Jail policy of letting prisoners self-medicate questioned —(The New Orleans Advocate)

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Inmate had long history of abuse

The Advocate – New Orleans

BY LAURA MAGGI, lmaggi@theadvocate.com

November 28, 2013

When he wasn’t in jail, Ricky Russell often was headed that way. He got drunk, sometimes so spectacularly that he ended up in handcuffs.

Police caught him stealing, red-handed, at least once. He was busted in 2005 for hurling a rock through the window at a Kia dealership in Kenner; he admitted to it as soon as police arrived. Stopped by an officer near New Orleans’ Palmer Park on another occasion, smelling of alcohol and slurring his words, Russell asked to be taken to jail. Sometimes he got into fights, once attacking a fellow resident at an unlicensed group home in Gentilly.

Russell struggled with depression, addiction and “emotional disturbance,” in the words of one childhood evaluation.

As a child, he lived for years at the Waldo Burton Boys Home, returning to his family only on weekends. As an adult, he depended on disability checks and mostly stayed at the group home. Court records described him as possibly bipolar.

In summer 2012, he was arrested for a much more serious crime: brutally killing the group home’s elderly caretaker.

At Orleans Parish Prison, where Russell was kept alone in a protective-custody cell, the volatile inmate was allowed to manage his own medication, a regimen that included an anti-depressant that experts say can be abused by addicts. He received a weeklong supply of two drugs, jail medical staff indicated earlier this year, which was consistent with a much-criticized “keep on person” medication policy at OPP.

Early on the morning of Feb. 7, Russell was found dead in his cell, his airway choked off by toilet paper he’d swallowed at some point the night before. He was the second Orleans jail inmate to commit suicide by eating toilet paper in the past few years.

The 26-year-old inmate died of asphyxiation, the coroner concluded. But the death certificate also lists “Wellbutrin toxicity” as a contributing factor.

That wouldn’t be a surprise to the other inmates on his tier. During his time at the jail, Russell repeatedly talked about taking all of his meds at once, according to an Orleans Parish Sheriff’s Office investigation after his death. A few inmates had seen him do it, including on the day before he was found unresponsive in his cell.

Although the sheriff’s Special Operations Division report quoted inmate after inmate as saying Russell talked widely about abusing his prescribed medication, the deputy who led the investigation left open the question of whether it was wise to let Russell handle his own drugs. Instead, the deputy concluded there was no indication of foul play and closed the book on the case.

Jail leaders declined to be interviewed for this story, but over the years, OPP officials have repeatedly defended the “keep on person” policy with regard to drugs.

In an Aug. 29 statement, Dr. Samuel Gore, the jail’s medical director, said each inmate was evaluated to determine whether he could manage his own medication or needed to be “directly observed” taking pills by a nurse.

But on Friday evening, after additional requests for information by The New Orleans Advocate, Gore sent a new statement, saying the jail had shifted to an updated policy for psychotropic medications such as Wellbutrin: dispensing them solely by “directly observed therapy.”

“The procedure was modified in a periodic review of pharmaceutical operations,” Gore said. “Additional staffing will improve our ability to continue this program.”

A jail spokesman said the change was made in early August, although it was not mentioned in the jail’s earlier statement.

Katie Schwartzmann, an attorney who filed the class-action lawsuit that helped prompt a recent federal consent decree mandating reforms at the jail, applauded the move, saying the jail now needs to follow through with other drugs.

“This is a positive and important change, and the policy possibly could have saved Ricky Russell’s life. As of yesterday, men in the jail told us that OPP is still administering other medication, including pain medication, 10 pills at a time,” Schwartzmann said Friday. “We hope they will move to direct-observation administration for all medication until the conditions in the jail are safe enough to allow otherwise.”

Schwartzmann said one of the problems with giving inmates multiple days’ worth of pills at a time is that some inmates barter them, or are attacked by stronger inmates who steal them.

“Right now the jail is too understaffed, violent and chaotic to administer large numbers of pills at one time,” she said.

For critics of the Orleans Parish jail, Russell’s death highlighted what they consider one of the major problems with the medical care offered by Sheriff Marlin Gusman’s staff. The “keep on person” medication policy was one of many targets of a 2009 U.S. Department of Justice investigation into the jail that eventually spawned the consent decree.

Fixing the jail’s inadequate provisions for mental health and medical care is a key requirement, but the agreement did not bar the agency from allowing inmates to manage their own psychotropic medication.

Eric Balaban, an attorney with the American Civil Liberties Union’s National Prison Project and a longtime critic of the Orleans jail, said that in two decades of prison legal advocacy he’s never heard of another jail handing out days’ worth of Wellbutrin to an inmate. The pills can be crushed and snorted by prisoners looking to get high, he said, making them potentially dangerous.

“No sensible system would authorize putting Wellbutrin as a keep-on-person medication,” he said.

Soon after Russell died, two inmates on his tier began to raise questions about the death. They were housed in a protective unit, meant for inmates who got into trouble in the general population or were vulnerable to attack.

These inmates housed in cells near Russell said they heard him ask nurses to see a psychiatrist the day before he died, but nothing was done.

“I remember him saying ‘I’m tired. I’m tired of this,’ ” one inmate told the Southern Poverty Law Center, according to an affidavit in the court record.

In a February statement, the jail denied that allegation, saying nurses are told to contact the psychiatrist immediately at an inmate’s request.

Jail officials did acknowledge that Russell received more than a day’s dose of his medications, saying that the day before his body was found he received “two prescriptions for the week, as prescribed.” The autopsy indicated those drugs were Wellbutrin and citalopram, another antidepressant.

When Russell first was incarcerated in June 2012, he voiced suicidal thoughts. He was depressed about his crime and lack of contact with family, Gore said at the time of his death.

But the doctor said Russell responded to treatment and was taken off suicide watch.

“At his most recent visit to the mental health staff, less than a week before his death, inmate Russell was in ‘good spirits,’ voiced satisfaction with his medication changes, and denied suicidal ideation,” Gore said.

Shortly after his death, Gusman’s office lambasted the inmates who criticized Russell’s treatment, saying they vastly overestimated the amount of drugs he was given. But the sheriff’s own investigation, spearheaded by Special Operations Division Deputy Jerry Martin Jr., corroborated a key critique: that Russell was irresponsible with his medication. Seven other inmates said they either saw Russell take excessive pills at once or heard him talk about it.

The sheriff’s investigation did not nail down how many pills Russell might have consumed. In the nine-page report, there is no description of any search of his cell, where he was held by himself. It is unclear whether the jail staff went through his belongings to assess whether he took all his medication.

Broader Justice Department investigations in 2009 and 2012 found that jail medical staffers too often fail to identify mental illness, use woefully inadequate suicide-prevention practices, and are too few in number to care for people with chronic conditions. In 2009, investigators particularly faulted the “keep on person” medication practices, finding that “OPP’s practices were inconsistent with generally accepted professional standards of care.”

A more recent study by James Austin, the city’s expert looking at the jail’s staffing needs, also found that the jail lacks sufficient medical staff. He recommended that OPP hire 10 more nurses, another administrator, a part-time psychiatrist and a part-time doctor.

While many correctional-medicine experts favor a “keep on person” policy for some drugs, several experts said it is not commonly used for psychotropic medications.

Dr. Jeffrey Metzner, a psychiatrist who helps develop correctional mental-health systems and who previously inspected OPP as an expert for the ACLU, said the types of drugs appropriate for inmates to keep themselves are over-the-counter medications or prescriptions such as asthma inhalers.

Russell’s mother and stepfather, who live in St. Rose, said Russell struggled to manage his mental illness and addictions, and was not a good candidate to administer his own drugs while incarcerated. His mother doubts he intended to commit suicide, as the coroner concluded.

“He didn’t want to kill himself,” Christy Russell said. “He was a drug addict; he wanted to get, most probably, high.”

Given a few bucks and a free afternoon, Russell was apt to gravitate to the nearest drugstore, where he’d buy a couple of bottles of cold medicine, his parents said. They often got calls from hospitals with the news that he had been checked into the ER, overdosed on one drug or another.

His life was marked by tragedy early on. When he was just a toddler, his father, also named Ricky Russell, was shot to death by Russell’s stepmother.

His stepfather, Butch Fascio, recalled a young child who loved to go crawfishing or sit on the levee eating boiled shrimp.

But he didn’t always live with his family. Unable to control Ricky, his mother said, she put her son in the Waldo Burton Home when he was 9. He lived there for years until he was kicked out in 2003.

Paperwork from his subsequent schools showed he continued to struggle with emotional difficulties, getting in trouble at school and breaking the law. While at a St. James youth lock-up after attacking his mother, he was twice placed on suicide watch.

As an adult, his parents described a cycle of abuse, arrests and stays in the hospital. Russell was in regular contact with law enforcement, getting arrested in Jefferson, Orleans and St. Charles parishes, although mostly for minor infractions until his most recent crime.

When released, he would end up back at the Gentilly home, although he often got thrown out after one infraction or another.

“Ricky couldn’t stop getting loaded. He would get to the point where he just got knocked out,” Fascio said. “I don’t know what he was on. When it came to drugs, he didn’t care.”

His mother said she didn’t see her son as a mean person. She can’t understand how he came to kill 74-year-old Lorraine Langlois, the caretaker at his group home.

Police determined Langlois was struck on the head with an air-conditioning unit and strangled with a plastic bag.

Russell allegedly confessed to the crime after driving Langlois’ car into Lake Pontchartrain. He was spotted walking away, soaking wet, by a Levee Board police officer.

In his one phone call home during his months at the jail, Russell told his family that “one thing had led to another” during a dispute with Langlois, his mother said.

He sent one letter, proclaiming that he was taking his medication and speculating hopefully that a plea deal would see him eventually released from prison.

“I can’t stop think about everybody that loves me. I’m sorry for being a ass hole all the time,” he wrote. “That the way I am. But I’m feel better a little bit. I’m on my med’s.”