Texas prison system under fire after injured inmate's death

Recently released investigative reports and interviews with investigators and prosecutors provide new details about Cox's death at a Huntsville prison — an incident that prompted state Sen. John Whitmire, D-Houston, to set a hearing in Austin today of the Senate Criminal Justice Committee. Senators plan to examine Cox's treatment, the alleged negligence on the part of medical staff and the state of health care in all Texas prisons.

A medical examiner ruled Cox's death a homicide by "medical neglect complicating blunt force trauma."

Reports from the state Office of Inspector General show that on four occasions prison medical staff did not administer Cox's prescribed medication because he could not get up to receive it. Instead, it was a concerned prison guard who once hand-fed Cox painkillers and another who finally alerted medical supervisors that the 48-year-old convict needed to be transferred to a hospital.

Walker County prosecutors acknowledged to the Chronicle that they twice refused to pursue charges against medical staff, despite state investigators' recommendations

Interviews and reports also suggest that hot-button Texas prison issues, such as the shortage of guards and medical personnel, may have affected Cox's treatment.

Convicted of prison killing

Cox, a Houston man, entered the Texas prison system in 1990, after he was convicted of burglary with intent to commit sexual assault. While in prison, he was convicted of murder in the death of another inmate.

He was incarcerated at the Estelle Unit in Huntsville on Jan. 23 last year when he scuffled with guards as they attempted to return him to his cell after a fumigation. Restrained, with his hands cuffed behind his back, Cox became combative, kicking guards who forced him to the floor. As Cox went down, he hit his head on his metal bunk and locker and began bleeding profusely.

Medical staff, employees of the University of Texas Medical Branch assigned to the prison, examined Cox and decided to transfer him to Huntsville Memorial Hospital. There he received stitches for cuts on his face and a CT scan on his neck and head, but doctors found no fractures. A hospital spokeswoman declined to comment.

Cox was returned to his cell.

Six hours later, Cox "told (a guard) he hurt too bad to get up or move," according to reports. He said he was paralyzed. A guard offered him Tylenol, which Cox could not get up and receive.

A nurse told the guard "that Cox would have to get up and accept the medication if he wanted it," according to investigators' records. "Cox did not receive any medication at that time."

That interaction was repeated three times over the next couple of days, as Cox lay in his own blood and waste on his cell floor, complaining of pain.

One guard, worried that Cox would die if he did not receive medical attention, contacted a supervisor with UTMB at the prison. Within 12 hours, Cox was taken to UTMB's John Sealy Hospital in Galveston, where doctors discovered his spinal fractures.

For the next 11 days, Cox remained at John Sealy, declining until his death, according to reports. The Galveston County medical examiner ruled his death a homicide.

The death prompted an investigation by the Office of Inspector General, an independent agency that monitors prisons, which was completed in July. Inspector General John Moriarty forwarded the case to prosecutors with the recommendation that charges be pursued against five of the medical staff at the Estelle Unit who treated Cox.

"I have the obligation to make sure the rights of the inmates are protected," Moriarty said. "I am the last voice for that person and I believe there was a criminal violation in this horrendous case."

UTMB officials described Cox's case as "unfortunate," not criminal, and said steps are being taken to "ensure that any mistakes made by our people are understood and not repeated," according to Dr. Ben Raimer, who directs the UTMB prison health care system.

Prosecutor Philip Hall, a 14-year veteran assigned to the state's prison prosecution unit, reviewed the file, characterizing a prosecutor's opinion as the "only one that counts." Hall said he found no criminal conduct.

"We had a guy who died under not normal circumstances and (OIG) wanted people charged," Hall said. "But just because the autopsy said medical negligence does not mean there was a crime."

Jurors were satisfied

He consulted with his boss, Gina Debottis , chief of the prison prosecution unit, and Walker County District Attorney David Weeks , who both agreed. The prosecutors said the medical staff's action could be explained by Huntsville Memorial Hospital's conclusion that Cox had no major injuries.

Hall presented the case to a Walker County grand jury in October and recommended that no one be charged. Jurors declined to investigate further. The case appeared closed.

But investigators from the Office of Inspector General appealed to Weeks, asking that he again review the case file and re-evaluate the decision not to pursue charges.

Weeks again declined, saying Cox's case is more emblematic of systemic problems in prisons — guard shortages, funding for medical care — than individual criminal wrongdoing.

"When you look at everything you can see how it happened," Weeks said. "It is a sad situation, but that doesn't make it criminal. I am here to prosecute cases that are valid and this one did not get to that threshold."

About the time Weeks re-examined the case, Cox's brother, also in a state prison, appealed to Whitmire. The senator began investigating and scheduled a hearing of the Senate Criminal Justice Committee for today.

roma.khanna@chron.com