One year later, inmate's death looms over state prison mental health debate

Before he began refusing treatment, the right of any prisoner within the North Carolina corrections system, the drugs had for months calmed his delusions and kept the symptoms of schizoaffective disorder in check. He stayed out of trouble, kept a job in the kitchen.

That refusal is the sort of thing the prison system is supposed to track. But in this case, the dates conflict a bit.

But for all the uncertainty in this man’s timeline, a few dates stand out with absolute clarity.

Thirty-five days later, Kerr would be dead.

Prison officials say Kerr’s death is the result of cascading failure by individuals in the custody, medical and mental health staffs at Alexander to properly care for an inmate serving more than 30 years as a habitual felon. Citing personnel, privacy and public safety exemptions, the state has declined to release much more of an explanation than that.

Hundreds of pages of documents presented in open court paint a clearer picture.

They show mental health and nursing staff dismissed Kerr’s slow deterioration as “faking” or “malingering,” ignoring the concerns of their colleagues and delaying proper treatment for days. They reveal growing uncertainty on how to deal with an inmate who by some accounts was too sick to follow orders as well as a siloed approach to prisoner treatment that prevented informed decisions.

Mixed with persistent staff shortages that forced long hours and frequent overtime, fired employees say cases like Kerr’s were primed to fall through the cracks.

And without significant changes, mental health advocates say it’s only a matter of time before it happens again.

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If it’s disciplinary segregation, you land there for infractions like disobeying orders or assaulting prison staff.

Michael Kerr did neither.

Daily reports from the wing where Kerr was confined – called the Red Unit – don’t really mention him.

But on the morning of Feb. 18, 2014, he became disruptive, earning infractions for disobeying orders and banging on his cell door. Those offenses meant a greater level of confinement.

Correctional officers bound Kerr’s ankles and wrists with grip restraints, made from a seatbelt-like material designed to prevent injury.

“Come on in, the water is fine,” he would repeat.

At a certain point, Alexander Capt. Lane Huneycutt saw no need for the restraints anymore. He removed everything but the handcuffs, then was able to get Kerr to stick his hands through the port in the cell door to get those removed too.

But it did prompt questions between a few of them who sought to correct an assertion that Kerr needed a transfer to Raleigh’s Central Prison, a facility with better mental health treatment options. Those familiar with Kerr weren’t inclined to move him, interpreting his behavior as intentional rather than a mental health issue.

It wouldn’t be the last time Kerr’s caretakers would accuse him of faking.

Nationally, the average percentage of inmates suffering some form of mental illness hovers around 17 percent.

Vicki Smith, executive director of Disability Rights NC, says the result, either by practice or policy, is that the prison system simply underdiagnoses mental illness.

"There could be many causes,” Smith said. “It could be that they don't have the staff, but also, prisoners and people with disabilities have certain rights that a regular prisoner wouldn't have. So sometimes underidentifying could be to their advantage."

Even those with a diagnosis or history of mental illness, though, could be accused of trying to fool staff with exaggerated physical or psychological symptoms to get something they want. It’s called “malingering” – and it is not a mental illness.

"Mental illness is so broadly misunderstood," Smith said. "That's where the malingering comes into play."

When these under- and misdiagnoses combine, advocates and experts say the symptoms of real mental illness can land prisoners in the jail within the jail – whether it’s their fault or not.

That’s a problem, says Dr. Joel Dvoskin, a national expert in forensic and clinical psychology based in Arizona. He said prisoners in a psychotic or suicidal state shouldn’t enter solitary confinement except in the most extreme circumstances, and even then, it’s important for therapeutic services to come to them.

“I don't believe it's right to punish somebody for a symptom of their mental illness,” Dvoskin said. “If someone has an epileptic seizure and they hit someone in their head, they shouldn't get accused of assault.”

While he said there’s no doubt a mental health diagnosis is complicated by a prison environment, Dvoskin said he advises those who suspect malingering to think critically about the underlying motivation – and consider the consequences of getting it wrong.

“Some people are just so concerned about not getting fooled that they're too skeptical,” he said. “I ask them, ‘What are they malingering for?’”

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But to Dr. Christine Butler, Kerr’s prison psychologist, the inmate’s actions were attributable to malingering.

"The belief at that time from Dr. Butler, the treating psychologist, was that Kerr was trying to manipulate a transfer to Central Prison," Michael Youron, a psychological manager fired after Kerr’s death, testified Tuesday at a hearing contesting his dismissal.

Butler, who resigned following Kerr’s death, could not be reached for comment.

These repeated violations also landed Kerr in disciplinary segregation in the long-term isolation unit, often called Big Seg, on the afternoon of Feb. 26. Later that night, he asked a sergeant on the block to speak to a psychologist, a request the officer passed along to Fitch, Youron’s boss.

On March 6, 2014, though, Butler began to doubt her diagnosis.

By then, prison logs indicate, Kerr’s disruptions had begun to slow.

On March 8, 2014, just after sunrise, prison staff called a code blue to cell B-1: Kerr was unresponsive on his bed.

“He was also coherent and mischievous enough to clog his sink and toilet with milk cartons,” the segregation unit shift narrative noted after the code blue.

Capt. Shawn Blackburn, the officer in charge of the facility at the time, cleaned out those cartons himself after sweeping up bits of nutraloaf and other garbage from the cell floor.

As they exited the cell, officers removed Kerr’s leg restraints and backed out, leaving the handcuffs on per policy. Blackburn told the inmate he’d have to come to the door and place his hands through the port to get them off.

Kerr didn’t move.

“I wanted inmate Kerr to have every opportunity to come out of the restraints,” Blackburn testified in his own personnel hearing. He also asked another psychologist to try to convince Kerr to come to the door. “I didn't want them on any longer than they needed to be.”

On the outside of the cell, someone scrawled another order on the chalkboard paint meant for notes about the inmate inside.

"Do not give him milk, per Capt. Blackburn," it read, according to hearing testimony.

It was the last time records indicate he was upright his own.

At least one staffer did voice her concerns that day.

The nurse, Lisa Kemp, later told investigators she passed the information along to the on-call psychologist. But Triplett tells it differently.

Triplett raised her concerns again to Blackburn the next day, and together with another corrections officer later, the on-call psychologist.

Yet in his cell, handcuffed and nearly motionless, Kerr remained, either refusing or unable to come to the door.

Although he was warned ahead of time, Archer noted the smell in the cell was bad.

“I asked Mr. Kerr to sit up so that I could get his vitals,” Archer wrote in a statement. “He just looked at me and smiled.”

After asking again, Archer interpreted the grin as refusal to comply.

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In the corridors of downtown Raleigh’s legislative office building, he can’t go far without handshakes from friends in the state senate and house.

A lawman turned lawmaker, his past career in the General Assembly and community corrections, which supervises offenders once they’re out of jail, has earned him a great deal of respect as the Department of Adult Corrections’ director. Far away from legislative committee rooms, mental health advocates speak highly of him, noting his background and their hope that he can affect long-needed change.

"They need a strong champion internally,” said Deby Dihoff, the executive director of the National Alliance on Mental Illness North Carolina who retired last year after years at the helm of the nonprofit advocacy group. “Possibly Commissioner Guice could be that guy.”

Guice has offered frequent and frank assessment of the prison system and the need for significant changes – including an infusion of cash from the General Assembly for mental health.

“My commitment is to talk about these issues and try to help educate people to the point where we can address these issues,” Guice said. “This, to me, is not a game. This is serious business. We’ve got to change some things.”

Although he said the corrections system had been moving toward those changes, Kerr’s death underscored the need to do more.

Just last week, lawmakers got a look at what those additional efforts will cost.

Gov. Pat McCrory’s budget calls for an additional $49.8 million over the next two years for prisons. That includes $20.8 million for correctional officer raises, as well as $17.8 million for a total of 271 additional mental health positions.

Other changes include a new training center for corrections officers and a new electronic health record system for inmates.

He said one obvious sign corrections is “working our people to death” across the board is the growth in spending on overtime pay. Years ago, Guice said, corrections might spend $12 million on overtime annually.

“This past year, we spent about $16 million,” Guice said in an interview in December. “We’re on track to spend over $21 million this year.”

Those worker shortages played out at Alexander to significant effect.

According to staffing records of the facility provided by DPS, the vacancy rate for nurses the month of Kerr’s death was about 18 percent. Department spokesperson Pam Walker said that was “considered to be average” for the state.

Nevertheless, staff at Alexander repeatedly asked for more resources as they struggled with high caseloads.

That surprised Director of Nursing Faye Duffin, who testified in Clark’s hearing that it was “a failure for them not to visit every month.”

Since last March however, the vacancy rate at Alexander has skyrocketed – 38 percent as of mid-February.

To compensate, the facility has leaned more heavily on temporary “travel” or contract nurses. What was once a travel nurse headcount of five last March has ballooned to 20.

That concerns advocates like Vicki Smith at Disability Rights NC.

"You can have positions filled, but if you constantly have travelers coming in and out, you're not going to have the same quality of care because of turnover," she said.

DPS says it’s tough hiring correctional medical staff everywhere, but Alexander’s newfound notoriety has made it even more challenging there.

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Johnson asked Kerr if he wanted to ship.

But the handcuffs were a problem.

Correctional officers, including Capt. Shawn Blackburn, say there wasn’t anything unusual about moving Kerr in a wheelchair. They say it was easier and faster to wheel Kerr’s 6-foot-tall, 243-pound frame to inmate receiving, where he would have to be searched and wait for transfer.

DPS fired St. Clair less than a month later.

At some point during the two-and-a-half-hour trip to Raleigh, as he sat bound and secured in his wheelchair suffering from the symptoms of severe dehydration, Kerr slipped into unconsciousness and died. Harold Shytle, a 75-year-old serving a 23-year sentence for sexually assaulting a child, was transferred alongside Kerr – likely the last person to see him alive.

DPS refused to allow Shytle to be interviewed.

But before officers loaded Kerr into the van, he did speak to Sgt. William Johnson.

Youron, the psychological manager now fighting to get his job back, told a judge this week that the department did not do enough to address the underlying lack of resources that he says contributed to Kerr’s death.

“I believe DPS pretty much just looked for scapegoats,” Youron said in a hearing Tuesday. “They just wanted to find someone to blame.”

But as the General Assembly grapples this summer with the funding proposals contained within the governor’s $21.5 billion state budget, they’ll be asking themselves the same questions as many other states struggling to fund their prison populations.

"Americans want to lock up more people than we're willing to pay for,” Dvoskin, the national psychology expert, said. “That's a dilemma that almost every correctional administration in America faces.”

The question now is whether the changes will help.

After reviewing the governor’s budget this week, Smith, of Disability Rights NC, called McCrory’s proposals a “forceful step toward improving mental health services.”

But what those proposals need now, she said, is action.

Otherwise, the approximately 4,500 inmates currently receiving mental health treatment – and the nearly 2,000 more whom statistics indicate likely need it – remain just as vulnerable as Michael Anthony Kerr.

"If this situation and the recommendation of experts like Dr. Metzner are not implemented, it will not just be on the shoulders of the Department of Public Safety,” Smith said. “There are other people – the governor and the General Assembly – that will have some culpability.”