Correctional Healthcare Consultant Gene Baldwin Statement
July 7, 2004
On Wednesday, June 30, 2004, I was at the McCracken County Regional Jail as part of a scheduled monthly visit in the capacity of correctional healthcare consultant. We had held a Quality Assurance meeting earlier that morning, and afterward I spent some time in the medical office talking to the nurse, Cathy Arnold, RN.
At one point a man was sent to see her complaining of chest discomfort, and I sat in the main medical office room behind Cathy while she evaluated him (Larry Smith). Smith was in no apparent distress, and reported that he had been awakened earlier that morning with chest discomfort and some sweating. He ran his fingers up and down his sternal midline to indicate the area of discomfort, and said that it was more pronounced when he would take a deeper breath.
Cathy connected Smith to the pulse oximeter/automatic blood pressure machine. I moved to a vantage point behind Smith and noticed that his oxygen saturation level was 100%, while his BP was elevated. I didn't make note of the BP reading, but noted the pulse ox reading, since it was in fact better than mine had been a short while earlier.
There appeared to be no cause for immediate concern, and I left the medical area and went to Jailer Cliff Gill's office. About 10-15 minutes into the time spent in Cliff's office (discussing unrelated matters), he noted on the 4-way split TV monitor in his office that there was apparently some type of emergency unfolding down the hall from the booking area, as an officer was seen on the monitor sprinting down the corridor. Radio traffic immediately picked up, relaying information about a "man down" in apparent cardiac arrest in one of the observation cells near the booking desk/control room area.
Cliff and I immediately went inside the secured area of the facility as radio traffic escalated regarding locating the medical supervisor (Bill Adams, EMT) and ensuring that the EMS unit that had been dispatched knew that they had a man in full cardiac arrest. (Bill had been across the street in the courthouse, but immediately returned to the jail.)
Cliff donned rubber gloves at the booking desk, and we proceeded down the hall to the observation cell, where Cathy and a deputy jailer (later identified as Eric Augustus) were working on Smith. Cathy was at the head with an ambubag, while Eric was doing chest compressions (CPR). Cathy called for O2 (oxygen) and I retrieved the cylinder/mask ensemble from the medical office. Upon my return they had rolled Smith onto his left side in an apparent attempt to better clear his airway. The was some apparent vomitus on the face and floor area around Smith's head.
Bill arrived around that time, and the AED unit was brought into action. Some members of the fire department team also arrived, as did staff from the ambulance service. I stood in the corridor looking into the cell as up to 8 people worked at resuscitating Smith. These efforts included 5 defibrillation shocks, by my count, before Smith was loaded onto a stretcher and loaded into the ambulance in the sallyport. Chest compressions and ambu-bagging continued throughout the process, other than when electrical shocks were being delivered. An IV was at some point inserted, and I saw injections being drawn up. I did not stay at the cell doorway throughout the entire process, but circulated in the booking and sallyport area to some extent as well. I later estimated that the on-site efforts to resuscitate Smith lasted about 20 minutes before he was loaded into the ambulance. At no point did it appear to me that Smith was responding positively. His eyes were fixed open and "glazed" at my first sight of him on the cell floor.
I made no mental notation of the time of Smith's arrival in the medical unit or of the time I later saw him on the observation cell floor, although I would estimate that about 15 minutes transpired between those two events. His presentation in the medical office did not reflect any medical emergency or suggest he was in cardiac/circulatory distress. He was not sweating or in apparent pain, but rather lightly rubbed his sternum with his fingertips in a vertical motion. His vocalizations in my presence did not suggest that he felt any serious pain, discomfort, shortness of breath or anxiety.
Gene C. Baldwin
7/2/04