What would you do if you had an infectious lump the size of a golf ball at the base of your tongue, struggled so hard just to breathe that you sounded like a “pig,” and your health provider told you to put some ice on it and try sleeping with your head a little higher?

Maybe get a second opinion?

Find a new health care provider?

Rush to the nearest emergency room?

Andrew Leighton had none of these options. He obediently went back to his cell at the Maine State Prison and died.

Leighton, you might recall, first made headlines throughout Maine in 2013. Beset by severe mental illness, he shot and killed his 68-year-old mother, Shirley Leighton, at their home in Falmouth. At the time, she and her husband, Thomas Leighton, were arranging for emergency mental health treatment for their son, as they had so many times over the years when his demons took over.

Two years later, his illness back under control, Andrew pleaded guilty to murder and began serving a 27-year sentence at the state’s maximum-security prison in Warren. He dutifully took his daily psychotropic medications, listened to classical music in his cell and stayed out of trouble.

Then, in the fall of 2018, tragedy struck again. As his fellow inmates told me at the time, Andrew began experiencing pain from his ear to his jaw. Despite repeated pleas for help to the prison’s health provider, then known as Correct Care Solutions, he only got sicker.

On Oct. 1, 2018, long after he should have been transferred to the prison infirmary, he died on the floor just outside his cell. He was 51.

Andrew’s father and sister, Kate Keene of Kennebunk, both of whom had stood by him throughout the entire ordeal, tried to get answers about what happened. Instead they ran into the brick wall of silence that too often goes up when a prisoner dies and few people beyond immediate family seem to notice, much less care.

Now, the Leightons are no longer asking for an explanation. They’re demanding one.

A lawsuit filed by Andrew’s estate on Jan. 19 in Cumberland County Superior Court alleges that the prison health provider, now called Wellpath, “failed to meet the standard of care of reasonably competent medical providers” and that its negligence led to Andrew’s death.

“It’s heartbreaking,” Susan Faunce, the Leightons’ attorney, said in an interview. “You have someone who’s sitting in prison. It’s not like you, as a patient, when you’re not feeling you’re getting the answers you need in terms of medical treatment, you can go down to the urgent care or go to somebody else. They’re really stuck with the care that they have there.”

The court complaint, based on medical records and depositions compiled by Faunce over the past two years, portrays a prisoner on a downward spiral that lasted not hours or days but a full two months:

It began July, 30, 2018, with what appeared to be a toothache. A dentist at the prison performed an X-ray and told Andrew to come back if the pain persisted.

It did – and then some. Four times over the next five weeks, Andrew returned with pain that eventually encompassed not just his teeth but his nose, ear and neck.

Penicillin and other antibiotics were prescribed, to no effect. At times, practitioners prescribed more medications without even examining him.

Then, on Sept. 27, the left side of his face throbbing from his sinuses to his ear to his chin, Andrew asked once again to be seen. The lymph nodes in his chin were swollen. He could not open his mouth. It hurt just to move his tongue.

The next day, a registered nurse finally examined Andrew, found the swelling in his chin firm to touch and consulted a doctor. The doctor, without seeing Andrew, ordered another round of antibiotics.

By Sept. 29, a Saturday, Andrew reported that he was having difficulty swallowing. Another registered nurse evaluated him, describing his neck as “a swollen hard mass” and finding a lump the size of a “golf ball” on his throat. Rather than contact a doctor immediately, she gave Andrew an appointment card for that Tuesday and told him to notify the medical clinic if he had any difficulty breathing.

One day later, Andrew reported he was having difficulty breathing. He said he made “an audible snoring sound” when he tried to breathe with his mouth closed. He also said he was unable to lie flat and hadn’t slept in days because the lump in his throat was blocking his airway.

According to the complaint, Susan Arbuckle-Keith, a registered nurse with Wellpath, “observed ‘odd swelling’ on Andrew’s neck and noticed that he was ‘quite scared and anxious.’ ”

But when he asked to be admitted to the prison infirmary, the complaint alleges, Arbuckle-Keith refused. Rather than call in a doctor, she “instructed Andrew to apply ice to his neck and to sleep with his head and neck slightly elevated.”

The next day, Oct. 1, while standing in line for early morning medications, Andrew had so much trouble breathing that he sounded like a “pig,” according to a medical assistant who observed him. She immediately called the medical clinic to request that he be seen.

But it was too late. Sometime between 7 and 7:30 a.m., Andrew was found unresponsive in his cell. CPR was attempted without success.

Finally, at 8:37 a.m., sprawled across the walkway outside his cell, Andrew was pronounced dead.

An autopsy later cited the cause of death as “acute inflammation at the base of the tongue and anterior neck structures with rhabdomyocytolysis, sialadenitis, and sepsis.”

Rhabdomyocytolysis is a complication from severe asthma, which Andrew’s sister said he had. Sialadenitis is an infection of the salivary glands. Sepsis, according to the Mayo Clinic, is “a potentially life-threatening condition that occurs when the body’s response to an infection damages its own tissues.”

This is not the first time that Arbuckle-Keith, the last Wellpath provider to see Andrew alive, has had some explaining to do.

Her disciplinary file with the Maine State Board of Nursing contains several citations from 1994 to 2010, most notably one for diverting medication from Mid Coast Hospital in Brunswick (she surrendered her license for a year) and falsifying patient records while working for Lincoln County Health (the nursing board placed her on a three-year probation).

Contacted Tuesday at her home in West Bath, Arbuckle-Keith said the disciplinary actions “have absolutely nothing to do with patient issues. I’m a recovering addict, and it all revolved around that.”

As for her treatment or lack thereof of Andrew Leighton, she said, “I need to get in touch with a lawyer. I’m not talking to you about this.” She then hung up.

The lawsuit is also far from Wellpath’s first brush with controversy. A scathing 2019 investigative report by CNN, titled “Help Me Before It’s Too Late,” chronicled a litany of lawsuits against the company in 120 correctional facilities across 32 states. In more than 70 such cases, CNN reported, an inmate died.

The article’s recurrent themes – medical requests that went ignored, failure to meet basic medical standards, deaths that could have been prevented – fit hand-in-glove with what happened to Andrew. The underlying motivators: cost containment and corporate profits.

Asked last week to discuss the Leightons’ lawsuit, Wellpath spokeswoman Judy Lilley responded in an email, “Wellpath does not comment on any active litigation. Additionally, due to privacy laws, Wellpath is unable to comment on the care provided in this case.”

Ditto for the Maine Department of Corrections, which farms out inmate medical services to Tennessee-based Wellpath.

Back in 2018, then-Commissioner Joseph Fitzpatrick assured me that Andrew’s death was being investigated both internally and by the Maine State Police.

What became of that? Current Commissioner Randall Liberty, who was the warden at the Maine State Prison when Andrew died, did not respond to repeated requests for an interview over the past week.

In a follow-up email, Anna Black, the department’s director of government affairs, wrote, “I can confirm that investigations occur after a resident’s death. However, records about specific residents are designated confidential by statute.”

According to attorney Faunce, Andrew’s father and sister aren’t talking publicly as they await a trial date. But their goal remains unchanged.

“For them, it’s about getting this information out there – having people think about their prison health care system,” Faunce said.

That’s an admittedly a tall order – murder and mental illness aren’t exactly things people like to dwell on. Slap both those labels on a state prison inmate and you’re lucky if he even registers on the public-sympathy scale.

To be sure, Andrew Leighton committed a terrible crime. And yes, under our system of justice, he needed to be held accountable for his actions.

But he also died an excruciating, unattended death. And justice also demands accountability for that.

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