Hospital: Mom booted from ER to die in jail was treated appropriately
By msnbc.com staff and news services
AP
Photo provided by the Jennings Police Department Mug shows Anna Brown.
RICHMOND
HEIGHTS, Mo. – Officials at a St. Louis hospital on Thursday defended
their actions in the case of a homeless woman who sought treatment for a
sprained ankle and died in police custody after being arrested for
refusing to leave the emergency room.
An autopsy determined that
Anna Brown's death in a jail cell in September was caused by blood clots
that formed in her legs and migrated to her lungs,
the St. Louis Post-Dispatch reported. The newspaper also obtained surveillance footage of
the woman's final moments. In the video, officers are seen carrying
Brown into a jail cell. The cell door closes and Brown is heard moaning
and crying.
Brown's family says authorities treated the 29-year-old mother of two
unfairly and have hired a St. Louis-based lawyer, Keith Link. Link did
not respond to telephone messages from msnbc.com on Thursday.
Richmond Heights police
officers stand with patient Anna Brown, who sits on the floor inside
St. Mary's Health Center telling the officers she did not need to leave
because she did not receive adequate care for the pain in her legs
Thursday, Sept. 21, 2011. A short time later Police arrested Brown for
trespassing and resisting arrest. Still frame from surveillance video
obtained by the St. Louis Post-Dispatch from Richmond Heights Police
Department via Sunshine Request.
RICHMOND HEIGHTS • Anna Brown wasn't leaving the emergency room quietly.
She yelled from a wheelchair at St. Mary's Health Center
security personnel and Richmond Heights police officers that her legs
hurt so badly she couldn't stand.
She had already been to two other hospitals that week in September, complaining of leg pain after spraining her ankle.
This time, she refused to leave.
A police officer arrested Brown for trespassing. He
wheeled her out in handcuffs after a doctor said she was healthy enough
to be locked up.
Brown was 29. A mother who had lost custody of two
children. Homeless. On Medicaid. And, an autopsy later revealed, dying
from blood clots that started in her legs, then lodged in her lungs.
She told officers she couldn't get out of the police car,
so they dragged her by her arms into the station. They left her lying
on the concrete floor of a jail cell, moaning and struggling to breathe.
Just 15 minutes later, a jail worker found her cold to the touch.
Officers suspected Brown was using drugs. Autopsy results showed she had no drugs in her system.
Six months later, family members still wonder how Brown's
sprained ankle led to her death in police custody, and whether anyone —
including themselves — is to blame.
There seems to be no simple answer.
St. Mary's officials say they did all they were supposed
to do for Brown. Richmond Heights police said they trusted a doctor who
said she was fit for jail.
Brown's mother, Dorothy Davis, isn't sure what to think.
"If the police killed my daughter, I want to know," she
said. "If the hospital is at fault, I want to know. I want to be able to
tell her children why their mother isn't here."
Davis also faults the St. Louis County Family Court,
which she said forced her into a heartbreaking dilemma after the state
took away Brown's children on a claim of neglect. Davis could take in
her grandchildren or her daughter, a judge said, but not both.
"I'm mad at myself because if I hadn't listened to the
courts, she would still be here," Davis said. "If she had been here at
this house, she would be here today."
STREETS BECAME HOME
Anna Brown was one of 10 children. She graduated from
Kirkwood High School. At 18, she had her first child, a boy. She had a
daughter nine years later. Brown was raising them alone when a tornado
destroyed her north St. Louis home on New Year's Eve 2010. She moved to
Berkeley.
Shortly after, she lost her job at a sandwich shop. Bills lapsed. The electricity was turned off. So was the gas. And the water.
Family members say Brown and her children appeared fine during visits at Davis' home in Normandy.
They weren't.
In April, a state Children's Division representative
found Brown's toilet filled with feces. Burn marks scarred the floors
and sinks where Brown had used small fires to stay warm. One
refrigerator could not be opened. Insects and rotting food filled
another, according to state reports given to the Post-Dispatch by
Brown's family.
Brown was not lucid and seemed confused as Berkeley
police arrested her for parental neglect. The courts awarded legal
custody of the kids to the Children's Division. Davis could have
physical custody, as long as Brown didn't live with her.
Brown's home was condemned. She ended up on the streets. She lived in four homeless shelters from May to September 2011.
At first, she visited her children at her mother's home.
That ended in June, when Brown started telling the children they didn't
have to listen to their grandparents and called the police to report
they were being abused. Police found no evidence of abuse.
After that, Brown had supervised visits with her children
at the Children's Division. She also called her mother daily to check
on them.
SLIPPING AWAY
Brown struggled with officials' requirements for
reuniting with her children. She passed two drug tests but balked at
others. "She felt that she had passed them, so there was no point in
doing them again," Davis said.
A court-ordered psychological evaluation to determine
whether Brown had cognitive, developmental, behavioral or mental
illnesses came back inconclusive. So the courts ordered a psychiatric
evaluation to determine whether Brown needed medication or a doctor's
treatment.
But Brown resisted, not understanding the difference between the two evaluations, according to her caseworker's notes.
Still, she may have known something was wrong. She joined
the St. Louis Empowerment Center, a drop-in center for the mentally
ill.
"It was like a light bulb went on when she heard others
tell their stories," said Kevin Dean, a peer specialist at the center.
"She was just starting to make progress."
Brown's witty comments often broke the ice during group
meetings, said Warren Brown, another peer specialist and no relation to
Anna.
Anna Brown one day said she hurt her ankle while walking near a ditch, Dean and Warren Brown recalled.
The last time they remember seeing her was in August 2011; she said she couldn't walk up the stairs.
Brown told her caseworker on Sept. 14 that she had been admitted to St. Louis University Hospital for a sprained ankle.
Bills her mother received show Brown stayed at that
hospital from Sept. 13-15 and underwent an EKG, some radiology services,
lab work and cardiovascular services.
"She wasn't very eager to go home, but we do all we can
to take care of the whole patient, and we want to make sure that we do
not push someone out the door as soon as she came here," said SLU
spokeswoman Laura Keller. She said there was no indication of a blood
clot in Brown's leg.
Krystle Brown said she saw her sister for the last time
after she was discharged from SLU. She dropped Anna off on Market Street
downtown, where Anna said she wanted to be.
Davis didn't want her daughter out in the rain and
ordered Krystle to bring her home — regardless of the court order. It
was too late. Krystle couldn't find her sister.
Four days later, Brown had her last supervised visit with her children. She was on crutches.
FINAL MOMENTS
State inspectors working for the Centers for Medicare and
Medicaid Services — a federal agency that regulates hospitals —
interviewed St. Mary's staff and reviewed medical records after the
Post-Dispatch asked about Brown's case in January.
They found that on Sept. 20, Brown returned to SLU
Hospital for knee and ankle pain. X-rays of her knees were negative and
she was given a prescription for a painkiller.
She refused to leave. Hospital security called St. Louis
police, who responded about 5 a.m. Brown told them she wanted to go to a
better hospital but refused to go in an ambulance, police said.
She then wheeled herself next door to Cardinal Glennon
Children's Medical Center, where doctors found tenderness in her legs.
They told her she was at a pediatric hospital. She said she wasn't
leaving unless someone took her to an adult hospital, according to the
inspectors.
An ambulance then took her to St. Mary's, inspectors
found. She arrived at 11:45 a.m. Her left ankle was swollen. She was
there for about seven hours, during which ultrasounds on both of her
legs were negative for blood clots. A nurse said she saw her stand up. A
social worker gave her a list of shelters and a phone number for
transportation.
She returned eight hours later by ambulance complaining
of abdominal pain only, inspectors said. She refused to sign discharge
papers but was discharged at 7 a.m.
Richmond Heights Officer Jason Tharp was at St. Mary's on
another call about 10 a.m. when a security officer, Steve Schaffer,
told him a woman was claiming she "did not receive adequate medical
attention and did not have to leave."
She was sitting in a wheelchair and told officers she was
waiting for a ride. Tharp told her to wait outside or face arrest for
trespassing.
"You can't arrest me. I know my rights, I can't even stand up!" she yelled, according to police.
Officer Scott Stebelman said he waited for about three
hours for a doctor to examine Brown before taking her to jail. At 12:30
p.m., a doctor issued a "Fit for Confinement" report, according to the
state inspectors.
The inspectors' report, however, contains some
differences from reports written by Richmond Heights police and the
county medical examiner's office:
• Police and medical examiner reports, based on
interviews from that day, quote St. Mary's staff as saying Brown did
complain of leg pain on her return visit, not just abdominal pain.
• A St. Mary's nurse told the medical examiner that Brown
was still complaining of leg and abdominal pain at 12:40 p.m.: "She was
advised that she had already been treated and needed to leave the
hospital."
• Police said the doctor's "fit for confinement" decision
was made at 1:20 p.m., not 12:30 p.m. Police also said Brown yelled "My
legs don't work!" as they wheeled her out after the exam.
DYING IN JAIL
Once in custody, Brown initially cursed at Tharp inside
his patrol car during the ride to jail and asked for a wheelchair after
officers ordered her out of the car, according to surveillance tapes.
"I can't put any pressure on my legs," she told them.
Two officers then pulled her into the station by her
arms. Police listed "suspected drug use" as Brown's physical state and
"unknown leg pain" under medical notes.
While at the police station, Brown's condition worsened.
Officers carried her by her arms and legs into a cell and left her on
her back on the floor. She moaned and moved her head back and forth.
She's last seen moving on the tapes at 2 p.m.
A dispatcher with East Central Dispatch zoomed a
surveillance camera in and out on Brown because "it was difficult to
determine if the prisoner was still breathing later due to the
pixilation grain on his monitor," police reported.
Fifteen minutes later, a jail worker readying meals found
Brown unresponsive. Several responders shocked her with a defibrillator
and started CPR. Paramedics rushed Brown back to St. Mary's.
Within hours of being declaring fit for confinement, Brown was pronounced dead.
Back in the jail cell, Richmond Heights Fire Chief Kerry
Hogan was putting away the jail's defibrillator when, according to a
recording of the conversation, a Richmond Heights officer told him: "We
got a 'fit (for confinement') on her a half hour ago. I mean, literally,
a half hour ago we brought her in here."
"Where at?" Hogan asked.
"St. Mary's."
"What was, uh. Any problems at all?"
"No, they thought she was a drug seeker."
"Well, that could very well be ... And that's a shame."
Acting Police Chief Maj. Roy Wright refused to identify
the officer on the tape. He also wouldn't let the Post-Dispatch
interview Stebelman, who sat with Brown for three hours waiting for a
doctor's exam. Wright said his officers had no way of knowing Brown's
dire condition.
"A lot of times people don't want to stay in jail and
will claim to be sick," he said. "We depend on medical officials to tell
us they're OK."
Likewise, the dispatcher monitoring Brown as she died had
no way of knowing she wasn't just sleeping, said Mark Dougherty,
general manager of East Central Dispatch.
"It's not unusual to have someone lay there lethargic," he said. "If he felt it was more severe, he would have called."
SEARCH FOR ANSWERS
All nine of Brown's siblings went to St. Mary's after
learning she was gravely ill. Confusion and frustration took over as
they waited 45 minutes for a doctor to tell them their sister was dead.
"They told us she came in from the jail unresponsive and, 'We don't know what happened,'" Krystle Brown recalled.
Davis said she did not receive a bill from St. Mary's, as
she had from SLU Hospital. She said she has been told she cannot see
the medical records without proving a legal right to them.
She vowed to not give up.
"When you lose a child, it's like a part of you you will
never, ever get back," Davis said. "It's like a part of your soul, a
part of you is totally gone. And when you don't know why, you keep
wondering, you keep guessing."
Brown's cause of death puzzles Davis because immobility
is a risk factor for deep vein thrombosis, the medical term for clots in
the legs. "My daughter was homeless. She had to move around
constantly."
But trauma, such as a sprained ankle, also is a risk
factor. So is obesity, said Dr. Samuel Goldhaber, a Harvard Medical
School professor and director of Brigham and Women's Hospital's Venous
Thromboembolism Research Group. At autopsy, Brown was 5 feet tall and
weighed 189 pounds.
"The body responds to trauma by revving up the
coagulation system to prevent the individual from bleeding to death from
the trauma," Goldhaber said. "But half the time, DVT is silent and
there are no symptoms whatsoever."
In most cases, diagnosed patients take blood thinners and
walk out of the hospital, said Dr. Elliott Haut, an emergency medicine
expert for Johns Hopkins Medicine.
"Relatively small periods of immobility can potentially
cause DVT," Haut said. "Not every test is 100 percent, but if you do the
test and see the veins you are supposed to, you shouldn't miss it."
St. Mary's staff leaned heavily on the state's investigation in defending its actions.
"Our records show that, in this case, everything that
should have been done medically was done properly. We found nothing that
would have changed this tragic outcome," according to a statement.
Hospital spokesman Neil Keisel said, without providing
specifics, that the medical examiner's report had inaccuracies and, "If
that information was true, we would've been cited by the" state
inspectors.
PASSING JUDGMENT
Brown's family hired an attorney, but a lawsuit hasn't been filed.
Should the matter make it to court, it will rest on
whether St. Mary's violated state medical malpractice laws, said Sean
Fosmire, a Michigan attorney with more than 30 years of experience
representing hospitals and physicians.
Centers for Medicare and Medicaid Services "must have
seen there was enough … medical testing to satisfy the federal law,"
Fosmire said. Federal law does not require accurate treatment, he noted.
If St. Mary's doctors "went through an exam, did testing
and determined that the diagnosis was something else like a leg cramp,
they may have been wrong, but that doesn't mean they're in violation of
the federal law," he said.
The family's success in court also would depend upon how
much a jury finds her life was worth — in dollars, said Tom Keefe, a
Belleville-based personal injury attorney.
"If you kill a homeless man with no job, he's not worth
very much. But if you wipe out (Cardinals star) Matt Holliday, who is
making $20 million a year, it's worth a lot of money," Keefe said. "Even
though they are both human beings and both victims, the truth is, death
cases are evaluated by the losses you can prove the survivors have
suffered."
Davis said she still has trouble sleeping and eating, and
constantly questions whether she should have taken in her daughter. She
said she wants permanent custody of her grandchildren, now 11 and 2.
Brown's son is in counseling to deal with his mother's
death but is earning A's and B's. The girl kisses a picture of her
mother whenever her grandmother wears a T-shirt bearing her image.
The family wore the shirts to Brown's burial on Oct. 8. Krystle Brown still wears hers to bed.
"She was not a drug dealer or a hooker or doing other
things that she could've ended up dead for," the sister said. "People
assume things because of they way they talk or the way they live or the
things they do.
"My sister is not here today because people passed judgement."
Blythe Bernhard and Jeremy Kohler of the Post-Dispatch contributed to this report.
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