Private contractors at a federal detention facility delayed calling for an ambulance for hours during a man’s health crisis the day before he died, video and records obtained by the Guardian can reveal.
Correctional staff pinned the bloody and bruised man to the floor in a medical observation cell for nearly four hours.
James Ramirez, a federal pre-trial detainee in the custody of the US Marshals Service (USMS) who had been previously diagnosed with paranoid schizophrenia, died in a solitary confinement cell while being held at the Cibola county correctional center in New Mexico in February 2022.
Cibola is a federal facility outside Albuquerque with a series of units in which people in the custody of the USMS and local county law enforcement, along with immigrants in Immigration and Customs Enforcement (Ice) custody, are detained. The jail is owned and operated by CoreCivic, one of the biggest private corrections companies in the US.
After spending months researching conditions at Cibola, the Guardian discovered that an alarmingly high number of deaths have occurred at the facility in recent years. One of the fatalities was that of Ramirez, 28. Meanwhile, the FBI is investigating what the agency in an affidavit called an “epidemic” of drug smuggling at the facility, including allegations that some CoreCivic workers have been involved.
Videos of Ramirez’s situation the day before he died, provided to the Guardian by an attorney working on a wrongful death lawsuit against CoreCivic and others, show a rare glimpse of a medical crisis that precedes a death inside a federal detention center. Cibola contracts with the Department of Homeland Security and the Department of Justice.
Hours of video footage, hundreds of pages of medical examiner reports, the wrongful death lawsuit and local police reports obtained by the Guardian show that CoreCivic medical staff waited several hours before transferring Ramirez to the hospital. In video obtained and edited for length by the Guardian, a nurse can be heard telling Ramirez that staff needed his consent to take him to hospital, even though the handcuffed man being restrained on the floor appeared barely conscious at the time.
Ramirez was eventually taken to the local Cibola general hospital in Grants, New Mexico, about an hour from Albuquerque, sedated and stitched up, according to multiple attorneys variously representing the family, CoreCivic and the hospital, as stated in court filings in the ongoing civil case in the New Mexico federal court.
The wrongful death lawsuit alleges hospital medical staff reported that Ramirez had “a baseball sized lump” on his forehead as well as lacerations after, they were told, “repeatedly smashing face on concrete”. According to the complaint, one nurse assessed that the patient had “likely suffered a traumatic brain injury”. He was administered ketamine to be sedated at the hospital ahead of being scanned. However, he did not receive psychological or psychiatric testing or a blood test for other drugs in his system, according to multiple court filings.
Later that same day, he was returned to Cibola, still sedated, according to the lawsuit, a medical investigator report and video footage. CoreCivic then in effect, the lawsuit alleges, “withdrew all chance of medical oversight and care from Mr Ramirez by putting him into solitary confinement, away from medical staff”. In a court filing, CoreCivic attorneys said the medical observation cells – where Ramirez had been previously held down for hours – were full.
The following afternoon, Ramirez was found dead in the cell, with “blood everywhere”, a report by the local Milan police department, dated 15 February 2022 and obtained by the Guardian, says.
Ramirez’s estate sued CoreCivic, a nurse and doctor working at the facility, the Cibola general hospital, and a doctor at the hospital in New Mexico federal court.
“Defendants assumed without confirmation that Mr Ramirez had ingested illicit drugs, and as a result, did nothing but restrain him during his medical and mental health crisis,” the lawsuit alleges, adding that due to the defendants’ “negligent acts”, Ramirez suffered an “unnecessary, avoidable, and wrongful death”.
By compiling hundreds of pages of official and legal reports, the Guardian established that, since 2018, there have been at least 15 detainee deaths inside the federal facility.
According to the Cibola contract, CoreCivic staff are required to regularly check on mentally ill detainees, specifying that those who are demonstrating “unusual or bizarre behavior” should receive more frequent observation.
CoreCivic is accused in the lawsuit of not following its own policies with Ramirez in terms of dealing with what the lawsuit describes as his “medical and/or mental health crisis”.
CoreCivic said it could not respond to the specifics of Ramirez’s case due to the ongoing lawsuit, but stated: “At all our facilities, including the Cibola County Correctional Center (CCCC), the safety, health and well-being of the individuals entrusted to our care and our dedicated staff is our top priority. This commitment is shared by our government partners. Our facilities have trained emergency response teams who work to ensure that any individual in distress receives appropriate medical care, and we are deeply saddened by and take very seriously the passing of any individual in our care. Any death is immediately reported to our government partners and investigated thoroughly and transparently.”
In court filings in the case, attorneys for CoreCivic said Ramirez’s death was unforeseeable and that the company denies all liability and allegations of wrongdoing. The other defendants similarly denied wrongdoing, in court filings. The hospital settled in the lawsuit and was unable to provide further comment to the Guardian.
The lawsuit from the Ramirez estate alleges that medical staff at Cibola, instead of responding to his “acute mental and physical distress” as a reasonable healthcare provider would, reasoned that he had “simply ingested drugs and did not need medical intervention”.
Ramirez was originally from California, his older sister Teresa Saldaña said in an interview.
“Growing up, we had a really difficult childhood,” Saldaña said.
Although Ramirez was not formally diagnosed with schizophrenia until later in his life, Saldaña remembers him as a teen telling her that he “heard the predator in his head. The predator would order him to do things, and if he didn’t then the predator would threaten to harm him.”
Ramirez struggled with substance abuse, his sister suspects, and she lost contact with him for about 10 years. The two siblings reconnected after Ramirez was arrested in 2021 and detained in Cibola. “We hadn’t spoken in a very long time, so he was excited to speak with me,” she said.
That year, Ramirez had allegedly robbed someone at gunpoint in Albuquerque, according to a criminal complaint. When local officers responded to the robbery, the complaint says that Ramirez opened fire. He shot and wounded four officers, including one seriously, and he was shot as well. He was charged with crimes including aggravated battery and armed robbery and, because of Ramirez’s prior criminal history, with “being a felon in possession of a firearm” – a federal crime.
Ramirez was placed under USMS custody and was sent to the Cibola facility in 2021, while his federal case proceeded.
According to court records, Ramirez had been diagnosed with paranoid schizophrenia before entering Cibola and intake documents from the facility seen by the Guardian show that the staff were aware of his diagnosis.
On 14 February 2022, Ramirez had been in solitary confinement for five days because he was suffering from paranoia, and CoreCivic staff observed that he was “unable to stand and [was] slurring his words”, the lawsuit alleges. Company lawyers in a court filing in the case speculate that Ramirez may have been “under the influence of drugs or alcohol”. He was taken to a medical observation cell on a gurney.
While there, after being taken off the gurney and left alone, Ramirez struggled to keep control of his body. Whenever he tried to stand, he would collapse. He can be seen on surveillance video footage, shared with the Guardian, stumbling, slipping and reeling around the back of the cell, in between falling down and lying helplessly on the floor. As he repeatedly stumbled, slid from a sitting position or toppled over, it can be seen that his head and face slammed into the wall, the sink, the floor and the concrete bed platform. Before long his head and upper body – and parts of the cell – became covered in blood.
Some facilities around the US have a policy of recording instances when officers use force on detainees. Footage, taken by staff on a handheld camera, shows that guards arrived and held Ramirez down to the floor in an apparent attempt to prevent further injury. However, they continued to do so for nearly four hours while, according to the lawsuit from Ramirez’s estate, and confirmed in the handheld video footage, the “correctional officers repeatedly called for medical assistance”.
Facility staff cuffed his wrists at his front and applied a soft head brace as he was held on his back. Ramirez, with his swollen eyes shut, and covered in bruises and blood, can be seen in the footage occasionally lurching against his restraints and making incomprehensible, guttural sounds. He can also be made out on the footage trying to bite himself.
After hours of the facility’s security staff pinning Ramirez to the floor, a CoreCivic nurse finally arrived but did not swiftly call for an ambulance, saying that Ramirez, who was occasionally grunting or snorting, needed to become “well enough” to say he gave consent to be taken to the hospital, to get stitched up, evaluated and treated.
“If you just talk to me, we can get you to the hospital and fixed up real quick,” the nurse can be heard saying in the video, while wearing a hat that reads: “Heroes work here.”
“They got better drugs than we do,” the nurse says in the video. The nurse is also named in the wrongful death lawsuit filed by Ramirez’s estate.
“He was completely out of it. He was seizing, he was incoherent, he couldn’t talk. It went on for hours,” said Parrish Collins, a civil rights attorney who also represents prison staff whistleblowers, based in New Mexico. Collins is one of the attorneys representing Ramirez’s estate in the wrongful death lawsuit against CoreCivic et al.
Almost six hours after his medical crisis began, Ramirez was taken to the Cibola general hospital, sedated with ketamine and stitched up, but not tested for drugs, court filings by attorneys representing CoreCivic and the doctor in question allege. Ramirez was discharged from the hospital hours later, “still sedated and unstable”, the lawsuit claims, and returned to Cibola.
He can be seen on further video footage being wheeled into the facility on a stretcher and into a solitary confinement cell. CoreCivic attorneys in a court filing said the medical observation cells were full when Ramirez was returned to the facility. There is no footage available from inside the cell where he died.
The following day, a CoreCivic nurse found him unresponsive in the cell, a court filing from a company attorney alleges. He was declared dead in the facility shortly after, according to court filings and the police and medical examiner reports in the case.
When a local police officer arrived to investigate the death, he found Ramirez’s body “had blood everywhere on it and bruising”, the Milan police department officer wrote in the incident report to investigate the “unattended death”. The report said there was “heavy dark bruising” around his eyes, forehead, wrists and hands. And his body “was positioned on the bare floor with his arms extended next to his head at about a 90 degree angle, with his left foor crossed under his right leg [sic]”.
The New Mexico office of the medical investigator conducted Ramirez’s autopsy to investigate his cause of death. The Guardian independently accessed two reports produced by the office, including a toxicology report and a postmortem physical examination report. The toxicology report documented various drugs in his system, including ketamine, the antidepressant mirtazapine and lorazepam, a medication for seizures and anxiety. Some of those drugs, including the schizophrenia medication Haldol, the lorazepam and the ketamine, had been administered by the hospital, court records say. The defendants’ filings speculate that Ramirez was under the influence of drugs and smelled of alcohol when he was originally taken to the medical observation cell at Cibola.
The postmortem exam documented “blunt trauma” on Ramirez’s face and head, swelling, cuts, a fractured nose, and bleeding from his scalp and neck. That report said the cause of death was “undetermined”.
The wrongful death lawsuit from the Ramirez estate is still ongoing in a federal New Mexico court. Lawyers representing the hospital told the Guardian they had reached a settlement in the case and had no further comment.
Lawyers representing the doctor who treated Ramirez at the hospital, before his death, did not respond to multiple requests for comment.
In a statement, the USMS said the agency “does not own or operate detention facilities but partners with state and local governments using intergovernmental agreements to house prisoners. Additionally, the agency houses prisoners in Federal Bureau of Prisons facilities and private detention facilities.
“The USMS ensures appropriate reviews are conducted annually on all non-federal detention facilities, and corrective action plans are implemented, as necessary,” the USMS statement said. “The USMS conducted a review of the Cibola County Correctional Center in June 2025.” The USMS did not provide further information when asked about the findings of this year’s review of the facility.
Ramirez’s family struggled with his death, including the uncertainty of what exactly took place during his time in Cibola.
“It was devastating, it was upsetting. This whole situation has been very emotional for me,” said Saldaña, his sister. “I had to go on medical leave. I couldn’t sleep for more than an hour a night. And this went on for about a year.”
The jarring video of Ramirez’s last day alive is one of the worst things Collins, the attorney representing the Ramirez estate, has seen, he said, even with years of experience litigating such issues.
Echoing the claims in the wrongful death suit, Collins said: “It’s pretty damn clear what killed him – it’s the lack of medical care,” adding that Ramirez’s death “was perfectly preventable – and they didn’t prevent it”.
