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DOJ Letter to Judge re Investigation of the Harris County Jail, Civil Rights Div, 2009

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U.S. Department of Justice
Civil Rights Division

Assistant Attorney General
950 Pennsylvania Avenue, NW - RFK
Washington, DC 20530

June 4, 2009
The Honorable Ed Emmett
County Judge
1001 Preston
Suite 911
Houston, TX 77002

Investigation of the Harris County Jail

Dear Judge Emmett:
On March 7, 2008, we notified your office of our intention
to investigate conditions at the Harris County Jail (Jail)
pursuant to the Civil Rights of Institutionalized Persons Act
("CRIPA n ), 42 U.S.C. § 1997. Consistent with statutory
requirements, we write to report the findings of our
investigation and to recommend remedial measures needed to ensure
that conditions at the Jail meet federal constitutional
requirements. See 42 U.S.C. § 1997b.
During our investigation, correctional experts in the fields
of penology, medicine, psychiatry, and life safety, assisted us
in reviewing records, interviewing staff, interviewing detainees,
and inspecting facility living conditions. Before, during, and
after our on-site inspections, we received and reviewed a large
number of documents, including policies and procedures, incident
reports, medical and mental health records, and other materials.
Consistent with our commitment to provide technical assistance
and conduct a transparent investigation, we provided debriefings
at the conclusion of two on-site inspections conducted in July
and August 2008. During the debriefings, our consultants
provided their initial impressions and tentative concerns.
Throughout this process, County and Jail officials
cooperated fully with our review. We appreciate the assistance
that they provided us and the candor of their response. Indeed,
we were impressed by the level of professionalism exhibited by
staff at all levels and with the sophistication of many Jail
systems. While we use individual incidents throughout this
letter to illustrate systemic deficiencies, we are aware that
this facility has a very difficult task handling large numbers of

- 2 detainees, many of whom have serious medical and mental health
problems. The examples we cite should not necessarily be
construed as a criticism of particular staff.
In many cases,
such incidents may be more reflective of inherent systemic
problems with Jail procedures or resources than the
professionalism or dedication of staff and admi nistrators.
We are pleased to adv ise you that Harris County Jail
complies with constitutional requirements in a number of
significant respects. The Jail's operational infrastructure
includes the existence of written pol icies and procedures,
clearly designated security and medical supervisors, training
programs, a booking and intake assessment process, infection
control programs, and fire safety precautions. At the same time,
however, we also conclude that certain conditions at the Jail
violate the constitutional rights of detainees. Indeed, the
number of inmates deaths related to inadequate medical care ,
described below, is alarming. As detailed below, we find that
the Jail fails to provide detainees with adequate:
(1) medical
care; (2) mental health care; (3) protection from serious
physical harm; and (4) protection from life safety hazards.


Harris County Jail incl udes four major jail facilities
constructed between the 1980s and the 1990s. At the time of our
site visit, the Jail housed over 9400 detainees . 1 The Jail's
design capacity is reportedly 9800 detainees. The Harris County
Sheriff's Department also places detainees at various sa tellit e
If those detainees are also counted, the Sheriff's
Department is responsible for a total of nearly 11,000 detainees.
In 2007 , the Jail processed over 130,000 admissions .
II .


CRIPA authorizes the Attorney General to investigate and
take appropriate action to enforce the constitutional rights of
jail detai nees and detainees subject to a pattern or practice of
unconstitutional condu ct or conditions . 42 U.S.C. § 1997. The
rights of pre-trial detainees are p rotected under the Fourteenth
Amendment which ensures that these deta i nees ~retain at least
those constitutional rights .
. enjoyed by convicted
prisoners." Bell v. Wolfish, 441 U.S. 520, 545 (1 979 ). Under


The Jail houses mainly pre-trial detainees , but also
houses some post-adjudication inmates . For the purpose of this
letter , both groups wi ll be referred to as detainees .

- 3 -

t he Eighth Amendment , prison officials have an affirmative du ty
to ensure that detainees receive adequate food, clothing ,
shelter , and medical care . Farmer v. Brennan , 511 U.S. 8 2 5 , 832
(1994) . The Eighth Amendment protects prison ers n ot only from
pre sent and continuing harm , but also from futu r e harm .
He lling v . McKinney , 509 U.S. 25, 33 (1993).
Detainees have a consti tutional right to adequate medica l
and mental heal t h care, including psychological and psychiatric
services. Farmer , 511 U. S . at 832. Detainees' constitutional
rights are violated when pr i son officials exh ibit deliberate
indifference to their serious medical needs . See
Estelle v. Gamble , 429 U.S. 97, 102 (1976). Detainee living
conditions must be "reasonab ly sanitary and safe. " Far mer 511
U. S . at 832 .


As a large urban detention facility , Harris County Jail
faces a number of significant problems inc l uding a h i gh detain ee
census and comp lex funding and logistical challenges . In man y
ways, the Jail actually pe rforms quite well . Jail policies a n d
procedures provide for a comprehensive detainee housing
assignment process , medica l sick call procedures , and regular
fa c ility maintenance . Staff r eceive broad tra in ing on Jail
ope r ations , supervision of detainees , and detai n e e rights.
Unfortunately, in a number o f critical a r eas , the Jail lacks
necessary systems to ensure compl iance with constitutional

Medical Care

The Jail has functional systems in place to provide medical
car e and treatment to a large population of deta inees. These
systems include an initial screening process , a more
comp rehensive he a lth assessme nt for longer- term detai n ees , a s i ck
cal l process, a modern cli nic , qualified medical staff , a
professional management structure, and mechanisms to obtai n
outside specialty care. Despite the general qual i ty of such
systems , the Jail fails to provide consistent and adequate c are
fo r detainees wi t h serious c hronic medical conditions. We fou nd
specific deficiencies in the Jail ' s provision of chronic care a n d
follow- up tre atme n t. Thes e deficiencies , in themselves and wh e n
combined with the problems in medical record-keep i ng and quality
assurance discussed below, a r e serious enough to place detai n ees
a t an unacceptable risk of death or injury .

- 4 1.

Inadequate Chronic Care

Detainees who suffer from chronic medical conditions require
assessment and ongoing treatment to prevent the progression of
their illnesses . As part o f t he treatment process, detainees
with chronic medical conditions require routine follow up to
mon itor the p r og r ess i on of the i r illness and the potentially
hazardous effects of medication. Because of crowding,
administrative weaknesses, and resource limits , the Jail does not
provide constitutionally adequate care to meet the serious
medical needs of detainees with chronic illness.
Generally accepted standards of correctional medical care
require that medical staff identify de t ainees with chronic
condi tions such as - diabe t es, tuberculosis , and heart disease and provide time ly treatment for such conditions . Unfortunate l y,
the Jail does not have an assessment process to adequately
iden t ify detainees with serious chronic medical conditions . In
particular, we found that the Jail has delegated screening to
nur ses who are in need of additional training and more
admi nistrative ove rsight by physicians. For instance , we fou nd
assessment forms completed by nursing staff who had not actually
completed the assessments. We also found that physicians do not
routinely see detainees with chronic conditions to assess the
sta t us of their health. Mor eover , Jail staff do not conduct
periodic surveys of the housing units to identify detainees who
may have chronic medical conditions, but who may not necessarily
be identified by the normal sick call process or the screening
procedures conducted during detainee booking.
Such deficiencies
result in gaps in the syste m for identifying detainee s with
serious chronic medical conditions. For instance, staff may miss
some detainees who are degenerating mentally or physically, but
who are unable or unwilling to utilize the normal sick call
process .
Problems wi th chronic care assessments are particularly
pronounced in the assessment of detainees receiving medications .
Generally accepted correctional medical standards require that
once medical staff identify a medical condition, they need to
order appropriate medications and then periodically re - assess
those medications to determine their effectiveness and to monitor
side effects . Th e Jail medical staff are not adequa t ely

- 5 -

conducting such periodic assessments .

Examples from 2007 - 2008


Detainee AA had a history of hypothyroidism and
seizures . 2 Medical staff administered two medications ,
each of which could have had potentiall y toxic side
effects . After the initial medication order , dosages
and blood levels of these medications were not
monitored .


Detainee BB suffered from a deep venous thrombosis
(blood clot) i n his lower extremity. Medical sta ff
administered an unsafe dosage of blood thinning
medication , placing the detainee at an i ncreased risk
of clot formation.
Such clots can cause serious
medical complications including sudden death . Staff
conducted lab tests which showed that the dosage might
be unsafe, but then failed to follow up on the test


Detainee CC had a history of heart failure . Medical
staff administered two medications with potentially
toxic side effects. Our record rev i ew suggests that
medical staff did not check CC's b l ood levels for
several months.


Inadequate Continuity of Medical Care

Chronic and some acute medical conditions require
approp r iate ongoing treatment and continuity of care. Fail u re to
address detainee medical conditions over time can lead to an
increased risk in morbidity and mortality. Systems and
practices , such as adequate record- keeping and follow - up exams by
qualified staff , must be in place to manage the serious medica l
condit ions of detainees during the length of their incarceration.
The Jail does not have a system in place to provide such
continuity of care for some of the detainees with the most
serious medical conditi ons .
The Jail's medical clinic serves as a makeshift emergency
room, stabilizing detainees with acute conditions . This model,
however, is problematic in a large urban detention facility with


To protect the identity of detainees, the in i tials u sed
in this lett er are not the actual detainees' initials.

- 6 hundreds of sick detainees. Many of the detainees with serious
medical conditions cannot be adequately identified or treated
solely through an acute care process.
In the absence of a chronic care program or other systems
for ensuring follow-up care, the sick call process serves as the
primary mechanism for the Jail to provide continuity of care.
This system is not capable of providing such continuity of care.
The sick call process itself is seriously strained due to
crowding, staffing limits, a n d some problematic practices.
instance, we received a number of complaints about delays in care
at the Jail's 1200 Baker facility.
Because of the way care is
organized at the Jail, the 1200 Baker hou sing units seem to be
particularly affected by any bottlenecks in access to the main
intake clinic, despite the fact that the clinic is also located
at 1200 Baker. Because the main clinic also serves as the main
intake facility and e mergency treatment center, the 1200 Baker
detainees must effectively share the same clinic resources as
newly admitted detainees, emergency cases, and detainee transfers
from other units who require additional medical supervision.
This puts a heavy strain on 1200 Baker medica l staff and impedes
detainee access to care.
More generally, the Jail's administrative procedures allow
delays in care to be easily overlooked. Jail procedures require
that detainees complete forms to request medical care. The Jail
disposes of these forms , however , just after they are processed.
Once the forms are destroyed, the Jail apparently cannot track
detainee requests for medical care in order to determi ne whether
they have been fulfilled. Another peculiar Jail practice
involves the process for responding to requests for specialty
care. As a matter of routine practice, Jail detainees submit
requests for specialty care to a clerk. This process has
apparently little or no physician oversight, which means that
access to specialty care is not initially reviewed by qualified
personnel. This lack of oversight means that individuals who may
need more intensive or immediate care receive the same level o f
attention as those with relatively low priority needs.
These problems would be troublesome enough for a clinic
dealing only with detainees who have acute medical complaints.
For detainees with chronic conditions, barriers to care can cause
them more difficulties than experienced by those inmates with
more typical medical complaints. Detainees with chronic illness
may need care to be much more timely and routine than some
detainees with acute conditions. At present, however , the
detainees have a difficult time first accessing the clinic, and
then receiving continuity of care. Detainees with mental illness

- 7 are an especially high risk group. Other detainees with chronic
conditions may at least have the capacity to seek care.
Detainees with mental illness, especially those who are acutely
psychotic or suicidal, may not even try to use the sick call
process to obtain continuing treatment of their conditions . Such
detainees may need regular follow-up visits and more consistent
access to medical staff.
Examples of the Jail's failure to provide appropriate
follow - up treatment and continuity of care inclu de the followi ng
examples from 2007-2008:

DD was a 74 - year - old detainee with a history of open
heart surgery. When DD visited the clinic presenting
complaints of incontinence, medical staff failed to
give DD a physical exam or take his vital s i gns.
sent DD back toDD's unit. The following day, DD
returned to the clinic with incontinence and elevated
blood pressure. Clinic staff sent DD to the hospital,
where he died shortly thereafter.


EE had a documented history of diabetes that received
inadequate medical attention. When EE complained of
symptoms, staff merely prescribed pain medication.
Initially , EE complained of leg pain and knee swellin g.
In response, staff provided EE with pain medica t ion.
EE complained a gain 5 days later about her symptoms.
The medical notes were essentially illegible, but
apparently staff again just provided pain medication .
The detainee complained of her symptoms once more that
same day. While waiting to be seen in the clinic , EE
collapsed and died shortly afterwards. The
documentation suggests that after EE collapsed, staff
failed to provide an appropria t e emergency response.
For instance, the records show that EE had a low blood
sugar level at the time of her collapse , but staff
failed to respond to the symptoms . Medi cal records
also suggest that the staff did not try to use an
automa t ic emergency defibrillator during the incident.


FF had a history of cirrhosis. Over several weeks, FF's
liver condition worsened, but staff repeatedly failed
to respond in a manner consistent with generally
accepted correctional medical standards . FF initially
presented to the clinic with a complaint of swelling to
his legs.
Jail staff prescribed blood p ressure
medication, even though FF ' s blood pressure was normal.
FF complained of chest pain and other conditions over

- 8 the next several weeks. Jail staff repeatedly sent FF
to the hospital but repeatedly failed to change his
medications, treatment plan, or conduct other
appropriate follow - up. For instance, on one of these
occasions, a deputy reported that FF was having trouble
walking. The staff sent FF to the hospital, and an
undated medical note indicates that FF needed fluid
removed from his stomach. Again, however, staff did
not alter FF's treatment plan; nor was there any
apparent documentation of vital signs. Approximately
one month after his initial complaint, FF died during
his last hospital stay. One troubling additional note
about this case is that during the period in question,
FF apparently spent much of his time at the Jail in a
housing unit instead of the infirmary. Given the
seriousness of FF's medical condition, he needed to be
in an infirmary in order to receive the level of care
required by generally accepted correctional medical
standards. The discontinuity of care and a lack of
follow-up by staff are of serious concern in this case.

Inadequate Medical Documentation and Quality Assurance

Medical record-keeping and quality assurance are basic
components of a clinical practice that is consistent with
generally accepted correctional medical standards. These systems
help identify and correct potential problems with patient care.
Harris County has deficiencies in both areas, and these
deficiencies contribute to prob l ems with chronic care and
continuity of care .
A complete and adequate medical records system is critical
to ensuring that medical staff are able to provide adequate care.
The Jail's process for maintaining medical records and processing
medical orders often leaves medical records unavailable to nurses
and doctors. Medical staff have little or no access to the
records when the pharmacy staff are filling out medication
orders, because the pharmacy staff have custody of the records
when completing those orders. During our fact-gathering, we also
found various record-keeping problems such as a lack of
compliance with professional record-keeping formats, illegible
physician notes, and factually inaccurate documentation. These
deficiencies affect the quality of care and the medical staff's
ability to meet Constitutional requirements.
As a matter of technical assistance, we should note that
correctional facilities often benefit from having an adequate
quality assurance process. Such a process can help


9 -

administrators self-identify and correct any deficiencies. A
large facility may have particular difficulty addressing systemic
constitutional deficiencies without such a process. The Jail
does engage in some effective quality improvement activities in
order to track and trend medical-related incidents at the
The activities do not, however, include adequate
mechanisms to review and evaluate Jail physicians; nor does the
process include mechanisms that could help ensure more consistent
and adequate record- keeping. The mortality review process does
not include feedback to appropriate physician staff.

Mental Health Care

Many of the Jail detainees require mental health care.
Approximately 2000 Jail detainees reportedly receive psychotropic
medications each day. Of the detainees receiving psychotropic
medications, approximately 200 are considered by the Jail to be
part of the mental health program. These detainees often cannot
be housed in general population because of their mental health
condition. The Jail needs a range of housing options to handle
such detainees, because detainees with mental illness have very
different needs depending on their circumstances.
Instead, the
Jail only has a limited number of on- site housing options for
detainees with mental illness. These basically consist of some
single cells and specialized dormitories.
Housing practices for detainees with mental illness are
problematic. For example, even though the ratio of male to
female mental health patients is about 2:1, the number of male
single cells to female single cells appears to be 32:1. Thus,
female detainees with mental illness are much more likely to be
left in inappropriate housing conditions while awaiting care. As
with medical care generally, the clinic in the 1200 Baker
building serves as the primary mental health resource. As noted
previously, the 1200 Baker clinic is overwhelmed. The Jail also
has access to some other treatment facilities, such as the Harris
County Psychiatric Center (Center), but these facilities have
limited resources. For example, the Center can house only 24
Jail detainees.
Many of the problems noted previously regarding chronic care
and medical care generally also apply to detainees with mental
illness. For example, the Jail's process for assessing and
treating detainees is focused on acute symptoms and does not
adequately identify detainees with serious mental health needs.
The mental health clinic functions like a hectic emergency room,

- 10 and de t ainees with serious mental health conditions of t en cannot
obtain timely and appropriate care. These deficiencies violate
generally accepted correctional mental health standards .
As a practical matter, while the general medical clinics can
meet the serious acute care needs of many detainees, the mental
health system does not adequately address the serious men tal
health care needs of detainees . Mental health policies designed
to cover a range of conditions exist, but overwhelmed staff often
do not i mplement them as written. A host of serious mental
health conditions cannot be adequately handled at the Jail
because of significant housing and treatment limitations. While
the Jail devote s additional resources to dealing with the most
acutely suicidal , even the basic care and supervision of the most
se ri ously mentally ill appears inadequate .

Inadequate Access to Mental Health Treatment

The Ja i l ' s wri tten policies include a process for screening
and prioritizing detainees with serious mental illness, but in
practice , the Jail does not adequately treat detainees based on
the seriousness of their condition . The Jail staff classify
requests for mental health care into four basic categories .
Category 1 includes detainees who are acutely suicidal or have
expressed homicidal complaints. Category 2 includes detainees
who have expressed some suicidal ideation but have not indicated
imminent action . Category 3 includes detainees with medication
issues. Category 4 includes detainees who need to see a case
manager. Because of limi tations on facility housing , staffing ,
and treatment options, the Jail can only address detainees in
Category 1 . Other detainees must wait for treatment , often for
significant periods of time, if they receive mental hea l th
treatment at all.
Given that mental health staff received about 17 , 000
requests in 2007 , the existing system for allocating mental
health r esources is inadequate. The Jail does not provide access
to mental health care for many inmates with serious needs .
Examples f r om 2007 - 2008 include:

GG entered the facility wi th a mental hea l th history.
At the time, GG apparently was withdrawing from
alcohol , but staff failed to provide appropriate
medication and initial intervention . Five days later,
someone observed GG in his cell, with blood seeping out
under the door. Security arrived, and they discovered
that GG had lacerated his hand and appeared to be
hallucinating. Staff transferred GG to the infirmary,

- 11 but they did not complete an initial psychiatric
assessment until five days later. Staff discharged GG
two days later.

HH's medical record suggested that he had a history of
not eating, but staff did not initially refer him to a
psychiatrist for assessment. After six months in the
Jail, HH complained of depression, and staff finally
referred HH to a psychiatrist. Mental health staff,
however, did not conduct an initial psychiatric
evaluation until three weeks after HH complained of
depression . Mental health staff noted that HH appeared
to be depressed . During the next two months, HH
received medication but did not see a psychiatrist.
HH ended up in an altercation and had to be placed in
isolation. Two days later, he began vomiting blood.
At the time of our tour, HH had been housed in
administrative separation for more than 18 months and
had been involved in various altercations with staff.
Given the nature of HH's mental health condition, the
Jail's delays in providing mental health treatment and
evaluation likely contributed to HH's continuing mental
decline and behavioral disturbances.


II entered the Jail with a history of seizures, but
apparently did not receive seizure medications at
intake . II experienced a seizure 19 days after arrival
at the Jail.
I I also had a history of cutting. There
was no follow- up on this psychiatric issue at all.


JJ served time i n the Jail on multiple occasions.
Staff medicated JJ without following generally accepted
correctional medication standards. Without an initial
screening, the Jail staff involuntarily medicated JJ
and housed him in the mental health department's acute
treatment cellbl ock. Staff then repeatedly treated JJ
with both anti-psychotic and mood-stabilizing
medications without adequate laboratory studies or
proper monitoring, placing the detainee at risk of
sudden death.


KK was identified as bipolar upon admission.
Psychiatry did not see KK for nearly a month, and KK
received no medication for his illness until about six
weeks after his admission.
In the interim, KK was
involved in altercations on four occasions, resulting
in the fracture of his arm.
Staff renewed KK's
medication order over this period without further

- 12 patient examination by a psychiatrist. Even after KK's
altercations, there appears to have been little followup by staff to deal with KK's mental health symptoms.


During intake, 11 reported a mental health history that
included risk factors for suicide. The Jail staff did
not refer LL to mental health services. Approximately
3 weeks l ater, LL lacerated his neck.
Inadequate Treatment and Psychotropic Medication

In a large urban detention center with a heavy mental health
caseload, staff need to have access to a variety of treatment
Such resources include an array of different types of
therapy, medication, and intensive supervision in order to
address different types of mental illness, and varying levels of
patient acuity .
Jail mental health staff have access to some mental health
resources, but those resources are not sufficient given the s i ze
of the mental h ealth caseload.
The Jail has few treatment
program options available for detainees with mental illness. The
Jail uses medications, additional staff monitoring, and some
structured housing for detainees with mental illness. For most
mental health conditions, the primary intervention is a
medication order, often with inadequate follow-up even for the
most seriously ill.
Indeed, once medical staff prescribe
medications , they often cannot or do not routinely follow-up on
those detainees unless the detainees themselves request care.
This is a substantial departure from generally accepted
correctional standards. Notably, detainees also reported that
there are significant delays when they request care.
In our document review, some of the treatment orders
appeared t o depart significantly from generally accepted
professional mental health standards. Some of these orders
suggest that staff may be utilizing medications in a clinically
inappropriate or unsafe manner. Examples of improper chemical
restraints and unsafe medication practices during the period from
2006 - 2008 include the following:

MM was in an acute psychotic state for nearly two weeks
before he died. At intake, staff prescribed
medications but they were never dispensed. As MM
became increasingly uncooperative , staff injected MM
with an intramuscular drug. Medical records suggest
significant problems with bas i c medication

- 13 documentation and staff approaches to medication non compliance. Soon after MM was injected, MM's breathing
grew shallow, and he became unresponsive. MM died
shortly afterwards.

NN spent the better part of a year in a State Hospital.
NN was found not competent and not restorable . For
some reason , he was sent back t o the Jail. Despite his
competency status , Jail staff nevertheless placed the
detainee in general housing and allowed him to keep
various medications on his person . NN was not a good
candidate for self-medication. NN appeared to suffer a
seizure and he was sent to the clinic. The clinic
staff suspected the detainee was "sleepy" due to his
psychotropic medications. They released the detainee
from the clinic, and he died shortly afterwards .


A Jail psychiatrist diagnosed 00 with schizoaffective
disorder (a situation where both mood and schizophrenic
symptoms exist) . 00 also had a history of mental
illness. OO's mental health de t eriorated , and staff
repeatedly renewed his medications without having him
seen again by a psychiatrist . 00 ended up in two
altercations, including one in which he struck a
deputy .


PP reported a history of seizures . PP suffered at
least one seizure in the Jail, but according to the
Jail's medical records, there was no proper follow-up.
Medical staff placed PP on four benzodiazepines, but
not a long-term anti-convulsant . 3 This suggests that
the purpose of the medications prescribed was more
likely to sedate the inmate, rather than to treat his


QQ required treatment for seizu r es . QQ experienced a
series of seizures, but on at least two clinic visits,
documentation suggests that QQ's chart was unavailable


If used at all for seizure disorder , benzodiazepines
are typically prescribed for short - term treatment . They are more
commonly used for acute detoxification. In the context of this
individual's history and record , the use of four medications of
the same class to sedate a detainee appears to be a misuse o f the

- 14 to the staff during the exams. This resulted in a
number of delays in care despite QQ's repeated

Inadequate Suicide Prevention

In general, a comprehensive system for providing adequate
mental health care should also include policies, procedures and
practices to prevent detainee suicides. Because suicide
prevention is itself an important legal concern, we note
specifically that the Jail has a number of conditions that are
dangerous for suicidal detainees.
First, the Jail lacks adequate video surveillance and
supervision in various holding areas.
Some of the cells used for
housing newly arrested detainees include unsafe physical fixtures
(~, exposed bars) that can be used to facilitate suicide.
While the Sheriff's Department was in the process of retrofitting
these cells during our tour, such efforts need to be broadened.
Many of the mental health holding areas throughou t the Jail
appear to be clinically inappropriate.
For instance, padded
rooms in administrative separation and maximum security units are
difficult to supervise and the conditions are so stark, they can
cause a detainee with mental illness to degenerate.
Second, the detainees' generally limited access to mental
health care can be especially dangerous for suicidal detainees,
since suicidal detainees may not be particularly inclined to seek
care on their own.
Thus, adequate screening and pro- active
efforts to identify and treat suicidal detainees are necessary to
ensure compliance with minimum standards of care.

Protection from Harm

We evaluated the Jail's detainee supervision procedures,
security classification process, housing practices, grievance
procedures, disciplinary process, and training program. We found
that many Jail policies and practices are consistent with minimum
co rrectional standards. Yet, at the same time, we also found
some significant and often glaring operational deficiencies.
security matters in particular, the Jail lacks :
(1) a minimally
adequate system for deterring excessive use of force, and (2) an
adequate plan for managing a large and sometimes violent detainee

- 15 1.

Excessive Use of Force

We have serious concerns about the use of force at the Jail.
The Jail's use of force policy is flawed in several regards.
First, neither written policy nor training provide staff with
clear guidance on prohibited use of force practices. For
example, Harris County Jail does not train staff that hogtying
and choke holds are dangerous, prohibited p ract ices.
Indeed, we
found a significant number of incidents where staff used
inappropriate force techniques, often without subsequent
documented investigation or correction by supervisors. Second,
use of force policies fail to distinguish between planned use of
force (~, for extracting an detainee from a cell) and
unplanned use of force (~, when responding to a fight) . In
many planned use of force situations, staff should be consulting
with supervisors, and possibly medical staff, before using force.
Third, Jail policies do not provide for routine v ideotaping of
use of force.
Fourth, the Jail does not have an appropriate
administrative process for reviewing use of force.
Jail policy
does not clearly require the individual using force to file a use
of force report; nor does Jail policy provide for routine,
systematic collection of witness statements. When supervisors
review use of force incidents, they do not have ready access to
important evidence.
Instead, they appear to rely excessively on
officer statements to determine what happened during an incident.
While Jail staff were helpful and willing to assemble use of
force documents requested by our review team, we found it
troubling that the Jail did not collect such documents as a
matter of course.
In other words, use of force occurs at the
Jail without adequate review, and Jail data regarding use of
force levels cannot be considered reliable. We believe that the
incidents noted during our review may only reflect part of what
is really occurring within the facility.
As a result o f systemic deficiencies including a lack of
appropriate policies and training, the Jail exposes detainees to
harm or risk of harm from excessive use of force.
In a
particularly troubling January 2008 case, staff applied a choke
hold to a detainee, who subsequently died.
The autopsy report
identified the manner of death as homicide. Our review of the
Jail's records suggests that such improper force technique is
being used with troubling frequency.
For instance, our
consultant found a pattern of such incidents when reviewing use
of force reports dated from January through June 2008. These
incidents included the following:

An officer reported that he "grabbed inmate RR by the
front of his jumpsuit top and the back of his neck and

- 16 forcibly placed inmate RR on the ground. Once on the
ground, I continued to apply pressure to inmate RR's
neck and placed my right knee in the small of his

An officer used both a headlock and multiple strikes to
SS's rib cage.


Officers "grab[bed] the front of [TT's] shirt and
place[d] him on the wall to gain control of the


Officers used force on UU that resulted in a laceration
requiring eleven staples to the scalp. Yet, the use of
force incident was not reported by either of the
officers who applied the force. Instead, another
officer initiated the "inmate offense report."

These and other similar incidents suggest that staff use
hazardous restraint and force techniques without appropriate
guidance or sanction. In some cases, medical records confirm
that detainees may have suffered notable injuries, such as
lacerations to the scalp or eye. Notably, when force was
investigated by supervisors, it appears that the supervisors
often determined that staff's use of force was appropriate
without obtaining independent medical review or multiple witness
At the time of our inspection, the Jail was already making
some effort to improve use of force reviews. At the time of our
tour, the Office of the Inspector General was in the early stages
of developing a use of force review process. We also understand
that the Jail continues expanding this process in ways that may
address some of the concerns noted in this letter. Nevertheless,
work must continue in this area before we can conclude that the
Jail meets minimum constitutional standards.


With a population approaching 10,000 detainees, the Jail is
one of the largest detention facilities in the country. The
Texas Jail Commission's decision to grant the County waivers to
house approximately 2000 detainees more than the Jail's original
design capacity is concerning on its face. At the same time,
however, a large detainee population, even if over design
capacity, does not itself necessarily violate minimum legal
standards. Moreover, the Sheriff's Department has adopted a
number of measures to alleviate crowding issues, such as

- 17 transferring detainees to outside facilities and providing
"portable bunks." Conditions would likely be much worse if the
detainees at outside contract facilities had to be housed in the
Houston Jail complex. The Sheriff's Department is clearly trying
to manage its population, and we acknowledge its efforts . While
crowded conditions may not, in and of themselves, violate the
Constitution, we are compelled to raise our concerns here because
(1) the Jail's crowded conditions currently exacerbate many of
the constitutional deficiencies identified in this letter; and
(2) the Jail needs a more comprehensive, systemic approach to
dealing with a large and growing Jail population.
Jail crowding affects multiple Jail systems . For instance,
it impedes detainee access to medical care, indirectly affects
detainee hygiene, and reduces the staff's ability to supervise
detainees in a safe manner. How the Jail handles inmate
supervision and violence illustrates some of the complexities
associated with overcrowding. The Jail has already adopted a
number of useful strategies for dealing with detainees who are
dangerous to themselves or others. These strategies include an
objective classification process for deciding where to house
detainees and contracts with outside facilities to handle
crowding pressure. Despite such strategies, the Jail is so
large, violence still breaks out frequently.
In one recent ten
month period, the Jail reported over 3000 fights, and 17 reported
sexual assaults . Also, as discussed above in the mental health
section of this letter, the Jail has had particu lar difficulty
managing violent detainees with behavioral and mental health
issues. Because crowding makes it difficult to supervise
detainees and prevent violence, additional Jail staffing or more
jail diversion programs could reduce the risk of detainees coming
to harm in the facility.
Managing a large population is a complex problem, and
requires both short-term administrative approaches and long-term
st rategies. For instance, changes to administrative processes
and better technology can help alleviate violence and supervision
problems associated with crowding. The Jail staff have limited
options to address violence and other serious incidents through
internal administrative and supervisory mechanisms . At the time
of our tour, the Jail did not have the ability to routinely
investigate violent incidents.
Instead, the Ja il staff had to
rely heavily on more cumbersome criminal prosecutions to deal
with such incidents.
In such a large facility, criminal
prosecutions may not be a sufficient deterrent to violence. More
structured administrative procedures for reviewing incidents,
identifying dangerous inmates, and correcting hazardous
situations are needed. The Jail also did not have procedures in

- 18 -

place that could more appropriately distinguish between
disturbances caused by detainees with mental illness and other
detainees . The response to the former often needs to be more
nuanced in order to avoid exacerbating the detainees' mental
illnesses and to ensure fairness . Instead of referring detainees
for structured treatment, the Jail staff instead often have to
rely on placing detainees with me ntal illnes s in isolation.
Isolation can actually make a detainee with mental illness worse
and is not as therapeutic as a properly designed, dedicated
treatment unit. Other administrative deficiencies include a lack
of staff control over hazardous contraband (~, detainee
razors) , and a disciplinary process that lacks safeguards to
protect witness confidentiality. Similarly, physical plant and
technology issues affect the Jail staff's ability to supervise
housing areas. The four main facilities do not have video
surveillance in critical areas. The satellite facilities also
lack adequate video surveillance.
More generally, while clearly the use of outside facilities
and other tactics have helped to alleviate some of the population
pressures at the Jail , it is less clear whether the Jail actually
has a workable long-term plan for dealing with the types of
systemic problems noted in this letter, especially in light of
potential population growth . The County is reportedly working to
address many of the specific issues raised in this letter, but at
this early remedial stage, it is difficult t o determine how much
progress will eventually be made. For instance, if the Jail
increases staff, but then the Jail population simultaneously
increases, those staff could quickly become overwhelmed . In
other words, when dealing with crowding and its effects on
security, medical care, and various Jail operations, the
Sheriff's Department should evaluate issues and remedies in a
systemic manner . Otherwise, it may be much more difficult to
resolve deficiencies in a complete and long-term manner.

Sanitation and Life Safety

The Jail buildings are generally modern and adequately
maintained. Staff receive training on a variety of emergency
procedures . The Jail lacks , however, certain necessary
structured maintenance, sanitation, and fire safety programs.
Given stresses upon Jail infrastructure crowding, the lack of
such programs raises concerns about sanitation and fire safety in
the Jail .

- 19 1.

Sanitation and Hygiene

While the Jail generally appeared to be clean and many
systems seemed to be well - maintained, certai n deficiencies in the
Jail's hygiene practices and maintenance programs expose
detainees to an unacceptable risk of injur y , disease, or other
Jail crowding contributes to these deficiencies.
First , the Jail does not have systems in place to ensure
adequate detainee personal hygiene. For example , the facility's
laundry facilities and procedures are currently inadequate given
the size of the Jail population. As a general matter, the Jail
does not even have a "par level" of clothing or linen available
for detainees.
In other words, the Jail does not maintain enough
accessible clothing or linen on - hand for the number of detainees
housed at the facility.
Moreover, the laundry operation does not
meet minimum sanitary standards. The laundry operation does not
properly wash and sanitize clothing. The laundry has only a few
machines, and a number of those were inoperative during our tour .
The staff also use a variety of inconsis tent, and often
inadequate , schedules and procedures for handling and cleaning
laundry. As a result, we found a significant amount of
unsanitary bedding, clothing , and mattresses throughout the
Such unsanitary conditions can expose detainees to a
serious risk from infectious disease .
Another example of poor hygiene practices involves detainee
grooming and shaving equipment. The Jail's barbers practice
their trade in an unhygienic manner .
Cl ipper blades, guards , and
supply boxes appeared to be dirty and had not been cleaned
between uses.
Detainee barbers did not keep their equipment in
disinfectant solutions. As discussed previously in this letter 's
section on protection from harm, razor blades are not well
controlled in the facility . The availability and use of dirty ,
shared razors and blades is a serious risk, both in terms of
disease transmission and as a securi t y matter .
Finally, the Jail's plumbing and mechanical systems require
improved maintenance in order to ensure hygienic conditions in
certain housing units . While most of the Jail is properly
maintained, the Jail ' s population size and gaps in the Jail ' s
maintenance program result in unsanitary conditions in the intake
and mental health units , where the Jail utilizes archaic flushable floor drains, essentially holes in the floor, instead of
toilets. Using such grossly inadequate faci lities for long
periods of time is itself problematic because they are

- 20 unhygienic. Moreover, when we tested some of the drains , they
back-flushed into the cells. Elsewhere throughout the Jail , we
found drains clogged with significant accumulations of debris .

Fire Safety

The Jail is a modern facility with a number of fire safety
features , such as alarm systems and fire s uppression equipment .
The main problem with the Jail's fire safety program is that
staff training and oversight appear to be inadequate. During our
site inspection , we found inadequate numbers of personnel trained
to perform emergency t asks . The Jail has a level of constant
staff turnover that makes it difficult to ensure that there are
fully trained staff on duty in the housing units . As a result,
when we randomly questioned staff about emergency procedures, we
found that a number of them did not know how to use emergency
equipment or h ow to respond during a drill. We also discovered
inconsistencies in safety documentation that further suggest a
lack of staff training. Finally , we found that the Jail staff
did not have adequate access to emergency keys in the event of a
failure in the Jail's electronic door control system .
Commendably, the Sheriff's Departmen t immed i ately took a number
of steps to address our fire safety concerns .
Importantly, these
efforts should be incorporated into ongoing, system- wide safety
reviews .


In order to address the constitutional deficiencies
identified above and protect the constitutional rights of
detainees, t h e Jail should implement, at a minimum, the following
measures in accordance with generally accepted professional
standards of correctional practice :

Medical care


The Jail should develop a chronic care program consistent
with generally accepted correctional medical standards .
This program should include a process that will identify
detainees who should be enrolled in a chronic care program;
a roster of detainees enrolled in the program; a schedule of
medical visits for each detainee enrolled in the program; a
system for determining which diagnostic tests will be
required for each chronic condition; and record- keeping
which includes documentation of lab work and medical orders.


The Jail shoul d update and improve the medical and mental
health quality assurance and training programs to ensure

- 21 compliance with generally accepted correctional medical
standards. These improvements should include additional
internal self-auditing to ensure that staff conduct
appropriate assessments, provide timely treatment, and
document care in a manner consistent with generally accepted
correctional medical standards.

The Jail should develop a system to monitor the effects of
medications and to ensure appropriate follow - up for
detainees with serious medical or mental health conditions.


The Jail should develop a system to track sick call requests
and identify barriers to timely access to medical or mental
health care. Sick call requests need to be triaged by
appropriate personnel to ensure appropriate and timely
access to medical care.


The Jail should ensure that medical consultation and
specialty services receive physician oversight.


The Jail should employ sufficien t qualified staff to ensure
detainees have adequate access to medical and mental health


Mental Heal th Care


The Jail should create a mental health program that will
allow the Jail to identify, treat, and monitor detainees
with chronic mental illness. As part of this development
process , responsible Jai l personnel may wish to consider
evaluating mental health programs in a variety of outside
institutions and adopt useful policies and procedures from
appropriate models.


The Jail should continue with e fforts to assess the mental
health caseload in the facility, and develop a variety of
housing and treatment options to address the needs of the
mentally ill. This system will need to organize treatment
options so that the Jail can deal with those across the
entire spectrum of care. The Jai l's mental health treatment
policies need to meet generally accepted standards of
correctional health care. These policies should provide for
the development of individual treatment plans and timely
access to levels of care appropriate to detainees' ment al
health needs. Such care should address detainees who are
stable and can be housed in genera l housing, detainees who
are highly unstable and require intensive supervision,
detainees who are stable but may require step-down services

- 22 before returning to general population, detainees who are
actively suicidal, and detainees who are at risk of suicide
but may not have expressed an immediate intent to commit
suicide .

Restraints should not be used as punishment, for the
convenience of staff, or in lieu of treatment. The Jail
should provide a variety of psycho-therapeutic treatment
options and adopt appropriate safeguards to avoid the
inappropriate use of chemical sedation.


The Jail shou l d implement policies for monitoring detainees
at risk of suicide that meet generally accepted correctional
mental health standards. The Jail should retrofit cells
used for suicidal detainees or detainees requiring intensive
supervision . The Jail should eliminate fixtures that can be
used to facilitate suicide (~, exposed bars or bath
fixtures) while at the same time avoid creating a
non-therapeutic environment (~ bare cells or extensive
use of isolation for psychotic detainees) .


The Jail should include mental health staff and
administrators as part of medical quality assurance and
other administrative management processes.


Protection from Harm


The Jail should ensure that there are a sufficient number of
adequately trained staff on duty to supervise detainees and
to respond to serious incidents.


The Jail


The Jail should increase video surveillance in critical
housing areas and alter staffing patterns to provide
additional direct supervision of housing units.


The Jail should develop and implement policies and
procedures to improve control over razors or other dangerous


The Jail should develop and implement additional policies
and procedures for the investigation of serious incidents,
including excessive use of force and detainee - on- detainee
violence. These policies and procedures should include
administrative responses to violence and a detainee
disciplinary process conducted in a confidential manner.
They should also include routine interview and document

shoul d_~hibit

r ------

the use of chokeholds and hogtying.

- 23 collection procedures that will allow investigators to
complete their inquiries in an objective manner consistent
with generally accepted correctional standards.


The Jail should alter its procedures for cell extractions
and other use of force situations to ensure that staff are
utilizing appropriate force techniques.
Such alterations
should include routine videotaping of planned use of force.
Sanitation and Life Safety


The Jail should develop and implement a long-term plan for
addressing Jail crowding and popu lation growth.


The Jail should develop and implement policies and
procedures to improve detainee hygiene to a level consistent
with generally accepted health standards. The Jail should
specifically improve laundry practices and f aci lities to
ensure that the Jail can adequately wash and sani tize
detainee laundry. The Jail should also maintain, at all
times, a sufficient supply of sanitary bedding, linen,
clo thing , razors, and other hygiene materials.


The Jail should increase staff training to ensure that staff
is prepared to implemen t emergency procedures and operate
emergency equipment the event of an emergency . J ail
supervisors shall periodically test and drill staff on their
knowledge of emergency procedures, and provide corrective
instruction as part of a Jail - wide safety program. The Jai l
should continue with its ongo ing effort to develop a
qualified Jail safety team to help conduct staff training
and oversee facility safety programs.

* * * * * * * * * * * * * * * * *
Please note that this findings letter is a public document.
It will be posted on the Civil Rights Divi sion 's website. While
we will provide a copy of this letter to any individual or entity
upon request, as a matter of courtesy, we will not post this
letter on the Civil Rights Division's website until ten calendar
days from the date of this let ter.
We hope to continue working with the County in an amicable
and cooperative fashion to resolve our outstanding concerns
regarding the Jail. Since we toured, the County has reported
that it has adopted a number of improvements, many of which
appear to be designed to address is sues r aised during our exit
interviews. We appreciate the County's pro - act i ve efforts .

- 24 Assuming there is continued cooperation from the County and
the Jail , we would be willing to send our consultants ' reports
under separate cover. These reports are not public documents .
Although the consultants' evaluations and work do not necessarily
reflect the official conclusions of the Department of Justice,
their observations, analys is, and recommendations provide further
elaboration of the issues discussed in th i s letter and offer
practical technical assistance in address i ng them .
We are obligated to advis e you that, in the event that we
are unable to reach a resolution regarding our concerns, the
Attorney General may initiate a lawsuit pursuant t o CRIPA to
correct deficiencies of the k i nd identified in this le tt er 49
days after app ropri ate officials have been notified of them .
42 U. S.C . § 1997b (a ) (1).
We would prefer, however , to resolve this matter by working
cooperatively with you and are confident that we will be able to
do so in this case. The lawyers assigned to this investigati on
will be contacti n g the County ' s attorney to discuss this matter
in further detail . If you have any questions regarding this
letter, please contact Shanetta Y. Cutla r, Chief o f the Civil
Rights Division's Special Litigation Section , at (202) 514-0195 .

Is/ Loretta King
Loret t a King
Acting Assistant Attorney General

Vince Ryan , Esq.
Harris County Attorney
Adrian Garcia
Harris County
The Honorable Tim Johnson , Esq.
United States Attorney
Southern District of Tex as