While in the custody of a county jail in Tucson, AZ, Casey had transformed from an energetic woman who maintained a healthy weight into a skeletal figure who could hardly move or speak. “She was just skin and bones,” her son, Carlin, said.

Casey, who struggled with mental health issues and was sometimes unhoused, was arrested in April 2022 on a probation violation. She spent several months awaiting her day in court at the Pima County Jail, where a for-profit corporation, NaphCare, was contracted to provide medical and mental healthcare.

But Casey did not receive her required psychiatric medications at the jail, according to her family. She grew fearful that the jail was trying to poison her and mostly ceased to eat or drink—a common symptom of untreated mental health issues. Jail and NaphCare staff were slow to intervene, and, on more than one occasion, Casey’s jailers did not bring her to her court dates. By summer’s end, Casey weighed well below 90 pounds. She was hospitalized multiple times, but was repeatedly sent back to the jail. A judge set aside her charges and ordered her emergency release to a hospital that August, but it was too late. She died soon after, in hospice, of “protein calorie malnutrition.”

Over the past year, the Lab has found evidence of more than 50 cases like Casey’s. Many follow a similar pattern: a person struggling with mental health issues was charged with a minor crime, placed in a local jail while awaiting trial or a hospital bed and left unable to access sufficient care. Person by person, they died of preventable causes, with starvation and dehydration often playing a significant role.

Meanwhile, in many of these jails, private corporations were paid millions to provide healthcare. We reached out to more than a dozen of these companies, including four that were responsible for the care of multiple people featured on this website. Most declined to comment on the specifics of the cases we identified; many cited patient privacy laws, pending litigation or confidential settlements. In some cases, the deaths took place in jails where healthcare was not privatized.

A spokesperson for NaphCare, the company responsible for Casey’s care, declined to discuss the details of her case, noting ongoing litigation, but said the company is “confident in the quality of care provided to our patients” and “committed to providing the highest quality healthcare to every patient.” NaphCare leadership also noted the company’s role in seeking out new forms of proactive care for people experiencing mental health crises in local jails and acknowledged the importance of community mental health resources that can help people avoid incarceration altogether.

We also reached out to two dozen sheriffs, counties and other government entities. Most declined to comment. But in Sebastian County, AR, Sheriff Hobe Runion acknowledged the need for change and noted that county jails are simply not the right venues for treating people in mental health crises, since “we’re not set up to care for them.” Runion said, of Larry Price’s starvation death in solitary confinement, “Gosh, it’s horrible… There’s no good way to spin it. So why try?” He added, “It’s horrendous, and I can’t make excuses.”

If you know of someone who died of starvation- or dehydration-related causes in a U.S. jail, please let us know.