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LEBANON, Pa. – In the days following her 18-year-old daughter's first arrest on heroin charges, Stephanie Moyer took solace thinking the nearby jail in central Pennsylvania would be a safe place for her to stay until she could get her into a treatment program.
However, Victoria "Tori" Herr sounded disoriented on a call home three days later.
"I just want something to drink. I want lemonade. They won't give me lemonade," she told her mother, who asked what was wrong. "I don't know, but I'm seeing people die. I'm going to die."
"I said, 'Well, maybe you're going through withdrawal,'" Moyer recalled last week, more than a year after Herr collapsed following days of severe vomiting and diarrhea at the Lebanon County Correctional Facility.
Herr, who had told intake officers she'd been using 10 bags of heroin a day, never regained consciousness and was taken off life support at a hospital five days later.
"This is a woman who died because she was detoxing," said Moyer's lawyer, Jonathan Feinberg, who filed a federal civil rights lawsuit Monday in Philadelphia. "Had Tori Herr's withdrawal been treated ... she almost certainly would be alive today."
Her case is one of at least a half-dozen deaths nationwide involving jail heroin withdrawal during the last two years. Advocates fear the number will grow given the nation's heroin crisis. They find the deaths particularly troubling because opioid withdrawal, while miserable, is rarely life-threatening if medication, monitoring and, in severe cases, intravenous fluids are available.
"Obviously, this is an emerging, growing problem and it's hitting communities all over the country. That's exponentially so in jails," said civil rights lawyer Emma Freudenberger, a co-counsel on the lawsuit. She believes that jails have a fundamental duty to care for their inmates, but wonders if some lack concern for people struggling with addiction.
Officials in Lebanon County, including the warden, the jail medical director and a lawyer for the county, did not return calls for comment about Herr's case Friday.
Other lawsuits and news reports around the country detail similarly harrowing withdrawal deaths.
— In Oregon, Madaline Pitkin, 26, wrote increasingly dire notes to jail staff before she died inside an Oregon jail in 2014, according to an investigation by The Oregonian published in April.
"This is a third or fourth call for help. I haven't been able to keep food, liquids, meds down in six days. ... I feel like I am very close to death. Can't hear, seeing lights, hearing voices. Please help me," Pitkin wrote before she died two years ago.
— In Detroit, David Stojcevski lost 50 pounds during a one-month stay over a $774 careless driving fine as he struggled to withdraw from methadone, opioids and the anti-anxiety drug benzodiazepine. A jail video shows him lying naked on a stone floor during what his family called his excruciatingly slow, painful death last year.
— In Colorado, 25-year-old Tyler Tabor of Thornton died last year after he was prescribed a mixture of drugs to treat his withdrawal symptoms, but never received them, according to his family's lawsuit.
"Opioids is one of the safer withdrawals," said Dr. Eke Kalu, general medical director for the Philadelphia Prison System, which is run by the prison medical contractor Corizon.
The city screens inmates using the Clinical Opiate Withdrawal Scale to assess their need for medication or IV fluids. Officials could not remember an opiate withdrawal death during that time.
Detainees at Rikers Island, in New York, also can get methadone maintenance, which some experts believe lowers the chance of relapsing upon release. But smaller jails may lack in-house medical units or sufficient monitoring. Prison advocates believe the lapses can amount to cruel and unusual punishment.
Herr was staggering by the time she was taken to the medical unit the last night at the jail, according to Moyer's lawsuit. She was given water and Ensure, but resumed vomiting when she returned to her cell, the suit says. Severe dehydration brought on by constant vomiting and diarrhea can lead to delirium, an electrolyte imbalance and cardiac damage. Herr also went some time without oxygen after she collapsed, causing irreversible brain damage, the suit said.
"I'm not a professional, but, as a mother — Day 1 — I would have taken her to the hospital if I would have seen her vomiting or not keeping things down," said Moyer, a graphic artist who raised her son and daughter on a quiet lane amid bucolic fields of corn and hay in Lebanon.
Warden Robert Karnes later told Moyer that his staff followed "all operational protocols" in treating her daughter, the lawsuit said.
Herr, a talented artist, graduated from high school in 2014 despite using heroin in the final months, something her mother attributes to her long struggle with anxiety. Moyer last saw her the day before her arrest, when she went to the apartment her daughter shared with a boyfriend to discuss an inpatient treatment program she had found.
"I told her that her name was Victoria and that's close to 'victorious,' and I promised her she would be victorious in getting through it," Moyer said. "She smiled and said, 'That means a lot to me, Mama.'"
Freudenberger doesn't expect jails to offer similar rehabilitation programs.
"But they had to do everything they could to keep her alive. If they couldn't do that, they had to send her somewhere else. They couldn't just let her die," she said.