U.S. Department of Justice
Civil Rights Division

Assistant Attorney General
950 Pennsylvania Avenue, NW - RFK
Washington, DC 20530

June 4, 2009

The Honorable Ed Emmett

County Judge

1001 Preston

Suite 911

Houston, TX 77002

RE:

Investigation of the Harris County Jail


Dear Judge Emmett:

On March 7, 2008, we notified your office of our intention

to investigate conditions at the Harris County Jail (Jail)

pursuant to the Civil Rights of Institutionalized Persons Act

(“CRIPA”), 42 U.S.C. § 1997. Consistent with statutory

requirements, we write to report the findings of our

investigation and to recommend remedial measures needed to ensure

that conditions at the Jail meet federal constitutional

requirements. See 42 U.S.C. § 1997b.

During our investigation, correctional experts in the fields

of penology, medicine, psychiatry, and life safety, assisted us

in reviewing records, interviewing staff, interviewing detainees,

and inspecting facility living conditions. Before, during, and

after our on-site inspections, we received and reviewed a large

number of documents, including policies and procedures, incident

reports, medical and mental health records, and other materials.

Consistent with our commitment to provide technical assistance

and conduct a transparent investigation, we provided debriefings

at the conclusion of two on–site inspections conducted in July

and August 2008. During the debriefings, our consultants

provided their initial impressions and tentative concerns.

Throughout this process, County and Jail officials

cooperated fully with our review. We appreciate the assistance

that they provided us and the candor of their response. Indeed,

we were impressed by the level of professionalism exhibited by

staff at all levels and with the sophistication of many Jail

systems. While we use individual incidents throughout this

letter to illustrate systemic deficiencies, we are aware that

this facility has a very difficult task handling large numbers of


- 2 ­
detainees, many of whom have serious medical and mental health

problems. The examples we cite should not necessarily be

construed as a criticism of particular staff. In many cases,

such incidents may be more reflective of inherent systemic

problems with Jail procedures or resources than the

professionalism or dedication of staff and administrators.

We are pleased to advise you that Harris County Jail

complies with constitutional requirements in a number of

significant respects. The Jail’s operational infrastructure

includes the existence of written policies and procedures,

clearly designated security and medical supervisors, training

programs, a booking and intake assessment process, infection

control programs, and fire safety precautions. At the same time,

however, we also conclude that certain conditions at the Jail

violate the constitutional rights of detainees. Indeed, the

number of inmates deaths related to inadequate medical care,

described below, is alarming. As detailed below, we find that

the Jail fails to provide detainees with adequate: (1) medical

care; (2) mental health care; (3) protection from serious

physical harm; and (4) protection from life safety hazards.

I.

DESCRIPTION OF THE JAIL


Harris County Jail includes four major jail facilities

constructed between the 1980s and the 1990s. At the time of our

site visit, the Jail housed over 9400 detainees.1 The Jail’s

design capacity is reportedly 9800 detainees. The Harris County

Sheriff’s Department also places detainees at various satellite

locations. If those detainees are also counted, the Sheriff’s

Department is responsible for a total of nearly 11,000 detainees.

In 2007, the Jail processed over 130,000 admissions. 

II.

LEGAL FRAMEWORK


CRIPA authorizes the Attorney General to investigate and

take appropriate action to enforce the constitutional rights of

jail detainees and detainees subject to a pattern or practice of

unconstitutional conduct or conditions. 42 U.S.C. § 1997. The

rights of pre-trial detainees are protected under the Fourteenth

Amendment which ensures that these detainees “retain at least

those constitutional rights . . . enjoyed by convicted

prisoners.” Bell v. Wolfish, 441 U.S. 520, 545 (1979). Under


1


The Jail houses mainly pre-trial detainees, but also

houses some post-adjudication inmates. For the purpose of this

letter, both groups will be referred to as detainees.


- 3 ­
the Eighth Amendment, prison officials have an affirmative duty

to ensure that detainees receive adequate food, clothing,

shelter, and medical care. Farmer v. Brennan, 511 U.S. 825, 832

(1994). The Eighth Amendment protects prisoners not only from

present and continuing harm, but also from future harm.

Helling v. McKinney, 509 U.S. 25, 33 (1993). 

Detainees have a constitutional right to adequate medical

and mental health care, including psychological and psychiatric

services. Farmer, 511 U.S. at 832. Detainees’ constitutional

rights are violated when prison officials exhibit deliberate

indifference to their serious medical needs. See

Estelle v. Gamble, 429 U.S. 97, 102 (1976). Detainee living

conditions must be “reasonably sanitary and safe.” Farmer 511

U.S. at 832. 

III.

CONSTITUTIONAL DEFICIENCIES


As a large urban detention facility, Harris County Jail

faces a number of significant problems including a high detainee

census and complex funding and logistical challenges. In many

ways, the Jail actually performs quite well. Jail policies and

procedures provide for a comprehensive detainee housing

assignment process, medical sick call procedures, and regular

facility maintenance. Staff receive broad training on Jail

operations, supervision of detainees, and detainee rights.

Unfortunately, in a number of critical areas, the Jail lacks

necessary systems to ensure compliance with constitutional

standards. 

A.

Medical Care


The Jail has functional systems in place to provide medical

care and treatment to a large population of detainees. These

systems include an initial screening process, a more

comprehensive health assessment for longer-term detainees, a sick

call process, a modern clinic, qualified medical staff, a

professional management structure, and mechanisms to obtain

outside specialty care. Despite the general quality of such

systems, the Jail fails to provide consistent and adequate care

for detainees with serious chronic medical conditions. We found

specific deficiencies in the Jail’s provision of chronic care and

follow-up treatment. These deficiencies, in themselves and when

combined with the problems in medical record-keeping and quality

assurance discussed below, are serious enough to place detainees

at an unacceptable risk of death or injury.


- 4 ­
1.

Inadequate Chronic Care


Detainees who suffer from chronic medical conditions require

assessment and ongoing treatment to prevent the progression of

their illnesses. As part of the treatment process, detainees

with chronic medical conditions require routine follow up to

monitor the progression of their illness and the potentially

hazardous effects of medication. Because of crowding,

administrative weaknesses, and resource limits, the Jail does not

provide constitutionally adequate care to meet the serious

medical needs of detainees with chronic illness.

Generally accepted standards of correctional medical care

require that medical staff identify detainees with chronic

conditions such as - diabetes, tuberculosis, and heart disease ­
and provide timely treatment for such conditions. Unfortunately,

the Jail does not have an assessment process to adequately

identify detainees with serious chronic medical conditions. In

particular, we found that the Jail has delegated screening to

nurses who are in need of additional training and more

administrative oversight by physicians. For instance, we found

assessment forms completed by nursing staff who had not actually

completed the assessments. We also found that physicians do not

routinely see detainees with chronic conditions to assess the

status of their health. Moreover, Jail staff do not conduct

periodic surveys of the housing units to identify detainees who

may have chronic medical conditions, but who may not necessarily

be identified by the normal sick call process or the screening

procedures conducted during detainee booking. Such deficiencies

result in gaps in the system for identifying detainees with

serious chronic medical conditions. For instance, staff may miss

some detainees who are degenerating mentally or physically, but

who are unable or unwilling to utilize the normal sick call

process.

Problems with chronic care assessments are particularly

pronounced in the assessment of detainees receiving medications.

Generally accepted correctional medical standards require that

once medical staff identify a medical condition, they need to

order appropriate medications and then periodically re-assess

those medications to determine their effectiveness and to monitor

side effects. The Jail medical staff are not adequately 


- 5 ­
conducting such periodic assessments.
include:


Examples from 2007-2008


•	

Detainee AA had a history of hypothyroidism and

seizures.2 Medical staff administered two medications,

each of which could have had potentially toxic side

effects. After the initial medication order, dosages

and blood levels of these medications were not

monitored. 


•	

Detainee BB suffered from a deep venous thrombosis

(blood clot) in his lower extremity. Medical staff

administered an unsafe dosage of blood thinning

medication, placing the detainee at an increased risk

of clot formation. Such clots can cause serious

medical complications including sudden death. Staff

conducted lab tests which showed that the dosage might

be unsafe, but then failed to follow up on the test

results.


•	

Detainee CC had a history of heart failure. Medical

staff administered two medications with potentially

toxic side effects. Our record review suggests that

medical staff did not check CC’s blood levels for

several months.


2.	

Inadequate Continuity of Medical Care


Chronic and some acute medical conditions require

appropriate ongoing treatment and continuity of care. Failure to

address detainee medical conditions over time can lead to an

increased risk in morbidity and mortality. Systems and

practices, such as adequate record-keeping and follow-up exams by

qualified staff, must be in place to manage the serious medical

conditions of detainees during the length of their incarceration.

The Jail does not have a system in place to provide such

continuity of care for some of the detainees with the most

serious medical conditions.

The Jail’s medical clinic serves as a makeshift emergency

room, stabilizing detainees with acute conditions. This model,

however, is problematic in a large urban detention facility with 


2


To protect the identity of detainees, the initials used

in this letter are not the actual detainees’ initials. 


- 6 ­
hundreds of sick detainees. Many of the detainees with serious

medical conditions cannot be adequately identified or treated

solely through an acute care process. 

In the absence of a chronic care program or other systems

for ensuring follow-up care, the sick call process serves as the

primary mechanism for the Jail to provide continuity of care.

This system is not capable of providing such continuity of care.

The sick call process itself is seriously strained due to

crowding, staffing limits, and some problematic practices. For

instance, we received a number of complaints about delays in care

at the Jail’s 1200 Baker facility. Because of the way care is

organized at the Jail, the 1200 Baker housing units seem to be

particularly affected by any bottlenecks in access to the main

intake clinic, despite the fact that the clinic is also located

at 1200 Baker. Because the main clinic also serves as the main

intake facility and emergency treatment center, the 1200 Baker

detainees must effectively share the same clinic resources as

newly admitted detainees, emergency cases, and detainee transfers

from other units who require additional medical supervision.

This puts a heavy strain on 1200 Baker medical staff and impedes

detainee access to care. 

More generally, the Jail’s administrative procedures allow

delays in care to be easily overlooked. Jail procedures require

that detainees complete forms to request medical care. The Jail

disposes of these forms, however, just after they are processed.

Once the forms are destroyed, the Jail apparently cannot track

detainee requests for medical care in order to determine whether

they have been fulfilled. Another peculiar Jail practice

involves the process for responding to requests for specialty

care. As a matter of routine practice, Jail detainees submit

requests for specialty care to a clerk. This process has

apparently little or no physician oversight, which means that

access to specialty care is not initially reviewed by qualified

personnel. This lack of oversight means that individuals who may

need more intensive or immediate care receive the same level of

attention as those with relatively low priority needs.

These problems would be troublesome enough for a clinic

dealing only with detainees who have acute medical complaints.

For detainees with chronic conditions, barriers to care can cause

them more difficulties than experienced by those inmates with

more typical medical complaints. Detainees with chronic illness

may need care to be much more timely and routine than some

detainees with acute conditions. At present, however, the

detainees have a difficult time first accessing the clinic, and

then receiving continuity of care. Detainees with mental illness


- 7 ­
are an especially high risk group. Other detainees with chronic

conditions may at least have the capacity to seek care.

Detainees with mental illness, especially those who are acutely

psychotic or suicidal, may not even try to use the sick call

process to obtain continuing treatment of their conditions. Such

detainees may need regular follow-up visits and more consistent

access to medical staff. 

Examples of the Jail’s failure to provide appropriate

follow-up treatment and continuity of care include the following

examples from 2007-2008:

•	

DD was a 74-year-old detainee with a history of open

heart surgery. When DD visited the clinic presenting

complaints of incontinence, medical staff failed to

give DD a physical exam or take his vital signs. Staff

sent DD back to DD’s unit. The following day, DD

returned to the clinic with incontinence and elevated

blood pressure. Clinic staff sent DD to the hospital,

where he died shortly thereafter.


•	

EE had a documented history of diabetes that received

inadequate medical attention. When EE complained of

symptoms, staff merely prescribed pain medication.

Initially, EE complained of leg pain and knee swelling.

In response, staff provided EE with pain medication.

EE complained again 5 days later about her symptoms.

The medical notes were essentially illegible, but

apparently staff again just provided pain medication.

The detainee complained of her symptoms once more that

same day. While waiting to be seen in the clinic, EE

collapsed and died shortly afterwards. The

documentation suggests that after EE collapsed, staff

failed to provide an appropriate emergency response.

For instance, the records show that EE had a low blood

sugar level at the time of her collapse, but staff

failed to respond to the symptoms. Medical records

also suggest that the staff did not try to use an

automatic emergency defibrillator during the incident.


•	

FF had a history of cirrhosis. Over several weeks, FF’s

liver condition worsened, but staff repeatedly failed

to respond in a manner consistent with generally

accepted correctional medical standards. FF initially

presented to the clinic with a complaint of swelling to

his legs. Jail staff prescribed blood pressure

medication, even though FF’s blood pressure was normal.

FF complained of chest pain and other conditions over


- 8 ­
the next several weeks. Jail staff repeatedly sent FF

to the hospital but repeatedly failed to change his

medications, treatment plan, or conduct other

appropriate follow-up. For instance, on one of these

occasions, a deputy reported that FF was having trouble

walking. The staff sent FF to the hospital, and an

undated medical note indicates that FF needed fluid

removed from his stomach. Again, however, staff did

not alter FF’s treatment plan; nor was there any

apparent documentation of vital signs. Approximately

one month after his initial complaint, FF died during

his last hospital stay. One troubling additional note

about this case is that during the period in question,

FF apparently spent much of his time at the Jail in a

housing unit instead of the infirmary. Given the

seriousness of FF’s medical condition, he needed to be

in an infirmary in order to receive the level of care

required by generally accepted correctional medical

standards. The discontinuity of care and a lack of

follow-up by staff are of serious concern in this case.

3.

Inadequate Medical Documentation and Quality Assurance


Medical record-keeping and quality assurance are basic

components of a clinical practice that is consistent with

generally accepted correctional medical standards. These systems

help identify and correct potential problems with patient care.

Harris County has deficiencies in both areas, and these

deficiencies contribute to problems with chronic care and

continuity of care.

A complete and adequate medical records system is critical

to ensuring that medical staff are able to provide adequate care.

The Jail’s process for maintaining medical records and processing

medical orders often leaves medical records unavailable to nurses

and doctors. Medical staff have little or no access to the

records when the pharmacy staff are filling out medication

orders, because the pharmacy staff have custody of the records

when completing those orders. During our fact-gathering, we also

found various record-keeping problems such as a lack of

compliance with professional record-keeping formats, illegible

physician notes, and factually inaccurate documentation. These

deficiencies affect the quality of care and the medical staff’s

ability to meet Constitutional requirements.

As a matter of technical assistance, we should note that

correctional facilities often benefit from having an adequate

quality assurance process. Such a process can help


- 9 ­
administrators self-identify and correct any deficiencies. A

large facility may have particular difficulty addressing systemic

constitutional deficiencies without such a process. The Jail

does engage in some effective quality improvement activities in

order to track and trend medical-related incidents at the

facility. The activities do not, however, include adequate

mechanisms to review and evaluate Jail physicians; nor does the

process include mechanisms that could help ensure more consistent

and adequate record-keeping. The mortality review process does

not include feedback to appropriate physician staff.

B.

Mental Health Care


Many of the Jail detainees require mental health care.

Approximately 2000 Jail detainees reportedly receive psychotropic

medications each day. Of the detainees receiving psychotropic

medications, approximately 200 are considered by the Jail to be

part of the mental health program. These detainees often cannot

be housed in general population because of their mental health

condition. The Jail needs a range of housing options to handle

such detainees, because detainees with mental illness have very

different needs depending on their circumstances. Instead, the

Jail only has a limited number of on-site housing options for

detainees with mental illness. These basically consist of some

single cells and specialized dormitories. 

Housing practices for detainees with mental illness are

problematic. For example, even though the ratio of male to

female mental health patients is about 2:1, the number of male

single cells to female single cells appears to be 32:1. Thus,

female detainees with mental illness are much more likely to be

left in inappropriate housing conditions while awaiting care. As

with medical care generally, the clinic in the 1200 Baker

building serves as the primary mental health resource. As noted

previously, the 1200 Baker clinic is overwhelmed. The Jail also

has access to some other treatment facilities, such as the Harris

County Psychiatric Center (Center), but these facilities have

limited resources. For example, the Center can house only 24

Jail detainees.

Many of the problems noted previously regarding chronic care

and medical care generally also apply to detainees with mental

illness. For example, the Jail’s process for assessing and

treating detainees is focused on acute symptoms and does not

adequately identify detainees with serious mental health needs.

The mental health clinic functions like a hectic emergency room, 


- 10 ­
and detainees with serious mental health conditions often cannot

obtain timely and appropriate care. These deficiencies violate

generally accepted correctional mental health standards.

As a practical matter, while the general medical clinics can

meet the serious acute care needs of many detainees, the mental

health system does not adequately address the serious mental

health care needs of detainees. Mental health policies designed

to cover a range of conditions exist, but overwhelmed staff often

do not implement them as written. A host of serious mental

health conditions cannot be adequately handled at the Jail

because of significant housing and treatment limitations. While

the Jail devotes additional resources to dealing with the most

acutely suicidal, even the basic care and supervision of the most

seriously mentally ill appears inadequate.

1.

Inadequate Access to Mental Health Treatment


The Jail’s written policies include a process for screening

and prioritizing detainees with serious mental illness, but in

practice, the Jail does not adequately treat detainees based on

the seriousness of their condition. The Jail staff classify

requests for mental health care into four basic categories.

Category 1 includes detainees who are acutely suicidal or have

expressed homicidal complaints. Category 2 includes detainees

who have expressed some suicidal ideation but have not indicated

imminent action. Category 3 includes detainees with medication

issues. Category 4 includes detainees who need to see a case

manager. Because of limitations on facility housing, staffing,

and treatment options, the Jail can only address detainees in

Category 1. Other detainees must wait for treatment, often for

significant periods of time, if they receive mental health

treatment at all.

Given that mental health staff received about 17,000

requests in 2007, the existing system for allocating mental

health resources is inadequate. The Jail does not provide access

to mental health care for many inmates with serious needs.

Examples from 2007-2008 include:

•	

GG entered the facility with a mental health history.

At the time, GG apparently was withdrawing from

alcohol, but staff failed to provide appropriate

medication and initial intervention. Five days later,

someone observed GG in his cell, with blood seeping out

under the door. Security arrived, and they discovered

that GG had lacerated his hand and appeared to be

hallucinating. Staff transferred GG to the infirmary,


- 11 ­
but they did not complete an initial psychiatric

assessment until five days later. Staff discharged GG

two days later.

•	

HH’s medical record suggested that he had a history of

not eating, but staff did not initially refer him to a

psychiatrist for assessment. After six months in the

Jail, HH complained of depression, and staff finally

referred HH to a psychiatrist. Mental health staff,

however, did not conduct an initial psychiatric

evaluation until three weeks after HH complained of

depression. Mental health staff noted that HH appeared

to be depressed. During the next two months, HH

received medication but did not see a psychiatrist.

HH ended up in an altercation and had to be placed in

isolation. Two days later, he began vomiting blood.

At the time of our tour, HH had been housed in

administrative separation for more than 18 months and

had been involved in various altercations with staff.

Given the nature of HH’s mental health condition, the

Jail’s delays in providing mental health treatment and

evaluation likely contributed to HH’s continuing mental

decline and behavioral disturbances. 


•	

II entered the Jail with a history of seizures, but

apparently did not receive seizure medications at

intake. II experienced a seizure 19 days after arrival

at the Jail. II also had a history of cutting. There

was no follow-up on this psychiatric issue at all.


•	

JJ served time in the Jail on multiple occasions.

Staff medicated JJ without following generally accepted

correctional medication standards. Without an initial

screening, the Jail staff involuntarily medicated JJ

and housed him in the mental health department’s acute

treatment cellblock. Staff then repeatedly treated JJ

with both anti-psychotic and mood-stabilizing

medications without adequate laboratory studies or

proper monitoring, placing the detainee at risk of

sudden death. 


•	

KK was identified as bipolar upon admission.

Psychiatry did not see KK for nearly a month, and KK

received no medication for his illness until about six

weeks after his admission. In the interim, KK was

involved in altercations on four occasions, resulting

in the fracture of his arm. Staff renewed KK’s

medication order over this period without further


- 12 ­
patient examination by a psychiatrist. Even after KK’s

altercations, there appears to have been little follow-

up by staff to deal with KK’s mental health symptoms.

•	

During intake, LL reported a mental health history that

included risk factors for suicide. The Jail staff did

not refer LL to mental health services. Approximately

3 weeks later, LL lacerated his neck.


2. 	Inadequate Treatment and Psychotropic Medication

Practices

In a large urban detention center with a heavy mental health

caseload, staff need to have access to a variety of treatment

resources. Such resources include an array of different types of

therapy, medication, and intensive supervision in order to

address different types of mental illness, and varying levels of

patient acuity. 

Jail mental health staff have access to some mental health

resources, but those resources are not sufficient given the size

of the mental health caseload. The Jail has few treatment

program options available for detainees with mental illness. The

Jail uses medications, additional staff monitoring, and some

structured housing for detainees with mental illness. For most

mental health conditions, the primary intervention is a

medication order, often with inadequate follow-up even for the

most seriously ill. Indeed, once medical staff prescribe

medications, they often cannot or do not routinely follow-up on

those detainees unless the detainees themselves request care.

This is a substantial departure from generally accepted

correctional standards. Notably, detainees also reported that

there are significant delays when they request care. 

In our document review, some of the treatment orders

appeared to depart significantly from generally accepted

professional mental health standards. Some of these orders

suggest that staff may be utilizing medications in a clinically

inappropriate or unsafe manner. Examples of improper chemical

restraints and unsafe medication practices during the period from

2006-2008 include the following:

•	

MM was in an acute psychotic state for nearly two weeks

before he died. At intake, staff prescribed

medications but they were never dispensed. As MM

became increasingly uncooperative, staff injected MM

with an intramuscular drug. Medical records suggest

significant problems with basic medication


- 13 ­
documentation and staff approaches to medication non­
compliance. Soon after MM was injected, MM’s breathing

grew shallow, and he became unresponsive. MM died

shortly afterwards.

•	

NN spent the better part of a year in a State Hospital.

NN was found not competent and not restorable. For

some reason, he was sent back to the Jail. Despite his

competency status, Jail staff nevertheless placed the

detainee in general housing and allowed him to keep

various medications on his person. NN was not a good

candidate for self-medication. NN appeared to suffer a

seizure and he was sent to the clinic. The clinic

staff suspected the detainee was “sleepy” due to his

psychotropic medications. They released the detainee

from the clinic, and he died shortly afterwards.


•	

A Jail psychiatrist diagnosed OO with schizoaffective

disorder (a situation where both mood and schizophrenic

symptoms exist). OO also had a history of mental

illness. OO’s mental health deteriorated, and staff

repeatedly renewed his medications without having him

seen again by a psychiatrist. OO ended up in two

altercations, including one in which he struck a

deputy.


•	

PP reported a history of seizures. PP suffered at

least one seizure in the Jail, but according to the

Jail’s medical records, there was no proper follow-up.

Medical staff placed PP on four benzodiazepines, but

not a long-term anti-convulsant.3 This suggests that

the purpose of the medications prescribed was more

likely to sedate the inmate, rather than to treat his

seizures.


•	

QQ required treatment for seizures. QQ experienced a

series of seizures, but on at least two clinic visits,

documentation suggests that QQ’s chart was unavailable 


3


If used at all for seizure disorder, benzodiazepines

are typically prescribed for short-term treatment. They are more

commonly used for acute detoxification. In the context of this

individual’s history and record, the use of four medications of

the same class to sedate a detainee appears to be a misuse of the

medications.


- 14 ­
to the staff during the exams. This resulted in a

number of delays in care despite QQ’s repeated

seizures.

3.

Inadequate Suicide Prevention


In general, a comprehensive system for providing adequate

mental health care should also include policies, procedures and

practices to prevent detainee suicides. Because suicide

prevention is itself an important legal concern, we note

specifically that the Jail has a number of conditions that are

dangerous for suicidal detainees.

First, the Jail lacks adequate video surveillance and

supervision in various holding areas. Some of the cells used for

housing newly arrested detainees include unsafe physical fixtures

(e.g., exposed bars) that can be used to facilitate suicide.

While the Sheriff’s Department was in the process of retrofitting

these cells during our tour, such efforts need to be broadened.

Many of the mental health holding areas throughout the Jail

appear to be clinically inappropriate. For instance, padded

rooms in administrative separation and maximum security units are

difficult to supervise and the conditions are so stark, they can

cause a detainee with mental illness to degenerate. 

Second, the detainees’ generally limited access to mental

health care can be especially dangerous for suicidal detainees,

since suicidal detainees may not be particularly inclined to seek

care on their own. Thus, adequate screening and pro-active

efforts to identify and treat suicidal detainees are necessary to

ensure compliance with minimum standards of care.

C.

Protection from Harm


We evaluated the Jail’s detainee supervision procedures,

security classification process, housing practices, grievance

procedures, disciplinary process, and training program. We found

that many Jail policies and practices are consistent with minimum

correctional standards. Yet, at the same time, we also found

some significant and often glaring operational deficiencies. For

security matters in particular, the Jail lacks: (1) a minimally

adequate system for deterring excessive use of force, and (2) an

adequate plan for managing a large and sometimes violent detainee

population. 


- 15 ­
1.	

Excessive Use of Force


We have serious concerns about the use of force at the Jail.

The Jail’s use of force policy is flawed in several regards.

First, neither written policy nor training provide staff with

clear guidance on prohibited use of force practices. For

example, Harris County Jail does not train staff that hogtying

and choke holds are dangerous, prohibited practices. Indeed, we

found a significant number of incidents where staff used

inappropriate force techniques, often without subsequent

documented investigation or correction by supervisors. Second,

use of force policies fail to distinguish between planned use of

force (e.g., for extracting an detainee from a cell) and

unplanned use of force (e.g., when responding to a fight). In

many planned use of force situations, staff should be consulting

with supervisors, and possibly medical staff, before using force.

Third, Jail policies do not provide for routine videotaping of

use of force. Fourth, the Jail does not have an appropriate

administrative process for reviewing use of force. Jail policy

does not clearly require the individual using force to file a use

of force report; nor does Jail policy provide for routine,

systematic collection of witness statements. When supervisors

review use of force incidents, they do not have ready access to

important evidence. Instead, they appear to rely excessively on

officer statements to determine what happened during an incident.

While Jail staff were helpful and willing to assemble use of

force documents requested by our review team, we found it

troubling that the Jail did not collect such documents as a

matter of course. In other words, use of force occurs at the

Jail without adequate review, and Jail data regarding use of

force levels cannot be considered reliable. We believe that the

incidents noted during our review may only reflect part of what

is really occurring within the facility.

As a result of systemic deficiencies including a lack of

appropriate policies and training, the Jail exposes detainees to

harm or risk of harm from excessive use of force. In a

particularly troubling January 2008 case, staff applied a choke

hold to a detainee, who subsequently died. The autopsy report

identified the manner of death as homicide. Our review of the

Jail’s records suggests that such improper force technique is

being used with troubling frequency. For instance, our

consultant found a pattern of such incidents when reviewing use

of force reports dated from January through June 2008. These

incidents included the following:

•	

An officer reported that he “grabbed inmate RR by the

front of his jumpsuit top and the back of his neck and


- 16 ­
forcibly placed inmate RR on the ground. Once on the

ground, I continued to apply pressure to inmate RR’s

neck and placed my right knee in the small of his

back.” 

•	

An officer used both a headlock and multiple strikes to

SS’s rib cage. 


•	

Officers “grab[bed] the front of [TT’s] shirt and

place[d] him on the wall to gain control of the

incident.”


•	

Officers used force on UU that resulted in a laceration

requiring eleven staples to the scalp. Yet, the use of

force incident was not reported by either of the

officers who applied the force. Instead, another

officer initiated the “inmate offense report.”


These and other similar incidents suggest that staff use

hazardous restraint and force techniques without appropriate

guidance or sanction. In some cases, medical records confirm

that detainees may have suffered notable injuries, such as

lacerations to the scalp or eye. Notably, when force was

investigated by supervisors, it appears that the supervisors

often determined that staff’s use of force was appropriate

without obtaining independent medical review or multiple witness

statements. 

At the time of our inspection, the Jail was already making

some effort to improve use of force reviews. At the time of our

tour, the Office of the Inspector General was in the early stages

of developing a use of force review process. We also understand

that the Jail continues expanding this process in ways that may

address some of the concerns noted in this letter. Nevertheless,

work must continue in this area before we can conclude that the

Jail meets minimum constitutional standards.

2.

Overcrowding


With a population approaching 10,000 detainees, the Jail is

one of the largest detention facilities in the country. The

Texas Jail Commission’s decision to grant the County waivers to

house approximately 2000 detainees more than the Jail’s original

design capacity is concerning on its face. At the same time,

however, a large detainee population, even if over design

capacity, does not itself necessarily violate minimum legal

standards. Moreover, the Sheriff’s Department has adopted a

number of measures to alleviate crowding issues, such as


- 17 ­
transferring detainees to outside facilities and providing

“portable bunks.” Conditions would likely be much worse if the

detainees at outside contract facilities had to be housed in the

Houston Jail complex. The Sheriff’s Department is clearly trying

to manage its population, and we acknowledge its efforts. While

crowded conditions may not, in and of themselves, violate the

Constitution, we are compelled to raise our concerns here because

(1) the Jail’s crowded conditions currently exacerbate many of

the constitutional deficiencies identified in this letter; and

(2) the Jail needs a more comprehensive, systemic approach to

dealing with a large and growing Jail population. 

Jail crowding affects multiple Jail systems. For instance,

it impedes detainee access to medical care, indirectly affects

detainee hygiene, and reduces the staff’s ability to supervise

detainees in a safe manner. How the Jail handles inmate

supervision and violence illustrates some of the complexities

associated with overcrowding. The Jail has already adopted a

number of useful strategies for dealing with detainees who are

dangerous to themselves or others. These strategies include an

objective classification process for deciding where to house

detainees and contracts with outside facilities to handle

crowding pressure. Despite such strategies, the Jail is so

large, violence still breaks out frequently. In one recent ten

month period, the Jail reported over 3000 fights, and 17 reported

sexual assaults. Also, as discussed above in the mental health

section of this letter, the Jail has had particular difficulty

managing violent detainees with behavioral and mental health

issues. Because crowding makes it difficult to supervise

detainees and prevent violence, additional Jail staffing or more

jail diversion programs could reduce the risk of detainees coming

to harm in the facility. 

Managing a large population is a complex problem, and

requires both short-term administrative approaches and long-term

strategies. For instance, changes to administrative processes

and better technology can help alleviate violence and supervision

problems associated with crowding. The Jail staff have limited

options to address violence and other serious incidents through

internal administrative and supervisory mechanisms. At the time

of our tour, the Jail did not have the ability to routinely

investigate violent incidents. Instead, the Jail staff had to

rely heavily on more cumbersome criminal prosecutions to deal

with such incidents. In such a large facility, criminal

prosecutions may not be a sufficient deterrent to violence. More

structured administrative procedures for reviewing incidents,

identifying dangerous inmates, and correcting hazardous

situations are needed. The Jail also did not have procedures in


- 18 ­
place that could more appropriately distinguish between

disturbances caused by detainees with mental illness and other

detainees. The response to the former often needs to be more

nuanced in order to avoid exacerbating the detainees’ mental

illnesses and to ensure fairness. Instead of referring detainees

for structured treatment, the Jail staff instead often have to

rely on placing detainees with mental illness in isolation.

Isolation can actually make a detainee with mental illness worse

and is not as therapeutic as a properly designed, dedicated

treatment unit. Other administrative deficiencies include a lack

of staff control over hazardous contraband (e.g., detainee

razors), and a disciplinary process that lacks safeguards to

protect witness confidentiality. Similarly, physical plant and

technology issues affect the Jail staff’s ability to supervise

housing areas. The four main facilities do not have video

surveillance in critical areas. The satellite facilities also

lack adequate video surveillance. 

More generally, while clearly the use of outside facilities

and other tactics have helped to alleviate some of the population

pressures at the Jail, it is less clear whether the Jail actually

has a workable long-term plan for dealing with the types of

systemic problems noted in this letter, especially in light of

potential population growth. The County is reportedly working to

address many of the specific issues raised in this letter, but at

this early remedial stage, it is difficult to determine how much

progress will eventually be made. For instance, if the Jail

increases staff, but then the Jail population simultaneously

increases, those staff could quickly become overwhelmed. In

other words, when dealing with crowding and its effects on

security, medical care, and various Jail operations, the

Sheriff’s Department should evaluate issues and remedies in a

systemic manner. Otherwise, it may be much more difficult to

resolve deficiencies in a complete and long-term manner.

D.

Sanitation and Life Safety


The Jail buildings are generally modern and adequately

maintained. Staff receive training on a variety of emergency

procedures. The Jail lacks, however, certain necessary

structured maintenance, sanitation, and fire safety programs.

Given stresses upon Jail infrastructure crowding, the lack of

such programs raises concerns about sanitation and fire safety in

the Jail. 


- 19 ­
1.

Sanitation and Hygiene


While the Jail generally appeared to be clean and many

systems seemed to be well-maintained, certain deficiencies in the

Jail’s hygiene practices and maintenance programs expose

detainees to an unacceptable risk of injury, disease, or other

harm. Jail crowding contributes to these deficiencies. 

First, the Jail does not have systems in place to ensure

adequate detainee personal hygiene. For example, the facility’s

laundry facilities and procedures are currently inadequate given

the size of the Jail population. As a general matter, the Jail

does not even have a “par level” of clothing or linen available

for detainees. In other words, the Jail does not maintain enough

accessible clothing or linen on-hand for the number of detainees

housed at the facility. Moreover, the laundry operation does not

meet minimum sanitary standards. The laundry operation does not

properly wash and sanitize clothing. The laundry has only a few

machines, and a number of those were inoperative during our tour.

The staff also use a variety of inconsistent, and often

inadequate, schedules and procedures for handling and cleaning

laundry. As a result, we found a significant amount of

unsanitary bedding, clothing, and mattresses throughout the

facility. Such unsanitary conditions can expose detainees to a

serious risk from infectious disease. 

Another example of poor hygiene practices involves detainee

grooming and shaving equipment. The Jail’s barbers practice

their trade in an unhygienic manner. Clipper blades, guards, and

supply boxes appeared to be dirty and had not been cleaned

between uses. Detainee barbers did not keep their equipment in

disinfectant solutions. As discussed previously in this letter’s

section on protection from harm, razor blades are not well

controlled in the facility. The availability and use of dirty,

shared razors and blades is a serious risk, both in terms of

disease transmission and as a security matter. 

Finally, the Jail’s plumbing and mechanical systems require

improved maintenance in order to ensure hygienic conditions in

certain housing units. While most of the Jail is properly

maintained, the Jail’s population size and gaps in the Jail’s

maintenance program result in unsanitary conditions in the intake

and mental health units, where the Jail utilizes archaic flush-

able floor drains, essentially holes in the floor, instead of

toilets. Using such grossly inadequate facilities for long

periods of time is itself problematic because they are 


- 20 ­
unhygienic. Moreover, when we tested some of the drains, they

back-flushed into the cells. Elsewhere throughout the Jail, we

found drains clogged with significant accumulations of debris. 

2.	

Fire Safety


The Jail is a modern facility with a number of fire safety

features, such as alarm systems and fire suppression equipment.

The main problem with the Jail’s fire safety program is that

staff training and oversight appear to be inadequate. During our

site inspection, we found inadequate numbers of personnel trained

to perform emergency tasks. The Jail has a level of constant

staff turnover that makes it difficult to ensure that there are

fully trained staff on duty in the housing units. As a result,

when we randomly questioned staff about emergency procedures, we

found that a number of them did not know how to use emergency

equipment or how to respond during a drill. We also discovered

inconsistencies in safety documentation that further suggest a

lack of staff training. Finally, we found that the Jail staff

did not have adequate access to emergency keys in the event of a

failure in the Jail’s electronic door control system.

Commendably, the Sheriff’s Department immediately took a number

of steps to address our fire safety concerns. Importantly, these

efforts should be incorporated into ongoing, system-wide safety

reviews. 

IV.	 RECOMMENDED REMEDIAL MEASURES

In order to address the constitutional deficiencies

identified above and protect the constitutional rights of

detainees, the Jail should implement, at a minimum, the following

measures in accordance with generally accepted professional

standards of correctional practice:

A.

Medical care


1. 	 The Jail should develop a chronic care program consistent

with generally accepted correctional medical standards.

This program should include a process that will identify

detainees who should be enrolled in a chronic care program;

a roster of detainees enrolled in the program; a schedule of

medical visits for each detainee enrolled in the program; a

system for determining which diagnostic tests will be

required for each chronic condition; and record-keeping

which includes documentation of lab work and medical orders.

2. 	 The Jail should update and improve the medical and mental

health quality assurance and training programs to ensure


- 21 ­
compliance with generally accepted correctional medical

standards. These improvements should include additional

internal self-auditing to ensure that staff conduct

appropriate assessments, provide timely treatment, and

document care in a manner consistent with generally accepted

correctional medical standards.

3. 	 The Jail should develop a system to monitor the effects of

medications and to ensure appropriate follow-up for

detainees with serious medical or mental health conditions. 

4. 	 The Jail should develop a system to track sick call requests

and identify barriers to timely access to medical or mental

health care. Sick call requests need to be triaged by

appropriate personnel to ensure appropriate and timely

access to medical care.

5. 	 The Jail should ensure that medical consultation and

specialty services receive physician oversight.

6. 	 The Jail should employ sufficient qualified staff to ensure

detainees have adequate access to medical and mental health

care.

B.

Mental Health Care


1. 	 The Jail should create a mental health program that will

allow the Jail to identify, treat, and monitor detainees

with chronic mental illness. As part of this development

process, responsible Jail personnel may wish to consider

evaluating mental health programs in a variety of outside

institutions and adopt useful policies and procedures from

appropriate models. 

2. 	 The Jail should continue with efforts to assess the mental

health caseload in the facility, and develop a variety of

housing and treatment options to address the needs of the

mentally ill. This system will need to organize treatment

options so that the Jail can deal with those across the

entire spectrum of care. The Jail’s mental health treatment

policies need to meet generally accepted standards of

correctional health care. These policies should provide for

the development of individual treatment plans and timely

access to levels of care appropriate to detainees’ mental

health needs. Such care should address detainees who are

stable and can be housed in general housing, detainees who

are highly unstable and require intensive supervision,

detainees who are stable but may require step-down services


- 22 ­
before returning to general population, detainees who are

actively suicidal, and detainees who are at risk of suicide

but may not have expressed an immediate intent to commit

suicide.

3. 	 Restraints should not be used as punishment, for the

convenience of staff, or in lieu of treatment. The Jail

should provide a variety of psycho-therapeutic treatment

options and adopt appropriate safeguards to avoid the

inappropriate use of chemical sedation. 

4. 	 The Jail should implement policies for monitoring detainees

at risk of suicide that meet generally accepted correctional

mental health standards. The Jail should retrofit cells

used for suicidal detainees or detainees requiring intensive

supervision. The Jail should eliminate fixtures that can be

used to facilitate suicide (e.g., exposed bars or bath

fixtures) while at the same time avoid creating a

non-therapeutic environment (e.g. bare cells or extensive

use of isolation for psychotic detainees).

5. 	 The Jail should include mental health staff and

administrators as part of medical quality assurance and

other administrative management processes. 

C.

Protection from Harm


1. 	 The Jail should ensure that there are a sufficient number of

adequately trained staff on duty to supervise detainees and

to respond to serious incidents.

2.	

The Jail should prohibit the use of chokeholds and hogtying.


3. 	 The Jail should increase video surveillance in critical

housing areas and alter staffing patterns to provide

additional direct supervision of housing units. 

4. 	 The Jail should develop and implement policies and

procedures to improve control over razors or other dangerous

items. 

5. 	 The Jail should develop and implement additional policies

and procedures for the investigation of serious incidents,

including excessive use of force and detainee-on-detainee

violence. These policies and procedures should include

administrative responses to violence and a detainee

disciplinary process conducted in a confidential manner.

They should also include routine interview and document


- 23 ­
collection procedures that will allow investigators to

complete their inquiries in an objective manner consistent

with generally accepted correctional standards. 

6. 	 The Jail should alter its procedures for cell extractions

and other use of force situations to ensure that staff are

utilizing appropriate force techniques. Such alterations

should include routine videotaping of planned use of force.

D.

Sanitation and Life Safety


1. 	 The Jail should develop and implement a long-term plan for

addressing Jail crowding and population growth.

2. 	 The Jail should develop and implement policies and

procedures to improve detainee hygiene to a level consistent

with generally accepted health standards. The Jail should

specifically improve laundry practices and facilities to

ensure that the Jail can adequately wash and sanitize

detainee laundry. The Jail should also maintain, at all

times, a sufficient supply of sanitary bedding, linen,

clothing, razors, and other hygiene materials. 

3. 	 The Jail should increase staff training to ensure that staff

is prepared to implement emergency procedures and operate

emergency equipment the event of an emergency. Jail

supervisors shall periodically test and drill staff on their

knowledge of emergency procedures, and provide corrective

instruction as part of a Jail-wide safety program. The Jail

should continue with its ongoing effort to develop a

qualified Jail safety team to help conduct staff training

and oversee facility safety programs.

* * * * * * * * * * * * * * * * *

Please note that this findings letter is a public document.

It will be posted on the Civil Rights Division’s website. While

we will provide a copy of this letter to any individual or entity

upon request, as a matter of courtesy, we will not post this

letter on the Civil Rights Division’s website until ten calendar

days from the date of this letter.

We hope to continue working with the County in an amicable

and cooperative fashion to resolve our outstanding concerns

regarding the Jail. Since we toured, the County has reported

that it has adopted a number of improvements, many of which

appear to be designed to address issues raised during our exit

interviews. We appreciate the County’s pro-active efforts.


- 24 ­
Assuming there is continued cooperation from the County and

the Jail, we would be willing to send our consultants’ reports

under separate cover. These reports are not public documents.

Although the consultants’ evaluations and work do not necessarily

reflect the official conclusions of the Department of Justice,

their observations, analysis, and recommendations provide further

elaboration of the issues discussed in this letter and offer

practical technical assistance in addressing them.

We are obligated to advise you that, in the event that we

are unable to reach a resolution regarding our concerns, the

Attorney General may initiate a lawsuit pursuant to CRIPA to

correct deficiencies of the kind identified in this letter 49

days after appropriate officials have been notified of them.

42 U.S.C. § 1997b(a)(1).

We would prefer, however, to resolve this matter by working

cooperatively with you and are confident that we will be able to

do so in this case. The lawyers assigned to this investigation

will be contacting the County’s attorney to discuss this matter

in further detail. If you have any questions regarding this

letter, please contact Shanetta Y. Cutlar, Chief of the Civil

Rights Division’s Special Litigation Section, at (202) 514-0195.

Sincerely,

/s/ Loretta King

Loretta King

Acting Assistant Attorney General

cc:	 Vince Ryan, Esq.

Harris County Attorney

Adrian Garcia

Sheriff

Harris County

The Honorable Tim Johnson, Esq.

United States Attorney

Southern District of Texas