Bernard Victorianne died in the San Diego Central Jail in 2012 from a drug overdose. His death could have been prevented if the jail officials had acted on the fact that they knew he had swallowed a bag full of methamphetamines and ignored warnings from a local hospital to get Victorianne prompt medical attention if he showed warning signs of an overdose.
Victorianne definitely showed signs- including screaming that his insides were “on fire”- but instead of treatment, jail personnel put him in solitary confinement. His family settled the case against the county in August, 2016 for $2.3 million.
A Bag of Meth
On September 12, 2012, Victorianne, 28, was arrested in City Heights on suspicion of DUI. He was on probation for drug violations at the time. The San Diego police officer who stopped the care saw Victorianne swallow a bag of meth.
He then ordered Victorianne taken to Alvarado Hospital for an examination. At the hospital, X-rays did not find the meth bag, but doctors sent the “prompt medical attention” warning to jail officials. The signs of drug overdose that the doctors stated Victorianne might go through included:
- Difficulty breathing
- Anxiety
- Agitation
- Extreme drowsiness
It turned out that Victorianne experienced all of these symptoms, but nothing was done.
The Next Week
After release from the hospital, Victorianne was sent directly to Central Jail.
Although jail officials knew of Victorianne’s medical state, he was initially placed in the jail’s general inmate population. When he began acting out and behaving in a “bizarre” manner, officials did not move him to a medical unit but placed him in solitary confinement. At the same time, Victorianne was given Benadryl, Ativan – a sedative – and the anti-psychotic drug Haldol.
Over the next week, Victorianne’s condition continued to deteriorate, but the medical staff did nothing.
The night before his death, jail deputies were required to do a count of each inmate, which involved scanning a wristband worn by each inmate. Victorianne’s cell was skipped, according to a surveillance video. On September 19, Victorianne did not pick up his breakfast from the cell door flap. Two deputies then entered the cell and found Victorianne nude and laying face down on the floor. One deputy later reported they found Victorianne breathing -but did not report his condition to medical or any other personnel. At the next jail check, three hours later, Victorianne was found dead.
An autopsy revealed a bag of meth, open on one end and tied shut on the other, in Victorianne’s stomach. The medical examiner listed the cause of death as methamphetamine poisoning.
The Independent Investigation
An independent investigation into Victorianne’s demise was conducted by the San Diego County Citizen Law Enforcement Review Board. The findings were presented in a closed session on September 9, 2014, almost two years after Victorianne’s death.
The CLERB found that the San Diego Sheriff’s Department personnel,
“…observed a series of behaviors and indicators which, with proper response, could have prevented the decedent’s untimely death. Observed swallowing a baggie of methamphetamine at the time of his arrest, the decedent received limited close observation during portions of his incarceration. On three separation occasions, decisions were made to transfer the decedent to another facility, only to be cancelled because of his unstable and bizarre behavior.”
The report notes that jail officials were “not able to maintain the minimum standards expected of those in mainline housing,” and when Victorianne was found in medical distress in his cell, he was placed in Administrative Segregation rather than Medical Observation. In the latter, he would have been closely monitored.
The report concludes that “Inmate count procedures were violated, resulting in the failure to monitor the decedent’s well-being, and when last seen, deputies failed to properly respond to a medical emergency.”
Based on the information available at the time of this report, including the autopsy findings and results of ancillary testing, the Medical Examiner “determined the cause of death to be methamphetamine toxicity, and the manner of death was classified as accidental. The evidence demonstrated that the actions and/or inactions of Department personnel were not justified.”
Follow the Policy
The settlement for Victorianne doesn’t require a change in jail policy, unlike many other wrongful death claims settled by the families of inmates. That’s because the jail had a policy in place, which would likely have saved Victorianne’s life had it only been followed.
That’s a simple fact – the best policies in the world have no effect if law enforcement personnel fail to enforce them. Had the San Diego Central Jail deputies and administrators followed their own policies, Bernard Victorianne would likely still be alive.
If you are a victim of jail neglect or medical malpractice you may be entitled to compensation and an opportunity to spotlight the misconduct, holding the culprits accountable. Learn your rights in a confidential, no-cost legal consultation. 866.836.4684 or CONNECT BY EMAIL