Exhibit J – Williamson County Jail Medical & Psychiatric Staffing Record and Outcome Analysis (2008 – 2025)

Prepared by LeRoy Nellis | October 2025

This WilCo jail staffing 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).

See related records on the Williamson County index page and official reporting from the Texas Attorney General custodial death database.

II. WilCo Jail Staffing Ledger (2008 – 2025)

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 + benefits — $23.74/hr — 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 — Williamson Co Recovery Plan (2025)

2024 FY 22–25 — Dr. Ghulam M. Khan – Psychiatric Provider — Commissioners Court Professional Services Agreement — Contract — Not listed — Licensed Psychiatrist — County record PDF

2025 Sep 19 — Part-Time Psychiatrist — GreenLife Healthcare Staffing — Part-time / ~16 hrs/wk — $110 – $135/hr — Prescriptive Authority — Get.it · ZipRecruiter

2025 Oct — Psychiatrist Physician Ref # BD-649-01 — Adelphi Medical Staffing LLC — Contract (4 yrs min 16 hrs/wk) — $250 – $285/hr — Prescriptive Authority — DocCafe listing · ZipRecruiter

III. Patterns & Key Findings

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.
Prescribing Authority: Psychotropics formally restricted to psychiatrists, but intermittent presence means mid-levels and corrections staff often execute orders.
Pay Evolution: 2008 – $85/hr → 2025 – $250–$285/hr (tripled).
Inspection Context: 2019 TCJS inspection found failure to complete physician-ordered specialist referrals.
Transparency: No public record confirms 24-hour licensed physician coverage at any time between 2008–2025.

IV. Chronological Event Timeline

2008 – Initial psychiatric contract
2018 – Transition to internal non-licensed roles
2019 – TCJS inspection deficiency
2022 – NP coverage expanded
2023 – Increase in complaints and deaths
2024 – Wrongful-death settlement
2025 – Continued recruitment and vacancy

V. Outcome Correlation

2018–2019: Minimal staff → TCJS deficiency
2020–2021: Intermittent coverage → medication complaints
2022: NP expansion → temporary stabilization
2023: Psychiatrist vacancy → increased incidents
2024: Settlement confirms risk
2025: Continued staffing gaps → ongoing claims

VI. Legal and Policy Interpretation

Failure to maintain coverage impacts constitutional protections
Non-compliance with Texas Administrative Code provisions
Federal contract obligations may trigger dual liability
Long-term pattern supports review under DOJ standards

VII. Conclusion

Williamson County Jail has operated for nearly two decades without continuous licensed medical oversight. Part-time psychiatric contracts and mid-level substitution remain standard practice. Inspection deficiencies, settlements, and ongoing recruitment gaps indicate foreseeable operational risk.

Williamson County Jail Staffing Analysis (2008–2025)