Death by Indifference

The last time Melissa Ross saw her daughter, Loukeithia “Kikki” Felts, she could barely breathe. “She was in a wheelchair, trying to breathe in deep, gulping gasps. She told me she was in a lot of pain,” Ross said. Earlier in the week, her daughter said, she had fallen out of bed. “Her hip was hurting real bad . She thought it might be broken.”

“Oh, Mama,” Ross remembers her saying, “I’m hurting so bad, I can’t even walk.”

Her face and her abdomen were swollen, there was food on her shirt, and her hair looked dirty and uncombed, the mother said. “She didn’t look like she’d been bathing,” Ross said. “I was shocked. That was not like her at all. … She took such good care of herself, kept herself so neat, and before she was burned, she was so beautiful.”

Felts’ 22-year-old daughter Chasiti had also come for the visit, to show off pictures of her new baby, Felts’ first grandchild. But Felts was so sick that she cut the visit short and asked to be taken back to her room. She kissed her mother and daughter goodbye and told them not to worry.

The next time Ross saw her only child, she was in a casket in a funeral home.

Felts died at the Federal Medical Center, Carswell, on Jan. 17, three days after her mother’s last visit. She was 38.

Before she left the prison that day, Ross called one of the duty officers, pointed out how ill her daughter seemed to be, and asked if he could get her some help. He said, “I’ll take care of her.” She called back that evening and spoke to the same guard, who told her, “I’m with her now,” and hung up. Ross never heard from the prison or her daughter again until she got the news that she had died.

“We have some disturbing news for you. We found your daughter dead today,” a social services officer said on the phone. No one told her then that her daughter had died in solitary confinement.

The death certificate listed causes of death as pulmonary edema, acute pulmonary thromboembolism, and chronic obstructive pulmonary disease (COPD). Ross, a medical records employee for a local doctor, was devastated.

“These conditions don’t suddenly appear overnight,” she said. “My daughter was terribly neglected out there, and it’s a hospital. How could such a thing happen? How?”

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It’s a question that families have been asking since 1994, when the Carswell facility opened as the only full-service hospital in the country for chronically ill women who have been convicted of federal crimes. Carswell replaced a federal hospital in Kentucky (for male and female patients) that had been shut down following a General Accounting Office investigation that found widespread medical neglect there. But almost since the day it opened, neglect has been a constant at Carswell too, with horror stories of fatal delays in care and even rape surfacing repeatedly through the years.

[pullquote_right]…county jails are not set up to deal with inmates who are so badly scarred both physically and psychologically. [/pullquote_right]The new federal prison hospital (this one for women only) had formerly been the medical center of Carswell Air Force Base, a Fort Worth institution since World War II that became a Strategic Air Command base at the height of the Cold War. When the threat from Russia faded with the fall of the Berlin Wall, Carswell was shuttered in a cost-saving measure. Several years later it reopened as the Naval Air Station Joint Reserve Base.

At the time Carswell closed, the Justice Department needed a hospital for women and — voila — Carswell’s base hospital was available for remodeling and upgrading. The five-story hospital, rising behind a huge razor-wire-topped fence, normally houses about 600 seriously ill or dying women and several hundred psychiatric patients. Another 300 or so low-security inmates live in barracks on the grounds outside the razor wire. There is a separate unit for high-profile inmates.

Changing names and leaving Kentucky did not change the culture of the prison hospital system. Carswell has a long history of medical neglect, sexual abuse, and safety violations that have resulted in untimely deaths or serious life-altering medical and psychological damage to the victims. Dozens of such cases have been documented  by this paper since 1999. (Stories about Carswell’s most egregious cases can be found in Fort Worth Weekly’s archives and on the web.) Felts is simply the latest victim, but if history is an indicator, certainly not the last.

Calls for investigations coming from judges, a doctor who worked there, and prison reform advocates have fallen on deaf ears. “These are the most vulnerable and least powerful members of our society,” said Wendy Murphy, a professor and victims’ rights advocate at New England Law school in Boston “They don’t vote, they have no voice, they are mostly forgotten except by their families, and many have even lost that contact,” she said in an interview for an earlier story.

 

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Felts, who robbed a bank of $3,000 in December 2010, died in the solitary- housing unit, otherwise known as the SHU, where inmates, even very sick ones, are sent to be punished.

On May 23, 2011, she was sentenced to 48 months for unarmed robbery. “She was guilty. We knew that, she knew it, we never tried to say otherwise. It broke our hearts,” Ross said. “But she didn’t get a death sentence.”

Felts was sent to Carswell for medical care by U.S. District Judge Terry Means of Fort Worth after her guilty plea, but not because of heart problems, her mother said.

In 2008, Felts had been burned badly over 65 percent of her body. Means sent her to Carswell because she needed special care for the burns and skin grafts that were still healing. She also needed additional surgeries, according to her medical records from Parkland Hospital in Dallas.

Felts, like many women who wind up in prison, had a past filled with “poor choices” her mother said. “She wanted things her stepfather and I could not give her,” Ross wrote in a long, pleading letter to Means. She asked that he sentence her daughter to house arrest so that Ross, who was a medic in the Army, could continue to take care of her.

At the time Felts robbed the bank, she was still under the care of Parkland for her burns and was living with her parents. She left one day saying she was going for a walk, her mother said, but instead met up with a couple of men from her past to help them rob the bank. The trio were quickly apprehended, Ross said.

Ross, originally from Georgia, has lived in Fort Worth since 1983. She said she and her husband, Felts’ stepfather, provided a loving home and that her husband loved Kikki  and raised her as his own for 30 years. The couple, both with good jobs, also raised  Felts’ daughter.

As an adult, “Kikki started to live a lifestyle of crime to get what she wanted,” Ross wrote to Means. She also became addicted to crack cocaine. That lifestyle led to the harrowing day Felts was burned. In March 2008, a 20-year-old drug dealer, believing wrongly that Felts had cheated him out of some crack cocaine, doused her body with lighter fluid and set her on fire. (The missing drugs were later found in his pickup, misplaced by the dealer, who is now serving 20 years in prison for attempted murder.)

Felts spent six months in Parkland’s burn unit in a coma, her mother said. She underwent 27 surgeries and needed more. “She is partially handicapped, and very disfigured, with limited use of her limbs,” her mother wrote to Means. She was then taking 16 pills a day, Ross said. “I had to crush them all together to allow her to be able to swallow them” because her lips were so swollen. One of her arms was frozen and useless.

Already addicted to one drug, Felts also became dependent on the morphine that she received at Parkland. “She needs to be where she can get some intense rehab,” Ross wrote to Means. Inside prison walls, she said, “her future will not be great because of her appearance. … I am aware of the seriousness of her crime … but sir, Kikki has already been sentenced for the rest of her life.”

Means was not moved by the letter. Felts was sent to Carswell.

 

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Ross is tormented by the realization that, despite her own attempts and those of attorney Peter Fleury with the federal public defender’s office, very little was done for Kikki medically after she walked through the razor wire at FMC Carswell.

Fleury said recently  that Felts was “very damaged” and “needed all kinds of medical care.”

Beverly McKenzie, a retired paralegal who worked in the public defender’s office when Felts was Fleury’s client, remembers her well. “She was the neediest of our clients” because of her “extensive medical problems,” McKenzie said. “Her face was terribly scarred, and all of her problems were results of her burns.”

McKenzie said that Felts’ medical records show that, prior to her arrest and after her release from Parkland, when she was living at her mother’s home, Felts was constantly calling 911.

Records from Parkland and John Peter Smith show that she was treated often at both emergency rooms for such things as acute conjunctivitis, shortness of breath, chest pain, psychological needs, “arm and head injuries following a fall,” and always, the diagnosis of chronic pain.

McKenzie said that after the arrest, Felts called her two and three times a week from the Dallas County jail, where she was being held for trial, with complaints of pain and neglect from the jail staff.

“I got as much help as I could for her,” McKenzie said, by getting her to Parkland several times during that period.

[pullquote_left]Women sent there already diagnosed with life-threatening diseases such as breast, lung, or liver cancer have had to wait up to six months or a year to be seen by an outside oncologist. [/pullquote_left]“She did act out,” the paralegal said, because she was in constant pain and not getting the help she needed. It became a vicious circle, with Felts crying and screaming at the staff and the staff retaliating by withholding her meds and ignoring her cries, McKenzie said. She noted that county jails are not set up to deal with inmates who are so badly scarred both physically and psychologically.

After she was sent to Carswell, Felts continued to call the paralegal, claiming extreme pain in her eyes and arm and saying that she could get no help.

Felts also told McKenzie that injuries from the arson attack — extensive damage to her lips, plus the loss of several teeth — made it difficult to chew but that her requests for a soft diet at Carswell were denied. As a result, McKenzie said, Felts found it almost impossible to eat. A special diet is possible at Carswell, McKenzie said — another client of the public defender’s office, with diabetes, was accommodated.

Because his office knew of the depth of her medical needs, McKenzie said, Fleury wrote to Carswell warden Joe Keffer to say he had been “recently informed that [Felts’] condition has worsened since her incarceration at FMC Carswell … . She complains about the constant pain in her eye and right arm.” He asked that she be allowed to see a medical doctor and receive surgery for both areas. “I ask only that … Ms. Felts gets the medical attention she needs,” Fleury wrote.

McKenzie said she doesn’t recall whether the warden responded.

The former paralegal thinks that Felts wound up in the SHU for the same reasons she was ignored at the Dallas jail. “She got mad when she didn’t get help, and she got thrown in the SHU for retaliation. I can’t imagine her being put there, in chronic pain.”

McKenzie pointed out that a difficult patient would never be treated this way in an outside hospital. Such a patient might have been restrained or sedated but not put into an isolated cell and ignored.

“It would certainly be nice if chronically ill people [in federal hospitals] were treated like patients and not like ordinary inmates are treated at prisons,” she said.

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According to Felts’ medical records, she needed eye surgeries because of the burn damage, she had blood clots in her legs that required monitoring, and she suffered from depression, hypertension, and anemia, among other conditions. Bright lights caused pain in her eyes, and she suffered from constant pain in her right arm.

At Carswell, Felts was put on a blood thinner for the clots and received some pain medications for her eye conditions. And that’s about it — at least according to the partial medical records that, thus far, are all that have been released to Ross.

Only after Fleury wrote to the prison warden to complain about Felts’ lack of care did Carswell officials begin the process of getting outside medical care for her excruciatingly painful eye conditions. But at the time of her death, almost three months after Fleury’s letter and despite recommendations from outside doctors that she receive it, none of that help had actually been provided.

The damage to Felts’ eyes from the arson attack had been severe. Records from Parkland show that she had a skin graft on her right upper lid and that because of the burns she had corneal ulcers on both eyes with “decreased ability to blink in the right eye … severe lid retraction … with scarring in the left eye … and dryness.”

Problems with Felts’ eyes were beginning to get critical in August 2011. An optometrist under contract to Carswell saw her and wrote in his report, “Both eyelids need surgical consideration.”

On Oct. 25, Felts wrote to a Dr. Reyes, a staff doctor whose first name is not given in the records. “Please help me, the lights are hurting me and my pain med needs to be increased,” she wrote. “I have a lot of pain in my arm and neck.”

She asked to be sent to Parkland.

On Oct. 26, Fleury’s letter was sent to the warden.

A week later, Reyes responded to Felts: “You have been followed by the eye doctors. Pain medications will not be increased.” (Underlined by the doctor.) The note made no mention of the optometrist’s recommendation or Felts’ request to go to Parkland.

On Dec. 1, Felts was seen by an outside ophthalmologist in Fort Worth who recommended that she be referred to John Peter Smith hospital “ASAP” for surgery to help “lid closure.” All of the outside consultants recommended pain medications such as oxycodone be continued.

A few days later, Felts found out  that Reyes had approved her request to go to Parkland. She asked if he had “started the process.”

Starting the process is crucial to the patients at Carswell. Often it takes months for inmates, even those with the most critical needs, to get appointments scheduled with outside physicians or hospitals. Women sent there already diagnosed with life-threatening diseases such as breast, lung, or liver cancer have had to wait up to six months or a year to be seen by an outside oncologist. Such de facto denial-by-delay of medical care has proven fatal to many of those women.

Reyes finally responded on Dec. 16, telling her that she had been referred to Parkland Burn Clinic and that “You must wait for your appointment.” He did not say when the appointment would be.

When she died in January, she was still waiting for the appointment.

Throughout the fall of 2011, Felts had also written several times to the medical staff asking for help with other chronic conditions. She was put on the blood thinner for clots in her legs, but apparently that was all.

A week before she died, Felts fell out of her bed and injured her hip. She was taken to John Peter Smith Hospital emergency room, but no broken bones were found. Ross thinks the fall is the reason her daughter was in a wheelchair and clearly in great pain during their final visit on Jan. 14.

After Felts died, her mother called JPS and was told that Felts was supposed to have been brought back to that hospital for follow-up care two days after the fall. But that hadn’t happened.

What isn’t in the medical records is any indication of COPD, one of the chronic conditions that, according to the death certificate, contributed to her death. Nothing in the records shows that she was ever diagnosed with or treated for COPD either at Parkland or Carswell. In one emergency room report she complained of  chest pain, but there was no follow-up to show treatment or a diagnosis.

Neither Keffer, the Carswell warden, nor Bureau of Prisons officials responded to the Weekly’s requests for comments and additional information on Felts’ case.

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The room where Felts spent her last hours is small, with a hard cot, a toilet, and one narrow window where food can be put through, inmates say. Guards are supposed to check the cells every hour. An inmate in an adjacent cell told Ross that Felts had been crying and screaming for help for hours, but no one came. Then, the inmate said, the crying stopped early on the morning of Jan. 17. Ross was notified that her daughter died at 1:21 p.m. that day.

Ross thinks she died much earlier, when her cries for help stopped, she said. “It hurts me to think that she may have laid there dead for a long time before they found her. Or if they had come earlier, could they have saved her?

“I don’t know why she was sent to the SHU, as sick as she was,” her mother said. “All I want are answers. I want to know what happened to her in those last hours. It’s what any parent would want.” Ross paused, tears running down her cheeks. “It breaks my heart to think of her dying alone, suffering and maybe calling for me. … She’s supposed to bury me, not me burying her.”

Copies of two “incident reports,” dated Jan. 13 about five minutes apart, shed light on why Felts was sent to the SHU. They state that Felts was “in the back area of the clinic demanding to be seen” after being told by a staff member to leave. When told she was out of bounds, she said, “So, I don’t care, you all going to do something for me.” The report stated, “Her issues were discussed and a plan of care addressed and she was again told to leave the clinic. She refused, yelling, ‘I’ll go to the SHU, I don’t care.’ ” Both reports said she became loud and belligerent, and security officers were called to remove her.

Sometime over that weekend, after she saw her mother and daughter on Saturday, Felts did wind up in the SHU.

Her medical records don’t reflect what medical issues were discussed with Felts that day, or what “plan of care” was decided on.

[quote]One of her fellow inmates called repeatedly that weekend to tell Ross how sick her daughter was and that no one was helping her. The friend called again on Monday to say Felts was in the SHU. Ross’ calls to the prison went unanswered.[/quote]

To date, Ross’ requests to the Bureau of Prisons for information have produced a  copy of the death certificate, some of Felts’ medical records, and the two incident reports.

But she has received no answers about her daughter’s last hours. Ross has also asked for but not received the autopsy report, even though she’s been told by a bureau staffer that the report is “ready and available.” The Weekly has also asked for a copy but to date there’s been no response from the bureau.

 

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I wrote my first story about medical abuses at Carswell in December 1999 — ironically, that story was also about a burn victim who had robbed a bank. The judge in that case sent the prisoner to Carswell because the BOP had certified Carswell as a hospital accredited by the Joint Commission On Hospital Accreditation, a private organization that certifies the healthcare quality and safety of hospitals receiving federal funding. The bureau had assured the judge that the woman would get “state-of-the-art care.”

But, as I learned through open-records requests, Carswell had not been approved by the certifying agency. It was not certified for another two years. The woman’s burn care was so bad that her sentencing judge wrote to the BOP that her incarceration there amounted to “cruel and unusual punishment” and ordered her removed from Carswell.

In another case, an ant infestation, in a ward for paralyzed and wheelchair-bound women, was so bad that ants were found swarming over — and in one case, inside — the women’s bodies.

At least eight cases of proven rape and sexual abuse were documented by the Weekly, including one instance of a guard who was sentenced to 12 years in prison for raping an inmate and another case involving a Catholic priest who served 48 months for repeatedly raping two women there over a period of several years.

Even workers at Carswell suffered from the Bureau of Prisons’ cavalier attitudes toward human suffering. Two brothers who worked in maintenance were ordered to remove X-ray equipment left over from the previous hospital.  It was highly toxic with lead that had also been contaminated with radiation, yet the men and about a dozen women  inmates who helped them were neither given safety breathing equipment nor even told of the dangerous exposure they would encounter. Lead dust filled the air in the room where they worked. Both brothers suffer from extreme lead poisoning, as does one of their wives. The women who worked there were moved, and no information has ever been released about their conditions.

Most of the egregious cases of medical neglect at Carswell involve cancer patients. One woman diagnosed with liver cancer was sent to Carswell for treatment but no treatment was ordered. When her family finally got some help from a U.S. senator, he was told by the then warden that she did not have cancer. Her cancer was later confirmed by Carswell, but still she was never treated. She was finally sent home to die under compassionate release. Her family was told by oncologists that her liver cancer was of a rare type that could have been cured had she been treated in time. Her crime: embezzlement.

Another woman died because she never received the kidney transplant that she needed. She was first told that the bureau doesn’t allow for transplants. Then the bureau said transplants were allowed but delayed so long in putting her on the waiting list that she became too ill for the operation.

A parole violation became a de facto death sentence for a woman who was diagnosed with lung cancer. When she began coughing up blood, she was told nothing was wrong, and she never received treatment. When her 18-month sentence was up, she went home to Alabama and died within weeks. Her doctors there told her family she was “terribly neglected” at Carswell.

Another inmate’s life-threatening heart condition was first diagnosed as a kidney infection. A diabetic was refused the combinations of medicines her doctor on the outside had prescribed to keep her diabetes in check. When, as a result, her blood sugar levels soared and she complained to her family and to this reporter, she was shipped out to another facility that did not even have a clinic, much less a hospital.

Women and their families and attorneys have told me that they were transferred, put in the SHU, or even had their sentences extended as a punishment for speaking to me about such abuses.

In one celebrated case a family did win — after their sister was dead. The prisoner, who suffered from Tourette’s syndrome, had served seven years for drug-related crimes. On the day before she was to leave to go home, she was found dead in a cell where she had been isolated as punishment for an angry outburst at her psychiatrist, who had refused to allow her inmate friends to give her a “getting out” party. Diagnosis: suicide. Her family didn’t buy it and filed a wrongful death suit against the BOP.

Last year, Judge Means ruled for the family, finding that Carswell had been negligent in her death.

In more than a decade of such documented abuses, the court system thus far has proven to be the only effective avenue of redress for individual Carswell inmates and their families, but usually only after horrendous or fatal damage has been done. As far as the Weekly has been able to determine, no BOP official and no warden or medical worker at Carswell has ever been disciplined because of such cases, nor policies changed, nor reforms put in place.

After Felts’ death, Ross received a short letter of condolence from Warden Keffer, who sent his personal condolences and informed her that a memorial service was held for Felts in Carswell’s chapel.

“I don’t care about any memorial service. I want answers,” Ross said.

In her view, since her daughter’s death, Carswell officials have only continued to heap insult on injury.

Ross said Keffer assured her she would get all of her daughter’s personal belongings, but none have been sent. “She had bought a crocheted doll for her grandbaby with some of the cash we sent her,” Ross said. She herself sent money to Carswell to pay to have her daughter’s things shipped to her home. “I have never seen any of it,” she said.

“And in all of this time,” Ross said, “the bureau never did spell her first name right. You would think they could at least have gotten that right.”