Deaths from Diabetic Ketoacidosis in County Jails are Preventable

Introduction

Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes that occurs when the body produces excessive ketones due to a lack of insulin. If left untreated, DKA can lead to coma and death within hours or days. While it is a preventable and treatable condition, deaths from DKA continue to occur in county jails across the United States, raising serious concerns about medical neglect, inadequate jail policies, and systemic failures in the correctional healthcare system.

This blog post explores the prevalence of DKA-related deaths in county jails, the factors contributing to these fatalities, legal implications, and potential reforms to prevent such tragedies in the future.  Our jail death law firm deals with unfortunate deaths occuring from numerous causes, most often the failure to provide emergcncy medical care.

Understanding Diabetic Ketoacidosis

DKA occurs when the body cannot use glucose due to insufficient insulin, forcing it to break down fat for energy. This process produces ketones, which make the blood acidic. The condition can develop rapidly, often within 24 hours, and is marked by symptoms such as:

• Extreme thirst and dehydration
• Frequent urination
• Nausea and vomiting
• Abdominal pain
• Rapid breathing
• Fruity-smelling breath
• Confusion or unconsciousness

Without immediate medical intervention—typically including insulin administration, intravenous fluids, and electrolyte replacement—DKA can result in death. For individuals in county jails, access to timely medical care can mean the difference between life and death.  Some jails employ their own medical personnel, others employ third-party companies to provide medical personnel, while others provide no medical personnel at all.  Our law firm has seen all three situations.

The Growing Crisis of DKA Deaths in County Jails

Reports of individuals dying from DKA in county jails have become alarmingly frequent. In many cases, incarcerated individuals with known diabetes are denied medication, ignored when they report symptoms, or misdiagnosed by untrained jail staff. Some are left to deteriorate in their cells without medical attention, leading to preventable fatalities. A study by the Bureau of Justice Statistics found that diabetes-related deaths in U.S. jails have increased over the past two decades. Many of these deaths stem from DKA, highlighting systemic failures in providing basic healthcare to incarcerated individuals.

These are Some Notable Cases

1. Terrill Thomas (Milwaukee County Jail, 2016)
   Thomas, a 38-year-old man allegedly with bipolar disorder and diabetes, was denied water and medical attention for seven days in jail. He died from dehydration and DKA. An investigation revealed that jail staff had shut off his water supply as punishment. Some officers were charged and convicted for their role in his death.

2. Michael Robinson (Broward County Jail, 2022)
   Robinson, a 33-year-old man with type 1 diabetes, repeatedly requested insulin while in custody. Despite showing clear symptoms of DKA, jail staff failed to provide necessary medical care. He was later found unresponsive in his cell and died from complications of untreated diabetes.

3. Shannon Muck (Galveston County Jail, 2019)
   Muck, a 39-year-old woman with type 1 diabetes, was arrested for a minor offense. While in jail, her insulin pump was taken away, and she was denied medical attention despite exhibiting severe symptoms of DKA. Her death was later ruled preventable, and her family filed a wrongful jail death lawsuit.

These cases, among many others, illustrate the devastating consequences of failing to provide adequate medical care for incarcerated individuals with diabetes.  Diabetes is a manageable illness, both inside and outside jails.

Contributing Factors

Several systemic issues contribute to the high incidence of DKA deaths in county jails:

1. Medical Neglect and Understaffing

Many county jails lack sufficient medical personnel, particularly those trained in chronic disease management. Some jails have only one nurse on duty for hundreds of inmates, making it difficult to monitor and respond to medical emergencies. In some cases, officers—not medical professionals—are left to determine whether an inmate requires urgent care, leading to deadly delays.

2. Denial or Delay of Insulin and Medical Treatment

Incarcerated individuals with diabetes require regular insulin injections, blood sugar monitoring, and access to proper nutrition. However, many jails fail to provide insulin in a timely manner. Some jails confiscate insulin pumps and glucose monitors upon intake, leaving diabetic inmates vulnerable to severe complications.

3. Lack of Training Among Jail Staff

Correctional officers are often untrained in recognizing the signs of DKA. Many jails lack clear protocols for identifying and responding to diabetic emergencies, leading to misdiagnosis or disregard of serious symptoms.  We find this to be similar to cases in which we have represented families of people dying in jail from sepsis, where jailers are not trained at all about sepsis.

4. Inadequate Screening During Intake

Proper medical screening upon arrest is crucial for identifying inmates with diabetes. However, many jails conduct only basic health assessments, failing to document chronic conditions. This can result in diabetic inmates being housed without proper medical oversight, increasing the risk of DKA.

5. Punitive Jail Policies

Some jails operate under a culture of punishment rather than rehabilitation. In many reported cases, diabetic inmates exhibiting signs of distress have been accused of faking illness, denied care as punishment, or left untreated in isolation cells. This cruel disregard for medical needs has led to unnecessary suffering and death.

Legal and Ethical Implications

The U.S. Constitution guarantees incarcerated convicted individuals the right to adequate medical care under the Eighth Amendment, which prohibits cruel and unusual punishment, and pretrial detainees under the Fourteenth Amendment. When jail officials deny necessary medical treatment, they can be held legally accountable.

Wrongful Death Lawsuits

Families of individuals who have died from untreated DKA in jail often file wrongful death lawsuits against the county and jail and/or medical staff. These lawsuits claim medical negligence and/or violation of constitutional rights.

Potential Reforms and Solutions

Preventing DKA-related deaths in county jails requires systemic reforms in correctional healthcare. Key recommendations include:

1. Mandatory Medical Training for Jail Staff

All correctional officers and jail personnel should receive training on recognizing and responding to diabetic emergencies. This includes identifying DKA symptoms and understanding the urgency of insulin administration.

2. Improved Medical Screening and Monitoring

Jails must implement thorough medical intake screenings to identify individuals with diabetes. Continuous glucose monitoring and regular medical check-ups should be mandatory for diabetic inmates.

3. Access to Insulin and Medical Devices

Diabetic inmates should have uninterrupted access to insulin, glucose monitors, and other necessary medical devices. Policies that confiscate insulin pumps should be abolished.

4. Independent Medical Oversight

County jails should be subject to independent medical oversight to ensure compliance with healthcare standards. Regular audits and unannounced inspections can help identify and correct deficiencies in medical care.  Some state agencies already conduct such inspections, such as the Texas Commission on Jail Standards.

5. Accountability for Negligence

Jail officials and healthcare providers who fail to provide adequate care should face legal consequences. Holding individuals accountable for medical neglect and deliberate indifference can serve as a deterrent against future violations.

6. Alternatives to Incarceration for Nonviolent Offenders

Many individuals with chronic medical conditions are jailed for minor offenses, such as unpaid fines or drug possession. Expanding alternatives to incarceration, such as community service or electronic monitoring, can reduce unnecessary exposure to inadequate jail healthcare.

Conclusion

Deaths from diabetic ketoacidosis in county jails are preventable tragedies that highlight serious deficiencies in the correctional healthcare system. These fatalities are often the result of medical neglect, poor training, and systemic indifference to the health of incarcerated individuals. Reforming jail healthcare policies, improving staff training, and holding negligent officials accountable are essential steps in preventing further unnecessary deaths. By addressing these failures, we can ensure that individuals with diabetes receive the medical care they need, regardless of their incarceration status, and uphold their fundamental human rights.  Civil rights lawsuits by families can also deter jails from giving short shrift to medical needs of county jail detainees.

Written By: Dean Malone

Dean Malone

Dean Malone is the founder of Law Offices of Dean Malone, P.C., a jail neglect civil rights law firm. Mr. Malone earned his bachelor's degree at the University of Texas at Dallas, graduating summa cum laude with a 4.0 GPA, and from Baylor University School of Law with a general civil litigation concentration. Mr. Malone served in several staff positions for the Baylor Law Review, including executive editor. Mr. Malone is an experienced trial lawyer, trying a number of cases to jury verdict and also handling arbitrations through final hearing. He heads the jail neglect section of his law firm, in which lawyers litigate cases involving serious injury and death resulting from jail neglect and abuse. Lawyers frequently refer cases to Mr. Malone due to his focus on this very complicated civil rights practice area.