He sought help to get off heroin. He ended up paralyzed in jail, and then dead.

Nine months ago, Apolinar “Hasen” Perdomo checked into a drug treatment facility in Raleigh hoping to deal with a heroin addiction he had recently begun supporting by selling drugs.

He was about to turn 27, and he told staff there he feared losing contact with his three-year-old son. He was already estranged from his parents in Fuquay-Varina.

His family hoped it was a turning point after several years of drug abuse and related criminal behavior. He’d spent six months in a state prison on felony convictions for obtaining property by false pretenses and was on post-release supervision. Others in the past had pushed him to get clean, but this time he had taken the first step, his mother said.

But when Perdomo checked into UNC Health Care’s WakeBrook drug and mental health treatment center in Raleigh, it triggered a series of events that ultimately led to his death, state and medical records show. There, he was given a flu shot that brought on a rare, but life-threatening disorder two weeks later as he sat in the Harnett County jail for violating the terms of his release from prison.

By the time medical staff at the jail and a local hospital began to suspect Perdomo had Guillain-Barre Syndrome, he was almost fully paralyzed, struggling to breathe and swallow. He was transported to Cape Fear Valley Medical Center in Fayetteville, where doctors performed a tracheotomy so he could breathe. They also gave him immunoglobulin, which is used to treat the disorder.

Instead of keeping him at the medical center’s intensive care unit, he was sent to Kindred Hospital in Greensboro, a long-term care facility specializing in assisting patients who need respirators. It was there that Perdomo began bleeding from the tracheotomy site. Doctors unsuccessfully tried surgically to stem the bleeding before he died. A pathologist hired by the family told them Perdomo also had a laceration to his liver — and an abdomen filled with blood.

Today, difficult questions torture Perdomo’s family. They don’t understand why he had to be locked up, why it took his near full paralysis for medical staff at the jail and a local hospital to figure out what may have been the cause, and how a common surgical procedure could have led to such a devastating outcome.

And after he died, they found little interest among any officials to help them determine what went wrong, said his mother.

“I really think the system, from the get go ... everything was wrong,” said Bienchis Esteva Feliz, a claims adjuster and former financial services representative. Her family moved here from New Jersey in 2007, and Hasen, or “Hazzy’’ as he liked to be called, was the oldest of four children.

The News & Observer sought to speak with numerous officials whose agencies and institutions handled Perdomo. The medical officials at Cape Fear, Central Harnett Hospital, Kindred and WakeBrook either could not be reached or cited medical privacy laws in offering little information on the case. The Harnett jail would only confirm the dates of Perdomo’s incarceration.

‘Feeling hopeful’

Perdomo grew up in New Jersey, where he learned to draw finely-detailed sketches, and developed a love for poetry. He was smart and easy going, but had begun using cocaine and pills by the time he was 16. Esteva Feliz and her husband moved the family to North Carolina, in part to give Perdomo a fresh start, but he dropped out of high school. He kept using drugs, and got into trouble with the law.

Records show he entered WakeBrook on March 8 seeking help for his drug addiction. He hadn’t worked as a barber in two months. He also told staff he suffered from depression, and used illicit drugs to self-medicate, WakeBrook records obtained from his mother show.

“He reported feeling hopeful about the future,” the center’s medical notes said on March 13, a day before he was about to be discharged. He had received the flu shot on March 12.

Perdomo hoped to check into a longer-term residential treatment program. But when he told a WakeBrook staffer that he was on post-release supervision in Harnett County, the staffer told him he couldn’t go into a program without the approval of the North Carolina Post-Release Supervision & Parole Commission. At that point, Perdomo admitted he had missed two monthly visits with his supervision officer.

He also had an outstanding Chatham County warrant. Records show he failed to appear on traffic charges. The commission had already revoked Perdomo’s post-release supervision on March 9, a day after he entered WakeBrook. After his release from WakeBrook, he was sent back to prison for 90 days.

He waited in the Harnett jail in Lillington for his prison assignment. This was the fourth time in the past six years officials revoked his post-release supervision or probation, state records show.

‘No feeling in legs or arms’

Esteva Feliz said her son had called her from the jail on March 31 to tell her he wasn’t feeling well and was losing feeling in his arms and legs. He called again the next morning in a panic, she said. He couldn’t get out of his bunk without help, and another inmate had fed him because he couldn’t hold a spoon.

Scared, Esteva Feliz said she called the jail and asked an officer to get help for her son.

His medical care within the jail was provided by Southern Health Partners of Chattanooga, Tennessee, which serves roughly 30 local jails across the state, more than any other private health care provider. The company has been a defendant in lawsuits involving five jail deaths in North Carolina over the past 10 years. The company’s CEO could not be reached.

Medical records obtained by Esteva Feliz include a log of Perdomo’s care in the jail. The log doesn’t identify who filled it out, but it is identified as a Southern Health document. On March 31, the log notes show Perdomo reported numbness in his legs and hands. A day later, he was brought back to medical staff at the jail in a wheelchair and reported “no feeling in legs or arms.”

He was taken that day to Central Harnett Hospital in Lillington, but was then returned with no specific diagnosis. “(I)nformed inmate to notify staff of any changes,” the Southern Health notes show.

The next entry is three days later, on April 4. A jail doctor suspected Perdomo may have had Guillain-Barre Syndrome and needed to go back to Central Harnett. There, Perdomo could not sit up, and nearly choked trying to drink tea.

This time, the hospital sent him to Cape Fear Valley Medical Center. It was there that a doctor performed a tracheotomy on Perdomo, which is a hole cut above the sternum, or breastbone, to insert a breathing tube. A respirator pumped air into his lungs. Doctors also put in a feeding tube, medical records show.

Calls were made to officials at Central Harnett and Cape Fear, but they could not be reached for comment.

Esteva Feliz said she sought to find out from the jail how her son was doing. But she said she did not learn he had been sent to Cape Fear until an acquaintance saw him there and contacted her.

Jail staff would only tell her she needed to talk with state post-release supervision officials. A supervision official in Harnett confirmed to her that Perdomo was in the hospital and let her see him for roughly 45 minutes that day.

“I headed to the hospital, got there to find out he was paralyzed from the neck down,” she said.

Begged mom to stay

That was how Perdomo celebrated his 27th birthday on April 9. He begged his mom to stay with him, but state officials told her she would need to get permits for more visits. She said she had to drive to Raleigh to a corrections department office to get a permit each day she sought to see her son for one hour at Cape Fear.

Esteva Feliz wanted him to recover in a hospital. He was weak and developing pneumonia. But she said she and her family could not stay with him to monitor his care, because of the time limit on visits.

On April 18, Esteva Feliz discovered her son was no longer at Cape Fear. He had been transferred to Kindred Hospital in Greensboro, a two-hour drive from her home. Medical records indicate the state consulted with Duke and UNC doctors who recommended the transfer. Again, she said she had to go through the process of getting permission to see him, but this time a doctor at Kindred cut through the red tape. He told her she needed to come right away.

Two days into his stay, Perdomo began bleeding heavily at the tracheotomy site. Doctors probed to find the source of the bleeding and stop it, before reinstalling the breathing tube, but he had to be resuscitated five times, Kindred records show.

Perdomo didn’t make it through the night. He died just after 2 a.m., April 21.

“This was a sad and unfortunate situation,” said Chad Lovett, Kindred’s chief executive officer, in a short email message. “Due to patient privacy laws, we are unable to comment about the specific details of any patient’s case or situation.”

Deaths from tracheotomies are uncommon, according to a 2012 study on the National Institutes of Health’s website that estimated about 500 deaths or permanent disabilities occur annually from the procedure. Roughly 100,000 tracheotomies are performed in the U.S. each year.

When an inmate dies, state law requires the medical examiner to investigate. Guilford County’s medical examiner, Jacqueline Perkins, who is a registered nurse, did not have an autopsy performed. She said she reviewed x-rays and other medical records before determining no one was at fault.

“When you know what someone’s diagnosed with, there’s no sense of sending them to an autopsy,” she said in an interview.

Relying on medical records, Perkins cited three factors in Perdomo’s death: bleeding from the tracheotomy site, pneumonia and complications from Guillain-Barre Syndrome.

Esteva Feliz turned to Brent Hall, a pathologist in Boone, to perform an autopsy. Hall’s report said he found wounds to Perdomo’s diaphragm and liver related to medical treatment. Hall declined through a staff member to comment on his report. It’s unclear where those injuries occurred.

(Hall is a former medical examiner for Watauga County, who resigned in 2013 after an elderly couple and an 11-year-old boy died after staying in the same Boone hotel room several weeks apart. In both cases, carbon monoxide gas from a broken swimming pool heater had leaked into the room. Hall resigned after the Charlotte Observer reported that the N.C. medical examiner’s office failed to alert local authorities about high levels of carbon monoxide in one of the elderly victim’s blood. )

Acree, the state public safety department spokesman, said the agency “has no information to indicate that anything improper happened regarding the incarceration or medical care of Mr. Perdomo. (The department) has no oversight of the local jail or hospitals involved, and it also has no reason to conduct any further inquiry.”

Reviewing visitation policies

He said the department is looking into its visitation policies after learning Esteva Feliz had to repeatedly drive to Raleigh to get visitation passes to see her son in Fayetteville.

Guillain-Barre Syndrome occurs when the body’s immune system begins attacking nerve cells, causing a loss of bodily function. It is rare, but it is not unknown by emergency room doctors, said Gil Wolfe, who is chairman of the University of Buffalo’s neurology department and is co-leading a clinical trial on treatment of the disorder. (He was not commenting on the circumstances of Perdomo’s case.)

“Yes, ER doctors are generally aware of GBS,” Wolfe said in an email message. “It is one of the neurologic emergencies that they recognize in my experience.”

The national Centers for Disease Control and Prevention said roughly 3,000 to 6,000 people are diagnosed with the disorder each year. It is rarely fatal if diagnosed in time and treated. Some people have died after the disorder severely limited their breathing.

Since the medical records show the flu shot triggered the syndrome, Perdomo’s estate could be eligible for damages from a special federal fund set up to cover adverse reactions to vaccinations. (For anyone thinking they should not get a flu shot, Wolfe said the syndrome is more prevalent in people who come down with the flu.)

Esteva Feliz said she is aware of the fund. She has hired lawyers with Robert Zaytoun’s firm in Raleigh to look into the legal implications of her son’s death.

Zaytoun said in an interview that he is particularly troubled by how long it took the Harnett jail to recognize how dangerously infirm Perdomo was.

“It is entirely clear that the delay in getting him to the proper medical facility for treatment was inexcusable, inexplicable,” Zaytoun said.

‘System needs to change’

In a five-part series last August and in subsequent stories, the N&O has investigated the circumstances behind many inmate deaths involving county jails. The reports have focused on a lack of inmate supervision and the quality of health care.

Zaytoun said Perdomo’s death and others call for a need to study the basic training for detention officers and sheriff’s deputies, “balancing their need for their own safety, and to be skeptical of things inmates say to them, versus being able to assess a medical situation as a first responder does and getting them to where they need to go.”

Whether Perdomo’s family files a lawsuit or not, Esteva Feliz said she wants the public to know what happened to her son. She thinks about him paralyzed in a hospital bed, only able to communicate by pretending to blow kisses and forming words with his mouth that his voice couldn’t speak. And yet one of his wrists was bound to a bed rail to restrain him.

“It’s just logic, even human sensitivity,” she said. “And I know they were doing their job, but the system needs to change.”

This story was originally published December 20, 2017 at 1:11 PM with the headline "He sought help to get off heroin. He ended up paralyzed in jail, and then dead.."