Wednesday, December 13, 2006

How To Pour $1 million Down A Black Hole

Paying the Piper

By Matt Pulle, Dallas Observer
Article Published Dec 7, 2006

Lew Sterrett Justice Center, a bad place to get sickAn inmate lawsuit, whose allegations of incompetence and neglect at the Dallas County jail have been echoed by a pair of internal investigations into the health care at the facility, continues to stymie the county. If that's not exactly a surprise, the case has also underscored the ineffectiveness of the county's outside defense counsel, the white-shoe law firm of Figari & Davenport, who have billed the county nearly $1 million and counting even as it has lost a series of motions before state and federal courts.

In 2004, James Mims, a mentally ill inmate at the Lew Sterrett Justice Center, suffered renal failure nearly two weeks after guards turned off the water in his cell. An internal affairs investigation found both the jail and its outside medical provider at fault. After lawyers for Mims and two other mentally ill inmates who died at the jail filed a lawsuit, the county enlisted Figari & Davenport to defend the case. That decision has yet to pay dividends, at least for the county.

An open records request for the firm's billing records show that it has charged the county $923,000 for its services, a sum that most inmate attorneys would quickly agree to as part of a settlement for even the most egregious case. The firm's senior partner, Ernest Figari, has billed $450 an hour.

But so far, the firm, which brags of its "outstanding results" on its Web site, has a rather unimpressive track record: In 2005, after The Dallas Morning News obtained an outside consultant's damning report of health care at the jail, which concluded that inmates were likely dying as a result of a neglectful medical program, the law firm sent a letter to the paper demanding that it return the report. The News refused, choosing instead to publish the report on its Web site. Undeterred, Figari then asked a state district judge to order the paper to remove the report from its Web site, but the firm lost that one too. Figari then tried to convince a federal magistrate and subsequently a federal judge that attorneys for Mims couldn't use or refer to the report as evidence in their case, claiming it was privileged attorney-client communication. Both times, the firm's motions were rejected. That was a major victory to the plaintiffs' attorneys since the independent study of the jail provided outside corroboration of the facility's dismal record of medical care.

"We think the report itself is the best evidence," said Fort Worth attorney Jeff Kobs, who represents the inmates' families, shortly after a federal magistrate ruled that the study of the jail was not considered privileged.

Figari lost again last month, this time before the 5th U.S. Circuit Court of Appeals, in its effort to include the jail's former medical provider, the University of Texas Medical Branch at Galveston, as a responsible party in the litigation. Now Figari is in the unenviable position of having to argue the facts in the case. Figari & Davenport's Dennis Lynch, who has argued unsuccessfully for the county in federal court, declined any comment on the ongoing litigation. Meanwhile, the opposing counsel, which is seeking not just damages but an overhaul of the jail's medical care program, is critical of how the county is choosing to defend the case.

"No money should be spent by the county defending past practices at the jail," Kobs says. "The county should admit what everyone already knows—that the system for delivering medical care to jail inmates is broken, that it needs to be fixed and that fixing it will cost money. The sooner county commissioners realize this, the sooner real reforms can take place."

Shortly after Mims' plight made the news, internal affairs investigators for the jail sought to find out what happened. Investigators interviewed nearly 50 jailers, supervisors and medical personnel, exposing epic failings throughout the jail health system. First, even though Mims had been found to be mentally incompetent to stand trial over a period of 25 years, having been transferred between Terrell State Hospital and the county jail during that time, UTMB's psychiatric staff failed to follow through on three separate referrals from medical personnel to evaluate him. They also failed to provide his prescribed medication.

Meanwhile, the investigators found that the guards and their supervisors failed to keep track of Mims when they turned off the water in his cell. They did that as a temporary measure after he flooded his space, only nobody kept a record that Mims was going without water. Left without his medication, Mims was unable to speak for himself. In their report, the investigators concluded that Mims simply "fell through the cracks." Remarkably, then Sheriff Jim Bowles did not discipline any of the guards responsible for Mims.

After the investigation, the county expected UTMB to pay for at least some of the costs stemming from Mims' lawsuit. In its 2002 contract with the county, the medical school agreed to "indemnify" the county in the event of any lawsuit stemming from their own mistakes. Allen Clemson, the administrator for the county and its top non-elected official, negotiated the contract and in a subsequent affidavit said that he thought UTMB agreed to be on the hook in the event of a case such as Mims'. But UTMB would later claim "sovereign immunity," which means that as a governmental entity, it is protected from most lawsuits. In other words, the indemnity clause to which UTMB agreed might as well have been worthless. Both Clemson and the District Attorney's Office, which also reviewed the contract, basically got duped by a medical school into thinking that they had some protection in such a case as Mims'.

Last week, Sheriff Lupe Valdez had some startling news for the board of managers at Parkland Memorial Hospital. Now that Parkland is the medical provider for the jail, 800 inmates are being transported to the hospital per month, four times as many as had been taken under UTMB. The medical school did not dispute the sheriff's numbers but declined comment. Valdez's statements suggest that under UTMB as many as 600 inmates per month were not receiving the care they needed. That's a lot of inmates who slipped through the cracks and even more new business for a defense firm such as Figari & Davenport.

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Starting to See a Pattern? Deliberate Indifference

Feds Detail Fatal Dangers at Jail: Suit Threatened Over Care; Dallas County Officials Say Conditions Improving
By Kevin Krause, The Dallas Morning News

Dec. 13--Conditions in the Dallas County Jail are so dangerous, they have contributed to the death and injury of numerous inmates and placed others at "risk of serious harm," a U.S. Department of Justice report has concluded.

The fact that problems persist at the troubled jail system -- the nation's seventh largest -- is not new. State inspectors have given the jail a failing grade four times in a row, and a consultant hired by the county warned early last year of its dangerously inadequate health care.

But for the first time, a report has documented multiple incidents of inmates with serious health problems dying or becoming maimed or disabled after failing to receive prompt or adequate medical care.

The report paints a disturbing portrait of the jail as a place where indifference to human suffering is common.

"Most seriously, we found numerous instances where DCJ's [the jail's] mismanagement contributed to preventable deaths, hospitalizations and unnecessary harm," according to the 47-page report made available to county commissioners on Tuesday.

Such deficiencies violate inmates' constitutional rights by failing to provide them with adequate medical and mental health care and safe and sanitary conditions, the report said.

U.S. Assistant Attorney General Wan J. Kim, who signed the report, included a long list of "remedial measures" and said that if the county doesn't address the government's concerns, the U.S. attorney general's office can file a lawsuit against the county 49 days after the report's release.

Dallas County officials say they have been working to correct deficiencies at the jail by putting Parkland Memorial Hospital in charge of jail health, starting construction on a new jail tower and improving sanitation, among other measures.

"It's not as though it's anything that's new to us," said Commissioner John Wiley Price, chairman of the commissioners' jail population committee. "We weren't waiting for them in order to fix some of this."

County Judge Margaret Keliher, who leaves office later this month, did not return calls seeking comment.

Sheriff Lupe Valdez is out of town all week and unavailable, but a spokesman said the Sheriff's Department is working closely with county commissioners and the federal government to fix the problems.

Lack of medical care

The Dallas County Jail, according to the Justice Department report, is a place where requests for medical attention go unanswered, where inmates can have multiple seizures and still not see a doctor. It's a place where one inmate went seven months without seeing a doctor or getting his HIV medication. Other inmates with medical and psychiatric illnesses lay in their own excrement for up to four days before receiving care.

Society's vulnerable fared as bad or worse in the jail, according to the report.

A pregnant woman who complained of continual bleeding could not get help for two months despite her repeated requests. An elderly inmate with severe health problems would probably have died if another inmate hadn't helped him. And an inmate suffering from bipolar disorder was seen repeatedly eating his own feces in March after receiving a "significant lack of continuity of care" during the previous six months.

At the jail, "inmates routinely miss doses of life-sustaining medications," the report said. One inmate with congestive heart failure died after jail staffers failed to give him medication that might have saved his life, it said.

Medical examination rooms were found to be unclean, with hazardous waste on the floors and no available sinks or towels in some rooms. No dental care was being provided when federal inspectors were on site in February.

The Justice Department noted that its findings were consistent with those from a consultant's report that was released as early as February 2005.

The county commissioned the report in late 2004 from Health Management Associates. It was written by Dr. Michael Puisis, a specialist in correctional health.

The Justice Department's civil rights division began looking into medical care, mental health care and sanitation at the jail about a year ago. Federal inspectors visited the jail in February and March. At the time, about 7,770 inmates were housed in the county's various jail facilities, the report said.

"Dallas County knew about it, Dallas County was told about it, and Dallas County never acted upon it," said lawyer David Finn, who is suing the county in federal court on behalf of a former inmate.

'Litany of horror'

Mr. Finn said he was horrified by the Justice Department's report, which he called a "Kafkaesque litany of horror."

"It shows deliberate indifference over a substantial period of time," he said. "The magnitude of the problem may be shocking. The existence of the problem should surprise no one."

The Justice Department report found inadequacies in 13 different areas: intake screening; acute care; chronic care; the treatment and management of communicable diseases; access to health care; follow-up care; record keeping; medication administration; medical facilities; specialty care; staffing, training and supervision; quality assurance; and dental care.

Deadly conditions at the jail were first alleged in a civil rights lawsuit filed in 2004 by lawyers for a mentally ill inmate who nearly died after water to his cell was shut off for two weeks. James Mims also didn't receive his medication for two months, which the suit called part of a long-standing pattern of abuse and neglect at the jail. The suit also alleges that mistreatment led to the death of inmate Clarence Lee Grant Jr. in 2003.

The Justice Department's report cited additional cases of neglect involving inmates who later died.

The October 2005 death of an HIV-infected inmate due to pneumonia, for example, could have been prevented if he had been given the antibiotic he was prescribed when he arrived at the jail, the report said. But the inmate didn't receive his medication until 11 days after he was booked in.

A second inmate died from a complication of diabetes the same month, two days after being booked into the jail, the report said. When he arrived at the jail, his blood sugar level was dangerously high, but he received no care from a physician while there, according to the report.

UTMB blamed

Mr. Price said that since Parkland has taken over, significantly more inmates are being transported to the hospital for care. He said the University of Texas Medical Branch, which had a three-year jail management contract, was to blame for most of the deficiencies in medical care.

Parkland, he said, is spending $28 million, twice as much as last year, to improve jail health care. Mr. Price said it was "far-reaching" for the government to blame inmate deaths on the county.

"They took a snapshot. It isn't anything that we weren't already working on," he said. "Everyone is acting as if we were just sitting there and being derelict. That's not the case."

Commissioner Maurine Dickey said she was disappointed that the Justice Department began investigating around the time that Parkland took over.

"They didn't give Parkland a chance to come in and transition," she said.

She said she was horrified by the reports of neglect.

"It's absolutely awful," she said. "At that time, we had suffered from years of neglect. We're paying the price for that now."

Screened by paramedics

Since Parkland took over, paramedics are now screening inmates for health problems at the book-in area, having replaced jail guards with no medical experience.

But the process remains deficient because no medical policies govern it, the Justice Department report said, and because "signs and symptoms of serious illness or contagious disease go unrecorded."

The Justice Department's report also said the jail failed to properly screen for tuberculosis, to contain outbreaks of it or to treat those who contracted it. In March, the backlog for X-rays of such patients reached 891 cases. The same was true for other communicable diseases such as staph infections.

Such inadequate practices pose a risk not only to other inmates and jail staff but also to the Dallas community, given the jail's high turnover, the report said.

The mentally ill fared no better in the Dallas County Jail, according to the report.

One inmate with a 20-year history of schizophrenia didn't receive his prescribed medication for five weeks. Jail staff without mental health training sometimes place inmates in single cells meant for suicidal inmates as punishment, the report said.

Suicide prevention was called "grossly inadequate" without proper training for staff or necessary reviews of suicides.

An inmate who hanged herself in 2003 had submitted a note two days before that said: "I need to see the doctor to get my medicine straightened out. ... I cannot afford to be treated this way! Please help me! I need my medication."



Among the more than 40 examples of inadequate care at the Dallas County Jail cited in a U.S. Department of Justice report released this week:

--An inmate suffering from alcohol withdrawal became disoriented and feverish within four days of being booked into the jail in 2004. He didn't see a doctor or nurse for several days and was later found lying in his feces. Even after finding him in that state, the jail staff took five hours to transport him to the hospital, where he died.

--An inmate with HIV who died in 2004 of pneumonia didn't receive an X-ray until two weeks after the jail staff had ordered one, and a doctor didn't look at the X-rays until about two weeks after that.

--An inmate died within 20 days of arriving at the jail in 2004 after he was unable to get care for his diabetic and heart conditions -- despite his efforts and those of his sister.

--An inmate went blind after a serious injury to his left eye in 2004 went untreated for seven days, even though jail staffers were aware of the injury.

--Jail staffers failed to detect a potentially fatal complication of alcohol withdrawal in an inmate who was brought to the jail in February. A Justice Department consultant who examined the inmate two days later found him to be psychotic with tremors, delusions and hallucinations. He was then hospitalized.


Copyright (c) 2006, The Dallas Morning News

Distributed by McClatchy-Tribune Business News.

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Source: The Dallas Morning News

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The Dallas Morning News

Anyone interested in reading the entire Department of Justice Report on the jail can get it from The Dallas Morning News website.

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Tuesday, December 12, 2006

Associated Press Report: Dallas Jail & DOJ

Justice Dept. report: Dallas jail conditions violate rights
By MATT CURRY-The Associated Press

DALLAS — The Dallas County Jail, one of the largest in the country, violates the constitutional rights of inmates by failing to provide adequate medical and mental health care, according to an eyebrow-raising federal report.

Page after page of violations are detailed in a letter from the U.S. Department of Justice, which also found that prisoners are not kept in safe or sanitary conditions at the detention complex, the seventh largest in the United States.

Among the more egregious examples were an HIV-positive prisoner who died in October 2005 from an infection after his antibiotic was withheld 11 days and a woman who hanged herself in January 2003. Her records included an inmate request form she filled out just two days earlier.

"I need to see the doctor to get my medicine straightened out. I am not getting my meds that my doctor faxed prior orders for me, and I brought in the medication myself and paid for it," it said. "I cannot afford to be treated this way! Please help me! I need my medicine."

There is no indication the woman, identified only as M.K., received the medicine.

The 47-page letter, dated Dec. 8 and signed by Assistant Attorney General Wan J. Kim, was addressed to County Judge Margaret Keliher, who was defeated in the November election and leaves office at the end of the month. She did not immediately return a phone message from The Associated Press.

Sheriff Lupe Valdez has not seen the report, said spokesman Raul Reyna, who referred questions to Keliher.

The letter indicates that federal authorities expect to resolve the problems by working with county officials. If they are unable to, they warn that a lawsuit could be filed.

In February 2005, a separate report found that lapses in medical care in the Dallas County jail system resulted in undetected illnesses, excess costs and risks to the public. That report was produced at Keliher's request by Health Management Associates, partly as a response to the near-death of James Mims. The mentally ill inmate's psychiatric medications were withheld for two months.

"If you listen to the local leaders, everything's fine. 'Problem? What problem?'" said Dallas attorney David Finn, who represents Mims in a federal lawsuit. "It's as if they are standing in front of a burning building, and people are jumping to their death from the fourth floor. You can smell the smoke, and you can see the flames, and they're telling the world that there's not a problem at the Dallas County Jail."

In November 2005, the Department of Justice's Civil Rights Division notified the county that it would investigate conditions at the jail.

Accompanied by consultants in correctional medical care, mental care and environmental health and safety, the office conducted its onsite inspections in February and March.

The report lists numerous examples of inadequate care and screening.

A prisoner identified as Q.S. was transferred to the hospital and died of alcohol withdrawal in December 2004. He had been admitted to the jail a week earlier with a history of alcohol withdrawal and seizures during the withdrawal, the report showed.

Within four of five days, he became disoriented, developed a fever and had an elevated blood pressure. The report says he was kept in the facility without physician or nursing care and no monitoring of his vital signs.

He was later discovered lying in his feces, but it took an additional five hours before he was taken to the hospital, where he died.

A juvenile identified as O.H. was taken to Parkland Memorial Hospital in June 2005 to receive sutures. He received no follow-up and was forced to remove them himself.

The investigation found several problems related to suicides.

"Due to a lack of training, correctional staff are ill-prepared to handle a suicide in progress, including how to cut down a hanging victim and employ other first aid measures," the report says. "Finally, contrary to generally accepted practice, there is no administrative review following a suicide or a suicide attempt to identify what could have been done to prevent the incident."

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A copy of the complete Department of Justice Report on the Dallas County Jail can be found on the Dallas Morning News

Judge David Finn

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Monday, December 11, 2006

DOJ Report: Preview

Well it's finally here. The United States Department of Justice has sent District Attorney Bill Hill and other elected officials a scathing rebuke over the way Dallas County has treated inmates.

In a letter dated December 8, 2006, Assistant United States Attorney General Wan Kim told Dallas that the jail is "grossly inadequate." Anyone with a brain who lives in Dallas knows this to be true. But the report goes on for 46 pages, detailing just how bad the conditions and treatment have been. Recall that on November 28, 2005 the Civil Rights Division of the United States Department of Justice notified Dallas County that DOJ would be investigating the conditions at the jail. You would have thought that would have gotten the attention of those Dallas officials. The DOJ investigators then parachuted into the jail on two separate occassions- first from February 20-24, 2006, and from March 20-23, 2006. What the federal investigators found was absolutely horrifying.

Among the findings of the report, several inmates died directly from the negligence of the staff, and the jail was absolutely filthy. Here's a quote directly from the report: "Having completed the fact-finding portion of our investigation in the Jail, we conclude that certain conditions at DCJ (Dallas County Jail) violate the constitutional rights of inmates confined there. As detailed below, we find that DCJ fails to provide inmates with: (1) adequate medical care; (2) adequate mental health care; and (3) safe and sanitary environmental conditions." Adding insult to injury, the Report points out that "in late 2004, the Dallas County Commissioners commissioned a study of medical and mental health care, the results of which became public in February 2005, and are consistent with the findings contained herein."
In other words, Dallas County, you can't say that you didn't know that you had a huge problem on your hands.

Now for the Report's conclusion. While it is couched in diplomatic language, the United States Department of Justice tells Dallas County that if it doesn't fix the problems immediately, the Department of Justice will file a lawsuit against Dallas County making them fix the problems. "We are obligated to advise you that, in the entirely unexpected event that we are unable to reach a resolution regarding our concerns, the Attorney General may initiate a lawsuit pursuant to the Civil Rights of Institutionalized Persons Act to correct deficiencies of the kind identified in this letter 49 days after appropriate officials have been notified of them."

Note to the County: The DOJ cannon trained on your position is loaded.

I hope to post the entire Report within the next few days. I suspect that you'll be reading more about this investigation very soon.


Judge David Finn

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