How Jail Deaths Are Investigated

5 Surprising Truths About How In-Custody Deaths Are Investigated

Beyond the Yellow Tape

Forensic investigation, as portrayed on television, is often a world of swift certainty, where scientific tests point to an undeniable truth in under an hour. The reality, however, is far more complex. Determining the cause and manner of death, especially for an individual who dies in custody, is a painstaking process filled with scientific uncertainty, human judgment, and systemic challenges.

This complex process is the subject of a comprehensive report from the National Academies of Sciences, Engineering, and Medicine, which peels back the curtain on how these critical investigations are conducted. The report reveals a system that is often misunderstood by the public. This article explores five of the most surprising truths to emerge from that deep dive into the world of medicolegal death investigation.

1. A Single Autopsy Can Be a Monumental Investigation

The case of a 24-year-old man who died in a tribal prison, presented by Dr. Deland Weyrauch of the Montana Medical Examiner’s Office, illustrates the immense effort a single investigation can demand. The process began with a 4.5-hour drive just to transport the body to the autopsy facility. Before the first incision was made, Weyrauch had to collect and synthesize a wide array of information, including law enforcement reports, pre-incarceration medical records, and all available video footage from the prison. The physical examination itself was meticulous, involving procedures like the individual dissection of every neck muscle to search for subtle signs of injury.

The critical clue, however, did not come from a visible injury. A microscopic tissue examination revealed myoglobin casts in the kidneys, pointing to a diagnosis of rhabdomyolysis—a condition where muscle tissue breaks down. This diagnosis was particularly challenging because its symptoms “may be vague or absent in up to 50 percent of patients.” While Weyrauch now had a medical mechanism for the death, the manner of death—homicide, accident, or suicide—remained an open question. The definitive answer came not from a microscope, but from a single line buried in an ambulance report: the decedent’s statement that this was his “first attempt of suicide” after ingesting his psychiatric medications.

2. Controversial “Causes of Death” Are Often Not Real Medical Diagnoses

In some high-profile cases, the cause of death has been attributed to conditions that have little to no scientific or medical basis. These controversial terms can obscure the actual events that led to a person’s death.

One of the most prominent examples is “excited delirium.” The term has been frequently cited as a cause of death in cases where individuals, often in a state of extreme agitation, die during or after police restraint. Its history is as troubling as its application. Though never recognized as a formal medical diagnosis, a small group of authors, many with ties to TASER International (now Axon Enterprise), helped popularize the term by publishing articles in medical literature, creating a concept that could be used to explain deaths that occur after the use of conducted energy devices.

Major health organizations, including the American Medical Association (AMA) and the World Health Organization, do not recognize it as a legitimate medical diagnosis. A report from Florida revealed that of 85 deaths labeled as excited delirium since 2010, at least 62 percent involved the use of force by law enforcement. The lack of scientific standing for the term has led many professional organizations to disavow it.

In recent years, multiple organizations, including NAME [National Association of Medical Examiners] and the American College of Emergency Physicians, have formally withdrawn support for excited delirium as a legitimate diagnosis.

Another condition, Sickle Cell Trait (SCT), has been cited as a contributing factor in at least 46 in-custody deaths of Black individuals since the late 1990s, according to an investigation by The New York Times. Medical experts assert that SCT is a silent genetic condition, not a disease, and will not cause a fatal outcome by itself. The American Society of Hematology (ASH) has definitively stated that listing SCT as contributing to death is “erroneous and must be re-examined for the underlying cause of death.”

3. “Homicide” Doesn’t Mean What You Think It Means

One of the greatest sources of public confusion surrounding in-custody deaths is the gap between the medical definition of “homicide” and the legal one. The two are not interchangeable.

For a medical examiner or coroner, “homicide” is a neutral classification used for public health statistics. It does not imply criminal intent or assign legal blame. The official definition used in the medicolegal community makes this clear:

A “homicide occurs when death results from a volitional act committed by another person to cause fear, harm, or death. Intent to cause death is a common element but is not required for classification as homicide.”

For example, if a police officer justifiably shoots and kills a person who posed a lethal threat, a medical examiner will still designate the manner of death as “homicide.” This is because the death occurred “at the hands of another.” Whether a crime was committed is a separate question for the legal system to decide. This distinction is crucial, as it separates a medical classification based on actions from a legal judgment of guilt or intent.

4. Independent Audits Can Radically Change Official Findings

After controversial testimony from a former chief medical examiner in a high-profile case, an independent audit was launched to review more than a decade of in-custody death investigations in Maryland. The results were stunning and revealed deep inconsistencies between the original findings and the independent review.

The audit, which examined 87 cases of unexpected death during or soon after restraint, found the following:

• For more than half (44 of 87) of the cases, the independent reviewers’ opinion on the manner of death differed from the original ruling.
• Reviewers unanimously deemed 36 deaths to be homicides that the original office had ruled as either undetermined, accidental, or natural.
• The original office ruled deaths as homicides even less often if the decedent was Black or was restrained by police.
• In nearly half the cases, the original cause-of-death statement referenced “excited” or “agitated” delirium, a term now widely rejected as a valid diagnosis.

These findings suggest that the first story is not always the complete or correct one. The independent reviewers unearthed systemic issues, noting that the original autopsy reports often “failed to acknowledge restraint as a potential contributing factor” and frequently “did not provide adequate justification for their determinations.” They also identified “routine deficiencies in OCME’s post-mortem examinations, including the number, content, and quality of autopsy photographs,” highlighting a critical need for quality control and accountability.

A System in Need of Scrutiny

The process of medicolegal death investigation is not an infallible science but a deeply complex and fallible human system. It relies on extensive investigation, expert interpretation, and a commitment to objectivity that can be challenged by bias, external pressure, and inconsistent standards.

The case of LaShawn Thompson, who died in a Fulton County jail cell in 2022, provides a final, powerful illustration. Thompson was found in his cell covered in feces, with a severe bedbug infestation and body insect infection. His death was initially ruled “undetermined.” Only after a second, independent autopsy was the death reclassified as a “homicide” due to severe neglect. This new determination triggered a U.S. Department of Justice civil rights investigation into the jail’s conditions.

The Thompson case, along with the findings of the Maryland audit, forces a critical reflection. If the official story can be so wrong, what systems do we need to ensure that every death in custody receives the scrutiny it deserves?

Contact A Wrongful Death Lawyer Near You

Even if a loved one is incarcerated, they still retain fundamental rights, including the right to safety and humane treatment. If they pass away while in jail, it is crucial that their death is thoroughly investigated to ensure accountability. Authorities must examine the circumstances surrounding the incident, and if negligence or misconduct is found, those responsible should be held accountable to uphold justice. If you have lost a loved one who was in prison at the time of their death and feel that their death was avoidable we urge you to reach out to the team here at the Lovely Law Firm. We will do all we can to get you the answers you’re looking for and fight for justice. Contact our office to book a free case consultation with one of our wrongful death attorneys in Myrtle Beach.