'They . . . let him lay in there and die.' Families question jail health care.

Oct. 19--Three months after Christopher Lee Wetherington was booked into the Craven County jail, he began slipping into a mental fog so deep that he talked to people who weren't there and refused to remain dressed. He turned down all food and water.

Wetherington, 33, of Cove City, was being held on charges related to the theft of a truck. Jail officials placed him on suicide watch in an isolation cell in the jail's booking area. Several days went by with little change in his behavior, until he was found laying on a mat, groaning. He was rushed to the hospital and placed in the intensive care unit, where he died early the next morning on May 12, 2015.

What hospital staff in New Bern discovered, and what a medical examiner's investigation later showed, was that a drug Wetherington took to control his bipolar disorder had risen to a toxic level in his bloodstream. That drug is lithium.

The jail's records showed it rose to dangerous levels, and was likely a contributor to his increasingly bizarre behavior. By his final week, it registered at 4.3 millimoles per liter -- more than three times what is considered a safe level -- but he still remained in the jail for four more days.

"They pretty much let him lay in there and die," said his stepsister, Ashley Jones, who lives near Cove City, about 100 miles southeast of Raleigh. "He was seen stumbling around, wouldn't keep his clothes on, eating his own feces. That's not alarming enough to seek some help?"

That's a question being asked after several jail inmates in North Carolina died who were in noticeably serious physical distress but remained behind bars for hours or days, records show.

-- In Wake County, heroin addict Cecelia Sypka spent three days in jail in the throes of withdrawal that included bouts of vomiting and diarrhea before she suffered a heart attack and was taken to WakeMed, where she died within a few hours. A state autopsy found Sypka, 44, died on April 29, 2015

from withdrawal complications, and noted her dehydration. In a lawsuit, Sypka's family claimed jail medical staff missed numerous signs that she was becoming severely dehydrated, and should have sent her to the hospital much sooner. She had been held on methamphetamine manufacturing charges.

-- In Cleveland County, Archie McNeilly Jr., 40, died from renal failure on May 12, 2015, after spending a week in the jail. His family claims in a lawsuit that detention officers and nurses did little in response to his complaints of weakness and abdominal pain, and were angered at his inability to control his bowel movements. An autopsy showed McNeilly had a large kidney stone and a related infection that shut down his kidneys. McNeilly had been accused of breaking and entering, larceny and possessing stolen property.

-- In Guilford County, Ellin Beth Schott, 57, spent three days in jail without her anti-seizure medicine. A jail nurse told her that until he could talk to a doctor, all he could give her was Tylenol, according to the medical examiner's report. By the time she was transported to the hospital, she had suffered multiple seizures and was in and out of consciousness. She died two days later on Aug. 26, 2015. She had been arrested on an illegal panhandling charge.

-- In Haywood County, jail officials settled a lawsuit prompted by a young woman's death from pneumonia in 2011. In Stanly County, jail officials settled another wrongful death claim brought by the family of a young woman who died in 2010 from diabetic ketoacidosis, which is triggered by abnormally high blood sugar. Both are maladies that typically don't kill young adults if they are treated in a timely fashion.

The deaths in Craven, Cleveland and Stanly counties all happened in jails served by the same health care provider, Southern Health Partners, a company based in Chattanooga, Tenn., that has contracts with roughly 30 jails in North Carolina, more than any other in the state. It has been a defendant in lawsuits involving four other jail deaths in North Carolina over the past 10 years.

Dr. Marc Stern, a former medical director for Washington state's prisons, said when jails struggle with inmate health care, the cause is usually traced back to funding.

"We simply don't spend enough money on health care in jails until there are serious problems," he said. "There's a lawsuit and someone throws more money at it."

Inmate health issues

Jails often have to provide medical care to people who walk in with serious health issues. Those with serious mental illnesses or drug addictions struggle to take care of themselves. Inmates are typically poorer than the average person, which increases the odds they aren't getting preventative health care. Local jails typically house inmates who are awaiting trial or are serving sentences for lesser crimes than state prison inmates.

As jails deal with higher numbers of inmates with mental illness or drug addictions, the health care costs go up if the facilities can't find efficiencies. State legislation passed in 2013, for example, made it much harder for jails to rely on charity care from hospitals by requiring them to pay at least 70 percent of the bill or twice the Medicaid rate, whichever is cheaper.

Since then, the Wake jail's health care costs have jumped. Last year, the jail paid $7.8 million for health care, nearly $1.4 million more than in 2013. That's a 21 percent increase. Jail officials suspect other factors also may have contributed to the increase, such as the closure of the Dorothea Dix mental hospital in Raleigh in 2012.

Greg Kash, an attorney representing Sypka's family, said in the lawsuit the jail's medical staff continued to treat her behind bars to avoid the cost of hospital care. The detention center on Hammond Road, which opened in 2012, has a medical unit that resembles a hospital ward with a nursing station, reclining beds and a laboratory for blood testing.

Dr. Obi Umesi, the jail's medical director, said the pending litigation prevented him from commenting on Sypka's death. But he said the jail does not hesitate to send inmates to the hospital if they need a higher level of care.

"At any point in time, once we think that the (required) care exceeds what we can offer, they're gone to the hospital," he said.

Sheriffs and jail administrators often have no medical training, and so they have to rely on the medical staff they hire, or outside contractors. In North Carolina, a niche industry of companies that specialize in inmate health serves a majority of the jails.

These companies can save jails money by performing more care in the jail than by sending inmates out to hospitals, which often means expensive emergency room care.

Allen Moran, the jail administrator for Dare County, said the jail began contracting its care out to Southern Health Partners in October 2015.

Moran saw the jail's health care costs drop dramatically. In the year before Southern took over, the jail spent $298,000 on inmate care. Last year under Southern, it shrank to $163,000.

Moran said the company achieved a big chunk of those savings by reviewing medical bills charged by outside providers and discovering the jail was entitled to lower rates. Before Southern Health took over, jail officials weren't checking to see what was the cheaper rate under the 2013 law. He said he's seen no issues with the care provided.

"They've saved us a great deal of money, going to them," he said. "We provide more service and it costs less."

Court records show Wetherington's estate filed a wrongful death claim against Craven County and Southern Health. Both settled the claim out of court. In the jail's case, Craven had to make public in a court filing the $50,000 it paid to Wetherington's estate.

That document stipulates that Wetherington's representatives, including attorney Douglas Abrams of Raleigh, not discuss the settlement with "any news reporter, news media organization, or the like." Abrams declined comment about the case.

The document refers to a separate settlement with Southern Health, but it wasn't filed with the court. State law doesn't require settlements between private parties to be made public.

An attorney for the county said no one had a copy of it. Numerous efforts to reach Southern Health officials were unsuccessful.

"I do not believe that the agreement between the Estate and the company was filed, and it is my understanding that the County does not have a copy of it," said Scott Hart, a private attorney representing Craven County, who did not respond to further questions about the death. "For whatever it's worth, I have never seen a copy of it, either."

Guilford County officials said they, too, had no information regarding a settlement between Schott's estate and the jail's health care provider, Correct Care Solutions of Nashville, Tenn. The county paid no money to Schott's estate and admitted no wrongdoing, but said in a news release that Correct Care would increase staffing to make sure inmate's prescription needs would be met.

Jim Cheney, a spokesman for Correct Care, declined to comment about the case, citing patient confidentiality. The company provides health care in correctional facilities across the country, including four other North Carolina jails, Durham, Forsyth, Mecklenburg and New Hanover.

Cheney said the company goes beyond providing "day to day" health care, with initiatives such as quarterly patient surveys that began in Durham and soon will be in the other four North Carolina jails. He said the company follows standards overseen by the National Commission on Correctional Healthcare and the American Correctional Association.

Jonathan Jones, director of the N.C. Open Government Coalition, said the lack of transparency when private health care contractors are involved makes it hard for citizens to know whether health care in jails is adequate.

"The practice of having a medical malpractice lawsuit sealed, especially when they result in death in an otherwise county-run facility, is really problematic," Jones said.

Settlements with government agencies are usually public, though judges who handled the wrongful death claims in Haywood and Stanly counties signed orders keeping them secret. Neither initially provided detailed explanations why, as the law requires, though one issued a subsequent ruling saying the death involved the medical area of the jail and therefore should be kept private under medical malpractice laws.

Cleveland County's jail administrator could not be reached, while officials in Haywood and Stanly counties have declined to talk about the deaths in their jails.

Supervision problems

According to state death records, of the 151 local jail inmates who died in the past five years in North Carolina, nearly half, or 73, died from causes listed as "natural or other." Heart disease was a leading killer. Sypka's death was attributed to her "harmful use" of illegal drugs.

Inmate health is not the sole responsibility of jail nurses and doctors, whether they are in-house or contracted. Detention officers are supposed to be trained to spot signs that inmates are ill or in pain and report those signs to medical staff.

That's one reason the state requires detention officers to check inmates at least twice an hour, and at least four times an hour if an inmate is considered to be a suicide risk, suffers from mental illness or is behaving wildly or erratically.

A recent News & Observer series, Jailed to Death, cited state reports in finding supervision problems in 51 inmate deaths over the past five years. That's one out of every three deaths during that period, and one out of every two investigated.

Wetherington's death was among them. The state Department of Health and Human Services' Construction Section, which oversees jail supervision and safety standards, said Wetherington should have been checked at least four times an hour after he had reported his mental illness and that he had thought about suicide when he was booked.

Craven County jail officials said they have instituted four times an hour checks in the booking area where Wetherington was being held in an isolation cell. They also said they had won approval for an increase in medical staffing, so they can be available in the booking area to observe inmates.

DHHS investigators have little oversight of health care in the jails. The regulations require jails to have a medical plan, and DHHS can cite them for failing to follow it. But the investigators do not try to determine if the health care provided was negligent.

Stern, the former Washington state prisons medical director, said there are no standards for jails, such as a ratio of health care staffing per number of inmates, because jails are not alike.

"There's not even any good national data or norms on how much you should be spending (on health care) per inmate each year," he said.

He said the medical examiner needs to be the key person to help the public see whether a jail death resulted from poor medical care. In North Carolina, medical examiner reports and autopsies are public record.

Wetherington's autopsy notes the high levels of lithium in his blood stream, while offering no opinion whether Wetherington should have been taken to the hospital days earlier.

Wetherington had two daughters ages 9 and 15. He grew up in the New Bern area, and had a difficult time focusing as a child. He didn't graduate from high school, drifting toward a crowd that often used drugs. It wasn't until roughly five years before his death that he was diagnosed as bipolar, his stepsister Ashley Jones said.

"He did a lot of bouncing around, and moving, and he just never really was in a stable place," she said. "And he always wanted to fit in. He was a people pleaser."

Wetherington had several prior run-ins with the law before stealing the truck, which he drove to Texas before being arrested. Jones said she visited him in the jail before his mental state deteriorated. She brought along one of his daughters, and she thought he was beginning to turn a corner.

After his death, relatives put up signs in front of their homes and created a Facebook page that seeks "Justice for Chris." Jones wasn't involved in the settlement and said she knows little about it.

Money for his daughters doesn't settle matters for her.

"Money doesn't bring justice to what happened to him, and why it happened," she said.

Dan Kane: 919-829-4861, @dankanenando

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