Damon Dreckmeier's blood was coming out both ends of him, and it had been coming out for hours.
Vomited blood ran out of his mouth, down his chin and over his neck; it stained the seat of his pants. A nauseating, numbing feeling began in his stomach and gradually spread through his body. He had lost so much blood his fingers became useless and his eyes lost their focus.
Dreckmeier was dying.
It was obvious to Dreckmeier. And it was obvious to his roommates.
Yet none of them was able to get him medical attention.
That's because Dreckmeier and his roommates were inmates in a Maricopa County jail, and despite their calls for help over a three-hour period the night of March 2, detention officers ignored them.
When Dreckmeier was finally taken seriously, he was rushed to the county hospital, where it took four pints of blood to replace what he had lost.
He was sent to jail because he had stolen a presigned check from a business and had cashed it for $4,800 using a faked driver's license. He pleaded guilty to faking the ID; the check charge was dropped when he promised to pay back the money. He had been sentenced to four years' probation and 111 days in jail.
In another part of the country, he might have served out that time uneventfully. But Dreckmeier had a double helping of bad luck: He has a degenerative but controllable digestive disorder, Crohn's disease, and he was sentenced to do his time in a place that takes pride in being the most inhospitable jail in the country.
Because the county jail's medical staff was unable--or unwilling--to supply Dreckmeier his prescribed medication, which keeps Crohn's disease symptoms at bay, he was hospitalized four times during his brief incarceration.
On the fourth trip, surgeons opened Dreckmeier up from sternum to pubic bone. After that operation, he developed an abscess, which had to be excised in a second surgery--and a fifth hospitalization--at a private hospital.
Because jail medical personnel couldn't come up with pills--they would have cost less than $400 for his entire incarceration--Maricopa County taxpayers will pay Dreckmeier's medical bill, estimated at about $300,000.
You may pay even more when Dreckmeier sues the county for his treatment in jail.
For weeks, Sheriff Joe Arpaio has bragged that a new report from the federal Department of Justice will refute the charges that feds made earlier about his jails.
After investigations begun in the fall of 1995, the Department of Justice found that inmates in the county jails--two thirds of whom await trial under an assumption of innocence--were abused by detention officers, that such abuse was covered up, and that inmates were subject to inadequate medical care.
An investigator's report alleging substandard medical and psychiatric services ran to 57 pages.
Arpaio has maintained that the Department of Justice got its investigation wrong, that the abuse was just inmate fiction. Meanwhile, the county organization that runs the jail's medical clinics, Correctional Health Services, claims that a larger budget and new policies have resulted in improvements which have impressed independent auditors.
In other words, everything's fine in the big house.
Damon Dreckmeier's recent experience contradicts that claim. And documents obtained by New Times as well as the assertions of former medical staffers suggest that Dreckmeier's treatment was consistent with a pattern of shoddy medical work (see accompanying story).
It's the same pattern the Department of Justice found nearly two years ago: inadequate staffing of physicians; diagnosis and treatment by nurses unqualified for such work; unreasonable delays for inmates needing medical attention; capricious delivery of medications.
It's a pattern that continues to leave the county open to liability lawsuits.
And it's a pattern that nearly killed Damon Dreckmeier.
Despite his medical problem, Dreckmeier was a normal, healthy-looking 22-year-old when he entered the county jail.
As he sits in a hospital bed awaiting yet another surgery, the former warehouse manager looks like a concentration-camp victim: knobby knees and skinny limbs and an emaciated torso crisscrossed with scars.
For days, brownish liquid had seeped from an abscess in his abdomen through a tube attached to his side. Now that the seeping has stopped, surgeons will cut Dreckmeier open and remove the rest of the brownish goo too thick to ooze out of the tube.
Yet, somehow, Dreckmeier's in a decent mood.
He's grateful when a nurse enters to change his IV bag, and she acknowledges his thanks with a smile and promises to check on him again soon.
The source of his good humor? He's at Scottsdale Memorial Hospital-North in a private room, no longer at the mercy of jail nurses and doctors.
In a move even the County Attorney's Office describes as "very rare," Dreckmeier's lawyer, Patti Shelton, convinced a Superior Court judge pro tem to cut Dreckmeier's sentence short by a month and allow him to be moved to the private hospital.
There was no objection by either the County Attorney's Office or Dreckmeier's probation officer. Everyone apparently agreed that Dreckmeier had been through enough.
After several weeks in the Scottsdale hospital, Dreckmeier has improved greatly, but he's still not out of danger. His doctors are confident the abscess will heal properly following surgery, but tell him that further complications could arise.
Dreckmeier worries that he'll never be as healthy as he was before he went to jail in February. He complains of several symptoms he's never had before. Stomach acids repeatedly find their way to his mouth, causing him to spit throughout the day. He still isn't eating much, and trips to the bathroom remain an unpleasant adventure.
But none of it--the five hospitalizations, the surgery, the abscess, the nearly lethal loss of blood--would have occurred, Dreckmeier says, if jail nurses had simply given him eight pills each day.
Four years ago, Dreckmeier learned that he suffers from Crohn's disease, a chronic digestive condition. Its cause is unknown, but Crohn's most often strikes people in their teens and 20s and is most common in Western Europe, Scandinavia and North America.
It can attack any part of the digestive system, from the mouth to rectum, but most often it eats away at the intestines. When the disease is acute, it causes severe cramping, bloody diarrhea and anemia. Eventually, sections of bowel made useless by the disease must be removed by surgery. Advanced imaging techniques enable doctors to target what portion of intestine needs removal, and can normally do so with minimal scarring. Dreckmeier had himself already endured an operation to remove part of his bowel and reconnect the healthy tissue.
Over a lifetime, a Crohn's victim may lose section after section of the 20 feet of small intestines that a person is born with. Fortunately, with as little as five feet of intestine left over, a person with Crohn's may still be able to lead a relatively normal life.
Many people with Crohn's must eventually learn to live with a stoma, what a writer suffering from the disease described as looking like a cherry tomato stuck on one's stomach, where healthy intestine is brought through the skin to allow waste materials to collect in a plastic bag.
Others are more lucky. For many sufferers, a closely followed regimen of medication can keep Crohn's from its active stage, staving off the disease's worst effects for years.
Until February, that described Damon Dreckmeier.
In 1989, he had moved to Arizona from Iowa, and after attending Arizona State University and a trade school, landed a job as the warehouse manager of a ceramics store.
He was shocked to learn in 1993 that he would live with Crohn's for the rest of his life, he says, but he soon learned to adapt. As long as he took a drug called mesalamine four times a day and didn't drink alcohol, he could eat what he wanted and felt few effects of the disease.
Besides, Crohn's was nothing compared to the problems he was having with girlfriends.
Dreckmeier had had a child with a woman he met in California in 1992. They had split up and had no formal agreement about the child's status, but Dreckmeier sent money--regularly, he says--and intended eventually to get a formal agreement on custody rights.
In 1995, he met another woman, Melanie Shadowens, who became pregnant with his second child late last year. Sharing expenses with his girlfriend and sending money to his ex, Dreckmeier says he became stuck. He was broke, and it made him desperate.
So he committed a crime.
Dreckmeier borrowed a friend's birth certificate and used it illegally to obtain a driver's license. (His own had been suspended when he failed to pay a speeding ticket.) Then, he stole a check--already mechanically signed--from his girlfriend's place of work, wrote the check in the amount of $4,800 to his fake identity and used the bogus driver's license to cash it.
The crime temporarily solved his money problems, and for months it went unnoticed.
Then on January 28, the FBI took Dreckmeier into custody and charged him with the check fraud. Shadowens bonded him out of jail that night.
FBI agents rearrested Dreckmeier on February 3, charging him with forging the driver's license. This time, he remained in jail. The check charge was dropped with his promise to repay the $4,800, and he pleaded guilty on March 28 to a class 4 felony for forging the fake ID.
On April 18, he was sentenced to four years' probation with 111 days of incarceration.
When FBI agents took Dreckmeier to jail on February 3, they allowed Shadowens to retrieve the prescription bottle for Dreckmeier's mesalamine. The agents told Shadowens to empty it out--no drugs can be brought into jail--and they promised to deliver the bottle to the jail's medical staff as evidence that he had the prescription.
The FBI agents followed through on that promise. Dreckmeier watched them hand the bottle to jail staffers at the intake unit.
He was assured that jail medical staff would get the prescription filled and continue Dreckmeier's schedule of pills.
Damon Dreckmeier entered Madison Street Jail on a Monday. He got no more mesalamine that day.
He didn't get any of his daily dosage of eight on Tuesday, either.
None was brought to him on Wednesday.
He also didn't get any on Thursday.
Instead, that day, February 6, guards came to haul Dreckmeier to a court hearing. When they arrived, Dreckmeier was doubled over in pain. His cellmates told the guards that Dreckmeier had been vomiting yellow fluids all day. Dreckmeier says he sat on the floor in excruciating pain, begging the guards to take him to a doctor.
He says one of them responded, "Get the fuck away from the door."
"When you're in jail," Dreckmeier says, "when you're behind closed doors, it's another world. The only people you can complain to are the guards, but they don't care. They don't give a shit about you."
Dreckmeier says that all week he had sent written "tank orders" to the jail's medical staff, asking for his medication. He pleaded with the guards that transported him to court. He finally prevailed on one detention officer who admitted that Dreckmeier looked terrible. A doctor's appointment was scheduled for him the next morning.
Dreckmeier had to spend another night in his cell, vomiting and doubled over in pain.
Inmates' medical needs are served by Correctional Health Services, a county agency which has served the jails since 1992. With a staff of 160 and a budget of $12 million, CHS runs clinics in all seven county jails as well as in juvenile facilities. When inmates require care that CHS cannot administer in the jails, most are transported to the Maricopa Medical Center, the county's hospital (some emergencies require that inmates go to other hospitals).
Two years ago, New Times requested access to medical records of inmates served by CHS. The county's response: that such records were public but too difficult to retrieve. Limited records of inmate deaths were released; during Sheriff Arpaio's tenure, at least 19 inmates have perished.
After a night of vomiting and pain, Dreckmeier was examined by a doctor. That doctor sent him on to the county hospital, where he was administered steroids and pain medicine.
Over the next three months, the same pattern would repeat itself: Jail medical staff either failed to supply Dreckmeier his required medicine or gave him an inferior substitute until he had to be rushed, three more times, to Maricopa Medical Center for emergency treatment.
After his initial, weeklong stay at the hospital, Dreckmeier was moved back to jail with instructions from hospital staff that his mesalamine prescription regimen be followed. But jail medical staff told him the jail didn't stock mesalamine, and nurses began giving him sulfasalazine instead. Dreckmeier told them he'd tried sulfasalazine and that it hadn't worked to keep his Crohn's disease dormant.
Dreckmeier says doctors at the jail told him about another option: If he could get a new prescription for mesalamine from an outside doctor, the jail would distribute it for him. But Dreckmeier's doctor, gastroenterologist Murray Cohen, hadn't seen Dreckmeier in more than a year, and refused to write a prescription unless he could examine him.
"Usually the physician who's there [in jail] would examine the patient and then pass on what he found. But the only communication I got was that a prescription was needed, and I couldn't write one if I hadn't seen the patient in such a long time. That would be bad medicine," Cohen says.
Nobody from the jail contacted Cohen again.
He backs up Dreckmeier's statement that sulfasalazine did not work as well for him as mesalamine. "It makes a difference particularly with the patient. And if he already has the experience that mesalamine worked well for him, then he's probably right."
"When I was on the sulfasalazine," Dreckmeier says, "my stomach was upset and I couldn't eat and I would get diarrhea. I'd never suffered from these kinds of symptoms, even when I first found out I had Crohn's. When I did get mesalamine from the medical-center doctors, I had no problems. If the jailers had just given me mesalamine, I would have been all right."
Dreckmeier was stuck with the sulfasalazine. Doctors at Durango Jail told him several times that sulfasalazine was as good as his mesalamine despite Dreckmeier's objections. He also didn't get as much of the sulfasalazine.
Dreckmeier's regimen of taking medication four times a day didn't match jail patterns, under which inmates were given medication at odd hours and only three times a day. One medicine call occurred each morning at 3, when a nurse would appear, say "First and last call for meds," and then leave before many sleeping inmates could respond. Only those who managed to set an internal clock, wake up and stand at a counter at that hour ended up with medicine.
Besides the inconsistent and inadequate medicating, Dreckmeier continued to be fed a diet that would aggravate his condition. Doctors had told him he would get a special diet, but day after day, he was fed with the general-population foods that were precisely the kind of thing that caused him complications: rancid cheeses and spicy foods. When Dreckmeier complained, he was told what other inmates also heard: If you don't like it, don't eat it.
About 10 on the evening of March 2, Dreckmeier began throwing up blood.
Blood also began staining his pants as it drained from his rectum.
He and his cellmates began a campaign to get the attention of guards, but Dreckmeier says their cries for help were ignored.
By midnight, Dreckmeier was vomiting alarming amounts of red fluid into the cell's toilet. He was losing so much blood he felt his fingers tighten up and freeze as he lost power in them; he also became unable to focus his vision.
At midnight, Dreckmeier says he and his cellmates were told by guards to pipe down, that if Dreckmeier needed attention, a nurse would be around at 3 a.m. to deliver meds.
A half-hour later, Dreckmeier's cellmates were yelling angrily at guards--they knew Dreckmeier was gravely ill. Dreckmeier remembers the response they got from a guard: "I fucking told you, go back to bed. The nurse will be here in two hours."
Dreckmeier was terrified. He began to lose sensation throughout his body. Then his jaw froze shut.
His heart raced.
At 1:30, guards finally came to his door in response to his cellmates' calls. When they opened it, Dreckmeier tumbled out on the floor.
Blood covered his chin and stained the seat of his pants, but Dreckmeier says guards were laughing. One said, "What the fuck is wrong with you?"
He says his cellmates told them that Dreckmeier had been vomiting blood for hours, and if they would come in and look at the toilet, they would see for themselves. But guards refused to enter the cell. Dreckmeier says he couldn't believe it--they still weren't taking him seriously.
That's when he retched once again, and this time blood shot out of his nostrils and through his clenched teeth onto the floor near the feet of the guards.
Only then, he says, did they decide to get him some medical attention.
Unfortunately, Dreckmeier next had to convince jail nurses that he needed emergency help.
He was taken to the jail's clinic, where nurses took his blood pressure.
"This can't be right," one of them said. Dreckmeier says the nurses assumed that something was wrong with their gauge and retrieved another. Again, he says, they couldn't believe the results of the test.
Dreckmeier's blood pressure was dangerously low, but he says it seemed like an eternity before the nurses realized that they had an emergency on their hands. Paramedics records show they weren't called by the jail until after 5 a.m., nearly four hours after Dreckmeier had been taken from his cell.
After calling 911, the clinic's nurses decided to get an IV started to replenish Dreckmeier's lost fluids.
One of them balked, however, saying that she wasn't qualified to put in an IV. The other admitted that she hadn't done it in two years but said she'd do her best.
"I'm thinking, 'Oh, my God, they're going to let me die here,'" Dreckmeier says.
Ten minutes later, saying, "I don't think he's going to make it," the nurses were still jabbing at his arm when Phoenix Fire Department paramedics arrived and started the IV properly.
Dreckmeier was told by paramedics that if they had been called 15 minutes later, he probably would have died.
Two more times Dreckmeier would return to jail with instructions from Maricopa Medical Center doctors that he be given mesalamine and a special diet.
And, still, with the county's tab for Dreckmeier's care climbing, jail staff could not or would not follow through on those orders.
Dreckmeier says he was put on the same erratic and inconsistent schedule of sulfasalazine and a poor diet.
"Sorry, we cannot get your medication at the pharmacy. You will take what we give you," wrote a nurse to Dreckmeier on March 10.
He was forced to take the ineffective sulfasalazine. Then, days later, the jail ran out of that, too.
On March 19, Dreckmeier sent an inmate request to medical staff, writing, "I haven't gotten my meds for 3 days and last time I lost 4 pints of blood because of the wrong meds and not given them to me. I need the right meds or I'm going to get real sick again. Thank you."
It came back with a nurse's reply: "We are out of your medicine and can't get it till next Monday, if you start to get sick again, please tell the guards right away."
Not very comforting words after Dreckmeier's last experience with the guards.
On April 18, Dreckmeier was sentenced and moved to Tent City. There, he was ordered to work from 8 to 4. That meant that he couldn't get medication during that time. And the work left him exhausted and unable to wake himself up at 3 a.m. to be ready for that meds call.
Dreckmeier was getting an inferior medicine and only half as often as he should.
On May 17, Dreckmeier had to be taken to the county hospital for a third time, this time for two full weeks. He spent four more days in the Madison Street Jail's infirmary, where jail doctors finally began giving Dreckmeier mesalamine four times a day. He was then sent back to Tent City, where he was told the mesalamine would continue to get to him.
In the next four days, Dreckmeier should have received a special diet and 32 mesalamine pills. But even after three hospitalizations and mounting costs for the county, the jail's medical staff was still unable to follow this simple directive. Dreckmeier says he was fed aggravating foods and received doses of mesalamine a total of six pills in that four days.
On June 4, Dreckmeier was taken to the county hospital for the fourth time.
He was given Demerol and says he was groggy when surgeons asked him to sign a consent form for surgery. He remembers signing it.
The next thing he remembers: waking up and seeing a red, oozing scar that stretched from his sternum to his pubic bone. It looked like Dreckmeier had been cleaned like a fish.
"They had done radical exploratory surgery on me. And I was asking the doctors, 'Why?' Just the week before, they had tested me extensively, and they knew what was wrong with me. I had active Crohn's because I wasn't getting my medication. But they cut me up like they didn't know what was wrong with me.
"What happened to me? Why did you cut me so far?" Dreckmeier says he asked surgeons who came to check on his condition. "You're in jail, we don't have to discuss it with you," one of the doctors told him, Dreckmeier says.
A doctor at Maricopa Medical Center who asked not to be named confirms that physicians are instructed not to inform inmates of the procedures performed on them--which is diametrically opposed to how doctors are trained in medical school.
When Dr. Jerome Targovnik was head of endocrinology at Maricopa Medical Center 10 years ago, he says that wasn't the case. "We treated inmates the same as we did other patients." He says it surprises him that inmates would not be told about their conditions.
After reviewing Dreckmeier's medical records, however, Targovnik says that Dreckmeier received excellent care at the hospital. The surgery was necessary because Dreckmeier had a life-threatening condition--a perforated bowel--and if doctors hadn't opened him up widely to clean him out, he would have died.
But Dreckmeier, still left in the dark by the medical center, is left to wonder what happened to him.
He says that in a previous surgery for his Crohn's, he had felt much better after only a week. But this time, after he had been moved to Madison Street Jail's infirmary, he did not recover well. He says he complained to doctors often. His urine was dark brown and his kidneys were sore, Dreckmeier says. He couldn't sleep, couldn't eat, and the pain in his gut was intense.
All of that was just a normal reaction to the surgery, he says doctors told him.
Dreckmeier, who had lost 40 pounds since his initial incarceration and could not bring himself to eat anything, began to hope that he would die.
"I didn't want to live; it hurt so bad," he says. "I was praying at night. Please take the pain away."
When his breathing became labored and his temperature hit 103 degrees, Dreckmeier knew something was seriously wrong. But doctors insisted that everything was normal, he says. On June 19, a doctor ordered a chest x-ray in response to Dreckmeier's complaints that he couldn't breathe.
The x-ray looked fine, the doctor told him.
The next day, after his attorney, Patti Shelton, won a judge's approval for him to be moved to Scottsdale Memorial Hospital-North, Dreckmeier was x-rayed again.
Only 24 hours after Madison Street Jail infirmary doctors had told him that he was fine, doctors at Scottsdale Memorial told Dreckmeier there was an abscess in his abdomen and that his x-ray showed pneumonia in one lung and fluid in both.
"I have this nightmare that I'm back in the county hospital and my belly is opened up and doctors are pulling shit out of me they shouldn't be taking out," Dreckmeier says as he recovers in Scottsdale Memorial.
Now that he's no longer an inmate, Dreckmeier is doing all he can to take advantage of his freedom.
Only days after his surgery to remove the abscess in his abdomen, Dreckmeier gingerly walked in his hospital garb from his room to a chapel downstairs.
There, with tubes still attached to various parts of his body, he married his girlfriend Melanie Shadowens. A week later, she gave birth to Jordan, their son.
In the days since, Dreckmeier has gained strength, although he still appears pale and walks hunched over slightly. He's out of the hospital and preparing for his next battle: to make the county pay for what he's been through.
"I'm going to sue because these people didn't know what they were doing," he says. "I don't want other people to go through what happened to me."
His attorney, Patti Shelton, with several colleagues has taken on several cases of inmate abuse and medical neglect, including that of Richard Post, the paraplegic who was put into a restraint chair so roughly jailers broke his neck. She plans to file a notice of claim with the county in Dreckmeier's case within days.
"I think we have to look at the broader issue," she says. "What happened to Damon was not an isolated issue. It was one of the more egregious cases, but not isolated. Damon looked like he had been in a concentration camp."
She says she's aware that Sheriff Joe Arpaio has bragged that a new report in the Department of Justice investigation will exonerate the jails and its medical staff. But she says that doesn't mean conditions in the jails have actually improved.
"I blame the U.S. attorney as much as anybody. The investigation was turned over to them, and as far as we can tell, they've just let the Sheriff's Office itself take care of the problems. And none of them have been taken care of. I mean, nobody wants to invite the federal government in to take care of things, but maybe it's time.
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