Dallas Morning News-Kevin Krause, April 2007

Former county jail inmates fighting for their lives

Officials reject claims, say ‘good standard’ of treatment was provided

08:33 AM CDT on Thursday, April 19, 2007
By KEVIN KRAUSE / The Dallas Morning News
kkrause@dallasnews.com

They walked into the Dallas County Jail, two men with drug problems.

They ended up in Parkland Memorial Hospital’s emergency room.

A feeding tube now keeps Lee Jefferson alive while he lies motionless in a persistent vegetative state. John Graves doesn’t know how long he will survive the cancer that ravaged his body while he was inside the jail.

The men’s families and lawyers say that they were denied adequate medical care inside the jail and that it contributed to or caused their dire conditions.

Their legal team, which recently won a $950,000 settlement from the county in a jail neglect case, is gathering medical and jail records and interviewing witnesses.

Lee Jefferson, 28, stopped breathing at the hospital, where he was taken after the Dallas County Jail ran out of medications to treat his blood disease. He was left with severe brain damage, and is now cared for by his mother, Madelyn Feaster. Sharon Phillips, Parkland’s vice president in charge of jail health, said the medical treatment the men received in jail was “within a good standard of care.” She said privacy laws prevented her from providing specifics.

Dallas lawyer David Finn, with whom Mr. Graves’ family is consulting, said he has made the U.S. Justice Department aware of the Jefferson and Graves cases. The department is scrutinizing the jail’s medical care, and officials will make an extensive follow-up visit to the jail next week.

Medical records show that both inmates received some medical attention inside the jail. Their cases highlight the challenges for jail health-care workers to properly assess and treat inmates, many of whom enter with, or later develop, serious medical conditions.

“Many of the individuals that are arrested and brought to the jail have not been taking very good care of themselves,” Ms. Phillips said.

County officials have blamed many of the jail’s problems on a former jail health contractor and insist that Parkland has greatly improved jail health since taking over those duties last year.

However, Mr. Jefferson didn’t receive the medication he needed for his sickle cell disease until a month after he was booked into the jail in January, said lawyer Russell Wilson, a member of Mr. Jefferson’s legal team who acquired his jail medical records.

And in the five days leading up to his February hospitalization, the jail ran out of one of his medications, an antibiotic, according to his jail medical records, Mr. Wilson said. Mr. Jefferson, 28, stopped breathing at the hospital. He was left with severe brain damage.

“He walked in that jail with the functions we all have. And he left deprived of everything but breath,” Mr. Wilson said.

A vicious cancer
Mr. Graves, 38, arrived at the jail in November. His family says he has battled a drug problem that is to blame for his legal troubles. His mother, Billie Rich, said she had wanted to get him into a state drug-rehabilitation facility, but the waiting list was too long.

Mr. Graves said that beginning in mid-January, he asked repeatedly to have the growing lump on the side of his left cheek examined. His jail medical records show that by March it had grown to a mass of about 2 inches by 3 inches.

When he was taken to Parkland on March 4, Mr. Graves said, he was pale and underweight, having vomited and defecated blood repeatedly. The aggressive cancer in his neck has since spread to his stomach. There is too much to remove. He doesn’t know how much longer he has to live.

The men were in jail, serving brief sentences – one for drug possession, the other for theft as a result of an underlying drug problem. Judges ordered them released from custody last month because of their rapidly deteriorating health.

Sheriff Lupe Valdez has launched investigations into the cases.

“If we’re wrong, we need to fix it,” she said.

Mr. Finn said someone must accept responsibility for what happened to Mr. Graves.

“You would think that with the Department of Justice breathing down its neck … the county would have eliminated this type of fiasco,” Mr. Finn said.

The Dallas County Jail has flunked four state inspections in a row. In December, the Justice Department released a scathing report documenting numerous cases in which lack of proper medical care contributed to the death and injury of inmates.

While Mr. Graves was in serious condition at Parkland late last month, an ambulance was dispatched to take him to a state hospital in Galveston, six hours away. He had been waiting since January to be transferred to the state’s custody to finish out his sentence.

At the time, he had only about two months remaining on his nine-month sentence for stealing an air-conditioning unit from a house under construction.

After an emergency hearing in Judge Lana Myers’ 203rd Criminal District Court, the judge released Mr. Graves because of his condition and put him on probation.

County and state officials could not explain why the decision was made to transfer him to state custody that late while he was seriously ill. The Sheriff’s Department and the Texas Department of Criminal Justice blame each other for arranging for the transport out of Dallas County.

Mr. Graves said that while in jail, guards ignored his repeated requests for help and accused him of faking illness to get out of the jail.

At Parkland, he needed several blood transfusions to replace blood he had vomited as the cancer grew on his cheek and in two places in his stomach, he said. Chemotherapy has reduced the tumor on his neck. But the cancer continues to grow inside his stomach. He faces additional treatments of chemotherapy.

John Graves doesn’t know how long he will survive the cancer that ravaged his body while he was inside the jail. “I’ve been healthy as an ox my whole life,” he said. “Dying dogs have been treated better.”

Ms. Phillips said that Mr. Graves saw a doctor multiple times in jail and that she is “comfortable with the standard of care” he was given.

His records show that Mr. Graves was first seen by a nurse for the lump on his jaw on Feb. 1. The next day, a doctor examined him and diagnosed the growth as an inflammation of the salivary gland. The doctor prescribed antibiotics, ibuprofen and Benadryl, records show.

Blood-test results, available about nine days earlier, showed a low red blood cell count, according to the records.

On Feb. 28, Mr. Graves complained that the antibiotics had not reduced the growth on his cheek. The next day, the same doctor noted that the growth had increased about 25 percent, and she ordered an “urgent” ultrasound.

Records don’t indicate whether the ultrasound test was performed. Mr. Graves said it wasn’t.

On March 4, Mr. Graves arrived at the nurse’s station by wheelchair, “very pale” and complaining of weakness, according to his medical records. He told nurses he had passed out earlier. Records show that he was sent to Parkland’s ER for “further evaluation” and while there was found to have non-Hodgkin’s lymphoma.

On March 17, he underwent stomach surgery to stop bleeding, and doctors said there was too much cancer in his stomach to remove, his family said.

Mr. Jefferson has had to take antibiotics twice daily to fight infection since his damaged spleen was removed when he was 18, said his mother, Madelyn Feaster. She said her son has been in and out of hospitals all his life because of sickle cell disease.

Mr. Jefferson also was taking folic acid, which helps make new red blood cells to replace dying ones. Red blood cells carry oxygen to the body.

Sickle cell disease is an inherited blood disorder in which a person’s red blood cells, normally flat and round, form into a sickle or crescent-moon shape and get stuck in blood vessels. Such blockages are known as crises, which often are followed by extreme pain.

The blockages can stop blood flow to major organs.

Mr. Wilson said Mr. Jefferson’s medical records indicate he didn’t receive his medications between Jan. 4 and Feb. 3, or during the days immediately prior to his transfer to Parkland on Feb. 24.

Ms. Feaster said she and other relatives called the jail multiple times, beginning on the day of his arrest, to tell staff about the medications her son needed daily.

She said her son told her by phone that he wasn’t getting his medicine and had gone into crisis four times in jail, where he was serving time for violating his probation on a cocaine-possession case. The final episode resulted in his hospitalization.

Mr. Wilson said the jail had a medical record on Mr. Jefferson from when he was in the jail previously. Staff knew or should have known what medications he was on, he said.

Mr. Wilson recently won a new trial for Mr. Jefferson on the probation violation charge he pleaded guilty to three days before his hospitalization. Mr. Wilson argued in court papers that the lack of proper medical care affected Mr. Jefferson’s decision to plead guilty. After granting the new trial, the judge ordered Mr. Jefferson back on probation, court records show.

Ms. Phillips said that based on the information Mr. Jefferson provided medical staff upon his arrival at the jail, she was satisfied with the “timeliness of care.”

“With the information we had that came directly from him, we did perform absolutely appropriately,” she said.

Ms. Feaster must care for her son around the clock in a small apartment until he can be moved to a nursing home. After initial scares when paramedics were called, she is becoming more adept at caring for him.

Using a plastic tube connected to a suction machine that she’s renting for $60 a month, she gently cleans her son’s mouth of saliva and mucous. Mr. Jefferson cannot move, except for an odd reflex motion.

“He walked in and came out like this,” said Ms. Feaster, who moved to Dallas from Queens, N.Y., with other family members to care for Mr. Jefferson.

When she saw him for the first time since his arrest, he was on life support at Parkland. He was released this month. Ms. Feaster says she wasn’t instructed on how to use the equipment. She did something wrong the other day, and he vomited all over himself.

He lies motionless on a borrowed hospital bed, a tube attached to his neck. He is breathing on his own, but that’s about all he does. His eyes open occasionally to gaze vacantly. Doctors told the family he has no awareness of anyone around him.

Still, Ms. Feaster holds out hope that her son can regain some functions. She said she felt pressured by doctors at the hospital to remove the feeding tube.

“They said, ‘He’s never going to come around. Let nature take its course,’ ” she said. “That’s like killing him. I felt that if God wanted him, he would have taken him.”

TWO INMATES AND JAIL HEALTH

Nov. 28: John Graves is booked into the Lew Sterrett Justice Center.

Dec. 11: The U.S. Justice Department issues a report detailing instances in which dangerous conditions at the jail contributed to the death and injury of numerous inmates and placed others at “risk of serious harm.”

Jan. 4: Lee Jefferson is jailed after violating his probation by being arrested by Dallas police on charges of giving a fake name when stopped.

Mid-January: Mr. Graves notices a lump on his jaw and begins seeking medical attention.

Jan. 26: Mr. Graves pleads guilty to felony theft and gets nine months in state jail.

Feb. 2: A jail doctor examines Mr. Graves and prescribes antibiotics for what she believes is an inflammation of the salivary gland.

Feb. 3: Mr. Jefferson receives medications for sickle-cell disease for the first time.

Feb. 21: Mr. Jefferson pleads guilty to violating his probation. His probation is revoked, and he’s sentenced to two years in prison.

Feb. 24: Mr. Jefferson is taken to Parkland Memorial Hospital for treatment of a sickle-cell pain crisis. He stops breathing and is connected to a breathing tube.

March 1: A doctor orders an urgent ultrasound of Mr. Graves’ tumor after antibiotics fail to reduce the growth on his neck. There is no record of the procedure being done.

March 4: Mr. Graves is taken to Parkland after throwing up blood and passing out. He is given blood transfusions. The mass on his neck has grown. Lymphoma in his neck and stomach is diagnosed.

March 17: Mr. Graves undergoes surgery to stop bleeding in his stomach, but doctors have to sew him up because of the amount of cancer they find.

March 21: A judge grants a motion by Mr. Jefferson’s attorney for a new trial based on lack of medical care at the time of his plea.

March 22: A judge orders the sheriff not to release Mr. Graves to the state’s custody after his mother goes to the courtroom in an attempt to stop a waiting ambulance from taking her seriously ill son to a Galveston state jail hospital.

March 23: The judge holds an emergency hearing, probates Mr. Graves’ sentence and orders him released from custody, with about two months remaining on his sentence.

March 26: A judge places Mr. Jefferson, who is in a persistent vegetative state, on unsupervised probation for five years.

April 2: Mr. Jefferson is released from Parkland into the care of his family.

SOURCES: Family members, family attorneys, court records and jail medical records