By Jim Schutze
By Rachel Watts
By Lauren Drewes Daniels
By Anna Merlan
By Lee Escobedo
When UTMB first bid for the job as the jail's medical provider in 2001, the medical school promised that it could cut costs and improve care. Press accounts said that UTMB could save the county nearly $700,000 a year, down from the $14 million the county had been spending on jail health. Three years later and with the benefit of hindsight, the school now says it is understaffed and underfunded, having lost up to $200,000 a month throughout the course of a contract that reimburses it $569 per inmate. Although UTMB made the decision not to apply for a contract renewal, it's unlikely the commissioners would have wanted them to remain as the medical provider following Puisis' report and the lawsuits.
Dr. Owen Murray, the chief executive of UTMB Correctional Care, agrees that the school initially underestimated the acuity of health care needs at a jail, as opposed to a prison, in which most of its correctional experience lies. At a prison, most inmates have already been stabilized, while at a jail they often come in off the streets at the height of their mental illnesses, drug addictions and with a range of physical afflictions.
"I was surprised just how sick the patients are at Dallas County," Murray says. "You have three times the rate of diabetes in the jail as you do in prison and twice the rate of hypertension."
Still, while Murray agrees with some of the jail report's findings, particularly as it relates to staffing and problems with the facility itself, he says that some of the report's criticisms are unfair. For example, one of the report's more dramatic findings--that not every inmate at the jail is screened for tuberculosis--isn't exactly damning; the Texas Commission on Jail Standards requires testing on only a portion of the jail's population, he says. Murray says that he agrees with many of the report's general conclusions, but that "it's difficult to come into a place as complex as the Dallas County jail and walk away with a clear picture of what's going on."
Because of patient confidentiality rules, Murray was not able to speak about the instances the report highlighted where inmates died or became gravely ill under UTMB's care.
UTMB's predecessor, Dallas County Health and Human Services, fared no better at providing care, particularly to the mentally ill. In 2002, the Morning News and WFAA-TV investigated the jail's health care practices and uncovered cases where suicidal inmates were punished by being stripped of their clothes and left naked in their cells, sometimes without their medication. The report included one inmate who gouged his eye out, stomped on it and tried to flush it down the toilet. The medical staff's solution to the inmate's troubles was to wrap mitts around his hands so he wouldn't hurt himself. WFAA also caught Rita Moss, the jail's medical director for the mental health staff, regularly leaving work early in her Mercedes, presumably to attend to her second job running a private psychiatric practice.
Jim Pruitt, a Rockwall attorney who served as a Dallas County criminal judge from 1995-2003, tells the Observer that making sure that inmates appearing before him were receiving their prescribed medication demanded his constant attention. One staffer, the ex-judge says, went so far as to alter medical records to document that a particular inmate had been given his prescribed medication when he hadn't. That staffer was later fired. Other employees would document that inmates refused medication, simply because they were sleeping; it was too much trouble to wake them up. Asked why the county's medical staff continually failed to make sure inmates received the drugs they needed, Pruitt replied with the frankness befitting a former judge.
"They were damn lazy."
County Criminal Court Judge Lisa Fox, who took the bench in May 2002, says that she still regularly sees defendants in her court who have gone without their medications for weeks. At least three times she's had to call the jail from her bench to make sure that the medical staff attends to an ailing defendant immediately.
"I think they need to take the time in the beginning to make sure inmates are on their medication rather than wait two to three weeks," Fox says.
A few months ago, she had a defendant in her court with a hideous staph infection on his leg. She ordered him to be taken to Parkland Hospital immediately.
"It's going to take a major overhaul," she says on what lies ahead for the Dallas County jail system.
Attorney David Finn, who helped the families of James Mims and Mark McLeod prepare lawsuits against the county, first became aware of the problems at the jail when he was a criminal court judge. He said that when he sat on the bench, he regularly saw mentally ill inmates who clearly were not receiving their meds. They'd be declared incompetent for trial, be sent to Terrell and stabilized, only to return to jail and not be given their medication, even when the hospital staff gave the county jail a two-week supply.
"Hundreds of thousands of dollars in meds are just getting flushed down the toilet," he says. "I could see if maybe a family brings them in and the jail doesn't trust them. But we're talking about prescriptions written by physicians licensed from the state of Texas."