About 24,000 people are held in Missouri's prisons. That's roughly how many people live in Webster Groves in St. Louis County.
In recent years, advocates for prison reform say they have observed an alarming — and confounding — pattern in Missouri's prison population. Year over year, the number of inmates keeps going down.
But the number of deaths keeps going up.
Through the late 1990s and 2010s, Missouri's prison population routinely crossed the 30,000 mark before falling to its current level. But 2024's 137 deaths behind bars marked a record high. Meanwhile, 2025's total of 108 deaths by November means that the state has again exceeded 100 annual prison deaths — for the fifth consecutive year.
"Going into this new year of 2026, we're starting to see the same patterns again of consistently over 100 deaths or more, every year," said Jerika White, criminal justice policy manager at the nonprofit Empower Missouri. "I will say a lot of that has to do with the lack of health care and the lack of oversight."
Those assertions, and the blame it places on Missouri's Department of Corrections, took center stage during a Jan. 14 hearing before the Missouri House Corrections Committee.
During that hearing (which was first reported on by the Missouri Independent), Department of Corrections director Trevor Foley faced pointed questions from lawmakers about Centurion Health, the contractor that provides medical care in Missouri's prisons.
At one point, Foley described the performance standards Centurion must meet under its contract with the state. Rep. Gregg Bush, of Columbia, asked Foley whether those standards included "mortality" — that is, whether an incarcerated patient lived or died.
"No," Foley said. "Not in terms of the outcome."
White provided counter testimony to Foley at the same hearing. Looking back on what Foley revealed, she said she was surprised at the casual way the director described a lack of oversight.
"All the people that have died consistently, year after year after year? For that to not be a measure is very concerning."
ML Smith, founder of the Missouri Justice Coalition, was also in attendance on Jan. 14 and testified after Foley responded to Bush's question. She said she wasn't surprised that mortality isn't considered a "performance standard" for Centurion Health.
"I'm glad it is now known — that the director actually stated it himself," she added. "I am thankful that he put that in, so that hopefully the committee members will want to look into the outcomes of mortality and why that is not a metric. Hopefully, this is a step in the right direction."
On this episode of St. Louis on the Air, Smith and White discussed their recent experience testifying for the Corrections Committee and their reaction to Foley's disclosures about oversight of Centurion Health. During the conversation, White shared accounts from two former Centurion employees who said the company was chronically understaffed and forced them to work in unsafe conditions.
STLPR reached out to Centurion Health earlier this week with a request for comment for this story and to clarify how "mortality" factors into the health care it provides in the state's prisons. The company did not respond.
Centurion is a privately owned company that has been Missouri's prison health contractor since 2021. It will be paid $212 million for those services in 2026. The company has been fined a total of $3 million for missing performance standards since 2024, the Missouri Independent reported.
To hear the full conversation with Empower Missouri's Jerika White and Missouri Justice Coalition's ML Smith, listen to "St. Louis on the Air" on Apple Podcasts, Spotify or YouTube, or click the play button below.
"St. Louis on the Air" brings you the stories of St. Louis and the people who live, work and create in our region. The show is produced by Miya Norfleet, Emily Woodbury, Danny Wicentowski, Elaine Cha and Alex Heuer. Layla Halilbasic is our production assistant. The audio engineer is Aaron Doerr.
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