Albany

It took five agonizing days for Mark Cannon to die.

His death spiral began at the Albany County jail when nurses for a private medical company brushed off the 24-year-old's severe neurological symptoms as heat exhaustion, instructing guards to give him some water and let him rest.

Twelve hours later, Cannon's condition had deteriorated to the point where he lay nearly motionless on the floor of an infirmary cell with foam oozing from his mouth. A nurse patted his arm and wiped away the saliva, wrongly believing Cannon was recovering from a seizure even though he had no history of medical problems.

When the nurse finally contacted a doctor for advice, he instructed her to immediately call an ambulance. But it was too late.

At Albany Medical Center, doctors determined Cannon had suffered a stroke — a loss of blood flow — to his brain stem that his attorney believes may have been caused when he was exercising in the recreation yard on the day he fell ill. Emergency surgery might have saved his life, but too many hours passed after the injury. He lingered for several days before being declared brain dead. At his family's request, Cannon was removed from life support.

Last year, an investigation ordered by the state Commission of Correction determined the care given to Cannon at the jail in August 2014 was "so grossly inadequate ... it shocks the conscience."

The investigation cited multiple missteps by nurses, including their repeated failure to acknowledge the severity of Cannon's symptoms or consult a physician until it was too late.

"Mark Cannon had a progressively deteriorating neurological situation that was completely disregarded by nursing staff despite dramatic signs and symptoms of an active neurological emergency and Cannon's repeated requests for medical care," the investigative report states.

The criticism wasn't an anomaly for Correctional Medical Care, a Pennsylvania-based private company. A month after Cannon's death in August 2014 — but long before his case was investigated — the office of New York's attorney general reached an agreement with the company that allowed it to remain in business in New York with monitoring through May 2018. The company paid a $200,000 penalty and agreed to improve staffing levels and training practices.

At the time of that agreement, Correctional Medical Care -— or CMC — had contracts worth more than $32 million a year with 13 county jails in New York, including Albany and Schenectady counties' facilities. It has maintained many of those jail contracts despite a checkered history. The state's Medical Review Board, which evaluated the company's performance at the 13 upstate jails several years ago, documented "egregious lapses in medical care" involving six inmate deaths at five county jails between 2009 and 2012.

Despite the oversight, the company tasked with handling the monitoring for the state has issued two reports that found serious lapses in CMC's operations at jails, including employing unlicensed and inexperienced staff, inadequate staffing and a "failure to adhere to medical and administrative protocols."

Albany County recently terminated the $3.7 million annual contract it had with CMC since 2012. In a deposition taken last month as part of a federal wrongful-death lawsuit filed by Cannon's mother, Sheriff Craig Apple testified the company's "performance" played a role in his decision, though he said the change was also based on a better offer from another company.

In the deposition, Apple was asked what he thought of the jailhouse videos that showed Cannon's 12-hour ordeal.

"As a layperson and as the sheriff, I saw what would be considered a complete lack of compassion," he said in response to questions from Elmer Robert Keach III, the attorney for Cannon's mother.

Jail video footage, state investigative reports and depositions filed in court records reveal the multiple missteps and negligent medical care that state investigators said contributed to Cannon's death. The videos show Cannon at times staggering through the facility as he was shuffled back and forth to the medical unit, at times begging guards and nurses for help before eventually becoming unable to stand or talk.

State investigation reports and court records also reveal that CMC's nurses, two of whom were later disciplined by the State Education Department, violated multiple protocols, failures that began the moment a guard called the jail's medical office at 4:12 p.m. on Aug. 26, 2014, and informed them Cannon was having problems and needed assistance. Instead of going to Cannon's tier to check him out, as required, nurse Curtis Goyer told the officer to give Cannon some water and ask him lie down. Goyer also failed to notify the facility's health administrator there was a problem, as required, according to state investigators.

"At the time I didn't feel as though he was experiencing a medical emergency," Goyer testified in April during a deposition in the wrongful death case, which is pending in federal court in Albany. "I made a medical determination, not a medical diagnosis."

Less than an hour later, a sergeant was notified that Cannon was incapable of walking or standing. Medical staff were told to come to the tier. Goyer, during his deposition, acknowledged it can take about 30 minutes for nurses to get to an inmate's cell because of delays in obtaining an escort. When pressed on whether an inmate suffering a heart attack or other serious medical condition could die during the time it takes to get to their cell, Goyer responded, "I really have no feeling about it — that's the way it is there."

He also said that to his knowledge, no nurse or anyone else employed by CMC had ever complained about the delays in responding to medical emergencies.

Keach, the attorney for Cannon's mother, asked Goyer if similar delays in responding to a patient emergency would be acceptable at St. Peter's Hospital, where Goyer is also employed. "This is not St. Peter's, this is a jail," he answered.

"I felt as though he was exhibiting signs of heat exhaustion, which is not uncommon for that time of year," Goyer explained.

In the 10 hours that followed the initial visit by Goyer and a second CMC nurse to Cannon's cell, there were shift changes of nurses and correctional staff, and Cannon was shuffled back and forth between his tier and the medical infirmary. At times, cameras showed him staggering into walls and vomiting.

Goyer admitted in his deposition that he did not conduct a neurological assessment of Cannon. "He did not present with any neurological facial deficit."

By 10 p.m. that first night — roughly six hours after Cannon asked for help — officers continued pressing CMC staff to assist the inmate.

"Each time, they were told that the inmate would be seen the next day for sick call and that he should continue to drink water," the state's investigation found.

Just after 3 a.m., with new officers and nursing staff on duty, Cannon was found lying on the floor of his cell unable to talk. His eyes were open and he was foaming at the mouth; his legs were stiff and his arms limp.

Officers scooped Cannon into a wheelchair and pushed him toward the infirmary. Videos of the transport show Cannon's head tilted to the left and his feet dragging beneath him.

Despite his severe symptoms, no one called an ambulance.

Kathleen Coogan, a CMC nurse, took Cannon's vital signs and waved an ammonia inhalant under his nose to see if he reacted. He pulled his head away. When Cannon was wheeled into an infirmary holding cell, cameras captured the scene as an officer pulled him out of the wheelchair and placed his limp body halfway onto a mattress on the floor. His feet were twitching, and Coogan said she continued to observe him on a live-camera feed and by peering through a window in the cell. Even at this point, no ambulance was called.

The state's investigation determined Coogan "failed to conduct a basic nursing and neurological assessment on a patient with obvious signs and symptoms of a neurological crisis ... that she thought Cannon had a seizure and that she would just watch him for a while."

Cannon remained motionless on the mattress for another hour. The cameras showed Coogan going in to see him at 4:30 a.m., and wiping his face and patting his arm. It was more than 12 hours after Cannon pleaded with guards that something was wrong and he needed medical help. Finally, Coogan called a doctor on call for CMC, who instructed her to call an ambulance. It would take nearly another hour for Cannon to be removed from the jail and taken to a hospital.

Emre Umar of Blue Bell, Pa., is president of CMC, a for-profit company owned by his wife, Maria Carpio. Neither are licensed medical professionals. Umar has acknowledged that for more than 10 years the company operated in New York in violation of state law requiring medical-care companies to be owned by a physician. The firm has since restructured to adhere to the law, although Umar remains in charge of its operations.

A year ago, in a pre-trial deposition taken as part of a federal lawsuit filed on behalf of an inmate who died at the Ulster County jail, where CMC was the medical provider, Umar acknowledged multiple and repeated lapses by his employees through the years. Still, he defended CMC's work.

"If you care so much about the people that you're trying to provide care for, why have so many of them died under difficult circumstances such as detailed in all the various Commission of Correction reports?" an attorney asked Umar.

"I think you would have to look at the physical state that the individual is in when they come into the facility, and then you will find out that we do not kill people. We do not let people die," Umar said. "These are people that have had no medical care throughout their entire lives, never seen a physician. They are drug abusers, they are alcoholics. So, you know, what you're saying is a total inaccurate statement."

He also acknowledged that since the implementation of the Affordable Care Act — or Obamacare — many inmates are being enrolled in government-funded health care. Prior to that, Umar admitted, sending an inmate to a hospital would lower CMC's profit margin because some of the costs would come out of their contract revenues. But he denied that there was a systemic problem, or that any staff members were prohibited or discouraged from sending inmates to a hospital in an emergency.

''We pride ourselves on doing a good job and we do not deny medical care even if it affects our bottom line," Umar said.

Keach, the attorney for Cannon's mother, said New York should ban CMC from doing business in the state of New York.

"It's time for the regulators to act," Keach said. "Mr. Umar's business model directly correlates profits with the denial of medical care, and he and his wife ... have made millions from that correlation."

blyons@timesunion.com • 518-454-5547 • @brendan_lyonstu