What’s behind a surge of deaths at one Ohio jail?

Montgomery county jail’s population is only 600 people – and all seven deaths happened within days of entering the facility, during pre-trial detention

By Stephen Starr

On October 5, 2023

Days after Steven Blackshear was booked into Montgomery county jail in downtown Dayton, Ohio, in January, a nurse found him shaking, in a fetal position and vomiting. He complained of chest and leg pains and was taken for medical testing. Two days later, he was found dead in his cell, covered only in towels.

The 54-year-old is one of seven people to have died in a surge of deaths at the jail since the beginning of this year.

For a facility with a population of slightly more than 600 people, it’s a huge and worrying toll.

It’s more than the number of deaths at jails in the five most-populous counties in Ohio combined, more than Montgomery county’s total for all of 2021 and 2022, and just one fewer than at Rikers Island in New York City – a facility with 10 times the incarcerated population – in the same time period.

A spokesperson for Rob Streck, the Montgomery county sheriff who runs the lockup, said that “ongoing legal considerations” prevented him from speaking to the Guardian about the jail deaths. At a news conference last week, however, Streck said that “this is the most physically ill, mentally ill and addicted population we have ever dealt with”.

At the briefing, Streck refused to take questions related to the deaths at his jail.

All seven of those who have died at the Montgomery jail did so within days of entering the facility and while in pre-trial detention. They had not been convicted of that which they were accused of doing.

Complications related to narcotics withdrawals or overdoses and mental health crises are suspected of contributing to several of the deaths.

“A jail is not equipped to be an emergency room,” said Joel Pruce of the Montgomery County Jail Coalition, a community organization pushing for reform at the facility. “People come in with medical needs that are extreme and significant, and a jail is not equipped to deal with them.

“I think everybody bears responsibility. At the end of the day, [it’s] the sheriff, the county commissioners, county administrators and Naphcare.”

Naphcare, a private company headquartered in Alabama, holds a $13m contract with Montgomery county to provide mental and physical healthcare to people housed at the jail.

Naphcare did not address the Guardian’s requests for specific information about how it treats people in its care. But the company suggested to Dayton media in June that the region’s opioid crisis was to blame for the deaths.

“Since January 2023, we have treated more than 1,000 individuals going through opioid withdrawal within the Montgomery county jail. In comparison, at other correctional facilities of a similar size, we have treated fewer than 100 patients going through opioid withdrawal within the same timeframe,” a spokesperson told the Dayton Daily News.

But the company has a terrible record at jails right across the country. Deaths at facilities it is contracted to provide health and medical care in Arizona, Georgia, Washington state and elsewhere have led to a string of lawsuits. One county in Arizona has fined Naphcare $3.1m for alleged deficiencies in its medical care. In 2021, it settled for nearly $700,000 after allegations that it overcharged the federal government for services provided.

It has also previously settled lawsuits with inmates at Montgomery county jail in Ohio. In 2012, a man died after being handcuffed face down for 22 minutes during a medical emergency. Naphcare settled its part in that case for $500,000, according to court documents. The company currently has rolling contracts with Montgomery county that would see it operate there until at least 2026.

Naphcare staff treat people suffering withdrawal symptoms through a detoxification program that requires staff to check on inmates multiple times a day.

But for the late Steven Blackshear, whose family declined to speak with the Guardian due to legal proceedings, that wasn’t enough.

After his arrest, he had been released by a Naphcare nurse into the general prison population despite “exhibiting opiate and benzodiazepine withdrawal symptoms,” according to a risk management report prepared by the sheriff’s office. Shortly after 2am two days after entering the jail, Blackshear was found dead in his cell by a corrections officer doing their rounds.

When a delegation of the Montgomery County Jail Coalition toured the facility in July, its members were shown how jail staff monitor a bank of cameras that in turn observe the incarcerated population. However, delegation members later expressed concern that the large number of cameras could make it difficult to quickly spot an individual in need of emergency care. Of the seven fatalities at the jail this year, at least four died after being found unresponsive in a cell.

On 22 September, the county announced plans to increase the number of special needs beds at the jail from 12 to 112 as part of a $20m renovation.

But for Isaiah Trammell and the six others who have died there this year, it comes too late. On 13 March, the 19-year-old was held at the jail on a domestic violence charge. Trammell had been “housed alone and on suicide precautions,” and had asked for a blanket, a mat and a phone call but was refused, according to a sheriff’s office risk management report.

The report found that Trammell then became enraged, had hurt himself and had suffered “very significant” swelling on his forehead that required medical care. A coroner’s report found that on 16 March, Trammell died due to complications from blunt force head trauma.

His death was ruled a suicide.

“Being in jail exacerbates a lot of the other crises they’re already experiencing, particularly mental health crises,” Pruce said. Each year, millions of people with mental health illnesses are booked into jails across the US.

Pruce said it most worried him that all seven deaths at the jail involved pre-trial detainees.

“It means you are being detained in jail without being convicted of the crime you are charged with,” Pruce said, “and dying.”

This piece was republished from The Guardian.