The state nursing commission won’t take action against a former Island County Jail nurse despite concerns that she failed to adequately care for a mentally ill inmate who died of dehydration a day after she saw him.

Nancy Barker stood outside Keaton Farris’ cell for about two minutes April 6. She observed him through a small slot in the door. He was naked, lying on the ground with his head propped on the wall and feet on the toilet.

Farris, 25, was mumbling to himself. He said something about a “medical professional” when Barker introduced herself. He said he wasn’t doing well. His color and breathing were normal, Barker reported. She also noted that he knew where he was.

Barker didn’t enter the cell or put her hands on Farris. She didn’t take his blood pressure or listen to his heart. She didn’t request a physician’s assistant follow up.

Farris died the next day of dehydration and malnutrition.

Corrections officers had shut off the water to his cell after Farris plugged the toilet with a pillow. Records show that officers failed to regularly check on Farris or offer him water. Farris, who was in the throes of a mental health crisis, had repeatedly refused water and food during the two weeks he was jailed in Coupeville. He lost more than 20 pounds while locked up.

Barker told Island County Sheriff’s detective Ed Wallace she knew the April 6 evaluation was inadequate. She blamed lack of access to her patient. Barker said she didn’t have the authority to force the guards to open the cell door, according to the statement she provided to the Nursing Care Quality Assurance Commission.

Corrections officers had deemed Farris a danger because he was difficult to move and refused their commands. They put him in a segregated cell and called for two corrections officers any time they moved him. Barker was accompanied by a single officer when she visited his cell.

Barker also told the nursing commission that her responsibilities were limited by the jail’s contract with the Island County Public Health. She worked at the jail 24 hours a week. She said it wasn’t her job to check on every inmate every day.

“Looking at the nurse’s situation, the limitations there, the commission didn’t see a good reason to pursue discipline against this nurse,” the agency’s legal manager Karl Hoehn said.

The investigation revealed that prior to April 6, Barker had no contact with Farris and didn’t have any of his medical records, Hoehn said. Barker also said that no one told her that Farris had been refusing food and water. He didn’t appear to be in acute distress at the time she saw him, Hoehn said.

It would be hard to show that her actions, given what she knew at the time, led to patient harm, he said.

“The tragic outcome is not squarely on her shoulders,” Hoehn said.

Island County Sheriff Mark Brown disputes that Barker would have been denied access to Farris if she had asked for the cell door to be opened.

“She did have the authority if she demanded to go into the cell,” Brown said.

Farris had his first manic episode in 2013. He’d stopped taking his medication after his acute symptoms subsided. His parents suspect that he was in a manic episode when he was first contacted by police on March 20, 2015. He didn’t receive any medication while in the Coupeville jail.

Fred Farris said he is disheartened by the commission’s decision. His son deserved better medical care than a quick once-over by a nurse, Farris said.

“It is disappointing to see that the (state) Department of Health has different standards for nurses in jails or prisons,” he said. “If she was in a hospital and the only medical health provider and her patient died of dehydration, I don’t think anyone would argue that she should lose her license.”

He and his family were told that Keaton Farris was being seen by a nurse. They had left messages for Barker, alerting her that Farris had bipolar disorder and needed his medication. She never called them back, Fred Farris said.

“I think it’s unconscionable to walk away from someone who needs your help without any sort of evaluation,” he said. “Our expert told us that Keaton’s condition was completely reversible up until the time of his death.”

Barker has been licensed since 1984. She began working for Island County Public Health in 2007. The department contracts with the jail for nursing services.

The state nursing commission had never received a complaint against Barker prior to the jail death, Hoehn said. Barker’s boss at the health department told investigators that she was a compassionate nurse who was devoted to the inmates, Hoehn said.

Barker was put on leave pending an investigation by the county health department. She resigned from her position July 20, and the health department closed its investigation. It didn’t file a complaint about Barker with the nursing commission.

The commission began investigating after a reporter at The Herald inquired about the status of Barker’s license.

Barker is a nurse at Maple Ridge Retirement and Assisted Living Community in Freeland, according to the commission’s records.

Meanwhile, the Whatcom County Prosecuting Attorney’s Office and the FBI continue to investigateFarris’ death for possible criminal charges.

Farris had been shuffled among three jails before being booked into the Coupeville lockup. He was taken into custody in Lynnwood. He missed court that day, and a San Juan County judge issued a $10,000 warrant. Farris was charged with identity theft for forging a $355 check in San Juan County.

He was housed in the jails in Snohomish and Skagit counties before being moved to Coupeville in Island County, which provides jail services under contract with San Juan County.

Several Island County Jail staff resigned after Farris’ death, including two corrections officers who allegedly falsified records. Brown fired the jail lieutenant.

Fred Farris and his family reached a $4 million settlement in December with Island County, San Juan and Skagit counties. As part of the agreement, Island County agreed that a corrections expert hired to evaluate the lockup’s operations will monitor the jail for 18 months. Phil Stanley made a series of recommendations in October to improve medical care for inmates, including more attention to those with mental illness and serious health conditions. Several improvements have been made and more are under way, based on Stanley’s recommendations.

Island County hired two nurses and an advanced registered nurse practitioner, who serves as the medical director. Nurses are now working seven days a week during business hours, new jail chief Jose Briones said.

The medical director also is on-call after hours. Nurses make rounds daily, interacting with every inmate. The jail’s policy is that nurses won’t be denied access to inmates if they need to make physical contact with their patients, Briones said.

The medical director, mental health provider and jail personnel are meeting weekly, sharing information about inmates and their health needs. Medical screening at booking also has improved, Briones said. The jail also now has access to medical records if the inmate has been seen by a local health provider, such as Whidbey General Hospital.

“We are looking at best practices on how to manage a difficult population and we’ve had additional training on how to handle mentally ill inmates,” Briones said.