Should we fix the jails or get addicts out of them?

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What went wrong, Part 2

by Jordan Green

The first installment of this story, published on Sept. 30, introduced Jen McCormack, a high-spirited 31-year-old who became addicted to a prescription painkiller and suffered a heart attack while awaiting trial in the Forsyth County jail. She was 18 weeks pregnant at the time. A disclosure here: I knew Jen through a circle of friends, mainly UNCG alumni, who gathered at parties held at our mutual friend, LaToya Winslow’s apartment on Mendenhall Street in Greensboro. Like most of her friends, I had no idea that Jen had developed a dependency on opiates and was shocked to hear about first her arrest and then her death.

Episodes of incontinence and falling, as detailed in jail incident reports, raised troubling questions about the quality of Jen’s treatment under the care of medical staff employed by Correct Care Solutions.

What remained unanswered in the first installment was what level of culpability the Forsyth County Sheriff’s Office and Correct Care Solutions hold in Jen’s death, and more importantly whether addicted persons, particularly pregnant women, should be locked up instead of receiving treatment while they face criminal charges.

What happened to Jen McCormack in the Forsyth County jail sometime before 10:33 a.m. on Sept. 13, 2014 is described in an official report by a county medical examiner as the “onset of injury or illness” — more specifically, cardiac arrest.

Once she arrived by ambulance at the emergency department at Winston-Salem’s Baptist Hospital, staff intubated her and induced hypothermia to lower the temperature of her brain and prevent it from shutting down due to lack of oxygen and blood flow, according to a report by Dr. Patrick Lantz, a pathologist at Baptist. The procedures appear to have made little difference considering that Dr. Lantz’s postmortem report next indicates that Jen was transferred to the intensive care unit, where she developed hypoxic ischemic brain injury and was mechanically ventilated until Sept. 18, when she died after her family made the decision to remove her from life support.

Jen’s father and brother, respectively John Sr. and John Jr., received the news in Pennsylvania, where they live.

“She had already gone to the hospital when we found out, me and my father,” John Jr. recalled. “I’ve never seen my dad cry except when he had to pass me or my sister off because our parents are divorced. He cried when he called and said, ‘We have to go down to North Carolina; your sister is in critical condition.’ We made a mad dash, and made it there in six hours.”

Working backwards from the cardiac arrest, Dr. Lantz’s postmortem external examination lists the probable cause of Jen’s death as hypoxic ischemic brain injury — the two terms refer to depletion of oxygen and blood flow, respectively. That primary cause of death, Dr. Lantz determined, was triggered by a cascading sequence of crises. From most proximate, they include complications of acute renal failure — another way of saying kidney failure; hyponatremic dehydration — a deficit of body water accompanied by low sodium; and finally, decreased fluid intake.

Put aside for a moment that one physician I contacted — Dr. Robert Newman — challenged the probable cause of death findings; maybe they don’t tell us all that much about what went wrong for Jen while she was awaiting trial in the Forsyth County lockup on charges of prescription drug fraud.

“Pathologists are very limited,” Dr. Jacquelyn Starer, a consulting physician in Massachusetts with extensive experience in addiction treatment, told me. “The cause of death can’t tell you whether someone received adequate medical care. You can’t rely on an autopsy for that. The end cause of death is often very similar in very different types of cases because your information is so limited. You need all the medical records to determine what happened.”

There are a lot of important details that we still don’t know:

• Janis, Jen’s mother, said that she was treated with Suboxone — an opioid medication that contains the drug buprenorphine and is used to treat narcotic addiction — when she underwent a drug-treatment program at Forsyth Medical Center in the eight days prior to her incarceration. Janis reported that she turned over the Suboxone to the jail authorities so Jen could continue treatment, but Correct Care Solutions has declined to address whether they continued Jen’s Suboxone or any other kind of medication-assisted therapy.

• Janis also said that Jen had a prescription for Xanax, an anti-anxiety medication, but that jail officials refused to allow her to bring the medication into the jail. We don’t know if Jen had access to Xanax or any other benzodiazepines — the active ingredient in the drug — while she was in jail.

• We don’t know why Jen was transferred out of the jail for off-site medical treatment on Sept. 3, 4 and 8.

• The jail logged an unexplained incident on Sept. 9, but the county declined to release the report on that basis of it being a “medical record” and “not within the purview” of North Carolina public records law. So we don’t know what happened on that date.

What is clear is that more and more women who are pregnant and addicted to opioids are likely to wind up in local jails in North Carolina and across the country, often without access to adequate medical care, not only endangering their health but also jeopardizing their pregnancies.

Rates of “opioid-exposed pregnancies have risen sharply across the state,” according to the NC Pregnancy & Opioid Exposure Project, a collaboration between the UNC-Chapel Hill School of Social Work and the state Division of Mental Health. As an indication of the number of pregnant women struggling with addiction — who by virtue of their substance use are likely to wind up in the criminal justice system — the rate of hospitalization associated with drug withdrawal in newborns multiplied fivefold from 2004 to 2012, according to the State Center for Health Statistics.

“The incarceration of addicted pregnant women is one of the major crises of our times,” Dr. Starer told me in an email, “and immediate criminal justice reform is needed. But, even with the status quo, incarcerated persons should receive appropriate and humane medical care, which is certainly not my impression of the care given in this account.”