TEXARKANA, Texas — Holly Barlow-Austin was reasonably healthy, her HIV under control with medication, when she was booked into a for-profit jail in Texas in April 2019 on a probation violation.
Barlow-Austin, 46, of Texarkana, died 10 weeks later, blind, malnourished, dehydrated and septic after being denied vital medication and nourishment while she pleaded, day after day, for help, a federal lawsuit filed by her family alleges.
“Her last 48 hours (in custody) were tantamount to torture,” Erik J. Heipt, the attorney representing Barlow-Austin’s family, told The Washington Post on Friday. “She was beyond saving by the time they took her to the hospital.”
Barlow-Austin’s drastic health deterioration is illustrated by video footage of her final two days in jail, in which she can be seen crawling weakly around a filthy medical observation cell, emaciated and too frail to stand or walk.
“Holly is unrecognizable. It’s haunting,” Barlow-Austin’s husband, Michael Austin, told the Post through Heipt. “Losing her has left me heartbroken.”
Despite the obvious signs of trouble, including bloodwork and increasingly alarming vital signs, jailers at Bi-State Jail in Texarkana accused Barlow-Austin of feigning symptoms, saying she “knows how to play the sickly role,” according to the lawsuit.
The federal filing accuses LaSalle Corrections, which runs Bi-State Jail and 17 other correctional facilities in Louisiana, Texas and Georgia, of neglect, abuse and the disregard of inmates' constitutional rights. Bi-State Jail, as its name suggests, straddles the Texas-Arkansas border.
“So long as the corporation continues to profit, nothing changes,” the lawsuit states. “This case goes the very heart of everything that’s wrong with the privatization of America’s county jails.”
According to the family’s lawsuit, Barlow-Austin died of sepsis due to a fungal infection of the blood. The secondary cause was cryptococcal meningitis, a brain and spinal infection caused by the fungus Cryptococcus neoformans. That specific type of meningitis is seen in people with HIV.
Another factor in her death was accelerated hypertension, described as a recent significant increase in blood pressure that can lead to organ damage.
“I can’t stop thinking about how badly she was treated,” Barlow-Austin’s mother, Mary Mathis, said in a statement.
Mathis said she has been unable to bring herself to watch the videos of her daughter’s final days in jail. She described Barlow-Austin as a loving, generous woman.
“She made the world a better place,” Mathis said.
A number of jail officials are named in the lawsuit, as is Bowie County and LaSalle Corrections. LaSalle came under fire earlier this month after reports emerged that immigrant detainees at another of its facilities, Irwin County Detention Center in Ocilla, Georgia, had undergone surgeries, including hysterectomies, that they either did not want or did not fully understand.
The allegations began with a nurse who claimed a doctor called the “uterus collector” was performing mass hysterectomies on migrant women.
The Associated Press could not substantiate the claims of mass hysterectomies but spoke to multiple women who said they felt pressured to have surgeries they did not understand the need for. The complaints sparked an investigation by the Department of Homeland Security’s inspector general.
Barlow-Austin, who had struggled with substance abuse, was arrested on a probation violation charge April 5, 2019, by Texarkana police officers. WFAA in Dallas reported last year that she violated her misdemeanor probation by cutting off her ankle monitor and traveling to Dallas to enter drug treatment facility.
“She told me when she got home, ‘I’m going to be the wife that you really deserve,'” Barlow-Austin’s husband, Michael Austin, told the news station in December.
There were consequences for violating probation, however. When Barlow-Austin was booked into Bi-State Jail the day after her arrest, the jail’s medical personnel were made aware of her HIV status, as well as her mental health conditions, including bipolar disorder.
“Among other prescription medications, Ms. Barlow-Austin was taking Triumeq, which is a fixed-dose combination of three meds used to treat HIV/AIDS,” the lawsuit states. “She was also taking fluconazole, a medication used to treat and prevent potentially deadly fungal infections, including cryptococcal meningitis, as well as medications for her mental health needs.”
Watch footage of Holly Barlow-Austin’s final 48 hours in jail below, courtesy of the Texarkana Gazette. Warning: The video may be disturbing for some readers to watch.
Jail medical staff faxed a request for Barlow-Austin’s medical records to her healthcare provider, Texarkana Care Clinic, but failed to follow up on the request. They did not receive the records until May 13, more than five weeks later and about halfway through Barlow-Austin’s stay in the jail.
Barlow-Austin’s family alleges that when she was booked into the jail, her vital signs were good and she reported no medical issues.
She was “able-bodied, hydrated and well-nourished,” the lawsuit says.
Two days later, Barlow-Austin’s husband took her medication to the jail, including her HIV medication, the fluconazole and her medications for bipolar disorder and depression.
“Despite her husband bringing in her four prescription medications on April 8, 2019, Ms. Barlow-Austin did not receive any medication until April 12, 2019, when she received only two of her prescription meds, citalopram and Triumeq, and she was given no medication whatsoever on the following two days,” the lawsuit states. “Moreover, she was not given any fluconazole until April 17, 2019, nine days after her husband brought the prescription medication bottles into the jail.”
The Texas Commission on Jail Standards later cited the jail for its failure to dispense her medications as prescribed, the suit says.
Predictably, Barlow-Austin got sick, her family alleges. A week after she was jailed, she submitted the first of multiple medical request forms complaining of a headache, dizziness and a lump on the right side of her neck.
Her blood pressure was high, and she complained of being unable to move her left leg.
On April 14, medical personnel collected blood, which showed that Barlow-Austin’s white blood cell count was dangerously low.
“These blood cells are crucial to fighting infection and safeguarding a person’s immune system,” the lawsuit states. “A normal CD4 range is about 500-1,500. Ms. Barlow-Austin’s results came back on April 17, 2019, and showed that her CD4 count was 87, indicating that her immune system was severely compromised.”
Her compromised immune system made her particularly susceptible to infections, including fungal meningitis, yet jail medical staff failed to come up with a comprehensive medical plan to address the problem, the document says.
Jail staff on April 17 began providing Barlow-Austin with her anti-fungal medication but by then she was already on the way to being desperately ill, her family’s lawsuit alleges.
Read the federal lawsuit filed by Barlow-Austin’s family below.
Over the next several weeks, as she continued to plead for medical care, Barlow-Austin’s condition deteriorated greatly. Her husband, Michael Austin, visited often and said she complained of a headache, dizziness and weakness each time he visited.
Barlow-Austin was repeatedly told by jail medical staff that she had a “tension headache,” the lawsuit states.
Elizabeth Edwards, who was jailed in Bi-State Jail at the same time as Barlow-Austin, said it was obvious her fellow inmate was not faking her illness.
“The guards wouldn’t do nothing,” Edwards told WFAA in December. “She was begging for help. She would ask them, ‘Please take me to the hospital.’”
Edwards and other inmates began helping Barlow-Austin where they could.
“She couldn’t sit up anymore,” Edwards told the news station. “We used to watch the guards snicker and laugh about it.”
Austin tried multiple times to address his wife’s condition with jail staff, as well as Bowie County Sheriff James Prince. Each time, his efforts were rebuffed, the lawsuit states.
As the days went by, Barlow-Austin’s eyesight began failing and she could no longer walk on her own. Eventually, in June, she was placed in a medical observation cell.
The heart-wrenching video clips from inside that cell show an emaciated Barlow-Austin’s final 48 hours, during which she was given very little water and was unable to eat more than a few bites of food. The footage shows her grimacing and crying out in pain as she clutches her head and writhes on the floor.
Jailers who walk by either ignore her cries or pause to look through the window before going about their business.
In the footage, Barlow-Austin appears unable to do more than crawl around on the floor, where she curls into a fetal position on a urine-soaked mat, with no pillow or blanket. Unable to see, she blindly feels around the cell for the Styrofoam meal trays and water cups provided to her, sometimes spilling the cup before she can drink the water.
Heipt told the Post he received the footage in a series of 2,000 clips, each under a minute in length, that he had to piece together.
“The only way I was able to know, for example, that (Barlow-Austin) only had three small cups of water during 48 hours is because I watched all 48 hours,” Heipt told the newspaper. “If you look at just the medical records provided by the company, LaSalle, you would have no idea of her blindness, inability to walk, difficulty even crawling or malnourished state.”
When Austin went to visit his wife in early June, she had to be brought to him in a wheelchair. Their final visit was cut short because she was in so much pain she needed to go back to her cell to lie down, the lawsuit states.
Beginning on June 5, visits to the jail ended with jail staff telling Austin his wife was “refusing” to see him. When Barlow-Austin’s mother, Mary Mathis, went to the jail to check on her daughter, she was told the same thing.
“LaSalle did not inform Ms. Barlow-Austin’s loved ones that she wasn’t actually refusing to see them — she was too sick to do so,” the document says.
On June 7, a guard filmed a brief encounter with Barlow-Austin, who is seen in the video lying on the floor of her cell amid empty water cups and other trash. The guard asks her if she wants to see a doctor.
Barlow-Austin mutters in a soft voice, saying either, “I don’t know” or “I don’t, no.”
“They don’t never do nothing,” a motionless Barlow-Austin tells the guard.
“Of course, there was no ‘doctor’ at the facility, and Ms. Barlow-Austin knew full well that her serious medical needs wouldn’t be addressed by the jail nursing staff,” Heipt writes in the lawsuit. "By then, she had been begging for medical care for nearly two months.
“Her condition had deteriorated to the point where she could no longer walk, stand or see.”
The lawsuit accuses the nursing staff of failing to make note of the inmate’s deteriorating health or, in some instances, fraudulently noting that she had no medical complaints even as the camera recorded her screaming and crying for help.
The footage also shows that Barlow-Austin was left in filthy conditions, wearing clothing that had not been changed in days and surrounded by old food containers that she had been unable to eat from.
At 12:18 p.m. on June 10, a guard drops a third carton of food on the floor of Barlow-Austin’s cell.
“No one has entered her cell to collect the old ones, which remain full of uneaten food and are, by now, unfit for human consumption,” the document says. “Because she can’t see, Ms. Barlow-Austin has no idea which carton is the newest one.”
A few minutes after the new food arrives, Barlow-Austin is seen opening one of the older containers and attempting to eat. She misses her mouth with her plastic spoon and her food spills out onto her dirty mat.
“This is the first time she’s eaten anything in 16 hours,” Heipt writes. “And in the 36 hours she’s been in the cell, she’s still only had two small cups of water. It’s been 12 hours since her last drink.”
That afternoon, guards watch as two inmates enter Barlow-Austin’s cell to clean. One inmate holds the ill woman’s hand and rubs her head while she appears to plead for help, but none of the guards seek medical attention.
Barlow-Austin is given a clean mat but is not given fresh clothes or a shower.
LaSalle records indicate that throughout the day on June 10, Barlow-Austin had been “exhibiting abnormal behavior” that was suggestive of mental confusion. Still, she is not given medical treatment or taken to a hospital.
The footage shows Barlow-Austin’s futher deterioration into the night. A licensed vocational nurse eventually enters the cell for the first time, 38 hours after the inmate was placed there.
“She proceeds to check Ms. Barlow-Austin’s vitals for the first time in over two weeks. Her heart rate is abnormally high at 130 beats per minute, and her blood pressure is 177 over 123, which indicates a hypertensive crisis,” the lawsuit alleges. "In addition, it’s obvious that she’s physically disabled, uncoordinated, disoriented, malnourished and blind.
“Coupled with these additional signs and symptoms, her high blood pressure reading constitutes a hypertensive emergency. It should trigger an immediate 911 call, but it doesn’t.”
Barlow-Austin is left alone in the cell until around 5:45 a.m. the next day when a guard, accompanied by LaSalle Assistant Warden Robert Page, enters to observe her. At that point, the inmate is no longer able to move on her own.
Still, she is left in the cell for another two hours before, shortly before 8 a.m., a guard and a nurse enter with a wheelchair and place her in it to take her for bloodwork in the medical office.
“Upon her arrival in the medical office, Ms. Barlow-Austin is ‘confused and unoriented,’ asking, ‘Where am I? Why am I here?’ She’s begging for water but physically unable to hold a cup when one is handed to her,” the lawsuit states. “She’s hypertensive and tachycardic — with a heart rate of 148 beats per minute. Her respiratory rate is abnormally low.”
The nursing staff was unable to draw blood because Barlow-Austin had no visible veins, an indication of severe dehydration.
“She’s visibly malnourished. Her pupils are not reactive to light,” the document says. "The medical staff finally decides that it’s time to call 911, and, shortly thereafter, responding medics transport her to the local emergency room via ambulance.
“By this time, she’s beyond saving.”
Barlow-Austin was placed on a feeding tube and IV fluids as soon as she arrived at the emergency room, to no avail. She died June 17, six days after being admitted to the hospital.
A photo made public by Heipt shows Barlow-Austin lying on a hospital bed, her eyes half open but unseeing. Tubes snake into her mouth and nose.
Click here to see the photo released by Heipt. Warning: The image may be too graphic for some readers.
The federal lawsuit alleges that Barlow-Austin’s family was never told of her medical crisis. Austin found out his wife was no longer being held at the jail on June 15, when he went to visit her.
“When asked why, LaSalle wouldn’t tell him,” the suit states. “He then called (Prince), who told him that his wife was in the hospital, gravely ill.”
The family was not allowed to see Barlow-Austin until the sheriff went to the hospital and approved their visit.
Because she was no longer classified as being in custody when she died, there has not been an investigation conducted by an outside agency, Heipt told the Post.
“One of the biggest problems in this case is that there has not been an investigation,” Heipt said. “The fact that they got around the in-custody death reporting requirements by simply releasing her from custody when her death was imminent, and then not reporting it to the state, is a problem.”
The Post reported that LaSalle Corrections, which is based out of Louisiana, has faced multiple prior lawsuits alleging abuse and neglect, particularly in healthcare for inmates.
Four inmates have died at Bi-State Jail since 2015, including a 20-year-old diabetic for whom staff failed to follow protocol. A licensed vocational nurse, Brittany Danae Johnson, pleaded guilty in 2017 to negligent homicide in the July 1, 2016, death of Morgan Angerbauer.
According to the Texarkana Gazette, Angerbauer, like Barlow-Austin, was captured on security footage banging on her cell door, screaming and pleading for help just feet from the nurse’s station.
Angerbauer asked Johnson to check her blood sugar the day before her death, but Johnson refused, telling her that staff members, not inmates, decided when medical care is rendered.
When jail trustees found Angerbauer unresponsive the next morning, Johnson was unable to get a blood sugar reading because Angerbauer’s levels were so high, the Gazette reported. The nurse read the reading as an error and gave the inmate glucose, which made the situation worse.
She also refused for more than a half-hour to call 911 for help. By the time paramedics arrived, Angerbauer was dead of diabetic ketoacidosis.
“She was lying on the floor of her cell with no blanket in her own vomit,” her mother, Jennifer Houser, told Johnson during her sentencing, according to the Gazette. “You refused to treat my child when you could have saved her.”
Johnson was sentenced to six months in jail, with 90 days suspended, in Angerbauer’s death.
The year before Angerbauer’s death, another inmate, Michael Sabbie, 35, told jailers he couldn’t breathe after being pepper-sprayed and handcuffed. He was found dead in his cell the following day.
Heipt represented Sabbie’s family in a lawsuit against LaSalle Corrections that was later settled. The attorney told the Post he believes the corporation could easily fix the problems at the jail.
“I think it’s a company that sees inmates as dollar signs and puts profits over people’s lives. They could easily fix the problems in their jails, but it would cost money to do so,” Heipt said. “Unless they’re held accountable in some fashion, there’s going to be another Michael Sabbie, another Holly, another Morgan.”