A logo sign outside of the headquarters of Corizon Health, Inc., in Brentwood, Tenn. on Feb. 4, 2017. Kristoffer Tripplaar, Sipa / AP Photo

A federal judge in Oregon has approved a $10 million judgment against Washington County and Corizon Health, following the 2014 death of a woman who died in the county jail.

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The settlement is the highest Corizon — a private health care company which operates in jails and prisons across the country — has ever paid in a judgment of this kind and means the company and county accept responsibility.

On April 24, 2014, Madaline Pitkin, 26, was found dead in a cell in the Washington County Jail where she was detoxing from heroin.

In 2016, Pitkin’s parents, Mary and Russell Pitkin, filed a lawsuit against Corizon and the county over their daughter’s death.

“What we wanted to accomplish with this lawsuit, was to help make change,” said Russell Pitkin, during an emotional news conference Friday in downtown Portland. “We wanted Washington County and Corizon to acknowledge that they were responsible for what happened and to make changes. There are too many of these kinds of deaths.”

Portland defense attorney David Sugerman, who didn’t work on the case, said the judgment is significant.

“The company has determined this is so risky, they would rather admit fault — which is very rare — and pay $10 million, than face the possible consequences of what a federal jury would do,” he said. “The company has admitted responsibility rather than face the wrath, the potential of a much higher outcome, a much higher verdict.”

Related: Lawsuit Filed Against Washington County And Corizon After Jail Death

Attorney John Coletti, one of the attorneys who represented the Pitkins, said their daughter needed basic medical care; an IV to stay hydrated while she detoxed.

“This is not cutting-edge medical care,” Coletti said. “This is third-world medical care. The ability to provide an IV is not heroic on any level.”

In a statement, Corizon Health CEO Steve Rector said the medical team at the jail failed Pitkin and her family.

“The amount of this settlement is unprecedented for our company and reflects how far removed the facts of this case are from our standards and expectations of care,” Rector said in a statement. “For whatever small comfort this may provide, the lessons we’ve learned from this case have been catalysts for significant changes we have made and are still making to our clinical program.”

Rector said Corizon reorganized in 2017 and now operates with a new leadership team and board.

On Friday, attorneys for the Pitkins cast doubt on whether Corizon has learned and changed.

After Pitkin’s death, Corizon put together its own internal review of what happened.

“They refused to produce it, we couldn’t get the judge to force them to produce it, so we still don’t know what their takeaway truly was from this and what they truly learned, if anything,” Coletti said.

Corizon stopped providing medical services in the jail on May 31, 2015, said Washington County Sheriff’s Deputy Jeff Talbot.

“Since that incident, many changes have been implemented to how healthcare is provided to inmates at the Washington County Jail,” Talbot wrote in an email. “Our current healthcare provider, NaphCare, has piloted a program in Washington County to provide medication that helps inmates who are detoxing from drugs.”

Before Pitkin died, Washington County officials were aware the jail’s medical care was insufficient.

Cristin Rettler, a former Corizon employee who worked in the jail, met with Washington County Sheriff Pat Garrett in late 2013 and early 2014 to share her unease about the low level of care the company was providing at the jail.

“I expressed my concerns about Corizon, and their — I thought their goals of reducing costs were in direct conflict with the goal of caring for our patients,” Rettler said in a May 2018 deposition.

Rettler said Garrett was concerned the county wasn’t getting the level of care from Corizon that it was paying for.

“And then, you know, the other concern was, you know, of course, the ethical piece. But — and I did think that the sheriff cared about that; that the patients were not being cared for.”

A spokesman for the sheriff, who didn't use Rettler's name, said a physician's assistant who met with the sheriff didn't disclose any concerns regarding the treatment of inmates or the quality of medical care. But the sheriff passed along concerns to the jail commander about treatment of staff.

'Please Help Me': Pitkin's Death

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On April 16, 2014, Pitkin was arrested by Tualatin Police for unlawful possession of heroin and she was booked into the Washington County Jail.

The lawsuit states Pitkin submitted at least four health care request forms during her week in the jail asking for care.

“None resulted in an exam, evaluation or other contact with medical staff,” the lawsuit filed by Portland attorney Tim Jones stated, another attorney representing Pitkin’s parents.

No doctor was on staff the day Pitkin died, the lawsuit states; the only doctor that had been on staff was terminated the day before.

When Pitkin was booked into the jail, a nurse ordered a clinical opiate withdrawal scale evaluation. But the nurse who did the evaluation incorrectly tabulated the results, the lawsuit states. Furthermore, the nurse told investigators the protocol had been approved by a doctor when, in fact, they were approved by a physician’s assistant, the lawsuit states.

On April 19, Pitkin submitted a form requesting medical care.

“Heroin withdrawal,” she wrote. “I told medical intake that I was detoxing & they said I was not yet sick enough to start meds. Now I am in full blown withdrawal and really need medical care. Please help!”

During the night, Pitkin vomited. She needed a change of bedding the next morning, the lawsuit states.

Again, she submitted a form requesting help.

"Detoxing from heroin REALLY Bad," she wrote. "Can't keep any food down. Heart beating so hard that I can't sleep."

The same nurse reviewed both requests. She noted Pitkin had been seen and her protocol started. But an autopsy would later reveal no controlled substances or common pharmaceuticals were in Pitkin’s system.

Following Pitkin’s second request, the nurse ordered Loperamide, a drug that treats diarrhea.

“No medical staff examined Pitkin or took any other actions in response to her second Health Care Request form,” Jones wrote in the lawsuit.

Madaline Pitkin, in an undated photo provided by the Pitkin family. Courtesy of Mary and Russell Pitkin

On April 23, the day before she died, Pitkin wrote again for help. It would be the last time.

“This is a 3rd or 4th call for help,” she wrote. “I haven’t been able to keep food, liquids, meds down in days … I feel like I am very close to death. Can’t hear, seeing lights, hearing voices. Please help me …”

A deputy in the jail called for medical staff. A nurse did another withdrawal evaluation.

“Unable to get a reliable blood pressure reading, Pitkin was transferred to the Medical Observation Unit,” Jones wrote in the lawsuit.

Piktin was taken to the medical unit and given a pitcher of Gatorade. By then, she was so weak she was having trouble sitting up to take medication.

The next morning a jail deputy saw Pitkin sweating profusely.

The deputy asked a nurse to check on Pitkin, but the nurse refused, saying she was there to check on an inmate with diabetes.

The deputy insisted. But it was too late.

“Pitkin was found lying on her cell floor with brown fluid leaking from mouth and nose, eyes open, mouth weakly moving with one arm moving/twitching,” Jones wrote in the lawsuit.

EMS responded, but couldn’t revive her.

Pitkin’s cause of death: chronic intravenous drug use. The manner: “natural.”

But at Friday’s news conference, Coletti, put it more bluntly:

“The cause of Madaline’s death was dehydration,” he said. “All Madaline Pitkin needed was an IV. Rather than give her an IV at the jail or send her to a hospital, they left her alone in her cell to die.”

Pitkin’s death was inhumane, he said, and it was preventable.