Unable to respond: Adam Howe's death raises questions about prisoner, mental health facilities
The death of Truro resident Adam Howe in a New Bedford jail cell as he faced a charge of murder raises questions about the safety net for individuals in the criminal justice system who have psychiatric needs — and what county officials could have done differently.
Howe, 34, was arrested in Truro after emergency workers responded to his mother's home around 9:30 p.m. on Sept. 30, according to the Cape and Islands District Attorney. The rescuers had been called to the property because of a request for a well-being check and a report of a fire.
At the property, the rescuers found Howe outside the house and something on fire on the lawn, which they determined was a human body. Howe was arrested and charged with murder. Evidence suggested the body was that of his 69-year-old mother, Susan Howe.
After his arrest, Adam Howe had difficulty breathing and was brought to Cape Cod Hospital, arriving around 12:30 a.m. on Oct. 1. He was examined and then shackled to a gurney and watched by hospital personnel "with eyes on him at all times," according to a statement from Cape and Islands District Attorney Michael O'Keefe in a statement.
After his release from the hospital, he was brought to Ash Street Jail in New Bedford, part of the Bristol County Jail and House of Correction system. Howe was found dead in his cell at 5:14 p.m. Oct. 2. In between officer rounds at the jail, Howe had clogged his airways with wet toilet paper and "suffered a medical emergency," a spokesperson for the Bristol County Sheriff's Office said in a statement.
The cause of Adam Howe's death is under investigation.
"There are big questions here, as to how the circumstances unfolded, and we need answers," state Sen. Julian Cyr, D-Truro, said. "This is a very tragic incident, and as a geographically isolated community, here at the Cape, we need to make sure that we can respond to all sorts of situations."
"It is clear that we were unable to respond this time," Cyr said.
On-call judge issues an order citing Section 12
Doctors at Cape Cod Hospital wanted Howe discharged as soon as a secure facility was identified to take him, according to O'Keefe.
After multiple efforts to locate an on-call judge, O'Keefe reached a judge at about 3 a.m. "I called at least four judges, and I finally got one who answered the phone," O'Keefe said in a phone interview.
The judge listened to O'Keefe and the doctor in charge of the Cape Cod Hospital Emergency Room, and ordered Howe to be involuntarily committed to Bridgewater State Hospital, a medium-security facility that provides psychiatric services operated by the state Department of Correction.
The order was issued citing Section 12, which relates to civil commitments, rather than Section 15, which allows defendants in criminal cases to be hospitalized at Bridgewater — for observation and evaluation — for up to 20 days.
A third option, or Section 18, covers those already detained in a correctional facility and in need of hospitalization for up to six months.
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"Only a jail superintendent can have someone committed under Section 18," O'Keefe said. "Since we were at a hospital, a doctor was able to provide the judge all of the criteria necessary for Section 12."
Under the circumstances, it was enough for the judge to issue a Section 12, which could have been changed into Section 15 after an arraignment or Section 18 after Howe was placed in jail, O'Keefe said.
"We transferred him to a jail so that a jail superintendent could move to have him committed (to Bridgewater) under Section 18," he said.
Bridgewater State Hospital refuses to take Howe
To place Howe in a jail or a secure psychiatric facility, O'Keefe briefed Bridgewater officials about the judge's order. But Bridgewater officials "refused to take Mr. Howe, saying they didn't take Section 12 commitments" and could only admit someone committed under Section 18, according to O'Keefe.
The Bridgewater facility provides clinical services by Wellpath LLC, a Tennessee-based company under contract with the state.
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"We kept asking if they can just take him so he can get the mental health services he needs," O'Keefe said. "They needed just to take him for three days, and then he could have been arraigned to court so that we could file for Section 15."
A frustrated O'Keefe said, "they just wouldn't take him."
Cyr, who is co-chair of the Joint Committee on Mental Health, Substance Use and Recovery, shared O'Keefe's dismay.
"We have a fine facility like Bridgewater State Hospital in Massachusetts, a secure psychiatric facility to essentially deal with very disturbed individuals involved in the criminal justice system," Cyr said. "The fact that they would rely on a technicality instead of finding a solution speaks to several issues that we have persistently seen at Bridgewater State Hospital."
Howe gets placed at Ash Street Jail in Bristol County
State police contacted several jails, including Barnstable County, but could not obtain admittance for Howe into any of them. Finally, Bristol County Sheriff's Department agreed to take him and place him in Ash Street Jail.
Both Howe's discharge summary from the hospital and the police report indicated "suicide ideation," according to O'Keefe's written account.
At the jail, Howe was placed on a security watch where a corrections officer "would visually check on him every 15 minutes." He was also clothed in a nylon rip-resistant smock, according to the Bristol County Sheriff's Office.
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The observation level taken by the Bristol County Sheriff's Office at Ash Street on Howe was inadequate, said James Pingeon, litigation director for the prisoner advocacy group Prisoners' Legal Services of Massachusetts.
"They put him on a 15-minute watch instead of a constant observation; this was clearly a judgment call they made, and it was obviously the wrong judgment call," Pingeon said.
But Bristol County Sheriff's Office spokesperson Jonathan Darling said otherwise.
Howe was "cleared by medical professionals and in terms of protocol, he was not 'required to be on a watch,'" Darling said
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"Due to the intensity of the charge he was facing, as it was a high profile case, our staff went out of their way to keep an eye on him," Darling said over the phone. "We didn't need to take any precautions at all, and yet we went above and beyond to place him on a 15-minutes watch."
In similar cases, Bristol County sends people to Bridgewater under Section 18 to get the inmate the proper mental health care services. In Howe's case, he should have been admitted to Bridgewater immediately after he got placed in the Ash Street jail, a delay which eventually cost him his life, Pingeon said.
Barnstable County Sheriff's Department's late response
The most logical choice for Howe, after Bridgewater refused to take him, would have been in jail under the Barnstable County Sheriff's department.
O'Keefe said they tried getting him into jail in Barnstable but "were unable to do so."
"I'm not sure if the state police got through to them, but we were all trying, and I didn't get an answer until 7:30 in the morning when we already found a jail that would take him," O'Keefe said.
Barnstable Sheriff James M. Cummings said over the phone he doesn't know why there was no response from the jail.
"I don't know what number they were calling, but there is always somebody at the correctional facility," he said. "Later, my superintendent spoke to somebody from the state police about six o'clock in the morning."
According to Cyr, who was briefed by the state police, the police did make contact with Barnstable, and they declined to take Howe, citing limited staffing.
Cummings noted that even if Barnstable did respond, his jail no longer operates a regional lockup facility, unlike Bristol County.
If they did, they wouldn't take somebody sick or suicidal because that causes "limited staffing issues," he said.
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Barnstable operated the regional lockup facility before the COVID-19 pandemic. But since the sheriff's office moved into a new facility, they no longer provide the regional service, said Cummings who is not running for reelection after 24 years on the job.
"We've been trying for years to get the regional lockup running again," he said, "but we are unable to get the legislature officials to come up with the necessary funding."
Cyr said he never heard from the sheriff's office about the budgetary constraints.
"There has been a long-standing dispute between the Legislature and the sheriff about resources and money," Cyr said, "but to my knowledge, there has been no conversation about this problem."
"It's alarming that the sheriff's office did not convey to us that they have these resources constrained," he said. "After such a tragic incident, I have questions about why this 24-hour state facility failed to serve our community."
If you need help
The National Suicide Prevention Lifeline is a hotline for individuals in crisis or for those looking to help someone else. To speak with a certified listener, call 988.
Crisis Text Line is a texting service for emotional crisis support. To speak with a trained listener, text HELLO to 741741. It is free, available 24/7, and confidential.
If you or someone you know is in crisis, you can also the Bay Cove Crisis Hotline at 1-833-229-2683. For more information about suicide prevention and how you can help, visit https://www.suicideispreventable.net/.
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This article originally appeared on Cape Cod Times: Adam Howe's death raises questions: prisoners, mental health care
