Court delays leave mentally ill waiting behind bars

It took handcuffs and a blast of pepper spray for police to drag a 72-year-old man from his downtown apartment.

Neighbors had called for help after hearing banging and other noises. Ronnie Medenwaldt answered the door with a knife and refused to leave. He was arrested, charged and jailed for three months before a judge ordered a mental health evaluation.

His journey through the justice system stalled there.

Medenwaldt sat in the Minnehaha County Jail for another eight months waiting for a psychiatrist to determine what role his mental illness played in the confrontation with police.

That Medenwaldt languished in jail for months while awaiting evaluation is not unusual in South Dakota, an Argus Leader Media investigation found. The legal purgatory raises questions about due process guaranteed under the U.S. Constitution, a potential civil rights violation that has sparked legal action in other states.

Argus Leader investigation: Locked in Limbo

South Dakota courts routinely jail mentally ill defendants like Medenwaldt for half a year or more without trial because of a backlog of court-ordered mental health exams, aggravated by a cap on evaluations at the state's mental health hospital. The time served waiting can count toward a sentence, if convicted. But if someone is deemed incompetent or not found guilty, that time is lost.

“What we are talking about is people sitting in the jail because they are mentally ill,” said Alecia Fuller, an attorney with the Pennington County Public Defender’s office.

State resources for mental competency evaluations can't keep up with a growing demand – the number of evaluations ordered last year was more than four times the state was willing to conduct. Mental health advocates rail against a system that on one hand doesn’t provide the necessary treatment for inmates and on the other won’t pay for the basic evaluation that may resolve the case – one way or the other.

A six-month Argus Leader Media investigation found:

• The average wait time for a competency evaluation at the state's mental health hospital is four months, but some have waited six months or longer. 
• The state's court system saw 147 requests for mental competency exams in fiscal year 2015. The state's mental hospital will only conduct 36 per year. 
• Minnehaha County spent about $100,000 last year on evaluations by private psychiatrists, who charge five to 10 times more than the state.

The uncalculated cost is the damage done to those who are waiting.

'Hauled out with nothing'

The last time Jennifer Miklos spoke with her former neighbor, Medenwaldt told her he had lost 70 pounds since he was put in jail in February.

Medenwaldt was like a grandfather to Miklos. He lived downstairs from her Sioux Falls apartment and was always there to listen or lend a hand when she needed it.

Sometime last fall, Medenwaldt's schizophrenia worsened. He became more agitated and less himself. On Feb. 12, a neighbor called Miklos to say police had surrounded Medenwaldt's front door. Miklos ran downstairs and begged police to let her talk to him but was told to stay away. She watched the standoff helplessly.

Locked in limbo: 'No other option but to plead guilty'

Nine months later, Medenwaldt was no closer to getting the help he needs, Miklos said. He was eventually evaluated and his attorney received a report on Oct. 13, but the charges against him were still unresolved.

"It's been really hard not knowing what's going on with him," Miklos said. "I saw him hauled out with nothing."

Assuring competence

The delays stem from a growing number of cases across the state involving mental health concerns.

Whenever questions arise about a defendant's mental state, everything stops. The court can't hold someone responsible if they couldn't control or didn't understand their actions, and it can't offer a fair trial to someone who isn't able to assist in their defense.

"We need assurance and to prove assurance to the court that a person is competent," said Minnehaha County Public Defender Traci Smith.

In these cases, a judge will call for a competency evaluation, a type of psychiatric exam aimed at determining how much a defendant understands about their actions, the allegations against them and the court proceedings taking place.

All other activity is put on hold until the psychiatrist comes back with a recommendation on whether the case can proceed or the defendant needs to be committed to a mental institution.

The state-run Human Services Center in Yankton has historically performed most of the evaluations. State law doesn't obligate it to perform them, though, and the facility has a long-standing limit of three per month on a first-come, first-serve basis.

Until recently, that was enough to meet the needs of most counties. The number of competency evaluations requested statewide hovered around 30 for most of the last decade. Then, in fiscal year 2014, the number spiked to 141, and in 2015 they reached 147.

Need outpacing resources

The increase in requests has outpaced state and local funding for conducting the evaluations, leading to a waiting list that has left dozens of cases suspended and mentally ill defendants languishing behind bars before trial.

"That makes me so furious," said Phyllis Arends, executive director of the National Alliance on Mental Illness Sioux Falls. "Jails are not treatment facilities. People are just being held and receiving nothing to help them get better."

Public defenders and advocates for the mentally ill said they can't specifically explain the recent spike in competency exam requests, but that it fits a trend of people with mental illnesses being swept into the criminal justice system.

The average wait time for evaluations at the Human Services Center is four months, according to officials there, who say they do not have the resources or a responsibility to increase its case load for counties.

HSC "does not have the capacity to conduct all forensic evaluations for counties, nor is that the mission of the hospital," said Tia Kafka, a spokeswoman for the Department of Social Services, which oversees the facility.

The state's largest counties are trying to shorten wait times by hiring private psychiatrists, but they haven't been able to close the gap, in part because there aren't enough mental health professionals in the state who are qualified and interested in taking on the work.

"I have seen some experts who don’t want to go into jail, who don't want to go into the prison or don't want to testify in court," Smith said.

Society's margins

So people like Medenwaldt wait.

Finding their stories is challenging. Many are on the margins of society. They don’t have family support. They don’t have community support. Their lawyers are restricted and reluctant to share details because of privacy concerns. A six-month review of court records by Argus Leader Media surfaced several cases involving long delays.

Charles Aklem Moses, 21, was arrested in April 2014, accused of breaking into a Sioux Falls apartment to steal $40 in medication. He waited 11 months for a competency hearing and his case remains unresolved.

Delbert Wayne Charging Crow Jr., 33, was arrested in January 2014 for trespassing, possession of meth and resisting arrest charges outside the Salvation Army warming center. He waited 11 months for a hearing to review his competency evaluation before being committed.

James Michael Marken, 38, fought with a police officer in March during a schizophrenic episode and sat in jail nearly eight months — five of which were spent waiting for an evaluation — before pleading guilty in late October.

It's unclear how many others have been in Marken's position. The state court system does not track how long it takes to complete competency evaluations after they are requested. Minnehaha County officials were unable to provide Argus Leader Media with a list of court cases in which competency evaluations were requested.

Constitutional questions

Wait times exceed those in neighboring states. In North Dakota, a state facility conducts the evaluations in less than one month. In Minnesota, a mix of state and private doctors complete them in one to two months. In Iowa, most are handled by a state psychiatric hospital in less than three months.

The delays are also comparable to ones that led to a legal challenge in Washington state, where a coalition led by the American Civil Liberties Union sued last year. A judge in April ordered state officials there to begin completing evaluations within seven days of a request.

Any solution proposed by the governor's office would not involve expanding the role of the Human Services Center in Yankton, said Tony Venhuizen, Gov. Dennis Daugaard's chief of staff.

"The demand isn't really in Yankton," Venhuizen said. "It doesn't make sense to build up the capacity there and require people to drive there. The state hospital has its own mission to fulfill."

Instead, Venhuizen said funding existing mental health facilities in Minnehaha and Pennington counties would be a better option for shortening the wait times.

Until then, Medenwaldt, Marken, and others arrested with mental illness continue to wait.