Ondi Ratcliffe waited for months to learn how, exactly, her uncle died in his cell in the booking area of the Spokane County Jail.

After countless phone calls to the medical examiner’s office from her home in Western Washington, Ratcliffe received an answer this week that only adds to the family’s frustration.

The official, clinical-sounding cause of death – “pulmonary aspiration of gastric contents due to combined opiate and methamphetamine intoxication” – completes a troubling image of how David Good died in the early hours of March 1.

Put simply, Good, a 52-year-old former semitruck mechanic with a long history of substance abuse, choked on his vomit and died in his cell more than 10 hours after he was booked, even though he was supposed to be monitored for signs that he was sick from withdrawal.

According to public records previously reported by The Spokesman-Review, jail staff were supposed to check on Good every 15 minutes, but 32 minutes elapsed between his last check and the time a corrections officer noticed him lying motionless on the cell floor. By then, records indicate, Good had already breathed his last breath.

After receiving toxicology results from the state’s crime laboratory, the medical examiner’s office categorized Good’s death as an accident. Emphysema and hypertensive heart disease are listed as contributing factors.

Good spent much of his life in the Seattle area before moving several years ago to Spokane, where he appears to have become homeless. Before his death, he was arrested at Deaconess Hospital on warrants stemming from months-old charges of trespassing, reckless burning and violations of Spokane’s “sit-lie” ordinance, which is intended to prevent loitering on downtown sidewalks.

In a phone call Wednesday, Ratcliffe said her uncle and his death were topics of much discussion at a recent family reunion.

“We all just love him and miss him,” she said. “No matter how hard he was living, he was a good guy.”

Good was the third person to die in Spokane County’s custody since June 2017. Another five inmate deaths have followed with increasing frequency. On average in 2018, one inmate has died every 34 days.

Most recently, on Saturday evening, 55-year-old Cindy Lou Hill, who was in jail on a charge of drug possession, was found unresponsive in her cell and rushed to a local hospital, where she was pronounced dead. The medical examiner’s office has confirmed she died of acute peritonitis, an often-painful inflammation of the silklike membrane that lines the abdominal wall and organs.

Spokane County contracts with an Alabama company, NaphCare Inc., to administer inmates’ medical care. It’s unclear what, if any, treatment Hill had received during her four-day incarceration.

Of the eight inmates who died in the past 14 months, six were men and two were women. The youngest was 24. The oldest was 56.

Three died after hanging themselves with bedsheets in their cells, prompting jail officials to call in a suicide-prevention expert and begin removing inmates’ bedsheets. One died after getting into a fistfight with a cellmate, who is now charged with second-degree manslaughter. Two deaths remain under investigation but appear to be related to drug withdrawal.

While detectives from the Spokane County Sheriff’s Office are tasked with investigating inmate deaths, the sheriff’s office has not operated the downtown jail or Geiger Corrections Center since 2013, when oversight of the two lockups was handed to the county commissioners. John McGrath is the appointed director of detention services.

In an interview Monday, Layne Pavey, a local activist who runs a business that helps connect the formerly incarcerated with stable housing, said she had heard many troubling accounts about conditions inside the jail.

“What we do know about the jail is that people are constantly calling people to help in emergencies, and the guards are not coming as quickly as they should be,” Pavey said. “We hear a lot about the lack of checking on people.”

Gordon Smith, the representative for the Spokane County corrections officers union, pushed back on those comments in a statement released Thursday evening. He wrote that the jail is overcrowded and understaffed, and that blaming the jail’s rank and file “shows a lack of understanding, pervasive in our community, of the true issues.”

When the downtown jail was built in 1986, it was designed to hold 462 inmates. As it quickly overflowed, additional cells were built in the adjacent Public Safety Building, and later the old Air Force barracks at Geiger were renovated to house even more inmates.

Efforts to reduce the county’s jail population have largely failed despite a targeted grant from the MacArthur Foundation. The average jail population in July was 980. The goal for that month, set by the Spokane Regional Law and Justice Council, was 805.

In his statement, Smith noted that the jail was originally designed for “direct supervision,” a management strategy in which inmates are allowed into common areas during the day with access to TV, books, phones, games and other activities.

“When adequately staffed, this model reduces inmate-on-inmate assaults, assaults on staff, inmate suicides and enhances response time to medical emergencies,” Smith wrote. “The Spokane County Jail is not adequately staffed, simply put. For years it has been operated more like a maximum-security prison, more so than what it was designed for: a pre-trial jail. There can be times where an individual corrections officer can be responsible for up to 184 inmates.”

Smith wrote that corrections officers “have little power to effect the changes that are necessary.” But he said they take pride in their successes – “such as successfully intervening in six serious suicide attempts this past weekend alone.”

“Corrections officers are not immune from the trauma,” he added. “I would never suggest that the pain is equal to the pain felt by the family members of those lost, but clients who die in custody take a serious toll on staff, no less than that of state troopers, patrol deputies and firefighters who must deal with horrific situations in the field.”