Alice
Nacogdoches County Jail, Nacogdoches, Texas

Pregnant for the first time at 33, Alice* was seeing a doctor and committed to a healthy pregnancy. Although she had longstanding mental health problems and substance use, she was prioritizing the health of her baby during pregnancy. But when she was arrested and held in the Nacogdoches County Jail for seven weeks pretrial, she was denied prenatal care for weeks and had repeated problems obtaining her life-sustaining medicine. Emotionally distraught, she was placed in solitary and treated as a problem prisoner. Both Alice and her mother Sally, a schoolteacher, were threatened with retaliation for making complaints.

This occurred four years after Texas Jail Project supported the passage of the first law protecting pregnant inmates in jails. HB 3654 (2009) requires jails to provide medical care, correct nutrition including prenatal vitamins, and safe housing and light work assignments.

*Names have been changed throughout at narrator's request.

Email from Alice's mother to Texas Jail Project, July, 2013:

Thank you so much for answering my email. Just to know somebody cares about our plight is very helpful. I did tell the Texas Commission on Jail Standards three things:

I told them about the sheriff refusing to give her prenatal treatment of any kind, I told them about the sheriff’s threat to her, and I told them about the retaliation against me. First time offenders in Nacogdoches usually get probation, but the District Attorney is holding out for 7-10 years in prison.

Just yesterday she was taken to see the midwives which serve the Medicaid population in this town of 40,000. The midwife thinks she has gestational diabetes, is highly anemic, and is an extremely high risk pregnancy. They want to do a diabetes test tomorrow, and send her to the doctor in Pasadena next week (the very thing the sheriff threatened her about). She was so scared yesterday when she called me crying she didn’t even want the nurse to tell him about it. Today she was punished by being put in “the holding tank” where she is locked up alone. There are women in the jail threatening her and her baby, but she was locked up after to head woman jailer yelled at her.

In the holding tank by herself, she could go into labor and no one would know for hours. I am in a struggling—I don’t know whether to follow my lawyer’s advice or make more trouble. I have already had to call the jail several times to make sure she got her medicine. She would call me crying at 9:50 (she is not allowed to call after 10) saying she hasn’t received her meds that day. They are always very rude to me, but they do give her meds late at night if I call. I am trying to do what my lawyer says and not make trouble but I am very uneasy about her being locked up alone and no one checking on her. I would like to get an opinion from another lawyer but this is already costing me much more than I can afford. I am so afraid for my daughter and granddaughter.

Also of concern to me (and one of the reasons why I have been so long in reporting this)--two lawyers from Nacogdoches both told me that the County Jail was under no obligation to provide prenatal care to its occupants, and we couldn’t force them to give prenatal care. Is this correct? If it is, then they have violated no law by not giving her prenatal care.

After verbal abuse, threats and punishment, Alice had been fearful of her mother making more complaints and of Texas Jail Project’s involvement. Her mother reports here, in another email, that Alice decided it is worth the risk.

She says “go for it”. She told me another outrage just now. A 23-year-old male officer was sent with her to the midwife’s office. He watched while she undressed, while she was examined, and was present and listening when the midwife asked her some very personal questions. The excuse from the sheriff’s office—they are short on transport personnel so they couldn’t send a woman.

No wonder incarcerated women are reluctant to see a gynecologist—that is an invasion of their right to privacy. Alice was in lock-down all night, until she was taken to the doctor this morning. There are other horrible things she didn’t have time to tell me but can tell the caseworker.

(TJP had been requesting that a state agency send an MHMR caseworker to visit her).

Our telephone conversations are costing me about $50 per week, but I am thinking it is necessary for her to have some connection with her family during this horror she is enduring.

As for getting another lawyer, I spent most of my ready cash hiring this one and am paying him out by the month, so there is no money to hire another one until the end of September, when I get my first paycheck from teaching. I was going to try to work out something with the private investigator my lawyer suggested hiring, but I am hoping that with the support you are giving me, the private investigator won’t be necessary.

Thanks again. You don’t know how much better Alice is feeling now that she knows there are people other than family on her side. It makes all the difference in the world …

After Sally reported the situation to the Texas Commission on Jail Standards, she received this official response:

TEXAS COMMISSION ON JAIL STANDARDS

July 23, 2013

Dear Ms. -----------------:

Your concerns regarding the Nacogdoches County Jail have been reviewed by the program specialist. After reviewing the allegations with the staff of the Nacogdoches County Jail, it was determined that no violation of jail standards has occurred.

Ms. -----------, documentation received revealed that I/M Alice has been seen by appropriate medical personnel. Alice is under the care of the jail doctor and is receiving all medications that have been ordered by the doctor. Documentation also revealed that Alice has refused medications and medical treatment on numerous occasions during a previous incarceration. State and federal privacy laws dictate the proper procedure of providing sensitive health information about another individual. HlPPA Rules will not allow me to share confidential medical details with you or any other family member. What I can inform you of is that I/M Alice is receiving adequate medical attention.

Ms. -----------, I feel it imperative to inform you on the inner workings of correctional medicine. Once an inmate is booked into a jail facility, they are no longer under the auspices of his/her primary care physician(s) or specialists. He/she will be treated by the physician(s) provided by the jail. In short, primary care physicians can prescribe medicines to jail inmates. However, if the jail physician deems the medications unnecessary. the jail is not requiredto dispense thosemedications. The Texas Commission on Jail Standards does not employ or contract with any physician(s). Therefore, we are at the mercy of the physician(s) contracted or employed at the county facilities and rely on their medical expertise.

The Texas Commission on Jail Standards does not question the professional opinion of medical personnel. If you feel that the treatment that your daughter has received was not appropriate, you should discuss this with the medical staff.

Ms. -----------, as the keeper of the jail, the Sheriff is required to maintain a safe and secure facility. When the jail staff notes that an inmate may be a threat to herself or others, they are required to do everything they can to make sure that the inmate is not allowed to harm herself or others.

Minimum Standards chapter 273.6 states inmates exhibiting behavior indicating that they are a danger to themselves or others shall be managed in such a way as to minimize the threat of injury or harm.

We will be taking no further action and have closed this case.

Anthony Mikesh, Program Specialist
Texas Commission on Jail Standards

Sally’s response to the Texas Commission on Jail Standards letter:

Anthony Mikesh, Program Specialist
Texas Commission on Jail Standards
PO Box 12985
Austin, TX 78711

July 29, 2013

Dear Mr. Mikesh:

I was raised to obey the law and respect those who enforce it. For 63 years I have done just that, never having been inside a jail or been charged with anything other than minor traffic violations. So it was a shock and disappointment to get a letter from you, an inspector with the Texas Commission on Jail Standards, and read all the ways you justified Nacogdoches jail’s neglectful treatment of my daughter.

To review, my pregnant daughter Alice, was incarcerated in the Nacogdoches County Jail twice this spring and summer: from May 17 to June 13, (28 days) and now since July 10, 21 days and counting. This makes 49 days she has been there altogether. Because of my belief in our justice system, I left her in the jail from May 17 until June 13, thinking she was being cared for and was safe from drugs.

During that time, she submitted 4-5written requests for prenatal care. She was 5 months pregnant at the time and worried that her baby had been damaged when she resisted arrest and was roughly treated by the arresting deputies. Your letter speaks of her refusal of medical treatment; she denies that she ever refused it once she got past the first two days of her stay. It is very easy for the jail to accuse her of this even though there is no proof she refused it. Why would she request prenatal care if she refused medical treatment?

Alice suffers from severe anxiety and is bipolar; these are actual medical conditions that she was diagnosed with decades ago and has been struggling with ever since. She asked us to bring her Zoloft and Klonopin which her ob/gyn had prescribed for her. We gave them to the nurse, who said Zoloft was fine but, “we don’t give this stuff (Klonopin) here.” So Alice had to suffer Klonopin withdrawal along with her other problems. That is a dangerous withdrawal which was not even necessary, because later the jail gave it to her.

During that first incarceration of 28 days, Alice was

1. Never seen by the [facility’s] doctor

2. Never given any meds except Zoloft

3. Never given any extra or special food because of her pregnancy

4. Never allowed to see the Medicaid midwives, which are routinely seen by all pregnant inmates in the Nacogdoches County Jail, and

5. Required to beg for a thicker pad for her bed, which was extremely painful for my 5 foot 8 inch daughter who weighed 134 lbs at 5 ½ months pregnant.

After paying for this through commissary, it was taken from her in a “shake-down” one week later. How can you say that this jail did not violate your standards?

Did you examine her records? Did you talk to the midwives or any medical personnel who give prenatal care? Did you ask if she was given a special diet and ask for verification of that? Did you talk to her?

The following week, she was actually taken to see the Medicaid midwives, who said she was extremely high risk, that she was anemic, and that she might have gestational diabetes. She was, thankfully, given the four-hour diabetes test; however, even though the results are in, she has not been informed if she is diabetic or not.

Only two days ago was she given the extra food (adequate nutrition) required by law for pregnant women. This came about after your report was made, sir, so that’s what it took to get her extra portions.

At least twice I have called the jail after 10 PM to remind them that she must be given her meds—they had not been given and the nurse had gone home, once for the entire weekend. Alice had called me in tears because she is so afraid of not getting them.

It appears that you don’t consider it even worth talking to me or to her about these serious concerns, and the implication is that neither of us could be telling the truth. I am hearing that the perception of her is as a drug user–and that alone. She is also a UT graduate and was a marathon runner. And no matter what she is charged with or what mistakes she’s made, she deserves adequate care.

Threats were made against Alice and me both after I contacted your agency. Did you even question the Sheriff about those threats?

Sir, It breaks my heart that Alice is being judged as not worthy of treatment because of her mistakes. She carries an innocent child within her body. She has named the baby Marcela. What happens to her, happens to Marcela. The anxiety she feels, Marcela feels. When Alice is “punished” because she made trouble for the jail, Marcela is being punished too.

To summarize, we hope that you will reconsider how you examine allegations like ours and not just listen to the jail staff’s one-sided account. And we hope you find ways to closely examine how the jail is fulfilling the law that protects pregnant women and their children, especially those with mental and physical disabilities. Isn’t the Jail Commission supposed to ensure that county jails follow the law?

Sincerely,

Sally -----------

Nacogdoches, TX

Cc: Brandon Wood, TCJS
Judge Donna Klaeger, TCJS
April Zamora, TCOOMMI
Beth Mitchell, Disability Rights Texas
Diana Claitor, Texas Jail Project
Matt Simpson, ACLU of Texas

Alice delivered her daughter and had a short time with her before being sent to the Texas state prison system. Her child is been cared for by her family.