When the administrator of the Washington County Jail in southwest Alabama answered the phone on the evening of June 20, 2016, he learned of a health emergency playing out in the jail he oversaw.

A 43-year-old inmate named Tracie Weaver had been vomiting for hours and her blood pressure was dangerously high, a dispatcher told then-jail administrator Arthur Ray Busby.

“We are going to have to do something with Tracie because she is throwing up everywhere. … Her blood pressure is at 183 over 113. I don’t have a county unit available to carry her to the hospital,” the dispatcher said.

Listen to the Call

A dispatcher tells then-jail administrator Arthur Ray Busby that Tracie Weaver is experiencing a medical crisis. Busby directs the dispatcher to figure out who will pay for Weaver’s medical care before sending her to a hospital.

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Weaver had been booked into the Washington County Jail a week prior and was awaiting trial on a charge of illegal possession of a credit or debit card.

The nearest hospital is only 1 ½ miles away, but Weaver remained in the jail as Busby directed staff to first figure out who would pay for her medical care.

“See if she had insurance, if she had Medicaid,” he told the dispatcher, who was referred to only as Kelly on the call. A recording of the conversation was provided to AL.com and ProPublica by Henry Brewster, a lawyer for Weaver’s family in a lawsuit filed in U.S. District Court for the Southern District of Alabama in Mobile in February 2018.

If Weaver was covered by Medicaid or private health insurance, then her medical bills would not be the county’s responsibility if the sheriff’s office released her from its custody.

“Like I told, uh, Kelly, find out what her Medicaid card is,” Busby told Tina Sullivan, a sheriff’s deputy on duty in the jail that night who was looped into the call. “And, uh, if she’s got full Medicaid.”

Twice, in the short conversation, Busby said that Weaver should be released on “furlough” before being handed over to a family member.

Typically, medical furloughs are granted to inmates who have terminal illnesses or require outpatient procedures or care for chronic conditions. But in this instance, Busby used the term to refer to a process much like that of the “medical bond,” a tool that AL.com and ProPublica have found sheriffs throughout Alabama pursue to release inmates and avoid being on the hook for their medical bills.

“Tell her to call her family, or call her family, and tell them to come get her and take her out to the hospital on furlough. … Call the family and tell them to come up and get her on a furlough, and take her on to the doctor,” Busby said.

At one point, Busby told the dispatcher to otherwise “wait on a county unit” to take Weaver to the hospital. Weaver was driven to the hospital later that evening in a sheriff’s office vehicle. By the following evening, she was dead. A state autopsy report said that she had suffered from a “massive cerebral hemorrhage” and that her cause of death was a “cerebrovascular accident,” the medical term for a stroke.

“You’re Gonna Have Deaths”

In most instances in which inmates in medical crisis are released via medical bonds and similar methods like recognizance bonds, the inmates survive. That was the case with Michael Tidwell, who was released from the same Washington County Jail in 2013 hours before he entered a diabetic coma.

Washington County Sheriff Richard Stringer said in an interview in his office in Chatom, a small town about an hour’s drive north of Mobile, that his jail has no medical professionals on staff, and that no doctors or nurses pay periodic visits to the facility.

As it stands today, Sandy Cooley, the jail’s current administrator, makes medical decisions for inmates “most of the time,” Stringer said.

Cooley, who has no formal medical training, said she believes Weaver’s death was unavoidable.

“We wound up taking her to the emergency room. But it would not have mattered; if she had been on the operating table, she’d have still died,” Cooley said during the interview in Stringer’s office.

Brewster, the attorney for Weaver’s family, also has represented other inmates, including Tidwell, and their families in similar cases. After reviewing the jail’s medical policies and other relevant documents in Weaver’s case, Brewster decried the lack of health care inmates receive.

“There is absolutely no internal medical care there and they are severely understaffed,” the Mobile-based lawyer said. “There’s no nurse, no doctor, no medical care, nothing at all. So if there’s a medical emergency, they are just taken to the county hospital.”

The sheriff deferred to Cooley when asked about Weaver’s death. But he said that “like any jail, you’re gonna have deaths.”

“Every time someone is booked into this jail, we go over their medical history. … We go through the whole scenario and you know, you do the best you can,” Stringer said.

He later provided a copy of the “health questionnaire” that the sheriff’s office requires inmates to fill out when they are booked into the jail. There are 28 terms listed on the one-page document, ranging from “Mental Problems” and “Asthma,” to “Diabetes” and “Poor Hygiene.” Each inmate is asked to respond with a yes or no answer to each and is given space to provide an explanation for their answer.

At the top of the list is a two-word question: “Has Insurance?”

Unanswered Questions

Other inmates said Weaver was already in bad shape when she arrived at the Washington County Jail shortly after she completed a 33-day substance abuse treatment program, according to the lawsuit Weaver’s estate filed against Stringer, Busby, Sullivan and two other sheriff’s office employees.

“From the point she began her stay in the Jail, fellow inmates who were familiar with her described her as physically and mentally weak and in distress,” the suit states. “She appeared underweight, ill, and unstable.”

Weaver’s health deteriorated further over the ensuing week as jail staff failed to provide her the medications she required, according to the lawsuit. Stringer, who denied wrongdoing in connection with her death, said that inmates in his jail have never been denied prescribed drugs.

“She suffered seizures and could barely talk. She suffered debilitating headaches and she cried constantly,” the lawsuit states. “One inmate described that she ‘wasn’t in reality.’ She could hardly eat on her own. She was drooling constantly.”

Weaver was eventually placed in solitary confinement, and a week after her booking, an inmate told jail staff that it appeared that Weaver was having a stroke, the lawsuit states. A guard went to her cell shortly afterward and told her that he was going to “knock the fuck out of her if she didn’t shut up,” threatened to pepper-spray her, then closed the door and walked away, the lawsuit said.

Within hours, “Tracie was drawn up, and could only verbalize ‘uh, uh.’ Tracie appeared to be dying and she was strapped in the chair [by jail staff.] Tracie had vomit all over her clothes,” the lawsuit said.

An inmate urged Sullivan, the deputy on duty, to get an ambulance for Weaver, according to the lawsuit, but was told that the jail’s policies and Busby’s rules required that guards get Busby’s permission before calling for an ambulance. Twenty more minutes went by with Weaver in a state of medical crisis, the suit said.

When she was finally taken downstairs, another sheriff’s deputy “told Tracie, who was clearly incompetent, to sign a paper so she could be released to the hospital. Tracie could only reply, ‘uh, uh.’ [The deputy] replied to Tracie, sarcastically, ‘You can say, “uh, uh” all you want, but if you don’t sign this paper, you are not being released,’” according to the lawsuit.

A sheriff’s office employee eventually drove Weaver to the Washington County Hospital. Doctors there told her loved ones she had suffered a brain hemorrhage or stroke, and Weaver slipped into a coma and had to be flown by helicopter to the University of South Alabama Medical Center.

The next day, doctors at the Mobile hospital reported that she had no brain function. She was taken off life support and died on June 21, 2016.

It’s unclear who paid for Weaver’s stay in the hospital. Stringer said in a telephone interview last week that his office did not pay for it.

“She was not in our custody,” he said. “She was released from here on a medical bond and once she was released we did not pay a medical bill.”

Weaver’s family members declined through Brewster to comment, but the lawyer said her estate was never sent any hospital bills.

In May, the federal lawsuit was settled for an undisclosed amount. A month before the settlement was finalized, Brewster said in an interview that the sheriff’s office cannot abdicate its duty to take care of its inmates’ medical needs.

“They have an obligation, despite what their finances are, when there are conditions that could lead to an inmate having a serious health condition, to provide adequate medical care,” Brewster said.

Settlements have been reached in at least three lawsuits filed against the Washington County Sheriff’s Office over the past decade that claimed it failed to provide adequate health care in the jail, including ones in which inmates were bonded out just prior to hospitalizations.

The jail still employs no medical staff.