Jacksonville’s jail death rate tripled after privatizing medical care

Some of those deaths include people who died in custody, like 33-year-old Amanda Howard and 28-year-old Lina Odom. Others, not reported by the Sheriff’s Office, died shortly after their release, like Dexter Barry.

Barry, 54, went two days in jail without anti-rejection medications for his transplanted heart and died after he was released. Howard died of diabetic ketoacidosis, which can occur when someone with Type 1 diabetes doesn’t get their insulin. And Odom died after her extreme alcohol withdrawal symptoms were ignored, according to her family’s settled lawsuit.

The City of Jacksonville ended its in-house medical care in October 2017 and hired Armor – a for-profit, private company – to run the jail’s health care. The last year the city used its own medical care, there were two deaths in the jail. The first year under Armor, there were 9. That increased rate has continued.

“I will say that there have been things that have happened that shouldn’t have happened,” Sheriff T.K. Waters told The Tributary in an interview about the jail last Tuesday. “It’s what probably takes place in just about every healthcare system inside of a facility like that.”

The city renewed its five-year contract with Armor on Oct. 24, weeks before Waters became sheriff. 

Waters previously said in an emailed statement that he worked with Armor personnel “to improve processes and resolve challenges that were brought to their attention” after The Tributary reported on Barry’s death. Last week, he said he couldn’t yet give more information on that review.

“I’m not trying to evade your questions. I just can’t answer a whole bunch right now,” he said, adding that he knows “people want me to just say, ‘Boom, this is what’s going to happen,’ but in order to do it right and do it justice, I have to make sure that I’m doing things the right way with all the information and making the right decisions.”

“I will say this,” he said. “The entire city will know about Armor and what I feel about them very shortly.” 

The Tributary’s reporting sparked an ongoing Sheriff’s Office review of Barry’s death and a state investigation into Armor’s failure to report that it had been convicted after another death elsewhere. Florida law prohibits public agencies from signing contracts with convicted companies.

It’s unclear how many Florida counties have contracts with Armor. That data isn’t kept by the state, and Armor has yet to provide the Tributary with copies of its current contracts. The Tributary found that contracts between the company and at least eight Florida counties have been dropped over the last few years for various reasons including a lack of accountability or inadequate care provided by the company’s employees.

Dante Trevisani, the executive director of the Florida Justice Institute, said the FJI receives complaints about poor health care in jails across the state, many of which use private contractors.

“These are human beings who deserve to be taken care of, especially if the state or the county has taken custody of them,” he said. “They have a moral and … a legal responsibility to care for them.”

During a townhall last week, the sheriff told the 1,200 people in attendance it’s his responsibility to make sure anyone who is inside that jail is safe and secure. While answering a question about the possibility of relocating the jail, Waters said, “a lot of safety issues are about the people that are inside there, and it’s my responsibility to make sure that they’re safe.”

Other issues with Armor health care

Armor Correctional Health Services’ role at the jail has come under fire since The Tributary first reported on Barry’s death in May.

Barry’s life-sustaining medications were, according to Armor, ordered but not received before he was released two days later in November 2022.  He died of a cardiac arrest caused by an autoimmune attack on his heart, according to an autopsy his family ordered. Armor’s chief operating officer disputed whether Barry’s missed medication caused his death.

The next month, at least eight more people reported that they didn’t receive their medication, according to interviews and records reviewed by The Tributary.

A Jacksonville mother told an attorney that her son wasn’t given his psychotropic medication for five days. The same day, a 48-year-old woman told a different attorney that she didn’t get her Zoloft prescription for five days. One man reported that he didn’t get his heart or blood thinner medication, which resulted in his legs swelling. Another person was injured in the jail but wasn’t treated. 

In early June, a Jacksonville woman contacted The Tributary, saying her Type 1 diabetic sister didn’t get her insulin after she was arrested. JSO declined to answer questions or provide records about the woman, citing privacy laws. 

An Armor spokesperson said there are many things that could prevent someone from getting their medications.

“For example, if a detainee is unruly, Armor will not have access to administer the detainee their medication,” the company said in an email. “The detainee may also refuse their medications. In addition, if the detainee is offsite at a court appearance, a specialty consultation, or hospitalized, Armor is unable to administer their medications. Lastly, if a medication is not onsite, it has to be ordered.”

Armor refused to answer questions about Rainbolt, Howard, Odom or the woman who went without her insulin in June because the company doesn’t comment on patient information. Armor settled a lawsuit with Odom’s family on July 12. Duval County settled with Odom’s family for $10,000 in September 2021.

Barry’s death is the only case Armor has directly addressed.

Frustrating release

Rainbolt was arrested on a Monday night. The eight days he spent in jail are the only time he said he’s ever skipped his medications – he has six different prescriptions, including an insulin shot for his Type 2 diabetes.

About four days into his incarceration, Rainbolt said, he was given “some kind of insulin shot,” but it didn’t make him feel better.

When he first got to the jail, Rainbolt assumed he’d get his medications because the arresting officer brought them with him – but he didn’t, despite telling the nursing staff what medications he took and why. He panicked and tried to call his sons, but he had trouble using the jail’s phone system. 

“Just by pure luck, I have a daughter who lives in New York, and I keep in touch with her on my laptop,” he said. “I email her once a day, and after about five days when she hadn’t heard from me, she contacted my two sons here in Jacksonville and they tried to nail down what happened to me.”

Kristin Rainbolt, 42, said the process of getting her father out of jail was frustrating and arduous. Before she knew he had been arrested, she called JSO and asked officers to perform a welfare check because she couldn’t reach him. Nothing happened. On her second call with JSO, she was told about her father’s arrest. 

“I was trying to get a hold of him, and you have to go through this system and pay” to communicate with him, she said. “I put $200 down, and never got to speak with him. I don’t know where that money is now.”

Eventually, Rainbolt’s kids paid his $5,003 bond, and he left jail – but he said he now suffers long-term physical effects from missing his medications.

Medical deaths under Armor

While some people, such as Rainbolt, can survive without their prescriptions, others can’t. Missed doses could have contributed to the jail’s tripled annual death rate since Armor took over its health care.

The Tributary analyzed 46 autopsies of the 109 deaths in the jail since 2010. The Tributary is still awaiting autopsies for deaths that occurred between 2010 and 2019.

At least 44 deaths since 2018 can be attributed to medical issues, according to an analysis of autopsies and JSO death investigations by The Tributary. These include deaths from any type of pre-existing condition (14), COVID (9), pneumonia (3), seizures (2),  suicides (8) and overdoses or withdrawals (8).

It begs the question: Would some of these people still be alive if they were never arrested?

NR Hines, a criminal justice policy strategist at the ACLU of Florida, said it’s difficult to pinpoint how many people die in jail due to lax medical intervention because of a lack of information – oftentimes, those deaths are labeled as “natural” and further investigation is never done.

“What we see is that this harm is extremely common in jails and prisons, but the general sentiment of society is that it’s acceptable because this person is in custody,” Hines said. “That, to a lot of people, removes the humanity of the person.”

According to a 2020 Reuters investigation, U.S. jails with medical services run by the sheriff’s office or local health department, on average, had 12.8 deaths per 10,000 inmates a year.

Jails with healthcare provided by the top 5 privatized companies, including Armor, had an additional 2.3 to 7.4 annual deaths per 10,000 inmates.

Jails where Armor operated had the second highest death rate in the investigation’s three-year period at 18.8 deaths per 10,000 inmates, Reuters found. The investigation analyzed data from 2016 to 2018. Nine people died at the Duval County jail in 2018, Armor’s first year in Duval.

Mismanaged withdrawal

Lina Odom died in the Duval jail in 2018 when she was 28 years old. Her family’s attorney, Jack Cook, said that Armor nurses and jail staff ignored her extreme alcohol and drug withdrawal symptoms.

“People like Lina are usually put under observation,” Cook said. “That’s what you need to do because as they are withdrawing, they’re in a danger zone. There are various reasons for that. They’re not hydrated. They can go into cardiac arrest. They have diarrhea. They can throw up and aspirate.”

Odom had a tough childhood, Cook said. She was separated from her father and fraternal grandmother at an early age, he said, and introduced to cigarettes by her mother at age 11.

Her father, Danny, spent the next 15 years trying to get Odom to live with him, the attorney said. By the time she was a teen, Odom started using drugs. As an adult, Odom struggled to maintain sobriety.

“Sadly, her father’s mental health has gone completely south since the loss of his daughter,” Cook said. “He’s a colorful character himself, and her grandmother is the same. She’s an old-world Italian nonna. These two were fighting hard for this girl’s sobriety.”

Cook filed a lawsuit against Armor on behalf of Odom’s father in 2020. According to that lawsuit and jail records, Odom was arrested twice in April 2018.

The first time, she was there for one day and medical records note that she had needle marks up and down her arms. Odom told nurses that she used crack and heroin daily, so she was placed under detox protocols, which usually comes with an added level of care. 

However, her second arrest, on April 22, went differently. 

Despite knowing her history and Odom again admitting that she was a daily drug user, she was never put under special observation, according to the settled lawsuit.

Instead of being medically evaluated, Cook said, Odom was sent to a mental health counselor because she kept falling asleep during questioning. She told the counselor that she wasn’t suicidal and had no diagnosis other than being “dope sick,” according to the lawsuit. 

Despite one nurse noting that Odom needed to be under withdrawal procedures, she was placed with the general population two days later, even after telling an Armor nurse that she was still withdrawing, Cook said.

“They throw her in gen pop; they mildly observe her, and she’s getting sicker and sicker, and she keeps going to the medical nurses, and they keep sending her back,” Cook said. “People like Lina belong in a hospital. They belong some place where they can get the treatment.”

An autopsy showed that Odom had cocaine in her system, according to the lawsuit. 

“Her withdrawal symptoms could have been easily managed,” Cook said. 

Cook said he hasn’t seen any compassion from Armor representatives since the lawsuit was filed. Cook repeatedly asked Armor to “do the right thing” by admitting their negligence, settling and doing better for patients in the future. On July 12, he got his wish, and Armor agreed to settle.

Cook isn’t the first person to notice Armor’s lack of compassion toward those who died. In Flagler County, Sheriff Rick Staly ended his department’s contract in 2019 after the death of 23-year-old Anthony Fennick, who suffered a medical episode.

“In response to this tragedy, Armor has shown little interest in anything other than denying responsibility and trying to bill us for even more money,” Staly said at the time.

Lina Odom’s Timeline

Lasting effects

The day after he was released, Rainbolt, the diabetic, said he passed out as he waited in line to pick up his ankle monitor. 

“I kept complaining that I was feeling weak, and then the next thing I know I was on a stretcher and in an ambulance,” he said. 

He received a hospital bill for $29,584.58, which included the ambulance ride, lab tests, radiology and a cat scan among other tests. After insurance agreed to cover most of the bill, Rainbolt was still on the hook for $475.

“I believe that T.K. Waters or someone in the Sheriff’s Office should pay that,” he told The Tributary. “It’s their fault all of that happened.”

Rainbolt uses a cane to walk now, saying, “I don’t feel as stable walking as I used to.”

Kristin blames her father’s sudden health decline on the care he didn’t receive in jail. She said he lost weight because he ate so little when he was missing his medication. The man who once did crossword puzzles daily and could spar in conversations now easily forgets things, Kristin said. 

“When he was first released, it was like I was talking to someone with dementia,” she said. “He’s improved, but this isn’t the same dad I had before he was arrested.”

Kristin doesn’t know what happened to the medications that Rainbolt said were brought to jail with him. When his family picked him up, they found him on a bench with the clothes he wore when he was arrested and a few personal items.

The Tributary requested a copy of Rainbolt’s jail property receipt, which should show what he brought into the jail and left with, but JSO declined the request, citing his ongoing criminal case. The department declined to release body camera footage of Rainbolt’s arrest for the same reason.

Court records show that Rainbolt, who was arrested for allegedly making threats online, has been approved for pre-trial diversion.

He hopes employees at the jail learn to listen to inmates because it’s about more than just medications. 

“I’m glad,” Rainbolt said, “I got out alive.”