When David Sacks was hired in late August as a mental health specialist at Allegheny County Jail [ACJ], he looked forward to doing what he knows best: caring for individuals with mental illness.

Sacks arrived with over two decades of experience in correctional mental healthcare. He’d overseen the restricted housing unit for mentally ill inmates at SCI Greene, a state maximum security prison in Greene County, for 13 years. “I had great hopes of being able to help them provide a higher level of treatment,” he said of joining ACJ’s staff. 

But in his first few weeks on the job, he noticed things that didn’t sit well with him: correctional sergeants seemed to outrank medical staff. Employee morale was “horrendous.” His treatment recommendations, he said, were sometimes ignored.   

By Sept. 19 — less than three weeks after he’d been hired — he’d had enough. In the middle of his shift, he quit. 

“My actions are the result of the toxic and highly countertherapeutic environment present at the facility,” he wrote in his resignation email, adding that the jail’s expectations were “inconsistent” with his professional ethics.

When asked to describe ACJ’s mental healthcare in one sentence, Sacks didn’t hesitate. “I can do it in one word,” he said in an interview. “Nonexistent.”

Sacks’s experience was not unique. PublicSource spoke to 15 former medical and mental health employees who described impossible workloads, insufficient staffing, being directed to do tasks that they worried threatened their medical licenses and management they denounced as “hostile” and underqualified.

Jail leadership knows the challenges of providing healthcare to inmates and note the efforts made to address past problems.

In response to questions from PublicSource, Warden Orlando Harper said in a statement that the jail’s mission is to provide care to inmates while ensuring the safety of everyone in the facility. He noted changes made over the past decade to meet the medical needs of a population that often has poor physical and mental health.

“Issues or concerns brought to the attention of management are addressed and changes made as appropriate,” Harper said in the lengthy statement. “If an issue or concern was not resolved as the person who has brought it to the attention of management believes it should have been, it does not mean that it wasn’t addressed.”

Harper also noted that due to the region’s growing healthcare sector locally, staff may have an expanded pool of opportunities outside the jail.

“We are certainly not the only facility in our region which is challenged with recruiting and retaining medical staff, something that has been exacerbated throughout this pandemic,” he said. “…We are fortunate to have the professionals that work in this facility and value their role in the provision of care to individuals committed to our care.”

A review by PublicSource of records spanning 20 months indicate the challenges for medical workers — and how the lack of staffing impacts inmates’ care.

David Sacks. (Photo by Ryan Loew/PublicSource)
David Sacks resigned after less than three weeks as a mental health specialist at Allegheny County Jail. (Photo by Ryan Loew/PublicSource)

At ACJ, the wait to see a psychiatrist can be weeks or months long, according to jail records. Jail administration said in a September interview that no long term, regular therapy or counseling options are given. Sometimes, according to former medical staff and staff emails to management, medications were given late — or missed entirely. Staff’s medical recommendations were sometimes disregarded, records show. The lack of staff has impacted medical providers’ ability to do their jobs so significantly that some reported fearing for employee safety, their medical licenses and the wellbeing of the individuals in their care.

“The lack of medical staff in Processing is a common occurrence and nothing ever seems to be done to correct it,” one employee wrote in an incident report in July, referencing the department where individuals go upon arrival to the jail for medical screenings. “This practice not only places the inmates well-being in danger, but also that of the officers.”

Former medical and mental healthcare workers PublicSource spoke with shared similar concerns. Many said medical staff were expected to take on what they believed to be an unfeasible amount of work. “It puts the nurse’s license in jeopardy, and the inmates’ safety. It just does,” Marjorie Dixon, a psychiatric aide who worked at ACJ for almost two decades and resigned in March, said of the stacked workloads. “It’s bad medicine. And somebody’s going to get hurt.” 

Correctional healthcare affects inmates’ rehabilitation and can have long-term ramifications for the community at large. Roughly 64% of people incarcerated in county jails in the United States have a mental health problem, according to a widely-cited 2005 study from the Department of Justice — an even higher rate than those incarcerated in state and federal prisons. Many inmates also have substance use or other health issues. Studies show that personalized mental health treatment in prisons can reduce individuals’ likelihood of re-offending and reentry.

Yet ACJ has struggled to retain medical and mental health staff for years

Between Feb. 1 and June 1, 19 county medical employees resigned or were terminated from their positions, according to county employee rosters. Of the 18 medical employees hired by the county in 2018, only three were still working for the county in June 2020. 

There are currently 77 county medical employees at ACJ. Those numbers do not include employees contracted through Allegheny Health Network. As of Dec. 1, there were 43 medical vacancies at the facility, including top management positions like health services administrator and director of nursing. 

“They just don’t have the staff to meet the needs of the inmates, unfortunately, and the inmates do suffer as a result of that. Medically and mentally,” said Chuck Timbers, a former nurse practitioner at ACJ with over four decades of nursing experience. Timbers left the jail in May, saying he was terminated for breaking social media policy by speaking out during the pandemic

In his statement, Harper noted that vacancies and staff call-offs can require changes in resources.

“We rely upon the dedicated staff at the facility, but also recognize their perceptions from their individual positions may not reflect the operation of the facility as a whole,” the statement said. “When staffing is a challenge, decisions are made to shift resources to where they are most needed…and in full recognition that there may be an impact on other areas and staff as a result of that change.”

Harper touted the jail’s collaboration with Allegheny Health Network, which provides physicians, psychologists and some physicians assistants and nurse practitioners. AHN in a statement to PublicSource noted improvements made in jail healthcare.

“AHN has worked closely with the county for more than five years to help provide high-quality healthcare services at the jail,” the statement said. “ In that time, we have together made considerable improvements in the overall health services at the facility, helping to meet the diverse and substantive health needs of its residents in a very challenging environment.”

The statement from AHN notes that they “recognize that there will always be opportunities for improvement, however, and we routinely work with the county to assess outcomes, protocols and resources” to ensure quality care.

‘Staff is so short that inmate care is being compromised’

Employees have been raising concerns about staffing for months.

In May, a group of anonymous employees penned an open letter to several journalists, legal advocacy groups and public officials, claiming that the lack of staff and employee workloads compromised inmates’ safety. The letter questioned why employee numbers have declined so drastically in the past several years. “Does anyone ever look at this and ask why? County jail staff are willing to discuss their concerns if asked directly by oversight bodies,” the letter reads. The county took over the jail’s medical services in 2015, after deciding not to renew its contract with the for-profit company Corizon Health.

A current employee who was involved in writing the letter said that to their knowledge, no substantive steps have been taken since the letter was sent. “We ask for help. We cry for help. We beg for help. And it falls on deaf ears,” said the employee, who asked to remain anonymous for fear of consequences at work.

Comments have also been sent to the Jail Oversight Board, pleading with the board to address the staffing issue. “Staff is so short that inmate care is being compromised,” an anonymous individual who identifies themself as a “concerned employee” wrote to the board in June. “Employees are doing jobs that normally 2, 3, or 4 staff would do.”

During the June meeting, Chief Deputy Warden of Healthcare Services Laura Williams acknowledged the concern. “So, we have absolutely had staff turnover. That was unfortunately present in our facility before the pandemic and also during the pandemic,” she said, attributing the turnover to employees finding other work or education opportunities. 

A recent attempt to address the staffing problem floundered almost as soon as it began. 

In August, a seasoned correctional healthcare professional named Janet Bunts was brought in as the jail’s new Healthcare Services Administrator. Her no.1 goal, according to an interview in the jail’s weekly newsletter in August, was to get the jail’s healthcare staffing back to adequate levels. With over 15 years of correctional experience, she was optimistically seen by some employees as the answer to the longstanding staffing troubles. “I want to build leaders and promote people to greater positions…” she said in the newsletter. “I want to get people happy to come to work.”

Those goals were quickly cut short. Bunts submitted her resignation in mid-November, just three months after she started, and left the jail that same day. Staff like her leave because of “a lack of leadership, a lack of orienting new staff, a lack of willingness to change their old ways,” she told the Tribune-Review. She did not agree to a PublicSource interview.

Bunts wasn’t alone. Soon after, two more of the jail’s top medical professionals — Michael Barfield, the longstanding Director of Mental Health, and psychiatrist William Leavitt — also submitted their resignations. Barfield declined to comment; Leavitt could not be reached.

The county brought on a new psychiatrist in early December.

“We are always happy for people to have new opportunities and understand that correctional medicine is not for everyone,” county spokesperson Amie Downs wrote in a Nov. 19 email to PublicSource regarding the resignations. 

Bethany Hallam, a member of the Jail Oversight Board, disagreed. “This problem can no longer be blamed on, ‘Corrections isn’t for everyone,’ when these folks have had decades of corrections experience and come to the Allegheny County Jail and leave,” Hallam said at the December board meeting. She asked the county if the Jail Oversight Board or an outside agency could conduct exit interviews with departing medical employees to better understand why they are leaving.

Williams was against the idea. “I think that everybody has their own reasons,” she said, “and should they choose to share them for themselves, I think they should have the opportunity to.”

The board overruled, voting to approve its ability to conduct exit interviews effective immediately.

By the December meeting, staff concerns about staffing hadn’t changed. “Despite what the chief of medical services tells you, healthcare is a mess,” an anonymous commenter who identified as a “concerned nurse” wrote to the Jail Oversight Board. Over the past four months, numerous former employees told PublicSource the lack of staff made their jobs harder and led to what they see as inadequate care.

“There were many times I was the only nurse there, and I had to handle all four of the mental health pods,” said Michelle Lattimer, a former mental health nurse who worked at the jail for three years. When full, the pods held over 100 inmates. “Sometimes we were spread so thin, there were times when the only time we even spoke to [inmates] is when we gave them medication.”

Lattimer said she was terminated in July for falsifying records in an incident that was a symptom of the short-staffing issue.

Several former employees told PublicSource the shortage of staff would cause staff to cut corners, such as pre-pouring inmates’ medication so it would be ready for the next shift — a discouraged practice that can lead to mistakes. “If you pre-poured medication, you are the one who is supposed to [give the] medication,” Lattimer said. “A lot of times, that’s not what happened.”

Others said they were given tasks outside of their professional training, an issue raised in the open letter from anonymous employees. “Numerous employees are being directed to perform jobs that are out of the scope of their practice or with little to no training,” it reads.

At the June Jail Oversight Board meeting, Williams denied that employees are being made to work “outside of their scope.”

Many of the more than a dozen employees PublicSource spoke to said that despite enjoying their jobs, they left their positions because of longstanding issues with management, which they described as “hostile,” “toxic” and “unprofessional.”

“The best way to describe it, it’s like elementary school,” said a former medical aide who requested anonymity, citing concerns about reputational damage. “I just couldn’t do it anymore. I loved what I did, I loved my coworkers. But the way we were treated down there, it’s just ridiculous.” She resigned earlier this year. 

A former nurse who resigned over the summer after over a decade at the jail agreed. “There’s just so many good nurses who generally cared about what they were doing, who were just harassed to the point where they could no longer be there anymore,” said the nurse, who requested anonymity out of fear of retaliation from jail management. “And it’s very sad.”

Other former employees questioned why supervisors without medical training, such as Williams and Deputy Health Services Administrator Ashley Brinkman, are allowed to override the decisions of staff with medical training. “How is that possible that none of them have a medical background but they’re still medical management for the jail?” asked Sara McClung, a former medical assistant who said she was terminated in May for arriving late to work.

Dr. Gail Kubrin, a psychiatrist who now works in a residential facility where she treats some of her former patients from ACJ, said jail management often disregarded her professional opinion, leading her to resign. “The warden routinely ignored any advice that I provided, in spite of the fact that he has no mental health experience and was supposed to listen. I mean, he just didn’t,” she said. “And bad things happened because of that.” 

Others agreed. “[Management] would not accept help. They would not accept advice. They were the boss and this is how it was going to be. And that made for dangerous conditions sometimes,” said Terry Garber, a former nurse who resigned last year. 

Dr. Peter Hauber, another former psychiatrist who left ACJ once his three-year contract expired last year, agreed. “Feeling ignored professionally was pretty routine,” he said.

Ultimately, Kubrin said the inmates suffered because of it. “It was clearly that they were punishing us, but they were punishing the patients. That’s the thing.” 

This story is the first one in a series focusing on mental health issues at Allegheny County Jail. COMING SOON: How the shortage of staff impacts medical and mental health treatment at ACJ.

Correction (12/14/20): This article previously misstated the length of Dr. Peter Hauber’s contract with ACJ. The article has also clarified the scope of Dr. Gail Kubrin’s current work.

Juliette Rihl is a reporter for PublicSource. She can be reached at juliette@publicsource.org or on Twitter @JulietteRihl.

Kellen Stepler assisted with research and Jennie Liska assisted with data work. 

This story was fact-checked by Oliver Morrison.

Mental health reporting has been made possible with funding by the Staunton Farm Foundation, but news decisions are made independently by PublicSource and not on the basis of donor support.

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Juliette Rihl reports on criminal justice, public safety and mental health for PublicSource. Her 2020 series on how court debt impacts low-income Allegheny County residents prompted the county to join...