A recent video released by the San Luis Obispo Tribune of an inmate that died in 2017, highlights several problems and struggles that lead to Jail Deaths. The information provided here is from the newspaper report. The video shows a violation of the inmate's civil rights as well as negligence, which is probably why the County settled the claim for $5 million dollars within 6 months.
The First Problem – No Money
Funding for mental health has been slashed across the board, so states, cities and municipalities have little money and little services to deal with folks with severe mental health issues. In this matter, the guy was a schizophrenic. Most of the schizophrenics are not dangerous to the public. They exhibit bizarre behavior because of hallucinations. So, when the police are called, the individual is dealing with whatever is going on in their head. They don't comply with the police and end up getting locked-up. This is even compounded because in many community there are just not enough acute mental health beds to get the person evaluated, stabilized and their medications monitored. Society has transferred the housing and treatment of folks with mental health issues to law enforcement instead of hospitals and mental health facilities.
The Second Problem – Lack of Training
I'm not here to bash law enforcement, but the requirement to be a jailer, in most places, is a high school diploma. Jailers must worry about the safety of themselves and other inmates, drugs, withdrawal and inmates' medical problems. When you look at the population of folks coming into jails, many of these people have alcohol and drug problems, mental illness and a host of medical conditions. How is a jailer supposed to handle the situation? Training!
Because of the nature of corrections, many jailers become apathetic and start with the belief that an inmate is trying to game the system by lying or exaggerating their issue. Most of the time this works because most conditions are self-limiting, however, this type of attitude doesn't work when the inmate presents with an urgent need.
The Story Here
The 36-year old man (Andrew Holland) who died in this case was a schizophrenic. The odds are that he should have been in a hospital instead of a jail but as discussed above, jails have become housing units for folks with mental illness. The cause of death was a pulmonary embolism. A PE is a blood clot or series of blood clots that usually travel from the legs into the lungs. A know contributor to the onset of blood clots in the legs is sitting for a long period of time. Long airplane flights and car rides are known risk factors. This is important in this case, because Holland was placed in a restraint chair for 2-days. It is fair to say, that he couldn't get up and walk around and get his blood flowing.
PE symptoms mimic a heart attack, folks will complain of chest pain and shortness of breath. When a PE is expected a blood test that checks for an enzyme, d-dimer can be performed. The diagnosis is usually confirmed with a special CT scan or a ventilation perfusion study. A PE is usually not diagnosed in jail.
On March 17, 2018, the Sheriff released a statement saying the “mental health system” failed Holland. According to the Sheriff, the mental health system refused to take Holland because it was allegedly at capacity, cut that was not true. The story reported that Holland had a history of violence and mental illness, and had voluntarily stopped his medication.
The troubling part of the video is the use of the restraint chair. Apparently, the jailers placed Holland in a restraint chair for two days straight. I believe any healthcare provider will opine that the use of the restraint chair caused or substantially contributed to the formation of blood clots, which led to Mr. Holland's PE. About an hour after he was released from the restraint chair Holland died.
What Does the Constitution Say About Physical Restraints in the Jail Setting?
Folks in jail have certain constitution rights. The level of constitutional protections depends on whether the person has been before a judicial officer yet. If the person has not been before a judicial officer, they are covered under the Fourth Amendment of the Constitution applying the standard from Graham v. Conner (the objective reasonableness standard). If the person is a pretrial detainee, they are covered the Due Process Clause of the Fourteenth Amendment, and the standard is deliberate indifference.
The question is – is it Okay for Jailers to Use Restraint Chairs?
The answer is yes, but the use must be reasonable and I think it's pretty safe to say that 2-days in a restraint chair is not reasonable. Restraint chairs can be used for the protection of the inmate and law enforcement, but restraints should not be used once the situation has de-escalated. Further, restraints should not be used a punishment.
These types of situations happen all over the place and they only way to prevent, unnecessary deaths is adequate funding for mental health and specific training on these issues for law enforcement.