Trouble in Mind

Texas's mentally impaired used to go to treatment centers. Now they go to prison.

On April 17, Reginald Lavergne died, ostensibly from pneumonia, at the Michael Unit near Palestine; an autopsy was conducted at the University of Texas Medical Branch at Galveston. According to the Houston Chronicle, although there is no evidence that Lavergne suffered from mental illness before entering prison, the initial autopsy report stated that he had been acting strangely prior to collapsing while taking a shower. According to the report, for approximately a month before his death, Lavergne had been displaying bizarre behavior, including coprophagia, or eating feces — something that would seem to be a strong indication that he'd suffered some kind of breakdown after coming to prison. But even so, he was not given mental health treatment.

Keith Ard, 30, a pudgy guy who talks in a whisper, says he was diagnosed with schizophrenia at age 13 or 14, after being sent to a boys home in Houston. He doesn't remember the name of the home or exactly why he was sent there. "I think I busted up this dude real bad when I robbed a store, or something like that," he says.

Ard makes his comments in the visitation room of the TDCJ's Retrieve Unit near Angleton, Texas, where he is serving a 25-year sentence for stealing stainless steel oil drums. According to one prison official, Ard's file "has psycho all over it." Unlike Jones, prison doctors prescribe antipsychotic drugs — albeit old-generation ones — for Ard. His problem is that he doesn't want to take them. He says the old-generation drugs make him feel sleepy and slow-moving, leaving him unable to defend himself. He says he has been assaulted in prison but hedges on the question of rape.

At the Hodge Unit: Ruben Morales, a second-time offender serving ten years.
At the Hodge Unit: Ruben Morales, a second-time offender serving ten years.
"If I have to go back, I'll either let them kill me or I'll kill myself": Aaron George, temporarily out of prison, with his sister and mother, Beverly.
"If I have to go back, I'll either let them kill me or I'll kill myself": Aaron George, temporarily out of prison, with his sister and mother, Beverly.

"You don't know the half of it" is all he will say. "These people just don't care what happens to you. But I'm going to have to get me some help."

How or from where, he doesn't know.This past spring, Judge Justice held hearings to determine whether parts of the Texas prison system should be released from the Ruiz order. National mental health experts testified to a host of problems: lack of access to psychiatric assessment, overdiagnosis of malingering, a restrictive medication list, lack of monitoring to make sure that inmates take their medicines, inexperienced guards, failure to protect heat-sensitive inmates using psychotropic drugs from exposure to the sun, and an overall failure to identify and treat inmates with mental illness. One expert called the psychiatric staffing "wholly inadequate," noting that one psychiatrist covers the approximately 7,000 general-population inmates housed at the Michael, Terrell and Powledge Units.

TDCJ executive director Wayne Scott did not respond to a request for an interview.

In 1993, the Texas Legislature created the Correctional Managed Health Care Advisory Committee. In an effort to control the health care costs of the state's rapidly expanding prison population, the committee contracted with two state medical schools — UTMB and the Texas Tech University Health Science Center — to provide health care for Texas prison inmates. UTMB covers the eastern half of the state, where more than 70 percent of all Texas prison inmates are housed. The Texas Tech media relations officials referred questions to Dr. Ronnie Owens, who until last August was regional director of psychiatric services for the school's HMO contract with TDCJ. Owens, now an assistant professor of psychiatry at Tech, acknowledges that the prison health care system is far from perfect, but he also defends it, especially when it comes to costs.

For example, he points out that new-generation medicines cost around $2.50 per pill. Old-generation medicines cost about 8 cents.

"If you have something on the order of 30,000 or 40,000 people taking medications, and the difference is around $2 a dose, times 365 days a year, you see the difference pretty quickly," says Owens.

He acknowledges that the older medicines have side effects but says that inmates on those medications are given drugs to counteract those symptoms and are also excused from work detail. Critics of the system point out, however, that because of the inherent boredom of prison, work is often a privilege.

Owens also says that if the older medicines are found to be ineffective on a particular prisoner, prison doctors have the authority to order the newer meds.

Nevertheless, says Owens, sometimes people forget that the first priority of a prison system is security, not health care.

In her testimony before Judge Justice earlier this year, Dr. Suzanne Ducate, director of mental health services for UTMB/TDCJ Correctional Managed Health, rejected the criticism. She says that telepsychology — the use of closed-circuit television to interview patients at multiple locations — allows doctors to assess inmates across the state. She also estimated that "based on the job description of the psychiatrists in our system, a caseload of up to 700 patients could easily be cared for by one psychiatristŠ."

"So these individuals," testified Ducate, "I don't think, had a clear picture of just how extensive our inpatient services are, because I don't understand how they could state that we are not caring for patients with the state-of-the-art facilities we have, with the extensive programming that we have, with the inpatient facilities, the special shelter housing programs, the stepdown units, the extensive development we have done of specializing programs like the psychiatric inpatient program."The Skyview and Hodge units are located next door to each other atop a hill in Rusk, Texas, with a view of the the oldest state-funded mental hospital in Texas. It's one of the places your parents used to threaten to banish you to if you didn't behave.

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