A jury declined to find Bexar County and University Health System responsible for the death of Janice Dotson-Stephens, who died in jail custody in Dec. 2018. Her daughter Michelle Dotson and other members of the family sued the county and its hospital alleging violations of her mother’s civil rights and violations of the Americans with Disabilities Act.
Dotson-Stephens died from heart disease that was exacerbated by her schizoaffective disorder. Despite being in Bexar County Adult Detention Center custody and being treated by doctors from UHS, medications for her diagnosed hypertension and schizophrenia were never given during the entirety of her 150 days.
Medical reports showed she suffered auditory hallucinations, often talked to herself, refused meals more than 100 times, and lost a considerable amount of weight.
“I had the same reaction that Michelle Dotson had, she’s shocked,” said Leslie Sachanowicz, the family’s attorney.
Lawyers for UHS argued they were unable to treat Dotson-Stephens for her heart and mental health issues because she repeatedly declined treatment. While they could if she was in a medical emergency, several doctors and detention workers testified she died unexpectedly.
“Dotson(-Stephens) had a constitutional and statutory right to refuse treatment. Period. End of story,” Laura Cavaretta, attorney for University Health System, which provides health care at the jail, told the jury Tuesday.
Her death drew national media attention and criticism from many who thought she should never have been in jail custody with her history of mental health issues. Her $300 bond meant she could have been free for $30. While she was arrested for misdemeanor trespassing she was nearing the maximum sentence length issued (six months) without ever having seen a trial. Critics of how the issue was handled include the county’s highest-elected official Judge Nelson Wolff.
Even lawyers for the county’s hospital called the system “broken” in its treatment of the mentally ill.
“We do agree that there’s a breakdown in the law and that needs to be addressed and to the extent University Health System and its physicians can participate in changing the law with the legislature, we will,” said Cavaretta after the verdict was announced.
Multiple doctors and social workers did reach out to the courts to prompt action in her care, according to court records.
The county pointed the finger at court-appointed lawyers who never got in touch or advocated for Dotson-Stephens. Then pointed to judges and slow-moving court staff who failed to schedule a competency hearing.
Dotson-Stephens had a long history of mental health issues — and interactions with the police. She spent time in state mental health facilities before and having been diverted there for past more serious offenses instead of to the county jail.
This time she was booked into the criminal justice system and all the authority for her care fell to judges and courtrooms Dotson-Stephens would never see.
Attorneys for the Dotson family questioned a system that could detain a woman without trial for months, fail to treat her many known illnesses, watch her physically and mentally deteriorate, die and then shrug their shoulders.
“Everyone in here is pointing the finger at everyone else,” Leslie Sachanowicz, attorney for the family, told the jury Tuesday.
More should have been done, he said. He pointed to medical reports that showed no treatment plan but noted erratic behavior. Dotson-Stephens was suffering from documented auditory hallucinations. She often talked to jail staff and doctors about “Anthony,” the name she gave to the voice she heard.
How could she ask for help with a mind so compromised, argued Sachanowicz.
“This is the sad part of this case — Ms. Janice Dotson-Stephens was a prisoner of her own mind and she was a prisoner at the Bexar County Jail,” said Sachanowicz
Her auditory hallucinations should have qualified her for “non-emergent” court-ordered treatment he argued, but that treatment was never requested by the county or its health workers.
“She did not seem to understand the nature of the examination and refused to proceed,” Dr. Brian Skop, a psychiatrist who attempted to examine her on Sept. 11, 2018, wrote at the time. “Given her degree of deterioration, it is recommended that she be referred for inpatient treatment… It is expected she can be restored to competency in the foreseeable future. She does not appear to have a rational or factual understanding of the proceedings against her.”
Skop filed a report with the judge in her trespassing case on Oct. 2 of that year. A competency hearing was never held.
“You’re right, the system is broken, but the solution is not to impose an obligation on health care providers or jail workers to make sure lawyers are doing their jobs or judges are doing their jobs,” Cavaretta said in court Monday.
Lawyers for the county said Dotson-Stephens was offered treatment and medication and “reached out to her on a daily basis.”
As one county lawyer argued, the entire system was not on trial and expecting detention workers to not only ensure the safety but to also advocate for the more than 60,000 people that went through the jail each year was not reasonable.
Sachanowicz and associate Mary Pietrazek were unable to convince the jury they had met the high bar of proving deliberate indifference by the county and its health workers. Failing to keep her alive was not enough of a reason nor was medical malpractice. They had to show the county refused to treat or intentionally mistreated her.
“It seems like it comes down to the way the questions were constructed for the jury,” Sachanowicz, indicating the jury instructions and the questions they were called upon to answer were too prescriptive.
Sachanowicz said the jail needs a policy for involuntary non-emergent medical treatment. That clearly contributed to her death, he argued. It is another example of how overcrowded jails in the state that aren’t intended to handle people for long stays or the mentally ill are increasingly tasked with it.
While the county argued this as a one-time failure, and not the part of a larger pattern, it can happen again.
“She was just warehoused (in jail),” Sachanowicz said. “So it’s just business as usual.”
