It was a busy holiday season for the decades-old lawsuit governing mental health treatment and medical care in the Baltimore jail system.

The litigation, which stretches back to the era of the Jimmy Carter presidency, is entering 2024 with a new judge and a soon-to-be-decided medical monitor. Dr. Michael Puisis resigned from the position in mid-December, weeks after he found himself at the center of an escalating fight between the state and the American Civil Liberties Union, plaintiffs in the lawsuit.

Meanwhile, the case was transferred to a new judge on Thursday, with U.S. Judge Matthew J. Maddox, a recent appointee of President Joe Biden, taking over for U.S. Judge Ellen Lipton Hollander.

The circumstances behind Puisis’ departure are not immediately apparent. A document that appears to contain his letter of resignation is sealed in court records. Reached by phone, Puisis declined to comment. The ACLU also declined to comment.

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The Maryland Office of the Attorney General, which handles the legal defense for the state-run jail system in the lawsuit, declined to comment.

The flurry of activity came roughly a month after a contentious court hearing in which attorneys for the private law firm hired by the state, Butler Snow LLP, stocked the gallery with jail officials and centered their arguments on the medical monitor.

Puisis, the Butler Snow attorneys argued, had been a main reason the state is lagging far behind its timeline of coming into compliance with the terms of a 2016 settlement by issuing confusing directives, offering sometimes contradictory advisories and levying unfair assessments of the progress made thus far.

Last year, attorneys working for the state had disallowed Puisis from directly interviewing clinicians at the jail, as he has done since 2020, without first arranging it with the state corrections department.

In his reports, Puisis has provided an atypical level of transparency into the dysfunction of the jail’s health care system under its current private medical provider, YesCare, whose parent company rebranded into two entities. One of those entities declared bankruptcy last year in a controversial legal maneuver that has blocked the monetary awards of hundreds of people who won or settled lawsuits over substandard medical care while incarcerated.

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Puisis has identified a multitude of deficiencies, most recently detailing how people with dementia were winding up improperly housed in the Baltimore Central Booking and Intake Center, and in at least one case, assaulted. He has served as an expert witness in numerous correctional health care lawsuits across the country.

About 10 days before Puisis resigned, on Dec. 8, the state filed a 33-page challenge to the medical monitor’s findings, backed up by more than a dozen exhibits. In that document, the state argued that Puisis “routinely ventures beyond the four corners of the settlement agreement or the constitution.”

“If the medical monitor identifies any monthly audit resulting a compliance percentage of less than 90%, the medical monitor denies substantial compliance without further analysis of the results,” the state argued. “Neither the courts nor the settlement agreement ever applied this type of robotic percentages test to the issue of deliberate indifference.”

In the November hearing, then-judge Hollander appeared to be sympathetic to the state’s arguments and its attorney’s frustrations, describing Puisis’ reports as “dense” and various provisions of the settlement agreement as “circular,” indicating that they could be interpreted numerous ways.

The departure of Puisis could be seen as a significant return by the Butler Snow firm, which is known for winning lucrative contracts to defend Southern prison systems.

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The attorneys were retained in a deal that faced little public scrutiny and made their first appearances on behalf of the state in the months before the November hearing.

Correction: This story has been updated to correct the spelling of Michael Puisis’ surname. It has also been updated to correct the year that Puisis was disallowed from directly interviewing clinicians and that a jail health care company declared bankruptcy.

Ben Conarck is a criminal justice reporter focusing on law enforcement for The Baltimore Banner. Previously, he covered healthcare and investigations for the Miami Herald and criminal justice for the Florida Times-Union. 

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