Alaska Department of Corrections Director Joe Schmidt says “one is too many” -- but do the number of deaths in Alaska’s prisons reflect the status quo, or a neglect of care for incarcerated Alaskans?

Based on 2010 prison and census records, the national prisoner mortality rate average was .217 percent of the U.S. prison population. Alaska was only slightly above that, with a prisoner mortality rate of .23 percent. In actual figures, that number represents the deaths of 13 inmates that year in a prison population of 5,597.

Comparatively, Hawaii had a similar prison population of 5,912, with 12 inmate deaths that year. Nebraska also had 12 inmates die, out of a population of 4,587.

Since 2010, the prison population under Alaska Department of Corrections custody has fluctuated between 6,114 and the most recently recorded number, 5,087. Since January 1, nine prisoners have died, placing this year’s prisoner mortality rate at a tentative .176 percent. Over the last 15 years, the inmate death rate has fluctuated between four and 14, averaging roughly nine inmates a year since 2000.

But what do those numbers actually reflect in terms of human life?

Between 2001 and 2011, the five leading causes of death in Alaska facilities were -- in order -- heart disease, suicide, illness (other than liver, heart or respiratory disease, or cancer), cancer, and liver disease.  Eight deaths since 2010 were suicides, and only four deaths were listed as traumas, which the DOC is the classification used when an inmate is intentionally or accidentally killed by another inmate.

“We didn’t find anything anomalous with this series of deaths this year, including the number of deaths,” Schmidt said at a recent public hearing on inmate deaths. “We lose between 10 and 12 a year.”

The families of at least two former inmates, however, believe not enough was done for their loved ones while in the care of DOC personnel.

Earlier this year in April, 20-year-old Davon Mosley was found dead in his cell at the Anchorage Jail. An initial autopsy revealed Mosley’s death was the result of internal bleeding from multiple intestinal ulcers. His family, doubting the DOC’s claims regarding Mosley’s death, hired an attorney and paid for an independent autopsy, which corroborated the first autopsy. Photos of Mosley’s body were allegedly taken at that time, and displayed scarring and bruising the family claims was from his time in the Anchorage Jail.

“I want to know why when Davon went to jail he looked like this,” said Mosley’s girlfriend Vernesia Gordon, referencing the photos. “And when we got him back, he looked like this, with bruises everywhere on his body.”

Amanda Kernak, 24, became another high-profile inmate death this spring when she was found unconscious and not breathing on the floor of her cell on April 10. Kernak was arrested after crashing into her boyfriend’s vehicle while intoxicated, and remanded with a blood-alcohol content over 0.3.

Kernak’s cell mate on April 8 said Kernak was violently ill throughout the day. According to the DOC, Kernak was too ill to be moved to Hiland Mountain Correctional Facility. DOC spokesperson Kaci Schroeder confirmed that Kernak had received the advanced intake health screening, but couldn’t say if information regarding a recent heart attack and prescribed medication for a heart condition had been reported by Kernak to medical staff.

“The manner of death [for Kernak] was found to be from natural causes secondary to complications of severe liver disease,” said DOC Deputy Director Sherrie Daigle of Kernak’s final autopsy report. “The department investigates every unexpected in custody death, but the final results of an investigation will not be known until the State Medical Examiner’s office completes an autopsy.”

Cea Anderson, the mother of Kirsten Simon, whose autopsy is pending after her June 6 death in DOC custody, also wondered if more could have been done to prevent her daughter’s death.

“I’m just wondering if she’d still be here today,” Anderson said. “That’s my question.”

The most recent death in Alaska’s prisons this year has been that of Robert Hansen, a serial killer believed to have killed between 17 and 21 women and serving a life sentence with over 400 years attached. While the specific illness has not been elaborated on due to HIPAA restrictions, Hansen, 75, is believed to have died from symptoms related to a long-term illness he was being treated for; Alaska State Troopers report he had do-not-resuscitate paperwork on file, and his body is pending autopsy.

Hansen is one of seven deaths considered to be medically related out of the nine. Of the remaining two, inmate Mark Bolus, 24, is believed to have committed suicide, while 29-year-old Elihu Gillespie’s death was ruled a homicide at the hand of another inmate.

To DOC Deputy Health Director Laura Brooks, every inmate’s life matters. She says steps are taken to help stop preventable deaths whenever possible, even from the moment an offender is brought in by the arresting officer.

“Everyone in any facility gets a health care screening [following their arrest],” Brooks said. “That involves questions about their medical history, that involves questions about any medication they might be taking, our medical staff will take their vital signs, and so on and so forth.”

Nearly 2,000 inmates are transported every year to local hospitals and clinics for outside appointments, and almost 600 of those required emergency treatment. With round-the-clock medical personnel as well as transportation to local hospitals available at each facility, Brooks believes every inmate has the chance to be treated by a medical professional for any condition.

For many inmates, it’s a new experience.

According to Brooks, who has worked for 17 years in the medical field within the DOC, many new inmates had never been seen by a physician prior to their arrest, and are diagnosed with various health and mental conditions for the first time while in custody.

“It’s really not unusual for us to see a woman in her third trimester get prenatal care for the first time after she gets arrested, for someone to have their first dental checkup in a decade in custody, or even for somebody who’s severely mentally ill to be diagnosed and treated for the first time in corrections,” Brooks said. “Our population comes to us with a serious lack of medical care on the outside, and so for many of them, they’re receiving health care for the first time after getting arrested.”

Along with the possibility for increased or first time access to healthcare, Brooks says prisoners also enjoy the right to doctor/patient confidentiality, but that many are either unaware of this or don’t believe it.

“They’re hesitant to tell us what medications they’ve been abusing, what kind of even prescription medications they’ve been abusing, or what kind of street drugs they have been using,” Brooks said. “They think they’re going to get another charge. We do our best to try to reassure them that that piece of what we do is confidential, but still I think there’s a definite wall there between the offender and the medical staff when they come in.”

Sometimes that wall could mean trouble for the patient.

“We need to get as accurate a history of their medical background as we possibly can, so we know as soon as possible what we may or may not be dealing with,” Brooks said. “If they don’t tell us, we have no way of knowing. And a lot of times they are reluctant to discuss that information with us. If we don’t know what it is that we’re supposed to be treating, we can’t treat it.”

Both Mosley and Kernak’s families testified at the public hearing, led by a legislative panel seeking new ways to prevent inmate deaths in the future. After weeks of investigations into the deaths and public testimony, the DOC released a new policy outlining how future deaths would be handled.

As of August 6, the Department of Safety will be able to notify the public via the media in cases where information does not impede their investigation, and the cause of death will be more readily available. Investigations by law enforcement will also be implemented, rather than being done by DOC employees. A previous version of the policy was revised in 2008, and DOC officials say they are hopeful that the latest version will provide more transparency for inmates’ families and the general public.

“There’s many folks who were interested; some folks in the legal field, some folks in the media, but our primary concern was the families,” Schmidt said. “The new policy doesn’t include a lot of new pieces. It just codifies a lot of little pieces.”

The new policy is the latest in steps taken by DOC to improve inmate health and security. The DOC reported also adding new medical personnel, and increasing training for all personnel, particularly to be able to identify at risk prisoners.

Along with physical health screenings and treatment, each facility is staffed with mental health professionals and psychiatrists who are trained to diagnose and treat mental illnesses across the spectrum. Other DOC personnel are trained in CPR and other lifesaving techniques, and every staff member is encouraged to report signs of suicidal thoughts in any inmate.

“They’re really our eyes and ears because they see these individuals every day, for hours and hours every day,” Brooks said. “So often times, they’re the first ones who are going to notice a change in behavior with somebody who’s been with us for a while.”

But not every death is preventable, Brooks says.

“[We] don’t know how to prevent every death that occurs in our system,” Brooks said. “These inmates, so many of these inmates come to us with multiple physical ailments that are further complicated by years of substance abuse, untreated mental illness…sometimes they’re not preventable. We really struggle with that.”

Editor's note: An initial version of this story inaccurately naming Cea Anderson as the mother of deceased inmate Amanda Kernak has been corrected.

KTUU's Chris Klint, Piet VanWeel, Mallory Peebles, Abby Hancock, and Adam Pinsker contributed to this story.