A DKA Death in Jail

Social justice blogs have lit up since word broke of the death of Michael Robinson, who died from apparent severe hyperglycemia after slipping into a coma while in custody in a southeast Missouri county jail on August 23. It is believed that Robinson had diabetes. Robinson is said to have become combative and then incoherent and then unresponsive, symptoms that would have been easily recognizable by health care workers who know diabetes.

Robinson Family members have alleged publicly that despite urgings that the man be given his daily insulin intake while in jail, he was confined without access to his medication or to medical attention. There is not yet an official confirmation of death from diabetic ketoacidosis (DKA), but that is, from the circumstances, suspected. Contributors to posts on two family member’s social media pages and a newly-launched crowdfunding page allude to a blood glucose level exceeding 2,000 mg/dL at time of hospitalization. It’s not yet clear whether Mr. Robinson died while in the jail, or in transit to one of two hospitals, or after arrival.

There are conflicting accounts, one of the man’s refusal or inability to sign a consent form to receive treatment, and another of refusal by correctional personnel to see the man’s agitated state, and pleas from family members, as something other than a subterfuge to obtain his release. The postings have been going up at a remarkable pace reflecting grief and outrage – questioning how someone could be allowed to die from a treatable medical condition while being held on what amounted to a non-criminal warrant in a domestic relations matter. A newly created “Justice for Michael Robinson” Facebook page had collected more than 1,700 closed group members by August 26.

The municipal police department that arrested Robinson has its own social media presence, as has become a widespread practice among law enforcement agencies in support of their community policing efforts. The police department’s Facebook page has a brief two-item entry from its log for the days of August 13th and 14th, one identifying Michael Robinson and reporting his transport to a county facility to await bond. The log notes the arrest at 12:37 in the morning. The department’s Facebook post has drawn numerous replies, some evidencing anger and some sadness and some critical of the way Mr. Robinson’s condition was handled at the jail.

While there is no shortage of emotion surrounding this case, hard facts are scarce, but that may change in the near future. Pemiscot County Sheriff Thomas Greenwall said on his LinkedIn page that he has turned the matter over to the state police for investigation. Insulin Nation spoke with Highway Patrol Sergeant Clark Parrot, a Troop E informations officer for the Pemiscot County area; Sergeant Parrot was unable to offer an official comment due to the ongoing nature of the investigation. He was able to say, nevertheless, that he expected it would take three to five weeks to complete the investigation and issue a report to the county prosecutor.

This is not the only recent incident of a possible DKA death during incarceration in the news. As this article goes to press, the New York Daily News is reporting on an investigation into the death of a Rikers Island detainee in August 2013, whose DKA symptoms were mistaken by guards as heroin withdrawal.

Whatever the facts in Robinson’s case, such reports point to the need to better train law enforcement personnel about the symptoms of hyperglycemia and hypoglycemia. A pilot program in the U.K. that provided first responders rudimentary training on hypoglycemia showed real benefits to the health outcomes of people with diabetes.

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Jim Cahill is a former staff writer for Insulin Nation and a former editor of Type 2 nation.

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