Depraved Indifference or Reckless Disregard?






I have a weird affinity for old “Law and Order” reruns. I’m not talking the lesser “Law and Order” spin offs like Criminal Intent and SVU…I prefer the originals. With a total of twenty seasons, there’s almost always an episode being broadcast on one channel or another.

I recently watched – for perhaps the third or fourth time – an episode about a man with serious mental illness who killed a woman by hitting her on the head with a rock. This man had auditory hallucinations due to schizophrenia. As he described it, his “bad uncle up in Yonkers” told him to kill people. Of course, he wasn’t guilty, by reason of insanity.

But the show rambled on, and detectives discovered this person was recently released from jail at Riker’s Island, where he hadn’t received much in the way of medical care. He hadn’t been properly treated for his schizophrenia, due to cost containment strategies of the company that provided medical care for prisoners. After he served his sentence, this sick man was dropped off with no medication and no plans for follow up medical care.

Jack McCoy, indignant and outraged (as he so often is on “Law and Order”), decided to charge the owner of the healthcare company with manslaughter. The physician assigned to treat the schizophrenic man was initially investigated, but he was able to prove he was threatened with being fired if he used expensive drugs or sent patients to the hospital. So then the owner of the company became the focus of Jack’s ire.

I don’t remember the exact count he was charged with, but the jury found him guilty, and he was sentenced to about a year’s incarceration. – in the very jail that his company contracted with to provide healthcare. The chief District Attorney, Nora Lewin, jokes that his immune system had better be good, because prisoners there don’t receive good health care.

I was thinking again about numerous news reports of patients with substance use disorders who die in jail, and it made me wish we had a few Jack McCoys in various locations.

Do you remember the case of David Stojcevski? I blogged about this horrible case on 10/20/2015, and again 2/25/2016. As a reminder, David was sentenced to thirty days in jail for non-payment of traffic tickets. He died on the seventeenth day of his sentence from what the autopsy said was “Acute withdrawal from chronic benzodiazepine, methadone, and opiate medication.” He had been on physician-prescribed methadone, clonazepam, and alprazolam, but was denied all of these medications during his incarceration. He was also not treated for the predictable withdrawal from these medications.

The family released videotape of his immense suffering (he had been moved to a “monitored” cell when he began to exhibit delirium) and are suing Macomb County, Michigan, where this jail was located. They are also suing Correct Care Solutions, the healthcare provider contracted to attend to the health of inmates.

The Justice Department investigated to see if criminal charges should be levied against the people who allowed David to die by denying him medical care. They investigated the charge of “deliberate indifference” on the part of jail staff and Correct Care Solutions personnel. Last year, the U.S. Attorney for that area announced they couldn’t find evidence for criminal intent on the part of jail workers and Correct Care Solutions that met the standard of beyond a reasonable doubt, so criminal charges were not brought.

Several days ago. the FBI was forced to release part of the documents regarding their investigation.

From the little that was released, the FBI discovered David had no intake of food during the last five days of his life, and that there were no medical visits from medical staff for the last 48 hours of his life. One guard said he got the impression from medical staff that they believed he was “faking” withdrawal symptoms.

The physician employed by Correct Care Solutions, after observing David, said he was not having seizures, and that he was faking those symptoms. An FBI physician said David should have been started on a withdrawal protocol, and that his fifty-pound weight loss and dehydration should have raised alarms. His opinion was that David died because of deliberate indifference to his medical needs.

The FBI’s records on their investigation showed there were medical visits that weren’t documented, or had poor documentation. Other news reports say 12 people have died in that county jail since 2012.

Even though there will be no criminal charges against the people who should have prevented David’s death by providing routine medical care, and the family’s civil case will proceed – at a snail’s pace.

I don’t understand the decision of the Justice Department. How can jails and prisons legally deny medical care to inmates? Isn’t that against the law? And if an inmate dies from lack of medical care from a completely preventable cause, shouldn’t that be illegal? Doesn’t this violate the 8th Amendment?

There’s a phrase I learned from “Law and Order.” It is res ipsa loquitor, and means “the thing speaks for itself.”

Surely the death of David Stojcevski from a treatable condition speaks for itself.

My question is this: how much louder do similar tragedies need to speak before changes are made to the disgraceful way inmates are treated?

11 responses to this post.

  1. Posted by Vicki Ittel on November 3, 2017 at 2:26 pm

    I also am passionate about this issue and the egregious behavior of many criminal justice systems. I am of the opinion that frequently it is not an issue of ignorance or even indifference, but rather willful neglect that stems from the stigma of addiction. I have unfortunately run into the attitude of “they are just addicts and it’s not going to kill them, so let them ride it out”.
    Well, as you point out, “it”can kill and would we really let a diabetic suffer in jail without their meds or insulin?
    Let’s work together and keep raising this awareness and change the treatment of folks in the criminal justice system suffering from the disease of addiction !


  2. Posted by Alan Wartenberg MD on November 3, 2017 at 5:07 pm

    I have been involved in (unfortunately) scores of similar cases. In one case of poorly treated opioid withdrawal (2 doses, as near as I can tell, of bentyl) a man vomited to the point where the EMT, when they were finally called (two days after the vomiting began, and a day after they drew “stat” lytes which were never reported and contained panic values including a chloride of 57), stated under oath that he walked through 2 inches of vomitus in the small cell. The response of an LPN assigned to “monitor” him was to give him a mop and pail and tell him to clean it up. When he finally got to a hospital, he had perforated his esophagus and developed mediastinitis. A several hundred thousand dollar admission ensued, which could have been avoided by a few bucks worth of meds, and even a smidgeon of kindness. Our prison medical care system constitutes an affront to humanity, and is a violation of treaties that we have signed.


  3. Posted by Sean McKinnon on November 4, 2017 at 4:25 pm

    Jack McCoy was one of the best characters on TV and Sam Waterstone did an excellent job in portraying this character.

    It is a disgrace that the criminal justice system does not treat Opioid Use Disorders as a medical disease.


  4. Posted by Tena Roberto on November 4, 2017 at 6:39 pm

    AMEN. Sometimes I want to scream. I have taken friends to the emergency department to be treated for infection for abscess or other addiction related diseases and the treatment or lack of treatment I have witnessed (one that led to her death) was insidious. I don’t know how our rights were taken because we have this particular disease but in many cases you will not or do not get good/fair/or legal treatment in many cases which leads to people not getting help. It’s always so much more expensive when the attic stays in active addiction with so many more people being affected. I try to get involved in everyway possible but it is frustrating. Thank you again for another great article.


  5. Posted by Bowza on November 5, 2017 at 12:05 am

    I know for a fact that when a person gets arrested and is know to be a drug addict and spends a few days in jail they are left to suffer in a hot or cold widowless cell with no form of human contact or a way to entertain themselves. Now this is at the stage when your still innocent and they treat you like scum , so I believe it gets worse when your locked up in a real prison. The fact is police and just about anyone who doesn’t understand what withdrawal does to a person couldn’t care less and thinks it’s like a bad cold and they did it to themselves and fuck them . I have heard people say they should kill all drug addicts that they are beyond help , I happen to know that’s not true and medicine assisted treatment works perfectly for people who want to stop . But unfortunately the world thinks it’s one drug for another and that won’t change ever . More people are dying from opiate epidemic overdoses than the aids virus in the 1980s and 1990s and it’s sons and daughters and moms and dads and it’s time for a new way of looking at methadone ans subutex because all the overdose victims would be alive if they got on a clinic , the sad part is that most didn’t because of stigma , discrimination and the fact you have to jump through hoops to get it abs the clinic treats you like less than human . The world needs to let a doctor treat addicts like any other disease and more people will get help and live normal lives !


  6. Posted by Ken Gaughran on November 5, 2017 at 1:42 am

    What a great piece of writing.  The prosecutor down to the prison guards and everybody in-between-especially Dr. Sherman- should be relieved of their duties.  One thing that should not be lost in this tragedy is withdrawals from benzos can be more life threatening than opiate withdrawal. I know that the victim was withdrawing from both, but my experiences is people in the medical and rehab community are not apprised of how horrific benzo withdrawal is.  The official rehab literature talks about deadly convulsions with alcohol cessation but fails to put the possible “lethal” moniker on abruptly stopping benzos. Thanks for your capriciousness,Ken Gaughran


  7. Posted by Lisa Wheeler on November 8, 2017 at 10:42 pm

    If it’s not criminal intent then it’s called negligence, malpractice and ultimately criminally STUPID!

    Great post! I too am a Law and Order junky of the original cut and know days, times and channels it’s on. Spousal unit grins and bears it…


  8. Posted by Judith A Gillett on December 19, 2017 at 11:34 pm

    As I have mentioned in a previous comment on one of your posts, I practice criminal defense in Maryland. I was wondering if you would be able to weigh in on something I recently encountered, as I am very concerned if it turns out to be accurate. A client’s family member was a long-term Suboxone user, stable in recovery. The individual was also being treated for adult adhd (as you are no doubt aware, mental health disorders seem to go hand in hand with substance abuse disorders). This individual’s rx Adderal was recently discontinued by the health care provider and the reason given was that the ASAM had recently advised all prescribers to no longer prescribe these sorts of adhd medications to patients taking Suboxone or other like medications. Unfortunately for this individual, the discontinuation of the medication was shortly followed by a complete psychotic break and the person in presently institutionalized for evaluation. I freely admit that I am not a physician, and that the precipitating event may not have been the discontinuation of the medication, but the timing certainly seems suspicious. Do you know if such a guideline has been issued? How could it possibly be medically appropriate and within the standard of care to deny patients medically necessary medications, particularly in light of the statistics showing the likelihood of untreated mental health disorders leading to self medication? I’m stunned that a blanket statement claiming useful medication is now contraindicated would ever be deemed appropriate, and would love to hear your thoughts on this. I am sincerely hoping you will be able to share that no such guidance indeed exists, and that countless mental health patients are not being left to fend for themselves.


    • I know of no statement from ASAM that says ADHD medications can’t be prescribed to patients taking buprenorphine (Suboxone etc.) for opioid use disorder. I do think most physicians would use caution when prescribing medications like Adderall, as it can be misused. It is a Schedule 2 controlled substance. However, the benefits versus risks must be weighed for the patient.
      Having said that, I think it would be very unusual for a patient taken off Adderall to have a psychotic break. In fact, misuse of stimulants is more likely to cuase such a problem.
      I suspect there may be more to the story…is it possible the physician suspected this patient was misusing the medication and thought it best to stop the Adderall? In such a situation, the physician should stop the medication. No taper is needed for Adderall, by the way. The only withdrawal syndrome might be some fatigue, difficulty concentrating, lower energy than usual but usually not severe.


  9. Posted by Linell Redden on September 18, 2018 at 1:28 am

    Disgraceful! My husband died in county jail in Texas 12 years ago due to indifference. Jail blamed everyone but themselves. If they can’t provide adequate medical care let ‘m go. My husband was pretrial detainee. No bond. Death was totally preventable.


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