1/24/2019

Print Page

Library: FRS TEXT ARCHIVE 2011-2020

Printing 1 Items

Without proper meds, mentally ill inmates in
Fresno County Jail feel ...
LOCKED IN TERROR
Reporter: Marc Benjamin and Barbara Anderson The Fresno Bee
Publication: THE FRESNO BEE
Edition: FINAL
Section: MAIN NEWS
Page: A1
Corrections:
Print Run Date: 8/11/2013
Digital Run Date:
Body Text: The Fresno County Jail has been a place of terror and despair for
mentally ill inmates who spiral deeper into madness because jail officials
withhold their medication.
About one in six jail inmates is sick enough to need antipsychotic drugs
to control schizophrenia, bipolar disorders and other psychiatric
conditions, but many sit for weeks in cells without medication previously
prescribed by private doctors, say family members, lawyers and
psychiatrists. If the inmates do get medication, it's often at a lower dose
or is a cheaper generic substitute that doesn't work as well, they say.
Six years ago, the jail drastically cut back on psychiatric drugs. A county
official said the intent was to curb drug abuse by inmates faking mental
illness. Critics say it was part of the county's cost-cutting efforts.
But the drug policy has raised costs significantly in other areas.
Taxpayers spend millions of dollars each year on the inmates -- above
and beyond the cost of caring for them in the jail. As their mental
conditions deteriorate, many lose the ability to help in their own defense
and must go to state mental hospitals for treatment. Fresno County has
sent nearly 400 inmates since 2007 to state mental hospitals, more per
capita than all of California's largest counties except Kern.
For many, a hospital stay is a short reprieve from psychosis. Medicine
prescribed by psychiatrists at state hospitals isn't continued once
inmates return to the jail, and their instability returns. Repeated trips to
state hospitals are all too common, judges say. One Fresno inmate was
admitted to a mental hospital nine times before his trial ended.
Besides the cost of expensive hospital treatment, taxpayers also foot the
bill when trials are delayed, courts are backlogged and the jail is
overcrowded.
Fresno County officials say they meet their legal obligations for
providing psychiatric services -- and the 2010-11 grand jury, which
investigated, concurred. But at least one judge wanted to hold a county
official in contempt of court for the county's treatment of mentally ill
inmates. And the county now faces lawsuits from a group that
previously only sued state prisons over medical conditions and from a
family whose relative was killed by a cellmate with mental illness.
Advocates for inmates say they are beginning to see improvements. The
county has brought in new leadership at the jail for psychiatric care and
is taking steps to turn jail medical and psychiatric services over to a
private contractor with expertise in jail medical care. Changes are
needed, because failing to properly care for mentally ill inmates has left
the community at risk, advocates say. All too often, families suffer the
consequences.
http://mcc-sccweb.mccintra.local/scripts/sccmgcgi.dll

1/13

 1/24/2019

Print Page

The relatives of one mentally ill offender say the jail's refusal to properly
medicate him turned him into a ticking time bomb. Within a day of his
release from jail, they say, Travis Fendley no longer could ignore the
voices sparked by his schizophrenia that allegedly told him to strangle
his grandmother. He is now in jail, charged with her death.
Fendley's family says his illness was allowed to spin out of control -with tragic outcomes -- while he was in Fresno County Jail last year on
other charges.
It was a terrifying time for Fendley. It became even more so for his
grandmother.
From family accounts, Fendley, 23, was agitated and nervous when he
was released from Fresno County Jail on Dec. 17. His aunt, Becky Alford
of Fresno, picked him up and planned to drive him to a psychiatric
hospital.
Fendley warned his aunt: "Things aren't going to turn out well."
He hadn't been given antipsychotic medication while in Fresno County
Jail, his family says, and he told them "the demons in his head" were
ordering him to hurt himself and his loved ones. He tried more than
once to kill himself, including trying to slash his throat while locked up,
his family says.
Alford tried to calm her nephew, but nothing worked. He jumped out of
her car and started walking to his grandmother's home in east-central
Fresno. He called Alford from there, begging to spend the night with the
78-year-old woman.
A winter storm was coming and her nephew needed a place to stay, but
Alford was fearful to let Fendley be alone with her mother. Joyce Frazier
was frail, and Fendley had just spent 10 days in jail on a charge that he
punched her. Frazier always forgave her grandson, and she would let
him spend the night unless Alford forbade it.
Alford compromised: Fendley could stay -- but only in the garage.
The next morning, Alford couldn't reach Frazier by telephone -- Fendley
answered twice and said his grandmother was asleep. She rushed to her
mother's home. The dog was barking and the screen door, always
secured, was unlocked. Fendley's cigarettes were on the kitchen table.
"I went hollering down the hallway for my mom, and I found her laying
on her bedroom floor -- dead," Alford said.
A series of changes
Critics say the care of mentally ill inmates at the Fresno County Jail
underwent a steady decline brought on by policy decisions and dwindling
budgets.
In 1998 and 2000, the jail's medical and psychiatric services were
accredited by the Institute for Medical Quality, a Bay Area organization
that examines prisons and jails in California. It was the agency that
verified the jail met constitutional standards of care.
The accreditation was voluntary. The agency reviewed the jail's policies,
procedures and medical records and interviewed jail medical staff and
inmates.
But the county didn't apply for re-accreditation in 2002, citing budget
problems, said Janet Herrala, administrator of the institute's corrections
and detentions health care program.
Oversight of jail psychiatric services also changed hands. The county's
behavioral health department, which provides outpatient psychiatric
services to the community, also oversaw services at the jail. But faced
with a $16 million budget deficit at the end of 2005, then-director of
behavioral health Giang Nguyen turned jail psychiatric services over to
http://mcc-sccweb.mccintra.local/scripts/sccmgcgi.dll

2/13

 1/24/2019

Print Page

the department of public health, which was then led by Dr. Edward
Moreno.
Since public health already provided medical services at the jail, officials
thought it made sense to consolidate the psychiatric and medical
services, said Susan Anderson, who served three terms on the Fresno
County Board of Supervisors before retiring in 2012.
"When the county does anything like that, it's always about saving
money," she said.
With the consolidation, jail psychiatric services were folded into a
department that was more comfortable giving flu shots, inspecting
restaurants and running sexually transmitted disease and tuberculosis
clinics than managing people with acute psychoses.
Merging the jail's medical and psychiatric services under the public
health department didn't end budget hemorrhages. Within two years of
taking control of jail psychiatric services, Moreno got approval from the
Board of Supervisors to eliminate the 11 p.m. to 7:30 a.m. nursing shift
to save $768,231. The sheriff's jail staff could be trained to screen
incoming inmates for health problems at night, Moreno said in 2008.
In an April interview, Moreno said he warned Fresno County supervisors
that cuts to his department's budget would likely delay routine medical
matters and lengthen the time inmates would wait until they saw
medical personnel.
He also cautioned: "There would be instances when some inmates would
not be seen at all."
Joanne Cox, a jail correctional officer who retired three years ago,
noticed a change in the assessment process when night-shift officers
began screening inmates at booking.
"I had the impression it wasn't as thorough," she said. "It was more
checklist-oriented, and they didn't seem to research it any more than
that. If you weren't exhibiting some kind of a problem, they would say,
'He's fine,' until it became a crisis call."
A complete assessment at booking can put in motion how quickly an
inmate has access to a jail psychiatrist and is prescribed treatment and
medications.
It didn't come quickly enough for Marco Lopez, a former Marine who
served in the Iraq war and was arrested on suspicion of bank robbery in
2011. He was previously diagnosed with bipolar disorder and posttraumatic stress disorder. His mother, Brigitte Lopez, said he waited
almost two weeks before county mental-health staff evaluated him
following his arrest.
His mental condition quickly deteriorated when the jail withheld
medications Lopez was taking before being put in custody, his mother
said.
"He didn't get anything for the first 10 days," she said. "He was in a
seclusion cell by himself, he was hearing voices and he was a behavior
problem."
Lopez said he eventually was given one-quarter of his normal dose of
Depakote for bipolar disorder, which did not help. He said he was given
nothing for psychosis during the almost two months he was in the jail.
County officials cannot comment on individual cases, county counsel
Kevin Briggs said.
Lopez, 30, is now out on bail and living with his parents in northeast
Fresno while awaiting trial. And he is again taking Abilify, his
antipsychotic medicine.
In their desperation to help, family members of Lopez and other inmates
said they took prescribed drugs to the jail or gave them to law
http://mcc-sccweb.mccintra.local/scripts/sccmgcgi.dll

3/13

 1/24/2019

Print Page

enforcement. They later learned those drugs never got to their loved
ones.
Jail officials don't know what drugs are in the bottles that family
members bring, and can't simply hand them over to inmates, said
Fresno County Undersheriff Tom Gattie: "What seems to be logical in the
real world is completely different in the jail."
Defense lawyer Barbara Hope O'Neill, who once represented Fendley,
said she frequently gets calls from families worried because inmates
aren't getting proper medication. Abruptly stopping a drug prescribed
for mental illness can be dangerous, she said.
"I'll call the (county) psychiatric department, and either nothing gets
done or it takes weeks to get something done," she said.
Solitary confinement
When Lopez's mental state worsened, the nightmare deepened: he
wound up in a part of the jail that inmates call "The Dog House."
There are 10 single-bunk cells located in each of the four upper floors
where inmates -- often with mental illnesses and in need of medications
-- go when they lose touch with reality or are considered a danger to
themselves or others.
Each cell has a cot, a small table and a combination toilet/sink. There's
no television.
Every other day, the inmates can shower and spend a brief time outside
the cell, often walking in circles in a room with some step equipment in
a corner and an unused ping-pong table. The room is called a gym.
Once inmates are back in their cells, their only contact with the outside
world is through a slot in the steel door. Food -- and medications, if any
-- is delivered through the slot, and inmates often yell at each other or
officers to communicate.
Those who may hurt themselves or someone else or destroy property
wind up in padded cells. Lopez recalls banging his head against the wall
and getting into fights with correctional officers before being put in a
padded cell.
There, they have no bunk, no sink. A hole in the middle of the floor is
the toilet. Their clothes are taken away, and they're given a modesty
garment that can't be fashioned into a noose. They also may end up in a
restraint chair, where their movements are restricted.
The isolation can push those inmates deeper into madness.
Sharon Alexander said her son, Wesley Alexander, who has
schizophrenia, was traumatized by the time he spent in an isolation cell
last year.
Alexander, 48, was accused in May 2012 of raping a woman who he
thought was his girlfriend when both were at Crestwood Fresno
Psychiatric Health Facility, a private program on contract with the
county.
He told his mother that at one point in the jail, he was overcome with
thirst and tried to sip water from the toilet hole after fashioning a straw
out of cellophane. He also placed a sock down the drain to sop up water,
she said.
While at Crestwood, he had been prescribed antipsychotic medications.
After his arrest, a doctor at the facility made sure his medical records
were delivered to the jail and advised jail officials to continue his
antipsychotic prescriptions, his mother said.
When he didn't get the drugs, his mental state quickly deteriorated.

http://mcc-sccweb.mccintra.local/scripts/sccmgcgi.dll

4/13

 1/24/2019

Print Page

"I had no clue that this went on at the jail, that they were not given
medication," Sharon Alexander said.
Reducing drug costs
Around the time that Moreno cut the nursing night shift, public health
officials began looking at other ways to reduce jail health costs. The
amount spent for psychiatric drugs stood out.
The county began a review of its drug formulary, a list of medications
allowed for inmates. Generic drugs, which cost less than brand-name
equivalents, were chosen whenever possible, Moreno said.
Two drugs -- Seroquel, used to treat schizophrenia symptoms, and
Wellbutrin, an antidepressant -- were yanked from the formulary list,
except in isolated cases.
The savings were dramatic: The amount spent yearly on psychotropic
drugs dropped by 89% over five years, from $924,372 in 2006-07 to
$194,975 in 2008-09 and then to $99,302 in 2011-12. Drug costs that
had consumed 28% of the $3.3 million jail psychiatric budget six years
ago were down to 3%.
In March 2009, two jail officials presented a paper about the restricted
formulary at a meeting of the California Department of Corrections and
Rehabilitation's Council on Mentally Ill Offenders in Seaside, near
Monterey. The council identifies the most cost-effective ways to keep the
mentally ill from breaking laws, and to treat them once they are
incarcerated.
The title of the paper by George "Bud" Laird, a psychologist who was the
county's correctional health division manager from May 2006 until he
retired in January 2012, and Pratap Narayan, the jail's full-time
psychiatrist: "Formulary Controls: Abuse of Psychotropics and
Dispensary Costs in the Incarceration Environment."
Two targeted drugs -- Seroquel and Wellbutrin -- were rife for abuse by
inmates, they said. Jail medical officials believed inmates would fake
mental illness to get them. Inmates call Seroquel "baby heroin" because
of its effects, Laird said, and Wellbutrin causes a rush similar to speed
when crushed or snorted.
The budget savings were coincidental, Laird said.
"I was not pressured to cut costs at the jail," Laird said in an interview
last month.
Narayan would not comment on the record.
Shortly after the drugs were banned, jail mental-health staff reported no
increase in crisis calls and no more inmates placed in safety cells to
prevent suicide or injuries to themselves or others, both Laird and
Moreno said.
Fresno County may have been justified in restricting Wellbutrin and
Seroquel because of abuse concerns, said Rusty Selix, executive director
of Mental Health America of California, a citizen-based advocacy
organization. But withholding the drugs from everyone is not a good
practice, he said: "You can't be so simplistic as to say, 'If you're already
on it, you can't stay on it.'
"There are definitely people who need those drugs. For some, they're
the only drugs that will work."
Soon after Fresno County eliminated the two drugs, other counties took
their cue and stopped dispensing Wellbutrin and Seroquel.
Even though county officials maintain otherwise, family members of
Fresno County inmates and other critics contend the county chose which
drugs to give inmates based on price, not therapeutic value.

http://mcc-sccweb.mccintra.local/scripts/sccmgcgi.dll

5/13

 1/24/2019

Print Page

Fendley's aunt says that when he was not in jail, he was taking four
drugs -- the antipsychotic medication Latuda, the anti-anxiety
medication clonazepam and two antidepressants, Prozac and trazodone.
Latuda has a retail price of $674 for a month's supply, Alford said.
Clonazepam cost $37, trazodone cost $11.99 and Fluoxetine, the
generic for Prozac, cost $35. Medi-Cal covered Fendley's prescription
costs when he was out of jail, but inmates lose the government
insurance benefits and the county has to pick up the tab.
Jail psychiatric staff gave only Prozac to Fendley, Alford said.
The consequence, said his relatives, was that Fendley slipped further
from reality. His mother, Pamela Frazier, questioned the jail's decision to
give him only the antidepressant. A psychiatrist told her that doing so
could worsen symptoms of schizophrenia.
Under fire
In 2010, the jail's medication policies were investigated by the Fresno
County grand jury, which had received a complaint about medications
being withheld or changed, leaving mentally ill inmates incompetent to
stand trial.
The grand jury cleared the jail of making significant medical errors and
said the law required only that it provide "emergency and basic health
care services to all inmates."
However, the grand jury added a caveat: "When medication prescribed
at State Hospitals appears to be successful, jail mental health
practitioners should make every effort to consider the rationale, which
led to that successful regimen of medication."
The county's limited jail medication policies soon captured the attention
of the Prison Law Office, an Oakland group that had up until then only
sued state prisons over medical conditions.
In 2011, Fresno became the first county in California to be sued by the
nonprofit law center. The lawsuit, which seeks to improve conditions at
the jail, is now in settlement negotiations.
The Prison Law Office said the jail's policies made the decision to sue a
no-brainer. "We singled out Fresno County because of the stories we
were hearing about their refusal to prescribe medications," said Kelly
Knapp, a staff lawyer.
Some jails are cautious about prescribing drugs with addictive qualities
or high street value, but medications restricted in Fresno County run the
gamut -- from highly abused to rarely abused drugs, Knapp said.
She said jail medical staff decide against continuing medications without
adequate justification: "That's what's unique about Fresno."
The cost savings the county got from its restricted drug formulary have
become costly to defend: Through June 30, the county has paid nearly
$228,000 to McCormick Barstow, the Fresno law firm handling its
defense.
The suit names as defendants the Sheriff's Office, which runs the jail,
and the Fresno County Department of Public Health.
The county's legal representative, Michael G. Woods, said Sheriff
Margaret Mims is not opposed to good medical care for inmates in her
jail. The intent "is to make whatever changes are necessary to provide
the quality of medical care constitutionally required for inmates in the
jail," Woods said.
Mims and members of Fresno County's Board of Supervisors would not
comment for this story upon the advice of counsel because of the Prison
Law Office lawsuit.

http://mcc-sccweb.mccintra.local/scripts/sccmgcgi.dll

6/13

 1/24/2019

Print Page

In April, a lawsuit related to the county's mental health services for
inmates was filed by the family of a homeless Fresno man who was
attacked in the jail and died later at a hospital. The wrongful death and
civil-rights lawsuit names Mims, Moreno, Narayan, Laird and other jail
and public health staff. They also are named in the Prison Law Office
suit.
The lawyers for the family of Troy Dewayne Phillips, 47, said his
cellmate, who by the accounts of other inmates and his own lawyer had
serious mental problems, stabbed Phillips more than a dozen times with
a pencil.
The family's lawyer, Peter Grenier of Washington, D.C., said jail officials
and jail medical staff practiced "deliberate indifference" in Phillips' death
by ignoring the medical needs of Jose "Jesse" Cuevas, 27, of Fresno,
and keeping Phillips in a cell with him.
Jail officials knew Cuevas was violent and had mental problems, Grenier
said.
"It was cruel and unusual punishment," he said. "It was like putting Troy
in a snake pit."
It's rare for inmates and inmates' families to sue over jail conditions,
said Fresno civil lawyer Warren Paboojian. One reason: payouts for pain
and suffering are limited to $250,000, he said.
Inmates also are not sympathetic defendants, and the cost to hire
experts for technical medical testimony can amount to about one-third
of the award, Paboojian said.
Judicial concerns
But such suits might find some sympathetic ears in Fresno's legal
community.
Judges have become increasingly concerned about inmates becoming
incompetent to stand trial, being treated at state mental hospitals and
then becoming incompetent again after returning to county jail custody.
Over the years, Fresno County Superior Court Judge Hilary Chittick, who
runs behavioral health court every other week for people whose mental
health issues led to criminal charges, has questioned jail psychiatric
policies.
They had a "different perspective. I am not saying what perspective is
correct, but there is no question there are different perspectives on the
way to handle" mentally ill inmates, she said.
Another Fresno County judge has found the county's treatment of
mentally ill inmates so wanting that he threatened to hold the jail's chief
psychiatrist in contempt of court.
Frustrated about inmates going back and forth between the jail and
state mental hospitals, Judge Jon Skiles a few months ago ordered jail
psychiatric staff to give medications to an inmate who had returned
from Atascadero State Hospital. He said he told jail medical staff "to give
any, and all, medications prescribed by the state hospital. If it wasn't
done, I would file an order to show cause for contempt."
Skiles later learned that there is no legal basis for him to file such an
order.
Jail psychiatrists have to assess and make their own diagnosis when
patients are booked, and that includes when they return from state
mental hospitals, Moreno said. "In many instances, doctors will arrive at
the same diagnosis, but sometimes they will arrive at a different
diagnosis."
Agreement on a diagnosis, however, doesn't guarantee the inmate will
continue getting the same medication that was prescribed at the state
hospital.
http://mcc-sccweb.mccintra.local/scripts/sccmgcgi.dll

7/13

 1/24/2019

Print Page

"We may start him or her on another antipsychotic medication that is
just as effective," Moreno said. For example, if an inmate had been
given Seroquel at the state hospital, "they would have to get approval
before continuing on Seroquel," he said.
Even the county's behavioral health workers have locked horns with jail
psychiatric staff over changing or withholding medications. The mental
health department has guardianship over people with illnesses that
prevent them from making health decisions for themselves.
There were times when jail psychiatric staff refused to prescribe
medication that behavioral health had prescribed to inmates, said Donna
Taylor, the county's director of behavioral health until retiring in midMay. Behavioral health staff intervened and inmates received the
medication, she said.
Costly decisions
The county may have saved millions on psychiatric medicines, but state
taxpayers have paid many millions more for Fresno County inmates to
go to mental hospitals to become competent to stand trial.
An average six-month state hospital stay costs $108,000. A six-month
course of Abilify -- a drug that several families said their relatives
needed but never got in the Fresno County Jail -- is about $9,000. In
2011-12, the last full year that statistics are available, 75 people were
sent from the jail to three of the state's four mental hospitals.
Based on an average stay, the cost would have been $8.1 million to
state taxpayers. The state was unable to provide the actual cost.
Fresno County sends more inmates to state mental hospitals than
almost every other large county in California. On a per-capita basis, only
Kern County exceeded Fresno County in inmate admissions to state
mental hospitals.
Inmates ping-ponging between the jail and state mental hospitals may
not see a trial date for years. Getting a bed at a state mental hospital
can take more than two months. According to a January 2012
Legislative Analyst's Office report on treating those who are incompetent
to stand trial, the average wait time for a bed was 68 days in 2009-10,
almost double the 35 days recommended by the courts.
The delay in placement "has been a challenge, and I know that's a
concern of many counties," said Kathryn Gaither, chief deputy director of
the Department of State Hospitals.
The department hopes to expand a pilot program that would allow
inmates who can be quickly restored to competency to be treated in jail
rather than at state hospitals, she said. "We think it will get them to trial
faster and at a lower cost," Gaither said.
David Anguiano, 58, of Fresno never had to worry about getting a state
hospital bed, however.
In 2007, he began a 5 1/2-year shuttle between Fresno County Jail and
the state hospital system.
Anguiano's lawyer, Eric Green, said his client was mentally ill when he
opened fire on May 23, 2007, on a mobile home of a Fresno man
reputed to be his drug dealer. A Navy veteran and former electrician,
Anguiano was under the care of Veterans Affairs. He was prescribed
Seroquel and Effexor, an anti-depressant, his sister said, but he
substituted those with street drugs and alcohol to control his illness and
stay awake because he was paranoid his home would get attacked.
When he went to Fresno County Jail after the shooting, he got no
medication for his illnesses, Green said. During court hearings, doctors
said he was not competent to stand trial. By the end of May 2008, he
made the first of nine trips to Metropolitan State Hospital in Los Angeles.
Anguiano's last seven stays at the jail lasted, on average, fewer than 14
days. His state hospital stays averaged 64 days over the same time.
http://mcc-sccweb.mccintra.local/scripts/sccmgcgi.dll

8/13

 1/24/2019

Print Page

State hospital doctors prescribed Abilify and anti-depression medication,
but Anguiano didn't get them after he returned to the Fresno jail, Green
said. He was evaluated by the jail's psychiatrist, Narayan, who testified
that Anguiano was faking some symptoms, the court transcript shows.
Narayan testified, however, that Anguiano received medication for
depression.
Narayan left jail employment in February. He now works at Avenal State
Prison.
Anguiano grew sicker in jail when medication was withheld, and Judge
Gary Orozco ruled that between hearings he should be returned to the
state hospital, which kept a bed open for him. In nearly 12 years as a
judge, he said, that happened only two other times in his courtroom.
Those repeated hospital trips to Los Angeles were necessary so he could
obtain psychotropic medication, said Anguiano's sister, Marta Anguiano
of Fair Oaks.
He was sentenced in December to life in prison on two counts of
attempted murder. In January, he became ill at Wasco State Prison. He
died from a bacterial infection in a Bakersfield hospital three days later.
The upshot of failing to properly medicate mentally ill inmates: "Justice
delayed is justice denied," said Scott Baly, a Fresno County public
defender who represented Tyrone Cowan, who was found guilty earlier
this year of a 2007 murder and sentenced to life in prison without the
possibility of parole.
Cowan, who his attorney said in court was diagnosed with mild
retardation, bipolar disorder and other mental illnesses, was sent to
Atascadero State Hospital four times leading up to his trial.
"It's difficult for all people involved in the process," said Baly, "including
law enforcement, witnesses, the families of victims and defendants'
families who rightly want closure from our criminal justice system."
Competency questioned
But some are suspicious of Fresno County's high number of jail inmates
who are deemed incompetent and unable to stand trial. They say many
inmates are faking and evaluators often are unfit to determine which
inmates truly are too mentally ill to assist in their defense.
Debra Souza, now a forensic psychologist and criminologist, studied
mental health services in Fresno County Jail for her doctoral dissertation
at Alliant University in Fresno and found that the county lacks the
guidelines, policies, procedures and training to make such
determinations with any degree of accuracy. Her dissertation review
committee included Narayan and Laird, the county's former correctional
health division manager.
Based on her analysis, the rate of defendants declared incompetent to
stand trial in Fresno County is more than twice the national average,
which means the state is paying more than twice the national average to
restore Fresno County inmates to competency.
Laird said in July that the idea that jails are full of mentally ill inmates is
stigmatizing to the mentally ill. "The mentally ill are rarely involved in
serious crimes," he said, and "if anything, the mentally ill are more often
victims than perpetrators."
A high-level official in the Fresno County District Attorney's Office also
isn't convinced that so many inmates are mentally ill.
Kelly Keenan, Fresno County's chief assistant district attorney, said
claiming incompetency is a way to delay a case and buy time for
defense lawyers. Malingering -- faking of mental health symptoms -often takes months to expose, Keenan said.
"I don't know anything about how the jail treats them," Keenan said, but
the incompetency statute "is written in such a way that the potential is
http://mcc-sccweb.mccintra.local/scripts/sccmgcgi.dll

9/13

 1/24/2019

Print Page

there to be taken advantage of.
"I have seen very few people who are truly incompetent," he said. "It's a
habit or custom of the defense bar (in Fresno County) to use this more
than other counties."
But there was no question about the incompetency of Scott Kinney, a
Fresno defense lawyer who was arrested in 2008 for domestic violence
and assault. Like his attorney father, Ernest Kinney, Scott Kinney has
manic depression and a bipolar disorder and had taken lithium for nearly
15 years.
Concerned about the drug's long-term effects, Kinney had tried to
switch to Abilify, but it didn't control his symptoms. And after his father
passed away, Kinney worked long hours to keep the law practice going.
Then came his arrest.
His mother was turned away at the jail when she brought his
prescriptions, and just days later he started to lose control.
Kinney stayed behind bars about nine months. In the first five months,
he lost 62 pounds.
While in jail, he said, he never got any medication, even though a judge
ordered the jail to give it to him in the early stages of his case.
He was placed in solitary confinement in January 2009. Part of that time
was spent in a restraint chair, a padded room or a "safety garment" until
he was sent to Atascadero in May 2009.
"My behavior must have been bizarre," he said.
He was at Atascadero for 70 days and returned to the jail, he said,
where he finally got his medication for one week before pleading no
contest to a felony that was later reduced to a misdemeanor.
"They wait for you to fall apart before they take care of your medical
condition (in the jail), but by then you think they're Martians and it's too
late," he said. "The jail doesn't want to recognize that people will
deteriorate, but when they do they'll become a bigger problem."
He was surprised to learn that some county officials believe many of the
mentally ill are malingering.
"Yeah, right, like I was faking it," Kinney said.
Advocates for the mentally ill question how many inmates fake their
symptoms. Nationwide, 16% of inmates have severe mental illness and
on average, those diagnosed with mental illness are held in jails much
longer than other inmates.
"A lot of people say they are faking it or malingering, but it would be
stupid to do that because you spend three times longer in jail," said Pete
Earley, a former Washington Post reporter turned mental health
advocate after his son was diagnosed with mental illness.
Properly medicating inmates keeps the court system from backing up
and adds extra space in the jail for inmates who should be there, said
Fresno psychiatrist Howard Terrell. Inmates also get their lives back
sooner, he said.
"You need to get them proper care right off the bat," Terrell said. "Get
them healthy, so you don't need to go off to Atascadero. It relieves huge
amounts of pain and suffering, costs to the jail, crowding in the jail and
streamlines the legal system. Doing the right thing makes sense
medically, ethically and financially."
Taking steps
Mental health and legal observers say change is on the way at Fresno
County Jail. How much will depend on the county's spending priorities.
http://mcc-sccweb.mccintra.local/scripts/sccmgcgi.dll

10/13

 1/24/2019

Print Page

Some change is inevitable. Negotiations with the Prison Law Office to
settle the 2011 lawsuit likely will require the county to improve
conditions for mentally ill inmates, and new leadership in the county
health department could result in new policies.
But in the past, supervisors have balked at using county general funds
for health programs for county inmates, relying instead on funds the
state provides from sales taxes and vehicle license fees.
It's unclear whether supervisors will switch gears and devote general
funds to jail services. The budget remains the same as last year at
$3.037 million, but two new medical service jobs were added.
Before Moreno departed in May as public health officer and director of
public health, he said the department was studying jail medical and
psychiatric services, but warned that improvements would be costly.
Some changes have taken place or are under way. In February, jail
psychiatrist Narayan resigned. He was replaced by Dr. Mayur Amin, who
had spent 20 years working for the county's behavioral health
department and oversaw the community's intensive mental-health
services for some of that time.
The past six years, Amin also worked part-time in state prisons in Kern
and Madera counties.
Dr. Robert Oldham, the county's interim health officer, said that since
Amin was hired, there has been a marked increase in the number of
inmates seen and treated for psychiatric illnesses.
"Everyone at Jail Psychiatric Services recognizes that this has been a
problem and are trying to address the medical and psychiatric needs (of
inmates)," he said.
Amin said he is comfortable working with psychiatrists in the community
-- many of whom he knows personally -- and with state psychiatrists; he
also is familiar with some of the jail inmates who he previously saw
through the county's behavioral health department.
"I am coming in here with my own set of experiences," he said.
Fresno psychiatrist Terrell said he has seen changes since Amin was
hired: more inmates are getting medications that are effective and
psychiatrists now are at the jail on weekends to treat inmates.
Before, correctional officers were told not to call psychiatric staff unless
they saw someone who was "acutely suicidal" or destroying state
property, Terrell said. Now, he said, Amin wants their collaboration.
However, Amin is the only full-time psychiatrist at the jail. Two
psychiatrists work part-time -- but their hours equal less than one fulltime position.
While the jail complies with state law for minimum health staff
standards, Moreno said, meeting the requirement is "a struggle, a
challenge."
According to a 2000 American Psychiatric Association report on forensic
psychiatry, inmates must have "timely access" to evaluation by a
competent mental health professional. "More important than the number
of staff is access to adequate care," the report said.
The Public Health Department has added staff -- a nurse practitioner
and mental health clinician -- to expand psychiatric services at the jail.
Fresno County is considering re-establishing separate jobs for the health
officer and health director, which were merged under Moreno.
And in response to criticism about conditions in the jail, the county is
moving toward hiring a contractor to provide psychiatric and medical
services. Taylor, the former Behavioral Health director who is now a
http://mcc-sccweb.mccintra.local/scripts/sccmgcgi.dll

11/13

 1/24/2019

Print Page

consultant for the Department of Public Health, said in July that the
county will seek bids from qualified contractors.
John Navarrette, Fresno County administrative officer, said issues at the
jail prompted the Board of Supervisors to consider privatizing medical
and psychiatric services.
"I think certain items were brought to our attention that we needed to
address and correct, and we need to see if there are ways we can
become more efficient and more cost-effective," he said.
Contractors provide jail medical and psychiatric services in about 30
counties statewide, including Madera, Tulare, Kings, Merced, Stanislaus,
San Benito and Monterey.
In addition, Taylor said, the jail has changed its policies, including
attempting to keep inmates who are returning from a state hospital on
the same medication, unless their behavior changes.
Harold Seymour, a Fresno psychologist who evaluates about 180
inmates for competency each year, said improvements had to be made
at the jail.
"The jail just had a mess on their hands because nobody was getting the
treatment that was clearly indicated," he said. This was tolerated by
county officials, he said, because they didn't want to pay for expensive
psychiatric drugs. "It was really sad," he said.
Had county officials closely examined the costs to taxpayers for state
hospital admissions, travel costs to take inmates to and from treatment
outside the county and lost time for deputies during transports, it should
have been easy to recognize the county would save money by giving
inmates their medication in the first place, Seymour said.
And the cost to the county likely will grow even higher.
Seymour expects more lawsuits, adding expense to the jail's psychiatric
policies: "It's going to cost so much more than what the county saved
on a short-term basis."
A family's tragedy
The cost to families can be immeasurable.
Fendley's family has been shattered since he was charged with
strangling his grandmother.
Found mentally incompetent in March to stand trial, he began wasting
away. He lost nearly 65 pounds in five months. On May 17, jail staff took
him to Community Regional Medical Center, where he lay unconscious
for more than two weeks.
In June, Fendley was sent to Atascadero State Hospital. There, he was
treated with drugs and counseling so he could understand the charges
he faces and assist in his defense. He was returned to the county jail in
July to face charges. Atascadero sent him back to the jail with a new
mental health diagnosis: personality disorder.
Pamela Frazier loves her son and wants him to get the care he needs for
his mental illness.
"You love him, you don't hate him and you still hurt for him, but what I
am afraid of is seeing the evil Travis," Frazier said. "I can't see that
person again."
She also blames the county for her mother's death. Frazier said she
warned jailers not to release her son because he was mentally ill and
dangerous.
"We knew we had lost him mentally," she said. "We didn't think he
would hurt my mother, but I believed he would hurt somebody."
http://mcc-sccweb.mccintra.local/scripts/sccmgcgi.dll

12/13

 1/24/2019

Print Page

The reporters can be reached at (559) 441-6330,
mbenjamin@fresnobee.com, banderson@fresnobee.com, @beebenjamin
and @beehealthwriter on Twitter.
INFOBOX
EDITOR'S NOTE
The Fresno Bee first reported on allegations of inadequate care of
mentally ill inmates at the Fresno County jail in 2009. The issue was
thrust back into the spotlight in December when a man allegedly
strangled his grandmother the day following his release from the jail. His
family says he was diagnosed with schizophrenia as a teenager and
doctors had prescribed psychiatric medication to control hallucinations
and other symptoms, but he did not get the medications while in the
jail. That example and others are part of the most extensive look ever
taken locally at the problems caused by medications being withheld from
jail inmates. Check out an enhanced online version of the story at
beewatchdog.com/locked-in-terror. This investigative report is the result
of eight months of reporting by The Bee's Marc Benjamin and Barbara
Anderson. The Fresno County policy has cost taxpayers money, caused
innocent victims to be caught up in violence and left mentally ill inmates
in worse shape than when they were taken into custody.

http://mcc-sccweb.mccintra.local/scripts/sccmgcgi.dll

13/13