The last time Shaunda Brummette saw her son, Daniel Sisson, it was in a Vista courtroom late in the afternoon of June 23, 2011. Sisson, a sandy-haired 21-year-old who'd grown up surfing North County beaches, was there to answer to a drug-possession charge; Brummette went with him to the hearing.
Sisson had been arrested the week before and posted bail, so he and his mom assumed the court appearance would be routine—he'd plead not guilty and wait for his next hearing.
But that's not what happened.
Because Sisson was on probation from an earlier conviction—also for drug possession—he was taken into custody. As deputies handcuffed him, he turned to look at his mom.
"It's the saddest look I've ever seen," Brummette says.
Less than two days later, Sisson was dead. His stay in jail was so short that his autopsy report noted that the ink from his booking fingerprints was still on his fingers. The medical examiner listed the cause of death as asphyxiation from an acute asthma attack, with heroin withdrawal as a contributing factor. A small amount of methamphetamine was also found in his system.
Since March 27, CityBeat's been taking a closer look at the 60 deaths that occurred in San Diego County jails between 2007 and 2012. Over that period, the county had the highest mortality rate of Californiaís 10 largest jail systems. Sisson's was one of 11 deaths in San Diego County jails in 2011. That year, only Los Angeles County recorded more deaths—19 total—and L.A.'s jail system is triple the size of San Diego's.
Alcohol withdrawal, experts say, can be deadly; cold-turkey withdrawal from opiates, on the other hand, is rarely life-threatening, unless an addict has an underlying medical condition—like asthma.
"Somebody who has some other disease, where the stress of withdrawal could make that disease worse, definitely deserves closer monitoring," says Marc Stern, a correctional-healthcare consultant and former health services director for the Washington State Department of Corrections. "So, if you know somebody has asthma, and they're going to go through withdrawal, yes, you have an obligation to monitor them more closely."
According to the medical examiner's report, Sisson was last seen alive at 5 p.m. on June 25, roughly 48 hours after he'd been booked into the Vista jail. The report doesn't say who saw him last.
When Sisson didn't respond to an 8:10 p.m. welfare check, the report says, deputies entered his cell. By that point, rigor mortis had set in, indicating that he'd been dead for at least three hours. A medical examiner investigator found a letter in the cell written by Sisson's cellmate, addressed "to America," describing Sisson's withdrawal symptoms. The report doesn't go into further detail on the letter; neither does it say whether the cellmate was still in the cell when deputies found Sisson.
Last year, Brummette and her husband, Greg Sisson, filed a lawsuit against the San Diego County Sheriff's Department. In it, they argue that the jail failed to abide by the California Code of Regulations for correctional facilities, which requires that "health and safety checks" involving "direct visual observation" of each inmate be performed at least hourly.
"They know he has addiction issues, they know he's detoxed in the past, they know he has asthma and they just throw him in a cell," says attorney Chris Morris, who's representing Sisson's parents.
Lack of close monitoring is a thread that runs through the jail system's addiction-related deaths. Ronald Scimeca, a 61-year-old homeless chronic alcoholic who'd been arrested for being drunk in public, was booked into the San Diego Central Jail at 10:25 p.m. on May 26, 2009, and suffered a seizure shortly after. He was placed in the jail's medical-observation unit, where, a medical examiner's report says, inmates are to be checked every 20 minutes. But, according to the report, four-and-a-half hours passed between when Scimeca was last seen alive and when he was found facedown in his bunk. According to the medical examiner's report, "obvious rigor mortis" had already set in. Across from Scimeca's cell, the report notes, was a nurse's station "that is not manned with personnel all the time."
Ray Mullins, a chronic alcoholic, was vomiting bile in the hours before he died on May 3, 2009. At 3 p.m. that day, he was seen lying facedown on his bed, his arm dangling over the edge, but it was 45 minutes before anyone checked on him. Inmates told a medical-examiner investigator that they'd tried to alert deputies to Mullins' condition but were ignored.
Calvin Cole's first cellmate complained about the 41-year-old schizophrenic addict's excessive vomiting, as did a second cellmate. Though Cole had been placed in the jail's medical unit, it was two other inmates who found him unresponsive—after he'd missed breakfast—and attempted CPR.
Marion Lopez, a heroin addict, died the day she was booked into jail. She laid down in her bunk at 7 p.m., but it wasn't until 11:59 p.m. that a deputy wondered why her cell door was ajar and found her dead.
While Richard Diaz's autopsy report notes that a deputy was checking on him regularly, the 40-year-old alcoholic and heroin addict with hepatitis C was repeatedly placed in a top bunk despite suffering from tremors and multiple seizures. He fell out of the bunk twice and was vomiting for three days before succumbing to a stomach obstruction.
Brummette doesn't know how long her son had been addicted to heroin. As a teen, he was anti-drug, she says. But a friend's death when Sisson was 16—from a heroin overdose—threw him into a funk and pushed him toward drugs rather than away from them. He was first arrested for drug possession in January 2010. His final stint in jail was his seventh in less than a year and a half.
Sisson tried to get help, Brummette says. He enrolled in an outpatient program created under Prop. 36, the state law that gives nonviolent drug offenders the option of treatment instead of jail, but it didn't seem to click. Not long before his death, he told his mom he was having a hard time staying clean. She called around to treatment facilities, looking for something she could afford. She finally got him seen by a doctor who prescribed Suboxone, an opiate-replacement medication that eases withdrawal and diminishes cravings without a high.
In February, Sisson was jailed in Vista on a probation violation. Brummette tried to bring him his Suboxone.
"I went out there to let them know that he was asthmatic and he was on Suboxone," she says. "I brought the doctor's note. I brought the medication bottle. They looked at me and said, 'You know what, we'll handle it our way.'"
Even though medication-assisted withdrawal from opiate addiction—via drugs like methadone or Suboxone—is considered to be the standard of care by the American Psychiatric Association, the American Society of Addiction Medicine, the National Commission on Correctional Healthcare and the Bureau of Prisons, it's rarely used in U.S. jails. Less than 10 percent are licensed to provide it. This means that inmates who aren't currently on opiate-replacement therapy when they're incarcerated can't start a program while in jail. Only pregnant inmates can start on methadone because withdrawal could threaten the life of the fetus.
In San Diego, inmates who are enrolled in a methadone program prior to being incarcerated have to arrange with their clinic to have their daily dosage brought to the jail. The same policy applies to other opiate-replacement drugs like Suboxone. But while methadone must be administered in a clinic setting, Suboxone can be prescribed by private-practice doctors, who might not have the ability to deliver jail doses.
Bottom line: Jail access to opiate-replacement drugs can prove tricky, says Gretchen Burns Bergman, executive director for the addiction-recovery organization A New PATH. Addicts might not be in the best position to arrange for their own care and might not have anyone on the outside to do it for them. When Bergman's son was arrested, she was the one who called the clinic to make sure his methadone was delivered to the jail—but first she had to settle some of his past-due bills.
"It's very difficult for family members to get any clear understanding of what's available," she says. "The sad truth is that people arrested for drug charges are treated like criminals, rather than people with a chronic relapsing disorder."
The county's response to the Sisson lawsuit places blame on Sisson for not telling jail medical staff during intake that he was addicted to heroin—and for being an addict in the first place.
"Sisson lied about the state of his health when he discussed his medical background with the intake nurse and due to his continual use of heroin (despite having been placed in a drug treatment program), he underwent withdrawal," says a motion filed by the county on July 25, 2012, seeking to dismiss the lawsuit.
"No one in the jail put him in this position; rather, it was a course of action he alone initiated," it goes on to say.
According to the medical examiner's report, Sisson initially didn't tell the intake nurse that he was an addict because he didn't want to be prescribed Vistaril, a sedative routinely given to inmates going through withdrawal. However, 14 hours later, the report says, his withdrawal symptoms were severe enough that he sought help, admitting to jail staff that he used heroin daily.
The report describes his withdrawal symptoms as "moderate"—vomiting, diarrhea, tremors and dilated pupils. He was prescribed Tylenol, the painkiller Naproxen and an anti-nausea medication, and he was given a small "rescue" inhaler. The autopsy report notes that the inhaler was found on Sisson's bed, though no traces of its active ingredient, Albuterol, were found in his system.
Brummette says it took months to get her son's autopsy report. Right now, it's all the information she has, and it's left a lot of unanswered questions: Even though Sisson didn't initially tell staff that he used heroin, the medical examiner's report says that he'd admitted to it during past jail stays; he'd also suffered an acute asthma attack during an earlier incarceration. So why wasn't staff aware of his history? Then there's the fact that the emergency inhaler appeared to have gone unused. Brummette says her son suffered from asthma all his life; he knew when an attack was coming on. And, he normally called her from jail; this time, she didn't hear from him. She wonders if this is evidence of the severity of his withdrawal.
The county's lawsuit asks "whether a visual safety check would have made any difference is speculative at best." But according to the National Commission on Correctional Healthcare, which sets recommended standards for correctional-facility health services, "high risk" inmates experiencing drug or alcohol withdrawal—meaning inmates with prior histories of withdrawal complications or seizures, older inmates and/or inmates with a history of major medical or psychiatric problems—should be monitored around the clock or, if that's not possible, transferred to a hospital.
Sisson was booked into jail on a Thursday. Brummette made plans to visit him that Saturday, but she was too tired when she got home from work. She decided to bump the visit to Sunday. Early Sunday morning, she got a phone call, letting her know her son was dead.
"They didn't say I could come see him; it was just done. It's like it was nothing."