Anjeanette Damon

adamon@rgj.com

Niko Smith spent the last 12 hours of his life pacing alone in a tiny cell at the Washoe County jail with only a metal toilet to keep him company.

With no food, no bench to sit on or blanket to keep him comfortable, he repeatedly tried to get a jail deputy’s attention, spending hours alternating between talking to the camera in his cell and attempting to call through the small gap between the bars and the floor.

Smith was coming down from a methamphetamine and ecstasy high. He had urinated on himself twice and had been acting erratically since Reno police dropped him off at the jail. Deputies had put him in a small holding cell just off the jail’s intake area for observation.

A camera recorded every second of the 11 hours and 43 minutes he spent in that cell.

He paced. He pulled at his hair. He talked to himself. He cried to the camera. He lay on his belly with his face pressed against the bottom of the cell door.

Periodically, deputies would stop by and chat with him. At one point he was given a sandwich, which he took a bite from then threw in the toilet. He went for stretches as long as two hours without talking to anyone but himself.

Finally, at 12:30 a.m., Smith dunked his head in his metal toilet, a move the police report described as an attempt to drown himself. When that didn’t work, he wrapped his jail shirt around his neck and tried to hang himself from the cell door.

Smith spent a half hour trying to kill himself, the entire episode playing out on the monitor on a deputy’s desk just outside his cell.

In the end, Smith didn’t die from suicide.

Read more of the Death Behind Bars series here

Part Two: Fatal spiral: Three men died following violent struggles with deputies at the Washoe County Jail

Part Three: High suicide rate follows breakdown in mental health care and prevention efforts at Washoe County Jai

Part Four: Have questions about Murder on the Space Coast? Connect with Torres on Facebook

Deputies finally noticed what he was doing and decided to move him to a suicide-watch cell.

Although he had been acting erratically, Smith followed all of the deputies' instructions as they moved him into the second cell. He didn’t physically rebel against deputies until they laid him face down on the floor, pinned his shoulders, hips and legs and attempted to remove his clothing.

That’s when the fatal struggle began.

“I don’t understand why you would handle a person trying to hang themselves like that,” said Smith’s brother Romeo Smith, who has watched the video of his brother dying. “I didn’t see no confrontation. Do you just lay my brother down like that? Is that the procedure? He wasn’t all that big. Six officers is too much.”

The coroner ruled Smith's death “homicide by excited delirium,” a condition precipitated by drug use or mental illness in which an agitated person enters a “fatal spiral” while over-exerting himself, often during a struggle against restraints.

Smith was one of three men to die after struggling against a crowd of deputies who pinned them to the floor on their stomachs at the Washoe County jail since 2015.

Inmates at the Washoe County jail aren’t only dying during struggles with deputies. The jail has seen its suicide rate triple. One woman died while detoxing. Another man had a baggie of methamphetamine burst in his digestive system — nearly two weeks after he arrived at the jail.

A months-long investigation by the Reno Gazette-Journal found the jail’s death rate has climbed precipitously since Sheriff Chuck Allen took office on Jan. 1, 2015.

According to data obtained by the RGJ, only 10 inmates died between 2007 and 2014 — all but two of the deaths were from natural causes.

In the two years since Allen took office, 13 inmates have died in custody.

Read More: Death Behind Bars: A look at the key players

The Washoe County jail's in-custody death rate — a calculation used to compare deaths across jails with varying populations — jumped from 83 per 100,000 in 2014 to 643 per 100,000 in 2015. It dipped to 573 per 100,000 in 2016. That’s five times the national average, according to the most recent numbers published by the Bureau of Justice Statistics.

Those who have died at the Washoe County jail were men and women; white, black, Latino and Asian; old and young; healthy and frail.

Many were not saints.

Smith, for example, had been in and out of jail for years. This time, he was suspected of trying to strangle his girlfriend while high on methamphetamine. The deputies knew him well and were troubled by his death, according to Washoe County Sheriff Capt. Heidi Howe, who is in charge of the jail.

Most of the people in jail, however, have not been convicted of a crime. More often than not, they are waiting for a day in court to determine whether they are guilty or innocent.

Others are serving sentences for misdemeanor crimes such as trespassing or other so-called nuisance crimes, often applied to the mentally ill or homeless.

"The people you are dealing with at the jail are people who have anti-social behavior, or have chronic alcoholism or have engaged in a crime. But those crimes, for the most part, don’t carry the death penalty,” said Cal Potter, a Las Vegas lawyer who has represented many inmates, or their survivors, harmed by lack of care in jails.

Over a 11-month investigation, the RGJ found:

About the time the spike in deaths began to occur, the Washoe County Sheriff’s Office switched medical contractors, awarding a no-bid $5.9 million annual contract to Alabama-based NaphCare. The jail skirted the competitive process by joining the contract NaphCare has with the Clark County Detention Center, a practice allowed under state law. It was the second time in two years the jail switched contractors, resulting in a tumultuous atmosphere for staff and lack of stability for inmates.

Jail staffing has remained relatively stable over the past five years, but a dramatic cut in staff during the recession reduced not only personnel, but institutional memory and attention to codified policies.

At some point, suicide prevention training stopped due to staffing reductions. Howe didn't know exactly when such training fell by the wayside, but said it had been gone for a couple of years. Such training was reinstituted after the Reno Gazette-Journal began asking questions about the suicides, but an independent audit found the training to be woefully inadequate.

An independent audit requested by the sheriff's office after the Reno Gazette-Journal began asking questions about the spike in deaths found fundamental breakdowns in the delivery of health care at the jail, particularly with mental health service and suicide prevention.

The jail’s medical director was terminated in May after a high-profile inmate, Richard "Richie" West II, overdosed on the methadone he was prescribed. NaphCare would not comment on the reason for the doctor's departure from the jail.

While the sheriff’s office has a policy for dealing with excited delirium, deputies did not follow the requirement to seek immediate medical attention for those exhibiting the signs until the men stopped breathing. Deputies also had not undergone regular training on how to recognize the symptoms and act to prevent a death. Such training and a new written policy were implemented about the time the Reno Gazette-Journal began asking questions about the increase in deaths.

Allen and his detention command staff said they remained flummoxed by the increase in deaths and do not believe problems with training played a role in any of the incidents. They list external factors such as Northern Nevada's high suicide rate and poor access to mental health care. They focus on the fact many inmates arrive at the jail in extremely poor health already.

"They aren’t getting daily medical care. A large portion of them haven’t been to a doctor in the last decade," Howe said. "When they walk in our door, they are a mess. All of the sudden we are expected, in the time it takes to walk through our threshold, to fix all of that. It's pretty challenging."

Allen likened the spike in deaths to a recent glut of traffic fatalities in Reno or a cancer cluster that afflicted Fallon in the late 1990s, for which no cause was ever discovered.

"Sometimes it's hard to put your finger on a particular problem or issue when talking about human lives," Allen said.

"It’s just disturbing to know that we are dealing with people who feel the need to take their own life once they come to jail," he continued. "I'm not going to diminish the number by any means. One suicide in a family is way too many."

He said that each time a "critical incident" occurs, jail leadership examines what happened, looking for ways to improve in the future.

Allen also noted this isn't the first time the Washoe County jail has experienced a spike in suicides. Between 2005 and 2006, a total of eight inmates committed suicide.

"It's important for the community to understand this isn't just a Sheriff Allen thing," he said.

Even then, however, the total number of deaths didn't exceed five in one year.

The increased death rate troubles former Sheriff Mike Haley, who had 10 deaths -- mostly natural -- occur in his eight years in office.

“Our first job in the detention side is care, custody and control, in that order,” Haley said. “We are responsible for them and their safety. That is a big deal.”

In fact, the jail has a constitutional responsibility to provide adequate health care to its inmates. Failure to do so is a violation of an inmate's right to be free of cruel and unusual punishment. Lawsuits are won on this important principle, costing taxpayers hundreds of thousands of dollars.

Haley said such an increase in deaths is an indication of fundamental problems under the new administration.

“The number of deaths far outweigh the number we had in past years, so somewhere along the way there’s a critical lack of information about how to run the organization,” he said. “Those cracks are occurring, and unfortunately people die when those cracks occur.”

“Bad things happen sometimes by coincidence, but oftentimes not,” Haley continued. “Often there are fundamental underlying deficiencies that are core fundamentals to the problem that is presenting itself.”

Haley's comments angered Allen, who noted that many of the people working in the jail were there during Haley's administration. Allen said he has tremendous confidence in the professionalism and competence of his staff.

"I have a lot of respect for Mike, but I am deeply offended and appalled by the statement he made," Allen said.

Another troubling aspect: Many of those who died in the past two years did so in relative secrecy.

Jail officials stopped putting out press releases on inmate deaths right about the time Allen took office, meaning no public scrutiny or even awareness of the problem. The jail's public information officer, Bob Harmon, said he personally made that decision in an attempt to respect privacy concerns.

While the jail is required to report deaths to the federal government, the Bureau of Justice Statistics simply compiles the information for statistical reporting. The data reporting does not prompt investigations or corrective actions against local jails.

Those statistics indicate the death and suicide rate at jails is rising nationally. But not nearly at the rate experienced at the Washoe County jail.

The Washoe County jail also had no protocol to request an investigation from an outside law enforcement agency before the RGJ began asking questions. The Washoe County district attorney, who issues a detailed report every time a citizen is shot and killed by a law enforcement officer, has not reviewed a single in-custody death at the jail.

In Smith’s death, for instance, no one but internal sheriff’s office personnel reviewed the circumstances of his death and detainment. Thomas Purdy and Justin Thompson died in a similar fashion as Smith, struggling against deputies. Sparks police investigated Purdy's death, and Thompson died after the sheriff's office instituted the new policy to request outside investigations.

Both investigations cleared deputies of any criminal wrongdoing. The sheriff's office declined to release the results of their internal investigations into the deaths.

In fact, even the mental health professionals working at the jail were unaware of the problem, reporting no knowledge of specific suicides that have happened in the last two years or the jail's dramatically high suicide rate, according to an independent audit of the facility conducted in January. The suicide rate at the Washoe County jail is five times the national average.

In the weeks after the RGJ began to scrutinize the increase of in-custody deaths, the jail began taking some action to address the spike:

Howe contracted with the National Commission for Correctional Health Care to do a four-day site review and recommend ways to improve inmate care. That report, which found fundamental breakdowns in the delivery of health care at the jail, will help guide the sheriff's office as it enters into a competitive bid process for a new medical care provider.

She has implemented training on how to recognize and prevent deaths from excited delirium. The jail also is now turning away arrestees who are exhibiting symptoms of excited delirium or calling REMSA to stand by with paramedics who can sedate the individuals.

Allen reversed Harmon’s decision not to issue press releases, deciding that transparency was important. Officials notified the public of three in-custody deaths that occurred after the RGJ began asking questions about the spike in deaths.

The jail instituted a new policy to request an outside law enforcement investigation of deaths that result from deputies going hands-on with an inmate. The new policy was signed on Jan. 18.

But District Attorney Chris Hicks said he sees no reason for his office to initiate reviews of those investigations as it does when a police officer shoots someone, largely because in-custody deaths don’t involve a decision by an officer to use deadly force.

"With officer-involved shootings, the officer has been placed in a position where they’ve had to remove their duty weapon and because they either feared for substantial bodily harm or death for themselves or the public at large, made that deliberate decision to use deadly force," Hicks said. "In the jail, they are trying to gain control of someone. So, I see the two as apples and oranges."

Hicks said the public can trust the Washoe County Sheriff's Office to objectively investigate the situation.

But that leaves the families of those who died at the jail with more questions than answers. They want to know why their loved one died within arm’s reach of medical and mental health care.

And they don’t want to see it happen to anyone else.

“For me, it’s more about: Nobody else should have to go through this," said Melinda Darmody, whose 25-year-old daughter Keely Darmody died while going through drug withdrawals at the jail.

"I don’t want anyone else’s loved one to die at a jail. There have got to be better processes and procedures for people who do go into jail.”