CLAYTON — An inmate at the St. Louis County Justice Center who was too ill to stand for two days before he collapsed and died in December had suffered a stroke caused by hypertensive cardiovascular disease, according to a report from the medical examiner released on Tuesday.
Jo’von Mitchell, 31, could not get off the floor of his cell for head counts or to visit a family member on Dec. 24. He summoned help early the next morning, for dizziness and a headache, and was observed by jail staff slurring words and unable to walk unassisted, according to an internal report obtained by the Post-Dispatch. It still took hours to get him medical care.
Mitchell was taken to the infirmary about 12:36 p.m. on Dec. 25. A nurse found him unresponsive in a cell after 5 p.m. and called a “code one.” He died two days later at a hospital.
St. Louis County Medical Examiner Dr. Mary Case said in an interview that a hemorrhage in the left cerebellum had caused “tremendous pressure” in the brain, the result of heart conditions caused by high blood pressure present over a long time.
Quick treatment of stroke symptoms is often considered essential to increasing chances of a person’s survival and reducing complications, particularly in the 80% of strokes that are caused by blood clots.
But it was unclear whether time was a factor in Mitchell’s death. His stroke was caused by hemorrhage, or uncontrolled bleeding in the brain, Case said. “I don’t know of any hemorrhage like this that you can stop quickly,” she said.
In a case involving a patient who suffered a stroke from a hemorrhage, medical professionals would try to control bleeding and reduce pressure on the brain. Case said that’s exactly what medical staff tried to do after Mitchell was admitted to St. Louis University Hospital on Dec. 25.
The Post-Dispatch detailed allegations by other inmates of delayed medical care for Mitchell. Case said Tuesday in an interview that she was not aware of those allegations, and she did not evaluate whether such a delay could have been a contributing factor to his death. She said she could not say whether earlier treatment might have given him a better chance of survival.
Mitchell had been in custody for more than three years awaiting trial on a charge of assaulting a police officer. During his long incarceration, it was not known whether he had shown symptoms that could have flagged him as a risk for a stroke. Case said she did not view Mitchell’s medical records and did not know if he was being treated for symptoms such as high blood pressure, although she said a person with hypertensive cardiovascular disease may not register high blood pressure.
“The role of a medical examiner is to determine cause and manner of death, so the questions that you are asking me are way outside of my area of knowledge,” she said.
Mitchell’s cellmate and other inmates told a reporter that jail workers disregarded signs for two days that he was gravely ill. Mitchell’s brother said jailers should have rushed him to the hospital when he was unable to get to his feet.
The internal report said jailers and nurses believed Mitchell had a bad headache or virus and that investigators believe he received attentive and appropriate care. But it also revealed that even though jail staffers seemed to understand by 4:30 a.m. on Dec. 25 that Mitchell was very ill, it took more than eight hours to transfer him to the infirmary.
County officials have not acknowledged any delays in treating Mitchell, in fact, claiming last month he had received treatment within two minute of reporting symptoms to jail staff. But the report obtained by the newspaper showed that was not the case.
A news release from County Executive Sam Page’s office said on Tuesday that “monitoring vital signs are an industry standard and help determine medical care, but they do not always identify all potential medical issues” and that the county health department would review its health screenings and work closely with a board appointed by Page to advise the jail.
Members of that board have expressed alarm they have received scant information from county officials about Mitchell’s case. And the county has refused to release details of its investigations into four other deaths at the jail in 2019, calling them confidential personnel and health records.
That may be about to change. The Post-Dispatch sent a new request for the records last month to Justice Services Director Raul Banasco, whom Page appointed late last year. Banasco responded in an email on Tuesday that his staff was working on “material that requires redacting” to fulfill the paper’s request.
And in a statement, County Counselor Beth Orwick said her Sunshine Law working group was reviewing reports “to see what we can release to the public in a way that does not infringe on the rights of the inmates and their families, or on our County employees.”