Hang time

In the early evening of March 31, 2009, San Antonio author, one-time Green Party candidate, and animal lover Harlan McVea opened a packet of mustard and began to write his suicide note. He was beginning a familiar descent into the hellish chills, cramping, and nausea of drug withdrawal. Though he preferred methadone, which he bought from friends in various drug-treatment programs, the 31-year-old McVea had been unable to score the previous week. Instead, he had used up $50 worth of heroin about four days earlier, he told the jail nurse after he was booked into Bexar County Jail on charges of attempting to secure drugs by fraud at a Northside grocery store.

The rote intake questions of the previous night’s interview still rattled about in McVea’s head as he sat in the back of the detox cell. He’d gone over his whole medical history as he told staff on duty of his childhood asthma, a beating in the head with a baseball bat years ago, and failed teenage suicide attempts. He didn’t feel suicidal now, he said, but he felt the panic in his chest and worried about his heart. “AP wants to see the nurse because he’s worried about withdrawal from Methadone, tonight. He’s worried he will get palpitations,” according to a medical screening performed the night before at the Magistrate’s Court down the road from the jail.

Screened again at the jail that morning, McVea talked about his bipolar disorder, obsessive-compulsive tendencies, depression. It had been two days since he had taken any of the prescribed medications for his mental disorders, he said. He also confessed he was no longer in a methadone maintenance program, but was, in fact, coming off heroin. “Pt. in acute withdrawal, shaky, confused, significant aches and pains,” reads the paperwork, “placed in detox for housing at this time. Will refer to `Center for Health Care Services` for Atypical meds and psychiatrist for evaluation.”

Despite McVea’s unsteady walk and complaints of feeling like he was about to pass out, the University Health System staffer who recommended he be seen by the clinic ranked his priority as “semi-urgent.” Mental-health follow-up was also requested, but listed as “non-urgent.” Then McVea was sent back to his cell. About 13 hours later, jail records suggest, McVea still had not received anything to ease his withdrawal or any of his prescribed psychiatric meds. With his cellmate asleep, McVea, author of Memoir of a Modern Opium Eater and a past contributor to the San Antonio Current, began to draw out his final letters in a yellow scrawl, bleeding the last of the mustard from its flimsy packet to write: “I’m so sorry mom. I love you.”

McVea’s was the first suicide at the Bexar County Jail in 2009. It would not be the last. With a prison population bursting near 100-percent capacity for most of the year, 2009 would witness the most jail suicides in at least a decade and triple the number recorded at any other jail in Texas.

Last week, the Bexar County Jail passed its third annual inspection in nine years. There was even a whiff of praise from the Texas Commission on Jail Standards — inspector George Johnson said it was “the best he had ever seen the Bexar County Jail.”

This week the Sheriff’s Department is showing off two model programs that have received national recognition for their potential to keep nonviolent offenders with mental illness and substance-abuse problems out of the jail at a gathering of the National Association of Counties in San Antonio. However, six hanging deaths between March 31 and December 25 of last year suggest reform is still a far way off for the jail. The challenge of identifying those with life-threatening mental-health disorders, coupled with court backlogs that result in extended incarcerations for those awaiting trial, is far from resolved. Many of the detainees who hung themselves did so while awaiting trial in Bexar County’s custody.

Despite McVea’s obvious warning signals — methadone or heroin withdrawal alone can result in thoughts of suicide, according to the scientific literature — he wasn’t placed on suicide watch. Two other detainees who committed suicide last year requested psychiatric help or physical protection from prison guards, but their requests were either denied because of the lack of another cell to move them to or because University Health System employees decided they were not actually at risk. The jail has contracted with UHS, the face of the Bexar County Hospital District, since 1995 for the medical care of its inmates.

Jonathan Fabian Ramirez, a 19-year-old epileptic, was transferred into Bexar County from a juvenile facility and fought constantly with guards, other inmates, and cellmates, according to jail records. He claimed to be under threat from other inmates for refusing to join one of the popular jail gangs. He was stabbed with a pencil in the back of the head in the summer of 2008. Other inmates had learned of his conviction for indecency with a child and were stalking him, he told jail officials. “I have been stabbed and beaten several time`s`. I sireousely `sic` fear for my life. And I feel that anywhere in `General Population` that I go I will be repeating this cycle,” he reported. After being placed in a double-doored cell, however, Ramirez begin to suffer from the isolation. On May 16, the log records Ramirez saying, “‘I want to kill `my`self because I’m all messed up. I have seizures and I can’t stand these double doors.’ That he felt like the walls were closing in on him and he can’t breathe. Evaluated by mental-health professional from UHS, who said he wasn’t suicidal and could be returned to unit.”

On August 2, concerns for Ramirez’s safety motivated jail staff to move him closer to the officer’s station for observation because there was no room in either the Suicide Prevention Unit or the Mental Health Unit. Ramirez again complained of being suicidal and asked to see a mental-health counselor. After seeing him the next day, a University Health System doctor said Ramirez was not suicidal and could be moved back to General Population. Four days later, Ramirez hung himself from his cell door.

Until last year, suicides were relatively rare at the Bexar County Jail, representing about one or two deaths per year. More common were the deaths of older inmates from lung cancer, emphysema, and liver failure. But they happened.

Crystal Hernandez was 25 when she tied a bedsheet to the upper bar of her cell on April 22, 2005. She was taken off life support and pronounced dead three days later at University Hospital.

Prison officials were preparing to move 45-year-old Anthony Cavazos to a new cell when they found him hanging in the summer of 2006 with a sock tied around his mouth.

Kevin W. Jamison, 28, hung himself with his jail uniform, which he hitched to the toothbrush rack on December 31, 2007, before kneeling on the floor.

It appeared we had peaked when 2007’s three suicides were followed by none in 2008. No such luck.

According to a 2006 U.S. Bureau of Justice Statistics report, 64 percent of inmates held in city and county jails have mental-health problems, compared to 45 percent in federal prisons and 56 percent in state prisons. The high number reflects the fact that it is at the local-jail level that most people arrested are initially held, the report concludes. From here, detainees may later be transferred to drug rehabs, mental-health facilities, or federal or state prisons, but the first stop is typically a local jail like Bexar County’s lockup.

Bexar County Jail Administrator Roger Dovalina said mental-health issues “play a large part in our population. We take it very seriously.” As detainees are processed into the jail, they receive as many as three screenings intended to catch those who may be at risk of attempting suicide. Once they are in the facility, however, it is up to the guards to notice and report suspect behavior — or for the inmates to voluntarily disclose their plans.

Dovalina said that the overcrowding of 2009 may have played a role in the high number of deaths last year. At maximum capacity, the main jail and annex can hold 4,598 detainees, but the Bexar County numbers passed 4,700 in 2009, requiring about 400 detainees over the course of the year to be housed at other facilities. “We were at 99- to 100-percent capacity most of the year,” Dovalina said. “When you’re running at 99 to 100 percent that means there’s really no room to move them around as we need to.”

While screening failures appear to explain the fates of McVea and Ramirez, space restrictions played against Darrell Johnson. Awaiting trial on charges of aggravated robbery, Johnson discovered the woman he robbed had a son inside with him. He reported being threatened. Compounding his troubles, Johnson reported he was being harassed by other inmates because “they think he is a snitch,” according to jail records. He requested protective custody the night of May 11, but there were no available rooms to move him to, documents show. He was approved for “administrative segregation” on May 12, but the next day he was found in his cell with a sheet wrapped around his neck; the other end was tied to the frame of the top bunk. Although the paging system failed, delaying full response for about a minute, one shift supervisor wrote in his report that he overheard a paramedic state Johnson “had been in this position for approximately 30 minutes before being found.”

Other suicides last year included Franky Salinas, one of the several-hundred Bexar County detainees shipped out to other jails because of overcrowding issues. The 19-year-old was awaiting trial on charges of aggravated kidnapping when he was found hanging at the Crystal City Correctional Facility on August 26.

Fernando Moreno, 18, the fifth suicide of the year, apparently hung himself while he was left alone in his cell. He was awaiting trial on a charge of aggravated robbery.

Joel Solis, 27, had been in custody only five days when he hung himself with a shoelace on Christmas Day. He was transported to Brooke Army Medical Center where he was later pronounced dead.

Today, the prison population in Bexar County is down to about 4,300 inmates, near 92-percent capacity. But those numbers tend to rise from January through October, Dovalina said. Rather than waiting to see if 2010 brings a repeat of last year, Bexar County Sheriff Amadeo Ortiz recently asked the U.S. Department of Justice’s National Institute of Corrections to conduct an assessment of the jail’s procedures. To that end, Dr. Lindsay Hayes, the 30-year director of the Jail Suicide Prevention and Liability Reduction program at the National Center on Institutions and Alternatives, will be headed to San Antonio to offer assistance. According to Hayes’s bio on the NCIA website, he is “an expert in the field of suicide prevention in jails, prisons and juvenile facilities. He has conducted the only four national studies of jail, prison, and juvenile suicide through contracts with the U.S. Justice Department.”

Statistically, it’s hard to spot a jail population at elevated risk in Texas. Until September of last year, the Texas Commission on Jail Standards did not require jails to report suicides as a separate category of total in-custody deaths. “That’s what’s been stymieing us,” said Diana Claitor, director of the Texas Jail Project, a non-profit organization dedicated to prison reform. “We don’t have any way to know, like to compare Bexar with Travis and Travis with Dallas.”

However, in a report to the Texas Legislature in 2004, the TCJS showed that, taking population size into account, Bexar County’s four suicides during 1999-2003 were exceeded only by El Paso and Galveston counties. Bexar was also one of only two counties in the state to be cited every year of the study for failing to maintain a minimum ratio of guards to inmates of 1 per 48. That failing appears to have been addressed in ’09.

“Either they’ve got enough officers on the floor to staff sufficiently or they’re using overtime,” said TCJS Executive Director Aden Muñoz. Bexar County may have received some “technical advice” following the three-day inspection but “nothing that would be major … to mark as to be out of compliance.”

As far as tracking suicide numbers, a new accounting is “way overdue,” Claitor said, “because jails like Bexar … that sounds like way too many to me.”

It is. Compared with the average number of suicides at jails nationwide (38 per 100,000), Bexar’s rate was 3.3 times “too many,” statistically speaking.

The last time McVea was seen alive is recorded in prison paperwork. “Officer Martinez stated that at approximately 2100 hours, he completed an hourly security check of the unit and stated to me that he had observed Inmate McVea sitting on the floor in the back of the cell, but did not observe anything unusual and did not see a sheet around Inmate McVea’s neck,” the floor sergeant on duty wrote. Fifteen minutes later, McVea’s cellmate buzzed over the intercom, saying McVea needed help. They found him hanging facedown, with his chest hovering just six inches above the floor of the cell. Deputies pulled him down and began CPR.

McVea had been serving a five-year probation sentence for a 2005 charge of attempting to secure drugs with a falsified prescription and, if found guilty of the March 30 arrest, faced up to 10 years in prison. Debbie Rinehart, McVea’s mother, doesn’t believe her son was taking drugs and is skeptical of the official version of events. “I don’t know anything about anything, but when someone hangs themselves isn’t there some just bodily involuntary jerking or noise or something? Isn’t there something?” she asked, incredulous that the cellmate could have slept through her son’s death.

But nearly 10 months on, Rinehart is finally done agonizing over jail papers. “If there is something that could bring Harlan back, yes, I’ll read whatever,” she said. “I know in my heart what was true, and the fact that some 300-pound sheriff deputy says X, Y, or Z, it’s not going to change my mind. They can put anything they want in there, and maybe it’s true and maybe it’s not.”

In the report to the Bexar County Medical Examiner’s Office, a sheriff’s deputy wrote, “IT WAS UNKNOWN IF THE DECEDENT HAD EVER ATTEMPTED SUICIDE IN THE PAST OR TALKED ABOUT SUICIDE.”

Chief Dovalina defended his staff’s decision not to place McVea on suicide watch, a decision which would have resulted in visual inspections every 15 minutes rather than every hour.

“The one thing I was told by UHS, he went through all the stages and he still denied having any suicidal issues,” Dovalina said. “Just because he has a history doesn’t mean we should automatically put him on suicide watch, because then we’d be denying his rights.”

A spokesperson for University Health System first suggested any questions about jail suicides should be directed to the jail. After being told that in two of the suicides jail staff were following the recommendation of UHS staff, UHS spokesperson Leni Kirkman complained, “Sounds like passing the buck to me.” Ultimately, no interview was granted by UHS, but a statement was released at noon on Tuesday that read, “One of these inmates was repeatedly interviewed and screened for suicide risk. UHS conducted a Root Cause Analysis in this particular case which found that treatment provided was appropriate. The other was screened and treated by mental health and was followed regularly in accordance with the mental health procedures and protocols. The sheriff’s department is responsible for the safety of inmates, to include suicide prevention, and this is outlined in their policies and procedures and according to the Texas Administrative Code. Anytime an inmate is identified as being at risk, a mental health assessment is done, and suicide precautions are recommended in accordance with the community standard of care and practice.”

Jail Administrator Dovalina said jailers couldn’t “second guess” what mental-health counselors recommended: “We follow what they tell us.” •

*As this story went to press Tuesday, jail officials confirmed another fatality at the jail. Ricardo Guzman, 43, died January 7, 2010, two days after his arrest on charges of possession of a controlled substance. He was being held in a detox cell while going through heroin withdrawal. Toxicology results are pending.


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