Joy
06-24-2002, 06:41 AM
Experts portrays Texas prisons as horrific home for mentally ill
Psychologist's report is biased, ill-founded, flat wrong, state officials say
By Mike Ward
AMERICAN-STATESMAN STAFF
Sunday, June 23, 2002
Some mentally ill prisoners suffer their inner torment without proper medication or supervision. Others receive little meaningful
treatment even when they are suicidal. And when nurses hand out pills, they sometimes poke them through food slots or kick
them under cell doors in a way that allows unstable prisoners to hoard and abuse the drugs.
Those were among the findings of a 42-page report made public last week that portrayed Texas prisons as a horrific home for
perhaps thousands of mentally ill criminals, a place where those Texans who are unable to control themselves are kept locked
in isolation cells.
Keith Curry, a Washington-based psychologist issued those findings in a report he prepared for prisoners' attorneys in the
just-closed Ruiz prison reform lawsuit. Curry, who works for Applied Forensics LLP, is an expert witness who has worked on
prison mental-health cases in several other states.
His views challenged assertions by state officials that medical care in Texas prisons is adequate, proper and much improved.
Those officials immediately branded the report as inaccurate, biased, ill-founded -- and just flat mistaken.
"The provision of mental health care in Texas prisons is abysmal," Curry said Thursday. "People who are coming out of this
system are infinitely worse than when they went in. A system like this is not good for (inmates) and not good for Texas."
Curry's credentials drew criticism from prison and medical officials, who noted that Curry is a psychologist and not a medical
doctor. They cast Curry's report as inaccurate and exaggerated. While isolated problems may remain, they said, mental health
care for convicts is good -- much better than even just a few years ago.
"All of his adjectives are overblown and emotion-stirring," said Carl Reynolds, general counsel for the Texas Department of
Criminal Justice. "It's sort of a hatchet job. . . . We believe the system is not like he pictures it."
The Brockman case
But the picture would be familiar to Cynthia Brockman, a Grand Prairie woman who appealed to a legislative committee to do
something about the plight of her mentally ill son, a murderer who suffers from a bipolar disorder.
Christopher Brockman was 15 when he started hallucinating. Consumed with anger, he would punch his fists through his
bedroom walls. The drugs he took for treatment seemed to worsen his condition.
"Chris would break down and say, 'I don't know why I can't control myself,' " Cynthia Brockman said.
He entered the Texas prison system three years ago at 17 after killing his best friend's stepmother. He stabbed her 42 times,
bending the blade of a pocket knife in the process.
Except for his life sentence, there was little certainty about his existence inside prison. He moved through a maze of treatments
and care.
"I was afraid my son was going to die," his mother said.
Despite warnings from a consulting psychiatrist in Dallas about the treatment, the youth began taking the anti-depressant drug
he was on at the time of the murder. His anger flashed again, and he ended up in an isolation cell for a week. He was switched
from drug to drug, nine in all, before winding up at the Skyview prison psychiatric hospital near Rusk, dazed and emotionally
unstable.
His experience mirrors notations in Curry's report. Curry concluded that large numbers of seriously mentally ill inmates are in
administrative segregation -- isolation cells. This punishment, which can make their illnesses worse, leaves inmates trapped in
isolation solely because their illnesses prevent them from correcting their behavior enough to qualify for less restrictive quarters.
Curry reviewed the records of 68 convicts who had been in segregation from one month to 17 years. The average was 5.2
years.
In all, prison officials say, a little more than 6,700 mentally ill inmates are in administrative segregation statewide.
Curry reported finding mentally ill convicts whose medication had been improperly halted and were too disoriented to appeal.
A shortage of trained staff meant that mentally ill inmates weren't properly monitored by prison medical personnel. Routine
blood tests weren't taken or logged into medical records, despite a requirement that tests be given with certain drugs. Inmates
suffered painful and debilitating side effects from their drug treatment, but received no proper treatment in response.
Among his findings:
* At the Robertson Unit outside Abilene, seven of 19 convicts in segregation cells were "found to be significantly neglected,"
including a 45-year-old man with chronic paranoid schizophrenia "found in a decompensated psychotic state. . . . There could
be no question that his decompensation was long and tortured. He clearly belonged on an in-patient psychiatric unit."
* Robertson, as well as the Lewis Unit near Woodville and the Smith Unit near Lamesa, had "very serious failures" in
treatment, "which illuminate systemic problems." Curry's examples: At Robertson, a 28-year-old convict was "floridly psychotic
and deteriorating." His medicines had been cut off after he refused to have blood drawn from his left arm, which was "severely
mutilated from multiple self-inflicted lacerations."
At Lewis, Curry reported finding 40 severely mentally ill convicts, even though prison officials had decreed that the mentally ill
would not be housed there. As a result, the medical staff was unable to provide the proper care.
* At the McConnell Unit near Beeville, Curry said that out of 25 medical records reviewed, one had a barely adequate
treatment plan and the other 24 contained plans "that were uniformly meaningless and outdated. . . . It is widely and in many
cases officially recognized that the absence of individualized treatment planning suggests seat of the pants treatment."
Even so, he credited the McConnell staff with defusing "potential crises through verbal interventions cell side in a commendable
way not seen at other units."
* At the Coffield Unit near Palestine, he observed medications being dispensed in paper cones passed through the bars of cell
doors with no attempt to watch inmates swallow the pills. "The nurses observed sometimes did not even break stride" as they
proceeded down the tier. "This practice allows inmates to do whatever they please with the medication, including hoarding or
disposal, and precludes any meaningful monitoring of compliance."
Curry said the practices "hamper the effective care of treatment-resistent inmates and create a market for dangerous drugs
within the facilities."
Prison and prison medical officials flatly disputed Curry's findings. They view him as a hired-gun psychologist, not a medical
doctor, who offered medical opinions. They say he did not report his medical concerns to doctors at the time of his tours. And
he made assumptions about the system as a whole after touring just a few prisons.
"The fact that he has a personal agenda does not make him a credible source," said Chris Comer, public affairs director for the
University of Texas Medical Branch in Galveston, which provides health care for about 80 percent of Texas' approximately
140,000 convicts. "Since he has clearly stated from the outset that he is opposed to administrative segregation, his report is
extremely biased. What's more, he offers no alternatives for those whose dangerous behavior -- to themselves and others --
necessitates this type of housing and who will not voluntarily remain in an inpatient facility."
Prison spokesman Larry Todd said, "We think all of our health care is comparable to what is available in the free world."
A product of Ruiz case
Despite its harsh conclusions, Curry's report was little more than a footnote in the Ruiz case by the time it ended last week.
Plaintiffs' attorneys said they expected the 5th U.S. Circuit Court of Appeals to close the case if U.S. District Judge William
Wayne Justice did not. So they agreed a few weeks ago with state officials not to contest the closure. Had they chosen to fight,
Curry's report would have been used as evidence of continuing problems that warranted keeping the case alive.
"Despite improvements, dehumanizing conditions for the mentally ill continue to be a problem," said Donna Brorby, a California
attorney who represented prisoners in the Ruiz case.
She said that although fewer acutely psychotic convicts were found in administrative segregation during Curry's recent visits
than were there four years ago, conditions remain "punitive and destructive."
In August, in an order, Justice had called Texas' administrative segregation cells "virtual incubators of psychosis." The housing
of mentally ill inmates in administrative segregation was one of three issues the court continued to monitor in Texas prisons
during the past year. Other issues were use of force by guards and protection of prisoners against predatory practices by other
prisoners.
Originally, there had been a long list of issues that required monitoring after Justice ruled in 1980 that confinement inside Texas
prisons constituted cruel and unusual punishment.
The Ruiz case, which spanned nearly three decades, led to an overhaul of the Texas prison system.
Comer noted that the dismissal of the Ruiz case validated that "all care being provided, including mental health care, is
'satisfactory.' So Keith Curry's characterization of the care being provided to mentally ill inmates is not consistent with that of a
neutral, third-party legal authority."
Curry said he stands by his report. He and others argue that the mental-health system in Texas prisons is shortsighted and
wasteful. Other states, they say, have found that providing proper mental-health care to prisoners actually saves money -- from
assaults on staff by uncontrollable prisoners, from high staff turnover rates because of dangerous working conditions, from
lawsuits and from high recidivism rates because the mentally ill leave prison relatively untreated.
They cite examples such as Michigan, which has eight levels of mental-health care, including special-treatment units, designed
to keep the mentally ill out of regular prisons and isolation cells. Arizona offers a full array of mental-health services that
emphasize "continuity of care," which covers prisoners who are mentally ill but not ill enough to require constant medical
treatment and sophisticated programs for those held in administrative segregation to ensure their illnesses are not worsened by
isolation. Florida, Virginia, California, Pennsylvania and Oregon are among other states that offer specialized care for mentally
ill prisoners that Texas does not.
At present, Texas spends more than $297 million annually on prison health care -- and indications are that tab could run higher
as costs of care, including mental health care, continue rising.
"Texas is penny-wise and pound-foolish," Curry said. "You have a chronic schizophrenic who assaults someone and winds up
with a 10-year sentence, enters the Texas prison system and has problems coping, ends up in a windowless cell and refuses his
meds because he's paranoid and does his last eight years in isolation. He gets out of prison and comes back to live in the
community. Is the public safer? Or would it have been better to provide that man treatment while he was in prison?
"You tell me what makes more sense? What's happening in Texas is not good for the public and it's not good for the inmates
who are mentally ill."
Psychologist's report is biased, ill-founded, flat wrong, state officials say
By Mike Ward
AMERICAN-STATESMAN STAFF
Sunday, June 23, 2002
Some mentally ill prisoners suffer their inner torment without proper medication or supervision. Others receive little meaningful
treatment even when they are suicidal. And when nurses hand out pills, they sometimes poke them through food slots or kick
them under cell doors in a way that allows unstable prisoners to hoard and abuse the drugs.
Those were among the findings of a 42-page report made public last week that portrayed Texas prisons as a horrific home for
perhaps thousands of mentally ill criminals, a place where those Texans who are unable to control themselves are kept locked
in isolation cells.
Keith Curry, a Washington-based psychologist issued those findings in a report he prepared for prisoners' attorneys in the
just-closed Ruiz prison reform lawsuit. Curry, who works for Applied Forensics LLP, is an expert witness who has worked on
prison mental-health cases in several other states.
His views challenged assertions by state officials that medical care in Texas prisons is adequate, proper and much improved.
Those officials immediately branded the report as inaccurate, biased, ill-founded -- and just flat mistaken.
"The provision of mental health care in Texas prisons is abysmal," Curry said Thursday. "People who are coming out of this
system are infinitely worse than when they went in. A system like this is not good for (inmates) and not good for Texas."
Curry's credentials drew criticism from prison and medical officials, who noted that Curry is a psychologist and not a medical
doctor. They cast Curry's report as inaccurate and exaggerated. While isolated problems may remain, they said, mental health
care for convicts is good -- much better than even just a few years ago.
"All of his adjectives are overblown and emotion-stirring," said Carl Reynolds, general counsel for the Texas Department of
Criminal Justice. "It's sort of a hatchet job. . . . We believe the system is not like he pictures it."
The Brockman case
But the picture would be familiar to Cynthia Brockman, a Grand Prairie woman who appealed to a legislative committee to do
something about the plight of her mentally ill son, a murderer who suffers from a bipolar disorder.
Christopher Brockman was 15 when he started hallucinating. Consumed with anger, he would punch his fists through his
bedroom walls. The drugs he took for treatment seemed to worsen his condition.
"Chris would break down and say, 'I don't know why I can't control myself,' " Cynthia Brockman said.
He entered the Texas prison system three years ago at 17 after killing his best friend's stepmother. He stabbed her 42 times,
bending the blade of a pocket knife in the process.
Except for his life sentence, there was little certainty about his existence inside prison. He moved through a maze of treatments
and care.
"I was afraid my son was going to die," his mother said.
Despite warnings from a consulting psychiatrist in Dallas about the treatment, the youth began taking the anti-depressant drug
he was on at the time of the murder. His anger flashed again, and he ended up in an isolation cell for a week. He was switched
from drug to drug, nine in all, before winding up at the Skyview prison psychiatric hospital near Rusk, dazed and emotionally
unstable.
His experience mirrors notations in Curry's report. Curry concluded that large numbers of seriously mentally ill inmates are in
administrative segregation -- isolation cells. This punishment, which can make their illnesses worse, leaves inmates trapped in
isolation solely because their illnesses prevent them from correcting their behavior enough to qualify for less restrictive quarters.
Curry reviewed the records of 68 convicts who had been in segregation from one month to 17 years. The average was 5.2
years.
In all, prison officials say, a little more than 6,700 mentally ill inmates are in administrative segregation statewide.
Curry reported finding mentally ill convicts whose medication had been improperly halted and were too disoriented to appeal.
A shortage of trained staff meant that mentally ill inmates weren't properly monitored by prison medical personnel. Routine
blood tests weren't taken or logged into medical records, despite a requirement that tests be given with certain drugs. Inmates
suffered painful and debilitating side effects from their drug treatment, but received no proper treatment in response.
Among his findings:
* At the Robertson Unit outside Abilene, seven of 19 convicts in segregation cells were "found to be significantly neglected,"
including a 45-year-old man with chronic paranoid schizophrenia "found in a decompensated psychotic state. . . . There could
be no question that his decompensation was long and tortured. He clearly belonged on an in-patient psychiatric unit."
* Robertson, as well as the Lewis Unit near Woodville and the Smith Unit near Lamesa, had "very serious failures" in
treatment, "which illuminate systemic problems." Curry's examples: At Robertson, a 28-year-old convict was "floridly psychotic
and deteriorating." His medicines had been cut off after he refused to have blood drawn from his left arm, which was "severely
mutilated from multiple self-inflicted lacerations."
At Lewis, Curry reported finding 40 severely mentally ill convicts, even though prison officials had decreed that the mentally ill
would not be housed there. As a result, the medical staff was unable to provide the proper care.
* At the McConnell Unit near Beeville, Curry said that out of 25 medical records reviewed, one had a barely adequate
treatment plan and the other 24 contained plans "that were uniformly meaningless and outdated. . . . It is widely and in many
cases officially recognized that the absence of individualized treatment planning suggests seat of the pants treatment."
Even so, he credited the McConnell staff with defusing "potential crises through verbal interventions cell side in a commendable
way not seen at other units."
* At the Coffield Unit near Palestine, he observed medications being dispensed in paper cones passed through the bars of cell
doors with no attempt to watch inmates swallow the pills. "The nurses observed sometimes did not even break stride" as they
proceeded down the tier. "This practice allows inmates to do whatever they please with the medication, including hoarding or
disposal, and precludes any meaningful monitoring of compliance."
Curry said the practices "hamper the effective care of treatment-resistent inmates and create a market for dangerous drugs
within the facilities."
Prison and prison medical officials flatly disputed Curry's findings. They view him as a hired-gun psychologist, not a medical
doctor, who offered medical opinions. They say he did not report his medical concerns to doctors at the time of his tours. And
he made assumptions about the system as a whole after touring just a few prisons.
"The fact that he has a personal agenda does not make him a credible source," said Chris Comer, public affairs director for the
University of Texas Medical Branch in Galveston, which provides health care for about 80 percent of Texas' approximately
140,000 convicts. "Since he has clearly stated from the outset that he is opposed to administrative segregation, his report is
extremely biased. What's more, he offers no alternatives for those whose dangerous behavior -- to themselves and others --
necessitates this type of housing and who will not voluntarily remain in an inpatient facility."
Prison spokesman Larry Todd said, "We think all of our health care is comparable to what is available in the free world."
A product of Ruiz case
Despite its harsh conclusions, Curry's report was little more than a footnote in the Ruiz case by the time it ended last week.
Plaintiffs' attorneys said they expected the 5th U.S. Circuit Court of Appeals to close the case if U.S. District Judge William
Wayne Justice did not. So they agreed a few weeks ago with state officials not to contest the closure. Had they chosen to fight,
Curry's report would have been used as evidence of continuing problems that warranted keeping the case alive.
"Despite improvements, dehumanizing conditions for the mentally ill continue to be a problem," said Donna Brorby, a California
attorney who represented prisoners in the Ruiz case.
She said that although fewer acutely psychotic convicts were found in administrative segregation during Curry's recent visits
than were there four years ago, conditions remain "punitive and destructive."
In August, in an order, Justice had called Texas' administrative segregation cells "virtual incubators of psychosis." The housing
of mentally ill inmates in administrative segregation was one of three issues the court continued to monitor in Texas prisons
during the past year. Other issues were use of force by guards and protection of prisoners against predatory practices by other
prisoners.
Originally, there had been a long list of issues that required monitoring after Justice ruled in 1980 that confinement inside Texas
prisons constituted cruel and unusual punishment.
The Ruiz case, which spanned nearly three decades, led to an overhaul of the Texas prison system.
Comer noted that the dismissal of the Ruiz case validated that "all care being provided, including mental health care, is
'satisfactory.' So Keith Curry's characterization of the care being provided to mentally ill inmates is not consistent with that of a
neutral, third-party legal authority."
Curry said he stands by his report. He and others argue that the mental-health system in Texas prisons is shortsighted and
wasteful. Other states, they say, have found that providing proper mental-health care to prisoners actually saves money -- from
assaults on staff by uncontrollable prisoners, from high staff turnover rates because of dangerous working conditions, from
lawsuits and from high recidivism rates because the mentally ill leave prison relatively untreated.
They cite examples such as Michigan, which has eight levels of mental-health care, including special-treatment units, designed
to keep the mentally ill out of regular prisons and isolation cells. Arizona offers a full array of mental-health services that
emphasize "continuity of care," which covers prisoners who are mentally ill but not ill enough to require constant medical
treatment and sophisticated programs for those held in administrative segregation to ensure their illnesses are not worsened by
isolation. Florida, Virginia, California, Pennsylvania and Oregon are among other states that offer specialized care for mentally
ill prisoners that Texas does not.
At present, Texas spends more than $297 million annually on prison health care -- and indications are that tab could run higher
as costs of care, including mental health care, continue rising.
"Texas is penny-wise and pound-foolish," Curry said. "You have a chronic schizophrenic who assaults someone and winds up
with a 10-year sentence, enters the Texas prison system and has problems coping, ends up in a windowless cell and refuses his
meds because he's paranoid and does his last eight years in isolation. He gets out of prison and comes back to live in the
community. Is the public safer? Or would it have been better to provide that man treatment while he was in prison?
"You tell me what makes more sense? What's happening in Texas is not good for the public and it's not good for the inmates
who are mentally ill."