On December 20, 2011, Hernandez pleaded guilty to one count of mortgage fraud. She also agreed to help prosecutors in exchange for dropping the other charges. Four days later, on Christmas Eve, Hernandez wrote a four-page letter in which she said she had lost 40 pounds in four months and claimed FDC officials were ignoring her worsening symptoms. "My right breast is hard like a rock and dark like I had hit it with something," she wrote. "They have sent me a note declining my request to get a sonogram.

"When I told the Dr. of my problems and that I need to be able to eat [organic food] his answer was: 'You lost a lot of weight? Tell the secret to the fat ones in the unit,' " she wrote. "I understand that I am in jail but do I have any way of surviving in these conditions? Can anybody help me?"

Hernandez was supposed to see a rheumatologist every 45 days to monitor her lupus, but she never saw one. "Her condition does not rise to a level of severity where she can jump in front of the line of other defendants," prosecutors explained.

Elsa Peña Nadal holds a picture of her daugher, Keskea Hernandez.
Michael E. Miller
Elsa Peña Nadal holds a picture of her daugher, Keskea Hernandez.
Keskea Hernandez
Courtesy of the Hernandez Family
Keskea Hernandez

Fellow inmates, at least, noticed Hernandez's declining health. Isis Torres, a nurse sentenced to 18 months at the FDC for Medicare fraud, remembers being shocked at how frail Hernandez seemed. "She was in a lot of pain," Torres says.

In April 2012, Hernandez's family fired DeFabio and hired attorney Seitles. "She looked sickly," he says of seeing Hernandez for the first time. "Her fingers were blue. She looked very undernourished, extremely skinny."

Seitles immediately requested a bond hearing before federal Judge Robert Scola. As a first-time nonviolent offender, Hernandez could easily be released on house arrest or at least transferred to another facility, he reasoned. Hernandez's family was hopeful.

"My mom takes care of me and I take care of her," wrote Giulianna, then 14, in a letter to Scola. "I can't, nor do I want, to think about all the pain she's going through being in the FDC without being able to stick to her diet and have access to her medications. Point is my mom needs [to be] home, for her sake and mine."

Seitles presented evidence of Hernandez's medical history, including her disability status from the U.S. government. "This isn't... some scheme to get out of the FDC," he told Scola during the June 20 hearing. Instead, Hernandez was genuinely sick: She had lost nearly a third of her body weight, was throwing up blood, hadn't menstruated since arriving at the FDC, and was at risk for organ failure, Seitles argued.

Thomas, the FDC clinical director, ridiculed the idea that Hernandez's life was at risk. "Those things that you just heard are an embellishment," she told Scola. "None of what [was] just cited to you is true." Thomas insisted Hernandez was getting proper care. "Someone who's in renal failure would be dead," she said.

Scola sided with the prosecutors. Instead of releasing Hernandez, he determined she was a flight risk and denied her bond.

"They treated her like she was a narco trafficker about to flee the country," says Manuel Cedeño, Hernandez's brother, who testified on her behalf. "Why would a sick woman leave the country where she has health insurance and a teenage daughter to live in a Third World country?"

In October, Hernandez was sentenced to 40 months in prison, of which she had already served 14. Suddenly facing two years without her mother, Giulianna fell into a depression. Her grades plummeted, and she stopped playing the piano because it reminded her of her mom.

Hernandez was also falling apart. She began losing hair. When her family came to visit her, she used a jailhouse coffee concoction as makeup to cover the splotches on her skin. "She didn't want to worry anyone," Cedeño says.

In private, however, Hernandez was panicking. Her calcified breast implant had turned into an open sore. Thomas had suggested transferring Hernandez to a medical facility, but Hernandez was afraid that exposing her depleted immune system to other sick inmates would be deadly.

On December 4, 2012, Hernandez wrote Judge Scola begging for lenience. She asked him to put her under house arrest where she could "stop [taking] all these steroids that are destroying my good cells and organs."

"Please, your honor, give me only 15 minutes... to show you what I have and that I am not making this up," she wrote. A week later, she sent another letter to the judge. It's unclear if Scola replied. He did not answer New Times' requests for comment.

Hernandez last spoke to her family on December 23, 2012. When Cedeño emailed her on Christmas Eve, she didn't answer. When he tried again the next day: silence.

Seitles also began to worry. Another FDC inmate told him she had seen Hernandez taken to a hospital. But when Seitles asked prison officials where his client was, they refused to answer. He sent three letters demanding to know where she was held. On January 7, he finally discovered she was shackled to a bed at Larkin Community Hospital in South Miami. Seitles obtained permission to visit her on January 10. It would be too late.

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