Nurse's COVID-19 Death Raises Questions About Delayed Testing At NC Prison
Barbara Anne Stewart died at a hospital in Danville, Va., on May 7 at age 57.
Five weeks earlier, she had come home from her job as a nurse at the Caswell Correctional Center complaining she didn't feel well.
Her husband, Seasar, took her to get tested for COVID-19. The test was positive.
That was April 2. For the first week or so, Seasar Stewart said, it was like she just had a bad cold. He thought her condition would improve. But things didn't get better. She stayed out of work for more than a week. And then things got so bad, Seasar Stewart called an ambulance to take his wife to the hospital.
An internal email sent to prison leaders by North Carolina Commissioner of Prisons Todd Ishee late on the afternoon of the day Stewart died didn't say Stewart had the virus.
"During this COVID-19 crisis, it is with great sadness that ... I inform you of the loss of Caswell Correctional Center's Nurse Barbara Stewart," Ishee wrote. "Please keep Warden Daye and the Caswell family in your thoughts and prayers as they move through this tremendously difficult time."
On May 8, the day after Stewart's death, the county health department offered voluntary drive-through testing for staff at the prison and also the following Monday, May 11. One week later, prison officials began offering a limited run of free testing to staff members at off-site locations across the state.
But Caswell County Health Director Jennifer Eastwood says she had offered to conduct on-site testing for prison staff dating back to mid-April. Within a week after she said she made her first offer, the prisons approved testing — but off-site, instead of the mass testing she had proposed at the facility.
Even now, advocates say, it is difficult for some prison employees to get tested. Reporting by a network of journalists working across the state found that to be the case. Stewart's death, meanwhile, has now sparked an investigation by the N.C. Department of Labor. Among other things, the department will examine whether any violations of health and safety standards contributed to the employee's illness.
Ardis Watkins, executive director of the State Employees Association of North Carolina, which counts prison workers among its members, was critical of how prisons are handling testing. Watkins said she and her staff are hearing from the prison employees who are afraid of going to work, being exposed to the virus and bringing it home to their families. She said that, under the original plan announced by DPS, employees at Pasquotank Correctional Institution in northeastern North Carolina would have to drive 112 miles away to be tested.
"It's not a serious plan," Watkins said.
'Baby, Things Ain't Going Too Good There'
Seasar Stewart said his wife tried to play off the dangers of going to work at a prison during the coronavirus pandemic.
She had high blood pressure, problems regulating her blood sugar and had been through multiple surgeries, he said. In his mind, a prison during a pandemic was a dangerous place for someone with the kind of medical history his wife had.
"I said, 'I don't want you to be around it,'" he recalled. "But she said, 'ain't nobody got it.' She's a nurse, she said, 'ain't nobody got it.'"
Barbara Stewart, who had worked for DPS for more than 25 years, continued to go to work at the medium security prison north of Greensboro. She tried to placate her husband's fears when she went home.
What made Seasar Stewart even more nervous was his understanding that nobody inside the prison was being tested in the time before she went on sick leave in early April.
"They didn't test nobody at the prison," he said. "I asked her, 'Are they going to test them?' She said, 'Nope.'"
He said Stewart and her co-workers were growing increasingly concerned about the lack of personal protective equipment, too, even resorting to bringing their own masks from home. Seasar Stewart said he sent his wife to work with several masks from his workshop at home.
Eventually, in early April, Barbara Stewart came home and stopped putting on the brave face for her worried husband.
"She came back and said, 'Baby, things ain't going too good there.' She said, a couple nurses are sick and I don't feel good and I want to go get checked,'" Seasar Stewart recalled.
Barbara Stewart was tested for COVID-19 on April 2 and stayed out of work after that. By the time she was taken to the hospital on April 17, the number of confirmed positive cases of COVID-19 at the prison had started to grow, the county health director said. Seasar Stewart said another nurse who worked with his wife had tested positive for the virus and they had heard of inmates testing positive, too.
That trend of growing cases started to concern Eastwood, the Caswell County Health Director. In an interview, Eastwood said she and the prison's warden, Doris Daye, had been in close contact regarding the virus and both shared a concern over the increase in the number of cases at the facility.
"We were in regular contact when we started having employees come back positive," Eastwood said. "So, at that time, I offered to test the employees."
Ultimately, Eastwood said, she offered for the county health department to test all employees and inmates on-site at the prison in mid-April. That was sometime between April 15 and 20, Eastwood said, according to her notes.
"My clinical staff had already been testing symptomatic or exposed prison employees at our facility, but felt a mass testing would be a more efficient use of our time and resources," Eastwood said.
Daye took the proposal to prison leadership in Raleigh, who approved the county testing staff but rejected the offer for on-site testing. In a phone call Thursday morning, Daye confirmed that prison leadership approved a plan on April 21 for the county health department to test staff off-site.
"They just felt, I guess, at the time that the numbers were low enough, we could just do it individually," Eastwood said.
But on May 8, the day after Stewart's death, the county health department was conducting voluntary drive-through testing for staff at the prison as well as the following Monday, May 11, Daye wrote in an affidavit.
"I think we had just gotten so many, the numbers had gotten so high and we were testing so many already, we just felt like we needed to test as many as we could at one time," Eastwood said.
By that point, Daye's affidavit said, 16 staff members had self-reported a positive COVID-19 test. The affidavit did not make any mention of Stewart, who had died from the virus one day earlier.
Prisons Leadership Refused To Confirm Death, Answer Questions
A spokesman for the Department of Public Safety, which oversees the state's prison system, denied seven requests over the past week to make Commissioner of Prisons Todd Ishee available for an interview. Ishee did take questions on a call with reporters on Thursday.
Prison leaders had not made any public announcement about the death of an employee during the pandemic until being pressed by a reporter for this story. At first, the spokesman, John Bull, refused to even confirm a Caswell Correctional Center employee had died.
"Pursuant to employee privacy rights, we are unable to respond to your request for information on the subject of staff death due to COVID-19," Bull said in an email requesting an interview for this story. "This response in no way states or implies a staff member has, in fact, died from COVID-19."
Later, in another email, Bull said whether a prison employee died at all was protected personnel information that could not be given out by law. Bull did not explain how Ishee was able to email dozens of senior prison leaders about Stewart's death weeks earlier, or how officials in the past have publicly identified employees killed in the line of duty.
It took seven days after the first inquiry for this story for Bull to confirm Stewart had died. But even two weeks after her death, he still would not say that she had tested positive for COVID-19. Bull has also insisted that prison leadership did not stop plans to test staff at the prison, as offered by the county health department. He instead claimed it was prison staff who initiated the request for staff testing.
"The warden reached out to the county health department on April 20 to discuss the possibility of the county testing the staff at Caswell Correctional," Bull said. "By the next day, April 21, it was agreed the testing would be done by the county at an off-site location. Commissioner Ishee approved that plan that day, April 21, when it was brought to him for a decision."
In an email late Wednesday night, Bull conceded no on-site staff testing had actually taken place at Caswell Correctional Center until May 8.
"Commissioner Ishee approved the voluntary employee testing for Caswell Correctional when the question was posed to him on April 21," Bull said. "The first date for actual testing was May 8."
Unlike in the original plan proposed by Eastwood, inmates were not included in the testing.
'It's Not A Serious Plan'
Starting this past Monday, prison employees have had the ability to get tested for COVID-19. The free tests will be available for two weeks. The plan was announced by DPS 10 days after the agency's leadership had scuttled a program from State Treasurer Dale Folwell and the State Health Plan to test every prison employee for free.
Under the plan put in place by DPS, prison employees can go to a FastMed Urgent Care Center and get tested. Department leadership said the testing was being done in partnership with the urgent care company and LabCorp, a national medical lab company headquartered in Burlington.
"The plan will provide a direct testing solution for the more than 21,000 employees who work across the state in prisons or juvenile facilities, or in the community supervising juveniles and adult offenders," a DPS press release said.
But, in follow-up questions, a DPS spokesman could not provide details on how the agency could guarantee all 21,000 employees would be able to get tested.
In a call with reporters Thursday, DPS Deputy Secretary Tracy Little said her office was not responsible for ordering tests but that she had conversations with officials at both FastMed and LabCorp regarding their ability to secure tests. She said she did not have any written documentation showing either company had committed to securing an adequate supply of tests.
"We believe the testing supplies are adequate and we don't have any reason to believe they are not," Little said.
The contract between the department and FastMed, produced by DPS in response to a public records request, makes clear that some employees who request a test may not get tested.
Prior to being tested, employees must fill out a form and answer whether they are pregnant or have any symptoms commonly associated with COVID-19, including fever, sore throat, muscle ache and loss of taste or smell.
"If you are currently experiencing symptoms of illness, it may keep you from being tested today," the form says. "If ill, you could be referred for treatment due to potential illness. The questions below will assist us in determining whether testing is right for you."
The contract between DPS and FastMed does not make clear how an employee who has symptoms associated with COVID-19 would be able to get tested for the virus.
In the call with reporters Thursday, Little could not explain why DPS had signed a contract with a company that was screening patients with COVID-19 symptoms from being tested for the virus.
"If someone presents with some type of symptom, the provider wants to ensure that they are doing an adequate assessment to know what's going on with that employee medically," Little said. "Our goal is for our employees to have access to the testing. We are facilitating that process and making that testing available to them."
Following the questions for Little, a FastMed spokesman said the company was updating its form to clarify that only employees with emergent symptoms would not receive a test at a clinic, because they would need to seek treatment in an emergency setting.
"My wife worked there for 27 years. And all she wanted was 30 years, man, that's all she wanted. To get her 30 years and retire. And they took that away from her. They took that away from her. They knew she wasn't well. They knew that she caught it and wasn't going to make it." - Seasar Stewart
Watkins, the head of the state employees association, said the DPS plan presents a number of hurdles that might keep staff from deciding to get tested.
"If it were a serious plan, it would encourage folks to take part by making it easy," she said. "This plan, in some cases, has employees driving two hours, one-way, to take the test — on their own time, with their own gas."
In a call with reporters on Thursday, DPS officials said two sites had been added near Pasquotank Correctional, one at an urgent care facility in Elizabeth City owned by a different company. A second clinic had been set up in Hyde County.
Watkins' sentiments were echoed by John Schwade, a retired North Carolina prison psychologist, in an email to several lawmakers this week. In particular, Schwade questioned why tests will only be available for 14 days, from May 18 to May 31.
"With employees required to work mandatory overtime amounting to a minimum of 36.75 hours per 28-day pay period, most do not have an abundance of free time, and if there are any significant needs in their home life — a sick family member, a vehicle or house in need of repair, etc. — they simply might not have the time to travel to a FastMed location, even if the trip is not unreasonably long," he wrote.
Schwade also pointed out that employees may have a need for testing after May 31, especially if they come into contact with an inmate who tested positive for COVID-19.
Watkins said the SEANC members that work in prisons know they're going into danger every day they go to work but aren't prepared to extend the danger they face every day to their families.
"They're used to going into danger every day, and they know that's part of the gig," Watkins said. "But to bring danger into their homes, into their families is taking things to another level, and they're uncomfortable with it in terms of anger, in terms of fear and worry. And it's just ridiculous."
Dr. Lauren Brinkley-Rubinstein, an associate professor at the UNC School of Medicine who is tracking cases of COVID-19 in prisons across the country, raised similar concerns.
"If you have staff who are very closely interacting with people in that setting — both other staff and those who are incarcerated — their risk is also high of getting COVID and then they're also going home and sleeping and living in their communities," Brinkley-Rubinstein said.
That increased risk factor of spreading the virus from the prison and into the community underscored the importance of testing all prison staff, she said.
"If they don't know if they have COVID or not, and there are very little ways to mitigate risk, then they are also putting their families and their communities at risk, Brinkley-Rubinstein said.
'They Took That Away From Her'
Seasar Stewart is still in quarantine at his home in Caswell County. Although he was released from the hospital, he still continues to test positive for COVID-19. Until the virus is gone, he won't be able to return to a normal life, starting with properly mourning the death of his wife, Barbara.
"Not really," Stewart said, starting to choke up, when asked if he'd been able to grieve Barbara's death.
A list of cases released by the Caswell County Health Department as of Wednesday shows the only resident who died of COVID-19 was exposed to the virus at work. But Stewart said he hadn't heard anything from state officials about treating his wife's death as a line-of-duty death, which would come with state benefits.
When a reporter asked if he'd heard from prison officials about the possibility of state death benefits, Stewart said he wasn't even aware that was an option.
On Thursday, Isshee, the commissioner of prisons, said the N.C. Department of Labor has now launched a probe into Stewart's death. A spokesperson for the labor department confirmed as much Thursday, saying the Occupational Safety and Health Division is investigating the case as a work-related fatality.
Isshee said no determination on line of duty death benefits would be made until that investigation was complete.
In his interview, Stewart didn't blame Daye, the prison's warden, a person he said his wife enjoyed working with.
"Miss Daye is a nice person and would have done all she could," he said.
Instead, he questioned prison leadership.
"My wife worked there for 27 years," Stewart said through tears. "And all she wanted was 30 years, man, that's all she wanted. To get her 30 years and retire. And they took that away from her. They took that away from her. They knew she wasn't well. They knew that she caught it and wasn't going to make it."
This story was jointly reported and edited by Kate Martin, Jordan Wilkie and Frank Taylor, of Carolina Public Press; Gavin Off, Ames Alexander and Doug Miller, of The Charlotte Observer; Dan Kane and Jordan Schrader, of The News & Observer; Nick Ochsner, of WBTV; Emily Featherston, of WECT; Tyler Dukes of WRAL; and Jason deBruyn, of WUNC-FM.