If you read "60 Dead Inmates," our five-part investigative series, reported and written by Kelly Davis and Dave Maass, examining the fatalities that occurred in San Diego County jails from 2007 to 2012, you were no doubt left with the impression that the attitude of the San Diego Sheriff's Department, which oversees the jail system, is basically this: So what?
Is 60 dead inmates in six years a lot? If you look at the number the way the U.S. Bureau of Justice Statistics (BJS) does, which is the same way major health organizations like the Centers for Disease Control do, it is. Those agencies use the mortality rate, which is the number of deaths divided by a jail or prison system's average daily population—the average number of prisoners in the facility on any given day in a year. It's the standard formula because it allows for comparisons in facilities across the country.
Of the 10 largest jail systems in California, San Diego County had the highest average mortality rate from 2007 to 2012: 202 deaths per 100,000 inmates.
The local Sheriff's Department doesn't use the mortality rate; it uses the "at-risk" rate, which is the number of deaths divided by the total number of bookings in a year. But the BJS doesn't use bookings-related data because high turnover in jails skews the data. Lindsey Hayes, project director at the National Center on Institutions & Alternatives, told us that the BJS "has been using the calculation of average daily population for 20 or 30 years or more, and no one complains about it unless they have a higher rate than the national average."
Since the Sheriff's Department doesn't use the standard formula, it apparently doesn't need to acknowledge that there's a problem, and the conversation ends.
But there is a problem. Using the mortality rate, if there were 17 fewer deaths between 2007 and 2012, San Diego County would've landed in the middle of the state's 10 largest jail systems. Our examination of the circumstances surrounding all 60 deaths showed that at least 19 of them were preventable. Some of the them, like the case of 35-year-old Tommy Tucker, featured in Part 2 of our series, involved excessive use of force. Others involved overdoses of drugs inmates shouldn't have had in their possession.
And many cases involved an egregious lack of monitoring of at-risk inmates' condition, even when other inmates alerted guards to cellmates in crisis. Indeed, failure to properly monitor inmates who were going through withdrawal from drugs, like 21- year-old Daniel Sisson, who was profiled in Part 3, or suicidal, like 39-year-old Shane Hipfel, who was featured in Part 4, was a thread that ran throughout our investigation—simple regular cell checks would've prevented some of these deaths.
The Sheriff's Department could have responded by saying our findings raised important questions, promising to look into the details and reexamine its policies if necessary. It didn't. It simply said that it takes all inmates deaths seriously and regularly ensures that its policies are being followed, stopping short of even acknowledging that the number of deaths is high.
Further underscoring the need for scrutiny is the fact that five inmates have died in county jails so far this year—two from drug overdoses and three by suicide.
We wish we could say that we have confidence in the entities that should be providing oversight—the county Grand Jury, the District Attorney's office, the county Board of Supervisors and, particularly, the Citizens Law Enforcement Review Board (CLERB). We don't.
The Sheriff's Department must initiate a review of recent deaths, ideally bringing in a consultant from outside the department to lead it. If Sheriff Bill Gore is unwilling to do so, the Board of Supervisors and CLERB must compel him to act. The department must also start treating the families of dead inmates with respect. A troubling pattern that we noticed in our reporting was how impossible it's been for families to get basic factual information; they sometimes have to sue the county to learn what happened, unnecessarily costing taxpayers money.
We recognize the difficulties in managing thousands of inmates, many of whom are mentally ill and/or drug-addicted. People who land in jail typically haven't been great at taking care of themselves.
But we'll leave you with a quote from Marc Stern, an expert in healthcare in correctional facilities and one of the folks we spoke to amid our research: "Dostoyevsky said one can judge a society by the way it treats its prisoners; the sentence is being in prison, not dying from poor healthcare."
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