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Jails face unique challenges in providing health resources

A lack of space at regional treatment centers and difficulty in getting accurate medical information from inmates are among the biggest challenges to managing medical resources for jail inmates, according to the Saunders County Jail Administrator Brian Styskal.

Jails are also seeing an inmate population whose medical needs are growing, Styskal said. That includes more inmates struggling with substance abuse issues and an aging population.

As the Fremont Tribune has previously reported, Dodge County, which houses its inmates in the Saunders County Jail as part of a contractual agreement, has seen increased medical costs for inmates in each year since the 2013-2014 fiscal year, and has already surpassed its medical expense budget for the first time in a decade for the 2017-2018 fiscal year. Saunders County will likely surpass its expected expenses on inmate medical costs this year, too, Styskal said.

Officials in both Dodge and Saunders County have said that the monetary issues highlight the difficulties of predicting the annual health needs of jail inmates, which can vary in abundance and expense. In Dodge County, for instance, complications surrounding one inmate’s suicide accounted for a large portion of the expenses. And the Saunders County Jail saw three total in-custody deaths, one a suicide and two health-related, in 2017, after having seen only one other in-custody death since its opening in 2009.

But the expenses also raise questions about the resources available for jail inmates who may be struggling with medical, mental health or substance abuse issues, especially as those needs appear to be growing. In an interview with the Fremont Tribune, Styskal outlined the protocols, resources and challenges surrounding inmate medical care.

The Saunders County jail follows a thorough screening process before even accepting inmates, Styskal said. It’s a process that begins before individuals are transported from the Dodge County Jail, which serves as a temporary holding facility for Dodge County inmates, and is continued at the Saunders County facility in Wahoo.

Jail officials will ask inmates about immediate medical needs, history of suicidal ideation, substance use and a host of other issues. If there are concerns, the inmate will be sent to a hospital for a medical screening, where a physician will make a determination of whether that inmate can go to jail, or if another facility, like a treatment center, would be a better fit.

Once an inmate enters Saunders County, they can receive medical treatment from Saunders County’s contracted correctional medical authority, Advanced Correctional Health Care.

“It’s treating ‘needs’ versus ‘wants,’ where you’ll frequently have people that come to jail that have not taken care of their health on the outside, (such as) their dental needs, and they come to jail and they want everything done for them,” Styskal said. “It’s not a situation that was created here, so you have to sort through some of that stuff to see what is a need versus what is a want.”

Advanced has a licensed mental health practitioner who comes to the jail once a week for a three-hour block.

“At times I could use far more hours than that, but that’s just to get the people that need it the most some contact with someone who can figure out what’s going on with them, get them going the appropriate way,” Styskal said.

In cases where immediate assistance is needed, the jail has access to a group called TASC that can provide such mental health services.

Corrections staff members also go through onsite training, Styskal said, where they are taught to take note of differences in inmates’ behaviors—such as decreases in social activity—and whether there have been any dramatic changes in their lives.

“Jail standards require that they’re checked on once an hour; we check on them every 20 to 30 minutes,” he said. “If someone is on a special watch, it could be a 15-minute watch.”

In recent years, the inmate population has become increasingly imbued with a variety of mental health and substance abuse issues.

“Substance abuse and mental health issues, it’s really an epidemic that is faced in all jails,” Styskal said. “We’ve noticed a significant uptick in that through the past several years.”

In Nebraska, Styskal argues, the problem has been exacerbated by the closing of state-run treatment centers for adults and inmates in Nebraska, particularly at the Hastings Regional Center, which stopped serving adults in 2007. If jail screenings reveal serious mental health concerns, inmates might be sent to any of the state’s Regional Centers, or other treatment programs, instead of jail. Most of the Saunders County inmates get sent to Lincoln’s Regional Center, but since the Hastings services closed, space has gotten tighter, Styskal claims, which often lands inmates on long waiting lists.

“We have a huge lack of appropriate housing for people with mental health needs in this state,” he said. “Essentially, (jails) end up warehousing an inmate who it’s been determined that they’d be better off somewhere else but they can’t take them there.”

And jails have unique limitations when it comes to handling people with mental health issues, Styskal said. He believes that, while suicide rates are high in both prisons and jails, jail inmates are more susceptible. That’s because jail inmates are just entering the justice system at that point, and are not far removed from the traumatic experience of getting arrested or going through trial. Additionally, prisons, which house inmates for longer sentences, are equipped with more—albeit, still strained—mental health resources than shorter-term jails, Styskal said.

“You’re going to have full time mental health staff, you’re going to have psychiatrists, psychologists and things like that,” he said. “They’re full time staff there. Obviously they have more inmates, so it still isn’t the best ratio probably given what we’re dealing with nowadays.”

Gaylene Armstrong, the director of the school of Criminology and Criminal Justice at the University of Nebraska-Omaha, agreed that jails do face unique challenges in combating suicide and lack the full-time resources of prisons to handle them, though she added that “there’s definitely a lack of resources in prisons as well.” But individuals who are dealing with the initial shock of arrest or the transiency of jail are at greater risk of feeling unstable.

“They’re dynamic, people are in and out, some people are there for only a couple of days until they’re released prior to hearing, they don’t know what is going to be happening to them,” she said. “There’s not a consistent social culture among the inmates.”

Additionally, the average age of jail inmates has increased across the country, both Armstrong and Styskal said, and Styskal believes that creates additional health concerns and costs in Saunders County.

Among the biggest obstacles to giving inmates appropriate care in county jails is that inmates are often hesitant to accurately report their medical histories or issues during screening—especially if those issues include persistent substance abuse, Styskal said.

Those inmates may be afraid to reveal anything that could be used against them legally, he added.

Styskal added that corrections staff is not law enforcement and is not interested in gathering evidence.

“If we find drugs on them when we’re booking them in, that’s one thing,” he said. “You can tell me you’ve done this, but I don’t necessarily have proof that you did that anyway. But we need to know that information so we can come up with the most appropriate treatment and observation of them.”

Armstrong agreed that underreporting of medical and mental health issues is prevalent in jails generally—and that’s because of both mistrust in the legal system and a general hesitancy to share serious issues, she said.

“People who are involved in the criminal justice system, they have a tendency to have a distrust of the criminal justice system to begin with, and then they might not be clear on the law,” she said. “People in general have a tendency just to not want to report health issues, addiction issues, histories of victimization.”

Oliver Glass, the Dodge County Attorney, said that, while he could theoretically use any statements not protected by attorney-client privilege, he has never requested any information collected by corrections officers during intake.

“It’s not something I would request,” he said. “What we’re going to use during a case is spontaneous utterances during arrest, anything they said to a law enforcement officer once they were Mirandized, that kind of stuff.”

As for the three in-custody deaths that occurred last year, Styskal said that required grand jury investigations of all of them found no evidence of any wrongdoing. He said he was not authorized to speak about the specifics of the cases.

“Sometimes, regardless of your best efforts, unfortunate things happen, but it sure isn’t for lack of the staff and everyone trying to do the right thing,” he said.

Correction: An earlier of this version of this story mistakenly reported that there were three suicides at the Saunders County Jail in 2017. There were three in-custody deaths, one of which was a suicide, and two of which were caused by health-related issues. We regret the error.

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Comfort dog handlers talk about school shooting

The teacher would say God put a veil over her eyes.

To believe the active shooter situation was only a drill.

To help keep students calm.

And to get those students to safety as a gunman killed 17 people and injured 17 more on Valentine’s Day at Marjory Stoneman Douglas High School in Parkland, Florida.

Weeks after the shootings, Fremonters Dawn Gilfry, Deb Heuer and Paula Price were at the school with a golden retriever named Katie.

Students hadn’t yet come into the classroom when their English teacher saw the dog.

“She laid on the floor with Katie and cried and held onto Katie,” Heuer said.

The moment proved poignant as handlers saw the teacher let out her emotions — before she’d collect herself and face the students.

“It was a God moment,” Heuer said. “This is why we’re here. God has put us here for such a time as this. God uses Katie – bringing that love and comfort to others.”

Katie was one of 11 Lutheran Church Charities K-9 Comfort Dogs taken to Florida after one of the world’s deadliest school massacres. The specially trained dogs’ and handlers’ purpose was to help bring comfort to grieving students, faculty and staff.

It was far from a new situation for Katie.

Since Katie became part of the Trinity family in 2015, the dog and various local handlers have been deployed to at least seven out-of-state locations involving national news-making tragedies.

Among those were the Pulse Night Club shooting in Orlando and the Route 91 Country Music Festival in Las Vegas.

On Feb. 26, team members from Trinity Lutheran Church and School left with Katie and headed out again — this time to Parkland.

The handlers took Katie to a Walmart on Feb. 27 to get some items and ended up spending two hours there. They’d learn this was the Walmart where the confessed shooter, 19-year-old Nikolas Cruz, went after the massacre.

One shopper had been afraid to go to the store after that.

“Seeing your dog makes it OK,” she said.

Skies were still dark when the team went to the school early Feb. 28, the first day of classes since the shooting. Lights flashed from police cars that lined the streets and media were setting up open tents.

“It was so surreal to know this tragedy happened and we were there going into it,” said Gilfry, the Top Dog handler. “Anytime we get deployed, we never know what to expect. We just know we have a job to do and that’s to show up with Katie and bring comfort to every person we meet.”

That Wednesday, the team was assigned to a Spanish teacher who’d lost a student from one of her classes.

“She was the most loving, empathetic, caring teacher,” Gilfry said. “She would hug each student, look them in the eyes and say, ‘You are loved. You are safe and I’m happy that you are here.’”

Students, who came in sluggish, became excited to see the dog. Even a counselor assigned to the classroom got to have special time with Katie.

The appreciative students couldn’t believe volunteers would come all the way from Nebraska to bring them comfort.

Heuer helped with another comfort dog, Sasha, in a room where the teacher let students talk about what the day of the shooting was like for them. She assured them their feelings and their inability to sleep or concentrate was natural.

That Thursday, the team was assigned to the English teacher, who’d sat on the floor and cried with Katie.

The same teacher had guided students safely out of the school, unsuspectingly believing the situation was only a drill and that drama students were portraying victims on the floor.

Because she believed the situation was a drill — all but one of her students, who was in an ROTC program, believed that, too.

It wasn’t until the teacher and students were safely outside the building that she saw the drama instructor.

That’s when she realized it wasn’t a drill.

The teacher later told how she believes God helped her.

“God putting that veil over her eyes enabled her to keep her students calm and safe,” Price said. “God was just there.”

Team members learned the teacher couldn’t greet students on their first day back at class, because she was at the funeral of her mother-in-law for whom she’d been a caretaker.

But the teacher had time to cry and hold Katie before students filled the classroom.

School was dismissed early each day that week so team members spent time with counselors, administrators and first responders.

Teams also gathered with student tennis players on the school’s football field. It was a chance for the dogs to have playtime.

“With 10 dogs and 50 tennis players on the football field, we had a countdown to ‘go play,’” Gilfry said. “To release those dogs and to hear all those boys and girls tennis players laugh and giggle – it was the highlight of our week to hear that in a big group.

“They got to chase the dogs. They got to throw the tennis balls.”

The dogs ran and had fun along with the students.

“It was a little bit of doggy heaven,” Price said.

Team members spent Friday with the English teacher her students, who talked about emotions of anxiousness, anger, fear and weariness.

“I’m tired of crying. I just cannot cry anymore,” one girl said.

Team members saw memorials for each victim in a park on March 2 and returned home the next day.

Katie and her volunteer handlers will get more assignments to churches, schools, nursing homes and events to listen and offer comfort.

“Everybody has a story they want to tell,” Price said. “We’re just there to listen. We don’t pass judgement. Katie doesn’t tell any secrets and neither do we.”

Colin Larson / COLIN LARSON, Fremont Tribune  

Esthetician Rachel Chvatal recently relocated her business, Rejuvenate Day Spa, from West Omaha to Downtown Fremont. 

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Katie sent to sites of several tragedies

A golden retriever named Katie has gone to several locations where national news-making tragedies occurred.

Katie is a specially trained Lutheran Church Charities K-9 Comfort Dog.

In 2015, Katie became part of the family and staff at Trinity Lutheran Church in Fremont.

“The mission of Lutheran Church Charities and Katie the Comfort Dog is to share the mercy, compassion, presence and proclamation of Jesus Christ to all who are suffering and in need,” said Deb Heuer, one of the dog’s handlers.

Katie works more than 2,000 hours a year, said Dawn Gilfry, the Top Dog handler.

Trained volunteers take Katie to churches, schools, nursing homes, hospitals, community and service groups, events and disaster response situations.

There are 14 trained volunteer handlers and Katie has a total team of 18.

Dogs like Katie are seeing-heart K-9s of a sort — specially trained to interact with people of all ages in a host of different situations.

The dog helps bring a calming influence, which allows people to open up and receive help.

“It’s a proven fact that when you sit and spend time with a dog, your blood pressure and heart rate comes down and it relaxes you,” Gilfry said.

Since coming to Trinity, Katie has been taken to the several out-of-state sites, most of which involved tragedies that made national news. They include:


  • — Umpqua Community College, Roseburg, Oregon, after a horrific mass shooting left 10 people, including the gunman, dead.


  • — Stillwater, Oklahoma, where a woman who police say was intoxicated plowed into a crowd attending the Oklahoma State University homecoming parade. Four adults and a child were killed; 47 people were injured.


  • — St. James Lutheran Church and School in south-central Minnesota, where fire destroyed the sanctuary and damaged the school. No lives were lost.


  • — Missouri, where two high school students drowned during a senior trip.


  • — Newtown, Connecticut to a send-off for children who’d survived the 2012 shooting as first-graders at Sandy Hook Elementary School. The students were moving on to a new school the following year. Katie was not at Newtown right after the 2012 massacre, when a gunman fatally shot 20 children between 6 and 7 years old, as well as six adult staff members.


  • — Dallas, Texas, where a shooter killed five police officers and wounded nine others. Two civilians also were wounded.


  • — Orlando, Florida, where a gunman killed 49 people and wounded 58 others in a terrorist attack and hate crime inside the Pulse night club. Comfort Dog teams visited shooting victims, news media employees, hospital staff, police, firefighters, people from the medical examiners’ office and government leaders.


  • — Marysville, Kansas for the visitation and funeral of a father and son who died in a grain truck accident.


  • — Las Vegas, Nevada, where a gunman fired on a crowd of concert-goers in a rampage that left 59 people dead and more than 500 injured.


  • — Parkland, Florida, where a gunman killed 17 people and injured 17 more in a school shooting.

Katie has been taken to places where students died in accidents or from suicide.

There is no charge to have Katie come to a location, but the dog must be invited to go to a location.

“We only go where she is invited,” Gilfry said.

More information about Katie is available at 402-721-5536 or the Facebook page @KatieComfortDog or Twitter or email at