Missoula County Jail

With a long pony-tail, a noticeable limp and an orange jumpsuit, Mathew Lederer looks like the hardened criminal the criminal justice system believes he is.

But looks can be deceiving. 

The 37-year-old chronically homeless man has been sitting in the Missoula County jail since Nov. 25 on several probation violations, all of which he denies.

He was picked up in January of last year by local law officers after they found a bit of hashish in his pocket. The Missoula County Attorney's Office charged the man with criminal possession of dangerous drugs.

"I'm not a violent offender," Lederer said during an interview at the jail. "I'm not a sex offender. I am a guy who doesn't like to pay rent." 

According to jail officials, two-thirds of the inmate population at the Missoula County Detention Center are, like Lederer, nonviolent offenders waiting for courts to decide their fate.

Meanwhile, the jail is bursting at the seams with a population that hovers around 360.

Lederer also represents a segment of the jail population who reported in an ACLU survey last month that they were dissatisfied with the medical and mental health services.

The report reflected unfavorably on the Missoula County jail, listing it as the worst in the state when it comes to providing inmates with proper access to medical and mental health care. 

For a man who has been on the streets for the majority of his life, Lederer is unusually eloquent and obviously intelligent.

He's the first to admit that his record is not perfect. There was a breaking and entering charge when he was 17, leaving him to spend his 18th birthday behind bars in Michigan. And he racked up more charges when he was living in Arkansas. When asked why he's chosen to be homeless, he also freely admits he has undiagnosed mental illness issues.

But there's another health issue that is much more immediate. From behind the glass of the visitation room, Lederer calls himself a "walking time bomb" because of a blood clot in his right leg.

In October, he suffered a pulmonary embolism, and after being arrested he started experiencing similar pain and symptoms.

He was admitted to the hospital in December for three days, but he continued to have pain in his right leg. The jail staff took him for an ultrasound that confirmed he had developed another blood clot in his right leg, but they refused him access to a doctor, he said.

On Jan. 3, he believes he had a stroke. 

Of course, there's no way to know for sure, because he claims he hasn't been back to the doctor since his initial hospital stay. But he drags his leg when he walks and says he slurs his speech at nighttime.

The right side of his mouth slightly droops. The jail's two nurses supply him with some of his prescriptions, both blood thinners, but jail policy refuses him access to prescribed muscle relaxers and pain medications. 

The pain, he said, is excruciating.

"I told (the mental health provider) I was depressed about the medical care," he said. "She told me to write a grievance."

Lederer of course did write a grievance – several in fact, to no avail. He said he's been refused access to medical care because, quite simply, the jail doesn't want to fork out the thousands of dollars it would cost to hospitalize him or the hundreds of dollars it would cost for him to see a specialist.

His attorney, Lisa Kauffman, explained if he was out on the streets, he could seek medical care at a local clinic, like Partnership Health, and the jail wouldn't have to foot the bill. 

Kauffman, who contracts with the Office of Public Defender, represents many impoverished and homeless defendants, like Lederer, who have a history of substance abuse and mental health issues. 

"Instead of helping people with resources, and other assistance, the system is too punitive," she wrote in an email to the Missoulian. "Thus the revolving door of justice, as poor people with mental health and drug use issues circle in and out of incarceration for most of their lives." 

Last Wednesday, District Judge Ed McLean sentenced Lederer to three years with the Department of Corrections. Kauffman said he will spend another six to eight months at the Missoula County jail while the DOC decides where to place him. 

***

No one thinks the jail's overcrowding has a simple solution, because the problem itself is a convoluted mixed bag of players, institutions and finite financial resources. 

Newly elected Missoula County Sheriff T.J. McDermott has vowed to make the jail a priority during his tenure as sheriff, and he and Undersheriff Jason Johnson have attended a host of meetings aimed at addressing the overcrowding issue.

"I think we need to just educate the community there are a lot of reasons why we get overcrowded and there are some breakdowns in a lot of systems in our community, (including) the justice system," Johnson said in an interview. "Nowadays, things take a lot longer to get through the justice system."

"Our system is just at the max altogether," Johnson added. "That contributes to people here waiting to go through that process." 

One sentiment that has been repeated during meetings with county officials is the jail really has very little control on who is brought to them. They point fingers at judges, who set high bonds that the poor and homeless cannot pay and saddle petty offenders with harsh sentences.

And probation officers, including Lederer's, file petitions to revoke when their parolee can't be found or fails to make an impromptu appearance.   

The public defender's office also has consistently noted their heavy caseloads, which leave attorneys without the time needed to devote to each client. 

***

Then there's the prevalence of addiction and mental health issues. 

Because of an absence of alternative solutions, people with mental health and addiction issues are brought to the jail on a daily basis.

The undersheriff says he hires detention officers, not health professionals. The guards just aren't equipped or trained to deal with the myriad of issues they come across.  

Nevertheless, by law, they have a responsibility to provide medical and mental health care for every single person incarcerated.

Johnson compares the Missoula jail to others he toured in Montana before he became the undersheriff.

He believes the services at Missoula's jail are significantly better than any other jail in Montana, some of which don't even provide in-house medical care.

Jail Commander Jason Kowalski said he couldn't comment on Lederer's health care because it would violate medical privacy, but he agreed to generally speak about the issue. He denied withholding medical care from any inmate. 

"Our inmates with significant medical issues are seen appropriately by medical staff," Kowalski said. "It may not be the resolution the inmate wants or feels is adequate for that situation, but we don't leave major medical issues hanging with nothing going on with them."

"Sometimes it just comes down to an inmate disagrees with the treatment they are receiving," Johnson added. "So we have to weigh the inmate's opinion of the treatment to a nurse practitioner's opinion of what is necessary." 

The jail contracts with Correctional Health Partners to provide inmates with one part-time nurse practitioner and two full-time nurses. CHP declined to be interviewed for this story.

However, Theresa Williams, the jail's lone mental health provider, did agree to an interview.  

"What I've seen is a lot of people, prior to coming to jail, have been coping and self-medicating with substances, and so that initially coming to jail is ... it's a shock," Williams said. "So I think that contributes to someone's ability to cope and see the bigger picture. Right now, they are hyper-focused on 'I'm not getting this needed med right now.' " 

Williams said she finds working with inmates rejuvenating and their stories, "humbling."

She said she's not overworked, but by the second week in March she had already met with 55 inmates in one-on-one counseling and in group sessions.

Kowalski said he and the undersheriff are looking for ways to fund another mental health provider at the jail. 

"We are proactive in this setting, but we are also looking at ways we can be proactive in the community," Williams said. "How do we prevent people from coming to jail, and help them access the support they need on the outside?" 

"We don't want them to come to jail," she added.

She said part of her job is collaborating with the Poverello Center and Missoula County Co-occurring court, the Crisis Intervention Team and law enforcement to help people before they come to jail. 

"We get the spotlight on us, but really we need to shine the spotlight back on the community, and what can the community do to prevent this," Williams said. 

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