Deaths, Politics

The Questions About The Death Of Sandra Bland That Still Need To Be Asked

Columnist Tamara Tabo examines the case of Sandra Bland, the young woman who died in a jail cell in Waller County, Texas.

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Many questions remain unanswered in the case of Sandra Bland, the young woman who died in a jail cell in Waller County, Texas. But there are few crucial questions that have yet to be asked.

The jail intake documents released by Waller County contain consequential internal inconsistencies. One form indicates that Sandra Bland was neither currently depressed nor had ever attempted suicide. Another mentions a suicide attempt in 2014, after losing a baby. Yet another form in the same stack of documents states that Sandra Bland attempted suicide in 2015.

The documents also contain conflicting information about Sandra Bland’s medical status. One form indicates that she suffered from epilepsy and managed the condition with the anti-seizure drug Keppra. Elsewhere, a form states that she was not currently taking any medication.

Waller County officials say that any inconsistencies in the intake documents are because Sandra Bland gave different responses at different times during the booking process.

QUESTION 1: “WHY DIDN’T JAIL OFFICIALS FOLLOW UP ON THE INCONSISTENCIES?”

Let’s provisionally accept that the inconsistent responses in the intake documents reflect inconsistent responses given by Sandra Bland herself.

Since the documents contain information that, in part, determines inmates’ treatment within the jail, someone must review the information. Based on reading the documents, the jail determined in which cell Sandra Bland should be held, for example.

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If jailers reviewed the forms enough to know that Sandra Bland should be placed in cell 95, when why didn’t they also look to the documents to determine whether she should be placed on suicide watch? Why didn’t they also look to the documents to see if she had a serious medical condition requiring prescription drug treatment?

After all, the intake forms include those questions precisely because the jail must use the answers to figure out how a given inmate must be handled while in custody. The questions aren’t there just so jailers can get acquainted with their new guest. Officials weren’t helping Sandra Bland draft an online dating profile. The information collected was of immediate, official consequence.

If, upon review, jail officials detected inconsistencies, they ought to have followed up by inquiring further with Sandra Bland. This should have been easy. Bland wasn’t going anywhere.

Jail officials should have scrutinized Sandra Bland’s intake information. Some of the responses should have raised red flags. Inconsistent responses should have raised more flags, not fewer.

QUESTION 2: DID JAIL OFFICIALS PROVIDE BLAND WITH APPROPRIATE MEDICAL ATTENTION?

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Ascertaining correct — or at least consistent — information would have been a top priority, if Waller County jail officials were fulfilling their duties. Why? Because jail officials are duty-bound to keep inmates reasonably safe while in custody. Inmates with high-risk mental health histories must be placed on suicide watch. Inmates with medical needs must be seen by medical staff.

Inmates who take prescription medications don’t automatically have access to them while confined to the jail. Even if someone happens to have, say, her insulin or her warfarin or whatever on her person at the time of arrest, the medications are confiscated along with her other personal property when she is booked. The jail physician can approve the treatment, allowing the inmate to either have her meds brought from home or gain access to equivalent treatment through jail medical services. Particularly in cases involving serious health conditions, time may be of the essence.

At least once, Sandra Bland indicated to jailers that she suffered from epilepsy, a potentially life-threatening condition. She also indicated that she took the prescription anti-seizure medication Keppra.

Patients taking Keppra, the trade name of the drug levetiracetam, are cautioned not to stop taking the drug all at once. The consequences of not titrating down can be fatal.

Jail medical staff, had they evaluated Sandra Bland, should have appreciated the risks involved with depriving her of the medication.

QUESTION 3: “WHAT ABOUT THE KEPPRA?” PART II

Perhaps more importantly, Keppra carries a host of possible side effects, several of them potentially relevant to Sandra Bland’s condition prior to her death.

The FDA’s safety information for Keppra warns:

“Patients, their caregivers, and families should be counseled that AEDs, including KEPPRA, may increase the risk of suicidal thoughts and behavior and should be advised of the need to be alert for the emergence or worsening of symptoms of depression, any unusual changes in mood or behavior, or the emergence of suicidal thoughts, behavior, or thoughts about self-harm. [ . . . ] Patients should be advised that KEPPRA may cause changes in behavior (e.g. aggression, agitation, anger, anxiety, apathy, depression, hostility, and irritability) and in rare cases patients may experience psychotic symptoms.”

The manufacturer’s website for Keppra lists under “Warnings and Precautions” that the drug “may cause suicidal thoughts or actions in a very small number of people, about 1 in 500.”

Lots of prescription drugs carry scary possible side effects, which makes hasty speculation unwise. But “1 in 500” is not a small chance, in terms of known drug side effects.

QUESTION 4: DID KEPPRA CONTRIBUTE TO EITHER SANDRA BLAND’S BEHAVIOR DURING THE TRAFFIC STOP, OR HER STATE OF MIND WHILE IN CUSTODY, OR BOTH?

Sandra Bland’s sister Sharon Cooper told The Associated Press that her sister suffered from seizures about a decade ago but had not had any in recent years and was not on medication. Cooper said her sister had a miscarriage in May 2014, but got through it. Cooper said she was not aware of any past suicide attempts by Brand.

The family’s account is important. However, Sandra Bland’s family may not have known that she had begun taking Keppra again. There’s no reason to assume that she, as an adult woman, would inform them. I’m pretty sure my own family couldn’t rattle off the prescription drugs that I take.

The Waller County District Attorney’s Office released the autopsy report of Sandra Bland on Thursday. Prosecutor Warren Diepraam told the press that there were cut marks on her left arm and at least 30 cut marks on her left wrist. The marks were reported to have been in varying stages of healing, scabbing, and scarring. This evidence seems to suggest that Sandra Bland may have been engaging in self-harm for weeks before her arrest.

A woman being held in the cell across from Sandra Bland told reporters that Bland was distressed, crying, and confused about why a friend had not yet bailed her out of jail.

I remain skeptical of the information released by the Sheriff’s Office. Doubts linger in my mind about whether Sandra Bland took her own life. Nevertheless, there is a cohesive picture that deserves to be ruled out: Sandra Bland was taking a prescription medication known to cause mood instability, a propensity toward self-harm, and suicidal ideation or behavior. Physical evidence that she may have been “cutting” prior to her arrest suggests that she might have been struggling with these problems for a while, whether the medication contributed to her struggles or not, and whether her family knew about it or not. She might have ended her own life.

We still don’t know.

There is one question which we do know the answer to: Whose fault is it that we are left asking these questions about the death of Sandra Bland?

The answer: Waller County officials.

Tamara Tabo is a summa cum laude graduate of the Thurgood Marshall School of Law at Texas Southern University, where she served as Editor-in-Chief of the school’s law review. After graduation, she clerked on the U.S. Court of Appeals for the Fifth Circuit. She currently heads the Center for Legal Pedagogy at Texas Southern University, an institute applying cognitive science to improvements in legal education. You can reach her at tabo.atl@gmail.com.

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