Throughout the 669 days that Joseph Heard spent in the D.C. jail, nearly a dozen employees working there had warnings that he was wrongly imprisoned and had opportunities to fix the mistake.

A review of records and testimony obtained over the course of Heard's lawsuit, which ended recently in a settlement, shows that the deaf, mute and mentally disabled man was held without reason because of missteps, policy flaws and missed -- or ignored -- chances to correct the error.

Heard should have been freed on his second day behind bars, an internal D.C. Department of Corrections investigation shows, when a jail records clerk confirmed with the court that he should not be in the jail because no charges were pending against him. She noted that in his file, but no one followed up to make sure he was freed.

Heard's caseworker, the jail employee designated as his chief advocate, could provide no record of meeting with him during the months Heard was assigned to her, although the department requires caseworkers to document each meeting. She later explained that she could not represent his interests well or learn his legal status because she could not find his file, according to the investigation.

A fellow inmate with limited sign language skills said in a deposition that he alerted Heard's social worker to Heard's claim that he was in jail by mistake but was told to mind his own business.

All that came at a time when the Department of Corrections had been warned repeatedly that its flawed records system was bound to result in people being jailed or released in error, but the department had done little to address the problem. A series of internal investigations and reports called the records office dysfunctional and the computer system riddled with errors.

Heard, 45, is set to receive between $1.2 million and $1.5 million from the District and a private jail contractor to compensate him for his 22-month ordeal. The settlement was approved last week by a federal judge who expressed her hope that the money would help Heard pay for housing and some modest comforts. Heard, who has a second-grade reading level, is living in Florida.

Officials at the Department of Corrections said that they are sorry for what happened to Heard and that they have taken numerous steps to clear up problems in jail records and computer systems so a case like his never happens again.

"I think that it goes without saying, that this is an incident that we deeply regret," interim director S. Elwood York Jr. said in a statement. "We've made great progress in the changes that have been made in our new system and will continue to strive to get even better."

Lawyers familiar with jail records said that the department has made improvements but that they think close attention is needed to ensure that the system does not deteriorate.

Lack of Follow-Up

Heard's plight began Oct. 13, 1999, according to the internal investigation, when D.C. Superior Court Judge John M. Campbell ordered him released from St. Elizabeths Hospital after determining that he was not competent to stand trial for a minor 1998 charge of unlawfully entering a George Washington University Law School building. U.S. marshals called the D.C. jail and asked what they should do with him. An officer there said Heard should be returned to the jail so officials could make sure there were no pending charges.

An evening-shift clerk at the jail noticed a discrepancy in Heard's records. The jail computer system, called CRISYS, showed he had a pending 1996 misdemeanor charge for touching a woman on the buttocks. But because misdemeanors typically carry sentences of less than six months, the timing seemed strange. It was too late in the day to check with the court, though, so she noted the discrepancy and left the matter for the day shift to handle.

The next day, records clerk Althea Haynes picked up the file, called the court and confirmed that Heard should not be in jail; the misdemeanor charge had been dismissed. Haynes put a note in the file saying the court was going to send paperwork to confirm this so Heard could be released, but neither she nor her supervisor, Benjamin Ellis, followed up, investigators concluded.

Then Heard's file, including the note from Haynes, disappeared. The internal investigation found that at some point in 2000, former warden Patricia Britton ordered that old files be purged from the office and archived at a federal records facility in Suitland. Ellis said that was done without input from records office staff members. Suitland documents show that Heard's file arrived in August 2000 and remained there until just before he was released in August 2001.

Cynthia Hackett, Heard's caseworker from his arrival until May 2001, was supposed to keep logs of meetings with Heard, but she could provide none. Her supervisor, Carl White, acknowledged to jail investigators that he did not thoroughly enforce the rule that case managers maintain up-to-date records.

Verlie Parish, a fellow inmate in the mental health unit, said in a deposition that sometime between December 1999 and January 2000, he was asked by jail officer Jesse C. Hicks to help interpret for Heard at Heard's mental health treatment team meeting. Parish, who said he has a deaf brother and can sign the alphabet, had been communicating with Heard. Parish said he alerted everyone at the meeting -- including a psychiatrist, social worker Joan Davage, Hackett and Hicks -- that Heard believed he was in jail by mistake, but nothing was done.

The jail's chief psychiatrist at the time, Warren Mebane, worked for the private contractor also involved in the settlement, the Center for Correctional Health and Policy Studies, which provided medical services at the jail. Mebane later told Heard's attorneys that it wasn't his job to alert jail staff of complaints of wrongful imprisonment. He said many people assert that they are innocent.

"I might add for the record that as part of the training of personnel in jails, we are all told we have our job to do, we are not to do anyone else's job, and we're not to take on inmate requests to do things that are outside of our job description, so that we do not become subject to their manipulations or schemes and scams and do things that could cost us our employment," he said in a deposition.

Mistake Comes to Light

The mistake was finally uncovered in July 2001 when the inmates in Heard's mental health unit were scheduled to be transferred to other facilities. Heard's name was not on the list. On Aug. 3, the jail contacted Heard's attorney and learned again that there were no pending charges. He was released Aug. 13

The department's month-long internal investigation, which then-Corrections Department Director Odie Washington declined to make public when it was completed in 2001, concluded that five people were negligent and responsible for Heard's imprisonment. It found Davage negligent for not getting deaf services for Heard, but because she was a contract employee, disciplinary action was not ordered. Haynes was suspended for 30 days and Ellis for 45. The department proposed that White receive a 45-day suspension, but he retired before it could be imposed.

The investigation recommended that Hackett be fired, but Washington reduced the punishment to a 20-day suspension. Hackett still works for the department, officials said, as does Ellis.

Attorneys for the four jail-staff members and for the Center for Correctional Health would not comment on the case. But in their depositions, several jail employees said they were made scapegoats for a department that was downsizing and routinely overburdening them.

"What really was distressing about this case is that the District had long been on notice that the jail records office was in a shambles and that it was likely people would be wrongly detained," said Heard's attorney, John Moustakas, pointing out the half-dozen studies that documented the records problem. "They knew they had a powder keg, and they were deliberately indifferent to it."

Joseph Heard was released in 2001 after 22 months in the D.C. jail.Joseph Heard, second from left, is reunited with his brothers, Leonard Pender, left, Billy Cason and Clarence Coleman in 2001. Heard received more than $1 million in a settlement of his wrongful imprisonment suit.