In a San Diego courtroom on Tuesday, attorney Chris Morris pieced together Daniel Sisson's final hours, arguing that staff at the Vista Detention Facility could have prevented the 21-year-old's death if only they'd properly monitored him while he was detoxing from heroin.
The sandy-haired North County surfer was found dead in his jail cell on June 25, 2011, from an acute asthma attack made worse by drug withdrawal. The San Diego County Medical Examiner estimated in an autopsy report that Sisson had been dead for several hours when a fellow inmate found him.
CityBeat wrote about Sisson in April 2013 as part of an ongoing examination of the high rate of deaths in San Diego County jails. A correctional-healthcare expert we talked to for that story pointed out that opiate withdrawal isn't normally life-threatening, but when an inmate going through withdrawal has an underlying medical condition—like asthma—he should be closely monitored. And, the National Commission on Correctional Healthcare, which sets standards for jail and prison health services, has recommended that inmates experiencing drug or alcohol withdrawal who have a major medical issue be monitored around the clock or, if that's not possible, transferred to a hospital. Morris said he plans to call expert witnesses who'll testify to this.
"There's a procedure put in place for that very reason," he told CityBeat. "There's an affirmative duty to monitor."
It's taken nearly two-and-a-half years for a federal lawsuit, filed by Sisson's mother and father, Shaunda Brummett and Greg Sisson, to go to trial. Earlier this year, the two sides tried and failed to reach a settlement; opening arguments took place on Tuesday.
Morris argued in his opening statement that Sisson should have been placed in a medical-observation unit, but was instead put in with the jail's general population. Even then, regulations require that deputies conduct hourly safety checks, Morris argued, the purpose of which is to look for inmates exhibiting signs of medical distress, trauma or engaging in criminal behavior.
Yet, surveillance footage from the day Sisson died shows deputies walking quickly past cell doors, barely looking in.
Sisson wasn't new to jail. In the year-and-a-half before he died, he'd been booked into the Vista Detention Facility several times, staying for between one and 13 days. In the four jail stays leading up to his arrest on June 23 for a probation violation, records show that he admitted during the medical-intake screening that he was a heroin addict. Documentation shows, too, that he always told jail staff about his asthma. But despite being given an inhaler and placed on medication to curb the effects of withdrawal, his jail medical records show that in December 2010, Sisson suffered an acute asthma attack.
But, on June 23, he answered "No" when asked during intake if he took street drugs. In an early response to the lawsuit, county lawyers argued that Sisson's death was solely the young man's responsibility:
"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. No one in the jail put him in this position; rather, it was a course of action he alone initiated."
On Tuesday, Senior Deputy County Counsel Kevin Kennedy kept with that argument, telling the jury that Sisson's death was the result of "a series of choices that Daniel alone made."
But Morris argued that Sisson turned to heroin not for recreational use but for self-medication. At age 10, he'd contracted a bacterial infection while on a surfing trip in Costa Rica. The infection led to Reiter's Syndrome, a form of inflammatory arthritis that, when it's severe, can leave a person in constant pain. At age 19, with his family unable to afford the treatment he'd relied on in the past, he was prescribed Vicodin and Oxycontin for pain, and eventually turned to heroin. In the months before his death, he struggled to get clean, telling his doctor that he was "desperate for help."
Though he initially denied being an addict, by 6 a.m. June 24, after withdrawal had kicked in—according to medical records, he'd vomited, his pupils were dilated and he was experiencing tremors—he admitted during a scheduled medical visit that he'd lied when he was asked about using street drugs. He said he didn't want to be prescribed Vistaril, an anti-anxiety medication that's part of the jail's heroin-withdrawal medical protocol, because it made him ill. Records show he was given the anti-nausea drug Tigan instead.
But the Tigan apparently didn't help. On June 24, Sisson's cellmate, Stephen King, wrote in a letter to his wife, "I got a roommate in my cell today. He is really sick. He was doing Heroin when he got arrested. Now he is throwing up all day."
The following morning, Sisson skipped breakfast. At 10 a.m., when a nurse came into the module to dispense medication—jail cells are grouped into modules where inmates get access to a common area for several hours a day—Sisson took a full six minutes to come out of his cell. Surveillance video shows him struggling to walk, with what looks like a blanket pulled around his shoulders. This should have triggered immediate medical attention, Morris argued, but it didn't. This is the last time Sisson is seen on surveillance video.
At 11:34 a.m., Sisson declined a scheduled medical visit, telling deputies via an intercom in his cell, "I'm good." This was another chance, Morris said, for medical intervention. Because it's not uncommon for inmates to refuse medical appointments, "the county has a policy in place for this situation," Morris said. A deputy should have gone into Sisson's cell and had him sign what's known as a "Refusal to Accept Medical Care" form. But that didn't happen.
"It was never signed," Morris said. "No attempt was ever made to bring Mr. Sisson his refusal form."
When dinner was passed out at 4:15 p.m., via a cart wheeled into the module, Sisson didn't come out of his cell. And, at 5:20 p.m., surveillance video shows a deputy walking quickly past the cell.
At that point, Morris said, "he's either dead or dying."
Morris said King, Sisson's cellmate, wasn't in the cell from 1 to 5 p.m. and that King said in a deposition that when he returned, Sisson was covered "from head to toe" in a blanket; King assumed he was sleeping.
It wasn't until 8:12 p.m., when he failed to come out of his cell to get his medication, that a fellow inmate checked on Sisson and found him dead.
The autopsy report notes that an inhaler he'd been given was found on Sisson's bed, though no traces of its active ingredient, Albuterol, were in his system—which raises the question of why someone with lifelong asthma wouldn't grab for his inhaler. Chronic opiate use effects the part of the brain that should alert a person that he's not getting enough oxygen, Morris told CityBeat during a break in the trial, and that's why monitoring is critical.
"For someone going through withdrawal," Morris said, "you don't know you're oxygen-deficient. You don't know you're slowly turning blue.'