Activists are raising concerns about a lack of information about what happened before three deaths in Orange County jails over a recent two-month period.

“Within two months, Anthony Aceves, Eric Denton, and Shikiira Kelly all died while in custody. Very little, if any, information has been given to their families [about] the cause and manner of their deaths,” said Gianni Castellanos, a Huntington Beach resident, during public comments at Tuesday’s county Board of Supervisors meeting.

“We have not forgotten their deaths. They’re unexplained deaths while under the county’s supervision,” said Michael Tucker, another activist, during public comments.

“We urge this board to push for changes to make the Orange County jails safer.”

Aceves and Denton each had “no obvious signs of trauma” on their bodies, while Kelly was found hanging in her cell, according to the Sheriff’s Department, which said it releases such information only about “unexpected” deaths. The department’s news releases don’t say what took place leading up to their deaths, and sheriff officials did not respond to questions Tuesday asking if more information could be released, such as whether deputies were properly conducting inmate safety checks at the time.

The concerns come after grand juries and a federal judge found evidence that OC jails failed to follow procedures meant to protect inmates and the public, including: a shortage of beds for inmates with serious mental illness, evidence of “a widespread practice of failing to ensure psychiatrists visited and spent enough time with inmates,” a jail escape being aided in part by deputies’ failure to properly check on inmates, and a lack of checking for vital signs that could save lives.

And in 2017, sheriff officials placed Danny Pham, a previously homeless man who was in jail for non-violent auto theft, in a cell with a man who had confessed to killing homeless people. The cellmate, Marvin Magallanes, then killed Pham.

The recent deaths drawing questions are of Aceves on May 23, Denton on July 15, and Kelly on July 18. Both Aceves and Kelly reportedly had mental illnesses.

The deaths were brought up at Tuesday’s county Board of Supervisors meeting by activists with the Orange County Racial Justice Collaborative. County supervisors did not respond to the commenters.

In 2017, a grand jury found major failures by jail managers helped three inmates escape from the main county jail, findings then-Sheriff Sandra Hutchens agreed with.

Those problems included a practice of not regularly searching contractors and visitors who entered the jail, failing to regularly inspect tunnels as required, and failing to follow body count policies. The counting failure helped give the escapees, who were being held on violent criminal charges, as much as 15 hours’ head start before their absence was discovered.

Last year, the county grand jury found dozens of inmate deaths involved jail staff failing to notice and document “obvious health issues,” assigning inmates to cells with people who had contagious diseases, failing to diagnose contagious diseases, and other issues.

“Over the last three years, 44% of custodial deaths in Orange County jails may have been preventable,” the grand jury wrote.

“Delays in treatment, failure to identify health threats at intake, failure to diagnose serious mental illness, and lack of timely referral to a healthcare professional have increased the chances that an inmate will not make it out alive. Modest changes in procedures at a relatively low cost could improve survival rates.”

In October, a federal judge found county officials let OC inmates go without psychiatric care for five weeks when their psychiatrist took a leave of absence.

“Module L’s senior psychiatrist, Dr. [Peter] Farrell, testified he would spend as little as five minutes with patients in the acute unit,” states the ruling by U.S. District Judge Cormac J. Carney.

“Most problematically, [the county] had no way to account for a psychiatrist’s absence. When a psychiatrist took leave, there was no policy to make sure that psychiatrist’s patients still received care,” the ruling added.

“Accordingly, when [a psychiatrist] took a 5-week leave in February and March 2015, [an inmate who later committed suicide] went without psychiatric care, as did the other inmates in his unit and in units whenever a psychiatrist went on vacation,” the judge wrote.

“From this evidence, a jury could reasonably conclude the County had a widespread practice of failing to ensure psychiatrists visited and spent enough time with inmates.”

And in June, the county grand jury released a report expressing concern that jail staff do not check vital signs, such as heart rate and blood pressure, on many inmates booked into jail.

“Performing vital signs on all inmates could protect the health of inmates entering the Orange County Jail system…by reducing the risk of a cardiovascular incident due to undiagnosed hypertension,” the grand jury wrote.

“Besides saving lives, this could help reduce the cost to the Orange County taxpayer of having to send inmates to an outside hospital for treatment while at the same time providing potential savings by reducing prospective civil litigation.”

Orange County is among many jurisdictions in the United States where the sheriff, who oversees jails, also is the county coroner who is in charge of investigating suspicious deaths.

“The sheriff and the coroner are one and the same here in Orange County, and in many places in our country. I believe this represents a conflict of interest,” Castellanos said during his public comments Tuesday.

National best practices, which were cited by OC’s sheriff and district attorney earlier this year, call for separating forensic medical assessments from law enforcement.

“Scientific and medical assessment conducted in forensic investigations should be independent of law enforcement efforts either to prosecute criminal suspects or even to determine whether a criminal act has indeed been committed,” according to the National Academy of Sciences study.

“Administratively, this means that forensic scientists should function independently of law enforcement administrators. The best science is conducted in a scientific setting as opposed to a law enforcement setting,” the study added.

The Sheriff’s Department didn’t respond to a request for comment on the conflict-of-interest concerns, nor a question asking what procedures are in place to protect the independence of death investigators in Orange County.

Kelly was scheduled to be released from jail the day after she died, according to her sister, Lily Garrett.

“She was excited about coming home,” Garrett told Voice of OC, adding that Kelly has a son who’s been getting ready to go to college.

“We want answers,” she added, like how often staff check on inmates who have mental health concerns and what happened leading up to Kelly’s death.

“Who do we call to seek honest answers from, when everybody’s on the same payroll system?” she asked.

Nick Gerda covers county government and Santa Ana for Voice of OC. You can contact him at

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