[In Texas, dying in jail is “par for the course.”]
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LOCKED UP AND LEFT TO DIE  
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Michael Barajas, Sophie Novack
November 1, 2021
Texas Observer
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_ In Texas, dying in jail is “par for the course.” _

, BOB JAGENDORF/FLICKR

 

Armando Carrillo had been waiting outside the Nueces County Jail for
hours when he heard sirens approaching in the middle of the night on
March 5, 2018. He had visited the jail earlier that day to see his
youngest son, Danny, 27, who had been incarcerated for three weeks on
a probation violation. Danny had sounded increasingly paranoid on the
phone leading up to the visit and started crying and cowering when
officers escorted him out of his cell. “You could tell he was losing
his mind. I’ve never seen him like that,” Armando says. Pacing
outside the jail later that night, Armando desperately called
attorneys and bail bondsmen to help him get his son out. His stomach
dropped when he saw an ambulance pull up to the box-like building
lined with razor wire around 2 a.m. He thought of his son’s rambling
last words hours before: “He was telling me, ‘I know I’m going
to get killed.’” 

Jail staff and people incarcerated with Danny said he seemed fine when
he entered the lockup but eventually started spiraling—sobbing day
and night, hallucinating, and babbling incoherently about threats
against his family. Danny, who had been diagnosed with mental health
and substance use disorders, had struggled in recent years—losing a
sister and bouncing between lockup and halfway houses. His mother, who
recently had brain surgery, had joined Armando to visit Danny that day
but was detained by officers who uncovered an old theft charge when
they screened her to enter. Guards said Danny became “belligerent”
when she was taken away, then later swung at them when they stormed
his cell to move him, striking one officer in the temple and another
in the nose. Three guards then tackled Danny and pinned him to the
floor, while a fourth stuck his knee into Danny’s back and a fifth
shocked him with a stun gun. Nurses who arrived to check on him about
10 minutes later found him bloodied, without a pulse. 

Hours later, officials released his mom. Danny, they said, was dead.

Like many local lockups in Texas, the Nueces County Jail has cycled in
and out of compliance with minimum state standards for decades. The
jail has grappled with overcrowding, deficient health care, and
violence in recent years. Ivan Armando Flores/Texas Observer

An autopsy ruled Danny Carrillo’s death a homicide, listing the
cause as “sudden cardiac death during restraint procedures.” He is
one of more than 1,100 people who have died in jail custody across
Texas since 2010. Last year, the Texas Commission on Jail Standards
(TCJS), which regulates county jails, counted 124 deaths, the highest
number since the agency started recording them in 2009. Most deaths
are among pretrial detainees, people who were never convicted of their
alleged crime. In Texas, sheriffs are subject to outside investigation
when people die in their jails. That job mostly falls to the Texas
Rangers, the detective arm of state police. 

As part of a months-long investigation, the _Texas
Observer_ reviewed more than 400 Rangers investigations into jail
deaths over the past decade. The records show that state police
regularly document jail conditions that can lead to preventable
deaths, such as jail staff ignoring people with deteriorating health,
taking hours to respond to emergencies, violently restraining
detainees in the middle of mental health crises, denying treatment for
chronic conditions like diabetes or heart disease, providing Tylenol
for liver failure, and mocking people who are moaning in pain. These
documents, together with jail inspection reports, state data, court
filings, and medical records, show how Texas’ patchwork regulatory
system repeatedly fails to ensure safe conditions behind bars. Records
from TCJS show that more than three dozen jails, including the one in
Nueces County, routinely fail to meet minimum standards in state
inspections and in some cases have cycled out of compliance for
decades—yet rarely face consequences. 

The _Observer_ identified dozens of cases in which the Rangers
documented allegations of mistreatment including medical neglect,
denial of medication, and abuse by jail staff. In at least 37 of the
deaths reviewed by the _Observer_, the Rangers recorded evidence of
jail staff actively dismissing signs of serious deterioration or cries
for help. A man who later died of sepsis was accused of faking his
pain and “just whining” by a jailer. In another instance, a nurse
quipped that a man dying from a brain bleed was “just acting” and
“should get an Oscar.”

The reports also show law enforcement taking people in medical
distress—such as those who had been in a car accident, were tased by
police, or were in the throes of a drug overdose—to jail instead of
a hospital. For example, in roughly one-fourth of overdose deaths, the
Rangers documented that medics cleared people for incarceration before
they died. In at least 20 of the 173 deaths ruled to be from
“natural causes,” the person had been hospitalized during
incarceration, then sent back to jail—in some cases multiple
times. 

Of the 122 suicides, more than half involved people with documented
histories of suicide risk, such as those who had previously attempted
suicide or been placed on suicide watch at the jail. About 16 percent
of those who died by suicide were on suicide watch and yet had not
been checked by guards for more than 30 minutes—the minimum standard
for suicidal or at-risk people detained in Texas jails. In 14 of the
suicide investigations, the Rangers found evidence that jailers had
lied about how frequently they conducted cell checks. The reports also
show how existing regulations fail to save lives: In December 2019, a
woman was booked into the Travis County Jail on an assault charge,
after being hospitalized for cutting her own throat during a fight
with her boyfriend. Jailers put her on suicide watch and looked in her
cell every half-hour as required but didn’t realize she had opened
the stitches in her neck until they saw blood on the wall. 

While the Rangers investigations routinely uncover evidence of neglect
and misconduct, they rarely result in consequences for jail staff,
even in cases involving potential criminal activity.
The _Observer_ identified at least eight cases where the Rangers
found evidence that jail staff had falsified logs of required cell
checks or medical treatment records related to in-custody
deaths—actions considered crimes under Texas law—yet local
prosecutors declined to take them to a grand jury. Five cases reviewed
by the _Observer_ were ruled to be homicides, yet none resulted in
charges. Four went to grand juries, which cleared the jailers
involved. In the fifth, the Smith County district attorney declined to
present the case of a man who died in April 2018 because a grand jury
had already cleared the sheriff’s deputy who shot him during a
traffic stop. The man required near-constant medical intervention for
his gunshot wounds during his 10 months in jail, according to the
Rangers investigation, and eventually refused medication, telling
doctors, “I would rather die than live with this.” 

Rangers documented their findings going to a grand jury in about a
fourth of the more than 400 cases reviewed by the _Observer_. Charges
were filed against jail staff in eight. The Rangers did not respond to
requests for comment for this story.

With deaths in lockups on the rise across Texas and the rest of the
country, reformers and jail regulators continue to urge state
lawmakers to increase oversight and pass broader reforms to divert
people from jail, particularly those with mental illness, who make up
close to 40 percent of people behind bars. TCJS Executive Director
Brandon Wood put the issue bluntly in a March meeting of the Texas
Judicial Commission on Mental Health: “If we can’t have more of an
impact and prevent our county jails from being the de facto mental
institutions of our time, then I’m afraid that we’ll be seen as
simply being like Nero, fiddling while Rome is burning.” The jail
commission numbers undercount the lives lost: In a 2019 report
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the agency said sheriff’s officials had skirted requirements
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report and investigate deaths “on multiple occasions” by abruptly
releasing people in medical crisis from custody just before they died.
Wood didn’t respond to requests for an interview for this story.

This year, as COVID-19 spread rapidly in Texas lockups, exacerbating
crises that predated the pandemic, Republican legislators passed a
law
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by Governor Greg Abbott to limit jail releases and require cash bail
for people accused of violent crimes. Opponents of the law fear it
will lead to more pretrial detention and compound problems inside
dangerous jails. Delays in court hearings during the pandemic have
further crowded packed jails in places like Nueces County, which this
spring began transferring people to jails in neighboring counties. 

In 2018, when the Rangers arrived at the Nueces County Jail to
investigate Danny Carrillo’s death, others incarcerated there were
relieved. “I’m glad y’all showed up because everybody was
talking like they’re just gonna slide it under the rug,” one man
told them. “I know y’all are going to get justice. Y’all are
Texas fucking Rangers.” Video interviews obtained by
the _Observer_ show how the Rangers’ investigation left out or
downplayed their concerns. “If you get into it with a guard,
they’re gonna come into the room and they’re going to fuck you up,
as long as they’re not around the cameras,” one man told
investigators, one of many statements that never made it into their
report.

Armando and Alicia Carrillo say their son Danny (pictured) loved to
cook and used to organize cookouts for relatives. They say the family
doesn’t gather like they used to since his death at the Nueces
County Jail IN 2018. Ivan Armando Flores / Texas Observer

Others detained near Danny told the Rangers that jailers berated him
before storming his cell and that the guard assigned to the cellblock
that morning, Jesus Galvan, had a reputation for being cruel and
taunted Danny before he was killed, according to interviews obtained
by the _Observer_. However, Galvan faced easy questioning from Ranger
Stephen West. Toward the end of his interview, Galvan told West,
“You know, this is my first incident like this.”

“It’s par for the course, buddy,” the Ranger replied. “It’s
to be expected. You’re gonna face some tough situations
sometimes.”

Months later, a Nueces County grand jury cleared everyone involved. 

The Nueces County Jail grappled with overcrowding, deficient mental
health care, and violence in the years before and after Danny
Carrillo’s death, according to Rangers reports, state inspection
documents, complaints to the jail commission, and criminal court
records. According to lawsuit filings, people incarcerated at the jail
called one cellblock “the dungeon” and named one particularly
violent guard “the punisher.” At least 11 Nueces County jailers
have been criminally charged in recent years, with allegations ranging
from brutality to lying about assaults in incident reports. Two of the
jailers who restrained Danny faced charges for lying about a
use-of-force incident that injured a woman at the jail months later;
those charges were later dismissed. Three guards were indicted in
another death at the jail that December, one of the eight cases
reviewed by the _Observer_ that resulted in criminal charges. Court
records show the officers—accused of assaulting the man and
photographing him naked, then lying about it—pleaded guilty in
exchange for probation and no jail time. 

Current Nueces County officials declined interviews or didn’t
respond to repeated requests for comment for this story, including
Sheriff J.C. Hooper. Former Nueces County Sheriff Jim Kaelin, who ran
the jail for 12 years until November 2018, told the _Observer_ he
didn’t remember Danny’s death, one of three at the jail that year,
saying, “That name doesn’t even ring a bell.” Last year, as
chair of the Nueces County Republican Party, he pushed a conspiracy
theory
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Facebook suggesting George Floyd’s murder was a staged event.
(Kaelin says he was just posting something that was sent to him by a
retired Texas Ranger.) The former sheriff, who spent nearly three
decades inside the Rangers’ parent agency, the Texas Department of
Public Safety (DPS), contends that deaths in custody are often
unfairly blamed on law enforcement, saying those in jail, who tend to
have higher rates of preexisting conditions, are a “volatile
population when it comes to medical.” 

Surveillance video of the cell block where Danny Carrillo was detained
n the Nueces County Jail shows guards storming his cell the night he
died.

“It’s OK to die anywhere in the United States, there would
probably not be much of an investigation, unless you died in a
jail,” Kaelin says. “If you die in a jail, there’s going to be a
tremendous amount of scrutiny over that death, as if somebody did
something, was negligent in the causing of that death.”

The Carrillo family sued the county and the jailers involved in
Danny’s death, none of whom admitted guilt in a settlement agreement
earlier this year. According to county records, it was the largest
settlement following a death at the jail in at least a decade:
$300,000, just over half of which went to the family after paying for
attorneys fees. Months later, Armando still hasn’t touched the
money. “It makes me feel like it’s blood money. I don’t know
what to do with it,” he says. “If I could bring my son back, I’d
give them back three times what they gave me.” 

♦♦♦

Sandra Bland cried throughout her time at the Waller County Jail,
sometimes sobbing so hard that guards had a difficult time
understanding her. She had just moved from Chicago for a job at
Prairie View A&M University, a historically Black college and her alma
mater. But on July 10, 2015, a Texas DPS trooper violently arrested
her during a traffic stop. Guards later remembered that when Bland,
28, arrived at the jail, she insisted the charge against her,
assaulting the trooper who pulled her over, was a lie, and “appeared
to be in a state of disbelief about what was happening to her.” 

Jail staff didn’t put Bland on suicide watch or any increased
monitoring, though she told them she was depressed and had tried
taking her own life the previous year. They did take note of the
alleged assault on the officer, housing her in a cell alone “due to
the aggressive offense she was arrested for.” Guards later said that
Bland didn’t seem to be eating and made several frustrated phone
calls in an attempt to make bail; she needed $515, but told jailers
she was broke. 

At 7:30 a.m. on July 13, 2015, jail staff rejected Bland’s request
to make more calls, a Rangers report indicates. Less than two hours
later, a guard found Bland hanging in her cell. The Rangers who
investigated her death found two books in her bunk: _101 Ways to Find
God’s Purpose in Your Life_, which was closed, and a Bible that had
been opened to Psalms 119. _Blessed are those whose ways are
blameless, who walk according to the law of the Lord._

Bland’s treatment at the hands of Texas law enforcement became a
national scandal that increased attention on police violence, racial
profiling, and negligent jails. Black people, who are overrepresented
in lockups across the country, comprise 13 percent of Texas’
population but 28 percent of deaths in county jails over the past
decade. In 2016, Bland’s family settled a wrongful-death lawsuit
against state and local officials for $1.9 million and an agreement by
the Waller County Jail to increase guard training and adopt an
automatic electronic cell check system. The next year, the Texas
Legislature passed a reform bill bearing Bland’s name that required
law enforcement to collect more data on traffic stops and “make a
good faith effort” to divert people with mental illness or substance
use problems into treatment instead of jail. The Sandra Bland Act also
strengthened mental health screening and training requirements for
jailers and mandated independent investigations of county jail deaths,
instead of allowing sheriff’s offices to investigate themselves. 

“Connecting some actual reforms to this, it mattered to me. God it
mattered to me,” says Cannon Lambert, the attorney who represented
Bland’s family. “I did not want a number. It had to be something
different.”

A memorial for Sandra Bland near Prairie View A&M University in July
2015, in Prairie View, Texas. AP photo/Pat Sullivan

Texas lawmakers first established safety standards for jails in the
late 1950s but provided no way to enforce them. The state health
department was tasked with inspections but wasn’t funded to do so
until more than a decade later, at which point it found nearly every
Texas jail in violation. Still, little could be done.

At the end of the civil rights movement, people incarcerated
nationwide began to fight back in court. From New York to Texas, they
organized class action lawsuits to demand better, safer conditions. In
1972, a prisoner named David Ruiz filed a lawsuit alleging brutal
treatment inside the Texas Department of Corrections, which ultimately
led to federal court monitoring of the state prison system for
decades. The same year, Lawrence Alberti, incarcerated in Harris
County Jail, filed a lawsuit alleging that severe overcrowding had
created a violent atmosphere and squalid conditions, which also led to
long-term federal court monitoring of Harris County’s jail and
criminal legal system. The lawmaker who authored legislation to
regulate jails later described ones he visited in 1973 as “out of
the dark ages,” according to an article in the _Texas Bar Journal
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“A bucket and a padlock were all the sanitation and security some of
them provided.” 

The mounting lawsuits against sheriffs and counties were a piecemeal,
expensive way of bringing individual lockups in line. So in 1975, the
Legislature passed a bill to create the Texas Commission on Jail
Standards, described
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a lawmaker involved as “a shotgun wedding between the Sheriffs’
Association and the ACLU with the State Bar of Texas as
‘matchmaker.’” By then, 40 percent of sheriffs or commissioners
courts in Texas were tied up in lawsuits. 

The number of people held in Texas jails has exploded by more than 500
percent since the 1970s—today, about 1 million
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churn through the lockups each year. But TCJS has changed little in
that time, perennially hampered by a shoestring budget and
short-staffing. The commission’s $1.4 million budget has supported
only three or four inspectors in recent years, the same number as
decades before. In the 58-county inspection region that includes
Nueces County, one person inspects 93 jails that detain more than
16,000 people.    

Attorneys, advocates for jail reforms, and even the Texas Sunset
Advisory Commission, the state’s watchdog agency, say that scant
resources and limited enforcement power perpetuate a cycle of
noncompliance. TCJS not only allows jails to resolve violations
slowly, it also fails to hold repeat violators accountable,
the Sunset Commission
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lawmakers this year. About 100 counties received at least one notice
of noncompliance from TCJS from 2017 to 2019; of those jails, nearly
half received two or more. The Harris County Jail, the largest in
Texas, saw six noncompliance notices during that time; four of them
cited staff for failing to properly monitor high-risk detainees. 

The Nueces County Jail, where Danny Carrillo was killed, highlights
larger regulatory failures that allow jails to remain dangerous.
Inspection records show that TCJS found the jail in violation every
year since it began inspections in the late 1970s until 1991,
routinely citing the sheriff’s office for understaffing and for
failing to adequately screen and classify inmates. Inspection records
detail similar problems for the next 30 years as the jail cycled in
and out of compliance: unsanitary conditions like mold on the walls
and ceilings, broken toilets and showers, and water dripping into
cells. The jail has been flagged for overcrowding numerous times,
including as recently as this year, sometimes keeping people in
temporary holding cells for several days beyond the 48-hour limit, and
stuffing detox cells well beyond capacity.

In February 2010, guards left a man who’d already attempted suicide
once inside the jail unmonitored in his cell for almost half an hour,
during which time he hanged himself. The man had recently been taken
off suicide watch, where he was checked on every 15 minutes, and was
left without increased monitoring even after he’d expressed suicidal
thoughts to a guard, according to the Rangers investigation. TCJS
inspections following the death cited the jail for deficiencies
regarding mental health and suicide screening, as well as failing to
appropriately monitor potentially suicidal people. The jail passed a
follow-up inspection in March, was cited again in April for failing to
monitor suicidal and other at-risk inmates, then passed again in
July. 

Later that year, in October, Gregory Cheek entered the Nueces County
Jail after suffering a psychotic episode that resulted in an arrest
for criminal trespassing. His mother, Katie Cheek, says Gregory had
stopped taking his medications for schizophrenia and bipolar disorder
and was wandering the streets homeless. Katie was relieved after a
judge ruled Gregory incompetent to stand trial and ordered him into
treatment at a state psychiatric hospital. Katie figured it was better
for him to wait for a hospital bed while in jail than on the street.
“At least he’ll be safe,” she recalls thinking. “We actually
had put our faith in them being his ‘protector.’” 

Gregory spent three and a half months in jail but never made it to the
state hospital. People incarcerated nearby described him wasting away
mentally and physically. They told the Rangers that guards took away
Gregory’s clothes, bedding, and mattress after he tore them up and
ate them, leaving him naked as the temperature outside dropped below
freezing. Jailers interviewed by the Rangers described him as “an
extremely disruptive prisoner who had mental health issues.” His
legs began to swell and “seep,” but he wasn’t given adequate
medical treatment, according to a lawsuit that was filed by his
parents and later settled with the county. A jail nurse told the
Rangers he discovered Gregory unresponsive with a forehead temperature
of 74 degrees on February 6, 2011. He died at a hospital in the early
morning on February 7 of a bacterial infection. TCJS noted no
deficiencies at the jail that year.

Incarcerated people and their loved ones file thousands of complaints
with TCJS alleging dangerous conditions inside Texas lockups every
year, but the complaints rarely lead anywhere. Records obtained by
the _Observer_ show that the agency often closes cases by saying
that medical complaints and criminal allegations, such as physical
abuse by guards, fall outside its purview. The agency forwards all
complaints to local jail administrators, whose responses range from
blanket denials to defensiveness. Occasionally, TCJS forwards
complaints to law enforcement agencies, including the Texas Rangers,
but it’s unclear if they take action on them. 

Nearly half of the Rangers’ 622 investigations in the past decade
were opened after January 1, 2018, when the Sandra Bland Act’s
requirement for outside investigations went into effect. But according
to the Rangers, they were not given additional funding or resources to
handle the workload. The investigations reviewed by
the _Observer_ range from more than 100 pages to just two. Reports
about deaths in the Tarrant County Jail—which have spiked in recent
years, with three in the same week in June 2020, three in September
2020, five in December 2020, and three in February 2021—averaged
about four pages, even as they document cases where people died after
being pepper-sprayed, tackled, and strapped into restraint chairs by
guards.  

In some cases reviewed by the _Observer_, Rangers failed to document
even basic information, such as a cause of death. Sometimes, they
didn’t talk to witnesses or appeared to simply write up internal
findings from the sheriff’s office without further investigation. A
recent _New York Times_ story
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Rangers investigations into in-custody deaths found numerous flaws,
shortcuts, and missteps that illustrate the same pro-police bias that
such investigations are commissioned to absolve. 

 

_READ HERE FOR MORE ON THE DOCUMENTS AND DATA THAT WERE USED TO REPORT
THIS STORY.
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The _Observer_ identified nearly 20 cases where the Rangers found
evidence that jail staff had falsified records but weren’t charged.
That includes the Rangers investigation into Bland’s death, which
showed that guards documented checking on her every hour as required
by Texas law, despite surveillance video proving they left her
unchecked for nearly two hours before she was found—a potential
felony for tampering with government records, the most common criminal
charge in the _Observer_’s review. A grand jury declined to indict
any jailers involved in Bland’s death. The trooper who arrested her
was fired and indicted for perjury, but the charge was later dropped.

Though Bland’s death prompted more Rangers investigations, Lambert,
the attorney for her family, says it also underscored their
limitations. “Let’s just be honest: They’re not independent,”
he says. “An independent review would mean that someone is brought
in with a fresh set of eyes with no agenda and is going to follow
information wherever it goes. But there is a real brethren in law
enforcement. … It blocks their ability to get to the truth in some
ways.” 

♦♦♦

J.Joseph Mongaras was already on his way to the Kaufman County Jail,
southeast of Dallas, when he got the call. It was May 19, 2019, and
Mongaras, a criminal defense attorney, was driving to visit Elmer Dale
Barrett, a 70-year-old Air Force veteran who was in the custody of the
U.S. Marshals Service on drug charges and being held in the county
jail. Barrett didn’t flag significant health concerns in screening
forms when he was booked that February, noting instead that he worried
about who would care for his 18-year-old dog. But Mongaras, his
court-appointed attorney, knew Barrett’s health had deteriorated
during his three months in jail and hoped his presence might convince
jail staff to give Barrett medical attention. If they didn’t,
Mongaras planned to push for a new hearing to get Barrett released.

But Mongaras never saw him again. When he answered the phone, he
learned that Barrett had died early that morning.

Starting in March, Barrett had filed at least four written requests
for medical attention. His handwriting grew more cramped as time wore
on, and his requests were denied. On May 2, he complained of
dizziness, but jail medical staff believed this was “an act” to go
to the hospital, the Rangers investigation shows. On May 5, he said he
had been having slight strokes and couldn’t feel the left side of
his body; “I need to see somebody ASAP please,” he wrote. On May
7, he said he’d had a stroke or heart attack; on May 16, he said he
had a stroke and needed to go to the hospital, telling staff he was
“going to die in here.”

Barrett died on May 19, 2019, of complications from a heart attack
that “may have happened approximately three to seven days prior to
his death,” according to the Rangers investigation. Several days
later, Mongaras received a letter Barrett had sent from jail. “I
need a PR bond or something so I can stay at home so I can take better
care of myself, it’s obvious they can’t do that here,” he wrote,
asking about a lawsuit against the jail. “They really didn’t care
if I died here on the floor.” 

After Barrett’s death, TCJS found the jail out of compliance for
what essentially amounted to a paperwork error: Medical tests ordered
by the physician on May 7 were not sent to the U.S. Marshals for
approval until more than a week later. In July, TCJS deemed that staff
had been trained and the issue resolved. 

Barrett’s death, like more than half of all deaths in Texas county
jails in the past decade, was blamed on “natural causes”—a term
that includes anything from heart attacks to late-stage cancer to
COVID-19 to complications from withdrawal. More than 70 percent of
those “natural” deaths were people younger than 60, according to
data from the nonprofit Texas Justice Initiative
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under 30 years old. The denial of medical care in correctional
facilities is considered a form of cruel and unusual punishment under
the Eighth Amendment. Yet the Rangers investigations reviewed by
the _Observer_ documented dozens of seemingly preventable
“natural” deaths like Barrett’s and Gregory Cheek’s, which
appear to have been caused or exacerbated by conditions in lockup and
denial of medical care. In both cases, the Rangers investigation was
brought to a grand jury, which cleared staff of any criminal
wrongdoing.

Krishnaveni Gundu, co-founder and executive director of the Texas Jail
Project, spent months after Barrett’s death collecting information,
hoping his family might file a lawsuit. She worked with Barrett’s
close friend Lauren Halbert, who received phone calls and letters from
Barrett in jail. A suit was never filed; the two-year statute of
limitations passed in May. 

Gundu still has trouble talking about Barrett’s death. It sticks
with her even amid the countless stories of trauma and neglect she
hears from other loved ones of incarcerated people. “I think it
really gets me because it was so clear where the liability was. It was
so clear who dropped the ball,” she says. She worries about Halbert,
who was recently incarcerated in the Smith County Jail for a substance
use charge and struggled to get help for her own medical issues.
Halbert cried as she spoke on the phone in the jail about the guilt
she feels that she couldn’t do more to help her friend. “It
shocked me pretty bad losing him,” she said. “It’s kind of one
of the reasons, I think, why I’m here. … And now I know exactly
what he went through.”

Michael Henning plays a song he wrote about his friend Elmer Dale
Barrett after his death in jail custody. This recording was made by
Krishnaveni Gundu, co-founder and executive director of the Texas Jail
Project.

On paper, Texas is one of the best states for jail regulation, says
Michele Deitch, a University of Texas at Austin professor and an
expert on prison and jail oversight, but that’s a low bar.
Twenty-one states have no regulatory or oversight body for jails at
all, according to a study she published last year. Some don’t even
track deaths behind bars. But in Texas, regulations haven’t ensured
safe conditions, in part because that was never really the mission,
she says: “The motivation behind jail standards is ‘Keep us out of
litigation,’ not ‘Help us get as good as we can be.’”

Deitch says debates over how much money jails need to improve
conditions must be tied to a larger conversation about reducing mass
incarceration. “While we’re waiting for facilities to shut down
and all these changes to be made in society that will allow that to
happen, you can’t ignore the needs of people who are locked up
because they’re suffering,” she says. Currently, jail regulations
do little to address broader issues with treatment or culture. “The
most common sentiment we hear from people is how they’re not even
looked at as human beings,” Gundu says. “Your safety doesn’t
matter. You don’t matter. … As soon as you go in, you just don’t
count.”

At least 10 people have died at the Nueces County Jail since Danny was
killed. That includes one man confined to the same cellblock, who
spoke with the Rangers hours after Danny died. He told them Danny was
struggling with hallucinations and that he tried to comfort him by
saying, “Pray, just pray that it’ll go away.” Guards found the
man, 65, dead in his cell from heart failure nearly five months later.
People incarcerated with him told the Rangers that he, too, had
struggled to get medical treatment.  

Armando Carrillo, Danny’s father, waited for hours outside the
Nueces County Courthouse the night guards killed his son inside the
jail next door. Danny Carrillo died in custody, the Nueces County
Medical Examiner’s Office called Danny’s death a homicide, listing
the cause as “sudden cardiac death during restraint procedures.”
Ivan Armando Flores / Texas Observer

A lawsuit filed in September against Nueces County and the jail’s
contracted medical provider at the time, Wellpath, says that Anthony
Thompson, 50, wasn’t given insulin during his 72 hours in jail in
2019, though he told jailers he was diabetic on at least three medical
screening forms and also called his mother, whom he lived with, about
his medication when he was booked. His brother, Joshua Wayne Smith,
says Thompson always kept his diabetes under control, taking his
insulin regularly. But after three days in jail for a DWI charge,
Thompson died from diabetic ketoacidosis, according to an autopsy
report. 

Complaints of medical neglect in lockups often land at the feet of
companies like Wellpath, the country’s largest for-profit medical
provider for jails. Wellpath treated people at the Nueces County Jail
from 2015 until late 2020. Lawsuits have accused Wellpath of deadly
care in lockups across the country, and a recent _CNN_ investigation
[[link removed]] found
that it failed to train workers and adequately staff facilities. The
Rangers investigation into Thompson’s death found that he was also
denied medicine to help with alcohol detoxing because the jail
didn’t have any; Wellpath employees who failed to share information
from his medical screening forms with one another blamed a software
error. 

Last August, the Nueces County District Attorney’s Office told the
Rangers they could close their investigation into Thompson’s death
“due to his death being a result of natural causes.” Nueces County
DA Mark Gonzalez didn’t respond to multiple requests for comment. 

“The notion that a person could be arrested for a class A, class B
misdemeanor and lose their life because someone chose not to follow
basic processes in medical administration is unconscionable,” says
Matt Manning, the attorney representing Thompson’s family, who was
previously second in command at the Nueces DA’s office. “A DWI is
not a death sentence. It is not a capital crime in the state of
Texas.”

Smith describes his older brother as his “protector” growing up,
stepping in whenever he saw him getting bullied at school. Thompson
was a father of two and grandfather to four. Smith says his brother
tried to stay positive despite tragedies in his life, like losing his
wife at an early age. “He was the glass-half-full jokester.” While
he mourns the loss of his brother, Smith is also furious about how he
died. “It’s just pure neglect and lack of concern for another
human,” he says. “If he were at my mother’s, he would still be
alive, because he would have gotten his medicine. Now my mother lives
alone.”   

_If you or someone you know needs help, call 1-800-273-8255 for the
National Suicide Prevention Lifeline._

_This story was made possible through the support of the Fund for
Investigative Journalism._

_MICHAEL BARAJAS
[[link removed]] is a staff
writer covering civil rights for the Texas Observer. Before joining
the Observer, he was editor of the San Antonio Current and managing
editor of the Houston Press. He holds a bachelor’s degree from Ohio
University’s E.W. Scripps School of Journalism._

_SOPHIE NOVACK
[[link removed]] is an editor
and reporter at the Texas Observer, where she mostly writes about
public health. She was previously a staff correspondent at National
Journal in Washington, D.C., where she covered health care nationally
and started reporting on reproductive health policy in Texas from
afar. She has a bachelor’s degree in English from Dartmouth
College._

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