Jail death ruled a "homicide," his family gets a $350,000 payout, but the deputies remain on the job despite the persistent efforts of a witness
"Were it not for the physiologic stresses imposed by the struggle and restraint, there is no reasonable medical certainty that Mr. Downes would have died at the moment he did." Assistant ME Judy Melinek, M.D. Concluded in her report. "The manner of death, homicide, indicates that the volitional actions of others caused or contributed to this death."
Although Chief Medical Examiner Amy Hart said her findings did not speak to any unlawful behavior on the part of the deputies, Esther Downes' attorney, Geri Green, says, "I think it was very brave of her to call it a homicide," noting that the finding strengthened the family's case against the city.
That "homicide" call came after a yearlong investigation that included analyzing a prone restraint method called "figure four," which incident reports from deputies say Downes was placed in moments before his death. In a figure four, a person lies in a prone position, hands held behind his/her back with knees bent and feet held in the air. Prone restraint is not uncommon but it is controversial as its various methods have lead to deaths.
Downes weighed more than 300 pounds and the autopsy found evidence of pressure on his neck and back. The report summarizes an interview with a trainer for the Sheriff's Department who said the hold is often difficult to accomplish on an overweight person. Additionally, other inmates reported hearing Downes yell that he could not breathe and a jail nurse said she could hear loud moaning coming from the safety cell where Downes was restrained.
Fahey said the department looked into the matter. "The department conducts its own internal investigation but its report is not public record," Fahey told us. The Police Department also investigated but in an email, spokesperson Albie Esparza said the results are confidential under laws protecting peace officers. "The case file was handled by SFPD, however those are not public records under section 6254(f) of the Government Code, which protects case files, even after a case has been terminated."
Ellen Hirst, a spokesperson for then-Sheriff Mike Hennessey, told reporters at the time that the department believed all procedures were executed properly. The department's official "Safety Cell Use" policies, which we reviewed, state "A prisoner may remain restrained, with handcuffs, waist chains, and/or leg irons as necessary, while in the safety cell to prevent self-inflicted injury" for no more than one hour. Yet the department's "Use of Force" policies state, "Choking and the use of carotid restraint are not allowed by the SFSD."
The ME concluded the cause of death to be probable respiratory arrest during prone restraint with morbid obesity. That conclusion, along with the report's other findings, lead Esther Downes' to charge in her lawsuit that the deputies used excessive force and illegal and unconstitutional restraint procedures on her son and "in an effort to conceal the homicide, conspired to cover up the cause and manner of death."
Attorney Ben Nissenbaum is an associate with the renowned John Burris Law firm in Oakland, which has done extensive work on civil rights and police brutality including the Rodney King case. He says the need to further subdue an inmate in a segregated area of the jail is suspicious.
"Why would you restrain a person in a safety cell?" says Nissenbaum. "They're already restrained. All you have to do is close the door."
He also noted that safety cells — unlike the rest of a jail facility — are not equipped with surveillance cameras. "There are no cameras or video inside the safety cells and that is common knowledge among deputies," Nissenbaum told us.