As a child growing up in Pueblo, Colorado, Jeremy Laintz travelled widely with his father, an aeronautics engineer at Lockheed Martin, who sometimes took his four kids along on business trips. Family vacations included tours of aerospace facilities and, on one occasion, a trip to watch a space-shuttle launch at Cape Canaveral. Laintz’s mother managed a bakery, and Laintz, the youngest child in the family, recalled enjoying a warm home life. He played soccer and football, and spent summers hunting and fishing on a ranch that his family owned in North Dakota. As a teen-ager, though, he slipped into trouble—he was arrested first for driving under the influence, and then, in his late teens, for felony car theft. He spent a year in prison, where he learned to weld, and a few more years in halfway houses. Then, in 2003, he moved to Alaska, where he joined a Christian fellowship and took seasonal jobs welding, repairing roofs, and working in a fish-processing plant. He often made good money, and his life seemed back on track.

Six years later, though, when he was thirty, he returned to Colorado and, while working in a warehouse, tore a tendon in his wrist. A doctor prescribed opioids for the pain, and Laintz immediately started abusing them. Then a friend persuaded him to try heroin, and soon he was addicted. He was arrested on a charge of possession and, while out on bond, in early October of 2016, failed to show up for a court-ordered drug test. He was arrested again and booked into the Pueblo County jail.

As part of the standard booking procedure, medical personnel at the jail evaluated him. Pueblo County had a contract with Correctional Health Partners, a doctor-owned, for-profit company based in Denver, to provide health services; there was a medical facility on site, supplied with basic equipment. Laintz told company nurses on duty that he used heroin and suffered from hepatitis C, an affliction common among intravenous drug users. Correctional Health staff prescribed loperamide (for diarrhea) and meclizine (for nausea and vomiting) to ease his withdrawal while he awaited sentencing, a lawyer representing Laintz said.

A week later, though, according to filings in a recent lawsuit, Laintz submitted a written request for medical help, noting that he was experiencing a level of pain “so bad I don’t know what is going on,” and that he could “hardly breathe” and “hardly move.” A Correctional Health E.M.T. gave him over-the-counter medication for “possible chest pain or anxiety/panic attack.” On October 15th, a Saturday, when his mother visited, Laintz complained to her, too, of severe pain. The following Thursday, he was sentenced to ninety days in jail. When his mother returned, a week later, he told her that he was still in “rough shape,” so she called the Correctional Health unit. His father also went to speak to the county sheriff, who oversaw the jail.

A physician’s assistant examined Laintz again, and found that he had low blood pressure and an elevated pulse. According to court documents, she told him to try “relaxation and breath control.” After he told deputies that he was too weak to walk to the dining hall, they allowed other inmates to bring him food in his cell. On November 1st, an administrator at Correctional Health left a voice-mail message for Laintz’s mother reporting that, according to the medical staff, “everything is pretty much normal.” He suggested that Laintz had been deliberately hyperventilating to produce his symptoms, in an attempt to be sent to the hospital. “There is no medical reason for him to go,” the administrator said, and asked her to tell her son “to quit hyperventilating and to coöperate with us.”

That evening, however, a sheriff’s deputy noticed that Laintz looked pale and was having difficulty breathing. The deputy declared an emergency, but, rather than send him to a hospital, a Correctional Health physician’s assistant ordered treatment with intravenous fluids in the jail’s medical facility. When Laintz insisted on being taken to the hospital, a sergeant at the jail overruled the assistant and sent Laintz in a police car to the St. Mary-Corwin Medical Center. There, according to his lawyer, doctors diagnosed dehydration, sepsis, pneumonia, and acute renal and respiratory failure. They put him in a medically induced coma and intubated him, then had him airlifted to a hospital near Denver, where he spent a month undergoing multiple procedures, including the partial removal of a lung. He also lost part of six toes to gangrene.

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Laintz is suing the county and Correctional Health Partners for “deliberately indifferent policies.” The county declined to comment on pending litigation. In a court filing on February 12th, Correctional Health disputed Laintz’s account, saying that “at no time” did its personnel fail to “address and treat his medical needs.” Madison Barr, a spokeswoman for the company, had previously told me that she also could not comment on the lawsuit, but she pointed out that increasing numbers of people are entering jails with medical problems related to chronic conditions, such as addiction, and that, at the time of their booking, “these conditions don’t necessarily show symptoms.”

There are more than three thousand jails in the United States, usually run by sheriffs and county offices, which house some seven hundred thousand people. They are typically waiting to make bail—or, if they can’t, to go to trial or enter a plea—or are serving short sentences. Barr is right about the crisis of chronic health conditions among them. According to a study released in 2017 by the Bureau of Justice Statistics, nearly half the people held in jails suffer from some kind of mental illness, and more than a quarter have a severe condition, such as bipolar disorder. The same year, the bureau reported that about two-thirds of sentenced jail inmates suffer from drug addiction or dependency; that number was based on data from 2007-09, so it does not take into account the recent catastrophic rise of opioid addiction. That epidemic and other public-health emergencies, in jails across the country, are being aggravated by failings in the criminal-justice system.

Jails have a much higher turnover rate than prisons, where inmates generally serve long sentences. Prison wardens face their own problems, serving populations that suffer from chronic diseases and conditions related to aging, in addition to high rates of addiction and mental illness. Yet the crisis is particularly acute in jails, because large numbers of people booked into custody are in a state of distress or, like Laintz, will suffer withdrawal, which can require close monitoring and specialized treatment that jail wardens are not equipped to provide. Many jails are in rural or poor counties, where administrators complain that they have neither the resources nor the expertise to hire, train, and supervise doctors and nurses in the particular demands that their facilities require. Increasingly, they have turned to for-profit companies operating in the field known as “correctional health care,” which pledge to deliver quality care while containing costs.

The growth of for-profit firms providing medical services to the incarcerated is part of a trend that started in the nineteen-eighties, during the Reagan Administration, toward privatization in the general management of correctional facilities. The trend accelerated after the passage of tough sentencing laws in the nineties—notably the Violent Crime Control and Law Enforcement Act of 1994—which caused the number of people held in jails and prisons to jump from about three hundred thousand, in 1980, to more than two million today. More than a third of that population is African-American. According to a 2018 study from the Pew Charitable Trusts, more than half the states hire private companies to provide at least some of their prison health care. There are no comprehensive statistics about the prevalence of private health-care companies in jails. But, according to the National Commission on Correctional Health Care, which accredits programs in correctional facilities around the country, about seventy per cent of the jails that it inspects outsource their medical services, and for-profit companies have a sizable share of those contracts.