MEDICAL & PSYCHIATRIC STAFFING RECORD AND OUTCOME ANALYSIS

(2008 – 2025)

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🩺  WILLIAMSON COUNTY JAIL

MEDICAL & PSYCHIATRIC STAFFING RECORD AND OUTCOME ANALYSIS

(2008 – 2025)

By LeRoy Nellis II | Prepared October 2025

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I.  OVERVIEW

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This record documents seventeen years of medical and psychiatric

staffing within the Williamson County Jail (Georgetown, Texas),

showing persistent reliance on part-time contractors and mid-level

providers rather than full-time licensed physicians.

The pattern demonstrates structural non-compliance with

Texas Administrative Code § 273.2 (24-hour physician availability)

and supports findings of deliberate indifference under

*Estelle v. Gamble* (1976) and *Farmer v. Brennan* (1994).

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II.  STAFFING LEDGER (2008 – 2025)

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Year | Position / Provider | Employer / Contract | Hours | Pay Rate | Prescribing Authority | Source / Notes

—–|———————-|——————–|——–|———–|———-

2008 | Dr. Michael Musgrove, Psychiatrist | Williamson Co – Professional Services | ≤ 20 hrs wk | $85 /hr | ✅ Licensed MD | Public contract PDF  

2018 Sep 17 | Medic – Jail | Williamson Co Sheriff’s Office | FT 40 hrs | $18.83 /hr | ❌ None | GovJobs archive  

2019 Mar 13 | Corrections Medical Officer | Williamson Co Sheriff’s Office | FT 40 hrs | $23.74 /hr + benefits | ❌ None | GovJobs listing  

2022 Aug | Nurse Practitioner – Jail Medical Unit | Williamson Co Sheriff’s Office (ARPA funded) | FT 7-day coverage | ≈ $95 k–$110 k annual | ⚠️ Mid-level only (under MD supervision) | Williamson Co Recovery Plan (2025)  

2024 FY 22–25 | Dr. Ghulam M. Khan – Psychiatric Provider | Commissioners Court Professional Services Agreement | Contract | Not listed ( $ / hr basis ) | ✅ Licensed Psychiatrist | County record PDF  

2025 Sep 19 | Part-Time Psychiatrist | GreenLife Healthcare Staffing (Contractor for WilCo Jail) | Part-time / as needed (~16 hrs wk) | $110 – $135 /hr | ✅ Prescriptive Authority | Get.it · ZipRecruiter  

2025 Oct | Psychiatrist Physician Ref # BD-649-01 | Adelphi Medical Staffing LLC (for WilCo Jail) | Contract (4 yrs min 16 hrs wk) | $250 – $285 /hr | ✅ Explicit (“Prescribe per Sheriff’s formulary”) | DocCafe listing · ZipRecruiter  

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III. PATTERNS & KEY FINDINGS

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1️⃣ Coverage Model  

 • All psychiatric providers are contract-based, ≤ 20 hours per week.  

 • Day-to-day care handled by Nurse Practitioners and EMTs without continuous MD oversight.  

2️⃣ Prescribing Authority  

 • Psychotropics formally restricted to psychiatrists, but intermittent presence means mid-levels and corrections staff often execute orders.  

3️⃣ Pay Evolution  

 • 2008 – $85/hr → 2025 – $250-$285/hr (Tripled).  

 • Reflects inflation and difficulty recruiting for chronic under-staffed facility.  

4️⃣ Inspection Context  

 • 2019 TCJS inspection found failure to complete physician-ordered specialist referrals (non-compliance TAC § 273.2).  

5️⃣ Transparency  

 • No public record confirms 24-hour licensed physician coverage at any time between 2008–2025.  

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IV. CHRONOLOGICAL EVENT TIMELINE (Annotated)

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2008 – Initial psychiatric contract (Dr. Musgrove, 20 hrs/wk).  

2018 – Transition to internal “Medic” and CMO positions without licensure.  

2019 – TCJS inspection cites failure to follow physician orders.  

2022 – ARPA funds expand NP coverage to 7 days/wk (acknowledging deficit).  

2023 – Spike in medical complaints and deaths; county approves temporary ARPA medical extensions.  

2024 – Johnny Tijerina wrongful-death settlement ($1.15 M, medical neglect).  

2024 – Dr. Khan contract renewed (FY 22–25).  

2025 Sep–Oct – GreenLife and Adelphi recruitment ads posted; psychiatric vacancy continues.  

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V. OUTCOME CORRELATION (Staffing vs Incidents)

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Year / Period | Staffing Condition | Documented Outcome / Event | Interpretation

————–|——————-|—————————–|—————-

2018–2019 | Minimal medical staff; no full-time psychiatrist | TCJS inspection deficiency | Non-compliance acknowledged by state.  

2020–2021 | Intermittent contract coverage | Multiple inmate grievances re: medications | Continuity of care failures emerge.  

2022 | NP 7-day coverage added | Temporary reduction in complaints but no psychiatric oversight increase | Short-term stabilization.  

2023 | Ongoing psychiatrist vacancy | Rise in medical neglect allegations and custodial deaths | Predictable under-coverage outcome.  

2024 | Khan contract renewal (FY22-25) | Johnny Tijerina death lawsuit → $1.15 M settlement | Confirms foreseeable harm from systemic neglect.  

2025 Q3–Q4 | Adelphi & GreenLife ads (16 hrs/wk coverage) | Persistent vacancy and medical injury claims (PIA #40621 evidence) | Deliberate indifference continuing.  

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VI. LEGAL AND POLICY INTERPRETATION

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• Constitutional Impact: Failure to maintain 24-hour medical coverage violates Eighth and Fourteenth Amendments (*Estelle*, *Kingsley*).  

• State Law Breach: Non-compliance with TAC § 273.2 and § 273.4 (physician availability and continuity of care).  

• Federal Contract Liability: Because the jail operates under an Intergovernmental Service Agreement with the U.S. Marshals Service, failures trigger dual sovereign liability under CRIPA (42 U.S.C. § 1997a).  

• Pattern-or-Practice Evidence: Chronological consistency (2008–2025) demonstrates deliberate policy of under-staffing, qualifying for pattern-or-practice review by DOJ Civil Rights Division.  

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VII. CONCLUSION

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Williamson County Jail has operated for nearly two decades without continuous licensed medical oversight.

Part-time psychiatric contracts and mid-level substitution have become a structural norm, not an exception.

Inspection deficiencies, wrongful-death settlements, and recurring recruitment ads prove foreseeable harm and administrative cover.

These findings support claims of systemic medical neglect and unlicensed practice under both Texas and federal law.

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Prepared for publication and official record submission.

© 2025 LeRoy Nellis II All Rights Reserved

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