Sepsis nearly killed him in jail. Now he fights for better inmate care.

Nicholas Jacobson had just been accused of murder when a raging infection nearly killed him. Left untreated for two weeks in a California jail, sepsis drove him into a coma as his organs started to shut down.

He survived – barely – and later won a cash settlement from the county.

Now, as he appeals a jury’s guilty verdict and faces the possibility of life in prison, Jacobson has dedicated part of that money toward educating inmates on their rights and exposing the medical neglect he says is rampant behind bars.

Illnesses are the main reason people die while in the custody of local jails or state and federal prisons across the country. Often described as “natural causes,” illnesses claim far more inmates than other causes like suicide, overdose or homicide – killing more than 30,000 prisoners between 2015 and 2023, according to a USA TODAY analysis of federal records.

Doctors pulled Jacobson back from the brink of death, but at least 1,780 prisoners weren’t so lucky during that eight-year period. Their death reports all mention sepsis, a life-threatening condition triggered when the body has an extreme reaction to an infection.

When caught promptly, sepsis can often be treated simply with antibiotics and fluids, doctors say. But medical care isn’t always prompt behind bars, and untreated septic shock can kill a patient within days or sometimes hours.

Jacobson arrived at the Martinez Detention Facility east of San Francisco in June 2017 with a fractured spine from being tossed 15 feet out of his car to the side of the freeway.

Accused of fatally shooting a nightclub bouncer, the 27-year-old had to crawl down two flights of stairs to the telephone to speak with his family because walking was too painful. Within days, blood and pus began oozing from an open wound on his inner thigh.

“No boy, don’t pull your pants down,” a jail nurse told Jacobson when he tried to show her the cyst. “Ain’t nobody looking down there.”

Jacobson blames the jail’s unhygienic conditions for starting his infection.

“They don’t clean it for the next person to come in. I had a dirty cell with a dirty toilet, and I sat on it with an open wound,” Jacobson said. “[The nurse] comes the next day, but then she doesn’t do nothing. She just laughs at me. Keeps it moving. And then boom, that’s when I start to get sick.”

Ignored medical requests lead to a coma

A fever and dizzy spells soon turned to diarrhea, then vomiting and coughing up black, bloody material. As a type 1 diabetic, Jacobson noticed his blood sugar levels stopped coming down with what little insulin he was receiving from the jail. Alarmed, he told the medical staff, both verbally and in writing.

“That could be a sign of infection, you know? The medical team should know that,” Jacobson said. “I could have just took some pills, some antibiotics, whatever, and I would have been fine. But instead, they just let the blood poisoning spread to my body, and to all my organs until everything started shutting down.”

Multiple requests for comment from the Contra Costa County Sheriff’s Office regarding Jacobson and his medical care were not returned. However, legal filings from 2019 show the office denied all wrongdoing.

Two weeks after his booking into the Martinez jail, he collapsed. Paramedics rushed the comatose Jacobson to the nearby Contra Costa Regional Medical Center.

Sandi Jacobson spent a few frantic days calling the hospital, begging to see her son, only to be turned down again and again. But then her phone rang.

“Grab any family members that want to come and say goodbye to your son. He’s failing quickly,” said a compassionate female voice on the other end of the line.

An ICU doctor had looked up Nick Jacobson’s emergency medical contact and called his mother.

“They won’t let us see him,” Sandi Jacobson recalls telling her.

“No, you will see him,” the doctor replied. “I’m making sure you’re going to see him.”

Sandi Jacobson sped down to the hospital with her husband and daughter, but she was the only one allowed into his room. Tubes were running into his nose and mouth, she said, and medical equipment lined his bedside. Three nurses flitted around checking vital signs as a police officer stood watch.

“I want you to open your eyes. I want to see your beautiful blue eyes again,” Sandi Jacobson told her unconscious son, patting his swollen hand. “If this is too hard for you to stay and you need to go, I totally understand it. … But if you want to fight, we’re going to fight with you.”

The next day, against the odds, Nick Jacobson was awake when his mother returned to visit. Two officers blocked her from entering. After some phone calls to their supervisor, they allowed Sandi Jacobson 15 minutes with her son.

“They can’t stop me. Mom, I’m going to be all right,” he recalled mumbling to her deliriously. “I still had some fight in me.”

Law to kill frivolous lawsuits stops real complaints, too

Recovery from sepsis was a long road for Nick Jacobson, as he spent much of the next six months handcuffed and shackled to a hospital bed with no visitors allowed. He endured a dozen surgeries to repair damage to his heart, lungs and spine, leaving 18-inch scars down his back that look like “Freddy Krueger got me,” he said.

As his criminal case slowly worked its way toward a trial, Jacobson decided to sue Contra Costa County for deliberate indifference to his medical needs and excessive use of force.

“We’re still people behind these walls,” Jacobson said, “and a lot of us have made very serious mistakes in life.”

But that doesn’t mean they don’t deserve decent health care, he said.

“They almost killed me, bro, and I know they could have prevented it,” Jacobson said. “I wanted to put them on the stand, and I wanted to look at all the doctors and let them know that they messed up, so they wouldn’t do it to the next person.”

That dream never came to pass, though.

A federal law passed in 1996 requires incarcerated people to file any grievances with their jail or prison and follow that facility’s defined process. There’s often a strict timeline for how long after an incident prisoners may submit a grievance. Only after exhausting this internal process may they sue in court.

The Prison Litigation Reform Act was meant to reduce frivolous lawsuits, but Kristen Mack, a Maryland civil rights attorney who frequently represents prisoners and their families, said she’s seen it screen out legitimate cases, too.

“Some facilities, it’s as short as 10 days you have to file your first ARP [administrative remedy procedure],” Mack said. “We’ve had clients that were physically in the hospital within the 30-day time period that they were supposed to file their initial ARP and because they didn’t do it, their complaint was dismissed.”

Jacobson said he missed his window to file an internal grievance with the Martinez Detention Facility, seriously weakening his case. In April 2020, Contra Costa County offered him $60,000 to drop the lawsuit in a settlement in which it admitted no wrongdoing.

“They shouldn’t get off the hook because 30 days or 60 days passes, and we didn’t ‘grievance it’ because we don’t know how to,” Jacobson said. “That’s a loophole for the system to get off the hook when they don’t take care of our medical needs.”

‘I can make a change. I can change lives.’

A year after the settlement, in 2021, a jury convicted Jacobson of murder and a judge sentenced him to 50 years to life in prison – an outcome that he said shocked him.

“I’m not guilty of what I was convicted of,” Jacobson said, declining to elaborate further on his case as he’s still appealing the guilty verdict.

Jacobson is religious – the type of Christian who regularly peppers conversation with anecdotes about singing worship songs in the prison chapel or a verse from the book of Romans:

“Tribulation produces perseverance. Perseverance produces character, and character produces hope,” he quoted effusively. “I can make a change. I can change lives.”

Inspired by the business classes he started taking in prison and a “Nonprofits for Dummies” book shared from a fellow inmate, Jacobson founded Keep Us Healthy in 2022.

“We want to educate inmates right now,” Jacobson said. “What procedures and what methods do they have to go through and follow to get the proper health care that they need.”

He drafted a vision statement, built a business plan and hired an attorney to ensure he met all the IRS requirements of charitable organizations. The organization is small – primarily Jacobson and a handful of family members – but it collects and publishes inmates’ stories of poor health care to raise awareness of the problem. Over the past three years, dozens of inmates have subscribed through a word-of-mouth campaign behind bars to receive the nonprofit’s newsletter containing these stories and advice to help them advocate for themselves.

“You are so helpless,” said Sandi Jacobson, describing what both inmates and their families feel when there’s a problem with prison medical care. “If we could just get help out to even just a couple of people and it makes that difference where they’re not suffering in pain, it’s worth it.”

Following her son’s verdict, Sandi Jacobson said she’s had people – even close friends – ask why prisons would need to provide for inmates’ medical needs.

“It may be behind bars, but he still has his whole life ahead of him, and nobody has the right to just take it away,” she said.

California doesn’t currently allow the execution of prisoners, but Sandi Jacobson suggested denying medical care can essentially turn shorter sentences into death sentences.

“If you’ve got somebody who’s only going in for, say, three years, and they don’t get that medical care, that three years could be their life,” she said.

As the settlement money dwindles, Nick Jacobson said he’s hoping grants or angel investors could help expand Keep Us Healthy’s efforts. He wants to gather a larger team to collect more inmates’ stories as well as push for reform to the Prison Litigation Reform Act on a state and national level.

In the meantime, as Nick Jacobson awaits further hearings in his appeal, the California Department of Corrections and Rehabilitation has shipped him from prison right back to where he nearly died – the county jail in Martinez.

Shortly after Jacobson’s settlement in 2020, the Martinez Detention Facility settled a separate class-action lawsuit and promised to invest more than $235 million over five years to increase staffing and improve health care.

USA TODAY’s repeated requests for comment about these changes were not returned from the Contra Costa County Sheriff’s Office.

“It has gotten better, but there’s still a lot of room for improvement,” Jacobson said.