‘Your Honor, I’m dying’

Inmate’s death followed two months in Cobb jail

The Cobb County jail where Sanders spent two months before being transferred to Pulaski State Prison.

Donna Sanders was sick, getting sicker and afraid she wouldn’t leave prison alive. When she was finally given the opportunity to describe her condition in a Cobb County courtroom, she didn’t sugarcoat it.

“Your Honor, I’m dying,” she told Superior Court Judge Robert Flournoy III at a probation revocation hearing in February 2013. “I just don’t want to die locked up. I want to be with my children.”

As it turned out, Sanders knew exactly how bad off she was, even if no one else did.

She pleaded for more care at the Cobb County jail. Then, on only her second day at Pulaski State Prison, the Moultrie woman was found on her bunk crying and struggling to breathe. Three hours later, she was dead.

An autopsy report said Sanders, 52, died from congestive heart failure in conjunction with end-stage renal disease. It also cited numerous other health issues, including diabetes, high blood pressure and HIV.

But that was just a final accounting for 68 tortuous days in custody, first in the Cobb County Adult Detention Center and then at Pulaski, as a seriously ill woman got lost in the margins of the correctional system and never made it out.

“She was so sick,” said Amanda Stuber, who grew close to Sanders when both were incarcerated in Cobb County. “You could see it. She was in her bed most of the time. She was never stable. It killed me to watch this happen.”

Document: Pulaski incident report for Sanders’ death

Medical records and other documents examined by the Atlanta Journal-Constitution raise questions about Sanders’ care at almost every turn.

In the Cobb County jail, Sanders was hospitalized seven times in two months for respiratory problems and for other issues as her regular dialysis treatments were reduced from four a week to three.

Then, when her breathing became labored at Pulaski, she was placed in the prison infirmary for observation with no doctor present even through her blood oxygen level was dangerously low.

The upshot was a downward spiral that shocked even those who knew Sanders was in fragile health.

“Sometimes I wish I could have done more,” Sanders’ daughter, Tonya Edwards, said recently through tears. “But, you know, I just thought she was coming home. Even though I knew she was sick, I thought she’d be coming home.”

A change in treatment

Sanders worked some as a cosmetologist, but most of her life was spent in and out of prisons and jails for offenses that included robbery, forgery and bad checks.

During a January 2013 traffic stop in Valdosta, authorities found that Sanders had an outstanding warrant in Cobb County for failing to comply with the terms of her probation from a 2004 robbery of a Marietta hair salon. Sanders stole $464 and threatened to shoot a salon employee, although it was later found that she didn’t actually have a gun, records show.

Diagnosed with kidney failure two years earlier, Sanders at the time of the traffic stop was undergoing dialysis four times a week instead of the standard three to remove the buildup of fluids on weekends, records from her health care provider show.

“That’s the only way she could survive,” Edwards said.

Document: Complaint letter

But that regimen changed when Sanders was booked into the Cobb County jail, according to her written statements and other documents.

“I’m still having to go to the hospital for fluids,” she wrote in a complaint she filed against the jail physician, Dr. Clarence Hendrix. “I’ve tried to explain to him (that) at home I had to go to dialysis four times a week — Monday, Wednesday, Friday, Saturday — to be able to make it through the weekend.”

She also mentioned the issue in a letter to her daughter.

“They still are not doing dialysis on me four times a week,” she wrote a month into her stay. “They said they are only going to pay for three treatments.”

Stuber recalled one Sunday when Sanders was so bloated that she had trouble walking and finally fell. Stuber said she tried to help, but a correctional officer shooed her away, saying, “Don’t matter, she’s gonna die anyway.”

Document: Letter to her daughter

Reducing a dialysis patient’s treatments from four to three a week could, over time, places added stress on the heart and lungs, said Dr. Leslie Spry, a Lincoln, Neb., nephrologist who serves as a spokesman for the National Kidney Foundation. Patients with conditions such as hypertension, heart disease and diabetes are particularly vulnerable when their treatments are altered, he said.

“If we have people on (dialysis) four times a week and they have to go back to three, they end up with more fluid (built up), worsening high blood pressure, strokes, those kinds of things,” Spry said.

A spokesman for WellStar Health System Inc., which provides medical services in the jail under a contract with the Cobb County Sheriff’s Department, declined to comment on Sanders’ treatment.

Speaking generally, the spokesman, Tyler Pearson, said the number of dialysis treatments for any particular inmate is based on the inmate’s needs as determined by the jail physician. The cost of the treatments is assumed by the county, he said.

Hendrix, a WellStar employee, did not respond to phone messages left at his office by the AJC.

Robert Quigley, a spokesman for Cobb County Sheriff Neil Warren, said no one from the sheriff’s office would comment for this story.

On the left, Donna Sanders before she entered jail. On the right, Sander’s booking photo for the Cobb County Jail.

The judge rules

When Sanders’ probation revocation case went to court, her health quickly became the main topic of discussion.

Her guilt or innocence wasn’t an issue. While on probation for the robbery, she had pleaded guilty to another felony, a forgery charge in Colquitt County.

Sanders could have been sentenced to up to eight years in prison, but her court-appointed attorney, Michael Syrop, argued that she shouldn’t serve any time.

“I mean, the fact of the matter is, even if she doesn’t do what she’s supposed to do from this point forward, it’s unlikely that she will ever survive to come back in front of this court again,” Syrop told Flournoy.

“Sometimes I wish I could have done more. But, you know, I just thought she was coming home. Even though I knew she was sick, I thought she’d be coming home.”

Tonya Edwards, Sanders’ daughter

Flournoy decided on a nine-month sentence, with credit for the time served in the Cobb jail. He gave no explanation other than to tell Syrop, “You have done a good job for your client.” He also noted that Sanders would at some point be subject to revocation proceedings in Gwinnett County because of an outstanding warrant there.

“And so you’ll go now to Gwinnett County and hopefully get that thing resolved and then get out and go on with your life, I hope,” the judge told Sanders.

Flournoy did not respond to an interview request from the AJC. His administrative assistant, Christa Flint, said the judge has long had a policy of not commenting on cases.

In a recent interview, Syrop said he believes Flournoy had no choice but to impose some prison time.

“As a judge, I think his hands were tied,” Syrop said. “Just because someone is sick, they’re not immune from the consequences of violating probation. The judge is going to assume that she’s in custody and getting medical care.”

‘I need an ambulance STAT’

A month after the hearing, Sanders was moved from Cobb County to the state prison system. A jail-to-prison transfer form prepared by the county listed her many illnesses and noted that she required dialysis “three x/week.”

Incarcerated as Virginia Wilson, a name she once used as an alias, Sanders spent just hours at the Department of Corrections’ diagnostic center at Lee Arrendale State Prison in Alto before being transported to Pulaski, a facility where inmates can receive dialysis.

Document: Nurse Ruth Beamon’s witness statement

Witness statement from nurse Ruth Beamon, which was included with Sanders’ medical records.

However, on her second night at the Hawkinsville prison, her health turned in a way from which she would not recover.

Sanders was found struggling to breathe in her dormitory, so she was moved to the infirmary. There, records show, the nurse on duty determined that her blood oxygen level was at a dangerous level and contacted the prison physician, Dr. Yvon Nazaire.

“Writer called Dr. Nazaire about abnormal finding (of) 89 percent,” the nurse, Ruth Beamon, wrote in a witness statement that was included with Sanders’ medical records. “Order received to keep her in the infirmary for 23 hours observation.”

A blood oxygen level below 90 percent means a person is suffering from hypoxemia, a condition that can lead to cardiac arrest if allowed to continue.

Sanders’ condition improved at first, Beamon wrote. But over the next 45 minutes the inmate became “restless” and her blood oxygen level and heart rate were “low,” the nurse wrote.

Beamon called Nazaire again. This time she was directed to send Sanders to the hospital.

911 call

“I think she’s in heart failure,” the nurse told the 911 operator. The call was too late. An hour later, Sanders was pronounced dead in the emergency room of Taylor Regional Hospital.

“I need an ambulance STAT, please, to take a patient to the ER. I think she’s in heart failure,” the nurse told the 911 operator.

The call was too late. An hour later, Sanders was pronounced dead in the emergency room of Taylor Regional Hospital.

Nazaire, asked recently about Sanders, said there was no need to send the inmate to the hospital earlier because she had been dialyzed when she arrived at Pulaski the day before.

“Somebody who has been dialyzed, what do you send them to the hospital for?” he said.

Edwards said she doesn’t understand why her mother wasn’t immediately sent to the hospital.

“I can’t see why they would choose to monitor someone who can’t breathe,” she said. “What was there to monitor?”

For Edwards, the circumstances are more painful because of the thoughts expressed by her mother in her last letter.

Writing from Pulaski just hours before she died, Sanders said there was hope she wouldn’t have to serve the entirety of her sentence.

“The parole people also (saw) me yesterday and explained to me that I could be coming home soon,” she wrote. “They don’t understand why they bother sending me to prison. I say the same thing.”