Before death, mentally ill inmate held in solitary

For his first court hearing, Terrill Thomas stood laughing and naked in his cell at the Milwaukee County Jail.

Thomas was being held in solitary confinement, and was too unstable to leave it. His public defender told the court commissioner that Thomas wouldn't or couldn't talk coherently.

"Over the noon hour, he was naked, (and he) said inappropriate comments to me and the officer that was standing next to me," Thomas' lawyer, Stephen Sargent, told the commissioner, according to a court transcript. "He could not speak further with me about the case."

Four days after the hearing, Thomas, 38, died in his jail cell.

Two weeks ago, the Milwaukee County medical examiner's office ruled the death a homicide, determining Thomas died of "profound dehydration" and noting he suffered from bipolar disorder.

Inmates who were near Thomas' cell told the Journal Sentinel that guards shut off his water after he began acting erratically. They said Thomas begged for water days before he died.

Death in County Jail ruled homicide; cause of death was dehydration

While the circumstances of his death are still being investigated, the account of Thomas' time in jail has renewed concerns about placing Milwaukee County's mentally ill inmates in solitary confinement, where they typically spend 23 hours each day locked in a cell.

Researchers have found that putting mentally ill inmates in solitary confinement can do long-term harm to an already vulnerable population. In recent years, dozens of state and local agencies across the country have reduced its use.

The practice is legal, with prison and jail administrators saying it helps ensure the safety of corrections officers and other inmates.

In 2015, an average of 45 inmates — nearly 5% of the Milwaukee County Jail's total population — were housed each day in the facility's 48-bed solitary confinement wing. The area is commonly referred to as "4-D," as it is on the fourth floor of the jail.

By comparison, the jail's mental health unit has 19 beds. Inmates there are more closely monitored by psychiatric staff.

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Pete Koneazny, litigation director for the Legal Aid Society of Milwaukee, said there's been "ongoing concern that 4-D is overused, and it's likely to disproportionately fall on people with mental illness."

Koneazny and a lawyer for the American Civil Liberties Union of Wisconsin get rare access to the solitary confinement wing twice a year, the result of a 2001 legal settlement with the county. The case stemmed from inmates alleging the jail was overcrowded and didn't have adequate medical services.

On his trips through 4-D, Koneazny said he has seen inmates who appear to be suffering from various forms of mental illness.

"Just about every time we go in, we'll see some people and think, 'Is this really the best place for that person?'" Koneazny said.

Milwaukee County Sheriff David A. Clarke Jr., whose office oversees the jail, refused to respond to questions from the Journal Sentinel about Thomas' death and jail policies.

"Both the ACLU and Sentinel Journal are criminal apologists and biased, and I refuse to be a part of their hit piece," Clarke said in a statement. Clarke frequently and intentionally refers to the Journal Sentinel by an incorrect name.

Much remains unknown about Thomas' case, including whether jail staff knew he was suffering from a mental illness or how they could allow him to become dehydrated to the point of death. The Milwaukee Police Department is still investigating his death.

Thomas was in jail on five felony charges. He was accused of shooting at a suspected car thief and hitting a bystander in the chest, then fleeing to the Potawatomi Hotel & Casino and firing two shots into the air. The gunshot victim survived.

Thomas' family members have said they believe he was in the midst of a mental breakdown at the time of his arrest.

Two inmates on 4-D who were interviewed by the Journal Sentinel also said Thomas was shouting irrationally and stuffing toilet paper in his mouth. Both inmates reported hearing that officers shut off the water in Thomas' cell, an apparent punishment for flooding a previous cell.

"Ideally, we would have liked to see him placed in a medical observation unit, somewhere he would have been in near-constant monitoring," said Thomas' cousin, Tiffany Robertson, speaking on behalf of his family. "Despite where they put him, our primary concern is the fact that he was deprived of water."

A proper placement?

Koneazny said it's his understanding that inmates land in solitary confinement for three reasons: discipline, protection from other inmates, or prior acts of aggression toward law enforcement.

Although he doesn't get access to inmates' medical records, Koneazny said he typically interviews about 15 to 20 inmates in 4-D during each visit. He suspects mentally ill inmates are being placed in solitary confinement based on his conversations with inmates and observations of the cells.

The placement and death of Thomas adds to those suspicions.

"That somebody could be in distress to the point of dying in there makes me question our assumptions as far as how frequently and how well people are monitored when they're in that secluded area of the jail," Koneazny said.

Koneazny said he's seen fewer distressed inmates in 4-D since 2013, when a private contractor, Armor Correctional Health Services, took over the jail's medical and psychiatric care. Still, the issue was significant enough that he and the ACLU of Wisconsin raised concern about it in reports to the court in December 2014 and January 2016.

Peter Hoeffel, executive director of the National Alliance on Mental Illness of Greater Milwaukee, said he has tried to learn more about solitary confinement at the county jail. But he said his questions have gone unanswered by the Milwaukee County Sheriff's Office.

"Without having access, authority and information, we don't know what their internal policy is and if they're following it or not," Hoeffel said. "We've only heard anecdotally or stories that this is happening.

Brenda Wesley, director of education and outreach for the National Alliance of Mental Illness of Greater Milwaukee, said she's seen firsthand that Milwaukee County's mentally ill inmates can be placed in solitary confinement. She said her son, Omar, spent parts of July and August in 4-D.

Originally diagnosed with paranoid schizophrenia, Omar Wesley has been in and out of jails and mental health treatment centers. He was deemed incompetent to stand trial on a robbery charge in December 2015, sent to a state psychiatric hospital, then returned to jail in late June. Within a couple of weeks, he was in solitary confinement at the jail, Brenda Wesley said.

Omar Wesley, 38, is now back at a state psychiatric hospital, where his condition has worsened, his mother said.

"He's still paranoid, there's still psychosis, he still hears voices," Brenda Wesley said. "Those symptoms have really been aggravated by the solitary confinement."

Representatives for Armor Correctional Health Services declined to address specific questions about its role in mental health assessments and the placement of inmates in solitary confinement. In a statement, the company said its "commitment and sole focus, in partnership with Milwaukee County, is the delivery of quality patient care in what is often a very challenging environment."

"A diagnosis differentiating between mental health and behavioral health issues is not often immediately discernible, even to very seasoned clinicians," the statement read.

'Not only outdated but cruel'

Thomas' placement in solitary confinement reflects the challenges faced by county jail and medical contractor staff.

Thomas' erratic behavior and failure to follow rules could have posed a safety threat. A detailed account of his nine days in jail hasn't been released by investigators, making it difficult to judge the severity of any threat. It's also possible that Thomas didn't tell jail staff about his mental health history and they didn't have access to his medical records.

Across Wisconsin and the country, corrections officials and political leaders have sought to keep inmates like Thomas out of solitary confinement.

The U.S. Department of Justice revised its guidelines in January, calling for inmates to be placed in the least restrictive setting possible while also ensuring safety. Corrections administrators and political leaders in several states — New York, Nebraska, North Carolina, Washington and  Wisconsin — have agreed to reduce use of solitary confinement in state prisons.

In Madison, local leaders and the county sheriff have said they plan to eliminate solitary confinement in the Dane County jail. It will likely require a reconfiguration of county jail facilities and additional corrections officers.

"No one is saying you don't need segregated space," said Carousel Bayrd, a Dane County supervisor. "But the traditional idea of what solitary confinement is, it's not only outdated but cruel."