ANAHUAC, Texas – The Sarah Hartsfield murder trial is underway in Chambers County, and medical records and in-hospital treatment of her husband, Joseph Hartsfield, are taking center stage.
Records presented to the jury showed Joseph had been hospitalized multiple times for diabetic complications, including diabetic ketoacidosis (DKA). One record from October 2018 noted that the “patient reports only taking short-term insulin but not taking any long-term insulin, it appears.” Other hospital records showed his blood sugar once soared to 488 with an A1C of 11%, and documents noted “medication noncompliance.”
Two doctors who treated or monitored Joseph then took the stand. Dr. Souad Enakuaa, an endocrinologist, testified that Joseph had “uncontrolled type 1 diabetes,” and said, “Joseph wasn’t compliant with prescribed insulin doses; Joseph had anxiety about hypoglycemia, Joseph would always do less or skip it.”
She also discussed his use of a Dexcom continuous glucose monitor. She said Caryn Legros, a registered nurse at Houston Methodist Baytown, who testified about Joseph’s condition when he first arrived at the hospital in January, that “Dexcom alerts if sugar is below 70 … when it’s below 55, it’s urgent low, and the alarm goes off repeatedly and loudly.” On that point, Enakuaa said that Joseph “set his ‘low’ to 100,” which she said “indicated Joseph was so scared to drop, not usual for patients to do that.”
Enakuaa also referenced medical treatment during Joseph’s hospitalization, stating that medical records showed he received “three amps of glucose and continuous glucose in hospital,” which she said implied “Joseph had a big but unknown amount of insulin.” On cross-examination, she acknowledged she did not know “if Joseph was receiving sound or (if his) phone was off” when the Dexcom alerted him of his low blood sugar on Jan. 6 through the 7. She said the Dexcom did not show signal loss because data showed on the report.
The second physician on the stand, Dr. John Knight, who had treated Joseph from 2016 through 2022, testified that Joseph’s diabetes was never well controlled, noting his A1C levels “averaged around 10 to 10.5%, which he described as ‘very uncontrolled.’ Knight also said that low blood sugar “is not something that typically results in death for his patients” and said that Joseph was the first of his patients to die from hypoglycemia. He called it “surprising” given Joseph’s history of high glucose.
We also heard from Caryn Legros, a registered nurse at Houston Methodist Baytown, who testified about Joseph’s condition when he first arrived at the hospital on January 7, 2023. She said the only report they received was of an “unresponsive patient that was hypoglycemic.” Legros told the jury that Joseph “wasn’t responding to any of the treatment,” and that though “the treatment should cause levels to go up and usually stay,” his blood sugar “would go up a little bit and then fall again.” She said she began questioning, “What am I missing? What am I not doing correctly?” and felt “something was counteracting the sugar water they were giving Joseph.”
KPRC 2 will continue its blog with the latest developments.
3:52 p.m. - Court ends for the day
3:32 p.m. - Court resumes. Brandon Kruse, a detective in Minnesota, was the 12th witness to take the stand
Kruse, a detective with the Douglas County Sheriff’s Office in Minnesota, said he first investigated Sarah Hartsfield in 2018 after the shooting of her then-boyfriend, David Bragg. He told the court the two “had been broken up for a short period” but were still living together with Sarah’s three children.
It was May 9, 2018, and Kruse said Sarah said that it was “soon to be Emma’s birthday” and that her ex-husband Chris had just come home from Korea to surprise the girls. She said David became jealous after learning Chris was in town, and “the domestic violence started.”
The investigator testified that Sarah told officers that she went to pick up her daughters from the school bus near her home and needed to go back inside to get clothes. She said she took a handgun in her back pocket, entered the house, and after an argument with David, “tried shooting him and the trigger wouldn’t go off.” She said she told him she would leave, but then David wrestled the gun from her and fired toward her, leaving “a bullet hole in the ceiling.” She testified she stood up, pulled her weapon, and “fired.” David fell to the ground. Hannah came into the residence while on the phone with 911.
The investigator said it “seemed odd” that Sarah would arm herself and enter her home instead of just leaving, saying that it was unusual to see someone “take two firearms into a residence.” He also noted that David had bullet holes in his back and lower left abdomen in a “tight grouping.” A missing clip from David’s gun, he said, was “abnormal.” He told jurors there were inconsistencies in Sarah’s story, and that while the case had initially been declined, it was later reopened. “Case is still open currently,” he said.
On cross-examination, defense attorney Case Darwin questioned the detective about whether Sarah had been arrested in connection with the shooting or had any pending charges, to which the detective answered no.
3:27 p.m. - Dr. Beynon dismissed. Judge orders 15-minute break
2:47 p.m. - Dr. Oghogho was dismissed, and the 11th witness, Dr. Marianne Beynon, an assistant medical examiner, took the stand
Beynon is an assistant medical examiner with the Harris County Institute of Forensic Sciences, who has performed more than 2,000 autopsies.
She said that “undetermined” is one of the five possible manners of death, used when she cannot definitively categorize a case as natural, accident, homicide, or suicide. That determination, she said, can ultimately become the jury’s decision in criminal cases.
She performed Joseph Hartsfield’s autopsy, reviewed his medical records, and examined toxicology results. The cause of death, she testified, was “complications of toxic effects of insulin, ” essentially an insulin overdose.
She told jurors Joseph’s brain showed global hypoxic ischemic injury, meaning it had been without oxygen for days. She saw no evidence of a stroke, despite Sarah Hartsfield contacting her office and sending a surveillance video she believed showed signs of one.
The examiner said this was an “acute event” and that Joseph would not have gone unresponsive and died if it weren’t for the large amount of insulin in his system. On cross-examination, she acknowledged Joseph had chronic coronary artery disease and was sometimes noncompliant with his diabetes medications, but said those conditions were unrelated to his acute hypoglycemia. She admitted she did not know how or when the insulin was administered and ultimately ruled the manner of death “undetermined.”
She told jurors that peers reviewed her findings and agreed, adding that she has only ever handled one insulin overdose case... this one.
2:02 p.m. - Dr. Oghogho dismissed, and the tenth witness, Dr. Saeed Kahkeshani, a neurologist, takes the stand
Dr. Kahkeshani is a neurologist at Houston Methodist who has been practicing since 1989. He explained that when Joseph Hartsfield arrived at the ER on Jan. 7, 2023, he was comatose and unresponsive with pneumonia and breathing issues. He said an MRI revealed ischemic evidence and “lack of oxygen to the brain.”
The doctor testified that Joseph suffered neurological damage from a prolonged period of hypoglycemia, which put him in a coma. He said hypoglycemia lasting “4-5 hours can irreversibly damage the brain,” adding that “20 hours is ‘too long.’” His diagnosis was hypoxic ischemic irreversible brain damage.
The neurologist told jurors it was “very difficult to get low blood sugar” and that the most likely cause would be “too much medication orally or insulin.”
He testified that medications like Valium, Ropinirole, and Benadryl could make a patient extremely drowsy, and combined with prolonged hypoglycemia, “would likely not be able to get up, walk around, or act normally.”
He ruled out stroke, saying Joseph’s case was an “acute event” based on lack of blood sugar, and testified Joseph was more at risk of severe brain damage “if someone introduced something to his body that made him have severe low blood sugar.”
1:27 p.m. - Court back in session after lunch break
When Dr. Eyitemi Oghogho returned to the stand, the jury heard more details about Joseph Hartsfield’s condition and what Sarah told hospital staff. Records show Sarah claimed Joseph suffered “chemical burns at work” to explain rashes on his body and told staff they were working on their diet together at home.
Joseph’s A1C was measured at 8.8%, and while Sarah said Joseph “always managed himself,” she also asked that he be listed as “Do Not Resuscitate,” something the doctor testified is not unusual.
Medical records also noted Joseph’s heart “wasn’t squeezing and functioning the way it should,” with enzyme levels indicating damage, and plaque buildup was seen in an intracranial artery.
11:45 a.m. - Lunch break
10:48 a.m. - Deputy Yeatman dismissed from the stand, and the ninth witness, Dr. Eyitemi Oghogho, was called to the stand
Dr. Eyitemi Oghogho, an emergency room physician at Houston Methodist Baytown, testified that she treated Joseph Hartsfield when he arrived at the hospital on Jan. 7, 2023. She has been a doctor for more than 10 years and is licensed in multiple states.
Dr. Oghogho said EMS told her Joseph’s glucose level “was in the 20s.” She testified that she put Joseph on life support, stabilized him, and ordered a CT scan, bloodwork, urine screen, and other studies. She observed that Joseph “had bruising to both arms, lower extremities, not breathing fully (grunting), vomit on the corner of his mouth, and was not responsive.”
She told jurors she treated hypoglycemia and gave Joseph “2 amps of dextrose, which patients typically respond to by waking up within minutes, but Joseph didn’t respond and his level would go back down.” She added, “Should have remained higher than what it kept dropping to.” A CT scan showed “brain injury, cells had died.” Dr. Oghogho testified that this indicated “low sugar level could mean injury to the brain.”
According to hospital records, Joseph arrived at 3:12 p.m. with a glucose level of 42. Dextrose was given first as an IV dose, then through a drip. Dr. Oghogho said she initially ordered a benzodiazepine but discontinued the order, noting she “didn’t administer benzo” even though a urine screen came back positive for it. Once Joseph began seizing later, records showed he “likely received lorazepam (benzo).” She clarified, “A doctor wouldn’t use benzos to treat low blood sugar; only related to seizure activity.”
Dr. Oghogho testified that she had concerns about the timeline, noting the “time in which Joseph was unresponsive and the time he arrived at the ER, how low his sugars were going, and him not responding to dextrose.” She described the facts of the case as “unique in her experience.”
Dr. Oghogho also told jurors that Sarah instructed her “not to communicate with her husband’s family,” which “stood out” to her. “Given Joseph’s severe state, assumed loved one would want to know info about him,” she said, adding that trying to withhold information was “uncomfortable.” She testified that she was “suspicious of Sarah.”
On cross-examination, defense attorney Case Darwin asked about sepsis. Dr. Oghogho explained that “sepsis is basically a condition in which there’s an infection, once the infection overruns the system, signs of organ damage are present.” Joseph’s “sepsis score was 7,” which she called “a high number.” She added Joseph “needed antibiotic treatment” and that sepsis “could contribute to hypoglycemic state.”
9:30 a.m. - Break so the judge can hear and rule on body camera video from Deputy Yeatman
The judge admitted body camera footage of Sarah Hartsfield’s interview at the hospital with Deputy Yeatman. In the recording, Sarah appeared “in pain when reaching for her driver’s license.” The audio was difficult to hear.
Sarah told deputies that Joseph “was tired” after working a night shift and coming home for a job interview. She said Joseph told her he needed insulin, so she “got the pens out of the fridge for him” and that she watched the Dexcom. Sarah became emotional, saying she “never leaves the house when he’s sleeping because his blood sugar is so erratic.”
She said she was asleep on the couch, kept hearing the alert go off, and thought Joseph was getting up to drink juice, so she kept refilling his glass. “I thought he was ok,” she said. Sarah told deputies that around 1 p.m., Joseph was sweating and his blood sugar was reading 40. When she returned to the room, “there was throw up all over Joseph.” She said she tried to wake him up, but he wouldn’t, so she called 911 at 2:02 p.m.
In the interview, Sarah cried, saying, “I’ve done all I can to monitor him … I don’t know how it got this bad.” At other times, she asked the deputy, “Is there a role you play in this? Is it just to document what happened?” The deputy said Sarah became “hysterical” when told “it’s not looking good for Joseph.”
Deputy Bryan Yeatman testified that he saw “2 pens and more in the fridge,” and Sarah told him she had only touched two insulin pens, which he said made taking fingerprints unnecessary. He said Sarah admitted she “felt guilty she didn’t do more,” explaining her surgery, medication, and that she had slept on the couch because Joseph “was snoring in bed.”
Yeatman said he tagged his report as “criminally negligent homicide” under the direction of his supervision. He added he did not know “who, how, when, how much, what kind, of insulin was administered to Joseph” and did not know “how anybody intentionally or knowingly caused the death of Joseph.”
9:08 a.m. - Deputy Bran Yeatman called as the eighth witness of the trial
Deputy Bryan Yeatman with the Chambers County Sheriff’s Office was called to testify. Prosecutor Sara Porterfield led his questioning.
Yeatman told jurors that medical staff had concerns about Joseph Hartsfield and “concerns about foul play.”
At the hospital, Yeatman spoke directly with Sarah Hartsfield. He said Sarah told him that Joseph “was tired from work” and that she “just had surgery.” According to Yeatman, Sarah said Joseph “was in bedroom laying down, sleeping” and that she called the ambulance around 2:02 p.m. the same day. Sarah also gave him a brief timeline of the day before, saying Joseph “came home from nightshift work, came home around 3–4 a.m. and had been in bed since he got home.”
Sarah told the deputy that Joseph got up “multiple times” before she called for help, “to get a drink and use the bathroom.” She said she made him “a broccoli cheese cheddar rice casserole dish” around 4:30–5, but that Joseph “only ate a bowl of it.” She added that Joseph asked for “2 insulin needles.”
Yeatman testified that Sarah told him she was “watching Dexcom and Joseph was snoring loudly,” that “alerts were going off,” and that she was seeing them. She also said she was “out of it because of prescribed medicine from recent surgery,” and that she was “staying on couch in living room; in and out of sleep.” Sarah admitted she “felt guilty because she was falling asleep.”
Yeatman described Sarah and Joseph’s home as having “a lot of moving boxes still in rooms, the house was in disarray.” Inside the main bedroom, he said he noticed “sheets were flipped over, a pile of vomit, clothes on the floor.”
At the hospital, Yeatman said that Joseph’s family “seemed distraught, concerned, wanted investigation,” while Sarah appeared “pretty content at the time; kind of there, calmer than the rest of the family.” He said Sarah “sobbed a little bit when talking to the deputy.”
On cross-examination, defense attorney Case Darwin focused on Yeatman’s body camera statement from Sarah at the hospital. Darwin presented a disc labeled as “Defense Exhibit 8: disc with Sarah hospital body camera recording.” The state objected, arguing it was not properly authenticated and “contains hearsay.” The judge ruled it was not hearsay.
9:00 a.m. - Court resumes on day 4