7/25/2005 Day: Monday P
THE DALLAS MORNING NEWS
County jail escapes feds’ eye
Dallas: Officials say probe isn’t needed, but critics welcome it
JAMES M. O’NEILL
METRO Zone: DALLAS Edition: SECOND Column Name: Series: Page Number: 1B Word Co
Just as in Dallas, county jails in Los Angeles, Santa Fe, N.M., Memphis, Tenn., Baltimore, Long Island, N.Y., and elsewhere have been cited for egregious problems in the delivery of health care to inmates, particularly the mentally ill.
The big difference among these jails: Dallas is the only one, so far, not to have the federal government swoop in and order widespread improvements under threat of a federal lawsuit.
County officials say it would be inappropriate for the U.S. Department of Justice Civil Rights Division to launch an investigation in Dallas now, since the commissioners have recognized the jail’s ills and are moving to fix them.
But many improvements the Justice Department forced on other counties are not in place at the Dallas County Jail. And mental-health advocates say Dallas would be ripe for a federal investigation.
“There’s just as much basis for their involvement here as in those other cities,” said Laurance Priddy of Advocacy Inc., an advocacy group for mentally ill inmates.
“We’d welcome any outside intervention since the county still isn’t doing anything, and we still have people not getting their medications,” Mr. Priddy said.
County Judge Margaret Keliher said she is not worried about the possibility of a federal investigation.
“We’ve recognized we have a problem, and we’re way down the road towards making major changes,” she said. “I think it would be inappropriate for them to come in now.”
Other commissioners have had costly outside intervention on their minds. Commissioner Maurine Dickey has urged swift action to improve jail health, after a scathing February report noted severe staff shortages and conditions that were life threatening to some inmates.
“We’re going to have to put money into it,” she said in March. “Let’s … not wait until we’re forced to by some outside party.”
Commissioner John Wiley Price said federal intervention has never been discussed by the commissioners.
“I just hope we don’t need DOJ to come in for us to become compliant,” he said. “Personally I don’t believe we’ve delivered on the standards for health care in the jail.”
Mr. Price said the commissioners are now moving to fix things, but it will take time, money and a struggle against a tight market for nurses.
“We’re trying to play catch-up,” he said. “We didn’t get into this quagmire overnight, and we won’t get out of it overnight. It’s going to take dollars.”
Commissioners set up a committee to fix jail health and are still waiting for final suggestions from a team of experts. Now that the University of Texas Medical Branch has decided not to renew its contract to oversee jail care, Parkland Memorial Hospital officials are gearing up to take over in November. But they are pressuring the commissioners for a tax increase to help raise spending on jail care by at least $6 million.
Over the past decade, the Justice Department has been aggressive in investigating county jails.
At the Nassau County jail on suburban Long Island, N.Y., “people were not getting their meds or even properly diagnosed with mental illness at book-in, and people who were suicidal were not getting flagged,” said Steven Greenfield, executive director of the Mental Health Association of Nassau County. “And if people were on their meds before they entered the jail, the meds were terminated at book-in and the mentally ill inmates decompensated.”
After investigating, the Department of Justice mandated a number of changes.
“There’s no question that outside oversight exerted pressure for change,” Mr. Greenfield said. “County government never want to raise taxes, so a stick from the outside definitely played a role.”
The Department of Justice also pressured Los Angeles County to make jail improvements.
“It moved the improvements along more quickly,” said Richard Van Horn, president of the Mental Health Association of Greater Los Angeles. “If you get the DOJ to come in, it will definitely improve your mental health care in the jail.”
Many changes ordered by the federal government in an agreement signed with Los Angeles County in 2002 are similar to the changes many advocates are calling on Dallas County to make:
*Inmates must be asked questions at book-in to learn whether they have mental illness history or suicidal feelings. Questioning is to take place “by an appropriately trained individual,” and in “a reasonably quiet and private area.”
In Dallas, medical screening is handled by jail guards who have no medical training. Experts say they can easily miss symptoms of illness as a result. And screening takes place in a large open room with dozens of people. Experts say that reduces the chance someone will admit they have a mental illness.
*The county must ensure “continuity of appropriate medicine” to “mentally ill who were receiving medicine prior to entering the jail.”
In Dallas, family members often can’t get medications to their jailed relatives, and state hospital officials have said they send medications with patients going back to the jail that are not used.
*The county must ensure “adequate therapy and counseling” for mentally ill, “adequate space for treatment,” and “adequate staff to provide treatment.”
In Dallas, there are too few staff members to distribute medications, and the mentally ill often go without their medication for weeks at a time.
Lack of funding
Many mental-health advocates argue that the larger problem is inadequate funding for programs that would help mentally ill people function successfully in the community. But because those programs are under stress, many mentally ill people stop taking their medications, causing their condition to erode. They end up committing minor crimes that land them in jails, which were never designed to provide such care.
“It’s a national crisis that people with mental illness are winding up in jails in many cases for quality-of-life offenses,” Mr. Greenfield said. “What could be worse for the recovery of someone with a mental disorder than to be placed in an isolated cell?”
The Los Angeles jail is still the single largest mental hospital in the nation, Mr. Van Horn said. “Like Texas, we’ve been underfunded for mental health programs for years,” he said.
California voters just passed an initiative to charge a 1 percent income tax on those with incomes exceeding $1 million to raise more money for mental health care. That could generate an additional $750 million for such programs, Mr. Van Horn said. Some of the money will fund urgent care centers.
“This will make a huge difference, because police will have a place to drop mentally ill people off besides the hospital emergency room” or the jail, he said.
“We need to be improving care for people on the outside,” he added, “before they even get to jail.”