Suicides Point to Gaps in Treatment

Money is not the only factor that determines the quality of care. Poor practices, records reveal, created a crisis situation at the South Texas Detention Complex at Pearsall, outside San Antonio.

On June 15, Gustavo Cadavid, chief of psychiatry for DIHS, waved a red flag after discovering that Pearsall's clinical director, Erik Johnson, had "close to 140 chart reviews" pending, meaning 140 patients still needed care. Cadavid had complained to headquarters several times about Johnson. "[I]t is becoming clear that there exist a crisis in the mental health care at Pearsall," he wrote in June.

Two hours later, Slate gave Cadavid some advice. "It is my suggestion that [medical director Timothy Shack] issue a clear order for Dr. Johnson to begin to provide treatment to mentally ill detainees," he wrote in an e-mail. "If he fails to follow the order, then this behavior needs to be interpreted as insolence and insubordination and documented as such."

Slate titled his e-mail "Crisis in mental health care in Pearsall." He copied it to seven top ICE and DIHS administrators, including the interim director of DIHS, Neil Sampson.

Immigration officials said the mental health care program at Pearsall meets national detention standards. Reached by phone, Johnson declined to comment. He is still at Pearsall.

The case of Junior Bannister, a detainee from Barbados, indicates that problems remain, as evidenced by another e-mail exchange.

When Bannister arrived at Pearsall in August, he told immigration officials that he had been taking Celexa, an antidepressant, for five years, since his young daughter died. When he was taken into custody, a top mental health official recommended continuing his medication, but his notes did not get scanned into Bannister's file.

Without his medication, he began having "auditory hallucinations." He complained often, and staff sent the concerns to Johnson, who never signed off on the prescription.

In January, a lawyer working with Bannister inquired about the delay, setting off a heated exchange between Johnson and his bosses, who discovered that the medical staff had seen Bannister 22 times.

Jay Sparks, officer in charge at Pearsall, sent a curt e-mail to Johnson on Jan. 11 after examining Bannister's medical records. "Now I am further puzzled. While I understand a shortage of medical staff, we evidently were staffed well enough to see this person 22 times, but in the course of all of this unable to get him the medication that had been recommended -- why would this be?"

Johnson replied 90 minutes later. "I could not get to him," he wrote. ". . . There are many things we are not able to get to."

Sparks e-mailed up the chain of command. "I believe this case illustrates that we need something more efficient," he wrote. ". . . If we need more medical staff, then they need to be deployed, but regardless of what the solution is, it needs to occur rather quickly, as access to adequate medical care for our detainees is a rather critical issue."