On the last day of July, months after quitting his job as a cook on an offshore oil rig, Monte Killian was tooling around the Fourth Ward in his pickup when, police say, they pulled him over and found a rock of crack in his mouth. Forty-five years old, Killian went to jail then, with all of the health problems that people have who wind up in jail — cavities in his teeth, blood clots in his leg, Hepatitis C and a full-blown case of AIDS.
The U.S. Department of Justice had recently found that "certain conditions at the [Harris County Jail] violate the constitutional rights of detainees." Justice officials were especially concerned with the jail's health care system and "found specific deficiencies in the Jail's provision of chronic care and follow-up treatment." "Indeed," they wrote, "the number of inmates' deaths related to inadequate medical care...is alarming."
Nonsense, was the reply from our county attorney, Vince Ryan. The problem was with the Justice Department's investigation, not the jail, he said. "Our criminal justice facilities are doing a great job."
So Killian received the usual jail welcome. Of all his medical needs, perhaps the most important was for HIV meds. "Missing two to three days doesn't cause horrible consequences in everyone," said Richard Beech, the head doctor at Legacy Community Health Center in Montrose, which specializes in HIV care and treats Killian. "It just can." The immune system can be wrecked, and in a less-than-sterile environment, anyone with a compromised immune system can easily contract an opportunistic infection, which, "of course," said Beech, "can kill you."
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And yet Killian was not given HIV meds when he arrived on July 31, nor was he allowed to have them brought to him. He was simply locked up with everyone else, moving from one holding cell to another, each so crowded, he wrote later, that "they had to make people who were sitting on the floor stand up so they could push us in." After three days, he arrived at last in the clinic, where, he says, he explained his medical condition "for the third or fourth or maybe 15th time to no avail." Finally, on August 5, Killian borrowed from a relative and managed to bond out "so I could get my medicine." Then, sadly, on September 11, he reported late to a pre-trial drug-testing and was tossed back in.
Again, there was "the unbelievable packing of human beings into standing-room-only cells." Again, he found himself "begging for medical attention and not getting heard." When Killian had been a week without his medication, his partner, Stephen Calmelet, called the Houston Press. I told Calmelet I'd make an inquiry with the Sheriff's Department, which runs the jail, and I was soon on the phone with Christina Garza, the sheriff's hard-boiled media manager.
Garza said she would "look into this allegation," and at the same time, she began cautioning me not to infer too much about the jail from "isolated and anecdotal accounts." That would be to make the same mistake the Justice Department had, when it was much better to rely on the jail's own statistics, she and Ryan maintained. Looking at the statistics, Ryan was able to say that the jail's death rate was not at all alarming, for what were a few deaths when the clinic manages the health care of some 134,000 inmates a year? In the same way, Garza pointed out that the jail has dispensed this year an average of about 12,000 medicines a day, or about 3.6 million through October — and how many "medication-related grievances" have there been? Just 135, she said, the great majority of which the jail's own investigators determined to be "unfounded."
With such numbers, Garza was quite comfortable saying that the jail is "safe, sanitary and in compliance with the strictest of standards" — no matter that the Texas Commission on Jail Standards had just, in September, found the jail in noncompliance for failure to dispense prescription meds. That was just an isolated incident, quickly corrected, Garza said, and it became clear that she viewed Monte Killian's case in the same way.
Calmelet soon happily reported that a "very apologetic" doctor had appeared before Killian and presented him with his meds. But why was there a delay in the first place? This information was far more difficult to acquire from Garza than statistics.
She asserted by e-mail that "Mr. Killian has not been ignored, nor have his medical requests been denied." More than that, Garza said, she couldn't say about him, because of federal privacy laws. Can Killian waive his privacy rights and grant me his health records? Garza allowed ten days to pass before sending a brief e-mail: "Mr. Killian has stated that, in his best interest, he would like to withhold the release of his medical records and is satisfied with the care that he has received thus far here at the Harris County jail."
Calmelet, who visited Killian every night, said, "That's not what he told me." So I told Garza that I'd like to interview Killian, to which Garza replied that I'd first need permission from both Killian's attorney and the judge in his case. But Killian's court-appointed attorney, Stephanie Martin, wouldn't return my calls. Garza reiterated that this procedure was "certainly not meant to obstruct access to the inmates," but was "simply to protect the rights of inmates." She said to "keep in mind that the Harris County Sheriff's Office...is responsible for their welfare."
In this way, I found myself at the jail one evening in October, shouting with all the other visitors through the glass. Killian, behind it in his orange jumper, looked something like Elliott Gould as he shouted back. No, he certainly wasn't satisfied with his medical care, he said. What happened was, he'd been taken alone into a room with a sergeant and "some officer in charge of media relations." The media officer, who was male, had said to him, "You don't really want your personal health information splashed all over the newspapers, do you?" And under those circumstances, "in fear for my safety," Killian said he really did not, whereas now, he said, "I do think, out of civic responsibility, I should allow my situation to be publicized."
In late October, two weeks after conveying this to Garza, I had Killian's records, and with several letters from Killian, and input from Calmelet, was able finally to see what had happened.
It turns out that everyone who enters the jail on prescription meds experiences a break in their regimen, and that lapses in HIV treatment tend to be especially long. Dr. Michael Seale, the jail's director of health services, acknowledged the importance of minimizing such delays but said, "You can't go ahead without appropriate information." Thus, the clinic's thorough routine: Instead of confirming an inmate's claim of HIV by simply calling the inmate's doctor, the jail finds it necessary to test the inmate all over again before prescribing medication.
Ray Hill, the host of The Prison Show and founder of AIDS Foundation Houston, said he often hears of cases like Killian's, and Killian himself told me he'd met two other inmates with AIDS who hadn't received medication, one of whom went without for two months before shipping off for prison. The delays seem to occur for two main reasons, said Hill. Antiretroviral therapy is very expensive, he said, and "yes, there's a bean counter in there somewhere who interrupts people's medication for purely fiscal considerations." Other than that, there's only incompetence to blame. The people who dispense medicine in the jail "are not the best of the lot," said Hill. "They're the people who ended up working in jail, and when they come to a problem, their basic response is to ignore it until someone tells them differently."
In any case, Killian's file shows that his AIDS was identified during his August visit, and yet when he returned in September, the diagnostic process began again. With his immune system already severely compromised, Killian spent two days in the holding cells before arriving in the clinic on September 13. From there, he was referred to the infectious disease clinic, and a notation for September 14 reads "labs ordered." Not until September 16, though, five days after Killian's arrival, was his blood collected to be tested for AIDS.
In the meantime, to treat the blood clots in his left leg, Killian received, without testing, warfarin, which costs about 50 cents a pill. Only after the AIDS results came in on September 19 did Killian get his Atripla, which goes for about $50 a pill. (From its "very limited" resources, the jail has this year provided inmates nearly $2 million worth of "HIV-related medication," Garza divulged.) At that point Killian had virtually no ability to fight infection, and a few days later, on September 22, he was found to be running a fever. Discovering this, one doctor just sent him back to his cell. Another, later that night, called Killian back to the clinic and scribbled in his file: "Fever in a patient with AIDS. Transfer to LBJ."
Five hours and myriad tests later, Killian was sent back to the jail, with a notation on his record for "Strict ER precautions. Return if worsening of symptoms/condition." There were also orders that his warfarin dose be increased from the "subtherapeutic" 10 milligrams to 15 milligrams, and that Killian be started on the antibiotic azithromycin to help him fight infection.
Back at the jail, on September 23, a doctor dutifully noted these orders, and instructed that they be fulfilled. The Department of Justice had faulted the jail for its "discontinuity of care and a lack of follow-up by staff," and found that such problems are "particularly pronounced in the assessment of detainees receiving medications," and indeed, it was five days before Killian was seen in the clinic again. The records show that on September 28, the day Garza said Killian was "satisfied with the care that he has received thus far here at the Harris County jail," Killian was actually telling a doctor that the orders from the hospital still had not been carried out.
The doctor "discussed with pharmacy" that this be done at once and also ordered that Killian be given five more milligrams of warfarin "now." This last word was written in all capitals, underlined and circled, but it was a letter from Killian dated October 1 that said, "I received my prescription for azithromycin today...The warfarin still hasn't changed to 15 mg."
The records from Garza go no further than October 7, but Killian said that in the middle of October, he began leaving notes for the staff that he was about to run out of his AIDS medicine. For three days he warned them, and still, on October 18, he ran out. Killian says he remained without Atripla for another three days.
Calmelet noticed that he began looking pale, "that internal-sickness kind of pale." Killian himself wrote that he was having not just fever with "a great amount of sweat" but also chills, "severe headaches, nausea, blurry vision." Believing that many of his symptoms were caused by an overdosage of Dapsone, another antibiotic he was taking, Killian tried to change the dosage, and when he couldn't, stopped taking the Dapsone. Knowing the state of his immune system, he also stopped eating from the trays that were brought him, which he said were dirty, and instead, bought food from the commissary and drank only from sealed containers.
But when Calmelet told him there had been a swine flu death in the jail (the victim had "other medical conditions," sheriff's officials said) Killian began crying, saying, "I hope I can make it out of here." The handwriting in his letters deteriorated, though, and on October 25, Calmelet said he had never seen Killian look so bad.
His family sought help from his lawyer, but again, Stephanie Martin wouldn't return calls. Calmelet tried to tell the jail Killian needed help, but no one would see him, and no one would call him back. Killian's sister, Angela, had better luck: The floor sergeant most courteously told her that he would check on Killian — and then, Calmelet reported, he yelled at Killian for having his sister come complaining.
Killian, meanwhile, had decided to avoid the clinic, "because of all the sickness" there. He told Calmelet that he was dizzy, that he was weak, that he was losing his hearing and seeing black spots. "Mentally and physically, he can't take anymore," Calmelet said. The prosecutor had offered Killian two years' probation, which, planning to fight, Killian had rejected. "Now, he's just trying to get out of jail as quickly as possible," Calmelet said, and indeed, on October 22, Killian wrote that "I have to get out of here no matter the cost to save my life."
On October 28, Killian, in shackles, shuffled into the 262nd State District Court. His mouth was open. His eyes were vacant. His whole body was trembling.
"Do you understand the charges against you?" asked Judge Mike Anderson.
"Yes," said Killian.
"And how do you plead to these charges?" said the judge.
"Guilty," said Killian.
He was released at 4:15 the next morning, Calmelet waiting for him and taking him later that morning to Legacy to see his regular doctor. When Killian had seen her last, on September 3, just before entering jail, his blood pressure was recorded as 130 over 74, with a weight of 211 pounds. Emerging from jail seven weeks later, he weighed 20 pounds less, and his blood pressure was 96 over 66. "Confused," the doctor wrote, underlining the word. Killian was also jaundiced, she noted, with blood in his nose and stool. "This is all recent," wrote the doctor, and again, dispatched Killian immediately to the emergency room.
At Memorial Hermann, he was found to be severely dehydrated, Angela Killian reported, and perhaps because of the dehydration, his warfarin was twice the recommended level. Killian was admitted to the hospital, and over the course of the next two weeks, received at least half a dozen blood transfusions and underwent countless tests, before he was diagnosed with liver cancer and Hodgkin's lymphoma.
He is currently undergoing chemotherapy, and Calmelet, his partner, retains hope for a complete recovery.
As for Garza, she was disappointed that the Press had chosen to focus a story on the care of a single inmate, but made clear that in compiling her statistics, she would count Monte Killian's case a success.
"Mr. Killian's medical issues were always promptly addressed by the physicians," she e-mailed. "Overall, our medical care professionals believe there are no indications of adverse outcomes and no indication that Mr. Killian was in a life-threatening situation."
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