When the guards found him, Miguel Carrera remembers, he was crawling around on the cell floor looking for his eye.

He’d just pulled it out himself. During a long night at an East Texas psychiatric prison, the 20-year-old had been left apparently unsupervised, alone with the haunting voices of his paranoid psychosis. He had a long history of severe mental illness, and on that morning he just wanted to stop the hallucinations that terrified him. So he picked up the only tool he had: a plastic spoon.

After he finished gouging out one eye, severing all the nerves and connective tissue, he started in on his other eye. Now, he’s permanently blind.

Two years later, the Houston man and his wife have filed a federal lawsuit against the prison medical provider, two guards and the former warden, alleging they deliberately understaffed the unit and then left him alone with the tools to hurt himself even though they knew about his mental illness and repeated threats of self-harm.

“The prison is both understaffed in terms of health care providers and guards,” said Houston attorney Kelly Greenwood Prather, who is representing Carrera and his family. “Thus, there’s not appropriate care and oversight for very mentally ill prisoners who have no way to protect themselves.”

A spokesman for the Texas Department of Criminal Justice declined to comment to the Chronicle, citing pending litigation. But a response filed in court earlier this year denied some of the allegations — including the claims of intentional understaffing — and said the agency didn’t have enough information to respond to most of the others.

The claims in Carrera’s case echo those in another lawsuit filed earlier this year after a 19-year-old prison described as “openly suicidal” — with an extensive psychiatric history — killed himself at the Hodge Unit. Like Carrera, the inmate heard voices, banged his head against the wall and refused to take medication.

Hearing voices

Long before he went to prison, Carrera had a history of serious mental health problems. Starting in his teens, he suffered vivid hallucinations and violently psychotic episodes, according to court filings. He was diagnosed with schizophrenia and bipolar disorder and started having minor run-ins with the law, racking up a pair of misdemeanor arrests for trespassing and drugs. In one encounter, he swallowed a Taser that police shot him with while trying to get control of him, a fact documented in his criminal and medical records.

He was barely 18 when he attacked a security guard with his fists, a violent outburst that the lawsuit attributes to his mental illness. Afterward, he was arrested and charged with assault of a security officer. At first, he was put on probation, but records show he was booted off in early 2016 after he failed drug tests for marijuana and prescription pills.

He was back behind bars at the end of the year after his wife called police when he started stabbing himself during a psychotic episode. In January 2017, the judge sent him to the Texas Department of Criminal Justice to serve out the rest of his three-year sentence.

By the time he hit prison grounds, he was experiencing paranoid delusions, so on Feb. 3, officials sent him to the Skyview Unit, one of the system’s three psychiatric prisons.

“While at Skyview Unit, Mr. Carrera continued to experience psychotic episodes,” according to the lawsuit. “The hallucinations and paranoid delusions caused him to scream that he wanted to kill himself. He tried to harm himself by banging his head on the floor and wall. Mr. Carrera never received any relief from the terrible thoughts he had in his head.”

Less than a week before he blinded himself, medical records show Carrera stayed up all night banging his head. He was in a restrictive psychiatric seclusion cell at the time, but the next day medical staff decided he wasn’t a danger to himself and moved him to the less-monitored crisis management wing after he claimed he wasn’t having hallucinations anymore.

But afterward, Carrera refused to take his medication and refused mental health services.

Permanently blinded

In the early hours of Feb. 12, he fell into a bout of florid delusions. He began experiencing “uncontrollable fear” and hallucinations to the point that he wanted to “end the horrible experience,” according to the lawsuit.

Listening to the voices in his head, he picked up the spoon and set to what medical records refer to as “self-enucleation.”

Although he thought he had removed the eye, instead it was left hanging by the optic nerve, according to the lawsuit.

Officers walked by for rounds at 6:30 a.m., but checked only that he was alert. Records show officers didn’t realize what had happened until around 8:30 a.m., when they found him in his bed with a bloody spoon and battered face.

Afterward, paramedics rushed him to a nearby hospital for five hours of emergency surgery. There, doctors attempted to save one eye but could not. They described Carrera’s future chances of vision in the less-damaged eye as “completely zero,” according to the suit.

A few months later, he was released from prison.

“He’s obviously unemployable at this point with limited education and no vision,” Prather said. “He’s basically living with family and trying to figure out how to earn a living.”

Carrera first filed suit in February, but on Monday his attorney filed an amended petition offering more detail about the claims and alleged supervision and staffing problems — both in TDCJ and at medical provider University of Texas Medical Branch — that created what the suit described as “an atmosphere of deliberate indifference” at the East Texas lockup.

High turnover and a lack of staff have long plagued the state’s prisons, many of which are in remote areas. As of late 2017, according to records obtained by the Chronicle, Skyview Unit had a 12 percent officer vacancy rate, making it one of the more robustly staffed prisons in the system.

Taken as a whole, Prather claims, the agency’s failure to protect Carrera from himself amounted to discrimination, as he was left less protected than non-mentally ill prisoners.

It was not unlike the case at the Hodge unit, where prisoner Sawyer Fletcher killed himself after experiencing similar mental health problems, according to another lawsuit filed this year. That suit, like Carrera’s, is still ongoing.

keri.blakinger@chron.com