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Pain Management

Cancer patient Tim Thomason didn't think he could feel any worse. His Denver jailers showed that he could.

Certain details are beyond dispute, however. Other prisoners were released. Thomason had to stay behind. Cleveland took him upstairs to yet another cell, and his medications were again taken away from him. Thomason asked other officers why he was being held and received no explanation. According to Thomason, his inquiries only further irritated Cleveland, who made comments about Thomason trying to "rat" on him and whispered, "I have your address." (Cleveland has denied these statements; his attorney did not respond to a request for comment.)

Around 7:30 p.m., deputies on the second floor were alerted by other prisoners banging on their cell doors and yelling, "Man down!" Thomason had suffered a seizure on the floor of his cell and hit his head, which was throbbing when he came to. Cleveland and another officer soon showed up with his property. He was free to go.

Thomason asked for a nurse. He asked for a gurney or a wheelchair, saying, "I'm going to have trouble walking." He asked someone to call 911. None of these requests were granted. According to Thomason's complaint, Cleveland told him that if he wanted medical attention, he would have to stay another night in the jail. The deputy gestured at the front door.

"There's your fucking 911, out there," he allegedly said.

Thomason walked home. He took his medications and tried to sleep, but his head and legs hurt too much. After a few hours, he called 911. An ambulance took him to the emergency room at Denver Health, where he was treated for post-seizure symptoms. Asked to rate his pain on a scale of one to ten, he gave it a nine.


When her son told her what had happened at the jail, Judy Largo filed a complaint with the Denver Sheriff Department internal investigations unit. The investigators found merit in three of her allegations, mostly dealing with the conduct of Cleveland, and dismissed the rest, either because of a lack of witnesses or a finding that policy had been correctly followed.

According to court documents, Cleveland has offered varying explanations for why Thomason was held so long after a judge ordered his release. He has said that Thomason was missing property and he took him upstairs to look for it; that the prisoner was disorderly and had faked a seizure; that he refused to leave. Investigators found that the deputy had "willfully departed from the truth" in the matter, and he was suspended for two months without pay.

But when it came to the larger questions about the jail's medical care and its release procedures, the investigation found no cause for disciplinary action. "Mr. Thomason was given medication for his pain in accordance to the medical staff's guidelines," Major Phil Deeds, the internal affairs commander, wrote to Largo. "Denver Sheriff Department procedures prohibit the administration of narcotics in all facilities."

Actually, it's not clear what sort of medication is allowed to PADF prisoners; the policy has undergone some curious gyrations in recent years. Thomason's attorneys discovered that the PADF's accreditation was called into question in 2004 by the National Commission on Correctional Health because of the practice of having jail nurses substitute ibuprofen for prisoners' prescribed medication, without any consultation with a physician. Jail officials then assured the NCCH that they had developed a procedure to treat prisoners who need narcotics for pain.

That procedure is described in the jail policy manual for 2006 as follows: "Patients requiring narcotic pain relief...will be housed on the Correctional Care Medical Facility (CCMF/Ward 18) to obtain these. Physician staff will make arrangements for transfer of the inmate to the CCMF by calling the facility and speaking with the nursing staff there."

Thomason's attorneys discovered that prisoners with a need for pain medication were almost never transferred to the CCMF, however. The city has acknowledged only two such transfers in the past five years — and the last one was three years ago. The clause requiring such transfers was deleted when the policy manual was updated last year.

But that doesn't mean cases like Thomason's are all that rare. The legal and illegal use of powerful prescription narcotics such as Oxycontin has soared in the past decade. As many as one in five adult Americans reportedly suffer from chronic pain, and an estimated 3 percent of the population is physically dependent on prescription meds. And many chronic-pain patients are finding their way to jail. When Nancye Zimmer was deposed in the Thomason case, the PADF nurse told the attorneys, "I make substitution with 800 [milligrams] of Motrin for narcotics every night that I work, almost. It's a usual procedure that's done all the time."

Apparently detaining prisoners hours after the records reflect that they've been "released" is done all the time, too. In depositions, several jail employees told Thomason's lawyers that the deputies have great discretion with regard to how they go about releasing individual inmates, particularly belligerent ones. The attorneys could discover no written policy or formal training on the issue. Some officers, including Cleveland, stated that they weren't aware of any rule requiring officers to let someone go prior to midnight on the day of their release.

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