Jail operators admitted no wrongdoing but agreed to a $100,000 settlement. For Atkinson's two children, it means each will receive $31,782.42 after legal fees and medical costs, according to a court document filed early this month.
The story of the final weeks of Atkinson's life, however, encompasses far more than a single error in a prison infirmary.
A review of court filings and medical and hospital records provided by Atkinson's family revealed:
Prison staff did not consistently provide prescribed medication, failed to monitor her vital signs, and misinterpreted Atkinson's psychotic behavior as a sign of drug abuse.
Atkinson was jailed on a probation violation three days after she was diagnosed with a severe form of lupus, a potentially fatal autoimmune disorder that can cause psychotic behavior. She was locked up because of a shoving match with another woman at Crozer-Chester Medical Center in which no one was injured. Probation officers ignored numerous pleas from her mother to give Atkinson house arrest instead of incarceration.
When Atkinson fell seriously ill, the jail transferred her to Riddle Memorial Hospital, which later sent her back to prison even though, medical records show, she was still suffering from delusions. Atkinson died about 40 hours later.
Six inmates have died from unnatural causes since 2001 at Delaware County's George W. Hill Correctional Center in Thornton. Operated by the GEO Group, it is the only privately run adult jail in the state.
In addition to Atkinson's death, two prisoners committed suicide, another was killed by a fellow inmate, and the fourth died of an overdose of heroin smuggled into the jail. A fifth died in 2005 of head and neck injuries after repeatedly throwing himself against his cell door, county officials said.
Jail Superintendent George W. Hill said in a statement that all deaths and injuries at the prison are investigated immediately "to determine if corrective action is necessary."
"Together with GEO, we strive to do our best, under sometimes difficult circumstances, to provide a safe environment for all concerned," he said.
A GEO Group spokesman said, "We have implemented training following . . . Ms. Atkinson's death."
Death rates in suburban jails vary from 3 per 1,000 inmates in Delaware County since 2001 to fewer than 1 per 1,000 in Montgomery County. Data for 2000 from Delaware County were unavailable.
Born and raised in Chester, Atkinson had difficulty finding and keeping a job.
"It wasn't always easy," her mother, Joyce Atkinson, said recently as she wore a sweatshirt bearing the image of Rosalyn, "but we had each other to lean on."
Atkinson worked a variety of low-paying positions at retail outlets. By the time she was 25, she had two daughters, Cye'Ayshia, now 8, and Ro'Nayshia, now 10, and was on public assistance.
She was also in trouble with the law.
On Sept. 9, 2002, Atkinson was at Crozer-Chester Medical Center to be treated for recurring severe headaches. There, she got into a shoving match with a hospital employee, Joi Tucker. Each filed a criminal complaint against the other. The relatively minor incident would have far-ranging repercussions for Atkinson, because she was still on probation from a 1997 altercation in which she had sliced Tucker's face during an argument over a man.
Atkinson returned to Crozer-Chester on Sept. 23, suffering from shortness of breath, headaches and vomiting.
Doctors ran a laundry list of tests, and on Oct. 5, she was discharged with a diagnosis of systemic lupus erythematosus, the most severe form of the disease.
The autoimmune disease - most common among African American women - causes a person's immune system to attack its own tissues and may have caused Atkinson's hypertension. Crozer-Chester doctors prescribed a series of drugs, including steroids and powerful blood-pressure medicine.
Then on Oct. 8, Atkinson was arrested at her mother's home.
Brawling with Tucker a month earlier had violated the terms of her probation. Her mother's pleas to probation and police officers that her daughter was too ill to be jailed went unheeded.
Once Atkinson was in the jail, her health quickly deteriorated, and her behavior became more and more erratic. Prison medical records documented her condition.
"Behavior bizarre - waits at cell door with belongings ready to leave," a jail employee wrote Oct. 11, Atkinson's fourth day in jail. "Inappropriate responses to questions. Constantly needs redirection."
The confusion and odd behavior were likely a symptom of Atkinson's lupus, said a doctor who reviewed Atkinson's medical records at The Inquirer's request.
About 30 percent of lupus patients can have neurological or psychiatric disease, including psychosis, said Dr. Joan M. Von Feldt, an associate professor of medicine at the University of Pennsylvania Health System's Division of Rheumatology.
A severe case, like Atkinson's, makes "neuro-psychiatric lupus" more likely and should have been "the first thing" Atkinson's doctors considered, Von Feldt said.
Instead, Atkinson ended up undergoing a detoxification regime after a prison psychiatrist reported that on Oct. 11, Atkinson had "admitted to using marijuana laced with PCP." But tests Oct. 15 showed no illegal drugs in her urine.
For at least two days, Oct. 13 and 14, she took no prescribed medication. Prison records say she "refused medication," which included steroids and two hypertension drugs to control her blood pressure, Verapamil and beta blockers. Infirmary documents show that medical staff had not taken her blood pressure or other vital signs Oct. 12-14.
By Oct. 14, her seventh day in jail, Atkinson was neither eating nor drinking.
That evening, infirmary physician Victoria Gessner increased Atkinson's steroid dosage. But by early Oct. 15, Atkinson was naked, crying and screaming in her cell, nurse Susan Pentney wrote.
Contacted at her home, Pentney would not comment directly on medical treatment at the jail but said: "I'm really anti accusing doctors and pointing fingers. I mean, the woman was in jail. You don't expect to get the best treatment in jail."
On the outside, Atkinson's family was fighting for her release. Her mother and sister contacted the Pennsylvania Prison Society, the NAACP, and their state representative.
Gwendolyn Atkinson, her sister, pleaded with a probation supervisor to give her sibling house arrest until a court hearing could be held.
"Explained to her that we were getting phone calls stating Rosalyn was given incorrect medication, she had been strapped to a bed with no clothes on since Friday and she had been throwing feces around and urinating on herself," Gwendolyn wrote in a journal she kept during the events.
Nancy Gray, deputy director of adult probation and parole, said the county has no written policy for determining when a person is jailed for a parole violation versus house arrest. Each decision is made by the individual probation officer, she said. But she noted that Atkinson was accused of assaulting a woman she had been convicted of assaulting five years earlier. "We had a person victimizing a victim," she said.
National standards written by the American Correctional Association and adopted by Pennsylvania include nothing about handling ill prisoners, but do state that "alternatives" to bail revocation and incarceration "are considered to the extent that public safety is not endangered."
Bill McDevitt, director of the Bureau of Probation Services for the Pennsylvania Board of Probation and Parole, said those standards, which counties must also meet to receive state aid, required that Atkinson receive a hearing on the new charge - the shoving match with Tucker - within 14 days of her arrest.
By Oct. 14, Atkinson had been in jail for seven of those 14 days, and her condition was worsening. The waste products in her blood soared to a level that indicated her kidneys were functioning at only about 10 percent efficiency.
She was "crying, screaming, hysterically at times, dancing, laughing at other times," according to infirmary records.
The following day, Gessner upped her dosage of Prednisone, records show. The steroid is used to treat lupus flares. The same day, the infirmary staff transferred her to Riddle Memorial Hospital.
Atkinson arrived dehydrated with dangerously high blood pressure, hospital records show. She was put on intravenous steroids and hypertension medication. She was handcuffed and guarded by two correctional officers, as was hospital and prison policy.
One physician, Christine Meyer, wrote that Atkinson's prescribed medications, including Prednisone, "apparently were not continued at her usual doses" at the jail.
After three days of treatment with intravenous steroids, Atkinson awoke the morning of Oct. 18 still confused about her surroundings but lucid enough to ask whether or not she was going to die.
Atkinson's family turned to lawyer John Nails.
On Oct. 21, 13 days after she was arrested, Atkinson had not yet appeared in court. The same day, Nails, the lawyer retained by her mother, filed a motion for an emergency hearing. A judge ordered that it be held within three days of her release from Riddle.
There, Atkinson remained delusional, and at 5 p.m. on Wednesday, Oct. 23, the bedridden woman asked a nurse: "How did I get stuck in the elevator?"
Nevertheless, Atkinson was sent back to jail that evening. Riddle Memorial Hospital refused to discuss Atkinson's treatment, citing patient-confidentiality rules.
Meyer, the physician who signed her discharge papers at Riddle, declined to discuss Atkinson's treatment. "I'm not going to comment at all on that case," she said last month.
Infirmary physician Gessner, who no longer works at the jail, said in a recent interview that Atkinson "came back from the hospital exactly as she left."
At jail, a prison nurse wrote on the same night that Atkinson was "still delusional" and "crying, banging on window, talking to self."
The following day, she was again "acting bizarre" and "speaking to persons not present," another nurse wrote. Atkinson did not sleep or eat that night.
The next morning, Atkinson's blood pressure plummeted. Worried jail nurses consulted Gessner by phone.
At 9 a.m., infirmary records show, Atkinson was given the hypertension drug Verapamil, which is used to treat a fast heart rate. The intravenous medication was prescribed in the hospital and approved by Gessner.
About 9:50 a.m., Atkinson's eyes stopped reacting to light, and prison nurse Patrick Teesdale ordered a jail employee to call 911.
Ambulance personnel and Teesdale initiated CPR, but Atkinson was already dead.
Reached at his home in Sewell, N.J., Teesdale said that he remembered the case well and that it had disturbed him deeply. He refused to comment further.
In notes Gessner wrote the day Atkinson died, she said potential causes were "massive myocardial infarction," or a heart attack. She also noted that the death could have been hastened by a "high dose" of the Verapamil and beta blocker. Both drugs reduce blood pressure, and medical literature says they can be dangerous if combined.
In recent interviews, Medical Examiner Frederic Hellman, while citing a relatively low overdose of Verapamil as the cause, added that combining it with the blood-pressure drug already in Atkinson's system could have contributed to her death.
Gessner defended the medical care Atkinson received.
"During my tenure there, her medical care was superior to any medical care she would have received in the community," Gessner said.
GEO Group spokesman Pablo Paez would not detail the new training that was ordered after Atkinson's death. He said the case was "settled without any admission of wrongdoing on behalf on medical staff or the administration of the facility."
Lawyer Jon Auritt of Media, who took Joyce Atkinson's case, explained the modest settlement this way in a court document filed earlier this month:
"Considering the fatal irreversibility of her illness at the time she entered the prison, it is unlikely, had decedent not passed away at the prison, any significant income would have been earned. . . ."
Damage awards are based, in part, on the victim's potential future earnings.
Auritt said that physicians consulted had determined that Atkinson would have died anyway, "just maybe not as soon" had she not been in jail.
Meanwhile, the county is seeking a new jail operator. Prison Board officials have said GEO Group's management of the prison had nothing to do with the decision to seek bids.
One circumstance surrounding her daughter's death that still nags at Joyce Atkinson is how jail officials notified her.
"They called me on the phone," she said recently. "They didn't even come to my house and tell me. They came here to arrest her - they could have come and told me she was dead."
Contact staff writer Tina Moore at 215-854-2664 or firstname.lastname@example.org.
A Timeline in the Atkinson Case
Sept. 9, 2002 - Rosalyn Atkinson gets into a shoving match with Joi Tucker, whom she had fought with five years earlier.
Sept. 23, 2002 - Atkinson, dehydrated and vomiting, goes to the emergency room at the Crozer-Chester Medical Center.
Oct. 5, 2002 - Doctors determine that Atkinson is suffering from lupus erythematosus, a severe form of the chronic illness. She is sent home with a prescription for medications to ease her symptoms.
Oct. 8 - Sheriff's deputies alerted to the fight with Tucker arrest Atkinson on a probation violation and take her to Delaware County's jail.
Oct. 10 - The jail infirmary, aware of her lupus, begins medicating Atkinson.
Oct. 11 - Infirmary nurses note that Atkinson's behavior is "bizarre." A jail psychologist notes that Atkinson told him she had smoked "wet," a potent mixture of marijuana and PCP.
Oct. 12-14 - Infirmary nurses note that Atkinson refused to have her vitals taken and wouldn't take her medication.
Oct. 15 A nurse's notes regarding Atkinson at 1 a.m. state that "inappropriate, bizarre, behavior continues. Thinking disorganized. No clothing."
By 8 a.m., a nurse writes that Atkinson is "lying in a fetal position, quiet."
At 2:40 p.m., she is transported to Riddle Memorial Hospital with dehydration and hypertension.
Oct. 15 - Joyce and Gwendolyn Atkinson, her mother and sister, call the Delaware County Office of Adult Probation and Parole. They explain her medical condition and ask the department to put Atkinson on home monitoring. They are unaware that she has been taken to the hospital.
Oct. 15 - At Riddle, doctors treat Atkinson with steroids and anti-hypertension medications. Several days of intravenous Solu-Medrol therapy improve her condition "drastically," Dr. Christine Meyer writes.
Oct. 15 - Atkinson is tested for illegal drugs at Riddle Memorial Hospital. The results come back negative for both phencyclidine (PCP) and marijuana.
Oct. 20 - At 4 p.m., Atkinson is "tearful" that she can't have visitors at Riddle Memorial Hospital.
Oct. 21 - Chester lawyer John W. Nails files a motion to get Atkinson released from jail.
Oct. 22 - Commonwealth Court Judge Patricia Jenkins rules that the district attorney should show cause for holding Atkinson within three days of her return to jail.
Oct. 23 - The hospital sends Atkinson back to jail at 6:30 p.m. She is placed in the infirmary.
Oct. 24 - Atkinson is "acting bizarre speaking to persons not present," a prison infirmary nurse notes.
Oct. 25 - At 8:30 a.m., Atkinson's blood pressure plummets to 80/42. Normal blood pressure is usually around 120/80.
By 9:50 a.m., her pupils are fixed and not reacting to light.
About 9:55 a.m., she is taken to ambulance entrance and has a weak pulse and slow, deep respiration. Her breathing ceased as a nurse made his report to ambulance personnel, nurse's notes show.
She is pronounced dead at Riddle Memorial Hospital an hour later.