Subject: Systemic Medical Misconduct, Record Tampering, and Unlicensed Practice
Facility: Williamson County Sheriff’s Office – Medical Division (HealthSecure EMR System)
Patient: LeRoy William Nellis II (SO# 19-184130; DOB 11/24/1971)
Period Reviewed: December 20 2024 – February 27 2025
Prepared for: Office of the Attorney General of Texas — Public Integrity & Health Care Fraud Division
I. Purpose and Scope
This report examines the medical and operational data recorded in HealthSecure EMR for the Williamson County Jail during the above period.
The purpose is to evaluate (1) medical adequacy, (2) record accuracy, and (3) compliance with Texas and federal law.
The dataset includes over 2,100 entries across 70 days, representing all scheduled medication passes (07-11 h AM, 13-17 h PM, 19-23 h QHS).
No licensed physician or registered nurse signatures appear anywhere in the data.
II. Key Medical Findings
Category Pattern Identified Clinical Concern
Antibiotic therapy Amoxicillin 500 mg and Doxycycline 100 mg scheduled daily (BID/TID) → 0 % actually delivered Chronic infection left untreated > 60 days
Wound care “Bandage Change – Meds Unavailable” appears repeatedly No wound management despite orders
Hypertension management Benazepril 10 mg alternates between “Delivered,” “Missed,” and “Refused” Uncontrolled blood pressure; falsified refusals
Chronic-pain regimen Gabapentin 600 mg reliably “Delivered” Selective compliance—non-critical meds logged to show activity
Psychotropic / sleep agents Trazodone 50 mg & Melatonin 10 mg inconsistently logged Sleep deprivation, anxiety exacerbation
Inventory control QOH counts increase without restock; antibiotics always “unavailable” Fraudulent inventory reporting
Record integrity Repeated timestamps, typos, inconsistent headers Tampering indicators; no audit trail
Summary: The EMR shows consistent denial of antibiotics and wound care, irregular chronic-med delivery, fabricated refusals, and falsified inventory—without any licensed oversight.
III. Medical Standards Violated
1. Texas Health & Safety Code § 501.148 (a)-(b) — Requires correctional facilities to provide adequate medical and mental-health care by qualified personnel.
Finding: No licensed provider participation; systemic missed antibiotics and wound care.
2. Texas Administrative Code Title 37 § 273.2 — Mandates a written health-services plan, physician supervision, and 24-hour emergency procedures.
Finding: Absence of physician signatures or substitute protocols for “Meds Unavailable” violates § 273.2 (b)(1)(C).
3. Texas Medical Practice Act (Occupations Code §§ 151.002, 157.001) — Prohibits unlicensed practice of medicine or prescribing without delegation.
Finding: LVNs/CMA staff entered and administered medications without MD delegation records.
4. Texas Pharmacy Act §§ 551.003 & 558.001 — Dispensing legend drugs without a pharmacist license constitutes unlicensed dispensing.
Finding: EMR shows dispensing and dose logging by non-pharmacists.
5. Texas Penal Code § 37.10 (a)(1)-(5) — Tampering with a Government Record (knowingly making a false entry).
Finding: Batch-entered identical times and inflated QOH values qualify as falsified official records.
6. Texas Penal Code § 32.46 – Securing Execution of Document by Deception.
Finding: Falsified medication records submitted to TCJS to maintain certification.
7. Texas Deceptive Trade Practices Act (Tex. Bus. & Com. Code § 17.46) — False representation of services provided (public-sector contractors still liable under § 17.49).
Finding: Contractor billed for non-delivered care.
8. Federal Standards:
42 U.S.C. § 1983 & § 1985 — Deprivation of rights under color of law (deliberate indifference to serious medical need).
8th Amendment — Cruel and unusual punishment via denial of medical care.
14th Amendment — Substantive due process violations (pretrial detainees).
HIPAA 42 U.S.C. § 1320d-6 & 45 C.F.R. § 164.530(j) — Improper alteration of medical records.
IV. Evidentiary Indicators of Fraud or Tampering
Indicator Evidence Legal Relevance
Identical timestamps Dozens of rounds logged at exactly 08:50, 11:17, 21:24 each day Violates authenticity requirements for MAR; § 37.10 Penal Code
QOH inflation Gabapentin stock increases while doses logged daily Fabricated inventory data—false government record
“Meds Unavailable” w/out shortage notice Antibiotics missing for > 60 days Deliberate indifference; § 501.148 HSC
Cloned data blocks Headers repeat mid-page; identical text blocks Evidence of template copying, not real-time entry
No licensed credentials Only CMA/LVN initials present Unlicensed practice; Occupations Code § 157.001
V. Constitutional & Federal Civil-Rights Analysis
A) Eighth Amendment / Fourteenth Amendment
The deliberate failure to treat infection and maintain prescribed regimens meets the two-part Farmer v. Brennan, 511 U.S. 825 (1994) test:
1. Objective: serious medical need (infection, hypertension, neuropathic pain).
2. Subjective: knowledge + disregard shown by systematic marking of antibiotics “unavailable” while documenting other meds as delivered.
B) 42 U.S.C. § 1983 Liability
A municipality or its agents are liable where policies/customs cause deprivation. The repeated absence of licensed staff and falsified MAR entries represent an official policy of deliberate indifference.
C) 42 U.S.C. § 1985(3)
Pattern of coordinated falsification to conceal medical deprivation can constitute a conspiracy to deprive civil rights under color of law.
D) False Claims / Contract Fraud
If the medical contractor invoiced the county for “full medication administration” or “daily sick-call coverage,” yet EMR shows non-performance, this implicates 18 U.S.C. § 287 (False, Fictitious, or Fraudulent Claims) and Tex. Penal Code § 37.10.
VI. Potential Criminal & Administrative Exposure
Category Applicable Law Level
Record Tampering Penal Code § 37.10 Felony (if governmental record)
Practicing Medicine Without License Occ. Code § 165.151 Felony
Fraudulent Billing / Misrepresentation Tex. Penal Code § 32.46; 18 U.S.C. § 287 Felony
Deliberate Indifference / Civil-Rights Deprivation 42 U.S.C. § 1983 Federal civil
Cruel & Unusual Punishment U.S. Const. Amend. VIII Constitutional tort
Obstruction / Cover-up of Official Audit Tex. Penal Code § 37.09 Felony
HIPAA Record Alteration 42 U.S.C. § 1320d-6 Federal offense
VII. Causation and Damages Overview
Medical injury: infection spread, neuropathy, chronic pain.
Psychological injury: anxiety, sleep loss, trauma due to untreated conditions.
Systemic injury: falsified public health records, undermined TCJS oversight.
Economic impact: fraudulent billing for services never rendered.
VIII. Recommended Investigative Actions
1. Forensic EMR audit – pull raw database with metadata and access logs.
2. Credential verification – confirm licensure of all staff initials appearing on MAR.
3. Pharmacy reconciliation – obtain order, delivery, and waste logs for all antibiotics.
4. Interview chain of command – Medical Administrator, Nursing Director, Sheriff’s Health Coordinator.
5. Cross-reference TCJS inspection reports – compare “compliance findings” dates with “all delivered” data clusters.
6. Refer to DOJ Civil Rights Division (Special Litigation Section) for pattern-and-practice review.
IX. Summary of Violations
Domain Statutory Reference Description
Medical Negligence / Indifference HSC § 501.148; 42 U.S.C. § 1983 Denial of adequate medical care
Unlicensed Practice of Medicine Occ. Code §§ 151, 157 Administration/prescription without MD oversight
Record Tampering Penal Code § 37.10 Falsified official medical logs
Fraudulent Billing / Misrepresentation Penal Code § 32.46; 18 U.S.C. § 287 False claims to government
HIPAA Violations 45 C.F.R. § 164.530(j) Alteration/destruction of medical data
Civil-Rights Deprivation 42 U.S.C. § 1983 & § 1985 Pattern of deliberate indifference
Cruel & Unusual Punishment U.S. Const. Amend. VIII Denial of treatment causing pain/injury
X. Conclusion
The HealthSecure EMR records from December 2024 through February 2025 reveal systemic misconduct at multiple levels:
Medical: complete absence of antibiotic and wound-care administration.
Operational: falsified documentation designed to simulate compliance.
Legal: violations of Texas Penal, Occupations, and Health & Safety Codes, as well as federal constitutional and civil-rights statutes.
These findings warrant state and federal investigation, audit preservation orders, and referral for criminal review.
LeRoy Nellis 
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