Did Jail procedure cause suicide?

Do employees at the McHenry County Sheriff's Department have enough training, when it comes to working with persons (suspects, inmates) who are experiencing emotional upset and/or mental health issues? Do procedures require departing shift officers to inform arriving shifts of problems with inmates? Are those procedures followed?

A month ago an inmate died by suicide on a Friday night. According to a report written four days after his death, he may not have been given all of his medications at the 9:00PM medication distribution. The inmate, Thomas Puchmelter, 42, had become argumentative with medical staff.

Then he was asked if he wanted the rest of his medication, and the inmate became argumentative with the Corrections Officer (CO) asking him that question. A second CO approached and ordered Puchmelter to his cell, escorting him there.

Puchmelter had been complaining of seizures and was detoxing. What happened when his medications were withheld?

An Order of Protection had been served on Puchmelter that day and was found later in his cell. Would he have been upset about that? Despondent? Suicidal?

The lengthy report of the investigation in his suicide failed to address the service of the Order of Protection and what Puchmelter's reaction was to it. An inmate reported to the investigating Deputy Sergeant that Puchmelter had been yelling at guards. A second inmate reported that Puchmelter and he had had a "conversation that centered on Thomas' feelings toward his mother kicking him out of her house." Both inmates said that Puchmelter had faked seizures, and one said that Puchmelter had told him he had faked a seizure.

Nothing in the report indicates that the evening shift relayed any of this information to the night shift. Puchmelter was in his cell, when the night shift came on duty.

Does it seem logical to anyone else that, had the night shift known of these problems, they might have kept a close eye on Puchmelter? Would they have moved him from his cell to a holding area, where monitoring would be more frequent?