Jail medical staff assumed Amy Lynn Cross was faking as she seized, foamed at the mouth and her fingers turned blue in a Colorado jail, a December lawsuit alleges. The 41-year-old woman, who was facing another drug charge, died of an overdose after a bag of methamphetamine broke inside of her body.
In Fort Smith, Arkansas, medical staff neglected 50-year-old Larry Price Jr., leaving him alone in a cell as he lost nearly half of his body weight, according to a lawsuit filed by his family last month. Price, arrested after cursing at and verbally threatening police during a mental health crisis, died of dehydration and malnutrition.
After nearly three weeks in the Cleveland County jail, Terrance Osborne died of congestive heart failure, one of two chronic diagnoses he suffered before he was arrested for suspected public intoxication, his family’s January lawsuit claims. Swelling in his face and legs left the 44-year-old unable to move, go to the bathroom or access food and medication, according to the lawsuit.
The target of those lawsuits is the same health care provider responsible for thousands of incarcerated Oklahomans, including two women who died in December while waiting for mental health evaluations at the Cleveland County jail.
The deaths of Shannon Hanchett and Kathryn Milano caused Cleveland County officials to reevaluate the treatment of detainees. Now, the sheriff and the health care provider are asking commissioners for more taxpayer money to expand care.
Sheriff Chris Amason asked the county’s board of commissioners for an additional $500,000 annually for more nurses and mental health professionals on Turn Key Health Clinics’ jail medical team.
In a Tuesday meeting, Rhett Burnett, a Turn Key official who oversees operations in Oklahoma and Kansas, told board members that good care is provided at the jail but an increasing population warrants more.
Founded in 2009 by state lawmaker Jon Echols, Turn Key Health Clinics operates in 100 detention facilities in nine states. The Oklahoma City-based company is the target of lawsuits in at least three states where patients have died under the care of its medical staff. A former Turn Key nurse told Oklahoma Watch that inadequate staffing left patients with substandard care.
Caring for people in custody requires reliance on first responders, hospitals and mental health care facilities for treatment beyond the abilities of the jail, Amason said. People detained in the jail can refuse treatment and medical staff cannot override a patient’s decision without a court order, which further delays care.
“Correctional health care is a highly litigious environment,” Turn Key attorney Austin Young said in an email. “Allegations do not equate to evidence, and we believe this is reflected in our litigation record. We are proud of the exceptional care that is provided by our devoted health care providers.”
Amason said that when the company approached him about the needed changes, which would raise Cleveland County’s annual payments to Turn Key to more than $1.4 million, Turn Key employees pointed to insufficient staffing, especially on the night shift.
One Nurse, 500 Patients
Turn Key is required to provide only one nurse to care for the jail’s hundreds of detainees, a contract provision that hasn’t changed since 2009 when the facility’s population was about half its current size.
“It’s very, very low for the acuity of care you have with people that are in jail typically,” said Richard Forbus, a former jail commander who recruits new clients and acts as a spokesman for the National Commission on Correctional Health Care. “That’s a very minimal level of care.”
Turn Key often provides more staff than its contract requires, according to an hourly report provided to Oklahoma Watch. Two nurses and a medical assistant are on duty most weekdays. Every night, a medical assistant supports a nurse during a portion of the late shift.
But the report shows there are times on weeknights and weekends when one licensed practical nurse is responsible for the entire jail, which topped 500 in December when Hanchett and Milano were detained.
Sheriff Amason’s proposal to commissioners would amend Cleveland County’s contract with Turn Key, which was renewed in July. New staffing mandates would limit the time a nurse can be the only medical staff at the jail to eight hours per week. Two new positions would help care for patients overnight. And a mental health counselor would be at the jail five days per week instead of three under the proposal.
Burnett, a Turn Key director and former Cleveland County undersheriff, presented the plan to commissioners in a packed meeting Tuesday. Burnett briefly held the position of acting sheriff after his boss, former sheriff Joe Lester, resigned following a state audit that found misspending including overpayment for inmate medical services.
“It is a very, very hectic and busy place with the needs that come from the inmates and this would help us handle it better,” Burnett said.
Norman baker Hanchett, known to friends and customers as the “Cookie Queen,” was in medical cell four at the Cleveland County jail when she was found unconscious on Dec. 8, according to a state health department report.
The 38-year-old mother of two was arrested the day after Thanksgiving by Norman police on charges of obstructing an officer and false reporting after calling 911 repeatedly to request a welfare check on her son. The arresting officer wrote in a court document that Hanchett was suffering from a mental health disorder.
In jail, Hanchett was placed on suicide watch, according to the health department report.
After a mental health evaluation by Turn Key staff, she was taken off suicide watch and moved to a medical cell closer to the nurse’s station. She was dehydrated, and medical staff were giving her Gatorade, the report shows. Hours before Hanchett was scheduled to have a mental health assessment required to be transferred to a treatment facility, first responders pronounced her dead. The state medical examiner has not yet ruled on her cause of death.
Two weeks later, Milano, a 66-year-old grandmother, didn’t respond when a Cleveland County deputy knocked on the door of the medical cell where she was detained.
On Nov. 22, Milano was arrested by Norman police for allegedly violating a victim protection order but the jail refused to take her due to health issues. She was taken to a hospital, according to court documents. Milano was arrested again on Nov. 25 by Noble police on suspicion of burglary after her next door neighbor accused her of stealing from him. That time, the jail admitted her. Milano needed dialysis but refused treatment, court records show. She was scheduled for a court-ordered mental health evaluation.
On Dec. 20, Milano was found curled up on her side, her face blue and blood dripping from her nose, according to a state health department report. A Turn Key nurse tried to revive Milano by rubbing her sternum. The nurse and a deputy performed compressions until first responders arrived, according to the report. Milano’s family disputed a statement provided by the sheriff’s office that claims she died at Norman Regional Hospital as a result of a pre-existing medical condition. The medical examiner has not yet released her cause of death.
‘I Couldn’t Make Any Difference’
At least nine other Oklahoma jails contract with Turn Key Health Clinics, including the Oklahoma County Detention Center, which is under investigation for health and safety violations.
Kimberly Goetz worked as a nurse for Turn Key and oversaw the nursing unit in the Oklahoma County jail for about six months in 2018. She said she quit after a woman having a seizure nearly died waiting for first responders to arrive because there was no doctor on site. Staff were not allowed to distribute medication or check on detainees without a corrections officer present, she said. She and her coworkers were often stuck waiting for an officer to become available before they could respond to patient needs, Goetz said.
Nurses sometimes lost track of who had received medications because there weren’t enough staff to care for approximately 1,600 patients, many of whom came into jail with medical or mental health conditions that worsened the longer they were locked up, Goetz said.
Jail staff ignored requests for help or accused detainees of faking it, Goetz said. Patients requesting a medical appointment waited for weeks or even months, she said. Others were unable to afford the $15 co-pay, which is collected by the county from detainees’ commissary accounts.
“I felt like I couldn’t make any difference or do any good because I was always being told to stop doing the work,” Goetz said.
A state multicounty grand jury is investigating the jail after a 2021 state inspection uncovered bedbugs, mold, overcrowded cells, unsafe staffing levels and other violations. A month after the inspection and days after a deadly hostage situation, Turn Key representatives threatened to terminate their contract with Oklahoma County unless the jail hired more detention officers. It did, and Turn Key remains the jail’s health care provider.
Echols, Oklahoma’s house majority floor leader, started Turn Key Health Clinics with attorney Jesse White and Trent Smith, a former University of Oklahoma football player and current member of the state Board of Education. Echols remains the company president and a shareholder.
Echols, R-Oklahoma City, said he works for the company’s CEO mostly outside of Oklahoma to minimize perceived conflicts of interest.
Turn Key founders each donated $1,000 to Tulsa Sheriff Vic Regalado’s campaign in 2016 before county officials changed restrictions that made Turn Key eligible to bid on the contract. Turn Key won the contract. Echols denied any impropriety. He said the previous bid restriction excluded all Oklahoma companies.
Regalado said Turn Key has improved the care of people in custody in the Tulsa County detention center, which includes two mental health housing units. Among Oklahoma’s 93 jails, only Tulsa County is accredited by the National Commission on Correctional Health Care.
Lawsuits Target Turn Key
The mental health of people detained in the Fort Smith, Arkansas, jail where Price starved wasn’t Turn Key’s responsibility, an attorney for the company asserted in an email to Oklahoma Watch. The company denied culpability in Price’s death saying in an emailed statement, “crisis management and mental health evaluations/assessments were to be contracted by Sebastian County and performed by an independent community mental health provider, not by Turn Key.”
In a court filing responding to the family’s lawsuit, the company claimed Price was combative and refused medication for schizophrenia. Price refused to eat or drink, had an IQ under 55 and was disabled, according to his family’s lawsuit. The case remains in litigation.
Second-degree manslaughter charges were filed and later dismissed against Turn Key staff in the 2016 death of Anthony Huff, who was strapped to a restraint chair in Garfield County jail for 48 hours without adequate food or water, court records show. Charges were also filed and dismissed against the sheriff.
In 2014, under its former name, ESW Correctional Healthcare, Turn Key settled lawsuits filed by the families of Curtis Gene Pruett, who died, and Lacee Danielle Marez, who fell into a coma under their care in Cleveland County.
Other lawsuits filed against Turn Key by incarcerated Oklahomans or their families blame medical staff for the paralysis of a man detained in Muskogee County and the deaths of men imprisoned in Canadian County and Creek County.
Since Hanchett and Milano died, letters from attorneys asking Cleveland County to preserve documents signal likely legal action in those cases.
“All loss of life is tragic, and Turn Key always wants to look at each event and see if there is a way to prevent it from happening again,” Echols said. “We also need to continue our efforts to help get patients out of jails that don’t need to be there.”
In November, the U.S. Department of Justice launched a federal investigation to determine whether Oklahoma fails to provide community-based mental health services to people in Oklahoma County, leading to unnecessary admissions to psychiatric facilities and police contact. Investigators will also examine Oklahoma City and its police department’s response to people in crisis.
In Hanchett’s case, jail staff asked for a mental health assessment, but Turn Key officials and Amason said they could not disclose how long before her appointment the request was made.
A judge ordered Milano’s evaluation on Dec. 15, five days before she died, according to court records.
Jail Mental Health Unit Planned
This isn’t the first time Cleveland County officials have considered expanding care for those struggling with mental health while in jail.
Six years before the deaths of Hanchett and Milano, a former sheriff and Turn Key representatives brought commissioners a plan to bring mental health services to the jail. The proposal prompted Commissioner Rod Cleveland to negotiate a better price for the service. Turn Key officials offered to provide limited counseling at no additional cost.
Soon, commissioners will have another chance to bolster jail health care.
Commissioner Rusty Grissom, who took office last month, took his first tour of the jail Feb. 13. Grissom said the north Norman facility was in good order.
After two Cleveland County Detention Center administrators resigned in January, Amason hired former Norman police lieutenant Cary Bryant to evaluate the jail’s mental health procedures and make recommendations. Bryant teaches law enforcement officers to detect signs of mental illness, how to calm someone who is struggling and when state law allows officers to detain someone in crisis against their will.
Up to 70% of people in custody at the Cleveland County jail have a mental health or substance abuse disorder, estimated Amason, who has overseen the jail since taking office in 2020. They don’t all experience a crisis while in custody, but maintaining their stability has long been a concern for the sheriff.
Last fall, commissioners allocated $8 million in federal pandemic relief funds to jail health care, including a mental health unit with separate housing for those suffering mental distress. Medical staff would be stationed in the unit providing more supervision and faster response times for people incarcerated in that area of the jail, Amason said.
The county has an open request for quotes for a jail consultant to develop a more detailed plan.
Cleveland County’s proposed mental health unit is not a treatment center, Amason said. It would be aimed at easing suffering for people while they’re in custody, and until they can be transferred or released and referred to certified treatment providers.
“I never wanted to be a mental health treatment center,” Amason said. “I mean, I don’t think people should come to jail to get mental health treatment. But we do have a responsibility to do what we can to provide them the best service while they’re in our care.”
Whitney Bryen is an investigative reporter at Oklahoma Watch covering vulnerable populations. Her recent investigations focus on mental health and substance abuse, criminal justice, domestic violence and nursing homes. Contact her at (405) 201-6057 or email@example.com. Follow her on Twitter @SoonerReporter.