Dr. Jeffrey Metzner, a nationally recognized forensic psychiatrist, testified that, according to the S.C. Department of Corrections' own internal audit, 40 percent of their mental health counselors do not have adequate credentials to perform necessary services for those with serious mental illnesses.
Dr. Metzner earlier emphasized the importance of consistency in counseling sessions with inmates who have mental illness diagnoses. He stated that the normal length of time to declare counseling sessions non-productive in an outside setting is much shorter than the time needed to determine that for mental health clients who are incarcerated. He testified that studies show positive reinforcement works best on that population; and while not always possible, it is the best methodology to employ. He stated that in order to achieve good outcomes that can protect the patient, as well as other inmates and staff, it is necessary to maintain consistent and appropriate staffing levels with those who are appropriately credentialed, and who in turn are supervised by an adequate number of Ph.D. level psychologists and board-certified psychiatrists.
When asked how S.C. compares to other states in regard to staff credentials, he answered, “Badly.”
Regarding issues of inappropriate behavior by counselors, Dr. Metzner agreed on cross-examination that the state was justified in terminating staff for failing to adhere to professional ethics and standards of conduct. However, Dr. Metzner indicated that the risk of inappropriate behavior on the part of counselors with their patients could be reduced if the state hired staff who have the recommended levels of education, training, credentials and licensure, in keeping with national standards.
Regarding issues of S.C.'s lower-than-national average suicide rate among the prison population, Dr. Metzner testified that more can and should be done to reduce the rate. Dr. Metzner cited a case in which a relative reported receiving what she thought sounded like a “suicide note” in the mail, reported it to authorities, but that information was not turned over to the mental health staff; he said with timely intervention, that could have been prevented.
Dr. Metzner described the Lee Correctional Supermax unit as “having feces all across the walls and floor” and a very small, fenced alternate containment area, which is known by the prison population as “the dog run.”
He outlined the conditions under which restraint can be used and how it must be administered and supervised, with constant supervision required, notation every 15 minutes of the patient’s status, and release and movement of limbs frequently to prevent clots, which can form in the legs and arms after restriction of movement. He noted that after eight hours of restraint without intermittent release and movement a person would “get up, walk to the shower and be dead within two minutes.”
That was in contrast to videos from prisons shown in the plaintiff's opening arguments the second day of trial that graphically showed two prisoners kept for extended periods in restraint despite pleas for medical assistance.
Dr. Metzner recommended the department adopt policies to determine compliance in drug administration so the staff will be in accord about what should be reported to psychiatric supervisors.
He agreed that improvements have been made in staffing on cross-examination, but on redirect, said more could be done. Defense counsel raised his voice and asked if Dr. Metzner knew there is a nursing shortage or whether he was aware how hard it is to get a psychiatrist to accept a position in a penitentiary. Judge Baxley admonished counsel to not yell at or badger the witness.
Dr. Metzner then replied, “It depends on what you pay them.”
The judge remarked that he has not had a witness kept so long on the stand in his court before, so he excused the witness and stood to shake his hand.
Susan Porter was challenged as a witness, but was qualified by the judge on the basis of her technical expertise. Porter compiled data from various text files submitted by the Department of Corrections. The SCDC took exception to her manipulation of their data, but the judge determined that because the department could not provide the charts requested, Porter's work was a benefit and would be allowed into testimony.