By Steve Mills
Originally published http://www.chicagotribune.com/news/local/breaking/ct-pontiac-inmate-death-20170717-story.html
In the moments after a confrontation with prison guards left inmate Terrance Jenkins unresponsive, the paramedics trying to save his life made a troubling discovery: five small, crumpled balls of what looked like notebook paper lodged in his throat, blocking his airway.
The death of the inmate, serving a life sentence at Pontiac Correctional Center for a 1983 murder, set off an immediate investigation by Illinois State Police. Within hours, teams of agents had descended on the maximum-security prison in the small downstate town to interview guards, inmates and medical personnel.
Months later, State Police submitted a nearly 400-page report to prosecutors in Livingston County, where the prison is located. Among the documents: an autopsy report that found Jenkins died from a blocked airway and compression asphyxiation from the way the guards had restrained him — putting their weight on his body as his hands were cuffed behind his back and his feet were shackled.
Prosecutors declined to bring charges against anyone involved. And, although Jenkins died in custody, no explanation ever emerged for how paper became lodged in his throat on an October Sunday in 2015.
One reason for the lack of an explanation: a State Police investigation that did not resolve the sometimes significant differences in the accounts of guards and prisoners, according to interviews and a review of documents and videos obtained by the Tribune under the Freedom of Information Act.
Guards, for instance, were not pressed to explain how the balls of paper got into Jenkins’ throat, nor were they pushed to say what happened to a rag or tissue Jenkins tried to bring from his cell to the recreation yard — the incident that supposedly violated rules and touched off the confrontation.
Aspects of Jenkins’ death were so troubling for at least one paramedic that he told the State Police the entire incident struck him as “sketchy” and that it “breathed shadiness.” He said that when he and a partner arrived at the prison’s medical unit and began trying to revive Jenkins, they asked the guards and nurses what had happened so they would know how to begin treatment.
No one told them.
“The whole thing, at least in my opinion, seemed way sketchier than anything else I’ve ever dealt with there,” the paramedic, Wesley Workman, said in his interview with the State Police.
What’s more, no video captured the incident, although dozens of video cameras are stationed around the sprawling facility about 100 miles southwest of Chicago, according to prison documents.
After prosecutors received the State Police report, they made little or no effort to answer the questions the report left unanswered. To be sure, the Livingston County state’s attorney’s office staff is small, making such an investigation tough. Besides then-State’s Attorney Seth Uphoff, the office employed two additional full-time prosecutors, a part-time investigator and support staff.
Still, there is no indication Uphoff pushed State Police investigators to revisit key questions.
Uphoff, who in March 2016 lost the Republican primary race to Randy Yedinak, who is now state’s attorney, declined comment. Yedinak said in an email that there was insufficient evidence to bring criminal charges.
Illinois Department of Corrections officials declined to comment, saying that they could not discuss the case because the department was conducting its own investigation of Jenkins’ death.
State Police, meanwhile, declined to comment, citing a pending lawsuit that Jenkins’ ex-wife and son — both of whom were estranged from the inmate — filed in federal court. That lawsuit, filed last year, alleges that the guards caused Jenkins’ death by “shoving” paper down his throat when he was restrained.
“The State Police investigation covers a broad number of people, but it raises more questions than it answers,” said Russell Ainsworth, the lawyer for Jenkins’ former wife, Phyllis Ellis, and their son, Terrance Jenkins Jr. “What we do know is that no one tried to follow up with what happened with this paper and no investigation was conducted to find out why Mr. Jenkins was found with this paper lodged in his throat.
“There was no interest in holding the guards accountable.”
One official involved in the case offered an explanation for what happened to Jenkins. Danny Watson, who at the time of Jenkins’ death was the deputy coroner and now is the county’s elected coroner, said he believed Jenkins stuffed the balls of paper in his mouth himself. He said he based his explanation on a conversation with two guards, one of whom rode to the hospital in the ambulance carrying Jenkins, the other who followed the ambulance.
The guards, Watson said in an interview, told him that Jenkins had tried to swallow the paper.
“In my mind, I know exactly what happened,” Watson said in the interview at his office. “It’s all perfectly innocent. Perfectly innocent on all counts.”
Inmates do, in fact, have access to notebook paper. But the two guards Watson described arrived on the scene at the prison after Jenkins was already restrained, the reports show, so they could not have seen Jenkins swallow the paper himself — even if that had occurred. In addition, the guards do not claim in interviews with State Police that Jenkins had tried to swallow the paper.
Nor does any other guard interviewed in the investigation.
Life in prison
By the time Jenkins died, he had spent much of his life entangled in the criminal justice system.
His criminal record began at age 11, when he was convicted in juvenile court of riding in a stolen car. Because of his “uncontrollable behavior” and frequent run-ins with the law, court records show, Jenkins was in and out of the state’s youth prisons. After one release, he stabbed a boy in the back.
By the early 1980s, then in his early 20s, he had at least seven convictions, four of them felonies. He had been locked up in the county jail numerous times and in state prison twice.
Jenkins was arrested and charged with murder in the fall of 1983, after a doctoral student at the University of Illinois at Chicago was shot and killed in an attempted armed robbery on campus, according to court records. Although Jenkins testified he was with family members when the crime occurred — he was newly married, though estranged from his wife, and together they had an infant son — a jury convicted him.
Prosecutors sought a death sentence for Jenkins, but the jury could not unanimously reach a verdict, as required under the law. Sentencing Jenkins, the judge noted he had been in and out of prison and other institutions for much of his life and that he was a poor candidate for rehabilitation.
“The best place he belongs is in the penitentiary, no question in my mind,” said Judge James Bailey, according to the transcript of Jenkins’ sentencing. “Therefore, it will be natural life.”
After he went to prison, Jenkins filed a number of appeals, to no avail.
At some point, Jenkins was assigned a cell in a protective custody unit, a section for inmates who are at risk. Inmates who have been threatened by gangs, who have helped staff in an investigation or are otherwise viewed as vulnerable are often held in protective custody, both to help guards identify them as at risk and to keep them from more predatory inmates in general population.
Jenkins’ prison file suggests the assignment was because of at least one incident in which he was assaulted by another inmate, as well as gang threats. One 2006 prison document says an inmate threw hot water and baby oil on Jenkins, and that Jenkins had refused demands from other inmates to attack a prison staffer — the kinds of incidents that could make an inmate especially vulnerable.
Pontiac is a dangerous prison for guards, too, since it holds some of the state’s most violent criminals. Statistics from the Department of Corrections show that Pontiac typically accounts for about one in five assaults on staff in the prison system, though there are more than two dozen prisons in Illinois. In fiscal year 2017, Pontiac accounted for nearly four in 10 assaults on staffers systemwide.
Jenkins was disciplined 21 times from 1998 to his death — a figure that lawyers who deal with prison issues said was less than average at a facility like Pontiac. Among the violations: damage to property, assaulting another inmate, disobeying direct orders and insolence. The most recent violation, in June 2015, was for “intimidation or threats.” He was given a month in segregation as punishment, according to prison records.
Jenkins was assessed as a moderate escape risk with a low level of aggression.
There is no indication he was at risk for suicide.
He had not had a visitor since September 2008, according to records, and had not seen his ex-wife or his son since at least the early 1990s, although both said in interviews they believed he was innocent.
Jenkins’ prison records, as well as his autopsy report, suggest he increasingly was in ill health. Nearly 4,700 pages of records show that he suffered from severe glaucoma and irreversible decreased vision; hundreds of pages are devoted to health issues, dozens of appointments with ophthalmologists at UIC and even eye operations in recent years.
The records show, too, that he suffered from a degenerative joint disease. Health issues often led to him being assigned the lower bunk so he would not have to climb to an upper bunk.
One prison health care worker told the State Police that Jenkins was “kind of a pain.”
An autopsy report, included in the State Police report, noted Jenkins was obese; he was 5-foot 8-inches and weighed 238 pounds. His coronary arteries were 75 percent to 85 percent blocked.
On Oct. 4, 2015, about 12:30 p.m., a group of inmates was being walked from their cells to the yard, where they often lifted weights or played basketball, or sat on benches and played cards, dominoes or board games. The guards patted them down near the doorway before they were allowed outside.
Jenkins, according to the guard who searched him, was carrying a white rag or a washcloth, although some inmates said he merely had tissue or toilet paper to dab his eyes, which leaked because of his glaucoma. Either way, the guards considered what he had contraband, something inmates are not allowed to have.
From here, the accounts of guards and inmates provided to State Police diverge, often in dramatic fashion. And though 91 cameras are positioned around the prison, with 77 in and around housing units, not one camera was in a position to capture what happened, according to the reports.
According to guards, Jenkins was told to return to his cell but refused. Officer Adam Deal told Jenkins to “cuff up” — to allow himself to be handcuffed. Jenkins allegedly disobeyed that order as well. Instead, he turned, squared up and took what the guards called a fighting stance, with his fists raised, according to the guards.
Jenkins moved up the stairs of the cellhouse. Confronted by Deal, he punched the officer in the nose, according to guards. A lieutenant, James Boland, used a pepper spray on Jenkins twice, although it seemed to have little effect on him, and he allegedly flailed his arms and kicked the guards.
A prisonwide emergency call was made, and guards responded. They cuffed Jenkins’ hands behind his back and worked to shackle his feet, though Jenkins allegedly continued to resist.
Deal said Jenkins was “yelling, screaming and cussing” and would not follow orders to stop.
At one point, the guards had Jenkins in a small room near the doorway to the yard as they tried to bring him under control. When a high-ranking officer arrived on the scene, he asked the guards what had started the incident.
“This guy punched Deal,” one officer said, according to the interviews.
Inmates told a different story. They said that tensions between guards and inmates had been building of late, in part because guards often were arbitrary in how they treated them. Guards were especially angry on that day, inmates said, because a cellhouse broom had gone missing.
That day, Boland — who some inmates said treated them rudely — used crude language to tell Jenkins to take the toilet paper back to his cell, the inmates said. Jenkins, who was known as Prince and was described by some inmates as outspoken, told Boland not to treat him like a child. Nonetheless, several inmates said, Jenkins began walking to his cell, though he kept talking as he went.
“The whole point is that Inmate Jenkins was following orders already. The lieutenant told him to go back to the cellhouse. He went,” said Jose Jimenez, serving a 22-year term for murder.
Rayshawn Hudgins, a former Chicago Housing Authority police officer serving time for sexually assaulting young men, said Boland and Deal frequently antagonized inmates.
“I was a police officer. I will side with the police 99 percent of the time. … But that was just wrong. That man was old. He had heart problems. He was overweight. He had a bad leg and eye problems. And it took that? For some tissue?” Hudgins said in the video of his questioning.
When the guards tried to subdue Jenkins, some prisoners said at least one guard had an arm around Jenkins’ throat, using a chokehold, while others were on his back. Other inmates said guards punched and kicked Jenkins during the confrontation, which by all accounts lasted several minutes.
None of the guards said Jenkins was punched or kicked, according to the State Police reports.
One inmate told the State Police he heard a guard ask Boland afterward if he held back during the incident.
Boland, according to the inmate, replied: “No, I don’t hold back. I went full throttle.”
None of the guards reported hearing that conversation.
At least one inmate said he heard Jenkins scream, “I can’t breathe.”
During the struggle, Jenkins became unresponsive. At that point, guards tried to revive him, with one guard performing chest compressions and another trying to restore his breathing. He was then put on a gurney — facedown, his hands and feet still cuffed — and taken to the prison infirmary.
Efforts to save Jenkins’ life continued in the infirmary, though guards were doing much of the work. One nurse said she saw some tiny pieces of paper around Jenkins’ mouth, and the prison’s doctor said he did, too. Both suspected they were from guard Derrick Caudle’s mouth-to-mouth shield, a device that serves as a barrier between a person performing mouth-to-mouth and the person receiving it.
Caudle, though, told the State Police that his state-issued shield was in good condition and he was not sure if there ever was paper on it. What’s more, the shield the state purchases for employees, according to IDOC contracts, has a sheet of instructions that is easily removable, so it is unlikely paper would find its way into a person’s mouth — though it is also possible Caudle used a different shield.
When two paramedics from Duffy Ambulance Service in town arrived, they were struck by the scene. Wesley Workman told State Police he was surprised to find guards working on Jenkins rather than medical personnel, though they were in the infirmary. He said that he had never seen that on other calls to the prison. And when he asked what had happened, so he could determine how to treat Jenkins, no one answered.
“The entire thing was way off and didn’t seem right. … It breathed shadiness from the get-go.”
Workman’s partner, Kaitlynn Fairley, also found the situation unusual. Though it was her first time at Pontiac, Fairley said she was struck that prison health workers “weren’t doing anything” while guards were performing CPR.
“We don’t know anything,” Fairley told State Police, “and nobody in there could tell us what happened.”
She said that the staff was doing a “half job” of suctioning Jenkins’ mouth to open an airway, a crucial task.
Fairley said she took over suctioning. As she was doing so, she told State Police, she noticed five “crinkled up” pieces of what looked like notebook paper lodged in Jenkins’ airway. She removed them and gave them to a prison nurse, then she and Workman wheeled Jenkins to their ambulance and rushed him to St. James Hospital in the town of Pontiac. One guard rode in the ambulance while another followed.
Fairley said that Jenkins was “technically” dead when they arrived at St. James. Nonetheless, doctors tried for about 10 minutes to revive him; they continued CPR, and gave him repeated doses of epinephrine to try to start his heart, all to no avail. A doctor pronounced Jenkins dead at 1:35 p.m., about an hour after the episode at the prison.
Although the Tribune obtained health law privacy waivers from Jenkins’ former wife, who a judge had ruled the administrator of his estate, the Duffy paramedics declined to be interviewed for this article.
Patrick Dowling, the doctor at St. James who led the team that tried to save Jenkins, said that “there was no medical reason” for paper to be in Jenkins’ throat. He could not offer an explanation for why it would have been there, according to the report of his State Police interview.
The day after Jenkins died, an autopsy was performed on his body. The forensic pathologist ruled the cause of death undetermined, according to the autopsy report, saying that it would be essential to know the results of the State Police investigation— interviews, video if available and other possible information — before answering the central question: What had killed Jenkins?
Two hours after the incident, and 45 minutes after Jenkins was pronounced dead, a Pontiac prison official contacted State Police. The State Police Division of Internal Investigation sent at least eight officers to Pontiac that Sunday, and they mostly worked in teams. They did a walk-through of the incident and questioned guards and prison health care workers. They also tried to find the white rag a guard said Jenkins carried, but it was never recovered. Nor were the balls of paper, although the paramedics had given them to a prison nurse, according to records. One agent went to the Duffy headquarters and to St. James to interview paramedics and the doctor and nurses who treated Jenkins.
Agents returned to the prison five days later and interviewed several dozen inmates, but said in their reports that only 16 of the inmates had any useful information about what led to Jenkins’ death.
Later, agents talked to one more inmate who had been transferred to another facility. Kenyate Jackson, who was serving 10 years for an aggravated robbery conviction, had written to an attorney in the Cook County Public Guardian’s office who had represented him when he was a juvenile. He said prison officials were covering up Jenkins’ mistreatment and told the attorney, Kina Arnold, to report the case. Arnold wrote to the state inspector general’s office, which notified State Police.
Jackson told State Police that a number of guards were on top of Jenkins. Asked if Jenkins was cooperating or resisting, he said “a little bit of both.” He said that, at one point, the guards picked up Jenkins and took him to a room where Jackson and other inmates could not see them.
But the guards, in their interviews, said Boland and Deal were professional with the inmates.
“I would say he’s by the book … as far as keeping those guys under control,” one guard said of Deal. And Boland told the State Police that the “inmates are always wanting to fight, it seems.”
Although the interviews with the guards and the inmates offer dramatically opposing accounts of the confrontation with Jenkins, they nonetheless seem revealing — at least about the investigation.
State Police showed a measure of deference to the guards. They were skeptical of inmates’ accounts, and they even seemed to brush off some information the inmates offered. Agents apparently never re-interviewed guards about the information they gathered from their interviews with inmates.
As a result, the guards were not asked about the missing broom some inmates said had stoked tensions the day Jenkins died, or if they had changed rules on what inmates could bring to the yard.
Indeed, the State Police did not seem to probe how the guards tended to treat the inmates.
With the investigation complete, State Police brought the case to the Livingston County state’s attorney’s office, led at the time by Seth Uphoff. Jenkins had died as Uphoff was facing a challenger in the Republican primary, Randy Yedinak. The prison is a big employer in the quiet town of about 12,000, and prison employees and their families and friends make up a large part of the county’s electorate.
Uphoff, now in private practice at a firm in Peoria, declined to comment on the Jenkins case. Yedinak, in an email, said that prosecutors under Uphoff reviewed the State Police report and determined that there was “insufficient evidence upon which to base a successful prosecution.”
Watson, now the county coroner, seemed to provide the only information suggesting Jenkins swallowed the paper intentionally. He said in an interview that there was no record of two guards saying that Jenkins had done so, however, and that no guard at the prison told the investigators that Jenkins put the paper down his own throat.
He said he took notes from his conversation with the guards, but threw them away.
Although the Department of Corrections said it is conducting its own investigation of Jenkins’ death, it is possible that no explanation will be found for how he died with balls of paper blocking his airway.
Indeed, State Police asked one guard if anyone was trying to cover up what happened.
“We’re in a prison,” the guard said. “(Expletive) happens.”