When Zackary Moffitt arrived at the hospital on July 6, 2013, he had a potentially fatal level of alcohol in his system.
The 33-year-old was four years sober when he met his wife, Cassandra Higgins, but he had struggled with alcoholism his entire life after becoming a regular drinker in his early teens while growing up in Leadville.
Amid bouts of sobriety and relapse, Moffitt had recently left rehab before he received news that his best friend died. After the funeral, Moffitt went on a bender that ended in tragedy.
That night at St. Anthony's Summit Hospital, he was admitted with a blood alcohol content of 0.392 before he eventually pulled out his IV and wandered outside. That's when a Summit County Sheriff's Office deputy arrested him and transported him to the county jail without receiving medical clearance, according to court documents.
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Over the next three days, deputies and a captain at the jail failed to request medical assistance as Moffitt went through severe alcohol withdrawal, vomiting and hallucinating.
By the morning of July 9, 2013, Moffitt had stripped naked as he experienced "delusions" and attempted to harm himself, court documents state. After entering the cell and restraining Moffitt, deputies finally called for medical care, but it was too late. He died four days later.
Four years after Moffitt's death, Summit County reached a $3.5 million settlement with his family. When negotiating the settlement, Higgins said she pushed for the county to build better services.
"Before I'd sign the settlement papers, I was like 'I'm not signing this. You guys need to have something going on,'" Higgins said. "'You guys need to have a rehab. You guys need to have a mental health clinic. Because any of these establishments would have saved his life, and you guys wouldn't be paying out this $3.5 million.'"
In the years since the Moffitt case highlighted behavioral health deficiencies in the jail and community, Summit County has explored new approaches to addressing mental health and substance-use needs, which studies have shown are more acute within the criminal justice system. Researchers at the National Institute on Drug Abuse found that 65% of the nation's prison population has an active substance-abuse disorder.
While there is more work to be done to reform the local criminal justice system, Higgins said services in Summit County have increased tenfold in the past decade.
Summit County Sheriff Jaime FitzSimons said that when he was appointed to his current role in 2016, lawsuits related to prior incidents at the jail — including the Moffitt case — made him "acutely aware" that things needed to change.
Alongside work being done in the community, FitzSimons, who is a member of Building Hope's board of directors, said he helped to create new programs within the criminal justice system aimed at addressing behavioral health needs.
Today, the Summit County Sheriff's Office offers substance-use and mental-health resources to those in the jail and has behavioral health specialists who help stabilize in place community members having crises — rather than arresting them.
Drugs and alcohol go "hand in hand" with mental health, and both contribute to the bulk of calls law enforcement officers respond to on a daily basis, FitzSimons said. Summit County has transformed the local mental health landscape in recent years but substance use deserves equal attention, he said.
"I think there is just so much more work to do," FitzSimons said. "I think as a community here in Summit County we're really carrying a heavy load — just as we did with mental health."
'A second chance'
Across the criminal justice system, there has been an increased focus in recent years on treating mental-health and substance-use issues rather than placing those who suffer from the disorders in jail, according to local officials.
Fifth Judicial District Attorney Heidi McCollum, whose jurisdiction includes Summit County, said the prosecutor's office takes a different approach to reaching a disposition in cases today than it did a decade ago.
"We don't have a 'let's just lock them up' approach. It doesn't work," McCollum said. "It doesn't solve any problem. It just kicks whatever problem was there down the road. … They haven't been helped. The community hasn't been helped. Society hasn't been helped."
Crimes that involve drugs and alcohol, such as driving under the influence, can be serious because of the danger posed to public safety. These crimes need to have consequences, McCollum said, but treatment is also something the district attorney's office wants people to be connected to so that they don't reoffend.
With the limited amount of treatment available in rural resort communities like Summit County, McCollum said her office has to be "phenomenally flexible" to allow defense attorneys and the probation office to determine what treatment is the best fit for an individual.
"In a perfect world, it would be great if everyone could get the specific treatment they needed immediately," McCollum said. "Unfortunately, that's not what our community can offer. My office is going to be the last entity standing in someone's way when they are seeking some kind of treatment."
Rather than prosecute some low-level felony cases, the district attorney's office also has an adult diversion program that offers some people the opportunity to have nonviolent offenses dismissed, McCollum said.
Established in 2019 by then-District Attorney Bruce Brown, the adult diversion program allows referrals to take responsibility for their actions through community service while participating in mental-health and substance-use treatment, McCollum said.
Regular check-ins with the district attorney's office help keep people in adult diversion on track so that the charges can be dismissed and the case never has to make its way through the court system, she added.
"They're not hardened criminals. They made a mistake," McCollum said. "Substance use or alcohol may be a part of the crime, but that doesn't mean they don't deserve a second chance."
In the past decade, mental health calls in the community have increased by 500%, according to data from the Summit County Sheriff's Office. But another new program aims to stabilize community members experiencing behavioral health issues — without getting the rest of the criminal justice system involved.
FitzSimons said the goal of the Sheriff's Office Systemwide Mental Assessment Response Team, or SMART, is to deescalate situations that have historically resulted in arrest or hospitalization and to assess whether a person should be referred to local services or a higher level of care.
Each team consists of a law enforcement officer and a behavioral health specialist, who co-respond to calls related to mental health, and a case manager who follows up.
"Our goal is to stabilize you in place, get you out of crisis now," FitzSimons said, "and set you up for success — like immediate success — by finding you a therapist or finding you a program to get more long-term stabilization."
Last year, S.M.A.R.T. responded to 1,383 calls for service — none of which resulted in arrests, according to the Sheriff's Office. The program also reportedly provided 23 scholarships to clients for immediate access to behavioral health services and helped 45 people get admitted to a higher level of care.
But even when people do end up being charged with a crime, a pretrial services program established by the Sheriff's Office in 2022 has leveled the playing field for who gets released from jail.
Pretrial service programs help criminal court judges determine whether a particular defendant is safe to be released on bail and under what conditions. If the defendant can be released, pretrial services can help monitor the defendant to ensure that they return to court and remain sober.
"We here aren't trying to incarcerate people, particularly if there's other better treatment options that are out there," Summit County Judge Edward Casias said. "And that begins from the time they're arrested until the time they're sentenced."
Especially for defendants with substance-use disorders, Casias said pretrial services has provided more information that helps with making determinations about whether that person poses a public safety risk or can be released back into the community.
Reports from pretrial services can tell the court whether a person has been able to remain sober, whether they've remained out of trouble and whether they've worked to access other resources in the community, he said.
"I'm much more inclined to try and rehabilitate than to punish," Casias said. "But if they don't rehabilitate, and they just drop the mic and walk away, then they've demonstrated they don't want that chance. Then you do become punitive."
'A warm handoff'
Today, anyone who is booked in the Summit County jail and remains there for more than 24 hours receives screenings for mental-health conditions, substance-use disorders and suicidal thoughts.
That is according to Summit County Sheriff's Office Lt. Sylvia Simms, the program coordinator for Strategies to Avoid Relapse and Recidivism, or STARR, as well as pretrial services.
STARR is a voluntary program that offers anyone in jail access to substance-use and mental-health services, Simms said. Established in 2020, the program consists of a law enforcement coordinator, case manager and licensed mental health clinician.
"We're investing in people. We're investing in their goals," Simms said. "If their goal is to stay sober and stay out of jail, we'll do anything we can to help them with that. That's what we call reducing recidivism. We don't want them to come back. We want them to be able to be a productive member of our community."
Of the 580 screenings completed at the jail last year, 387 — or about 67% — were positive for a mental-health or substance-use disorder, according to data provided by the Sheriff's Office.
Last year, STARR had 392 clients — more than half of the 734 people booked in the Summit County jail, the data shows. Those numbers are as high as they are despite the fact that many people don't stay in custody long enough to qualify for the program, Simms said.
Ruby Hornback, the clinical case manager for STARR, is a certified addiction specialist who discusses goals with clients, helps motivate them to seek treatment and connects them with resources.
"In therapy work, we understand that if you can't get those basic needs met — having food, having shelter, feeling safe — it's really hard to then move forward and address the underlying issues that are a little bit more complex around mental health and substance use," Hornback said. "And it's a vicious cycle, too, because you're dealing with stress."
Being incarcerated can have a major impact on a person's life, including on their employment and housing, Hornback said. But STARR aims to help those people by providing them with treatment while in jail and helping connect them with outside services when they are released.
STARR offers a range of evidence-based therapeutic interventions including eye movement desensitization and reprocessing therapy, an acupuncture protocol known as AcuDetox that is proven to reduce cravings and symptoms of withdrawal, and medication-assisted treatment. Group and individual therapy sessions with a focus on substance use, anger, communication and life skills are also offered.
Last year, STARR connected 39 clients with medication-assisted treatment in the jail. Medication-assisted treatment combines counseling with prescribed medications that reduce alcohol or opioid cravings and withdrawal.
Even after someone is released from jail, STARR continues to conduct post-release tracking for those on medication-assisted treatment for up to 12 months while also connecting people with other free and low-cost services in the community.
"We're able to help people achieve sobriety while they're here," FitzSimons said. "And then provide them with services — not only when they're here incarcerated — but also a warm handoff to our community partners to help them continue to be successful."
'Someone is there to help you'
Programs like SMART, STARR and pretrial services work together — intervening on mental health calls using clinicians to avoid arrests, connecting those who are jailed with services, and releasing defendants who don't pose a community safety threat with supervision, FitzSimons said.
While there will always be people who need to be jailed while awaiting a disposition in their case, the sheriff said the combined result of these programs is to keep the jail population low.
"It's done wonders for our community," FitzSimons said. "Our jail population hovers at 32, and it's a 93-bed facility. It's crazy. Those 32 that are incarcerated are people that are not suitable to be released; they're a risk to the community. But the other people have all kept their jobs. They've all kept their cars. They've kept their dog."
With programs like those at the Sheriff's Office, Casias said there are more interventions to help people who come into contact with the criminal justice system find behavioral health treatment than there were in the past.
Getting involved with the criminal justice system can be a wakeup call for many people — and these programs have helped reduce the number of people reoffending when they are released back into the community, Casias said.
"There's that ability to know someone is there to help you," Casias said. "I know that there are people who have been in the STARR program, gotten out (of jail) and have come back to the SMART program and said, 'I need help.'"
McCollum said that the criminal justice programs that have been built up in Summit County in recent years help connect people with services so that they can move on with their lives and be a productive member of the community.
But while mental-health and substance-use services in the criminal justice system have grown more focused on treatment and rehabilitation, McCollum said there is still a lot more work to be done.
"I'm not saying the problem is solved," McCollum said. "Tons of resources are needed. We need more programs, facilities, treatment providers, services than we have. But at least we're starting down that road."
