The concluding paragraphs of the investigation--the summing up of the summary, as it were, written by Detective Todd Bates and reviewed by Sergeant James Lusson--argue that on June 1 in the Madison Street Jail, Norberg fought as his jailers attempted to strap him into a restraining chair, and then suddenly went limp. The final page contains one sentence: "The Medical Examiner has ruled that Norberg's death was accidental."
What can't be found in the breezy, 137-page summary are witness statements that suggest another conclusion entirely: that out-of-control detention officers, bent on revenge for having to restrain the combative inmate, ignored warnings that they were asphyxiating Norberg.
At least one detention officer--one who was paying close attention to Norberg's condition--contradicts the scenario that Norberg "suddenly went limp." In fact, she claims she tried to tell the guards that they were suffocating Norberg, who had literally turned purple.
She says an officer snapped back at her, "Who gives a fuck."
That comment doesn't show up in the summary put out by the Sheriff's Office. Nor in the brief, tidied-up review of the investigation that appeared in the October 17 Arizona Republic, along with news that County Attorney Rick Romley plans to follow up on leads unpursued by Sheriff Joe Arpaio's investigators.
For this and other details that raise serious questions about the actions of Arpaio's jailers--as well as the felicitous summarizing skills of his investigators--one has to plow through the 2,100-page, six-volume version of the investigation.
It's shrink-wrapped, too, and carries a price tag of $1,050.
The first couple reams of paper in the investigative tome are devoted to Norberg's chaotic wanderings in Mesa on May 31. From the beginning of the Norberg controversy, the Sheriff's Office has stressed Norberg's criminal history, his problems with drugs and alcohol and his bizarre behavior on his final day as if it all suggested that Norberg deserved to die while awaiting trial in Arpaio's jail. (And at first, most news organizations went along with it. The Republic's initial front-page story on Norberg's death was titled: "Dead Inmate Had Long Record.")
But ironically, the investigator's thorough documentation of Norberg's acts in Mesa provides a telling picture of how authorities outside the Sheriff's Office deal with a problem inmate. Although Norberg had wrestled with a Mesa police officer and knocked off his glasses--warranting an aggravated-assault charge--employees at Mesa jail were able to get the inmate to cooperate and respond to basic requests.
On the morning of June 1, about 12 hours after being arrested, Norberg was moved to Madison Street Jail. That afternoon, the report states, his combativeness resulted in a brawl with Sheriff Arpaio's guards.
Despite his ability to throw off a multiplicity of guards grasping for his limbs, Norberg was eventually pinned to the floor of a holding tank and handcuffed, investigators were told. He was then tossed into a hallway by two detention officers--an occurrence which can be seen fairly clearly on the blurry videotape released by the Sheriff's Office.
Norberg was laid on his stomach, and detention officers sat on his legs to control him.
At this point, a crucial decision was made.
When Norberg had become combative in Mesa, police officers there reacted by cuffing Norberg and leaving him in a cell by himself. At Madison Street Jail, however, someone decided that it was a better idea to force him into a medieval-looking restraining chair and wrap a towel around his mouth.
It turned out to be a lethal choice. But after a four-month, 2,100-page investigation, MCSO detectives apparently could get no closer to understanding how and why that choice was made.
Sheriff's investigators don't seem interested in who had requested the chair. In fact, none of the dozens of witnesses interviewed is asked to explain who had called for the chair, or to detail what circumstances justified its use.
Instead, investigators seem predisposed to assume that the restraint chair's use was unremarkable. Summarizing one interview, an investigator makes it sound as if use of the chair was standard practice:
"Nurse [Kay] Campbell told me that from her past experience, she knew additional officers would be coming and that Norberg would probably be placed into the restraint chair."
If Campbell made such a statement, it is not included in the complete transcript of her interview.
Other jailers admit that the chair was rarely used.
One detention officer tells investigators that in his four months at Madison Street intake, he'd never seen an inmate "chaired." Another estimates that it happened about three times a year.
And even less frequent than the use of the restraint chair, apparently, was instruction on how to use it properly.