By KEVIN KRAUSE / The Dallas Morning News
kkrause@dallasnews.com

The five-person team visited the jails during the first week in April and documented nagging problems in two 40-page reports filed as part of a federal lawsuit against Dallas County to force improvements in jail health care, sanitation and fire safety.

County commissioners are expected to discuss the report today in a closed session.

Many of the deficiencies noted were first pointed out in a scathing 2006 U.S. Justice Department report that said jail conditions contributed to the death and injury of numerous inmates and placed others at risk of serious harm.

The low marks, while not posing immediate consequences for the county, signal possible trouble in gaining elusive state jail certification. Commissioners say they’re confident the jails will meet all state standards by September.

Among the biggest problems noted in the latest monitoring report filed last week in federal court was that inmates with health problems weren’t seeing doctors fast enough. The report also said that inmates, especially those with chronic diseases, weren’t receiving prompt follow-up care.

Lack of an adequate jail infirmary and mental health facilities was cited among the biggest underlying problems.

Some inmates’ serious medical conditions got worse because the problems weren’t discovered at the initial screening or because inmates weren’t seen fast enough after screening, the report said.

“Many remaining issues relate to the ability to track patients, schedule patients and ensure that medical documents are in the electronic record,” the report said.

In one example cited, an inmate arriving at one of the jails told the medical staff he had a broken finger. A clinician saw the inmate the following day, but he didn’t receive appropriate evaluation and follow-up. The inmate’s diagnosis – a fractured finger – came six weeks later and required surgery to repair a poorly healed bone, the report said.

Another inmate who arrived with a history of tuberculosis was sent to the infirmary for evaluation. But no other clinical notes were found regarding the evaluation.

Few inmates had an examination within 14 days of arrival, the report said.

Commissioner John Wiley Price said he’s pleased with what the county has been able to accomplish in only three years, given what he described as 19 years of neglect.

“It didn’t get this way overnight, and it’s not going to get repaired overnight,” he said. “When you’ve seen where we’ve come from, the report speaks to what we’ve done in a short time.”

Sheriff Lupe Valdez, whose department manages the jails, said in a written statement that since the inspectors’ visit, “we have made significant progress” and moved “beyond the issues that were outlined in the report.”

Allen Clemson, the Commissioners Court administrator, said the quality of care in the jails is “outstanding” and better than any jail in the state.

“There will continually be issues. You’ll never be able to get it to 100 percent,” he said.

County officials signed an agreed order last year with the federal government that spells out what the county must do to improve sanitation and medical and mental health services in its jail system.

As part of that agreement, the county has to pay for several recognized experts in correctional health care to provide periodic monitoring reports on the jails during the next two years.

Mr. Clemson said the county will continue to address the issues the team finds.

The jails have not passed a state inspection since 2003. But Dallas County commissioners have spent more than $110 million on jail improvements. Parkland Memorial Hospital is now providing medical and mental health care, and a new jail tower is under construction.

The inspectors reported that Parkland admissions – an average of 44 per month – could be reduced if the jails had an improved infirmary and better chronic disease management.

County officials have planned for new examination rooms and other medical spaces in the jails to be completed in stages. While some construction projects are under way, a new jail infirmary isn’t scheduled to open for another three years, the report said.

Mr. Clemson said the county still is in the design phase of a planned $47 million infirmary that will have between 300 and 400 beds.

Other problems cited in the monitoring report include:

•Seriously ill inmates returning from the hospital who weren’t seen by a doctor for several days.

•Many patients with chronic illness who are “lost to follow up.”

•Some patients who aren’t getting their medications renewed.

•Lack of a reliable system for logging, tracking and responding to sick calls.

•Multiple problems with the electronic medical record system.

•Lack of working fire safety systems in all five jails.

Another problem noted was inadequate privacy during medical screening. Inspectors said that may have been why only two of 10 HIV-positive inmates reported their condition during the screening.

Mentally ill inmates are inappropriately locked in their cells for 23 hours a day, because of staffing shortages and lack of space for “out-of-cell time,” according to the report.

In the mental health category, other problems reported were a difficulty in tracking patients, lack of privacy, inadequate staffing and a lack of adequate space to conduct mental health evaluations.

The report highlighted several areas of improvement, including jail maintenance response times, the cleanliness of laundry, and a training program to help jail guards recognize and respond to health emergencies.

In addition, there is now excellent leadership of health operations, the jails are on a “steady foundation of funding,” and clinical staffs are of high quality, the report said.

A new federal report says problems remain in Dallas County jails. Among them:

•Difficulty tracking patients’ medical needs.

•Lack of privacy during medical screening.

•Lack of follow-up for inmates returning from the hospital.

•Inadequate fire safety systems in all five jails, including broken or inadequate alarm systems in four jails.

•Slow response to inmate sick calls.

•Use of dirty mattresses that can no longer be cleaned and should be thrown out.

•Improper use of chemical cleaning agents by inmates.

•Lack of dedicated sanitation officers.

Jeffrey Ellard lies in a bed at Presbyterian Hospital recovering from surgery. Nearly two weeks ago, doctors implanted a metal rod in his left leg in place of his femur. In June 2006, a judge ordered a special hearing allowing Ellard to be released from the Dallas County jail so he could receive emergency care. While he was incarcerated, Ellard had to change his own bandages and wasn’t taken to see a doctor even as the cut in his leg became badly infected.

When Ellard appeared in court, he had a six-inch wound that blazed a path to his upper thigh before opening into a big, soggy hole stocked with pus and the pieces of toilet paper he used to stem the bleeding.

“It was extremely painful and at times it was excruciating,” Ellard says from his hospital bed. “I spent hours and hours just suffering. Eventually I fell asleep out of exhaustion.”

Today, David Finn, the attorney who intervened to arrange the emergency court appearance for Ellard after hearing from his distraught sister, says that his client is still fighting for his health. “He has cancer in the wound, and he may still lose his leg.”

Earlier this month the U.S. Justice Department filed a federal lawsuit against the county and Sheriff Lupe Valdez after one too many stories like Jeffrey Ellard’s. “Defendants have engaged in and continue to engage in a pattern or practice of failing to protect inmates at the Dallas County Jail from serious harm and undue risk from serious harm,” reads the complaint. The feds also point out that the problems at the jail have been “obvious and known to Defendants for a substantial period of time, yet Defendants have failed to address adequately the conditions described.”

Incredibly, the county and sheriff’s office tried to spin the lawsuit as a mere legal technicality. Allen Clemson, administrator for the county, says that the Department of Justice’s lawsuit formalizes local authorities’ own efforts to improve the jail, which have included hiring new guards, changing medical providers and building a new tower to ease overcrowding.

“The claim that was filed in federal court is a legal step that is needed to get the agreement that we had with DOJ before the judge so it could be signed,” Clemson explains.

Both Clemson and Valdez have also noted how the Justice Department praised them for their “unprecedented” level of cooperation, which is akin to a teacher praising a failing student for trying really hard. Regardless of the county’s post-lawsuit PR, when Justice Department officials first announced their investigation of the jail, they told the county that the prospect of a lawsuit was an “entirely unexpected event.” So, what happened?

Mark Haney, one of the attorneys who won a $950,000 settlement from the county last year in a federal lawsuit against the jail, says that the Justice Department’s litigation shows the federal government does not trust the locals to fix the problem. “What the feds are demanding is accountability,” he says. “The county has demonstrated historically that their word is not good, so the feds are saying the only way we’re going to walk away from this thing is if we have a court order that forces the county to do the right thing.”

Although Sheriff Valdez inherited a troubled office when she was elected in 2004, it’s not clear the jail is any safer or more sanitary now than when she took over. While much of the Justice Department’s investigation criticized the facility’s old health care provider, which does not directly fall under the sheriff’s responsibility, the feds remained sharply critical of how the place is run. The feds’ report describes the facility as a filthy place, which they illustrate vividly, including one depiction of how flies buzz above clogged shower drains in several of the facility’s bathrooms. Perhaps most important, the report concluded that guards were poorly trained, particularly in recognizing signs of mental illnesses.

In one particularly gut-wrenching case, the feds tell the story of “W.T.,” a schizophrenic inmate who suffered a seizure and fell off her bunk. Officers responded but told nurses she was merely “dizzy.” Based on that evaluation, the nurses chose not to check up on the inmate. Three hours later, the inmate was found dead in her cell.

“This death may have been prevented had the officers recognized that W.T.’s condition was critical and communicated this to the nursing staff,” the report read.

The sheriff’s office has implemented several policies recently to improve how it cares for mentally ill inmates. For one, the jail now gives mental and medical health assessments to men and women as soon as they’re processed. The office has also developed training programs for guards to help them spot mental health crises.

With Valdez, a Democrat, facing a spirited primary challenger, her office is quick to point out the steps they’ve taken to improve the long-beleaguered jail. In addition to the new mental health policies, the sheriff’s office has adopted dozens of detailed changes, ranging from how it sanitizes mattresses to the way it investigates inmate suicides.

Despite the department’s new measures, in March the Texas Commission on Jail Standards flunked the Dallas County jail for the fourth straight time, including every test under Valdez’s watch. The state’s main complaint was that the facility is understaffed. That’s not the fault of Valdez, and the Dallas County Commissioners Court has only recently begun to fix that by spending more than $10 million for new guard positions.

But the state found other problems that seem to reflect directly on the sheriff. Just like the feds, state inspectors have cited the jail for a litany of sanitation issues, from broken toilets and showers to dirty sheets and towels. The state also concluded that the jail’s staff is not adequately trained for emergency situations. Lest anyone think the inspectors are overly critical, only one other urban jail, Travis County, flunked the state inspection last year, and that was for a technical set of issues that the facility is now addressing. In contrast, the state flunked the Dallas County jail in 14 different areas.

These shortcomings have real-life consequences too. In April, an inmate named Lee Jefferson wound up in a coma after he didn’t receive medication for his sickle cell anemia, his lawyer told The Dallas Morning News. Another inmate, John Graves, told the paper he developed cancer after nobody at the jail would check out the growing lump on his cheek. Immediately, Sheriff Valdez announced an investigation into what happened to both inmates. Nearly six months later, Valdez’s office, in effect, concluded that nobody did anything wrong.

“It is our view that an adequate and complete inquiry was conducted and the outcome could not have been avoided due to the pre-existing conditions in which we received these two inmates at the jail,” says spokesman Michael Ortiz in an e-mail to the Dallas Observer. Ortiz says that the office’s investigation rested in part on Parkland hospital’s own review of the county’s conduct. Sharon Phillips, the hospital’s vice president in charge of jail health, examined the medical records of the two inmates. What exactly did she discover? Well, apparently nothing that she didn’t already know when the Morning News first brought the case to her attention. In his e-mail to the Observer, Ortiz referred us back to Phillips’ own comments to the paper when it reported about Jefferson and Graves.

“Mrs. Phillips was quoted, in the very same article, as saying the medical treatment the men received in jail was ‘within a good standard of care,’” Ortiz writes. “Mrs. Sharon Phillips went on to say, ‘Many of the individuals that are arrested and brought to the jail have not been taking very good care of THEMSELVES.’”

With explanations like that one, is it much of a surprise that the feds filed their lawsuit? Mark Haney says that even after the county agreed to settle his lawsuit, his office is still being flooded with complaints about the Dallas County jail. “The call we typically get is from a distraught mother or father calling about a loved one with a known medical condition that’s not being taken care of,” he says. “To be honest with you, often there’s not a lot I can do for them.”

David Finn

DALLAS – Conditions at the Dallas County jail are unsafe and the health care there inadequate, putting inmates at risk, federal prosecutors allege in a lawsuit against the county and its sheriff.

The U.S. Attorney’s office asked the federal court to require the county to correct deficiencies at the jail, which is among the largest detention complexes in the nation.

In the lawsuit filed Wednesday, the federal government contends that the county and its sheriff, Lupe Valdez, have known about the problems at the jail for some time and have failed to address them adequately.

By failing to fix the inadequacies, the inmates’ rights were violated, according to the lawsuit.

“Through the acts and omissions…Defendants have exhibited deliberate indifference to the health and safety of Dallas County Jail inmates,” the lawsuit said.

Federal officials contend the jail hasn’t provided adequate medical and mental health care to inmates and hasn’t ensured a safe and sanitary environment for detainees.

A federal report sent to Dallas officials in December said the jail violated the constitutional rights of inmates by failing to provide adequate medical and mental health care.

The Justice Department warned the county in December of a lawsuit if the problems weren’t fixed.

A separate report from February 2005 found that lapses in medical care in the Dallas County jail system resulted in undetected illnesses, excess costs and risks to the public.

The Texas Commission on Jail Standards warned the county earlier this year to fix jail staffing problems or face possible closure. Jail officials said then they want to get the population down to about 6,000. They’ve held as many as 7,770 inmates.

In February, county officials approved a nearly $1 million settlement with the families of three mentally ill inmates who were denied medication while at the jail.

A little more than half of the award went to James Mims, a jail inmate whose psychiatric medications were withheld for two months in 2004. Mims nearly died when water was shut off in his cell for two weeks, his attorney said.

The problems aren’t just in dealing with mentally ill inmates, but also extend to people who require medication, such as diabetics, David Finn said.
“We’re talking about basic health care. If people treated animals this way, they would be … prosecuted,” he said.
A message left Thursday for a sheriff’s spokesman was not immediately returned. Valdez, elected more than two years ago, is responsible for the county’s five jail facilities. The complex houses those awaiting trial and sentenced inmates.

A message left Thursday evening at the office of Dallas County Judge Jim Foster, the county’s top executive, wasn’t immediately returned.