Woman's Death Reveals a Troubled East Texas Jail

LONGVIEW — Amy Lynn Cowling was 33, she had three children and she became a grandmother a day after she died in an East Texas jail — slumped over her bed, clutching a bottle of Diet Dr Pepper, after a day of wailing and seizures. 

Cowling, whom state troopers pulled over on Christmas Eve for speeding and arrested for outstanding warrants on minor theft charges and traffic violations, was bipolar, methadone dependent and had just one kidney. She took a raft of medications every day. For the five days she was in Gregg County Jail, Cowling and her family members pleaded with officials to give her the medicines that sat in her purse in the jail's storage room. They never did.

Cowling's death is just the most recent at Gregg County Sheriff Maxey Cerliano's jail in Longview. Since 2005, there have been nine deaths here, a large number compared to other lockup facilities its size. Interviews with jail and prison experts and others who have had firsthand experiences with the lockup and its medical staff, and a review of scores of public documents reveal a troubled local jail where staff turnover is extremely high and inmates routinely complain about medical care. Cerliano defends his jail and said he does his best to investigate and fire bad jailers. Inmates, he said, often receive better health care in his jail than on the outside. “It’s only about doing the right thing,” Cerliano said.

Criminal justice advocates say the situation in Gregg County, while troublesome, is not unique; it’s representative of systemic problems that plague local jails statewide. “Until it affects a family like this, no one knows how bad things are,” said Michele Deitch, a prisons expert and professor at the University of Texas' LBJ School of Public Affairs.

“I was begging them to help her”

Vicki Bankhead never went a day without talking to Cowling, her daughter and best friend. “I miss hearing her voice,” Bankhead said, sobbing. Her daughter didn’t have the easiest life. Cowling became a mother at age 15. She had become addicted to prescription pills and was found guilty in 2001 of possessing a fraudulent prescription. She suffered from bipolar disorder and struggled to keep a job and make ends meet. Although she had been clean for several years and was getting treatment at a methadone clinic, Bankhead said, her daughter had other health problems, including heart troubles and a failing kidney. “Amy needed her medication to stay alive, and I knew that; I knew that,” she said. “That’s why I was begging them to help her repeatedly.”

Public records show that Cowling told officials booking her into Gregg County Jail that she had high blood pressure, arthritis and only one kidney. She also reported that she took Seroquel to treat bipolar disorder and that she had been receiving methadone treatment for a decade. But neither Seroquel nor methadone is allowed in the Gregg County Jail.

State standards do not require that jails provide inmates with the same prescription drugs they took in the outside world, only that they provide treatment according to the facility’s health care plan. Dr. Lewis A. Browne, the county health administrator and jail doctor since 1992, decides which drugs are allowed. Drugs like Seroquel and methadone are prized commodities among addicts in jails, he said, and providing them would give inmates the opportunity to trade illicit favors for the chance to get high, and would put at risk those who might really need medication. Those inmates, he said, are often assaulted and forced by other prisoners to give up their drugs.

“Some of it is really to protect people,” he said of the jail’s medications policy.

Gregg County officials said Cowling received appropriate medications, although they weren’t the ones she had been taking. Browne wouldn’t discuss Cowling's case specifically, citing potential litigation the jail may face, but he said he prescribes medications for inmates that are comparable to ones they were taking, if he determines they are needed.

Reports on her case submitted to the Texas attorney general’s office show that Cowling began having "seizure activity" while she was in the facility. The morning before she died, a jail nurse called Browne to report that Cowling was “hollering and uncooperative.” Browne told the nurse to give Cowling a dose of the antipsychotic drug Haldol. When a nurse called Browne that evening to report Cowling was yelling again, he ordered more Haldol and put her on suicide watch, which requires that jailers check on an inmate every 30 minutes. County officials would not say whether Browne ever physically examined Cowling, and he declined to discuss her case, but the doctor said he only visits the jail on Wednesdays. Cowling was booked on a Friday, and a jailer discovered her dead just after midnight on Wednesday.

Precisely what caused Cowling’s death remains unknown. A preliminary autopsy was inconclusive because the pathologist said a toxicology report was needed. But according to reports, the pathologist questioned why Cowling was given Haldol. Her family has retained a lawyer, Jarom Tefteller, based in Gilmer, and they are outraged by the treatment she received in jail. They have not decided whether to sue the jail and its administrators. “The main goal here is not financial reward,” Tefteller said. “It’s to get answers and to get justice.”

Whatever the cause, county officials contend Cowling’s death was not their fault. She was not honest with them about all of her health problems, said Robert Davis, an attorney for the county. Bipolar disorder and methadone treatment are not life-threatening conditions, he said, and if Cowling had some underlying health issue, the jail was unaware.

“I absolutely do not believe that the jail or jail staff contributed to this inmate’s death whatsoever,” Davis said.

Cerliano, however, concedes that not everything went according to the jail’s policies the night Cowling died. After her death, Cerliano conducted an investigation that he said showed one jailer falsified observation logs that night. He fired five jailers for policy violations and a sixth resigned. (Not all of the firings were related to Cowling’s death, he said, but were for conduct discovered during the course of the investigation.) Two of the jailers were arrested for falsifying government documents. And following the investigation, Cerliano said he added another supervisor to one of the evening shifts. Still, he said, the jail staff followed medical protocol in caring for Cowling.

“We do everything we can to take care of inmates in our custody,” he said.

History of deaths, complaints, lawsuits, staff turnover

Cowling’s death was the ninth at Gregg County Jail since 2005. One was a suicide, and the other eight died from health conditions like cancer, diabetes and stomach ulcers.

Most other facilities of similar size across Texas reported far fewer deaths during the same time period. Gregg County can house up to 916 inmates. Bowie County Jail, in East Texas near the Arkansas border, has five more beds and reported five deaths since 2005. Brazoria County, south of Houston on the Gulf Coast, is slightly larger and also reported five deaths. In Williamson County in Central Texas near Austin, the jail has 1,128 beds and reported just two deaths. Fort Worth’s Tarrant County Jail can house five times as many inmates as Gregg County. It reported 13 deaths since 2005.

Since 2008, Gregg County inmates have filed more than 20 complaints about conditions in the lockup with the Texas Commission on Jail Standards. One inmate reported he was unable to shower for at least 10 days because the stall had about six inches of standing water with “what looks like human feses [sic] floating in it.” An anonymous caller — who later turned out to be a police officer — reported to the commission in January 2010 that hundreds of bats were flying around the jail and that inmates and staff members were walking around with nets trying to catch them. In response to the complaint, Chief Deputy Ricky Clark told the commission that only 40 to 60 bats were found in the jail. And, he said, a pest service would be visiting the facility “not next week but the following week” to make sure all the bats were gone.

Most of the complaints, though, were health-care related. Brent Birdwell, the inmate who hanged himself in the jail in 2009, had complained that, among many other grievances, he was not allowed medication he had been prescribed on the outside and that despite two weeks of requests, he had not been seen by a doctor. He was found hanging by a makeshift noose from a shower head eight months later. Other inmates also complained that they couldn’t get medicine and didn’t receive timely medical attention. In letters responding to nearly all the complaints, Adan Muñoz, the commission's executive director, wrote, “The Texas Commission on Jail Standards does not question the professional opinion of medical personnel.” He advised the complaining inmates to talk with the jail medical staff. 

David Phelps was in Gregg County Jail for violating probation and for outstanding warrants at the same time that Cowling was in the facility. Phelps said his arm had been broken multiple times in the past and that it was re-injured when officers arrested him. “My left arm was hanging and dangling,” he said. Phelps said Browne would give him only Tylenol for pain. When he got an infection, he said the doctor prescribed antibiotics, but he remained in so much pain that at times he vomited.

Inmates have sued Cerliano and Browne at least twice since 2005, alleging their constitutional rights were violated by the jail’s deliberate indifference to their medical needs. One plaintiff’s leg was amputated after a judge ordered the jail to transfer him to a local hospital because he had a bone infection. In both of the cases, the courts found that Browne and the jail attempted to provide adequate medical care with examinations and medication. While it may not have been to the inmates’ liking, the court said, officials were not deliberately indifferent.

Browne, who has his own family medical practice in Longview and is paid more than $100,000 per year to act as the jail doctor and director of the county health authority, said inmate health care is “the toughest medical situation to deal with.” Inmates are often dishonest about their health conditions. Many are drug users who will fabricate medical problems to get pills. And they are usually unhappy to be in jail at all and not inclined to trust or cooperate with the jail doctor.

“We try to do the best we can with what we have,” he said. “Patients will tell you bizarre things sometimes.” Adding to the challenge is that it is hard to retain medical staff willing to put up with the stressful conditions in a jail. For his part, Browne said, he would rather not be saddled with caring for inmates, but it’s part of the job. “Someone’s got to do it,” he said.

The medical staffers at Gregg County Jail are not the only ones with a high turnover rate. Records from the sheriff’s department show that in 2009 and 2010, more than 40 percent of the 167 jail employees either quit or were fired. Most of those who are fired, Cerliano said, are terminated because they have violated department policies. And on a number of occasions, he said, jailers were fired because they falsified records, as a jailer is accused of doing on the night Cowling died.

“Has it happened before? Yes,” Cerliano said. “We deal with it quickly and severely.” He acknowledged that the turnover is high but said the “numbers are what they are.” The pay is low for jailers, he said, about $26,000 per year. At the same time, they have to go through months of training, pass drug screenings and work in challenging situations.

“We still have people who don’t follow the rules and make poor decisions,” Cerliano said. “I can’t tell you how frustrating that is.”

Lt. David Drosche, who works in the Brazos County Sheriff’s Office and is president of the Texas Jail Association, agreed that retaining jail staff is difficult but said that a 40 percent turnover rate is “extremely high.” In his department with 172 jail positions, he said, the turnover was about 8 percent in 2009 and about 12 percent in 2010. The higher the turnover, he said, the more inexperienced jailers in a facility. “It’s going to take a lot of holding those officers accountable,” Drosche said.

Experts: Deaths, staffing should prompt investigation

Unlike local jails in many other states, county lockups in Texas are accountable to the Texas Commission on Jail Standards, which inspects facilities, monitors inmate complaints and establishes minimum standards. Until Cowling’s death, the Gregg County Jail had passed every commission inspection for the last five years. And within weeks after the death, the commission decided the jail was back in compliance with state standards.

But the commission doesn’t require that jails meet specific health care criteria, only that the jails have medical plans on file. It also doesn’t keep track of jail staff turnover.

Deitch, the jail expert from UT, said the disproportionately high death numbers in Gregg County, the large number of complaints and the high turnover rate among jail staff warrant closer investigation of how the facility operates and how it’s managed. “This should be triggering a look at how they’re training, how they’re supervising and how they’re hiring,” she said.

Diana Claitor, executive director of the Texas Jail Project, which advocates for improved jail conditions, said complaints about medical care at county lockups are not uncommon. Neither are deaths. From January 2005 to September 2009, more than 280 inmates died from illnesses in county jails statewide. Better health care standards and monitoring of data like staff turnover, Claitor said, could help prevent deaths like Cowling’s.

“One of the chief factors playing into mistreatment or neglect would be ill-trained, inexperienced staff,” she said. But in the tough financial times Texas is experiencing — a projected $15 billion to $27 billion budget shortfall — pressing the jail standards commission to take on additional oversight duties is a tough sell, Claitor said.

Muñoz, who leads the jail standards commission, said he agrees that monitoring turnover could help the agency better understand how a facility operates and could raise flags about potential problems. “I’m not sure why it hasn’t been done,” he said. Muñoz said he could ask sheriffs to submit turnover data, but that they would have to do so voluntarily.

Cerliano said his jailers already receive more training than is required by state standards and that the medical staff provides the best care possible under the circumstances. Cowling’s death was unfortunate, he said, but it does not mean major changes are needed in the way jails like his are regulated.

“We do have inmates that come in sick. It’s never a pleasant time,” he said. “It’s incumbent upon us to try to do the best we can with what we have to work with."