FARGO — Danielle Wilkie's sobs were drowned out by blenders in a busy south Fargo coffee shop.
She used the sleeves of her North Dakota State College of Science sweatshirt to wipe away tears after a long day of driving to and from the college in Wahpeton, where she's pursuing a construction management degree in honor of two men she lost last year.
In a span of less than four months, Wilkie's little brother and father died — both while inmates at North Dakota county jails.
“It’s completely surreal that it happened one after another,” she said.
At home on her dresser are the ashes of her father, Oscar Wilkie Jr. The 52-year-old died from a methamphetamine overdose just three hours after entering Rolette County Jail on April 14, 2018.
Her brother, Oscar Wilkie III, struggled with addiction as well. The 26-year-old was prescribed painkillers in high school after he was hit by a car while riding a bike, and that led to a heroin habit. When he was booked into Ward County Jail on outstanding warrants Jan. 4, 2018, officers weren’t aware that he was going through heroin withdrawal despite his history of drug charges.
It isn’t clear what killed her brother, Danielle Wilkie said. Based on a preliminary report on his death, the North Dakota Department of Corrections and Rehabilitation found no need for further investigation by the state Bureau of Criminal Investigation.
The BCI did investigate her father's death. BCI documents note that jail staff failed to follow policies when they didn't complete medical clearance on Oscar Wilkie Jr. Rather than bring him to the local hospital or Indian Health Services clinic, he was placed in a holding cell.
Neither death resulted in disciplinary actions or procedural changes ordered by the DOCR, according to a DOCR spokesperson. As for the BCI investigation, it concluded that "violation of jail policy and procedure is not a criminal act."
"A lot of the stigma for addicts is that they deserve what they get without regard for the fact that they have a family," Danielle Wilkie said. "They're treated like criminals, not people with a disease that need help."
National experts on addiction and safe withdrawal in jails say there are more effective approaches to prevent tragedies like those the Wilkies and other families in the U.S. have faced.
Lindsey Vuolo, director of health law and policy with the National Center on Addiction and Substance Abuse at Columbia University, said a common misconception is that removing a person from drugs will resolve their addiction, but it's far more complex than that.
"There's an obligation for jails to be treating people and not just ignoring people who have addiction," Vuolo said.
The National Center on Addiction and Substance Abuse found that 85% of incarcerated adults are substance involved, but only 10% of those incarcerated with addiction receive care. The impacts of this can be deadly.
Treatment vs. punishment
DOCR records say Oscar Wilkie III told other inmates he was going through heroin withdrawal. Three days after his arrest, after receiving no medical treatment, he was found unresponsive in his cell. A cellmate alerted jail staff, but it was too late to revive him.
Vuolo said that forced withdrawal alone is not treatment and withdrawal increases the risk of overdose upon release. If an inmate with a lower tolerance after incarceration uses the same amount of drug, the chances of them overdosing are 12 times higher, she said.
She said the pain of withdrawal is often why people go back to using — not to get high, but to stave off withdrawal symptoms. Symptoms can be physical, like sweating, vomiting, seizures and fatigue, as well as emotional and mental, like anxiety, depression and hallucinations. Opioid withdrawal mimics the flu and isn't typically deadly, but symptoms of constant vomiting and diarrhea can result in severe dehydration, which can be life-threatening.
Though it puts a strain on jails, the facilities are required to provide medical treatment to inmates. Unfortunately, Vuolo said, too many inmates are punished, not treated.
Screening of inmates by trained health professionals should happen upon intake, she said. Without accurate screening results, staff won't be able to connect inmates with appropriate interventions and treatments.
“It's an urgent and serious problem because withdrawal-related deaths can be prevented,” said Laura Brookes, director of policy at the Center for Health and Justice at Treatment Alternatives for Safe Communities in Chicago.
Brookes said jail leadership and staff play a critical role in ensuring safe withdrawal by designing and implementing procedures that will work in their facilities.
Ward County Sheriff Bob Roed, who took office in January 2019, said an increasing challenge in his jail is dealing with inmates going through withdrawal or overdosing.
The jail in Minot averages about 110 inmates, Roed said. He estimates 20% are detoxing, but the number of inmates coming in under the influence of drugs or alcohol is much higher.
When screened by officers, not nurses, during intake, inmates aren't always honest, Roed said. "If they haven't identified they are on anything, it's really hard to tell, so staff just has to monitor them."
Officers may not discover an inmate is going through withdrawal, but if staff recognize signs, they provide free Gatorade for the first 24 hours, Roed said. There is also increased observation, and a nurse on staff on weekdays.
Ward County Jail staff noted that Oscar Wilkie III seemed fine during booking on a Thursday. His cellmate told authorities it wasn't until Saturday night that Oscar Wilkie III started vomiting from heroin withdrawal. On Sunday morning, his cellmate heard Oscar Wilkie III "hit the wall" and "make a gurgling noise like he was choking on his tongue," according to an internal review.
That review said officers found Oscar Wilkie III unresponsive after his cellmate used an intercom to call for medical assistance. Officers administered the overdose reversal drug, naloxone, and when that didn't revive him, a defibrillator was used, but he remained unresponsive.
An ambulance brought him to Trinity Hospital in Minot where he died Jan. 10, according to his obituary.
In the case of Danielle Wilkie's father, he was in a holding cell at Rolette County Jail in north-central North Dakota and monitored via an audio system. When an officer didn't hear him snoring, he looked at surveillance video and noticed that "Wilkie appeared to be clutching his chest," DOCR records state.
Officers called for an ambulance and used a defibrillator and then performed CPR before the elder Wilkie was taken to a nearby hospital, where he was pronounced dead shortly after arriving, according to DOCR documents.
BCI investigators found that the jail violated policy when staff didn't complete the medical intake form, and instead brought Oscar Wilkie Jr. to a holding cell. Officers had to help him walk to the cell and noted a heavy odor of alcohol. Jail policy requires that an inmate who cannot walk on their own receive medical clearance before they are incarcerated, according to BCI documents.
Oscar Wilkie Jr.'s autopsy report said he had a "history of methamphetamine abuse and was believed to be under the influence of drugs and/or (alcohol) when arrested." At intake, officers found a plastic tube in his pocket that he acknowledged using for meth, but told them he last used the drug the day before.
Rolette County Jail officials did not return repeated calls seeking comment on this story.
'To help save lives'
Julie Savat, administrator of the Clay County Jail in Moorhead, said that during intake screening, officers need to gather as much information on inmates as possible, and you can't just rely on what the inmate is willing to admit. Jail staff should get information from the arresting officers or probation officers. She said her staff also checks inmates for dilated eyes and needle tracks on their skin.
Savat and Cass County Jail Administrator Andrew Frobig both said identifying and treating an inmate under the influence of alcohol is much easier than drugs because of breathalyzer tests. If results of the test are concerning, inmates can be taken to a detox area, they said. But with drugs, it's difficult to know an inmate's intoxication level and whether they are at risk of overdose or withdrawal.
"Someone can come in and be OK but took something a half hour before," Savat said, so staff have to wait and "see which way they are heading." Another inmate could be incarcerated for three days then suddenly they're "not doing too hot," she said.
Savat said there's a detox center next to the Clay County Jail and medical staff can respond immediately. Clay County also partners with a company, MEnD Correctional Care, that specializes in inmate health care.
Brookes said Chicago has a dedicated medical facility for inmates, but that might be challenging for rural areas. She said each jail needs to assess the challenges and recognize the need for treatment and the consequences of untreated inmates.
"Our hope is to help jails recognize and put in place the protocols and training that they need to help save lives," she said.
An example of this, Brookes said, is in Rhode Island where prisons offer inmates methadone, Suboxone and Vivitrol — all medications to treat opioid addiction. She said prisons there saw a 60% reduction in opioid-related deaths.
Cass County Jail partners with a Fargo clinic that provides methadone, a drug that's also available in Minot and Bismarck. Frobig said inmates can apply with the clinic to enroll in methadone treatment while incarcerated, but it's for long-term care, not to stave off cravings for a few days during incarceration.
Savat said her jail does not typically deal with methadone, but like most jails, including Cass and Ward, Clay County Jail officers carry naloxone.
The DOCR does not collect data on inmate deaths in North Dakota jails. Across the country, 1,053 inmates died in local jails in 2014, according to the most recent U.S. Department of Justice survey.
Ninety of those deaths were attributed to "drug-alcohol intoxication." The survey, however, does not give an option for reporting deaths due to complications from withdrawal.
Looking into litigation
The Wilkie family is in the process of filing a wrongful death lawsuit in the case of Oscar Wilkie III, according to the family's attorney, Amanda Corey.
Corey wouldn't comment further on the lawsuit, but said more can be done in county jails to prevent additional tragedies.
There are others who lost loved ones in Ward County Jail who say inmates don’t receive enough medical care when going through withdrawal or dealing with addiction.
The jail was under increased supervision by the state up until 2017 following the death of inmate Dustin Irwin in 2014.
Irwin died after repeatedly asking for help, and his cellmate pleaded with officers to give Irwin medical assistance after persistent vomiting and diarrhea, which can result in severe dehydration. Staff were later interviewed and expressed a lack of compassion for those incarcerated, stating that inmates don't deserve health care and that inmates should be shot rather than brought to jail, according to DOCR documents.
Cindy Springstead, of Minot, is also pursuing litigation after her son, Walter, died in Ward County Jail in 2016. The 24-year-old was detoxing from heroin and was placed in a cell alone. Walter Springstead killed himself three days after his arrest.
His mother said the third day is typically the peak of withdrawal when many people have suicidal ideation because the pain from withdrawal is so severe.
"Heroin withdrawal won't kill you. It's the dehydration and suicidal ideation," she said. "People deserve effective treatment and not forced withdrawal."
Since losing her son, affectionately known as "Buddy," she volunteers at the jail to check on inmates who are dealing with withdrawal and addiction. She makes sure they have money to buy food and drinks from the commissary and that medical requests are being met. At one point, she said she ordered eight cases of Gatorade to keep inmates hydrated.
Springstead said volunteering is emotionally exhausting work. Some of the horror stories have caused her to drop to her hands and knees sobbing when she returns home.
On days when she feels like quitting, she said she reads Hebrews 13:3: "Remember those who are in prison, as though in prison with them, and those who are mistreated, since you also are in the body."
"I can't save Buddy anymore, but at least I can help someone not bury their child," she said.