An apparent seizure, a fall, and the use of a controversial restraint technique at the Forsyth County jail all led to John Neville’s death in December, according to an autopsy report.
The report, authored by Dr. Patrick Lantz, details the last moments of Neville’s life and the actions of the jailers and nurse ultimately charged in his death.
The autopsy answers many questions but leaves others unanswered. Lantz authored his report after reviewing video of the incident and investigative reports from authorities. What is known: Authorities never choked Neville or placed direct pressure on his chest or back.
Yet, for minutes, Neville, who was in a position often described as hog-tied, pleaded with authorities for help, telling them he couldn't breathe, according to the autopsy.
Phrases like "Please," "Help me" "Let me go," and "I can't breathe."
The officers didn't let him go, one of them telling him at least twice "Come on, buddy, if you can talk, you can breathe," according to three independent sources familiar with the investigation.
At one point in the nearly hour-long ordeal, Neville called out to someone specific.
"Mama," he is reported to have said.
It would be nine minutes after his final words before jailers could remove his handcuffs — a key broke and it took two sets of bolt cutters to cut them off — and another seven minutes before CPR started.
Officially, Neville died of a brain injury in the hospital two days after arriving. According to the autopsy, Neville’s brain injury came about after his heart stopped beating. He asphyxiated while being restrained with his arms behind his back and his legs folded up in a hog-tie position. He was revived several times, at the jail and in the hospital, before eventually going into a coma and dying.
The autopsy report was released a day after Forsyth County District Attorney Jim O'Neill announced that five former detention officers and a nurse had been charged with involuntary manslaughter.
They include Lt. Lavette Maria Williams, 47; Cpl. Edward Joseph Roussel, 50; Officer Christopher Bryan Stamper, 42; Officer Antonio Woodley Jr., 26; Officer Sarah Elizabeth Poole, 36; and nurse Michelle Heughins, 44. Heughins had not been served with the arrest warrant as of Thursday afternoon. The former detention officers were released on a $15,000 unsecured bond and are scheduled to appear in court on July 23.
In a statement, the jail's health-care provider, Wellpath, defended Heughins, saying she "performed her duties" and "did not engage in misconduct."
“We are all saddened by the death of Mr. Neville," a spokesman wrote in an email. "We are confident that a review of the circumstances surrounding Mr. Neville’s death will reveal that Ms. Heughins fulfilled her obligations as a registered nurse by acting professionally and reasonably in her efforts to save his life."
The following is a chronological account of the events the morning of Dec. 2, as detailed by Neville’s autopsy, starting with his falling from his bunk due to an apparent seizure.
At 3:26 a.m. on Dec. 2, one of Neville’s cellmates in the jail heard a loud bang in the cell. At first he thought he was dreaming, but then he saw Neville, 56, on the floor, shaking, according to the autopsy report. Neville was sleeping on the top bunk, slightly more than four feet off the ground, and appeared to have fallen. The cellmate thought it looked like Neville was having a seizure and pressed the emergency call button in the cell.
The jailers entered and found Neville lying on the cell floor, sweating, vomit on his clothing and blood around his mouth, according to the autopsy. He didn’t directly respond to verbal commands but would groan. The nurse that night, Michelle Heughins, said Neville was lying on his right side, snoring and unresponsive — but his pupils responded to light.
According to his autopsy, Neville’s medical intake form at the jail showed he suffered from an undiagnosed sleep disorder.
Heughins gave Neville a sternal rub — a painful stimulus of the chest using her knuckles — and he opened his eyelids, regaining consciousness, according to the autopsy. Neville was incoherent, confused, uncooperative and became aggressive toward the jailers and nurse, trying to sit up, kicking his legs and swinging his arms.
Jail staff told him he wasn’t in trouble, but was having a medical emergency and “needed to calm down and stop resisting,” according to Lantz’s report. Eventually, jail staff restrained Neville on his back, holding his arms and legs down.
Neville started yelling again, but was incoherent and then lost consciousness once more, Lantz wrote. Heughins gave another sternal rub and Neville woke up again, still incoherent but aggressive once more, kicking his legs and thrashing his body around.
Lantz described Neville’s mumblings as largely incoherent but was able to discern phrases such as “Let me go,” “Help me up” and “Mama.” At some point Neville tried to bite members of the jail staff, and a “spit mask” — normally a plastic hood — was placed over his head. It’s not clear when, if ever, the spit mask was removed, according to the report.
Heughins tried to take Neville’s blood pressure but couldn’t, and jailers rolled him onto his stomach before handcuffing him and using metal restraints on his ankle, according to the autopsy. At some point, while on his stomach, Neville said “I can’t breathe,” the first of at least 10 times he would say it that night, according to three people familiar with the incident.
Eventually the jailers helped him to his feet and walked him to a restraint chair, Lantz wrote. After sitting in the chair, jail staff handcuffed Neville’s hands behind his back and put metal restraints on his ankles. The jailers were taking him to a multi-purpose room on a different floor and, while moving him, they noticed Neville had fecal incontinence. During the move to a different floor, Neville appeared confused, saying “help me,” and often writhed about, moving his torso forward and twisting.
The jail staff placed Neville in a single-person cell for observation, and Neville walked with assistance from the chair into the cell before kneeling down and being placed prone — face down on his stomach — onto a mattress, according to the autopsy. Neville continued writhing on the ground, moving his torso and tensing his arms and legs.
Jailers handcuffed his arms behind his back and placed his legs in metal restraints again, according to the autopsy.
Eventually the jailers removed the restraints from his legs and folded his legs, with his heels near his buttocks, Lantz wrote. The position Lantz described is similar to a hog-tie position, but it’s unclear how Neville’s legs were restrained in that position.
Neville pleaded with the jailers while restrained, saying “Please,” “Let me go,” “I can’t breathe” and “Help me.” The jailers then tried to remove the handcuffs, but the key broke about 2.5 minutes after he was first placed in a prone position, the report said. Jailers tried to use another key, but it didn’t work either.
At some point during this exchange, at least one person in the room told Neville "Come on, buddy, if you can talk, you can breathe," according to three independent sources familiar with the investigation.
Neville uttered his last intelligible words 3.5 minutes after being placed into a prone restraint. In the next 30 seconds, jailers tried to use bolt cutters to cut the handcuffs off, but they didn’t work either. It would be another 7 minutes until another pair of bolt cutters succeeded in removing the handcuffs. In that time, Neville stopped moving and speaking entirely, according to the report.
The jail staff stripped him of his jump suit, Heughins checked him and they left Neville in the cell, closing the door behind them. At some point afterward, Heughins told the detention officer she couldn’t see Neville breathing, and the officers re-entered the cell and rolled him onto his back, securing his arms and legs, according to the autopsy. Neville had no pulse.
Someone put a CPR mask over his face, and chest compressions began. A defibrillator wasn’t used. Eventually the fire department and EMS arrived, and they continued CPR outside of the cell. The jailers had restrained his arms and legs while he received CPR. At 4:35 a.m., Neville had a pulse again, according to the autopsy.
At 5:02 a.m., Neville arrived at Wake Forest Baptist Medical Center, unresponsive again but with a blood pressure of 220/200, according to Lantz. Then his heart rate and blood pressure dropped, and his pulse was lost again. He was revived numerous times and was eventually admitted to the ICU.
In the ICU, a CT scan revealed brain damage, and his condition deteriorated. His organs failed, according to Lantz, and two days later, on Dec. 4, Neville died.
Neville had THC, the active ingredient in marijuana, in his system but no other drugs or alcohol, according to a toxicology report.
Photos: Protesters Arrested at John Neville Demonstration
A 911 call just before the shooting death last year of Julius Randolph Sampson Jr. reveals the caller giving police the first information about the racially charged incident.
A female employee inside BJ's Restaurant & Brewhouse made a 911 call at 3:39 p.m. on Aug. 6, 2019. The caller first gives the restaurant address of 192 Hanes Mall Way to the dispatcher inside the Burke Public Safety Center.
"I see a guest at my bar cursing," the caller said.
The caller then tells the dispatcher that two males are involved.
"One is wearing a Hawaiian shirt, and one is wearing an orange shirt," the caller said. "They are arguing with two other guests who are trying to protect the women at the bar. This is going to be bad."
The caller tells the dispatcher that she doesn't see any weapons among the men who are arguing. But there was a gun — and only moments after the call, Sampson, a married father of three who worked at the mall as a barber, would lie dying in front of the restaurant.
Robert Anthony Granato, 23, was indicted Monday on first-degree murder in Sampson's death and a charge of carrying a concealed gun after or while consuming alcohol.
The shooting has sparked allegations that Granato, who is white, killed Sampson because Sampson was Black. Granato's attorney, Paul James, is claiming self-defense.
On Thursday, a Forsyth County judge ordered the release of a redacted audio recording of the initial 911 call and six others related to the shooting.
In September, Judge David Hall of Forsyth Superior Court had sealed the 911 tapes, which are typically public records, saying he needed to do so to preserve the integrity of the investigation. A coalition of media organizations — including the Winston-Salem Journal, WGHP, WXII and WFMY — fought to have the 911 tapes released publicly.
Chief Assistant District Attorney Jennifer Martin said last year that more time was needed to interview witnesses in the case.
But on Thursday, Martin and Granato's attorney, Paul James, did not object to the 911 tapes being released because witness statements and evidence have been gathered, which led to Granato's indictment. Information that would identify the callers was removed from the recordings before they were made public.
A second 911 call was made two minutes after the first, at 3:41 p.m., by the same female employee who made the initial 911 call.
"I just got shots fired at 192 Hanes Mall (Circle). Hurry up!" the caller said to the dispatcher.
The dispatcher asked the female employee about the shooter. "We have him down," the employee replied. "We have him pinned down."
More calls to 911 quickly followed.
"We were eating inside the restaurant, and they shot one of the guys," said a female customer who called at 3:42 p.m. "Oh my God!"
The dispatcher then asked the caller, "Where's the guy who was shot? Where is he at? Inside?"
The caller responded, "He's outside. He's outside." The caller then told the dispatcher that victim was a male.
"Listen ma'am," the dispatcher responded. "Officers are on the way. Officers are on the way."
The caller began to cry.
"Where's the person with the gun?' the dispatcher asked next. "Where's the person with the gun?"
The caller replied, "He's on the ground right now."
The dispatcher then implored the caller to calm down and take a deep breath.
"Here are the police right now," the caller responded.
"Oh my God. They shot him."
For the first time since 1941, Winston-Salem State will not play football in the fall.
CIAA chancellors and presidents voted this afternoon to suspend the fall athletics season because of the ongoing concerns over the coronavirus pandemic.
“This was a difficult decision but remains consistent with our long-standing priority of always acting in the best interest of our student-athletes, coaches, and support staff,” CIAA commissioner Jacqie McWilliams said in a statement. “While there will be no athletic competition in the fall, we will continue to support opportunities that enhance the experiences of our student-athletes, member institutions and partners.”
The conference did not decide whether football and the other fall sports would be played in the spring.
If a move to the spring is adopted, revised game and practice schedules will be established along with the process of determining conference champions for these respective sports, the conference said.
“The safety, health and well-being of our student-athletes, coaches and staff are non-negotiable," said Clyde Doughty, Bowie State's athletics director and president of the CIAA Athletic Directors Association. "Decisions of this magnitude are made with those factors as No. 1 priority while looking to address current issues that have an adverse impact on all of us.”
Dominique Graves, WSSU's starting quarterback, said the Rams learned about the postponement through a Zoom meeting for all fall athletes with Athletics Director Etienne Thomas and Chancellor Elwood Robinson.
"It's not a total surprise when you see what's happening all over the country," Graves said. "We're disappointed because we wanted to play, but it makes sense from a safety perspective."
Graves, a rising junior, said hopes football will be played in the spring, but he wasn't optimistic.
"The way it's going a lot of things have to happen," he said.
"We all have to focus on keeping our bodies in shape and we will definitely focus on our books. We have to stay in shape and be ready for the spring if we can play."
Robinson said he wasn't sure whether the virus would permit football to be played in the spring.
"The athletic directors in the CIAA and Etienne Thomas have done a tremendous job, so what happens in the spring with football is not determined," Robinson said. "This virus has got people thinking about every move we make and that's the nature of this thing."
But he said the suspension was the right decision.
"When you look at this thing and how the pandemic has affected everybody and it's so fluid right now," Robinson said.
Robinson said he didn't sugarcoat the situation during the video conference.
"We have worked extremely hard to be ready for our students, which include the athletes, to come back to a safe environment this fall," he said. "But we don't know what's coming from other states, and that's how ravaging this virus has become. So I wanted to make sure they know how much we appreciate them and wanted to make sure they know they will be safe."
The CIAA will honor all athletics scholarships for fall sports, which also include volleyball and cross country.
WSSU students are still scheduled to report to campus for the fall semester Aug. 17. The football team will not report as scheduled Aug. 4.
Thomas said she wasn't sure what the revenue loss would be. WSSU had four home games remaining on its schedule.
"The impact on revenue will be felt," she said. "But we also don't have to spend on travel, and one of our big trips was to Chowan."
Another hit on the athletics department will be the $50,000 that would have come with the game at N.C. Central.
"We definitely want to play that game at some point," Thomas said.
Robert Massey, the Rams' interim head coach, said he's saddened that football would not be played this fall.
"The virus is speaking for itself right now, and the health and safety of these kids is the most important thing right now," Massey said. "We're all disappointed, but that's the reality.
"They have to now focus on their studies and focus on getting their degrees. We will all miss it, for sure, but there's something more important in this world right now and it's about getting a vaccine for this virus so we can play again and everybody can be safe."
Pressure is mounting, from medical associations to the White House, for schools to resume in-person learning in August, but many teachers, concerned with their own health, are not on board with the push to return to a brick-and-mortar classroom.
They have lots of questions, including their use of sick leave and personal leave, should they contract COVID-19 while teaching. Teachers accrue sick days based on their longevity and so don’t all have the same amount of sick leave.
On Tuesday, two members of the Winston-Salem/Forsyth County Schools Board of Education, Barbara Burke and Elisabeth Motsinger, said at a meeting that teachers shouldn’t have to use their sick and personal leave if they become sick with COVID-19. Motsinger, a healthcare professional, noted that it can take a person 8 to 12 weeks to recover from the virus.
“It’s very important to be clear about that and request, as a district, that the state cover all of the sick leave for employees who get COVID at work and (not expect school employees) to use their personal time for that,” Motsinger said.
Val Young, the president of Forsyth County Association of Educators, said Wednesday that the use of sick leave to recover from COVID is among many issues that local districts will have to address.
“If I were in school and knew I was doing everything I could to prevent getting ill, and I get sick, I’m not going to be that thrilled about using my sick leave for something like this,” she said. “We need a directive and policy. It’s a conversation that needs to be had, and soon, because school is right around the corner.”
Over the last few days, President Donald Trump has called for schools to reopen, even threatening to withhold federal funding if they do not. At a White House round table earlier this week, he said that some states are making school reopening a political issue.
“They think it’s going to be good for them politically, so they keep the schools closed,” he said. “No way. We’re very much going to put pressure on governors and everybody else to open the schools.”
Education Secretary Betsy DeVos told Fox News commentator Tucker Carlson that “there’s no excuse for schools not to reopen. ... This is more an issue of adults who are more interested in their own issues than serving their students.”
Locally, many teachers are pushing back. One Facebook page dedicated to local education issues has been filled with posts from teachers concerned about their health and about spreading the virus in their homes.
One local educator, Kathie Fansler, has started a petition on change.org, asking local school officials to devote resources to remote learning.
“In-person classes are risky for children, families, teachers and school staff. Winston-Salem/Forsyth County teachers say NO to in-person classes in August,” the petition reads.
At Wednesday’s meeting of the State Board of Education, information from the N.C. Department of Health and Human Services appeared to minimize the risk of the virus spreading among children. The information, shared in a Power Point, said that children may be less likely to become infected after exposure and may be less likely to infect others with COVID-19.
“Early modeling studies of COVID-19 predict school closures alone would prevent only 2 to 4% of deaths,” according to one slide shared with the state board.