O ne afternoon in December 2022, Greg Belzley made the familiar two-hour drive from his home in Prospect, Kentucky, to downtown Cincinnati. He had booked a room at the Hampton Inn, where he always stays when he’s in town. And he suggested we meet at the tapas restaurant where he always eats. He didn’t want to risk a bad night’s sleep or, worse, food poisoning. The following morning, he was due to deliver oral arguments before a panel at the 6th Circuit Court of Appeals.

“Routine is everything,” he explained after the waitress had taken our order.

He sipped a bourbon as he began to talk through the details of the case, moving fast like he’d rehearsed it all before.

His client was the widow of a man named Christopher Helphenstine who had been arrested in rural Kentucky for allegedly selling small amounts of heroin to police informants. While in jail, he began suffering severe drug withdrawal symptoms. Five days later, he was dead. As far as Belzley could tell, the jailers had done little to save the man’s life.

Helphenstine’s wife sued the county, an on-call doctor, law enforcement officials and several jail staffers. Though Belzley believed he could show the jail staff’s treatment of Helphenstine amounted to a violation of the man’s constitutional rights, a district judge had thrown the case out. In lawsuits over medical care in prisons and jails, proving negligence is not enough. Instead, you have to prove something called “deliberate indifference” — basically that staff intentionally ignored your serious medical need. Deliberate indifference is an extremely high legal standard that has undermined lawsuits over jail deaths across the country.

With this case, though, Belzley saw an opportunity. He’d appealed the case to the 6th Circuit, not only to seek justice for Helphenstine’s family, but also to make it slightly easier for the many other families whose loved ones have died in jails to seek their own justice.

The next morning, I met Belzley outside his hotel. The sky was gray and full, but there was no rain. We walked together to the courthouse, an angular building with tall, thin windows cut into the Indiana limestone facade.

We passed through security, and he led me to an empty lounge, a staging area for attorneys waiting to argue cases.

There was at least an hour to go before Helphenstine’s case would be up. Belzley — wearing a purple tie; he never wears red or blue (“You can’t be too careful,” he said) — sat alone at a large glass-top table. He pulled from his bag a yellow legal pad full of neatly written notes and a white binder. Running along the top of the binder were tabs for various case laws, and along the side were shortcuts to details on each of the defendants. He flipped through it, almost compulsively. He’d reviewed the material many times, including the night before, but he wanted to do it again. Preparation was critical. He would have just a few minutes to convince the judges that families like Helphenstine’s deserved their day in court.

For the next 40 minutes, he sat and paced and sat again, listening to the arguments in the other cases through a speaker in the room. I asked what he was listening for, and he told me he wasn’t sure. He used to try to get a sense of whether it was a “hot or cold bench,” he said, but not anymore. Moods can change fast, and his cases usually get the judges spun up. Of the three who would hear his appeal, Belzley was pretty sure he had at least one vote from a Democratic appointee and figured he stood a good chance of winning over a more conservative justice based on some of his past rulings. Chief Judge Jeffrey Sutton, a George W. Bush appointee, was a wild card.

Belzley stood and fidgeted some more, absentmindedly running his hands over the hinges of a closet door. And then, finally, he declared it was time to go in.

C hris Helphenstine’s ordeal began on April 14, 2017, when a sheriff’s deputy, aware of his outstanding warrant, pulled him over outside Tollesboro, a small community in northeastern Kentucky. The deputy booked Helphenstine into the Lewis County Detention Center on one misdemeanor charge of drug possession (for having a single pill of Xanax without evidence of a prescription) and one felony charge of trafficking a controlled substance, the heroin he had allegedly sold to informants.

Every year, millions of people, mostly men, cycle through local jails across the country, according to federal data . Almost half have a history of mental illness ; even more abuse drugs. Some are serving short sentences or awaiting transfers to prisons, but the majority have not been convicted and are being held for trial.

County sheriffs and other jailers are supposed to provide health services for the people in their care. Some hire a nurse or contract with a doctor; others, increasingly, hire a for-profit medical services company. The quality of care often comes down to what counties can afford — or can’t. Four years after Helphenstine’s death, Lewis County’s governing body voted unanimously to shutter the detention center. The jail’s budget had been growing ever larger, eating away at county resources, according to media reports at the time.

“Julie, I’m sorry about your birthday,” Helphenstine told his wife when he called her from the jail. He’d left their house to grab some soda while she was getting ready for a night out to celebrate. Julie said she told him not to worry about that. She just wanted to get him home.

They had first met in high school when he was dating her cousin. “Of course, we’d party every weekend,” Julie said. “You know how teenagers are.” They lost touch, though, until one afternoon in 2005 when she happened to run into him leaving her grandma’s house. By then, she was in her 20s. “We need to hang out like we used to,” she had told him. They married in October 2008, and the following year, their son was born.

Two days after his arrest, Helphenstine was still in jail as the drugs left his system and withdrawal symptoms set in. By Sunday evening, he was throwing up so much that officers moved him to a single-man detox cell. Guards later testified that Helphenstine told them he was “dope sick” and he wanted to be left alone. The jailers took to checking on him every 20 minutes or so through a flap on the door of his isolation cell, according to court records.

In practice, medical care behind bars is a mess. Not much data exists, but one nationwide survey , done more than a decade ago, found that nearly 70% of jail detainees had not received a medical examination behind bars. A quarter reported not being seen by a health care provider following serious injury. In jails, broken hands go unset, tumors are ignored, potentially deadly viruses remain untreated. And people die from withdrawal.

By late Monday night, according to the court documents, Helphenstine couldn’t eat or drink and hadn’t left his bed for 24 hours. He smelled of sweat and vomit. According to jail policies , “drug or alcohol withdrawal” qualifies as a medical emergency. But rather than call for an ambulance, one officer sent a midnight fax marked “urgent” to the doctor, according to court documents. She noted that Helphenstine was in withdrawal, though she wasn’t sure from what. The doctor was supposed to have been on call at “all times,” according to jail policy.

By Tuesday morning, Helphenstine was so sick that the deputy who took him to his arraignment described him as “acting like he’s clear out of it,” according to a transcript of the hearing. The judge postponed the proceedings.

Accounts diverge here. The jail’s on-call physician testified in a deposition that he told staff, during two separate phone calls, that they should take Helphenstine to the hospital. Both times, the doctor said, he was told Helphenstine refused to go there. None of the deputies, however, remembered these conversations or Helphenstine refusing help, according to their depositions.

Video footage of Helphenstine’s last few hours in the isolation cell shows his rapid decline. He appears shaky and unbalanced as he moves around the room, eventually resting on a metal bench. He hangs his head and rubs his feet against the ground. Slowly, he begins to slouch, sliding to the floor. Shortly after midnight, he lies face down on his cot. His body quivers and shakes, his foot spasms, his head jerks to the side. This goes on for nearly three hours.

At 2:40 a.m., two jail employees enter the room. One offers him some Ensure through a straw, but he has trouble drinking. They leave as he continues to shake. At 3:20 a.m., he falls still. Ten minutes later, guards enter the cell, roll him to the floor, remove the bed and start administering CPR. Ten minutes after that, paramedics arrive. At 3:44 a.m., they carry him out, leaving behind a dirty towel on the concrete floor. He was pronounced dead in an ambulance on the way to the hospital, according to court records. He was 40 years old.

The county medical examiner noted the cause of death as “acute (fentanyl) and chronic drug abuse.” Many others — judges, the jail staff, medical experts — called it withdrawal.

Helphenstine had gotten in trouble once before, pleaded guilty to a drug charge, and spent five years on supervised probation. That aside, Julie called him an “all-around good old country boy.” He would do anything for his family, she said, describing him as loyal, a hard worker whatever the job. He was afraid of storms — something she would tease him for. She’d also give him a hard time about a tattoo he’d picked up in jail: a heart, like the kind you get for your mom, only this one had his own name — “Chris” — right in the middle.

Julie Helphenstine couldn’t forgive what had happened. As she saw it, if only the jailers had sent Chris to a hospital, her husband would still be alive. Instead, she was a widow after nearly nine years of marriage; their son would grow up without his dad. There would be no more Halloween pranks, no more fishing trips to the reservoirs and creeks and ponds around their home.

So, with the help of Belzley and his co-counsel, Jim Thomerson, she sued.

It was probably inevitable that Belzley would become involved. Prisoners’ rights cases are complicated, and Belzley is one of the very few lawyers in Kentucky who works on them full time. He has filed more than 100 lawsuits, many involving inadequate medical care behind bars. Often, as with the Helphenstine case, another attorney will ask Belzley for help navigating the law. He’s worked on so many cases, he said, that nothing much surprises him anymore. Even so, as he paged through the Helphenstine file, the details infuriated him.

None of the people who worked at the detention center had medical training beyond basic first aid and CPR. The facility’s on-call physician was an elderly osteopath whose license had been revoked in Ohio and suspended (and later reinstated) in Kentucky more than two decades before for sexual misconduct with three patients, according to state records and court filings. He turned up only once a week, if that, according to records produced in court. The only help Helphenstine got was two anti-nausea prescriptions, some cold Mountain Dew and a couple of sips of Ensure, according to court records.

Many prisoners and their families come to Belzley with stories like these, and he has to turn most away. There’s only so much one man can do. Here, though, he said, it was an easy decision. “Helphenstine was experiencing a medical emergency,” Belzley wrote in his first court filing. “But defendants didn’t treat it as one.”

T he first time I had a conversation with Belzley was over Zoom. I’d called to talk to him about a few cases he said showed how the “deliberate indifference” standard stymies valid civil rights claims. Belzley, who is now 69, logged on, short white hair disheveled, and apologized for wearing a Lamb of God T-shirt. “I’m a big heavy metal fan,” he said. Behind him were rows of books, many of them by or about Clarence Darrow, a onetime corporate lawyer who became one of the most prominent civil rights lawyers of the last century. Like his hero, Belzley quit the comforts of commercial law to do something he sees as closer to God’s work: trying to protect the rights of people locked away in jails and prisons.

Belzley grew up in Houston, then Tulsa; his family moved wherever Standard Oil needed his father. He first became interested in constitutional law as an undergraduate at Northern Illinois University. After graduation, he went to the University of Texas School of Law in Austin and met Camille Bathurst, the woman he’d marry. Eventually they settled in Louisville.

Belzley spent the first part of his career working for bigger law offices, helping companies avoid large payouts after accidents with multiple fatalities. Then, in 1986, his law firm got a case about a woman who had been unlawfully strip-searched while in jail. He picked it up on contingency, meaning he’d be working for free unless he won. He did. About a year later, another strip search case came his way. It turned into a class action lawsuit that lasted 10 years and ended in an $11.5 million settlement.

After that, his name started to get around. Prisoner-rights lawyers tend to build their careers by word of mouth. And so it was with Belzley. He’d never given much thought to America’s prisons and jails, but as incarcerated people started calling and writing, it felt like a path he had to follow.

Whenever the law firm’s partners could spare him some time, Belzley would pick up a civil rights case. Eventually, he decided he couldn’t stomach corporate law any longer. “I got so sick of the bullshit,” he said. So he quit and opened a one-man shop in the front room of his home.

The decision to start his own practice was a risky one.

Belzley’s daughter Alexandra, whom he calls Xan, was 11 or 12 at the time he struck out on his own. He recalls walking with her through their neighborhood and asking her what she thought about his move. Her answer: “Well, who’s gonna help them if you don’t, Daddy?” Xan doesn’t remember this, but by now it’s family lore.

Life Inside

The cases he had decided to take on are not easy to win. Judges are often inclined to show deference to prison and jail officials.

Often, Belzley will receive a judgment and read the ruling in disbelief.

“These are decisions that don’t make any sense,” Belzley told me. “They’re not good for the country. They’re not good for the people. They ignore the Constitution. They ignore precedent, and somebody needs to start raising hell about it. And I’ve decided to start doing it.”

For incarcerated people (or their surviving family members) who feel their constitutional rights have been violated, the federal courts are often the only recourse. There’s no national oversight of jails and often little or none at the state level.

Over the years, however, getting courts to step in has gotten even tougher. “It’s very hard to bring these cases procedurally,” said Michele Deitch, the director of the Prison and Jail Innovation Lab at the University of Texas at Austin. “It’s very hard to get the courts to exercise any kind of oversight.” Many judges have become increasingly resistant to prisoners’ civil rights cases, she said.

Margo Schlanger, a law professor and the founder of an online clearinghouse focused on civil rights litigation, has tracked the outcomes of prisoner civil rights cases in federal district courts over more than three decades. In general, fewer than 15% of them end with a judgment in favor of the detained person or their family members.

Medical cases, like Helphenstine’s, are particularly difficult. People in jails and prisons have a constitutional right to “adequate medical care,” derived from the Eighth Amendment, the ban on cruel and unusual punishment. The amendment is just 16 words long — “Excessive bail shall not be required, nor excessive fines imposed, nor cruel and unusual punishments inflicted” — but over the years, legal theory evolved in such a way that plaintiffs must prove “deliberate indifference.” The standard was first established by the U.S. Supreme Court in 1976. Under this doctrine, lawyers must show not only that jail staff were careless, but that they knew about — and disregarded — a prisoner’s “serious medical needs.” Writing for the majority, Justice Thurgood Marshall made a distinction between “an accident” and the “unnecessary and wanton infliction of pain.”

Lawyers and scholars call this a “state of mind” test, and critics say showing that an action was deliberate is one of the most difficult bars to meet in litigation. Judges and juries tend to give guards and prison officials the benefit of the doubt, trusting that what they say in a courtroom is what they really thought in the moment, even when there may be evidence to the contrary. Deborah Golden, a D.C. lawyer who specializes in prisoners’ rights, said that in such cases she must prove that someone is not just a “complete idiot” but purposely denied necessary care. “And it’s a total defense to say, ‘I’m sorry, I’m a complete idiot,’” she said.

Critics say deliberate indifference allows prisons and jails to dodge judicial review, undermining accountability and allowing appalling conditions to proliferate. “It invites courts to look at outrageously harmful, morally unacceptable conduct and — if they don’t find that the prison official actually realized the risk — to label it ‘not cruel,’” said Sharon Dolovich, a law professor at UCLA and one of the leading experts on deliberate indifference.

That’s essentially what happened at first with the Helphenstine case. In 2022, U.S. District Judge Henry Wilhoit in the Eastern District of Kentucky issued a summary judgment in favor of Lewis County and its jailers. There was no jury, there were no oral arguments. “This case is indeed a tragedy,” Wilhoit wrote . “Helphenstine’s death may well have been avoided had the deputies made different decisions in the crucial days and hours.” Still, the judge noted in six separate places, “Awareness of withdrawal is not tantamount to deliberate indifference.”

After Wilhoit handed down his decision, Belzley took a moment to curse the ruling, and then he started work on the appeal.

He had an idea.

I n 2015, the Supreme Court heard the case of a Wisconsin man who had been awaiting trial when a sheriff’s deputy shocked him with a Taser while he lay handcuffed on a jailhouse bunk. The plaintiff, Michael Kingsley, said this was excessive force that violated his constitutional rights. Only he didn’t cite the “cruel and unusual punishment” amendment; rather, he said the attack violated his right to due process under the 14th Amendment. That amendment essentially protects people’s rights to a full legal process before the government may deprive them of life, liberty or property.

Kingsley argued that his treatment in jail constituted a punishment before he was convicted of anything. The high court agreed. The result was that Kingsley needed to prove only that the force the jailers used on him was objectively unreasonable.

Some lawyers argue — and some courts have agreed — that the Kingsley standard ought to apply when pretrial detainees complain of inadequate medical care. In other words, people awaiting trial shouldn’t have to argue that jailers deliberately ignored their health needs, only that jailers should have known about those needs. The federal courts of appeals, however, are split. At least five circuit courts have, to varying degrees, embraced the change to a lower threshold, while four others have continued to apply the “deliberate indifference” standard.

The situation in the 6th Circuit, which includes Kentucky, was among the murkiest. In one case, Brawner v. Scott County, a panel of 6th Circuit judges ruled that a detainee only had to prove that their jailer should have known of the risk, rather than knew of and ignored it. Then a year later, a different panel, ruling on a case called Trozzi v. Lake County, appeared to roll that back. The judge who wrote that opinion, Chad Readler, a Trump-era appointee, seemed inclined to go further, suggesting that ignoring a prisoner’s serious medical needs was not a violation of the Constitution and that these sorts of claims did not belong in federal court.

The Record

Belzley hoped to force the court to clarify its position on deliberate indifference. “I don’t know what the law is,” he said, “and I don’t think the 6th Circuit does, either.”

Though it may seem like a narrow point of contention, a subtle difference in legal wording, future cases might live or die by it. Circuit courts can affect Supreme Court decisions. A judgment made here could bolster a ruling to restrict prisoners’ rights further — or help people like Julie Helphenstine seek justice for her husband.

O ral arguments move quickly. Each side gets 15 minutes, and judges typically don’t let lawyers run long. Inside the courtroom in Cincinnati, Belzley went first. Once he’d introduced himself, he cut straight to the matter he wanted settled: Would the court respect the ruling in the Brawner case so that all he had to prove was that the defendants should have known of the risks Helphenstine faced? Or did the later Trozzi decision mean that a strict deliberate indifference remained the standard for people held before trial?

Just as Belzley was getting into the specifics of the two decisions, Sutton cut him off. “Just don’t worry about that,” the judge said. “We can handle the point you’re dealing with.”

Belzley switched to the circumstances of Helphenstine’s death.

After a few minutes, though, Judge Richard Griffin steered it back to the question Belzley hoped to answer: To succeed under Brawner, all Belzley had to prove was that the jailers should have known about the excessive risks to Helphenstine’s health. And that, the judge said, is “really a jury question. That’s what your argument is, right?”

“That’s right,” Belzley said.

With that, his time was up.

When the lawyer for the jailers began speaking, Griffin made it clear he favored the “should have known” standard, not the one requiring deliberate indifference. Then the arguments shifted back to the question of why the jailers didn’t intervene.

Sutton, the chief judge, mentioned the video showing Helphenstine shaking, then falling quiet, asking, “Why isn’t that a heads-up that something serious is going on?”

The lawsuit Belzley had filed listed a number of employees, and the lawyer tried to take them one by one, echoing arguments in his briefs that the jailers took appropriate actions once he’d become unresponsive. “They immediately went to emergency medical protocols by calling for an ambulance, administering CPR, doing everything they could, these deputy jailers, to try and save this man,” he said.

“Come on,” Griffin said. “He was in bad shape all along, wasn’t he?”

“He fluctuated,” the attorney said, but the judge quickly cut him off.

“He’s got a serious medical condition,” the judge said. “And he receives no medical treatment, or very little, I mean, I think it’s an egregious case.”

A separate attorney for the on-call physician pressed the argument that Helphenstine had refused treatment. The judges asked Belzley about this once he returned for rebuttal. There was a bit of back-and-forth about whether Helphenstine could be forced to go to the hospital, but it didn’t last long.

“Thank you, your honors,” Belzley said.

News Inside

Oral arguments were over.

I walked with Belzley back to his hotel, and we sat in the lobby drinking hours-old coffee. He was talking fast, half to me, half to himself, trying to puzzle out what just happened.

“I did the best I could,” he said.

M onths passed without word, until one Thursday in early February 2023, I received an email from Belzley. The subject: “Helphenstine - 6th Circuit Opinion.”

I scrolled straight to the last page. And there it was: “For these reasons, we reverse the district court’s grant of summary judgment.”

Belzley had won the appeal. The Helphenstine case could proceed and possibly go to trial.

Griffin had written the opinion, and he’d come down decisively on Belzley’s side. From here on out, pretrial detainees held in Kentucky, Tennessee, Ohio and Michigan — the states governed by the 6th Circuit’s rulings — would no longer have to prove deliberate indifference in medical care claims. They could prevail by simply showing that prison officials should have known of the risk at hand.

“I was just very pleased, very pleased,” Belzley said when we spoke by phone a few days later. “You know, as opposed to a one-beer night, it was a two-beer night. And I’m very happy for the client, because Ms. Helphenstine and Mr. Helphenstine’s little boy, y’know, these are the lives that are behind these cases.”

Belzley expected they’d eventually reach a settlement with the county; few cases go before a jury these days. What’s more, the decision potentially would allow other cases to move forward, he said. “So everybody who practices in the 6th Circuit is breathing a considerable sigh of relief.”

Not two weeks later, I received word from Belzley that the lawyer for the jail had asked the full 15-judge court to hear the case again. Ultimately, the 6th Circuit declined.

One member of the court, Readler — the judge who had written the Trozzi opinion endorsing a standard closer to deliberate indifference — took the unorthodox step of issuing a statement on the subject. He called on the Supreme Court to settle the circuit split on deliberate indifference.

The defendants’ lawyer quickly petitioned the Supreme Court to hear the case. Though the justices had initially requested responses from both parties, in the end, they took a pass.

Still, Belzley and other experts suspect the high court will eventually address the matter. “What my gut tells me is this issue has the Supreme Court’s attention,” Belzley said.

To Julie Helphenstine, the details of the legal arguments were less important. For her, the lawsuit was about just one thing: “I brought this case to right the wrongs they did to Chris. Because he is a person and he was loved.”

A couple of years ago, Julie told me, their son felled his first buck — a 10-pointer. She got it mounted for him, and after they’d hung it up, he turned to her. “Mama,” he said, “Daddy woulda liked that one.”

She looked at him, trying like she always does to hold herself together.

“He would have been very proud of you,” she said.

This summer, more than seven years after Chris’ death, Julie settled her case with the county and jailers for an undisclosed sum.

W hen I first met Belzley, he’d told me he was planning to retire at age 70. As the year went on, though, he kept talking further into the future. So recently, I asked him if his plans had changed. They had, he said. He’ll still cut back some, going from as many as 40 cases down to about 20, but retirement was no longer on his mind.

I wondered if maybe it had something to do with the small but consequential victory in the Helphenstine case. No, he said, not directly. The decision had more to do with legacy. He was hoping to work with some younger lawyers, train them to follow in his footsteps. “Frankly I’m worried about who’s going to take this over,” he said. And not just in Kentucky, but nationwide. “It’s a very tough business.”

So, Belzley said, he plans to stay in it as long as he can.

“You can only do what you can do, but I’m gonna try and do what I can,” he said. “I’m a mean old bastard, you know, and I feel something of a calling.”