Niki Capaci had her faults, but she was first and foremost a mother and a protector, her family said.
As a young girl, she had severe asthma, so while her siblings played outside, she played house. She even treated her youngest brother, Ben Capaci, as if he were her own kid, he said.
"She always tried to be protective of me. Even when she knew I was wrong, I knew I was wrong, she would still try to step in," he said.
And she was baby obsessed from even a young age. Maybe that's why she started having kids as young as she did, Ben Capaci said. At 15, she had her first child.
"She went into the role of mother young and went into it with everything she had," he said. She went on to have seven children, who are now between the ages of 9 and 25.
Niki Capaci died last year at age 40 while incarcerated at the Orange County Jail in Goshen, New York.
Without her, the Capaci family is adrift.
"Feeling lost is an understatement for us," her three youngest children said in a statement to NPR. "We would have never thought that we'd lose our own mom so early in life. Nothing will ever make us feel okay again because we won't ever see our mother again."
The family has also been burdened with questions since her death more than a year ago: What exactly happened between May 3, 2023, when Capaci was first incarcerated, and the early morning of May 6, 2023, when she was found unresponsive in her cell and was later pronounced dead?
The family is suing Orange County and the jail's health care provider, Wellpath, in federal court for damages for personal injuries, pain and suffering, emotional distress, wrongful death and economic damages.
The lawsuit names two staffers: Cyrel Dasraj, an Orange County corrections officer, and Teneshia Washington, a nurse with Wellpath responsible for caring for inmates at the Orange County jail. The lawsuit alleges that Dasraj failed to check on Capaci while she was in her cell and that Washington, as well as other unidentified medical providers at the jail, failed to properly assess and treat Capaci. Neither could be immediately reached for comment.
Capaci's case draws attention to the challenge facing the U.S. of caring for jailed people with addictions who are struggling with withdrawal, addiction experts told NPR. Jails and prisons are frequently ill equipped to handle the medical needs required to safely wean someone off addictive substances like opioids, in Capaci's case.
At least 63% of people sentenced to jail meet the definition of addiction — compared with 5% of adults who are not incarcerated, according to U.S. Justice Department research. That research also has found that among sentenced jail inmates with addiction issues, less than 20% had participated in any form of drug treatment while incarcerated "and only 1 percent received detoxification services."
The Capaci family has demanded information since Niki Capaci died, but family members say the details they've received through records requests have only raised more questions about how she was treated by medical providers and what led to her death. It has prevented them from properly grieving and moving on, they said.
"It has dragged out the grieving process for all involved for way longer than it should. It's been a year already," said Capaci's mother, Carolyn Morse.
Here's what the family says it knows
Capaci was being held in the Orange County Jail for violating her probation for prior drug charges. The jail is owned and operated by the county and its sheriff's office. Capaci had told her family that she was likely going to stay for no more than a week, before probably being transferred to a rehab facility, the family told NPR over a video chat in late May.
From the outset, Capaci was exhibiting symptoms of severe withdrawal from opioids, according to the family's lawsuit.
The lawsuit says that Capaci was intolerant to buprenorphine, a common medication used to treat opioid use disorders, and that it made her extremely ill.
But she was given the drug anyway, according to her family, who kept in touch with Capaci through calls while she was incarcerated. She was also given a host of other medications, according to her autopsy report and some medical records from her time in jail that were reviewed by NPR.
After being given buprenorphine, she became extremely ill with uncontrollable vomiting and diarrhea, the family said. Besides being given anti-nausea and antidiarrheal medication and being checked by jail staff in her cell sporadically, the family says it believes Capaci was largely left alone in her cell without any medical intervention by jail staff.
The family received the autopsy report for Capaci, but it didn't include the fact that she died in jail. It lists her cause of death as an accident caused by acute drug intoxication. The autopsy report also makes no mention of the administration of buprenorphine that the family says Capaci told them she was given and that is listed as being given to her in medical records from her time in the jail.
The autopsy report also lists multiple medications — including a drug used for both anxiety and alcohol withdrawal (which Capaci had no history of being addicted to, according to her family) and several benzodiazepines (which are used as a sedative) — that were found in her body.
The fact that this autopsy report doesn't list Capaci's death as taking place in jail is problematic but not unusual, said Terence Keel, who heads the In-Custody Death Project, which investigates the history and current practices of the American medical examiner system.
"I see a lack of care to the amount of drugs that she was prescribed and its effects on her body," he said. And because the autopsy report doesn't mention that she was in jail, "this record reads like the state is trying to release itself from being responsible for her death," said Keel, who is also a professor of human biology and society at the University of California, Los Angeles.
Reading Capaci's autopsy report, Keel said, "you would just simply say this person was a drug addict who died of drug complications, but the context changes if you begin to realize that this person was in jail."
All of this leaves the family with the belief that Capaci died from a combination of opioid withdrawal — not entirely uncommon, especially in jails and prisons, according to experts who study addiction — and from medical neglect from Orange County jailers and the jail's medical staff, employed by Wellpath, the largest commercial provider of health care in jails and prisons across the United States. Wellpath has been the target of several federal lawsuits and is being scrutinized by 12 U.S. senators who are looking into its health care practices.
NPR attempted to contact the Orange County medical examiner who completed Capaci's autopsy. We were referred to the office of Orange County Executive Steven M. Neuhaus, who did not respond.
Representatives for Wellpath didn't respond to multiple requests for comment.
A representative for the Orange County Sheriff's Office said in a statement that Capaci's estate "has engaged legal counsel to file a Notice of Claim on its behalf. A hearing was conducted with a representative of the Estate. County Attorney Richard Golden has stated: 'The Estate of Nicki [sic] Capaci has chosen the litigation path to address its concerns. As a result, the County's responses will be set out in that forum and will have no other comment.'"
Risks associated with addiction and withdrawal in jails
Dr. Kelly Ramsey, a member of the board of the American Society of Addiction Medicine, and Michael Farrell, the director of the National Drug and Alcohol Research Centre at Australia's University of New South Wales, Sydney, who both spoke to NPR, warn that failing to treat withdrawal symptoms in a safe and timely manner could lead to serious injury or death.
But finding explicit data on the prevalence of deaths in jail caused by drug or alcohol withdrawal is difficult. Many of these deaths end up being categorized as death by "illness" or "other" by jails that submit death records to the U.S. Department of Justice. That's because there is no specific reporting category for deaths associated with withdrawal.
Jails, where there are typically not enough resources, "present challenges for addressing substance withdrawal" and addiction, the DOJ's Office of Justice Programs said in a June 2023 publication providing guidelines for local governments, jails and health care professionals.
The guidelines recommend that jails and other institutions provide access to both buprenorphine and methadone, considered front-line treatments for opioid withdrawal.
Keel, of UCLA, said it's crucial that jails and their staffs are properly trained to identify and treat withdrawal because it's a jail's responsibility to care for the people it incarcerates.
Ideally, someone suffering from opioid use disorder who is incarcerated should have access to all necessary medications, said Ramsey.
"Some patients may respond well to buprenorphine. Other patients may respond better to methadone," particularly with opioids like fentanyl, Ramsey said.
What Wellpath's record shows
The Capaci family alleges that Niki Capaci suffered medical neglect during her severe withdrawal and says Wellpath is partly to blame.
The company, established in its current form following a 2018 merger, is the country's largest correctional health care organization, providing medical services in prisons and jails for more than 300,000 people across 37 states.
Wellpath has been accused by critics of inadequate and delayed care, with chronic understaffing and medical conditions going ignored, which in some cases has allegedly led to inmate deaths.
As a result, the company has been sued by dozens of family members of deceased prisoners — now to include the Capaci family. Some of these lawsuits have also targeted local jails or prisons and the towns and cities they are located in — costing localities millions of dollars in settlements and judgments from the lawsuits. Still, towns and cities across the country continue to choose Wellpath to provide medical care for their jails and prisons.
A 2019 CNN investigation found that in lawsuits filed between 2014 and 2018, Correct Care Solutions (CCS), now Wellpath, was accused of contributing to more than 70 jail deaths.
Wellpath's predecessor, CCS, was named as a defendant in roughly 1,400 federal lawsuits over the decade leading up to the merger, according to a letter from 11 Democratic U.S. senators and independent Sen. Bernie Sanders that was sent to Wellpath and founders of H.I.G. Capital, which owns Wellpath. Many of those lawsuits have ended in some form of compensation for the plaintiffs, the senators wrote.
In that CNN report, Wellpath's leadership called deaths of inmates isolated incidents and defended the company's overall work.
Sens. Elizabeth Warren and Jon Ossoff, who are leading the effort to question Wellpath, declined to comment for this story.
Like the case being brought by the Capaci family, some of the other lawsuits filed against Wellpath have alleged that employees ignored signs of distress from inmates, with deadly consequences.
In 2022, an 18-year-old named Dezaree Archuleta who was incarcerated in Colorado's El Paso County Jail died by suicide. Her family told Colorado Public Radio that she had repeatedly expressed suicidal ideations. The El Paso County Sheriff's Office settled with the Archuleta family for $1 million after the teen's death.
A 2021 Justice Department investigation of the San Luis Obispo County Jail in California found that Wellpath didn't have enough medical staff on duty, putting inmates at serious risk of harm.
The senators who have questioned the company have asked Wellpath specifically about its procedures to treat opioid withdrawal.
The deaths of two men incarcerated at New York's Orange County Jail before Capaci arrived also have been tied to poor medical care by Wellpath, according to state reports.
The 2021 suicide of 26-year-old Troy Conklin in the jail was investigated by New York's Commission of Correction. The agency found that he had a heightened risk for suicide, with three attempts within 30 days, but that Wellpath providers in the jail failed to recognize it.
Less than a year later, the commission found that the death of Ricky Mack, a 65-year-old man with dehydration, chronic kidney disease, COVID-19 and a host of other ailments at the time of his death, was tied to "gross failures in the medical assessments" of Mack. Had he been properly diagnosed and transferred to a hospital, his death could have been prevented, the commission's report concluded. Wellpath responded in each report to say it was making improvements and holding more employee training. In Mack's case, one employee was terminated.
The Commission of Correction has not commented on whether Capaci's death will be investigated.
Capaci's addiction stemmed from an injury and painkillers
Despite having children at a young age, Capaci stayed in school and went on to become a registered nurse at 21, her mother, Carolyn Morse, said with a hint of pride in her voice.
This job allowed her to support her growing family.
"She did everything she could to provide for them. She did a very good job — until the drugs," said Ben Capaci, her younger brother.
But the heavy lifting and tough work as a nurse quickly wore down Niki Capaci's body. At 23, she injured her back and went on to have at least three surgeries for herniated disks, Morse said.
Like so many other people in the U.S. who have an opioid addiction, Morse said, Capaci started out with painkillers legally prescribed to her by doctors. Capaci took them as prescribed for years, while not realizing she was essentially a functioning addict, her family said.
Then a few years ago, doctors took them away, leading Capaci to do what so many others do: find another source. She turned to illegal forms of opioids and eventually fentanyl.
Her eldest daughter, Aryana Davila, said their relationship was not always the best.
"Because of especially how the last few years went with me and my mom's relationship, I regret a lot of stuff. And I dwell on it," she said.
The night before her mother died, Davila was working at a Mexican restaurant. It was Cinco de Mayo and the place was packed. Her mother kept calling her from jail. She was telling Davila that she was really sick.
Davila told Capaci to call the emergency button placed in her cell to get guards to help her.
"And she kept pressing it. And I was on the phone with her, and I heard them tell her to stop and [that] she wasn't dying. She was trying to get help," Davila said. "She was throwing up. Like I could tell she was puking on the phone. It was very obvious that it was serious. Anybody with half a mind could tell it was serious."
While she was working, her mother kept calling. Davila, exasperated, told her to call her back in the morning.
That was the last time she would speak to her mother.
The family alleges missing and contradictory information
Capaci was found unresponsive in her cell at approximately 6:04 a.m. on May 6, 2023, according to her family's lawsuit and jail medical records. It wasn't until more than seven hours later that Davila was informed by Orange County Sheriff's Office officers that her mother was dead, she recounted to NPR.
Over the past year, the family obtained some of Capaci's jail medical records.
Jaehyun Oh, the family's attorney, compared the process of trying to get information to trying to put a puzzle together without all the pieces.
When Capaci was booked and placed in the jail's general population, she was also placed on 15-minute interval special watches by jail and Wellpath personnel to monitor her for potential withdrawal symptoms, the family's complaint says. But those checks took place less frequently and not in accordance with procedure, they allege.
At one point during Capaci’s incarceration, two hours elapsed between checks by staff — not 15 minutes as required, the lawsuit alleges. During the evening of May 5 and into the morning of May 6, there were stretches from 30 minutes up to an hour when no one looked in on her.
Notably, logs meant for tracking inmate behavior and special watches from May 4 at 3:30 p.m. to May 5 at 10 p.m. "are missing or non-existent," the lawsuit says.
"Even when the 15-minute checks were performed, the monitoring was cursory and nominal, often reduced to a single glance into the jail cell," the lawsuit says.
The records they have received include contradictory and confusing information, Oh said.
Documents shed some light on the medication that was administered or that was scheduled to be administered to Capaci. Those records state that during her time in jail, those medications included buprenorphine, folic acid, vitamin B1, acetaminophen, multiple anti-nausea and antidiarrheal medications and chlordiazepoxide (a long-acting benzodiazepine used for treating mild-to-severe anxiety disorder and withdrawal symptoms of acute alcohol use disorder).
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At around 8 p.m. on May 5, she was transported to the jail's medical center in a wheelchair and was given anti-nausea medication to help stop her repeated vomiting. The suit alleges that no doctor physically examined Capaci and solely an "on-call provider" spoke to staff members over the phone and told them to give her medication to stop the vomiting.
At around 1:35 a.m. on May 6, Capaci was transferred again to the jail's medical center.
Jail surveillance videos of her awaiting transfer that were shared with NPR show Capaci barely able to remain standing upright in one area of the jail and leaning on the door.
At one point, she lies on the floor as she waits for a guard to open the door.
Less than five hours later, she was found unresponsive in her cell. Officers called 911, and attempts to administer CPR and an AED (automated external defibrillator) proved fruitless.
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Farrell, of the National Drug and Alcohol Research Centre in Australia, along with two other professors of drug research, was part of a study titled "Yes, people can die from opiate withdrawal." It found that persistent vomiting and diarrhea are tied to untreated withdrawal, leading to fatal levels of dehydration.
The toxicology report included in the Orange County medical examiner's autopsy lists benzodiazepines, methadone, opioids, oxycodone, additional sedatives and fentanyl. It doesn't include buprenorphine, the withdrawal drug Capaci was allegedly given while in jail.
UCLA's Keel, who is not involved in this lawsuit but who reviewed Capaci's autopsy, said, "There are high levels of controlled substances that are in her system that seem higher than what you would expect from someone being in jail for two days."
There's "an extraordinary number of benzos," which are basically a sedative, Keel said. "When you have a lot of them, they can interact with one another" and with other drugs in the system, he said.
To Keel, the report shows that "either she was getting access to drugs while she was in jail. Or they weren't giving her the drugs to deal with the withdrawals."
It's a question with no clear answer, Ben Capaci said.
"You got seven kids that don't really know what happened to their mother. My sister went through a lot of excruciating pain, I'm sure, at the end," he said.
The Capaci family doesn't want others to go through what it has
There have been increased efforts in recent years to boost medication-assisted treatment in jails and prisons across the country.
On Oct. 7, 2021, New York Gov. Kathy Hochul signed into law legislation that establishes inmate access to medication-assisted treatment programs. It also requires jails to have access to medication used to treat opioid use disorder, including methadone, buprenorphine and naltrexone.
The New York State Sheriffs' Association opposed the legislation, saying in a memo that the "decision whether to offer [medication-assisted treatment] is one that resides, and should remain with, the Sheriff," New York Focus, a nonprofit newsroom, reported. The association also cited the cost of the medications and fears that inmates would attempt to smuggle opioids into jail.
But Ramsey, the American Society of Addiction Medicine board member, said having all medications available to incarcerated people can save lives.
"People with opioid use disorder who are on methadone or buprenorphine have at least a 50% decrease in mortality by being on the medication. It decreases the risk for both opioid-related or overdose mortality," she said.
Under this 2021 law, local correctional facilities are required to submit an annual report of provided treatment services to New York's Commission of Correction. The most recent report shows that the Orange County Jail, where Capaci died, couldn't initiate methadone therapy but otherwise "provided continuation for individuals already prescribed."
Ramsey notes that efforts to provide particular medications for opioid use disorder in jails and prisons are slowly improving, but part of that is due to a reactive response to lawsuits filed by families or federal agencies.
By pursuing this lawsuit, the Capaci family hopes that no other family goes through what they have, says Carolyn Morse, Capaci's mother.
"It's very hard to deal with. And I don't want to see any other families go through this," Morse said. "And if we can help get a little bit of policy and procedure changed or even adhered to … if anything can get changed from this lawsuit, that will make me very happy."
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