Tarrant says Mayo Clinic backs autopsy in Robert Miller jail death, contrary to experts

Tarrant County officials said Monday that the Mayo Clinic has “confirmed” that a jail inmate who died in 2019 had sickle cell trait, which aligns with the county medical examiner’s cause of death but contradicts what outside medical experts have told the Star-Telegram.

The inmate, Robert Miller, died shortly after sheriff’s officers pepper-sprayed him multiple times at close range when he was being booked. Miller, who had asthma, was not given medical attention after he told a nurse he could not breathe. He was found unconscious and face-down in his cell 38 minutes later and died the next morning at JPS Hospital with inflamed lungs, a swollen neck and blood leaking from his ears and nose, according to medical records obtained by the Star-Telegram.

An autopsy report by the Tarrant County Medical Examiner’s Office found the cause of death was “natural” from sickle cell crisis. However, an investigation by Star-Telegram published in October found evidence that suggests Miller may have died as a consequence to how he was treated in the jail.

Experts who reviewed Miller’s medical records said he almost certainly did not have the disease. Red blood cells can take the sickle shape after death if the person had the trait for sickle cell anemia, but carrying the trait does not mean the person has sickle cell disease.

Sickle cell trait is not a disease, according to the Centers for Disease Control and Prevention. It means someone has inherited the gene from one of their parents.

People with the trait usually do not have any of the symptoms of sickle cell disease, but in rare cases they might experience complications of the disease and in “extreme cases” sudden death, according to the CDC.

The county’s statement Monday said it sent Miller’s blood samples to the Mayo Clinic, which “confirmed the cause of sickle cell crisis originally diagnosed by the Tarrant County Medical Examiner’s Office was due to sickle cell trait.” The county did not say how it got Miller’s blood.

Messages left with the Mayo Clinic were not immediately returned.

The American Society of Hematology, which represents 18,000 medical professionals who study and treat blood diseases, says in its position on sickle cell trait: “It is medically inaccurate to claim sickle cell crisis as the cause of death based solely on the presence of sickled cells at autopsy.”

Sudden death is so rare in people with sickle cell trait that cases in which it is listed as the cause or a major factor in a death “must be viewed with profound skepticism,” the organization says.

The Star-Telegram’s investigation in December prompted county officials to contract with an independent forensic pathologist for “consulting services including review of select cases under the jurisdiction of the Tarrant County Medical Examiner.” The contract with the pathologist expired in February, and for weeks county officials refused to discuss what the pathologist did or found.

KERA reported on Saturday the pathologist, Dr. J. Scott Denton of Bloomington, Illinois, did not conduct a review.

“There is no review report. There was no review. The contract expired and no materials were ever sent to me,” Denton told KERA.

The county said its contract with Denton was for consulting services and “the intent was never to conduct a second autopsy,” though that would have been impossible since Miller was cremated.

“With the Mayo Clinic’s confirmation of sickle cell trait, no information was sent to Dr. Denton,” the county said.

The county said it would have no further comment because the case is under litigation.

Roger Mitchell, former chief medical examiner for the District of Columbia who is chair of pathology at Howard University, was one of the experts the Star-Telegram interviewed in its investigation into Miller’s death.

Mitchell said Monday that the fact that Miller had sickle cell trait does not mean he died from a sickle cell crisis.

Red blood cells sickle when there’s a hypoxic environment in someone’s body, which means there’s a depletion of oxygen.

“My question is, why did he have decreased oxygen in his body?” Mitchell said. “The answer to that is because he was pepper sprayed.”

Mitchell said Miller’s cause of death would not be the sickle cell trait, but rather whatever caused the decreased oxygen levels.

“You have to look at the reason why the individual has a low oxygen level to cause his cells to sickle,” Mitchell said. “And if the reason that he had that low oxygen is not natural, then his cause and manner of death are not natural.”

In the Star-Telegram’s initial investigation, Mitchell and another expert also said red blood cells can take on a sickled shape after death if the person carried the trait for sickle cell anemia. When someone dies, their body loses oxygen.

Medical examiner records had listed Miller’s manner of death as “natural.” As of Monday afternoon, his manner of death had been changed to “undetermined.”

An attorney for Miller’s widow Shanelle Jenkins, who is pursuing a wrongful death lawsuit against the Tarrant County Sheriff’s Office, declined to comment.

This is a developing story. Check back for updates.