Pictured: Terence Keel, Professor of Human Biology & Society and African American Studies, and Founding Director of the UCLA Lab for BioCritical Studies. Photographed by Troy Upperman.
As LA County faces the highest in-custody death rate it has seen in 20 years, organizers from across the county are calling for enhanced transparency and accountability in jail governance. UCLA Radio’s Ellis Wren sat down with Dr. Terence Keel, Professor of Human Biology & Society and African American Studies, and Founding Director of the UCLA Lab for BioCritical Studies, to discuss how jail conditions and governance cause premature death and frequent misclassification in death investigator’s reports.
Since its establishment in 2020, the UCLA Lab for BioCritical Studies (BCS) has investigated in-custody deaths across the United States and become a leading voice calling for institutional accountability and policy-based reforms. In his forthcoming book, The Coroner’s Silence: Death Records and the Hidden Victims of Police Violence (Beacon Press, 2025), Dr. Keel foregrounds the stories of those who have lost their lives in custody while analyzing how systemic mishandling of evidence and medical documents shields law enforcement from accountability.
This interview has been edited for clarity and brevity purposes.
Ellis: Men’s Central Jail, right here in LA, has become a focal point for jail closure advocates due to its high rate of human rights violations and in-custody deaths, including five that have been reported since the start of 2025. It still remains open despite LA County committing to its closure a few years ago. I understand that you recently spoke at a rally for mourning mothers who lost loved ones in MCJ, so I wanted to start this interview off by asking what is obstructing MCJ’s closure?
Dr. Keel: Well, it’s great to be talking to you about these issues. As you know, Los Angeles has the largest jail system in the nation, and it has one of the largest police forces when you combine the sheriff’s office and the police department together. And so what’s going on in LA gives us a window into what’s happening across the country. And what we’re seeing nationally is a movement to move away from jails as the venue and place that we turn to when dealing with people who are unhoused, when dealing with people who are struggling with mental illness, when dealing with populations that have a substance abuse issue.
These are all problems that can, and should, be solved with institutions of care. And the movement here locally that has been led by the JusticeLA Coalition, which is a consortium of multiple social justice organizations that include Dignity and Power Now and the Southern California ACLU, has been arguing for quite some time now – nearly 10 years – that the jail does not provide care or treatment, and it certainly doesn’t help people who are in need. And so the movement for Care First is designed to actually create real solutions that put people in places that allow them to recover and to restore themselves.
I think that the hesitancy is complicated. There’s a lot of layers to it. I think at one level, we as a nation have become fairly comfortable using jails and prisons to solve social and political problems.
And when given the opportunity to think about something different, or to think about an alternative to incarceration, I think it activates within our local elected officials – and certainly the constituencies that put them into power – fear and concern about, well, what’s going to happen with the future of safety? Are streets going to be safe? Are we going to be allowing people who should be in jail to roam the streets? There’s this sort of fear that gets activated that, quite frankly, is not an accurate representation of someone who’s unhoused or someone who’s struggling with mental illness. Or someone who’s struggling with substance abuse, which quite frankly, when you look at the income inequality and the number of us that are dealing with opioid addictions, and the number of us are dealing with some other substance addiction – we all have someone in our close or immediate circle that’s struggling with one of these issues.
So it’s not like these are people that are foreign to us that we should be scared of. These are friends. These are uncles. These are brothers. These are sisters. These are family members that we all have in our lives. And so I think part of the hesitancy is this sort of translation to understand that institutions of care are the tools that we need to solve these problems. Not incarceration.
And I think, certainly in a state like California, in a place like Los Angeles, which gets the reputation of being left-leaning and progressive and a blue state – and in some ways it is – when it comes to law enforcement, prisons, incarceration: we are incredibly conservative and we have been really since the 1850s. And I think this is where our history gets the best of us. And it leads to this hesitancy and it leads to this sort of political unwillingness to think creatively and with ambition about alternative solutions to jail and incarceration.
Ellis: And I understand that a large addition to that unwillingness comes from institutional forces like LASD that really influence decision-making and policy by the city and county governments. How are the causes of in-custody deaths obscured by the carceral system and what role does LASD play in that when it comes to MCJ?
Dr. Keel: Well, you know, police unions around the nation are an incredible source of power, and also obstacles for reform. They have an incredible army of lawyers that support and protect law enforcement, making it very difficult for everyday citizens and civilians to file lawsuits against individual police and police departments. There’s such a high bar that has been set. And the lobbying that unions have done has helped set that bar really high.
So, you know, to convict a law enforcement officer of a crime when they take someone’s life or hurt someone, it’s incredibly difficult to do – as we’re witnessing with recent cases in the media around exactly this issue. And so I think that the solution involves rethinking our relationship to police as the primary source for creating order in a society.
I mean, if we think about this historically, law enforcement is a means of organizing social relationships and creating order and regularity within a society. And the question that we have to confront for our generation is a difficult one, but it’s also very simple. Are police the best people, the best institutions to be thinking about this? Can we imagine alternative solutions that give us safety, make us feel comfortable, make us feel like we have dignity? I think that’s a big political question that we have to grapple with as a generation.
Now, when it comes to understanding what happens when people die in custody and how the actions of police obscure what really is going on when someone dies during arrest or in jail, this is where our history and our politics get the best of us. If we are using law enforcement as the primary tool to create social order, and law enforcement takes people’s lives while doing this, and law enforcement are not charged when they do this, then we essentially have a system that incentivizes lethal violence. We have a system that incentivizes violations to our constitutional rights – violations to very basic common notions of human dignity and decency that we’ve just come to accept.
And so you can see this acceptance in the way that these death records are written. It is very often the case that a death record is written either by a medical examiner, who is a licensed physician, or it’s written by a coroner, who most often are not licensed physicians but are usually the people that are sent to the scene to provide an interview and a description of what happened in the moments prior, during, and after someone lost their life. And usually those early descriptions – whether it’s someone dying in a jail cell and a coroner is sent on the scene to describe what happened, or whether it’s a coroner sent to the streets of South LA to write these notes – these are what the medical examiner is going to read when they get the body a day or two later, or sometimes even longer afterwards.
So they’re often relying on these early narratives to help them understand what places of the body to look at, or what might have gone on in the moments prior to this person’s death. And it sort of skews their vision towards certain details and not others. And it’s there you get the first introduction of bias that results in records that minimize and downplay police violence as the primary cause for people dying. And this is something that we’ve discovered in my lab.
In 2020, I founded the UCLA Lab for BioCritical Studies, which was one of the first research units here at UCLA, and across all of the UCs actually, to look at and examine the death records of people who have lost their lives in custody. And what we have found is that it is very often the case that physicians who are charged to tell us the truth turn to people’s pre-existing health conditions, their mental health status, their substance abuse issues, and use those factors as the primary cause for why someone is dying in custody. Not the actions of police or law enforcement who use force, who use pepper spray and tasers and other things that we know to hurt and harm and kill people.
Ellis: For sure. I know that specifically for MCJ, there exist a lot of disparities in which deaths are attributed to natural causes. I want to ask, how do the jail’s conditions and governance cause its extremely high mortality rates?
Dr. Keel: Great question. You know, jails are institutions where, and I don’t think many Americans realize this, a wider section of American society – so across all demographic groups: white, Republican, Christian, conservative, Latino, Arab, transgender, mixed race, et cetera – more of that large segment of American society will find their way into a jail at one point or another. Partly because we have a range of laws that make it such that when people break a law, we have a cash bail system that requires them to stay in jail, and they’re going to stay in jail until they get a court date and have the opportunity to go in front of a judge.
So that’s different from a prison, because a prison is where you’re sent after you’re convicted. And why this matters is that jails are very often at capacity. They don’t have a lot of space. They don’t have a lot of staff to watch and to monitor. And they certainly don’t have all of the resources needed inside the jail to keep people healthy and to keep people well.
And so what we have noticed in our research is that many of the physicians and doctors who are inside the jail are frankly flat-out ignoring and neglecting the health needs of people who are brought into these facilities.
You know, we’ve seen records of otherwise healthy young people in their 30s who are dying in jail because they’re not getting access to diabetes medication. Or they’re being given a prescription for some sort of mental health illness and there’s an adverse drug interaction because they were prescribed another drug before they were brought into that facility.
We’re seeing examples of people dying of sepsis and bacterial infections inside the jail because the conditions are so filthy and unclean. Just a small cut or wound or gash, which is not a difficult thing to have happen to you when you’re in jail because law enforcement uses force or they put you in jail cells with people that might have violent tendencies. It’s very easy to find yourself injured inside of a jail environment. And then when you’re in an environment that has feces and urine and bacteria, it’s easy for an injury to turn into something life-threatening. And so these are all factors that a death report should be able to quantify and talk about in an autopsy record. But we very often don’t see this.
What I would like to see are more medical examiners using the homicide description to talk about what’s going on when people die inside of a jail. Death investigators, they have five categories of death they can use. Either the death is natural, it’s a suicide, it’s a homicide, it’s undetermined, or it’s an accident.
A jail is a place where every aspect of your life is controlled, every aspect of your life is under surveillance. And so if someone dies because they’re not getting access to diabetes medication, that should be classified as homicide, medical neglect. If someone is dying because of sepsis, that should be classified as institutional homicide – and the institution as a whole should be held accountable for why this person died – or homicide, medical neglect.
But instead, what we’re finding is that cases like these are being classified as a natural death. We really question whether or not you can die naturally in jail. Usually a natural death is a death that each of us will experience later in life under the care of a physician. But when people are dying in their 30s from heart conditions or diabetes or other kinds of health conditions that usually don’t take our lives until our 60s and 70s, there’s a real question of whether or not that’s actually a natural death. And this is something that we’re really concerned about because it’s not just happening here in LA: it’s happening in many jail facilities around the nation.
Ellis: Yeah, I think there’s a good point about how jail facilities are so highly controlled – it seems important to question if we can really attribute these types of deaths to natural causes. But looking more closely, are there any disparities in what deaths are classified as natural as opposed to, say, homicide or accident?
Dr. Keel: Sure. Well, in the jail environment, certainly in Los Angeles County, and my lab has produced several reports about this – I’ve also published some peer-reviewed articles with my colleague Nicholas Shapiro here at UCLA – what we have found is that the leading causes of death inside LA County jail are natural deaths and suicides, and then there’s a large number of deaths that are classified as undetermined.
So for the natural deaths, we’ve talked a bit about those already. These are deaths, again, that should be as a result of natural conditions and not external factors. But again, if you die of sepsis because there’s feces in your jail cell and you have an open wound, those are external factors that could be or could have or should have been eliminated, and therefore this person should still be alive.
We are also finding that in the natural death classification, a large number of Black men are being classified as having died from natural causes, and a great number of those cases are being classified as death as a result of a cardiac event. But again, when we look at the average age of these deaths in cases over the last 10 to 15 years, the average age of a natural death from a cardiac event is around 40 to 45 years of age, which is significantly lower than the mortality that we see among the free population for people who die from cardiac events. Usually those are happening in their late 50s, early 60s. So there’s a 10 to 20 year gap that we’re witnessing in the natural death cases.
The suicide cases are also troubling and alarming because they show and tell us that the conditions in jail produce a tremendous amount of fear and anxiety among people.
You have to think about this. You’re put in a jail and you’re the primary breadwinner for your family, and you don’t have the means to bail yourself out. And your court date may not be for another four to six months. Who’s going to go to work for your family and pay the bills? What if you have debts? What if you’ve got a young person you’re taking care of who’s sick or ill or an elderly family member? Being incarcerated for people who are politically and economically vulnerable adds additional stress to them.
And then the environment itself, where there’s lots of violence, people are dying – I think, right now, we’re on track for essentially almost a death a month inside LA County jails – people are aware people are dying inside the jail.
That heightens one’s anxiety. And if someone is brought into a jail facility and they might have mental health conditions that mean they need a safer environment where they can regulate their nervous system, they’re going to find the volatility of a jail environment incredibly unsettling. And it’s going to exacerbate whatever mental health conditions they have, creating the opportunity, tragically, for them to take their own lives.
So again, these are deaths that could be avoided in the field of public health. We call these preventable deaths, deaths that are excessive, that could have and should have been avoided. And I think suicides are definitely one of those.
Lastly, the undetermined deaths. In several reports that we’ve published, these are deaths that seem to be in LA County, highly represented by young Latino men. A lot of young Latino men are being classified in the jails as dying from undetermined causes.
And what’s troubling about that is that according to the National Association of Medical Examiners, which is the national organization of forensic scientists that help write guidelines for what medical examiners should say and do when they’re examining a body, an undetermined death should only be used in cases where there’s two competing death classifications or in an environment where you have no information about what happened. Imagine you find the bones of someone in a desert and you don’t know the age, the gender, how long they’ve been there. You just see remains. Well, that scenario is impossible in jail.
If someone’s dying in jail, that person is under a 24-hour surveillance watch. There are usually routine checks every 15 minutes; what they eat, what they drink, how much free time they have, who they visit are all regulated. So the conditions are very clear and known. So the fact that this category is being used at such a high level is concerning to us because the jail is a data-rich environment. There’s lots of information available.
In cases where there’s two competing death classifications, which we’ve seen – we’ve seen cases where someone is classified as an accident and then also classified as potentially a homicide – I think there is where we need a third party review system to examine death records where the medical examiner themselves can’t quite determine what’s going on.
If I were to write a peer review article tomorrow and submit it, the level of scrutiny that I would undergo as an academic is ten times more intense than an official death record written by a medical examiner in Los Angeles County. And that’s absurd. That shouldn’t happen. These are the end of people’s lives. We want to get this right. And yet we don’t have an external review system to double check the work of medical examiners and coroners, especially those who are using the undetermined death classification. And this is something that we should be doing here in the state of California and certainly in Los Angeles.
Ellis: I think it’s really important that you brought up the disparities between the rigor of different review processes in public health. And I wanted to ask, especially considering the work that the Lab for BioCritical Studies does, why is it important to consider and factor in structural violences into public health issues?
Dr. Keel: I think when we are confronted with someone who dies early or under mysterious conditions, we have a choice to make.
We can choose to see this person in a vacuum where we are only paying attention to their biology. Or we can choose to see that our health, our life expectancy, whether or not we live with dignity, whether or not we live with resources, are all determined by the society and the values that structure our world. We have a choice to make. And so for this lab, what’s really important for me and all of the brilliant young undergraduate researchers here at UCLA is to put people’s deaths in a larger historical, political, legal environment.
So if we think about, let’s say – and there’s been lots of research on this – a place like southeast Los Angeles that has a high concentration of Black and low-income Latino communities, really since World War II when many people migrated to this part of Los Angeles. They couldn’t get homes and properties in West LA because of racial segregation and redlining. These are communities that historically have not had consistent labor opportunities or consistent access to healthcare, which includes mental health care.
Public health scholars have been able to quantify that if you live in a city where you have unmet mental health needs, meaning you probably have some kind of mental health condition, but there are no medical health care providers, or you don’t have the actual resources to see a medical health care professional, you are at a significantly higher risk of coming into contact with police at some point in your life when compared to someone who has a therapist or primary care physician. And that’s staggering when you think about that. I mean, just that one small modification, having access to healthcare and having a mental health professional could mean the difference between a lethal police encounter or going home safely.
And I think understanding that changes what you can say about someone dying from, for instance, supposedly having bipolar disorder and schizophrenia, because these are not lethal conditions. But what we do know is that when people suffer from mental health conditions and have unmet mental health needs, especially if they’re Black or Latino or low-income, they are more likely to encounter use of force, aggression and violence from police – partly because we don’t have the capacity in our law enforcement offices to see these people and humanize them to understand that, hey, maybe if I’m suffering a mental health crisis, I might not be able to understand the commands you’re giving me. I might be unsettled in such a way where I need someone who can de-escalate a situation.
It’s very difficult to de-escalate a situation when the other person has a lethal weapon and represents a police department that is known to take people’s lives. That only elevates the tension in the environment. It raises stress hormones and puts people in their fight-or-flight physiology. And for someone who’s suffering with unmet mental health needs, that’s a tragic cocktail for early death.
These are all the things that we think about in the lab. And so we do our due diligence to not just see people in isolation, but instead put people in this larger historical political environment and context.
Ellis: Yeah, I think it goes back to what you were talking about at the start, how as a society we currently use police and incarceration as a means of managing social disorder that might be produced by a lack of welfare or health infrastructure. So that kind of leads to my next question for you. Can the U.S.’s carceral system be reformed by means like improving prison conditions or higher ethical standards in governance? Or do these structural issues demand a full dismantling of mass incarceration?
Dr. Keel: I appreciate the question. I think I’m going to approach it a little bit differently by saying, well, what is the goal that we want? What’s the kind of society we want to live in? And if we approach it from that angle, then I think we can think about a range of solutions under different timelines.
So if the solution is that you and I want to live in a world where no one dies during arrest and no one dies if they’re placed into jail, because if we’re going to have a criminal justice system, if people do commit crime – especially violent offenses – I want to see them go through the criminal justice process.
I want to see them to defend their innocence. Maybe we’ve missed a detail. Maybe there is something that law enforcement missed that the lawyers can actually represent in court and that person gets to go home free. I want to live in a world where that is possible.
That can’t be possible if someone dies in jail pre-trial. If someone dies before they even have a chance to go in front of a judge, we’re talking about an alternative form of capital punishment. That’s a system that’s unacceptable to me, and I think it’s unacceptable to many others.
So if we want to live in a world where no one dies in jail, no one dies during arrest, then I think what we have to do is provide alternative solutions to interact with people who are dealing with a social crisis or dealing with a situation that requires help. Maybe the solution is not dialing 911. Maybe the solution is dialing the number of a local community representative who’s trained in mental health, has trauma-informed therapy modalities, or is a trauma specialist. And they arrive on the scene and assess what the needs are of the individual.
I think in that sort of scenario, it provides a more humane solution for people who need care. If someone is unhoused and they happen to be loitering in an area where the local county wants to clean up because we have the Olympics coming around the corner, for example, the solution is not putting those people in jail.
The solution is making sure that we’re writing laws locally that provide affordable housing, and for communities that are dealing with acute economic disparities, making sure that there are programs that actually service those communities. Because if you’re not servicing them, then guess what? They’re going to end up on the streets. And if they end up on the streets and we only have police to “help them,” in air quotes, then they’re going to end up in jail. So to change our criminal justice system, you have to think more broadly about economic, political, and legal inequalities that allow people to get snared up in the trap of law enforcement and instead design alternative solutions so that communities are getting the care and treatment that they need.
That is where we need to go as a society. So reforming police and reforming jail institutions is just one component. It could be a part of it, right? For Christ’s sakes, why are there feces and sepsis infections inside LA County Jail? That should be changed. That should be reformed. These institutions should be the highest quality that we can make them, right? That needs to happen.
But we can’t stop there. I think we have to think more broadly and say, well, do we need so many people circulating through these jail environments? Maybe there are alternative solutions that never require bringing someone into jail in the first place. I think we have to start building towards that future while also reforming the institutions that are with us right now. So it has to be a multiple timeline, right? And I think the endpoint isn’t just jail reform.
It needs to also be, how do we give people the care that they need? Because that’s what people need. I mean, we are a nation with staggering inequalities. We are a nation that is one of the most unhealthy nations in terms of heart risk and hypertension and diabetes when compared to any other advanced industrial democracy.
And we are also a nation that kills more people than any other advanced Western democracy. We lead the nation on both these things: poor health outcomes, lots of police violence. We’re going to have to solve lots of these problems to get to a place where no one is dying during arrest, no one is dying in custody, and we have a criminal justice system that works for people and not against them.
Ellis: For sure. And I think the origin of a lot of those creative solutions does lie in research and academia. But does the BCS Lab currently face challenges due to federal funding cuts for research?
Dr. Keel: Oh yes, we do for sure. The thing is that we actually faced challenges for funding even before this current administration, and I think that has a lot to do with the fact that quite frankly, people don’t imagine incarcerated people as people worthy of study.
And it’s a tragic truth that we had to confront very early in our efforts to secure grant funding. We were fortunate enough to have organizations like the Robert Wood Johnson Foundation and the NIH and the Russell Sage Foundation to support some of our early work that really helped us get moving in our current direction. But now we have a team of around 35 undergraduate student researchers, postdoctoral fellows, several graduate students, and multiple faculty with affiliations with research institutions around the country. We’re a large operation now, and so resources are vital to continue the momentum and the new kinds of projects that we’re doing.
The federal funding environment is a scary one. We applied and were selected for a grant from the National Science Foundation under the STS program. But we were also told that despite the fact that we were chosen for this award, there were not enough resources available to give us the grant funding. It was a very bittersweet pill to swallow. On the one hand, it’s very hard to have a grant selected for funding for NSF; it’s incredibly competitive. But to be told that you were competitive enough and you were chosen to get the grant, but we ran out of money because of the funding environment: it’s a very difficult thing to confront.
We are doing our best to try to identify alternative funding sources. We’re really hoping that private organizations and private foundations are going to step up in this current environment. We saw this happen after the deaths of George Floyd and Breonna Taylor, when there was a tremendous amount of money – certainly from the left and the progressive side – going towards a range of social justice and social equality projects. We’re hoping that we’re going to get the same kind of leadership from private foundations – because we need it. And it’s not just my lab. There are many great labs and many great institutions working on these issues that also need this support.
Ellis: In other forms of support, how can UCLA students and community members get involved in envisioning a different future for public safety?
Dr. Keel: I would say that a great place to start is to be in contact with the BioCritical Studies Lab. We are working really carefully and closely with many local social justice organizations, including Dignity and Power Now and the JusticeLA Coalition. They regularly have actions throughout the county to drum up support, raise awareness. These organizations are always looking for young, bright minds to help support these rallies, help support some of the data gathering to give to elected officials to move the needle on these issues, and our lab has been a great broker between these organizations and students on campus. So I would encourage students to reach out to our lab. I’ll make sure to provide the email for your readers so that they can reach out to us. It’s just [email protected].
I also would encourage them to pay attention to the work that Dignity and Power Now and the JusticeLA Coalition are doing. They regularly have newsletters. They’re regularly in the media. Just inform yourself a little bit about what’s going on. What ends up happening, in my experience watching students who navigate this space, is that by becoming informed, they see where their gifts and talents can be of use.
Students at UCLA are brilliant. They’re bright. They make all of us feel like our country’s in good hands moving into the future. I think students have to lean into their talents and show that, hey, I want to be able to support. Maybe it’s a volunteer role. Maybe it’s a paid role. It all depends on what the funding situation is for these organizations.
What I do know is that showing up matters. Showing up moves the needle. When we first started doing protests and rallies and organizing in the early 2020s, it was just a handful of folks who were there. The grieving families, the local organizations behind them, and the students in my lab. Now this has moved and it’s grown. We hope it continues to grow, and we hope that students who live in Los Angeles County for the four years they’re going to be here at UCLA pay attention to the politics around the campus.
I think that in the recent several years, UCLA students have become really aware of how the larger trends in our society impact their education, impact their own freedom of speech, impact the decisions they make for their career paths. I just think that the more that students dial into these conversations, the more they’re going to get out of their education and the more they’re going to feel like, hey, I was a part of a solution in this historic moment.
And I do believe that in 30, 40, 50 years, we’re going to look back here like how we look back at the 60s with all the student protests and organizing that really helped create the modern academic institution as we know it. I think that we’re going to see a similar sort of shift, but it’s going to require students to help us get there. Because students have more power than they realize.
Ellis: Okay, I think that’s a great note to end on unless there’s any last thoughts you’d like to leave with our listeners. Thank you for coming and discussing this crucial topic with me.
Dr. Keel: No, I’m really grateful for this opportunity and thank you for taking up this issue – it’s a really, really important one.
This interview was conducted Wednesday, May 21 and broadcast on the UCLA Radio News Department’s NewsHour show on Thursday, May 22.
