Mental Health Inc

by Art Levine

  Looking back, he also believes that if a program like Operation: Tohidu had been available to Andrew White, “It could have offered some new opportunity for him and helped him, but there’s no guarantee.” Andrew’s father, Stan, told Towner about the program.

  A key component of the Operation: Tohidu training is the “psychoeducation” component on a variety of psychological and treatment issues, grounded in references to scientific literature—while challenging common medical myths. At a morning training, for instance, Vieten asked the veterans during a PowerPoint presentation how many believed the “chemical imbalance” theory of mental illness. Almost everyone raised their hands. But she pointed out, “Not only is this chemical imbalance thing a theory and not a fact, but it’s not even a good theory.” She was also challenging what she calls the belief in a “quick hand-to-mouth answer” of psychiatric medications and diagnoses that pathologize normal human discomfort and often serve as chemical restraints.

  Vieten offers a radical counterweight to the decades of drug industry marketing and deception that had victimized veterans who, like Jason Simcakoski, were all collateral damage in a deadly, greed-driven corporate campaign nearly unrivaled in modern American history. Even if her hard-line stance about the dangers of psychiatric medications, especially in the long run, put her at odds with some compassionate psychiatrists who use medications appropriately, there were good reasons for pointing to an alternative way out to undo all the damage that has been done.

  These veterans had been prisoners of a system that had failed them, but they had, for now, found a way to escape. Another group of traumatized Americans—mentally ill inmates in urban jails—were not so fortunate.

  CHAPTER 9

  How LA County’s Mental Health Officials Neglect Inmates and Ignore Violence

  BEFORE BREAKFAST ON NOVEMBER 8, 2014 IN THE WOMEN’S JAIL IN Los Angeles County, a popular inmate named Unique Moore coughed and complained she couldn’t breathe. A thirty-seven-year-old African American, she had a history of diabetes, asthma and severe mental illness. Moore struggled to catch her breath on the lower bunk and desperately asked her cellmate in the top bunk, or “cellie,” to call the guard for an inhaler (LA County jails do not allow inhalers in cells, as they can be used as weapons or dispensers for illegal drugs). As a lawsuit that Moore’s family filed in 2016 asserted, the cellie repeatedly pressed the emergency call button inside each cell to summon help. Inside the cell in “pod” 3400 of the 2,300-woman jail in suburban Lynwood, the minutes ticked by without a response. About ten minutes into the ordeal, Moore fell down unconscious. Her cellie screamed out. But Moore couldn’t be roused.

  Unique Moore was one of Los Angeles County’s nearly 700,000 adults with serious mental illness. Like Moore, many die far too young, and at least half receive no treatment at all. Yet each year thousands are routed into the LA County Jail, the largest single facility for holding mentally ill people in the country. The jail is a truly horrifying place, and non-violent mentally ill offenders should not have been sent there at all. Instead, their confinement made the goal of “recovery”—leading a fulfilling life while managing their illness—more elusive than ever.

  On the morning of Moore’s death, the guards, mostly men at that time of day, dawdled. “A lot of times when we wanted toilet paper or sanitary napkins, they ignored us,” recalls Kendra Cox, who was jailed in the adjoining pod, 3300. “They probably thought it was insignificant,” she says. “They were men.”

  But the guards for Unique’s pod weren’t even present. They schmoozed with colleagues in pod 3300 before their workday. Kendra alleges that, initially, they didn’t answer the incessant alarm from Unique’s cell, a claim that the cellmate buttressed. Kendra learned about the delayed emergency response when inmates near Unique shouted and pounded on their thick metal doors. So the inmates’ yelling followed the ignored ringing of the emergency bell. In the other pod where Kendra bunked, the sounds were muffled. Yet the inmates’ cries for help woke Kendra and inmates nearby.

  But the shouting and pounding did not stir the guards nearby. For about twenty minutes, Kendra says, she stood near the door at her cell, looking out the small observation window and wondering where the guards were. Eventually, the guards responded. When they showed up, Unique was on the cell floor unconscious, but, they claimed in reports, still breathing. After the jail’s medical staff arrived at her cell, she had gone into cardiac arrest before they could administer CPR. Then they summoned the county’s Fire Department paramedics.

  After she was carted away from the jail to an ambulance, word spread through the jailhouse grapevine about “Chocolate.” Shortly before 8 a.m. at St. Francis Medical Center Unique Moore was declared dead.

  Soon enough, it seems, yet another cover-up from the Los Angeles County Sheriff’s Department (LASD) began. Based on the version of events from the LASD, the coroner reported that Moore was “routinely” checked by the jail’s medical staff whenever she needed her inhaler. In Unique’s case, as an LASD detective later claimed to the coroner, a deputy sped his way to the medical staff, retrieved the inhaler and returned to find that Unique had fallen to the floor, semi-conscious and breathing with difficulty. The LASD insisted, “As soon as the decedent was pulled out of her cell, the decedent went into cardiac arrest.” That’s the LASD’s story and they’re sticking to it.

  The LASD initially declined to comment on the incident or even concede that Unique had died. By October 2015, when I told the sheriff’s department that I had obtained the coroner’s report, the agency finally admitted she died, but blamed it on her drug abuse, not medical neglect.

  The silence, evasions and apparent deceptions weren’t surprising. After all, since December 2013, federal prosecutors have hit the sheriff’s department with nearly two dozen federal criminal indictments for assault, obstruction of justice and corruption; most of the twenty-one convicted guards and administrators, including the defiant undersheriff, Paul Tanaka, have been sentenced to prison. His boss, former sheriff Lee Baca, initially faced a trial in December 2016 for allegedly lying to the FBI. It ended in a mistrial after jurors were deadlocked. Prosecutors announced in January 2017 that they planned to retry him on corruption charges. In June 2016, the stiffest sentence as of mid-March 2017—five years—was given to Tanaka, the mastermind of a scheme to block an FBI investigation into the jail’s reign of violence towards inmates that he allowed to flourish. Any remaining illusions about the department’s penchant for cover-ups were shattered with the conviction of the once-powerful Baca in March 2017 for obstructing a federal investigation into abuses at the jail and related charges. In May, he was sentenced to three years in prison.

  Earlier, in August 2015, the LASD had finally agreed to a federally-appointed monitor to ensure that it carries out sweeping reforms across the jail system to rein in deputies’ abuse of inmates and to improve care for mentally ill prisoners. The federal action followed the department’s agreement in April 2015 to curb abuses documented in a class-action ACLU lawsuit stemming from decades of violence against inmates in the men’s jail.

  Mentally ill inmates are vulnerable across the country, but especially so in LA County and in the nation’s most brutal prisons. They have been attacked at higher rates than other inmates, according to the sheriff’s department’s own “use of force” data and national reports by groups such as Human Rights Watch. About the same time that Tanaka was first accused by prosecutors of covering up violence in May 2015, Human Rights Watch reported on commonplace violence by guards targeting the severely mentally ill across the country, including for such minor infractions as using profanity. The report summed up, “Corrections officials at times needlessly and punitively deluge them with chemical sprays; shock them with electric stun devices; strap them to chairs and beds for days on end; break their jaws, noses, ribs; or leave them with lacerations, second-degree burns, deep bruises, and damaged internal organs.” Furthermore, Human Rights Watch observed, “The violence can traumatize already v
ulnerable men and women, aggravating their symptoms and making future mental health treatment more difficult.” (Strikingly, at least 60 percent of all jail inmates haven’t been convicted of crimes, but are often too poor to post bail.)

  As The Los Angeles Times reported, the drive to abuse mentally ill and other inmates was so great in the jail system that a rookie deputy, Joshua Sather, said he succumbed to pressure from a supervisor to beat up a misbehaving mentally ill inmate: “We’re going to go in and teach this guy a lesson,” his supervisor told him. A top graduate of his recruiting class, Sather soon quit the department.

  Human Rights Watch cited several needless deaths in its report, illustrating that the culture of violence in the Los Angeles County Jail was not unique to California. One shocking incident involved Christopher Lopez, who died in 2013 at Pueblo, Colorado’s San Carlos Correctional Facility after lying handcuffed nearly naked on the floor for hours, being repeatedly force-fed antipsychotics and suffering seizures. Meanwhile, clinicians and jailers laughed at him while chatting about vacation plans as Lopez, who had delusions that he was Jesus Christ, lay face down on the cell floor dying, according to a lawsuit his mother brought, which the Department of Corrections settled for $3 million in December 2014.

  What’s especially striking about official violence aimed at the mentally ill and other inmates is the resistance to making changes. For instance, the LASD didn’t even start rooting out the violence and neglect until the end of 2013, after deputies were indicted, Sheriff Lee Baca retired early and the Board of Supervisors ordered the department to reform.

  LA County Jail health professionals have not yet been exposed as acting as cruelly as their Colorado prison counterparts. Yet many of the same scornful attitudes have flourished for years, according to the jail’s former mental health clinicians, the Department of Justice and ACLU reports. Both jail and mental health department leaders have countenanced or ignored staffers laughing at the mentally ill and ignoring inmates in physical agony. This pattern of neglect made it possible for violence against inmates, including the mentally ill, to continue unabated.

  But as a former LA County Department of Mental Health jail clinician, who asked to be anonymous, points out, “The deputies and the sheriff’s department are in charge.” This counselor noted that the jail staff, whose ranks law enforcement officials dominate, set the tone and approach to mental health care, even though mental health services have been provided by Department of Mental Health (DMH) clinicians deployed to the jails. (Medical treatment for physical illnesses has traditionally been handled by the sheriff’s department health workers, while the jail’s mental health care was the responsibility of Department of Mental Health staffers.) But the culture of the jail was shaped by the brutal cruelty sanctioned by the LASD for years. That may help explain why too many mental health workers, whether at a prison in Pueblo or inside the Los Angeles County Jail, have lost their moral compass and departed from the Hippocratic Oath: “First, Do No Harm.”

  In the summer of 2015, the county Board of Supervisors moved to strip both the mental health and sheriff’s departments of the authority to run health care in the jail, placing that responsibility with a new office in the county’s Department of Health that was scheduled to assume control in late 2016. But that change won’t by itself ensure that mentally ill inmates are treated appropriately or, most critically, given alternatives to incarceration.

  People like Lopez and Moore should not have been in jails or prisons. Of the 356,000 severely mentally ill inmates in the nation on any given day, most have lacked reliable access to community-based services and treatment facilities, let alone high-quality care. By some estimates, ten times as many seriously mentally ill prisoners are in jails and state prisons—mostly for non-violent offenses—than in state mental hospitals. In LA County, a perfect storm of neglect, an absence of accountability and the department-wide shielding of wrongdoers led to the decades-long nightmare that brutalized inmates.

  The US Justice Department in 2016 continued its criminal probe into violence, corruption and obstruction of justice at the LA County Jail. Meanwhile, it has finalized the court-ordered consent decree announced in August 2015 to force reform of the “persistent failure” of the jail system’s abysmal mental health care.

  The federal oversight would come too late for Unique Moore. Kendra and other inmates often saw her, ballooning to more than two hundred pounds in part due to her meds, wandering around the open area outside the cells in a medication-induced stupor. Unique’s history of serious mental illnesses included bipolar disorder and schizophrenia. Yet she was kept with the general jail population. She was also given a potentially fatal cocktail of drugs, including the antidepressant Elavil and the antipsychotic Seroquel that, according to the FDA, posed a significant risk of sudden cardiac death when prescribed together. Unique’s complex medical history made her especially vulnerable. She had suffered from congestive heart failure, diabetes, asthma, anemia, chronic obstructive pulmonary disease and neuropathy, all clearly disclosed to the jail’s medical staff when she was arrested for violating her probation less than a month earlier.

  Unique needed careful monitoring and prompt attention in case of breathing or cardiac emergencies. But as far as Kendra could tell, few, if any, of the mentally ill inmates in the general population got medical exams. Kendra’s allegations received support from a harsh assessment the Department of Justice rendered in June 2014 about the quality of care given mentally ill inmates, and the views of some current and former LA County Department of Mental Health clinicians who worked in the jail. “There was no oversight and an indifference to bad clinical care” for both medical and psychological conditions, one DMH therapist says.

  But according to the LASD, Moore had received plentiful, regular health care. Its official, rosy version of events provided no hint of a delayed response to Unique’s medical needs by the sheriff’s department. Yet it suggested an alternative factor in the inmate’s puzzling death: “Possibly overdosed on a narcotics substance.” When I inquired again nearly a year after her death, a spokesperson for the LASD’s homicide bureau told me that the medical examiner also concluded that the death was due primarily to her drug abuse history. Yet the medical examiner found no illegal drugs in her system—just prescribed medications including Seroquel, the antidepressants Elavil and Pamelor, along with Benadryl. He concluded, “The cause of death is attributed to the asthma,” but he amended his initial findings after input from the LASD detectives, adding: “The mode of death is accident due to the history of drug use”—despite the absence of any illegal drugs or alcohol on the day she died.

  “The state failed her,” Unique’s father, James Moore, believes, in part because the drug treatment programs she attended during her prison stays were undercut by the widespread availability of illegal drugs in prison.

  This shoddy care has a cost. After they end up in the LA County Jail, 95 percent of mentally ill inmates have substance-abuse disorders that remain untreated. In fact, they are so unmoored from their families and communities that more than 80 percent are homeless or lack stable housing when released, as the new LA County Sheriff, Jim McDonnell, noted in testimony in February 2015 before the President’s Task Force on 21st Century Policing. “Jails were not built as treatment centers or with long-term treatment in mind,” McDonnell said. But that’s little excuse for the apparent widespread patterns of neglect and abuse that continue in the women’s jail after the men’s jails have gotten so much law-enforcement and legal attention.

  When Moore returned to the LA County women’s jail in the fall of 2014 for the final time, it was probably one of the worst places in the country for a person with her problems to be incarcerated. In fact, DMH workers and former inmates report that female inmates’ medical and psychiatric problems are often ignored for weeks. In extreme cases, female inmates pull out their own rotting teeth, according to Kristina Ronnquist, a former social worker intern in the women’s jail in 2013 and 2014. Just as dist
urbing for some inmates, Ronnquist notes, “On the second floor [for the most seriously mentally ill], they’re decompensating because of the environment. They’re rubbing feces over themselves and rubbing it on the windows. And many of them are non-violent.” She adds, “I had no idea any of this was going on. I was shocked and horrified.”

  Sheriff’s deputies and detectives downplayed such complaints, similar to the way they launched a superficial inquiry into Moore’s death. Although they did so within hours of her demise, the investigating officers came from the same department that allegedly threatened, terrorized and intimidated the inmates under its watch routinely. “They treated us horribly, like we were second-class citizens,” Kendra says of the custody staff, noting that no inmates dared to call out the guards on the early-morning shift for their delayed response. “We didn’t tell them what really happened,” she says now.

  But as my interviews with former inmates revealed, the sheriff’s department failed to interview inmates on Unique’s pod after they were released. Officers knew that inmates wouldn’t dare snitch on them while inside. Abetted by a report to the coroner’s office at odds with inmate accounts, it seems the sheriff’s deputies on duty offered a version of events that put their response in the best possible light. Much of that will likely unravel in the face of the new lawsuit charging neglect, wrongful death and a violation of Moore’s civil rights, supported by multiple eyewitnesses to the alleged deadly delay that cost Moore her life—and that could cost Los Angeles County millions of dollars.

  • • •

  BUT MOORE’S DEATH, AS WELL AS THE ABUSE, VIOLENCE AND NEGLECT that continues at the women’s jail, received scant newspaper ink or TV coverage. The lion’s share of media and legal scrutiny has gone to the men’s jails. A citizens commission in 2012 found a “persistent pattern of unreasonable force” in the men’s jails. Even before more than twenty deputies and administrators were convicted of violence and corruption-related charges, ACLU reports documented horrifying conditions at the jail. In fact, there has been two decades’ worth of lawsuits, Justice Department reports and court orders highlighting abusive conditions for mentally ill inmates, mostly in the men’s jail. The latest round of reforms stems from a 2011 Los Angeles Times investigative series that helped stoke public outrage, and the ACLU’s lawsuits and reports. This public shock and anger, a belated response to decades of violence and neglect in the men’s jails, is well deserved.