On her second day of detoxing from heroin, Brianna Beland pleaded for help from within the walls of the Charleston County jail.
The 31-year-old mother from North Charleston, normally bubbly and easygoing, explained to a family friend on the other end of a video visitation monitor that she'd been vomiting all over herself and had a fever. Enduring withdrawal behind bars felt like torture, she said.
A sense of urgency in her voice gave way to tears.
"I’m dying and they won’t do a damn thing to help me," Beland said that day in August 2017.
Two days later, a nurse found her unresponsive in the jail's infirmary. An autopsy would determine that complications of withdrawal from chronic opiate dependence had claimed her life.
Attorneys for Beland's family are now suing the Charleston County Sheriff's Office and its medical contractor, Carolina Center for Occupational Health, claiming wrongful death and negligence. They allege that staff didn't take Beland seriously and failed to provide proper care for dehydration and "obvious" signs of opioid withdrawal.
Carolina Center for Occupational Health declined to be interviewed for this story. The Sheriff's Office, in a filing answering the lawsuit, denied allegations of negligence and said it did not deviate from its standard of care in Beland's case.
Beland was among at least 153 people who have died in jail custody across South Carolina in the past decade, according to records maintained by the S.C. Department of Corrections. In the last five years, the death toll included eight inmates at Charleston County's Al Cannon Detention Center.
The Sheriff's Office requested that the State Law Enforcement Division investigate Beland's case, which is standard protocol for the agency's deaths in custody. Medical records, an autopsy report, and statements from jail staff and inmates contained in the SLED investigative report, obtained through a Freedom of Information Act request, offer insight into Beland's final days.
Before her arrest, Beland sought help for addiction in the form of medication-assisted treatment. She told a doctor she had relapsed on heroin while trying to cope with depression and anxiety following the sudden death of her longtime boyfriend.
"She does not want this to take over," the physician wrote in July 2017 when prescribing her Suboxone, the brand name for buprenorphine, which treats opioid addiction and curbs the uncomfortable symptoms of withdrawal.
Then, in August of that year, Beland landed in jail on a bench warrant for shoplifting. That cut off her access to Suboxone because the detention center, at the time, didn't allow maintenance medication.
Though the opioid epidemic has saddled jails around the country with acting as stand-in detox centers, the vast majority have favored an abstinence-based approach over intervening with medication. Fewer than 1 percent of jails and prisons permit access to any of the three FDA-approved drugs that treat opioid dependence.
Officials estimate that 60 to 80 percent of people booked into the Charleston County jail are addicted to drugs. The detention center recently introduced Suboxone, allowing incoming inmates who are already prescribed the medication to continue their treatment. Leaders behind the effort say Charleston County is the first jail in the state to provide the drug.
But in 2017, Beland was forced to detox cold turkey like most opioid-dependent people in jail or prison.
Fellow inmates said they witnessed her decline as she vomited into a bucket over several days, unable to hold down food or water. Her hands cramped so severely that they became locked in a curled position. One inmate would recall that she looked “dangerously sick.”
On her fifth day in jail, Beland died.
Detox behind bars
Her arrest can be traced to a pack of colored pens worth $3.94.
In April 2017, a loss prevention employee at Walmart reported to North Charleston police that she saw Beland swipe the pens and stuff them in her bag. An officer wrote Beland a courtesy summons ticket for shoplifting.
A judge issued a bench warrant for Beland’s arrest after she failed to pay a fine. The warrant came up Aug. 14, 2017, when an officer ran her information after a fender-bender crash in Mount Pleasant.
Beland, who worked several jobs cleaning vacation homes and churches while she studied to be a paralegal, faced a $1,030 fine or 25 days in jail. She went to jail that night.
Beland told medical staff during her intake screening that she'd been using two bags of heroin a day.
Fellow inmates in her housing unit observed her vomiting a few days after she arrived. A woman showed Beland how to use a kiosk to request a nurse visit and would later tell SLED that she grew “very concerned” for Beland’s health. She suggested that Beland fake a seizure to get medical attention.
On Aug. 17, her fourth day in jail, Beland was reportedly found passed out in the recreation yard with a towel under her head. She said she’d fallen and that she was withdrawing from opioids and benzodiazepines, the class of drugs that commonly includes Xanax and Valium. She complained of throwing up and was given medication for nausea. After a four-hour observation in the medical unit, she returned to her pod.
Beland then stopped getting out of bed to eat or drink, recalled one inmate who thought she started looking "bad." Medical staff checked on her routinely and noted she was sleeping.
The next day, Aug. 18, she started experiencing hand spasms, which caught the attention of a detention officer. Beland said spasms happened when she detoxes. Back in the medical unit, she reported she felt horrible and had vomited all night. Staff prescribed a muscle relaxer, told her to drink more water and advised that she see a nurse for monitoring. Beland returned to the housing unit.
By evening, her hands appeared to have locked up completely, curling into themselves. An inmate spoon-fed her dinner.
Another inmate told SLED she had begged the officer on duty for help. She said the officer replied that Beland should drink water, there was nothing the officer could do. An inmate rubbed Beland’s hands to try to bring her some relief.
Around 7:45 p.m., Beland said she was unable to move from her bed. An officer radioed a medical emergency after seeing that her hands were clenched and her eyes “disoriented.”
“I told her just to stay calm and I prayed with her,” said the inmate who'd rubbed her hands earlier, according to the SLED report.
Nurses loaded Beland into a wheelchair and rolled her to the infirmary.
A nurse noted in an assessment that Beland had been suffering withdrawal symptoms for 12 hours. She couldn't stand or move her fingers. By that point, records showed she'd been prescribed medication to treat nausea, diarrhea and muscle cramping.
She was placed in a room across from the nurse's desk with another inmate, who heard her moaning and complaining. Beland pressed the call button once and had the inmate press it for her another time. She fell off the bed, complained of being hot and appeared to be spitting up blood. The other inmate in the room said staff responded quickly and acted professional.
Surveillance video from the hallway showed officers and nurses wheeling Beland to her own room at the back of the medical ward shortly after 9 p.m.
A nurse and a detention officer checked on her several times over the next hour. The officer briefly entered Beland's room at 10:18 p.m.
At 10:49 p.m., a nurse peeked into the window of the darkened room. She and the detention officer returned two minutes later and walked in. They reported that they found Beland clothed and sitting on the toilet, leaning against the wall. She was unresponsive.
Staff began life-saving efforts before EMS transported Beland to a hospital. She was pronounced dead just after midnight.
To some, Beland's case is reminiscent of the death of Joyce Curnell, an Edisto Island woman who died in the Charleston County jail of a stomach ulcer in July 2015. Curnell was treated at a hospital for a stomach illness before authorities arrested her on a bench warrant in a shoplifting case. Her family's attorneys alleged that personnel deprived her of water and left her to die as she threw up.
In 2017, Carolina Center for Occupational Health and the Sheriff’s Office settled with Curnell’s family for $1.1 million.
Barriers to treatment
The effects of opioid detox are rarely fatal, said Dr. Lipi Roy, clinical assistant professor at NYU Langone Health in New York City and former chief of addiction medicine at Rikers Island jail. Typically, withdrawal from alcohol or benzodiazepines is considered more dangerous due to the risk of seizures.
Opioid withdrawal can look like intense flu-like symptoms, such as vomiting, diarrhea, severe sweats and abdominal pain. Patients might experience irritability, anxiety and increased suicidal thoughts. The process can last anywhere from five days to four weeks, Roy said.
“People with opioid addiction should be taken seriously, too,” Roy said. “Look how deeply uncomfortable it is. That’s why people keep using. … It’s to keep from getting sick.”
Georgetown attorney Ed Bell, whose office filed the lawsuit in Beland's death, said jail staff instead treated Beland "like a common bum." Lawyers contend that her dire condition should have garnered emergency medical attention.
"She was trying to get help," Bell said. "Sometimes the only help someone can get is to get arrested. To them, that should be a safe haven."
Roy said for the same reason that a patient with diabetes wouldn't be denied insulin, people with opioid use disorder should not be denied maintenance medication while incarcerated. Such an approach is stigmatizing and a "human rights violation," she said.
Last year, the American Correctional Association and the American Society of Addiction Medicine released a joint statement supporting the use of addiction treatment in correctional settings.
But the fight for access continues. A woman in Maine sued a county jail to get her prescribed addiction medication while serving her sentence. A federal appeals court recently ruled in her favor. An inmate in Massachusetts is taking the Federal Bureau of Prisons to court for access to methadone.
The S.C. Department of Corrections is currently administering Vivitrol, the brand name for the injectable form of naltrexone, to 24 prison inmates who are within six months of being released.
Locally, roughly 15 inmates have been served by the Charleston County jail's new buprenorphine program. The effort got off the ground a little more than a year after Beland's death, yet officials say talks had been in the works for at least six years.
"It’s been a long-needed thing," said Caitlin Kratz, opioid treatment program administrator for the Charleston Center, which is collaborating on the project.
'Should've been safe'
Those closest to Beland still wrestle with the thought that her death could have been prevented.
Carolyn Tyler, her best friend since childhood, said she feels that authorities wrote Beland off as a "junkie" and neglected her medical needs.
She remembers Beland's best qualities: Her humor. Her nurturing way with people. How, through her struggles with addiction and depression, she wanted to do the right thing for the sake of her daughter, who was 4 and living with Beland's mother when she died.
Beland should have been able to walk out of the detention center after serving her time, Tyler said.
"She should've been safe," she said. "Just because she was in jail doesn’t make her life any less valuable than the next person’s."
Some SC law enforcement agencies have failed to inform the state of jail inmate deaths in their custody despite a decades-old law mandating that they do so, a Post and Courier analysis shows.