This document presents a comprehensive analysis of 390 custodial deaths across Texas's four largest county jails (Bexar, Dallas, Harris, Travis). Includes logistic regression models, visualizations of the screening paradox, and evidence of institutional factors driving the 3.6-fold variation in preventable death rates. Keywords: jail suicide, custodial deaths, Texas, mental health screening, institutional failure

Analysis of 390 custodial deaths across Texas's four largest county jails (2015-2025) reveals a 3.6 fold variation in preventable death rates, from 7.8% in Dallas County to 27.9% in Travis County. Suggesting that institutional factors, not individual characteristics, determine outcomes. This research provides evidence-based recommendations for statewide jail reform to prevent unnecessary deaths in custody.