'Positional asphyxia' may have contributed to teen's death after Memphis Youth Villages incident

"Positional asphyxia" is a suspected contributor to the death of 17-year-old Alegend Jones, who died days after an altercation with counselors at Youth Villages, according to the full autopsy report obtained by The Commercial Appeal.

However, it ultimately was not the listed cause of death on the report because the medical examiner could not say, with certainty, what position Jones was in, and where counselors were, when she became unresponsive.

"The suspected contributor to death is positional asphyxia due to being restrained, with asthma as a contributing factor," the autopsy summary read. "Positional asphyxia occurs when an individual body becomes positioned in a way in which their breathing is compromised. However, because we are unaware of her precise positioning during the restraint, this cannot be declared with certainty."

The full autopsy report, which The CA obtained through a public records request, paints a slightly different picture from the statement Youth Villages made regarding the autopsy's findings Tuesday afternoon.

Findings by a medical examiner that are listed in autopsies do not indicate criminal activity or intent, even in cases where the manner of death is listed as "homicide," such as the Gershun Freeman case. The manner of death in Jones' autopsy was listed as "undetermined."

Youth Villages, in response to a series of questions from The CA about the full autopsy, said their previous statement did not include mention of the suspected positional asphyxia because they wanted to include only the "official finding from the Medical Examiner's report."

"Witnesses confirmed appropriate therapeutic hold techniques were used and medical staff were present," Youth Villages said. "Our staff are trained in behavioral interventions and follow strict protocols when working with the young people we serve. Staff follow Crisis Prevention Institute’s (CPI) techniques and safety training, which emphasize prevention, intervention, and nonphysical methods of managing disruptive behavior."

Youth Villages is a nonprofit that opened its doors in Memphis to help "youth with the most severe mental, emotional and behavioral challenges" at its residential care centers.

Relating to the manner of death being "undetermined," Forsyth County, North Carolina Medical Examiner Dr. Donald Richard Jason said that is a label given when a medical examiner cannot say with certainty whether the person died from natural causes. He also said there have been debates over whether a medical examiner should list them on a death certificate.

"I think cause of death is more important," he said. "Manner of death is only put in there because that's required on a death certificate. It's not meant to be finding fault."

Youth Villages, in a previous statement, said the autopsy "shows there was no abuse or intentional physical injury caused by our staff" and that Jones was placed in a "therapeutic hold" by counselors. On Thursday, they elaborated on why and how therapeutic holds are used.

"Therapeutic holds are designed to help the child calm down and regulate their behavior. A therapeutic hold involves physically holding a child in the least-restrictive way to protect the safety of the child and our staff. This involves trained and certified staff members holding a child’s arms and legs while the child is standing and ensuring the child’s head and airway are protected. A nurse or other trained medical professional oversees therapeutic holds to continuously confirm the young person’s safety," the group said.

What else did Alegend Jones' autopsy show?

The autopsy did not include a manner of death, listing it as "undetermined" and listed Jones' cause of death as "complications of restraint" with asthma as a contributing factor, both of which were noted in Youth Villages' statement.

However, the summary and interpretation section of the autopsy provides additional detail about the moments before Jones went unresponsive.

According to the autopsy summary, Jones was picked up from an appointment at the Shelby County Health Department in mid-November 2023 by police after getting in an altercation with Youth Villages staff. She was taken back to the Youth Villages campus in Bartlett by the police.

"The police transport video showed the decedent (Jones) cooperating with the police and in significant emotional distress," the autopsy said. "The video of the confrontation with staff showed the decedent appearing to pull away from a staff member and then being grabbed, and restrained by multiple staff members."

Parts of the video do not show the entire confrontation, as the autopsy says the "group moves just out of the main life of sight of the camera," but said that staffers continue to restrain Jones.

More: Attorney Ben Crump says Alegend Jones footage is 'telling.' When video will be released to public

"During the duration of the restraint, multiple staff members rotate in and out of the restraining group, and the decedent can be seen moving," the autopsy said. "After some time has passed, the decedent stops moving and the staff appear to realize she requires adjustment. When they attempt to get her to stand, it appears she needs support."

After trying to stand Jones back up, the autopsy said the staffers placed her on her back and started to give her CPR "when no pulse was identified" and emergency services were called for. When emergency services arrived, they began treating Jones and took her to the hospital.

She was taken to St. Francis Hospital and later taken to Methodist Germantown Hospital. Imaging taken at Methodist "showed severe cerebral edema, with brain compression and herniation. Neurologist and neurosurgeon evaluations indicated that no further intervention would improve outcome due to the severity of the swelling. After all life-saving efforts were exhausted, she was pronounced dead," the autopsy said.

The autopsy specifically mentioned not being able to see Jones' positioning during the restraint at Youth Villages but noted that it comes with risks. The same restraint, the autopsy said, was used at both the health department and on the Youth Villages campus and training materials were given to the medical examiner to review.

"The training documents include the protocol of having a nurse present during the restraint, as well as a section addressing positional asphyxia and how care should be taken with the use of any restraint in order to prevent restraint-related deaths, often attributed to positional asphyxia," the autopsy read. "These training documents indicate inherent risks to the restrained individual."

The autopsy summary said that the manner of death cannot be determined by the medical examiner because "what actually happened in the restraint is not known."

"It can be declared that she was breathing and in no physical distress before the restraint and was unresponsive after the restraint," the autopsy read. "Therefore, based on all currently known investigative information, autopsy examination, toxicology analysis and circumstances surrounding and leading up to the death, the cause of death is attributed to complications of restraint with a contributing factor of asthma and the manner of death is undetermined."

Positional asphyxia has to take place over multiple minutes and is "not a short loop thing," according to Jason. He has worked in a medical examiner's office since 1974, conducted over 10,000 autopsies and testified in multiple criminal cases, including positional asphyxia cases.

"[Positional asphyxia] can happen a number of ways," Jason said in a phone interview with The CA. "One way is that a person is face-down, on a surface, with people on top of the person. It could also, possibly, be a hold around the neck — could be a chokehold or a sleeper hold."

As an example of positional asphyxia, which does not necessarily parallel what happened with Jones, Jason pointed to George Floyd's killing in Minneapolis by a police officer in 2020, where the now-former Minneapolis police officer Derek Chauvin had Floyd on the ground, with a knee on his neck and upper back.

In a situation like that, a victim might say they can't breathe, "and the person restraining them will say, 'Well, if they say they can't breathe, then they can breathe,'" Jason said. "But that's not good enough. Not only is the breathing interfered with, but also the blood supply to the brain is interfered with."

The autopsy summary ends by saying that alterations to the findings would be considered if more information were to become available.

The Bartlett Police Department immediately began investigating the incident at Youth Villages, and the Tennessee Department of Children's Services later confirmed to The CA that it had an investigation open.

The Shelby County District Attorney's office declined to comment about the findings of the autopsy, or if chargers are forthcoming, citing the active and ongoing investigation.

What else does the autopsy say?

An exterior examination of Jones' body by the medical examiner found two "healing wounds" on Jones' right shoulder and her right hip. It also found three "healing puncture wounds" on the back of her left hand.

Her chest and right arm also had a number of small "brown abrasions" and "gray" contusions.

Those injuries were listed in the "evidence of injury" section of the autopsy report.

The external examination noted that there were "no palpable deformities of the skull or face," but noted a hemorrhage in her right eye. It also notes that the "neck is symmetrical and the trachea is midline."

The medical examiner's report said the bones and cartilage in Jones' neck were "intact" and that there was "a small hemorrhage near the right sternocleidomastoid muscle."

The sternocleidomastoid is a muscle that runs from the base of a skull, right behind an ear and jaw, down to the sternum and collarbone, according to a diagram available on the Cleveland Clinic website.

There was no additional hemorrhaging noted in the neck.

A toxicology analysis showed the presence of prescription medicines in Jones' system, the autopsy said. It also found elevated levels of creatinine, sodium, chloride and urea nitrogen, which the autopsy said was "consistent with hypernatremic dehydration."

That type of dehydration, referred to by the National Institutes of Health as hypernatremia, and can be caused by "net water loss or excess sodium intake."

The other injuries noted by the report were recorded as required when conducting an autopsy, but do not necessarily mean they were part of the altercation or resulted in Jones' death.

Lucas Finton is a criminal justice reporter with The Commercial Appeal. He can be reached at [email protected], or (901)208-3922, and followed on X, formerly known as Twitter, @LucasFinton.

This article originally appeared on Memphis Commercial Appeal: 'Positional asphyxia' may have been factor in Alegend Jones' death