Internal Report Details Severely Malnourished Detainees at Atlanta-Area Jail

The facility’s medical provider described people with mental illness wasting away in a unit overrun by an outbreak of lice and scabies.

Shaun Versey/Flickr

Internal Report Details Severely Malnourished Detainees at Atlanta-Area Jail

The facility’s medical provider described people with mental illness wasting away in a unit overrun by an outbreak of lice and scabies.


Early on the morning of Sept. 13, an officer at the Fulton County Jail in Georgia found a man slumped over on the floor of his cell in a unit that houses people with mental illness. He was covered in lice and feces, the officer wrote in an incident report obtained by The Appeal.

The officer had gone to the man’s cell to take him to the Medical Observation Unit for “psych observation,” amid concerns about his rapidly deteriorating health, according to her report. After finding his body, she radioed for medical help. Other staffers arrived and began performing CPR, but the man never regained consciousness. He was 35 years old. (The Appeal was unable to reach the man’s family by publication and is not naming him out of respect for their privacy.)

His court records point to a history of mental health issues that precede his time at the Fulton County Jail. He’d been arrested in Alabama in 2017 for allegedly stealing a car while he was homeless. After his arrest, the Alabama court ordered a competency evaluation and, while his case was pending, he cycled in and out of jail and court-approved placements in a treatment facility and group home. His trial on the theft charge was set for April 2021, but he didn’t show up and a warrant was issued, which would ultimately lead to him being held without bond in Georgia after a misdemeanor arrest in June.

In the days before the man’s death in the Fulton County Jail, officers had become alarmed by his condition and attempted to have medical staff intervene, according to the incident reports. The guard who found his body wrote that she had communicated with mental health staff and a sergeant about his “living conditions” and “voiced concern,” most recently on Sept. 8. A second officer reported that he’d told a “psych nurse” that the “situation needs some attention,” and had attempted to have medical staff move him to the Medical Observation Unit earlier that week. He had also shared his concerns with the same sergeant.

A newly obtained report from the jail’s medical provider reveals that the man’s final days were indicative of widespread neglect of the jail’s most vulnerable detainees, who were wasting away in squalid conditions. At the time of his death, more than 90 percent of people in his unit were so malnourished that they had developed cachexia, a wasting syndrome that typically affects people with advanced-stage cancer, according to the report by NaphCare, a private company that provides health care to the jail’s detainees.

NaphCare reported that the men were detained in filthy cells and most were barely functioning. Over 90 percent of detainees had not been “receiving essential medications” or completing their “ADLS,” which refers to “activities of daily living,” such as showering, dressing, using the toilet, and eating, according to the report, obtained by Atlanta-based civil rights group the Southern Center for Human Rights.

“They were literally physically, visually breaking down,” said Devin Franklin, Movement Policy Counsel for the Southern Center for Human Rights and a former public defender.

The report also states that every person in the unit had lice or scabies—in some cases both—and that the outbreak was discovered “on or around” Sept. 13, the day the man’s body was discovered.

The records custodian for the Fulton County Sheriff’s office told The Appeal in an email that the report, which is not dated or signed and is not on letterhead, was created by the NaphCare health services administrator. Neither NaphCare nor Fulton County Sheriff Patrick Labat responded to repeated requests for comment.

Upon learning of the outbreak, the sheriff’s office “took immediate action” and implemented a decontamination plan that was completed by the end of September, according to the report. All impacted detainees were treated with a 98 percent compliance rate, it states.

The NaphCare administrator detailed a four-point action plan, which includes screening new detainees for vermin and implementing “door-to-door pill pass.” To address rampant malnutrition, the plan advised staff to “increase inmate diet orders to include supplemental nutrition as applicable.”

The NaphCare administrator also recommended that staff conduct daily rounds to identify vulnerable detainees and develop plans for “high-risk” people. There is no mention of individual follow-up with those suffering from malnutrition, or of how often rounds had been taking place before.

NaphCare, which provides medical care in jails and prisons throughout the country, has been repeatedly accused of neglecting the medical needs of detained people, sometimes with catastrophic consequences.

In 2019, 18-year-old Tyrique Tookes had been detained in the Fulton County Jail for about seven weeks when he told medical staff that he was experiencing excruciating chest pains. A physician’s assistant thought he might have heartburn and recommended fluids, Tums, ice packs, and ibuprofen. About a week later, Tookes died of cardiac tamponade, a condition where pressure is placed on the heart from a build-up of fluid. Last year, his parents sued NaphCare and several of the company’s employees, alleging that medical neglect had caused their son’s death.

Fulton County Jail continues to subject detainees to inhumane and sometimes life-threatening conditions. An investigation by the Atlanta Journal-Constitution of the state’s five largest jails revealed that more people have died at the facility since 2009 than any of the other jails studied. As of late October, ten people have died at the jail this year, according to local news reports.

The latest revelations about detainee mistreatment contained in the NaphCare report come as community leaders, the sheriff, and local officials continue to fight over plans to address overcrowding at the facility. This summer, at the sheriff’s urging, the county, sheriff’s department, and the city of Atlanta entered into an agreement to transfer up to 700 people from the Fulton jail to the Atlanta City Detention Center, pending the completion of a jail population study. Labat has called the study a tactic intended to delay the transfers. But Councilmember Liliana Bakhtiari said at a recent council meeting that they “need to understand why people are in there.”

“I will not in the blink of an eye damn people’s lives to be in jail without questioning it,” said Bakhtiari, according to the Atlanta Journal-Constitution, which has reported extensively on the Fulton County Jail.

Civil rights activists have spoken out against the impending transfers, saying the nightmarish conditions underscore the need to reduce the number of people detained, not invest further in incarceration. In an October letter to the Atlanta mayor and city council, dozens of local and national groups lambasted the transfer plan, saying it would “result in more people being locked up,” even though hundreds could be released.

Almost half of the roughly 3,000 people held at the jail have not been formally charged with a crime, according to an analysis of the population at the facility on Sept. 14, conducted by the national American Civil Liberties Union and the ACLU of Georgia. Many of these people had been detained at the jail for months, with some held for more than a year. More than 200 people were detained only on misdemeanors.

“We all agree that this is a humanitarian crisis,” said Franklin from the Southern Center for Human Rights. “But we also think that you have to respond to [a] humanitarian crisis in ways that respect people’s humanity.”

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