For 30 minutes, Brian Tracey lay naked and unable to breathe on the floor of the medical ward at the St. Johns County Detention Center, a low-roofed building south of Jacksonville, Florida. It was Dec. 15, 2023, the day Tracey was supposed to be released from jail.

By the time deputies noticed him, it was too late. His girlfriend, who’d posted bond for Tracey after nine days, waited outside for him but was instead greeted by a deputy and chaplain, who told her Tracey was dead.

Medical staff working for the jail’s health provider, Armor Health of St. Johns County LLC, an affiliate of Miami-based Armor Health, said Tracey, 62, was showing flu-like symptoms and suffered from chronic obstructive pulmonary disease, a lung condition that makes it difficult to breathe. In the days and hours before his death, Tracey had passed out and appeared confused, according to a police report from the county sheriff’s office, which investigated the death. Much of what is known about how he died comes from this report, which includes Tracey’s autopsy, interviews with deputies and medical staff, and a description of a video of Tracey in the medical ward.

Four experts reviewed available detention and autopsy records for The Florida Trib and ProPublica. All four — two retired jail commanders and two medical doctors with extensive knowledge of jail treatment — determined that Tracey should have been hospitalized based on the symptoms he showed at the jail, which were later determined by an autopsy to be caused by pneumonia with COVID-19.

He never was.

For people like Tracey, who arrive in poor health, jails can be particularly dangerous, according to a growing body of medical research. Jailhouse deaths have been rising in the United States for the past decade, with about half due to illness, according to the Bureau of Justice Statistics.

Yet even as the death rate climbs, improving healthcare in jails has proven difficult. Many jails have turned to private contractors to care for inmates. But when those contractors perform poorly, there’s little pressure on the sheriffs or local governments to make a change. That’s even more true in Florida, where the vast majority of jails are run by elected sheriffs with little oversight from local and state officials.

“Healthcare overall in Florida prisons and jails is a difficult and frankly ignored issue that’s put on the back burner,” said former Republican state Sen. Jeff Brandes, who was vice chair of the state’s Criminal Justice Committee. “And it’s one that has no independent accountability or oversight. It’s kind of a black box that operates in the state.”

Contracts Despite a Conviction

In the decade leading up to Tracey’s death, Armor Health Management LLC, known as Armor Health, and its predecessor, Armor Correctional Health Services Inc., faced allegations that they failed to hospitalize patients who needed more intensive care, according to court records obtained by The Florida Trib and ProPublica. (Armor Health had previously been operating as Armor Correctional Health Services Inc. until legally converting to an LLC in 2021.)

From 2014 to early 2021, Armor Correctional Health Services was sued over 450 times, the company reported in documents submitted to St. Johns County as part of a contract-bidding process in 2021. Lawsuits over subpar jailhouse healthcare are frequently filed and often dismissed, as was the case in two-thirds of the suits filed against Armor. The bid documents show the company has settled at least 56 suits that alleged medical negligence or inappropriate medical care. Court records show that at least 13 of those cases alleged a delay in hospital care. More than 100 cases are still pending, according to the documents. In a 2020 wrongful death suit against Armor Correctional Health Services, lawyers hired a medical expert to review internal company reports of inmate deaths at Armor facilities obtained through discovery. The expert claimed the company failed to hospitalize patients in more than 70 instances, according to court documents.

Armor denied claims that it has provided poor care or that its staff failed to hospitalize people, saying of the expert review that “each case involves unique medical circumstances, and deaths referenced were related to drug overdoses, natural causes, or other clinical conditions that were not associated with decisions regarding hospital transfer.”

Other states have taken action against Armor. After 14 inmates died at two county jails in New York where Armor Correctional Health Services of New York Inc. provided healthcare, the state sued the company in 2016 for breach of contract and fraud. The New York State Commission of Correction’s Medical Review Board found what it called “egregious lapses in medical care” in seven of the deaths, and a separate investigation by the state attorney general found that the company failed to keep accurate records. Armor settled the suit and denied responsibility, but the agreement barred the company from doing business in New York for three years. Armor is now allowed to operate in the state.

In Wisconsin, prosecutors said Armor Correctional Health Services failed one jail inmate to such a degree that they charged it with a felony. In December 2018, Milwaukee prosecutors levied eight criminal counts against the company for its role in the death of a Wisconsin inmate who died from dehydration while under its care. The charges included seven counts of falsifying a record and one felony count of abuse of a resident of a penal facility. A jury in 2022 found the company guilty of all charges.

Prosecutors had hoped the conviction would push jails to cancel contracts with Armor, they said in an interview. And at least in Florida, they had reason to believe that might happen. Under Florida law, companies convicted of crimes directly related to transactions with government agencies must report the conviction to the state within 30 days and are barred from working with Florida public entities. Barred companies are also placed on a public list of convicted vendors. But the Florida Department of Management Services told reporters in 2023 that the company did not report its conviction to the state — a claim the company rejects. The company also continued to do work in Florida under a range of names linked to entities that had similar leadership and structure.

After it was charged but prior to its conviction, the company filed paperwork with Florida converting itself to a new corporation under the name Armor........

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