'Time is brain tissue'
Like a heart attack, ischemic stroke is a medical catastrophe that stalks the adult population of the United States. Accounting for roughly 9 in 10 strokes, according to the American Stroke Association — hemorrhagic stroke, involving bleeding within the brain, is far less common — an ischemic stroke occurs when a clot blocks a vessel that carries blood to the brain.
Prompt treatment is key. Kelly Cullen, director of patient care services at Mease Dunedin Hospital, said the most effective treatment — a "clot buster" drug injected into the bloodstream that dissolves the obstruction to the brain — can be used with success for up to four and a half hours after the onset of a stroke.
After that, treatment can still be applied for another several hours, albeit with a lower success rate. Beyond eight hours, Cullen said, a stroke has usually caused irreversible damage to the parts of the brain where blood flow was blocked.
"When you're having a stroke, time is brain tissue," Cullen said. "The earliest intervention that you can do for a stroke has the best outcome for a patient."
Health professionals are taught to watch for a recognizable cluster of symptoms caused by loss of blood to the brain during ischemic strokes — notably impaired speech, confusion and weakness or lack of coordination on one side of the body.
When he was jailed on May 11, Hicks was showing at least several of these signs.
Surveillance video provided by the Sheriff's Office in response to a request from the Times shows Hicks' inert left leg was dragging from the wheelchair deputies used to move him into the jail. According to his estate's lawsuit, he was unable to wield a pen to sign intake forms.
A Sheriff's Office internal review later found Hicks was put in a holding cell without a medical screening, despite the presence of three nurses who stood watching him. One nurse, the investigation states, "apparently determined … that Hicks was feigning injury and could walk."
Jail surveillance video shows Hicks lying on the floor of the cell, face-down and mostly motionless. From time to time his right limbs twitched, or he tried to crawl forward using only the right side of his body.
Hours passed. At 3:25 p.m. he received his first medical assessment, according to the internal review. Armor personnel did not diagnose his stroke, but suggested he be monitored as a psychiatric patient. In conversations with jail personnel, Hicks attributed his lack of mobility to chronic back problems.
At about 5:30 p.m. he was transferred to the Falkenburg Road Jail, where deputies checked on him every 15 minutes. Not until 12:10 p.m. on May 12, a full day after he was booked, did he finally receive a psychiatric evaluation by a social worker.
"The employee noted that (Hicks) could not engage, smelled of urine, and complained of incontinence, and indicated that he could not use his legs or walk," the lawsuit states. "His behavior was inappropriate, he had decreased psyc****tor activity" and was "delusional with a poor memory."
It was not until later that night that Armor employees began to come to terms with Hicks' serious condition. According to the Sheriff's Office review, medical notes indicate Hicks was found "lying in urine in the cell."
At 10:24 p.m., the review states, a nurse who examined him concluded he "displayed symptoms of a potential stroke." But two more hours passed as Armor health workers continued to assess Hicks and debate the right course of action.
He was finally transported to Tampa General Hospital at 12:20 a.m. on May 13, according to the sheriff's investigation.
It had been 35 hours and 57 minutes since Hicks was booked into the Orient Road Jail.
Internal review
At the hospital, the lawsuit states, he "was diagnosed as having suffered a subacute ischemic stroke, which he had been suffering from for a considerable length of time … he had suffered severe brain damage and it was too late to administer the appropriate treatment."
According to an internal memo on the legal settlement by Thea Clark, an attorney for the Sheriff's Office, an unidentified neurosurgeon who treated Hicks at Tampa General was "extremely critical of the medical care provided by Armor, as well as Armor and HCSO's delay in transferring Mr. Hicks to the hospital."
It is unclear exactly when Hicks' stroke began, though the circumstances of his arrest suggest its onset could have occurred while he was driving his car the morning of May 11. But the outcome is not in question: Hicks entered a coma and died from the stroke and related complications on Aug. 7.
In an internal memo dated July 19, 2012, Hillsborough sheriff's Col. James Previtera presented the findings of the agency's internal review of the jail's handling of Hicks.
Previtera wrote that "there is basis for immediate retraining related to the signs and symptoms of specific medical conditions, especially those subtle indicators of stroke."
He also removed the jail security clearance of an Armor administrator and his assistant, citing "improper handling" of Hicks' medical records and "conflicting statements about the existence of the records."
The Sheriff's Office stopped short of a broader rupture with the Miami-based company, which according to its website provides medical services at jails in Florida and four other states. Armor still handles inmates' care in Hillsborough County.
The terms of the firm's contract with the Sheriff's Office allow for a base pay rate ranging from roughly $53,000 to $60,000 per day, depending on the size of the jail population.
Previtera wrote in his memo that he had been in touch with Armor CEO Bruce Teal to express "extreme dismay with the manner in which his staff assessed and treated Mr. Hicks. The matter is the subject of continued internal review by Armor and corrective action is expected."
Meanwhile, Clark's internal memo on the case suggested the settlement with Hicks' heirs, while sizable, was in the best interests of the Sheriff's Office.
"There is no doubt in my mind," she wrote, "that if plaintiff's claims were presented to a jury, plaintiff would receive a judgment against HCSO in amounts that far exceed $200,000."
Timeline
Nearly 36 hours before getting help
May 11, 2012, 8:30-9 a.m.: The Florida Highway Patrol, Hillsborough County Sheriff's Office and Hillsborough County Fire Rescue make contact with Allen Daniel Hicks Sr. after passers-by report that he is swerving into a guardrail on Interstate 275 north of Bearss Avenue.
12:23 p.m.: His left leg dragging from a wheelchair, Hicks is booked into the Orient Road Jail and placed in a holding cell, where he lies facedown on the floor.
3:25 p.m.: Hicks receives his first medical assessment by Armor Correctional Health Services personnel. Stroke is not diagnosed, but a psychiatric evaluation is recommended.
5:24 p.m.: Hicks is transferred to the Falkenburg Road Jail.
May 12, 12:10 p.m.: Hicks is given a psychiatric evaluation by a social worker.
10:24 p.m.: A nurse examines Hicks and concludes he displays "symptoms of a potential stroke."
10:42 p.m.: Hicks is removed from his cell, where he is found lying in a pool of urine, and taken to the jail infirmary.
May 13, 12:20 a.m.: Hicks is transported to Tampa General Hospital and diagnosed with ischemic stroke. A neurosurgeon at the facility says he has suffered severe brain damage. The doctor is "extremely critical" of the care Hicks received in jail.
Aug. 7, 2012: After slipping into a coma, Hicks dies of his stroke and related complications.
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Originally Posted by David Jamieson
