Ambrett Spencer sat up in bed. It was 2:40 a.m., and the pain in her stomach was not right. She was nine months pregnant, but this didn't feel like labor pains. She'd been pregnant before, and given birth to a healthy boy. This was different.
So Spencer climbed out of her bed and called for medical help.
But she wasn't at home.
Sheriff Joe Arpaio
Spencer was sleeping in Bunk 69 at Maricopa County's Estrella Jail in west Phoenix. Months before she got pregnant, Spencer, 30, had been arrested for drunk driving and pleaded guilty. She was now serving her sentence. (When she became pregnant, she was in treatment and not drinking, she says.) Doctor visits had confirmed that she was pregnant with a healthy baby girl.
Spencer and her attorney declined interview requests, but the records in an ongoing lawsuit she's filed against Sheriff Joe Arpaio tell the story.
As one of Arpaio's inmates, Spencer had no way of calling a doctor that night, April 21, 2006. The best she could do was call for the detention officer working the graveyard shift.
In the month she'd been in the jail, Spencer had seen plenty of inmates turned away when requesting medical attention, so she was relieved when the guard called the infirmary at a little after 3 a.m. The infirmary nurse asked how bad the pain was.
On a scale of one to 10, Spencer said it was a 10.
The nurse told her to go immediately to the infirmary. So Spencer got ready for a trip to medical.
Then she waited. The sergeant on duty decided that Spencer was not top priority, he said later in a sheriff's report about the incident.
About an hour after she requested help, Spencer was escorted to the infirmary. The one healthcare professional on the premises, a nurse, took Spencer's blood pressure. She also detected the baby's heartbeat, around 4 a.m.
The nurse — who later admitted she had no prenatal training — told Spencer that she'd be going to the hospital, but she also decided that Spencer's pain was not an emergency.
Another hour later, Spencer passed out. The nurse took her blood pressure again; it was fatally low. The nurse called an ambulance and tried to get an IV into Spencer's arm. She couldn't.
When EMT Jarrid Ortiz arrived, Spencer, who is African-American, had lost so much color it was clear to him that it was an emergency. "If you are turning that color, you're not getting enough blood to your organs and skin," Ortiz later told a sheriff's detective.
By the time the ambulance arrived at the Maricopa County Hospital, Spencer had been in severe pain and without a doctor for almost four hours. Doctors delivered Ambria Renee Spencer, a 9-pound baby girl with a quarter-inch of thick hair on her head.
Ambria was dead. Spencer's pain had been caused by internal bleeding — a malady known as placental abruption. Babies often survive the condition, if their mothers go immediately to a hospital. The treatment is simple: immediate delivery. Otherwise, the baby dies from blood loss.
Inmates in Arpaio's jails aren't usually allowed to see their babies after birth. Despite protests from the jail guard, hospital employees brought baby Ambria to Spencer, so she could see her daughter before the funeral.
Spencer described the moment for attorneys in her deposition.
"I kept praying that she would just open her eyes because she looked like she was alive."
Ambrett Spencer was one of 1,578 pregnant women who passed through Arpaio's jails in 2006, county records show. Only 42 of those women gave birth while in custody.
Spencer pleaded guilty to two DUIs and served her time. Now she's out, and she's suing Joe Arpaio and the county's Correctional Health Services department. Spencer believes delayed medical care caused her baby's death.
She's not the only inmate to say so. Four other inmates or their family members have contacted New Times this year, describing miscarriages, stillbirths, or harsh conditions for pregnant women in Arpaio's jails.
They blame poor medical care or, at times, no medical care. They also say that rotten food, potentially contaminated water, a lack of prenatal vitamins, and careless detention officers contribute to the problems.
Records show the claims may not be groundless. For example, the water well in the facility where pregnant women are jailed has been infested with mice and mice feces since 2005, Maricopa County Environmental Health Services Records show.
Mice carry a parasite — toxoplasma — that can infect water and cause birth defects, according to the Centers for Disease Control. It's so dangerous that the CDC says pregnant women shouldn't even touch litter boxes — because cats eat mice and their feces can contain the parasite.
"Most infected infants do not have symptoms at birth but can develop serious symptoms later in life, such as blindness or mental disability," the CDC writes in its description. "Occasionally infected newborns have serious eye or brain damage at birth."
In addition to that parasite, Dr. Leslie Barton, a pediatrics professor at the University of Arizona School of Medicine, has found that mice feces and urine also carry a virus that can cause birth defects, including chromosomal defects.
It's not just the water. Last week a federal judge ruled that Arpaio's current jail conditions violate the U.S. Constitution, specifically when it comes to healthcare, overcrowding, and access to medication. U.S. District Court Judge Neil Wake issued a list of 15 changes — including diet, medical care, and medication — that Arpaio must make by December.
A month before that ruling, the jails also lost their national health accreditation, which is required by state law.
Arpaio does not deny that his jails are tough. He's actually built his career on claims that he doesn't coddle criminals.
Into the fray of Arpaio's "tough" jails come about 1,500 pregnant inmates each year. Some of them say their care hardly differs from what's given the other inmates. That is ironic, since Joe Arpaio claims to care about the unborn in his jails. In 2005, he refused to allow inmate abortions. Arpaio fought that battle all the way to the U.S. Supreme Court, where he lost.
A person like Ambrett Spencer — who admits she drove drunk more than once — deserves to be punished. But jail does not have to be a potentially unsafe place for an unborn child. Unlike Maricopa County, many other correctional facilities in the U.S. offer programs to care for pregnant women.
Dr. Mary Byrne, professor of clinical healthcare for the underserved at Columbia University, has studied prenatal care in jails and prisons for years. She points to the state of New York as a model. There, all pregnant inmates are sent to a maximum-security prison where they take birthing and parenting classes. It's worked so well that six other states have adopted similar programs.
In 2005, the San Bernardino County Sheriff's Department in California started its own program — after jail nurses and doctors realized that many pregnant inmates were getting depressed.
"Nurses and social workers at the jail and at the hospital noticed that inmates giving birth were usually scared, alone, unsure of their baby's fate and often ill-equipped to deal with the situations and decisions confronting them after giving birth," nursing director Debby Lucas wrote in a review of the program.
As a result, the San Bernardino jail started Lamaze childbirth classes, as well as parenting classes for pregnant inmates.
The Monroe County Jail in New York offers prenatal care as part of its rehabilitation for pregnant inmates. Mothers-to-be can also get tutoring about rape crisis, family planning, smoking cessation, and community resources.
In Seattle, the King County Jail brings in social workers and nurses every Wednesday to train pregnant inmates in prenatal care, examine their health, and answer questions. Some social workers even keep in touch with pregnant inmates after their release.
In Arpaio's jail, pregnant inmates say the only prenatal care they get is a bottom bunk, an extra blanket, a "snack" (which is sometimes inedible, they say), and prenatal vitamins — if the vitamins come that day.
In September, New Times asked to talk to the jail's healthcare director about prenatal care. Correctional Health Services has not yet scheduled an interview with its director, Betty Adams.
Former inmates have been far more willing to speak.
Michelle McCollum was in the first trimester of her pregnancy when she awaited trial in 2005 for possession of marijuana. She later pleaded guilty and was sentenced to probation.
McCollum blames unchecked violence and delayed medical care for the loss of her pregnancy. On August 21, 2005, she was attacked by two other inmates, she says in an affidavit filed in the lawsuit that recently found jail conditions unconstitutional.
Two inmates punched McCollum in the stomach repeatedly. After the attack, she and another inmate cried to guards for help. But McCollum writes that detention officers refused to bring her to the infirmary — even after she told them she was pregnant and injured.
Three days after the attack, McCollum's bleeding wouldn't stop. She was finally taken to the Maricopa County Hospital. There, doctors said she had miscarried and ordered that she return to the hospital for a checkup.
Despite her reminders, jail personnel did not take McCollum back to the hospital. On September 17, she began bleeding again. The bleeding wouldn't stop.
An ambulance finally rushed McCollum back to the hospital — where doctors gave her a blood transfusion because she had lost so much blood. Then they performed a procedure called a D&C, which removed the remains of the pregnancy.
Lilly Lee recently got out of the Estrella Jail. Upon her release, she called New Times to spread the word about pregnant inmates.
"The detention officers knew these women were undergoing miscarriages, and we were telling them," she says. "They just wouldn't do anything. There were a lot of things going on in there that I don't think a lot of people know."
Michael Bergman, an executive chef, agrees. His fiancée, Reyna Dziovecki, was in the jail for only two days, but it was enough to make him fear for the life of their baby. The charges against Dziovecki have since been dropped.
"She was eight months pregnant. She literally didn't eat anything from 5 p.m. one night to 6:45 a.m. two days later," he says. Bergman says he spent that time running from one downtown building to another, trying to bond his fiancée out. He finally did.
"You never really pay attention to this stuff until it happens to you. Then it does, and it's just scary how they treat people," he says.
Ambrett Spencer acknowledged in court that she deserved jail time for her actions. On May 21, 2005, she made a potentially deadly choice by driving drunk.
Instead of killing anyone, though, Spencer caused a minor fender-bender when she bumped into another car while stopping at an intersection. The other driver was not injured. When the cops arrived, Spencer confessed to driving under the influence. Not that she needed to. She blew a .204 B.A.C.
Spencer started alcohol treatment at Terros Rehab in west Phoenix. Months later, she got pregnant. Spencer was 30 and excited to have a second child. She hoped to marry her fiancé, Kenny, the baby's father.
In March 2006, Spencer pleaded guilty to two DUIs and received a 2 1/2-year sentence.
Spencer had been in the jail for about a month when the baby was born.
Spencer worked at hospitals for six years, registering pregnant mothers when they came in to give birth. Based on that experience, she says, she would have headed straight for a hospital had she not been in the jail that night.
Drug use plays a factor in many jail pregnancies, but Spencer's baby had no drugs in her system, nor did she show any symptoms of fetal alcohol syndrome, a county autopsy reveals.
The Maricopa County Medical Examiner concluded that Spencer's baby died from placental abruption — a malady that occurs naturally in about one in 100 near-term pregnancies.
Dr. Michael Foley, an OB/GYN at Scottsdale Healthcare, explains abruption as the separation of the placenta from the wall of the womb. That separation results in bleeding and a loss of blood to the baby.
The condition is not usually fatal, if the mother gets to a hospital, says Dr. Ingrid Haas, another OB/GYN. The treatment for abruption is simple, both doctors agreed: immediate delivery. The longer the delay, the less likely that the baby will survive. (Both doctors declined to speak about Spencer specifically, but spoke about abruption in general terms.)
Haas has never seen a placental abruption end in death — that is, when the mother went straight to the hospital. "Likelihood of survival is very good if the woman is full-term and goes straight to the hospital," she said.
She added that the fastest abruption she's ever seen wasn't complete until one hour after the severe pain started. That would explain why Spencer's baby still had a heartbeat around 4 a.m. — more than an hour after the pain began.
When Spencer's lawsuit goes to trial, possibly next year, medical experts will likely say that her baby would have survived — if Spencer had been taken straight to the hospital.
Ultimately, a judge or jury will decide whether Arpaio's guards and health staff were at fault. In the county's favor is the fact that placental abruption can be difficult to diagnose.
But Spencer's attorney, Joel Robbins, writes that the abruption would have been diagnosed — if Spencer had seen an actual doctor. "Despite Ambrett's obvious pain and distress, Defendants waited hours to obtain emergency treatment for Ambrett," he writes.
Arpaio and the county deny any wrongdoing, though they do acknowledge that Spencer complained of pain. Dennis Wilenchik, the county's contract attorney, wrote in a court brief that staff took Spencer's vitals, documented the fetal heart rate, and then called for an ambulance at 4:44 a.m.
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The county blames Southwest Ambulance — for not transporting Spencer to the hospital quickly enough. Wilenchik writes that Southwest took nearly an hour to get Spencer to the hospital. By the county's own records, however, Southwest Ambulance was not called until almost two hours after jail staff knew about Spencer's pain.
Spencer blames the jail for keeping her from a hospital.
"I'm not blaming anyone for the placental abruption," she says in her deposition, but "they could have gotten me to the hospital sooner. They could have gotten me up to medical sooner . . . Why didn't I see the doctor? That's a question that I've gone over in my head a billion times. A doctor never came in there to see me."
If her baby had survived, today Ambria Spencer would be 2 years old.