One prisoner died of alcohol withdrawal. Constipation killed another. A third succumbed to gangrene.
The deaths sound like they come from the logs of a Civil War POW encampment, but all three are alleged to have befallen detainees at the Madison County Jail in Huntsville, Alabama, while they were awaiting trial.
In 2013.
"What connects them all is that all of these people were in the medical-watch area, supposedly under the care of nurses," said Florence-based civil rights attorney Hank Sherrod, who in the past six weeks has filed federal lawsuits on behalf of the families of the alleged victims.
The suits target the county, jail and Advanced Correctional Healthcare Inc., the company paid to provide medical services to county inmates. The suits allege that the county and ACH reached a "deliberately indifferent" agreement to delay or deny care as a cost-saving measure.
With county consent, the suits allege, ACH "staffed the Madison County Jail inadequately, hired substandard medical personnel willing to put cost over inmate health and safety, denied inmates medications and delayed or denied medically necessary referrals to outside providers."
Both Madison County and ACH officials declined to be interviewed for this story because of the pending litigation. They instead provided CNN with brief statements.
"Advanced Correctional Healthcare is pleased to have the opportunity to deliver a high standard of health care for Madison County Jail patients while partnering with Madison County to address the need to provide quality healthcare within its budget. ACH will not try its cases in the (media)," read a statement from ACH spokesman JD Dalfonso.
Madison County Attorney Jeff Rich said in an email he had a longstanding policy of not commenting on lawsuits.
"Although the almost instantaneous and continual flow of information arguably calls for a more substantive response, I believe it remains wise to reserve comment and let the litigation process run its course," he wrote.
'They just watched him ... totally indifferent'
The allegations surrounding the August 2013 death of Deundrez Woods of Huntsville are the most disturbing.
Arrested in June 2013 on shoplifting and third-degree assault charges, the 19-year-old behaved normally for several weeks until "jail records show that by August 6, Woods was confused, hallucinating and unable to communicate with correction and medical personnel," according to one of the lawsuits. He was then moved to the jail's medical unit.
"They just watched him," Sherrod said. "They were happy to let him lie there ... totally indifferent to what was really going on."
Fifteen days later, he died of a blood clot originating in his gangrenous foot, the lawsuit states, further alleging he was treated as a problem prisoner rather than a man suffering from a life-threatening infection.
Woods was stunned with a Taser on August 6, 9 and 14, according to the lawsuit, and no one took his vital signs from August 7 to August 19.
On August 17, the odor emanating from his foot was so foul that guards "dragged Woods from his cell to the shower, sprayed him with water and then placed him, still naked, in a different cell," the suit states.
"Jail records affirmatively show Woods did not eat from August 14-19 and that as of August 12, Woods' water supply was cut off," the lawsuit states. "Jail records also show Woods was naked during this period."
According to the lawsuit, after August 14, no ACH nurse entered Woods' cell until August 19, the day he died.
The report that Woods wasn't eating left his mother incredulous. A high school football player and heavyweight wrestler, the young man would eat anything but beans, his mother said.
"He was a big boy. He liked to eat," said Tanyatta Woods, adding that when she needs her spirits lifted, she goes to the restaurant where she and Deundrez shared their last meal and he put down "$50 worth of Mexican food."
The night before her phone interview with CNN, Tanyatta Woods was up all night crying over Deundrez's death, she said. She couldn't sleep, and her other son had to comfort her.
She recalled for CNN on Monday how she saw Deundrez a few days before he died. He was brought into court August 15 in a wheelchair, she said.
She asked court and jail officials why he was in a wheelchair, and they cited patient privacy laws, she said. One official told her Deundrez was suffering from mental problems, but having a nursing and pharmaceutical license, she realized something else was wrong with her son, she said.
"I told them my son didn't have any mental problems," she said. "They couldn't explain to me why he was in a wheelchair."
He seemed confused and unresponsive, she said. His lips were discolored, he was having trouble seeing and he didn't seem to remember much, other than the name of his 2-year-old son, Jalen, his mother said.
"I begged them to take him to the hospital," she said. "They refused."
The next time she saw Deundrez was in the hospital August 19. He was on life support. She'd have him taken off two days later.
Other deaths in the same jail
Woods' case came about five months after Nikki Listau died and about two months before Tanisha Jefferson died, after serving time in the same jail.
Listau, 60, was arrested at her home and charged with harassing communications on March 10, 2013. She couldn't walk and had to be booked into the jail in a wheelchair, another lawsuit states.
The delirium tremens, or DTs, from her alcohol withdrawal was so severe that she suffered seizures and broke her left femur and fractured multiple ribs "as a result of falling off of her bunk while in a medical watch cell," according to the lawsuit.
When a guard found her naked on the cell floor, "rambling incoherently," her March 11 video court appearance was canceled.
Two hours later, Listau was found unresponsive in her cell, the lawsuit says. She was pronounced dead the following day.
"Despite her condition, Listau received no treatment; defendants just watched Listau deteriorate and eventually die," the lawsuit states.
Unlike Listau, Jefferson, 30, was apparently cognizant that something was wrong with her, according to the lawsuit filed by her mother.
Arrested on a harassment charge October 14, 2013, she began complaining of rectal and abdominal pain on October 19. She also told jail officials she was unable to have a bowel movement, a third lawsuit states.
On October 25, the mother of three filed a medical grievance saying she had been sick for at least 10 days, and in an October 28 request to see a doctor, Jefferson asserted she feared for her life and warned that jail and medical staff would be responsible "if something happened to her," the lawsuit states.
Sherrod elaborated, saying Jefferson wrote a note that read, "If I die, it's on y'all."
Jefferson saw a doctor the following day and was prescribed laxatives and sent back to her cell, where she told fellow inmates and jail staff she hadn't had a bowel movement in 13 days and "she thought she would explode, that she was so weak and in pain she could hardly walk," the lawsuit states.
"On October 30, 2013, Jefferson took another turn for the worse. She started sweating and started having difficulty breathing," according to the lawsuit, and ACH medical staff were told of Jefferson's condition, "yet did nothing."
She saw another nurse the next day and was sent back to her cell again, the lawsuit states.
That evening, at about 8:40 p.m., she passed out in her cell after "complaining of even more extreme abdominal pain," according to the lawsuit.
Even then, Jefferson was not sent to the hospital. Instead, she was taken by wheelchair to the medical department for observation. An ambulance was not called until Jefferson became nonresponsive around 9:09 p.m.
By that time, it was too late.
She died on Halloween "as a result of complications related to a bowel obstruction most likely caused by an extended period of constipation," the lawsuit says.
Lawsuits allege a money-saving motive
All three lawsuits allege that, in each case, the conditions were so severe that even a layperson would have realized they were life-threatening, but ACH ignored each inmate's symptoms to save money.
"ACH's business model, reflected in the agreement, succeeds by underbidding the competition and implementing severe cost control measures, the necessary result of which is unnecessary inmate suffering and liability claims (dealt with through liability insurance)," the suits say.
Even in the months after the three deaths, Sherrod noted, jail administrator Steve Morrison spoke at length of the financial burden of providing health care to inmates.
In an April story published several months before any of the lawsuits were filed, CNN affiliate WAFF-TV reported the county was seeking state or federal coverage for certain health care expenses. Morrison told the station, "Constitutionally we're supposed to provide medical care. ... It doesn't say we have to pay for it."
The jail has $800,000 earmarked for outside care, Morrison said, but the funds can be depleted with just a few hospitalizations.
"We had an inmate that had some type of illness from all the psychotropic drugs that he'd been taking throughout his lifetime. He was in a coma for a long time, and it was almost $300,000 for him. Now when you get just one of those out of a thousand inmates, that can really cripple your budget," Morrison told the station.
The jail referred all of CNN's questions to the county attorney, who issued only the aforementioned statement.
Sherrod hopes jail and ACH staff aren't intentionally letting people die to save money, but they've demonstrated a willingness to "roll the dice with people's lives," he said.
"They wait and wait and wait and hope it goes away. That's a formula for killing people," he said.
The lawsuits ask for unspecified compensatory and punitive damages and legal fees, and while that may provide some relief to the loved ones of those who died, Tanyatta Woods is more interested in answers: Namely, why would jail staff ignore her son's suffering for days, even after he became unresponsive?
She's not the only one wanting answers, she said. Her son was a "lovable" fellow with many family members and friends. Deundrez even kept in touch with his middle school coaches and teachers, and they, too, were shocked by his death, she said.
Until she gets her answers, she'll lean on her other son as well as Deundrez's old pals from his football and wrestling teams. They love her shrimp Alfredo, and she's more than happy to whip up a barbecue or fish fry for them.
"I still keep a house full of his football (teammates)," she said. "All the kids still come by and check on me."
