"Don't let me bury you; I can't bury you," Fullen told her brother.
Immediately, Fullen pleaded with guards to look after him, but they laughed at her. Later, a sergeant told her to stop "babying him." Over the next few months, Fullen and her parents continued to plead in vain with jail officials to place Lynch on suicide watch. A few months later, while Fullen was at the State Fair with her family, a detective with the Sheriff's Department told her that her brother was dead.
"I started screaming at the middle of the State Fair. People are staring, and I'm just saying, 'Chris is dead, Chris is dead,'" Fullen recalls.
Jail officials would later tell her that her brother committed suicide after having overdosed on an antidepressant.
This week, the U.S. Justice Department concluded a near epic report on the county's jail, highlighting a grim pattern of negligent health care and unprofessional conduct that unnecessarily costs people their lives. Citing the jail for a long list of failures, from not treating communicable diseases to having large concentrations of drain flies and fly larvae swarming in bathrooms, the Justice Department's findings were far worse than anyone expected. Coming a little more than a year after the feds first announced their investigation of the jail, the report, first obtained by the Dallas Observer, documented at least 11 inmates whose deaths could have been prevented had both the Dallas County Sheriff's Department and the jail's medical provider followed basic standards of jail health and operation. One of those inmates was Christopher Lynch.
"It's as if they were POWs in a Third World country," says Fullen about the health care of inmates at the jail. "If I got to do an impact statement, I'd have the guards and the health care professionals stay in the same jail that my brother did, and we'll see if they make it."
Sent to all five county commissioners, along with Sheriff Lupe Valdez, who runs the jail, the report informed them that their facility regularly violates the rights of inmates confined there, particularly those who are ailing. "The DCJ [Dallas County jail] fails to provide inmates with adequate medical care that complies with constitutional requirements," the report notes, finding serious deficiencies in screening, chronic care, acute care, follow-up care, staffing and training, among other areas.
The report focused largely on the record of the jail's former medical provider, the University of Texas Medical Branch in Galveston (UTMB). Parkland Memorial Hospital didn't take over the medical care until last March, after the Justice Department began its investigation, and is largely being credited for improving certain practices. Still, the Justice Department's investigators exposed the jail's long record of incompetence, in which basic practices of medicine are typically ignored at grave risk to sick inmates. On the first day investigators toured the jail this past February, when UTMB's medical staff would be expected to be on their best behavior, many inmates failed to receive their medications. The Justice Department would conclude this was not exactly a one-time event.
"At DCJ, inmates routinely miss doses of life-sustaining medications," concluded the report.
At the Observer's press time, county officials, who have continually failed to staff the jail according to state standards, were still digesting the findings, but they don't exactly have the luxury to review them at their leisure. After having run the jail on the cheap for years, the county has now only seven weeks to address the recommendations of the report. If it doesn't, the "attorney general may initiate a lawsuit...to correct deficiencies of the kind identified in this letter."
Attorney David Finn, who has represented a number of inmates who have complained about the jail's health care practices, first alerted the Department of Justice about the condition of the jail nearly two years ago. The Sheriff's Department had just concluded that it had allowed inmate James Mims to "fall through the cracks" when he suffered renal failure nearly two weeks after guards turned off the water to his cell. Now as one of the attorneys representing Mims, Finn says the Department of Justice's report, which he read after the Observer faxed him a copy, corroborates the litany of allegations against the jail over the years.
"This puts a spotlight on the problem; it underlines the accuracy and legitimacy of our claims, and it will force the county to fix this mess," he says. "That's something our lawsuit can't do."
Although the report concentrates on the jail's abysmal record of mental and medical health care, it was also extremely critical of the operation of the jail, which is the responsibility of Sheriff Valdez. At press time, Valdez was out of town and had not yet reviewed the report's findings, but it's not likely she'll enjoy what she reads. The report notes that Valdez's correctional officers simply aren't trained to watch over suicidal inmates. The placement of inmates in suicide cells is arbitrary and often used as punishment instead of protection, prompting investigators to conclude that the jail's suicide practices are "grossly inadequate."
In general, the report depicts a jail that is not professionally run. For example, one of the findings was that the jail lacks "adequate control over razors and other commissary items," and as a result investigators spotted inmates stockpiling razors and food. Jailers also leave brooms and mops in cells for extended periods of time, a practice that the Justice Department notes "ignores the fact that these items can be used as, or converted into, weapons."
The Justice Department also found that parts of the facility are filthy and that overall the jail's "sanitation practices are grossly inadequate and vary widely among each facility." In their tours of the jail, investigators spotted leaky toilets and sinks, clogged drains, fly larvae in the bathroom and floors that remain wet for long periods of time. Some areas of the jail are not fitted with smoke detection equipment, while some jailers remarkably don't have working knowledge of the jail's own emergency procedures.
The report makes an even stronger case against UTMB ever administering health care at a jail again. Investigators found one inmate whose blood sugar was recorded at a dangerously high level yet received no physician care while at the jail. He subsequently died. Another inmate with a documented history of alcoholism and seizures went without physician or nursing care while at the jail. He became disoriented, suffered from elevated blood pressure and developed a fever. Later, after he was found lying in his own feces, it took staff five hours to transfer him to the hospital, where he later died.
In general, the report found that under UTMB, the jail regularly failed to spot inmates who needed care for chronic conditions and continually lagged in treating those who needed hospitalization. "DCJ's failure to provide such care has subjected inmates to serious harm," the report concluded.
One of the inmates the report profiled was Jeffrey Ellard, who in June had to be released from the jail by a court order so that he could finally receive care for his badly infected leg. "It's unconscionable how they treat people in there," says Julie Ellard-Levine, Ellard's sister. "If he had not been released from jail, he would have died."
The report was most critical of the jail's mental health care, noting plainly that it "fails to appropriately assess and treat inmates with mental illnesses." Investigators concluded that the jail's medical staff struggles to keep track of which inmates are on psychotropic drugs. In one example, the report notes that an inmate was left to languish without any kind of mental evaluation for two months despite several referrals for psychiatric care. He was not receiving his prescribed anti-psychotic and anti-seizure medication either. Soon after, he was spotted "laying prostrate in his own excrement for three to four days." The inmate was later hospitalized for kidney failure.
Mental health advocates weren't terribly surprised by the Justice Department's findings.
"This report has exposed what a lot of us knew for a long time. It's time for us to admit we have a serious problem," says Tim Simmons, the president of the Mental Health Association of Greater Dallas, who is pushing for the jail to have an independent ombudsman to track inmate and family complaints.
For years, problems at the jail have been allowed to fester in part because inmates don't often make for the most sympathetic victims. They're not exactly a powerful special interest group either. Of course, many of them have not yet been convicted of a crime, while others who have become gravely ill at the jail were detained on offenses as minor as driving with a suspended license. And then there are the family members who often have no recourse but to sit back and watch their loved ones suffer until they're on the brink of death.
Last year, the Department of Justice contacted Deanna Mooney about her son Jerry Mooney, whose agonizing plight at the Dallas County jail reads like the script of a horror movie. Mooney had a severe hernia, which developed after a gunshot wound, but it went unchecked by UTMB's medical staff. His stomach became abnormally swollen, at one point making him look as if he were pregnant. Even worse, Mooney could not get guards to give him new colostomy bags, which would often burst all over him. At his lowest point, the inmate had to scrub layers of feces off a toilet with a toothbrush after nobody else would clean it. For months, Deanna Mooney, her husband and daughter would plead with jail staff to attend to Jerry but were typically brushed aside.
"It's appalling, it's a shame, it's a disgrace, it's horrible," Deanna Mooney says. "Nobody should be able to get away with treating human beings the way they're treating [them]. People are being tortured—not only the inmates but the families trying to get them help. They treat us like we're the scum of the earth."
