Inmate seeks treatment
By Brian D. Bridgeford and Tim Damos
Sauk County jail inmate Tyler N. Mills says he is in such mental agony he petitioned the court for the death penalty in early May. As an alternative, he says he wants the psychiatric care and medications necessary to treat his serious mental health conditions. In a hand-written motion, he says medications such as BuSpar and Klonopin have helped him deal with severe anxiety, feelings of panic and impulses to kill himself, but jail policy does not allow him to receive them. A disability rights attorney working with Mills has alleged conditions and practices at Sauk County's jail are inadequate and has called for a full investigation by the Department of Corrections. Jail officials say those allegations are baseless. Milwaukee-based psychiatrist Michael Bell said Friday that Mills' complaints are representative of rising concerns about mental health, jails and prisons. More people with mental illnesses are being incarcerated, and there are not enough resources in the system to provide care for them. "In prison (and) jail systems, I think you see jail administrators saying, 'You can have any medication you want,' but there's pressure direct and sometimes indirect on the physicians working in those settings to keep an eye on cost and to put people on medications that are cheaper as opposed to what's good for them," Bell said. Mills says he wants to be examined by a psychiatrist and to receive treatment at a mental hospital. "I am tired of feeling panicky," he wrote. "I am tired of feeling like I am bouncing off the walls. I am tired of suicidal feelings of helplessness and hopelessness." The court rejected his death-penalty motion and other issues Mills raised. Wisconsin has not had the death penalty since the 1850s; 10 years prison time is the maximum penalty for any of the charges he faces. Mills has been in the Sauk County Law Enforcement Center jail since he was arrested in May 2006 on charges including car theft, stealing credit cards, burglary and possessing burglar tools. Access to care A sheriff's department report from May describes Mills telling jailers he wanted to kill himself on at least two days. Jail staff members eventually placed him in a restraining chair and were ordered to check on him every 15 minutes, the report states. Documents in his court file describe Mills as suffering from fetal alcohol syndrome, a type of brain damage that can occur when a pregnant mother drinks heavily. Records show Mills never has had a stable life or work history and includes a long list of mental hospitals and institutions where he has lived. Mills is not getting appropriate psychiatric care and his rights under federal law are not being met, says Todd Winstrom, an attorney with Disability Rights Wisconsin. He sent a letter to the Wisconsin Department of Corrections jail inspector complaining about the mental health care provided at the jail and is representing Mills in the effort to get him improved treatment. Under state law, "appropriate medical care for prisoners is mandatory," but "sheriffs have the discretion as to how to provide that care." Sauk County jail Capt. Michael Hafemann said that means Mills does not have the right to choose his treatment. "He has been assigned to see our doctor and he refuses to see our doctor," Hafemann said. "He wants to go to his own doctor in Washington state. Well, that's not going to happen." A Peoria, Ill.-based firm, Health Professionals, Ltd., provides health care services at the jail for about $62,000 per year. The company supplies a licensed physician who visits the jail one day each week for a maximum of six hours to see inmates. The company also guarantees the jail round-the-clock on-call access to a physician. During an interview at the jail Friday morning, Mills disputed Hafemann's claim that he has been uncooperative, saying he has seen HPL's doctor five or six times. He said the doctor agreed to prescribe him certain medication, but he was denied access to the medications because they were not on HPL's list of drugs. Winstrom said the treatment offered is inadequate in view of the serious, long-term problems with which Mills is afflicted. "So to the extent that he's refused to accept what they've offered, that's the primary thing," Winstrom said. "What he's being offered is not adequate either in the (rational) sense, the medical sense or the legal sense." While Hafemann would not discuss the specifics of Mills' condition, he did say Mills is getting the treatment he needs through visits from human services staff. A need for specialists? Winstrom, Mills' attorney, says there are two fundamental problems in the jail's policy for dealing with inmates with mental illnesses. In general, a prisoner with mental health problems is examined by a physician working for HPL who is not a trained psychiatrist or mental health specialist, he said. Once he examines the patient, he can consult by phone with a psychiatrist at the company's headquarters. Bell treats patients in Milwaukee and is a faculty member at the Medical College of Wisconsin. He is also on the American Psychiatric Association's Committee on Persons with Mental Illness in the Criminal Justice System. He said treating jail inmates with mental illnesses without using specialists should only be seen as a short-term solution. "People who end up in (jails and) prisons are usually those with more severe and chronic mental illness," he said. "Mental illness, if left untreated, can be debilitating and gets severe over time." The jail's contracted physician can prescribe psychiatric medicine to inmates, Hafemann said, or he can consult with a Peoria-based psychiatrist over the phone, if he feels it is necessary. But inmates are not provided direct access to a psychiatrist. "You don't go to a specialist for every ailment that you have," Hafemann said. "Most people get their high anxiety medications, not from a psychiatrist, they get it from a family practitioner." Sauk County Human Services also has psychiatrists on staff, but they are used as consultants for the psychotherapists, usually someone with a master's degree in either social work or guidance and counseling who meets with inmates at the jail. Human Services Director William Orth said his staff can recommend prescriptions, but the HPL physician must approve them. Drugs available, staff says Another issue, Mills' attorney says, is HPL's selection of psychiatric drugs, called a formulary, is too limited and does not contain newer, more effective medications. Jail policy allows HPL and the jail administration to treat patients with older, less effective medications the patient already may have tried and found ineffective, Winstrom said. HPL officials did not respond to multiple attempts to comment for this story. Pressures including tight budgets push jail administrations and health care providers to select less-expensive medications for prisoners, Bell said. But newer, sometimes more expensive psychiatric medications are much more effective in treating mental illnesses, he said. Hafemann said no inmate is denied access to a medication because it is not on HPL's list. He denied Winstrom's assertion that HPL's formulary is limited. "It's not limited. It covers all medications that anybody would need," Hafemann said. "That's an absolute lie." If HPL's doctor determines someone needs a particular brand of medication not included in the formulary, that individual gets the medication, according to Hafemann. The jail's nursing director, Margo Busser, said HPL's list is not absolute. "There are some non-generic drugs out there. If it is something that there is no generic and it's all they can tolerate, they get it," she said. The county tries to collect costs associated with medical care from the inmates. Hafemann said the county usually succeeds in collecting about 47 percent of the money it spends on medication at the jail. Last year, it spent just less than $40,000. Treatment costs may climb Mills said he would like to be placed on the medications that have worked for him in the past or be committed to an institution that could provide him with the care he says he needs. Hafemann said Mills has undergone multiple evaluations but has never been recommended for an inpatient facility. When an inmate or citizen is committed to a state institution, the county picks up the tab, which can range anywhere from $500 to $800 per day, depending on the hospital and which unit the patient is assigned to, Orth said. And fees are getting higher. Orth said he expects the county will have to pay between $700,000 and $800,000 next year to treat inmates who need inpatient care. The county has budgeted $600,000 for those expenses this year. Winstrom said he will continue to pursue information on the jail's policy for psychiatric treatment of prisoners and investigate its impact on prisoners with mental illnesses. Under federal law, one option he has to force a change in policy is to sue Sauk County, he said. Bell said jails and prisons are becoming the places where the largest numbers of people with serious mental illnesses are housed. "If it is appropriate to treat a prisoner with cancer or a terminal liver disease, then it is just as appropriate to treat their mental illness," he said. "The treatment of the human mind and brain is perhaps the thing that makes us the most human and the thing we most treasure."