Death behind bars: Inmate suicides, overdoses among causes

As an officer escorted Douglas Ramsey to a phone at the Polk County Jail in 2013, he sprinted away and slammed his head into a concrete wall so hard that he later died from the injury.

Tana Lekin, an inmate in the Jones County Jail who was presumed drunk or high, was placed in a holding cell in March 2015, where she died of self-strangulation. At least 14 minutes elapsed from when Lekin failed to respond to a check and when jailers entered her cell to offer assistance, records show.

In March, Lamont Walls, a 38-year-old Des Moines resident, died in the Polk County Jail. Officials say he ingested drugs before his arrest, one of several other Iowa inmates whose deaths resulted from drug overdoses or other medical conditions.

Ramsey was jailed for interfering with police, Lekin for burglary and Walls on drug-related charges. What the three deaths have in common are lapses in prisoner oversight, critics contend.

Detailed, up-to-date data on all Iowa inmate deaths are elusive. But an analysis by The Des Moines Register, relying on public records, lawsuits and news stories, shows at least 19 Iowa inmates have killed themselves since Jan. 1, 2013. Among them are five state prisoners and 14 county jail inmates, including five who took their lives from October 2015 through April at jails in Jasper, Page, Grundy, Madison and Washington counties.

Law enforcement officials deny any fault. But the president of the state’s largest sheriffs’ organization issued a dire prediction in response to questions about the incidents: More problems are on the horizon.

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The U.S. Department of Justice estimates that the majority of inmates in federal, state and county correctional facilities have mental health issues. And with Iowa’s closure of mental health facilities in Clarinda and Mount Pleasant in the past year, law enforcement agencies are increasingly stressed, said John Godar, president of the Iowa State Sheriffs’ & Deputies’ Association and a major for the Linn County Sheriff’s Department.

“The jails are doing the best they can, but this is a mental health crisis, and we’ve got the state shutting down mental health facilities,” Godar said. “Where do those people go? Jail. And the jails are being tasked to do more than they were ever designed to do.”

A special report issued in August by the U.S. Bureau of Justice Statistics shows that 967 inmates died in county jails and local lockups nationwide in 2013, the most recent year for which data are available. Illness was the leading cause of death, accounting for about half. Next came suicides, which amounted to just over one-third of fatalities. Drug or alcohol overdoses resulted in an additional 7 percent.

The report listed Iowa's local jails as having the fifth-highest inmate mortality rate in the U.S. for 2013. Deaths at state prisons were not included in that rate.

Just because the number of cases is relatively static doesn’t mean the problem should be ignored, said Dave O’Brien, an attorney from Cedar Rapids.

O’Brien represents the Lekin family and has filed a wrongful death lawsuit against Jones County. Failure to properly identify or monitor suicidal inmates violates the responsibilities of law enforcement, results in needless deaths and injuries and can be costly to taxpayers, who are potentially liable for jury awards and settlements, O’Brien said.

Godar insists that jail staff have been better trained in recent years in how to process inmates with mental health issues. But he also notes that jails are designed to hold people who are serving minor sentences or those awaiting trial, not as a repository for people who require mental health care.

“You have to watch these folks extremely closely, and that’s not always happening,” he said.

“These people need treatment,” Godar said. “Yes, they’ve committed a crime, and they’ve got to answer to that. But how do we stop the cycle if we don’t get them the mental health assistance they need?”

Godar continued: “Who is at more risk to commit suicide? People with mental health issues. And now that you’ve put them in a jail or prison environment instead of a treatment environment, I just think it’s a recipe for disaster.”

Longtime concerns

Inmate safety has been a longtime concern globally, and mental illness a common complicating factor.

The World Health Organization, for example, has long advocated that prisons treat mental health issues, partly as a way to reduce recidivism.

In Iowa, former Gov. Tom Vilsack in 2003 asked for the state ombudsman to review two deaths at the Anamosa State Penitentiary. The ombudsman ultimately reviewed four Iowa prison deaths and concluded that, in each case, the inmate had mental health issues and had been placed on heightened observation status before suicide or severe self-mutilation.

Iowa's prison system evaluates each inmate taken into custody for physical and mental health needs.  The system also has a detailed placement and treatment program to assist inmates with mental health needs.

But the ombudsman’s task force recommended several improvements, all involving prisoners with a history of self-harm. One inmate died from a heart attack while being restrained; one died from asphyxia while obstructing his airway with his underwear and toilet paper, and another blinded herself with her finger while in solitary confinement. A fourth inmate died of unknown causes, but authorities noted that they could not rule out an acute dose of the anti-depression drug Doxepin because of inconsistencies in blood and urine testing.

Among the recommendations: constant access to emergency mental health care; expanded jail staff training, specifically in areas dealing with inmates who suffer mental illness; and development of a system to report and investigate all jail deaths.

The Iowa Department of Corrections responded by implementing most of the recommendations, the final 2004 report shows.

New studies: Problems persist

Ombudsman assistant Eleena Mitchell-Sadler is a former training specialist for Iowa’s Corrections Department and worked with that agency as it addressed the issues cited in the report. Additional training was one of the department’s key responses, she said.

A dozen years after that report was released, it's difficult to make broad statements about whether Iowa’s prisons uphold best practices, because the office is complaint-driven and generally focuses on individual cases instead of possible systemic issues, noted Bert Dalmer, another ombudsman assistant.

But in smaller follow-up studies and annual reports, the office has found that problems persist.

The group’s latest annual report, for example, shows that in the past five years, the office was involved with 411 complaints filed against the state Corrections Department alleging adverse issues resulting from mental illness.

In 2009, the office published findings of its investigation into the use of restraint chairs on inmates in Appanoose, Jefferson, Polk, Wapello and Woodbury county jails. That report showed widespread use of the devices on inmates who caused minor disruptions. It noted cases where inmates with known mental illnesses were restrained without attempts to seek medical or mental health care, leading to extended use of the devices.

One of the ombudsman’s recommendations in 2009 was that jails expand their mental health screenings to better determine which inmates need outside professional help. The office hasn’t tracked adoption of the expanded screening, which involved a list of  questions to be asked of inmates.

“The one thing that has not changed is that jails and prisons are still the warehouses for the mentally ill,” said Kristie Hirschman, acting ombudsman.

Has inmate care eroded?

After a suicide two years ago, Polk County, the state's largest county-operated lockup, with 1,500 beds, redesigned what is known as a preclassification unit, where inmates generally are housed during their first three days. Gone from that unit are individual cell doors. Instead of two beds, there are four bunks. Jail staff check on inmates in the unit every 15 minutes, instead of the standard 30-minute checks.

The first 72 hours of incarceration are considered the highest risk for inmate suicides. Sgt. Brandon Bracelin of the Polk County Sheriff's Office said more frequent checks and more inmates to a cell increase the chances someone would spot a suicide attempt and alert jail staff.

Polk County Jail recorded 23 suicide attempts or suicide prevention measures taken — such as placing inmates in a padded cell — in 2013, 18 in 2014 and 15 last year, information obtained through a records request shows.

"We do everything we can to prevent inmate suicides," Bracelin said.

Sen. Rich Taylor, D-Mount Pleasant, believes that the overall care of inmates with mental health issues has eroded in recent years due not only to the 2015 closures of the two state-run mental health facilities, but also the closure of a prison mental health facility at Fort Madison in 2013.

Gov. Terry Branstad’s administration closed the $26 million, 200-bed mental health facility after 10 years of operation as part of a restructuring tied to building a new prison in Fort Madison. The administration says the changes resulted in better care with the addition of two prison psychiatrists and improved supervision.

The now-closed prison mental health facility was built as part of an agreement to settle a federal lawsuit after U.S. District Judge Donald O’Brien criticized conditions at Fort Madison. The judge in 1997 described grim scenes among mentally ill inmates, including those who covered their cell walls with feces and collected urine to throw at prison staff.

Branstad responded at the time by calling O'Brien a “liberal, activist federal judge” who was too worried about inmate rights.

'We're not getting help for these prisoners'

The Bureau of Justice Statistics data include no information to assess whether mental health facility closures have contributed to more jail and prison deaths or whether mental illness was a factor.

But Dr. Harbans Deol, the Corrections Department's medical services director, said the closures of the two state-run mental health facilities and the Fort Madison prison mental health facility, both cited by Taylor, have not caused more problems.

The state in the past six years has provided a two-day training course for nearly all prison employees to help them assist prisoners who suffer from mental illness and to de-escalate tense situations. That training did not exist previously, Deol said.

“We want our employees to understand that people who are mentally ill have a biological basis for it, and sometimes an inmate's behavior may be a symptom of a mental illness,” he said.

Reforms have also limited use of seclusion and restraints, he said.

Ben Hammes, a spokesman for the governor, said he is unaware of complaints from sheriff's departments that the mental health closures resulted in more problems at county jails. Hammes said changes supported by the governor have helped law enforcement better identify health care facilities that have available space for patients with mental health issues.

Iowa medical facilities have 721 psychiatric inpatient hospital beds. A spot check by the Register last month found that 52 were available statewide.

Amy McCoy, a spokeswoman for the Department of Human Services, said both of the closed mental health facilities had fewer than 25 beds for adults with mental health issues. DHS officials believe the closures have caused limited disruptions in care. But she said the agency has heard from law enforcement with concerns about travel times and cost.

“There were always transportation needs,” McCoy said. “But, that said, we continue to examine where the bed needs are.”

Godar, president of the sheriffs' and deputies’ association, said driving time to place inmates in appropriate mental health facilities sometimes is as long as four hours. That has resulted in extra cost, care delays and loss of law enforcement time that could be focused on other public safety issues, he said.

Taylor, the senator, noted examples such as Lee County, where monthly transportation costs have increased by thousands of dollars, which he attributes to the closures.

Taylor acknowledges that the impact can be difficult to assess because dozens of local and county governments are involved. He has said he will ask the state’s Legislative Services Agency to study the matter.

“It’s ridiculous,” Taylor said. “We’re just putting another tax on the taxpayers, but the worse problem is, we’re not getting help for these prisoners, either.”