An incomplete picture

“History received from detention officers: She had been incarcerated 2.5 weeks prior, and while in detention center she was placed on suicide precautions,” Lantz wrote in his postmortem report. “She had been on hunger strikes attempting to starve herself, spitting out food and liquids for a number of days. She refused to drink or eat most of the time.”

Incident reports filed by detention officers in some ways contradict the accounts staff provided to Dr. Lantz, and include critical details omitted from Lantz’s report. Those details would have put events in a different light.

Four incident reports authored by detention officers make no mention of Jen “spitting out food and liquids,” as Lantz wrote, although the reports indicate she was experiencing a loss of appetite and refusing to eat.

The postmortem report completed by Dr. Lantz makes no mention of multiple incidents of Jen falling and urinating on herself, which are documented in the jail incident reports.

Lantz told me he doesn’t recall seeing any reference to those incidents in any of the reports he reviewed, but he added that had he seen the information he doubted that it would have changed his conclusions.

Dr. Robert Newman, a former assistant commissioner for addiction programs for the New York City Health Department who was responsible for implementing the city’s methadone program in the early 1970s, challenged Dr. Lantz’s conclusions about the likely causes of Jen’s death after reviewing the report.

“The medical examiner’s entries under the heading ‘probable cause of death’ seem to me to be totally unsupported — and, indeed, refuted by the limited information available,” Newman said. “Nothing confirms the cause of death: ‘hypoxic ischemic brain injury’ — what brain injury? When did it ostensibly occur? Examined by what medical facility? Treated how? Observation period after the ‘injury’?”

Lantz’s postmortem report alluded to the fact that Jen’s suicide watch required that jail staff conduct observation checks on her every 15 minutes. The contrast between the check reported at 10:15 a.m. and the one at about 10:30 on the morning of her sudden failure of health is jarring.

“At her 10:15 check, she was alert and mentation was appropriate,” Lantz wrote. “Around 10:30 she was found to be slightly discolored, a nurse was called and she was determined to have a weak pulse. Shortly after no pulse found, CPR initiated.”

Lantz told me in a recent interview: “It does seem a little odd that she would be found unresponsive just 15 minutes after being checked and found alert. I’m not sure what the check entailed. They may have thought she was sleeping.”

If Jen had been sleeping during the reported 10:15 a.m. check, it’s hard to understand how she would have been “alert.”

Newman told me that the implication that Jen “died as a result of lack of fluid intake seems to me preposterous. She was under constant supervision — every 15 minutes. At 10:15 she is said to be ‘alert and mentation appropriate.’ Eighteen minutes later she was ‘discolored’ and unresponsive and without a pulse. The timing itself would have demanded a full autopsy.”

Under state guidelines, the decision of whether to perform an autopsy, as opposed to a more limited external exam, is up to the county medical examiner.

“Based on her period of hospitalization she was here [at the hospital] for six days,” Lantz told me, explaining his decision not to perform an autopsy. “There wouldn’t have been much to learn from an autopsy. If she had come directly from the jail and died, it would have been a different matter.”

The theory that Jen was carrying out a hunger strike and suffering from dehydration is confounded by reports that on at least two occasions she experienced significant urinary incontinence, suggesting that she was taking in at least some water.

Going back to Jen’s ninth day in jail — also nine days before she was found unresponsive — when she was discovered trapped against the wall by her bed with a large amount of urine on the floor, Nurse Carol Surratt advised Jen “to eat her meals and slow down drinking water,” according to the report filed by Pfc. McBride.

“They probably told her to slow down on drinking water because of the incontinence episode,” Dr. Starer told me, “because there is no medical reason for that advice.”

Starer’s theory that Jen had suffered a seizure puts the official story that she was on hunger strike in a different light.

“When you have a seizure you go into a fugue,” Starer said. “You wouldn’t really be inclined to eat.”

A theme of the jail incident reports is the suggestion that Jen was faking her symptoms.

“Inmate McCormackschuler has been refusing to walk or use the toilet on her own,” Pfc. McBride wrote again on Sept. 13, using a compound of Jen’s last name and a name from her previous marriage. “Medical has stated that Inmate McCormackschuler is capable and there is no medical reason at this time that she cannot walk on her own.”

The report was made scarcely eight hours before she was found unresponsive in her cell.

Dr. Jody Rich, director of the Center for Prisoner Health and Human Rights at Brown University in Rhode Island, said there could be some truth to staff’s characterizations about Jen’s behavior.

“The truth is, they probably often do have patients who malinger, act out, deliberately pee all over themselves and worse,” he said. “And who knows, I am sure she felt miserable — maybe some of her behavior was deliberate.”

Pfc. McBride’s reference to Jen’s urinary incontinence on the eve of her collapse adds a curious twist to the theory that dehydration contributed to her death.

“The active suicide gown that had been issued to Inmate McCormackschuler was underneath her and soaked with urine,” McBride wrote. “We could not mop up the mess around her with her in the cell without producing a hazard.”

Dr. Starer said in her opinion the episode is “not consistent with dehydration.”

While maintaining that he hadn’t been aware of the urinary incontinence episodes, Dr. Lantz made a statement that seems to cut against his position.

“Toward the very end if she was dehydrated you wouldn’t expect her to urinate because the kidneys have a mechanism to hold on to as much water as possible and the urine will be concentrated,” he said.

After Jen was relocated to a new cell, McBride reported that she “refused to respond to directives and just stared at officers.” The report goes on to say: “Medical assisted by placing an ammonia capsule under her nose. At that time Inmate McCormackschuler held her breath and medical administered a chest rub to get her to respond.”

The report struck Dr. Starer as odd when she read it.

“You do a chest rub to see if somebody’s conscious, but if she’s staring at officers then she’s conscious,” she said. “None of that makes sense.”

Starer added that in her opinion Jen should have been transferred off site long before the episode on the eve of her collapse.

Dr. Lantz suggested that any judgments about whether Jen should have been transferred to a hospital earlier can’t help but be colored by the knowledge that the worst ultimately transpired.

“That would be in hindsight,” he said. “It looks like if she transferred earlier it may have made a difference. Then again, it’s going to depend on protocols and everything else as far as what all the factors were.”

John Jr.’s perspective on the relative quality of care Jen received at Forsyth County jail is informed by his family’s history of involvement in the detention industry. His parents worked together in the profession, and John Sr. has continued to operate detention centers while Janis has spent much of her career working in dispatch for police departments. As a child, John Jr. spent time hanging around detention centers and developed a familiarity with their processes.

“I don’t know if she was having a hunger strike,” he said. “I know for a fact with my family if it becomes a danger to the person they’re going to force them to go to the infirmary to get IV. That’s what’s always done in a jail. It’s amazing to me that not only as an addict, but also as a pregnant woman she had to be their priority. She’s a pregnant woman going cold turkey off opiates, which is going to make her sick.”

Along with being unaware that Jen had been falling and urinating on herself, Lantz was also not informed that Jen was released from custody a day prior to her death. He marked on her postmortem report that she Jen’s “death occurred while in custody.”

“I didn’t know that,” Lantz said. “That never got passed down to me. Technically when someone comes from the jail I would assume they were in custody. If a district attorney did give an order to lift the bond I had no knowledge of that.”

As a bizarre coda to the story, John Jr. said when he arrived at Baptist Hospital, the sheriff’s office was limiting the family to 20 minutes with Jen per day, so that each person was allowed to spend five minutes with her. A sheriff’s deputy was posted in Jen’s hospital room throughout, until the family worked one of Janis’ law enforcement connections to get Jen released from custody so they could have full access to her before they took her off life support and allowed her to pass.

John Jr. couldn’t handle the hospital room scene, and left two days prior to Jen’s death to spend time with his grandfather in Kernersville.

“To have a sheriff looking over her and to hear my last words to my sister felt degrading,” he said. “And a needless use of force. There was no reason why they needed to waste resources to watch her.”

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