America’s Rural-Jail-Death Problem

This story was originally published by The Atlantic. Subscribe to the magazine’s newsletters.

In the early-morning hours of January 7, 2019, when it became clear that 30-year-old Christopher Hall might die, no medical staff were on duty at the Boyd County Detention Center.

Hall had been booked into the rural eastern-Kentucky jail in the final days of 2018 on a drug-possession charge. During intake, he informed officers that he typically used heroin or methamphetamine every day, that he had high blood pressure and hepatitis C, and that he had experienced delirium tremens or other serious withdrawal symptoms when he’d gone off drugs in the past. But there is no record of Hall seeing a physician during his time in the jail. Instead, medical consultations were made over the phone.

Court records note that during Hall’s first few days at BCDC, “nothing was documented to verify … that he was being monitored or assessed.” He developed a persistent fever, for which he was seen by medical staff several times and given Tylenol, in addition to his blood-pressure medication. On January 6, Hall was prescribed withdrawal medication, but just before midnight, a nurse wrote in his record that he was “withdrawing hard.” Shortly after this, the court records note, jail deputies laughed as they watched an incarcerated janitor clean up Hall’s diarrhea. Hall’s condition continued to worsen, and he eventually stopped speaking.

Staff called an ambulance in the morning, but it was too late. Hall died 13 days after being booked in, with a final emergency-department diagnosis of sepsis, a brain abscess, and “an altered mental status.” An ongoing wrongful-death lawsuit filed by the mother of his child alleges that jail and medical staff “displayed a conscious disregard for his right[s] and safety.” (The defendants have disputed the claims in court, arguing that their “actions were reasonable, proper, justified, legal and undertaken without any wrongful intent, impact or effect.”) Hall was the fourth person to die in eight months at BCDC.

Across the country, an average of roughly three people died each day in local jails of all sizes in 2016, according to the Bureau of Justice Statistics, or BJS—a rate that is almost certainly an underestimate. A disproportionate number of those deaths happen in America’s smallest jails. Mortality rates were highest in jails holding a daily average of fewer than 50 people between 2000 and 2012, the last period for which BJS reported mortality by jail size; suicide rates were inversely correlated with jail size from 2000 to 2007. Small-to-midsize jails tend to have fewer resources to provide adequate mental-health and medical care, suicide prevention, and drug treatment—services that many people entering jails need. They also often have less oversight and are more overcrowded than their larger counterparts. In many ways, small institutions are the most troubling example of America’s epidemic of preventable deaths in jails—and they are also the least likely to draw public attention.

[Read: They called for help. They’d always regret it.]

American prison and jail populations grew unchecked for much of the late-20th and early-21st centuries. More recently, criminal-justice reform ushered in a wave of new policies that have led to slow declines in the overall incarcerated population since its peak in 2008.

But much of this reduction has taken place in state and federal prisons. Major urban jails have seen reductions too, with populations dropping 18 percent from 2013 to 2019. The opposite is true, however, in the rest of the nation’s 3,134 local jails, which are operated by counties or cities and typically hold people who are awaiting trial or serving short sentences. Over the same time frame, jail populations shot up 27 percent in rural areas, and 7 percent in small-to-midsize cities.

Boyd, a county of around 50,000 residents that borders West Virginia and Ohio, expanded its jail from 93 beds to 202 in 2006, according to the county jailer, William D. Hensley. By January 2021, the facility held 286 people—142 percent its intended capacity—with many people sleeping on mats on the floor. In 2018, the most recent year for which there are data, Boyd County jailed an average of 823 per 100,000 residents—a far higher percentage than major cities like New York, Los Angeles, and Houston.

Overcrowding can mean less programming, fewer services, unsafe conditions, and more time locked down in cells. These problems coincide with other structural difficulties confronting small jails. “Rural jail administrators face all of the challenges of large urban jails but they are further disadvantaged by their location in counties that can draw from a relatively small tax base,” explained Rick Ruddell and G. Larry Mays, professors at the University of Regina and New Mexico State University, respectively, in a 2011 International Journal of Rural Criminology paper, noting that this can affect officer retention, availability of rehabilitative programming, and health-care services.

“Particularly in small communities, in places that are pretty resource-poor or have limited infrastructure, jails become the first-line response to a lot of things, including people who are in crisis, and mental-health crisis, people with substance-use disorders,” says Jasmine Heiss, the director of the Vera Institute of Justice’s In Our Backyards initiative, which studies the rise of incarceration in small cities and rural areas. In the absence of broader societal support systems, incarceration has become the catch-all solution in areas hit hard by poverty, unemployment, and the meth and opioid epidemics.

BCDC has long been plagued by overcrowding, abuse, poor health care, and abysmal conditions. It has a history of overdoses, including eight women who overdosed during one month in 2017. That same year, 10 incarcerated people set a fire to protest conditions, causing damage that forced the jail to briefly close. A civil-rights investigation by the U.S. Department of Justice found that jail officers regularly violated people’s constitutional rights from 2015 through 2018, including using excessive chemicals and tasers, and regularly restraining both men and women in suicide smocks without underwear, exposing their genitals to other incarcerated people and staff.

Three people died in BCDC in the eight months before Christopher Hall’s death, two by overdose. The third, Michael Moore, died of blunt-force trauma after several officers threw him around, tipped his restraint chair, and slammed his head into the ground, as surveillance video showed. (Four of the officers pleaded not guilty to first-degree manslaughter and have not yet been tried; a fifth, facing lesser charges, accepted a plea deal. Moore’s family received a $1.75 million civil settlement.) These numbers make BCDC’s prisoner-mortality rate in 2018 roughly 10 times higher than the average for local jails as of 2016, the most recent year for which Bureau of Justice Statistics figures are available (the mortality rate reported by the BJS is likely an undercount, since it relies on self-reporting, which has been historically underenforced). Following these deaths, the county official in charge of the jail resigned, and William Hensley, his elected successor, promised reform. But Hall died just weeks into Hensley’s tenure. As a corrections expert who analyzed the jail’s logbooks for the lawsuit explained, “Jailer Hensley inherited a broken system, and he was trying to fix it as fast as he could. Unfortunately, Mr. Hall did not have the time for those fixes to take place.”

And some structural problems—overcrowding by the courts, an unequal society that often uses incarceration as a solution to mental illness and addiction—cannot be fixed by any one jail or jailer.

[Read: The rise of rural incarceration]

Many of the same problems persist in larger towns and small cities—places that, like small towns and rural areas, tend to get less attention and have inadequate resources.

Although it is Pennsylvania’s capital, Harrisburg has a population of just under 50,000. “It’s a small city, but it has a big heart,” Kevin Maxson, a lifelong Harrisburg resident and prison-abolition activist, told me. “Everybody knows everybody.” The city is served by the Dauphin County Prison (county lockups in Pennsylvania are referred to as prisons, not jails), where at least 13 people have died since 2014.

Like the Boyd County Detention Center, DCP is chronically overcrowded; in 2018, it had 725 beds in cells but an average daily population of 1,065 people. Communal dayrooms, originally intended for recreation, have been converted into dorm-style housing with bunks. John Hargreaves, the director of volunteers at the Pennsylvania Prison Society, a nonprofit that inspects and reports on jail conditions, has been visiting DCP regularly since 1979. “When I used to go there, in the old days, they had dayrooms where they had ping-pong tables,” he told me. “Not anymore! They’re all bunks.” Advocates and people formerly incarcerated in DCP say the facility has rodent infestations, and the outside recreation yards have been closed for years, meaning that people spend their entire stays without ever stepping outside.

“It’s pure hell,” said Maxson, who spent 11 months in DCP on drug charges in 2009 and 2010. “From the moment you go in there … You hear people screaming and yelling, you hear people getting beat on … Maybe they read your charges, they decide they want to jump you. They come in your cell, act like you did something wrong, black off the camera, pull out their cameraphones, and record you getting your ass whipped.”

“It used to be, if somebody, you know, was running their mouth a little bit, then unfortunately, they probably would get beaten pretty good,” said a man who formerly worked as a correctional officer and spoke on the condition of anonymity. “There were two cells where the front door of the cell was on camera, but once you got them in the cell, you couldn’t see what happened. And that’s generally where people would get brutalized pretty good.”

In 2019, Ty’rique Riley died on life support a few days after being transported to the hospital from DCP. He had been booked into the jail after his concerned parents, Carmen Riley and Thomas Matthews, called the police for help, reporting that their son was acting strange and holding a sledgehammer.

During his eight days in DCP, correctional officers allegedly sprayed Riley repeatedly with pepper spray, beat him, wrestled him to the ground, and shackled him in a cell in a suicide smock, according to a lawsuit filed by his parents. After days of receiving minimal medical attention for either his mental state or his injuries from the restraints, staff called an ambulance. While waiting for it to arrive, officers forced Riley to the ground, shackled him, and placed him in a restraint chair, the suit alleges. At some point, Riley stopped breathing.

Riley’s parents arrived at his scheduled court hearing the following day, only to learn from a judge that their son was in the ICU. Riley never woke up, and he died four days later. It was less than three weeks after his 21st birthday.

“I had a wonderful child that was taken from me,” Riley’s father told me. The parents fondly recalled when young Riley and his mother would join Matthews, a truck driver, on rides to see the countryside. “Ty’rique used to sit and be my copilot, and learn how to read maps before GPS came out,” Matthews said. “Everything that I did, he was behind me, in my footsteps.”

Later, when Matthews had the first of several heart attacks, Riley took over chopping wood and mowing the grass for his family and his grandmother. “Now that he’s been gone, I had to put the boots on and try to go out here to do it myself,” Matthews said.

[Read: The shocking lack of lawyers in rural America]

After Riley died, his grieving parents reached out to Maxson, who began organizing protests outside the jail, eventually forming an organization called Voices 4 the Voiceless. More than two months after Riley’s death, and amid mounting community pressure for answers and accountability, the county coroner, Graham Hetrick, announced that he found Riley to have died of natural causes from an undiagnosed brain inflammation. The following day, the district attorney closed the criminal investigation, saying he’d found no criminal wrongdoing. Riley’s parents filed a wrongful-death lawsuit in February 2020, citing the alleged abuse Riley suffered in the jail. Dauphin County Press Secretary Brett Hambright declined to comment on pending litigation, and referred The Atlantic to the district attorney’s findings. He added that “there is ongoing review of prison operations and reform and improvements to areas deemed in need.”

Maxson’s group continued to protest regularly outside DCP throughout the spring and summer of 2020, yet the deaths continued. On August 20, Herbert Tilghman died in what the county called a “fatal medical event.” Supporters on the outside say he was going through drug withdrawal and did not get the medical care he needed.

“I actually witnessed, and saw with my eyes, an inmate die,” one man who was incarcerated at the time told me, referring to Tilghman. (The man is on parole and fears retaliation if named.) “I watched the medical staff, when they called a medical emergency. I literally watched them walk—not run, but just walk—to the cell block where the inmate was lying on the floor … They’re drinking coffee and walking down the hall and chitchatting and whatever. And then when they finally realized that he was dying, that he was dead, then everybody wanted to get serious, but it was too late.”

Nine days after Tilghman’s death, Jimmy King Jr. died in DCP of complications from a traumatic brain injury that the district attorney said he received at the hands of his cell mate, with whom he had fought previously.

The two deaths prompted the Dauphin County Prison Board of Inspectors to launch an independent medical review of jail policies, which the county declined to provide to The Atlantic.

The vera institute of justice has analyzed contributors to jail growth and overcrowding in rural areas like Boyd County and smaller cities like Harrisburg. They’ve found that smaller counties are less likely to have resources for programs like pretrial services and diversion programs that keep people out of jail. They also use pretrial detention at a higher rate than many jails in bigger cities. Before 1993, roughly half of the U.S. jail population was awaiting trial. Currently, it’s nearly two-thirds, and many of the people who are incarcerated cannot afford bail. In 2018, just 17 percent of people booked into jail in Boyd County were released before trial without bail—and only 26 percent of those whose release was dependent on cash bail could afford to go home. Although the Sixth Amendment guarantees the right to a “speedy trial,” presumed-innocent people around the country regularly wait in jail for months or even years for their cases to resolve.

The practice does not seem to enhance public safety: A Prison Policy Initiative analysis of bail reforms around the country found that releasing more people before trial does not lead to more crime. Pretrial detention does, however, keep people in dangerous and overcrowded jails, instead of allowing them to await trial safely from home. Christopher Hall and Ty’rique Riley both died while being held before trial. In fact, about 75 percent of people whose deaths in jails were reported to the BJS from 2006 to 2016 were awaiting trial.

“They’re innocent ’til proven guilty,” says Riley Ross III, who, along with Kevin Mincey, is representing Riley’s parents in their lawsuit. “But before they can have a day in court, and have a chance to prove that they’re innocent, they’re dead. And so they never even get to answer to the charges that put them there in the first place.”

Jails are also growing in size as they increasingly take on populations from outside their counties. Despite already being overcrowded, Dauphin County Prison currently holds 97 detainees on behalf of the federal U.S. Marshals, in exchange for a $90 per diem payment. Roughly 80 percent of jails around the country rented out bed space in 2013 to other counties, federal agencies like the U.S. Marshals and U.S. Immigration and Customs Enforcement, or state prison systems. This especially bloats jail populations in rural areas: In 2013, 46 percent of people in rural southern jails were being held for other jurisdictions.

This trend has completely changed the landscape of local jailing in states like Kentucky, where Christopher Hall died. In 2019, the Kentucky Department of Corrections incarcerated about 24,000 people, but fewer than 13,000 of them were held in state prisons. Instead of decarcerating, the state farms out half its prison population to county jails for $31.34 a day, leaving people serving multiyear sentences in small jails with worse access to programs, services, and health care. Hensley, the Boyd County jailer, said that during the pandemic, the DOC has simply stopped collecting people from his jail after their sentencing, meaning that the already-overcrowded facility currently holds 127 state-sentenced individuals. (The Kentucky DOC confirmed that transfers were halted on March 11, 2020, but have since resumed on a “controlled basis.”) Around the country, state departments of corrections limiting their intake during the pandemic have become yet another contributor to growth in jail populations.

Many counties across Kentucky have embraced incarceration in an attempt to shore up revenue shortages, says Judah Schept, a professor at Eastern Kentucky University who studies rural incarceration. These counties seek contracts to house state and federal detainees in their county jails, while also trying to win bids for prisons. In eastern Kentucky, replacing disappearing coal-related jobs is a particular concern. “You have counties becoming reliant on jail infrastructure,” he said. “You have folks who live there anticipating work opportunities at jails and prisons, because coal employment is gone. And you have increasing numbers of people actually going into jail.”

Sometimes, when small counties build massive jails with the intention of housing state and federal detainees, this increased bed space can actually enable more local incarceration. As one small-county sheriff in upstate New York explained to Vera, regarding new jail construction, “They said, ‘If you build it, they will come.’ And that’s what happened. The judges knew there was room, so they threw them in jail.”

And so, in towns and small cities across the country, families like Hall’s and Riley’s mourn loved ones who were booked into local jails and never came home.

In 2017, Kelly Coltrain died after staff at Nevada’s 28-bed Mineral County Jail denied her request to go to the hospital while she was detoxing; her body was not discovered for nearly six hours. In 2018, Roger Lee Wells slept on the floor of an overcrowded medical cell in the Cascade County Detention Center, serving Great Falls, Montana; he died after his requests for his medication were ignored and he suffered multiple seizures. In 2019, staff at the Bi-State Justice Center, a jail on the border between Texas and Arkansas, filed release paperwork for Holly Barlow-Austin while she was in the hospital in critical condition. When she died soon after of high blood pressure and fungal meningitis, the jail did not report the death to state authorities, claiming she was no longer under their jurisdiction. (The Cascade County Detention Center and Bi-State did not respond to requests for comment.)

Vera’s Jasmine Heiss said deaths in jails are almost certainly underreported. “The reports of conditions in these smaller communities are so devastating, it is reasonable to believe that people are dying who are never recorded, that we don’t even know about,” she said, noting this “pervasive trend of people being released from jail when they’re really on death’s doorstep. And so their death is not recorded inside.”

Across the U.S., jails fly under the radar without much oversight; John Hargreaves of the Pennsylvania Prison Society told me that “each county is a fiefdom unto themselves.” But Boyd and DCP have received an unusual amount of attention and public scrutiny in recent years—including Boyd’s Justice Department investigation—in response to their shocking conditions and frequent deaths. This attention might be paving the way for some reforms. In the time since Hall’s death, BCDC has switched to a different health-care company, added cameras, and increased training and officer pay; Hensley said use-of-force incidents have decreased dramatically. The jail has also lowered its population by implementing a community-service diversion program, although it remains critically overcrowded, and, by early December, had 193 COVID-19 cases. In 2019, the Dauphin County Prison Board approved the purchase of body cameras for correctional officers; staff started wearing them this past December and January.

The former DCP correctional officer said a culture change is needed to shift the way incarcerated people are treated. He told me some of his former colleagues did a good job, but others were repeatedly violent. “Most people didn’t really talk about it,” he recalled. “They kind of took their paycheck and went home. And the people that did care, or spoke up? You didn’t have a very good time there … They’ll run you out of there. But they’ll also let you know that if something ever happens, they’re not coming to help you.

“The longer I was there, I kind of realized that, you know, these people are humans too. And they don’t deserve to be treated the way they [were].”

But until the trends of overpopulation and mistreatment in under-resourced jails are reversed, families will continue to experience the anguish of losing their loved ones.

“In my sleep, I hear him call me,” Ty’rique Riley’s father said. “‘Dad, Dad, Dad, Dad, Dad!’ repeatedly. All the time. ‘Dad!’ And it still echoes in my mind. ‘Dad, Dad, Dad!’ That’s where we’re at right now.”

This article is part of our project “The Cycle,” which is supported by a grant from the John D. and Catherine T. MacArthur Foundation’s Safety and Justice Challenge.

Support for this article was provided by the Alicia Patterson Foundation and the Pulitzer Center. Additional reporting was done by Jean Casella and Sarah Shourd.