On the Thursday, November 20, 2025 episode of The Excerpt podcast: A USA TODAY exclusive investigation uncovered roughly 49,000 deaths in jails and prisons over eight years, including at least 1,800 tied to sepsis, a condition often survivable with basic treatment. USA TODAY Investigative Data Reporter Austin Fast walks through what he found in unredacted federal death reports, the stories of inmates denied care and the families still fighting for answers.

Hit play on the player below to hear the podcast and follow along with the transcript beneath it. This transcript was automatically generated, and then edited for clarity in its current form. There may be some differences between the audio and the text.

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Dana Taylor:

Incarcerated people in the US often face delayed or inadequate medical care, making something as treatable as an infection deadly. And to varying degrees, all of us pay the price. Hello and welcome to USA TODAY's The Excerpt. I'm Dana Taylor. Today is Thursday, November 20th, 2025.

A USA TODAY exclusive investigation on prison deaths has revealed that many of them are entirely preventable. What does that say about justice in America? USA TODAY investigative data reporter Austin Fast dug into data from thousands of mistakenly published death reports, as well as those he received after a freedom of information lawsuit. He also spoke with families grappling with tragic losses that may have been avoided to get the human side of the story. Thank you so much for joining me, Austin.

Austin Fast:

Yeah, I'm happy to be here. Thanks for having me.

Dana Taylor:

You led a USA TODAY investigation that looked at unredacted in-custody death reports from the US Department of Justice. How many years of data did you gain access to? And in terms of numbers, what did you find? Also, how do prison deaths compare to those outside the prison system?

Austin Fast:

So we were able to get records on about eight years of data, so from 2015 through 2023, and we had to compile a few different sources together to get those all gathered together. And altogether, it's about 49,000 deaths of people in local jails, state prisons, and federal prisons. So when I spoke with doctors, they were telling me that, in a lot of cases, prisoners have what they call comorbidities, so things they struggle with, chronic illnesses that put them at a disadvantage compared to people outside of the prison system.

Dana Taylor:

You shared a number of stories that I found disturbing, Austin, in your reporting. Can you tell me about Rick Hall?

Austin Fast:

Well, I should say first that I found, of all those deaths that I looked at, there were about 1,800 incarcerated people who died with sepsis, and that's most likely an undercount because a lot of these reports were incomplete or they listed the cause of death as a terminal illness, like cancer. And so they may have had sepsis, but it wasn't actually listed on there. So at least 1,800. Rick Hall was one of them.

His sister told me that this shows that this could really happen to anyone. I mean, Rick had no criminal history, no previous charges. What happened to him is that he had a mental health crisis. He was at a bar late one night and something snapped, his sister told me. Someone called 911, and when the police got there about 4:00 AM at the bar, he was hallucinating talking to imaginary people in the parking lot, throwing things around. And so the police took him to the jail there outside of Baltimore, really for his own protection.

Really, from the start, the records that they later found showed that he had a mental health issue and they were waiting for a competency hearing, which would allow him to be sent to a state psychiatric hospital where he could get more care than what a jail clinic can provide. But in the meantime, because he really couldn't speak, his sister was trying to call the jail every day. She couldn't talk to him. She was trying to talk to the doctors, to the jail staff, and they just kept saying, "Well, you can't see him. He has to make his own phone calls out." But he really wasn't in the mental state to do that.

And so what happened is, within the two weeks that he was there, he had an ulcer that burst in his intestines and that allowed an infection spread through his intestines, and he died within two weeks. He wasn't being treated. He was lying naked on a hard cement floor for most of those two weeks. And it was just brutal to read the descriptions and to hear from his sister who had to deal with all of that.

Dana Taylor:

Austin, how widespread is the issue of unhygienic conditions and a lack of adequate medical care leading to often preventable deaths?

Austin Fast:

Well, I was looking at sepsis because it is a case that, if it's caught, in most cases people can survive with just antibiotics and fluids. It's a pretty simple treatment. And as I was looking, I found dozens of lawsuits involving just sepsis. There's hundreds of lawsuits involving other issues, medical care in jails and prisons. There's hundreds of these lawsuits that happen every year, all across the country. I spoke with a few lawyers in different states who told me that they get calls three to four times a week, sometimes from families, asking about these types of cases. So it is pretty common.

Dana Taylor:

What happens in the body when you have sepsis?

Austin Fast:

So sepsis, for those who don't know, it's a life-threatening medical emergency. What it is, is your immune system is overreacting to an infection. Your body is trying to fight it off, but it's just coming on too aggressively, and so it creates inflammation all across your body. And when that happens, the inflammation can damage your organs. And when that happens, it can kill you pretty quickly, within just days or, in some cases, even just hours, if it isn't treated. And so that's why, every hour, every day that treatment is denied by security or health staff out of jail, that raises the risk that they will die of this condition that, really, they just need antibiotics and fluids in order to recover, in a lot of cases outside of jails.

Dana Taylor:

What did prison inmates share with you when you asked them about seeking healthcare?

Austin Fast:

Yeah, so I did speak with several inmates for this story, and what they said is, a lot of times, their requests... They can't just go down to the urgent care, or go to their doctor's office, go to the hospital. They have to, most times, submit a request in writing. If they have multiple requests, sometimes they have to separate them. There's a lot of bureaucracy to get the treatment that they are asking for. And what they told me is that staff, a lot of times, they're skeptical. They don't believe the inmates when they're saying that they have whatever symptom they have. In a lot of cases, they think that... By they, I'm talking about the staff of the jail or the prison, they think that the inmate is trying to get out of work or some other responsibilities within in the jail.

And this actually has a name. They call it malingering, which can be a punishable offense in a lot of jails and prisons. The inmates can be fined. Their commissary funds can be docked. They could be sent to solitary confinement as punishment if they're accused of malingering. And so the way that some legal experts told me... I mean, think. Say you have a cold and you want to complain about it, but then you're thinking in your mind, "Well, what if I'm not believed and they think I'm faking? I could go to solitary confinement for this." I mean, how likely would you be to reach out and ask for help? And so it's coming from both sides, in terms of the staff sometimes doesn't believe the inmate, and the inmates sometimes are hesitant to come forward when they really do need help.

Dana Taylor:

Both the system and the stories you shared in your piece are complicated. What does the research reveal when looking at medical neglect on an individual level, from staff members to healthcare contractors?

Austin Fast:

It really is hard to generalize because there's so many... When you look at local jails across the country, there's over 3,000 local jails across the country that each have their own policies, their own rules. The 50 state prison systems that, again, have their own policies and rules. And so it really varies from state to state, or from prison to prison. But in general, what doctors told me is that, like I mentioned a little bit ago, prisoners' lifestyles have already left them more susceptible to medical issues and to disease. They have poor outcomes in general as compared to those of us who have not spent time behind bars.

Dana Taylor:

As you said, we're not talking about one prison system here. More broadly, what did you find when you looked at issues around funding and staffing at the institutional level?

Austin Fast:

We're hearing this everywhere right now in 2025. Everywhere is understaffed, underfunded, and jails and prisons are no different. Some smaller places might not even have someone on staff every day. One of the jails that I mention in the story, they only had someone there a few days a week. It really depends on the scenario at that jail and prison.

And so in some cases, communities, rather than handling all the ins and outs of staffing a medical clinic at the jail and prison, they may turn to contractors. So there's for-profit companies that will come in, and staff your jail clinic, and handle all the healthcare. Which sounds great, but it turns out that these types of companies have a lot of issues. There's been lawsuit after lawsuit against some of these companies. A lawyer I spoke with said that, in a lot of cases, if after they built up so many lawsuits and debt through settlements, a lot of times they can declare bankruptcy and just simply change their name, start a new company. And so they still have the same doctors, but a new name, and so the cycle kind of continues.

Another issue I was told by a legal expert I spoke with, that the federal rules that govern Medicare don't apply in a lot of cases behind bars, so Medicare won't pay for prisoners' procedures if they need some sort of complex cancer care or other complex procedures that are expensive. And so a jail or prison might be a little more hesitant to give those top-of-the-line treatments to someone who's a ward of the state.

Another issue I was told about is that, in some cases, there's doctors and nurses that may not be fully licensed. Now, Medicare would require that, but because Medicare doesn't apply behind bars, people who may have had issues in a hospital or doctor's office outside of prison and can't work as a doctor or a nurse in those regular clinical settings, they can go work in a jail or prison on a restricted license. And so that was happening in Louisiana, and was a big part of a lawsuit there about 10 years ago against the state penitentiary, but I'm told that it still is happening in some places.

Dana Taylor:

You wrote about a 26-year-old man who was called The Boy Who Cried Wolf. Tell me about Ellis Jr. and if his story is uncommon.

Austin Fast:

Yeah, so that's Terrell Ellis. He was from Ottawa County, Oklahoma. So he was just a 26-year-old man, a father of a young child, and he had a DUI charge, so driving under the influence. He turned himself in because he was trying to take care of it and his dad told me that he wanted to really make his life right, and clean himself up for his kid, and be there.

But 12 days after he did that, so he came down with pneumonia and he ended up dying of sepsis in less than two weeks after he turned himself in. And in those two weeks, the nurse, the only nurse there at the jail in Northeast Oklahoma, she... I mean, there's surveillance video that shows her screaming at him, cursing at him, telling him there's nothing wrong with him. The Boy Who Cried Wolf statement, I mean, you mentioned just a second ago, that was caught in the tape of another inmate actually kind of joining in with the guards to make fun of Terrell as he is wheezing, and coughing, and begging for his inhaler because he thought he was having an asthma attack because he had dealt with asthma before, but because no one had diagnosed him with the infection that was causing pneumonia, that's what was really happening, and he had no idea.

And neither did the staff until he collapsed and had to be taken away to the hospital where he died just a couple hours later. And so his family sued. Like I mentioned, there's a lot of lawsuits around these types of cases. His family sued. It actually went to trial and his family was awarded $33 million, which the county is still appealing that, so they haven't seen a penny of that money yet.

Dana Taylor:

Austin, do the access to healthcare issues we've talked about here center on violating the prohibition on cruel and unusual punishment? What have some of these families successfully argued in court?

Austin Fast:

Yes, so that is the legal principle. We are supposed to, according to the Eighth Amendment, we're supposed to be free from cruel and unusual punishments. And so, about 50 years ago, there was a court case where the Supreme Court ruled that inmates do, in fact, have a constitutional right to medical care. And so the legal standard that families have to prove is that a staff at a jail or a prison was what's called deliberately indifferent to their medical needs. And so, if they can prove that, then their lawsuit stands a chance of winning. And I mean, for good or bad, most of these lawsuits actually don't even end up making it to court. Most of the dozens of lawsuits that I reviewed for this project, they got settled before the trial, or some of them were thrown out on technicalities.

Dana Taylor:

Austin, I think, we'd be hard-pressed to find someone who doesn't believe the healthcare system is failing many Americans. What's the cost, though, whether it be money or ethics, if the healthcare system in correctional facilities is not addressed?

Austin Fast:

First of all, I mean, there's the human cost. People are dying. 49,000 deaths over the past eight years in jail and prison. A lot of them are longer-term illnesses that we might expect, like cancer or heart attacks, stuff like that. But so many of them, as I've mentioned through our conversation, were from preventable causes that, really, they should have lived longer.

And so the families get broken when these things happen. I mean, I mentioned Terrell Ellis left behind... I think he had a two-year-old child. There was another family that I mentioned in the story. The woman who died, she was 34 years old and had a seven-year-old and a four-year-old who are left behind with family members who have to step up and take care of those kids. And so that's the first cost, is the human cost of broken families.

And as a society, we have agreed that people should be innocent until proven guilty. And in these cases, for some offenses as minor as trespassing or missing a probation meeting, people are essentially getting a death sentence because they're not getting the medical care that they are constitutionally supposed to be getting. They're just, in a lot of cases, put in a cell and then left there to languish until they do die from preventable causes.

And so then, in addition to those more ethical reasons, I mean, there is the financial cost to a community. Insurance will cover the payouts up to an extent, but in a lot of cases... I mean, like so many of these things that I've been discussing through our conversation, it's individual depending on the jail or the prison and how their system is set up. But if the settlement is large enough, it might exceed the limit of what the insurance company will cover or whatever. Some states have trusts that counties set up for liability insurance, and in places where the settlements are above those limits, then it could fall on the taxpayers who end up having to cover the difference.

Dana Taylor:

You can learn more about this USA TODAY exclusive investigation and see a map with your local prisons by visiting usatoday.com. Austin, thank you so much for being on The Excerpt.

Austin Fast:

Yeah, thank you for having me.

Dana Taylor:

Thanks for our senior producer Kaely Monahan for production assistance. Our executive producer is Laura Beatty. Let us know what you think of this episode by sending a note to podcasts at usatoday.com. Thanks for listening. I'm Dana Taylor. I'll be back tomorrow morning with another episode of USA TODAY's The Excerpt.

This article originally appeared on USA TODAY: How lack of medical care behind bars becomes a death sentence | The Excerpt