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Unlucky Seven

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Before he killed himself, Livacoli showed signs of psychological problems, according to state investigative reports. Livacoli wasn't a violent criminal -- he'd been incarcerated the previous June for failure to pay child support. After three months in the workhouse, he began a hunger strike. It's not clear when he ended his strike, but his distress obviously got worse. On Oct. 28, he submitted a request to see a social worker, writing, "I asking you please get me out of here today. I can't stand it no more. I'm about to do something very wrong so please get me out." There is no record that anyone responded to that written request.

Livacoli was clearly agitated on the day he died. He had had a hearing that day and was certain the judge would free him, but he was ordered back to the workhouse, dashing his hope of going home for Christmas. When he returned to his cell, he was yelling and argued with another inmate, which was completely out of character, according to an inmate interviewed by a homicide detective. The day after Livacoli died, the jail psychologist who'd been on the job for two months told investigators that he'd never received a referral regarding Livacoli and that there was no information in his files indicating the former psychologist had seen him.

The state investigator exonerated the staff, stating, "This investigation has been unable to identify any culpable negligence on the part of the St. Louis City Medium Security Institution or any of its agents." Williams, the union representative, laughs at that conclusion. "That's a government agency," she says. "They do that for each other." As far as Williams is concerned, jail administrators have been slow to address issues -- in particular, low staffing levels and inadequate training -- that she believes have contributed to the suicides.

The Livacoli case marked the beginning of disturbing patterns in the city's response to suicides. 'Suicide-proof' towel hooks helped at least two more workhouse inmates kill themselves before the hooks -- and fire-sprinkler heads that offered convenient anchors for makeshift nooses -- were finally removed sometime in the spring or summer of 2000. Subsequent suicides also revealed gaps in CPR training for guards that persisted even after a half-dozen inmates hanged themselves. Despite a suicide rate that reached nearly one per month, guards still scrambled for tools to free hanging inmates. And there were substantial delays in calling the fire department when inmates were found hanging.

Five weeks after Livacoli's death, Donald Theis hanged himself in jail while awaiting trial on sodomy charges. Theis had just returned to his cell after a visit with his girlfriend, who told him their relationship was over. When Theis returned to his cell at 7 p.m. Jan. 28, 2000, he asked to talk to a guard. The guard told him he was going on break but promised to have a long conversation with him when he returned. He never got the chance.

Theis was fine when a different guard checked his cell at 7:05 p.m. He was hanging from a bedsheet tied to a ceiling vent when she walked past his cell again a few minutes later. A jailer detected a faint pulse after guards untied the sheet and laid Theis on the floor. A nurse arrived almost immediately and started CPR. Theis was pronounced dead at 7:59 p.m. after being brought to St. Louis University Hospital.

Judging from investigative records, the jail's initial response was quick: Less than five minutes passed before Theis was found, and first aid was prompt. However, fire-department paramedics weren't called until 7:23 p.m., about 15 minutes after Theis was discovered hanging. Paramedics arrived at 7:27 p.m. The fire department says it doesn't keep dispatch times for calls before Dec. 22, 1999, but available records show that jailers routinely waited five minutes or longer after discovering hanging inmates before calling the fire department. Bruce Petty, executive assistant to the commissioner of corrections, says he can't explain the delays.

Lloyd was the next to die. Then, two weeks later, on March 4, Edward Harris hanged himself in the workhouse the day after being convicted of murder, which carried a mandatory life-without-parole sentence. Again, jailers weren't prepared.

The day before Harris died, a guard saw him weeping after finishing a phone call. Knowing that Harris was facing life in prison, the guard asked him whether he was OK, even going so far as to offer him pamphlets on suicide prevention. Harris declined the offer. "I'm cool; that's the last thing I'll think about doing," he said. The guard reported that Harris later joked and laughed while playing basketball. That evening, an inmate also asked Harris how he was doing. "I'll be all right," Harris answered. "God has a place for me."

The guard assigned to Harris' housing unit the day he died wasn't aware of the pending prison sentence but later reported that Harris seemed fine. Indeed, he asked for an extra helping when the guard handed out food trays about 12:30 p.m. Other inmates, however, sensed that the conviction lay heavy on Harris' mind. Shortly after noon, an inmate told police that he had shown Harris a story about his conviction from that morning's St. Louis Post-Dispatch. After reading the article, the inmate told detectives, Harris went into his cell and sat on the toilet. The inmate said he could see beads of sweat forming on Harris' head.

An inmate received no answer when he knocked on the door of Harris' cell at 12:55 p.m. and asked whether he was asleep. About five minutes later, a guard found him hanging from a torn bedsheet tied to a towel hook. Jailers had trouble freeing Harris from his makeshift noose. While some guards struggled to hold him up, others tried unsuccessfully to untie the knots. There was nothing available with which to cut the sheet, and so Harris hung for approximately 15 minutes before someone finally used a cigarette lighter to burn through the fabric.

Quentin Davis, who was awaiting trial on murder charges, was the next to die. Neither guards nor paramedics attempted first aid. There was little point. By the time Davis, 21, was found hanging from a torn sheet attached to a towel hook at 7:18 a.m. June 23, 2000, his body was cool to the touch and stiff with rigor mortis. Police homicide detectives determined that Davis had used part of a ballpoint pen to push the torn sheet behind the supposedly suicide-proof towel hook.

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