Imagine slipping and falling on a wet floor, suffering a painful fracture in your leg that requires surgery, but not receiving a diagnosis, treatment or even pain medication for more than three days. Imagine only having an ice pack to apply to that injury as it continues to swell, turning black and blue. Imagine being told you're not “on the list” to see a doctor as your pain goes from severe to excruciating. Fifty-seven-year-old Susan Ledbetter doesn't have to imagine an ordeal like that, she says she lived it.
In 2012, Ledbetter began serving almost nine months at Alabama's Tutwiler Prison for Women for drug charges. In May 2012, she turned herself into Calhoun County authorities, pleaded guilty to second degree unlawful manufacturing of a controlled substance and in her words, “wanted to do her time and get on with her life.”
She reported to Tutwiler Prison June 1, 2012 and shortly after arriving, began working in the prison's kitchen.
Ledbetter, a mother and grandmother, a former truck driver and bartender, has not had an easy life. We interviewed her outside her mobile home in rural Calhoun County, a home she returned to after prison with no power or running water. Her utilities were turned off while she was incarcerated and it took her months to scrape together enough money to get them turned back on.
“We're doing the best we can,” she said, as she broke up kindling for a wood heater she uses to warm up the home she shares with her husband.
The medical term for the injury Ledbetter suffered at Tutwiler is a tibia plateau fracture which is a break in the tibia or shinbone that affects the stability of the knee joint. Birmingham Orthopedic Surgeon Dr. Geoffrey Connor did not treat Ledbetter, but says this is a common injury that compromises the integrity of the knee “like pushing your thumb into styrofoam.”
"Typically with a fall or a substantial twisting injury, you'll get, most commonly, force along the outer edge of the tibia, and for lack of a better term, it kind of crumbles underneath you,” Dr. Connor explained. “That results in a substantial amount of pain and swelling and inability to put weight on it."
Ledbetter's injury happened on Sunday night, December 9, 2012. She said she visited the prison medical hall that evening to receive scheduled treatment for an infection on her right toes.
Ledbetter had noticed two inmates who appeared to be mopping, and as she left the medical hall she said one of them shouted a warning at her to go back the way she came, but Ledbetter said it was too late. She had already taken a step on the wet floor. Her foot slipped and her legs went out from under her. She said she hit the floor and immediately felt shooting pain in her right knee. Ledbetter said the first person to respond was a prison nurse, who told her to get up by herself.
"She said, ‘We can't help you, we can't touch you,'" Ledbetter recalled the nurse saying. "And I said, 'Ma'am, my leg's hurt and I can't get up.'"
Ledbetter said the nurse eventually helped her up upon realizing Ledbetter was "swimming in wax stripper." She said the inmates outside the medical hall were re-waxing the floors but Ledbetter never saw any signs.
"No signage up, nobody in the medical hall had any knowledge of what was going on out there or nothing," Ledbetter said.
Ledbetter spent that night in the infirmary and was given an ice pack for her knee. Records from Alabama Department of Corrections indicate a nurse filed a report about Ledbetter's fall that night and supports Ledbetter's claims that only an ice pack was provided for relief. Ledbetter said her knee was swelling and the pain was getting worse.
“I think on a Sunday night, at 8:30 at night, they could see I was already hurt,” said Ledbetter. “I don't know why an ambulance wasn't called to start with, but they said in the prison system, they had to make sure I was hurt, that I wasn't faking.”
Ledbetter said she was told she needed an X-ray, and according to ADOC records, an X-ray was ordered for the following morning. Records indicate the next morning, the X-ray technician was informed that Ledbetter was in the infirmary, but for some unknown reason, an X-ray was not done that day. That meant more time under the ice pack for Ledbetter, who waited two more days until the X-ray technician returned to the prison and this time, Ledbetter was ready.
"When I see the X-ray man go down the hall, I had my clothes on, I was sitting in that wheelchair at 7:30 waiting on him to show up," Ledbetter said. “I followed him right on down the hall, I said, ‘I don't know who's getting X-rayed but I'm here!'"
Ledbetter said the X-ray technician told her "good girl" and admitted that he'd missed her on Monday because prison officials didn't tell him about her until after he had already left Tutwiler Prison and was working at Kilby Prison. She said about 45 minutes after he performed the X-ray, prison officials called an ambulance that took her to the emergency room at Jackson Hospital in Montgomery.
So why did Ledbetter, with a serious leg injury, have to wait almost three full days for an X-ray? Why wasn't an ambulance called immediately? These are questions we asked the Alabama Department of Correction's (ADOC) healthcare vendor, Corizon Health. Through a spokesperson, they sent us the following statement:
"Corizon Health cannot comment on individual patient care due to state and federal privacy regulations. However, we can tell you we utilize x-ray services when they are medically necessary, and that x-rays aren't required to be made in order to summon an ambulance. If specific specialized care is required for a patient that cannot be provided on-site at the facility, Corizon Health works with a network of various community providers and hospitals, and we cooperatively develop an appropriate care plan. Each case is reviewed on its individual clinical presentation, and appropriate steps are taken based on established industry criteria and medical necessity."
At Jackson Hospital, Ledbetter received her diagnosis of a tibial plateau fracture. Jackson Hospital records indicate she experienced symptoms of "marked pain" and "a significant amount of swelling." Records also say the fracture had to be fixed surgically, otherwise the injury could cause "severe arthritis" and "marked disability."
Ledbetter described her state at Jackson Hospital, more than three days after she suffered her fall.
"It was excruciating, I was crying, when I got to the hospital, the lady instantly give me a big dose of Dilaudid," remembered Ledbetter. "That nurse said, 'I can tell you're in pain.' I was in so much pain, I was shaking at that time, by the time they got me to the hospital."
Ledbetter said the doctor wanted to operate on her right away, but prison officials sent her back to Tutwiler.
"The prison made me return to prison," said Ledbetter. "They said they had to have a meeting to get all that approved."
Ledbetter's surgery finally happened on Friday, December 21, 2012, nine days after she was seen in the emergency room and twelve days after she had fallen and split her bone. We reached out to the ADOC about Ledbetter's case and a spokesperson emailed us the following statement:
"Access to emergency health care is obtained by notifying an ADOC security staff member. Any emergency or injury is to be reported to staff immediately. All emergencies or injuries are screened for priority of treatment and will then be examined accordingly. Appropriate medical care is provided by institutional health services staff."
Ledbetter feels her long wait for diagnosis and treatment of her injury was unnecessary and she was surprised that prison staff seemed OK watching her suffer.
Dr. Geoffrey Connor said this type of injury needs to be addressed as soon as possible and waiting can come with substantial risk.
"The most substantial morbidity in this case, with the delay, would likely be pain," said Dr. Connor. "But you could possibly suffer a blood clot too, having immobility without medical treatment over a prolonged period of time - 24, 48, 72 hours - that can result in a blood clot, and that's a life threatening problem."
Ledbetter said between arthritis and her leg injury, she now lives in constant pain. She said she wanted to share her story, not for sympathy or money, but for the women still incarcerated at Tutwiler Prison.
"I just don't want any other women to have to lay there for four days with a broke leg and in the pain I was in," she said.
In June 2014, the Southern Poverty Law Center (SPLC) and the Alabama Disabilities Advocacy Program filed a federal lawsuit against the ADOC over inadequate medical and mental health care in Alabama prisons. The SPLC also published a scathing report based on "inspections of 15 Alabama prisons, interviews with well over 100 prisoners and a review of thousands of pages of medical records detailing." The report, Cruel Confinement, alleges the ADOC is "deliberately indifferent to the serious medical needs of the prisoners in its custody."
Note about this story: FOX6 News interviewed Susan Ledbetter in February of 2014, but could not file this story until Ledbetter provided us with her medical records, to support her side of the story. She was able to obtain some records by petitioning Jackson Hospital and her surgeon, Dr. Michael Davis. She first submitted a request to ADOC for records in February 2014 and got no response. Again, she followed ADOC instructions and sent in a second request in June 2014 and again, received no response. She finally received her ADOC medical records three weeks ago, after FOX6 News contacted ADOC on her behalf.