ALBANY COUNTY — Adam Rappaport’s suicide last month in the Albany County jail embodies two nationwide problems for inmates today — drug addiction and self-harm.

Rappaport was addicted to heroin, said his mother, and, in the past, has talked about suicide.

Christian Clark, who has been the superintendent of the Albany County Correctional Facility for a year and a half, said that, in the last year, he has seen a marked increase in the use of heroin. “It’s inexpensive and a lot of people are turning to it,” he said. “We are seeing an increase of folks who are coming in with heroin dependency or charges with selling or using heroin.”

“Unfortunately, heroin is a very big problem in our region,” said Chief Deputy Michael Monteleone with the Albany County Sheriff’s Office, answering questions in the absence of Sheriff Craig Apple, who is away until Nov. 17.

Monteleone noted recent large-scale arrests of heroin dealers and said, “It’s something we see fairly commonly at the jail because of crimes being committed for heroin addiction or actually selling of heroin.”

Adam Rappaport’s mother believes the reason he attempted the Guilderland burglaries for which he was jailed, preceding trial, was his addiction.

He is not alone.

“Substance use disorders are highly prevalent among inmate populations, affecting an estimated 30 to 60 percent of inmates,” according to a February 2014 report by the Federal Bureau of Prisons on detoxification of chemically dependent inmates.

“The Bureau of Justice Statistics reports that an estimated 70 percent of all inmates in local jail facilities in the U.S. had committed a drug offense or used drugs regularly, an estimated 35 percent were under the influence of drugs at the time of the offense,” the 2014 report goes on.

The Albany County jail offers methadone treatment for heroin addicts but the problem isn’t solved just by giving them methadone in jail. The facility has about 800 inmates at any given time and, Clark said, nearly 7,000 over the past year.

Because the average stay in the county jail is 30 days, Clark said, the facility’s staff has no way of tracking inmates’ long-term health.

“They could be here on the methadone and then released back out on the street so its very difficult to track because of our population,” Clark said. “It’s not like a state prison where, once you’re in, you’re in for a set amount of time. A lot of these folks come in on a charge and then they’re bailed out or released by the court where we won’t see them again until they come back — whatever. We have a lot of folks that come in and out of here a lot.”

This can be disheartening, he said.

The 2014 Federal Bureau of Prisons report also says, “The frequency of suicide attempt is substantially higher among patients with a substance use disorder. Frequent and thorough patient assessments are indicated during the withdrawal period with particular attention to thoughts of self-harm.” It advises that opiate detoxification, such as from heroin, can be completed safely in less than two weeks.

The rate of suicides in jails is almost three times the rate in prisons, according to the Suicide Prevention Resource Center’s guide for correctional officers.

Asked why this would be, Clark said, “This is just my opinion: You have an individual coming off the street where an individual going to state prison has had time to think about what they’re going to be doing for the rest of their lives. They’ve come to accept maybe why they’re going to prison. And I think, when you’re arrested and thrown into the county jail, it’s got to be a shock to some people’s systems. I can’t imagine what goes through somebody’s head but, again, 7,000 people in the last 12 months....”

Inmate suicide is not just a national problem but a problem worldwide. A 2007 report by the World Health Organization, “Preventing Suicide in Jails and Prisons,” states, “Jails and prisons are repositories for vulnerable groups that are traditionally among the highest risk for suicide, such as young males, persons with mental disorders, socially disenfranchised, socially isolated, people with substance use problems, and those who have previously enacted suicidal behaviours.”

The report goes on, “The psychological impact of arrest and incarceration, drug addicts’ symptoms of withdrawal, an expected long prison sentence or the day-to-day stresses associated with prison life may exceed the coping skills of the average prisoner, let alone the more vulnerable individuals.”

The profile of pre-trial inmates who commit suicide in custody, detailed in the World Health Organization report, fits 29-year-old Adam Rappaport: male, young, unmarried, and first-time offenders who have been arrested for minor, usually substance-related offenses.

“They are typically intoxicated at the time of their arrest and commit suicide at an early stage of their confinement...because of sudden isolation, shock of imprisonment, lack of information, insecurity about the future,” the report says.

The report recommends “paying attention to reception and first night procedures, induction processes, and levels of care for prisoners.” It recommends correctional facilities have a comprehensive suicide prevention policy, train their staff, screen for suicide upon entrance, continue to monitor, and not house suicidal inmates in single cells.

“The majority of suicides in correctional settings occur when an inmate is isolated from staff and fellow inmates,” the report says, stating that some facilities successfully use “specially trained inmate ‘buddies’ or ‘listeners.’”

The World Health Organization report also says that communication is key in preventing suicides — between the arresting officer and correctional staff, among facility staff, and between staff and the inmate. “In many ways, suicide prevention begins at the point of arrest,” the report says.

The National Institute of Corrections worked with the National Center on Institutions and Alternatives to study suicides in jails and prisons and determined that the 2006 suicide rate in detention facilities was 36 deaths per 100,000 inmates, which is about three times greater than in the general population. The rate, though, was a dramatic three-fold decrease from 20 years ago — in 1986, for every 100,000 inmates, 107 suicides were reported.

The report attributes this to national correctional standards that now require comprehensive suicide prevention programming, better training for jail staff, and more in-depth inquiry of suicide risk factors during the intake process. In 2013, in New York State, there were 26 inmate suicides, six of them in county jails. Based on the dramatic decrease, the report states, “The antiquated mindset that ‘inmate suicides cannot be prevented’ should forever be put to rest.’”

Rappaport’s admission

Albany County’s jail has in place much of what the Federal Bureau of Prisons and the World Health Organization recommends but, still, Rappaport is dead.

Maryanne Rappaport said, when she turned in her son to Guilderland Police, she told them he might be suicidal and that he was addicted to heroin.

Captain Curtis Cox with the Guilderland Police confirmed that and said, since they traced Rappaport through the court, “We notified the court that he needed a drug and mental-health referral. If someone is going to be arraigned, we notify the court about the problems, and they notify the jail. It’s a written report. Often times, the transporting officers do not have any knowledge of the case.”

Asked if staff at the correctional facility were aware of that information, Clark said, “It’s part of our procedure, when an inmate is booked in, which means processed into the facility, we look for any information from any arresting agency that brings them here. I don’t know whether that information was passed on or not.”

Typically, he said, “It’s a verbal from the officer bringing the inmate in.” He said there was no written form for arresting officers from various police departments to inform jail staff about inmates’ suicidal tendencies or drug addictions.

Asked if Rappaport would have been treated differently if there had been such a communication, Clark said, “If we receive information that an inmate is either suicidal or on drugs or possibly ingested drugs, there are steps that we would have taken to protect that inmate as well as us. If an inmate comes in and we’re told that the inmate is possibly suicidal, we would run through the suicide screening guidelines and refer them to Mental Health if we felt that he was at risk to himself.”

Regardless of such communication or lack of it, Rappaport, like other inmates admitted to the jail, was screened for suicide, Clark said. “Basically, it’s a list of questions that we ask every new inmate that comes in, and we’re asking about their state of mind, and any losses towards, you know, jobs or relations, anything bothering you from the outside, and that would give us a score of where we think the inmate is mentally or emotionally.”

Clark said he didn’t know how Rappaport scored on this assessment. Apple had told The Enterprise earlier about the screening during intake and said, “But, you can ask all the right questions, and, if someone doesn’t answer truthfully...”

“We would hope they would be truthful because we are trying to help and not hurt here,” said Clark.

As far as treating Rappaport’s addiction, Clark said, “If an inmate comes in and they state they are on heroin…our Medical Department puts them on a protocol….They do basically a physical examination. They check to see if he’s suffering from any type of withdrawal, which was done in this case, voluntarily by the inmate…They started what they call a heroin protocol.”

Clark described the protocol this way: “They look for a pulse rate, whether the individual was sweating, if he’s restless, pupil size, bone or joint aches, and runny nose, or tearing...And, depending on whether the individual is suffering from these or showing these symptoms, it would cause Medical to take appropriate action.”

Such action, which can include methadone treatment, wasn’t called for in Rappaport’s case, Clark said. “I don’t believe he showed many symptoms of any type of withdrawal.” After he was evaluated according to the protocol, “There wasn’t further action taken on him,” said Clark.

Had Rappaport shown withdrawal symptoms, he could have been treated through the jail’s Medical Department, Clark said. The department is staffed by 10 professionals during the day shift with fewer on other shifts, and a doctor is at the jail 40 hours a week, Clark said.

In cases of emergency, Colonie emergency medical services can transfer inmates to local hospitals, as happened with Rappaport. Medical emergencies requiring hospitalization happen once or twice a month, Clark estimated.

“If there’s a fight and an inmate appears to be concussed, we may send him out to be looked at by the hospital for a possible concussion or a break or a sprain,” said Clark. “Sometimes these folks playing basketball do get injured here. We have a lot of twisted ankles, concussions due to falling.”

Drug-related hospitalizations are “very rare,” said Clark. For methadone treatment, he said, “Sometimes they’ll come down to medical to receive the treatment and then they’ll go back to their tier, depending on how severe it is. We do have severe withdrawals where they’ve been taken to the hospital. But, if it’s not considered severe, we can do it right here.”

Rappaport’s suicide

Rappaport was “in reception” when he hanged himself in his cell, Apple said. Reception, he explained, means that Rappaport was in between intake and classification.

“He was being called down for the screening and wasn’t responding,” said Apple. “That is when someone went to his cell to check on him.”

Officers, along with medical staff, began to perform cardiopulmonary resuscitation, and Colonie emergency medical services transported Rappaport to Albany Medical Center where he was pronounced dead.

Rappaport was in a cell by himself. Most of Albany County’s inmates are housed in single cells because of the structure of the jail, Monteleone said.

Montelone described the layout of the jail this way: “There are linear tiers, tiers with cells that are side by side in a straight line with a catwalk in the front for the correction officer and the inmates to move about at certain times.”

Then there is a dormitory layout, which he described as “more of an open format with two floors of linear cells”; they look across a courtyard area at other similar cells.

“It would be very difficult for you to commit suicide in a group setting,” said Clark, echoing the World Health Organization findings. “We do have some of that type of housing here but for the majority it’s single-cell housing units.” He estimated that 150 of the jail’s roughly 800 inmates are housed in the dormitory setting.

Asked if more inmates couldn’t be placed in the dormitory setting because of how the prison is built, Clark said, “It’s that and how the person is classified. Some individuals are more of a risk and they need to be in their own cell. Some inmates who we feel can get along with others easily, would be less of a risk for us, would be in the group setting, a dormitory-style setting.”

In the last nine years seven inmates of the Albany County jail have killed themselves:

— June 2005, Sheldon Spotards, 22, of Albany, accused burglar, was found hanging from a torn piece of bedsheet;

— December 2005, Jason Kutey, 28, sentenced for kidnapping and burglary, had a plastic bag tied over his head with socks;

— March 2006, John Miles, 36, homeless, indicted for murder, used bedsheets to choke himself, tying them to a sink and leaning forward;

— March 2006, Ernest Cross, 29, hanged by a bedsheet from his cell bars;

— October 2012, Stanley Haluska, 63, of Berne, awaiting extradition on sex-abuse charges, attempted to suffocate himself with a plastic bag, died at Albany Medical Center;

— May 2013, Demearle Gulledge, 36, of Jefferson County, facing second-degree assault charges, hanged by a bedsheet from the bar doors of his cell; and

— October 2014, Adam Rappaport, 29, accused of two burglaries, died of asphyxia due to self-inflicted strangulation.

Bedsheets were used in four of the suicides and plastic bags in two.

“The inmates need to have bedding,” said Monteleone, adding, “It would be ideal to make a sheet that is not detachable.”

“Each inmate is issued a blanket and two sheets upon them coming into the facility. And, in the case of Mr. Rappaport, he was considered to be a normal inmate with no mental-health precautions, so he had those two items with him — the blankets and the sheets in his cell,” said Clark. “As far as the garbage bags, we do have the large garbage containers on the tiers and occasionally some [bags] will be passed out to the inmate population by the inmate runner.

 “The inmate runner is an inmate who works on the tier and passes out the food trays, collects the food trays, does the cleaning on the tier, collecting garbage, cleaning out the garbage cans. They call him a runner. Basically, he’s an inmate who works on the tier…” The runner would have access to plastic bags and so could give them to inmates, he said.

Asked, if Rappaport had been considered at risk, would he have been given sheets, Clark said, “If an inmate was on constant observation, say if we believed he was going to be a risk to himself, and was not seen by Mental Health, an officer would have been stationed outside his cell constantly observing him — called a constant observation.

“In some cases, if an overt act occurs, where they attempt to harm themselves, those sheets and blankets will be removed and they’ll be given a large gown that cannot be tied or used in the manner of a blanket or a sheet. So they don’t sit in their cells naked, they’re given a gown to wear to keep them warm and keep the privacy as best we can.”

Six to eight professionals from Albany County Mental Health work at the jail, Clark said, and, if someone is considered a risk for suicide, “Mental Health would see them, try to get to the bottom of their problems, try to get them where they could live in the correctional facility…get them calm, where they could be placed in normal housing.”

The coroner’s report, according to Mrs. Rappaport, said her son had asphyxiated himself with a narrow woven band. Asked what that was, Clark said he didn’t know.

The aftermath

Mrs. Rappaport was distressed by jokes about junkies and corpses she said corrections officers were making in the emergency room of Albany Medical Center as she was deciding whether or not to take her son off of life support.

“Obviously,” Monteleone responded through The Enterprise, “the issue she raises with the jokes, if that happened, clearly it’s not appropriate…We don’t expect our personnel to be engaging in” that sort of behavior.

Similarly, Clark said, “At all times, our staff should be acting professionally.  I don’t know about these conversations that were had. This is the first I’ve heard of it. But our staff is held to a regard where they should be acting professionally, especially in a situation like that where there’s family nearby of this inmate who’s at the hospital.”

Asked if the joke-telling in the emergency room would be investigated, Clark said, “If we received a complaint, it would be thoroughly investigated by the Office of Professional Standards, correct.” Monteleone runs that office.

Asked if a formal complaint had to be filed to trigger the investigation, Clark said, “I don’t even know if it has to be written, ma’am. I believe, if the family reached out and said, they heard this, or they want it looked into, I’m sure a request could be made.”

Asked, if it turned out to be true, if some kind of instruction or discipline would be given to the officers, Clark said, “I can’t comment on discipline or personnel matters.”

Asked, in general terms, he said, “I’m not sure what we would come up with.”

Clark said that the jail’s corrections officers are well trained in basic academy where they take a suicide-prevention course. Additionally, every year, the staff goes through a refresher training course for suicide prevention.

Asked what the training covers, he said, “We’re looking for the signs that an inmate would exhibit and how we take those signs to get them help. Know the signs, know how to speak to people, try to find out what they’re thinking and then get them referred to the proper people.”

Mrs. Rappaport made the decision to donate her son’s organs; nurses and doctors were wearing masks, gowns, and gloves in a sterile environment, when, she said, a corrections officer walked into the room without a gown or mask, just to look.

“Usually, the hospital would require an officer to gown up, to dress appropriately,” said Clark. “Again, I haven’t heard any of this until now.”

Until a prisoner’s body is turned over to a coroner, Monteleone said, “he’s technically our responsibility.” Officers in hospital situations are instructed “to maintain custody and control,” he said.

“Until that individual was proclaimed dead, we need to stay with the inmate,” said Clark. “He is in the custody of the sheriff, which means an officer would have to stay with him at all times.”

Overall, Clark said, “I think my staff does a very good job. We ask them to remain professional at all times, especially in this difficult situation. And this is a difficult situation for everybody.”

Later, Mrs. Rappaport went to the jail to collect her son’s things and expected to see the jail’s superintendent. “My child died in his care and he can’t give two seconds to come down and give me a hug and say, ‘Sorry for your loss,’” said Mrs. Rappaport.

“I was advised that a secretary was going down to hand Ms. Rappaport Adam’s property,” said Clark. “I don’t remember being asked to come down and speak to her. She did not ask to speak to me while she was here. I usually don’t hand out property to families, no.”

The Rappaports have been frustrated not to be able to find out details about the last hours of Adam Rappaport’s life. Asked if the jail has a protocol for informing families who want information, Clark said, “I’m not really sure. I think all requests would go to the sheriff on those instances. He would make that decision.”

Asked if there is more his jail could do to prevent suicides, Clark said, “There’s always ways to improve, ma’am, but to tell you the truth we had nearly 7,000 inmates come into this facility in the past 12 months — 7,000 and I think my staff does a very good job trying to protect those individuals from themselves.”