Ricky Russell was 26 years old when he died inside Orleans Parish Prison's (OPP) Conchetta facility Feb. 7. Russell was awaiting trial on charges that he murdered 74-year-old Lorraine Langlois in a group home last summer. Prosecutors said he bludgeoned her to death with an air-conditioning unit.
In the late-night hours leading up to his death, Russell was laughing uncontrollably, according to Jaime Hernandez, who was housed on the same tier.
"He said he was high and seeing things in his cells," reads Hernandez's sworn declaration, filed on Feb. 14 in Jones et al. v. Orleans Parish Sheriff Marlin Gusman et al., a class-action lawsuit that has led to a proposed federal consent decree for OPP. The consent decree was unveiled in December but awaits final court approval.
According to Hernandez's declaration, Russell was likely on Depakote and Wellbutrin, psychotropic medications used to treat bipolar disorder and depression, respectively. Hernandez says OPP nurses would give Russell, who reported having a long history of mental illness and had recently been under suicide watch, 45 pills of each drug once a week — to self-administer. Nurses checked on Russell the night before, and he asked to see a psychiatrist. Hernandez said that request was denied.
"Around two o'clock in the morning, Ricky all of a sudden stopped laughing," Hernandez's declaration reads. "I thought he had gone to sleep."
What's more, Hernandez claims, Russell — who was in a cell by himself — was left unsupervised overnight. The last time the men on the tier saw a guard was about 7 p.m. the night before for roll call. Sheriff's deputies found Russell unresponsive around 5:30 a.m.
Orleans Parish Sheriff's Office (OPSO) medical director Dr. Samuel Gore disputes a number of points in Hernandez's declaration. He says he has not been able to confirm that Russell was prevented from seeing a doctor. And Hernandez, he says, is wrong about the medication.
"I'm not going to go into the specific medications he was taking, but I can tell you he wasn't even taking Depakote, so: fairly not correct in his description of the medications," Gore told Gambit in a phone interview. Gore neither confirmed nor denied Russell was taking Wellbutrin. A Feb. 14 written statement, sent just after the release of Hernandez's declaration and attributed to Gore says Russell was given "medication for depression." The cause of Russell's death is undetermined. Results of a toxicology screening, which will include tests for the legal medications he was taking, won't be available for several weeks.
But the death raises another issue of concern: OPP guards' habit of giving inmates several days' worth of medication, trusting them to self-administer the drugs properly without supervision.
OPP employs a "keep on person" (or KOP) medication policy, where some inmates are periodically given several days' worth of medication — including, in some cases, psychotropic drugs — to take as prescribed. "OPP nurses distribute several weeks of pills to prisoners at a time, without providing adequate information and education to prisoners and without adequate labeling of the pills. This is the practice for all prisoners not on the suicide tier, including those prisoners with severe mental illness," reads a recent plaintiff filing in the lawsuit. (Southern Poverty Law Center attorney Katie Schwartzmann, the lead plaintiff attorney in the case, declined to comment for this article.)
Gore defends the policy, saying it only applies to patients who have been determined to be stable.
"It really doesn't have anything to do with suicidal or not,'" Gore told Gambit. "If someone's suicidal, they're definitely not 'keep on person.' They're definitely on DOT, directly observed therapy," where staff members watch them take medication. "But it's really more of a policy dependent on how clinically stable they are. We have some people on KOP. We have some people on directly observed therapy."
Gore says OPP medication administration varies on a case-by-case basis throughout the jail.
That's how 'keep on person' is supposed to work, says Dr. Terry Kupers, a psychiatrist and faculty member at the Wright Institute in Berkeley, Calif., and a national expert on the psychological effects of imprisonment. "Typically, what happens is that the clinician doing the prescribing is going to order 'keep on person' or 'dispense by nurse,'" he says. "It's going to depend on issues of compliance and how stable the person is, that sort of thing."
Records and statements from OPSO officials seem to bring into question whether Russell was an ideal candidate for a 'keep on person' regimen.
Criminal court records show Russell was sent to doctors twice for mental health evaluations. The doctors and the court deemed him fit to stand trial, but court-submitted evaluation letters note a history of mental illness and antisocial behavior.
"Mr. Russell reported to us that he that he has a fairly extensive history of psychiatric and behavioral problems, consistent with his having been raised in the foster care system," reads an Oct. 11 report from forensic psychologist Rafael Salcedo and forensic psychiatrist Richard Richoux. Based on his medication, it says, "As an adult, it appears that he may have been diagnosed as suffering from either bipolar disorder, or schizoaffective disorder."
Russell had been on suicide watch within the past year, according to Gore's written statement. When Russell first came to OPP in June 2012, he "voiced suicidal thoughts and depression relating to his charges and inability to contact his family." He was placed under observation in OPP's "psych tier," where he was treated and medicated for depression.
But Gore says Russell had been through a full review with an OPP psychiatrist, who deemed him stable enough to administer his own medicine.
"He'd been seeing the psychiatrist frequently," Gore says. "He'd been seeing the social worker frequently. He had reported he was doing better, feeling better. And so he was deemed clinically stable to be put on KOP." Gore added that patients given new medications must sign a consent form, acknowledging they want it and know how to take it. "So it's not necessarily surprising that someone would be KOP if they'd been on suicide watch in the year prior," he says.
Without commenting on Russell's case specifically, Kupers suggested that self-administered antidepressants, such as Wellbutrin, might be particularly risky.
"Antidepressants are pretty dangerous if someone's going to commit suicide," Kupers said.
A 2009 letter and report from the U.S. Department of Justice (DOJ) to Gusman criticizes 'keep on person' as providing too little oversight. The report says the policy likely contributed to three non-fatal overdoses in 2007 and 2008, all involving psychotropic drugs, including antipsychotics and antidepressants.
Gore says the Department of Justice has retreated from a position of advocating an end to 'keep on person' disbursement since that report.
"When their expert psychiatrist came to visit us ... we discussed that. We specifically discussed that," Gore says, adding that they discussed a change in policy and Gore asked if it would require additional staff. "He said, 'You don't have to do that.' ... As long as we were documenting that they know how to take their medicines and they're stable, then KOP is reasonable."
The proposed consent decree between DOJ and Gusman doesn't specifically mandate any changes to the "keep on person" policy. It does, however include the following directive: "Ensure that psychotropic medications are administered in a clinically appropriate manner as to prevent misuse, overdose, theft or violence related to the medication."
Hernandez says Russell felt he wasn't getting enough help at OPP. He wanted to go "upstate" (presumably meaning to the state-run Eastern Louisiana Mental Health System in Jackson, La.) for mental health treatment. "I asked him why he didn't just say he was suicidal to get help. He said he was afraid of going to the psych tier, like something worse would happen to him there," his declaration says.
The 2009 DOJ report says inmates under suicide observation were often put in five-point restraints, sometimes for days at a time. It called the practice "inhumane."
"We haven't used restraints in years," Gore says. "I think it's probably been since 2009 since we used restraints."
Russell's isolation also may have presented a risk. He was living in protective custody, away from other inmates in a single-person cell. Suicide risk increases dramatically if inmates are left alone, Kupers says.
"In any prison system, there's probably between 2 to 6 percent of the prisoners in solitary, in some form of segregation," Kupers says. "About 50 percent of successful suicides happen among the prisoners in solitary. It's a stunning statistic."
According to Gore, Russell was being monitored frequently during the staff's daily rounds and in additional "segregation checks," performed three times per week. "Someone who's housed alone, particularly if they're segregated or isolated, they can deteriorate mentally," he says. "So the nurses actually go and do rounds specific to that."
The Hernandez declaration, however, says OPP deputies weren't properly supervising the tier. The last time they saw a guard, it says, was at 7 p.m. roll call the night before Russell's death.
According to the Feb. 14 statement from the sheriff's office, officials reviewed records from that night and determined a deputy was on the floor at the time of Russell's death. A supervisor also logged in that night for a security check. A public records request for copies of those records, filed on Feb. 15, was not returned by press time Feb. 22.
But the sheriff's office statement doesn't say anything about whether the guard was making rounds, or whether it was even permissible for a single guard to conduct regular rounds. "OPP policy does not allow staff to walk down the tier hallway alone, so rounds often are not conducted," says a recent plaintiff filing in Jones v. Gusman.
Gusman spokesman Marc Ehrhardt did not return repeated email and telephone requests for information on several of the alleged OPP policies that would prohibit a guard from conducting rounds alone. Gambit requested verification of the number of guards on duty on the night of Russell's death, as well as the locations of inmates Hernandez and Anthony Groves (who corroborated much of Hernandez's declaration in a Times-Picayune report) relative to Russell that night.
Current staffing levels may not allow for additional rounds. The prison's Conchetta facility houses roughly 300 inmates in six housing units, according to court filings. On an average night shift, there are only five guards.
If approved, the proposed OPP consent decree would require rounds to be conducted at irregular intervals — at least once every 30 minutes for regular housing units. For special management housing, including protective custody tiers such as Russell's, rounds would be required every 15 minutes.
Kupers says jails should be especially careful with inmates who recently have expressed suicidal thoughts. Often, he said, inmates falsely tell doctors they've recovered. "Whether or not they're suicidal, they get tired of being in observation.
"They say, 'No, I'm not. Take me back to my cell,'" Kupers says. "They go back to their cells and they kill themselves."