Cell Disease

Being sick in Dallas County's troubled jail can be a death sentence

McLeod's death and the county's response were far from unique. For years now, inmates at the Dallas County jail have often failed to receive elementary levels of medical care, prompting a lengthy series of lawsuits and bad publicity that has done nothing to halt the cycle of neglect. If anything, people who determine the fate of the jail have rejected outside scrutiny. Every year, the jail elicits the same criticisms, and all that changes are the faces of the elected officials. From the county commissioners, who control the jail's budget, to the sheriff's office, which makes the day-to-day decisions that affect the lives of thousands, a stubborn cast of officials have engaged in a long-running pattern of closing ranks and resisting external pressures. Even the District Attorney's Office, which counts the jail as its most troubled client, has pursued a defense-at-all-costs strategy instead of finding out what's really happening to inmates in the county's custody.


It was a textbook Lew Sterrett death: a troubled inmate suffers dramatic deterioration amid guards and a neglectful medical staff. Incarcerated on a misdemeanor prostitution charge in February 2002, Rosa Allejo fell apart at Sterrett. Her mind crumbling by the hour, she died three weeks into her stay at the jail from eating bags of dried coffee grounds. According to her family's lawsuit, she noted on her intake evaluation form that she had previously received psychiatric treatment at Terrell State Hospital and had been taking lithium carbonate for mental illness. Within a week, though, Allejo became a wreck.

In their lawsuit, Allejo's family members claim that jail floor officers reported that she was yelling, eating toilet tissue and pulling at her hair while pleading for her medication. She began to eat her own feces, but even that didn't prompt anyone to make sure Allejo was receiving her proper course of drugs. Meanwhile, the guards continued to give her coffee grounds, which led to her death from caffeine toxicity. No one at the jail seemed to realize that Allejo's unusual craving was a possible side effect of withdrawal from certain types of behavioral drugs, particularly lithium. Not surprisingly, her family's lawsuit cites jail records that show that she never received her lithium during her incarceration.

Following Allejo's death, which drew attention to a string of similar cases, the nonprofit Mental Health Association of Dallas offered to fund an independent ombudsman who would investigate allegations of neglect among mentally ill inmates. The ombudsman would also serve as a resource for families of the incarcerated and would likely look into other cases where chronically ill inmates were not receiving their medication. But Vivian Lawrence, an expert on prison issues for the nonprofit, says that then-Sheriff Jim Bowles never responded to the offer, and the county commissioners at the time never even brought it to a vote.

"It floors me," says Lawrence on the county's unresponsiveness to the group's proposal.

This year, the Mental Health Association has offered to train the jail's detention officers, free of charge. Citing overtime costs, Sheriff Lupe Valdez's office has declined the offer.

"This has been going on for so long, you can't say there is any one commissioner responsible for this," Lawrence says of the jail's entrenched problems. "You can't necessarily blame the sheriff, since we have a new sheriff. I just think there is a culture at the jail where they just say, 'We have done this so long, and we're not going to change.'"

In 1998, four years before the deaths of Mark McLeod and Rosa Allejo, a panel of health experts analyzed mental health issues at the jail, including why some inmates were not receiving their medications. Seven years after the panel looked at the jail, an outside consultant employed by the county studied the jail and again criticized how mentally ill inmates are treated.

"If you look at the 1998 report and the report the current consultant did in February of this year, there are a lot of the same recommendations," Lawrence says.

First-term County Judge Margaret Keliher has taken steps to tackle the long-term defects that have plagued the jail. Over the objections of some of her colleagues, she has pushed for the county to hire enough detention officers to meet state standards and institute structural changes that include revamping the jail's flawed intake procedures. Her office has also helped guide a fledgling but promising mental health diversion program that tracks nonviolent mentally ill inmates and places them out of jail and into a program of coordinated care.

Perhaps most important, Keliher not only pushed for the 2005 consultant's report on Sterrett, she secured private funding to pay for it.

But Keliher, along with the rest of the commissioners court, has gone to federal court to suppress that same report, which is being cited in an inmate lawsuit against the county. The report is a blow-by-blow account of the jail's inept health care system, blaming the facility's medical providers as well as its guards. After the report was concluded, The Dallas Morning News asked for a copy, but the District Attorney's Office denied the paper's request.

Regardless, Morning Newsreporter Jim O'Neill obtained a confidential copy of the report and wrote about it in detail. That prompted the commissioners court's outside counsel, the corporate law firm of Figari & Davenport, to send a letter to the paper demanding that they cease writing about and immediately return the report. The Morning News wasn't exactly intimidated; its response was to post the so-called confidential report on its Web site. Then in July, Figari & Davenport failed to convince a federal magistrate that plaintiffs in an inmate lawsuit couldn't cite the report as evidence that the pattern of poor care at the jail led to their client's death. The law firm appealed that decision and lost. For their efforts, Figari & Davenport has been paid more than $100,000 by the county.

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