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Autopsy of Gregg County Jail inmate blames poor health

By Richard Yeakley
June 13, 2013 at 11 p.m.

A Gregg County Jail inmate died in March of a combination of a syndrome known as excited delirium and other existing health problems, according to an autopsy report made public Friday.

Bobby Joe Madewell Jr., 51, was declared dead at Good Shepherd Medical Center early March 21 after being subdued by jail staff and becoming unconscious, according to the autopsy conducted by the Tarrant County medical examiner.

An attorney representing the jail said the report showed there was no wrongdoing in the death.

"The cause of his death was related to his chronic cardiovascular health problems," said Robert Davis, the Tyler attorney representing the jail. "It is not the fault of anybody at the county. The county medical staff did a very good job with him."

The autopsy results make a wrongful-death civil suit less likely in the case, he said.

"The plaintiff's attorney would have to bring a cause of action, and the autopsy very clearly shows that he was not suffering from withdrawal of any type," Davis said.

Madewell's mother retained an attorney after the death, saying her son went into withdrawal after being denied prescription Xanax, which led to the behavior resulting in his being subdued by jailers. The drug was withheld because it is not on the jail's list of approved medications.

Madewell had been in custody at the county jail since March 12, accused of bond forfeiture for charges of aggravated assault with a deadly weapon.

About 12:40 a.m. March 21, jail officials said, Madewell exhibited what jail staff called erratic behavior.

At the time, Sheriff Maxey Cerliano said Madewell was subdued with a so-called drive stun from a Taser after becoming violent with jail personnel who checked on him.

"Following policy and procedures, officers used a Taser and attempted to apply restraints to control the inmate. The inmate became unconscious and was immediately assisted by staff as well as medical staff on duty," Cerliano said in a statement after the incident.

Madewell was taken by ambulance to Good Shepherd, where he was pronounced dead by Justice of the Peace B.H. Jameson.

The report lists two causes of death: "Sudden death associated with excited delirium and restraint" and "coronary atherosclerosis, hepatic steatosis and history suggestive of neuroleptic malignant snydrome."

Atherosclerosis is commonly referred to as hardening of the arteries, while hepatic steatosis is fatty liver syndrome. Neuroleptic malignant snydrome is a neurological disorder.

The examiner also indicated under cause of death that, "There are no signs of notable trauma. There are significant intercurrent disease processes that likely contributed to death."

Elsewhere, the report indicates a 60 percent to 70 percent occlusion of Madewell's left coronary artery and 10 percent occlusion of circumflex and right coronary arteries.

Dr. Judy Melinek, a board-certified forensic pathologist and an expert in cause of death determination, said excited delirium is a recognized cause of death often associated with drug intoxication or mental illness.

"Agitated delirium is a physiologic state of agitation and sympathetic stress often brought about by acute drug intoxication or mental illness but can also be caused by other metabolic processes, such as hypoglycemia or hyperthermia," she said. "There appears to be an underlying biological predisposition to this disorder that has been associated with neurochemical receptors in the brain. Affected individuals are often sweating, highly agitated and appear impervious to pain."

Agitated delirium is often listed as a cause of death in connection to deaths during police restraints, a link that has caused civil rights advocates to call the designation a way to absolve blame in deaths caused by excessive force.

But scientists across the nation consider the finding legitimate, and cases have been documented in which a person died from excited delirium without officer involvement, Melinek said.

She said the act of restraining a person who is suffering excited delirium - which is needed to sedate the person - often heightens the response.

"The longer the physical altercation, the more likely the person is going to die or get injured," she said.

However, a death because of excited delirium and restraint does not necessarily absolve an agency of responsibility, she noted.

"You have to look at the circumstances of the case and the behavior of the officers and whether they were following the law and their rules based on the policies and procedures of the agency," Melinek said.

Madewell's attorney, Jarom Tefteller of Gilmer, dismissed the autopsy findings, saying he intends to move forward with filing a civil lawsuit.

The lawyer, who sued the county in the 2010 jail death of Amy Cowling and settled out of court for $1.9 million, said he sees similarities in the two cases.

"I see drastic parallels between this case and the Cowling case. We feel very confident that the same unconstitutional health care policies that led to Amy's death were at the core of this death," Tefteller said, referring to policies that may disallow an inmate some prescribed medications. "We are planning on proceeding forward with a civil rights lawsuit in federal court in the near future."

Melinek, who reviewed the autopsy report Friday, expressed concern over something the autopsy didn't say. It listed "superficial blunt force injuries of head, face, torso and extremities" in the findings section, but never detailed the injuries, an omission she said violates a fundamental rule of preparing an autopsy report.

"I have never seen an autopsy report where they acknowledge there is trauma, and then fail to detail the trauma. That is very concerning to me," she said.



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