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A Pakistani national who died in the Hudson County, N.J., Jail while being held in secret after Sept. 11 made requests for medical attention that were ignored in the days leading up to his death, according to a report released by Human Rights Watch. Rafiq Mohammed Butt, who died of cardiac dysrythmia brought on by narrowed coronary arteries, also spent part of the morning of his death knocking on his cell door in a futile attempt to get the attention of corrections officers, the Aug. 15 report claims. Jail officials, however, contradict the account produced by the New York-based watchdog group and based primarily on information provided by Butt’s cellmate, who has since been ordered deported. The jail officials’ account, backed by jail paperwork and an autopsy report from the state medical examiner’s office, indicates that Butt received medical attention on several occasions, had no symptoms and died without warning in his sleep. Both accounts hinge on whether Butt, 55, displayed or complained of symptoms to jail staff. His condition would have been treatable if caught in time. The problem with narrowed and underdeveloped coronary arteries like Butt’s, doctors say, is that the condition can exist undetected for long periods and kill without warning or it can produce extended bouts of chest pain, giving doctors ample time to act. Butt arrived at the jail on Sept. 20, as the federal government’s roundup of hundreds of Muslim men of “special interest” began to gather force after the attacks on the World Trade Center and the Pentagon. Butt, a restaurant worker, was living in Queens, N.Y., when he was picked up. He had arrived in the United States in September 2000 and had overstayed his visa, the reason he was kept in jail. Butt spoke English poorly and did not have a lawyer, and little was known about him until several days after he died on Oct. 23, when federal and county authorities made a brief announcement of his death. His closest family member, nephew Mohammad Bilal Mirza, last saw him in August 2001. He says he did not find out where Butt was located until he received a call from Irfan Ahmed, vice consul of the Pakistani embassy in New York, saying Butt had died. “If I had known which jail he was in I would go there. But I didn’t know,” Mirza says. “Despite our requests [to the Immigration and Naturalization Service] they didn’t give us a death certificate or any autopsy report,” says Ahmed. Mirza also says he was promised a report from the INS on his uncle’s death, but none was sent. Russ Bergeron, INS spokesman in Washington, D.C., says the agency does not give out autopsy reports or death certificates; such information, he says, has to be requested from local authorities. He suggests there may have been a misunderstanding by the embassy and the next of kin that the INS provides that information. The lack of additional information spurred Human Rights Watch attorney Cesar Munoz to track down Butt’s cellmate, Mohammed Munir Gondal, to get the details of Butt’s final days. The results of that interview form the basis of the organization’s report. The Human Rights Watch report says that as Butt did not speak English, Gondal helped him fill out five or six forms requesting to see a medic in the 10 days before he died, but Butt never saw a doctor. On the morning of his death, “[a]t about 6 a.m., Butt said he felt ‘pain.’ ” According to Gondal, Butt knocked on the cell door for five or 10 minutes in an unsuccessful attempt to get an officer’s attention. Butt then went back to sleep. After 9 a.m., Gondal woke up and called Butt, but he did not answer. Butt had been granted a voluntary departure eight days before his death but was awaiting valid travel documents, says Bergeron. Human Rights Watch requested details of Butt’s death from the INS, the FBI and the Hudson County prosecutor’s office, which briefly looked into the matter, but no details were forthcoming. Jail Director Ralph Green allowed the Law Journal to examine some paperwork surrounding Butt’s death. The documents say that a “code white” was recorded by officers at 10:45 a.m., and that Butt was pronounced dead by a doctor at 11:05 a.m. The autopsy report confirms that Butt died of “acute cardiac dysrythmia due to anomalous coronary artery with atherosclerotic coronary stenosis.” Butt’s coronary arteries were 30 percent to 70 percent narrower than they should have been. The jail is equipped with heart monitoring equipment, Green says, but there is no indication it was used on Butt. “It’s my belief that had he received medical treatment earlier he could have survived,” says Dr. Marc Siegel, an assistant professor at New York University Medical School who wrote an article published in The Nation on Dec. 3, 2001, based on interviews with several medical officials at the jail and the man who conducted the autopsy. Siegel adds, however, that the condition can take its victims by surprise and that without symptoms or complaints from the patient, it can go undiagnosed. “There are a lot of ifs here,” he says. In contrast to Human Rights Watch’s findings, the jail produced documents indicating that Butt had been seen by a doctor three times for routine intake examinations in the first few days after his arrival. Paperwork dated Sept. 29, 2001, indicates “No acute pulmonary disease” and “Heart – normal.” The doctor’s signature is illegible. An Oct. 3 report detailing a chest X-ray to screen for tuberculosis states “heart size is within normal limits.” It bears the same unreadable scrawl identifying the doctor. The jail also produced four “sick call” lists, showing three requests by Butt to see the dentist and one to have his fingernails clipped, the last one 48 hours before his death. None of the lists indicate Butt wanted to see a doctor. “It’s hard to believe his nails were getting clipped and he wasn’t complaining of chest pain,” says Siegel. Green has a different take. “Had this guy been banging on the door and holding his heart that would’ve been the first thing we did — move him to the medical center,” Green says. “All the inmates have to do is sign up for a sick call and we put them on a list and we see that they’re seen. We also have in place, and have always had in place, an inmates’ grievance procedure. When someone fails to put their name on the sick call and they fail to see a doctor, they can fill out the grievance form and that automatically comes to the director’s office or the warden’s office and we automatically see that they get the attention they need.” Butt never asked to see a doctor, Green says. Green and the jail staffer who investigated Butt’s death, Sgt. Joe Stout, agree that Gondal had made to them the same allegations he made to Human Rights Watch — that Butt had banged on his cell door the morning he died. Stout says, however, that inmates in the cells on either side, the corrections officer on duty that day, and the “tier representative” — a trusted inmate with cleanup duties — all said they had heard nothing. Green and Stout also agree that Gondal had made the same claims about the unfulfilled medical requests. Gondal’s story could not be verified, they say. The discrepancies between the two accounts illustrate the potential consequences of secret arrests, critics of the detention process say. “There was never a public explanation of what happened to this person. The autopsy was not released. Basic information about whether he had seen a doctor before, that kind of information, was not disclosed. That’s the problem. We contacted the INS to ask what happened to this person and the INS refused to tell us,” says Munoz of Human Rights Watch. “We don’t know exactly what happened. That’s the bottom line,” Munoz adds. Deborah Jacobs, executive director of the American Civil Liberties Union of New Jersey, unsuccessfully filed suit in Superior Court to obtain more information from the Hudson County Jail on who is detained there. “There are many cases that show that neglect of medical care is not unusual in prisons or jails. And when an individual is secretly detained, doesn’t have access to legal counsel, and doesn’t have strong language skills, it’s even more likely that they will struggle to obtain needed medical treatment,” she says. Green bridles at the suggestion that inmates without lawyers or the language skills necessary to navigate jail are left to die inside his facility. “I take that personally,” he says. Detainees have access to counsel, it’s just not free as in criminal cases. “We don’t hesitate to move them out of there [when they become ill].”

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