After listening to about six hours of testimony during a coroner's inquest, a Schuylkill County jury on Monday concluded that 21-year-old Matthew Koncsler died in a prison cell on March 31, 2013, of an accidental overdose. Negligence was a contributing factor, jurors said.

"I guess we got some justice served out of this, and my son Matt's up there, happy somehow," Koncsler's mother, Sherry Koncsler, said through tears after the six-person jury stated its conclusion.

The next step, said District Attorney Christine Holman and coroner David J. Moylan, is for the county prison board to examine why inmates were not better supervised, and to tighten protocols to reduce the chances of such a thing happening again.

The board may also look into changing the procedure of inmates not receiving body cavity searches upon admission. Now, on the rare occasion when a body search is deemed necessary, the inmate is taken to a local emergency room to have that done, one prison guard testified.

Koncsler was five days into a three-to-18 month sentence for selling a $40 bag of marijuana when he died. He was last seen alive by jail staff when they locked him in his cell at 10 o'clock the previous night.

It wasn't until the next morning that Koncsler's cellmates realized he was dead, and began banging on the cell door and yelling for guards.

'Anything could be passed'

The jury, which deliberated for about a half-hour, did not name a specific drug. Koncsler had ingested heroin within an hour of his death, according to medical experts, and there were other drugs in his system. The jury did not single out anyone as responsible for the neglect that contributed to his death.

They considered various aspects, said juror Gary Klemovage of Frackville, including the actions of security guards and video footage from cameras in the cell block that showed inmates passing something from hand-to-hand at the station where they received their medications.

"Apparently it was going on for some time, with nothing being done. If someone had stepped in and done something, then maybe none of this would have happened," he said.

However, Klemovage said, "we're not pointing a finger at anyone in particular."

Another juror, Donald Klinger of Lavelle, referred to testimony that cigarettes and tobacco were passed into Koncsler's cell by other inmates.

"If cigarettes could be passed, so could anything," he said.

The testimony included that of James Landron Jr. of Reading, one of Koncsler's two cellmates.

In detox

Landron said that he, Koncsler and an inmate whose last name is Delgado were all in the same cell under a 72-hour lockdown. They were "in detox," being weaned from the illegal drugs and being given other drugs, such as librium and Tylenol 3, which would be tapered off.

Landron testified that inmates Koncsler knew would pass him cigarettes and a bag of tobacco through a slot at the bottom of the cell door. He said he did not see any drugs being passed.

Landron testified he saw Koncsler crushing pills he was given by prison staff.

"I seen him snort pills," Landron said.

He said some of the nurses who give the medications would make sure inmates swallowed the pills, but others did not.

Landron also testified that Koncsler snored loudly, was having trouble catching his breath and was complaining of head pain in the hours before he died.

The lights were turned out at 11 p.m. or 11:30 p.m., and the three, all of whom had trouble sleeping while detoxifying, talked as they drifted off to sleep, he said.

'He was gone'

A few hours later, Delgado, in the bottom bunk, noticed Koncsler wasn't snoring as he usually did, and hit the underside of Koncsler's mattress to try to rouse him.

Landron said Delgado told him he was worried about Koncsler, but Landron, on a mattress on the floor, was half-asleep and brushed him off.

A guard, Robert L. Merton, checked the cell on his 7 a.m. rounds, saw that all three appeared to be asleep. Koncsler was on his side, facing the wall and covered with a sheet, Merton testified.

It wasn't until about 7:30 or so that Delgado and Landron woke and tried to wake Koncsler, only to find him cold.

"He was gone," Landron testified.

They banged on the cell door and called for a guard. They finally caught the attention of a "laundry dude," Landron said, who alerted Merton.

Merton checked Koncsler, whom he said looked like he was sleeping, on his side, facing the wall, with his head on the pillow and his arm stretched out above his head.

He touched Koncsler, finding him dead, "hard as a rock and ice cold."

Merton testified that Delgado and Landron, both visibly shaken, immediately left the cell and were taken to another area of the prison. Merton summoned medical staff and other guards. Then police and the coroner were called.

New information

After the inquest, Holman said that Pottsville Detective Steve Guers may use new information learned from testimony to continue his investigation.

Guers testified he interviewed inmates and took photographs, and checked Koncsler's body, finding no signs of trauma and no white powder on Koncsler's hands or nose.

Guers said Delgado told him he saw Koncsler with pills the night of March 30.

Forensic pathologist Rameen Starling-Roney testified via video that the cause of Koncsler's death was "mixed substance toxicity," meaning interactions among several drugs in Koncsler's system contributed to his death.

Forensic toxicologist Wendy Adams testified that heroin was introduced into Koncsler's body within one hour of his death.

Dr. Carolann Littzi, an addictive medication specialist, testified via video that Koncsler had metabolites of heroin in his system.

Moylan and deputy coroner Christian Weiser presented a "virtual autopsy."

"Missing tapes'

Deputy coroner Joseph Pothering said he found no indications of trauma on Koncsler's body. He also presented video tapes of the cellblock showing inmates passing something outside the medication kiosk.

Pothering said he asked the prison for recordings of each of the four days Koncsler was in the prison, from March 27 until his death. He received only tapes from March 27 and March 30. The tapes from March 28 and March 29 are missing, he said.

Also testifying were prison guard Amber Lynn Ginther of Ashland, who described the inmate intake procedure, which she said includes a strip search but not a body cavity search.

Prison guard Robert L. Merton testified about being alerted by Koncsler's cellmates the morning of March 31 that something was wrong.

He went into the cell and found Koncsler dead in the upper bunk.

Certified medical assistant Shannon McShaw testified that according to Koncsler's records, he said he drank heavily and was addicted to Xanax, Percocet and opiates, and smoked two packs of cigarettes a day.

She testified that inmates sometimes exaggerate their addictions in order to get more of the drugs given to taper them off the controlled substances.

Licensed practical nurse Tara Hamm of South Tamaqua testified that Koncsler was started on detox medications on March 28.

Pottsville police officer Grant Yoder testified he found nothing suspicious in Koncsler's cell and no signs of a struggle.

Koncsler's mother testified, saying she knew her son used some drugs, particularly oxycodone, but was shocked to learn he also used heroin.

She also read aloud a statement, crying as she spoke of his love for his two children, now 2 and 4 years old, and his girlfriend, Kayla Weikel.

"Every day that goes by, I still can't believe my son is gone," she said.

Koncsler's stepbrother, Vincent Eroh, also testified, saying he was not aware of Koncsler's drug use.

The inquest was the first one held in Schuylkill County since the late 1990s when one was held by then-coroner John Mika, Moylan said.