Months after inmate death, audit notes 'neglect' at prison
Posted December 18, 2014
Raleigh, N.C. — Months after the dehydration death of a mentally ill inmate, an audit of the prison where he was left handcuffed in solitary confinement for five days reported continued problems with large caseloads, low staff morale and neglect of several prisoners.
State officials say subsequent follow-ups to the audit found no prisoners at risk, and they pointed out the vast majority of the standards were met. But mental health advocates say even the standards the prison did meet fall woefully short of modern treatment updates that have languished for years in a bureaucratic back-and-forth between state agencies.
Those updated rules, advocates say, could have saved the life of Michael Anthony Kerr, who died of thirst in the back of a prison transfer van March 12 during the 160-mile trip from Alexander Correctional Institution in Taylorsville to Central Prison in Raleigh.
Weeks after the audit, Alexander's psychological coordinator submitted a two-page plan to fix the standards the prison failed to meet, noting that staff members would regularly review their procedures and record-keeping.
Mental health groups say progress the Department of Public Safety has made in the nine months since Kerr's death is not enough to fix long-simmering issues at both Alexander and the more than 50 other prisons across the state.
"This is one of those examples where you just react to what’s there," said Deby Dihoff, executive director of the National Alliance on Mental Illness North Carolina. "In fact, the big picture is what’s not there."
Audit notes 'neglected' medical needs for inmates
Staff from the N.C. Department of Health and Human Services visited Alexander on Aug. 14 to review the prison's mental health services based on about 40 different requirements for care and treatment. The prison met all but six of the standards, although several included comments detailing issues and concerns.
One requirement the prison met, for example, specifies that facilities should have a registered nurse available for inmate care.
"The standard is met, however, several staff vacancies are reported, and it is also reported that staff morale is low due to recent events which led to the terminations of several nursing positions," DHHS auditors wrote.
At least five nurses at Alexander resigned or were fired by DPS for personal conduct amid the investigations into Kerr's death. One of those nurses, former supervisor Jacqueline Clark, is appealing the department's dismissal.
Corrections Deputy Director of Health Services Terri Catlett said the department added 18 to 20 temporary "travel nurses" to the prison's shifts, an action the audit also notes.
"To fill the position shortage it is reported that traveling nurses are assigned to the segregation unit and that within the last 30 days, two inmates' medical needs were 'neglected,'" auditors wrote. "Later, after a nurse complained, the inmates were transferred to the infirmary."
Catlett said the comment came from one of the temporary nurses reacting to an inmate on a hunger strike. Although the nurse would have been informed about the strikes, which the audit notes have been on the rise in the facility, Catlett said the nurse may not have been used to seeing them in a prison environment.
"Sudden weight loss can be disturbing," Catlett said.
She said the other inmate referenced wasn't able to make a scheduled medical appointment because of a security lockdown.
Catlett also reiterated the prison met the standard in this case – that each site employ or contract a registered nurse to ensure inmates receive nursing care. And although she said it was clear the nurse was concerned, she said the inmate's needs were "absolutely not" neglected.
"We did investigate and determined there wasn't problem," Catlett said.
Mental health advocates such as Dihoff, who reviewed the audit, say the report's comments note that the department hasn't gone far enough to improve conditions at Alexander and other prisons.
"It just smacked me in the face that these are the same old pathetically sad and incomplete rules," Dihoff said. "And yet, even with those, they’re not getting them all right."
For the standards the facility didn't meet, Catlett said the problems were mostly with proper documentation and record-keeping procedures. In one case, for example, auditors cited a failure to have "a single, thin line drawn" through a record error.
"I can tell you all the staff – to include medical record staff, the psychological program manager – are doing very frequent audits of the records to ensure these areas that weren't met are corrected and followed," Catlett said in an interview last week.
But Dihoff said the standards themselves, unchanged since 1994, are a much larger issue.
"You get all lost in these goofy things about 'a single line through the corrections,' all that stuff," Dihoff said. "That’s not what it’s all about. Our rules are wrong."
New standards could have saved life, advocates say
Although the rules for the treatment of mentally ill inmates are now more than two decades old, members of a DHHS commission have been working to update them for almost seven years.
Among other things, the new standards would add more regular review of prison procedures, put stricter rules on restraint and isolated confinement and improve treatment plan requirements for inmates.
"The new rules would be consistent with the acceptable level of care in the 21st century," Vicki Smith, executive director of Disability Rights North Carolina, said. "They would reflect the changes in treatment that have occurred since 1994."
In November, the commission voted to halt the process altogether, according to a DHHS spokesperson.
It's not exactly clear why.
Emails to several current members of the Commission for Mental Health, Developmental Disabilities and Substance Abuse Services were not returned. The minutes of the November meeting have not yet been released.
But according to minutes from another meeting earlier this year, it's likely money was a major factor.
After two years spent estimating the cost of the new standards, DPS officials told members of the commission in early 2012 that changes, which would require additional staff and resources, would amount to about $9 million – less than 1 percent of the state's prison budget.
"As near as we can tell, there's no disagreement about whether changes are well founded," Smith, whose organization has long pushed for the new rules, said. "It comes down to money."
After tweaking two of the 48 rules to alleviate some financial concerns, the commission unanimously approved them in June 2012. But after revising the estimated cost and resubmitting them in January 2013 to the Office of State Budget Management, financial analysts decided not to sign off on the changes.
It's possible, according to minutes from a commission meeting in July, that the rules will be "revisited at a later date."
Dihoff said that won't help inmates like Kerr, who spent more than 30 days in segregated confinement and at least six months without treatment for schizoaffective disorder before he died.
"He was in seclusion that was not regulated, and if the rules had been passed and implemented, his life probably would have been saved," Dihoff said.
Changes may be coming with new budget
Catlett said some of the rule changes recommended by the committee, however, have been implemented by prison staffs across the state.
"Some of the things we were able to do with zero cost to the organization have been put in place," Catlett said. "Those that required dollars attached to it, we've had to go back and take a look at that."
One example, she said, was better assessment tools for inmates who may be suffering from mental illness. The department rolled out other changes after Kerr's death, including an ongoing move to relocate a residential mental health unit from Alexander to Maury Correctional in Hookerton.
Other changes, including those that will need additional nurses and psychology staff, may come with the $20 million budget expansion the department plans to request from state lawmakers as part of the governor's 2015 budget. State Prisons Commissioner David Guice announced that request last week before a legislative oversight meeting on public safety.
Guice said he has been proactive in trying to move the prison system forward for the almost 37,800 people in state custody, including the 4,645 receiving mental health treatment.
"We are trying to change a culture of how we do business as it relates to mental health," Guice said. "We started that desire and moving in that direction before the Kerr situation occurred."
Several mental health advocates see reason to hope.
Dihoff said she believes that Guice, who has a community corrections background, wants to do the right thing. And she said it's possible his 2013 appointment as prisons chief could be the catalyst for change at DPS, which has historically been sluggish to reform.
"They need a champion who does it because they believe it’s the right thing to do instead of because a bunch of advocates are sitting there bugging them," Dihoff said. "It’s hard to feel a great sense that they’re dying to get these reforms done."
Smith said she's looking to that budget request to judge how serious the McCrory administration is about fixing the issues with mental health in prisons. Without those resources, she said, all the efforts toward reforming treatment of inmates will just be talk.
"These folks will eventually come home," Smith said. "They deserve humane treatment so they can be rehabilitated."