Questions raised in death of inmate

Answers sought on care at jail, hospitalization, guards' handling of body

October 05, 2004|By Dan Fesperman | Dan Fesperman,SUN STAFF

The last time any friend or relative saw Deborah Epifanio alive, she seemed reasonably healthy, had a full head of hair and was looking forward to the day she would be released from the Baltimore women's detention center.

Two weeks later, Epifanio, 34, arrived by ambulance at University of Maryland Medical Center with a shaved head, a lumpy bruise on her forehead and symptoms that included fainting spells, apparently after being injured days earlier in a jailhouse fight.

Emergency room doctors were on the verge of discharging her when she suddenly stiffened and became unresponsive to commands. Suspecting something more serious, they performed a spinal tap and found she had cryptococcal meningitis, which is common to patients infected with the AIDS virus.

She died four days later, in the early hours of Sept. 14.

Doctors say there is little mystery about what killed her. Cryptococcal meningitis is fatal within a few weeks in about 20 percent of the cases, said Dr. Lori Fantry, the attending physician during Epifanio's hospital stay. But questions remain about the days leading up to her death, her medical treatment - or lack of it - at the jail, the delay before she was hospitalized and the way correctional officials handled her body afterward.

Members of Epifanio's family, who weren't told of her dire condition until the day before her death, are seeking answers from state and hospital authorities who at times have seemed reluctant to provide them. The Maryland Department of Public Safety and Correctional Services has launched an internal investigation.

"The whole thing is like they're trying to cover something up," said Frank Schwartz, one of Epifanio's two brothers. Mildred Revis, one of three sisters, has led efforts to get to the bottom of the matter.

Sgt. Donald Lane, the departmental investigator handling the case, declined to comment. Autopsy results might not be available for weeks.

Asked about records of a possible jailhouse fight, department spokesman Mark Vernarelli, said: "We have no record of an incident report involving this detainee, but [the internal investigation unit] is certainly investigating this entire case."

A rough chronology of events can be pieced together from interviews with caregivers and family members, and from the 112 pages of medical records of Epifanio's hospital stay - documents the family received from the medical center nine days after her death.

A troubled life

Epifanio had led a troubled life for some time.

"Debbie was an addict and homeless, living out on the street, and she is mentally retarded," said Shirley Newman, another of her sisters.

"She used to talk to herself, and she was always laughed at and beat up on," Revis said. "In most ways, she had the mind of a 12-year-old."

Those factors added up to a string of arrests, incarcerations and occasional health problems. She was treated for drug addiction and became infected with the human immunodeficiency virus, which causes AIDS. Her 11-year-old daughter had been put in foster care.

Earlier this year, after a conviction on prostitution charges, she was imprisoned at the Maryland Correctional Institution for Women for five months. Upon her release Aug. 20, officials from the Baltimore Detention Center immediately took Epifanio into custody on a pending charge from 2000, when she allegedly defied a judge by taking her daughter from the courthouse after the ruling that placed the girl in foster care.

Family members stayed in touch when they could, sometimes visiting or writing letters, occasionally sending money orders or clothing. A family friend, James Cash, visited her at the detention center on Friday, Aug. 27.

"She looked good," he said. "She seemed in good spirits."

Revis visited the following Friday, only to be told that visiting day had been switched to Thursday. On Sept. 9, the following Thursday, Cash visited again, only to be told: "Debbie is waiting to see her doctor, so she's not coming out."

By then, according to hospital records, she was suffering symptoms that included fainting and pain in her neck, head and back. Notations by doctors and nurses indicate a fight Sept. 7 or 8. Though state correctional officials say that no report was filed about a fight, a handwritten notation by an emergency room physician a half-hour after Epifanio's admission to the hospital, logged at 1:15 a.m. Sept. 10, cites an "assault by cell mate. Pt. [Patient] was struck to back [illegible] fist and fell to floor; hit her head on her bed. Pt. states pain is `all over lower back.'"

It is unclear how hospital staff learned of the fight and earlier symptoms, but notations in the records refer generally to information obtained from Epifanio and jail employees.

Epifanio had arrived by ambulance at 12:47 a.m., but the emergency room report indicates that she may have been experiencing symptoms before the fight, noting: "Pt's neuro [symptoms] were present before head trauma per jail officer."

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