Mayra Ramirez needed urgent hospitalization before her death in custody
Mayra Ramirez, 58, died in the custody of the Marion County Sheriff’s Office on Sept. 7, 2023. [Supplied]
On the day she was sent to jail, Mayra Ramirez told the judge she would not survive if incarcerated. Her premonition turned out to be true. After battling severe medical issues and near-constant pain, Ramirez died two years later while she was still held at the Marion County Jail.
During her incarceration, Ramirez made at least 33 urgent requests for medical care, often filing multiple requests in one day. Her requests include pleas of “Help me,” “I am in so much pain,” and “I don’t know how much longer I’m going to last.”
Ramirez, a 58-year-old woman from Ocala, was hospitalized four times while in custody, mostly for complications from pancreatitis and heart disease. The fourth time she arrived at AdventHealth Ocala Hospital was to pronounce her deceased.
Ramirez died on Sept. 7, 2023, after jail staff said she “turned blue and fell to the floor” at about 6:46 p.m. Marion County Fire Rescue was called in response to Ramirez exhibiting symptoms of “heart failure.” CPR began at 6:50 p.m., and she was then transported to the hospital and pronounced dead.
Ramirez’ death in custody is one of a series of similar incidents that raise concerns about the quality of care inmates at the county facility receive. The MCSO, which operates the jail, has reported 29 deaths at the facility from 2021 to 2024.
Heart of Florida Health Care is contracted to provide medical care at the jail. Heart of Florida representatives have told the “Gazette” that the agency cannot provide comment on specific patients’ medical care.
Two days before her death, Ramirez had been coughing up blood, a condition known as hemoptysis. Rather than being taken to the hospital as she had been the two previous times she was coughing up blood, she was only taken to the jail’s infirmary.
On the evening of Sept. 7, Ramirez told medical staff she was suffering from epigastric pain. When she was asked to get up to take her medication, she struggled. The nurse went to check on another inmate and when she came back Ramirez fell to the floor and “turned blue.”
MCFR records indicate that at the time of her death, Ramirez was on the medications buspirone, an anxiety treatment; hydroxyzine, used to treat anxiety; mirtazapine, an antidepressant; quetiapine, used to treat bipolar and schizophrenia; and spironolactone, which is used to treat high blood pressure.
Ramirez was jailed after failing to appear in court for a July 2021 hearing on a charge of DUI manslaughter after a November 2019 crash on Interstate 75 that left a woman dead. Circuit Judge Lisa Herndon ordered Ramirez to be jailed in September 2021. Ramirez was never tried in court for the DUI manslaughter charge, which was dismissed after her death.
Ramirez’s mother, Blanky Bradshaw, told the “Gazette” that her daughter often said she knew she would die before leaving the jail.
Bradshaw told the “Gazette” that at the time of the 2019 car crash, Ramirez was on pain medication prescribed by a doctor after another car accident years before. Bradshaw said her daughter had become reliant on the drugs due to her many health issues.
“I’m not perfect. Nobody’s perfect, but I know my kids,” Bradshaw said. “She was not drunk. She was taking medication, and she was not intentionally driving under the influence.”
Ramirez had been prescribed alprazolam, an anti-anxiety medication, by a doctor prior to the 2019 crash at a dose of one tablet, three times a day. Nine days before the crash, her dosage was lowered by her doctor, but the prescription she picked up from the pharmacy was for the previous higher dose, according to court records obtained through the Marion County Clerk of Court.
Toxicologist Andres Lugo testified in court at a pre-trial hearing that Ramirez was not under the influence at the time of the crash as the medication was prescribed by a doctor and unknowingly taken at the wrong dose, court records show.
The state successfully argued that the defense did not provide a sufficient factual basis for an involuntary intoxication defense. Ramirez was represented by Assistant Public Defender Theodore Riquelme. She was denied bond.
As soon as she entered the jail, her requests for medical help began. On Sept. 3, she requested “emergency medical attention,” telling jail staff that she had a deteriorated spine, was wheelchair bound and had been disabled since 2005.
While Ramirez was being booked into the jail, Heart of Florida, which contracts with Marion County to provide medical services at the jail, instructed that she be given a wheelchair for any long-distance walking.
In the medical assistance request forms she filed, Ramirez often said she didn’t have access to a wheelchair and had to walk long distances despite her disability. She described her back, hip and knee joints as being “bone on bone” and that she suffered from extreme pain and often fell.
While medical records show that Ramirez’s symptoms related to pancreatitis; heart issues; back, neck and knee pain; and gastrointestinal issues continued until the time of her death, Ramirez was not sent to the hospital for any of her concerns in the year leading up to her death.
Ramirez also was diagnosed with bipolar disorder, depression, anxiety and post-traumatic stress disorder. Records show that Ramirez was seen frequently for her mental health issues while in jail and was consistently on medication to treat psychiatric disorders.
From the time Ramirez entered the jail in September 2021 until July 2022, Dr. Ivette Colon Reyes was the medical director at the Marion County Jail. While Colon was there, Ramirez was treated at the hospital three times for severe medical issues, related to the heart and pancreas and for mobility issues.
In July 2022, Dr. Jose Rafael Rodriguez took over as the medical director for Marion County and Sumter County jails under a Heart of Florida contract.
Rodriguez has been practicing medicine in Florida since 2014 under an Area of Critical Need Medical Doctor license that must be renewed annually by Florida Department of Health. According to his licensure information with the state of Florida, Rodriguez was formerly licensed in Puerto Rico from 2002 until 2016. He earned his medical degree from the Universidad Autónoma de Guadalajara.
Rodriguez previously worked at the Lowell Correctional Institute from 2015 until 2021. During the time when oversaw medical care at Lowell, the Miami Herald and later the Department of Justice investigated the facility for lack of medical care, unusually high cases of rape, and death due to lack of medical care.
Request for bond
On June 7, 2022, a hearing was held to reconsider Ramirez’s bond, presided over by Judge Lisa Herndon. This was the third hearing where Ramirez asked to be let out on bond.
Colon testified the jail’s medical facility could not provide the level of care that was necessary for Ramirez’s ailments.
“I have a nerve root disorder, as well as disk degeneration…cervical degeneration,” Ramirez said. “Therefore, it radiates pain through my arms and through my back at all times. I am in need of my cervical injections pain management that I get every three to six months.”
Through Ramirez’s many requests for care within the jail, she often cited her chronic pain as an issue. She told the judge that she often needed help from other inmates getting out of bed, standing, walking and even showering.
“Both of my knees are bone-on-bone…I have always gotten pain medication and cortisone injections on my knees because it is advanced osteoporosis arthritis. It is not only on the kneecaps, but through the body, and that’s one of the pain things,” Ramirez said.
Colon said Ramirez had access to only lighter medications for pain and inflammation, such as ibuprofen and acetaminophen, but she cannot provide any controlled medications unless a patient is terminal.
“She’s not getting the pain medication that she was getting on the outside because unfortunately within the jail I cannot order Percocets or Roxicets or any controlled Type II medications unless the patient is terminal,” Colon said.
Ramirez told the judge that because of the osteoporosis, she has suffered many falls since entering the jail. By the time of this June 2022 hearing, Ramirez said she had asked for a wheelchair in September, October, November, December and January of 2021 through 2022, but that the detention deputies do not provide her any walking aids despite Colon ordering it for her.
Colon testified Ramirez always had access to a wheelchair while she was visiting the infirmary but that Colon had no control over whether Ramirez had access to any wheelchair or mobility aid in the housing units.
Additionally, Ramirez testified that she suffered from heart conditions such as tachycardia and arrhythmia. Ultimately, Ramirez’s death was determined to have been caused by heart failure.
In reconsidering bond for Ramirez, the judge took into account her history of a wet reckless conviction in 2007, which is a less severe conviction for reckless driving associated with drugs or alcohol; and convictions for a DUI and battery of a law enforcement officer in 2009; and disorderly conduct in 2016.
“Based upon her priors and the actions in this case that I have read in the (probable cause), I’m not comfortable releasing her, so your motion for bond is denied,” Herndon said.
Medical history in jail:
On Dec. 28, 2021, Ramirez was sent to the AdventHealth emergency room for a hypotensive episode. When she returned from the hospital, she was housed in the infirmary.
In inmate requests filed Jan. 28, 2022, Ramirez pleaded multiple times for care, expressing extreme pain and discomfort.
“Please! I’m in so much pain! My hip and leg (left side) is bone on bone. I have had almost a dozen falls,” she wrote. “Nurse Sawme informed me that Dr. Colon was going to see me last week and yet I’m still waiting. Please help! I don’t know how much longer I’m going to last.”
On the same day, she filed another report saying: “It has been over 24 days that I have been requesting an appointment to be seen by Dr. Colon, MCJ medical director, due to my heart condition and my physical disabilities. Please help … I am still waiting in pain.”
Ramirez was transported to AdventHealth for abdominal pain and hemoptysis, or coughing up blood, twice in May of 2022—once on May 9 and again on May 22.
Her records show that she was experiencing pain to the epigastric area, radiating to the left upper abdomen and to the back, and that she was coughing up blood that was a bright red color.
On July 16, 2022, X-rays conducted show that Ramirez was again coughing up blood. She continued to strongly ask for treatment for pain in her stomach. Providers ordered that Ramirez have an endoscopy scheduled with a gastroenterologist. She also injured her foot in a recent fall, records show.
Ramirez was again sent to AdventHealth for her concerns. She was diagnosed with syncope and a nondisplaced fracture of the fifth metatarsal bone of the left foot, records show.
Inmate requests from Ramirez in November 2022 indicate that she had not received the medication she needed after an appointment with Rodriguez the week prior. During that visit, Rodriguez noted that Ramirez had made multiple complaints for chronic pain issues and heartburn.
In December 2022, Ramirez told providers that she had been having abdominal pain for about three months. On Dec. 7, 2022, she was examined and treated for pancreatitis. Rodriguez told her to come back if the pain worsened, which she did in early January 2023.
In the first week of January 2023, Ramirez was seen for multiple sick calls regarding her abdominal pain. Rodriguez noted that her pain had worsened since last her visit over concerns of pancreatitis on Dec. 7, 2022.
Ramirez was placed on a schedule to receive routine sick calls often weekly or biweekly in the year leading up to her death, infirmary records show. Records show that her health issues only continued from January to September 2023, but she was not sent to the hospital.
Ramirez again began coughing up blood on Sept. 5. She was sent to the infirmary, until she collapsed and became unresponsive on the evening of her death.
She was sent to AdventHealth and was examined at 7:07 p.m., but by that time she was already being kept alive only by CPR.
Bradshaw said she spoke to her daughter on the phone daily, sometimes twice a day in the morning and at night. She began to grow concerned when she didn’t hear from her the night before and the morning of her death.
“I was very worried, because I just saw her yesterday morning and she was in such a bad pain that she had to cut off the visit,” Bradshaw said. “That was very strange for her, because she loved to talk, and that was the only way she was in in touch with the outside.”
Bradshaw said that at about midnight on the night of her daughter’s death, deputies showed up at her door. Being 76 years old at the time, Bradshaw told deputies she wouldn’t speak to them until her son arrived.
“I said, ‘I’m not going to open the door for you, because I know that you’re bringing bad news, and I don’t want to hear,’” she said.
The deputies then informed her that her daughter had died in the jail. Bradshaw said she never received a call from any jail staff to explain the circumstances of Ramirez’s death and has undergone a costly and time-intensive search for answers ever since.
Mayra Ramirez (second to left) with family members. [Supplied]
Bradshaw said after her daughter died, she called again and again to speak to anyone who could give her more information.
“They called me once—to go and pick up the box of her belongings,” Bradshaw said.
Now, a year and a half later, Bradshaw says the box remains untouched.
“It’s in the garage, because I don’t have the heart to open that and start digging in there,” she said.
Editor’s Note: Investigate This! at The Marshall Project provided guidance to the Ocala Gazette team on how to navigate obtaining information under the federal Death In Custody Reporting Act.
For previous reporting on the Marion County Jail, visit the links below.
Family seeks answers in the death of 39-year-old inmate
Whistleblower sues Marion County Sheriff Billy Woods
Six more recent deaths in law enforcement custody come to light
Florida has no law requiring deaths in custody to be reported by local law enforcement
People in the Marion County Jail are suffering. This is why it matters.
Jail footage shows inmate complied with orders before fatal use of force
“Ocala Gazette” lawsuit against MCSO to be reassigned to another judge following hearing
‘Ocala Gazette’ sues MCSO over video of jail inmate’s death at hands of deputies
Family of Marion jail inmate who died in custody files wrongful death suit against sheriff
No charges for officers involved in inmate death
Inmate death at Marion County Jail prompts FDLE investigation
Support community journalism
The first goal of the Ocala Gazette is to deliver trustworthy local journalism so corruption, misinformation and abuse are not hidden from the public or unchallenged.
