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Inmate's death should be ruled homicide, scathing state report finds

UPDATE 7/19/18: Pathologist won't alter his findings in India Cummings' cause of death

In the days leading to her death, Holding Center inmate India Cummings would babble on the floor of her cell and lie in a puddle of her urine, but the Erie County jail's key staff failed to respond as she declined mentally and physically, a state agency says.

The Commission of Correction's Medical Review Board said Cummings' death from a host of factors in 2016 should be called a homicide – a death at the hands of others – because of medical neglect.

"The medical and mental health care provided to Cummings by Erie County during the course of incarceration, and her care, custody and safekeeping by Erie County sheriff deputies was so grossly incompetent and inadequate as to shock the conscience," the state panel of doctors and lawyers said in a report The Buffalo News obtained Monday.

The Medical Review Board said Cummings could have survived with "adequate and appropriate medical and mental health care."

Cummings' death in February 2016, after 17 days in the Holding Center, incited protests against Sheriff Timothy B. Howard and the team of jail deputies, administrators and clinicians who labor inside the downtown jail. She was the 21st inmate to die in an Erie County lockup since Howard became sheriff in 2005. The list has since swelled to 24, even as federal court-appointed monitors work to improve the health care and mental health care afforded county inmates.

The Commission of Correction's Medical Review Board, which investigates in-custody deaths in New York, has faulted the jail's medical care in other cases. The stage agency called the medical attention given to drug defendant David Liddick, who died in 2014 after complaining of abdominal pain, "grossly incompetent." Similarly, the agency said accused killer Robert Henchen, received “inadequate mental health care of professional-misconduct proportions" before he died in 2007 from pneumonia brought on by malnutrition and dehydration.

But saying an Erie County jail death should be ruled a homicide because of medical neglect appears to be a first for the Commission of Correction and its Medical Review Board. The state agency, however, cannot change the cause and manner of death on its own. So it called on the Erie County Medical Examiner's Office to do so.

Lawmaker asks sheriff for answers after critical state report on inmate's death

Still, the only person who could change the conclusions of the autopsy is Dr. Scott F. LaPoint, a pathologist from Monroe County who was helping Erie County deal with its backlog of cases when he examined Cummings' body and the circumstances of her demise in 2016.

LaPoint, noting that he needed more information, left both the cause and manner of the inmate's death as "undetermined." LaPoint did not immediately respond to an email requesting comment Monday. But, like the Medical Review Board, LaPoint believed that an untreated broken arm contributed to the death.

According to witnesses and police reports compiled in February 2016, the 27-year-old Cummings burst from her Lackawanna apartment on Feb. 1, 2016, determined to return to Rochester, where she had lived for many years.

She approached a Ford Taurus, punched the driver and dragged him out of his car, Lackawanna police said. She then led officers on a chase that ended after the Taurus struck three vehicles and a school bus. Acquaintances said she had been smoking synthetic marijuana and attributed her behavior to the dangerous substance known as K2.

LaPoint had said he could not be certain whether Cummings broke her arm in a car crash, or when arrested by police, or in later clashes with jail deputies. So he could not say if the break was accidental or inflicted by others. But the pathologist said muscle and tissue damage released chemicals that led to kidney failure through a condition called rhabdomyolysis. Further, high levels of ketones in her body – ketoacidosis – existed before she arrived at the jail and probably explained her ongoing confusion and erratic behavior, he wrote.

Two days after she was jailed, Cummings was taken to the Holding Center infirmary. But while there, she argued with the medical staff and was denied treatment. Then she 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 Erie County Medical Center for “a possible broken bone,” according to another report. But she struggled with deputies placing her into a patrol vehicle for the drive back to the Holding Center. Both episodes led to more charges against her.

A picture of a confused inmate in a mental tailspin emerges as the Medical Review Board chronicles Cummings' last days. She refused medications, rejected several meals and went long stretches of time, as much as 32 hours in one span, without urinating. She "seemed out of it" and "didn't act like she knew she was in jail," a jail deputy told a commission investigator.

On Feb. 13, 2016 – 13 days after arriving in the Holding Center – Cummings was under one-on-one observation. She was babbling to herself and peeing on the floor. The next day, she lay on the floor of her cell moaning, and she urinated on herself. On Feb. 16, she had a bowel movement on the floor of her cell, and there's no record it was cleaned up that day, the Medical Review Board said. That afternoon, she was seen smashing cereal on her body and on the floor and screaming, "I have a sister."

When a deputy arrived for a shift that began at 11 p.m. on Feb. 16, 2016, Cummings was again naked and lying on the floor of her cell or on her bunk, crying. The deputy, according to the state report, called her sergeant, said something was wrong with Cummings and asked to have the cell cleaned. When a maintenance worker arrived, Cummings could barely stand. She had lost all her strength, the deputy told state investigators. Cummings was placed in a wheelchair and rolled to the medical unit.

The state's narrative is redacted after that. But apparently Cummings suffered the "medical event" that a Howard spokesman at the time said led to her being rushed to Buffalo General Medical Center – the nearest hospital for dire emergencies. She died in Erie County Medical Center on Feb. 21, 2016.

A list of 24 Erie County inmates who have died since Howard became sheriff

"The cause of her death," the Medical Review Board said, "was a massive pulmonary embolism resulting from acute renal failure, rhabdomyolysis, dehydration and fracture of the humerus; and that the manner of her death was homicide by medical neglect." The Medical Review Board, relying on a statement Cummings made, believes the arm was broken during her arrest in Lackawanna.

The Medical Review Board faulted jail officials for a number of records not made and policies not followed. And the panel said that while the inmate's physical and mental decline was noted on certain documents, those reports failed to mobilize the key medical and mental health care officials who could have made a difference.

The Medical Review Board said it was "unconscionable that for a six-day period, Cummings was maintained on constant-observation status, with documented observations of her failing to eat, failing to urinate (and) mentally decompensating without any immediate referrals to the jail physician or reports to jail administration."

The jail's medical and mental health staffs were led by County Executive Mark C. Poloncarz's appointees. A Poloncarz spokesman, Peter Anderson, said he would not comment, citing pending litigation.

The Medical Review Board said the sheriff holds the ultimate responsibility to keep inmates safe, and asserted his facility failed to follow the state Correctional Law provision requiring that he and his staff do so. The Howard team also said it would not comment on the report because a lawsuit, filed by Cummings' mother, is pending against Erie County.

Pathologist won't alter his findings in India Cummings' cause of death

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