Deaths in Custody: A 25-Year Review of Jail Deaths in Bexar County, Texas.

Although deaths in custody are an expected occurrence, they are often subjected to increased scrutiny and raise many questions as to circumstances surrounding the death as well as the cause and manner of death. It is usually the responsibility of the medical examiner to answer these questions. Relatively few studies have reviewed the causes and manners of death that occur while in custody and even fewer specific to jail populations. This study reviews the cause and manner of death of persons in custody in an urban county from 1985 to 2010. A retrospective review of death investigations, including death certificates and autopsy reports, was conducted on all deaths that occurred in custody during the period. The age and sex of the decedent as well as the place of death were also recorded. Most deaths were attributed to natural disease followed by suicide, and most deaths occurred either in the emergency department or in the hospital. Regarding the cause of death, cardiovascular disease followed by suicide by hanging accounted for the most number of deaths (25% and 20% of all deaths, respectively). It is recommended that all deaths in custody be reported to the medical examiner and that a thorough death investigation be conducted to properly define and document the cause and manner of death. This is particularly important given the increased scrutiny to which deaths in custody are often subjected.