Death in Fort Bend jail raises questions on facility’s medical, mental health care
In June, Esmeralda Trigo walked away from the Fort Bend County Jail with a plastic bag of her brother’s belongings.
Later, sorting through it in her Rosenberg home, she pulled out flip-flops, some commissary snacks and a book of New Testament psalms in which Albert Ramirez had neatly jotted down a few phone numbers. Tucked inside the book was another note: “I am having problems with my stamach (sic).”
When Ramirez was arrested in February 2020 on an aggravated robbery charge, his sister hoped time behind bars might bring positive change. Maybe he would get sober. Maybe, after his release, he would find a wife, go back to church, start fixing up old cars again. Maybe, despite a cancer diagnosis, the siblings would have more time together.
“When you get out, I know that you can do it — I’m doing it. All you got to do is stay right here and keep walking with me and you’ll be all right,” his sister, who has been sober for three years, would tell him. “But no. It didn’t happen that way.”
Ramirez, 57, died of natural causes on June 13 at OakBend hospital in the custody of the Fort Bend County Sheriff’s Office. The final autopsy report is not yet available, according to the county medical examiner, but preliminary information suggests the cause was cirrhosis of the liver. Ramirez also had cancer of the liver, according to his sister.
Trigo is raising questions about whether the jail provided her brother with adequate medical and mental health care, as well as about its response to her efforts to check on
her brother.
“I just feel like the jail could have done more,” she said. “They chose not to.”
Treatment was ‘proper’
The facts surrounding the inmate’s condition prior to his death appear “extremely troubling,” said Bill Ogden, a Houston attorney representing the family. The firm is in the fact-finding phase of an investigation into his death.
The attorney has requested medical records from the jail, but the sheriff ’s office will release the information only to an appointed representative of the estate. The attorney has asked a court to appoint Trigo as the executor.
Per protocol, the Texas Rangers are also investigating the incustody death.
A spokesperson for the sheriff ’s office said the agency cannot discuss specific medications or treatment provided to Ramirez, citing federal laws covering patient privacy.
“Proper treatment was rendered and protocols followed,” the agency said.
The sheriff ’s office did not address an emailed question about whether Ramirez received cancer treatment.
The jail has registered and licensed vocational nurses available around the clock, according to the sheriff ’s office. Nurse practitioners, a physician and certified medication aides are available each day and on-call afterhours. Inmates may be taken to an outside doctor or specialist if such treatment is warranted.
The death of an inmate for medical reasons is not surprising or uncommon, said Krishnaveni Gundu, co-founder and executive director of the Texas Jail Project.
Complaints about medical treatment in jails across Texas pour into her inbox. The Texas Commission on Jail Standards has recorded more than 1,150 incustody deaths since 2009, nearly half of which were deemed natural.
Limited resources and overcrowded jails make it “impossible to treat each other like human beings,” Gundu said. The solution, she said, is to reduce the jail population and invest in systems of care instead of punishment.
Addiction, mental illness, homelessness and disability have been systematically criminalized, Gundu said.
“People who should be cared for in the ERs or in psych facilities are ending up in jails because we don’t have enough treatment and care options for substance-use issues or mental health crises,” she said.
‘He was in a lot of pain’
On June 4, Trigo received a call from Henry Anthony Rodriguez, a family friend who was also being held at the jail. Rodriguez had been looking out for his sick cellmate for more than a year, helping him get dressed or to the bathroom.
Ramirez was often sleeping, had trouble eating and occasionally soiled himself on the way to the bathroom. Twice he fell from his top bunk, Rodriguez said, before staff moved him to a different bed. The man seemed weak, tired and “cloudy,” Rodriguez said, and his body became swollen — a symptom of cirrhosis of the liver.
“He was in a lot of pain,” Rodriguez said.
Ramirez spent 16 months in jail awaiting a hearing that was repeatedly pushed back. He told his sister he didn’t want to bond out. She suspects he didn’t want to burden her or slip back into drinking.
That Friday, Rodriguez had to wake up Ramirez, who “got up really hurting” and did not want to collect his things from the commissary.
“He was slumped over, like an old man walking without a cane,” Rodriguez said. “We told him, ‘Are you OK, man? What’s wrong?’ ”
Rodriguez helped Ramirez carry his bag, and when they returned, the ailing man lay down and said nothing. Rodriguez called for jail staff. In about half an hour, someone came with a wheelchair. It was the last time Rodriguez saw his friend.
The jail transported Ramirez to the hospital that day, according to the custodial death report.
Before then, Ramirez had been taken to the jail infirmary many times, his fellow inmate said, but staff would typically bring him back to his cell within a day or two.
Looking back, Rodriguez said he believes the jail should have provided Ramirez with better and quicker medical attention.
“They waited till he was dying just to get him to the hospital,” Rodriguez said. “That wasn’t right.”
‘He needed mental help’
After getting the urgent phone call from Rodriguez, Trigo called the jail and inquired about her brother’s condition. An employee told her that staff could not provide information due to medical privacy laws.
The next day, Trigo called back. No answer. She tried phoning the jail chaplain. In the evening, she visited the jail in person, but the staff still wouldn’t tell her anything.
Trigo did not know where to go or how to get through. Did she need a lawyer? Could she talk to a judge? She just wanted to see her brother, to talk to him, to ask if he was OK.
“But they never gave me that chance,” Trigo said.
On June 10, nearly a week after Ramirez was hospitalized, officials told Trigo to come to the hospital immediately. Her brother was terminally ill.
Then Trigo’s phone started blowing up. Staffers from the sheriff ’s office and district attorney’s office were calling to express condolences and to try to give Ramirez a personal recognizance bond to release him from custody.
The outreach upset Trigo. She felt that officials were trying to avoid responsibility since her brother was “on his deathbed.”
When Trigo arrived at the hospital, her brother was lying in an emergency room bed, gasping for air. His feet twitched. His eyes looked yellow. She didn’t know if he recognized her.
Doctors asked her if they should administer morphine to facilitate a peaceful death, but she instructed them to try to save him. Soon, the medics placed Ramirez on a breathing machine. His eyelids shut.
While the family waited by his bedside, a law enforcement officer stood guard. There was a pair of handcuffs on the bed. Trigo asked the guard to remove them.
Three days later, the family decided to take Ramirez off life support.
In his final moments, Ramirez was surrounded by the faces of family and chords of Christian music. Trigo hugged him and told him that he was loved and not alone.
Breaking the chains
Those were the same words Trigo had spoken again and again to her brother, though he struggled to believe them as he battled addiction, alcoholism, depression and loneliness.
Ramirez wasn’t a dangerous person, Trigo said, but someone whose misbehavior was rooted in mental illness and addiction. She believes he committed the crime for which he was jailed — displaying a knife to a Dollar General clerk and stealing the cash register’s contents — because he was concerned that he owed someone money.
Ramirez was a repeat DWI offender, according to court records, and a trespassing conviction recently landed him in jail for three weeks.
“To me, he didn't belong in a jail,” Trigo said. “He needed mental help. He needed probably a hospital.”
His sister understood the demons. She had spent time in jail and struggled with addiction. Eventually, after seeking help in a women’s shelter, she found a way out through God.
“I think if I didn’t have kids, I probably would’ve kept going like that, too. But my kids meant more to me,” Trigo said.
Trigo tried to help Ramirez by showing him compassion or tough love. When he was living on the street, she gave him a home with rules. No, she told him, she would not drive him to the store to buy beer.
He accompanied her to the grocery store, cleaned up after himself, picked up her grandchildren from the school across the street and made them noodle soup. He loved playing with the kids and enjoyed a nice meal — mole sauce or chicharrón en salsa — more than anything.
Now, there are memories of him scattered throughout Trigo’s home in Rosenberg. His portrait hangs on the wall over his favorite nook on the couch where he would watch “Law and Order.” A black box containing his ashes rests on a shelf in the living room. A collage of photos stands in the corner by a pile of his jackets.
There’s a box of pamphlets from his funeral that makes Trigo smile when she remembers the beautiful service. Family members chose songs they felt defined his life: “Cansado del Camino,” “Worn,” and “Chain Breaker.”
The lyrics of the last song, by Christian rock artist Zach Williams, reminded Trigo of the cycle of challenges that entrapped her brother.
“We’ve all found ourselves worn out from the same old fight. We’ve all run to things we know just ain’t right. There’s a better life,” she sang softly on her couch, wiping tears, as the YouTube video played on her phone. “There’s a better life.”