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CLAYTON, Mo. (AP) — An alarming string of deaths inside St. Louis County's jail led to a slew of changes, and county leaders believe the changes are paying off.

The St. Louis Post-Dispatch reported it has been nearly six months since Daniel Stout, 31, died from peritonitis, the last of four 2019 deaths at the St. Louis County Justice Center.

County leaders cite personnel moves, disciplinary actions and reforms designed to improve professionalism, accountability and collaboration. Other changes sought to identify and address acute health problems more quickly.

Alcohol poisoning killed Larry Reavis, 51, in January. A month later, John M. Shy, 29, died from internal bleeding after screaming in pain for hours. Lamar Catchings, 20, died of a treatable form of leukemia in March after no one sought to diagnose what was wrong with him.

Catchings' mother, TaShonda Troupe, is still seeking answers.

"No one to this day has been held accountable for his death," Troupe told the County Council recently. Her lawyer sued the county to obtain records about the jail's operations, and the county has fought to keep some of that material from the public domain.

Still, reforms appear to be working.

Police Lt. Col. Troy Doyle, who has served as acting jail director since April, said he fired eight and suspending 18 jail guards and supervisors. The staff of 347 guards now receives training at the St. Louis County and Municipal Police Academy. And guards face more forceful disciplinary actions for their failures.

"I do know there was a culture of, I'm not going to say free-for-all, but people weren't being held accountable, that's the bottom line," Doyle said.

Surveillance at the jail has been upgraded, including adding 35 cameras and more frequent rounds by guards.

Doyle said that perhaps the most important reform seeks to bring jail practices in line with national standards for investigating in-custody deaths. Now, a death in the jail will trigger the formation of an "in-custody death investigation team" to analyze the root causes of the death and set up a schedule for following up with changes, if needed.

Doyle will return to the police department next month after Raul Banasco takes command at the jail. Banasco was chosen by Sam Page, who took over as county executive in April after his fellow Democrat, Steve Stenger, resigned amid a bribery and corruption scandal. Stenger pleaded guilty to federal charges and is now in prison.

Page revived the county's long-dormant justice services advisory board and installed the Rev. Phillip Duvall, a civil rights activist and frequent critic of the county's criminal justice system, as its chairman.

Medical procedures and staffing have also changed. Guards have the authority to request medical treatment when they feel it is necessary, rather than waiting for medical staff to act. Doyle said a guard recently sent an inmate to the hospital with a serious medical condition, something that might have taken multiple steps before.

The county health department now has more nurses and round-the-clock staffing by nurse practitioners and physician assistants, in recognition that many inmates suffer from mental and physical health problems or drug dependencies. Health officials say there is greater urgency in identifying and treating sick patients.

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