HOUSTON, Texas (KTRK) -- Whenever Deborah Smith's grandson asks when his mom is coming back home, she said as hard as it is, she has to be honest with him. She doesn't want to give him false hope.
The 38-year-old mother is not coming back.
Deborah's daughter, Kristan Smith, was booked into the Harris County Jail on April 27, 2022, on an aggravated assault charge.
A month later, Kristan, who was diabetic and had blood pressure problems, died on May 28, 2022, while in custody. Like many inmates at the jail, Kristan was a pre-trial detainee and had only been charged, but not convicted, of a crime.
The Harris County Sheriff's Office said Kristan was found "unresponsive in her bunk" on May 20, 2022, and was transported to a local hospital.
"We arrived and found her condition (as) anyone's worst nightmare," Deborah told 13 Investigates. "She was unconscious. Both her eyes were open. They eventually taped them down."
Eight days later, Kristan died. Her mom said she never regained consciousness.
Now, more than eight months later, Deborah still has questions about what led up to her daughter's death and our 13 Investigates found she's not the only one.
Since the start of 2022, there have been 31 people who died in Harris County custody, including four who died this year at the jail.
13 Investigates: 4 inmate deaths counted at Harris County jail in the month of January
13 Investigates has been looking into overcrowding and healthcare conditions at the jail over the last year. After speaking with family members of several inmates who died in jail, we learned the fight for answers is not easy.
And although it can't bring back their loved ones, the healthcare system that oversees the jail says it is making changing.
"There's no way she should have lost her life lack for medication. Was there maybe a confrontation before the end? I don't know at this point but one thing, I will not stop until I get justice and change, not just for Kristan Smith, justice for all the people that have been wronged and changes at Harris County Jail."
During the Texas Commission on Jail Standards' quarterly meeting in Austin on Wednesday, Deborah was joined by 18 other advocates and family members of people who died in custody in Harris and Hays counties.
Jacilet Griffin told the commission it has been 323 days since her son, Evan Lee, died but she still doesn't know what happened inside the Harris County Jail before he was hospitalized.
"What can this commission do? What do you plan to do to help the conspiracy in the Harris County Jail," Griffin said on Wednesday. "I urge this commission to work with the Harris County Sheriff's Office and their stakeholders, who are detaining our community people pretrial in a deadly jail, to divert and depopulate bondable people and prevent more deaths."
The executive director of the Texas Commission on Jail Standards took time after the meeting to have private conversations with Smith, and other families of inmates who died.
"I'm living it, so I can be a help," Smith said.
The sheriff's office didn't grant our request for an interview, nor has it provided the documents we requested about Kristan's death.
Instead, the agency sent a response saying the death rate at the Harris County Jail is similar to what is happening at jails in other large counties across Texas.
The sheriff's office also points out a large backlog for criminal cases that began with Hurricane Harvey and has gotten worse due to the pandemic.
As of Tuesday, the county reports there are 9,918 inmates in the Harris County Jail and another 932 outsourced to other facilities due to a lack of space, according to county data. Nearly a third of inmates booked in the last five days are still in jail.
"Even though the number of people booked into the jail in recent years has declined, our court system is simply not moving fast enough to adjudicate cases in a timely manner," Harris County Sheriff's Office Chief of Staff Jason Spencer said in an emailed statement. "Today, the average Harris County Jail inmate spends over 200 days in jail, which is about six times longer than the national average."
As of November, there were 39,522 active cases waiting for a disposition in criminal court, according to Harris County District Courts data. About 33% of them are more than a year old.
Ultimately, Spencer said, the jail cannot fix the problems with overcrowding alone.
"The crisis in the Harris County Jail requires significant action on the part of all participants in the Harris County criminal justice system," Spencer said.
Families of those who died in jail agree that the system is broken.
"It's horrible when you get that call and you just spoke to them the night before," she said. "I knew she was not coming back. We need some changes because lives are being lost."
'They have a responsibility'
Griffin can still hear the ringing in her ears.
"My son's last conversation. 'Momma, Get me out of here. I'm dying here,'" she recalls him saying in a call from jail. "My prayer is that no other family has to experience this unfortunate situation of death. ... I know it should not be a house of a castle but every single individual in that building... they have a responsibility."
ABC13 first spoke with Griffin last March when her 31-year-old son was hospitalized and on life support.
While Griffin said her son was found unresponsive on March 18 in his cell, she told ABC13 last year that she learned her son was in the hospital only after a doctor called her. She said the doctor also told her Lee had head trauma.
In December, the Harris County Medical Examiner's Office ruled Lee's death a homicide.
"Evan will not be back with us, but the next person, medically, mentally diabetic, pregnant, whatever it is, it could be addressed one by one," Griffin said.
Both Lee and Smith were not eligible to get out of jail on a personal recognizance bond, which requires no upfront payment and is a promise that the inmate will return to court on their own accord. That's because in 2021, Senate Bill 6 was signed into law and now requires people accused of violent crimes to pay a percent of their bail upfront to get out of jail. The law also requires judges to take a suspect's criminal history into consideration before setting bond.
Advocates say those laws keep poor inmates in jail longer and contributes to overcrowding at the jail.
"The system is broken, all the way around," Deborah said. "It's a sad thing that a lot of innocent people have lost their lives."
When we interviewed Deborah at her home in Houston last month, she held up two large photos of her daughter. She brought them with her show the jail commission in Austin.
"This is who I gave them," she said, as she pointed to a photo of her daughter smiling.
"This is who they gave me back," she said, gesturing to a photo of Kristan lying unconscious on a hospital bed, with tubes coming out of her mouth.
Kristan died nearly two months after Harris Health System assumed healthcare for jail inmates.
The sheriff's office said county commissioner's approved an additional $93.9 million for the county's jail healthcare budget in 2023.
13 Investigates asked, but Harris Health and the sheriff's office did not provide specifics on the care Kristan received in custody.
"We cannot address the specifics regarding a particular patient's care, but we review all death cases collaboratively with the Harris County Sheriff's Office. It's important to note that deaths in a correctional facility may be due to many reasons including natural causes and not necessarily related to medical care or treatment," Michael Hill, executive vice president of correctional healthcare operations at Harris Health said in a statement to 13 Investigates.
Hill said since taking over healthcare at the jail, they are working on improvements, including making sure inmates receive medication quicker and increasing staffing at the clinic.
The health system has also set up telemedicine capabilities to "speed up the delivery of specialty care" to inmates.
It is also modifying its process for "bringing individuals in custody into the jail when their health condition is not stable." This means people who are arrested are sent to a local hospital "until their chronic or acute condition is resolved" before getting booked into the jail.
Deborah said her daughter was in jail because her family couldn't afford the $30,000 bond that was set in her case.
From jail, Deborah said Kristan told her she could sell her belongings to help because she could just buy new items if she needed them once she got out of jail.
"She knew I'm doing the best I can to try to raise it," Deborah said.
As she was trying to raise money to pay for her daughter to be released from jail, Kristan's attorney had her bond reduced to $5,000, but by then Deborah said her daughter was already dead.
Since Kristan's death, Deborah's been taking care of the youngest of her four children.
She can't tell her grandson her mom is coming back, but at least wants to know the truth about what happened in the days leading up to Kristan's death.
"That's basically where I'm at - what truly happened to Kristan," she said. "If anybody sees this (and) was in the cell with Kristan Smith, please try to contact me. I want to know what happened to my daughter because this is unnecessary."
If you're a current or former Harris County Sheriff's Office employee who would like to speak with our 13 Investigates team, use the form below. If you'd like to remain anonymous, let us know, but it is helpful if you provide a way for us to contact you. (On mobile? You can open our form by tapping here.)
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