Tom Conklin

Tom Conklin is a field investigator with the Office of the Medical Investigator.

Ruben Toledo – Cibola County Detention Center (jail death) — 7-1-2017

 

Summary

After a federal park ranger arrested him on a charge of drunk driving on June 21, Ruben Toledo, of Albuquerque, was transferred to the Cibola County Detention Center, where he proceeded to go through alcohol withdrawals, according to court documents.

Allegedly denied adequate medical care, he became so weak he could not walk but, after suffering at least one seizure, a nurse directed he be put into a shower on June 24. Guards carried him there, where he slumped over, before calling for emergency medical attention. When emergency staff arrived, they began CPR and Toledo was transferred to the Cibola hospital, and then to the University of New Mexico Hospital because his condition was so bad. He was taken off of life support on July 1, 2017. He never regained consciousness after he left the jail, according to a lawsuit complaint, filed Aug. 8, 2019.

Federal District Judge Kenneth Gonzales dismissed one count of the lawsuit filed against nurse Michael Hildenbrant and physician’s assistant Michelle Lucero, for violation of due process rights for inadequate medical care, on the grounds they are entitled to qualified immunity, in an order dated Sept. 2, 2020.

Read stories about the case or see the case documents on Google Drive or Document Cloud

Contents

 

Initial arrest

On June 20, 2017, U.S. Park Ranger Steven Powers arrested Ruben Toledo, 42, on charges of DUI, possession of alcohol in a vehicle and possession of a controlled substance.

Petroglyph National Monument, Albuquerque, NM. Photo by Mike Tungate/Flickr. CC-BY-ND

Powers wrote in an affidavit for a criminal complaint that he pulled up to Toledo’s truck, in the parking lot of the Petroglyph National Monument, because it was near closing time. Toledo appeared to be drunk and there were two open beers on the floorboard. Another unnamed person was also in the truck.

After conducting a field sobriety test, followed by a breath test, Powers arrested Toledo. The breath test came back at 0.27. During a search of the truck, Powers found marijuana, he wrote.

After taking him to a Albuquerque Police Department substation, Toledo’s blood-alcohol content came back as between 0.23 and 0.20, he wrote.

He was booked into the Sandoval County jail, Powers wrote.

Held without bail

On June 21, Toledo was also brought into court, in front of Magistrate Judge Kirtan Khalsa, for an initial appearance. Prosecutor Nicholas Ganjei, with the U.S. Attorney’s Office, moved for Toledo to be held without bail. Toledo had no attorney and Khalsa ordered him held without bail. The entire hearing lasted for five minutes, according to a minutes sheet.

It is not clear if this was before or after he was transferred from the Sandoval County Detention Center to the Cibola County Detention Center.

A preliminary detention hearing was supposed to be set for the next day, June 22, but there are no more docket entries after those for June 21, which included a notice of an oral detention order issued by Khalsa and the appoint of Christopher Lucero as Toledo’s attorney.

Although the docket does not reflect when it was edited, Toledo was “terminated” as a part to the case on June 23.

Nothing else exists on the docket, even though Toledo would remain in the state’s custody until his death 10 days later at the University of New Mexico Hospital in Albuquerque, after being taken off life support.

Lawsuit against Cibola County Detention Center

On June 20, 2019, Toledo’s wife, Natalia Antonio, filed a lawsuit through attorney Alyssa Quijano against the Cibola County, warden Adrianne Jaramillo, nurse Michael Hildenbrant, Sgt. Lisa Burnside and physician’s assistant Michelle Lucero, for Toledo’s wrongful death. The following is from the amended complaint filed on Aug. 8, 2019.

June 21

Toledo was “quickly transferred” from the Sandoval County Detention Center to the Cibola County Detention Center the day following his arrest, June 21, 2017, attorney Alyssa Quijano wrote in an amended complaint against the Cibola County Detention Center for Toledo’s wrongful death.

“When Ruben arrived at the facility, he told staff he suffered from depression and anxiety, and staff noted that he was chemically impaired,” she wrote.

Toledo said he had been drinking the day prior to being booked and his vital signs were abnormal — his blood pressure was 169/94, his pulse was 100 beats per minute and he had a glucose level of 161. Jail staff cleared him to be housed in general population, Quijano wrote.

Toledo remained in the general population for two days and he began to suffer from alcohol withdrawal, she wrote.

As in Toledo’s case, alcohol withdrawal is often be deadly. (At least three cases currently in the jail death database were from alcohol withdrawal, although this is incomplete and many autopsy reports are pending or have not been requested yet).

Toledo asked to be moved out of the general population because he feared he was in danger from other inmates attacking him and he was beginning to have hallucinations, a symptom of severe alcohol withdrawal, also known as delirium tremens, Quijano wrote.

June 23

On June 23, two days after he had been transferred to the Cibola County Detention Center, Physician’s Assistant Michelle Lucero saw him. He reported is daily alcohol use before being booked and she found his blood pressure and pulse were elevated, she wrote.

Lucero found that Toledo was a “difficult historian” with a “poor memory” and he has a “knowledge deficit.”

“Despite obvious signs and symptoms of alcohol withdrawal, Defendant Lucero failed to provide any treatment for his withdrawal,” Quijano wrote. “Instead, Defendant Lucero ordered Mr. Toledo be given Lisinopril, a blood pressure medication, and Metformin, a medication used to treat diabetes. Ruben was sent back to his cell with no further care or monitoring ordered.”

Later that day, Toledo called the master control room, screaming, to be let out of his cell, as he had been hallucinating. When guards opened his door, he tried to get out. Guards handcuffed him and brought him to the medical unit. There, he told staff he was experiencing alcohol withdrawal and was hallucinating, she wrote.

The medical staff called nurse Michael Hildenbrant, who does not have prescribing authority and was not at the facility, said to put him on their alcohol withdrawal “protocol,” which included prescription medications. He should have been hospitalized, she wrote.

Quijano wrote, “When this medication was prescribed, Ruben’s vitals were still abnormal, with a blood pressure of 179/100 and a pulse of 120 beats per minute. Until this point, Ruben had not been monitored for his withdrawal. In light of his severe symptoms of withdrawal, Ruben should have been hospitalized. Instead, Ruben was sent to segregation.”

Hildenbrant prescribed Librium (Chlordiazepoxide) and clonidine. However, his condition had so deteriorated that the Librium “amounted to no care at all,” Quijano wrote.

While in segregation, Toledo was to be periodically monitored by jail guards, but not by medical staff. He continued to act strangely, including weeping in his cell, chanting and wrapping himself in toilet paper.

“Despite this, Ruben received no medical attention in response to his erratic behavior,” Quijano said.

Later that evening, presumably June 23, medical assistant Rayleen Ray went to his cell to give him his medication. He was lying on the ground. He refused to take his medication and eventually agreed, but only if he could take it standing up, she wrote.

Toledo’s condition was so bad that he could not stand up on his own and guards had to help him to his feet. He was still not provided any medical care, she wrote.

A few hours later, Ray went to check on Ruben and looked at him through the food port. She told the segregation guard to alert if if things were not “looking good,” Quijano wrote.

June 24

The next morning, Toledo had an alcohol-induced seizure. Sgt. Lisa Burnside was called to Toledo’s cell and looked at him through the food port. He was on the floor, seizing, Quijano wrote.

Officers entered the cell and once he stopped, Burnside asked if he was OK. Toledo looked at her but he could not speak. She saw dried blood on his forehead an indication that he suffered a head injury while in his cell, likely from a seizure, she wrote.

“Rather than call 911, Defendant Burnside directed officers to take Ruben to the shower to clean up,” Quijano wrote.

Burnside went to find Toledo a new, clean cell, she wrote.

“Ruben needed a hospital, not a new cell,” Quijano wrote.

Toledo was so weak that he could not walk on his own. Guards carried him to the shower, Quijano, wrote.

“When officers got him to the shower, Ruben was unable to stand on his own, so he was placed on the ground,” she wrote. “Ruben slumped over on the ground and became unresponsive.”

The guards did not call for medical staff, 911 or other emergency medical services. Instead, they tried to lift Toledo into a chair, before “eventually” calling for medical staff.

“When they arrived, medical staff directed officers to call 911 and begin CPR,” Quijano wrote.

Once he left the jail, he would never regain consciousness, she wrote.

Toledo was transported to the Cibola General Hospital. When he arrived, he was unresponsive. Blood work showed his sodium levels were “critically high” and his carbon dioxide levels were “critically low,” she wrote.

“Medical staff also noted Ruben suffered significant bruising,” Quijano wrote.

He was also extremely dehydrated. His condition was so severe that they were not able to treat him and he was transferred to the University of New Mexico Hospital, she wrote.

Toledo remained on life support until July 1, 2017. Soon after he was taken off, he was pronounced dead. The county closed the jail three weeks later, she wrote.

Deprivation of civil rights

Quijano sued Lucero, Burnside and Hildenbrant for violation of Toledo’s due process rights through inadequate medical care and wrote that if Toledo received the medical attention he needed as he experienced alcohol withdrawal, he would have survived.

District Judge Kenneth Gonzales dismissed count one of the lawsuit filed against Hildenbrant and Lucero on the grounds they are entitled to qualified immunity.

“Defendants knew they were incapable of providing adequate medical care at CCDC,” Quijano wrote. “Defendants failed to obtain medical care until Ruben was slumped over and unresponsive. Ruben never regained consciousness after this.”

Cibola County, Lucero, Burnside and Hildenbrant are also being sued for negligent maintenance of a medical facility and negligent provision of medical care.

“Defendants routinely provided substandard care, or no care at all, to inmates in their facility,” Quijano wrote. “Upon information and belief, Defendants do not transport inmates to the emergency room to avoid costs of treatment.”

Quijano also lodged one count of a custom and policy of violating constitutional rights against warden Adrianna Jaramillo, alleging that during her tenure and that of her predecessors, the jail provided inadequate medical care to inmates.

She cited the case of Douglas Edmisten, who died in the jail in 2016 from internal bleeding. His family filed a wrongful death lawsuit and it settled for $5 million.

A motion to dismiss filed by the county is pending.

Autopsy report

Office of the Medical Investigator pathologist Matthew Cain wrote, in a heavily redacted autopsy report, that based on the evidence presented to him, Toledo died from chronic alcohol abuse and he had “significant liver disease” and alcoholics are at risk for “metabolic abnormalities” and withdrawal complications.

Despite evidence of alcohol withdrawal in the lawsuit, it is not mentioned in the autopsy report, except as a perfunctory note in the summary and opinion that it can cause seizures and death. Neither Cain’s report nor the deputy field investigation by Tom Conklin makes mention of the seizures Toledo suffered, as noted in the wrongful death lawsuit, although it is unclear what was redacted.

Cain wrote that Toledo had no evidence of “significant” injury. However, in the evidence of injuries section of the autopsy report, he listed three wounds on Toledo:

  • A blunt head injury. “Healing laceration on forehead”
  • On the chest: “Faint, black, 7 cm contusion on left side of chest”
  • On the extremities: “Abrasions on left knee.”

Toledo suffered a head wound seven days before he died, Quijana wrote in the lawsuit complaint.

The narrative of the deputy field investigation, by Tom Conklin, is redacted except for two-and-a-half sentences. It makes no mention of seizures or Toledo’s fall:

“Seth advised that the decedent had been incarcerated in the Cibola County Detention Center. The decedent was found shaking on the shower floor. He became unresponsive and bystander (REDACTED).”

The narrative outlined in the lawsuit compares starkly with the outline Cain and Conklin noted in the autopsy report and the deputy field investigation.

In the field investigation, Conklin wrote Toledo was “found shaking on the shower floor.” What happened next is redacted.

In Cain’s summary and opinion, he used the same sentence, that Toledo was “found shaking on the shower floor.” Again, what happened next is redacted.

That compares starkly with the lawsuit allegations, that guards carried Toledo into the shower and he slumped over. Guards then lifted Toledo into a chair and eventually called for medical help, according to the lawsuit.

Neither Cain’s autopsy report not Conklin’s field investigation mention that Toledo was taken to a local hospital, and then to the University of New Mexico hospital, after he lost consciousness at the jail.

Both documents also do not mention that Toledo died after being taken off of life support.

Read stories about the case or see the case documents on Google Drive or Document Cloud