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Inadequate Medical Care in Texas Jails Kills Hundreds of Prisoners

by Matt Clarke

According to information provided by the Texas attorney general’s office, 282 prisoners died due to medical causes in county jails run by the state’s 254 sheriff’s departments between January 2005 and September 2009. That represents an average of around 63 jail prisoner deaths related to illnesses each year – about the same number who die annually in Texas’ state prison system. The difference is that the prison system holds about twice as many prisoners as the state’s county jails.

Although some prisoners would die as a result of medical problems whether they were incarcerated or not, according to experts a lack of jail health care standards contributes to unnecessary and preventable deaths in Texas.

“People aren’t dying of old age in jails,” stated professor Michele Deitch of the University of Texas at Austin’s Lyndon B. Johnson School of Public Affairs, an expert on jail conditions. “Those numbers are more likely to be reflective of medical concerns.”

The Texas Commission on Jail Standards (TCJS) regulates and inspects conditions in the state’s county jails. However, TCJS regulations require only that jails have a plan to provide medical care to prisoners. There are no standards regarding the quality or speed of availability of medical care.

“Everybody has an ethical obligation to do the right thing,” said Adam Muñoz, TCJS’s director and former sheriff of Kleberg County. “How they do it is up to them.”

Trusting county jail officials to be ethical in their provision of health care to prisoners isn’t good enough, said Deitch. It’s not just that cash-strapped counties will choose the cheapest types of medication and treatment. Without enforceable standards, they can gamble that a prisoner will be released or sent to prison and become somebody else’s problem before a lack of medical treatment causes injury or death. They’ll often win that bet, since most jail prisoners are held only briefly.

But sometimes they guess wrong and a prisoner will lose his or her life as a result. Such was the case with Robert Foster, 57, who died in a Gregg County Jail cell in August 2009. Foster was obese and had diabetes and a heart condition; he had been locked up around 10 weeks on charges of deadly conduct. According to Gregg County Sheriff Maxey Cerliano, Foster was typical of many prisoners who suffer from illnesses they had neglected for years due to drug addiction, mental illness or poverty.

“While those [prisoners] are treated in jail,” said Cerliano, “sometimes they’re just unable to sustain life.”

But sometimes they’re like Amy Lynn Cowling, 33, who died at the Gregg County Jail on December 29, 2010 following her arrest on warrants for traffic violations and theft charges. Cowling was bipolar, on methadone, had heart problems and one kidney, and was taking a number of medications. Although Cowling and her family told jail staff that she needed the prescription medications in her purse, which had been placed in the jail’s storage room, during the five days she was incarcerated she instead received different, substitute meds. Five jail employees were fired in connection with Cowling’s death: Brian West, Tomeka Cross, Kashena Davis, “Jacueline” Smiddy and Gary Lewis. West and Cross were charged with falsifying jail records.

Nine prisoners have died at the Gregg County Jail since 2005, and eight of those deaths were due to medical-related causes.

Sheriff Cerliano’s comment is typical of responses by jail officials, who say they are doing all they can to care for people with pre-existing medical problems while facing budget cuts and rising health care costs. Located in rural East Texas, Gregg County has an annual public safety budget of $15 million. It spends $1 million of that amount to provide health care services at its 916-bed jail, which has an average daily prisoner population of 790. The jail employs eight medical staff members and pays for medication and health care supplies. A doctor visits once a week.

Five prisoners have died at the Nueces County Jail since September 2009, and the jail has failed around 40% of its TCJS inspections since 2005. From September 2009 to April 2010, the TCJS issued six noncompliance notices for deficiencies at the Nueces County Jail, including failing to notify the TCJS of a prisoner’s death within 24 hours, and jail staff failing to complete mental health and suicide screening forms.

One seriously ill prisoner can bust the budget of a small county, noted Tim Brown, a senior analyst with the Texas Association of Counties. For example, in rural Ector County, a single prisoner with terminal cancer has accounted for over $140,000 in treatment costs.

“Not just well people get arrested,” observed Ector County Sheriff Mark Donaldson.
“Some people are in bad shape ... it’s our responsibility to take care of them.”

Brown agreed, saying that prisoner health care expenditures are “not costs the county can avoid in any way.”

But those costs are skyrocketing – a reflection of the rising cost of health care in general. In Texas counties with populations of one million or more, average jail health care costs tripled from around $5 million in 2005 to $15 million in 2009. Counties are thus trying hard to reduce such expenses.

Saving health care dollars is fine unless the method used involves the denial of necessary medical treatment. So the question becomes, what can be done to compel counties to provide constitutionally adequate prisoner health care despite the growing costs?
“Jails have never felt that compunction unless they’re sued,” said Deitch.

That’s what happened in Dallas County after Rosie Sims, a mentally ill jail prisoner, died due to untreated pneumonia in 2005. She had been incarcerated for 18 months and had never received “even a routine physical examination.” According to Scott Medlock, director of the prisoners’ rights program at the Texas Civil Rights Project, there was only one nurse on duty to care for 3,000 prisoners on the night that Sims died. Dallas County’s jails were so out of compliance that the U.S. Department of Justice threatened to take them over after serious health and safety violations were discovered in 2005. [See: PLN, Feb. 2009, p.28; Nov. 2007, p.14].

Dallas County agreed in July 2009 to pay $250,000 to settle a wrongful death suit filed by Sims’ family. At the same time, the county settled a lawsuit involving former jail prisoner Bruce A. McDonald, who claimed he did not receive medical care for a serious eye injury, resulting in partial blindness. McDonald accepted a $190,000 settlement. Previously, in April 2009, a federal jury awarded $355,000 to former Dallas County jail prisoner Robert Duvall, who was not treated for a severe MRSA infection that resulted in a high fever, nausea, uncontrolled vomiting, extreme swelling of his feet and legs, and blindness. [See: PLN, July 2010, p.16].

Yet Dallas County is considered a success story. After Lupe Valdez, a former jailer, was elected sheriff in 2004, the nation’s sixth-largest jail system improved significantly. It now partners with Dallas County’s Parkland Hospital to provide health care for prisoners. The jail has a staffed infirmary with dialysis equipment and on-site medical attention available 24/7. To achieve this, the county spent over $138 million on jail health care improvements.

The expenditure paid off when, for the first time in seven years, Dallas County’s jail passed its state inspection. Problems still persist, though, such as the August 2, 2009 death of jail prisoner Craig Morris, who died due to a severe case of pneumonia. He was homeless at the time of his arrest on a misdemeanor charge. Morris’ family filed a wrongful death suit against the county in February 2011.

The improvement in health care at the Dallas County Jail is the exception that proves the rule, according to Diana Claitor, director of the Texas Jail Project. Inadequate medical care is the most common complaint she hears from prisoners and concerned family members.

“A whole lot of these people would not have died in the outside world,” said Claitor, adding that the public perception is that prisoners arrive at the jails with health conditions they created through their own bad behavior. “There is an attitude that they don’t deserve good health care.”

While both Claitor and Scott Medlock believe that statewide jail health care standards would be beneficial, they question whether TCJS could enforce them. The only sanction available to TCJS is to shut down a jail – a radical measure that almost never happens.
Claitor suggested an independent ombudsman that jail prisoners and their families could ask to intervene, but did not indicate how the ombudsman could enforce his or her decisions.

Medlock recommended a complete rethink of how county jails are run, with a greater emphasis on releasing nonviolent prisoners awaiting trial, treating mentally ill prisoners, investing in preventative health care and voluntarily implementing national health care standards. This would reduce jail medical costs by treating illnesses before they become serious due to neglect, thus avoiding expensive emergency care and subsequent litigation.
“These people have broken the law,” said Medlock. “But they certainly haven’t earned the death penalty, which is what some of them are getting” in Texas jails. The Texas Civil Rights Project has called the lack of adequate medical care in county jails a “secret death penalty.”

While requiring county jails to adhere to minimum standards for prisoner health care would be a good start, without an agency to monitor those standards and enforce compliance it is unlikely anything will change. Nor is the TCJS up to that task, as the Commission faces a 30% budget cut in the state’s proposed biennial budget. Thus, the TCJS may be limited to merely sending its standard form-letter response to prisoners who complain about inadequate medical care, which states, “The Texas Commission on Jail Standards does not question the professional opinion of medical personnel.”

Sources: Texas Tribune,,,

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