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Psychiatric Care In Jails

by Betsy Greer

Member, North Virginia AMI


What is the standard of medical care required of a physician for the treatment of incarcerated mentally ill individuals? The National Alliance for the Mentally Ill (NAMI) says the standard "is the same as that of the average, competent physician in the community."

NAMI and the Tennessee Alliance for the Mentally Ill asserted that in a successful appeal in a wrongful death suit against a Tennessee jailhouse psychiatrist. June Husted of California is suing Dr. Everett Echols III for negligent care of her son Todd Husted which, she says, was the proximate cause of Todd's suicide at a Nashville jail.

Todd Husted was jailed in Nashville in May 1988 for auto larceny and malicious mischief. The suit centers on Echols' actions when, as a part-time psychiatrist for the Nashville jail, he examined Todd Husted and diagnosed him as suffering from "schizophrenia, undifferentiated type." He prescribed medication and ordered two blood tests for the presence of drugs -- one test immediately and one seven days later as a way to ascertain the amount of antipsychotic medication in the blood. June Husted mailed to the jail Todd's medical and psychiatric records that listed previous suicide attempts by her son. She also talked to a psychologist at the jail who, in turn, told Echols of these previous suicide attempts.

Two weeks after the initial examination, Echols renewed the same prescriptions without examining Todd Husted or his medical records. Six days later, Husted committed suicide. A test of his blood at that time showed no measurable content of lithium.

"Deceased committed suicide while in a psychotic state because of the lack of medication in his blood. Defendant [Echols] had no idea of whether deceased was taking the prescribed medications because he never saw any blood test results," said the Tennessee Appeals Court, which overturned a directed verdict for Echols and the dismissal of Husted's wrongful death suit against him. It ordered a jury trial of the suit.

NAMI/TAMI submitted a friend-of-the-court brief in the appeal. "The circumstances of this case raise serious questions about whether Dr. Echols' treatment of Todd Husted while in the metro jail complied with minimally acceptable professional standards." They argued that Echols' failure to review materials sent by the prisoner's mother, "including the extensive records of past hospitalizations," and the "virtual lack of follow-up after the initial evaluation" were a breach of duty to provide minimal adequate care.

"Amici assert that the failure of [Dr. Echols] to identify Todd Husted as suicidal was due to his lack of follow-up in this case, coupled with his failure to review the extensive past records provided and his failure to return the repeated calls placed to him by Plaintiff/Appellant June Husted," NAMI/TAMI said.

"The tragic death of Todd Husted, an individual suffering from schizophrenia, a severe brain disorder could have been prevented with appropriate psychiatric treatment during his incarceration in the Nashville Metro Jail." The NAMI/TAMI brief cited case law and national standards to show that "The standard of care required of a physician who treats patients in correctional facilities is the same as that of the average, competent physician in the community."


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