Illustration by Michael Hogue/The Dallas Morning News.

Unresponsive More women are going to jail in need of drug and alcohol treatment. Help often comes too late Alicia Skeats was a tall blond Texan who believed in second chances: for stray cats, unreliable boyfriends and her own battle with addiction. She took methadone to fight an old heroin habit; her scanty legal troubles involved traffic violations. The 33-year-old climbed into a cab in Mesquite on April 15, 2014; five days later she was found “unresponsive,” dead on the floor of the Dallas County jail. Law enforcement officials labeled her death as “natural causes”; her autopsy said drug withdrawal killed her. Alicia Skeats, 33, loved animals, cars and drift racing. (Facebook) As a record number of women go to jail in Texas, sheriffs are increasingly coping with a special class of inmates: women with minor criminal records but major mental-health and addiction problems. A recent federal survey found that almost a third of women in jails showed symptoms of serious psychological distress, even higher than the rate for men. And when inmates die in jail, drugs are more commonly the cause for women than for men, according to an analysis of state data by The Dallas Morning News. At least 10 of the 86 female jail fatalities since 2011 were attributed to overdoses. But at least another 10 women died from addiction-related problems that the state failed to track, according to our review of the cases, autopsies and medical records. Many of those drug-linked deaths, like Skeats’, were attributed to “natural causes.” A few were called accidents or suicides. For example, Dallas County jailers labeled a 33-year-old woman’s 2012 death a “justifiable homicide” in the state’s database, but the medical examiner ruled she died of a heroin overdose. The way deaths get labeled can obscure their true causes. The municipal lockup in the Gulf Coast town of Aransas Pass recorded a 27-year-old woman’s death in 2011 as “accidental injury to self,” but her autopsy revealed she died of a cocaine overdose. How do inmates die in Texas jails? The cause of death listed on custodial death reports filed following jail deaths from 2011 to 2016. Source: Texas Commission on Jail Standards Stephanie Lamm/DMN The state Attorney General’s Office, which maintains the database of deaths, generally does not update its records when autopsy and toxicology results are complete, even if the findings contradict the jail’s original report. A spokeswoman said the agency does not perform audits to determine if law enforcement agencies are complying, and it is “left to the reporting agency to determine the appropriate amount of information to include.” Jail is where people who are arrested await trial or serve time for low-level infractions like probation violations. Many are eligible to be released on bail but can’t afford to pay it. A higher percentage of women than men are jailed for substance-abuse incidents and don’t get adequate treatment in custody for addiction, said Ranjana Natarajan, director of the University of Texas Law Civil Rights Clinic and an author of a 2016 study of mental illness and addiction-related deaths in jail. While the Federal Bureau of Prisons and other states have minimum standards for medical detox of addicted inmates, most local and county jails don’t, Natarajan said. Unless local lockups improve drug treatment, she said, “you’re going to see a lot of women suffer in jail as a result — and sometimes, they’re going to die.”


Unresponsive The following are excerpts from custodial death reports submitted by jails to the Office of the Attorney General and autopsy reports from medical examiners. Click the photos below to read about each case.

x (Courtesy of ObitTree) Krystina McDermott, 25 Location: El Paso Reported Manner of Death: Natural causes Medical Examiner Ruling: Stroke associated with heroin use Custodial death report (Taken verbatim from state reports) 6-25-2014 WEDNESDAY 5:39PM. El Paso City Police Dept. arrested the Deceased/Krystina McDermott on an outstanding warrant from Dallas County TX. 11:37PM. The Deceased was booked into The El Paso County Sheriffs Office Detention Facility on outstanding warrant. During the process of booking, the Deceased was questioned VIA Intake-Medical Evaluation. The Deceased did not admit to any drug abuse or alcoholism abuse but did admit to having Epilepsy-Seizures at least 2 to 3 a month. Booking was completed on 6-26-2014, THURSDAY 1:43AM. The Deceased was assigned to cell block 1110. 6-27-2014 FRIDAY 5:05PM. The Deceased suffered a seizure. The Deceased is taken to the Jail Clinic for treatment. After seizure passes the Deceased admits to be withdrawing from Heroin use. Medical Protocol is administered for drug withdrawals. 5:55PM. The Deceased admits she is withdrawing from Alcohol abuse. Medical Protocol is administered for alcohol withdrawals. Drug protocol is ceased pending alcohol protocol. Deceased is stabilized and Deceased is returned to cell block 1110. 6-28-2014 SATURDAY 12:00PM. The Deceased is medicated at her cell block 1110. 12:28PM. The Deceased suffers another seizure. The Deceased is found not to have a pulse and CPR is administered. An A.E.D. device is brought to the location and activated. The device instructs to administer a shock and the shock is given. The device then instructs, continue compressions. No other shock is instructed. The Decease regains heart beat/pulse and the Deceased is transferred to local hospital, (LAS PALMAS MEDICAL CENTER), for further treatment. 7-7-2014 MONDAY Hospital studies show that that the Deceased has minimal brain activity, vegetative state. The Deceased is breathing only with aid of ventilator. Next-of-Kin, Mother, conferred with medical Doctors about withdrawing life support. 4:25PM. Per Next-of Kin, mother, life support is withdrawn from the Deceased. 4:50PM. The Deceased dies.

x (Courtesy of Facebook) Magnolia Blakeman, 28 Location: Beaumont Reported Manner of Death: Alcohol/Drug intoxication Medical Examiner Ruling: Combined toxic effects of methamphetamine, synthetic cannabinoids and hydrocodone Custodial death report (Taken verbatim from state reports) Deceased was arrested by the Port Arthur Police Department at St. Mary's Hospital, Port Arthur, Texas, for Public Intoxication. She was transported to our facility and held in a single cell prior to booking and medical screening. Due to her violent behavior she was restrained and a helmet placed on her head. Deceased had been trying to injure herself and made the remark that she was going to cut her throat. Deceased was placed on suicide watch. After an hour of being observed by supervisors at our facility, the decision was made to have her moved to our infirmary for further observation. She was not able to be housed in general population due to her continued violent behavior. As she was being placed in the cell, in the infirmary, Blakeman became unresponsive. Infirmary staff was notified immediately and outside EMS was called. CPR was performed as she was being transported to Baptist Hospital. She was later pronounced dead

x (Courtesy of Parker Ashworth Funeral Home) Anissa Bramhall, 35 Location: Kaufman Reported Manner of Death: Other Medical Examiner Ruling: Brain hemmorrhage due to methamphetamine abuse in combination with Coumadin therapy for Protein C deficiency Custodial death report (Taken verbatim from state reports) On March 19, 2014 at approximately 1256 hours, Anissa M. Barmhill [sic] was arrested for Public Intoxication (MC) by Kaufman Police Department. Due to Barmhills conduct, the arresting officer took Barmhill to the Kaufman Emergency Room for evaluation. Barmhill was medically cleared to be brought to jail. Upon receiving Barmhill into the Kaufman County Jail, the initial health screening form was immediately completed. Barmhill answered the questions for the physical and mental health screening. Officers did note that Barmhill could not sit still and had awkward rapid movements. Medical staff assessed Barmhill, took vitals and recorded orders to continue monitoring. Barmhill was placed in a holding cell (C11) and was placed under a special watch to be checked at a minimum every thirty (30) minutes. Throughout the night the thirty (30) minute checks were completed. At approximately 0500 hours, March 20, 2014, LVN Kelly contacted Sgt. Blair requesting time to check Barmhill and obtain vital signs. Sgt. Blair looked in on Barmhill and observed that Barmhill had urinated on herself. At this time Sgt. Blair, Officer Salters and LVN Kelly gathered the necessary items to change Barmhills clothing and fresh bedding items. LVN Kelly retrieved a Depends, while Blair and Salters retrieved a clean uniform and bedding. Officers Salters and Blair along with LVN Kelly entered the cell and aroused Barmhill using an ammonia capsule. The officers and LVN Kelly had to undress and redress Barmhill. Barmhill was cooperative and showed little resistance to changing clothes. As they were beginning to move Barmhill to a clean mattress, they observed that Barmhill did not appear to be breathing. LVN Kelly checked for a pulse and none was found. Immediately Sgt. Blair via radio contacted Shift Supervisor Lt. Owen to respond and requested an ambulance to be dispatched. LVN Kelly retrieved the AED and it was applied to Barmhill. Lt. Owen and Sgt. Blair began CPR. The ambulance arrived and the paramedics advised the officers to continue CPR and use of the AED, while they set up. Shortly after the first ambulance, a second ambulance arrived and the paramedics took over CPR. Barmhill was transferred to a gurney and the ambulances AED and was transported to Kaufman Presbyterian Hospital Emergency Room. Barmhill was eventually transported to Baylor Hospital, Dallas. Ms. Barmhill died at 1317 hours on March 20, 2014. The public intoxication charge was dropped by Kaufman Police Department prior to Barmhill being transferred to Dallas. An autopsy has been performed and results are pending.

x Courtesy of Facebook Challase Jennings, 47 Location: Austin Reported Manner of Death: Other Medical Examiner Ruling: Chronic alcoholism, acute alcohol withdrawal and heart disease Custodial death report (Taken verbatim from state reports) Deceased was arrested on 03-06-15 for Driving While Intoxicated and Leaving the Scene of an Accident. At the time of booking deceased admitted she drank 6 to 7 glasses of wine a day but denied going through alcohol withdrawal. Deceased was placed on withdrawal monitoring. Deceased was checked by jail medical staff on March 6 at 11:30 PM, March 7 at 12:00 PM and 3:10 PM and on March 8 at 12:05 AM. Deceased was found unresponsive on March 8th at approximately 7:30 AM. CPR was performed on deceased by corrections officers, jail medical staff and paramedics. Deceased was pronounced dead at 8:14 AM on 03-08-15. The Medical Examiner’s report determined the cause of death to be natural due to chronic ethanolism, including atherosclerotic cardiovascular disease.

Texas has no statewide standards for detox procedures in county jails. Some inmates withdrawing from alcohol or other drugs — opiates, anti-anxiety drugs, methamphetamines — died while toughing it out cold turkey, suffering cardiac arrest or seizures. Sometimes they commited suicide. ‘I can’t stop’ The same weekend in 2014 that Alicia Skeats went to jail in Dallas County, Amber May wore out her welcome with the police in Perryton, a Panhandle town where almost everybody knows everybody. Amber May (Family photo.) May, a freckle-faced strawberry blonde, had been working at a nursing home when she met truck driver Jerry Anderson. The couple married and in 2005 had twin girls, he said. But she suffered from bipolar disorder, schizophrenia and depression, which made it tough for her to stay sober, her family said. She had attempted suicide before, drinking antifreeze. “Don’t you get it? I can’t stop,” she would tell them. When she couldn’t afford vodka, she’d go to Dollar General and buy mouthwash or aftershave instead. Her relatives think she was drunk on Listerine when Perryton police arrested her, not for the first time, in 2014. She tried to kick a window out of a patrol car; the police cuffed her hands and legs, then used a Taser on her. When May was booked into the Ochiltree County jail, she filled out a form: View note Instead of placing her on suicide watch or in an available detox cell, the jailer put her in one with two metal telephone cords. He said he checked on her “a couple of times,” but May had her back to him and her head was hanging forward. It wasn’t until the jailer brought another woman into the cell that he noticed May was dead, slumped over like a rag doll, two telephone cords around her neck.


May died before a magistrate even had a chance to set her bail. May’s family sued with the help of the Texas Civil Rights Project. Earlier this year, Ochiltree County officials settled the lawsuit in federal court. In addition to creating a half-million-dollar trust fund for May’s family, the settlement requires improved training for jail staff, heightened monitoring for inmates and design of a suicide-proof jail cell. Ideally, May should not have been locked up in the first place, said Hani Mirza, one of the family’s lawyers. “There’s a lot of people out there who would have survived if they just got certain medical treatment or mental health treatment.” Ochiltree County Sheriff Terry Bouchard declined to comment. The settlement came in April, almost two years after the death of Sandra Bland in a southeast Texas jail cell led to a national outcry. Bland’s suicide led the Texas Legislature to pass a law named in her honor. It requires counties to provide inmates with prescribed medications, increase screenings for depression and suicide risk and offer around-the-clock access to mental health professionals. It also requires that independent law enforcement agencies investigate jail deaths. But the new law doesn’t provide money to pay for all of its mandates. Without financial help, most jails won’t be able to meet the standards, said Dennis Wilson, the sheriff of Limestone County, just east of Waco. He serves on the board of the Texas Commission on Jail Standards, which inspects county — though not municipal — jails. Like many smaller county jails, his contracts out medical services and spends a lot of its budget on health-care expenses, including frequent trips to the emergency room. Jails were never designed to be stand-ins for mental health facilities or detox centers, but that’s how they’re being used, Wilson said. “We can’t lose sight of the fact that these people are human beings, and they’re suffering from mental health issues,” he said. “It’s so easy to throw them in the backseat, drive to the county jail and kick them out. And then they’re somebody else’s problem.” Days spent in jail before death Most women who died in Texas jails were in custody less than a week. Source: Office of the Attorney General, Custodial Death Reports 2011-2016 Stephanie Lamm/DMN A dreaded phone call Lee Koch had just gotten out of the shower on Easter Sunday morning in 2014 when she got a call from Parkland Hospital: Your daughter is here. Come as soon as you can. Alicia Skeats’ partying had started in high school, with private school friends who had too much money and freedom, her mother said. Marijuana turned to Xanax and pain pills, then heroin. Despite stints in rehab, Skeats had a pattern: It always started with her falling in love with some guy, and ending up back on drugs. At first, methadone treatment seemed like the answer to Skeats’ struggles. She could get off heroin safely, for about $150 a week. Her mother paid for it. But Skeats came to regret it, her mother said, because she found methadone even harder to shake than heroin.