The Real Cost of Prisons Weblog

Those inmates are given medications, mostly tranquilizers, to help them cope with the physical symptoms, such as vomiting, nausea, lethargy and confusion, resulting from going cold turkey in the hands of law enforcement, officials said.

One of those detoxing inmates, said jail superintendent Jay Ashe, was Cynthia Brace.

Brace, a 41-year-old Holyoke woman and longtime heroin user, died Aug. 20, one day after she was sent to the Ludlow facility following her arrest on drug charges.

"Was that a detox case? Yeah. Yeah. It's not that hard to guess with these numbers," said Jay Ashe, the brother of Hampden County Sheriff Michael J. Ashe, during a recent interview. "Unfortunately, she died during the treatment."

Brace's lawyer, Shawn P. Allyn of Holyoke, said her death was more than unfortunate, it was unnecessary.

"This death could have and should have been prevented," said Allyn, who also represents Brace's husband, Cecil, who is awaiting trial in Hampden Superior Court on drug and other charges.

Allyn said he has asked the state attorney general to investigate Brace's death, and charged jail officials with failing to provide proper care while she detoxed. He said that was, in effect, cruel and unusual punishment and a violation of his client's constitutional rights.

Allyn, who represents Brace's estate, said he intends to file a wrongful death suit against the county facility, the Hampden County Sheriff's Department and the Massachusetts Department of Corrections.

"Requiring an inmate to go 'cold turkey' clearly demonstrates a deliberate indifference to the serious health risk and potential of medical harm this may have on a given inmate," Allyn said.

The state medical examiner ruled Brace's death was the result of natural causes, and District Attorney William M. Bennett told The Republican there is no indication of foul play.

So far, jail and county officials have not provided The Republican with the autopsy reports or detailed records of her treatment, citing laws relating to inmate privacy.

Prior to an April hearing on Beacon Hill about inmates with mental illness, Sheriff Ashe said the jail could not have done anything differently in Brace's case.

Jay Ashe said her death was investigated internally, by the Massachusetts State Police and by the Hampden County district attorney, and Ashe expressed confidence that jail staff followed all proper procedures.

"We're very comfortable with it," he said of the jail's response.

Brace was arrested by Holyoke police on Aug. 18 in connection with drug charges and allegations of elderly abuse of a city man.

Two days later she was dead.

Brace was brought to the jail on a Friday afternoon after a Holyoke District Court judge ordered her held without bail.

According to a timeline issued by the jail shortly after Brace's death, she was seen twice by medical staff on the first day and put through the standard orientation procedure.

According to a heavily redacted, eight-page account of Brace's stay at the jail - released recently only after The Republican filed a public records request with Sheriff Ashe - jail officials, nurses and other medical staff had numerous, regular contacts with Brace.

The report, released by lawyers representing the sheriff, detailed regular 15-minute checks throughout the night and the following morning, although all medical references were blacked out. Brace reportedly was alert and conversant between periods of sleep, was given two showers and her bedclothes were changed several times.

The last contact between Brace and medical staff was noted at 10:55 a.m. on Aug. 19, shortly after she was given medication and placed on a stretcher in a hallway near the nurse's station, according to the report. At about 11:20 a.m., a registered nurse noticed that Brace "was on her left side but that her head was turned awkwardly."

Emergency life-saving steps were taken after the nurse found that "she wasn't breathing" and that "she didn't have a pulse, no respiration."

Earlier, officials said Brace had been vomiting and was brought to the jail's medical unit for treatment.

At 11:55 a.m., the report states, she was taken by ambulance to Baystate Medical Center in Springfield, where she was pronounced dead at 11:59 a.m.

Lawyer Edward J. McDonough Jr., who represents the sheriff, stressed that all references to Brace's specific medical condition were blacked out in the report because Allyn refused to waive privacy protections for Brace.

McDonough denied the newspaper's request for the results of an internal investigation into Brace's death, citing they are the purview of "medical peer review proceedings" and specifically exempt from public disclosure.

He also refused to provide internal communications about Brace's condition, saying public disclosure of such materials "would so prejudice the possibility of effective law enforcement that such disclosure would not be in the public interest."

The district attorney and the medical examiner's offices used similar language in declining to provide similar requests for interoffice correspondence regarding Brace's death.

The Republican is considering appealing those decisions, particularly regarding the internal review of Brace's death, since the public is entitled to know how a person in state or county custody is cared for.

Allyn, who received a copy of the autopsy report, said it shows that neither Medical Examiner Dr. Joann Richmond nor consulting cardiac specialist, Dr. David L. Gang of Baystate Pathology Associates in Springfield, could definitively conclude why Brace died.

Each doctor offered cardiac arrhythmia, or an irregular heartbeat, as a possible cause of death. Allyn said he doubts those determinations because, although she was a longtime drug user, Brace had "no prior heart problems to this degree."

The report also notes Brace had bruising on her wrists, Allyn said.

Brace is the 25th person to die in jail custody in the last 25 years, a period spanning an estimated 55,000 inmates, according to jail statistics.

Eighteen of the deaths were of inmates being held in custody, and the rest were people who died while in day-reporting or work release programs.

Eight of the deaths were attributed to AIDS-related illnesses. Four were considered suicides, and the remainder were from a variety of medical conditions, including brain hemhorrage, stroke, liver disease, lung cancer, heart disease and sleep apnea.

Six other inmates, like Brace, died within the first two weeks of custody. Three of them were suicides.

Jail officials, speaking generally about detox procedures and not the Brace case specifically, said the volume of new inmates needing detox is just one part of the bigger issue involving chronic health and mental health issues at the jail.

"They're big. That's what we're dealing with," Jay Ashe said of the medical concerns. "No one has any idea, (and) no one wants to know. The medical issues are huge, aside from the detox."

Nationally, since the declaration of the War on Drugs in the mid-1980s, county jails have seen between 60 and 70 percent of new inmates needing detox, said Dr. Scott Chavez, vice president of the National Commission on Correctional Health Care.

"Jails are at the front lines of (the war) on drug addition," he said.

Sheriffs throughout the state recently went to Beacon Hill to lobby for an additional $9 million to assist with treatment of mentally ill inmates.

As social service agencies have seen budget cuts in the last few years, county jails have been left to treat inmates arriving with mental, medical and addiction issues, said James F. Walsh, executive director of the Massachusetts Sheriff's Association.

The estimated number needing treatment at the Ludlow facility is comparable with other county jails across the state, Walsh said.

There has been no official study but the sense is that the problem has only gotten worse over the last decade, he said.

Officials with the Ludlow facility said roughly half of all inmates have historically needed some kind of detox, but as the jail population has grown in recent years, the number of detox cases has grown proportionately.

For the first time since the Ludlow facility opened 14 years ago, jail officials have recently begun describing the facility with a word not used since the days of the old York Street jail: overcrowded.

At the beginning of April, the jail had a record 1,642 inmates inside a facility designed to hold 962, or 171 percent above the planned capacity, according to jail officials.

The pretrial population of 814 inmates, following an increase of 17 percent over the previous three months, is now just below the sentenced population of 828.

Overcrowding complicates every aspect of running the facility, jail officials say.

Jay Ashe agreed the jails are being forced to pick up the slack on detoxing as community-based programs that specialize in addictions are losing resources.

"We have become the detox center," he said. "There are very few resources until you hit rock bottom."

As Sheriff Ashe notes, "Jails are a reservoir of illness, and no less so than in terms of the illness of addictions."

With many inmates, the addiction masks an underlying health concern that also needs to be addressed, officials said.

Terri Theroux, director of health care at the Ludlow jail, said that in addition to seeing patients in varying stages of addiction, the medical staff has to treat people suffering from illnesses such as asthma, chronic illness, hypertension and hepatitis.

"Generally, there are very sick people, and (the illness) could be exacerbated by the detoxification of one substance or another," she said.

Theroux said the detox treatments vary from inmate to inmate, depending on the substance, how long the person has been addicted and the last amount taken.

Men and women are kept separated from each other at the jail, but the detox procedures are exactly the same, she said.

The jail has no infirmary with bed space for inmates needing treatment. Instead its medical unit is run like a clinic, and inmates receive treatment and return to their cell. Those needing more serious care are transferred to local hospitals.

The Ludlow jail was given full accreditation last year by the National Commission on Correctional Health Care, and was named its facility of the year in 1998.

Chavez, who has toured the Ludlow facility, said its health care services are highly regarded, and are seen as a model for more than a dozen jails nationwide.

The jail's approach is to contract doctors from area health clinics and assign inmates to doctors based on proximity to the community where the inmate resides, he said.

This encourages inmates to continue going to the area health clinic after release, he said.

Medical staff check in with detox inmates daily, but it is up to corrections officers to keep an eye on them, Theroux said. A person who has been an addict for a longer period has a rougher time coming clean than a new user, she said.

Sometimes, Theroux said, inmates arrive in rough shape because they've been held in a police lockup for a day or more without a fix and with no medical assistance. "Detoxification may take several days for a person to rid him or herself of the substance," said Theroux. The jail's procedures seek only to "ease the detoxification process."

Jay Ashe said the initial detox treatments seek only to minimize the physical symptoms of withdrawal. The psychological reasons for addiction are addressed later in counseling, he said.

The jail does not treat inmates with methadone, a synthetic narcotic used to treat heroin addicts, but its use has been under consideration for the past year, he said.

Detoxing inmates are given medications used as various forms of "mild tranquilizers," such as Librium, a short-term medication used for treating anxiety associated with types of withdrawal, Jay Ashe said.

"We're trying to calm them down and deal with the detox issue," he said.

Patrick Johnson can be reached at pjohnson@repub.com

David Reid can be reached at dreid@repub.com

©2006 The Republican