How Part-Time Medicine and Unlicensed Practice Destroyed My Health
By LeRoy Nellis
(Published on LeRoyNellis.blog and http://www.academia.edu)
SECTION I — INTRODUCTION
I write these pages not as a lawyer, not as a journalist, but as a man who survived the medical system inside the Williamson County Jail—if “system” is even the right word.
For 326 days I lived inside a concrete box in Georgetown, Texas, while people wearing uniforms and medical patches decided which days I would receive medication, which days I would be denied it, and which days I would simply be forgotten. I was not serving a sentence. I had not been convicted. I was a pre-trial detainee—presumed innocent under the Constitution. But inside those walls, innocence has no value. The law stops at the booking desk, and medicine becomes punishment.
What I saw and endured revealed a county operation that treats healthcare as a part-time obligation—a revolving door of contractors, unlicensed staff, and EMTs making decisions far beyond their training. County records, public job postings, and contracts show a pattern that spans years: psychiatrists hired for only sixteen to twenty hours a week to cover more than five hundred inmates. The rest of the week there is no doctor, no psychiatrist, no oversight—only medics and correctional “medical officers” dispensing psychotropic drugs, injections, and diabetic treatments they are not licensed to administer.
Those practices did not merely violate policy; they destroyed my health. I entered that jail physically sound. I was left blind and disabled.
The purpose of this paper is to document how that happened—not only to me, but to the hundreds of men and women cycled through the same regime. What follows is both personal testimony and evidentiary record, drawn from county contracts, inspection reports, lawsuits, and the notes I wrote in confinement. It is a story of neglect disguised as care, of a county saving money by hiring part-time doctors for full-time suffering, and of the human cost of what I have come to call administrative torture.
The Faces Behind the White Coats
When I first arrived, I was processed through medical intake by a man introducing himself as Dr. Alan Brooks. He carried the confidence of a physician—the voice, the clipboard, the authority—but no one in the jail could produce a license number. Later, when I checked the Texas Medical Board database, his name wasn’t there. He was not licensed to practice medicine in this state, yet he prescribed and approved treatments as though he were.
Another name appeared repeatedly on prescription logs: Dr. Ghulam M. Khan, sometimes spelled Kahn. He was listed on county contracts and medical forms, but his licensing records did not match what we were told inside. I saw him twice. The first time was a formality—a required consultation to obtain shaving privileges—where he diagnosed me with bipolar disorder and prescribed medication. The second time, undercover inmates—what the county calls ISFs, or “inmate service facilitators”—pressured me to tell him I was “feeling helpless.” They said he would prescribe sleeping pills. Instead of following their script, I told him the truth: that the county had been harassing me systematically since 2019, beginning with the excessive-force incident that started all of this. That conversation, and the manipulation surrounding it, forced me to ask the question that still echoes through this case: why does Williamson County have such a fixation on me?
I later learned that psychiatric care at the jail had been outsourced to Adelphi Medical Staffing and GreenLife Healthcare—companies advertising part-time coverage of sixteen hours a week. Sixteen hours of psychiatric care for a population of five to six hundred inmates is not healthcare; it’s bookkeeping.
What I Witnessed
During those months I watched men detox without supervision, diabetics collapse from missed doses, and inmates hallucinate after being given the wrong pills. I documented the patterns: EMTs wearing EMS patches but refusing to show credentials; a medic who admitted learning to read glucose meters from YouTube; a EMS Medical Technician struggling to handle hundreds of patients seven days a week with no physician present.
Each incident pointed to the same conclusion—what happened to me was not an anomaly. It was the logical result of a design built on neglect.
Purpose of This Record
In the sections that follow, I outline how Williamson County Jail structured its medical program around temporary contracts and minimal oversight; how unlicensed or underqualified personnel were allowed to prescribe, inject, and withhold medication; and how those decisions produced lasting injury. I also show how these practices violate federal law, state regulation, and the basic human-rights standards that even prisoners of war are guaranteed under international conventions.
Most importantly, I explain how it feels when the very people sworn to preserve life use medicine as a weapon—and how a county turned the practice of healing into a system of harm.
SECTION II — THE STRUCTURE OF NEGLECT
When you live inside a jail long enough, you start to notice patterns. At first they seem like coincidences—one missing medication here, one delayed insulin shot there—but over time the pattern reveals itself as policy. What happened in Williamson County wasn’t a few bad nurses or an unlucky day in the infirmary. It was an entire operating model built on absence: no full-time physician, no consistent psychiatrist, and no line of accountability that survived past a rotating contract.
A. How the County Staffed Its Jail
The paper trail shows exactly how they designed it.
In 2008 the county signed a “professional services” agreement with a psychiatrist named Dr. Michael Musgrove. The contract required up to 20 hours per week—“as needed.” The county didn’t even guarantee they would request his services weekly. The arrangement cost them $85 an hour and bought the illusion of psychiatric care.
By 2021 that same model re-appeared under a new name: Dr. Ghulam M. Khan. Same idea—contractor status, hourly rate, limited hours, no full-time obligation. The 2025 job listings through Adelphi Medical Staffing and GreenLife Healthcare repeat the cycle again: “minimum 16 hours per week psychiatrist for correctional facility.” Sixteen hours to cover 550 to 600 inmates. The math tells the story: if every inmate needed just ten minutes of evaluation a week, it would require nearly a hundred hours of doctor time. Williamson County budgeted one-sixth of that.
The rest of the gap they filled with people who shouldn’t have been there alone. EMS Medical Technicians, EMTs, and jailers wearing medical patches became the default “health-care team.” They could hand out pills, log vitals, even inject medications—but they weren’t doctors. They called the supervising psychiatrist if things got bad enough, but most of the time they simply made judgment calls. The county labeled it “cost-efficient care.” I call it what it was: unlicensed practice under the color of authority.
B. What That Looks Like on the Inside
Every morning the line for “med pass” would form in R-Pod. In theory a medic was supposed to verify your name, dosage, and diagnosis. In practice, it was whoever the sergeant assigned that day. Sometimes it was an EMT with no badge number visible. Sometimes it was a corrections officer wearing an EMS patch, the same person who might have searched your cell an hour earlier. The pills came out of unmarked cups; nobody explained what they were for. If you asked, you risked being skipped next time.
I remember one day asking why my diabetic readings hadn’t been taken from March 25, 2025 to July 11, 2025 (108 days total). The medic said, “Doctor’s orders.” When I asked which doctor, he laughed and didn’t give me an answer. That Houston doctor that all the meds are running through, the “doctor” never set foot in jail. Later I found out my chart listed a Houston-based physician who allegedly approved prescriptions remotely. No tele-visits, no phone calls, nothing. They were signing orders for people they’d never seen.
C. The Economics of Neglect
It wasn’t just laziness; it was design. A full-time psychiatrist in Texas corrections might cost $200,000 a year with benefits. A contractor at $250 an hour for 16 hours a week costs roughly $208,000 a year—but with no benefits, no overtime, and no obligation to show up beyond those 16 hours. If the contractor quits, the county simply posts another ad. The liability stays the same, the paperwork resets, and the patients—people like me—start over from zero again.
The county’s own 2025 Recovery Plan boasts that “medical costs have been reduced by contracting out medical services.” They bragged about turning seven-day coverage into an accomplishment, even though that coverage came from a single EMS Medical Technician caring for hundreds. They never mention quality, only savings.
When you look at the Texas Commission on Jail Standards (TCJS) inspection logs, you can see the price of that strategy. In 2019 the inspectors wrote that two inmates never received the specialist appointments ordered by the jail’s physician. That single line in an audit hides real people: someone whose infection spread, someone whose vision blurred, someone who never got follow-up. Multiply that by every missed referral and you have the human arithmetic of austerity.
D. My Own Encounters
I first met the man calling himself Dr. Alan Brooks after I had already been placed on prescription medication. He wore the title easily, introduced himself as the physician on duty, and began issuing orders without hesitation. Months later, when I finally convinced my mother to search, she searched the Texas Medical Board database. His name was nowhere to be found. The person treating—and injecting—me had no legal authority to practice medicine in this state.
Not long after that discovery, an EMT named Larry R. Davis came into the unit carrying a syringe labeled Insulin. Without explanation, he drew fluid from a vial and injected approximately fifty cc into my arm. Within days, nearly the entire R-Pod was sick. One of the inmate service facilitators, an undercover informant known as “Joe Dirt,” joked, “Thanks, Nellis, for getting us all sick.” The comment lodged in my mind. Weeks earlier I had overheard two undercover officers—Derek W. Garretson and Nathan J. Henderson—talking about a viral outbreak they had “read everything about.” Garrretson remarked that he had confirmed I had never received any COVID vaccinations and said he couldn’t understand why I hadn’t become ill. He was right about the vaccines—I had never taken one—but what he didn’t know was that I had already contracted COVID four times before incarceration and carried natural antibodies. Whatever they injected into me that day may have reached others, but it didn’t take hold in me. At the same time, local news reported an outbreak in Travis and Williamson Counties during late March 2024. The timing matched too precisely to ignore.
Soon afterward, I developed severe diarrhea that struck almost every time I ate. My bunkmate mentioned that certain “eye-drop chemicals” could cause the same reaction. The symptoms came about fifteen minutes after each meal. I had no alternative but to eat what the jail provided. My mother tried to help by funding my commissary account so I could survive on packaged food instead of trays. I told her I thought something in the kitchen was making me sick—careful not to sound paranoid—but I knew this wasn’t an allergy. I had never experienced anything like it before entering Williamson County Jail.
When I stopped eating jail food and lived entirely on commissary, the diarrhea subsided. Then the commissary began “running out” of exactly the items I relied on—simple staples like crackers and noodles. Each week another product vanished. Soon minor thefts started; items disappeared from my bag. I tied two pairs of socks together to make a crude lock so nobody could reach inside. For a few weeks I survived on double shipments and avoided the kitchen. Then the supply problems returned, forcing me back to jail food, and the sickness returned with it. One day I used the restroom more than ten times in two hours. My body was emptying itself.
Within days I developed kidney pain so sharp I couldn’t sleep. My urine turned red with blood. For five nights I stayed awake, vomiting water from the pain. I filed medical requests—none were answered. When I finally caught EMT Joshua D. Ransom on rounds, he said there were no painkillers available and that “if it seems bad enough” he would call an ambulance, but he didn’t think it was “that bad.” His solution was to drink more water and “flush” my kidneys. The only medication I received was two ibuprofen twice daily—when they had it. At least two of those days they didn’t. Desperate, I tried dialing 911 from the jail phone, but the system offered no emergency access. Eventually the pain eased on its own. It was the worst agony I had ever endured, and I still believed it was the limit of what they could do.
When the pain evolved into nerve damage, I was told again to “wait for the doctor.” The doctor never came. A medic promised to escalate “if it got worse.” It did. Nothing changed. When I finally healed enough to walk, I was sent to see the same “Dr. Brooks.” He explained that jail policy prohibited pain medications. During that brief exam he found a bleeding mole on my back and wrote a referral for removal and biopsy—signing the paperwork as a physician. That document remains proof that he represented himself as a doctor without a license.
Not long afterward, a hard knot appeared where an abdominal injection had been given. EMT David A. Miller smirked and said, “Probably just where you keep sticking yourself with insulin.” At the time I had been filing repeated requests to stop insulin entirely. I’m a Type-2 diabetic and had never taken insulin before incarceration. From my first day in custody they forced it on me. During intake, Miller took my statement—later altered in the record I obtained through a FOIA request in September 2025—in which I told him clearly that I was Type-2 and controlled my condition through diet and pills and pills. He replied, “Everyone here takes insulin,” checked my blood sugar, and injected me with R insulin. It became routine.
Soon after, my right leg and foot swelled to twice their normal size. I waited nearly ten days, filing requests daily, before anyone examined me. When I finally saw “Dr. Brooks,” he diagnosed cellulitis and prescribed ten days of heavy antibiotics. The swelling and fever eventually subsided, but new symptoms appeared: a dime-sized blind spot in my vision and a burning, stinging sensation across the entire right side of my body—nerve damage that felt like constant bee stings. I submitted more medical requests and finally met with Brooks again. By then I understood that I had a potential medical claim. My family began researching his credentials; at first they couldn’t believe the level of cruelty I described. Months later they confirmed through the Texas Medical Board that he held no medical license.
Brooks prescribed 300 mg of gabapentin for the nerve pain. It helped briefly, until staff began delaying the doses, stretching intervals up to eight hours. The pain returned in waves. I submitted another request, asking for a double dose—600 mg three times daily regimen I still take today to dull the pain.
After my first release, I was re-arrested a month later on new allegations that voided my previous cash bond—the same tactic the county used in 2019 when false charges cost me $55,000 in legal fees and nearly two years away from my daughter before being dropped. Those maneuvers kept me confined while my health collapsed. Even after partial blindness and kidney failure, I was denied bond reduction and a medical writ. In Court 255, Judge Sarah Mathews said she would speak with Chief Kathleen A. Pokluda about transportation to outside appointments. My family later learned the request had been denied.
The neglect intensified after staff realized Brooks’s license status had been exposed. EMT Rachael C. Lentz withheld my medication for more than nineteen hours, leaving me in extreme pain. When I confronted her, she laughed. Public records show that Lentz does not hold a jailer’s license—only a peace-officer certification—which raises a serious question about whether the “EMS” patches on these uniforms correspond to valid medical credentials. My open-records requests to verify those licenses were diverted by the Williamson County Sheriff’s Office to the Texas Attorney General for review. I filed a written rebuttal, and I am still waiting for a determination.
I wasn’t the only one who suffered. One inmate with epilepsy pleaded for three days to receive his seizure medication; staff told him to “hydrate.” He collapsed in the shower before anyone responded. Another man diagnosed with schizophrenia was handed the wrong medication and spent a week in isolation screaming that the walls were moving. I can testify that what he described wasn’t entirely delusion—the walls and floors in Southside do vibrate. The stress fractures running through the concrete in every cell I occupied—five in total—prove that constant mechanical tremor is part of the environment. Each of these incidents, mine included, traces back to the same foundation: a medical system run on part-time labor, unlicensed authority, and a complete lack of oversight.
Pokluda herself is listed as Chief of the jail’s medical division and previously worked for the Texas Commission on Jail Standards. Her dual role raises legitimate concern about influence over the inspection reports that continue to clear the facility despite documented abuse. The corruption in Williamson County does not end at its borders—it bleeds through state agencies meant to regulate it.
E. Oversight on Paper Only
The county loves paperwork. Every complaint triggers a form; every form disappears into a digital abyss. When I filed grievances about unlicensed staff, the responses always read the same: “Unsubstantiated” That phrase became a shield—an admission and a denial in one. As long as someone, somewhere, had a contract, they claimed compliance. The fact that the contract guaranteed only a few hours of real medical presence didn’t matter.
I wrote letters to the Texas Medical Board, to the Texas Commission on Jail Standards, to anyone who would listen. Most went unanswered, but the act of writing became survival. Each line was proof that I had noticed, that I hadn’t accepted their silence as normal.
Inside, neglect becomes the background noise of your existence. You learn to time your symptoms to the shift schedule, to beg for the day when the “real doctor” might show up. Some inmates mark the psychiatrist’s hours on their walls like holy days. Most never see him at all.
F. The Design’s Logical End
What happens when you build a medical system around absence? People stop expecting help. Guards learn that pain is just another discipline tool. Mid-level staff start believing they’re doctors because no one above them corrects them. The county saves a few thousand dollars a month, and the inmates lose years of their lives.
That’s how I became blind and disabled—not from a single act of violence, but from the slow erosion of care. My nerves deteriorated, my balance shifted, and my sleep patterns collapsed after nearly a year in solitary without treatment. The county calls it “budget management.” I call it a crime hidden in plain sight.
SECTION III — THE HUMAN COST
By the time I realized what was happening to my body, it was already too late.
Neglect doesn’t arrive as a single event; it seeps in. It begins with the small things that nobody outside would believe—missed doses, wrong labels, a cuff that never comes off until the blood drains from your hands. You tell yourself that tomorrow will be different. It isn’t.
A. Physical Breakdown
After months of erratic medication, my nervous system started to short-circuit. I’d wake up with numb fingers and burning calves, sometimes unable to stand for the morning chow. The medics called it “circulation issues.” I called it what it was—sadistic torture.
They gave me two ibuprofen a day and told me to drink water. When the pain spread to my spine and left leg, I begged to see a specialist. The EMS Medical Technician nodded, wrote something on a chart, and said, “We’ll get you approved.” The approval never came.
My eyesight blurred in March 2025. The world inside that cell turned into a smear of gray and shadow. I pressed the intercom. No one answered. For three weeks I saw the world through fog. The only medical attention I received was a flashlight in the eyes and a guard’s joke about “detoxing.”
Each of those moments stacked like bricks in the wall of permanent injury. By the time I was released, my balance was gone, my hands shook, and simple things—reading, writing, climbing stairs—had become a daily struggle. The doctors who examined me afterward used phrases like nerve degeneration and long-term trauma response. I use a simpler one: disability by neglect.
B. Life in Solitary
Solitary confinement has a way of teaching the body to die in slow motion. I spent 326 days there, in a cell no larger than a walk-in closet. The fluorescent lights burned twenty-four hours a day. The vent moaned like a machine that had forgotten how to stop. Human voices became rare enough that I started talking to the concrete.
Every sound inside that box is amplified—the shuffle of guards’ boots, the keys, the metal snap of the food slot. You start counting them to keep time. I could tell who was on shift by the rhythm of their steps. I could tell when someone new had joined the medical staff by the silence that followed their rounds; the veterans at least pretended to care.
Sleep was a rumor. They woke us at random for “wellness checks,” shining flashlights through the slot. My blood pressure spiked, my skin broke out, and the migraines became constant. When I tried to refuse medication until I saw a real doctor, they marked me as non-compliant. Non-compliance in Williamson County means punishment—no phone, no commissary, more time alone.
Over those months, my sense of time collapsed. The body keeps a clock the mind can’t ignore. Without daylight, it loses rhythm. My muscles atrophied, my joints froze. I used a towel tied to the bunk rail to stretch my arms so they wouldn’t lock up completely. Nobody offered physical therapy. Nobody even asked why I limped.
C. Psychological Erosion
When you strip away light, movement, and touch, the mind begins to consume itself. The first casualty is trust. I stopped believing anyone would help me; then I stopped believing I was worth helping. Depression ceased to be an emotion—it became gravity, pulling every thought downward.
They called it administrative segregation. I call it psychological warfare. Each day was a reminder that the medical door stayed locked unless a sergeant decided otherwise. I watched men slam their heads against concrete just to feel something other than silence. I understood the impulse.
After a while, sanity becomes something you measure in inches, not miles. I built my own mantra—raw, defiant, necessary: “I don’t fucking lose.” I recited it every morning, sometimes just to hear a human voice. That sentence became the thin thread that tethered me to myself. One day I managed to write three complete sentences in my notebook without my hand shaking. Another day I slept four uninterrupted hours. Those moments were victories—small, almost invisible—but in that place, survival is measured exactly that way.
D. The Moment I Broke
The day I finally understood that I was blind and disabled came not in jail but in the parking lot after my release. I stepped out of the car and nearly collapsed. The sunlight felt like fire. My right leg refused to hold my weight, and my vision tilted sideways. The nurse from the intake had said I’d “get used to freedom again.” What she meant was, you’ll learn to live broken.
Freedom without function isn’t freedom. It’s evidence.
E. The Wider Toll
I wasn’t the only one. Men I knew inside—Anthony, Jaleel, Miguel—left that jail in worse shape than they entered. One died from untreated infection three weeks after release. Another was re-arrested after a psychotic break that began when his medication regimen changed three times in a month. The county never tracked those outcomes; they only track budgets.
Each of us became data points in a silent epidemic: medical damage as a cost-saving measure. For the administrators, it worked. For the rest of us, it became a lifetime sentence written in pain.
This is what I mean when I say the human cost. It isn’t just what they did—it’s what they refused to do. It’s the absence of care that carved itself into my body, one missed dose at a time.
SECTION IV — LEGAL AND ETHICAL ANALYSIS
When I finally began piecing together what had been done to me, I realized the cruelty wasn’t just personal—it was structural. What happened inside that jail wasn’t an accident; it was a violation of law that the county normalized by repetition.
A. The Constitution They Forgot
The Eighth Amendment forbids cruel and unusual punishment. The Fourteenth promises due process before punishment can even begin. Those two lines of the Constitution are supposed to protect people like me—people who have not been convicted of a crime. In Williamson County, those protections never made it past the booking desk.
In 1976, the U.S. Supreme Court decided Estelle v. Gamble. The case involved a Texas prisoner who, like me, was denied proper medical treatment. The Court held that “deliberate indifference to serious medical needs of prisoners” violates the Eighth Amendment. I read that line in the law library months later and laughed out loud, because in my experience “deliberate indifference” was county policy.
When a jail knows an inmate is suffering, knows the treatment is inadequate, and continues to do nothing, that’s not neglect—it’s calculated disregard. And when it happens to a person still presumed innocent, it crosses from cruelty into unconstitutional punishment under Kingsley v. Hendrickson (2015), where the Supreme Court ruled that pre-trial detainees must be treated according to an “objective reasonableness” standard. Williamson County failed that test every single day I was there.
B. Texas Law and Medical Practice
Texas law is equally clear. The Occupations Code §157 states that only a licensed physician may delegate prescriptive authority, and even then, the delegation requires a written protocol, supervision, and oversight. The county’s own contracts confirm there was no full-time physician overseeing medication management. That means hundreds of psychotropic and medical prescriptions were written or continued by people who, legally, had no right to do so.
Under Texas Health and Safety Code Chapters 571–578, county jails must ensure that inmates with mental illness receive appropriate psychiatric care from licensed professionals. They must also ensure that no person is forcibly medicated without due process. Williamson County filed numerous “Orders to Administer Psychoactive Medications” during 2023–2025, showing that involuntary treatment was common. But there’s no record of who prescribed those medications or whether the prescriber even held a valid Texas license.
That’s the legal equivalent of performing surgery without a scalpel or license—it’s malpractice built into the schedule.
C. Federal Oversight and CRIPA
The federal government has a mechanism for situations like this: the Civil Rights of Institutionalized Persons Act (CRIPA), codified at 34 U.S.C. §12601. It authorizes the Department of Justice to investigate systemic civil rights violations in jails and prisons. The DOJ’s Civil Rights Division has used it to expose abuses in places like Alabama, Mississippi, and Arizona. Yet somehow, despite lawsuits, deaths, and a documented pattern of medical neglect, Williamson County keeps operating under the radar.
Maybe that’s because they learned how to hide behind contracts. The intergovernmental agreements that fund county jails—especially those that house federal detainees—blur accountability. When things go wrong, the county blames the contractor, the contractor blames the county, and the patient disappears into paperwork. Dual sovereignty becomes dual denial.
D. Ethics in Name Only
The American Medical Association’s Code of Medical Ethics states that physicians have a duty to “regard responsibility to the patient as paramount” and that doctors working in correctional facilities must “provide the same standard of care as in the community.” On paper, every one of those words is beautiful. Inside the jail, they’re meaningless.
When someone like “Dr. Brooks” presents himself as a doctor without a license, he not only violates state law—he violates the entire ethical foundation of medicine. When the county knowingly contracts psychiatrists for sixteen hours a week to oversee hundreds of patients, it breaks the first commandment of care: Do no harm.
The harm in Williamson County wasn’t theoretical. It was measured in paralysis, vision loss, psychosis, and death. It was measured in 326 days of isolation where the only consistent medical treatment was silence.
E. Accountability Evasion
Every oversight agency I contacted had a reason to pass the file along. The Texas Medical Board said it had “limited jurisdiction over county facilities.” The Texas Commission on Jail Standards said it could “only ensure compliance with operational plans.” The Department of State Health Services referred me to the sheriff’s office, which sent me back to the jail administrator.
This bureaucratic merry-go-round isn’t inefficiency—it’s insulation. Each office is designed to deflect responsibility long enough for the story to fade. That’s why lawsuits like Tijerina v. Williamson County settle quietly for $1.15 million instead of ever reaching trial. Settlements buy silence; they don’t buy justice.
F. When Neglect Becomes Policy
What I experienced and documented fits every element of a constitutional violation:
- Serious medical need – confirmed nerve damage, vision impairment, and chronic pain.
- Knowledge by officials – repeated grievances, requests, and written medical orders.
- Failure to act – months without treatment, improper delegation to unlicensed staff.
That’s the textbook definition of “deliberate indifference.” It’s not an allegation; it’s a lived reality.
Ethically, it also qualifies as what human rights scholars call administrative torture: the use of bureaucratic processes to inflict sustained physical or psychological suffering without leaving visible scars. Solitary confinement, sleep deprivation, medical neglect—they all serve the same purpose: to break a person while maintaining plausible deniability.
G. Why It Matters
People assume jail abuse happens somewhere else—to the violent, to the guilty, to the forgotten. But the truth is that most of the men and women suffering inside are legally innocent, waiting for trial. In Texas, more than sixty percent of county jail deaths in 2024–2025 occurred among pre-trial detainees. Many of those deaths trace back to medical neglect and untreated conditions.
My story isn’t an exception; it’s a warning. When a local government decides that medicine is optional and oversight is too expensive, the Constitution becomes a suggestion instead of a guarantee.
The law calls it deliberate indifference. I call it slow-motion murder by paperwork.
SECTION V — STRUCTURAL CAUSES AND PROPOSED REFORMS
When I step back from the personal pain and look at the larger system, the pattern is obvious. Williamson County’s medical abuse wasn’t the product of one corrupt doctor or a single lazy nurse. It was built into the structure—written into contracts, budgets, and a culture that values liability protection over human life.
A. The Money Machine
Every contract the county signs starts with the same line: “Services shall be provided as needed.”
Those three words have become the county’s business model. They allow administrators to claim compliance while cutting costs. A psychiatrist on paper satisfies the Texas Commission on Jail Standards; whether that doctor ever shows up doesn’t matter as long as there’s an invoice.
For the county, that arrangement means savings. For inmates, it means medical roulette. The human body doesn’t operate “as needed.” It operates constantly. Diabetes, hypertension, infection—they don’t wait for a sixteen-hour-a-week contractor.
The counties call this “fiscal responsibility.” What it really is, is calculated neglect disguised as efficiency.
B. How Dual Sovereignty Hides the Blame
Williamson County doesn’t stand alone. Its contracts tie directly into a national web of intergovernmental agreements—IGSAs—that let counties lease jail beds to the U.S. Marshals Service, ICE, and other agencies. Those deals bring in millions, but they also blur accountability. When a federal detainee dies in county custody, the county blames Washington; Washington blames the county.
I call it the double-mirror effect of dual sovereignty: every reflection sends the blame somewhere else until the victim disappears in the glass.
This same framework protects the medical side. If a contractor commits malpractice, the county says it wasn’t their employee. If the contractor claims the county underfunded staffing, the county points to the budget approved by federal reimbursement formulas. In the end, nobody is responsible, and the suffering continues.
C. Culture of Control
Neglect isn’t always about indifference; sometimes it’s about dominance. In jail, withholding care becomes a form of control. They know pain changes behavior. When you beg for insulin or antibiotics, you learn humility. When you sign grievance after grievance that never leaves the building, you learn hopelessness. That psychological conditioning keeps the population docile without ever raising a baton.
I saw it happen to men who used to fight every injustice. After weeks of being denied meds or forced into restraint chairs, they stopped complaining. That silence is the real currency of the system.
The First Conversation with Sergeant Young and the Birth of the HVT File
Fifteen minutes after I was booked into the Williamson County Jail I asked Sergeant Bruce E. Young Jr. for protective custody. I wanted a secure cell until I could understand the situation. He looked at me and said, “That’s usually reserved for judges and celebrities. We don’t have the staff to support that.” Then he added, “You’ll be placed with people like you.”
That phrase stopped me cold. People like me? He had not reviewed a file, had not asked a question, yet he already knew something about who I was and where I would be housed. That was my first signal that I had been pre-classified—a High-Value Target in a system that profiles detainees before the booking ink is dry.
Two weeks later I learned how the classification worked. Every inmate was issued a badge containing a small RFID tag. The meal carts were positioned close enough for the sensors to register each badge as the cameras captured the face above it. During the first weeks—what they called “suicide watch”—inmates were left unshaven so the recognition software could record facial-hair growth and refine its match. Once the algorithm had learned a person’s features, the officers quietly told him he no longer needed to carry the badge. That was the sign that the system could now identify him without it.
When I later checked the kiosk, the reason for denying protective custody read: “No civil-rights violation—see Dr. Kahn to be removed from observation.” I then discovered that Dr. Ghulam Kahn had placed me on suicide watch from the day of intake. ISFs—Inmate Service Facilitators—told me that everyone started that way. It wasn’t for safety; it was for calibration.
The pod held twenty-four cameras, including in the showers. As the RFID and video data accumulated, the system built a behavioral profile that could be cross-referenced with NCIC and TCIC databases. The classification process blended surveillance with investigation, turning inmates into research subjects whose movements, expressions, and interactions were measured against federal intelligence templates.
From September 13 through December 13, 2024, I was confined to cell B9-R1, a non-ADA-compliant unit despite my medical limitations. The bunk sat nearly five feet off the floor; even-numbered cells had lower beds, but I was repeatedly assigned to elevated ones. Inside those cells, the floors and walls vibrated separately. A cup of water left on the ground rippled in concentric rings. I later learned that the Texas Commission on Jail Standards received forty-four complaints about those vibrations in 2024 and dismissed them as “unsubstantiated.” Anyone inspecting B8-R1, B5-L6, B7-R6, C14-R8, or the third- and fourth-floor dayrooms can still see the stress fractures at the slab edges—evidence that something within the structure moves.
That conversation with Sergeant Young was not an introduction; it was a designation. From that moment forward, every placement, every “mental-health” review, and every denial of medical access followed the same coded logic designed for surveillance, not safety.
D. Oversight That Isn’t
On paper, Texas has watchdogs—the TCJS, the Medical Board, the State Auditor. In practice, each one operates with limited jurisdiction and limited courage. Inspections are announced weeks in advance. Jail administrators clean up records, temporarily fix violations, and pass the audit. Once the inspectors leave, everything reverts.
Complaints are funneled through internal channels that report back to the very people accused. The phrase “found to be within policy” has become a ritual absolution. It doesn’t mean nothing happened; it means the paperwork was consistent with neglect.
E. The Human Economics of Disability
By the time I left, I was a statistic—a blind and disabled man with nerve damage, vision loss, and chronic pain. Outside, the county spent thousands on lawyers to defend the system that caused it. Inside, the cost of one full-time licensed doctor would have been less than a single settlement payout.
That’s the paradox of cruelty disguised as thrift: it saves money only until someone survives long enough to tell the truth.
F. What Needs to Change
- Mandatory Full-Time Medical Coverage
Any facility housing more than 300 inmates should be required by law to maintain at least one licensed physician and one psychiatrist on site or on call twenty-four hours a day, seven days a week. Contracts that specify “as-needed” hours should be deemed non-compliant. - Transparent Licensing Verification
Counties must publicly list the license numbers and disciplinary history of every medical professional practicing inside their jails. No inmate should have to guess whether the person holding the syringe is a real doctor. - Independent Oversight Boards
Create regional medical-oversight boards made up of physicians, former inmates, and civil-rights attorneys with authority to inspect unannounced and publish findings directly to the public. - Whistleblower and Inmate Protection
Guarantee confidentiality and protection from retaliation for staff or inmates who report medical misconduct. Fear keeps abuse alive. - Data Accountability
Require every county to report medical incidents, medication errors, and deaths in custody within seventy-two hours to both state and federal databases. Transparency is the only antidote to systemic denial. - Rehabilitation for the Harmed
Establish a state-funded compensation program for individuals blind and disabled by verified jail medical negligence. Survival shouldn’t mean living as evidence without remedy.
G. My Personal Resolution
People sometimes ask me why I keep writing about this instead of just moving on. The answer is simple: moving on would mean accepting that what happened to me was normal. It isn’t. Normal doesn’t leave a man half-blind and crippled from preventable injuries. Normal doesn’t inject vaccines without consent or let unlicensed people play doctor.
I write because silence would make me complicit. I write because somewhere in that jail tonight another man is pressing the intercom and getting no answer. Maybe he’ll live. Maybe he won’t. But if this paper reaches one investigator, one lawmaker, or one citizen who still believes in accountability, then the suffering wasn’t completely wasted.
H. Closing Reflection
Williamson County Jail taught me how fragile rights become when nobody’s watching. The Constitution may promise protection, but inside those walls, promises mean nothing without enforcement.
I’m blind and disabled today not because of an accident, but because a system found it cheaper to neglect me than to treat me. My story is one among hundreds, and it will keep repeating until full-time medicine replaces part-time profit, until licensing replaces pretending, and until the people paid to heal remember that their first duty is to do no harm.
That’s what this paper is for: to turn suffering into evidence, and evidence into change.
LeRoy Nellis 
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