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Judge ends Morgan jail oversight, says mentally ill inmates at 'substantial risk'

Decatur Daily - 9/5/2018

Sept. 05--Even as he ended 17 years of court oversight of the Morgan County Jail, a federal judge found the jail's treatment of its many inmates with mental health issues creates a substantial risk of serious harm.

U.S. District Judge Abdul Kallon last week terminated the remaining two provisions of a 2001 order that at one time governed everything from staffing to health care to library supplies. The order was amended in 2009, when Greg Bartlett was sheriff, to specifically prohibit the sheriff from pocketing leftover money designated for the feeding of inmates. That provision, along with many others, was terminated last year.

The two provisions of the order that Kallon terminated last week involved the handling of mentally ill inmates and the use of prescription medications for inmates. Defendants in the case included the sheriff and the Morgan County Commission.

Sheriff Ana Franklin's lawyer in the case, Barney Lovelace, said the jail had been subject to various consent decrees since 1996.

"Sheriff Franklin is the first sheriff in 22 years to not be subject to the supervision of the federal courts," Lovelace said of the sheriff, who will leave office in January. "That is a great accomplishment and will save the county a significant amount of money in the future."

The jail inmates who were plaintiffs in the case were assisted by the Atlanta-based Southern Center for Human Rights. Aaron Littman, a lawyer for the center, said the sheriff's legal victory did not erase the judge's findings.

"The sheriff and the county were made aware over the course of this litigation that they were providing substandard mental health care; Judge Kallon's findings confirm as much," Littman said. "Although the consent decree is no longer in effect, the sheriff and the county know that they have fallen short.

"Going forward, they may be liable for failing to ensure that persons with mental illness in their custody receive adequate assessment and treatment."

Franklin said the consent decree would not have been terminated but for improvements she's made at the jail over the last eight years. While there will be financial savings, she cautioned that it would be a mistake to unravel advances she and her staff have made.

"The goal is to operate a constitutionally sound, safe environment for the inmates as well as the employees," she said Tuesday in a text. "I would hope that the commission and the upcoming sheriff would understand the dangers of going backward."

The plaintiffs argued that psychiatric staffing is inadequate, that the jail fails to refer mentally ill patients for treatment upon intake, and that its practice of immediately discontinuing prescription medications for those inmates who test positive for illegal drugs is dangerous.

A psychiatrist who testified on behalf of the inmates concluded the jail's practices in each of these three areas created substantial risks of serious harm for inmates, and the judge agreed. But those findings, he ruled, were not enough to allow the consent decree to remain in place.

Dr. Kelly Coffman was the only psychiatrist to testify at the October hearing in which Franklin sought to terminate the last two provisions of the consent decree. Kallon said he accepted Coffman's testimony as accurate.

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According to Coffman's testimony, the jail had 125 mental health patients during her review last year, but the jail's psychiatrist only visited the jail about five hours per month and spent an average of six minutes with each patient he examined during his visit.

This limited psychiatric care meant that only about 27 of the 125 inmates needing mental health treatment were receiving it on a monthly basis, and they were not receiving any psychiatric medications until an initial consultation that would take place, at the earliest, one to six months after they entered the jail.

Coffman's testimony, Kallon ruled, supports a finding that inadequate psychiatric staffing at the jail creates a substantial risk that mentally ill inmates will harm themselves or others.

Coffman also was critical of the jail's process for referring new inmates for psychiatric treatment, a process she said "essentially does not exist." Even when jail personnel identified detainees as displaying signs of severe mental illness, she said, some were not referred for psychiatric treatment. The only way these inmates could get the treatment was through a sick-call procedure that requires a co-payment before they can see a nurse. The nurse could then place the inmate on a lengthy waiting list to see the psychiatrist.

Coffman testified that requiring mentally ill inmates to request treatment often is unrealistic, especially in a jail setting.

The jail's failure to refer detainees displaying signs of serious mental illness at intake creates a substantial risk of serious harm, Kallon ruled.

A jail policy, according to Kallon, prohibits new inmates who test positive for controlled substances "from receiving any psychiatric medication for 30 days." According to the psychiatrist, this can cause dangerous withdrawal symptoms for those inmates who have been taking the prescribed medications before incarceration.

"In the case of benzodiazepenes (such as Valium or Xanax), these include life-threatening fluctuations in blood pressure and heart rate that can cause seizures or death," Kallon said in recounting the testimony, risks that are increased because of the "long wait before detainees can receive a new prescription or treatment for withdrawal symptoms."

Franklin said the discontinuation of medications for those who have been using street drugs is carefully monitored by medical professionals.

"So far -- even with the increasing numbers of inmates and the mental health and substance abuse crises that jails are dumping grounds for -- we have not had a suicide in our facility, nor lost someone from a detox or drug-related overdose or mismanaged medication reaction," Franklin said. "... We are extremely proud of the work that the medical staff and jail employees do in an attempt to take care of our people that are housed in our facility."

Coffman also was critical of the jail for a policy that does not allow for automatic follow-up appointments with a psychiatrist, which effectively means the mentally ill inmate must seek the follow-up appointment on his own. This practice also creates a risk of serious harm, Kallon ruled.

While Kallon agreed with the plaintiffs that the jail's mental health care was dangerous for detainees, he said the sunset provisions of the federal Prison Litigation Reform Act required him to end judicial oversight.

The 2001 order had to be terminated, he ruled, unless evidence was presented that jail officials "acted with deliberate indifference to a harm or risk of harm."

"While the court is concerned by the evidence of inadequate mental health care at the jail, the plaintiffs have failed to satisfy their burden of showing that defendants were deliberately indifferent to the risks of inadequate care," he wrote.

Franklin said the ruling was a vindication of her two terms in office.

"Generally the ruling is confirmation that the changes that have been made in our jail are those that were in the best interests of all involved and were constitutionally sound," Franklin said. "... I am very proud of the staff that has made the changes needed to accomplish this goal. We no longer have a stain of the past issues, and should be able to move forward in a good direction for the future."

-- eric@decaturdaily.com or 256-340-2435. Twitter @DD_Fleischauer.

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(c)2018 The Decatur Daily (Decatur, Ala.)

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