For more than a year, county jail staff and sheriff's deputies have contended with a diabetic inmate engaged in a game of “Russian roulette” as he neglects his health and exacerbates his medical condition.

“What he actually does, anytime something doesn't go his way, or when he's having a bad day, he'll refuse to take his food and his insulin,” said Ashley Adams, director of nursing at the Butler County Prison health unit, who described the situation Tuesday at a monthly meeting of the Butler County Prison Board, whose members include the three commissioners, Sheriff Mike Slupe, Judge William Shaffer and others.

“It's like a strike,” Adams said.

She said the 38-year-old inmate's behavior has led to questions about how the jail operates and its responsibility to an inmate whose actions lead to his life being in danger. Adams and other county officials declined to release the inmate's name, citing HIPAA, which guarantees health privacy by the federal government.

An issue for 19 months

For now, Slupe said they are in a “holding pattern,” waiting to see what the conclusion of the inmate's criminal case will bring.

For 19 months, Adams said, the jail's staff has dealt with the inmate's manipulation of his condition and in the process has cost overtime for deputy-escorted hospital visits and strained the resources of the jail.

During his incarceration, she said, he has been hospitalized at least seven times and there have been at least 75 incidents of the inmate going into hypoglycemia with seizures, which happens when his blood sugar levels are low. The hypoglycemia is treated in the jail, Adams said.

Slupe said he hasn't yet calculated what the cost has been to taxpayers.

“That length of stay is much too long for our facility,” Adams said after the meeting.

She said the inmate, who is being held pre-trial in the jail on drug charges, is using his medical condition to get what he wants.

“Interestingly, he's not suicidal. But he's so committed to his cause of being released pre-trial or to prove we're incompetent that he's willing put himself at that amount of risk,” Adams said. “Each of these incidents puts him at risk of death. And he's aware of the potential consequences.”

District Attorney Richard Goldinger, whose office prosecutes all defendants in the county, said the inmate's case is scheduled for trial in March, but “you can't control continuances granted by a judge.”

He said he has instructed the prosecutor in charge of the case to oppose any continuance requests from the inmate, who is represented by the public defender's office. Chief Public Defender Kevin Flaherty didn't respond to a request for comment.

“We're at the point where we want to get it done,” Goldinger said.

Inmates can't be forced to eat

Under the jail's policy, inmates can't be forced to eat, but Slupe said what this inmate is doing doesn't constitute a hunger strike since the inmate has never held a sustained period of starvation. “He as a patient has a right to refuse treatment, but the line becomes blurred when he's here for 19 months and is causing a drain on the system, and if he dies here, we have to deal with the aftermath, which is never a simple process,” Adams said.

She described his process as a gradual manipulation of his diabetes.

Typically, she said, the inmate will start the “strike” by refusing to eat. This causes his body to break down muscle to be converted into energy. This process happens to anybody in the first stages of starvation. But since this inmate is a type 1 diabetic, his pancreas can't turn the sugar in his blood into insulin.

“So, now he's creating a high blood sugar level,” Adams said. “And this young man is very well versed and educated in his condition.”

The high blood sugar leads to a condition called diabetic ketoacidosis as a result of harmful acid.

In his condition, his body is creating all the blood sugar, but his pancreas can't produce insulin, which is needed to process it.

“Once he's in this state, he must be hospitalized,” Adams said, noting he has been placed in intensive care.

”He knows this might be the last time. He's essentially playing Russian roulette,” Adams said. “He wants to be released pre-trial because he hasn't been convicted.”

Once at the hospital, Adams said the inmate becomes compliant with the caretakers, and in three to five days he's back in the jail.

Adams noted the jail's staff has tried to work with the inmate to prevent this behavior. She said they have tried to tailor a diet for him that would help with his diabetes, even offering him a piece of paper to write down what he can and can't eat.

But, Adams said, he refused to participate.

“He's committed to his cause,” she said.