BY JANE PRENDERGAST and CINDY SCHROEDER
The Cincinnati Enquirer
COVINGTON -- Autopsy results show that when a diabetic man died in the Kenton County Jail in June, he had almost no sugar in his bloodstream.
No one can say exactly why James Franklin's glucose level was 2. And while there is no one right number for diabetics, the almost non-existent 2 is far lower than levels suggested by the American Diabetes Association, which range from 80 to 140.
"Anything below 60 is dangerous," said Jan Kellogg, a Cincinnati certified diabetes educator. "What you're saying is he didn't have enough glucose to stay alive."
Dr. Chandrasekhar Kota, an Edgewood endocrinologist, said there are two possible reasons for such a low sugar level -- either Mr. Franklin took in too much insulin or he didn't eat the right amount of food. He likely would have lost consciousness by the time his sugar level hit about 20, the doctor said, and "a 2 would mean he was in a coma."
Even factoring in a slight decrease attributed to a lapse in time between Mr. Franklin's death and the taking of the lab sample would not explain the level, said Damian Minarik, a forensic science specialist for Kentucky's Department for Health Services. The state's clinical chemistry experts tested fluid from Mr. Franklin's eye for the autopsy.
The 68-year-old Elsmere man, a retired janitor for the state transportation department, died June 26. His death is at the center of a debate over how well the Covington jail is operated. The county's top official and its police chief have called for Jailer Don Younger to hire somebody to run the facility, saying Mr. Younger cannot do the job well enough. Mr. Younger, who is running for re-election, says he does not need help.
County officials have only financial control over the jail because Mr. Younger is separately elected. But they have said they are afraid of how much liability the county would have in a lawsuit over Mr. Franklin's death.
Scott Greenwood, an attorney working for Mr. Franklin's family, said he is outraged at how the inmate was treated. Deputy jailers described Mr. Franklin as able to carry on a normal conversation and get around well when he arrived at the jail June 13. By the time he died, they reported he was calling deputies by the wrong names, taking his clothes off repeatedly and soiling himself.
"They trusted someone in that condition to self-medicate -- that's crazy," Mr. Greenwood said. "There is no evidence that anyone tried to do anything except keep him under lock and key." Jail nurse Pam Sams told police investigators that she was concerned about Mr. Franklin's condition and that she was trying to get him transferred to a medical facility. But Mr. Younger said she did not make those concerns known to other jail staff. She and other medical personnel could have arranged for the transfer themselves, he said, but they did not.
The jailer said he has not asked Ms. Sams why she didn't arrange the transfer. He said he didn't ask because he didn't want to interfere with the police investigation. The investigation is now closed, with police finding no criminal wrongdoing.
The jail's medical staff includes a licensed practical nurse, a doctor under county contract, and three medical assistants who are certified to dispense medication, Mr. Younger said. One of the medical assistants also is an emergency medical technician. He said the insulin syringes brought to Mr. Franklin would have been prepared by one of the jail's medical personnel.
Mr. Franklin had seen the doctor once during his jail stay, the jailer said. He was treated then for his diabetes and some scrapes he received when he was arrested.
A deputy jailer assigned to check Mr. Franklin in his isolation cell every 20 minutes was fired after she admitted she did not do so. She said she last saw Mr. Franklin between 1 and 2 a.m. The coroner estimated his time of death at 5 a.m.
If a diabetic's insulin and sugar levels get out of balance, most patients notice physical symptoms such as hunger, sweating and shaking, and they know they need to eat, Dr. Kota said. There are mental symptoms too, including confusion, lightheadedness and slurred speech, he said, but sometimes because of those, the patient doesn't notice the physical effects.
It's for that reason that a diabetic's family and others are often trained to administer insulin, Ms. Kellogg said.
Mr. Greenwood questions why a man who deputies admit had become confused and disoriented would be allowed to continue to monitor his own food intake.
