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

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