A New Project at Yale Examines In-Custody Starvation Deaths

A disturbing new report from The New Yorker, produced in collaboration with the Investigative Reporting Lab at Yale, found that more than fifty people have died from starvation while in custody in American jails over the past decade and a half. The Yale program has also launched a website, Starved for Care, that provides an in-depth look at the stories of more than two dozen people starved to death in the jail system. Due to spotty record-keeping in the carceral system, the cases discovered by the reporters almost certainly do not capture the full scale of the problem.

The New Yorker’s report focuses on the case of Mary Faith Casey, who died after spending four months in the Pima County Jail in Tucson, Arizona. Casey was diagnosed with schizophrenia, post traumatic stress disorder and bipolar disorder and was homeless at the time of her arrest. According to the report, Casey spent four months in jail after a security guard called police to report her as a “nuisance” and she was taken into custody due to her failure to register a change of address after being released on probation for a previous minor charge. 

Believing jail staff was trying to poison her, Casey refused to eat for prolonged periods during her incarceration. Instead of transferring her to a hospital, jail staff kept her in the Pima County Jail and failed to bring her to several court dates. Four months after her arrest, Casey was finally brought to court, having dropped from 145 pounds down to 91 pounds. During her time in the Pima County Jail, she was held “incommunicado,” according to family members, as the jail claimed she wasn’t eligible for online communication. She had informed medical staff at the jail of her mental health struggles, but they simply noted she was “alert,” “responsive,” and “cooperative,” and had a “flat” affect. 

When she was finally brought to court, Casey was covered in open sores, looking “skeletal,” and had to wear a diaper and be transported in a wheelchair.  The judge was so alarmed by the sight of Casey that he ordered her immediate release into a local hospital for emergency care. Doctors noted she had been suffering from “severe” malnutrition.

After a month in the hospital, she was released to hospice care at her sister’s home, and she died shortly after. Her family is suing county and jail officials, alleging “constitutionally inadequate care” that caused her death. The suit also names NaphCare, a private company that provides medical services to the Pima County Jail. A lawyer working on the case told The New Yorker that her extreme weight loss was the “res ipsa loquitor” of the case–in other words, her malnutrition was so severe that it proved in and of itself that the jail had acted negligently in caring for her. Casey’s family is still struggling to understand how this could have happened to her inside an American jail, and has never been provided a clear explanation of what exactly went wrong during her time in the Pima County Jail. 

The stories highlighted on the Starved for Care website are equally unconscionable. Lonnie Rupard, a 47-year-old father with a history of schizophrenia, died in San Diego Central Jail after three months in custody, during which he lost 60 pounds. A report from the county medical examiner’s office noted that “ultimately (Rupard) was dependent upon others for his care,” and classified the death as a homicide. 25-year-old Keaton Farris died from dehydration and malnutrition after jail staff at the Island County Jail in Washington State turned off the water in his cell. Protesters demanding justice for his death carried signs that read “he died thirsty.” The Starved for Care website contains links to news stories about these and other cases and, where available, court documents from lawsuits over the deaths.

The article in The New Yorker, written by journalist Sarah Stillman with assistance from Eliza Fawcett and Matt Nadel at Yale, makes the point that this experience could happen to anyone. Casey, for example, lived a “glamorous” lifestyle and was friends with Nike founder Phil Knight before her mental illness intensified and destabilized her life. 

And the death sentences imposed on the people highlighted by the project weren’t for serious crimes. “In nearly all the cases I reviewed, the individuals were locked up pretrial, often on questionable charges,” Stillman notes in the piece. No one deserves the treatment described in the article, regardless of the severity of the crime they’re accused of, but the fact that most of these cases involved low-level crimes highlights the arbitrary nature of American criminal punishment. 

Inadequate treatment for mental-health issues, a widespread problem in American prisons and jails, contributed to the starvation deaths in most or all of the cases highlighted by the report. Casey had refused to eat while incarcerated, believing that jail staff were attempting to poison her, but her situation was not treated as an emergency and she was left to languish for months in the Pima County Jail before a judge realized the severity of her situation. “Nearly every starvation or dehydration victim had been arrested in the midst of a mental-health crisis, often on petty charges tied to their psychiatric distress,” Stillman writes. 

The report also documents the difficulty in obtaining even the most basic information about the American carceral system, noting that “jail death data are surprisingly hard to obtain.” The article recounts efforts to get information from Los Angeles County jails. In response to a public records request, the Los Angeles Sheriff’s Department responded it was “unable to identify any records as responsive” to the request. The department later provided the reporters with a list of all in-custody deaths in Los Angeles County, and reporters discovered that the records documented the death of 33-year-old Sergio Silva, who died of “dehydration due to history of mental confusion.” 

The UCLA Law Behind Bars Data Project has faced similar difficulties in getting information about in-custody deaths, as states and counties often stonewall or provide incomplete information. 21 states provide us with no information at all about the circumstances of death for those who died in their custody, and 23 states withhold the names of those who died. 

Even working with limited data, we at the Behind Bars Data Project have found a major crisis of in-custody deaths. In 2021, the last year for which we have complete data, we documented 5,222 deaths in prisons and jails in the United States. In Arizona, where Mary Faith Casey was starved in custody, the project documented 161 in-custody deaths in 2021. These numbers are likely an undercount; among other factors, as The New Yorker’s piece points out, jails often release people on the brink of death so that they won’t have to count them in in-custody death statistics. 

Deaths in prisons and jails are an epidemic in the United States, a country with one of the highest incarceration rates in the world. The reporting by Stillman and the Yale team shines a light on the brutality of the American carceral system and the indifference that is too often shown to the lives of incarcerated people. The Behind Bars Data Project’s mission is to provide transparency on the crisis of in-custody deaths and provide policy makers and the public with the information they need to effectively drive change. We firmly believe a jail sentence should never be a death sentence, and we will continue to advocate for an end to in-custody deaths.