Drug deaths and overdoses plague Philly jails, raising concerns about plans to step up Kensington arrests

Donna McDonough used to pray that her daughter, Kelly Ann Crawford, would be arrested.

Crawford had bipolar disorder and was addicted to fentanyl and Xanax. She’d tried drug treatment several times, McDonough said. But she always ended up back in Kensington, where she was unhoused and broke but somehow regularly found a way to feed the stray cats. Her mother said that nothing — not her daughter’s deep love for her two children, not her dreams of a second career as a veterinary tech — had been enough to help Crawford find her way out.

So, said McDonough, of Wilmington, “I often prayed that she would wind up in jail, so that she would be clean and find a program that worked for her.”

On Dec. 11, 2023, Crawford, then 43, was arrested for drug possession and reportedly jailed on a bench warrant.

But it wasn’t the answer to her mother’s prayers.

The next day, McDonough got a call that her daughter had been found unresponsive in a cell.

On Dec. 14, Crawford was pronounced dead — one of at least 25 people who have died in the Philadelphia jails since 2018 of accidents related to drug intoxication, an Inquirer review of medical examiner’s data and court records has found.

Some of the deaths were from overdoses; other people were going through withdrawal when they died, according to court filings.

In addition to the 25, one woman took her own life while in withdrawal in the jail, according to a 2022 lawsuit. And at least three more people died in Philadelphia police holding cells, including a man who died by suicide while in withdrawal.

As Philadelphia Mayor Cherelle L. Parker has laid out plans for cleaning up Kensington’s open-air drug markets, police leaders have made clear that arresting people who use drugs is part of that plan.

“Many of these individuals are going to get locked up for low-level offenses,” Police Commissioner Kevin Bethel told City Council at a May 6 budget hearing.

Some will be eligible for Police Assisted Diversion, which allows people to avoid charges and instead access services. But people with repeated arrest histories, those who are on probation, and those who, like Crawford, have open warrants, are more likely to end up in jail.

The recent history of drug-related deaths within the jails — and recent internal reports obtained by The Inquirer showing that prisoners are regularly being hospitalized for overdoses — raise questions about whether the direly understaffed facilities can safely house an influx of medically fragile prisoners.

“None of these deaths were determined to have been avoidable,” said Bruce Herdman, the jail system’s medical director. “We did what we were supposed to do.”

The Philadelphia Department of Prisons, which houses people awaiting trial or serving short sentences, is known as a leader in providing medications for opioid use disorder. It’s one of just a handful of county jails in Pennsylvania that not only fills existing prescriptions but also offers the opportunity to start on buprenorphine, an opioid that quells cravings.

But in practice, severe short-staffing has hamstrung those policies — and fueled a climate of disorder and violence in the jails, which in the last few years have seen riots, a string of escapes, and dozens of deaths.

» READ MORE: 29 people died in Philly jails in the pandemic. City officials said they did 'a good job.'

Civil rights lawyers, representing the 4,500 people locked in the Northeast Philadelphia jail complex in a class-action lawsuit filed in 2020, have urged a federal judge to hold the city in contempt — for the third time in four years — for its ongoing failure to address unconstitutional conditions in the city jails.

A monitor, appointed by the judge in that case, reported that although jail policy requires an assessment within four hours of admission, that happens less than 30% of the time. Herdman said most people are screened within 15 hours.

Four months ago, the jail’s medical staff began offering prisoners buprenorphine during their intake process to ease withdrawal. (Before, treatment was limited to addressing digestive issues, aches and other secondary symptoms.) But, he said, a dearth of correctional officers has created a weeks-long backlog in the jail’s addiction treatment program, which is separate from the medical treatment offered at intake.

Nationally, nearly 70% of people in county jails have some form of substance use disorder, studies have found.

And drug- and alcohol-related deaths in jail have been on the rise — quadrupling nationwide between 2000 and 2019, the most recent year tracked by the Bureau of Justice Statistics.

Meanwhile, illegal drugs are readily available in the jails, according to corrections officers, prisoners, and advocates alike, who report that acrid clouds of smoke from the drug K2, a type of synthetic marijuana, permeate the units.

While staff are trained to administer naloxone, the overdose reversing drug, incarcerated people have described units left unstaffed for hours on end — leaving medical emergencies unnoticed. One prisoner, in a recent lawsuit, said that after he was attacked in April, he lay with a broken kneecap for 12 hours before staff showed up.

McDonough is skeptical that the city’s plan to clean up Kensington will save other young women like her daughter.

“I don’t see an end to it. They’re going to find drugs whenever they can, wherever they can, and the drug dealers are going to be out there pushing it, selling it, giving it away sometimes,” she said. “I think my daughter was just a victim of it all and couldn’t find her way out.”

Locking up people who are in addiction — and who, given Philadelphia’s increasingly unpredictable drug supply, may be using an uncertain cocktail of substances — can pose danger from the street all the way to the jail cell, recent incidents show.

In 2020, a 28-year-old man visiting from Maine, Jonathon Dowd, overdosed and was revived with naloxone when police arrived. Dowd was disoriented and combative — a common reaction for people revived with the drug, which can send a person into sudden withdrawal. Police allegedly responded by slamming his head onto the pavement and punching him in the face. Dowd died of head trauma, according to a lawsuit that was settled for $275,000.

» READ MORE: Dozens of new police are being deployed to Kensington, amid stricter drug enforcement

According to a police spokesperson, officers or police lockup attendants complete a medical screening of each arrested person, asking about recent drug use. Anyone identified as in withdrawal is monitored at 10-minute intervals and, if necessary, transferred to a medical facility.

But, in 2021, three people overdosing or in withdrawal died in police custody, according to lawsuits filed by their families.

A 44-year-old man who had used methamphetamine was found dead in a cell 48 hours after his arrest — and about four hours since anyone had checked on him, according to a court filing.

A 68-year-old from Kensington in withdrawal from opioids was vomiting and moaning in pain while his cellmate yelled for help for hours, according to a lawsuit. His body was found the next morning.

And a 50-year-old man from Glenolden, also in withdrawal from opioids and vomiting blood, was taken to a hospital and given morphine, according to a lawsuit — but then returned to a police district, where, three hours later, he killed himself.

Jeanmarie Perrone, an emergency physician at Penn Medicine and the founding director of the health system’s Center for Addiction Medicine and Policy, said opioid withdrawal is typically not life-threatening — but underlying health conditions, or multidrug use, can result in serious complications.

A 2016 editorial in the medical journal Addiction noted that opioid withdrawal can lead to fatal dehydration if not properly treated — a particular risk, the authors wrote, for people in jails.

“If you’re older and fragile, you get dehydrated from nausea and vomiting, and have low blood pressure,” Perrone said. “That combination generally results in people seeking help. But in the jail setting, if they can’t seek help, they might be someone who gets sicker.”

» READ MORE: Addiction medication in Pennsylvania’s jails is often inadequate or nonexistent, new report finds

Withdrawal from alcohol or benzodiazepines, such as Xanax, is even more dangerous, she said, with the potential to cause fatal seizures. McDonough, whose daughter Kelly Ann Crawford died in jail last year, said Crawford had seizures while in withdrawal, so she believes her daughter’s death could have been withdrawal-related.

Perrone has also witnessed patients expressing suicidal feelings during withdrawal.

“People feel worse than they’ve ever felt. I’ve seen people in the ER who say, ‘I’m going to kill myself if I can’t get help.’ They’re at the very end of all hope,” she said.

The Philadelphia jail system’s drug treatment program is one of just three in the state that allow incarcerated people to begin taking buprenorphine.

According to the National Institutes of Health, withdrawal from short-acting opioids such as heroin lasts four to 10 days. That window, said Perrone, is an ideal time to start a patient on such medication.

But Philadelphia’s jail staffing crisis has interfered with access to such treatment, said Sarah Bleiberg Bellos, of the Pennsylvania Institutional Law Project, one of the firms leading in the class-action lawsuit.

Perrone said that, based on her experience treating patients released from Philadelphia jails, “only a fraction of the people who need [buprenorphine] when they get to the jail are actually getting it.”

Herdman acknowledged that there’s currently a 15-day wait for treatment, on average, because the jails lack enough correctional officers to take prisoners to medical units.

The long wait can be dangerous. The greatest risk for people in addiction, Perrone said, comes when they’ve lost their tolerance for opioids, putting them at high risk of a fatal overdose — whether from contraband drugs obtained in jail or from illicit opioids bought upon their release.

Some prisoners may not even be at the jail long enough to receive the treatment, Herdman said. “There’s a delay on almost every service here,” he said.

In addition, he said, about 50% of patients in the buprenorphine program are ultimately kicked off the program for giving their medications to other prisoners. He hopes to start offering an injectable, long-acting medication instead later this year.

More than half of the drug-related deaths took place within the first two days of a person’s stay at the jail, officials said — presumably of the effects of drugs consumed before their arrest.

One woman, Christi Buoncristiano, who was arrested on drug charges, waited two days for medication to treat her withdrawal, but didn’t receive it. She died after jumping from a second-floor tier at the Detention Center, according to a lawsuit filed by her daughter, Nicolette.

In an email, Nicolette said the loss has devastated her family. “One day I will have to explain to my children that they do not have a grandmother because the staff at the Philadelphia prison did not care when she was suffering a complete medical and mental breakdown.”

Another woman, who told prison staff she was a three-bag-a-day heroin user, was prescribed medications to ease nausea, headache and other symptoms — but none was actually dispensed, according to a lawsuit. Two days into her incarceration, she was found unresponsive, and later died. Her death was not listed on the jails’ death register, as she was discharged while hospitalized.

In other cases, people were apparently able to get access to illicit drugs while incarcerated.

On Feb. 29, 2020, two men died within an hour of one another at Curran-Fromhold Correctional Facility. A lawsuit filed by the family of one of the men, Steven Vansciver Jr., alleged that he was among four people to overdose in jail that day. That case was settled for $85,000.

The flow of contraband, including drugs and weapons, continues today, dozens of internal incident reports obtained by The Inquirer show.

In May and June alone, correctional officers seized a variety of drugs, cell phones, cigarettes, and homemade weapons — at least seven of which were discovered only after prisoners suffered puncture wounds to the chest, back, head or neck.

In that time, at least eight people were hospitalized for adverse reactions to drugs obtained while incarcerated. That includes three people found in a dorm May 28 experiencing “seizure-like” symptoms; a man who was revived only after three doses of naloxone on June 19; and a man who overdosed and was found on the floor of his cell on June 17.

Staff and incarcerated people complain about the haze of K2; one correctional officer, who said it was making her dizzy, passed out during her shift, according to internal records.

“The K2 secondhand smog is dense and unescapable all day long,” Vincent Chapolini, a man jailed on the latest of a near lifelong string of burglary charges, wrote in a lawsuit.

Asked how the jails are preparing to ensure the safety of the influx of prisoners from Kensington, Prisons Commissioner Michael Resnick said no such preparations are needed.

“The point of the mayor’s program is they won’t be incarcerated,” he said. “They’ll be going into treatment.”

But police leaders and Parker have made clear that even though incarceration is not the goal, enforcement plans do involve arrests of drug dealers and of those engaged in public drug use, prostitution or other “quality-of-life” crimes.

Several who died in jail were arrested for such low-level drug charges — and then, like Kelly Ann Crawford, incarcerated due to probation detainers or warrants.

Instead of preparing for more prisoners, the jails are still trying to stabilize staffing levels that plummeted in the pandemic.

In April 2022, to settle the federal class-action suit, the city promised to draft a plan for return to normal operations by that November. Instead, things deteriorated: Now, about half of city corrections jobs are vacant.

At a hearing in June, U.S. District Judge Gerald McHugh said he believed there was a basis to find that the city was in contempt of court. He’ll hear more evidence this month before ruling.

Bleiberg Bellos, of the Pennsylvania Institutional Law Project, and other advocates say that, if the city can’t recruit more staff, it needs to find a way to reduce the jail population.

“If the population goes up and the staffing level stays the same,” she said, “it’s just going to exacerbate all these issues.”

Staff writer Anna Orso contributed to this article.