Alton Rodgers was 31 years old and suffering from bilateral bronchopneumonia, bed sores, and severe malnutrition when he died of head trauma on January 19, 2016, in the custody of the Texas Department of Criminal Justice. Guards had found Rodgers unresponsive in his cell at the William P. Clements Unit in Amarillo, one of the most violent prisons in Texas, the previous day. His fatal injury, the official paperwork noted, was consistent with having his head “slammed onto the concrete floor.” The TDCJ immediately began investigating a suspect, Rodgers’s cellmate, Joe Greggs. But the official findings raised a cloud of doubt. Why did they ignore or make so very little of Rodgers’s dire medical condition even before the blows to his head? The inmate’s family has raised questions about Greggs’s alleged involvement, Rodgers’s medical treatment at the Clements unit, and the conduct of the prison staff. In October, the family, represented by attorney Jesse Quackenbush, filed a $120 million wrongful death lawsuit against the TDCJ, alleging that guard brutality and untreated tuberculosis contributed to his death. Rodgers was first diagnoses with tuberculosis in 2002 or 2003. “The purpose of the lawsuit is to change the way [the state of Texas] treats inmates who are suffering very serious diseases,” Quackenbush told The Intercept. Alton Rodgers in April 2012. Photo: Texas Department of Criminal JusticeRodgers stood 6 feet 7 inches tall and weighed 148 pounds when he died. His body mass index was 16.7, dangerously lower than the bottom of the normal range, which physicians set at 18.5. According to Northwest Texas Hospital records, Rodgers was admitted with hypoglycemia, a urinary tract infection, dehydration, bilateral bronchopneumonia, bed sores indicating prolonged immobility, and other conditions. The Intercept asked Carlos Torres, a forensic doctor based in Dallas with no previous knowledge of the case, to review Rodgers’s medical records. While it was clear to Torres, who has held positions at the University of Texas and Harvard, that Rodgers had died of “massive brain injuries secondary to blunt trauma to the head,” he said that the fluid in both of the inmate’s lungs resulting from bronchopneumonia was also a contributing cause. Viral or bacterial infections can cause this condition, Torres explained. He further noted that the inmate had been diagnosed with schizophrenia and intermittent explosive disorder, a rare condition that leads to outbursts of anger. “The other important finding was that he was malnourished,” said Torres. Rodgers was “extremely underweight … his BMI actually went down significantly during the last several weeks of his life.” Medical records maintained by the Texas Tech University Health Sciences Center, which oversees health care in Clements, are sparse for the last four months of Rodgers’s life. From October 1, 2015 to January 19, 2016, the records indicate only one physical health check, on November 6, and that was a check-up after a cell extraction, a procedure which involves the forceful removal of an inmate from his quarters. His last mental health check occurred on November 24. These records indicate that Rodgers weighed 167 pounds in November 2015, and he had dropped to 148 by the time of his death. “I could not find any explanation as to the [weight] loss during that period of time,” Torres noted. Torres did notice something peculiar relating to Rodgers’s diet, however. According to an entry dated June 24, 2015, Rodgers claimed that raisins and peanut butter were the only foods he could keep down and requested that his diet be changed. This request was denied, the attending nurse wrote, because there was “no diet of just peanut butter and raisins. According to medical records filed after Rodgers was admitted to the hospital in January, guards said Rodgers “had been known to be starving himself secondary to ‘trying to die.’” “These are contradictory statements from the patient and from the [health care] providers,” Torres observed. Without further records, Torres stressed, he couldn’t make a judgement, but he certainly did not find any evidence that efforts had been made to increase Rodgers’s weight. “If someone is losing weight inadvertently, they should have a complete medical evaluation, including a psychiatric evaluation, to see if there’s a reason,” said Robert Greifinger, former head medical officer at the New York State Department of Corrections, in answer to questions about the standard of health care prisons are legally required to meet. “Prison health officials are required to provide timely access to care. Part of that timely access is accurate documentation of responsiveness and documentation of the nature of response for requests of medical care.” There is nothing in the medical records obtained by The Intercept to suggest such evaluations ever took place. And the gaps in the records make some assessments very difficult. For example, Torres said that active tuberculosis was probably not a factor in Rodgers’s death, but the lack of records makes it impossible to entirely rule that out. This poor quality of record keeping would be considered unacceptable in a hosptial, Torres said, adding that the standard of care had more than likely been compromised “by not having adequate records and documentation of what happened to this person.” Even the autopsy, for which records do exist, raised questions. Standard autopsy procedure would have required a culture to determine the origin of Rodgers’s bilateral bronchopneumonia, Torres said, and as far as he could tell from the autopsy report, no such test had been performed. Rodgers’s condition could have been contagious, depending on whether it was viral, fungal, or bacterial, Torres noted. He could have posed a danger to other inmates as well as guards and nurses. His condition was also potentially deadly in and of itself. Regardless of the head trauma, “if his weight did not go up, if he was not being treated for the bronchopneumonia, he would have died in a matter of days or weeks,” the doctor said. A male nurse holding a prisoner’s medical file, Fleury Merogis Prison, France. November 2009. Photo: BSIP/UIG/Getty Images A Pattern of Negligence Complaints about health care and record-keeping at Clements are not hard to come by, and many of them center on the prison’s alleged refusal to test inmates for tuberculosis. Roughly one-third of the world population has latent tuberculosis, and those with weakened immune systems are more likely to develop symptoms. Incarcerated persons typically fall into this category. According to the Centers for Disease Control, tuberculosis in prisons is a “public health concern” because it is highly contagious and can spread to other inmates as well as prison staff, who can then communicate it to others outside prison. Kevin “Rashid” Johnson, an inmate at Clements and a founder of the New Afrikan Black Panther Party-Prison Chapter, told The Intercept in a letter that in the 18 years he has spent behind bars, he has typically declined to be tested for tuberculosis out of fear of cross-contamination, because the test requires an injection. This year, Johnson said, a fellow inmate tested positive for the disease and never received treatment. For that reason, Johnson requested a test. He states that he was refused the test by the prison’s medical officials and that the prison’s records falsely claim he refused when the test was offered him on June 3. Another inmate at Clements, Jason Walker, told The Intercept a similar story. Walker claimed that he requested tuberculosis tests on several occasions without success. Prison officials told him, “You have not been in contact with TB.” After Walker filed grievances asking for tuberculosis shots for all inmates in his section, prison officials responded, “No further action required.” In yet another grievance, Walker alleges that a false test was administered following his complaints of tuberculosis exposure. Prison officials responded that Walker “received timely and appropriate care.” These inmates surmise that the prison has put itself at risk of tuberculosis infection for budgetary reasons. The 2017 Texas state budget calls for a four percent decrease in funding for the state’s prison system, which amounts to a $250 million in slashed funds for a system that is already under pressure. “The medical, security, mailroom and grievance [departments] are all severely under-staffed. This is what draws their negligence,” Walker suggested. Johnson, who is active in organizing against “slave labor” in prison, concluded by saying that the prison system wants “to make money off us, not spend it on us.” New federal inmates prepare to undergo health screenings while being processed at the Val Verde Correctional Facility in Del Rio, Texas. Photo: Tom Pennington/Fort Worth Star-Telegram/MCT/Getty ImagesAlthough the adversarial relationship between prison staff and inmates may cast doubt on the prisoners’ allegations, there is also evidence that the TDCJ knows it was at fault in letting Rodgers’s health deteriorate. After Rodgers’s death, TDCJ reprimanded 17 guards for falsifying documents and recommended the firing of their supervisor, Major Rowdy Boggs, who resigned during the disciplinary process. Senior Warden Barry Martin and Assistant Warden James Beach both retired within a month. Jason Clark, a TDCJ spokesperson, told the Texas Tribune that guards weren’t completing required checks on Rodgers’s cell. He declined to say for how long this was the case. The Northwest Texas Hospital entry form for Rodgers states that guards were “unable to provide when patient was last seen awake and alert.” The Intercept filed two pubic information requests with TDCJ, asking for the door logs on Rodgers cell from September 1, 2015, to February 1, 2016, and a copy of the results into an investigation into Rodgers’s death. TDCJ has asked the Texas attorney general for a legal opinion on whether these documents must be released, citing “confidential information” and an exception that enables a “governmental body to protect its position in litigation,” referring to the lawsuit against TDCJ. At the time of publication, the attorney general had not made a decision on either information request. When asked how so few checks could be conducted on an inmate who had severe bilateral bronchopneumonia and was emaciated, Deric McEvers, a former guard at Clements who worked in the facility for almost six years starting in 2008, responded that this was “an extreme lapse in security and medical.” Prison staff members routinely check on inmates and deliver medications in the middle of the night, McEvers explained, often between 1 a.m. and 3 a.m. At that time, the inmate “barely has the lights on, he’s in bed, nobody’s paying attention to him. They’re putting the pills in the window — dropping and going.” According to state regulations guards are required to check on inmates every 30 minutes and conduct a “bed book check” twice a day in which an inmate must get up and look a guard in the eye. The former guard found the lack of records documenting these required checks during the last two months of Rodgers’s life suspicious. “The fact that there’s no medical records makes me think something got brushed off,” he said, suggesting that the prison might have withheld or destroyed documents. He suggested that staff could have falsified documents to show that bed books and other required checks were taking place. McEvers told The Intercept that document falsification was routine and “happens, I’d say, more than daily.” Tyrail Crosby, another former Clements guard, concurred, saying that document falsification is “very common” there. He recalled that one of his superiors asked him to falsify documents during his first week on the job. Crosby’s concerns go further than record falsification: “It’s too many people dying in there,” he said. In 2013, two prisoners — Christopher Douglas Woolverton, 51, and Arcade Joseph Comeaux, 56 — died within one month of each other. Their families have also filed wrongful death lawsuits. Woolverton, who had asthma, was found dead in his cell in a pool of his own urine and feces, according to the lawsuit. He allegedly had symptoms of stage IV chronic kidney disease and had suffered weight loss even greater than Rodgers, dropping 44 pounds in just under three months, from 157 pounds on August 29, 2013, to 113 pounds on October 22, according to the complaint. Comeaux died on November 13, 2013, due to trouble breathing and a heart attack during an attempted electrocardiogram. Crosby was a guard at the prison at the time. He was asked to film Comeaux, who was also asthmatic, being escorted from his cell to the infirmary that day. Comeaux was breathing “very hard” and fighting to catch his breath as guards held him down on an examination bed, Crosby told The Intercept. After a struggle, he died. A wing inside a Texas prison. Photo: Andrew Lichtenstein/Corbis/Getty Images“That’s the first time I’ve ever seen, in my life, somebody pass. From being alive, fully aware of where they’re at, to actually dying,” Crosby said, still shaken by the experience. Crosby resigned from Clements during an investigation into his repeated tardiness. He cited the prison’s culture of racism and morally questionable actions, such as document falsification, as well as his newborn child, as reasons for repeatedly showing up late to work. McEvers was fired after being charged with misdemeanor assault after being accosted by a formerly incarcerated person at a party. Both the Texas Department of Criminal Justice and the Texas Tech University Health Sciences Center, declined to comment, citing ongoing litigation. Top photo: Prisoners from all over the vast Texas prison system come to the Walls Unit in Huntsville, Texas to be processed for release at the completion of their sentences. 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