Almost 5 months pregnant, Linda Acoff screamed in ache inside a cell within the Cuyahoga County Jail.
The strain and cramping intensified. Blood specks dotting the chilly flooring had been met solely with a nurse’s providing of additional sanitary napkins and a dose of Tylenol.
A number of extra hours handed on that January 2024 morning earlier than Acoff’s cellmate alerted a jailer, who appeared inside earlier than speeding to declare a medical emergency. Safety video exhibits Acoff masking her anguished face as she’s taken out on a stretcher.
Left behind within the being pregnant pod cell had been the stays of Acoff’s fetus, a lady misplaced at 17 weeks, in accordance with the Cuyahoga County medical expert, who additionally discovered Acoff had contracted an an infection of the fluid and tissues inside her uterus.
Over a 12 months later, Acoff grew emotional, struggling to know why jail and medical personnel failed to offer quick care.
“I used to be in ache, extreme ache, and so they did nothing about it,” Acoff stated. “It’s a traumatic expertise. You do not obtain the assistance that you just want once I felt like they might have saved my child.”
What occurred to Acoff not solely raises questions over prenatal healthcare for incarcerated girls, however it additionally highlights systemic lapses in medical care extra broadly within the county jail.
Whereas the nurse on this case was fired, Acoff’s being pregnant loss and the outcomes of different pregnant girls in jail aren’t tracked by Ohio.
The state requires county jails to report in-custody deaths, however there aren’t any reporting requirements for miscarriages or stillbirths in jails, a Marshall Challenge – Cleveland and Information 5 Cleveland investigation has discovered.
Linda Acoff was 17 weeks pregnant and pleading for assist, however investigators say Cuyahoga County Jail workers delayed correct medical care. What occurred to Acoff not solely raises questions on prenatal well being look after incarcerated girls, it highlights systemic lapses in medical care extra broadly within the county jail.
Advocates and medical medical doctors name the shortage of reporting for these failed pregnancies a blind spot for girls’s healthcare behind bars.
Dr. Carolyn Sufrin, a board member of the Nationwide Fee on Correctional Well being Care and a fellow of the American Faculty of Obstetricians and Gynecologists, stated it’s important to trace being pregnant outcomes in jails.
“Ladies who don’t rely, don’t get counted,” she stated, “and ladies who don’t get counted, don’t rely.”
‘A tragic occasion’
Acoff, 30, entered the Cuyahoga County Jail on Dec. 15, 2023, for a probation violation of failing to finish court-ordered psychological well being remedy. Acoff stated she began to develop ache as quickly as she entered the jail’s being pregnant pod.
On Jan. 7, jail information present a nurse visited Acoff in her cell for 2 minutes, providing the sanitary pads and Tylenol.
Her situation solely worsened the subsequent day, however Acoff stated she acquired no extra assist.
“I used to be banging on the door for hours after I used to be bleeding on myself,” she stated.
Cuyahoga County Medical Examiner Dr. Thomas Gilson dominated the being pregnant loss a “stillborn,” though Ohio regulation considers a stillbirth solely after at the very least 20 weeks of gestation.
After being handled at MetroHealth Medical Heart, jail officers launched Acoff later that day on residence detention.
Antoine Hare, Acoff’s boyfriend, teared up when discussing what she endured and the way he envisioned being a father as a “blessing.”
The expertise, coupled together with her unanswered pleas for assist, has left her traumatized, Hare stated.
“She should not have been handled like that,” he stated. “We’re human beings, so we’re alleged to get the right medical care, interval. Irrespective of the place we’re at.”
After Acoff’s launch, inner emails present prime jail leaders questioning the necessity to report the stillbirth to the state, whereas additionally answering a Cleveland.com reporter’s inquiry in regards to the medical emergency.
On Jan. 9, 2024, investigator Paul Marich emailed jail wardens that the county wouldn’t be required to file a crucial incident report in regards to the stillbirth with the Ohio Bureau of Grownup Detention, which oversees jails, as a result of the fetus Acoff was carrying was not incarcerated.
“Whereas it is a tragic occasion… [the state guideline] signifies that it should be an inmate,” Marich wrote in an e mail.
Primarily based on the reporting guidelines, “… I don’t consider (Acoff’s stillbirth) will entice media consideration.”
On Jan. 12, 2024, Jennifer Ciaccia, a Cuyahoga County spokesperson, alerted quite a few county officers that the journalist had requested in regards to the “being pregnant loss” and had questions on medical coaching and jail protocols, e mail information present.
Ciaccia supplied officers with a draft response, which stated an incarcerated lady was receiving medical remedy within the jail’s being pregnant pod.
Prime Cuyahoga County officers, together with Sheriff Harold Pretel, then spent a number of hours crafting and enhancing an announcement about Acoff’s remedy inside considered one of Ohio’s most-troubled jails.
Later, Ciaccia advised the officers: “Fast replace. They’re not operating this story, however could wish to do a bigger piece on medical and postpartum companies provided to girls in custody. We are able to discuss subsequent week.”
‘Egregious efficiency failure’
MetroHealth Medical Heart supplies healthcare companies contained in the Cuyahoga County Jail.
From January 2022 via December 2024, the jail housed at the very least 305 girls with identified pregnancies. Of these, 16 girls gave beginning whereas incarcerated.
In those self same three years, only one failed being pregnant was reported — Acoff’s, in accordance with William Dube, a spokesperson for the MetroHealth Medical Heart.
After a hospital inner investigation into Acoff’s medical care, officers fired a registered nurse and issued a written warning to a different for failing to assist Acoff, hospital information present.
The hospital investigation discovered that:
After talking to Acoff about her well being points, Nurse Felicity White despatched an e mail to the on-call doctor as a substitute of calling, as a result of the physician had already seen Acoff. She then went to lunch.
Through the hospital investigation, White advised officers she “instantly despatched the affected person out after speaking with the supplier.” Nevertheless, she defined, “there could have been a delay as a result of brief staffing on the safety facet.”
Video footage confirmed White depart the ground for a break and return 20 minutes later. She waited greater than an hour to name an ambulance for Acoff, information present. White was beforehand disciplined for related efficiency delays with one other affected person.
White was terminated as a result of her “lack of correct escalation is taken into account an “egregious efficiency failure.”
Michael Adams, a registered nurse who joined MetroHealth in 2022, acquired a written warning for failing to “full work or carry out duties” when he didn’t name a maternity physician for Acoff or have her despatched out for remedy.
White declined to remark. Adams couldn’t be reached for remark.
A MetroHealth Medical Heart spokesperson declined to touch upon Acoff’s remedy, however stated the hospital is “singularly dedicated to offering the very best high quality affected person care to all and is honored to offer devoted medical companies to sufferers within the Cuyahoga County Jail.”
Medical care supplied contained in the county jail has come beneath scrutiny previously 12 months amid claims of delayed remedy and mounting deaths.
The Marshall Challenge – Cleveland and Information 5 Cleveland obtained hours of surveillance movies and hundreds of pages of information as a part of a yearlong investigation into a number of deaths on the jail.
In a single case, two days after Acoff’s stillbirth, jailers had been accused of ignoring a person’s pleas for medical assist after he repeatedly complained about chest pains. He collapsed on the ground, and 9 minutes handed earlier than jail staff began CPR. The person later died.
In April 2024, the state positioned the county on a corrective motion plan for delaying remedy. Jail deaths involving incarcerated adults result in investigations that may usually finish with jails being positioned on corrective motion plans when workers fail to offer correct medical care.
Requires change, reporting necessities
In 2019, Sufrin, the Nationwide Fee on Correctional Well being Care board member, helped writer a nationwide examine that tracked being pregnant outcomes in U.S. prisons and 5 massive jails. The examine estimated that 55,000 pregnant girls enter jails every year.
Sufrin stated the shortage of reporting necessities makes it not possible to know whether or not any of the nation’s greater than 3,000 jails are failing pregnant girls. She stated a stigma exists round individuals within the legal justice system.
“Each pregnant lady’s physique and well being issues,” Sufrin stated. “If all of these pregnancies are affected by preterm births or stillbirths, or in the event that they’re all regular, wholesome infants, these are issues that we have to know in order that we are able to then spend money on healthcare assets for our nation’s jails.”
In October, the U.S. Authorities Accountability Workplace issued a report that discovered the nation is going through a maternal well being disaster as a result of it incarcerates girls on the highest charge on the planet.
One key takeaway concluded: “There was little analysis or knowledge so far on maternal well being in (jail and jail) settings, and there’s a want for higher knowledge on girls who’re pregnant, outcomes of their pregnancies, and postpartum restoration whereas incarcerated.”
That very same month, the Ohio Jail Advisory Board, which establishes requirements and insurance policies for jails throughout the state, held its quarterly assembly in Columbus.
The Ohio Division of Rehabilitation and Correction oversees the board, which is made up of state and native officers.
Minutes from the October 2024 assembly present {that a} state official briefly led a dialogue on whether or not being pregnant outcomes must be reported to the state.
“A number of events requested questions and raised issues in regards to the timing, substance and course of for making such studies. No consensus was reached,” in accordance with the assembly minutes. “The matter was tabled for additional dialogue later.”
Gloria Rodgers, a former Summit County Council member serving on the advisory board, stated the dialog lasted solely minutes with minimal questions requested.
Rodgers, a longtime nurse, stated she advised the board that being pregnant outcomes in jails should be counted.
“This can be a medical subject. It must be required to be reported,” Rodgers recalled telling the board.
State jail officers declined to reply questions in regards to the lack of reporting necessities for being pregnant losses.
Dr. Michael Baldonieri, an assistant professor of reproductive biology on the Case Western Reserve College College of Medication, stated the an infection Acoff suffered is without doubt one of the extra severe problems of being pregnant as a result of it could rapidly result in the mom and child getting sick.
Any lady complaining over a number of days in regards to the signs ought to have raised alarms for medical workers, he stated. Even at 17 weeks, there’s some hope that Acoff’s being pregnant might have been saved if she had acquired correct medical care, he stated.
“If there’s early applicable prognosis and intervention, that child can completely survive if the affected person is handled promptly,” he stated.
Baldonieri can also be a member of the Ohio Being pregnant-Related Mortality Overview Committee, which was created in 2010 to develop interventions to scale back maternal mortality, notably for pregnancy-related deaths.
Ohio ought to require county jails to report miscarriages and stillbirths, he stated, so total tendencies will be tracked to enhance mortality charges and being pregnant outcomes.
“If we’re not on the lookout for issues, if we’re not conscious of issues, they’re not going to be discovered,” Baldonieri stated.
