Attorneys seek emergency order to force changes at San Diego County jails

A group of civil rights attorneys filed an emergency request in federal court Monday, asking a judge to order the San Diego County Sheriff’s Department to make immediate changes to address serious lapses in care in its jails.

The filing includes two dozen sworn statements from people currently incarcerated in San Diego County jails and former jail staff who describe deficiencies in mental health care, medical care, addiction treatment and overall jail conditions. Multiple documents describe deaths that could have been prevented with proper attention, including the Nov. 27 death of 57-year-old Robert Moniger.

According to declarations filed by Moniger’s former cellmates, Michael Keavney and Dylan LaCroix, for days Moniger was struggling to breathe and begging for help from deputies and medical staff.

“The deputies ignored him,” LaCroix wrote, “and did not respond or summon medical assistance. The deputies refused to pull him out of the cell and get him help.”

LaCroix said he, Moniger and Keavney all pushed the cell’s emergency call button multiple times, to no avail.

On Nov. 26, Moniger was moved to a 4-by-6-foot single-person cell.

“The next day, we were woken up by a detective who told me and Mr. Keavney that Mr. Moniger died,” LaCroix wrote.

Moniger’s cause of death has not been determined and his autopsy report is pending completion.

“It is like a Third World country in here,” LaCroix wrote. “Jail staff care absolutely zero about the welfare of incarcerated people.”

‘Filthy, inhumane conditions’

The motion for emergency relief follows a 200-plus page complaint in February, one week after the release of a scathing state audit that found that San Diego County jails had the highest rate of deaths among California’s largest counties.

Aaron Fischer, one of the attorneys who filed the lawsuit, said a recent string of eight deaths prompted Monday’s filing.

“This motion is about the need for the jail to take the most basic steps to stem this endless tide of in-custody deaths, and to meaningfully address some of the most serious problems that are harming our clients every single day,” he said.

Serious problems include law enforcement undermining recommendations by medical staff, an overreliance on segregation and isolation, lack of accessible housing for people in wheelchairs — and wheelchairs being taken away from people who need them — and delays in responding to medical issues.

The motion also asks Judge Anthony Battaglia to require the Sheriff’s Department to fix broken emergency call systems and surveillance cameras, overhaul the system that’s supposed to detect when drugs are brought into the jail, implement so-called “medication assisted treatment” for people addicted to opiates and ensure incarcerated people have access to the overdose-reversal drug naloxone.

Addressing these problems, Fischer said, will save lives.

“We are asking the court to order meaningful, practical remedies to address the most serious harms, and to allow for oversight and accountability immediately and as the case moves forward,” he said.

Clinician Jennifer Alonso is one of two former jail staff members who submitted declarations. Alonso’s last day of work was April 23. She described her decision to quit “one of the hardest decisions of my life,” but said the job had become untenable. According to her declaration, she carried an exhausting caseload of between 140 and 160 patients and was forced to provide therapy through cell-door food flaps, meaning anyone in earshot could hear the conversation.

“I care deeply for my patients,” Alonso wrote in her declaration. “I have observed my patients decompensate, suffer in what can only be described as filthy, inhumane conditions, and in some cases, die by suicide. My patients were subjected to terrible conditions and put at risk of great harm every day, and I felt powerless to give them the care they need and deserve.”

One of Alonso’s patients was Lester Marroquin, who died by suicide on May 30, 2021 — Alonso’s day off — after being removed from the Central Jail’s psychiatric observation unit and placed into administration segregation, which is essentially solitary confinement.

“No one informed me about custody staff moving Mr. Marroquin back into (administrative segregation) housing where he had previously decompensated, and I was not consulted about whether it was clinically safe for him to be returned to Ad-Seg following his removal from psychiatric observation,” she wrote.

“That same day, Mr. Marroquin banged his head several times, placed his head in the toilet of his Ad-Seg cell, and finally died of acute water intoxication,” Alonso wrote. “I still cry when I think about what happened to Mr. Marroquin; he should not have died.”

Marroquin could have been placed in enhanced observation housing (EOH), a unit designed for actively suicidal people, but Alonso described EOH as being more restrictive than administrative segregation.

“The EOH unit is defined by extreme deprivation and isolation,” she wrote. “My clinician colleagues and I consider the EOH cells to be barbaric.”

Alonso attributed the current shortage of mental health clinicians to unbearable working conditions in San Diego County jails.

“Other clinicians working at other San Diego County Jail facilities have also left,” she wrote. “I am aware that many of them, like me, left because of the terrible system in which we have to work.”

Christine Evans, a psychiatrist who formerly worked as the jail system’s medical director and, more recently, chief psychiatrist, left her position in July 2021. In her declaration, she described multiple instances when Sheriff’s Department officials overruled recommendations by clinical staff to improve patient care.

“I believe that the existing system is fundamentally unable to balance clinical and operational needs to ensure safety, despite the many staff who want things to be better,” she wrote. “Without significant and meaningful change to this status quo, such that clinical services are empowered with equal agency to that of custody-command, these patients will remain in peril.”

A Sheriff’s Department spokeswoman did not respond directly to the allegations in the new court filings, but said that the department “is committed to providing the best medical and mental health care for individuals in our custody.”

She added that the department is working to implement recommendations in the state audit relating to mental health screenings and inmate safety and medical care, but said many of those changes hinge on hiring and retaining additional staff.

“We have reorganized our leadership team in charge of hiring and we have deconstructed our process in order to make improvements,” said Lt. Amber Baggs. “We are working with County Human Resources to add workers in a more streamlined way than has been done in the past and one that provides more pay and incentives to make the positions more attractive.”

Many of the issues described in the lawsuit have been raised before in outside investigations and media reports, including The San Diego Union-Tribune’s 2019 “Dying Behind Bars” series and follow-up articles.

The county’s Citizens’ Law Enforcement Review Board has, on multiple occasions, faulted the department for broken surveillance cameras, nonworking emergency call buttons and slow responses to medical crises.

In its 2018 report on San Diego County jails’ high rate of suicides, the oversight organization Disability Rights California identified cell-side therapy sessions as a serious problem.

“Non-confidential clinical contacts undermine treatment, as prisoners are reluctant to disclose sensitive information about their mental health history or current situation,” the report said.

Fischer, who co-authored the 2018 report, said he has been disappointed to see this kind of therapy still in use.

“Without confidential clinical contacts, to assess people’s mental health needs and to provide treatment, the system cannot even begin to provide constitutionally adequate care,” he said.

‘Easily available’ narcotics

The new filings also argue the Sheriff’s Department has failed to enact policies and procedures to address the high rate of opiate overdoses, particularly fentanyl, in its jails. Over the last three years, overdose deaths in San Diego County jails have increased from one every five months to one every two to three months, according to court documents.

Last week, 25-year-old Omar Ornelas died and his cellmate was hospitalized after both ingested fentanyl.

In his declaration, Christopher Norwood, 35, described how he had kicked his heroin addiction with the help of the medication Suboxone, which prevents opiate cravings.

“I was clean and had not used heroin for months when I arrived at the Jail in June 2021,” he wrote.

Norwood also struggles with psychosis and depression. After his arrest, he wrote, he waited two weeks to see a mental health clinician and was forced to have a cell-side visit with a deputy standing nearby.

“I told the clinician about my addiction and that I had been sober for 100 days,” he wrote. “I asked if Suboxone was available because it would help me avoid heroin. I knew from past incarcerations that drugs like heroin, methamphetamine, and fentanyl are widely available in the Jail.”

He was told he could not get Suboxone.

Norwood wrote that on July 17, 2021, he overdosed on fentanyl and had to be hospitalized. When he returned to the jail, he never saw an addiction counselor, despite making several requests.

“The Jail did not provide me with Narcotics Anonymous or other substance use education programs,” he said, echoing an issue raised in other depositions. “Instead, I had to rely on a sobriety book from outside the Jail and work on my own to try to stay clean and sober. It is not easy in an environment like the Jail, where opioids are easily available, and where I have not received adequate treatment for my addiction and mental health needs.”

Robert Cohen, an expert in addiction in correctional settings, testified that the high number of overdoses and opiate-related deaths indicate that the Sheriff’s Department is failing to keep drugs from entering the jail and “failing to ensure that people experiencing opioid use disorder have access to medication and therapy to relieve their cravings as well as medication to prevent overdose deaths.”

A recent report commissioned by the county’s law enforcement review board found that San Diego County jail inmates were more likely to die from a drug overdose than inmates in the state’s 10 largest jail systems.

Cohen notes that the California Department of Corrections and Rehabilitation uses medication-assisted treatment, or MAT, as does New York city jails.

The San Diego County Sheriff’s Department currently offers MAT on a limited basis in the Las Colinas women’s jail. In the March 14 media release, Undersheriff Kelly Martinez said only that “the MAT program is expected to expand,” but did not specify when.

Cohen also recommended that the jail follow Los Angeles County’s lead and make naloxone — the overdose reversal drug — available to everyone in its jails. Currently, only deputies carry naloxone.

“More lives could be saved … if incarcerated people in the Jail had access to naloxone to administer on others in the event of an emergency,” Cohen writes.

A hearing on the motion is scheduled for June 16.

Jonathan Markowitz, a staff attorney with the ACLU Foundation of San Diego & Imperial Counties, which is assisting with the lawsuit, said he hopes it will force county officials to rethink who is ending up in jail and why.

“The jail system in San Diego is inadequate, unable, and unfit to care for people in its custody,” he said. “But reform is not enough. We need to rethink our priorities as a community and reach the point where the county no longer relies upon incarceration as a method of addressing perceived social problems and inequities.”

Here are some of the declarations included in the filing from people who are either currently incarcerated in San Diego County jails or were recent inmates:

“I witnessed many incarcerated women suffer psychotic breaks. Some women smeared feces over the walls and doors of their cells. The overflow individuals waiting for placement in the PSU (Psychiatric Security Unit) had the same restrictions as high-level security individuals in my unit, which meant they could not leave their cells often, had little opportunity to program, and mental health contacts were non-confidential. Many other incarcerated women in my unit started to have mental breakdowns after being in their cells for days at a time. I heard them scream from their cells.” Las Colinas Women’s Detention Facility

“(The enhanced observation cell) was a small cell with a dirty mattress. I was naked except for a suicide blanket. I saw other people’s spit all over the walls and what looked like urine streaks. I could only drink water out of a little nub on top of the toilet… When I was in the EOH cell, I felt like dying. I felt like leaving the jail either in a body bag or going to the hospital.”Central Jail

“The urinal is filthy and disgusting; it is discolored and caked with a fungus or some other kind of deposit that is many different colors. The urinal fills up with water and gets clogged around ten or more times a day. When this happens, the liquid in the bottom of the urinal spills over and dumps out onto the floor of the bathroom, forming a large pool of liquid that, over time, makes its way towards a drain on the floor. People in my housing unit regularly walk through this liquid while in the bathroom, and then track the urine and water mixture throughout the housing unit when they exit the bathroom. Custody staff will not give us mops to use, so we have to use balled-up towels instead.” George Bailey Detention Facility

“During medical appointments, custody staff are always present and overhear my conversations about my medical issues. Sometimes when I talk to a medical professional, custody staff will chime in with their opinions and observations. In addition, custody staff sometimes openly discuss my medical issues in front of other incarcerated people. Custody staff will openly complain in front of other people in my housing unit about my medical and disability needs, and their obligation to accommodate them.” Central Jail

“For more than two years, the Jail did not give me a CPAP machine. Many times during those two years, I would wake up gasping for air. Sometimes, my cellmates would have to wake me up in the middle of the night. They would kick my bunk if I was snoring loudly or struggling to breathe. It caused issues with my cellmates and they wanted to move out to get away from me. I was unable to get a full night’s sleep the entire time I was without my CPAP. I often woke up with terrible chest pains and a racing heart. The pain was so bad that it sometimes felt like I was having mini heart attacks. Without consistent sleep, I had constant migraines, dizziness, fatigue, and confusion for two years.” George Bailey Detention Facility

“I have been incarcerated at the Jail approximately 33 times since 2014. I have not had a regular home since around the year 2000, and have been homeless for most of the past 20 years. I have been incarcerated repeatedly on charges for public intoxication. I have never been offered alternatives to incarceration nor received assistance for alcohol dependence. I have never received alcohol treatment while incarcerated at the Jail. I have never received any reentry programming in connection with my discharge from the Jail. When I am released from the Jail, I am released to the street and go right back to being homeless without any treatment.” Central Jail