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Madison Jensen told Duchesne County jail staff she'd been vomiting for four straight days. She had diarrhea. She needed help.
"Can't hold anything down," she wrote in a medical request. "Not even water."
The medical request was mistakenly dated Dec. 31, 2016, about a month after she was found dead on the floor of a holding cell. Likely, Jensen made the plea for help Dec. 1, hours before the end.
Newly disclosed medical records say she had lost at least 17 pounds during her short jail stay.
A Utah medical examiner's report the family provided to The Salt Lake Tribune classified the 21-year-old woman's death as "natural" a result of cardiac arrhythmia caused by opiate withdrawal and dehydration.
Jensen thought something else was going on.
"I know my body and it is not [detoxing]," she wrote in a scrawling script. "I am completely detoxed. My roomate [sic] caught the stomach bug … from me."
It all started when Jensen's family had called the sheriff's office for help in November after she threatened suicide at home. She also said she recently used heroin, and the family thought a set of medications she was on was making her worse.
Deputy Jared Harrison warned Jensen's father, Jared, that jail wasn't an alternative to rehab. But Jared Jensen said he needed help. His wife was ill and couldn't handle the stress of Madison's erratic behavior. Jared Jensen needed her out of the house and thought his daughter would be safe in jail, where she could be under suicide watch. Plus, he said, Madison didn't protest during her arrest.
'Excruciating' • Documents in the medical examiner's report provide the most thorough look to date at what caused Jensen's death, which has been disputed by the Duchesne County Sheriff's Office.
The documents indicate the jail which refers to itself as a narcotics-free facility didn't give Jensen her pain and anxiety medications. Experts on opiate withdrawal question the decision to withhold one of the three medications she was on, suggesting it contributed to her "excruciating" final days.
"She was going through opioid withdrawal syndrome and antidepressant withdrawal," said Matt Finch, an opiate withdrawal recovery specialist in California. "I can't even imagine how much pain she was going through."
The office has declined to release surveillance video that would show Jensen's care during her time in jail. The Duchesne County attorney and Uintah County Sheriff's Office each has declined to release records that would shed more light on Jensen's treatment.
Medical examiner's office records indicate Jensen lost at least 17 pounds in four days' time perhaps as much as 42 pounds, according to unexplained discrepancies. Investigator John Crowley from the state medical examiner's office wrote that Jensen, who was nearly 6 feet tall, weighed 87 pounds when she was found dead. Medical examiners later put her final weight at 112 pounds.
Jensen weighed 129 pounds when she was booked according to the sheriff's office, which tracks with the 130 pounds her family said she weighed Nov. 11.
Erik Christensen, the chief medical examiner, speaking generally about the autopsy process, said it's hard to determine precise weight because a body may be in a bag or on a backboard when it's brought in for examination.
'The incident' • Crowley's report details what he saw on surveillance footage when she was last seen alive.
At 12:49 p.m., on Dec. 1, Jensen tried to drink water. About a minute later, water and a brown liquid spewed from her mouth. At 12:56 p.m., Jensen had what Crowley describes as "the incident."
Her "legs go straight and feet and toes point straight and ridged [sic]," Crowley wrote. "Madison's arms cross and her wrist [sic] look to lock up in a bent position. Madison then does a roll of sorts [off] the bench and onto the floor in a sitting up position and continues to have the incident with the legs and arms locked up."
Her body twitched and stopped. At 1:28 p.m., 32 minutes after she was last seen alive, the jail's nurse discovered her body lying face up on the holding cell floor. Attempts were made to save her life.
A toxicology report showed Jensen had no trace of drugs in her system when she died. She told officers she had last done heroin four days before being arrested for possession of paraphernalia and testing positive for marijuana and heroin. She said she did heroin four times.
Experts on opiates say withdrawal itself isn't fatal. Other factors like heart conditions can lead to death while someone is withdrawing, said Py Driscoll, an internal medicine doctor who works at the Alta Mira rehab center in Sausalito, Calif. Dehydration from withdrawal is easily preventable and treatable, she said.
"I've never had to send someone from our treatment program at Alta Mira to the hospital for dehydration," she said, adding that caregivers typically treat addicts by "giving them medicines and giving them lots and lots of Gatorade every hour [and] making sure they're drinking."
There are even over-the-counter treatments available to help people suffering from withdrawal, such as vitamin C. But that's mainly to help with the severe pain that goes with coming off heroin and other opiates.
"Most people can survive it without anything," Finch said. "Typically, the normal person would not ever have to worry about dying from coming off opiates. It's just something you never have to worry about."
Investigation • Medical examiners said drugs didn't directly contribute to Jensen's death. "Toxicology was noncontributory." Harrison, the arresting officer, also told investigators Jensen was acting and talking normally on the way to the jail.
Jensen had been taking three medications: Wellbutrin for anxiety and depression, Clonidine for high blood pressure and Tramadol, an opioid painkiller.
Crowley wrote that she was receiving only one medication, Clonidine, "because the others had not been approved for Madison to take."
Still, the medical examiners wrote, "withdrawal is a complication of chronic drug use and therefore, the manner of death is certified as natural."
Duchesne County Attorney Stephen Foote is reviewing the case for possible criminal charges for jail staff. He said he would release a timeline of Jensen's time in the jail, but likely would prevent the release of video that would show what happened, saying it was a matter of security.
Jared Jensen, meanwhile, has taken the initial steps required to sue the county, Duchesne County jail and staff.
"When she says she didn't eat or drink for four days and you still didn't put an IV in her arm, you dropped the ball on her," he said. "I want everyone involved with her death removed from that jail, including the sheriff and Lt. [Jason] Curry, [the jail commander] so no other parent has to do this again."