On Oct. 6, 2017, Michele Smiley was booked into the Buncombe County Detention Facility for a probation violation. In an effort to avoid drug possession charges, Smiley, a 34-year-old mother of six children, swallowed large amounts of methamphetamine before being arrested. Shortly after, Smiley told staff at the North Carolina jail, including a nurse, that she was overheating. Smiley also showed signs of having a severe reaction to the methamphetamine. But instead of receiving medical care, Smiley was locked into a cell alone where she eventually lost consciousness. A few hours later, at a nearby hospital, she was declared dead from an overdose.
“Don’t worry, you’re not going to die, you’re just going to get really high,” a guard allegedly told Smiley, according to a wrongful death lawsuit filed in October 2018 by Smiley’s grandmother against former Sheriff Van Duncan, five jailers, a nurse, and the nurse’s employer, Southeast Correctional Medical Group.
Southeast Correctional Medical Group is now part of Wellpath, a Tennessee-based healthcare company that treats “vulnerable patients in challenging clinical environments.” A Wellpath spokesperson told The Appeal that the company does not comment on pending or ongoing litigation.
“Sheriff Miller recognizes that the jail facility and our criminal justice system are simply not designed to serve the medical and behavioral health needs of our inmates,” a spokesperson for Quentin Miller, Buncombe County’s current sheriff, told The Appeal. “Our behavioral health staff at the jail estimate that 60 percent or more of our inmates have symptoms of one or more of the following: opioid use disorder, substance abuse disorder, severe and persistent mental illness.”
Smiley’s case was included in a report from Disability Rights North Carolina that documented the alarming rise of deaths from overdose and suicide in the state’s jails in recent years. “A resident incarcerated in a [North Carolina] jail is fifteen times more likely to die from suicide than a free resident,” according to the report. The report also showed that overdose deaths inside the state’s jails increased by 175 percent from 2017 to 2018.
“We’re on track to have another record year of suicides in North Carolina jails,” Susan Pollitt, a senior attorney for Disability Rights North Carolina, told The Appeal. “It is urgent that changes be made to policies and procedures for North Carolina jails.”
In the first nine months of 2019, 17 of the 35 jail deaths reported to state officials were suicides, according to the report. “The overwhelming majority of jail suicide victims (95%) had not been convicted and were being held in jail due to arrest or awaiting trial,” the report’s authors note.
The most recent suicide death in Buncombe County Detention Facility occurred on Nov. 10. Eric Grogan attempted to kill himself after spending less than one month at the jail. He then died from injuries related to the attempt, according to a Buncombe County sheriff’s statement. Grogan was not on suicide watch during the attempt.
There have been several other recent deaths and suicides in North Carolina jails, including in Rowan, Guilford, and Gaston counties.
More than 300 people die by suicide in jails every year, according to the most recent data available from the Bureau of Justice Statistics. And county jails hold an extraordinary number of people, most of them pretrial and therefore legally innocent: Of the 2.3 million confined nationwide, 612,000 are in local jails.
Small jails tend to have higher suicide rates than larger jails, according to a Department of Justice report. Jails holding 50 or fewer people have a suicide rate of 167 per 100,000 persons, while jails as a whole have a rate of 42 per 100,000, according to the DOJ.
“It’s concerning that [the Bureau of Justice Statistics] hasn’t released data on suicides in local jails since 2016,” Wanda Bertram of the Prison Policy Initiative told The Appeal. “With the national data so long overdue, it’s hard to chart this national trend, which says so much about how counties are treating people behind bars.”
“Confinement creates a perfect storm of conditions that increase the risk of self-harm,” Dr. Kimberley Sue, medical director of the Harm Reduction Coalition and a Rikers Island physician, told The Appeal. “People inside face psychological distress, social stress from being away from family and community, as well as institutional failure and neglect of proper medical attention.”
“All jails and prisons see illicit drug use in their facilities, regardless of security efforts to keep them out,” Sue said. “The lack of provision of medication for people with opioid use disorder––like methadone or buprenorphine––during incarceration actually increases the risk that opioid overdoses are fatal.” But few jails and prisons across the country offer these medications, and some jails still consider them contraband.
Sheriff Miller’s spokesperson told The Appeal that the sheriff has hired three people to implement a medication treatment program at the Buncombe County Detention Facility. Since the jail began tracking people with substance use disorders last August, roughly 90 people each month who are admitted to the jail have an opioid use disorder.
Sue also emphasized that the first two weeks of jail are an especially “dangerous adjustment period.” That time has been called the “shock of confinement.”
Indeed, according to the Disability Rights North Carolina report, most of the suicides in 2017 and 2018 occurred within a few days of admission to the state’s jails: “In 2017 and 2018, 20 percent of all jail suicides occurred within one day of the person entering the jail, 65 percent occurred within a week of entry, and 80 percent within 12 days.”
The report’s authors provided recommendations to prevent overdose deaths and suicides, such as improved intake screening, new policies regarding observational rounds, as well as uniform medical treatment. But the authors wrote that implementation of new safety procedures were delayed by 66 North Carolina sheriffs and the North Carolina Sheriffs’ Association, a significant lobbying force in state politics. To delay the implementation, each sheriff signed a personal letter stating that adoption of new jail procedures would “be subject to a delayed effective date.”
Pollitt says the move by the sheriffs’ association means new rules and procedures could be delayed for over a year. “The current rules are 25 years old,” she said. “Our research and investigation showed these rules are not keeping people safe. And the new rules proposed by [Department of Health and Human Services] are minimal and ordinary rules that many states have adopted or are adopting.”
“The sheriffs are a powerful association and they could move North Carolina forward and stand up and recognize that there are changes in the jails that need to happen, and they could make that happen,” Pollitt said.
Eddie Caldwell, executive vice president of the North Carolina Sheriffs’ Association, told the News & Observer that some of the recommendations were not “feasible.”
The association did not respond to requests for comment from The Appeal.
“If we want to reduce jail suicides, we don’t just need more oversight of local jails,” Betram of the Prison Policy Initiative said. “We also need to demand that police departments and prosecutors send fewer people to jail in the first place.”