Seeking Blame in Morgan Angerbauer’s DKA Death

The fault may lie in the private prison system.



Last year, Morgan Angerbauer, who had Type 1 diabetes, died from diabetic ketoacidosis in jail; her death came hours after she pleaded with a jail nurse to treat her and some time after she grew unresponsive and slipped into a coma. Her death brought about the arrest of a licensed vocational nurse (LVN) responsible for Morgan’s medical care and a civil action against the nurse and her employer, a privately-operated detention facility in Texarkana.
Morgan Angerbauer was being held after a Miller County, Arkansas sheriff arrested her on a violation of a November 2014 appearance bond in an Arkansas state drug possession case. Morgan had been diagnosed with Type 1 diabetes as a child and she was struggling with addiction when she died.


The civil complaint filed in the U.S. District Court (Eastern District of Texas) on September 9 alleges that although LVN Britney Johnson did respond to several of Angerbauer’s requests for blood testing and insulin administration earlier in the day, in the hours leading up to Angerbauer’s death Johnson had decided that she was authorized to test blood and administer insulin at her discretion. It also alleges that Johnson administered glucose to an unresponsive diabetic patient. The video of Angerbauer’s death shows that there were no jail employees present during attempts to revive Morgan Angerbauer other than Johnson and uniformed officers, one of whom was operating a video camera.

The complaint claims civil rights violations, as Johnson might have been acting in a way that exceeded her authority when she decided to independently make treatment decisions, and this may give rise to criminal culpability as well as civil liability, and lack of due care leading to wrongful death. At publication time, the complaint has yet to be responded to by multiple defendants, who include John Doe and Jane Doe employees of LaSalle, whose identities are yet to be determined. The lawyer representing Morgan Angerbauer’s surviving parents has obtained an order allowing additional time to serve the complaint. In a brief filed with the court in support of the extension of time, it’s stated that the nurse who refused Morgan’s pleas to have her blood sugar levels tested, and who had administered glucose after Morgan had become comatose, had fled the jurisdiction “due to public backlash against her stemming from the death of Ms.Angerbauer.”


Southwestern Correctional LLC, operator of the Bi-State Jail and the Bowie County Correctional Center where Angerbauer died, is one of several affiliated closely-held business entities domiciled in Texas, Louisiana, and Georgia, doing business under the name Lasalle Corrections, and is ultimately controlled by two families from Ruston, Louisiana, according to public records of multiple states.

Here is what LaSalle says on its website about its health care services for individuals incarcerated at its facilities:

Professional, quality, and cost-effective medical care can be a challenge in the corrections industry environment. LaSalle Corrections’ managed facilities and healthcare personnel provide the critical resources to treat the diversity of medical needs of inmates in a secure setting. We employ and contract with experienced physicians, nurses, and other medical professionals to provide care tailored for inmates. Our staff understands the importance of maintaining proper documentation of medical records that is critical for effective treatments. Constant and clear communication with inmates and amongst the staff are essential for an efficient healthcare delivery system. Managing costs and monitoring effective medical care can be daunting, but LaSalle can help you successfully provide inmate healthcare.

Over the past two decades, the privatization of detention and penal facilities, once expressly prohibited by law, has become accepted practice. Experts in criminology, members of the criminal defense bar, law professors, law review writers, and civil rights advocates agree that this evolution in public policy comes mainly from the 1984 mandate for fixed federal sentencing requirements and state legislators’ desire to hold down taxpayer expense. Because private sector businesses often achieve, or at least are perceived as achieving, economic efficiencies, many turned to private prison services for the swelling number of incarcerated.

Too often, there is a gulf separating public management of an institution by the federal Bureau of Prisons and private prison management by an executive group appointed by stakeholders in a profit-making business. Mike Tartaglia of The Sixth Amendment Center, an advocacy organization for the incarcerated, authored a lengthy law review research note addressing the corrections privatization phenomenon. On the subject of inmate health care, he pointed out that medical care “comprises a substantial percentage of a prison’s budget and can impact prisoners’ rights even more directly than staffing issues.” As illustration, he describes the experience of an Arizona facility housing convicts with complex medical problems. After twice contracting out medical services and still seeing spikes in death, it was discovered that those housed in the facility may have endured “years of mismanaging chronic conditions.”

A memorandum issued by Deputy U.S. Attorney General Sally Q. Yates last August to the Bureau of Prisons, made the argument that privately operated institutions had not saved substantially on costs. The memorandum also cited a DOJ Inspector General’s report that found the practice hadn’t maintained the same level of safety and security as the government’s facilities were capable of maintaining.

LaSalle, a Louisiana real estate development and property management company with long experience building and managing long-term care homes, entered the jail and correctional facility business in 1997, according to a February 2013 story in Prison Legal News. That part of its business has grown since then to employ more than 1,250 people and to operate eighteen facilities in Louisiana, Georgia, and Texas with a total capacity of 13,000 inmates.

A review of the operating officer biographies posted on LaSalle’s website shows that the men and women responsible for management of its facilities have substantial law enforcement and correctional backgrounds. Among them are wardens, health service professionals, and administrators with dozens of years of service in state and federal jail and prison facilities. In Angerbauer’s case, however, it appears certain that a supervisory failure, and a lack of crucially necessary medical training and skill, contributed to her death.

Insulin_Nation_Seeking_Blame_in_Morgan_Angerbauers_DKA_Death_350pxA job posting for a correctional officer on LaSalle’s website for the Bowie County facility where Morgan died notes that an applicant must be a U.S. citizen with no history of felony charges, and that those hired had one year to complete the requirements to obtain a Texas Commission on Law Enforcement Jailer’s License, but it also states that the job “[r]equires zero experience as a correctional officer.” The proficiency charts published by the commission do not discuss a requirement for training in recognizing a medical emergency.

The Texas Nursing Practice Act establishes the licensed vocational nurse (LVN) designation for those practitioners who have attained training and competency below that of a registered or graduate nurse. Under regulations promulgated by the Texas Board of Nursing, an LVN must work under the direct supervision of a registered nurse, physician’s assistant, or physician. The LVN’s scope of practice is limited to patient record keeping, participation in forming care plans for individual patients, and “assisting in the evaluation of the client’s responses to nursing interventions and the identification of client needs.” Customarily, LVNs staff industrial health and first aid offices, hospitals, and schools, but they are not empowered to exercise independent judgement in treating patients. In Texas, the minimum educational requirement for an LVN is an accumulation of two academic years in classroom and clinical study. There is no degree requirement.

The private prison industry has been on the defensive as prison populations have declined in recent years and there have been multiple public allegations against substandard treatment in private prisons, according to a Bloomberg report. In August 2016, the U.S. Department of Justice said it would stop contracting with private prisons to house federal inmates. However, stock prices in private prison companies surged after Donald Trump’s electoral college victory, as Mr. Trump has shown a higher comfort level than Obama with privatized contracts for public services.

In the months ahead, we will continue to track the court cases against Angerbauer’s jailers.

If you have a story to share of Type 1 diabetes care in the jail or prison systems, please email our editor at cidlebrook@epscomm.com. Anonymity can be protected for some sources.

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Jim Cahill is a senior writer for Insulin Nation and Type 2 Nation. Before turning to writing, he was a lawyer in government and private practice who focused on consumer protection and regulatory law. He can be contacted at jcahill@epscomm.com.