When Baltimore State's Attorney Maryliyn Mosby charged six police officers in the death of Freddie Gray, she said they had ignored Gray's pleas for medical care during his arrest and a 45-minute transport van ride.
Records obtained by The Baltimore Sun show that city police often disregard or are oblivious to injuries and illnesses among people they apprehend — in fact, such cases occur by the thousands.
From June 2012 through April 2015, correctional officers at the Baltimore City Detention Center have refused to admit nearly 2,600 detainees who were in police custody, according to state records obtained through a Maryland Public Information Act request.
In those records, intake officers in Central Booking noted a wide variety of injuries, including fractured bones, facial trauma and hypertension. Of the detainees denied entry, 123 had visible head injuries, the third most common medical problem cited by jail officials, records show.
The jail records redacted the names of detainees, but a Sun investigation found similar problems among Baltimore residents and others who have made allegations of police brutality.
Salahudeen Abdul-Aziz, who was awarded $170,000 by a jury in 2011, testified that he was arrested and transported to the Western District after being beaten by police and left with a broken nose, facial fracture and other injuries. Hours later, he went to Central Booking and then to Bon Secours Hospital, according to court records.
Abdul-Aziz said last week that jailers at Central Booking "wouldn't let me in the door as soon as they saw my face. ... I thought I was gonna die that day. Freddie Gray wasn't so lucky."
Some critics say the data from the state-run jail show that city officers don't care about the condition of detainees.
"It goes to demonstrate the callous indifference the officers show when they are involved with the public," said attorney A. Dwight Pettit, who has sued dozens of city officers in the past 40 years. "Why would they render medical care when they rendered many of the injuries on the people?"
Criminologists and law enforcement experts say Gray's death shows that police lack adequate training to detect injuries. Many suspects fake injuries in an effort to avoid a jail cell, they add.
"The curriculum has been generally the same for the past 20-30 years at the [police] academy," said Hamin Shabazz, chair of the Department of Criminal Justice at Stevenson University and a former police officer in Camden, N.J, He served on the panel that reviewed the death of Tyrone West, who died from a heart condition made worse by a struggle with officers during a traffic stop amid summer heat in 2012.
Officers, Shabazz said, "do get some in-service training, but what happens is training is usually reactive, after something has happened."
The Sun's examination of more than 100 lawsuits against officers — in which the city paid more than $6 million in court judgments and settlements — found that dozens of residents accused police of inflicting severe injuries during questionable arrests and disregarding appeals for medical attention.
Such problems have damaged relations between police and residents, according to officials and community leaders. On Friday, U.S. Attorney General Loretta Lynch announced a broad civil rights investigation into the police department, a move designed to address the "serious erosion of public trust."
Baltimore police did not respond to several requests for comment.
Experts say it's unknown how often officers deny medical care for suspects, who are constitutionally guaranteed health care before being booked into jail. That denial can cause discomfort or worsen a condition — and lead to death, as prosecutors allege in the case of Gray, who had a severed spine.
Authorities have not conclusively determined how Gray was injured though they suspect he was hurt riding in the transport van. Prosecutors allege his hands and feet were cuffed, and he wasn't wearing a seat belt, a violation of police department policy. Police policy also requires officers to obtain medical help when suspects request it.
Police task force members who investigated the case believed that Gray suffered a "catastrophic injury" while being taken from the arrest at Gilmor Homes to the Western District police station. They also discovered that one of the officers said Gray had "jailitis" — a faked illness — after he complained about his condition.
In announcing criminal charges against the officers, Mosby said at least five of Gray's requests for medical care were ignored.
After arriving at Central Booking, detainees are examined by intake nurses to determine whether they are stable enough for the four- to five-hour booking process, said Gerard Shields, spokesman for the state Department of Public Safety and Correctional Services. If someone is rejected, the responsibility falls on police to get medical care, he added.
"The police are not medical personnel and may not be aware of the severity or presence of all injuries," Shields said. "Our protocol is to assess all detainees at the door to see if they can medically withstand the booking process. We are able to treat many injuries on site so these are determined on a case by case basis. If we can treat them, we will."
Detainees rejected by intake officers represent about 2 percent of total bookings into the jail during from June 2012 through April.
The scrutiny applied before booking suspects also helps the jail control operating costs. Once a suspect is admitted to the jail, medical costs fall on that agency.
Some experts said that the criminal charges resulting from Gray's death could spur more officers to quickly call paramedics — whether an injury is visible or not.
"As part of the state's attorney's case, the officers were accused of misconduct in office," said Charles J. Key, a former Baltimore police lieutenant who now consults on use of force cases. "They didn't call for an ambulance ... other officers would have to be fools not to call for an ambulance."
Officers run into problems in deciding whether an injury is legitimate or fake, Key said. While in the police academy, recruits complete some first-responder training, but eventually it comes down to an officer's judgment about whether to seek medical help, he added.
"If they observe an injury like a compound fracture with bone through the skin ... or there is a condition, like a heart attack, they are supposed to call for assistance," Key said.
Some cities are providing more training for police officers, and one model showing promise is Crisis Intervention Team training, which helps officers identify people with mental health issues and de-escalate situations, said Jim Parsons, vice president and research director of the Vera Institute of Justice, a nonprofit research and advisory group.
In New York, where officers have also been scrutinized for mistreating people in custody, there is a new emphasis on quickly getting better medical and mental health treatment.
Part of the program calls for additional medical screenings for those entering the correctional system, to ensure illnesses and injuries are spotted and treated sooner, said Parsons, who is working with the New York system.
That may save resources, as Parsons said many New York officers had begun overcompensating by taking so many people to the emergency room that a large percentage received no treatment.
New York police also will begin diverting some people committing minor crimes from jails to treatment centers. A recent task force report found about 40 percent of those in city jails had a mental health issue and 85 percent had a substance abuse disorder.
"It'll still be a balance," Parsons said. "We want to transfer people to the hospital when they have real health need. Even with training that can be difficult."
The Sun investigation found a number of cases like that of Abdul-Aziz, who was arrested but later had charges dropped. The city paid tens of thousands of dollars to suspects who had told officers about injuries or pre-existing conditions, but did not receive prompt treatment.
John Bonkowski, who received a $75,000 settlement over allegations that he was beaten by an officer in 2012, "complained of pain at the scene but was denied medical treatment," according to his lawsuit. He was held without treatment at the Central District Station for about three hours before being taken by ambulance to a hospital where doctors found he had a fractured ankle, a broken jaw and cuts on his head and face, the lawsuit said.
Bonkowski, who had driven his car while intoxicated through a gate in a downtown parking garage, accused officers of pulling him out of a car and pummeling him with their fists and batons. Officers contended that Bonkowski crashed into another car and hit an officer.
Starr Brown, an East Baltimore accountant, called police to report a group of teenagers beating a girl in 2009, but wound up facing criminal charges herself. In fighting those charges, Brown and neighbors testified that officers were told she was pregnant as they pulled her off a porch.
At the trial, Brown testified that the officers ignored her pleas about the pregnancy. "They said they hear it all the time," Brown told the judge, adding that officers then threw her to the ground and rammed a knee in her back. Charges against Brown were dismissed and she received $125,000 in a 2011 settlement.
In such settlements, the officers and city do not acknowledge liability for the injuries.
Bryan A. Levitt, who has represented plaintiffs in such lawsuits, said Baltimore's mayor and police commissioner frequently go before cameras to tout reforms, but nothing has improved the relationship between officers and residents.
"Policing is such a sad state of affairs," he said. "Nobody is held accountable."
Dr. Thomas A Tallman, medical director for the MetroHealth Correctional Health Program in the Cuyahoga County Sheriff's Department, which includes Cleveland, said police in that city are fairly accurate in assessing emergencies.
"It's not frequently someone shows up right out of a police car and needs to go to the hospital," Tallman said. "Though it does happen."
Inmates are good at faking injuries and often refuse to provide important details, which can mean "there is really nothing wrong or something bad is going to happen," Tallman said. He stressed that it's not up to an officer to make the determination about medical care, and that alcohol and drugs often play a role in the situation.
For example, he said, if a handcuffed suspect in the back of a police cruiser complains of chest pains, the person needs to be screened in an emergency room.
"A lot of officers know quickly they are getting into an area they are not comfortable with," Tallman said. "They know they are not equipped to evaluate chest pains."
In December, the Department of Justice completed a civil rights investigation of the Cleveland Division of Police. The scathing report said police had a pattern of "unreasonable and unnecessary use of force" on suspects. The findings came not long after after a rookie officer shot Tamir Rice, a 12-year-old African-American child.
Mayor Frank G. Jackson requested the federal investigation — the same move Baltimore Mayor Stephanie Rawlings-Blake made last week.
Baltimore Sun newsroom data developer Patrick Maynard contributed to this article.