Deadly detox at MCSO jail
Juan Miranda Valentin marriage to Keyshalin Costa, 2015. [supplied]
Detoxing from drugs or alcohol can be dangerous anywhere, but when it happens in a turbulent jail environment, the person going through the withdrawal symptoms can be in even greater danger.
The case of a Marion County jail inmate, who died five days after being incarcerated while he was overcoming admitted drug use, raises questions about the level of care being provided to inmates at the facility. Challenges detoxing in jails have been widely reported. According to a 2022 joint report by the Bureau of Justice Assistance within the US Department of Justice and the National Institute of Corrections, 63% of those sentenced to jail have a substance use disorder, compared to 5% of adults who are not incarcerated.
Yet statistics from the Department of Justice from 2000 to 2019 reflect the nationwide number of inmate deaths at local jails who have died from drug/alcohol intoxication during that period increased by 397%. Female inmates’ deaths of drug or alcohol was nearly double the rate of males.
Since the median length of stay in jail before death from alcohol or drug intoxication is just one day, jail medical staff must be ready with detox protocols in place.
As part of an ongoing investigation into the uptick in deaths at the Marion County jail, records recently obtained from the jail indicate post-booking ER visits decreased by more than half compared to their historical average from 2022 through 2024 when some inmates died for reasons that could be attributed to delayed medical intervention.
Under a $14 million annual contract, the Heart of Florida Health Center provides medical care to Marion County Jail inmates, which includes the cost of emergency care. HOF, however, has refused to respond to a public records request by the “Gazette” for financial records for emergency care, and their bills to the Marion County Sheriff’s Office, which operates the jail, do not provide detailed information.
Records show that the death rate of persons incarcerated at the Marion County Jail is four times the national average. As part of an ongoing investigation into this disturbing trend, the “Gazette” examined whether delayed medical care and questionable oversight in the care of Juan Valentin lead to his death on Oct. 3, 2024, five days after his initial incarceration.
Juan Valentin
Valentin, 61, was a mechanic who struggled with drug addiction since he was a young man, according to his wife, Keyshalin. The couple met when Valentin, originally from Puerto Rico, moved to Marion County, Florida in 2007. They were married in 2015.
Keyshalin said that despite her husband’s battle with addiction, she will always remember him as a “beautiful soul” and continues to miss speaking with him.
Medical records indicate that Valentin had gone through detox protocols in 2018 and 2020 at the Marion County Jail. Keyshalin questioned why jail medical staff delayed transporting him to a hospital when his symptoms became severe during his 2024 arrest.
With help from Keyshalin as Valentin’s next of kin, the “Gazette” was able to obtain HOF medical records for that provide a timeline for his care from the time he was incarcerated on two counts of petty theft to his death five days later while being transported from the jail to the hospital on Oct. 3, 2024.
It should be noted that the jail infirmary has no electronic monitoring equipment and relies solely on human monitoring, according to a source familiar with the jail clinic.
Valentin was booked at the jail at 4:46 p.m. Two hours later, during his medical intake, he admitted to using opioids and cocaine in the last 12 hours. His vitals are rechecked over the next four hours, and his history of hypertension and diabetes was documented.
According to Medically Supervised Withdrawal For Inmates With Substance Use Disorders put out by the Federal Bureau of Prisons, the symptoms that clinicians watch for are “change in mental status, increasing anxiety, hallucinations, temperature greater than 100.4, insomnia, severe abdominal pain, upper and lower gastrointestinal bleeding, changes in responsiveness of pupils, significant increases and/or decreases in blood pressure and heart rate, heightened deep tendon reflexes and ankle clonus, a reflex beating of the foot when pressed rostrally, indicating profound central nervous system irritability and the potential for seizures.”
Records indicate a nurse checked Valentin’s blood sugar every night he was at the jail to monitor the risk of diabetes, but his blood sugar levels remained within a safe range.
The US Department of Justice has published guidelines for monitoring inmates that are detoxing and issued special cautions for people over the age of 55 with other comorbidities. Under those guidelines, inmates with a higher number of symptoms need a higher level of monitoring or potentially a transfer to a facility with more resources.
Saturday, Sept. 28, 2024
Valentin is assigned a bunk in the general population at 11:10 p.m.
Sunday, Sept. 29, 2024
At 1:20 p.m., he presented positive symptoms of withdrawal, joint pain, GI upset, anxiety/irritability, restlessness. LPN Belinda Sullivan described it as “mild withdrawal.” Valentin receives a script that allows him to have a lower bunk.
At 4:31 p.m., Valentin was given ibuprofen, anti-diarrheal medication and medication for nausea/vomiting by R.N. Christine Brown.
Monday, Sept. 30, 2024
At 8:44 a.m., Valentin was brought to the jail infirmary by a guard. Valentin will stay in the infirmary for the final days leading up to his death.
According to HOF records written by Nicholas Christofidis, APRN, Valentin presented body aches and headache and is said to be at 8/10 on the pain scale. Valentin’s blood pressure is an elevated 185/105. Christofidis prescribed Lisinopril, used to treat high blood pressure, for Valentin, without ordering lab work.
Typical blood pressure is usually lower than 120/8 for most adults, while low blood pressure is less than 90/60.
At 9:11 a.m., Valetin weighed in at 150 lbs. Records indicate he has lost 11 pounds since his booking. The notes reflect that Valetin’s temperature was 95 degrees, and the initial medical intake records indicate a temperature of 65 during booking. Both temperatures are so beyond the norm that it raises questions about their accuracy. Christofidis prescribed two more medications to treat high blood pressure, aspirin and diabetes medication, Metformin. His blood pressure had risen to 220/110, his pulse rate was 57.
At 11:45 a.m., Valetin’s blood pressure was the same, but his pulse has increased to 80. Christofidis prescribed Amlodipine which can relax blood vessels and reduce workload on the heart. Two hours later, he learns that Valentin had not taken his prescribed medications for hypertension and diabetes in more than 15 months.
Valentin’s next medical record entry at 5 p.m. showed his blood pressure was 230/110. Dorisvel Ramos, R.N. called Dr. Jose Rodriguez, the jail medical director, who ordered that Valentin be admitted to the jail infirmary and prescribed additional medication to treat high blood pressure.
Two hours later, around 7 p.m., John Little, R.N. in the infirmary, records that Valentin reports a pain level of 0/10. His blood pressure was 186/104, pulse rate 86.
Tuesday, Oct. 1, 2024
Valentin’s vitals were checked 12 hours later at 7:30 a.m. by Ramos. Valentin’s blood pressure was listed at 190/130, pulse was 109, and his temperature is 98.4. The pain level is reported at 9/10 and his diet is listed as poor.
At 9 a.m., Christofidis assessed Valentin as “withdrawing from heroin and has elevated BP.” Valentin’s lisinopril is increased to 40 mgs daily despite having no bloodwork.
By 11 a.m., Valetin’s blood pressure is recorded as 220/115.
Valentin’s vitals were not checked until 2 p.m., and his blood pressure 210/120, pulse 69. He was prescribed an antihistamine sedative used to treat anxiety and tension.
Valentin’s vitals are checked at 7:20 p.m. and Little recorded his blood pressure at 136/100, pulse 102 and noted symptoms of “elevated pulse, stomach cramps and gooseflesh skin.”
Wednesday, Oct. 2, 2024
Valentin’s blood sugar level was checked overnight, according to records, however his vitals were not noted again for 17 hours.
At 12:23 p.m. Melissa Burns, R.N. noted Valentin’s blood pressure at 100/71, pulse 120, temperature 97.8. He was not eating and reported nausea, vomiting, diarrhea, and a 7/10 pain level “all over his body.”
More than eight hours later, Andrea Younes, R.N., reports a blood pressure level of 115/81, pulse of 112, 10/10 pain for headache. Valentin was “mat on floor for precautions, receiving Phenergan, Vistaril and ibuprofen for pain management.”
Thursday, Oct. 3, 2024
Valentin’s vitals were checked at 7:42 a.m. and his blood pressure was 100/63, his pulse is 109, respiration rate was an elevated level of 22. Janice Gissendanner, R.N. indicated Valentin was hallucinating at times and having a hard time sitting up or ambulating. Since Valentin was not urinating, he was sent to the treatment room in a wheelchair where they decided to do a straight catheterization. They were unable to obtain enough urine from Valentin, and he was ordered to receive IV fluids.
Despite already having records of low blood pressure, medical records reflect that staff gave Valentin three medications that could lower his blood pressure even more, as well as medications with sedative effects.
At 8:54 a.m., Duanne Cunningham, APRN, indicated Valentin cannot urinate and has not had a bowel movement in three days. He noted that “nursing staff reports several attempts for IV unable to get started.” Cunningham ordered lab work for the first time and tells nurses to push Valentin to drink two cups of water, start Librium and “taper due to suspected detox and behavior.”
For the first time, Cunningham recorded concerns that Valentin may also be having alcohol withdrawals in addition to drugs. Valentin was forthcoming at intake about recent drug use but denied alcohol use, which his wife confirms has historically been the case.
According to a correction officer’s report, at approximately 10:57 a.m., Valetin was transferred to another infirmary room with two padded mattresses on the floor. At some point shortly thereafter, one of the officers alerted nurses that Valentin is throwing up black vomit, “crashed” and began vomiting blood.
Paramedics are requested to transport Valentin to AdventHealth, but Valentin codes in the ambulance and is pronounced dead upon arrival at AdventHealth Hospital.
The follow-up “investigation” into Valetin’s in custody death
The medical examiner did an external review of Valentin’s body and attributed his cause of death to “chronic ethanol and drug use” with contributing conditions listed as “hypertensive and arteriosclerotic cardiovascular disease.”
The medical examiner’s office confirmed they did not review HOF medical records, and they did not do an independent toxicology report. The omission is notable since HOF did not have any lab testing for Valentin either.
H. McMurray from MCSO Major Crimes was asked to follow up with Sgt. Nathan McClain at the Marion County jail for the death investigation. There were no cameras on the room where Valentin lay on two mats alone, but there were cameras on the “exterior which he would provide to me at a later time.” MCSO reports do not include any narrative of what that video reflected.
“I was advised by Sergeant McClain they initially expected the decedent to recover, so room number 105 had been cleaned prior to my arrival. I went inside of cell number 105, which had been cleaned/bleached,” McMurray wrote.
“The manner of death was listed as natural. Due to the manner of death being natural with no suspicious circumstances present, I request this case be closed,” McMurray concluded.
Public records requests by the “Gazette” to MCSO for the video of outside the cell where Valetin lay before calling paramedics have been denied, citing statutes meant to protect jail security.
_____________________
For previous reporting on the Marion County Jail, visit the links below.
Details into the 2023 death of an elderly veteran in the Marion County Jail
Young woman dies in MCSO custody, details remain undisclosed
Mayra Ramirez needed urgent hospitalization before her death in custody
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
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.
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.
