's troubles was to wrap mitts around his hands so he wouldn't hurt himself. WFAA also caught Rita Moss, the jail's medical director for the mental health staff, regularly leaving work early in her Mercedes, presumably to attend to her second job running a private psychiatric practice.
Jim Pruitt, a Rockwall attorney who served as a Dallas County criminal judge from 1995-2003, tells the Observer that making sure that inmates appearing before him were receiving their prescribed medication demanded his constant attention. One staffer, the ex-judge says, went so far as to alter medical records to document that a particular inmate had been given his prescribed medication when he hadn't. That staffer was later fired. Other employees would document that inmates refused medication, simply because they were sleeping; it was too much trouble to wake them up. Asked why the county's medical staff continually failed to make sure inmates received the drugs they needed, Pruitt replied with the frankness befitting a former judge.
"They were damn lazy."
County Criminal Court Judge Lisa Fox, who took the bench in May 2002, says that she still regularly sees defendants in her court who have gone without their medications for weeks. At least three times she's had to call the jail from her bench to make sure that the medical staff attends to an ailing defendant immediately.
"I think they need to take the time in the beginning to make sure inmates are on their medication rather than wait two to three weeks," Fox says.
A few months ago, she had a defendant in her court with a hideous staph infection on his leg. She ordered him to be taken to Parkland Hospital immediately.
"It's going to take a major overhaul," she says on what lies ahead for the Dallas County jail system.
Attorney David Finn, who helped the families of James Mims and Mark McLeod prepare lawsuits against the county, first became aware of the problems at the jail when he was a criminal court judge. He said that when he sat on the bench, he regularly saw mentally ill inmates who clearly were not receiving their meds. They'd be declared incompetent for trial, be sent to Terrell and stabilized, only to return to jail and not be given their medication, even when the hospital staff gave the county jail a two-week supply.
"Hundreds of thousands of dollars in meds are just getting flushed down the toilet," he says. "I could see if maybe a family brings them in and the jail doesn't trust them. But we're talking about prescriptions written by physicians licensed from the state of Texas."
Finn regularly receives letters from inmates detailing their lack of care at the jail. He also regularly visits the jail, talks to employees who work there and hears a never-ending parade of families detail how their loved ones are languishing in the custody of the county.
"If you have a loved one at the jail and they're sick, you have to make it a full-time job to keep them alive."
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That's exactly how Donald and Shirley Scott felt as they watched their son nearly lose his life at the jail last year. Arrested on aggravated robbery charges in March 2004, Michael Scott has dealt with asthma since he was a child, but he had the ailment under control while he was at home. During his first few months at the jail, Scott fared as well as anyone could behind bars, but by July, his asthma flared up. Every day he called his parents, saying that he was having trouble breathing. The guards, he added, weren't taking him seriously.
So Scott's parents called the jail's infirmary, and the nurses gave him the standard treatment for asthmatics.
But the Scotts say that the jail's treatment plan did not relieve any of his symptoms. On August 2, he was rushed by ambulance to Parkland after he again had trouble breathing. He was stabilized and returned to the jail. On September 3, he once again struggled to breathe. He was taken to Parkland a second time, and his doctors prescribed him a new regimen of drugs to strengthen his lungs, but his parents say that when he returned to the jail, he was only given a standard inhaler, which is for someone with mild asthma. Their son's condition became much worse.
Parkland and UTMB officials acknowledge that they each have different lists of preferred drugs and that sometimes this discrepancy creates a conflict. When Parkland takes over managing medical care at the jail later this year, it should be a lot easier to coordinate care. But that's of little consolation to the Scotts.
They say that when their son returned to the jail after his first three trips to Parkland, he didn't improve. His inhaler was providing little relief. On the morning of September 14, 2004, he called his dad after a sleepless night and said he couldn't breathe. His heart was beating rapidly. That day he was sent to Parkland and doctors hooked him up to a respirator. When his parents arrived at the hospital, they were stunned to see their son connected to a series of tubes, his eyes closed and his once-lean body puffed up and bloated.
"The doctors couldn't guarantee us he was going to live," says Donald Scott, from his home in Arlington.
Scott's parents provided the Observer with Parkland records that show that he spent 10 days at the hospital, September 14 to 24. The records also show that he made six other visits to Parkland from August to November of 2004. For nearly a week, Scott was on life support. They also had photographs of their son attached to a respirator.
"The doctor told us the bill he accumulated in intensive care was a lot more expensive to the county than the medication he should have been getting," Donald Scott says.
And yet, he says that when his son returned to the jail, he still was not receiving his prescribed medication. Michael Scott would tell his dad during their regular phone calls that he still was having trouble breathing. Finally, he went back to Parkland in a scheduled outpatient appointment and a pulmonologist took it upon herself to make sure that Scott received the exact round of drugs that he needed. The 21-year-old, who would later plead guilty to aggravated robbery charges, never had any problems receiving his medication during the rest of his stay at Dallas County.
Still, Shirley Scott says that after her son went on life support, his speech was slurred for months. He had trouble walking for weeks and doctors say that he could be at risk for memory loss. His parents say that even today, nearly a year after he fell sick, he seems to talk more slowly.
Jerry Wayne Mooney may also never be the same after his three years at the jail that seemed to bring out the worst in the guards and medical staff. (See "We Hate Your Guts," July 28, 2005). After a shootout with Irving police, Mooney spent a month at Parkland, recovering from nearly a dozen bullet wounds. The gunshots left Mooney's abdominal muscles shredded, allowing his intestines to push into his belly and form a sac of wrinkled gray skin that flopped over his waist. Doctors also performed a colostomy and later in his discharge instructions stated that nurses needed to change his colostomy bags regularly.
When he was discharged into the jail, he was placed in solitary confinement, supposedly for his own protection since he had to carry his colostomy bag. But Mooney and his family say that he spent 62 days in solitary confinement, and nurses failed to change his bags for as long as 11 days.
"I was put in solitary confinement and left to rot," Mooney says. "They didn't change my bandages, and I got a staph infection for five weeks before they did anything about it."
Even worse, Mooney got a hernia stemming from his stomach surgery, and the jail's medical staff failed to provide him with abdominal support binders. As a result, his family says, the hernia gradually continued to grow and now looks like a bowling ball striking a bedsheet. Doctors at Parkland initially thought they could correct his distended abdomen, but the jail staff failed to bring him to a scheduled surgery last year, after a computer error inexplicably released him from jail. His family believes that when Mooney later returned to Lew Sterrett, he was handed a new booking number which caused him to be lost in the computer system when the date came for him to be brought to Parkland.
As Mooney was awaiting trial on his charges, his family and his attorneys had to press the jail staff constantly to make sure he wasn't falling through the facility's considerable cracks. One of his two lawyers, Tona Trollinger, says they needed five separate court orders to ensure that he was receiving his medication, among other basic health care needs. She continually called the jail to make sure they gave him colostomy bags and that he was taken to his scheduled appointments at Parkland.
"The quality of care is abysmal," says Trollinger, a former law professor. "They knew that his attorneys were watching him, and they still haven't been giving him quality medical care. They don't give him colostomy bags; the administration of the medication is erratic; they don't allow him to see a doctor when he asks."
Trollinger says the guards have been especially disappointing, complaining whenever they're asked to check up on Mooney.
Today, after being incarcerated at the jail for three years, he says that were it not for his attorneys and his family hounding the jail staff, "he would have been left for dead."
Scott Williams says he would have faced the same fate were it not for a criminal court judge. In February, he ended up at the jail after being arrested for DUI. Thanks to a failed tracking system that prompted more embarrassing headlines for the jail, Williams stayed there for a week, unaccounted for by a malfunctioning computer program. The Dallas Morning News ran a front-page story on Williams and other inmates who languished in the jail for days and weeks after the facility's new computer program failed to keep tabs on inmates.
Being a family paper, the Morning News did not detail the conditions of the jail as recalled by Williams and other inmates. Williams says that inmates wrote their names in shit on the walls, and a water fountain was the waste receptacle of choice for one inmate with diarrhea.
"There was shit on the toilets. When I'm talking shit, I'm talking an inch of shit," he says. "I just squatted over it and pushed and tried to aim as best I could."
Williams says that because he wasn't eating sandwiches provided to him, he was forced to strip naked and move to a suicide cell. He shivered for 12 hours, lying on the floor without a blanket, trying to avoid shattered glass on the floor of his cell. Because he hadn't been receiving his medicine for depression and anxiety, he suffered through an agonizing withdrawal. At night, he'd hear inmates who weren't receiving their prescribed drugs bang noisily on their cells in protest.
"I was in hell, buddy," says Williams, who, on top of it all, is HIV-positive. Fortunately for Williams, when he appeared before Criminal Court Judge Lisa Fox, she could tell he had been to hell and back, and she gave him a personal recognizance bond that should have released him immediately. Other defendants who had been neglected have come into her court, and lawyers and advocates alike have credited her for making sure the defendants receive care if they need it.
"[Williams] wasn't getting his medication," she says. "I believed he was suffering and that he didn't need to be in jail."
Fox says that even though the personal recognizance bond should have had Williams out of the jail immediately in the custody of his mother, he wound up staying an extra day. That's because Williams says he showed a guard a pink slip of paper that said he was to be released in the custody of his mother, but the guard wasn't impressed. "'Fuck Judge Fox; she didn't call my mama, so why the fuck should I give a shit what she says?'" Williams says the guard told him.
A few months later, Williams and his partner were at their Turtle Creek apartment watching a show on the History Channel about concentration camps. Williams instantly compared what he saw to his own experiences at Dallas County. Still overwhelmed by what he endured, he became agitated and turned to his partner and said, "I would have rather been there."
David Finn
posted by Dallas Federal Criminal Defense Attorney - David Finn at 12:01 PM
2 Comments:
One Dallas man is trying to lay out the mistakes in the Dallas County justice system for the world to see at http://www.angelfire.com/crazy4/texas
We hope you'll take a look around and contact us if you have additional information or a story you'd like to tell.
Dear Attorney Finn:
We both know all to well that the officials responsible for the lawful and humane operations and management of the Dallas County jail have failed the taxpayers and those confined there. I agree that there is no one person that can bear the blame alone. The sheriff's, each county commissioner and the county judge are all "GUILTY" of knowing acquiescence in the inhumane and unconstitutional conditons of confinemnet at the jail and of presistently violating a statutroy and moral duty to inquire about the deplorable conditions as well as the pervasive mistreatment of detainess by jail staff and to act responsibly based on that knowledge to corect those problems. The situation has gotten way out of hand despite all the so-called inspections, reinspections, warning of possible fines, and shut-downs by the Texas Commission on Jail Standards and U.S. Department of Justice. I
The only thing that gets county officials attention [somewhat] is when detainees, their loved ones, or decent lawyers as yourself, initiate the appropriate legal actions to challenge the widespread civil and human right violations occurring there daily. I have initiated several federal lawsuits agaoinst sheriff valdez, the county commisioners and others concerning that jail. I have also written some articles and Making The Walls Transparent- Texas Chapter(MTWT-Texas) maintains a website that monitors the behind the scene activities at the county jail and criminal court system.
One day when the public awakes from their trance and realizes the cost and health risk involved and allowing things to continue as is, none of the usual excuses and hollow promises will do.
"Sharif"
www.angelfire.com/crazy4/texas
www.angelfire.com/crazy4/texas/Valdez.html
www.angelfire.com/crazy4/texas/classaction.html
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