Defender: state balked at heart surgery

When they discovered that inmate Bill Cathell Jr. needed open-heart surgery, Delaware prison officials tried to get him released so they didn't have to pay his medical bills, a state public defender contends.

Cathell wasn't released, and he didn't have the emergency open-heart surgery. He died at Johns Hopkins Hospital in Baltimore days after state officials pondered a decision about transporting him to the hospital, one of the few in the region capable of handling endocarditis, an infection of the heart valve.

The 44-year-old inmate wasn't capable of demanding better care. Mentally disabled and schizophrenic, Cathell had the mind of an 8 year old. He had been in and out of psychiatric hospitals and group homes most of his life. An arson charge landed him in Gander Hill Prison in Wilmington, where he could not make bail.

Cathell died this year on July 17. Ed Hillis, Cathell's public defender, said Department of Correction officials told him that Cathell could be saved only by having emergency open-heart surgery. And he's angry that the state spent four days attempting to orchestrate his release from Department of Correction custody rather than rushing him to a competent surgeon.

Deputy Attorney General Ophelia Waters denies that the state scrambled to release Cathell during the final days of his life so that the state wouldn't have to pick up a costly surgery. She said cost was not a factor in her attempt to release him from prison.

Typically a death certificate includes cause of death and contributing factors, if any, Hillis notes. Curiously, Cathell's death certificate says prison officials determined he'd been diagnosed with endocarditis one week before he died.

"I don't think that language is appropriate," Hillis said.

One cardiologist said Cathell likely contracted the disease months before he died. Cathell may have felt sick, but not so sick anyone would have noticed, said Dr. Christopher Cabell, assistant professor of medicine-cardiology at Duke University Medical Center's Clinical Research Institute. "It takes a long time to diagnose, and the patient can be very ill when the diagnosis is made. In the beginning it's really insidious."

Early release

Waters, who is assigned to the Department of Correction, advised Hillis to request a bail reduction hearing so the inmate could be released from prison. Hillis claimed Waters expressed concern about how much it would cost to send Cathell to Johns Hopkins, the closest hospital that could treat his heart ailment, and to station guards in his hospital room after surgery.

A public defender for 20 years, Hillis became suspicious: This was the first time in his career an attorney general had ever asked him to help get an inmate released. "It was bizarre," he said, that the Department of Correction would want an inmate charged with arson to walk free without posting bail. "I was concerned that once the DOC was no longer technically responsible for him, he'd end up having to get his own care."

"If a judge granted the request," Hillis added, "the prison could have discharged Cathell, called him a taxi and sent him on his way."

He decided against filing the motion, and instead told prison officials they should provide medical care immediately.

In an interview with The News Journal, Waters first denied trying to get Cathell released. Minutes later, though, she recalled speaking to "a public defender about having someone transferred."

Asked why the DOC didn't take Cathell to a hospital when he first became sick, Waters said, "I don't know all the circumstances. Let me get back to you."

Lori Sitler, a spokeswoman for the Attorney General's Office, later arranged a telephone interview with Waters and Chief Deputy Attorney General Carl Danberg, who said Waters was only trying to sort through the "complex issue of jurisdiction" when discussing the case with Hillis.

"The question was, can the DOC transfer an individual into a hospital in the state of Maryland and maintain legal custody of the individual?" Danberg explained. "The DOC never discussed Mr. Cathell's medical bills, never discussed the cost of treatment. This was not a financial decision."

Waters denied she told Hillis she was concerned about medical care costs.

"He's incorrect," she said. "I don't recall the conversation about costs. I certainly know that the conversation was not about costs."

Hillis scoffed at that interpretation. He insisted that the issue was not jurisdiction, as Danberg maintained, but financial.

"They move inmates around all the time," he said. "If they need a court order, they can get it. They should have been more concerned about getting his medical care than the costs associated with accompanying him to Maryland."

Said Cathell's mother, Carol Cathell: "He shouldn't have been in there. They told us nothing. We got no response from the DOC. I didn't know he was even sick or anything until I got a phone call the night before he died."

Not a criminal

Bill Cathell loved music. As a child, spoons or pencils became microphones for impromptu concerts in his parent's basement.

But "he had issues telling right from wrong," said David Curtis, a neighbor of Cathell's family.

And Cathell had a strained relationship with his own family.

"He was very violent at home toward me, which is one reason we stayed away from him," his mother said. "We couldn't handle him. He was our oldest son. Our two younger children were afraid, too."

But Curtis and his wife, Donna, grew close to Cathell.

"He just sort of adopted us," neighbor Curtis said. "He was just fun to be around. We accepted him for who he was."

Cathell's behavior depended a lot on where he was living, his friends said. Group homes were best, because trained staff would ease him through tantrums.

Apartments were the worst, especially if Cathell was paired with a mentally disabled roommate. There was no direct supervision.

"One night, in an apartment, Bill got impatient and upset, and threw his TV out the window," Curtis said. "Then he broke the window on the manager's office."

The courts became involved, and Cathell was released to a group home on Wilson Road in Wilmington. "It was very good for him," Curtis said.

Curtis and his wife often signed Cathell out from the group home and took him on day trips.

"He loved to go to the mall," Curtis said. "Even though he'd been institutionalized most of his adult life, when we walked through the mall, he'd know more people than we did. Everybody said, 'Hi.' "

Cathell started riding the bus and working part time at a Wawa.

"He worked close to my office. My co-workers adopted him, too," Curtis said. "We'd go out to lunch. It was a good situation."

But things changed when Cathell physically assaulted the woman who operated the home, and he was sent back to the state hospital.

"They released him to another apartment, with another disabled person, which was never going to work," Curtis said. "They should have placed him in a more structured environment, with staff around, normal staff, who could calm him down and get help. It seemed there was nothing available."

In January, he was arrested and sent to Gander Hill after setting a fire in his apartment, causing an estimated $500 damage.

"His roommate was a smoker, which was against the rules, and Bill got mad," Curtis said. "He admitted to the fire inspector that he set the fire intentionally. He had threatened suicide."

Cathell was charged with first-degree felony arson and first-degree felony reckless endangering. He was arraigned and held in Gander Hill in lieu of $40,000 secured bail.

The couple knew Cathell wouldn't do well in prison, so they found a place at another group home and reserved a bed for him. The home's director told the couple to work with the attorney general and the public defender's office to expedite the transfer.

"We sent letters to the AG and lieutenant governor's office," said Curtis, who learned at that time, months before Cathell died, that the Attorney General's Office was resisting efforts to reduce bail and release Cathell.

On July 15, Curtis arrived home and found an urgent message from a prison captain on his answering machine.

"We knew it was serious," he said.

Curtis called back twice and spoke to two shift commanders, who refused to tell him anything because he wasn't a relative. Asked if Cathell had died, one shift commander told Curtis, "Bill's still alive."

"He acted like I was out of my mind for asking," Curtis said. "I was relieved. I concluded that he had misbehaved."

Curtis called the prison the next day, hoping to get a prison supervisor to talk with him. He was told Cathell had died at Johns Hopkins, where he had finally been transferred. But he didn't arrive in time to have the emergency open-heart surgery.

"Somebody needs to find out what the hell happened," Curtis said. "He was like everyone else. He had his liabilities, but he was genuinely fun to be around. Both of us feel so bad that Bill died alone, scared, under miserable circumstances."