In rare move, San Diego County sues its own jail health care providers over brutal cellmate killing

The county of San Diego is suing two of its jail health care providers, alleging that failures by their employees led to the brutal killing of 24-year-old Brandon Yates inside a cell at the San Diego Central Jail.

Filed last week in federal court, the claim argues that NaphCare and its subcontractor, Liberty Healthcare, violated their contracts by failing to provide adequate mental health care to Alvin Ruis — a man with a known history of psychosis, violence and self-harm.

Ruis was placed in a cell with Yates and ultimately tortured and killed him.

The county, a named defendant in a wrongful death lawsuit filed by Yates’ family earlier this year, is seeking a ruling that would hold NaphCare and Liberty financially responsible for any damages awarded to the family — and allow the county to recover legal costs.

The county’s claim does not say the Yates’ allegations are true but rather argues that the providers’ contracts hold them liable for any injuries or deaths resulting from “any act, error, omission or negligence” by employees.

The Sheriff’s Office declined to comment on how the claim might affect the relationship with its contractors.

Earlier this year, Sheriff Kelly Martinez warned county officials that NaphCare and other jail medical providers might cancel their contracts if the Citizens’ Law Enforcement Review Board, or CLERB, were granted authority to investigate medical and mental health care after an in-custody death.

Red flags ignored

Brandon Yates was arrested in January 2024 after being found asleep in a backyard shed. He had a history of mental illness and substance use. His parents say he was trying to turn his life around and had just started an apprenticeship as a commercial fisherman.

Less than 24 hours after he was booked, Yates was found dead in a cell he shared with Ruis, who had a lengthy history of violent behavior, including threats against deputies and other incarcerated people.

Deputies moved Yates into Ruis’ cell on Jan. 16 after two men warned a deputy “there would be trouble” if Yates wasn’t removed from their housing unit.

“Brandon was speaking nonsensically and babbling nonstop,” his family’s lawsuit says.

Yates’ parents, Dan Yates and Andrea Carrier, have spoken publicly about their son’s struggles with mental illness and their hope that he might get treatment in jail.

“It never occurred to me that his life was at risk,” Carrier said.

According to the lawsuit, Yates and Ruis soon began arguing about religion. Ruis later told investigators he believed Yates was the devil — and that God had given him permission to kill him.

During the attack, Yates repeatedly pressed the cell’s emergency call button and begged deputies over the intercom to intervene. But his pleas — and those from men in nearby cells — went unanswered.

Ruis placed Yates into a chokehold, poured liquid soap into his nose and mouth and smothered him with a blanket until he died. Afterward, Ruis stripped Yates’ body and arranged it to resemble Jesus’ crucifixion.

Ruis reportedly told investigators he staged the scene to show that Yates’ death was not a suicide.

The county’s claim alleges that from Dec. 27, 2023, to Jan. 16, 2024, Ruis was evaluated at least five times by clinicians employed by NaphCare and Liberty. During that time, he made suicidal threats, had violent outbursts and exhibited symptoms of acute psychosis — including religious delusions and threats to harm others.

Despite these red flags, the county argues, the clinicians failed to admit Ruis to the jail’s psychiatric stabilization unit, did not initiate involuntary treatment and did not alert custody staff that he posed a serious risk.

The county named three clinicians and one social worker in the filing, arguing they had access to Ruis’ psychiatric history but failed to act on it. The claim says additional employees may have played a role but have not yet been identified.

The contractors’ liability “is based upon their alleged negligent and wrongful conduct both in providing medical and mental healthcare services … and in allegedly failing to meet the appropriate standard of care in addressing symptoms observed,” the county’s claim says.

But the Yates family’s lawsuit argues that both deputies and psychiatric staff knew Ruis posed a threat.

Ruis was classified as a “bypass inmate” and “keep separate,” meaning he should not have been housed with others. According to department policy, deputies who moved Yates into Ruis’ cell would have been required to confirm whether Ruis’ classification allowed for shared housing.

Julia Yoo, the family’s attorney, said the county’s cross-complaint highlights a deeper failure with its oversight of its own contractors.

“I just think it’s just remarkable that we are paying $60 million a year to NaphCare,” Yoo said, “yet no one in the county is watching over this contractor to make sure that it’s actually fulfilling its obligations — until people die these gruesome, inhumane, horrific deaths.”

Because discovery in her case hasn’t begun, Yoo said she doesn’t know everything the county has uncovered about its medical providers.

“Ultimately you can’t contract away your constitutional obligation to the people that you’re charged with caring for,” she said.

‘Confident employees acted appropriately’

The county’s claim comes nearly a month after a federal judge denied its request to have the Yates’ wrongful death lawsuit thrown out.

In an Aug. 21 ruling, U.S. District Judge Thomas J. Whelan found that the family had plausibly alleged deliberate indifference by jail staff.

“The court agrees with plaintiff that the right to be free from inmate-on-inmate violence is clearly established,” Whelan wrote.

NaphCare, a for-profit company based in Alabama, took over jail medical services in July 2022 under what was initially a five-year, $288 million contract.

Within less than a year, the Sheriff’s Office had issued corrective action notices to NaphCare for failing to pay outside hospitals and medical specialists, using unlicensed staff and ignoring requests to replace broken medical equipment, among other deficiencies. The Sheriff’s Office said all issues identified as needing to be corrected have been resolved.

NaphCare has also been named in several lawsuits involving alleged medical neglect in San Diego jails. But this is the first time the county has filed a claim against the contractor.

A NaphCare spokesperson said the company “is confident employees acted appropriately and with the highest level of professionalism and compassion.”

“The tragic death involved in this matter was not the result of any action or inaction by our staff or organization,” Dana Jackson said via email. “We remain dedicated to providing the highest quality healthcare to every patient we serve in San Diego County and beyond.”

Liberty Healthcare did not respond to a request for comment on the county’s claim.

Ruis has been charged with murder and remains in custody. No trial date has been set in either his criminal case or the Yates’ lawsuit.