Jail Suicides: Do They Represent a Flaw in the System?

When sheriff’s deputies found Sergio Alvarez swinging from the crossbars of his cell, a noose fashioned from strips of a blanket tightened around his neck, they cut him down and sent him to a jail psychiatrist.

The suicide attempt was not judged serious and the 25-year-old North Hollywood man, who had been in jail two months awaiting trial on a burglary charge--was returned to the general population at Los Angeles County’s Men’s Central Jail.

But two weeks later, on Jan. 3, 1984--after his involvement in a Christmas Eve fight led authorities to place him in solitary confinement for 11 days--Alvarez killed himself. Deputies found him hanging from a towel rack shortly before 7 a.m., this time using an Ace Bandage as his noose.

Now his mother, Josefina Cabrales, has filed a civil rights lawsuit in federal court, charging that jail authorities acted with deliberate indifference to Alvarez’s psychiatric needs and are liable for his death. The family, which charges the county with “cruel and unusual punishment,” is seeking $10 million in general and punitive damages. The case is scheduled to go to trial Jan. 6 before U.S. District Judge Mariana R. Pfaelzer.

Stephen and Marion Yagman, attorneys for Cabrales, maintain that many of the suicides in Los Angeles County Jail in the last decade could have been prevented. Since 1975, 31 inmates have killed themselves in the Men’s Central Jail; 7 have committed suicide while in custody in other county facilities, according to county officials. All were by hanging.

The suit charges that the Sheriff’s Department routinely violates state corrections policy by keeping inmates in solitary confinement longer than 10 days, and that this practice led inexorably to Alvarez’s death.

And it charges that the county failed to provide adequate mental evaluation and treatment for prisoners, even in cases like that of Alvarez, who exhibited unmistakable signs of increasing emotional distress.

At the time of Alvarez’s incarceration, for example, there were only two jail psychiatrists attempting to handle 1,600 patients a month--which meant an average of nine minutes to examine each inmate referred to them. In addition, sheriff’s deputies were not trained in how to recognize signs of suicidal tendencies and mental illness, according to depositions taken in the case.

Both the Sheriff’s Department and the county Department of Mental Health, which is responsible for mental health services to jail inmates, declined to discuss the specifics of the Cabrales case.

But officials of both agencies contend--and private attorneys who specialize in prisoners’ rights litigation agree--that many of the system’s inadequacies have been corrected since then and that improvement continues. The changes were spurred by a combination of factors, including lawsuits brought against the county, new personnel at the jail and in the Department of Mental Health and increased awareness of inmates’ needs.

“We’re proud of our record of suicides, which is much lower than in the general population,” says Chief James W. Painter, who heads the sheriff’s custody division. In fact, the suicide rate among the general population is eight times that of the jail average of three suicides a year over the last decade.

Painter noted that last year 200,000 inmates passed through the County Jail system; there was one suicide, committed by an inmate receiving medical treatment for head injuries suffered in a motorcycle accident before his arrest.

“But even one suicide is too many . . . so we are concerned,” Painter said, pointing to stepped up efforts to train deputies, new inmate screening procedures and a greatly expanded staff of mental health professionals.

Painter estimates that a third of the county’s inmates are mentally ill, a percentage that has grown dramatically with decreasing use of state mental hospitals. And he says the problems are compounded by overcrowding. Currently, nearly 8,000 of the system’s 20,000 inmates are crammed into the Central Jail in downtown Los Angeles, which is designed to hold about 5,000. Most of the remainder are spread through five other facilities throughout the county.

Such overcrowding puts extra pressure on inmates and leads to territorial fights, Painter noted. But he said there may be a good side to overcrowding too: “It gives them an opportunity to complain about their lot in life . . . and makes it less likely that they will be by themselves. If you have six men in a four-person cell, it’s hard (to commit suicide).”

One thing that has not changed since Alvarez’s suicide, however, is the practice of confining inmates accused of jail infractions to single cells for up to 13 days. They are held in what is called the “pre-discipline” module for up to three days while awaiting a hearing; inmates found guilty are then placed in similar quarters for up to 10 days of “disciplinary isolation,” with all privileges suspended. One day this month, 88 men were being held in isolation.

Judge Pfaelzer has already ruled, in response to pretrial motions in the Cabrales case, that these practices violate regulations set by the state Board of Corrections, which limits solitary confinement to 10 days. But she has not ordered the county to alter the practice.

However, Painter disputes that finding. The Sheriff’s Department does not count the days in pre-discipline toward the maximum allowed because it “doesn’t mean loss of privileges, only separation (from other inmates),” he said.

Even in discipline, he added, “the inmates are not down in a dungeon. They can talk to one another.”

Yagman, however, claims that Alvarez’s last days in what inmates call “The Hole” were in solitary confinement of the worst sort: “a form of crude behavior modification” in which he could see no one, was fed only water and cold “jute balls” (a nutritionally sufficient but tasteless compacted food), allowed no pencil or paper, cards or reading materials other than a Bible, deprived of exercise, showers and clean clothes, and made to sleep on a thin pallet.

‘Everything Changed’

A witness who occupied a cell in the same row at the time will testify in the Cabrales case that “everything changed” after Alvarez’s suicide, Marion Yagman said. The walls were painted baby blue, covering the graffiti scrawled by desperate men, the cells were cleaned up and inmates were provided with hot meals, soap and toilet paper.

The groundwork for still other changes had been laid by a series of lawsuits filed in the late ‘70s and early ‘80s by the American Civil Liberties Union and the Center for Law in the Public Interest challenging the handling of mentally disturbed prisoners.

Under Elsie Lu, deputy director of forensic services for the county Department of Mental Health, and Peter Chen, chief of jail mental health services, services for such inmates have been reorganized and expanded:

- As part of the booking process, inmates are questioned about their history of mental illness and whether they are taking any medication. But recognizing that isn’t enough; mental health staff members will soon be assigned to the evening shift (when most of the inmates arrive for processing) to evaluate new arrivals, in an attempt to identify disturbed prisoners immediately.

- A 40-cell mental observation module houses new arrivals who exhibit bizarre behavior until their evaluation the next morning by a counselor and psychiatrist.

- About 300 inmates who need specialized mental health care are housed separately from the general population in four units, including one section for Spanish-speaking inmates. The most seriously disturbed are under constant observation; others are checked frequently. Suicide risks are sent to the infirmary.

‘They Play Games’

A special section is reserved for what Chen calls “pseudo-suicidal types.” “We have a lot of sociopaths who don’t want to be in the general modules, so they play games, slash their wrists. We know them well, they’re in and out of jail . . . but sometimes we cannot ignore (their attempts),” he explained.

- A 35-bed forensic in-patient unit treats severely disturbed inmates who can’t be transferred out because they are considered security risks or are charged with serious offenses. It is sort of a mini-mental hospital with a 24-hour staff.

- More than 100 beds have been set aside at Metropolitan State Hospital in Norwalk for inmates who are judged a danger to themselves or others or gravely disabled.

- Staffing has been beefed up. A staff of 44--which includes 5 psychiatrists, 1 psychologist, 7 social workers, 12 mental health counselors and psychiatric technicians and 1 occupational therapist--are assigned to the outpatient program at Men’s Central Jail, and additional psychiatrists are being recruited. A psychiatrist is available around the clock, seven days a week, Chen said.

- A treatment program of individual counseling and group therapy has been offered since July, 1984, for those who don’t qualify for hospitalization. In addition, about 500 inmates are maintained on psychotropic medication.

Even longtime critics of the jail’s handling of mentally ill inmates say that the improvements are substantial and continuing.

Class-Action Suit

Tim McFlynn, the public interest lawyer who first focused attention on the jail’s inadequate mental program in a class-action suit filed in 1979, says he doubts that another “Beltram” could occur in 1986. He was referring to former inmate Ronald Beltram, who alleged that he “flipped out” as a result of his incarceration. The suit was settled last year after the county agreed to make permanent certain procedures ordered in a court-imposed preliminary injunction in 1979 and to expand its psychiatric services.

“Both in theory and in fact the situation has improved and continues to,” McFlynn said, “although there are still some problems.”

But the changes came too late for Sergio Alvarez.

Alvarez, a stained-glass artist and construction worker, was found unconscious in his cell four days after his arrest and on a second occasion less than a month later, Yagman says. He was shuffled from cell to cell, and from Men’s Central Jail to the Pitchess Honor Rancho and back.

He was catalogued as being “indifferent, suspicious, manipulative and unable to cope in the general population,” and diagnosed by a psychiatrist as having schizophrenic traits; yet he was returned to the general jail population, where he got involved in the fight that landed him in solitary confinement.

Called Out for Help

During those last days in solitary, Alvarez repeatedly called out for help, but was ignored, Yagman said a witness will testify. He complained of headaches, of being depressed and upset.

Then one night, he draped a blanket across his cell for privacy, sang a series of sad Spanish songs and hanged himself from his towel rack, keeping his knees bent to avoid touching the floor.

His lifeless body was found the next morning.

Yagman says that delay was the jail’s final indifference. “The Sheriff’s Department claims it’s an iron-clad rule that those cells are checked every 15 to 30 minutes. He was found hanging at 6:47 a.m. But the autopsy results and liver studies from the coroner show he had died three hours earlier.”

A considerable number of the prisoners fell, after even a short confinement, into a semi-fatuous condition, from which it was next to impossible to arouse them, and others became violently insane; others still committed suicide; while those who stood the ordeal better were not generally reformed, and in most cases did not recover sufficient mental activity to be of any subsequent service to the community. . . .

--U.S. Supreme Court, writing on solitary

confinement, In re Medley, 1890