While Armor has declined to seek court assistance to treat inmates over their wishes in the jail, the company has sought help outside the jail via the state's Baker Act, which allows people to be held involuntarily in a psychiatric facility for up to three days if they are a threat to themselves or others.

After five days in jail, Armor sent Herring to a psychiatric crisis center. Medical staff at Henderson Behavioral Health noted he was uncooperative, fasting and refusing medication during his three days there. They sent him back to the jail with no medication, according to Henderson records.

After another week of refusals, Herring became so dehydrated, jailers sent him to Broward Health North in Deerfield Beach, where a doctor declared him a danger to himself and ordered a shot of the anti-psychotic medication Haldol every eight hours for two days.

"The gentleman is critically ill and will need to be monitored closely in the intensive care unit," another doctor wrote, according to medical records.

After six days, hospital staff recommended Herring be discharged to a psychiatric facility, according to medical records. But a sheriff's deputy said Herring needed to return to the jail's infirmary.

Back in jail, Herring again refused medication, food and drink and was put back in isolation in the jail's infirmary. Martin, the jail psychiatrist, did not give him an emergency injection, as doctors at the hospital had done. After three days, Martin wondered if Herring might get help at a hearing the following day.

"Perhaps the judge will Baker Act him to a facility where he can be treated medically (and) psychiatrically," Martin wrote.

Herring collapsed before the Nov. 16 hearing and spent the last five weeks of his life in a coma at Broward Health Medical Center in Fort Lauderdale.

A judge released Herring from custody on Nov. 21 while he was on life support. That enabled Kaether to freely visit her son, and relieved Armor and the Sheriff's Office of the cost of his continued treatment. It also meant the Sheriff's Office did not investigate the circumstances of his death, because he was not in their custody when he died on Dec. 23, 2012.

Armor apparently didn't investigate either. In response to a court order in a lawsuit over another jail death, the company turned over investigations from that time period, and Herring's was not among them.

Armor is responsible to pay up to $50,000 for an inmate's care at an outside facility, according to the company's contract with the Sheriff's Office. The company does not have to pay when an inmate is sent to a psychiatric clinic under the Baker Act or to a state mental hospital after being found incompetent to stand trial.

That means Armor has a financial incentive not to send inmates to outside health care providers, Fort Lauderdale attorney Greg Lauer argued in a federal lawsuit on behalf of the family of Raleigh Priester, another inmate who died.

"They've made a promise with the sheriff and the people of Broward County to accept $25 million a year to provide comprehensive health care," Lauer said. "That means if you have an individual who is not eating because the Good Lord has told him not to eat, you're not allowed to just stand by and let him die."

Armor said in its statement on Saturday that it has made about 11,000 referrals for off-site care over the past 10 years.

"The fact Armor has an individual cap totally contradicts any claim the company is incentivized not to provide care," the company said.

Five months in isolation

An examination of the final days of Priester, 52, reveals how Armor medical staff relied on a severely mentally ill inmate to make decisions for himself, even as he deteriorated before them. Martin, the jail psychiatrist, did not take steps to provide mental health medication although he thought that would likely prevent Priester from suffering.

Priester was arrested in February 2012, accused of throwing rocks at a Fort Lauderdale parking garage employee. Priester, a Fort Lauderdale native, had been ruled not guilty by reason of insanity in a robbery and burglary years earlier. He had been diagnosed with schizophrenia.

Martin recognized early on that Priester was seriously troubled.

"He was denying any history of mental illness," Martin later said in a deposition during the federal lawsuit. "He was denying being on medication. Denying having taken any medication in the past. He was denying everything."

Priester's jail medical records show he refused medical care, but it was not always clear how, the Sun Sentinel found. Sometimes he was asleep, did not show up for medication distribution, or was talking to himself. All were counted as refusals.

Martin said in the deposition that he had seen people with schizophrenia not eat if they were untreated, and that Priester could have benefited from taking mental health medication.

"The psychosis would have been controlled. He would have been -- the goal would be to get him to be functioning like a normal individual," Martin said.

Yet Armor doctors did not take steps to get him that treatment in the jail. They could have requested a guardian to make medical decisions for Priester, or filed a court order to give Priester his mental health medication over his objections. They did neither.

Jail medical staff hoped a judge would declare him mentally incompetent to stand trial and send him back to a state mental hospital, where he had spent more than 11 years of his life. But that commitment process can take months.

As Priester continued to refuse medical care, Armor staff noted his declining health. Less than three weeks after he was booked, a nurse found him banging his head on the floor of his cell.

Priester was incarcerated for two months before jail staff tried to send him to a psychiatric facility under the Baker Act.

" ... he was likely to be severely harmed by not eating and not taking care of himself," Martin said of the decision. The facility rejected Priester because of his poor physical health.

Another month passed. Priester's blood pressure plummeted and he was taken to a hospital on May 22, 2012. Doctors diagnosed him with a blood infection, pneumonia, and ulcers on his feet. Standing 5-foot-11, he weighed about 140 pounds and was malnourished -- despite jail staff reports that he regularly ate 75-100 percent of his meals.

After four days in the hospital, he gained about 11 pounds. Four days later, he returned to jail, where he again was left untreated mentally. He also did not get insulin injections -- Dr. Stanley Frankowitz, the jail's medical doctor at the time, said he did not believe Priester had diabetes. He had been diagnosed with the condition during a previous state hospital stay.

"Maybe he was a diabetic at one time before I knew him. I have no idea," Frankowitz said in a 2015 deposition. He declined to comment for this article.

Priester collapsed in his cell and died on July 10, 2012. He had lost 30 pounds in the month and a half since he was in the hospital, records show, and weighed 120 pounds when he died.

The medical examiner cited heart disease as his primary cause of death.

"If you would have a pet, and that pet was treated the way he was treated as a human being, you would be arrested," said Priester's sister, Ceaniel Edwards. "He suffered."

Edwards, represented by Lauer, sued Armor in federal court and settled for a confidential amount in 2015.

An Armor review concluded that Priester received adequate care in jail. "Perhaps he could have benefited from a closer (follow up) from medical?" the report said.

Troubled but left alone

Kennith Kellum, of Hollywood, had turned himself in on warrants for crimes including drug possession and resisting arrest, fulfilling a promise he made to his dying father.

As he was booked into jail in June 2010, he told an Armor health worker he had bipolar disorder and anxiety. Had the worker noticed the red mark across the front of his neck, she later said in a deposition for a state lawsuit about Kellum's death, she would have put him on suicide watch.

Instead, jailers sent him to a solitary confinement cell because of past "negative behavior" during a previous jail stay, a detective later wrote.

Twenty-seven hours after he was put in the cell, a deputy found the 21-year-old hanging by his bed sheet.

Suicide is a leading cause of death in jails, and the risk is higher soon after people are booked and while experiencing symptoms of a mental illness.

Isolation of 23 hours a day, as Kellum faced, also increases the risk.

"There's no question, and there's lot of data, when you take someone with a psychosis of any kind and put them in solitary confinement it almost invariably gets worse," said Dr. E. Fuller Torrey, a research psychiatrist and founder of the Treatment Advocacy Center, which pushes for more effective treatment for people with mental illnesses.

The National Commission on Correctional Health Care, which has accredited Broward jails, said in April that mentally ill people should not be in solitary confinement for any period of time, and anyone who is not given meaningful contact with others is considered in be in solitary confinement.

A 1995 jail monitoring agreement states that Broward inmates identified as a suicide risk should not be in a "single occupancy cell" unless they are observed 24 hours a day.

That did not happen for Kellum. He was not identified as a risk despite his mental illness and the mark across his neck -- possibly left by a previous suicide attempt, a sheriff's investigator later concluded. Kellum had "ample time" to hang himself between deputy wellness checks every 30 minutes, the detective found.

"He was aware of the deputies' procedures, the times shift changes were to occur, as well as how they were conducted," the detective wrote.

The Sun Sentinel found three other mentally ill inmates who hanged themselves while they were housed alone in cells. One man, who had attempted suicide by overdosing on prescription drugs just before he was booked, hanged himself on his fifth day in jail, according to a Sheriff's Office investigation. Another had a previous suicide attempt in custody and often refused his mental health medication, Sheriff's Office records show. The third, a 19-year-old with a history of bipolar disorder, was put in 23 hours of daily solitary confinement a year into her incarceration.

After 13 days, a deputy found her hanging from a bed sheet.

Details not included

Broward Sheriff's Office investigations do not mention lapses in medical and mental health care detailed in Armor reviews, including delays in medical care and staff breakdowns that preceded inmate deaths.

The Sheriff's Office reviews inmate deaths to see if a deputy committed misconduct or if a fellow inmate contributed to the death. Those investigations are public.

Armor conducts its own review when an inmate dies to document the person's treatment and evaluate staff performance, but the company keeps those private, saying they are proprietary and confidential by law.

Yusimir Arencibia, a Sheriff's Office-designated health care manager, has access to all Armor inmate medical records except for the death investigation reports. She said she talks often with representatives of Armor and gets all of the information she needs for her own reviews.

But the Sun Sentinel found that critical details outlined in Armor reviews are not always included in Sheriff's Office investigative reports.

This was the case with Steven Shogan.

Shogan, 30, had schizophrenia and was accused of stabbing a man to death in 2011. The Queens, N.Y., native had been in the Main Jail in downtown Fort Lauderdale for a year when he was moved out of solitary confinement on Jan. 1, 2013. Two weeks later, he hanged himself.

What the Sheriff's Office investigation does not say: For the 12 days before he died, jail nurses failed to give Shogan his medicine, an oversight documented in Armor's report.

Other confidential Armor reviews obtained by the Sun Sentinel acknowledge lapses unmentioned in Sheriff's Office investigations into inmate deaths: at least a 24-hour delay in seeking a higher level of care for a man who later died from a heart attack and blood infection, and a man with a head injury left untreated for days.

Suarez, the Armor spokeswoman, did not answer the Sun Sentinel's questions about whether any Armor employees were disciplined in these cases, saying the company does not comment on employee matters. The newspaper found no mention of discipline or policy changes in Armor's confidential reviews.

Contact the reporter: shobbs@sun-sentinel.com or 954-356-4520