Posted on August 04th, 2024

Two days after Thanksgiving in 2022, Shannon Hanchett walked into an AT&T store for a new phone, and ended up in handcuffs.

Hanchett ran the Cookie Cottage, a popular bakery in this college town, where she made treats named for places across the state, from Stilwell Strawberry to Lawton Lemon. But lately, her mental health seemed to be fraying. She was falling behind on orders. Her marriage was crumbling. And the 38-year-old mother of two had picked fights with family and friends.

This article was published in partnership with The Frontier.

It all detonated that day in the AT&T store. Employees phoned police after Hanchett began pacing, ranting and calling 911. Body camera footage shows an officer from the Norman Police Department talking to her for several minutes, then tackling, handcuffing and arresting her for misusing the emergency line.

Like so many people experiencing mental health crises in the U.S., Hanchett landed not in a psychiatric hospital, but in a county jail. In her case, it was Norman’s Cleveland County Detention Center, which contracts with a for-profit company to provide medical care: Turn Key Health Clinics.

And for Hanchett, that’s where things got even worse.

As local jails have morphed into some of the largest mental health treatment facilities in the U.S., many counties have outsourced medical care to private companies that promise to contain rising costs. Turn Key is one of the fastest growing in the middle of the country.

At least 50 people who were under Turn Key’s care died during the past decade, an investigation by The Marshall Project and The Frontier found. Our reporting unearthed company policies and practices that have endangered people in jail — especially those with mental illness.

In dozens of cases, Turn Key employees didn’t send people to the hospital when they were in crisis, catatonic or refusing to eat or drink. The company staffed mental health and other medical positions with low-level nursing assistants trained to perform basic tasks like taking vital signs, but not to diagnose or assess medical conditions.

Medical doctors and more advanced-level nurses working for Turn Key frequently consulted over the phone for a limited number of hours per week instead of making in-person visits, according to government records and documents obtained through lawsuits.

Until last year, the company often restricted the kinds of medicines it would provide people in jail, not giving them long-acting psychiatric drugs and prescriptions they had received before their arrests.

We obtained records from sheriffs who raised concerns about the company not providing the proper medications for people in jail with mental illness. “I have been told that Turn Key does not prescribe those types of medications,” one Texas sheriff wrote in a 2022 email. “This is causing a cascade of problems not only for their safety and well-being, but for the staff and facility as well.”

Turn Key officials declined interview requests for this story. In response to written questions, the company issued a statement from its medical director, Dr. William Cooper: “Turn Key’s goal is to provide the highest level of care pursuant to the client’s budget. … The company continues to expand because of the quality of the care provided.” He added that Turn Key is “constantly working to build on the quality of care it provides.”

To examine the company’s practices, we obtained records, including internal documents and emails between company leaders and public officials, in nearly 70 counties across Oklahoma, Texas, Arkansas, Louisiana, Colorado, Kansas and Montana. We also reviewed more than 100 lawsuits involving jail deaths and injuries. Many were dismissed for not meeting legal hurdles required for civil rights lawsuits: Plaintiffs must prove that the company wasn’t just negligent, but showed “deliberate indifference” to patients’ medical needs, among other requirements. Some suits resulted in settlements, many of which were confidential, and nearly two dozen suits remain pending.

A woman in Colorado died after a bag of drugs she’d hidden in her body burst, while a Turn Key nurse allegedly dismissed her symptoms and refused to call an ambulance. A man in Arkansas died after medical staff didn’t give him medication to prevent deadly symptoms of alcohol withdrawal and didn’t call an ambulance until he became unresponsive. Another man in Arkansas died after medical records show he wasn’t given the seizure medication he needed, and he was strapped to a restraint chair and covered with a spit hood.

Turn Key declined to respond to questions concerning these incidents.

Medical care in jails can be complicated and costly, said Dr. Anne Spaulding, founder of the Center for the Health of Incarcerated Persons at Emory University in Atlanta. Most people in jails are there awaiting trial, and many arrive with complex needs — some are in drug withdrawal or experiencing mental health crises; others need expensive treatments such as HIV drugs, insulin or dialysis.

Jail operators have a constitutional obligation to supply necessary medical care, whatever the illness, she said. “When you lock the door of a jail or prison cell, you are preventing the person from going out and seeking health care elsewhere,” she said. “So you have to provide it.”

But there are no national standards for what constitutes necessary medical treatment in jail, and federal courts are split over what level of care is adequate, especially for people awaiting trial. Close to half of people in jail have received a diagnosis of a major mental illness, according to government data last compiled in 2017, and two-thirds suffer from substance abuse. Women, the fastest-growing group of people in jails, have even higher rates of mental health and addiction problems.

Some, like Hanchett, have undiagnosed psychiatric issues and were arrested after public episodes. It took 10 days after she was put in jail before a doctor consulted on Hanchett’s care. Turn Key’s primary psychiatrist prescribed antipsychotic pills and noted Hanchett didn’t respond to questions. Medical staff recorded her symptoms as “severe — having a marked impact on the inmate’s ability to function satisfactorily in the current outpatient setting.”

By then she had been lying on the floor of an empty cell for days, mostly naked, dehydrated and in deep psychosis, records show. The licensed practical nurse at the jail consulted with an off-site Turn Key nurse practitioner, who said to give Hanchett some Gatorade, according to jail records. Her pulse was weakening, her blood pressure dropping — she couldn’t stand up or dress herself.

A nurse reported hearing Hanchett saying: “They are going to kill me.”

Original post: https://www.themarshallproject.org/2024/07/30/oklahoma-jail-turn-key-health-deaths