Ruben Nunez’s stay in San Diego’s Central Jail this past August was supposed to be short, less than a week, for a court hearing to determine whether psychiatrists at Patton State Hospital in San Bernardino could continue to involuntarily medicate him.
Five days after he arrived at the jail, Nunez, 46, was dead from a psychiatric condition known as psychogenic water intoxication, or psychogenic polydipsia, that causes unrelenting thirst and can go hand-in-hand with serious mental illness.
Sufferers drink water uncontrollably, sometimes to the point of death.
Nunez’s death, one of 12 in San Diego jails in 2015, raises questions about whether staff failed to properly monitor him.
Between 2013 and 2015, 41 people died in San Diego jails, pushing the county’s inmate mortality rate higher than even Los Angeles County, where the jail system has come under federal scrutiny.
That puts the San Diego County jail mortality rate at 244 per 100,000 compared to 144 in Los Angeles County.
Nunez, who grew up in San Diego, was diagnosed with schizophrenia as a teenager, according to his mother, Lydia Nunez.
When he was taking his medication, he could be friendly and outgoing, she said. Off medication, he sometimes turned violent.
In early 2014, he was kicked out of the board-and-care where he’d been living, became homeless and was arrested in San Diego and charged with felony assault for throwing a rock through a car window, according to court records.
Nunez was sentenced to Patton, an inpatient psychiatric hospital, in August 2014 after being found incompetent to stand trial. A judge also ordered that he be involuntarily medicated. Such orders expire after one year, meaning Nunez would need to return to San Diego for a hearing to extend the medication order.
In a declaration filed with the court in July 2015, Dr. Nazem Ghobrial, Nunez’s psychiatrist at Patton, argued that without psychiatric medication, Nunez posed a danger to himself and others.
“He [refuses] to accept that he has a mental illness or [needs] to be treated for it,” Ghobrial wrote. Nunez also showed “symptoms of psychogenic water intoxication,” the declaration says.
At Patton, Nunez sometimes required constant monitoring to ensure he didn’t drink water to excess, the declaration says.
“He is not able to recognize why this is of concern,” Ghobrial wrote. “Without treatment this could have easily killed him.”
Less than five days after being transferred from Patton to the Central Jail, Nunez was found unresponsive in his cell. According to his autopsy report, he had cerebral edema, meaning he’d consumed so much water, his body wasn’t able to excrete it fast enough to keep it from accumulating in his brain.
When Nunez arrived at the jail from Patton on Aug. 8, 2015, he was placed in a cell on the sixth floor, which is reserved for inmates with psychiatric conditions, the report says. There’s no indication Nunez’s access to water was limited or restricted.
John Ingrassia, the sheriff’s jail commander, said water can be shut off in individuals cells, but referred any questions about Nunez’s case to the jail medical director.
Sheriff’s spokeswoman Jan Caldwell said the department would have no comment on the Nunez case, given pending litigation.
The report says that at 2:13 a.m. on Aug. 13, during a routine security check, a deputy saw Nunez vomiting in his cell and called a nurse who, according to the report, gave him his medication but didn’t alert medical staff.
At 3:18 a.m., during another security check, a deputy found Nunez on the floor of his cell, not breathing. CPR failed to revive him.
The autopsy report describes efforts to resuscitate him as “aggressive,” resulting in 11 fractured ribs and lacerations to his liver and spleen.
An investigator with the Medical Examiner’s Office noted in his report that the cell “smelled of urine and vomit.” There was vomit in the sink, on a table, on the floor, on the cell’s lower bunk and bloody vomit splattered on a wall.
The report says Nunez’s jail medical records showed he had “a history of… hyponatremia” — a condition caused by excessive water intake — “which required water restriction.”
Critical in determining what jail staff knew about Nunez is a three-page discharge form that would have been sent to the jail from Patton, explaining Nunez’s diagnoses, medical risks and any special needs.
When state hospital patients are transferred to other facilities, even for a short period of time, such a form is faxed ahead of the patient’s arrival, said Department of State Hospitals spokesman Ken Paglia. As a backup measure, a copy of the discharge form is included in whatever documents travel with the patient.
For psychiatric patients who have a problem with water intoxication, there’s an additional form that lays out a strict protocol for monitoring water intake and blood levels.
Due to medical privacy laws, Paglia said he couldn’t discuss Nunez’s case or confirm whether the forms arrived at the jail.
Lydia Nunez filed a multimillion dollar claim against the county — a precursor to a lawsuit — which was rejected in February. Julia Yoo, of the law firm Iredale & Yoo, has agreed to represent Nunez’s parents in a lawsuit.
The same firm represented a University of California San Diego student who was left without food or water in a federal detention facility for five days, and settled his claim for $4 million in 2013.
Lawsuits over detention facilities can also be costly for county taxpayers. Last year, San Diego County settled two lawsuits stemming from deaths in its correctional facilities — $1 million for the family of a 16-year-old girl who committed suicide at the Girls Rehabilitation Facility in Kearny Mesa in 2013 and $3.2 million for the family of a Vista jail inmate who died from drug-withdrawal complications in 2011.
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