Williamson County Jail Staffing Analysis (2008–2025)
Exhibit J documents seventeen years of part-time psychiatric contracts and mid-level substitution at the Georgetown, Texas facility.
The Williamson County Jail in Georgetown, Texas has operated for nearly two decades without continuous licensed medical oversight, according to Exhibit J, a staffing record prepared by LeRoy Nellis in October 2025. The document covers medical and psychiatric staffing from 2008 through 2025. It shows persistent reliance on part-time contractors and mid-level providers rather than full-time licensed physicians. The record argues that this pattern demonstrates structural non-compliance with Texas Administrative Code § 273.2, which requires twenty-four-hour physician availability, and supports findings of deliberate indifference under Estelle v. Gamble (1976) and Farmer v. Brennan (1994).
The staffing pattern:
Every psychiatric provider serving the jail between 2008 and 2025 was contract-based and worked no more than twenty hours per week. Day-to-day care was handled by nurse practitioners and EMTs without continuous MD oversight. Psychotropic medications were formally restricted to psychiatrists, but intermittent presence meant mid-levels and corrections staff often executed orders.
The ledger traces a long arc. In 2008, Dr. Michael Musgrove, a psychiatrist, worked under a Williamson County professional services contract at no more than twenty hours per week at $85/hr as a licensed MD, per a public contract PDF. By September 17, 2018, a medic worked full-time forty hours per week at $18.83/hr with no prescribing authority, employed by the Williamson County Sheriff's Office, per a GovJobs archive. On March 13, 2019, a corrections medical officer worked full-time forty hours plus benefits at $23.74/hr, also with no prescribing authority, per a GovJobs listing.
In August 2022, a nurse practitioner in the jail medical unit began full-time seven-day coverage at ≈ $95 k–$110 k annual, funded by ARPA, with mid-level authority only, under the Williamson County Recovery Plan (2025). In fiscal years 2022 through 2025, Dr. Ghulam M. Khan served as psychiatric provider under a Commissioners Court professional services agreement, with licensed psychiatrist status per a county record PDF. By September 19, 2025, a part-time psychiatrist worked about sixteen hours per week through GreenLife Healthcare Staffing at $110 – $135/hr with prescriptive authority, per Get.it and ZipRecruiter. By October 2025, a psychiatrist physician, reference BD-649-01, was sought through Adelphi Medical Staffing LLC on a contract of at least four years and at least sixteen hours per week at $250 – $285/hr with prescriptive authority, per DocCafe and ZipRecruiter.
The pay evolution:
The hourly rate for psychiatric coverage tripled across the period. It moved from $85/hr in 2008 to $250 – $285/hr in 2025. No public record confirms twenty-four-hour licensed physician coverage at any time between 2008 and 2025.
The 2019 inspection:
A 2019 inspection by the Texas Commission on Jail Standards found failure to complete physician-ordered specialist referrals. The chronology in the record notes an increase in complaints and deaths in 2023. A wrongful-death settlement followed in 2024. Recruitment gaps continued into 2025.
The outcome correlation:
The record correlates staffing levels with outcomes across the period. Minimal staff in 2018 and 2019 preceded the TCJS deficiency. Intermittent coverage from 2020 through 2021 preceded medication complaints. The 2022 nurse practitioner expansion brought temporary stabilization. A psychiatrist vacancy in 2023 preceded increased incidents. The 2024 settlement confirmed risk. Continued staffing gaps in 2025 meant ongoing claims.
The legal stakes:
Failure to maintain coverage impacts constitutional protections, the record states. Non-compliance with Texas Administrative Code provisions is alleged. Federal contract obligations may trigger dual liability. The long-term pattern supports review under Department of Justice standards.
What the Record Shows:
Williamson County Jail has operated for nearly two decades without continuous licensed medical oversight. Part-time psychiatric contracts and mid-level substitution remain standard practice. Inspection deficiencies, settlements, and ongoing recruitment gaps indicate foreseeable operational risk. No public record confirms twenty-four-hour licensed physician coverage at any time between 2008 and 2025.
“Williamson County Jail has operated for nearly two decades without continuous licensed medical oversight.”