SANTA ANA — Incarceration is the primary risk factor for death in Orange County jails, according to a new report released this week by the ACLU of Southern California that documents systemic medical neglect, delayed care and a lack of accountability across more than a decade of in-custody deaths.
The report, “I’m Getting Weaker as Each Day Passes: An Analysis of Death and Dying in Orange County Jails,” examines deaths between 2010 and 2021 and relies primarily on internal Orange County Sheriff’s Department records obtained through public records requests, cross-referenced with investigations conducted by the Orange County District Attorney’s Office.
The analysis concludes that jail conditions themselves — including medical neglect, untreated withdrawal, exposure to violence and severe mental health strain — directly contribute to premature and preventable deaths.
Between 2010 and 2021, at least 119 people died while incarcerated in Orange County jails, according to the report. Nearly half of those deaths occurred within one month of booking, and at least 35 people died within a week of entering custody. The report notes that the death rate has remained high in recent years, with at least eight people dying in Orange County jail facilities in 2025.
“No one should expect to lose their life while held in custody,” the report states. “Yet, people are dying every year inside Orange County jails — many within days of being booked.”
The ACLU found that the most common circumstances surrounding deaths in custody involved failures in the jail intake and medical “triage” process, suicide, physical violence, substance use and medical neglect. According to the report, jails are filled with people who have serious health needs that the facilities are ill-equipped to address.
“Jails are ill-equipped to provide medical or mental health care and yet are filled with those who need it most,” the report states.
The report challenges claims by Orange County Sheriff Don Barnes that people who die in jail are victims of their own choices rather than the conditions of incarceration. Barnes has previously stated, “People who are dying in our care … are not dying because they’re in jail. They are dying from things that are life choices.” The ACLU report directly disputes that framing, finding that incarceration itself often accelerates or precipitates fatal outcomes.
“There is ample evidence that jail itself contributes to these deaths,” the report says. “Many of these deaths may not have occurred outside of jail.”
The analysis also raises serious concerns about accountability. According to the report, the Orange County District Attorney’s Office did not find the Sheriff’s Department at fault in any of the 119 deaths reviewed. The ACLU describes internal investigations as lacking transparency, noting that some deaths had no corresponding district attorney reports and that official accounts sometimes contained contradictions regarding medical care, timelines and conditions leading up to death.
“The fact that there was not a single case in the 119 we examined where OCDA found OCSD at fault for the death is itself worthy of scrutiny,” the report states.
Many of the deaths documented in the report involve people suffering from substance use disorders or mental illness, particularly in the days immediately following arrest. The report finds that the jail intake triage process frequently fails to identify or adequately respond to medical crises, even when policies appear to be followed.
The ACLU also highlights racial disparities in incarceration and deaths in custody. Black and Latine residents are disproportionately represented in Orange County’s jail population compared to the county’s overall demographics, and the report notes that Black people are disproportionately represented among deaths ruled suicides.
“Black/African American residents comprise only 2% of the Orange County population but 7% of the jail population,” the report states. “Latine residents comprise 35% of the county but 61% of the jail population.”
Suicides in Orange County jails spiked during the COVID-19 pandemic, according to the report, with the number of suicides in 2021 equaling the combined total of the previous seven years. The report notes that pandemic-era policies such as prolonged isolation, suspension of in-person visits and limited communication with family exacerbated mental health crises, even as they were intended to reduce viral spread.
“Incarceration is inherently damaging to physical and mental health,” the report states, adding that conditions during the pandemic intensified the harm.
In addition to medical neglect and suicide, the report documents cases involving physical violence by deputies or failures to protect incarcerated people from violence by others. In some instances, the official cause of death was listed as “natural” or “accidental,” despite evidence of severe trauma or use of force.
The ACLU argues that such classifications obscure the role incarceration plays in causing death. “Words such as ‘natural’ or ‘accidental’ make deaths seem inevitable and unrelated to incarceration, obscuring the circumstances of deaths,” the report states.
The report concludes with recommendations focused on reducing reliance on incarceration rather than attempting to reform jail conditions alone. The ACLU calls for depopulating jails to reduce the risk of overdose, suicide and medical neglect, prioritizing pretrial release and diversion, expanding access to community-based mental health and substance use treatment, and investing in supportive housing.
“Jails are especially unsafe for people who need medical or mental health care, and yet Orange County jails are filled with precisely those individuals,” said Jacob Reisberg, senior policy counsel at the ACLU of Southern California. “The most effective way to prevent in-custody deaths is to reduce reliance on incarceration and invest instead in community-based treatment, housing, and support systems that keep people alive.”
ACLU of Southern California officials said the report reflects a broader statewide and national crisis, as deaths in local jails continue to rise even as jail populations decline. The organization urged Orange County officials to view the findings as an indictment of incarceration as a default response to poverty, addiction and mental illness.
The full report is available here.
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