By Claire Withycombe • The Bulletin

Policy guidelines and the jail video

The Deschutes County jail has a set of procedures that deputies are expected to follow, including general guidelines for responding to potential medical emergencies. Accompanying this story are protocols quoted from four relevant sections of guidelines for the sheriff’s office and the jail as well as images taken from security footage inside the jail the night Edwin Burl Mays died of a drug overdose in his holding cell.

‘Neglect of duty’

No entertainment: “With the exception of breaks, members shall not read, play games, watch television or movies or otherwise entertain themselves while on duty, except as may be required in the performance of duty. Members may, however, engage in these or similar activities if required for training or investigative purposes.”

Use of holding cells

Ill or injured inmates: “No detainee shall be placed in a temporary holding cell who has injuries or illnesses that require hospitalization or attention of a health care professional.”

Two-hour time limit: “Detainees may be held in the temporary holding cell for no longer than two hours. A visual check of the detainee shall be made at least every fifteen minutes.”

Holding cells can be used for observation of intoxicated inmates: “Once medically accepted for lodging, intoxicated inmates or those under the influence of controlled substances may be placed in a holding cell in Booking for observation purposes, while staff determines whether the person meets criteria for housing or release. a) During the initial four (4) hours of observation, DCAJ medical staff will wake the inmate every hour to evaluate the subject and confirm that all is well.”

Recognizing ‘excited delirium’

Medical emergency: “Deputies responding to or arriving at the scene where a person is suspected to be in a state of Excited Delirium shall treat the incident as a medical emergency. However, the classification of the incident as a medical emergency is in addition to whatever other law enforcement response may be required, including the use of reasonable force.”

“Reasonable opinion”: “While deputies lack the psychiatric expertise to make an Excited Delirium diagnosis, deputies can develop a reasonable opinion that the person may be in an Excited Delirium state and require medical attention.”

Emergencies and calling 911

Nursing staff: “It will be the responsibility of medical nursing staff for be familiar with the procedures, medication and equipment used to respond to emergencies that may occur in the facility. The following situations will be covered. A. Anaphylaxis B. Seizures C. Syncope (fainting) D. Choking/breathing Emergencies E. Cardiac Arrest F. Injuries G. Emergency Childbirth/Hemorrhage H. Altered Mental Status. I. Hypoglycemia.”

General guidelines: “A. EMTs should be called immediately. … E. If the inmate is unconscious, immediately begin to assess airway, breathing and circulation. If indicated, initiate CPR, attach the AED as soon as possible.”

When to call 911: “Under any/all circumstances involving an unconscious inmate, call 911 for EMTs immediately.”

Sources: Deschutes County Sheriff’s Office and jail policy guidelines

Images taken from Deschutes County jail video

Deschutes County Sheriff’s deputies called EMTs when they found Edwin Burl Mays lying in his holding cell next to a pool of his own vomit, several hours after he began displaying erratic behavior and a half-hour after deputies noticed he had a cut on his head.

But there was nothing EMTs could do: Mays, 31, died in the Deschutes County jail of a methamphetamine overdose Dec. 14.

A Bulletin review of Deschutes County Sheriff’s policies show some rules may have not been followed that night, while others may not have been specific enough to address Mays’ methamphetamine intoxication.

What corrections deputies are obligated to do when an inmate is under the influence of methamphetamine is not explicit, though general departmental protocols exist for intoxicated inmates and for inmates experiencing withdrawal from drugs and alcohol. Sheriff’s office policy also indicates deputies should be able to recognize excited delirium — which can be a sign of methamphetamine intoxication — and are instructed to treat it as a medical emergency.

The Deschutes County Sheriff’s Office now is the subject of a state investigation and a potential lawsuit on behalf of Mays’ estate.

Neglect of duty

Some of the sheriff’s office policies were violated on the night Mays died. For starters, deputies were watching a football game that night, according to the video . But the sheriff’s office policy states employees should not watch television on duty.

“With the exception of breaks, members shall not read, play games, watch television or movies or otherwise entertain themselves while on duty, except as may be required in the performance of duty,” policy states. “Members may, however, engage in these or similar activities if required for training or investigative purposes.”

Holding cells

Mays died in a holding cell in the booking area of the jail.

Sheriff’s office policy states inmates with illness or injury are not to be kept in holding cells and that the holding cells have a two-hour time limit, with “visual checks” every 15 minutes. However, general guidelines for intoxicated inmates state that once they are “medically accepted for lodging” they are to be monitored in holding cells and woken up every hour for the first four hours of observation.

Sheriff’s Deputy Jesse Hurley arrived for his shift about an hour after Mays was first brought in at about 4:45 p.m .

Hurley told Bend Police Detective Christopher Morin, who was investigating the death, that waiting to fully process Mays was “common practice” when an inmate is under the influence of alcohol or drugs, and that corrections staff will keep an intoxicated inmate in a holding cell until he or she can answer the “booking questions.”

Recognizing delirium

When Mays was stopped and arrested by Bend Police earlier that day, Officer Whitney Wiles wrote in her report that he appeared agitated and had trouble sitting still but told her he would answer jail staff’s questions.

At the booking counter at the jail, Wiles attempted to take the man’s pulse. “I was curious for training purposes as to what his pulse rate was based on my belief he was under the influence of a (Central Nervous System) stimulant,” she wrote. But she couldn’t: Mays was wearing handcuffs, because jail policy states handcuffs are to remain on inmates at the counter.

Mays paced around his cell while sheriff’s employees, according to the video, imitated him, said he was “tweaking” and made remarks such as, “he’s wound up tighter than a six-dollar watch.”

People high on methamphetamine often act in this way, which is referred to as excited or agitated delirium.

Departmental policy provides deputies examples of what excited delirium induced by drug abuse looks like and how to respond, though it is not evident that deputies have specific training on how to respond to serious drug overdoses. Policy indicates that when an employee recognizes excited delirium it should be treated as a “medical emergency.”

“While deputies lack the psychiatric expertise to make an Excited Delirium diagnosis, deputies can develop a reasonable opinion that the person may be in an Excited Delirium state and require medical attention,” the policy states.

“A fair amount of our inmates do enter the facility that are, you know, intoxicated or high on some controlled substance,” said Deschutes County Sheriff’s Capt. Shane Nelson, who oversees the jail, on Thursday. “And that’s why we monitor them and ask the intake questions. We also get info from the arresting officer. That includes mental health as well.”

It’s unclear whether Mays, in his condition, had sufficient presence of mind to adequately or reliably express his medical needs.

When to call

According to jail policy, medical nursing staff are responsible for being familiar with procedures, medication and equipment used to respond to emergencies. In an emergency, EMTs “should be called immediately,” according to the policy governing medical staff. Situations considered emergencies include fainting, cardiac arrest, injuries and “altered mental status.”

At intake, medical staff or a specially trained officer are instructed to screen the inmate to determine whether he or she is suffering from alcohol withdrawal. When an inmate is suspected of having abused substances and is exhibiting withdrawal symptoms, the inmate will be seen by the facility nurse. If the nurse is unavailable, then a health-trained officer must refer to treatment protocols that address unconscious inmates and drug and alcohol withdrawal.

Under Deschutes County jail policy, a health-trained officer is a corrections deputy “who has received specialized training in identifying and handling persons suspected of having medical or mental health disorders.”

The training consists of eight hours of in-service training that includes training with respect to “detoxification and substance abuse, including recognition of signs and symptoms of intoxication and chemical substance abuse/dependency; alcohol withdrawal … (and) handling of intoxicated inmates,” according to the policy.

In the event that a facility nurse is unavailable, health-trained officers are charged with addressing medical emergencies. All county corrections deputies are health-trained officers, according to Nelson.

At about 8:30 p.m., the video shows Mays face down in the holding cell. Both deputies and fire and rescue employees who responded that night told investigators that Mays had a superficial cut on his head.

When an inmate is found or reported to be unconscious, according to jail policy, staffers should check whether the inmate has an open airway, whether the inmate is breathing and has a pulse. If he or she is not breathing, deputies are directed to start respiration only. If both respiration and pulse are absent, deputies are directed to start CPR. Finally, the protocol states, “under any/all circumstances involving an unconscious inmate, call 911 for EMTs immediately.”

Around 9 p.m., according to the video, deputies began performing chest compressions. But when EMTs arrived at the jail shortly after 9 p.m., the defibrillator that sheriff’s deputies had attached to Mays’ chest didn’t return an electrical signal: He had flatlined.

Did Mays ask for help?

Apparent inconsistencies emerge with respect to whether Mays asked for emergency medical treatment.

Sheriff’s Sgt. Deke DeMars, who investigated the incident as part of the initial review , wrote: “At (about 7 p.m., according to the video) Deputy (David) Chambers said something similar to (needs to go to hospital). It was hard to hear exactly what Deputy Chambers said but it appeared he was speaking with Deputy Hurley. Deputy Hurley replied stating ‘probably does.’”

DeMars then interviewed corrections staff about what was apparently said with respect to medical treatment:

• “Deputy Hurley told me in substance he did not remember any deputy telling him that Mays said he needed to go to the hospital,” wrote DeMars. “I asked Deputy Hurley if he remembered Deputy Chambers telling him that Mays wanted to go to the hospital and Deputy Hurley told me no.”

• “Deputy Chambers said Davenport stated he thought Mays might need to go to the hospital. Deputy Chambers told me Mays then said “no” indicating that he did not need medical attention. Deputy Chambers said he closed the cell door at that time.”

• “Deputy Parks said she did not hear Deputy Chambers say anything about anyone wanting to go to the hospital.”

• “Sgt. (Tedd) Morris told me he did not remember Deputy Chambers coming up to him and reporting that Davenport made comments about Mays needing to go to the hospital.”

Could Mays have been saved?

Medical treatment for methamphetamine intoxication can involve monitoring, hydration and administration of a sedative.

“I don’t know what policy they’d have except to get them to an ER as soon as possible,” said Dr. Robert Julien, a Portland psychopharmacologist and anesthesiologist, of patients experiencing excited delirium.

“Did people check vital signs when they were supposed to?” said Dr. Richard Dart, of Rocky Mountain Poison & Drug Center in Denver. “Did they miss signs of intoxication?”

Signs of methamphetamine intoxication include a high heart rate and agitation, Dart said. Mays appeared to exhibit these behaviors, according to the video and to the reports. And deputies may have suspected Mays had drugs in his system : Hurley told Morin that when Mays arrived he was “tweaking.”

“What usually happens is either sometimes they truly didn’t know and weren’t expecting it, and didn’t know to check, and the patient dies,” Dart said. “If the patient tries to hide it and does successfully and dies rapidly there’s not a lot we can do. If they actually knew it then they should have been monitoring.”

In the event that emergency responders recognize the signs of intoxication, a medical professional can administer a class of drug called a benzodiazepine.

“It’s a sedative that calms them down, makes them less agitated and sometimes that’s all you need,” Dart said. “And you put an IV in and watch them and monitor them.”

When EMTs responded that December night, they provided “high performance CPR” and administered Narcan to Mays, according to interviews with Bend Fire & Rescue staff. “Narcan is for opiates. That does not exist for methamphetamine,” said Dart. Narcan is a brand name for the drug Naloxone, which is often used to treat heroin overdoses.

Mays’ blood tested for levels of methamphetamine greater than 5 milligrams per liter. It’s unclear whether at that level — methamphetamine intoxication is measured on a scale of 1 to 5 milligrams per liter of blood — Mays could have recovered.

“The levels are very difficult to interpret,” Dart said. “And especially after death because things redistribute in the body. But meth, like almost all drugs, the body builds up a tolerance to it. … The level that would kill one person may not kill another person.”

Moving forward

The Deschutes County Sheriff’s Office opened a new $11 million, 144-bed expansion of the jail this past fall. The space includes expanded areas for medical and mental health treatment.

Nelson, who will succeed Sheriff Larry Blanton when he retires June 30, seeks to hire three additional full-time nurses so that medical staff are available 24 hours a day, he said Thursday. He said that initiative was not in response to either Mays’ death in December or the state investigation.

“We’ve been working to expand our medical coverage for over a year now, trying to get more coverage during the day,” Nelson said. “It was in light of the upcoming jail expansion. It’s also in light of how we can always do business better. We’re constantly reviewing policy and procedure and seeing how we can improve.”

— Reporter: 541-383-0376,

cwithycombe@bendbulletin.com

9631147