Lawyers for people held in Baltimore City jail ask court to extend health care settlement

A month out from when a federal judge ordered the Baltimore City Booking and Intake Center to finish overhauling its health care system, lawyers representing people held in the facility say it’s poised to miss the deadline — yet again.

On Friday, the lawyers asked the court to give the Maryland Department of Public Safety and Correctional Services, which operates the city jail, two more years to improve the medical and mental health services it provides and make the facility more accessible for people with disabilities.

In the motion, the lawyers asked the court to impose interim deadlines before a final deadline of June 30, 2026, to keep the state “on track” in reaching compliance with each of the nine provisions laid out in the 2016 settlement agreement with the American Civil Liberties Union.

“If they miss those deadlines, then we hope the court will take action at that time,” said David Fathi, director of the ACLU National Prison Project and one of the attorneys representing people incarcerated in the city jail.

Under the original terms of the settlement, the state was supposed to finish improving the jail’s health care system by June 2020. However, when the state’s compliance with the settlement lagging, the court extended the deadline first to June 2022, then to December 2023 and finally to June 2024.

“No modification can remedy the ongoing harm caused to the Plaintiff class by Defendants’ failure to keep the promises made eight years ago,” the ACLU’s motion Friday said. “The bell cannot be unrung.”

“But,” the motion continued, “extending the Settlement Agreement for an additional two years will allow the Plaintiff class to receive, at long last, some of the benefit owed to them while placing Defendants in substantially the same position they would have been under the original agreement.”

In October, Dr. Michael Puisis — appointed by the court to monitor the state’s compliance with the terms of the settlement — filed a lengthy report that found the state to only be in “substantial compliance” with one of eight goals spelled out in the agreement for improving the jail’s medical care. The state, Puisis found, was making progress on some of the goals but in noncompliance with others.

In a filing earlier this month, however, the state didn’t agree. Its efforts to improve medical care for people incarcerated at the city jail demonstrate “greater levels of compliance than reported,” the state said, and often exceed the thresholds it’s required to meet.

In the report, filed May 15, the state identified the medical monitoring process used by Puisis as a “significant obstacle” to reaching substantial compliance with all the settlement’s goals, as it created “unnecessary confusion and delays.”

Puisis resigned from his role as the settlement’s medical monitor in December. In the state’s May 15 motion, it expressed hope the new monitor would “fairly assess” the jail’s delivery of medical care and find the state in compliance with the settlement.

On Friday, the ACLU’s Fathi expressed disappointment in the state’s response. He noted that it had changed its tune since last summer, when Maryland Attorney General Anthony Brown and Assistant Attorney General Laura Mullally filed a timeline that showed the facility wouldn’t be able to reach substantial compliance on all the settlement’s goals until December 2025. In August, Fathi said, the state hired private legal representation to take over the settlement.

“It would be one thing if the state was taking responsibility, coming up with a plan of how they were going to reach compliance,” Fathi said. But “they’re shooting the messenger. They’re just blaming the monitors.”

Before Puisis’ departure, he reported that the jail had reached substantial compliance on the agreement’s goal for sick calls. People held in the jail have daily opportunities to ask for health care, and medical professionals usually respond to their requests on a timely basis, he said.

However, he identified the jail’s medical record system as a sticking point in the facility’s progress in improving its health care services. In the hybrid paper-electronic record system, Puisis found many people incarcerated at the jail were listed as “deceased,” even though they were still alive, or had multiple electronic records, each with different medical information about them.

In October, the last time Puisis visited the jail before resigning as monitor, he documented a patient who lost more than 40 pounds in two months, according to the motion lawyers filed Friday. When the patient was sent to the emergency department, they were found to be in hypovolemic shock, a dangerous condition in which a person’s heart can’t pump enough blood to all of their organs, putting them at risk of organ failure.

In the most recent report filed by Dr. Jeffrey Metzner, the court-appointed mental health monitor, he documented delays in seeing patients with urgent mental health care needs, the ACLU said in its motion Friday. Metzner, however, found the state in compliance with several settlement goals for improving mental health services, and in partial compliance with others.