by Casey J. Bastian
On November 2, 2022, California’s Monterey County agreed to pay $775,000 to settle a lawsuit brought by the estate of Rafael Ramirez Lara, a mentally ill detainee allegedly ignored in the county jail while he compulsively drank water until he died.
An undisclosed portion of the payout was covered by Wellpath, the privately contracted healthcare provider at the Monterey County Jail (MCJ). Wellpath is one of the nation’s largest private providers of healthcare behind bars, with contracts in 394 county jails and community facilities and more than 140 state and federal prisons in 36 states. The firm has held the contract to provide healthcare at MCJ since it was given to a corporate ancestor, California Forensic Medical Group (CFMG), in 1984.
MCJ and CFMG settled an earlier class-action suit in 2015 with an agreement to address issues of poor medical and mental healthcare, inadequate staffing, accommodations for disabled prisoners and serious safety problems. [See: PLN, Apr. 2016, p.18.]
That agreement also included a $4.8 million payment by Defendants for class attorney fees. But that couldn’t keep the parties from returning to the federal court for the Northern District of California, which ordered Defendants to pay another $150,000 for failing to live up to the agreement and appointed special monitors to enforce it in July 2019. [See: PLN, Oct. 2019, p.39.]
Under an “Implementation Plan” filed with the Court in that suit, MCJ was supposed to adopt new policies that included language interpreters, mental health screening during intake, continuation of medications begun prior to incarceration and monitoring of health conditions, among other improvements. The events surrounding Lara’s death suggest that those changes were not effectively implemented.
After the first of three arrests in April 2018, just 20 months passed before Lara, 57, died on December 22, 2019. He spent nearly eight of those months in MCJ. Jail records note that Lara “engaged in multiple self-harming activities” at MCJ in June 2018: banging his head against a wall and breaking his hand punching a window. After these incidents, Lara was taken to Natividad Medical Center (NMC), where staff noted “bizarre behavior” and a “history of schizophrenia.” Lara was given a prescription for the anti-psychotic medication Haldol by NMC staff. But the prescription was never renewed by Wellpath or MCJ staff. Records also indicate Lara was never evaluated again while confined at the MCJ.
During the next serval months, Lara’s mental health continued to decline, according to the complaint later filed on his behalf. He became convinced that neither he nor his family was safe even in their family home. Family members were attempting to have him held for a 72-hour psychiatric evaluation under Cal. Welf. & Inst. Code § 5150, when Lara was arrested again on September 1, 2019.
The jail had previously recorded that Lara required a Spanish translator, but one was not provided, the complaint noted. The jail also knew he suffered from schizophrenia, but he was not referred to mental health services. He even admitted using alcohol the day of his arrest, but he wasn’t directed to withdrawal services, either.
On September 3, 2019, Lara’s family called MCJ, advising staffers that they “should not wait for Mr. Lara to seek help.” In response, jail staff stated that Lara “can seek help if he wants to.” Meanwhile, a Wellpath therapist documented seeing Lara “cell front” two times during September, but there was no evaluation nor any direct contact with Lara. He was left “without any further mental health contact, intervention, or medication for the next thirty days,” the complaint also recalled.
On October 23, 2019, Lara got into a fight with his cellmate, accusing him of raping Lara while he slept. Lara was taken to NMC with “blood all over his face and clothing.” But he was discharged the next day. MCJ provided Lara with no medical or mental health support, and no Prison Rape Elimination Act investigation was opened.
On the day Lara died, the sound of his toilet flushing “over and over could be heard from the dayroom of the unit,” the complaint noted. Lara could be heard coughing and vomiting as well. Witnesses stated that water was running under the cell door. MCJ staff noted the water, but no one made a welfare check on Lara. At approximately 12:12 p.m., he was discovered “face-down and unresponsive on the floor of his cell in a pool of fluid and blood.” Lara was taken to the NMC and pronounced dead.
As it turned out, Lara had died of hyponatremia – low sodium – due to “acute water intoxication.” Sheriff and coroner Steve Bernal blamed the death on Psychogenic Polydipsia – compulsive water drinking – arising from Lara’s schizophrenia, noting in the autopsy report that this is “most often associated with mental health disorders, and may result in water intoxication.” When enough water flushes too much sodium from the body, the patient lapses into hyponatremia, suffering “nausea and vomiting, confusion, severe changes in mental state, psychotic symptoms and can lead to seizures, coma, and death.”
Lara’s untreated schizophrenia caused him to compulsively drink water until his sodium levels fell fatally low, and he drowned in his own vomit – a disturbing and preventable death in the custody and care of MCJ and Wellpath staff. The settlement included a check for $310,000 made payable directly to Oakland’s Rifkin Law Office, which represented the estate in its suit. See: Est. of Ramirez Lara v. Cty. of Monterey, USDC (N.D. Cal.), Case No. 4:21-cv-02409.
Additional source: Voices of Monterey
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