In Texas jails, deaths from failure to give proper medication are shrouded in secrecy

Days after Thanksgiving, an incarcerated man at the Dallas County Jail collapsed as he waited for breakfast. As he fell, he hit his chin and broke his ankle. When he woke up, he was on a gurney being rushed to the Parkland Hospital emergency room.

He was confused about why his body suddenly gave out, but blood and urine tests uncovered that he was erroneously prescribed a medication that significantly lowered his blood pressure, causing him to faint.

“I have never had any physical problems requiring any medication,” he wrote in a letter to the Texas Commission of Jail Standards, which was obtained by the Star-Telegram.

His case is not unusual in Texas, according to lawyers across the state.

The No. 1 complaint received about state jails by inmates and their families is that incarcerated people are not given the medications they were prescribed prior to being detained, said Krish Gundu, executive director of the Texas Jail Project. The nonprofit advocacy group based near Houston works to ensure incarcerated Texans are being cared for properly.

The second most common complaint is that incarcerated people were prescribed the wrong medication once they were in jail. They were either given different psychiatric medications or – like the Dallas County man – were given medications they hadn’t previously taken.

These complaints are sent to and investigated by the Texas Commission on Jail Standards. Often, the commission closes the complaints by saying it will not go against the recommendations of medical professionals who treat inmates in jails.

The Dallas man’s complaint has not been resolved by the commission yet. He has since been released from the Dallas County Jail, but his story is a striking example of what can happen when proper medications are not given. He’s also one of the lucky ones – some people end up dead.

The full scope of how many people are injured or die in Texas jails because of these problems will likely never be known, Gundu said.

“How many of those deaths that are listed as ‘natural’ turned out to be people who didn’t get their medication?” Gundu said. “If they were not incarcerated and they were taking their medications, would they still be alive?”

The issue is not limited to the Dallas County Jail. The system is convoluted between jails, hospitals, county mental health services and other players, making it difficult to determine who is at fault when someone isn’t properly medicated. But, according to advocates, this problem can be fixed.

“I think, by and large, this issue comes down to resources and funding,” said Greg Hansch, executive director of the National Alliance on Mental Illness Texas. “I believe that there needs to be funding made available to county jails, to ensure that people are getting the right medications, and that may be through a group purchasing agreement, or giving them access to the same prescription drug formulary that is made available in state hospitals.”

Sometimes, it leads to death

Javonte Myers started having seizures when he was 18.

His mom, Sondrea Miller, estimated he’d gone to a hospital at least a dozen times. Despite his hospitalizations, Myers knew how to handle his disorder. He took his medications and managed the best he could while he bounced from couch to couch because he didn’t have a permanent home.

Ten years after his diagnosis, a seizure killed Myers in a Tarrant County jail cell on June 19, 2020. Three days earlier, jail officials had taken him to JPS Hospital because of another episode, his family said. Records from Myers’ intake show that jailers knew about his seizures and mental health disorders.

“Why couldn’t they have left him in the hospital? Or let him go?” Paul Miller, his step-father, said after Myers’ death. Myers had been arrested on a charge of criminal trespass, often used against people experiencing homelessness.

His parents feared Myers didn’t get his medicine and that he wasn’t checked on frequently enough. Their fears were confirmed a year later when the Texas Rangers released an investigation that revealed two jailers lied 20 times about checking on Myers. The jailers were criminally charged.

Myers’ death is an example of how these cases can be under-reported, because his was classified as natural causes due to a seizure disorder. That determination does not leave room for causation – whether someone had a disorder that was previously managed with medications that they were not given in jail.

And some deaths don’t receive such a thorough investigation Myers’ did.

“Jail staff act as gatekeepers to medical care, and their first response to any request for medical care is to allege that the incarcerated person is ‘faking it’ and to keep denying until sometimes it’s too late,” Gundu said.

Tarrant County in-custody death reports for seven additional natural deaths in 2020 do not mention whether the deceased was receiving medication before or during their stay at the jail. Of the deaths, three were people under the age of 40 who died of a heart condition.

Since 2019, at least 41 deaths at the Tarrant County Jail where an autopsy was performed have been attributed to natural causes, two of them related to COVID-19. (Most known COVID cases never went before a medical examiner.) The cause of about a dozen other deaths have not yet been determined.

In Dallas County, 55 incarcerated people have died of natural causes in that time, according to state data.

Hansch, the executive director of the National Alliance on Mental Illness Texas, agrees that the number of natural deaths related to mismanaged medications is underestimated. But he would go as far as extending that to suicides – 18 have been reported in the Dallas and Tarrant jails combined since 2019.

“There have been some very high profile suicides in Texas jails,” he said. “I think it is entirely within the realm of possibility that some of those suicides may have been prevented if people had been receiving appropriate mental health services, including but not limited to mental health medication. So how big of a problem this is isn’t clear.”

Dr. Eli Shupe, an assistant professor in the Department of Philosophy and Humanities at the University of Texas at Arlington, toured the Tarrant County Jail on Dec. 20 with other members of the Fort Worth Friends Meeting.

Shupe is a biomedical ethicist and was particularly interested in inmate care. She said she was impressed by the number of dialysis machines she saw at the jail but was concerned about the lack of access to some other interventions.

“It sounds like there are a lot of medications that they won’t dispose of to prisoners, and if you’re taking those medications and you end up in Tarrant County Jail, you’re just going to withdraw,” she said.

As the group walked through a section of the jail that housed women, Shupe said, she could hear at least one woman yell, “They’re not giving us our medications.”

Shupe said that when she pressed jail officials about their medication and detox policies, “I was just told that JPS has all of that and I would have to make a public information request.”

Who is responsible?

Stacey Gordon-Johnson testified in front of the Texas Commission on Jail Standards that she did not receive her medications during the 10 days she spent at the Tarrant County Jail in July.

When asked about the allegation, a jail spokesperson referred the Star-Telegram to JPS, stating, “all medications are distributed by John Peter Smith Hospital staff who work in our jail 24/7.”

A hospital spokesperson sent the reporter a statement that said, “JPS Health Network provides health care for inmates at the Tarrant County Jail and the procedure includes a health screening when individuals arrive at the facility. Due to patient privacy rules, JPS cannot comment on individual medical cases.”

Recently, a JPS spokesperson said “All inmates upon arrival to the jail are screened by an RN and evaluated for any medical conditions present upon arrival. Although inmates may bring in outside prescribed medications, the staff may only administer those medications that are prescribed for administration by the jail clinical providers.”

When jails are confronted with questions about the health care they provide to inmates, they routinely refer to the local hospital – including when Houston reporters questioned why a 28-year-old man died of diabetic ketoacidosis five days after he was booked into the Harris County Jail.

Yet hospitals won’t release detailed information, citing that they cannot disclose personal information about patients.

Hansch argues that everyone is responsible for inmate care.

“We have a patchwork of different actors in this system,” he said. “We have community mental health providers, we have state hospitals, we have sheriffs administering county jails, and we have the state criminal justice agency, so I think that the bug gets passed around when it comes to who to blame or to point the finger at. I think it’s the collective system’s responsibility.”

That type of set-up makes it difficult for families to hold one particular agency or group responsible for their loved one’s care. Gundu said there’s already no recourse for families because the state commission on jail standards “has no teeth to enforce any of their minimum standards.”

“Once irreparable harm has been done, all the agency can do is find the jail non-compliant, but often even that is an impossible challenge when a privatized medical provider in the jail decides to cut corners on prescription meds or essential lab work, tests and procedures,” Gundu said.

The Texas Commission on Jail Standards did not respond to requests for an interview.

The patchwork system can also make it difficult to affect change.

Rich Forbus, vice president of program development for the National Commission on Correctional Health Care, said jails should establish best practices that match clinical regulations set by the American Medical Association.

The NCCHC is an accreditation agency that ensures jails are operating their medical and mental health services within constitutionally accepted standards.

Tarrant County is not an accredited jail with the NCCHC. The majority of Texas jails aren’t, because they are regulated by the Texas Commission on Jail Standards, Forbus said. Of the 240 county jails in the state, only five counties are accredited through the NCCHC. The group does not identify those jails without permission.

In 2022, the Tarrant County Jail hired a nurse liaison who “advocates for inmates and serves as a liaison between the medical provider, John Peter Smith Hospital, and the Sheriff’s Office,” spokesperson Robbie Hoy wrote in an email.

The liaison does not administer medications, and jail officials did not respond to a request to interview her.

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