Jen McCracken was watching television when the phone rang that evening. The call was from the Jefferson County Detention Facility, where her husband, Ken McGill, had been incarcerated since July for a DUI. Ken would often call from the jail, leaving her short, sweet messages when she wasn't around, asking about her day when she was. But this call was different.
"I think I had a stroke today," he said. Ken didn't sound right; his voice was quiet and slurred, tinged with fear and confusion. "I need you to help me."
"How am I going to help you? You're in jail, Ken!" Jen yelled frantically into the phone. She was miles away in Denver — and since she'd worked as a correctional officer at Kit Carson Correctional Center in Burlington, she knew how the system worked. From the outside, there was nothing she could do.
"I need you to call them, Jen, and tell them something is wrong," Ken begged. "I keep telling them; they keep taking me downstairs, and it's not doing anything."
"Tell them you need to go to the hospital," said Jen again and again during the conversation, which was taped, as the jail does routinely with all phone calls (it saves the tapes for two years, in case they're relevant in criminal matters). "Obviously, they can tell by the way you're talking something is wrong."
Ken's response was unintelligible, tangled in his throat. "I can't understand a word you are saying," Jen told him.
Ken tried again, slower: "Something. Is. Really. Wrong."
"When did this start?" she asked anxiously.
"This morning, at eight o'clock." Ken struggled with the words. "And all day it's been getting worse and worse. I can't feel the whole right side of my body now. And I can't even talk. I am scared to death."
"They need to take you to the emergency room," Jen told him. "Why don't you say, 'I think I am having a stroke. I can't feel the whole right side of my body.'
"The hospital is literally around the corner," she continued, thinking of St. Anthony Hospital in Lakewood. "They have to call the fucking ambulance for you."
"Hold on," said Ken. "Hold on." Then he was gone.
"Hello, hello?" A new voice was on the line, one of the other inmates. "This is Vance. I came in with Ken. Um, something is wrong with him." Then Vance Goetz was gone, too. Over the phone, Jen could make out the muffled sounds of activity and Ken crying. "I think he had a stroke," she heard Goetz telling someone, followed by more commotion. "Can somebody help me over here?!" Goetz yelled. "I need help! Help!"
Then Goetz was back: "The nurse is here now." He took down Jen's number and told her, "If I hear something, I will let you know."
And just like that, the call was over. Jen tried to convince herself that everything would be all right. "He will get the help he needs," she remembers telling herself. "He is with the right people, and they will do the right thing."
Ken McGill's problems had started that morning, while he was working his inmate job as a member of the kitchen staff. Just after they'd finished preparing breakfast, he began feeling dizzy, the room spinning so badly he could hardly balance.
Ken wasn't used to feeling sick. The strapping, six-foot-three 44-year-old had played competitive soccer for more than twenty years and liked to ski moguls. Nor was he the kind of inmate to make up stuff to cause trouble. Fellow prisoners describe him as an earnest, friendly guy who fit in easily among the eighty men in his low-security jail unit, most of whom were incarcerated for drinking offenses and other fairly minor crimes. Ken was keeping his head low, doing his time, counting the days until his expected release in mid-November.
When the dizziness didn't subside, Ken requested to go to the jail's medical clinic. His kitchen supervisor asked if he could wait until after lunch, and Ken agreed. He'd always been a hard worker. Growing up in Morrison, he'd barely graduated from high school, but then he started driving heavy equipment for construction companies — "You just play with real, live Tonka trucks all day long," he'd later say — and worked his way to upper management, preparing bids for multimillion-dollar jobs around the metro area.
Yes, he'd gotten into trouble with the law, including a couple of DUIs in the late '80s and early '90s. But he was struggling with abandonment issues, which he'd had since he'd learned he was adopted; it didn't help that when Ken turned eighteen, his adoptive parents sold their house, bought an RV, and set him up alone in an apartment while they traveled the country. "I felt rebellious," Ken says of that period. "I felt like I didn't have any direction."
He found it when he met Jen in 1993. They've been together ever since, and he raised as his own the son she already had, helping Jen deal with the young boy's bipolar disorder. One time, when the child was eight, he lashed out so violently — stabbing his teacher with a pencil and attacking his babysitter — that in desperation, Ken slapped him. "I don't know if anything else would have helped in that situation," says Ken. "He was out of control." But his stepson's teachers noticed the mark on his face, and Ken ended up with a misdemeanor child-abuse charge.
And the DUI charge that ultimately led him to be locked up in Jefferson County jail? In early 2011, he went out one night to celebrate winning a big construction bid. He gave his car keys to a designated driver, but at some point in the revelry he wound up with the keys again. A cop pulled him over a block from the house in Lakewood where he and Jen were living at the time. As a multiple DUI offender, in January 2012 he was sentenced to Jefferson County's one-year Inmate/Outmate Program. He spent a couple months in jail before getting out as part of a supervised release program, and he applied for a new driver's license so he could work. While a loophole in the Colorado Department of Motor Vehicles allowed that license to be approved, his case manager didn't like it: As part of the release program, he wasn't supposed to be driving. So in July Ken was sent back to jail, to spend the rest of his sentence, minus good-conduct time, behind bars.
Which is why he was in the kitchen of the Jefferson County jail on September 17, 2012, the room spinning around him — and the spinning continued to get worse. Finally, after the lunch shift was over, a correctional worker took Ken to the medical clinic in the jail's basement. The facility was staffed around the clock by a half-dozen nurses and a charge nurse; there was also a physician's assistant there during the day and a doctor who came in several times a week. All of them worked for Correctional Healthcare Companies (CHC), the Greenwood Village-based company that oversees medical care for the 1,200 to 1,300 inmates typically housed in the jail — as well as facilities in many other states.
Like many jails and prisons around the country, Jefferson County's has turned to the private sector to help keep down health-care costs for inmate populations that are both growing and aging: According to the ACLU, the number of inmates 55 or older has increased by 1,300 percent since the 1980s. "They have been providing medical care [at the jail] since 2003, and we have been pleased with their work during the entire ten-year relationship," says Jefferson County Sheriff's Office spokesman Mark Techmeyer of CHC, which is currently paid $4,274,000 a year by the county for its services. (Prior to contracting with CHC, Jefferson County used Prison Health Services, the country's largest correctional medical company; before that, the county ran the jail's medical clinic itself.)
When he went to the clinic that afternoon, one of the CHC nurses looked Ken over and told him the doctor would see him when he visited the jail the next day. Ken was likely just dehydrated, she told him, and she sent him back to his unit with instructions to drink water and get some rest. Ken did as he was told, taking a nap on his bunk, but when he awoke a few hours later, the dizziness was worse and he had a horrible headache that was spreading down his neck. Walking down the stairs in his unit, Ken had to hold the railing with both hands — and on the bottom step, he slipped and fell.
The deputy on duty took him back to the medical clinic in a wheelchair. This time, Ken saw the physician's assistant, who told him the culprit was likely a migraine accompanied by vertigo. Ken was given medicine for his headache and the dizziness, then returned to his unit. While he was sitting in the common area a little after 7 p.m., everything went from bad to worse. "That's when my body started changing," says Ken. "I could feel my face starting to droop. I was able to control my right side a lot less than my left side."
By now, it was clear to others that something was wrong. Two of Ken's friends in the unit, Vance Goetz and Gilbert Renteria, approached and asked if he was okay. "I think I am having a stroke," Ken told them, slurring his words. The realization came to him like puzzle pieces clicking into place. "My body was screaming at me, 'You are having a stroke!'" he remembers.
Looking at him, both Goetz and Renteria agreed. "I worked as a dialysis tech," says Renteria. "I knew the signs and symptoms of heart attacks and stroke. Everyone knows one side of your body goes limp, and you notice the speech changing."
"I knew something was wrong," agrees Goetz. "I am not a doctor, but you know. And when he stood up and started walking with one leg dragging, I really knew it."
But when Renteria tried to alert the deputies, he was told to wait for the nurse, who would be by soon to hand out meds for the evening. In the meantime, Ken was deteriorating. Waves of extreme dizziness and pain began washing over him, and after each one, his body seemed slightly less functional than before. His right arm began curling in on itself. He couldn't focus on what was going on around him in the common area; his mind couldn't process what was happening in the Broncos game on the TV. And the right side of his face was numb. "It felt like my face was hanging off of my skull," he says.
He focused on contacting his wife. "If I can get to Jen, she can get some help," he remembers thinking. Goetz helped him to the jailhouse phone, but when he reached Jen, it was as if his brain was stuck in first gear. He kept repeating that he needed help, but he couldn't carry on a conversation, couldn't grasp what she was telling him. Some of his words wouldn't come out at all. Suddenly, he was no longer talking to her; he was on the floor. While Goetz got on the phone to talk with Jen, a deputy and a nurse helped Ken into a wheelchair and took him back down to the medical clinic.
Ken told the charge nurse there that he thought he was having a stroke. She ran a couple of tests and then said that he was just experiencing an anxiety attack. She gave him Gatorade and sent him back to his unit to sleep, noting that he "walked around in [the] clinic with no issue or complication." But at that point he could barely walk, Ken says, and needed a wheelchair to make it back upstairs.
Because of his dizzy spells, Ken was moved from his upper bunk to an open lower bunk in another part of the unit. While he lay in bed, girding himself for the next wave of pain and dizziness, the man in the next bed introduced himself as Mike, and said he had been a licensed emergency medical technician. "I've been watching you all night," Mike told Ken, and then walked him through his own, informal series of neurological tests. The results — the right side of Ken's face appearing flaccid, his right hand demonstrating a much weaker grip, one pupil far more dilated than the other — left little doubt in his mind, Mike says now: "These were classic signs of what I would say is a stroke."
"You are a human being," Mike remembers telling Ken. (He asked that his last name not be used because of ongoing legal matters.) "You need to stand up, and you need to scream that you need to be seen by a doctor."
Ken didn't seem able to do that — so Mike did it on his behalf. He got out of bed and approached a deputy, risking punishment for being up and about after evening lockdown. "Ken is in bad shape," he said. "I think he is having a stroke."
"Who the fuck are you?" replied the deputy. "Are you a doctor?"
"I was an emergency medical technician," said Mike. "This is a dire medical situation. This man needs a doctor now."
Finally, the deputy relented. For the fourth time that day, Ken was taken down to the medical clinic.
He would never return to the unit.
Back in the medical clinic, Ken did what his wife and Mike had told him to do: In tears, he insisted he was having a stroke, demanded to see a doctor, demanded to go to the hospital. As a nurse would write in his medical chart, he told them that "it feels like my whole [right] side is dead."
It's just an anxiety attack, the nurses kept telling him as he spent the next several hours on a gurney in an observation room. In his medical records, they noted that his pupils seemed normal, his grips were equal, his speech was "slowed, not slurred," his gait was "guarded," and that he didn't have a headache. When Ken told them he couldn't swallow the Gatorade he'd been given, one of nurses poured out the liquid and told him to use his finger to scrape out and eat the sugary residue left in the cup. When he said he needed help getting to the bathroom, he was told that wasn't their job, that he could manage it on his own.
"In my opinion, I was a burden to them," he says. "It felt like not one person in the whole place cared."
At one point, it felt like his throat was closing up, and Ken had to shout to be heard. It sounded like he was yelling at everyone. Looking back, Ken figures that was the last straw for the nurses. A little before two in the morning, they told him he would be spending the rest of the night in the SHU — the jail's Security Housing Unit, also known as solitary confinement.
"It is literally the darkest place in the whole jail," Ken says of the basement-level chamber where he was placed. The only light came from a faint iridescent bulb overhead, bathing everything in an unsettling blue hue. It was the same cell where Austin Sigg, charged with murdering Jessica Ridgeway, is currently housed.
"The SHU is not disciplinary," says Techmeyer, the Jefferson County Sheriff's Office spokesman. "It is for inmates who might be at a higher risk than the general population." The SHU also has a full bed, rather than just the gurneys in the medical clinic's observation rooms, so it might have been a more comfortable place for Ken to spend the night. That is, if the bed hadn't already been occupied by another prisoner.
A deputy said he'd return with a plastic cot, but that cot never came. So Ken spent the rest of the night lying on the concrete floor, unable to sleep. The man in the bed didn't sleep much, either. "Don't die in here," he kept telling Ken. "Don't die."
While the man seemed to be struggling with psychological problems, Ken feared he might not be far from the truth. "I thought I was going to die," he says now. "I thought I wasn't going to come out of there."
When breakfast arrived at 5:30 a.m., Ken couldn't eat; his fellow prisoner consumed both meals. Finally, several hours later, Ken gathered his remaining strength and, ignoring the other inmate's claims that he'd get them both in trouble, crawled across the floor, hauled himself up and pressed his body against the cell's alarm button. When a deputy opened the door, Ken, sobbing, repeated what had become his mantra: He was having a stroke and needed to go to the hospital.
Ken was taken back to the medical clinic. A little after 9 a.m., the jailhouse doctor finally arrived. He ran Ken through his own series of neurological tests, then called the medical staff into the room and repeated the tests so that they could watch. In Ken's medical records, the doctor noted his slurred speech as well as a noticeable weakness on the right side of his body and his face — ailments Ken had been complaining about for hours but that no one else had noted. "This man obviously went through a massively traumatic experience," Ken remembers the doctor telling the nurses. "I don't know how you guys missed this."
Then he turned to Ken. "I think you are having a stroke," he said. "We will get you to the hospital."
So Ken waited to be transported to the hospital. And waited.
An hour after she received the disturbing phone call from Ken on September 17, Jen got another call from the Jefferson County Detention Facility. This time, it was a correctional officer. He told her that Ken was fine, he'd just suffered an anxiety attack.
She didn't believe it. "I have had anxiety attacks," she says. "Never would they make me slur my words that bad, where it's hard to understand what the person is saying."
And when she didn't hear from Ken the next day, she knew she was right: He wasn't fine. So around 7 p.m., when she got off work from her call-center job, she went to the jail. "We transported him to the hospital earlier today," the correctional officer at the front desk told her after looking up Ken's information. "But if it was an emergency, we would have contacted you."
She couldn't get any more details.
Jen could understand why, for security reasons, the jail wouldn't disclose where an inmate was being treated offsite. But she couldn't understand why no one would tell her Ken's medical condition, especially since she was his emergency contact. "It was as if they thought if they didn't say anything, they could push it under the rug and it would be all right," she says.
She wasn't going to let that happen. She began calling every area hospital she could think of, even roaming the halls of St. Anthony Hospital near the jail. But there was no sign of Ken — until she received a voice-mail message on Thursday afternoon, three days after she'd last heard from her husband.
"I am okay," Ken said in the same quiet, slurred voice she'd heard during his call that Monday evening. "I am paralyzed on my right side...I can still talk. I am doing okay. I love you. Just hold on, baby." He said he was at Exempla Lutheran Medical Center in Wheat Ridge — the one hospital she hadn't thought of. Jen left work and headed straight there. A deputy was posted at the door of Ken's room, but when his back was turned, she slipped inside. She found Ken shackled to a hospital bed, covered in IV tubes and heart-monitor electrodes.
"You don't want to see someone you love in that position," she says. "He looked terrible, like he'd lost so much weight." The right side of his face was drooping, and he couldn't seem to figure out how to put down the sandwich he was holding in order to hug her. He couldn't form the words to say he loved her.
Ken had been transferred to Lutheran from the jail — three hours after the doctor had said he was likely having a stroke. He wasn't taken there in an ambulance; he was shackled and put in the back of a transport van, where he lost his balance and fell off the seat. He remembers one of the deputies in the front laughing at him and saying, "You can quit the charades; you've convinced these people you need an outpatient MRI."
But when they got to the hospital, the MRI proved Ken wasn't faking it. At 12:30 p.m. that day, more than 28 hours after he'd first started experiencing problems, the brain scan confirmed that Ken had suffered a major stroke. When he heard the news, Ken broke out in tears, then turned to the two deputies who'd taken him to the hospital. "I am going to fucking sue you," he said.
The officers guarding Ken refused to let him call his wife because of security concerns; nor would they give him the jail's medical-release form, which would allow them to provide information to Jen. Finally, two days after he'd arrived at Lutheran, he was given a phone to order his lunch from the hospital cafeteria as part of his therapy, and he saw his chance. He called Jen.
Now here she was, hugging him as he lay in the hospital bed — although the guard soon arrived and escorted her out. The next day Ken was transferred to Boulder Community Hospital; again, Jen was not notified. And another week would pass before she heard anything more.
"That's what hurts me the worst," says Ken. "Knowing my family went through two weeks of hell." Finally, on September 27, he refused to continue therapy at Boulder Community Hospital until he was allowed to call Jen. Jail officials relented, and Ken let his wife know where he was. The next day, there was another development: Thanks to Jen's efforts, Jefferson County Judge Verna Carpenter had granted Ken early release.
Ken was free — although he didn't feel like it. "I feel like I got the worst sentence possible," he says. "I feel like I've been served a life sentence."
Ken walks back and forth, back and forth across the floor of the physical-therapy clinic he visits several times a week, slowly tilting his head up and down as he takes each careful step. He's doing this to help recalibrate his internal equilibrium system, since his stroke destroyed part of his brain stem, leaving him with difficulty balancing. For Ken, the therapy isn't easy. He hesitates and stumbles as he puts one foot in front of the other. "I've been really dizzy this week," he tells his physical therapist, Christina Mulholland.
"The day you come in and don't say you're dizzy, I'll do cartwheels," Mulholland replies.
After the session, Ken has an appointment with his doctor to obtain more of the medical patches he wears behind his ear. The patches ease the vertigo he's been dealing with since he first felt dizzy in the jailhouse kitchen last September, but they leave his neck red and irritated.
Dealing with the repercussions of the stroke "has become my full-time job," he says. Along with dizziness and balance problems, he suffers from constant fatigue and has a hard time concentrating; his right arm is plagued by limited motion, weakness and pain. His slurred speech has improved, but he still speaks in a quieter, more hesitant tone. And the once-active skier can't be in the cold for more than a few minutes before it feels like he's freezing.
Jen's life has changed, too. "I feel more like a caregiver instead of a wife," she says.
Even if he had time for a job between all his appointments, Ken says he can no longer work in his field: His dizziness would be a liability on construction sites, and his mental lapses prohibit him from doing the complicated construction bids he used to prepare. "I can't live the life I used to live," he says. "I just don't know what my future is going to hold for me."
Ken's physician, Alan Schultz, says this outcome might have been avoided if Ken had been treated in a timely fashion. "We have a saying in the medical world that 'time is tissue,'" he explains. "And when somebody has a stroke, it's matter of minutes, not hours, that actually makes a difference. Brain death starts at four minutes, and cells are basically toast at ten minutes."
And the jail's medical personnel waiting more than sixteen hours after Ken's noticeable signs of a stroke, such as slurred speech and facial droop, appeared before sending him to the hospital? "That is a debacle of medical care," says Schultz. "It is absolutely asinine."
That's why Ken and Jen have filed suit against Jefferson County, as well as Correctional Healthcare Companies and several of the CHC medical personnel who worked at the jail. Their lawsuit alleges that those involved were negligent in failing to address Ken's obvious medical needs and interfering with his wife's ability to participate in treatment. The suit also claims that they violated Ken's civil rights under the Eighth Amendment's "cruel and unusual punishment" clause, which entitles prisoners to adequate medical care.
"I find the facts alleged in this case to be particularly outrageous," says Anna Holland Edwards of Holland, Holland Edwards & Grossman, the Denver-based law firm representing the couple. "We as a society do not convict people to a time of abandonment in medical crisis. Ken was serving the time, taking responsibility for what he had done. Nothing he had done justified being treated as though his life didn't matter."
Holland Edwards knows that the medical needs of a jail inmate might not be the most sympathetic of stories these days, especially since many Americans who aren't behind bars have their own problems with health care and health insurance. But as she points out, "Jail is one of the few places where you don't have a choice for health care," she says. "The combination of law-enforcement power and deficient medical care is extremely dangerous, because prisoners cannot act for their own welfare. They can't just go to another doctor if they are being abandoned in a crisis."
For her, one of the most compelling pieces of evidence came from a suggestion by Ken: He wondered if the jail might still have the recording of his September 17 phone conversation with his wife. The recording, which the attorney obtained from the sheriff's office, was a bombshell. "We have an actual tape at 8:30 p.m. of him slurring his words, complaining of right-sided weakness, telling people he thought he had a stroke," she says. "Ken did exactly what one should do: He brought his earliest symptoms to medical staff in the jail. If he had not been prevented by his jailers and their private care system from getting the emergency care he knew he needed and his co-inmates knew he needed, he would have been able to be taken to any emergency room and be treated for this obvious life-threatening emergency and would not be nearly as disabled as he is today, if at all."
But Techmeyer says the deputies at the jail did everything they could to address Ken's needs. "I don't know really what else we could do from the deputies' standpoint to make sure he was provided medical care," says Techmeyer. "We were responsive to his requests for medical care and sent him down for evaluation." And while Jeffco is legally responsible for the care Ken received, the nurses and doctors worked for CHC, he notes, adding, "I don't think it's fair for me to comment on their actions and how they arrived at their evaluations."
CHC also appears reluctant to comment. The company did not respond to multiple messages, including those left with its in-house corporate legal department, which takes "a proactive approach to litigation and risk management to reduce our clients' exposure to liability," according to the CHC website.
This isn't the first time that CHC, which manages the health care of more than 70,000 inmates in 27 states, has faced complaints. In 2008, a Department of Justice investigation of the Oklahoma County Jail in Oklahoma found that "detainees' serious medical needs are not adequately met" by the jail's medical program, which was being run by Correctional Healthcare Management, a CHC subsidiary. In particular, the report highlighted the "unconscionable" instance of a female detainee forced to remain seated in a wheelchair and handcuffed to a handrail while giving birth to a three-month-premature baby that was later pronounced dead. Lawsuits against the company have repeatedly captured headlines; the stories describe multiple inmate deaths and detail how one prisoner had to have several parts of his limbs removed because of an untreated septic condition. In Illinois, more than a million dollars has reportedly been paid out since 2010 to settle lawsuits against Dr. Stephen Cullinan and his company, Health Professionals Limited, which was acquired by CHC in 2007. And here in Colorado, lawsuits have been filed against CHC and its subsidiaries over inmate care in Larimer, Pueblo, Mesa, El Paso and Teller counties.
Jefferson County has also been sued multiple times over CHC's services at its jail. According to Techmeyer, the amount the county has spent on these lawsuits should be addressed by CHC's in-house legal department.
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Bradley Brockmann, executive director of the Center for Prisoner Health and Human Rights at Brown University Medical School, notes that private companies like CHC, which are paid a lump sum up front for their services, have a profit incentive to keep inmate medical services as basic and cheap as possible. For example, according to its contract with Jefferson County, Correctional Healthcare Companies is responsible for covering the first $50,000 of all costs incurred by transferring an inmate to an offsite facility. That means sending Ken to a hospital, as he requested repeatedly in the midst of his stroke, would cost the company up to $50,000. "Giving contracts to the lowest bidder to provide the cheapest services might save some money to the correctional institution, but in the long term it's destroying people's lives," says Brockmann. "More transparency is desperately needed, with some accountability beyond the institution's bottom line. Any light that can be shined into these areas can be helpful."
Ken is trying to fight for that accountability and transparency. "Maybe the reason you are living is the Lord wants to use you to open their eyes," Mike, the former EMT turned inmate, told Ken a few months after his stroke. "They need a wake-up call in there."
Ken hopes his lawsuit will be that wake-up call. But even if he wins, a victory won't give him his life back. It won't stop the nightmares that plague him at night, the ones illuminated by the horrible blue light from his time in the SHU.
"I am just trying to find a switch to turn off that light," he says.