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Colorado Prisoner Dies as Nurse Watches Videotape; $2.45 Million Settlement

by Ed Lyon

In September 2019, the final signature of an Arapahoe County, Colorado official was affixed to a $2.45 million settlement agreement in a civil rights lawsuit over the death of prisoner Jeffrey Scott Lillis. Lillis was 37 years old when he was booked into the Arapahoe County Detention Facility (ACDF) as a pretrial detainee in August 2014.

During the first part of December 2014, Lillis became ill and submitted a written request for medical care. His condition worsened so quickly that he presented himself to the nurse who was dispensing medications in the cellblock the next morning. Seeing his condition, the nurse ordered his transfer to the medical unit for observation. Lillis had a temperature of 102.9; he was coughing, congested, had a sore throat and said he ached all over his body. He received Tylenol, Mucinex and antihistamines. By evening, his temperature had dropped to 102.5 but he was experiencing nausea and diarrhea – symptoms of bacterial pneumonia.

Lillis’ medical records indicated that he also had hepatitis C, a complicating medical condition, yet none of the nurses observing him called a doctor for consultation. Instead, he was given Ibuprofen and Gatorade.

The next day he was coughing up blood and experiencing low blood pressure, accompanied by disorientation and agitation, which are indicative of hypoxia and sepsis as well as pneumonia.

The nurse phoned an on-call physician but told him only that Lillis had “blood-tinged sputum,” omitting the abnormal vital signs, high temperature and other serious symptoms. The doctor prescribed a codeine cough remedy the medical unit did not carry.

On the morning of December 14, 2014 – the last day of Lillis’ life – the nurse added “weakness” to his charted symptoms, along with an elevated pulse rate and low blood pressure, indicating advanced sepsis and that he had become hypovolemic (his heart was unable to pump sufficient blood to his body). He was told to rest and drink fluids. By that evening, Lillis was complaining of “liver pain” and was even more disoriented. The guards could tell his condition was worsening but the nurses would not notify or call a doctor for consultation.

Video footage showed Lillis collapsing on the floor at 7:30 p.m., and a jailer called for a nurse. Instead of immediately attending to Lillis, the responding nurse had the guard rewind the video several times so she could review his fall for 10 minutes. A medical emergency was finally declared at 7:43 p.m. The defibrillator could not be found. When a suction machine – needed to clear the vomit from Lillis’ airway so he could breathe – was finally located and brought to the cell, it was discovered the suction tube and related components were missing.

The coroner determined that Lillis had “very severe pneumonia” and died from “sepsis due to severe lobar pneumonia.” The condition of his lungs indicated that he died an extremely painful death after days of suffering. [See: PLN, Sept. 2018, p.32].

Denver attorney Erica T. Grossman filed a wrongful death suit on behalf of Lillis’ estate and surviving family members. Among the defendants were for-profit medical providers Correct Care Solutions, LLC; Correctional Health Care Companies, LLC; Great Peak Healthcare Services, P.C.; Maxim Healthcare Services, Inc. and Correctional Healthcare Physicians, P.C. The $2.45 million settlement was reached on September 3, 2019. See: Estate of Jeffrey Scott Lillis v. Correct Care Solutions, LLC, U.S.D.C. (D. Col.), Case No. 1:16-cv-03038-KLM. 


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Related legal case

Estate of Jeffrey Scott Lillis v. Correct Care Solutions, LLC