(6-6-16) Officials from the National Alliance on Mental Illness, Mental Health America, the NAACP, the ACLU, and the Bazelon Center for Mental Health Law today called on the U.S. Justice Department to investigate the death of Jamycheal Mitchell, a 24 year-old African American with a history of mental illness, who died last August in the Hampton Roads Regional Jail in Virginia.
Mitchell had been arrested for allegedly stealing $5 worth of snacks from a convenience store and was found dead in his feces covered cell 109 days later while waiting for transfer to a state mental hospital for evaluation. A medical examiner said he’d died from a heart attack caused by “wasting syndrome.” He had lost 40 to 50 pounds.
Mira Signer, the executive director of Virginia NAMI chapter, was a driving force behind the letter, which was signed by NAMI National’s CEO Mary Giliberti; Evelyn Steward, president of NAMI Hampton News; Bruce Cruser, executive director of Mental Health America of Virginia; Claire Guthrie Gastanaga, executive director of the ACLU in Virginia; Ira Burnim, legal director of the Judge David L. Bazelon Center for Mental Health Law, and James P. Boyd, president of the Portsmouth branch of the NAACP.
In an Op Ed published in The Washington Post last month, I asked for the Justice Department’s Civil Rights Division to investigate Mitchell’s death. In that editorial, which drew the ire of the Virginia Attorney General’s office, I complained about probes of Mitchell’s death released by the Virginia Department of Behavioral Health and Developmental Disabilities (DBHDS) and the State Office of Inspector General. Both balked at actually investigating what transpired inside the jail, claiming they didn’t have jurisdiction to look there. So far, Hampton jail officials are the only ones who actually know what took place in the jail. Eight days after Mitchell’s body was found, they conducted an internal investigation and announced their employees had done nothing wrong. They have refused to make that report public. Jail officials also taped over video taken outside Mitchell’s cell that would have shown how often employee’s gave him food or entered his cell.
In their letter to the Justice Department, the authors wrote: “the ultimate question remains unknown: how did Mitchell starve to death before the jail staff’s and medical staff’s eyes?”
Mitchell was supposed to be checked by a nurse once a day and also eyeballed by correctional staff regularly, yet there is no mention in any jail or nursing reports that have been made public about his alarming loss of weight.
Mitchell’s family has filed a $60 million civil suit against the jail and state. On June 3rd, in a separate matter, an attorney for the family of Natasha McKenna, a 37 year-old African America with mental health problems, filed a $15 million lawsuit against jail officials in Fairfax. McKenna died in 2015 after being repeatedly stunned by deputies with a Taser. In addition, Virginia state Senator Creigh Deeds filed a $6 million wrongful death lawsuit against the state spurred by the 2013 death of his son, Gus, who was turned away by mental health officials during a psychotic break when he needed emergency hospitalization. Gus Deeds attacked his father before ending his own life.
That brings the total of civil lawsuits filed in Virginia because of alleged wrongful deaths of persons with mental illnesses to $81 million.
In their request for Justice Department intervention, the advocates noted: “Federal action is imperative to prevent further tragedies and to facilitate sustained improvement in coordinated response to justice involved persons with mental illness in Virginia.”
In addition to that letter, former state Inspector General G. Douglas Bevelacqua, released a copy of a letter today that he sent to Virginia Senator Deeds and Delegate Robert B. Bell, who are chairing a joint state legislative committee investigating the state’s mental health care system. Bevelacqua accused his former employer — the Inspector General’s office – of not conducting an “investigation” into Mitchell’s death but rather simply “reviewing” it. He claimed that “review” was “fatally flawed.” In his letter, Bevelacqua also charged that the private company hired by the jail to provide medical services to Mitchell and other inmates was not licensed by the DBHDS to provide mental health services as required by law and added that the company that replaced it after Mitchell’s death also is not licensed to provide mental health care.
As a proud Virginia resident, it is embarrassing that mental health officials and civil rights groups believe that the only way they can get a legitimate investigation into a troubled man’s death in jail is by calling in the Justice Department.
Shameful!
I want to especially thank NAMI’s Mira Signer and Mary Giliberti, and also Ira Burnim at Bazelon, for pushing the need for an independent investigation.
Here is a copy of today’s Justice Department letter:
Steven H. Rosenbaum
Section Chief, Special Litigation Section
U.S. Department of Justice Civil Rights Division 950 Pennsylvania Avenue, NW Special Litigation Section Washington, D.C. 20530
June 6, 2016
Dear Mr. Rosenbaum:
The undersigned organizations and individuals respectfully request that pursuant to the Civil Rights of Institutionalized Persons Act (CRIPA), 42 U.S.C. 1997 et seq., the Justice Department immediately begin an investigation into the circumstances and conditions at the Hampton Roads Regional Jail that led to the August 19, 2015 death of Jamycheal Mitchell, a 24-year old man 2
with a history of mental illness who was arrested for stealing $5 of junk food at a local convenience store.i
Mr. Mitchell died 109 days after his initial arrest and incarceration. In those 109 days he lost 40-50 pounds and he died “alone in a jail cell with feces on the wall and urine on the floor”.ii
A report from the state Medical Examiner’s Office revealed that Mitchell died of probable cardiac arrhythmia and wasting syndrome. Wasting syndrome is defined as a profound loss of weight, greater than 10 percent of a person’s original body weight.
Yet the Hampton Roads Regional Jail conducted an internal investigation and cleared itself of any wrongdoing. Therefore the ultimate question remains unknown: how did Mitchell starve to death before the jail staff’s and medical staff’s eyes?iii
The death of Mr. Mitchell reveals not only egregious problems at the local level, it also illustrates serious and widespread deficiencies in the lack of coordination across systems responsible for responding to individuals experiencing serious mental health crises. As we believe that preventing future tragedies of this magnitude requires a multi-systems response at both county and state levels, we request that your investigation include an assessment of the role that lack of coordination and accountability across systems may have played in contributing to Mr. Mitchell’s deterioration and ultimate death
The death of Mr. Mitchell reveals not only egregious problems at the local level, it also illustrates serious and widespread deficiencies in the lack of coordination across systems responsible for responding to individuals experiencing serious mental health crises. As we believe that preventing future tragedies of this magnitude requires a multi-systems response at both county and state levels, we request that your investigation include an assessment of the role that lack of coordination and accountability across systems may have played in contributing to Mr. Mitchell’s deterioration and ultimate death.
Our request is based on the March 2016 investigation document from the Virginia Department of Behavioral Health and Developmental Disabilities (DBHDS) which revealed a number of mistakes that were made by government entities once Mr. Mitchell was jailed. For example, a court order that was faxed to Eastern State Hospital that would have put Mr. Mitchell in the care of a hospital was placed in a desk drawer by an “overwhelmed” employeeiv and not discovered until after the young man had died. Additionally, the report revealed that the Portsmouth Department of Behavioral Healthcare Services (the city’s local mental health agency responsible for conducting psychiatric assessments, including screening for hospitalization) had not completed an examination that could have led to Mr. Mitchell being quickly transferred to a psychiatric hospital.
The report further documented that:
On April 22, 2015 Mr. Jamycheal Mitchell was arrested, charged with petit larceny and trespassing in Portsmouth, Virginia.
Mr. Mitchell was incarcerated at the Hampton Roads Regional Jail in Portsmouth, Virginia.
On May 21, 2015, a Competency Restoration Order (CRO) was issued in the Portsmouth General District Court.
The CRO mandated that Mr. Mitchell be sent to Eastern State Hospital (ESH) to restore his competency to stand trial.
Although the Portsmouth General District Court allegedly mailed the CRO to ESH on approximately May 27, 2015, representatives from ESH stated that they did not receive this order, and there was no record found that this CRO was mailed by the Portsmouth General District Court or received by ESH.
On August 4, 2015, the Forensic Log at ESH showed there were 34 individuals on a wait list to be admitted to ESH.
Mr. Mitchell’s name was not on the August 4th, August 11th, or August 18, 2015 ESH Forensic Logs.
Mr. Mitchell remained incarcerated at the Hampton Roads Regional Jail until his death on August 19, 2015.
Our request is also based on the investigation report conducted by the State Office of Inspector General (OSIG), released on April 5, 2016- nearly 8 months after Mitchell’s death. The report outlines a number of systemic failures that led to the death of Jamycheal Mitchell and says that these systemic weaknesses were known to lawmakers and government agencies long before Mitchell died and had been recommended to be addressed- some urgently- but that various policy, procedural, and legislative changes had nonetheless not been enacted. Notably, the OSIG report also says that the root causes of the incident remain at risk for recurrence without enacting changes. This is an ominous warning and warrants thorough investigation and urgent remedial action.
We are extremely concerned about the likelihood of future deaths if the problems are not remedied. According to the 2015 Virginia Criminal Compensation Board Mental Illness in Jails Report (most recent report for which data is available)v:
In June 2015 there were 7,054 individuals identified as having mental illness in Virginia’s jails
16.81% of total jail population was reported as suffering from some form of mental illness
7.87% reported as suffering from “serious mental illness”
Female inmates were disproportionately more likely to be identified as mentally ill compared to male inmates
We believe that the problems illustrated in this case, including neglect and possible abuse within the jail as well as lack of systemic coordination among responsible systems, are not isolated to this particular example.
In past cases, the Department of Justice’s intervention has served as a catalyst for significant improvements in mental health treatment capacity in local jails, including Los Angeles, Miami, and Chicago. The Department’s intervention has also stimulated systemic improvements in states, including Georgia, New Hampshire, and Massachusetts. In light of the magnitude and scope of the problems documented in this tragic case, the Department’s expertise and experience, formal findings, and if necessary litigation will play an important, constructive role in working to achieve desperately needed reforms. Federal action is imperative to prevent further tragedies and to facilitate sustained improvements in coordinated responses to justice involved persons with mental illness in Virginia.
Thank you for your consideration.
Sincerely.
Mira Signer,
Mary Giliberti,
Claire Guthrie Gastañaga,
Evelyn Steward Bruce Cruser,
James P. Boyd
Ira Burnim, Esq.
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