James Tatsch had no criminal charges pending against him when he died in jail from a complication of diabetes. 

Tatsch, who was 48 years old, was jailed while waiting on mental health treatment during Mississippi’s involuntary commitment process. When he was found unresponsive in his cell in Corinth on Jan. 17, he had been detained for 12 days. 

His death was caused by diabetic ketoacidosis, a condition that develops when a person’s body does not have enough insulin for blood sugar to provide energy to its cells, according to the findings of the state medical examiner’s autopsy report. 

Jail staff knew Tatsch was diabetic, Alcorn County Sheriff Ben Caldwell told Mississippi Today. He does not believe the jail is at fault for Tatsch’s death. 

“From everything that I’ve seen and all the reports and all the information that I’ve checked on, it appears that my staff was doing what they needed to do,” he said. “It’s a tragedy.”

Alcorn County Correctional Facility does not have a written or uniform policy for treating diabetic patients, said Caldwell. Rather, the facility’s medical staff – a doctor, registered nurse and a licensed practical nurse – creates an individualized procedure of care for each patient. 

Death by diabetic ketoacidosis is preventable, said nurse practitioner KC Arnold, owner of The Diabetes Center in Ocean Springs.

Illness, missed insulin shots, a clogged insulin pump or the wrong insulin dose are the most common causes of diabetic ketoacidosis, according to the Centers for Disease Control and Prevention. 

Arnold said people in custody with diabetes are often given a combination of intermediate and rapid-acting insulin twice a day. 

“It’s not the best care, but that would keep him out of (diabetic ketoacidosis) if he had known diabetes,” she said. 

READ MORE: Committed to Jail series

Jails and prisons should have written policies and procedures for diabetes care and provide training to medical and non-medical staff, said the American Diabetes Association in a statement published earlier this year. 

“These policies would ensure that detainees have timely access to necessary treatment at all appropriate levels of care,” the statement said. 

Tatsch is one of at least 15 people who have died after being jailed through Mississippi’s involuntary commitment process. Nine of them committed suicide. 

During the process, people who pose a threat to themselves or others can be ordered to county jails while they await mental health evaluation or treatment. 

Laws allowing people with mental health concerns to be involuntarily taken into custody exist in every state. But reporting from Mississippi Today and ProPublica revealed that no other state jailed people in the civil commitment process without criminal charges with such frequency, and often for days or weeks. 

The state revised its civil commitment law earlier this year. It now requires a screening to be completed by the local Community Mental Health Center before a person is jailed and for other treatment options be considered first.  

Because Tatsch’s death is under investigation, Mississippi Today could not access jail records. Caldwell, however, provided an account of what happened that day.  

The morning of the day he died, Tatsch began “acting erratically,” Caldwell said. He was moved from a standard housing unit to the jail’s “segregation” area, where he was locked in a cell alone and checked on by guards every 30 minutes. 

His blood sugar was checked at 12:08pm. It was high, and he was given insulin. 

A guard checked on Tatsch, spoke to him and observed him eating from a jail-issued snack bag less than half an hour before he was found unconscious. He was found unresponsive within 30 minutes and transported to Magnolia Regional Health Center, where he was pronounced dead. 

The incident time was 10:40pm, according to the Mississippi Bureau of Investigation incident report.

Caldwell was not certain what other diabetic care Tatsch received on the day of his death. He first told Mississippi Today that the midday blood sugar check was the result of a complaint made by Tatsch, but later said it was a regular mealtime test. He was unsure when Tatsch’s blood sugar was checked at other times during the day. 

He said he could not share details about Tatsch’s treatment regimen or say when he last received insulin because he turned all relevant documents over to the Mississippi Bureau of Investigation, including statements from officers on duty. 

The agency began looking into Tatsch’s death after Caldwell asked for an investigation. He made the request less than an hour after Tatsch’s death occurred, according to the incident report. 

The investigation will be presented to a grand jury, or a group of citizens who review evidence to determine whether someone should be tried for a crime, in November. 

The grand jury proceeding was requested by former Alcorn County District Attorney John Weddle. Current District Attorney Jason Herring said he could not comment on pending matters, but that the county presents all in-custody death cases to a grand jury. 

Caldwell reviewed the incident for any possible policy changes that could have prevented the death but found none, he said. 

“This is a tragedy, but this is not representative of the care they provide the inmates here. That’s our number one priority, obviously the safety and security of the public as well as the inmates that are here and their safety and wellbeing.”

Arnold said symptoms of diabetic ketoacidosis arise before a patient is in critical condition and can include vomiting, frequent urination, weakness or nausea.

“Any medical practitioner would recognize that,” she said. 

Greta Martin, litigation director for Disability Rights Mississippi, said she sees a statewide failure in jails and prisons to properly treat diabetes, which qualifies as a disability under the Americans with Disabilities Act. 

Incarcerated people with diabetes often do not receive timely medication, regular chronic care check-ups or prescribed diabetes diets, said Martin. 

“Diabetes unchecked and untreated can cause a myriad of problems that could be significant and life threatening,” she said. 

Seventeen people have died in state custody from diabetes-related causes since 2015, according to Department of Corrections records. This number does not include people who are in counties’ custody, like Tatsch.

Jail and medical personnel have been held liable for an incarcerated person’s death from diabetes in Mississippi before. 

In 2022, George County agreed to pay a $2.8 million settlement after an insulin-dependent man in George County Regional Correctional Facility went seven days without insulin. The jail’s nurse was sentenced to 15 years for manslaughter. 

Sheriffs are responsible for providing proper medical care to people incarcerated in county jails, including people held in jail during civil commitment, said Cliff Johnson, the director of Mississippi’s MacArthur Justice Center, an organization that advocates for people who are incarcerated.

“Sheriffs have consistently complained to us that the burden of Mississippi’s inadequate mental health system has fallen on them,” he said. 

“They concede that they’re not trained to take care of people with mental illness and they wish they didn’t have to. The reality for sheriffs … is that they owe everyone in their jail a duty to keep them safe, to provide them with the medical care and the mental health care the law requires.”

It is unclear if Tatsch was ever evaluated by a mental health professional or had a hearing during his 12-day incarceration. At the time, the law required a hearing to be held within seven to 10 days. 

Alcorn County Chancery Clerk Keith Settlemires, whose office is responsible for coordinating the civil commitment process, declined to speak to Mississippi Today about Tatsch’s case. 

Jason Ramey, the executive director of Region IV, the local community mental health center that provides screening during the civil commitment process, said that Region IV has communicated with the Alcorn County Chancery Clerk’s office about the services the center provides, including a crisis stabilization unit.

Crisis stabilization units offer stabilization and treatment to people with severe mental illness or who are in psychiatric crisis and provide an alternative to incarceration for people in the civil commitment process. 

Mississippi Today reached out to several of Tatsch’s family members but did not reach any who knew him personally. 

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.