Before someone dies of dehydration, he or she will likely experience several days of nausea, dizziness, severe headaches, fainting, seizures, insomnia, rapid heart rate, sunken eyes and a swelling of the tongue.

Based on an autopsy report released last week, that may have been what North Carolina inmate Michael Anthony Kerr was going through in the final days of his month-long stay in solitary confinement at a Taylorsville prison.

Kerr died March 12 as prison workers tried to transfer the 53-year-old to Central Prison in Raleigh, the state’s chief mental health and medical center for male inmates. The long-awaited autopsy from the Office of the Chief Medical Examiner stated dehydration was the apparent cause, although the examiner added that it was unclear whether prison workers did not provide water or if Kerr refused water.

“Just because he’s an inmate, he’s still a human being,” said his sister, Brenda Liles, when she learned of the report last week. “They’ll lock you up for being cruel to animals. Who is going to be locked up for my brother being dead?”

Kerr had been diagnosed with schizoaffective disorder, which combines the psychotic symptoms of schizophrenia with a mood disorder such as depression. Sources, including at least one inmate in a neighboring cell, said prison workers allowed a catatonic Kerr to languish in his own feces for several days before they attempted to transfer him to Central Prison. Kerr had lost weight and required a wheelchair to leave his cell shortly before his death, they said.

“When you’ve got a man isolated, how can he get the water and the food if you don’t give it to him?” Liles said.

W. David Guice, commissioner of adult correction and juvenile justice for the N.C. Department of Public Safety, said his agency’s investigation determined Kerr had access to water from a sink in his cell, but prison procedures were not followed in multiple areas. DPS declined to elaborate on the nature of those procedures.

The medical examiner’s report noted Kerr was not being treated for his mental illness at the time of his death. The examination also found abrasions on his forearms likely caused by his restraints and an unexplained contusion on his head.

Since the INDY reported Kerr’s death in April, DPS has fired nine prison workers, including three psychological service providers, four nurses and a prison guard. Two additional employees resigned and another 20 to 30 were disciplined or reassigned as DPS, the State Bureau of Investigation and nonprofit Disability Rights N.C. opened investigations.

Disability Rights has finished its probe, but, citing the confidentiality of some documents such as health records, Vicki Smith, the group’s executive director, said she would not publicly release the findings. However, Smith wrote in an email that the investigation found “severe deficiencies in the provision of services to inmates to mental illnesssuch significant problems that constitutional rights are implicated.”

“We don’t think a man placed in a cell by state officials should be allowed to die by dehydration, and DPS officials don’t think so either,” Smith said.

Smith said her group is negotiating several major reforms with DPS, which she described as “extremely cooperative.”

Inmates with mental illness will no longer be held in isolation for more than a few days if treatment professionals determine it would be harmful, Smith said. Additionally, inmates with mental illness would no longer be placed in solitary confinement simply because of their symptoms, she said. Prison officials would also improve screening for mental illness, create an “alternative setting” to provide therapy for inmates with mental illness and fill “extreme” staff shortages in clinical positions at North Carolina prisons.

Smith added that DPS will consult with Colorado psychiatrist Jeffrey Metzner, a leading researcher on the detrimental effects of solitary confinement on prisoners.

DPS spokeswoman Pam Walker would not comment on the reform process.

DPS officials said workers at the Taylorsville prison could face criminal charges depending on the outcome of the investigation, although no charges had been filed as of Monday.

This story originally appeared on the INDY‘s news blog last week.