SAN DIEGO — Keith Bach died on September 28, 2023, at the San Diego Central Jail. He was a 63-year-old Type 1 diabetic.

Chula Vista Police arrested Bach on September 25, 2023, on charges related to criminal threats and vandalism. During the booking process, he fainted and was taken to a hospital.

After his return to jail, Bach told medical staff that he received insulin via pump up to eight times a day. He also informed them that he was set to run out of insulin by 8 a.m. the day after his return.

Bach alerted a deputy to his need for insulin. Fellow inmates advised him to use the intercom button to get attention, and inmates recounted him pressing the button repeatedly.

A deputy and a medical staffer stood outside the module to distribute medications through a food flap while Bach's two cellmates stood in line. Camera footage shows Bach standing at the doorway of his cell during this distribution.

The Citizen Law Enforcement Review Board reported that medical staff failed to provide Bach's insulin dose after he was moved to his cell. Medical staff never directly interacted with Bach and listed him as refusing to take medication.

A deputy and medical staff entered the module to administer a blood sugar check, but the medical staff remained on the downstairs floor while the deputy went to check on Bach. The deputy encountered Bach lying naked on the floor and asked if he wanted to take his medication. The deputy described Bach's gestures as a "shoo away motion with his hand." Just over two hours after the deputy's interaction, Bach was found unconscious and not breathing on the floor of his cell.

The Medical Examiner's Office determined the cause of death was a diabetic complication. The San Diego County Medical Examiner's Office ruled Bach's death a homicide by neglect.

The Medical Examiner's Office report stated, "However, considering the inaction (i.e. neglect) characterizing the events leading to inadequate care while incarcerated of Mr. Bach's health conditions and ultimately his death, the manner of death is classified as homicide." District Attorney Summer Stephen declined to file criminal charges against anyone involved in Bach's death.

Cecilia Bach filed a lawsuit against San Diego County nearly a year after Keith Bach's death. San Diego County paid at least $86 million for jail-related payouts from 2015 to the beginning of the year.

The death of William Hayden Schuck resulted in a $16.73 million settlement from San Diego County. The death of Elisa Serna resulted in a $14 million payout from San Diego County.

The San Diego Sheriff's Office stated it would not comment on settled litigation. The office stated that Medical Services has implemented safeguards for the care of individuals with Type 1 diabetes, including notifying senior registered nurses of such individuals.

It also stated that patients awaiting insulin pumps are housed in the medical unit. The office added that an electronic alert in the Sheriff's information system notifies personnel of an individual's insulin pump use.

The office wrote, "We routinely evaluate our clinical practices, implement process improvements when opportunities are identified, and work collaboratively across medical and custody disciplines to enhance the care provided to individuals entrusted to our custody." It said that providers can utilize Continuous Glucose Monitoring technology to supplement diabetes management protocols.