MOORHEAD, Minn. — Abby Rudolph reeked so badly when she spoke to her mother at the Clay County jail in November 2016, she worried she could be smelled through the glass partition.
As the teenager withdrew from opioids, she told her mother she couldn’t control her bowels. She was puking so much they wouldn’t let her stay with the other inmates. She was segregated in a locked cell with vomit all over her, she said.
“I don’t want to go back there,” she pleaded with her mom.
Two days later, Rudolph was dead.
An investigation into Rudolph’s death by the Minnesota Department of Corrections, which licenses county jails, found only one minor infraction that likely had nothing to do with the teen’s death. Otherwise, the investigator wrote to the Clay County sheriff, “Your staff appear to have been very compassionate and treated Ms. Rudolph very professionally.”
But KARE 11 found evidence her care was anything but compassionate and professional.
After reviewing hundreds of pages of court records and hours of jail surveillance video in the Rudolph case, KARE 11 found the teenager was left untreated for drug withdrawal – lying on a cell floor for hours unable to control her vomiting or diarrhea.
Experts say Rudolph’s death likely could have been prevented had she been provided treatment for her withdrawal symptoms.
In only four days at the jail, she lost 17 pounds – nearly 13% of her body weight.
“She was begging, begging for help and there was no compassion given to her. There was no respect for her basic human needs and what happened was wrong,” said Colin Peterson, an attorney representing the family in a federal lawsuit.
The Department of Corrections, which licenses and inspects jails, reviewed Rudolph's death and told Clay County that its staff “appeared to take appropriate action” with Rudolph.
However, KARE 11 has found that the DOC’s death investigations are routinely flawed and often toothless.
Since that report was broadcast, the man in charge of the jail inspection unit stepped down.
National guidelines not followed
National guidelines say to avoid needless suffering and even death, inmates going through withdrawal should be treated with effective medication.
But records show Rudolph was never given any medication – nor intravenous fluids to help make up for her persistent vomiting and diarrhea.
If jails have appropriate treatment and protocols in place, withdrawal-related deaths, “should be basically non-existent,” said Dr. Kevin Fiscella, an addiction specialist who sits on the board of the National Commission on Correctional Health Care.
Any inmate death from withdrawal, “is a needless event. It is a preventable event,” he said.
Clay County declined to comment on the case, citing the open lawsuit. In court filings, the county defended its care of Rudolph, reiterating that its personnel treated Rudolph with compassion, citing the DOC’s finding.
The county deflected much of the blame for Rudolph’s death onto the jail’s for-profit health care provider, MEnD Correctional Care, which the family also sued. The county argued that all decisions concerning her medical treatment “were the sole responsibility of qualified MEnD personnel.”
Despite that, four years after Rudolph’s death, the county still uses MEnD to provide health care for its inmates, and since 2014 has paid the company more than $1.7 million, records show.
MEnD settled with the Rudolph family for an undisclosed amount in May 2019. The company’s president and CEO, Todd Leonard, did not respond to a request for comment.
However, deposition transcripts from the lawsuit show MeND staff pointing the finger back at the guards for not telling them just how sick Rudolph was.
From shoplifting arrest to death
Abby Rudolph’s story of addiction is a familiar one. Raised in a white-collar family, she was bright and energetic, said her brother Jack. Creative and artistic, she wanted to go to college to develop those talents.
But her family says she broke her hip in high school and became addicted to opioids. When those drugs weren’t enough, she turned to heroin.
On Oct. 30, 2016, she was caught shoplifting at a Moorhead Menard’s and booked into the Clay County jail.
At the time, she did not tell any of the guards or medical staff she was withdrawing.
But by the next night her fellow inmates were already worried about her.
“She was up all night yelling and thrashing in her sleep,” two inmates wrote in a note to a guard. “She has said she feels too weak to stand and feels hot and faint.”
The note said Abby had told them she was “withdrawing from heroin.”
“All of us in the female block feel she needs to be monitored for her own good.”
She was moved into a holding cell, where at one point a guard saw her sleeping next to vomit on the floor. Given that she was coming down from drugs, “this wasn’t too unusual of a behavior to notice,” the guard later wrote in a report. The guard mentioned the vomit to a team leader, but neither sought to get Rudolph help.
The next day her mother, Jill, came to the jail to visit.
Abby couldn’t hold down food by that point. She told her mom she was sick, left in a room with her own vomit.
She begged to go home.
Her mother told her no, not this time. The family was broke and couldn’t afford to post bail. And besides, she told her, she had been a bad mother to her daughter all her life.
“I have to raise you to be able to take care of yourself, and I have not done that.”
“You think you’re a bad mom. You’re not.”
“No, all I’ve protected you from all of the problems. … you’ve never faced reality.”
“I am now,” Abby replied.
“I love you,” Jill told her. “I’ve got to go. I do love you. Do you doubt that? I love you more than anything.”
She would not see her daughter alive again.
After returning to her cell, a MEnD nurse requested a drug test be done on Rudolph. The guard who went to give Rudolph the test later described what she saw as “various bodily fluids throughout the cell and had a bad smell.”
Rudolph fessed up: she was coming down from drugs, she told the guard. She let the guard know that she was so sick that she puked several times and missed the toilet. Before she could do a drug test, she’d need a new change of underwear, she said.
The guard left her cell and returned with a clean jumpsuit, the drug test, and something else: a bucket to clean up her cell.
As Rudolph began cleaning her cell, the MEnD nurse got the drug test results back, showing she was positive for opioids along with meth, THC and amphetamines.
Now there could be no doubt that Rudolph was withdrawing and needed help. The nurse ordered a liquid diet, but no medication for her.
Rudolph only got sicker throughout the day. By that night, Rudolph was talking to herself. Guards moved her to another cell, this one with 24/7 video monitoring. There, she was also to be checked on in person at least every 15 minutes and her condition logged on seclusion sheets.
The guards were diligent in their checks, dutifully marking her condition as “OK” on the dozens of times they peered into her cell.
In reality, her condition was deteriorating. Video showed her vomiting over and over during the night. But none of that was documented on the seclusion sheets.
At one point, a guard would later report that Rudolph tried to get his attention late Nov. 1. He saw vomit in her toilet and that she was lying on a mat on the floor next to it. That wasn’t noted in the jail log either.
The MEnD nurse would later say in court depositions that because the guards never documented Rudolph’s vomiting on the seclusion sheets, she didn’t know how sick the teenager truly was.
By 9 a.m. on November 2, Rudolph had soiled her clothes and bedding. After being taken for a shower, she again went to see the MEnD nurse, who for the first time gave her a drug withdrawal assessment. If Rudolph scored high enough, the nurse would have been required to contact a doctor.
But it would be another missed opportunity. She was scored too low.
The nurse noted that Rudolph was “starry-eyed” but “alert and oriented.” Yet the nurse also wrote in her notes that she “encouraged (Rudolph) to use toilet in cell instead of being incontinent on floor. Inmate states she did not realize what she was doing.”
She was sent back to her cell, again without any treatment.
Guards continued their 15-minute checks, each time marking her as “OK.” There is only one mention of vomit, a guard noting “gave water, new vomit bag.”
Abby’s last day alive
In the early morning hours of November 3, her vomiting continued. A review of jail video found she used a vomit bag eight times between midnight and 7 a.m.
A steady stream of guards walked in and out of her cell that morning, bringing her new dixie cups and replacing her vomit bag as she got worse. By noon, a guard noticed Rudolph had a “catatonic look” on her face, just gazing at the wall. The guard thought she “seemed out of it.
Still, it would still be nearly two hours – approximately 1:45 that afternoon – before a guard asked the nurse whether Rudolph was on medication for her withdrawals.
That prompted the nurse to again give Rudolph a chemical assessment, this time scoring her high enough that a doctor should have been contacted.
But a doctor would never weigh in.
Before calling the doctor, the nurse and a guard took Rudolph to the shower. She needed help walking there, and once inside, could no longer stand. Her body began to jerk and seize.
Paramedics quickly arrived and put her in the back of an ambulance. But they would never make it out of the jail parking lot. She stopped breathing. As they tried to save her life, she again vomited. Less than an hour after she was taken to the shower, she was pronounced dead.
A mother’s questions
Fargo police first told Rudolph’s mother, Jill, about her daughter’s death. Distraught, in tears, she called a Clay County detective trying to understand how that could have happened.
“She became ill today while she was in the jail,” the detective told her. He said an ambulance was called, but they couldn’t resuscitate her.
“She was sick, and no one helped her?” she asked.
“She was sick, and she became sick in the jail,” the detective responded. “Her condition deteriorated to the point where they were unable to revive her.”
“Why wasn’t help called earlier?”
“They did. They called right away.”
“You had just stated that her condition deteriorated. So why wasn’t someone called? I was there the other day and she was sick as could be.”
An autopsy conducted by the Ramsey County Medical Examiner concluded that Rudolph died of natural causes from acute bronchopneumonia, stopping the criminal investigation into the case.
Experts at the Centers for Disease Control were also consulted. Their pathology report indicated bronchopneumonia, but added an additional factor – “with aspiration.”
“That means somebody is vomiting and as they’re vomiting and coughing the vomit goes down their windpipe and gets into their lungs,” Dr. Kevin Fiscella of the National Commission on Correctional Health Care explained.
As part of the Rudolph family’s lawsuit, their attorney sent the medical files to an additional pathologist for review. Dr. Mary Ann Sens concluded Rudolph died from complications of her acute drug withdrawal. She said her withdrawal caused her vomiting and ultimately led to the aspiration pneumonia.
Dr. Sens also found that Abby Rudolph’s seizure likely resulted from severe, untreated dehydration due to her vomiting and diarrhea. Dr. Sens said the dehydration caused chemical imbalances in her system and contributed to her death.
Rudolph’s death had a devastating impact on her family. Her mother who had already been battling alcoholism, died two years later.
“I believe in broken heart syndrome,” said Rudolph’s brother, Jack.
Jack believes that had his sister lived, she would have gotten cleaned up, maybe gone to college to pursue art.
But now, there are only questions about why Rudolph’s withdrawal went untreated, and constant thoughts about her suffering before she died.
“That’s something no one should ever have to think about or know happened to one of their family members,” he said.
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