Grand Jury report targets Todd Road Jail inmate suicides

    June 10, 2011
    By Peggy Kelly
    Santa Paula News

    Two inmates that committed suicide at the Todd Road Jail (TRJ) in 2010 had signaled their intentions, but authorities were not notified of the past attempts of one inmate or the mental health issues of the second.

    The findings were included in the report “Inmate Processing and Suicide Prevention in Ventura County Jail,” released this week by the Grand Jury. The Ventura County Sheriff’s Department must “identify and mitigate those factors associated with the inmate and within the facility environment which may either trigger or facilitate a suicide.”

    Culled from state rates for natural deaths and suicides and calculated per 100,000 inmates, the Grand Jury reported the rate of inmate deaths in Ventura County was in the top 12 percent of jails nationwide for seven of the last 11 years. And the inmate suicide rate over the 11 years “is less than the smallest jails nationally and greater than most of the largest jails in California.”

    The report noted white inmates are six times more likely to commit suicide than black inmates and three times more likely than Hispanic inmates. And “Violent offenders commit suicide at nearly triple the rate of nonviolent offenders.”

    Of all offender groups, “public order offenders” - those crimes involving weapons, parole violation, obstruction of justice, etc. - spent the shortest time in custody prior to committing suicide; half of their suicides took place in the first three days of custody. Property and drug offenders each had a median time in custody of about a week prior to suicide. Half of the violent offender suicides took place after spending three weeks in custody.

    At least 80 percent of suicides in custody occurred in the inmate’s cell. Time of day was not a factor.

    In 2010 two inmates who committed suicide, referred to as A and B, were between the ages of 48-52 and had prior incarcerations. B had been jailed frequently during the prior six years.

    In both suicides, “custody personnel responded quickly. Deputies and attending nurses performed emergency procedures until Emergency Medical Technicians arrived in a timely manner and transported the inmates to the hospital.”

    The report stated A was interviewed by a nurse three days after Main Jail booking, was transferred to the TRJ eight days after booking, and was found hanged in his cell 104 days after booking. “An after-death investigation identified that former cellmates stated they had observed two prior suicide attempts. The first attempt was reportedly one day after booking; the second was 96 days after booking.” Although the report stated “Both attempts were unknown to the custody staff prior to the suicide investigation,” the first cellmate claimed to have contacted an unsworn Main Jail employee about this incident, a contact that was unsubstantiated.

    The second suicide attempt at TRJ was not reported to VCSD personnel by the cellmate before the successful suicide. Inmate B was transferred to TRJ four days after booking and was found hanged in his cell seven days later. The report stated some family members were aware the inmate had a bipolar disorder, was under psychiatric care, and had exhibited suicidal behavior, information not told to custody personnel.

    Based on the analysis of prior suicides, safety modifications to cells and bunks were initiated. Modifications were completed at the Main Jail, but according to the Investigative Reports and grand jury visits, the modifications were not yet completed in the cells of inmates A or B at the TRJ.

    Despite the department’s “thoroughness and dedication” to the investigations, “The fact that the Sheriff’s Department is investigating deaths in its own jail can be perceived as a lack of transparency,” and the report recommended the DA’s Office conduct such reviews, “as is done in officer-involved shootings.” County Health Care agency should also participate in suicide analysis “to provide an independent perspective.”

    A brochure for inmate visitors, asking for information to be reported to a jail nurse about the inmate’s mental and physical behavior prior to incarceration that could indicate a risk of suicide, should be developed.

    The report recommended that the VCSD contact family members of inmates that commit suicide to express condolences and determine if there was known or suspected risk before they were jailed.

    Copies of this and other Grand Jury reports can be downloaded from the website at http://grandjury.countyofventura.org.





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