ANAHUAC, Texas – The Sarah Hartsfield murder trial resumed Wednesday in Chambers County with new revelations about her husband’s death and emotional testimony from his family.
Prosecutors revealed that, in addition to having a fatal amount of insulin in his system, Joseph Hartsfield may have also had prescription drugs in his body, even though his family insists he avoided medication. That detail deepened their suspicions about the circumstances leading up to his death.
Joseph’s mother and sister, Helen and Jeannie, spent hours on the stand on Tuesday describing what they called a turbulent marriage between Sarah and Joseph.
They testified that Sarah seemed controlling, often kept them from visiting Joseph in the hospital during his final days, and ultimately excluded them from his funeral.
Both said they were disturbed to learn about additional substances found in Joseph’s system, especially because he did not have a prescription for the medication.
The testimony also included claims about Sarah’s past, where she’d been married four times before. Family members told jurors that Sarah once said she killed an ex in Minnesota and had previously been investigated by the FBI for allegedly plotting against another ex and his wife.
The defense fought to keep that information out, filing a 103-page motion to suppress it as “wild speculation.” But the judge allowed the family’s testimony to continue.
Legal analyst Rick Detoto told KPRC 2 that while the defense is working to limit what the jury hears, it now faces the challenge of rebutting damaging claims.
Court documents also shed light on what investigators discovered after Sarah’s arrest. A realtor told detectives he had been texting with Sarah just days before Joseph’s death about her “exit strategy” from the marriage and selling the couple’s house. And when Sarah was booked into jail and learned she had been indicted, she allegedly told staff, “Well, there’s no way they could have found that much evidence against me.”
As the trial continues, the defense is expected to keep pressing its case that Joseph’s health issues, not Sarah’s actions, led to his death. Meanwhile, prosecutors have lined up dozens of witnesses, including medical and law enforcement experts.
4:38 p.m. - Court excused for the day
4:21 p.m. - Seventh witness, Caryn Legros, a registered nurse, called to the stand
A registered nurse at Houston Methodist Baytown testified she has worked there for three years, with previous experience at Memorial Hermann and St. Luke’s.
On Jan. 7, 2023, she was two months into her role in the emergency department at Houston Methodist Hospital in Baytown when Joseph Hartsfield was brought in mid-afternoon by EMS. She said the only report they received was of an “unresponsive patient that was hypoglycemic.”
According to Legros‘s testimony, Joseph “wasn’t responding to any of the treatment.” She explained that he was not responsive enough to take anything by mouth and had to be given treatment by IV.
Legros said Joseph’s blood sugar “would go up a little bit and then fall again,” which caused her concern. She testified, “The treatment should cause levels to go up and usually stay because it’s pretty much sugar water.” Instead, staff had to keep checking his glucose because it continued to decline. She said she started questioning herself, asking, “What am I missing? What am I not doing correctly?”
She told jurors she felt “something was counteracting the sugar water they were giving Joseph.” She consulted with a doctor, and Joseph was placed on a higher protocol with a bag of sugar water.
Legros testified that she had “never had a patient not respond like Joseph did” and called it “very unusual” for her, making her question if she was doing anything wrong. She also noted she has never had a patient die from low blood sugar.
On cross-examination, the defense pointed out that the hospital would have documented any benzodiazepines. When asked if she knew who, how, when, or where insulin was administered to Joseph, she responded, “No, sir,” to all questions.
On redirect, Prosecutor Mallory Vargas emphasized that it was “very concerning that (Joseph’s) glucose (was) that low for that long, 20 hours.”
4:11 p.m. - Sixth witness called to the stand, Jack Terry, a paramedic
The paramedic testified he has worked in the field since 1998, with over 25 years of experience, and has been with Allegiance in Woodville, Texas, for three years. He previously worked for Chambers County EMS and responded to Sarah and Joseph Hartsfield’s home.
He admitted he has a hard time remembering the call but said his report shows he was treating Joseph on Jan. 7, 2023. He recalled responding to an “unconscious person” and treating Joseph for hypoglycemia before transporting him to the hospital. According to his notes, Joseph “responded slightly but never woke up and responded completely” to the treatment.
He explained that diabetics with low blood sugar are usually treated with glucose and said, “I get low sugar calls often.” He added that most patients respond to treatment before leaving the house, though some still require transport to the hospital; many do not.
On that call, he gave Joseph “a 250 cc bag of D10 and 25 grams of D50,” describing it as “a little more than normal.” He testified he “would have expected Joseph to respond to that.” When Joseph arrived at the hospital, his blood sugar was 22–25, which he described as “very low” but “not that uncommon.”
The paramedic also testified that he has “no knowledge” of a patient dying from low blood sugar and said these types of calls are “very common” in his career.
He recalled speaking to Sarah Hartsfield at the scene, who told him Joseph had last been seen the night before. He said he did not document insulin pens in the home and was not sure if he entered the house.
On cross-examination, the defense noted the paramedic only remembered what was in his report.
The witness was excused after only a few minutes on the stand.
4:00 p.m. - Court back in session. Dr. Enakuaa returns to the stand
Continuing, Dr. Enakuaa testified about the Dexcom device, explaining it can have “sensor failures, signal loss, (and) technical issues” because it works via Bluetooth. She said, “If it’s reading, it’s accurate; if it’s not reading, it wouldn’t show on the report.”
Dr. Enakuaa admitted that she isn’t aware of recalls to Dexcom and couldn’t explain “how (the) alert sound doesn’t work if volume is down on (the) phone.” She called it “dangerous to inject fast-acting insulin after dinner.”
Medical records showed Joseph received “three amps of glucose and continuous glucose in hospital,” which the doctor said meant “Joseph had a big but unknown amount of insulin.” Dr. Enakuaa testified, “I don’t believe Joseph would have given that amount of insulin to himself because Joseph is always ‘careful.’” She also told jurors, “If (a) Dexcom alert was going off for hours, it would have alerted a conscious person.”
When questioned further, Dr. Enakuaa said she didn’t know “if Joseph was receiving sound or (if his) phone was off,” but maintained that “signal loss didn’t occur because data shows on (the) report.”
3:40 p.m. - Court on 15-minute break.
2:01 p.m. - State calls fifth witness to the stand, Dr. Souad Enakuaa, an endocrinologist
Dr. Enakuaa, an expert in endocrinology who specializes in “diabetes, thyroid, bone health, anything involving hormones,” testified about her former patient, Joseph.
She said she first began seeing him in July 2022 and had “seen Joseph four times.”
She described Joseph as having “uncontrolled type 1 diabetes,” noting that the term “juvenile diabetes” isn’t used anymore. According to Dr. Enakuaa, Joseph struggled with insulin. “Joseph wasn’t compliant with prescribed insulin doses; Joseph had anxiety about hypoglycemia, Joseph would always do less or skip it.”
STATE’S EXHIBIT 19 was presented: “Joseph’s continuous glucose monitoring report,” data pulled directly from his Dexcom device.
Dr. Enakuaa said Sarah Hartsfield joined Joseph for a virtual visit and later followed up with her. “Sarah called me after the visit. Sarah provided me with information that Joseph was taking way less insulin than what he told me.”
Joseph used injection pens for insulin. He “refused the pump, thinking it would cause more hypoglycemia,” though during their last visit, Joseph agreed to try it, but the pharmacy never shipped it, and JH didn’t fill that prescription.”
Dr. Enakuaa described Joseph’s Dexcom settings: “Dexcom alerts if sugar is below 70, it’s called low sugar, when it’s below 55, it’s urgent low, and the alarm goes off repeatedly and loudly.” But Joseph “set his ‘low’ to 100,” which she said “indicated Joseph was so scared to drop, not usual for patients to do that.”
STATE’S EXHIBIT 20 was another key piece of evidence: the doctor’s own note. “Sarah called 1/11/23, Jospeh admitted to hospital for hypoglycemia and doesn’t know if Joseph woke up for the alarm, Sarah said he was unresponsive, EMS gave IV, but Joseph didn’t wake up, currently in ICU intubated for 6 days, Sarah said Joseph doesn’t follow instructions.” According to her note, Sarah also said “major stroke or heart attack… doesn’t know if Joseph will make it.”
1:00 p.m. - Court back from lunch
Medical records showed Joseph was hospitalized multiple times with diabetic ketoacidosis (DKA). On October 11, 2018, he was admitted to St. Joseph Regional Health Center and diagnosed with DKA. A report noted, “patient reports only taking short-term insulin but not taking any long-term insulin, it appears.” The document also cited “medication noncompliance.” Joseph was discharged the next day.
Hospital records from March 20, 2022 and June 9–12, 2022 showed another hospitalization for DKA. At Houston Methodist, his blood sugar reached 488 with an A1C of 11%. Records stated Joseph admitted to checking his glucose level “sporadically” and not following a set regimen. He also “denied owning any durable medical equipment or home oxygen.”
Dr. Knight testified he first treated Joseph in August 2016, prescribing a fairly high dose of long-term insulin, “30 units in the morning, 50 in the evening.” Knight described it as a “fairly high dose, especially for type 1.” He said splitting the dose “might allow better absorption,” but it carried “no more risk than single-day dosing.” Knight last saw Joseph in March 2022, following gallbladder surgery. A June 2022 document stated “no PCP.”
The court also saw Defense Exhibit 2, medical records from Brooke Army Medical Center, documenting Sarah Hartsfield’s hospitalization from December 26–28, 2022 for complications from a breast implant infection. She was discharged on several medications, including hydrocodone, diazepam (Valium), gabapentin, doxycycline, clindamycin, and others. The doctor explained: hydrocodone and Valium can cause drowsiness; gabapentin is used for nerve pain and can also cause drowsiness; and Benadryl-equivalent medications may have sedative effects as well.
On redirect, prosecutor Mallory Vargas asked about glucagon, a life-saving medication for diabetics in crisis. The doctor told jurors he “would be surprised if glucagon wasn’t administered by a person highly involved in medical care.” He added that while medications may be prescribed, “there’s no knowledge if they were actually on that medicine unless there was a screening through urine.”
The witness was excused but could be recalled later.
11:45 a.m. - Court breaks for lunch
10:19 a.m. - John Knight, pediatrician at Kelsey Seybold in Huntsville, was called as the fourth witness
Dr. John Knight, an internist and pediatrician at Kelsey-Seybold in Huntsville, treated Joseph Hartsfield for several years.
Dr. Knight, who graduated from UT Houston Medical School in 1992 and has practiced for nearly three decades, told jurors he began treating Hartsfield in 2016 and continued as his doctor until 2022.
Knight said Joseph had Type 1 diabetes, which meant his pancreas could not produce insulin, and he needed the hormone regularly to regulate his blood sugar. He explained that Joseph was capable of administering his own insulin and “had his way of treating his diabetes,” though his blood sugar was never well-controlled. According to Knight, Joseph often had high blood sugar, suffered from conditions like high blood pressure and erectile dysfunction, and was hospitalized several times for diabetic ketoacidosis (DKA), a serious complication caused by dangerously high blood sugar.
The doctor said that low blood sugar, or hypoglycemia, is not something that typically results in death for his patients. In fact, he testified Joseph was the first patient he had ever treated who died from low blood sugar. Knight said he was “surprised” to learn Joseph’s cause of death, given his history of consistently elevated glucose levels. He explained that patients experiencing low blood sugar usually respond quickly to interventions like candy, soda, or glucose tablets, and most are not even hospitalized for their episodes.
During cross-examination, the defense pressed Knight on the differences between Type 1 and Type 2 diabetes, as well as how insulin therapy works. He confirmed Joseph’s A1C levels, a long-term marker of blood sugar, were very high, averaging around 10 to 10.5%, which he described as “very uncontrolled.”
Knight also noted that while insulin pumps are often recommended for convenience and control, Joseph had stopped using one before becoming his patient.
The doctor described diabetes as a serious, life-long condition requiring strict monitoring, diet planning, and teamwork among medical professionals.
10:01 a.m. - The witness was excused shortly before the court break
9:52 a.m. - Third witness, Olivia Hardy, the dispatch supervisor in Chambers County, called to the stand
Olivia Hardy is a dispatch supervisor for the Chambers County Sheriff’s Office. She explained that dispatchers take both emergency and non-emergency calls and route them appropriately to EMS or law enforcement.
Jurors then heard the 911 call Sarah Hartsfield made on January 7, 2023. In the recording, played at 9:57 a.m., Sarah’s voice sounded calm as she told the dispatcher, “I need help … my husband, is breathing but he’s not responding, I can’t get him to wake up.” She gave her address, gate code, and Joseph’s age, before adding, “he’s breathing, he’s breathing really heavy but I’m trying to wake him up … it’s like he’s not there.” Sarah could be heard crying and struggling to speak, saying her name through tears: “Sarah … ok, ok.”
Hardy testified that she has taken many calls involving diabetics and said it is not normal for those calls to end in death. “In my experience, the crew on the ambulance is able to treat the diabetic,” she told jurors. Prosecutors asked if it was normal for someone to delay calling 911 in a situation like Joseph’s. Hardy answered no.
During cross-examination, defense attorney Case Darwin pointed out that Hardy is not a doctor and does not have scientific training. She agreed, saying her knowledge is based on years of real-life experience handling emergency calls. On redirect, prosecutors noted that Hardy and her team stay in constant contact with EMS crews on scene.
9:07 a.m. - Defense attorney Case Darwin continues cross-examination with Jeannie Hartsfield
Testimony from Joseph Hartsfield’s sister, Jeannie, continued Wednesday as defense attorney Case Darwin continued his cross-examination. Much of the questioning focused on Jeannie’s past statements to law enforcement and her beliefs about Sarah Hartsfield’s role in her brother’s death.
Darwin asked Jeannie to read portions of a document related to Sarah’s self-defense shooting of her former fiancé, David Bragg. Jeannie testified that Sarah told her she had killed a man in self-defense.
Darwin also pressed Jeannie on whether she had accused Sarah of killing Joseph directly. She clarified, “I did not accuse Sarah of killing Joe,” but said she did express concern to an officer that Sarah had killed her brother. Jeannie said an officer first called her cell phone before meeting her at the hospital on January 7, 2023, where about 10 family members had gathered.
The defense introduced several exhibits, including Jeannie’s past statements and a letter from Douglas County prosecutors declining charges against Sarah in the 2018 shooting of Bragg. Jeannie said she only knew what Sarah had told her about that incident and about a separate FBI investigation. She acknowledged she was “concerned” about Joseph’s death but said, “Concern is concern, not an accusation.”
Prosecutors returned on redirect, asking Jeannie about her final conversations with Joseph. She testified that when Joseph came home on December 28, 2022, he told her he was worried Sarah would “kill him in his sleep.” She said she tried to convince him not to go back, but Joseph insisted he had to return to work. Jeannie was emotional as she described those moments, telling jurors she was “terrified” for her brother and that her “worst fears came true.”
Throughout her testimony, Jeannie admitted she didn’t know exactly how Joseph died but said she believed Sarah let him “lay there to die.” She told the jury she and Sarah once had “World War Three” on the phone, and while she “loved Sarah to death” in the beginning, by the time Joseph was hospitalized, she hated her. She also explained that Sarah kept the family from Joseph’s funeral, forcing them to hold a separate service without his body.
Jeannie also said she spoke to law enforcement because she felt they needed information to investigate her brother’s death. “I was terrified for Joe,” she told the jury.
9:00 a.m. - Court back in session for day 3 of trial