The attorney for the estate of a 55-year-old woman who died in custody of the Spokane County Jail of a ruptured intestine told jurors Tuesday he anticipated requesting a judgment in the “multiple millions of dollars” against the contractor tasked with providing inmates care.
Edwin Budge told the jury of seven men and three women such a sum was necessary to “send a stiff financial message to NaphCare” about the medical treatment of Cindy Lou Hill, who was pronounced dead in August 2018 after a five-day stay in the county jail. Spokane County was also sued by the survivors of Hill, who was in jail on a charge of heroin possession and who was showing signs of opioid withdrawal before her death. That complicated her treatment, said Ketia Wick, an attorney representing NaphCare, in opening statements of the trial Tuesday morning.
“They had questions, and they responded,” Wick said of NaphCare, including ordering two reviews of the case that determined Hill’s death was caused by an “extremely rare condition.”
The two-week trial will involve expert and eye-witness testimony, as well as written reports and video evidence. It will not include more than six hours of video captured directly outside Hill’s cell on Aug. 25, 2018, when she was placed on medical watch by Hannah Gubitz, a nurse working for NaphCare who initially examined Hill that morning. That’s because the county deleted that evidence, and could not provide an explanation in the run-up to the trial.
U.S. Judge Mary Dimke previously ruled that deletion required sanctions against Spokane County, and found them legally liable for Hill’s death. While the county can present evidence at trial to the jury, the ruling effectively pits the county against its own health care contractor, requiring jurors to determine the degree of responsibility both for NaphCare and Spokane County when rendering a verdict.
Both Wick and John Justice, who is representing the county, told jurors that staff responded appropriately to Hill’s medical concerns on that Saturday morning nearly four years ago, and that her death was an unfortunate medical anomaly. Her vital signs were normal, and while she complained of pain, she also exercised her right to refuse a medical examination at 3 p.m., according to the county and NaphCare.
That conclusion was questioned Tuesday afternoon by Lori Roscoe, an expert witness called by the attorneys for Hill who is a registered nurse based in Florida specializing in health care in corrections facilities. Roscoe told jurors that Gubitz and NaphCare failed to recognize that Hill’s symptoms were likely not caused by heroin withdrawals, but a more urgent health problem.
Roscoe said there were several “red flags” when Gubitz first spoke to Hill that morning, including that she was shirtless and had to be dragged to the cell door for inspection by a fellow inmate. She also noted that the intense pain Hill appeared to be in was not consistent with withdrawal.
“That is not a symptom of opiate withdrawal,” Roscoe said of the pain Hill appeared to be in, based on jail reports.
Budge, using a diagram of the intestine during opening statements to show how Hill died, said the release of stomach bacteria into the bloodstream causes intense pain.
“It scorches, and it sears, the inside of the body,” Budge said.
Hill was moved shortly after 9 a.m. to an area of the jail where guards are asked to supervise inmates who might be in need of medical attention. Wick told jurors that determination is made because inmates may need to be supervised “not medically, but just to see what happens.”
Christopher Quirk, one of the other attorneys representing NaphCare, questioned Roscoe’s conclusions. Quirk noted that the policy of checking cells every half hour in the medical watch area was written by the county, not NaphCare, and that the records did not clearly indicate whether Hill was unable to receive a health assessment, or she refused.
A jail guard brought Hill her evening meal just before 4:30 p.m. Jurors were shown an image of Hill’s cell, with a chocolate milk carton, a wrapped sandwich and an orange still sitting in a slot in the door. She was discovered unresponsive by the same guard at 5:24 p.m., and emergency personnel were called to the jail. She was pronounced dead at the hospital that evening.
Wick told jurors an autopsy report surmised that Hill’s intestinal injury was caused by the tearing of scar tissue from a previous medical procedure, and argued that Gubitz followed procedure based on the information available at the time.
Hill’s death was one of eight at the facility over a 14-month period. NaphCare was under contract to provide care at the jail throughout that period, first signing a contract with the county to provide health care at the jail in May 2016 to address a shortage of applicants for nursing spots at the jail. The county later extended the contract, even as some inmates and others raised questions about inmate care.
The jury trial is scheduled to conclude sometime next week.