Officials at the Burlington County Jail should have known about an inmate's heart condition and a hospital's recommendation that he receive follow-up treatment - which his fiancee alleges he was never taken to - before he died Feb. 25, according to medical records provided by her.
Jerome Iozzia, 50, of Browns Mills, was one of two inmates who died during a two-month period during the winter amid allegations of neglect, which jail officials have denied.
Robert Taylor, 75, a homeless man, died Dec. 30. A fellow inmate alleged that Taylor lay dead in his feces for hours.
The county medical examiner ruled both Taylor's and Iozzia's deaths to be from natural causes, and the Prosecutor's Office ruled out wrongdoing. But Iozzia's fiancee and other inmates have alleged negligence by correctional officers and CFG Health Systems, the company that runs medical operations in the jail.
The fiancee, Jasmine Rodriguez, has said that jail and CFG officials failed to take Iozzia to the hospital for follow-up, despite his failing health and scheduled appointments. She said she was planning to file a lawsuit against the jail, Warden Lawrence Artis, and CFG.
County officials and Les Paschall, CFG's chief executive, declined to comment, citing the threatened litigation. According to county officials, CFG is conducting its own investigation into Iozzia's death.
Iozzia, an unemployed heating and air-conditioning technician, was battling heroin addiction, Rodriguez said. His troubles came to a head in mid-November when he was detained on charges of aggravated assault and resisting arrest after scuffling with a Pemberton Township police officer.
Iozzia reported having chest pains after the incident, and police brought him to the Lourdes emergency department at Deborah Heart and Lung Center. Doctors determined that he was having heart rhythm problems.
Typically, police call the jail and have it send a correctional officer to the hospital to watch a suspect who is admitted, said Pemberton Township Lt. Brian Wechkus. Wechkus, who knew of Iozzia's encounter with township police, said that probably happened in this case.
On Nov. 18, Iozzia had a pacemaker installed at Deborah. According to the medical records Rodriguez provided, an endocrinologist recommended that Iozzia have blood work done at the jail in six weeks, and told him when further testing might need to be performed.
"I told this to the patient in the presence of the guards, and I explained everything on how he needs follow-up, and I wrote it out on his discharge papers as well," the endocrinologist wrote in a memo titled "In-house Consultation."
In a separate form, hospital officials wrote that "the discharge plan and follow-up were discussed with medical personal at the prison."
The form also included instructions, saying if Iozzia developed fevers or other pain at the pacemaker site, "he is to come back to the hospital."
County spokesman Eric Arpert, citing the threatened litigation, declined to comment this week on whether jail authorities received that information. In an interview last month, he said Iozzia was not taken for hospital follow-up, but days later he denied saying that.
Follow-up hospital visits for Iozzia were scheduled for Dec. 17 and Feb. 17.
In letters sent during his three months in jail, when he was unable to post bail, Iozzia told his fiancee that he was never taken to the hospital and that jail officials "are not takin care of my heart."
Rodriguez said the hospital told her it had no records showing he was seen there after his pacemaker was installed.
County officials said last month that Iozzia was taken to the jail clinic several times, including during his last days.
The officials said that on Feb. 24, the day before he died, a correctional officer noticed him shaking in his cell and took him to the clinic. Later that day, they said, he was seen struggling to walk and was taken to the clinic again.
The next day, Iozzia collapsed, officials said, and was pronounced dead at Virtua Memorial.
Iozzia died of "pneumonia/empyema/sepsis," according to his death certificate, which his fiancee provided. Empyema is usually caused by a lung infection and leads to a buildup of pus. It develops in the vicinity of a pacemaker.
Sepsis is an infection in the blood and is particularly dangerous in a person with a pacemaker, doctors say, and the pacemaker must be removed.
It's unclear when Iozzia's condition began deteriorating, or whether it would have been spotted at his scheduled follow-up visit on Feb. 17, eight days before he died.
But doctors say that particular visit - three months after a pacemaker installation - is valuable in determining, among other things, whether an infection has surfaced, and whether a pacemaker is triggering the correct number of heartbeats.
"It's fairly important to see the patients in the early aftermath of the procedure to be able to monitor these things and make the appropriate adjustments," said Samir Saba, director of cardiac electrophysiology at the University of Pittsburgh Medical Center. He was not familiar with the Iozzia case and spoke in general.
Rodriguez, the mother of Iozzia's 11-year-old son, Nico, said the medical records prove that Iozzia should have seen doctors outside the jail clinic.
"His death shouldn't have happened," she said.