Trial Coverage: Week 5

Dr. Watson’s testimony focused primarily on his recent psychological evaluation of Damon Howard, an inmate who testified in court earlier during the trial. Dr. Watson offered the opinion that Mr. Howard is not psychotic, but is instead malingering his symptoms.  He testified that he believes Mr. Howard is clearly an actor.   

However, despite stressing the importance of considering all available collateral sources of information, including the patient’s mental health and presentation history, before rendering a diagnosis, Dr. Watson admitted that he did not review Mr. Howard’s medical records and did not even ask to see them. He also admitted that he did not know whether Mr. Howard was medicated on the day he was evaluated.    

When presented with excerpts from Mr. Howard’s medical records showing that Mr. Howard has a long history of consistent symptoms, and also that various SCDC psychiatrists have consistently found Mr. Howard delusional and schizophrenic for several years, Dr. Watson maintained his opinion that Mr. Howard is faking it.  Dr. Watson testified that even though this was his first time ever meeting Mr. Howard, and that he only spent an hour and a half evaluating him, he nonetheless disagrees with the diagnoses rendered by Mr. Howard’s treating psychiatrists who have treated him for years.

Following Dr. Watson’s testimony, the Defendants rested their case.  Closing arguments will take place on Friday, March 23, at the Richland County Judicial Center.

Haas recalled that prior to his deposition in December, 2011, he had reviewed the depositions of Plaintiff's experts. He suggested that he has since reviewed additional depositions, but could not recall which ones those were. 

He admitted that he did not visit Perry or Lieber correctional institutions, two area mental health facilities that have been primary targets of criticism in this trial. He offered the opinion, to a reasonable degree of certainty as a forensic psychiatrist, that SCDC inmates are not subjected to cruel and unusual punishment in S.C. 

However, Dr. Haas admitted at the time of his deposition that he did not know the system. He described himself as an outsider who had been provided little information about SCDC's operation. He admitted that he did not know whether additional facility tours or inspections would be helpful to him in his assessment of SCDC's mental health system.

When asked on cross examination when he reviewed SCDC mental health training plans and a video, which he had previously testified he relied upon, he admitted that he first viewed them yesterday – the day prior to taking the stand to testify.

Dr. Haas testified that he only reviewed the mental health system in its current state. He did not review historical data or evidence. He relied largely on information received from SCDC staff who he spoke with during his short visits. His source of his information for Lee correctional institution, another area mental health facility, was Lead Counselor Paul Dennis, the same counselor who testified last week that he considers inmates medication compliant so long as they get at least one of their medications once in a three day period. 

Comparisons were made between the Kentucky Department of Corrections, where Haas worked for 18 years, and SCDC. Dr. Haas agreed that every element of mental health service should have a quality component to it and noted that of the 13 prisons in the Kentucky system, each was accredited by the American Corrections Association (ACA). Evidence was presented earlier in the trial that SCDC decided to abandon its ACA accreditation years ago to save money. Dr. Haas agreed that, had he found himself in a similar situation in Kentucky, he would have advised against abandoning accreditation.

In South Carolina, inmates facing disciplinary charges may be determined Guilty But Not Accountable (GBNA) if their actions are determined to be manifestations of their mental illness.  However, such a finding does not preclude that inmate from nonetheless being placed in lock up on disciplinary detention. Dr. Haas agreed that he would have a problem with this practice, admitting that he was not aware of this practice or how often it occurred. 

In further testimony, Dr. Haas said he had no firsthand knowledge of the use of showers and alternate cells for Crisis Intervention (CI). Dr. Haas stated he took the word of Paul Dennis, the lead counselor at Lee, whom he stated had told him the practice was unusual and had been stopped immediately after it was discovered. Haas admitted that he had not reviewed logs from Lieber showing the use of such alternate cell placements for CI purposes, but he agreed that the use of such locations would not be appropriate.

He testified that if he were to audit the time periods in which counselors and psychiatrists see patients, that he would allow some latitude of a day or two here and there. He agreed, however, that if mentally ill inmates are not being seen on time consistently at multiple institutions throughout the SCDC system, then that would be an indication of a systemic deficiency.

Dr. Haas testified regarding suicide prevention policies in Kentucky and in South Carolina. Dr. Haas supported the policy in Kentucky, that suicidal inmates must be continuously monitored. Although SCDC once had a suicide prevention policy requiring continuous observation, that policy has been changed to now require only 15 minute checks. 

Dr. Haas had previously testified that he spent approximately 65 hours on this case prior to his deposition, including travel time. Judge Baxley asked Dr. Haas how much time he has spent since his deposition in December, 2011. Dr. Haas answered that he has spent an additional 15 to 20 hours. It was unclear whether that time included his trip back to South Carolina for trial.

Janine Wrecsics testified from a nursing perspective regarding medication issues at the department, admitting that medication administration records were not accurately kept when she began at SCDC. She suggested that improvements to the record-keeping and administration of medications have occurred over the past couple years.  She discussed the administration of formulary and non-formulary medications.  She explained that certain drugs such as Seroquel, Neurontin and Wellbutrin are no longer on the formulary due to their potential for abuse.

During cross-examination, she was asked about the importance of continuity of care as it pertains to accurately monitoring medication compliance.  She agreed that it is important for treating clinicians to know a patient's treatment history in order to ensure that continuity of care remains in tact.

 She suggested that the current 34 percent nursing staff vacancy rate creates problems for SCDC nursing staff in delivering health services.

Wrecsics admitted that there are inconsistencies in the medication administration forms used to track compliance.  Specifically, the codes used to track compliance on the MARs are inconsistent with those set forth in policy.  She stated that she has raised this issue in the past.  The inconsistency, however, remains.

Dr. Pamela Crawford has worked at SCDC as a part-time psychiatrist since 2006.  She primarily works for the Department of Mental Health, but she works eight hours per week with mentally ill women inmates at Camille Graham and Leath correctional institutions.

Dr. Crawford testified that she has a caseload of 175-200 patients.  She testified that her duties have changed over the past couple years.  One of the changes, which she testified occurred in 2011, involved a new directive requiring a psychiatrist to change the mental health classifications for inmates on the mental health case load, as opposed to internal medicine practitioners.  

Dr. Crawford explained that continuity of medication administration is extremely important for some patients, who she stated would get very sick and need hospitalization if they miss medications.  For others, she suggested daily compliance is not as critical.

She discussed Geocare, an independent mental health provider contracted to provide in-patient services to female inmates.  Dr. Crawford explained that an extremely low number of women are sent to Geocare because she does whatever she can to treat her patients on location.  She explained that she is usually able to provide the needed treatment safely and effectively because she knows the patients, the counselors know the patients, and the institution is essentially home for them.  Dr. Crawford testified that she has created a rapport with the women on her case load, which she said has improved her ability to treat her patients.  She also stated that in her experience women are less likely than men to engage in serious self-injurious behavior because they have a stronger support system.

Stalder admitted that he has never been retained as an expert, outside of a lawsuit, to provide consultation to a prison system. He has testified as an expert in two cases involving use of force. 

Stalder testified that he began his evaluation of SCDC in late 2011.  He toured Lee Correctional Institution and Kirkland Correctional Institution, including a walk-through of Camille Graham, Gilliam Psychiatric Hospital, and the maximum security unit.  He spent no more than a couple hours at each location.  He admitted that during these tours, his only substantive conversation was with the warden.  He did not interview any other staff or inmates.

He suggested that MK9 chemical munitions (pepper spray in a size usually reserved for large crowd riot control) are no longer used on individuals by SCDC correctional officers.  He testified that a warden assured him that he could not remember the last time MK9 had been used and that it was not stored in the housing area.  Stalder was shown several examples in which the MK9 was used recently, contradicting the warden's purported assurances.   

When asked whether he made any effort to look back at SCDC's practices preceding his tours, he answered that he was only interested in what was happening "here and now." 

The witness was excused; court adjourned until 9 a.m. Tuesday.