Tarrant says Mayo Clinic backs autopsy in Robert Miller jail death, contrary to experts
Tarrant County officials said Monday that the Mayo Clinic “confirmed” that a jail inmate who died in 2019 had sickle cell trait, which they say backs the county medical examiner’s cause of death as “sickle cell crisis.”
But in its attempt to settle the matter, the county is further contradicting what multiple outside medical experts tell the Star-Telegram: that someone with the trait alone cannot have a sickle cell crisis, much less die from it.
The inmate, Robert Miller, died shortly after sheriff’s officers pepper-sprayed him multiple times at close range during booking. Miller, who had asthma, was not given medical attention after he told a nurse he could not breathe. He was found unconscious and face-down in his cell 38 minutes later and died the next morning at JPS Hospital with inflamed lungs, a swollen neck and blood leaking from his ears and nose, according to medical records obtained by the Star-Telegram.
An autopsy report finished in 2020 by the county Medical Examiner’s Office found the cause of death was “natural” from sickle cell crisis. However, an investigation by Star-Telegram published last October found evidence that suggests Miller may have died as a consequence to how he was treated in the jail. As of Monday afternoon, Miller’s manner of death had been changed to “undetermined.”
The county’s statement Monday said it sent Miller’s blood samples to the Mayo Clinic, which “confirmed the cause of sickle cell crisis originally diagnosed by the Tarrant County Medical Examiner’s Office was due to sickle cell trait.”
Dr. Rakhi Naik, an associate professor of medicine at the Johns Hopkins School of Medicine, said that someone with the sickle cell trait alone — and not sickle cell disease — could not die of a sickle cell crisis.
The assumption that Miller or any other person with the trait could die from a crisis is based on flawed medical research from decades ago, Naik said.
Sickle cell disease affects about 10 million Americans, and most commonly affects Black Americans. A hallmark of the disease are pain “crises,” which occur when sickled red blood cells get stuck in blood vessels close to a bone, Naik said. This causes the bone to not get any blood supply, and feels like “daggers raining down on you all throughout your body,” Naik said.
If left untreated, these sickle cell crises can lead to death. But not in patients who only have the sickle cell trait, and not the disease, Naik said.
“There is no way for that to happen under physiologic conditions with somebody who has sickle cell trait,” she said.
Patients with the trait alone don’t have the C-shaped, or sickled, red blood cells that block the flow of blood to the bone, said Dr. Hannah Lichtsinn, an expert in the disease from Minnesota.
“Sickle cell trait cannot lead to a sickle cell crisis,” Lichtsinn said. “That’s not how the disease works.”
The Mayo Clinic’s press office did not immediately respond to questions from the Star-Telegram about what tests it performed on Miller’s blood samples.
The gold standard for diagnosing someone with either the sickle cell trait or sickle cell disease is called a hemoglobin electrophoresis, Lichtsinn said. If Miller was diagnosed posthumously with the trait, he could not also have sickle cell disease, Lichtsinn said, because the test “is binary. It’s trait or disease.”
Both Lichtsinn and Naik said there is no blood test that can diagnosis a sickle cell crisis, as the county claimed in its statement.
Another expert who reviewed Miller’s records for the Star-Telegram was Roger Mitchell, chair of pathology at Howard University. He said Monday that Miller’s death should be attributed to what caused him to lose oxygen — being pepper sprayed.
Sickle cell trait
Sickle cell trait is not a disease, but rather occurs when someone inherits one sickle cell gene and one normal gene, according to the Centers for Disease Control and Prevention.
People with the trait usually do not have any symptoms of sickle cell disease. In rare circumstances, Lichtsinn said, people who just have the trait can suffer medical complications, but not a sickle cell crisis.
The American Society of Hematology, which represents 18,000 medical professionals who study and treat blood diseases, says in its position on sickle cell trait: “It is medically inaccurate to claim sickle cell crisis as the cause of death based solely on the presence of sickled cells at autopsy.”
Sudden death is so rare in people with sickle cell trait that cases in which it is listed as the cause or major factor in a death “must be viewed with profound skepticism,” the organization says.
Naik and Lichtsinn both said that the term sickle cell crisis, and what it actually means, are frequently misunderstood by forensic pathologists, who have mistakenly linked the trait to a cause of death.
“There’s absolutely no physiological or medical reason for anyone to believe this is true,” Lichtsinn said. “So why does this practice exist?
“It sure appears to be related to finding a reason to explain a death when the real reason is something that they’re trying to keep covered.”
Outside review never happened
The Star-Telegram’s investigation in December prompted county officials to contract with an independent forensic pathologist for “consulting services including review of select cases under the jurisdiction of the Tarrant County Medical Examiner.” The contract with the pathologist expired in February, and for weeks county officials refused to discuss what the pathologist did or found.
As first reported Saturday by KERA, the pathologist never received any materials to review.
A county spokesman said Monday that Dr. J. Scott Denton’s services were never needed because of the Mayo Clinic’s findings.
The spokesman said the contract with Denton was for consulting and “the intent was never to conduct a second autopsy,” though that would have been impossible since Miller was cremated.
“With the Mayo Clinic’s confirmation of sickle cell trait, no information was sent to Dr. Denton,” the county said.
But emails obtained by the Star-Telegram on Monday suggest that as of Feb. 28, the last day of Denton’s contract, the county still intended to employ Denton’s services.
Denton, who lives in Illinois, received an email from a lawyer for Miller’s widow asking about the status of his review. Denton forwarded it to Tarrant County’s medical examiner, Kendall Crowns, asking how to respond, and noting that he never received materials to review.
“I will be honest that to me the email from the civil rights attorney changes the whole tone and scope of the review,” Denton wrote to Crowns. “I was unaware of such a family/attorney review and those circumstances he detailed in his email, or that he was the cause of the review.”
Crowns responded that he would send overnight all the materials for Denton’s review and extend his contract beyond Feb. 28.
The materials were never sent, nor was the contract extended.
‘Why did he have decreased oxygen in his body?’
Mitchell, the Howard University chair of pathology who reviewed Miller’s records, is the former chief medical examiner for the District of Columbia.
Mitchell said Monday that the fact that Miller had sickle cell trait does not mean he died from a sickle cell crisis.
Red blood cells sickle when there’s a hypoxic environment in someone’s body, which means there’s a depletion of oxygen.
“My question is, why did he have decreased oxygen in his body?” Mitchell said. “The answer to that is because he was pepper sprayed.”
Mitchell said Miller’s cause of death would not be the sickle cell trait, but rather whatever caused the decreased oxygen levels.
“You have to look at the reason why the individual has a low oxygen level to cause his cells to sickle,” Mitchell said. “And if the reason that he had that low oxygen is not natural, then his cause and manner of death are not natural.”
In the Star-Telegram’s initial investigation, Mitchell and another expert also said red blood cells can take on a sickled shape after death if the person carried the trait for sickle cell anemia. When someone dies, their body loses oxygen.
County judge responds
Tarrant County Judge Tim O’Hare said in a statement that Miller’s death and the loss of any young life was “tragic.”
Noting that Miller died before he became judge, O’Hare wrote in a statement to the Star-Telegram that he had reviewed footage of Miller in custody and corresponding documents. He said he did not believe jailers had done anything wrong.
“I did not witness, nor do I believe that the professional staff at the Tarrant County Jail engaged in any misconduct or wrongdoing,” O’Hare wrote.
O’Hare also mentioned the other parties who had looked into Miller’s death, the Texas Rangers and the medical examiner, and Jenkins’ lawsuit.
“No wrongdoing has been alleged,” O’Hare wrote. “Additionally, both a trial court and an appeals court have dismissed claims of wrongful death.
“I possess the deepest sympathies for Mr. Miller’s friends, family, and loved ones, but I believe that the matter of his death has been treated with the seriousness that our residents should expect, and deserve, from their government, and at every step no wrongdoing has been uncovered,” O’Hare wrote. “Treating prisoners with dignity and concern will always be a priority.”
He ended his statement with a Bible verse, Psalm 69:33: “For the Lord hears the poor, and does not despise His prisoners.”
This story was originally published April 24, 2023 at 2:13 PM.
