Sick Cells 

Sheriff C.T. Woody heralds efforts to reduce medical costs at the city jail. Former staffers say it may have led to two inmate deaths.

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Inadequate medical care at Richmond City Jail and a precipitous drop in spending on critical medications may be endangering the lives of inmates suffering from HIV and mental health problems, charges a recently filed lawsuit against the Richmond Sheriff's Office and former medical staffers at the jail.

According to the suit, interviews with former jail employees and documents obtained by Style Weekly, Sheriff C.T. Woody's efforts to reduce medical costs may have led to needy patients being denied drugs, and could have played a role in two of the five deaths at the city jail in 2008.

In a lawsuit filed Feb. 17, eight-year sheriff's office veteran Deborah Koger, who was fired in May, alleges a pattern of bullying and racial discrimination by the command staff at the direction of Sheriff Woody. Similar lawsuits filed by two other former deputies, who Woody says were fired for incompetence, were settled out of court last year for an undisclosed amount.

Koger's allegation about inadequate medical care is noted in passing in the filing, incidental to alleged racial discrimination:

“On July 3, 2007, [Koger] e-mailed … Sheriff Woody about several incidents at the Jail Annex, whereby supervisory officer Sergeant Deborah Dickerson … had denied physically and mentally ill inmates medication,” the suit alleges, saying Koger was retaliated against when she reported the matter.

The suit also refers to the case of a former female inmate, Sunday Lucas, who has retained a lawyer but not yet filed a lawsuit against the office. Last year she suffered a stroke in jail, allegedly after her pleas for medical assistance were ignored over the course of three days. Lucas, in an interview with Style, alleges that a deputy molested her while she was receiving treatment at the Medical College of Virginia, and that after she returned to jail deputies denied her basic care.

Koger says the problem is bigger than two examples.

“I know that the [medical staff] are so short [that] where the HIV patients are usually kept and the really mentally ill are kept, they'll walk down that row [of cells] and say ‘medication,’” Koger says. “And if those guys don't stand up and get their medication, they'll walk on by them.”

As one sick inmate lingered in his cell in a wing where AIDS patients were housed, Koger says, “I actually watched [staff] go by his cell. This man wasn't going to get up — couldn't get up. That was two or three days before he died. I'm not a nurse but … with these guys who are knocking on death's door, I would try more than saying ‘medication’ and strolling by their cell.”

There were five deaths at the jail last year. The state medical examiner's office confirms two of the inmates had HIV and died of AIDS-related illnesses. In a third, two independent medical professionals tell Style the official reported cause of death was a common AIDS-related illness.

Koger's claims and the medical examiner's findings are anecdotal, but department records on AIDS-related medication spending aren't.

The sheriff's office couldn't provide 2008 spending data by press time, but previously obtained records show a precipitous decrease in spending on medication at Richmond Jail.

Between 2004 and 2006, the Sheriff's Office spent between $860,000 and $1.04 million on medications. Two drug categories, AIDS medications and drugs used to treat mental illness, account for two-thirds or more of that total.

By 2006, when spending on medication reached its peak, those two drug categories accounted for more than $700,000.

In 2007 — the first year Woody prepared his own budget after the departure of former Sheriff Michelle Mitchell — spending on AIDS and mental health drugs accounted for less than $87,000. The total medications bill was more than $700,000.

In a statement, Woody defends his cost savings:

“I am extremely proud of the management practices and cost-saving efforts made by the personnel assigned to our Medical Unit over the last few years,” Woody says. “At no time did the reduction in spending have an impact on the quality of care provided to jail residents by our Medical Staff.”

At a Richmond First Club luncheon last week where he and sheriffs from Henrico and Chesterfield counties were featured speakers, Woody talked about the challenges of dealing with the mentally ill in jail. He said the cost savings corrected problems left by his predecessor, Mitchell.

“Everyone was high on drugs from the medications they were being given,” he said, calling the jail “a dumping ground” for the mentally ill. “It's not right for those that have mental health problems to have to come to Richmond City Jail.”

Woody said medications were overused, overbought and under-supervised. “Nobody was on generics,” he said of past policies. “Nobody's on hardcore drugs now in Richmond City Jail. Everybody is on generics.”

He implemented other cost-saving policies. Previously, for inmates coming to jail who required daily maintenance courses of drugs for conditions such as AIDS, the medical department ordered a full course of the drugs. Sometimes that meant buying a 90-day supply, when the prisoner's stay might be far shorter. State regulations required the remaining medicine to be tossed, according to the sheriff's office.

Woody's administration implemented an agreement in which pharmacies buy back leftover drugs — a common practice at other area jails. In one month, according to the sheriff's office, the buy-back program saved more than $70,000.

Such savings explain the $400,000 Woody says he returned to the city from a budget surplus last year.

Woody calls the drastic reduction in costs — and in staff — an improvement. The jail relies on a single full-time mental health counselor, jail officials say, with the rest of the burden on a “three- or four-person” medical staff, including “a full-time physician.” Faith community groups also provide some services. By comparison, Henrico has eight staffers and a doctor on contract.

But Woody's changes weren't improvements, says William Rhoades, a former staff psychologist at the jail who turned 65 and retired in January 2008, shortly brfore Woody created a separate wing for mentally ill inmates.

Two psychiatrists previously contracted by the jail were let go, Rhoades says, adding that the special psychiatric wing amounted to a holding pen with very little oversight. He says his own retirement was forced by Woody's attempts to assign him dangerous duty as solitary overseer of that wing, “locked all day in a cell with 45 inmates with mental problems.”

Though not charged with direct care of AIDS patients, Rhoades says he recalls “a new policy on HIV people that if the HIV people weren't taking their meds in the street, we weren't going to start them here.”

A similar policy was applied to medication for mental illnesses. “We didn't feel obligated to give them those drugs,” Rhoades says of jail policy, if the inmate wasn't consistently taking them before their arrest. And for those who were taking them, Rhoades says, the jail's doctor sometimes altered those medications.

Changing prescribed medications for mental illness to save money — even changing to a generic version of a drug — can have uncalculated results on a patient, Rhoades says. The sheriff's office maintains that no alterations in medications were made without a proper medical determination.

Rhoades says that medication — and food — though proffered to ill inmates, was not necessarily administered.

One prisoner on the AIDS wing stopped eating, he says. The jail continued to offer food, Rhoades says, until the day the inmate died. But what it didn't do was attempt to intervene by seeking outside mental health care or moving the prisoner to a hospital.

“For Woody to say he's inherited [problems at the jail], yes he has inherited it,” Rhoades says, but in correcting it the sheriff also avoided dealing with the problem. “Sometimes all you have to do is what's legal and you don't have to worry so much about what's ethical.”

Koger's suit seeks $300,000 in back pay and damages. Woody's office did not respond to request for comment on the lawsuit.  S


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