Video recorded inside the Oneida County Correctional Facility in upstate New York last year show nurses and corrections officers crowding into an infirmary cell after a crucial minutes-long delay, criticizing faulty equipment and cracking jokes about their efforts as they administer CPR to an inmate dying on the floor.
The body camera footage, which has been reviewed by The New York Times, showed the minutes before the man, Antwan Cater, 25, was pronounced dead from a synthetic-marijuana-induced seizure in February 2024. The recordings are the latest in a series of videos that have given the public a view into deaths in New York jails and prisons this year.
A federal lawsuit in the case, filed by Mr. Cater’s father, Terry Watson, in the Northern District of New York, names the county, the medical provider Wellpath Holdings Inc. and 10 nurses and corrections officers as defendants. Mr. Cater’s death was a result of the staff’s “negligence and medical malpractice,” according to the suit.
“Each minute they did nothing to help Antwan, the probability of his survival dropped significantly,” Mr. Watson’s lawyers wrote. “By first ignoring Antwan’s seizure and then standing around idly for minutes, the correction officers and medical staff sealed Antwan’s fate.”
On Monday, a lawyer for Oneida County, Maryangela Scalzo, said it would not comment on a pending case. Representatives for the county, about 250 miles northwest of New York City, did not answer questions about its own internal investigation or say whether the employees named in the suit were on staff. A union for corrections officers, the New York State Correctional Officers & Police Benevolent Association, had no comment on the case.
Wellpath has faced dozens of wrongful death lawsuits and accusations that its employees have provided deficient medical care to prisoners. The company did not comment on the suit by Mr. Cater’s father.
The lawsuit, which seeks an unspecified sum, comes as the public’s awareness of the violence and medical emergencies that have plagued lockups in the state has grown. Guards and medical staff members rarely face external consequences in the aftermath of such episodes.
Mr. Cater’s case, which prompted a state regulatory agency to say there had been “significant” problems with the medical response, provides a rare window into one of the state’s county jails. Those facilities have typically received less public and media scrutiny compared with state prisons and New York City’s notorious Rikers Island complex.
Problems for Mr. Cater, who had a daughter and had struggled with drugs and his mental health, began soon after he arrived at the jail. He had been arrested after failing to report to a treatment program ordered after a shoplifting charge and was being held while his case proceeded through the court.
Mr. Cater told the jail’s staff about his drug use, according to the suit. Shortly after, he started “refusing medical services and meals, became disoriented and nonverbal, and was seen crying and talking to himself,” according to the suit. Staff members observed Mr. Cater “hitting his bunk, shaking the gate and crying, jumping naked in his cell, drinking water from the toilet, calling for his parents” and did nothing, the lawyers wrote.
About two weeks after he was booked into the jail, Mr. Cater was transferred into an infirmary cell — a still image shows him barefoot and naked clutching a blanket around him.
Around 12:50 p.m. on Feb. 13, a corrections officer walked by and saw Mr. Cater flat on the floor, turning his head side to side with his eyes open. The officer reported Mr. Cater’s condition to a nurse, according to the lawsuit. The nurse did not act.
At 12:58 p.m., corrections officers — accompanied by the officer who had alerted the nurse — entered Mr. Cater’s cell with a force order in hand to compel him to go to court. They found him on the floor unresponsive.
The nurse arrived about two minutes later, according to the suit. Before trying to resuscitate Mr. Cater, the nurse asked him questions that were captured on video, including, “You’re not happy in here?”
“You have to talk to me,” the nurse said. “I can’t help you if you don’t talk to me, Antwan.”
Mr. Cater did not move.
The nurse took over two minutes to check Mr. Cater’s pulse. At 1:02 p.m., he announced that he couldn’t detect one.
Not until two minutes later did another nurse begin performing CPR, which continued for more than 40 minutes as medical staff members took turns assisting and the cell became increasingly crowded. They administered Narcan to Mr. Cater without success.
As the minutes ticked by, the staff members spoke among themselves, at points sounding frustrated about pieces of medical equipment that “suck,” and questioning whether anything “works around here,” according to the lawsuit and video.
Representatives for the county would not answer questions about the nurse’s complaints about equipment.
At other points, the nurses cracked jokes. One nurse called the experience “good training,” getting a few laughs. Another chimed in, saying, “I think I burned a thousand calories” performing CPR, adding: “I’m too fat for this.”
Just over a minute later, paramedics on the scene pronounced Mr. Cater dead. The video shows a corrections officer ordering the staff members to drop everything. They then shuffle out of the cell. Mr. Cater was left on the floor, splayed on his back, his clothing mostly removed and his face obstructed by the medical equipment.
Mr. Watson said in a statement through his lawyers at Emery Celli Brinckerhoff Abady Ward & Maazel that a parent should not “have to learn that their child was mocked in their final moments by those charged with protecting them.”
Born in 1998, Mr. Cater grew up in Utica, N.Y., where he worked at supermarkets and fast food restaurants. His daughter was 8 when he died.
Mr. Cater used synthetic marijuana, or K2, according to the suit. He had experienced two drug-induced seizures in the year before his death. However, his lawyers said, guards failed both to properly monitor Mr. Cater in his unit and to “control the use of K2 by incarcerated people.”
“He was more than the worst moments of his life,” Mr. Watson said. “He was a beloved son, father, brother and friend, full of heart and hope. Yet the dignity and respect that officials say every human being deserves were not afforded to him.”
In recent years, a succession of horrific episodes have been captured by video in lockups throughout New York State.
Last year, body camera footage showed the moments when a 43-year-old prisoner at Marcy Correctional Facility in Oneida County was fatally punched and kicked while handcuffed and shackled. Last month, a Utica jury convicted a prison guard of murder, and six others have pleaded guilty to various charges. This month, after deaths at Rikers Island, a Board of Correction report found that staff members there did not follow safety protocols and that uniformed employees did not notify medical staff members of emergencies in a timely manner.
Mr. Cater’s death was one of six at the Oneida County jail since 2021, and one of five about which the State Commission of Correction’s Medical Review Board released a report, according to its website. The board found “significant issues with the medical response and resuscitation measures” provided to Mr. Cater. The board said that the jail’s medical director “shall initiate a comprehensive retraining of CPR and resuscitation procedures to all medical staff.”
Jails, which are usually run by counties, should have detailed guidelines for how staff members respond to medical emergencies, said Hernandez D. Stroud, a senior fellow at the Brennan Center for Justice at the New York University School of Law. In Mr. Cater’s case, he said, the response appeared delayed and haphazard.
“We’re talking about minutes, but minutes could be the difference in someone’s life,” he said.
County representatives did not answer questions about its emergency response policies and whether staff members had acted according to those guidelines. They did not say whether any employees had been retrained or disciplined following the response.
The Medical Review Board also directed the county’s legislature to “review the above findings and conduct an inquiry into the fitness of the formally designated provider.” The provider, Wellpath, formerly known as Correct Care Solutions, did not respond to a request for comment.
The company, which according to its website provides care to “350+ local detention facilities around the country” exited bankruptcy this year after settling with junior creditors for $15 million, according to reports. Wellpath has faced dozens of wrongful death lawsuits and accusations that it has provided deficient medical care to prisoners.
The board also found that Mr. Cater’s initial medical history and physical and mental health assessment from both his arrest last year and his incarceration in December 2023 had not been signed by a physician. According to state regulations, all prisoners should be examined by a physician licensed to practice in New York no later than 14 days after they are admitted.
In reports following Mr. Cater’s death, according to the suit, jail staff members said that they had at first thought Mr. Cater was faking a medical emergency to avoid court.
But one of his father’s lawyers, Katherine Rosenfeld, said that the doctors and nurses had failed in their duty to keep Mr. Cater safe. “It should be very difficult to die in this way,” she said.
Georgia Gee and Alain Delaquérière contributed research.
Hurubie Meko is a Times reporter covering criminal justice in New York, with a focus on the Manhattan district attorney’s office and state courts.
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