Sheriff and Judge in Battle Over Medical Care in Jail

ATHENS — In November, David Conis Jr. sat in a Henderson County courtroom, vomiting repeatedly because of his vacillating blood-sugar levels, terrified that he was facing a diabetic coma.

“It’s not a good feeling to start puking up bile,” said Conis, who has Type 1 diabetes.

Henderson County state district Judge Carter Tarrance, concerned that the county jail was not providing adequate care, sent Conis to a local clinic and ordered the jail to follow the doctor’s instructions. When the jail did not do that, Tarrance said he was faced with a problem: Should he release Conis, a sex offender who had failed to register, on bond — or keep him in jail with potentially life-threatening health risks?

Now the judge and Sheriff Ray Nutt of Henderson County are in a pitched battle — that could turn litigious — over accountability for medical care in the lockup. Tarrance argues that other inmates have received similarly shoddy treatment and that judges should have the authority to order improved health care when lives could be in jeopardy. Lawyers for the county say the jail’s medical services are exemplary and that the judge overstepped his authority.

“He has absolutely no business trying to be a doctor from the bench,” a lawyer for the county, Robert Davis, said.

Conis was arrested in September and charged with unauthorized use of a motor vehicle — he says he borrowed a friend’s car — and failing to register as a sex offender. He told jail staff members that he was diabetic but did not have his insulin. He then asked a friend to bring him the insulin, but jail employees refused to accept the drug because it was not marked with a prescription label. Instead of following the protocol the inmate said he had used for two decades, the jail doctor prescribed a different type of insulin and a special diet.

“It’s crap,” said Conis, who was released after pleading guilty Nov. 20 to unauthorized use of a motor vehicle and receiving one year of probation that requires him to register as a sex offender. “I told them that from jump,” he said.

He said his blood sugar would spike each day, and he felt his vision worsening as a result. He ordered cookies and crackers from the jail commissary to even out the levels, he said, but jail employees refused to deliver them.

Conis said he was put in solitary confinement after jailers accused him of stealing food from other inmates, a claim he denies.

“I thought I was actually going to die,” he said.

On Oct. 24, Tarrance ordered the jail to take Conis to the emergency room for treatment and to follow the doctor’s instructions. At a Nov. 8 hearing, the judge learned that the jail had not followed the instructions, and he ordered staff members to take Conis to another doctor and comply with that doctor’s directives. After the second order, the Henderson County commissioners, at Nutt’s request, hired a lawyer to “look into and take any actions necessary to preserve the autonomy and interests of the sheriff’s office,” according to a statement from County Attorney Clint Davis reported in The Athens Daily Review.

“A district court judge has absolutely no power and no authority to order a county to do any kind of specific medical treatment,” Robert Davis, the county’s outside lawyer, said.

The judge’s orders, he said, violated the constitutional separation of powers between the judicial and executive branches of county government. If inmates believe a jail is providing inadequate care, they can take legal action.

Medical privacy laws prevented him from speaking specifically about Conis, but Davis said that inmates with diabetes sometimes used food and medication to manipulate their conditions, hoping to have their bonds reduced, to build a lawsuit against the jail or to get out from behind bars and into a hospital.

“These individuals have a tendency to be exceptionally manipulative,” he said.

Through a partnership with a private medical provider, Davis contended, the Henderson County Jail provides better medical care than most inmates would receive on the outside.

In response to the county’s actions, 20 local defense lawyers signed a letter to the Henderson County Commissioners Court expressing support for the judge.

One of the lawyers, Brian Schmidt, said a young client had recently gone without antidepressants for two weeks in the jail. The young man became so mentally unstable that it affected Schmidt’s ability to represent him.

“There needs to be an immediate method we can use to bring this before somebody to try and get some relief,” Schmidt said.

Tarrance said he was particularly concerned about the treatment of mentally ill inmates, who are sometimes kept in solitary confinement without medication.

“There has to be some kind of oversight,” Tarrance said.

He said he planned to ask state lawmakers to consider a law that would specifically allow judges to intervene when they identified deliberate indifference to inmates’ medical needs.

Inmates’ rights advocates say that claims of poor medical services in the county jails are not unusual and that more oversight is needed.

A founder of the Texas Jail Project, Diana Claitor, said that over the last two years, her organization had received a spike in reports of health care concerns statewide from inmates and their family members. She also said she had seen little willingness among lawmakers to increase oversight.

The Texas Commission on Jail Standards oversees the 245 county jails in Texas. It requires jails to provide medical and mental health care, and it takes complaints from inmates. But Claitor said standards were lacking and little action was taken in response to complaints.

According to data from the commission, inmates lodged nearly 80 complaints against the Henderson County Jail over the last three years, including more than a dozen about medical care. The agency ruled that only one of the allegations had been founded.

Brandon Wood, executive director of the commission, said health care complaints were the most frequent that his agency received from inmates. But he argued that the commission’s standards ensured that the facilities were providing the care inmates needed.

If a jail is not complying with health care standards, the commission will issue a notice of noncompliance, Wood said. Health care concerns are also likely to draw attention from the federal government as a potential violation of constitutional rights.

“You just do not deny medical care,” Wood said.