A pathologist was unable to determine the cause of death for India Cummings, the 27-year-old woman who died 20 days after entering the Erie County Holding Center last year, a lawyer for her family revealed during a vigil for her Monday. The vigil was staged outside the home of the official who oversees the jail, Sheriff Timothy B. Howard.
Both the cause and manner of Cummings' death are listed as "undetermined," according to lawyer Matthew Albert, who circulated the autopsy report completed by Dr. Scott F. LaPoint of Monroe County. LaPoint has been hired by Erie County to help with its backlog of cases.
"What they said was, 'We don't know what happened here,' '' Albert said during the Martin Luther King Day vigil near the sheriff's home, which sits atop a hill in South Wales in southern Erie County. Albert said the legal team preparing a lawsuit against the county has turned to its own experts for help in determining what killed the woman, who was hurried from the jail to Buffalo General Medical Center on Feb. 17. She was later transferred to Erie County Medical Center and pronounced dead on Feb. 21.
While LaPoint did not determine a cause and manner of death, he identified likely contributors:
- High levels of ketones in her body existed before she arrived at the jail and probably explained her ongoing confusion and erratic behavior. Her ketoacidosis could have been brought on by a lack of food or the synthetic marijuana she reportedly smoked, or both, and led to the "medical event" jail officials said she experienced on Feb. 17.
- Muscle and tissue damage released chemicals that led to kidney failure. At the time of her death, Cummings had a broken arm that had not been in a hospital-provided brace for long periods of her time in the jail. The hours she spent lying on the floor of her cell also could have led to muscle damage, LaPoint wrote, explaining the condition known as rhabdomyolysis.
- Dehydration, which can compound the effects of both ketoacidosis and rhabdomyolysis.
According to LaPoint, Cummings told jail officials she hurt her arm when arrested in Lackawanna but later gave other versions of how the injury occurred.
While Albert said Lackawanna police admit using force on the woman's arm, the pathologist wrote that he could not determine how the bone broke. He would have to know the circumstances in order to deem her death a homicide, a death at the hands of others.
He wrote: "Since the cause of the fracture -- the one definitively non-natural contributing factor -- is unknown, the manner of death cannot be classified and thus must be classified as undetermined."
The State Commission of Correction, which investigates in-custody deaths, is examining the case and will come out with its own findings. But the agency's inquiries can take years. For example, the commission in October released its review of the death of Holding Center inmate Richard A. Metcalf, Jr., roughly four years after he was pronounced dead in 2012. The commission said Metcalf was suffocated by the jail deputies who wrongly tied a "spit mask" around his neck to stop him from spitting blood. The agency said he did not die of a heart attack, as the county medical examiner at the time determined.
Like Metcalf, Cummings was engaging in self-injuring behavior in the run-up to her death. Lackawanna police arrested her Feb. 1 after she carjacked then crashed a vehicle in a desperate attempt to return to her hometown of Rochester. Cummings’ landlord, her neighbors and her godmother linked her behavior to her use of synthetic marijuana.
Two days after Cummings was jailed on $15,000 bail, she was taken to the Holding Center infirmary for reasons not specified in a Sheriff’s Office report. While there, she argued with the medical staff and punched a jail deputy returning her to her cell. The female deputy keeled over with a concussion as several deputies were called to subdue the inmate.
The next day, Feb. 4, Cummings was examined at ECMC for “a possible broken bone,” according to another report. But records indicate she struggled with deputies placing her into the patrol car for the drive back to the Holding Center. Both episodes led to more charges against her.
Inmates confined near Cummings gave Albert, the family attorney, depositions saying she wasn't eating and would bang her head against the bars of her cell. Added LaPoint: "She was noted to frequently be lying on the floor of her cell, urinating on the floor, and other strange behaviors," and, "she was documented to have eaten only a few meals and drank little during the subsequent period of direct observation."
On Feb. 17, a sheriff's investigator called Cummings' mother to tell her that her daughter was on life support in Buffalo General. The mother was told that Cummings had been banging her head against a wall and went into cardiac arrest. Cummings’ vital signs flatlined the following Sunday.
The vigil in South Wales drew about a dozen people to the country road that leads to the sheriff's home. There, Albert said that LaPoint's findings, while inconclusive about a cause and manner of death, still illustrate a lack of medical care in the Holding Center, which remains under the watch of federal court monitors who assess the health care and mental health care provided inmates.
"That broken arm, combined with the maltreatment of India Cummings, combined with the complete lack of medical care led to her death," Albert said in remarks he delivered during the vigil and posted on Facebook. "That is what happened and led to her withering away and dying in plain sight over a two-week period."