A special inspection conducted after an in-custody death at the Bi-State Justice Building jail in March found LaSalle Corrections out of compliance with inmate check record-keeping, according to documents.
Following the March 11 jail death of Franklin Greathouse, 59, the Texas Commission on Jail Standards conducted a special inspection.
A report dated April 16 found the jail out of compliance with state law and specifically referred to cell checks. The report notes that while all cell checks were documented as having been done, a comparison of the paperwork to surveillance footage showed otherwise.
"After reviewing video evidence in conjunction with self-reporting by facility administration, it was determined that eight, 60-minute, face-to-face observations, prior to the inmate being discovered, did not occur, even though the rounds were documented at least every 60 minutes on the observation logs," the April inspection report states.
LaSalle, which has contracted with Bowie County, Texas, to operate the jail since 2013, did not respond to a request for comment.
Texas Commission on Jail Standards Assistant Director Shannon Herklotz said the Bi-State jail was returned to compliant status May 29.
A press statement from the Bowie County Sheriff's Office released after Greathouse's death described jail staff as having performed CPR on Greathouse until he was pronounced dead after his body was discovered by another inmate.
Chief Deputy Jeff Neal said results of an autopsy performed on Greathouse have been returned, but he is not authorized to release the results.
As required by law, BCSO formally reported the in-custody death March 20 to the Texas Attorney General's Office.
According to a summary prepared by BCSO, Greathouse was a homeless, "repeat inmate" with a history of alcohol abuse. Greathouse was booked into the jail about 9:45 p.m. March 10.
"Greathouse complained of a seizure on March 11 and was seen by LaSalle Corrections Medical," the BCSO death report states. "Greathouse was responsive and able to walk to his own cell within F-pod; dispelling his claim of seizure."
Another inmate discovered Greathouse about 7 p.m. March 11 lying unresponsive on the floor of his cell. A licensed practical nurse working for LaSalle and several correctional officers responded and a call for outside emergency medical help was made, according to BCSO's official account.
Staff and paramedics performed CPR until an EKG confirmed Greathouse showed no sign of life, the report states. The BCSO death report does not specify who in LaSalle Corrections medical determined that Greathouse's ability to walk meant that his claim of a seizure should be discounted.
Doctors can make medical diagnoses, registered nurses can make nursing diagnoses, licensed vocational nurses and licensed practical nurses cannot make medical diagnoses, according to accepted nursing standards.
Herklotz said all Texas jails are inspected at least once a year and that jail administrators are not informed when an inspection is scheduled. In-custody deaths, escapes and occasionally complaints trigger special inspections, Herklotz said.
In addition to finding the Bi-State jail noncompliant for failing to conduct the mandatory observations, the April report notes that the jail was out of compliance with a law that requires documentation of an inmate's suspected or known mental illness or disability and notification of the local magistrate.
In Bowie County, local justices of the peace serve as magistrates. The inspection notes that there was no documentation that magistrate notification was occurring under those conditions.
The second person to die in the Bi-State jail this year, Michael Rodden, 48, was discovered hanging by two socks tied together from a bolt on a window in his one-man cell July 6, according to a death report on file with the Texas Attorney General's Office.
According to BCSO's death report on Rodden's death, Rodden was the subject of a recent "Officer Safety" message that had been disseminated to area law enforcement via email.
Rodden reportedly intimated to Texarkana, Texas, Police Department officers who arrested him the evening of July 3 that he "would commit suicide by cop in future interactions with law enforcement," according to the death report.
"Those officers (TTPD) relayed that information to area law enforcement by email but neglected to inform jail staff during the book-in procedure," the BCSO death reports.
The Bi-State jail is under the supervision of the Bowie County Sheriff's Office.
A representative of the Texarkana, Texas, Police Department declined to comment.
Neal said technology meant to ensure required observation checks are being done has been installed in the administrative segregation cells in the jail and that the technology will soon be operational "jail wide."
The technology includes the installation of RFID chips on cell doors which can be read by a handheld scanner. Correctional officers performing cell checks must physically be at the cell door to scan an RFID chip and document the observation occurred, Neal said.
Neal said LaSalle is bearing the cost of installing the "Guardian RFID system."
Herklotz said private jail management companies have come under increased scrutiny in light of jail deaths throughout the state which critics lament are the result of for-profit companies putting their bottom lines over the rights and needs of the incarcerated.
Texas House Bill 4468, which takes effect Sept. 1, mandates that the compliance status of a privately run county jail, such as the Bi-State jail, shall be reviewed at the next meeting of the board of the Texas Commission on Jail Standards if the jail is deemed noncompliant during a regular annual inspection or special inspection.
Herklotz said that means a private management company could be required to appear before the commission, address the non-compliance and face potential action by the board.
LaSalle has operated the Bi-State jail and jail annex since 2013.
Two lawsuits involving the July 2015 death of Michael Sabbie and the July 2016 death of Morgan Angerbauer in the jail also reference LaSalle's inmate check protocol.
Court filings in the two lawsuits against the company allege correctional officers routinely filled out logs documenting face-to-face cell checks at the beginning of a shift rather than as the checks are completed.
That practice led to checks being documented that did not actually occur, the lawsuits allege.
The family of Michael Sabbie sued in federal court after Sabbie's death on July 22, 2015. Sabbie complained of shortness of breath during his roughly two-day stay in the jail.
After nursing staff diagnosed Sabbie as faking, Sabbie, 35, attempted to enter an area of the jail where phones are located. A correctional officer grabbed Sabbie by the back of his shirt and threw him to the ground.
Sabbie can be heard on video stating, "I can't breathe, I can't breathe," repeatedly as officers pile on top of him and one pepper sprays him in the face.
LaSalle settled the suit with Sabbie's family this year. The terms of the settlement are undisclosed and filed under seal in the Texarkana Division of the Eastern District of Texas. U.S. District Judge Robert Schroeder III signed off on the case's resolution last week.
A suit concerning the July 1, 2016, death of Morgan Angerbauer remains pending.
Angerbauer, 20, died of diabetic ketoacidosis after being denied medical treatment. Video surveillance shows Angerbauer repeatedly screamed for help in the hours before her death.
Former Licensed Vocational Nurse Brittany Johnson pleaded guilty to misdemeanor negligent homicide and served a 90-day jail sentence in Miller County, Ark., in connection with the death.
The civil case concerning Angerbauer's death is scheduled for jury selection before Schroeder in October in Texarkana's downtown federal building.
Angerbauer's family and friends are planning to release balloons in her honor at 2 p.m. Sunday in front of the Bi-State Justice Building.
Had she lived, Angerbauer would have turned 24 last week.