\u201cI still cry when I think about what happened to Mr. Marroquin; he should not have died,\u201d Alonso later wrote in a sworn declaration.<\/p>\n
That declaration<\/a> became a cornerstone of a federal class-action lawsuit alleging systemic failures in how San Diego County jails treat people with mental illness. It helped drive a sweeping settlement<\/a> announced earlier this month.<\/p>\n When Alonso learned of that\u00a0settlement, she said she felt relief and emotion. She\u2019d worked as a clinician in the jails for three years before leaving. She loved her job but had grown increasingly frustrated over her inability to protect patients she believed were being harmed by jail practices.<\/p>\n \u201cObviously there\u2019s more work to be done,\u201d she said in an interview last week, \u201cbut it sounds like they\u2019re trying to commit to make things better, which is amazing.\u201d<\/p>\n Once fully implemented, the agreement<\/a> will fundamentally reshape how mentally ill people are evaluated, housed and treated in the county\u2019s seven jails, where nearly half of the roughly 4,100 people in custody take medication for a psychiatric condition.<\/p>\n Under the settlement, sworn staff will no longer be allowed to routinely override decisions made by psychiatrists, psychologists and other mental health professionals \u2014 something Alonso said happened frequently during her time working inside the jails.<\/p>\n Instead, every person booked into custody must be evaluated to determine their mental health needs and assigned a specific level of care. That classification will dictate where they are housed and what treatment they receive, including therapy, clinical monitoring and medication.<\/p>\n The changes also target one of the jail system\u2019s most criticized practices: placing mentally ill people in isolation cells \u2014 known as administrative separation<\/a>, or \u201cad sep\u201d\u00a0\u2014 sometimes for weeks or months, with limited treatment and little privacy when care is provided.<\/p>\n The San Diego County medical examiner ruled the March 2022 death of Lonnie Rupard<\/a> in an administrative separation cell a homicide. Rupard, who had schizophrenia, died of pneumonia, malnutrition and dehydration after his health deteriorated dramatically in custody.<\/p>\n \u201cWhile elements of self-neglect were present, ultimately this decedent was dependent upon others for his care; therefore, the manner of death is classified as homicide,\u201d the medical examiner concluded.<\/p>\n Just five months later, on Aug. 16, 2022, Matthew Settles<\/a> died by suicide in an administrative separation cell.<\/p>\n Jail officials had placed him there \u201cdue to a propensity for violence and a failure to adhere to minimum jail standards,\u201d records show. But a note from a homicide investigator indicated that by the time of his death, Settles \u201chad exhibited no negative behavior since 7\/15\/22.\u201d<\/p>\n Settles had a history of self-harm. Records show he was rarely out of his cell and nearly all of his mental health care was conducted through the cell door, with a deputy present.<\/p>\n One of the settlement\u2019s most important safeguards, attorneys for plaintiffs say, is that decisions about whether to place a person in ad sep must be based on their current clinical condition \u2014 not their charges, housing history or prior classification.<\/p>\n If custody staff disagree with a clinician\u2019s recommendation, the decision must be documented and reviewed by supervisors.<\/p>\n \u201cNot only does mental health supervisory and custody supervisory need to look at it, but then they also need to provide the right level of care and placement within 24 hours,\u201d said Aaron Fischer, one of the plaintiffs\u2019 attorneys.<\/p>\n Alonso said that kind of clinical oversight was often absent when she worked inside the Central Jail.<\/p>\n \u201cThere would be many times where I\u2019d come into work and I would say, where is this person?\u201d she said. \u201cAnd they\u2019d say, \u2018Oh, they put him in ad-seg overnight.\u2019 And I\u2019m like, how do they get to decide that without the clinician being here?\u201d<\/p>\n In her declaration, Alonso described carrying a caseload of more than 150 patients \u2014 far too many to treat effectively.<\/p>\n The settlement directly addresses clinician workloads. It requires the Sheriff\u2019s Office to conduct a comprehensive staffing and needs assessment to determine how many clinicians, treatment beds and specialized housing units are necessary to provide adequate care.<\/p>\n It also calls for expanding outpatient step-down units \u2014 specialized housing designed for people with serious mental illness who require structured treatment but not full psychiatric hospitalization.<\/p>\n Currently, the Sheriff\u2019s Office operates outpatient step-down units at the Rock Mountain Detention Facility for men and Las Colinas Detention and Reentry Facility for women, with a combined 224 beds. Under the settlement, the county plans to add 68 more beds at Rock Mountain by March 2027, depending on patient need.<\/p>\n Clinicians say access to those beds \u2014 and appropriate care \u2014 had for too long been limited.<\/p>\n Aseel Ross, a former jail mental health clinician who worked at George Bailey Detention Facility through September 2023, testified in a deposition taken as part of the class-action lawsuit that some patients were excluded from the outpatient step-down unit despite showing serious psychiatric symptoms.<\/p>\n Ross also testified that a\u00a0lack of structured treatment planning further undermined care.<\/p>\n \u201cEverybody should have a treatment plan,\u201d she testified.<\/p>\n She said she had proposed implementing structured treatment plans and daily therapeutic programming for mentally ill patients, including those in administrative separation. While her immediate supervisors supported the idea, she said jail leadership never approved it before she left her position.<\/p>\n The settlement requires individualized treatment planning and expanded access to therapeutic programs for mentally ill people.<\/p>\n Sheriff\u2019s officials said they are committed to implementing the agreement\u2019s terms.<\/p>\n \u201cThe Sheriff\u2019s Office takes the settlement terms very seriously, and we will be working diligently to be sure the terms are being adhered to,\u201d Sheriff\u2019s Lt. David Collins said.<\/p>\n Collins said the agreement formalizes improvements already underway, while also acknowledging past deficiencies.<\/p>\n \u201cMany of the changes and improvements were already identified, requested, in process or being worked upon,\u201d Collins said. \u201cHowever, we are grateful the settlement brought some deficiencies to our attention.\u201d<\/p>\n The agreement follows years of deaths involving people with severe mental illness, many of whom deteriorated while in isolation or without adequate treatment.<\/p>\n Just last summer, a 43-year-old schizophrenic man named Corey Dean<\/a> died in jail after he was left alone in an isolation cell, despite pleas for help from other men in the jail.<\/p>\n Two weeks later, Karim Talib<\/a>, an 82-year-old suffering from dementia,\u00a0was found dead\u00a0in his Central Jail cell. Again people in nearby cells said their pleas to deputies and jail medical staff to help him went unanswered.<\/p>\n Both families are\u00a0now\u00a0suing<\/a>\u00a0San Diego County.<\/p>\n The settlement is part of a broader class-action case<\/a> filed in 2020 by a formerly jailed man named\u00a0Darryl Dunsmore, who initially represented himself before civil rights attorneys expanded the lawsuit into a sweeping challenge to jail conditions.<\/p>\n The case alleged\u00a0widespread failures in mental health care, medical treatment, disability access and basic safety.<\/p>\n Last year, in a separate partial settlement, the county agreed to separate reforms<\/a> aimed at improving treatment for people with disabilities, including facility upgrades and greater access to assistive devices.<\/p>\n But the class-action case known as Dunsmore v. San Diego County must still resolve complaints over a host of other jail practices, including medical treatment, dental services, safety and security, environmental health, access to lawyers and racial discrimination.<\/p>\n No trial date has been scheduled on those issues, but the parties continue to discuss potential remedies.<\/p>\n The new mental health settlement imposes sweeping new requirements but stops short of dictating exactly how the Sheriff\u2019s Office must restructure its system.<\/p>\n Instead, it establishes enforceable standards for clinical evaluations, housing decisions and treatment access, while giving plaintiffs\u2019 attorneys and a court-appointed neutral expert the authority to monitor compliance.<\/p>\n The neutral expert will have access to jail facilities, records and staff, and will issue public reports evaluating the county\u2019s progress.<\/p>\n \u201cWe can also submit concerns directly to mental health staff, and they have to respond within 10 days,\u201d Fischer said. \u201cThat is a useful way to identify inefficiencies, but also to identify people who are in the wrong place.\u201d<\/p>\n The agreement\u2019s level-of-care system closely resembles reforms proposed years earlier by jail psychiatrist Dr. Christine Evans, who left her position after her recommendations were repeatedly rejected.<\/p>\n In 2017, Evans developed a plan to establish a structured system for evaluating mental health needs and assigning appropriate treatment levels.<\/p>\n \u201cTo my dismay and disappointment, the jail\u2019s command staff declined to implement the proposal,\u201d she later wrote in a sworn declaration<\/a>.<\/p>\n Evans ultimately resigned in 2021 after what she described as repeated failures to address serious deficiencies in staffing and patient care.<\/p>\n![\"The](\"https:\/\/www.newsbeep.com\/us-ca\/wp-content\/uploads\/2026\/02\/SUT-L-Ad-Seg-1.jpg\")
The San Diego County Sheriff\u2019s George Bailey Detention Facility in the Otay Mesa area on Thursday, May 25, 2023 in San Diego. (Eduardo Contreras \/ The San Diego Union-Tribune)<\/p>\n![\"Attorney](\"https:\/\/www.newsbeep.com\/us-ca\/wp-content\/uploads\/2026\/02\/SUT-L-DUNSMORE-HEARING-_002.jpg\")
Attorney Gay Grunfeld speaks at a press conference outside the federal courthouse in downtown San Diego on Thursday, July 24, 2025. (Sandy Huffaker for The San Diego Union-Tribune)<\/p>\n