Dying Inside: Legal Standards, Litigation, and Strategies for Addressing Drug-Related Deaths in Jail Custody

Local jails must provide healthcare for incarcerated people, many of whom have complex health conditions. Public reporting and litigation have shown that a failure to meet standards of care can lead to preventable deaths in custody. According to the Bureau of Justice Statistics, deaths in jails due to drug or alcohol intoxication increased almost 19% from 2017 to 2018 and more than quadrupled between 2000 and 2018. Substance-related deaths in jail custody reflect a range of interconnected and complex issues, including lack of training, inadequate withdrawal management and medical care, inadequate suicide prevention protocol, and excessive use of force by correctional officers. As stimulant-related harms increase, and as substance-related deaths in jails rise at alarming rates, a targeted focus on correctional settings may reduce jail mortality.

The discussion will begin by highlighting trends in substance-related deaths and related conditions in jails. We will discuss strategies to reduce high-risk conditions of confinement and decrease litigation exposure stemming from lack of proper withdrawal management. Using a novel dataset of jury verdicts, settlements, and dockets of civil lawsuits from 2015-2020 brought by the estates of individuals who died in jail custody, we will review common fact patterns that resulted in these deaths. We will then provide recommendations for government officials, healthcare providers, and jail administrators on implementing withdrawal management protocols in jails. Finally, we will review model withdrawal management state legislation.