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With jail deaths on the rise, California counties look to improve

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With jail deaths on the rise, California counties look to improve

Picture of Matthew Brannon
Record Searchlight
Wednesday, October 7, 2020

Steven Neuroth spent the last night of his life struggling to breathe in a county jail. Hours earlier, the 55-year-old diagnosed with schizophrenia had been arrested after police found him running in traffic, saying someone was after him. 

When he acted paranoid and uncooperative at the Mendocino County Jail, guards punched Neuroth, threw him to the floor and restrained him in a way that led to his suffocation and death, his attorney charged in a lawsuit in federal court. 

Years after Neuroth’s death, California county jails remain a vessel for preventable fatalities. State data shows the Golden State hit a 15-year high in 2019, with 157 people dying in the custody of a county jail, over 80% of whom hadn’t been convicted. 



Across the country, experts have pointed to a lack of resources and leadership in local jails, leading to thin staffing, bargain medical care and hollow oversight. Some California counties are reporting rising jail death rates, twice or three times as high as that of their neighboring jurisdictions. 

At the same time, some counties are making progress bringing down death rates of the people in their care. Interviews with law enforcement officials, attorneys and outside experts indicate that changes in policing, initiative in leadership and a prioritization of health can save lives. 

For one county, a decade of improvement

Keeping people safe is a core but complicated responsibility for any county jail. Administrators say people in jail are more likely to be in worse physical or mental health to begin with, and supervising hundreds of them at once doesn’t simplify things. 

Faced with those challenges and others, some counties have still seen declines in the number of deaths in jail custody. One of them is San Francisco County. 

“That’s been a source of pride,” said Sheriff Paul Miyamoto, a 24-year veteran of the department who took it over in 2020.

A three-year snapshot of state data shows San Francisco reported 13 jail deaths from 2010 to 2012. From 2017 to 2019, they reported four.


That constant check-in is really important because it values the person and it actually leads to a reduction in suicide attempts or people being in crisis." - Sheriff Paul Miyamoto


Part of the answer is likely less stress on the system. The sheriff’s department reported about 5,000 fewer bookings in 2019 than 2012, a decline of about 30%. But that may not account for the decline on its own.

Miyamoto pointed to a “seminal event” in 2013. A public hospital policed by the sheriff’s office had a woman go missing before a worker found her dead in a stairwell 17 days later. The sheriff’s office was roundly criticized for its failure to keep track of her.

“It also led philosophically to a change in our entire department,” Miyamoto said. “(It) changed our perspective and refocused us on making sure that we increased rounds, that we increased keeping track of people (and) didn’t take for granted that people slept through the night.” 

Miyamoto spoke highly of suicide prevention policies. Considered by some to be one of the more preventable causes of death in custody, analysis showed suicides make up a lower-than-average share of the county jail fatalities in San Francisco.

The local district attorney’s office and others in the area have been vocal about pushing for more mental health services. Miyamoto said the county’s largest jail facility has behavioral health assistance teams, partnerships between trained deputies and mental health specialists who continually interact with people and check what services they’re using. 

“That constant check-in is really important because it values the person and it actually leads to a reduction in suicide attempts or people being in crisis,” he said.




‘Relatively inexpensive reforms’

While San Francisco’s investment in jail safety has paid off, it could be harder to replicate in rural countries, which may not have access to the same level of resources. 

That challenge is acknowledged by Nick Straley, an attorney at Seattle-based Columbia Legal Services, which issued a detailed report on Washington state jail deaths in 2019. 

“Society hasn’t been willing to do what’s actually necessary to care for people,” he said. “We leave it to the criminal justice system and local jails to provide basic health care to people who need much more attentive services.”

Their report identified eight "relatively inexpensive reforms" that can reduce deaths in jails. They include:

  • Decreasing the number of those with mental illness and substance use in jail with more community-based programs
  • Increasing oversight and transparency with uniform data reporting requirements
  • Improving the intake process with more thorough medical and mental health screenings 
  • Using evidence-based overdose and withdrawal protocols
  • More comprehensive suicide prevention policies, including not isolating those who might be suicidal
  • Training jail staff on de-escalation techniques, managing people in crisis and to use force only when "absolutely necessary"
  • Ensuring a jail has enough staff to supervise and care for all people in jail
  • Requiring jails to perform a serious incident review after a death or a near death, including identifying possible policy changes and making such a review available to the public

Straley said those in jail will fare better with holistic, wraparound services over isolation and punishment. 

“It’s actually cheaper in the long run,” he said, “because you save on emergency room care, you save on jail expenses, you save all these various ancillary costs because you keep people out of the jail.”

The RAND Corporation, a think tank initially created to assist the U.S. military, held its own expert panel on jail and prison deaths in 2017. It concluded “most forms” of deaths in correctional facilities are preventable with proper interventions. 

“Resources aside … organizational culture issues can be just as daunting and must be addressed," read the report. “Leaders must instill in their staff the message that everyone is responsible for the health and safety of the inmate population.”

The costs of inaction

A significant challenge noted by RAND and Straley is that it can be hard to gather popular support to devote limited resources to jail inmates, a population generally seen unsympathetically in the eyes of the public. 

While some are less persuaded by the human costs of jail deaths, the fiscal price of inaction can tally up for taxpayers, too.

In Steven Neuroth’s case, his family received a $5 million settlement in a wrongful death suit, with $3 million coming from Mendocino County, $1.5 from California Forensic Medical Group and $500,000 from the city of Willits.

Mendocino County's probation chief (left) and sheriff stand in front of the jail in a photo posted to the sheriff's Facebook page on July 8, 2020. MENDOCINO COUNTY SHERIFF

Emails and calls to the Mendocino County Sheriff's Office for this story were not returned. California Forensic Medical Group has since merged with another company to form Wellpath, which did not comment on this article after a reporter reached out by phone and email. 

As Neuroth's case was settled in 2018, a wrongful death suit involving the Monterey County Jail cost that county and California Forensic Medical Group $825,000. Meanwhile, Lake County agreed to pay $2 million for a wrongful death suit that year as well, with California Forensic Medical Group agreeing to pay an undisclosed amount of money.y phone and email. 

The settlements can come off as a wakeup call, with some bringing positive policy changes. Mendocino County now requires that all intake screenings and patient assessments in jail be performed by registered nurses or higher level caregivers. And the county agreed to train jail staff on crisis situations and suffocation by January 2021, according to court documents. 

The jail also no longer gets its medical services from California Forensic Medical Group — which a Sacramento Bee investigation linked to higher rates of suicide and drug overdose

Mendocino County didn’t report any deaths in jail custody from 2017 to 2019. 

Bringing changes home

In Shasta County, the jail saw nine deaths during those three years, an increase from previous years. It also has a comparatively high share of suicides, has about 30% of its population on mental health medication, and contracts its health services through Wellpath. 

The county already has one of the state’s highest arrest rates. When adjusted for population, residents of Shasta County and others in the North State have a much higher likelihood of dying in a county jail, according to Record Searchlight analysis. 

Research indicates health costs of incarceration stretch beyond the facility’s walls. A study published in January examined the “spillover” effects for an inmate’s family and community. It found increases in county jail incarceration rates are associated with a rise in that county's overall mortality rates. A similar study found the effects on public health and mortality is even more pronounced in rural counties. 

“A clear implication of this research for politicians and policymakers is that reducing the use of jails and prisons could have the benefit of improving their population’s health,” the latter paper concludes.

Capt. Gene Randall, who was assigned to run the jail system by Sheriff Eric Magrini in 2020, acknowledges the challenge. 

“It’d be very naive to think that there’s not better ways of doing things,” Randall said.

Randall said the jail's administration is exploring the possibility of a medically assisted treatment (MAT) program, which would use medications like methadone to help ease painful withdrawal symptoms for substance users — a practice the RAND study found was a “top-tier need” for preventing jail deaths that is often underutilized. 

Randall said he hoped the program could work with other county agencies to make sure people are able to get treatment after release, promoting health and reducing recidivism.


When I’m looking at the succession of the department, I want to look optimistically. I would hope that the landscape and the layout of the correctional facility would be changing for the better.” - Capt. Gene Randall


Randall also said his facility will soon begin a Jail-Based Competency Treatment program contracted with the Department of State Hospitals. Programs like that have been catching on throughout the state as a way to locally house and treat inmates deemed incompetent to stand trial rather than transferring them to a DSH hospital. 

Asked what changes he’d like to see long term, he imagined the jail would have better means of providing mental health services and substance abuse programs to help decrease an inmate’s chances of returning to jail. 

“When I’m looking at the succession of the department, I want to look optimistically,” Randall said. “I would hope that the landscape and the layout of the correctional facility would be changing for the better.”

This article is the third in a three-part series. Matt Brannon wrote this story while participating in the USC Center for Health Journalism's California Fellowship.

[This article was originally published by Record Searchlight.]