Cruel and unusual punishment for inmates?
Over the past 6 years, at least 101 inmates have died at the Harris County Jail
Harris County Jail inmate Calvin Mack lay sprawled on a cellblock floor, coughing up blood, bleeding profusely, his fellow prisoners yelling for guards to get help.
Mack, a homeless and hardened drug addict, continued to bleed, continued to die. “What do you want me to do, get a Band-Aid … ?” a deputy quipped when he first appeared at the cellblock. Four hours passed before the officer called for medical help.
By then, Mack was all but dead.
By inmate standards, Calvin Mack’s life was not unusual. A petty criminal who spent most of his time smoking crack under cover of the Fifth Ward shadow world, he had been arrested on minor drug charges almost every other year over the past decade.
His death, on the other hand, was anything but usual. But questionable care in the Harris County jail is not isolated to his case.
A Houston Chronicle review of state and county records reveals that from January 2001 through December 2006, at least 101 inmates — an average of about 17 a year — have died while in the custody of the Harris County Jail. In 2006 alone, after three consecutive years of failing to be in compliance with state standards, the jail recorded 22 in-custody deaths.
At the time of their deaths, at least 72 of the inmates — more than 70 percent — were awaiting court hearings and had yet to be convicted of the crimes that led to their incarceration.
Records and interviews show that almost one-third of the deaths involve questions of inadequate responses from guards and staff, failure by jail officials to provide inmates with essential medical and psychiatric care and medications, unsanitary conditions, and two allegations of physical abuse by guards.
In at least 13 cases, relatives or documents raise questions over whether inmates received needed medications prior to their deaths. Additionally, 11 of the deaths involve infections and illnesses suggesting sanitation problems. In 10 other cases, death reports suggest possible neglect, as in the Mack case.
None of the records reviewed, however, concludes that jail staff contributed directly to the 101 deaths since 2001. During the same period, the Dallas County jail recorded 70 deaths.
Harris County Sheriff Tommy Thomas declined the Chronicle’s request for an interview. He did reply to written questions, though he would not comment on specific cases, citing confidentiality laws.
Overall, Thomas wrote, the Harris County Sheriff’s Office “takes great pride” in the health care it provides to jail inmates. He pointed out that jail officials are charged with the massive task of conducting medical screening on the more than 9,100 prisoners housed in the jail each month.
The sheriff also noted that “delivery of health care to inmates is further challenged by the fact that many inmates lacked preventative health care in the free world, many suffered from substance abuse prior to incarceration, and many come to jail with chronic, untreated medical conditions.”
“We feel that we are meeting the challenges of inmate health care delivery within those constraints, are committed to making ongoing improvements in all that we do, and are doing our best to exceed constitutionally mandated services to the inmate population,” Thomas wrote.
Twelve years ago, prisoner litigation forced the county to spend more than $100 million in jail construction because of crowding. The money was meant to improve jail conditions and alleviate problems with safety, security and inmate care, many of which still exist.
The jail is struggling with a guard shortage and has budgeted more than $20 million on overtime in the past year to meet minimum staffing standards required by state law.
Custodial Death Report
Texas requires all law enforcement agencies to file a Custodial Death Report with the state Attorney General’s Office any time an in-custody death occurs. However, the AG’s office serves basically as “a repository of the reports,” said AG spokesman Tom Kelley. “That’s all we do.”
The Texas Commission on Jail Standards keeps no records or figures on in-custody deaths. The commission does monitor county jail populations and determines whether the facilities are in compliance with the state-mandated ratio of one guard to every 48 prisoners — a standard that Harris County had failed to meet the past three years.
Most health care in the jail system is provided by the University of Texas Health Science Center at Houston. Health care cost the county more than $18 million in the past year.
Plans are under way to improve the jail’s health care system. a Dr. Michael Seale, the jail’s medical director, declined to comment for this article.
Thomas, in his letter to the Chronicle, said the jail is committed to becoming “the benchmark for the delivery of correctional medicine nationally” and “will provide efficient, effective and compassionate medical care within the constraints of the jail’s security operations.”
State records show Harris County’s daily jail population averaged more than 9,100 inmates through the first 10 months of 2006. Sixteen percent of those inmates — more than 1,400 — have what the executive director of the Mental Health Association of Greater Houston describes as “a serious mental illness.” Yet the county provides only 51 mental health beds at the jail. The rest are housed in the jail’s general population, although some in solitary cells.
Exacerbating the mental and medical challenges of inmates are rules that ban inmates from bringing their own medicines into the jail. Instead, they must wait for a jail doctor to prescribe them and a staffer to hand them out. For some, that can mean delays in getting crucial care.
The Chronicle attempted to contact the relatives of every person who has died at the jail since 2001, and many of them claimed that inmates were not regularly receiving medications they had been prescribed before going to jail.
Travis McKinney, an epileptic, had not had a seizure in the eight months before his arrest for assault. During the four weeks he was in jail, he had two, the last one fatal.
The 21-year-old’s body was discovered on the cell floor near toilets where investigators say he slept. His anti-seizure medication was on the floor near his blanket. Whether he was getting and taking the medication regularly is unclear, according to the records. Though jail nurses reported they saw McKinney take his pills the night before his death, medical examiner’s records state that “he was not compliant with his medications.”
McKinney had spent substantial time in county mental health facilities and had a known history of epilepsy, leaving his family members to wonder why he was not placed in the jail’s mental health ward — instead of with the general population — where his condition might have been more closely monitored.
Similarly, Leamon Caldwell, 58, died in the jail in February 2006 from hypertension, or high blood pressure. Family members were told that Caldwell refused to take his medication. They suspect he wasn’t receiving meds at all.
Thomas disputes many claims about health care problems as “anecdotal,” adding, “While we would have little reason to question the sincerity of the families and friends in reporting what they have been told by the inmates, we do question the credibility of what the inmates themselves allegedly reported. Inmates will cast their jail experience in the worst possible light in an attempt to gain sympathy.”
He told the Chronicle that every inmate undergoes “medical intake screening” when booked into the jail, and at least 1,000 each month are later assessed by doctors.
Bad conditions reported
Prisoners also claim they have been forced to sleep on mattresses on cellblock floors — sometimes next to toilets. They maintain that the crowded living conditions at the jail are ripe for disease and bacteria, particularly methicillin-resistant Staphylococcus aureus, or staph, a potentially lethal blood infection.
As a result, numerous inmates contend they have contracted staph infections while incarcerated. Jail records show that between January 2001 and April 2005, there were 60 medical quarantines at the jail. The records show at least two of the quarantines were related to staph infections. The causes of 11 other quarantines are not listed.
Many inmates come to the jail already fraught with myriad health problems. If they arrive with pre-existing medical conditions, as many do, conditions at the jail can make matters worse.
In October 2001, inmate Stacy Earl Matlock, 38, died from “complications of cirrhosis of the liver,” according to the autopsy report. The report also notes that Matlock “developed multisystem organ failure secondary to a multi-resistant staph aureus bacteremia.”
In July 2002, according to the autopsy report, prisoner Roland Oliva, 33, died of sepsis, a bacterial infection of the blood.
Concerns by inmates and family members, particularly about sanitation, also have been raised by the Texas Commission on Jail Standards, which found crowded conditions have created sanitation, safety and security issues.
These problems and others at the jail have provoked the scrutiny of the American Civil Liberties Union of Texas, which is concerned about overpopulation, in part because of a slow-moving criminal justice system.
“The size of the Harris County Jail population makes it difficult for jail administrators to manage the (inmates) and provide the necessary level of care that not only is necessary for the inmates but protection of the correctional officers and other staff members,” said Nicole Porter, the ACLU’s jail-project director.
Richard Newby, president of the Harris County Deputies Organization, said overtime demands and manpower shortages force guards to “prioritze” their attention to inmates: “Unless you see something that makes you think there’s something (serious) going on, the standard answer is to tell the inmate” to put it in writing.
Inevitably, some deaths are impossible to prevent. The question is whether some inmates might be saved with more rapid medical response or thorough attention.
David Whitlock, 46, fell from his bunk, collapsed on the floor and succumbed to heart failure three hours later. But records show attempts to treat him before he died might have been obstructed by the lack of proper medical equipment.
According to statements from Debra Alston, the jail’s former head of nursing, an adult-sized breathing tube could not be found on the emergency crash cart, a factor that could have contributed to his death.
Jail officials disagreed with the nurse. She was fired 14 months after asking questions about the death for reasons “both related and unrelated to the allegations” about Whitlock, the sheriff said. Among other things, she was accused of “provoking disharmony,” breaching confidentiality and dishonesty, records show. Alston told the Chronicle her firing was in retaliation for the Whitlock matter.
Thomas said the death was investigated internally by the Board of Nursing Examiners and “closed without recommendation.”
The same, however, cannot be said for Calvin Mack, whose case was among the most troubling, even by the admission of jail authorities.
Final trip to jail
Mack was booked into the Harris County Jail for the final time May 30, 2005. Six days later, he was dead.
His older sister, Harriett Mack, said she tried for years without success to get her brother off the streets and off drugs. But nothing worked. He also had AIDS.
The AIDS diagnosis earned him a bed in the medical division on the second floor of the jail’s 1200 Baker facility in downtown Houston. But five days later, when his condition turned critical, jailers did little to help him, records show.
According to inmate Clifford Olson, several prisoners noticed that Mack was in physical distress while sitting on the toilet. He soon began coughing up blood and bleeding from his rectum. Olson says Mack asked the other inmates to get the attention of the guards.
It was about that time — at the beginning of the overnight shift — that Phillip G. Balthazar came on duty to guard the medical cellblock. Olson and other inmates told him Mack needed medical attention.
“What do you want me to do, get a Band-Aid for his ass?” Balthazar asked the inmates, according to both Olson and a sheriff’s office report obtained by the Chronicle.
During the next several hours, Olson and other inmates continued unsuccessfully to plead with Balthazar about Mack’s deteriorating condition. Mack pulled himself into the showers, which also are used by the other inmates.
“So everybody could see a wide little river of blood going down the drain, being washed out of the shower, for about an hour,” Olson said.
About 2 a.m. Mack began having seizures. It took another 40 minutes for medical personnel to arrive with a gurney — four hours after inmates first called for help.
Mack was taken to LBJ Hospital, where he died from “respiratory distress,” according to the Custodial Death Report.
Three months later, Dr. Ana E. Lopez of the Harris County Medical Examiner’s Office ruled that Mack’s death was an “accident” caused from “intracerebral hemorrhage due to hypertensive cardiovascular disease and cocaine toxicity.” In other words: a brain hemorrhage from high blood pressure and history of cocaine use.
But investigators from the medical examiner’s office were never informed by the sheriff’s office about the delay in Mack’s medical care, she said. Asked whether that might have made a difference in her ruling of an accidental death, she replied, “I’d have to think about that.”
Lopez stressed that Mack’s stroke was massive. She was not sure whether prompt medical attention would have saved his life. “The cause and manner of death would still be the same,” Lopez said.
The sheriff’s office’s internal affairs division conducted its own probe of Mack’s death. Detectives interviewed the 66 inmates who were housed in cellblock 2F1 with Mack, including Olson.
Of those inmates, 32 gave statements similar or identical to Olson’s. Several were given polygraph examinations, which they passed.
“It is clear that Deputy Balthazar was notified by numerous inmates that an inmate under his control was experiencing a medical emergency,” reads the internal affairs report. “It (was) his duty to evaluate and report such a condition in a timely manner. It appears Deputy Balthazar chose not to do so. … This delay in effective intervention may have been a factor which contributed to catastrophic medical results for Mack.”
Balthazar was dismissed Aug. 3, 2005. The termination letter accuses him of a “significant discrepancy” in his statement to detectives and of giving “deceptive” answers during a polygraph exam.
In a report on the incident that Balthazar filed with the sheriff’s office, the deputy concluded that Mack “might be having a bad case of hemorrhoids” and that he immediately notified the medical clinic of the situation.
Contacted by the Chronicle, Balthazar said, “I was in charge of 133 people by myself. If I’d had some help, things might have been better.” He added that he called the jail clinic and was told no one was available to help Mack.
He also denies making the “Band-Aid” statement.
Balthazar now serves as a reserve deputy for the Harris County Precinct 6 Constable’s Office.
The Mack probe also resulted in the demotion of Lt. Christopher Y. Lee to deputy. In his disciplinary letter dated Aug. 9, 2005, Lee is accused of “failing to initiate any type of investigation into the events leading up to and surrounding inmate Mack’s need for medical attention.”
Lee did not return calls from the Chronicle.
Sheriff Thomas said the case was referred to the Harris County District Attorney’s Office. The DA closed it with no action.
According to inmates, there also was little concern for decontaminating the cell after Mack had been taken to the hospital. It took more than five hours before workers arrived with supplies to clean the infected area.
Mack’s sister Harriett expected more.
“I expected them to treat him like a human,” she said.
Houston Chronicle reporter Anita Hassan contributed to this report.