Teen Vomits to Death in Jail After Opioid Withdrawal Left Untreated

A teenager in Minnesota, who experienced uncontrollable vomiting and diarrhea due to opioid withdrawal, died days after being admitted into Clay County Jail. Nineteen-year-old Abby Rudolph, who was arrested for shoplifting just days before her death, was left untreated for drug withdrawal while in jail, despite guards being informed that she was "withdrawing from heroin," according to inmates. Rudolph was seen lying on the floor of her jail cell for hours unable to control her vomiting and diarrhea, according to court records and jail surveillance video reviewed by Minneosta's KARE 11 television station. The teenager was never given any medication to treat her constant vomiting and diarrhea, records show, according to KARE 11. "She was begging, begging for help and there was no compassion given to her. There was no respect for her basic human needs and what happened was wrong," said Colin Peterson, an attorney representing the family in a federal lawsuit following the incident. However, the Minnesota Department of Corrections (DOC), which licenses county jails, claimed Clay County Jail staff "appear to have been very compassionate and treated Ms. Rudolph very professionally." The DOC's investigation was reported to have found only one minor violation, which the DOC claimed likely did not have anything to do with the death of Rudolph, KARE 11 reported.

Guards were informed of the teenager's withdrawal

Following a hip injury in high school, Rudolph became addicted to opioids before turning to heroin. She was sent to Clay County Jail after being arrested on October 30, 2016 for shoplifting at a Menards store in Moorhead. At the time of her arrest, she did not inform any guards and medical staff about her withdrawal. But on her second night at the jail, she was "up all night yelling and thrashing in her sleep," two inmates wrote in a note to a guard, which also said Rudolph had told the inmates she was "withdrawing from heroin." After she was transferred to a separate cell, a guard reportedly saw Rudolph sleeping next to her vomit on the floor of the cell, which "wasn't too unusual of a behavior to notice," given that she was coming down from drugs, the guard noted in a report. The guard mentioned Rudolph's vomiting to a team leader but neither sought help for the teenager, according to KARE 11. The following day, Rudolph was visited by her mother, who said the family couldn't afford to post bail, despite Rudolph's pleas to go home. Following her mother's visit, a nurse from the Mend Correctional Care (MEnD), the jail's health care provider, requested a drug test be done on Rudolph. The teenager informed the guard who was administering the drug test that she was coming down from drugs. Rudolph tested positive for opioids along with methamphetamine, THC (tetrahydrocannabinol) and amphetamines, according to the test results. The MEnD nurse ordered a liquid diet, but no medication, for Rudolph, KARE 11 reported.

No medication given following withdrawal assessment

The teenager's condition reportedly deteriorated throughout the day and surveillance video showed her vomiting repeatedly during the night. However, the guards (who were meant to monitor Rudolph every 15 minutes) never noted her vomiting on the seclusion sheets, according to court depositions in which the MEnD nurse claimed she didn't know how sick Rudolph was because the guards didn't document the vomiting episodes. The teenager was given a drug withdrawal assessment by the MEnD nurse on November 2, for which she scored high enough, it would have been required to call a doctor. But she scored too low and was sent back to her cell without any treatment by the nurse who noted that Rudolph was "starry-eyed" but "alert and oriented." The regular 15-minute checks were resumed by the guards who marked Rudolph as being "OK," with only one mention of vomit in all the notes, which read "gave water, new vomit bag." The following morning on November 3, her persistent vomiting continued, according to surveillance video which showed Rudolph used a vomit bag eight times between midnight and 7 a.m. local time. By noon local time, a guard noted the teenager had a "catatonic look" on her face and about two hours later asked the MEnD nurse whether Rudolph was on medication for her withdrawal symptoms. Following a chemical assessment by the nurse, Rudolph scored high enough for a doctor to be contacted. Before contacting the doctor, Rudolph was taken to a shower by the nurse and guard where her body began to jerk and seize. Paramedics were called and she was put in an ambulance where she vomited again and later stopped breathing before the vehicle left the parking lot. She was pronounced dead less than an hour after she was taken to the shower.

Death was "needless, preventable event"

Rudolph was reported to have died of natural causes from acute bronchopneumonia, according to an autopsy conducted by the Ramsey County Medical Examiner, which stopped a criminal investigation of the case. A pathology report by experts at the U.S. Centers for Disease Control and Prevention (CDC) also indicated bronchopneumonia but also "with aspiration." Dr. Kevin Fiscella, an addiction specialist and board member of the National Commission on Correctional Health Care NCCHC), told KARE 11: "That means somebody is vomiting and as they're vomiting and coughing the vomit goes down their windpipe and gets into their lungs." Rudolph's medical files were sent to another pathologist for review, who concluded Rudolph died from complications of her acute drug withdrawal. Dr. Mary Ann Sens noted the teenager's withdrawal caused her vomiting and led to the aspiration pneumonia. Rudolph's seizure was likely a result of severe, untreated dehydration due to her vomiting and diarrhea, which caused chemical imbalances in her system and contributed to her death, according to Dr. Sens. Fiscella noted that if appropriate treatment and protocols are in place in jails, withdrawal-related deaths, "should be basically non-existent," noting any inmate death from withdrawal, "is a needless event. It is a preventable event." Clay County declined to comment on the case due the ongoing lawsuit. But in court filings, the county defended its care of Rudolph, referring to the finding of the aforementioned investigation by the DOC. The county also argued that all decisions concerning her medical treatment "were the sole responsibility of qualified MEnD personnel," according to KARE 11. In May 2019, MEnD settled with the Rudolph family for an undisclosed amount following a lawsuit against MEnD. Newsweek has contacted the Minnesota Department of Corrections and the Clay County Sheriff's Office for comment.