Collage by JM Rieger Photographs of some of the people who died in jails across the United States from July 13, 2015, to July 13, 2016.

WASHINGTON ― In any given year, the vast majority of the thousands of jails in the United States do not report a single death. That makes sense. Jails are supposed to be controlled environments. You can’t get in a car accident behind bars. You shouldn’t be able to overdose on drugs or attempt suicide without a staff member noticing. If you have a health problem, jails should provide medical care.

But each year, about 1,000 Americans die in jail anyway. Many die without the public knowing why, or whether their deaths could have been prevented. Although the federal government collects data on jail deaths, it only publishes that data years later, and in aggregate, making it impossible to identify facilities that have particularly high death rates.

“It’s a national scandal that we have so little information about people who die in state custody,” said David Fathi, director of the American Civil Liberties Union’s National Prison Project. “I don’t know of any other developed country where it’s really impossible to say how many people died in jails and prisons in a given year.”

Earlier this year, The Huffington Post sought to fill the gap by tracking jail deaths from July 13, 2015, to July 13, 2016, the year following the high-profile death of 28-year-old Sandra Bland in a Texas jail. Unlike prisons, jails typically hold people for only short periods and most of their inmates have not been convicted of a crime. Although our list remains incomplete, we uncovered hundreds of deaths that were never reported in the media. Using this data of more than 800 deaths, we crunched the numbers to identify outliers, focusing on jails where three or more people died over the year — more than 40 facilities — and comparing those deaths to the jail’s average daily inmate population reported in 2013 or later. (In some cases, we contacted jails directly and received the most current population.)

We identified 15 jails that had death rates more than double the last available national average, which is 135 deaths a year per 100,000 inmates. Here are the top 10, in alphabetical order. Scroll to the end of this article for more detailed information about each jail, as well as their responses.

Charles County Detention Center (La Plata, Maryland)

Delaware County Jail (Delaware, Ohio)

Floyd County Jail (Rome, Georgia)

Hampton Roads Regional Jail (Portsmouth, Virginia)

Imperial County Jail (El Centro, California)

Pinal County Jail (Florence, Arizona)

Richmond City Jail (Richmond, Virginia)

Roanoke City Jail (Roanoke, Virginia)

St. Louis County Justice Center (Clayton, Missouri):

Warren County Regional Jail (Bowling Green, Kentucky)

Not every death that occurs in custody is someone’s fault. Circumstances, like the mental health screening or medical care an inmate did or didn’t receive, are more important than overall numbers. But the circumstances of an inmate’s death can be difficult to discern from the publicly released data. Many in-custody deaths caused by force, for example, are attributed to another cause, said Steve Martin, a corrections expert who has monitored excessive force cases in prisons and jails across the U.S. A death may be listed as a heart attack, but the public might not know that a stun gun was used on an inmate prior to his or her death.

But a high death rate, even for a year, can nevertheless be an indicator that a facility needs closer scrutiny.

The Rutherford County Adult Detention Center in Murfreesboro, Tennessee, where three people died during the period we examined, lost its state certification this month. The facility is among the 15 facilities we identified with a death rate of twice the national average. Sheriff Robert Arnold, who is facing a multiple-count federal indictment, is accused of profiting off a company that sold e-cigarettes to inmates and has been locked up after allegations he attempted to coerce witnesses and assaulted his wife. Hampton Roads Regional Jail, which is on the list, is the subject of a federal civil rights investigation after a number of questionable deaths — including that of a 24-year-old inmate with a mental illness who appears to have starved to death after being arrested for allegedly stealing about $5 in snacks.

Other jails on our list appear to recognize there is room for improvement: A spokesperson for the Floyd County Sheriff’s Office in Georgia told HuffPost the county jail started working with a suicide prevention expert in June, and St. Louis County in Missouri said it brought in suicide-resistant sleeping bags and blankets and replaced air vents in high-risk areas to make it harder for inmates to commit suicide.

“The number of in-custody deaths during that period was extremely high and unusual for our detention center,” Diane Richardson, a spokeswoman for the Charles County Sheriff’s Office in Maryland, told HuffPost. One man, unable to afford $100 bond for a misdemeanor, took his own life the same day as Sandra Bland. Richardson noted that the sheriff had invited a representative of the National Commission on Correctional Health Care to assess the jail’s policies in late 2015, following suicides in July and October of last year. All inmates now must wear slip-on shoes, and structural changes were made in the facility, including replacing air vents and sealing up holes in steel beds.

Any death should raise a red flag, said Kit Wright, a sergeant and nurse at the Brazos County Sheriff’s Office in Texas, who noted that at one point her jail went eight years without a death. (The jail is not on our list.) Even in cases in which it’s clear that a deceased inmate had extenuating health problems, Wright said, it’s important to go through a medical file and determine what else could have been done, even if an inmate had complained of a runny nose and was not treated.

In the year we looked at, St. Louis County Justice Center had six deaths.

One of them was was Sherron Dale, a 42-year-old who reported to the jail last October to serve a 90-day sentence on a drug charge. He was found dead in his cell less than two weeks later. (Unlike Dale, most people who die in jail are awaiting hearings, trial or sentencing or are simply incarcerated because they can’t afford bail.)

Dale died of a relatively common medical condition, a peptic ulcer, according to the St. Louis County medical examiner. Peptic ulcers are easily treated, usually with antibiotics and an acid reducer, according to medical experts consulted by HuffPost. But an untreated one would have caused severe pain for several days leading up to his death, and it would have been nearly impossible for him to sleep. Records indicated that Dale last had contact with a corrections officer at 11 p.m. on Oct. 14 according to the medical examiner’s report, and wasn’t found until 6:50 a.m. on Oct. 15, 2015. Jail records provided to The Huffington Post, which were heavily redacted, make it unclear what, if any, medical treatment Dale was provided.

St. Louis County officials did not respond to specific questions about Dale’s case but said “most” of the six deaths at their facility were the result of “long-term drug abuse.” Peptic ulcers, however, are common, treatable, and not linked to drug abuse.

Dale’s mother, Jeanette, called the chief medical examiner to find out more about what happened to her son. Dr. Mary Case told her the peptic ulcer was “a treatable condition,” according to medical examiner records. (Case also told Dale she “did not have opinions about any treatment he [Sherron Dale] received,” according to the report.)

“Why they never checked on him in all that time?” Jeanette Dale asked HuffPost.

At another facility on our list, the Richmond City Jail, a 26-year-old inmate died in January. Initial coverage of Gregory Lee Hill’s case suggested that he had a heart attack in his cell and that medical staffers were unable to revive him. His family claimed in a lawsuit that he took three or four doses of the anti-anxiety medication Xanax on a daily basis and was going through withdrawal, which went unrecorded by jail staff.

When he became medically distressed, behaving in an “erratic and abnormal” manner, according to documents cited in the lawsuit, corrections officers “physically restrained and pepper sprayed” Hill before taking him to medical. Staff for the private correctional medical provider NaphCare warned jail officials that Hill was going to die if he wasn’t taken to the hospital, according to the lawsuit. Hill’s family claims the jail didn’t listen. A NaphCare representative did not immediately respond to a request for comment.

But Hill’s death — and thousands of others — have not been counted in the public reports released so far by the Bureau of Justice Statistics. The agency’s last public report covers a period that ended nearly three years ago, in December 2013. And there are legal restrictions in place that prevent BJS from distributing useful data — the kind of data that would allow citizens, policymakers and reporters to identify jails with high death rates and begin to understand what changes should be made to save lives.

“The American public has no idea what’s taking place, and because of the lack of public awareness, there’s a corresponding lack of public outrage,” said Erik Heipt, a lawyer who represents numerous families of individuals who died in jail during the year HuffPost examined.

“Once people are locked up in jail,” said Sam Bagenstos, the former No. 2 official in the Justice Department’s Civil Rights Division, “it’s almost like they are forgotten to politics.”

Here’s our list again, complete with death counts, inmate populations, and the jails’ responses:

Charles County Detention Center (La Plata, Maryland)

3 deaths from July 13, 2015, to July 13, 2016. No deaths since.

Average daily population for November 2016: 300

Comment: “In December 2015, under the direction of Sheriff Troy Berry, a representative of the National Commission on Correctional Health Care was invited by Director Brandon Foster of the Charles County Detention Center to observe and assess the policies and practices at the CCDC relating to suicide prevention and in-custody deaths,” spokeswoman Diane Richardson said in a statement. “As a result of the assessment, several suggestions were made to enhance the monitoring of inmates, especially those who are potentially suicidal.”

Delaware County Jail (Delaware, Ohio)

3 deaths from July 13, 2015, to July 13, 2016. No deaths since.

Average daily population for 2015: 240

Comment: Tracy Whited, a spokeswoman for the Delaware County Sheriff’s Office, noted that “in the decade prior to these unfortunate deaths, we only had one death in our jail.” She added that the department is engaged in “ongoing review of our policies, [correctional officer] training, and facilities retrofitting to reduce risk.”

Floyd County Jail (Rome, Georgia)

6 deaths from July 13, 2015, to July 13, 2016. No deaths since.

Daily population on Nov. 30, 2016: 630

Comment: “We recently contracted with Mr. Lindsay M. Hayes of the National Center on Institutions and Alternatives to conduct a review of training, policies and procedures associated with suicide prevention,” said Cpl. Carrie Edge, spokeswoman for the Floyd County Sheriff’s Office.

Hampton Roads Regional Jail (Portsmouth, Virginia)

6 deaths from July 13, 2015, to July 13, 2016. One death since.

Recent daily population: 1,150

Comment: Norfolk Sheriff Bob McCabe, who took over leadership at Hampton Roads Regional Jail after another high-profile death this August, said he’s implemented a number of changes, and no deaths have occurred since he took over. But McCabe said he’d expected the facility to have a higher death rate because several jails in the area send their sickest inmates there. “I still haven’t been able to find another jail like ours” that takes in sick inmates from a number of different jails, he said.

Imperial County Jail (El Centro, California)

4 deaths from July 13, 2015, to July 13, 2016. No deaths since.

Daily population on Dec. 8, 2016: 436

Comment: Rebecca Terrazas-Baxter, a spokeswoman for Imperial County, said “it it is important to understand the nature of their deaths and the circumstances at the time of their deaths.” She noted that one of the inmates was apprehended by U.S. Customs and Border Protection agents and “died while he was in custody, however he was never an inmate of the county jail.” She added, “The County of Imperial takes the health and safety of both jail staff and its inmates very seriously.”

Pinal County Jail (Florence, Arizona)

4 deaths from July 13, 2015, to July 13, 2016. One death since.

Average daily population: 600-650

Comment: Tim Gaffney, deputy chief for administration at the Pinal County Sheriff’s Office, emphasized that “it is important for your readers to understand the causes” of death. He added, “Inmate assaults unfortunately are going to occur when dealing with the criminal mind and their intentions. PCSO staff and Correctional Health do an excellent job on intervention, but unfortunately detention staff cannot be everywhere at all times. It is also unfortunate that suspects who are booked into jail are most often not honest regarding the substances they have ingested, to include the amount that they have ingested.”

Richmond City Jail (Richmond, Virginia)

7 deaths from July 13, 2015, to July 13, 2016. No deaths since.

Average daily population in 2015: 1,078

Comment: “Jail deaths fluctuate depending upon circumstances,” said Richmond Sheriff’s Office General Counsel Tony Pham. “One year, there will be no deaths, another, there may be deaths which occur. No jail controls the individuals who are committed to their custody. This is similar to emergency rooms across the nation. Jails house temporary or short-term inmates who have short sentences or are transferred to the state’s department of corrections. Given the transient nature of the inmates in our custody, the medical professionals do their best to address the medical needs of a large jail population. However, unlike primary care physicians, jail professionals are not always provide[d] historical inmate medical histories for a variety of reasons, which may, at times, complicate matters.”

Roanoke City Jail (Roanoke, Virginia)

3 deaths from July 13, 2015, to July 13, 2016. No deaths since.

Most recent average daily population: 560

Comment: “Medical care at the jail is provided by a highly specialized and nationally accredited medical services contractor,” said Maj. David Bell, chief deputy of the Roanoke Sheriff’s Office.

St. Louis County Justice Center (Clayton, Missouri):

6 deaths from July 13, 2015, to July 13, 2016. Two deaths since.

December 2016 inmate population: 1,199

Comment: “One death in our jail is one to many,” Cordell Whitlock, director of communications for the county’s executive office, said in a statement. “The Department of Justice Services and Department of Public Health will continue to make every effort to prevent deaths from any cause. Morbidity/Mortality reviews are conducted after each death by a multi-disciplinary team from Department of Justice Services and Department of Public Health to determine if any changes to policy and/or procedures are needed. In regard to suicides, for example, all sheets and blankets have been removed from high risk areas and been replaced by suicide resistant sleeping bags and blankets, which are extremely difficult to tear. Air vents within cells have been replaced with louvered vents to reduce the likelihood of inmates to be able to fasten anything to vents. Risk assessments are also being updated to identify persons during admission screening so that they may be closely observed.”

Warren County Regional Jail (Bowling Green, Kentucky)

3 deaths from July 13, 2015, to July 13, 2016. Number of deaths since is unclear.

Average daily population in 2013: 508

Comment: No response.

Some caveats:

This list is based on a database of jail deaths that is still incomplete, so facilities where we obtained better data may have more deaths logged.

Many jails are small. It’s rare for small jails to have multiple deaths within a year. In 2013, only 6.4 percent of jail jurisdictions reported two or more deaths to the U.S. Justice Department. Some big facilities, such as Cook County Jail in Chicago, which had at least 14 deaths, do not appear on our list because the ratio of deaths to jail population isn’t more than double the national average.

We used average daily inmate populations to identify jails with unusually high death rates. Average daily inmate populations can vary from year to year. In many cases, we were able to find recent Justice Department data. In some cases in which the best available data was older than 2013, we followed up with individual jails and used the population numbers they gave us. We also followed up with all 10 jails highlighted in this piece to get the most recent population numbers.

We do not have multiple years of data, which would give a more complete picture of potential problems. When we contacted the Delaware County Sheriff’s Office, for example, a spokesperson said that although there were three deaths in the time period we examined, there was only one in the decade prior. St. Louis County had only one death in the year prior to our data set. Charles County in Maryland, which had two suicides in a year, had just one in the prior decade. But that kind of multi-year information simply isn’t available without surveying individual jails.

Additional reporting by Mariah Stewart.

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