Willie Whaley’s type 1 diabetes was out of control, and the people in charge of his care had reason to know it. Time after time, they checked his blood sugar and found it dangerously high, sometimes so high the meter was unable to read it.
Such readings are a sign of potentially deadly diabetic ketoacidosis and should lead to immediate hospitalization, say experts in the treatment of diabetes. But Whaley was in a place where a different kind of thinking exists. Instead of a hospital, he was confined to a cell at Georgia State Prison. And that’s where he was later discovered, his lifeless body on his bunk.
Whaley's death in December 2017 is now the subject of a federal lawsuit that once again points to flaws in the medical care provided to Georgia's state prison inmates. AJC investigations have repeatedly found that misdiagnoses and delayed or denied treatments have led to a grim legacy of deaths. Substandard prison medical care also has cost the state millions of dollars in lawsuit settlements in recent years.
Whaley’s mother, Rebecca Hill, is seeking at least $10 million in damages for what she claims is negligence by an assortment of officials and workers with the Georgia Department of Corrections and Georgia Correctional HealthCare, the branch of Augusta University that employs the medical personnel working in the prison system.
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Hill's lawsuit follows stories in The Atlanta Journal-Constitution last year describing how 12 diabetics, including her 31-year-old son, died in Georgia prisons or jails due to diabetic ketoacidosis, a condition that can develop when diabetes isn't properly treated. Some who died hadn't been previously diagnosed as diabetics. But others were known to have the disease and still were denied the insulin or medication they needed.
The details spelled out in Hill’s lawsuit along with medical records and other documents reviewed by the AJC add to that narrative, graphically showing how one of Georgia’s oldest and largest prisons was seemingly ill-equipped to deal with an insulin-dependent diabetic whose disease was growing worse over time.
“A type 1 diabetic should not fall through the cracks,” said Hill’s attorney, Troy Kiber. “That’s the main takeaway from this.”
Diabetic ketoacidosis, commonly known as DKA, occurs when the inability to process blood sugar, or glucose, causes the bloodstream to become acidic. All diabetics are susceptible to DKA, but type 1 diabetics are particularly vulnerable because they can’t survive without regular injections of insulin to control their blood sugar.
In Whaley’s case, records show that some of the key warning signs of DKA, including spiking blood sugar and erratic behavior, were present for weeks but didn’t set off alarms.
At least 18 times in the final month of Whaley’s life, his blood sugar rose above 300, nearly three times a normal reading. Eleven readings were simply recorded as “high” or “hi,” indicating they were beyond 600, the meter’s measuring capacity. Yet there’s no evidence he was sent to a hospital for the treatment necessary to stabilize him.
After a succession of high readings, Whaley was discovered speaking incoherently on the floor of the prison emergency room, but he was returned to his cell without medical intervention, according to the lawsuit.
Soon after the incident in the ER, Whaley began refusing insulin and blood sugar monitoring, and he continued to refuse until he died two days later. At the time of his death, he hadn’t received insulin for 54 hours.
GDC regulations in place at the time required that inmates be referred to a mental health provider if they refused serious medical treatment and there was reason to question their competency. However, there’s no evidence that such a referral was made on Whaley’s behalf even though prison staff reported that he refused insulin and monitoring four times in the days leading up to his death, records show.
"A type 1 diabetic should not fall through the cracks. That's the main takeaway from this." —Troy Kiber, attorney for Rebecca Hill, mother of Willie Whaley
In an interview, Hill said she was unfamiliar with diabetic ketoacidosis until she learned it was on her son’s death certificate. “I read things, Google things, and it says that, should diabetic ketoacidosis continue more than 48 hours, (it can be deadly),” she said.
Neither the Department of Corrections nor Georgia Correctional HealthCare would comment for this story, citing the fact that Whaley’s death is the subject of pending litigation.
Asked about diabetes and diabetic ketoacidosis during a deposition for an unrelated lawsuit last November, Georgia Correctional HealthCare’s statewide medical director, Dr. Billy Nichols, said the organization has tried to educate its people on those subjects. He added that GCHC had “fairly recently” staged a “major presentation” on the treatment of diabetes for its clinicians. “So we don’t take it lightly,” he said.
In the last three years, the state has paid nearly $800,000 to settle two lawsuits alleging mismanagement of inmates' diabetes. In one, $550,000 was paid to Michael Tarver, a diabetic whose left leg had to be amputated because a cut became infected. In the other, $215,000 was paid to the family of Esteban Mosqueda-Romero, who died of diabetic ketoacidosis after prison medical workers failed to recognize that he was a diabetic.
`You’re not logical’
Living with type 1 diabetes requires a daily regimen of insulin and blood sugar monitoring that can be a challenge in prison. Even so, a dramatic rise in blood sugar coupled with unusual behavior should cause healthcare workers to realize a diabetic needs emergency care, experts said.
Dr. Bruce Bode, an Atlanta diabetes specialist who is on the Emory School of Medicine faculty, said any diabetic whose blood sugar is above 500 must be hospitalized. A person in that condition needs insulin and electrolytes quickly via IV and can’t be trusted to make rational decisions, he said.
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“If your sugar is above 500, you’re not logical,” he said. “You’re making a lot of stupid decisions and your brain is not functioning normally.”
Bode has no connection to the Whaley case, but he said it appears to be another instance in which prison medical personnel failed to see that the health of a diabetic inmate was dangerously declining.
“No question (those prison healthcare workers) should have put him in the hospital,” Bode said. “They don’t have the ability to manage that.”
Dr. Timothy Young, who worked as a physician at Augusta State Medical Prison for 16 years before resigning in 2018, said caring for type 1 diabetics is particularly difficult in prison because the timing of meals and insulin injections, crucial in managing the disease, is frequently disrupted due to security issues and staffing limitations.
“The treatment of type 1 diabetes hinges on the predictable,” he said. “Nobody in the real world lives that way, but at least they have the option. You don’t have a choice in prison, because the insulin’s not with you and you can’t eat when you want.”
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But Young, who in 2017 exposed unsafe and unsanitary conditions at the prison hospital and has since filed a lawsuit claiming he was forced from his job in retaliation, was quick to point out that nothing about prison regulations should get in the way of realizing that a diabetic is on the brink of death.
After reviewing some of Whaley’s medical records at the AJC’s request, Young offered a blunt assessment of the inmate’s care: “He should have been treated for DKA three days before he died. They were watching him die.”
From bad to worse
Whaley worked as a welder and heavy equipment operator in and around Dalton, his home town. In June 2016, he began serving a three-year prison sentence for methamphetamine possession, his third stint in the system since 2009.
Almost from the very start, his diabetes was poorly controlled, and by December 2017 it had reached the point where almost every blood sugar reading was well outside normal range, records show.
"If your sugar is above 500, you're not logical. You're making a lot of stupid decisions and your brain is not functioning normally." —Dr. Bruce Bode, an Atlanta diabetes specialist
According to Hill’s lawsuit, the situation turned dire when Whaley went to the prison ER at 5 a.m. on Dec. 18, an hour after his blood sugar was found to be “hi.”
In the waiting area, Whaley laid down on the floor and began talking incoherently, according to an incident report prepared by the officer on duty. In response, the officer, Edward Rooks, administered a drug test that came back positive for meth, the report states.
Returned to his cell, Whaley had his blood sugar checked again three hours later — another “hi” reading — and received what would be his last dose of insulin before he began to refuse it.
Two days later, guards went to Whaley’s cell after hearing his cellmate cry out, “Lieutenant, my bunkmate just threw up, I don’t think he’s breathing,” according to the incident report. He was pronounced dead 21 minutes later.
Hill, who until recently worked a swing shift at one of the Dalton-area floor-covering plants, said she grew worried when she didn’t hear from her son for several days and got a phone call from another inmate who said Whaley couldn’t hold his head up without vomiting.
To find out what was going on, she called the prison, and that’s how she learned of her son’s death. She said the assistant warden who took the call would only tell her that the death wasn’t the result of violence
The autopsy found that Whaley’s blood sugar at the time of death was 597. A toxicology screen for meth and other drugs came back negative.
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