Ohio places prison physician on paid leave during investigation of inmate’s suicide

Daily Reporter, June 10, 2011

COLUMBUS, Ohio — Ohio has placed a prison doctor on paid administrative leave during an investigation into the suicide of an inmate under the doctor’s care.

Department of Rehabilitation and Correction spokesman Carlo LoParo said Friday the action taken with Dr. Myron Shank is standard during such investigations.

The state is looking into the June 2 suicide of Gregory Stamper, convicted of a double homicide in 1995, who hanged himself at Allen Correctional Institution in Lima in northwestern Ohio.

Read the rest here.

AZ: Suicide/homicide rates skyrocket at AZ Department of Corrections

From Arizona Prison Watch

I obtained prisoner death records last week from the AZ Department of Corrections, and the stats on suicides and homicides since Brewer took office are mind-boggling: they’re twice the rate as they were when Janet was governor; this fiscal year (beginning July 2010) the suicides are on track for being three times the annual rate.

In no instance of the recent suicides has there been documentation that ADC staff had any culpability – though I’ve had more than one family member tell me that their mentally ill loved one had been taken off of their psychiatric medications in prisons before their suicide or homicide. That sounds to me like a pattern of institutional neglect.

Anthony Lester‘s death remains a mystery to me, by the way – the ADC record detailing his death lists his injuries as self-inflicted (his jugular, his right wrist, and his leg were all cut with a razor) , but a document compiling the deaths for the year calls it a homicide. Tony’s family was told it was a suicide – a “highly preventable” one, which they tried to warn the ADC he was at risk for. They have other information suggesting that he believed he was in imminent danger from a gang, though. Until I get confirmation to the contrary, I’m leaving him in the suicide category.

Tony suffered from schizophrenia, and was sentenced to more than a decade in prison due to two women being slightly injured trying to prevent him from cutting his throat (both required band-aids at the scene) during a psychotic episode. He had to be restored to sanity before he could go on trial, of course. That’s par for Maricopa County’s treatment of people with mental illness who needed psychiatric hospitalization before or at the time of their “crime”. If I could sick the DOJ on every responsible judge and prosecuting attorney, I would, because that’s a violation of the Olmstead Decision, as far as I’m concerned. The Olmstead Decision was a Supreme Court verdict that determined that the Americans with Disabilities Act (ADA) requires states to deinstitutionalize and place people with disabilities in the least restrictive setting possible.

Arizona, after 20 years of Arnold v. Sarn litigation, is still underserving the seriously mentally ill in the community. Here they’re just criminally prosecuted for the symptoms of their illness and thrown into the most restrictive setting possible – state prison (often maximum security) – largely because the state lacks adequate outpatient and inpatient alternatives for individuals at risk of harming themselves or others (we spend it all on corrections instead. If ADC Director Ryan had any courage, he’d call that what it is and tell the state where to put their money and the courts where to stuff their convictions).

Why else would a judge give a man with schizophrenia three years for climbing a utility tower in a thunderstorm to be closer to God? Why would he even be prosecuted for that in the first place? I think they actually believed they were protecting him from himself. Sadly, Shannon Palmer ended up being murdered by his cellmate two years in.

The deaths by “natural causes” are also extremely young – go to the ADC’s website, under ADC in the News, for death notices. There’s an archive on that page, too. I suspect that it’s complications from the effects of the Hep C virus that’s killing people so young inside. I’ll be analyzing the documents I obtained further to confirm that, and post it when I compile it all.

Here are the links for the APW posts about the more recent suicides:

Special Management Unit: Prisoner suicide at ASPC Eyman (11/4) – James Galloway

Prison suicide and gangs at Florence Central (10/01) – Duron Cunningham, Rosario Rodriguez-Bojorquez

Additionally, I missed a couple of suicides in my compilation that I didn’t have info on until now:

Douglas Nunn 33 (8/29/09) – ASPC-Florence/Central

Patricia Velez 25 (4/28/10) – ASPC-Perryville/Lumley

All 3 of the women who have killed themselves in the past year and a half hung themselves and were housed in Lumley, where the maximum security yard is. All three were in their 20s. I don’t know if Patricia had a mental illness or not: a psychological report was sealed by the court when she was sentenced to 7.5 years for aggravated assault and fleeing a law enforcement vehicle. Geshell and Sasha, the other two women from Lumley who killed themselves, did have evidence of a serious mental illness when sentenced.

Two of the men who killed themselves recently were both from ASPC-Florence/Central. The largest number of male suicides in any one prison have occurred at ASPC-Eyman, however.

Sometime in the next couple of days I’ll break down the suicides and homicides by race and age, and tell you how they compare to stats for the overall prison population, as well as to rates in the general population. It seems to me that if all the violence boiled down to a gang war, the Aryan Brotherhood is winning.

Small Upstate New York County Jail Has Big Problem With Suicides

By Mosi Secret, ProPublica – March 29, 2010 9:33 am EDT

At the 680-bed Erie County Holding Facility, a small jail on the shores of Lake Erie in Buffalo, N.Y., six inmates have committed suicide in the past five years, as many as at Rikers Island, the sprawling New York City jail that typically houses about 14,000 inmates.

In 2007, an Erie inmate killed himself by diving off a 15-foot railing in full view of sheriff’s deputies. That same year, an inmate took his life after officials removed him from 24-hour suicide watch and put him with the other inmates. In 2008, two detainees used bed sheets to hang themselves from air vents, raising to 15 the number of inmates who had committed suicide this way, or tried to, since 2002.

County jails, most of them originally designed to hold low-level offenders, now serve, to some degree, as de facto psychiatric wards. Los Angeles County Sheriff Lee Baca famously referred to the jails he oversees as “the largest mental health institution in the country.”

Small County Jail in Upstate New York Has Big Problem With Suicides
While large jail systems have made substantial inroads in safeguarding mentally ill inmates, sharply reducing suicide rates since the early 1980s, some smaller jails — hobbled by poor layouts, thin staffing and inadequate training — are struggling to meet the most basic requirements set by federal law.

Their shortcomings can take a deadly toll. Suicides account for more than two of five deaths at smaller jails, versus fewer than one of five in the country’s 50 largest jails, Bureau of Justice Statistics show. Despite improvements in prevention techniques, inmates at smaller jails remain twice as likely as those at larger jails to die by their own hand. Detainees at the Erie facility kill themselves at a rate five times the national average.

“It is difficult for these small jails when they are competing with resources that go to free society,” said Christine Tartaro, an associate professor of criminal justice at Richard Stockton College in New Jersey and co-author of the 2009 book “Suicide and Self-Harm in Prisons and Jails.”

The Justice Department’s civil rights division issued findings on six jails nationwide last year for providing substandard mental health care. Four were smaller jails, housing 1,500 inmates or fewer, the Erie County Holding Facility among them.

The Justice Department began its investigation into problems at the Erie County jail in 2007, but local officials denied its experts unfettered access to the facility and failed to make improvements voluntarily, court records show. Stymied, the department sued the county last September, alleging it had an “inability to supervise inmates, identify inmates at risk for suicide, correct deficiencies in cells that facilitate suicide attempts, and prevent likely suicide attempts.”

Erie County officials did not return phone calls from ProPublica about the case. County Attorney Cheryl Green has asserted in court documents that the jail meets constitutional requirements and that inmates cannot expect “the amenities, conveniences and services of a good hotel.”

A federal judge recently ordered the county to allow Justice Department experts into the jail, partly because three inmates have committed suicide there since oral arguments began in the case in December. Officials from the agency toured the facility last week.

Unlike prisons, which house offenders who have been sentenced, jails hold mostly pretrial detainees – people who have not yet been convicted.

New inmates may be detoxing from alcohol or street drugs. They often arrive without medical records and whatever prescription medications they are taking. Some may be upset following confrontations with police. Things can turn bad in a hurry: A census of jail suicides between 2000 and 2002 found almost a quarter of the deaths happened within 48 hours of admission, and nearly half occurred in the first week of custody.

A proper intake screening is critical, experts say. “You can pick up the signs and when there is a problem, you do a mental health study and then you take the precautions that are necessary,” said Fred Cohen, an Arizona attorney who is an expert in correctional law and a federal court monitor for Ohio’s juvenile detention centers. “Most of the signs and symptoms of the likelihood of suicide are either ignored or the guys don’t know.”

In Erie County, a 2008 report by the National Commission on Correctional Health Care found that the intake screenings were inadequate and that there was no documentation proving that the correctional officers performing them had been trained. They collected medical information, but often failed to record it properly: “The receiving screening information is not filed in the health record in almost 40 percent of the patient records reviewed,” the commission reported.

Some smaller jails, especially older ones, lack the design features and equipment to monitor inmates identified as having suicidal tendencies. At more modern jails, that means glass-walled cells allowing for continuous observation, and Velcro smocks and tear-proof blankets that can’t be torn up and turned into nooses.

Cells at the Erie County facility, by contrast, provided inmates with “multiple ways to facilitate committing suicide,” according to the national commission’s assessment. The jail’s old-fashioned steel beds, window bars, grab bars and removable wall plates could be used by inmates to harm themselves.

Experts say smaller jails often have too little staff to provide inmates with adequate care – a situation likely to worsen as state and local governments deal with shrinking budgets.

In 2003, Erie County eliminated several health care positions at the jail, including the head nurse and almost half of the mental health staff. The next year, the holding center began admitting inmates who had been held in the Buffalo Police Department’s lockup, further straining the staff.

“Medical staff report that they are not always able to take vital signs, feel rushed and experience burnout,” the national commission’s report found. “The facility does not have a chronic care program; treatment plans are not developed even for inmates with serious mental illness; and progress notes are often not entered in the medical record.”

In Erie County and elsewhere, those monitoring jail inmates are typically sheriff’s deputies with limited training in recognizing the signs of mental illness – most of their training prepares them to be street cops.

“The sheriff’s office has two very different sets of responsibilities,” says David Fathi, director of the ACLU’s National Prison Project, who has litigated several constitutional claims against jails and prisons. “One is to be law enforcement patrol officers to the free world and one is to be correctional officers. … Often there is a preference among the deputies for patrol duty. To the extent that correctional work is thought of as a less desirable job function, it often gets short shrift in terms of training and resources. … My anecdotal experience it that seems to be more often a problem in smaller jails.”

The Erie County sheriff’s deputies who work in the jail get just eight hours of training in suicide prevention screening, court documents show.

With six suicides since 2005 and many more attempts, the Erie County jail may yet emerge as a battleground for determining the minimum quality of care to which jail inmates are entitled.

It is facing heightened scrutiny from state regulators as well as the Justice Department. Earlier this month, the chairman of the New York State Commission of Correction, Thomas Beilein, ordered a comprehensive review of the facility’s suicide screening program and sent two investigators to inspect the jail. Erie County Sheriff Timothy Howard cooperated with that inspection.

Howard and other Erie officials continue to battle the Justice Department, however, maintaining that federal overseers have overreached in their demands [1]. With the long-sought tour complete, DOJ lawyers say they will soon return to court to force the county’s hand.

“If our lawsuit is successful, the Department would ask the Court to remedy unconstitutional conditions at the Holding Center to ensure that the jail is safe and humane,” a DOJ spokesperson said in an e-mail. “We are not seeking fines or monetary penalties, or remedies beyond the basic standards of care guaranteed by the Constitution.”


http://www.propublica.org/article/small-erie-county-jail-has-big-problem-with-suicides

Some public comments, made at the Meeting of the Board of Prison Commissioners, July 14, 2009

For the Record

Meeting of the Board of Prison Commissioners

July 14, 2009

To the Members of the Prison Commission and the Public,

Since last meeting, April 14th, nothing has changed that I have noticed: inmates in Ely State Prison are still not being treated properly for serious medical problems, the prison is still on lockdown except for 2 units, some inmates are kept illegally on a ‘High Risk Potential’ even though there are no apparent reasons to keep them on this inhuman status (keeping an inmate on a leash while he has to walk through the visiting room to the restroom during a visit, sounds a lot like what we saw on pictures in the media of Abu Ghraib).

There also are no programs, no steps, to step down from one level to the next.

Inmates are not able to make telephone calls according to the rules, because telephones are not brought to the inmates when they need to make a call to their relatives.

Cleaning material is scarcely handed out if at all. There are far too many strip-searches, even though it is even noted in the media that it is some employees who bring in illegal drugs, not inmates. Strip-searches are inhumane and the ones who have to check up become dehumanized too by doing them so often. People, whether inside or out, have to be able to retain their dignity.

Also, I hear that very recently, order forms were taken out of catalogues of a bookseller, by those employed in ESP in unit 3, so that the inmates are discouraged to (or can not even) order any books to read. This is unnecessary and it only produces a dangerous level of lethargy and disturbance of minds.

Also, mentally ill patients are being housed in this maximum security prison, whereas it is not meant to be a mental hospital. This brings along high levels of noise and disturbance for those patients (who need treatment) as well as those next door who try to make something of their lives, even if they are locked up. See also the article in Las Vegas Sun recently, July 12 (http://lasvegassun.com/news/2009/jul/12/illness-keeps-many-cycle-through-jail/).

There needs to be a change of mentality in society, in Nevada, within the Department of Corrections, from only cutting costs without any alternative and improvement to making society better and by doing this, preventing crime and cutting cost by not having to house so many people for years on end with no goal, no medical care, no redemption, no growth, no forgiveness, no love.

Is this a message for ‘soft-hearts’? I think it takes guts to want to change and engage in supporting children so that they grow up becoming balanced adults, in stead of greedy, corrupt, selfish people who will believe that crime (doing bad) pays and that being greedy is good. It takes courage to really invest in rehabilitating people who have made wrong decisions, who have succumbed to becoming addicted to hard-drugs. It is not only stupid to be so-called “tough on crime” by not wanting to see what this system results in, it will cost society ultimately too much in money and dangerous situations (most inmates will one day be released!) to lock people up with no alternative and to not want to see they are people, with needs just like you and me. We who pay for the prison system, you and me (I too pay tax over there, as well as those who are incarcerated pay tax), we want oversight over what is happening to our money; and we whose parents, children, husbands and wives, boyfriends and girlfriends, siblings are locked up: we want to know that even though they are locked up, they are at the same time looked after and offered chances for growth and rehabilitation.

The amount of lawsuits against the warden of ESP is growing, and do we really want our money to go to these lawsuits, if a better warden would be found, who listens and acts when it matters, and who is not a frightening dictator under whose management diabetics rot to death? Surely Nevada can do much better than this!

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TO: NEVADA STATE BOARD OF PRISON COMMISSIONERS
FROM: MERCEDES MAHARIS MA MS MA
RE: DEATHS AND UNACCEPTABLE PRISON CONDITIONS

DATE: 14 July 2009

Good Day.

Requested prisoner deaths from May of 2007 to the present have failed to arrive, but here is a partial list only from Carson County, for your information:

Anthony Weber 05/02/07

Richard Adams 05/10/07

Michael Kisling 05/19/07

Warren Staden 06/06/07

Anthony Melchor 06/08/07

Pioquinto Herrera 06/27/07

Virgil Stephens 07/06/07

Virgil Perry 07/29/07

Maynard Humphrey 08/09/07

Mark Miller 08/15/07

Ronald Royston 09/03/07

Michael Wallace 09/03/07

Robert Boswell 11/25/07

Dale Burroughs 12/19/07

Edwin Chartier 12/20/07

James Bey 02/13/08

Jack Leafdale 03/06/08

Lawrence Booker 03/10/08

Luther Hayslip 03/21/08

Armondo Claro-Garcia 03/26/08

Johnnie McGraw 05/18/08

John Stafford 05/27/08

Darren Enlow 05/29/08

Thomas Smith 05/31/08

Hermenegildo Escalara-Barragan 06/02/08

John Dillon 06/04/08

Sylvester Azbill 06/08/08

Bobby Boswell 06/12/08

Felipe Azanon 06/21/08

David St. Pierre 07/07/08

Thomas Zanetti 08/22/08

Pinkus Ralzin 08/29/08

Jose Obregon 09/23/08

William Barney 10/15/08

Donald Tanner 11/04/08

Sever Marga 12/05/08

Raymond Price 12/06/08

Michael Bowman 12/25/08

Though I was polite in my inquiry, the director of nursing hung up in my ear, after telling me to go to your office, AG Cortez Masto. But, to date I have received no answer to my inquiries for NDOC death data and other requests. Why is your staff unable to find my letters and answer them? Is NDOC also losing death data, or not recording it? Your public information staff member told me she would call me back regarding my inquiries, but, she has not.

For your direct information, here are copies of my certified letters to you, AG Masto:

11 May 2009

Attorney General Catherine Cortez Masto

Office of the Attorney General
100 North Carson Street
Carson City, Nevada 89701-4717

Dear Attorney General Cortez Masto,

I met you at the 21 Feb 2009 meeting of the League of Women Voters of Las Vegas Valley where you spoke on “The Role of the Board of Prison Commissioners.” I’m the lady from Arizona who came a long way to hear you. Remember that we spoke both before and after the meeting?

I shared with you that new leadership was needed for the prisons. You told me that I might like to attend the commissioners’ meeting in April because Mr. Miller was going to bring that up.

Well, I need your help. I spoke at the 14 April meeting, you may remember, and made a written submission for the record, what I see as a pattern of failure, abuse and ways to stop lawsuits.

20 April 2009 I emailed a request for a “DVD and/or audio” of the Nevada State Board of Prison Commissioners’ meeting of 14 April 2009 to Secretary of State Ross Miller’s office assistant, Sally.

I received no email reply. 30 April 2009 I called Mr. Miller’s office. Ms. Sally Lincoln told me that Mr. Miller had sent you my request. She said that he had concerns about fulfilling my request because of family privacy rights that concerned him. But, this was a public meeting.

Ms. Lincoln told me that they had no projected date as to when you would have a decision on whether or not my request could be fulfilled.

Will you please have Mr. Miller’s office send immediately (advise me of costs if there are costs):

a copy of the DVD recording of the meeting (containing both pictures and audio); plus,
a copy of the submissions made to the prison board; and
the sign in list.
I wish that you had given some hope to us at the meeting, a comforting word or two. We want prisoners to succeed. Please do so in the future? We need fully accredited to professional standards… in all areas.

In closing, can you please send what happened during the disturbance in High Desert State Prison 13 April 2009 that Mr. Skolnik talked about at the14th board meeting? Please include photos of both prisoners and guards who were injured, if they were? I sincerely hope all are in good health now.

And my second certified letter:

And:

19 June 2009

Attorney General Catherine Cortez Masto

Office of the Attorney General
100 North Carson Street
Carson City, Nevada 89701-4717

Dear Attorney General Cortez Masto,

Three requests for information, please, from the NDOC? If these is a charge for copying, please advise

1. Please send the updated death list information for NDOC prisoners for who have expired while inside NDOC: 20 May 2009 to the present; (NDOC Nursing Director ref’d me to your office);

2. Please send what happened during the disturbance in High Desert State Prison 13 April 2009 that Mr. Skolnik talked about at the14 April board meeting including photos of both prisoners and guards who were injured, if they were? I sincerely hope all are in good health now; and

3. Please send a record of use of force inside NDOC facilities for the past five years, with photos;

4. Please send breakdown of those in solitary confinement, Ad Seg or Dis Seg, as I believe NDOC

officials refer to it, by time and race since 01 January 2007. Years ago NDOC officials did not keep this information. I hope they do now since it is important to understand how officials are administrating Nevada prisons in this regard.

Please answer my inquiries as soon as possible?

Why were staff members unable to prevent this recent tragic death at High Desert State Prison?

Bryan Tyler Nowell, Age 45
Administrative Segregation/Disciplinary Segregation Unit (The HOLE: Solitary Confinement)
Born 05/17/64
Died 03 June 2009
Suicide: Asphyxia by Hanging

Solitary confinement, as I submitted to you in my comments 14 April 2009, the Dr. Stuart Grassian report referenced, causes damage to human beings and in this case, death. We must stop this inhumane process today. Please give the order to Director Skolnik, Governor Gibbons, AG Cortez Masto, Mr. Miller… today, that solitary confinement stops now.

How many suicides have happened since May 2007 in Nevada prisons?

How are first line responders on duty in Nevada prisons educated to recognize those who are mentally unstable and may be thinking of taking their lives?

Are corrections officers advised about who is taking psychotropic drugs? Shouldn’t they know this in order to prevent suicide and other violence?

What is the budget for first responder education?

For a person to die in solitary confinement, or be allegedly gassed approximately 20 times and have a guard break a finger in a food slot at Ely State Prison recently, per a new Ely lawsuit in US District Court, is unacceptable and socially reprehensible. Prisoners are people.

Why are NDOC officials denied a prisoner with a rare liver disease medical care at High Desert, Mr. Miller? Will you please visit him to see for yourself? Will he die before release? Don’t you want to see his refused medical grievances? His life is at stake.

Why are NDOC officials shuttling the Ely HIV prisoner, whom guards there and at NSP have beaten, stabbed and shot during his Nevada incarceration, for treatment to High Desert, even though there are no specialists there to help him? Does this not further stress this prisoner to the point that he, too, will die young? Please move this prisoner to NNCC where he belongs.

We want to see education for officers and staff in violence prevention in Nevada prisons.

Where does the prison food coming from? What is the daily cost now? Why are we receiving reports of Nevada prisons serving expired food and that it is dwindling in serving sizes? How many calories are our prisoners getting daily? Where are the dieticians to supervise food service? Is it true that Nevada prisoner requests for Kosher food are not being honored?

What about those prison buses that the Department of Transportation has no responsibility to check for safety during prisoner transports? Who manufacturers those buses? Who inspects them and how often? How do prisoners get out alive if there is an accident? Are they coached on what to do in case of an accident to be able to get out safely? Why don’t prisoners get to see out? Are bus drivers licensed commercially? How many buses are there?

Is it true that NDOC officials allow senior corrections officers to recruit informants, snitches in prison terms, from the prison population, putting even more stress on prisoners. Do they order corrections officers to put prisoners on the train to Ely without due process? How much retaliation takes place against those who refuse? To what extent is retaliation taking place?

Why do Nevada prison mailrooms refuse to deliver books to prisoners, approved books that arrive? What happens to books undelivered to prisons? Why do corrections officers read magazines that families and loved ones pay for and reportedly keep them from the prisoners for weeks? Why don’t mailroom officials follow mail AR’s? Why do you allow punishment to all Ely prisoners by making them use tiny ink well fillers to write their letters with? To stop them from writing to loved ones and filing lawsuits?

Are you being loyal to the law by allowing unaccredited standards, operations and policies to continue inside Nevada prisons?

Why don’t Nevada prisoners in solitary confinement get daily fresh air and exercise, as is their right? Why do corrections officers take prisoners out at midnight, interrupting the sleep cycle?

Why do you allow Ely lockdown for years and years and years to continue? Please stop this today. You have the power. You can do it.

What are the guidelines for putting people into solitary confinement, ad seg, dis seg, to use your euphemisms?

Where are the felony charges against Nevada prisoners who are in solitary for extended periods?

Please produce the records of how long prison officials are keeping Nevada prisoners in solitary confinement.

Why don’t Nevada prisoners go to jail for assaults? Why don’t Nevada corrections officers go to jail for assaults?

How are the perpetrators of rape charged? Do they go to court? Or, do NDOC officials punish them by extending sentences without due process?

What are the NDOC regulations for time limits, if any, placed on people going into solitary?

Where are, and what are, the administrative regulations for the amount of time that officials can put prisoners in solitary confinement?

How much money is in the budget for corrections officers’ educations about recognition of mental health problems that prisoners may be suffering?

Here are excerpts of a letter from a prisoners’ family member that we received 13 July 2009:

…” I have suffered 13 years under the duress and frustration of the corrupt Nevada Prison System, Judicial system period. This is the “Country of Nevada”. Good Ole boys for sure and Ely guards are barbarians! P.up trucks drinking in the hills, cruel, I have seen the bleeding wounds on my husband’s ankles from having the shackles set to wear they rub and rub and break open old scabs from the week before, one guard will hike them up and tighten them another will just let them shift all around, I mean come on, walk from port to visit belly chain hands behind back cuffed shackles like he,s the incredible hulk and an escort officer, sometimes two, give me a break!

Ooooh are those guards tough, gag me, disgusting display of over the top unnecessary pain for the prisoner and extreme drama to increase the all ready distorted sense of importance these guards have!

No wonder they have such domestic violence problems!

…we do not trust anyone in connection with law they are all crooked corrupt tools of the higher echelon of our corrupt legal system.

As I stated I have suffered 13 years as has my husband I am ready to take a stand no matter what this lousy system needs to be torn down from the top down.”

What response do you advise us to give to this free person who is suffering daily because of operations and policies at Ely State Prison?

Please, take the high road in eliminating unacceptable Nevada prison conditions starting today. Implement a platform of rehabilitation and hope.

Please replace ineffective NDOC leadership with professional administration.

Please implement oversight in Nevada prisons today==before more violence erupts and the death toll for Nevada prisoners continues to escalate.

Yours truly,

Mercedes Maharis MA MS MA