By Jennifer Autrey: Star-Telegram Staff Writer

Jailers had watched her frantic distress for five days. Stopping up the toilet to flood her cell. Trying to hang herself with her gown. Announcing that she was pregnant with Jesus' child.

At 10:15 p.m. that Thursday, though, Christi Ball was resting, snoring even, with her back against the door. Things were finally peaceful in cell 24, pod 63D, of the Tarrant County Correction Center.

But when a sheriff's officer checked on Ball a half-hour later, the snoring had ceased. Another officer opened the cell door. Ball slumped into the doorway.

Blood oozed from her mouth. She was naked, soaked in urine, not breathing.

An ambulance was summoned, but doctors pronounced Ball dead at John Peter Smith Hospital at 11:45 p.m. on Oct. 21, 2004. She became a statistic: one of 10 Tarrant County Jail inmates to die that year.

Ball had no criminal record. She was accused of only one crime: refusing to leave JPS, where she was seeking help.

Could she have been saved? Her family says there were so many chances that slipped away. If only JPS had committed her, rather than arrested her. If only Mental Health Mental Retardation of Tarrant County had put her back on her medication.

Perhaps even with the best of care, she would have died. An autopsy found that Ball, who was 35, died of an inherited heart defect that had never been detected.

But those who loved Ball are tormented by the thought that she was put at risk by her arrest and the minimal care provided by JPS. At the least, they say, she might have been spared the anguish of her final days. Instead, she was isolated from her family, unable to even ask for them because she was in the grip of the mania that comes with bipolar disorder.

"JPS put a bond against her," said her sister, Tiffany Dean. "Somebody there made that call. Somebody made the ultimate call to turn her away."

Because Ball's father, Michael Wayne Dean, consulted an attorney to look into his daughter's death, JPS officials would not discuss the hospital's treatment of Ball.

But JPS spokeswoman Drenda Witt said that every person, regardless of what he or she may have done, receives medical care. Someone is arrested only if the person refuses to leave after receiving medical care, she said.

The October spiral

Ball, born Christi Michele Dean, had just finished her freshman year at Texas Wesleyan University when she first showed signs of mental illness in 1989.

Her younger sister, Tiffany, was the first to notice. Her parents didn't believe her. Christi had always been the perfect child: smart, organized. She had graduated seventh in her class at Richland High School just two years before.

But as time wore on, the symptoms became too powerful to ignore. Her manic phases were punctuated with combative moments, wild spending and grandiose ideas of what might be accomplished.

With medication, Ball was able to complete her college degree in biology, get married and hold down a job in a food lab.

But every few years, the sickness would wreck her life. In one cycle, her marriage shattered.

Each time, doctors would stabilize her, and Ball's mother and grandmother would help her rebuild her life. But with each recovery, a little bit of the sweet Christi they knew as a child would be gone.

Ball's relatives could tell she was getting sick whenever she started calling around the clock.

The pattern churned up again in early October. Ball began hinting that she might stop taking her psychiatric medication so she could get pregnant, even though her relatives counseled her against ever having a child.

On Oct. 4, she visited MHMR's Mid-Cities office in Bedford, complaining of lightheadedness, irritability and mood swings. Doctors adjusted her medication. Three days later she was back, and her meds were adjusted again.

By then, Ball was in full manic mode. On Oct. 11, she sent her relatives into an uproar when she announced that she was getting married and having a child. She told them she had moved in with a 73-year-old who lived in a retirement community.

She had also gone on a $6,000 credit-card spree at Neiman Marcus for the wedding and charged hundreds more at a day spa where she had her armpits waxed and her eyebrows shaped.

On Oct. 12, MHMR adjusted her meds a third time.

Seeking help

Ball began her odyssey to area hospitals with a visit to Harris Methodist H.E.B. that same day, complaining of lightheadedness.

She looked disheveled. When a doctor hinted that she was manic, Ball got angry, said her mother, Connie Jaynes.

"She was wanting the doctors to convince us that there was nothing wrong with her," said Jaynes, who met her at the emergency room. "Well, we knew when she was sick."

The next day, Ball sought help at Baylor Regional Medical Center at Grapevine for the lightheadedness. Her blood pressure and heart rate were up. A nurse noted "hypermania." Ball refused treatment and left.

The next evening, Ball arrived at hospital No. 3: Baylor Medical Center at Southwest Fort Worth.

Ball refused treatment but also refused to leave. Just after midnight, the hospital called Fort Worth police. When Officer M. Kuzenka arrived, he urged Ball to go -- and to take the plants she had brought to the emergency room.

Ball's reply: "I will kill you and the people inside this hospital."

Kuzenka shot her legs with his Taser to get her into his squad car. Then he took her to yet another facility: John Peter Smith, the county's public hospital. In the early hours of Friday, Oct. 15, she was sent to the psychiatric unit on the 10th floor.

First appeal to JPS

"I am Jesus Christ Almighty and you will burn in hell. You don't know who you are detaining," Ball screamed.

At JPS, Ball charged a nurse, pinched a mental health technician and attempted to wrestle police to the floor, according to medical records.

JPS staff injected her with medicine in her right hip to try to control her, then placed her in seclusion.

After about 90 minutes, doctors told Ball she could be released from seclusion. Apparently, she was supposed to leave, although terms of her release were not included in paperwork the Star-Telegram obtained from the hospital.

Instead of going home, Ball got on the phone. Then she took off her clothes. Less than three hours later, she was back in seclusion.

A little before 9 a.m., the hospital discharged her again -- even though Ball told JPS officials that she wanted to be in a hospital somewhere and that she had no place to live.

To make sure she stayed away, an officer with the JPS Police Department escorted her from the psychiatric unit and gave her a warning ticket for criminal trespassing.

5 hospitals in 2 days

Fort Worth police gave Ball a ride to her mother's office that Friday morning. But her mother was home in Decatur. Co-workers called her, but they also called an ambulance.

Ball was taken to her fifth hospital in two days: Baylor All Saints Medical Center at Fort Worth.

"I can speak all languages," Ball told the Baylor staff.

Once again, Ball refused the offered treatment and left sometime that afternoon.

In the meantime, Jaynes was frantically trying to get her daughter committed to a psychiatric hospital. She failed. Ball's relatives were told that all the judges had already left for the weekend. What's more, Jaynes was told, it wasn't obvious that Ball could hurt herself or others -- the criteria for involuntary commitment.

At JPS, "they treated her just enough to get her stabilized a little bit. That's what hurt us as far as getting a mental health warrant," Jaynes said.

At about 8 p.m., Ball was picked up by a MedStar ambulance at a hotel that had complained about a psychotic woman. MedStar took Ball back to Baylor All Saints at Fort Worth.

Within 90 minutes, Baylor called Fort Worth police to report that Ball was threatening other patients. When an officer arrived, Ball told him that if she was not seen by the hospital staff, she would punish him.

"I'll kick your ass, too," she said.

Fort Worth police took her into custody, transported her to JPS hospital and filled out an application for her mental detention there.

For the third time that day, JPS ordered Ball into seclusion. A note in the medical record explained what happened: "Patient attempted to wrestle staff to floor. Pt. charged toward staff in search room, then sat down on floor, refusing to dress after disrobing."

Later that night, the hospital discharged Ball again, with advice to follow up with MHMR. Apparently, she again refused to leave.

At 1:33 a.m. Saturday, Oct. 16, almost 24 hours after she had first visited JPS, the hospital's police force gave her another warning ticket for criminal trespass and showed her the door.

A trip to jail

At 6:30 a.m. Saturday, an ambulance was called to a Fort Worth department store. MedStar employees found Ball inside, next to a broken glass door. She said she was pregnant and needed to get clothing for the baby God gave her. MedStar took her back to JPS.

Not long after, Fort Worth and JPS police were called to the emergency room to deal with a combative woman. JPS officer Christopher Jolly wrote that he found a woman "that was yelling and cursing at the officer and stating, 'I'm having God's baby and that I need to leave.' "

The officers took Ball to the psychiatric unit, this time for a voluntary commitment, Jolly wrote. That might have saved her, her relatives believe.

But the staff turned her away, telling Jolly that she had just been released.

"The subject was then escorted off the property and advised that she was not to return to this location unless it was for medical attention," Jolly wrote.

Ball whipped around. "I am 12 months pregnant," she said. God informed her to have her baby sometime that night at JPS, she told them.

At that, Jolly arrested Ball, citing her with criminal trespass.

He took her to the Tarrant County Jail and filled out a referral form for MHMR of Tarrant County, which has the mental health contract for inmates.

Hospital officials declined to comment on why Ball wasn't committed. But Witt described the circumstances that the hospital might consider committing patients against their will:

"The involuntary admission criteria to the inpatient psychiatric unit is based on the determination by a physician that the patient has a valid psychiatric diagnosis that cannot be managed in an outpatient setting and is dangerous to self or others," she wrote.

Naked in a single cell

Ball was booked and taken before a magistrate judge, who advised her of her rights and set bail at $2,500. Ball refused to sign the paperwork.

A second form, Request for Appointed Counsel, was also not signed. It had a notation: "unable to understand."

At the jail, Ball went through a medical screening that JPS conducts as part of its contract to provide medical care for inmates. Scrawled across the form's boxes is this note: "Unable to get any answers from patient."

Ball was assigned to an individual cell in general population, with a recommendation that MHMR follow up.

That afternoon, during the hour inmates can visit the day room, Ball came out of her cell -- naked -- and went to the phone.

Sheriff's officers told her to put her uniform on.

She cried, "Never!"

The next day, logs show that Ball was yelling incoherently. The sheriff's jail staff filled out another request for mental health services.

On Monday, Oct. 18, Ball's relatives -- panicked that they hadn't heard from her in 48 hours -- tried to file a missing persons report. Fort Worth police checked the jail logs and found her name.

Ball's sister called the jail and talked with an MHMR caseworker. She told the caseworker that Ball had probably been off her medication for at least four days and that her relatives wanted to help her.

The caseworker said that Ball would have to sign a signature card before relatives could see her -- something she had so far been unable to do. But he assured Dean that Ball would be safe, that she would see a doctor and get her medications.

"The only reason we did not take her out is because we thought she would get the help she needed," Jaynes said.

Later that day, jailers found Ball lying faceup on the floor with blood coming out of her mouth, the result of a 20-second seizure.

Her last day

On Tuesday, Oct. 19, Ball was moved to the jail infirmary -- run by JPS -- for evaluation. The next day, she was sent back to her pod.

"Doesn't need medical, per Dr. Green," was a notation on her patient history.

Medical records also say that she appeared disoriented.

"Doesn't know why she is here," the history said.

Back in her pod, Ball started tearing her paper uniform and wrapping the pieces around her neck, abdomen and ankles. Sheriff's officers called the code for a suicide attempt and placed her on enhanced supervision.

Later that day, Ball was visited by a MHMR psychiatrist, who wrote a prescription to address the mania. A psychiatrist saw her again Thursday, Oct. 21, after she was found with feces all over her bed.

"Staff reports that she has been refusing Psych meds," someone noted in her chart.

The psychiatrist wrote more prescriptions for agitation and a prescription for Haldol -- a medicine that Ball's relatives said she was allergic to.

"Though disorganized, appears less confused, improving," the MHMR doctor noted.

Caseworkers didn't force medication on her -- they only do that in extreme circumstances, a spokesman said.

A few hours later, Ball was found lifeless.

The what-ifs

Ball's relatives cannot help but wonder what might have happened had she received the help she needed.

They learned from the coroner's report that she died of hypertrophic cardiomyopathy, an inherited defect that causes thickening in the lining of the heart. But they wondered whether her uncontrolled mania added to the stress on her heart.

Dr. Eric Popjes, a cardiologist at Penn State Heart and Vascular Institute in Hershey, Pa., said that stress can exacerbate symptoms of the disorder. Stress can also cause abnormal rhythms.

But no one knows whether a link exists between manic behavior and the likelihood of death from the condition, said Dr. Barry Maron, director of Hypertrophic Cardiomyopathy Center at the Minneapolis Heart Institute Foundation.

"Whether that did it or not, you know, anything is possible. Is it probable? There would be no way to know," Maron said.

Ball's relatives also wonder why MHMR didn't work to get her out of jail and into a psychiatric facility.

But that process requires a lawyer, and Ball was never assigned one.

Sonja Gaines, chief of mental health services at MHMR of Tarrant County, said she doesn't know what else could have been done for Ball.

"This is not to minimize her death," Gaines said. "We were dismayed with her death. But we have psychotic people in the jail, especially with such limited state hospital space. On any given day, you might have several psychotic people there. She's not the sickest person we've seen."

In the end, Ball's relatives believe that her fate was sealed by JPS' decision not to keep her in the psychiatric ward.

Ball was sick enough to deserve help, her relatives said, and she never got it.