October 9, 2012

When people are arrested and taken to jail, they don’t expect it to be easy. But a stay at the jail shouldn’t include being denied basic treatment for physical or mental health problems. This is why the ACLU of Wisconsin Foundation and Legal Aid Society of Milwaukee have been working through the courts on behalf of all prisoners in the Milwaukee County Jail and County Correctional Facility-South.

A decade ago, health conditions at the Milwaukee County Jail were cause for concern. So much concern, in fact, that a judge ordered a consent decree that required specific improvements in physical and mental health care. The court also appointed a correctional health care expert as a monitor to regularly evaluate whether or not health services at the jail improved and complied with the order.

But since then Sheriff David Clarke has not treated the court decree or the crisis of conditions seriously. The Sheriff has never fully complied with the decree and even cut corners to reduce program costs by not hiring important administrative leaders. Eventually, without adequate administrative help, the existing medical director resigned.

The Sheriff then unilaterally made a decision to outsource the entire medical program to a for-profit vendor. Clarke announced his decision in 2011 without consulting the County Board, the County Executive, the court-appointed medical monitor or legal advocates for the prisoners. The move, which blindsided everyone, exacerbated existing morale problems among remaining health care staff and accelerated an exodus of experienced employees frustrated by the lack of professional medical leadership. It also signaled the chaos engulfing the program, making the prospects of filling the leadership vacancies even more difficult.

Without medical leadership, health conditions at the jail got worse. As the Sheriff’s failure to fill medical leadership positions dragged on, the jail had become an increasingly dangerous place for incarcerated people with serious mental and physical health conditions. 

During an evaluation visit in July, the court-appointed medical monitor personally witnessed several situations that were mishandled by staff. His review of the jail’s medical records also revealed a system that put sick prisoners in serious jeopardy. The medical monitor noted that:

  • A pregnant woman with active mental health disturbances was on the verge of being strapped into a restraint bed and tasered by guards, despite objections from nurses.
  • A nurse was called to a housing unit where a man was vomiting and his eyes rolled back in his head as he complained of severe abdominal pain. The nurse dismissed his symptoms as “alteration of comfort” and sent him back to his bunk. A few days later he required hospitalization.
  • Three prisoners on suicide watch were nearly released without psychiatric clearance.
  • In another case, a prisoner who attempted suicide was sent back to his cell by guards without calling for a psychiatric assessment. 

The monitor’s report showed that the Sheriff was not in compliance with the court’s consent decree and outlines examples of shockingly bad clinical decision-making that likely would not have occurred if there was a medical director or chief psychiatrist to ensure proper oversight and training of medical staff.

But worse yet, there have been four reported deaths of prisoners in the Sheriff’s custody since the jail’s medical director resigned in late 2010. 

One of the prisoners who died was a 51 year old man with serious psychiatric problems that were well known to the jail where he had been incarcerated several times over the years. Because of hallucinations and threats of suicide, he was placed in the psychiatric observation unit. Inexplicably, he was put in a cell without running water. He stopped eating and though he was seen by a psychiatrist and social workers, his level of hydration was never checked and he was never referred to a medical doctor. He was never sent to the hospital even after he had not eaten for four days. He died 13 days after arriving at the jail.

The medical monitor concluded that the man’s fluid intake should have been monitored and he should have been seen by a physician or sent to a hospital after multiple days of not eating. These steps might have lead to earlier intervention that could have prevented his death. It is unclear whether this or the other deaths were truly preventable, but the deaths are cause for serious concern.

In addition to the monitor’s report, as lawyers working on behalf of the prisoners at the jail, we have seen how dangerous the conditions at the jail are. During tours, we have seen clearly psychiatrically disturbed prisoners locked in solitary confinement cells intended for discipline, not treatment. We have heard numerous accounts of long delays in receiving crucial medications and other treatment. One psychiatrist blatantly stated that he takes prisoners off of medications that have controlled their symptoms because jail should be unpleasant.

Conditions at the jail have to improve. But while Sheriff Clarke is willfully out of compliance with the court’s consent decree, these dangerous conditions will continue as long as the jail lacks adequate medical staff who can treat people who are physically or mentally ill like patients, not like criminals.

The Milwaukee County Board took some action when it directed the Sheriff to transfer prisoner health services to the County Department of Health and Human Services, an arrangement that has been successful in other jails around the country. Earlier this year, it seemed that the agreement was moving forward. But after months of work by DHHS and Sheriff’s department staff, Sheriff Clarke sabotaged this process by hiring his own lawyer in May to file a motion to dismiss the consent decree in an attempt to eliminate objections from the medical monitor and obtain court blessing to act unilaterally to outsource health services. 

The Sheriff’s action reveals a grandiosity that would be comical, were the consequences not so dangerous. The Sheriff insists that he “has no superior” in the County and that he need consult no one in deciding how to manage the jail’s medical staffing. When we tried to arrange a meeting to discuss how the Sheriff might work with the monitor to design a contract that would satisfy the requirements of the decree, the Sheriff’s lawyer blustered that the medical monitor – who was appointed by the court, not at the pleasure of the Sheriff – “is hereby directed to stand down.”

Last week, Legal Aid Society of Milwaukee and the American Civil Liberties Union of Wisconsin Foundation asked the Milwaukee County Circuit Court to order Sheriff Clarke to hire a medical director and chief psychiatrist. We asked the court to require that prisoners with serious medical and psychiatric problems be held elsewhere if the Sheriff fails to find a solution to the stark health conditions in the jail within two weeks.

The Sheriff’s stubborn insistence on having his way, despite the warnings of the medical monitor and what appeared to be a workable solution to get medical staffing back on track, has left us with no choice but to invoke the powers of the court to protect the basic human rights of Milwaukee County’s prisoners. If the Sheriff refuses to comply with a court order, he must be held accountable for his willful contempt of court. The law allows the court to impose daily fines or even imprisonment until the disobedience ends. Perhaps a stay in his own jail would give Sheriff Clarke food for thought.

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