By Linda Martz
Mansfield News Journal
MANSFIELD — The mother of a heavy drinker who died after he suffered an alcohol withdrawal seizure in the Richland County Jail believes her son should have been placed in a padded cell.
Michael P. Reid died after cracking his skull as he fell April 8, 2009.
“If you were told that someone would have a seizure if they stopped drinking, would you put them someplace that was made all of concrete, with a chance that they’d fall and crack their head?” asked Susanne Reid.
There have been two such incidents in the Richland County Jail in the past four years.
On Sept. 29, 2012, 28-year-old inmate Corey S. Tolar collpased in the jail. Tolar was taken to the hospital, where he was pronounced dead. A coroner ruled he died from complications of heroin withdrawal.
Susanne Reid said it was difficult for her to hear that a second inmate died in the jail last fall. If there are issues that still need to be addressed at the jail, she would like to see that occur.
“OK, this other young man, so he did wrong. But he was still a human life,” she said. “He had a mother. He had a family. Someone loved him.”
Michael Reid, booked in for a misdemeanor probation violation, died the morning after he entered the jail. He was placed in a cell near the book-in area so corrections officers could monitor him.
A lawsuit brought by his aunt, Carol Stefan, is focused on decisions made by nurses and other staff at the Richland County Jail. It is set for trial Sept. 16 in U.S. District Court.
Should the 37-year-old have been placed in a cell with soft surfaces, instead of concrete and steel?
Richland County’s top mental health official said recently he would not expect the county to include padded cells when it designed its new jail.
State mental institutions eliminated padded cells decades ago because of sanitary concerns, said Joe Trolian, director of the Richland County Board of Alcohol and Mental Health Recovery Services.
Even when an alcoholic is undergoing detoxification in a hospital or clinic setting, he is not necessarily being kept in an area with no sharp surfaces or furniture he could fall from, Trolian argued.
Former Mansfield police Chief Phil Messer said the Mansfield City Jail, which was closed at the same time the Richland County Jail opened, had a padded cell from the time it was constructed in the 1970s.
Inmates who were at risk because they were suicidal, extremely drunk or high, or undergoing withdrawal, could be held there more safely, Messer said.
“There was one of those (cells). You could only put one person in it,” Messer said. “All of the walls were padded. There were no structures in it that would allow a prisoner to injure themselves on it.”
While that cell had a floor toilet, it was well sealed, and he doesn’t remember sanitation issues occurring, Messer said.
Richland County Jail Capt. Joe Masi said he could not comment on aspects of the jail’s design or any issues related to deaths at the jail, because of the pending lawsuit. The attorney handling the lawsuit brought by Reid’s aunt did not respond to questions.
At least one other corrections facility has padded cells — the Ashland County Jail, built in 2001.
“We have two (padded cells),” said Ashland County Sheriff’s Capt. Beth Jackenheimer. “They are used as needed when prisoners who are suicidal, violent or are substance abusers in withdrawal, are incarcerated there.”
Appleseed Community Mental Health Center, the county’s crisis management agency, makes recommendations as inmates with specialized issues are assessed, Jackenheimer said.
The specialized cells are of normal size, but specially designed with softer surfaces and no furniture a prisoner could use to slip any kind of noose around, (including sinks or standard toilets). The Ashland County Sheriff’s Office has a policy not allowing public photographs of the facility.
“It’s like a hard padded surface. They can’t try to hang themselves on anything,” Jackenheimer said. “We put them in a suicide smock.”
Jackenheimer said the padded cells can be quickly scrubbed and sanitized, and sanitation issues have not occurred.
Most jails probably do not have padded cells, said Bradley W. Brockmann, executive director for The Center for Prisoner Health and Human Rights in Providence, Rhode Island.
If a facility cannot provide an appropriate setting to safely keep inmates with a history of seizures, “they should be moved to a facility where they can,” Brockmann said. The attorney added that deaths involving inmates who have died from withdrawal have resulted in numerous lawsuits nationwide.
An inmate’s statement when he was booked into a jail that he had a history of seizures when he stopped drinking should have been a red flag for jail staff, Brockmann said.
“If he has a record of withdrawal in this jail or this state, that should have been noticed,” he said.
The National Commission on Correctional Health Care Standards for Health Services in Jails, and the Federal Bureau of Prisons’ Clinical Practice Guidelines for Detoxification, provide guidance on how local jails should deal with risks related to inmate intoxication and withdrawal.
Jail staff should screen inmates for potential problems when they are booked in — paying particularly close attention to those identified as substance abusers with a history of seizures during withdrawal, Brockmann said.
Chemical detoxification — involving the medically supervised, tapered use of methadone or clonidine to get a substance abuser through the initial period of risk from withdrawal — is used in some jails, he said.
However, a survey completed about 15 years ago showed that only about 25 percent of facilities provided detoxification, Brockmann said.
“The rest kind of just throw people in a drunk tank,” he said.
The Richland County Jail had a protocol that allowed for use of drugs and vitamins including clonidine when an inmate was going through withdrawal, according to testimony in court depositions in Michael Reid’s death.
However, former jail commander Maj. Roger Paxton and Dr. Kenneth D. Williams, part-time medical director for the jail in 2009, testified that the drugs weren’t purchased in advance and readily available when Reid was an inmate there.
“I mean, it’s a huge variation in what jails do based on their size, the amount of money they have,” Williams testified in a deposition for the lawsuit. “The standard of care is just — it’s different, I’m sure, between very big facilities and very small ones.”
The Cuyahoga County Jail, for example, had two doctors working two shifts, with a pharmacy of its own. Meanwhile, at the time of Reid’s death, the Richland County Jail had a doctor available for twice-weekly visits for two to three hours, and was staffed with nurses for two of the three shifts.
If detoxification drugs are to be used, they “need to be immediately on hand,” since chronic substance abusers could go into withdrawal with little warning, Brockmann said.
Kevin Fiscella, professor of family medicine and public health sciences at the University of Rochester, who has studied alcohol and opiate withdrawal in U.S. jails, said a growing number of detention facilities are taking steps to deal with medical risks.
Typically, that starts with requiring jail intake staff to screen inmates for risk, using standard questions, and to recognize signs of intoxication or signs of early withdrawal when persons are admitted.
“Those who screen positive for intoxication or who are at significant risk for withdrawal should be expeditiously evaluated by qualified medical personnel,” Fiscella said. “Persons judged to be at risk should be transferred to a medical area of the jail suitable for observation of intoxication and/or withdrawal and treated and/or triaged based on standard medical protocols.”
In some cases, early transport to hospital emergency departments is needed, he said.
“The level of protection in the environment where the person is being detained should match the level of risk based on the person’s medical history — such as prior seizures, previous withdrawal, and DTs — in addition to a medical examination and assessment of the severity and trajectory of withdrawal symptoms,” Fiscella said.
Qualified medical personnel should match the level of risk for that inmate to protective measures, he said. Depending on risk, protective measures might include low jail beds (perhaps 12 inches from the floor) to minimize trauma should the person fall, type of flooring, padded surfaces and specialized clothing.
Ken Stolle, a sheriff in Virginia Beach, responded to a similar tragedy by instituting changes after 31-year-old Jacquelynn Diane Schwartz died in the Virginia Beach City Jail on July 18, 2010.
Schwartz was jailed for showing up to a court hearing intoxicated. She was placed in a medical isolation cell after she started shaking. The inmate was found dead after she slipped off and swallowed her inmate ID bracelet, possibly while hallucinating.
Stolle created two mental health pods at the jail, which houses more than 1,000 prisoners — one for men, one for women. Inmates taken there were monitored more frequently. Prisoners in the mental health pods sleep on a mattress or directly on the floor, instead of an elevated bed frame, reducing risk of injuries from falls.
ID bracelets being used at the jail were replaced with larger ones to prevent swallowing.
Messer said he would expect jail officials at any facility where a death occurred to review circumstances that may have contributed to what happened, and institute any changes needed to prevent recurrence.
“That jail business is a high-risk business with great responsibility,” he said. “If it turns out you’re wrong, you just really have to make whatever changes are needed. You don’t want to wait until you lose a civil suit before you do that.”
Reprinted with permission of the Mansfield News Journal