The family of a homeless man who died about 24 hours after being booked into a Texas jail believes the county is concealing the true cause of his death.

Robert Miller, 38, was found face down and unconscious in his cell. The Tarrant County Lail told hospital staff they suspected a drug overdose, but no drugs were found in his system. Miller had attention deficit disorder, post-traumatic stress disorder and asthma. He told jail staff he “could not breathe” minutes before he was discovered.

The county medical examiner ruled that his death was from natural causes linked to a sickle-cell crisis.

However, Miller’s family and a group of experts who reviewed his medical records said he never had sickle-cell disease. Jail officials failed to mention that Miller was handcuffed and pepper-sprayed multiple times before guards left him in the cell.

“Something was off about it,” the man’s father, Willie Miller, said.

Willie Miller didn’t know his son had been arrested until he got word he was dying.

Robert Miller left the home he shared with his wife and young child in 2015 after a disagreement over his mental health treatment. Willie Miller tried to persuade his son to live with him in his Fort Worth, Texas, home to no avail. He received a call from a chaplain on Aug. 1, 2019, informing him that his son was nearing death.

The older man, who uses a wheelchair, could not get to the hospital right away. When he arrived at the John Peter Smith Hospital in Fort Worth, his son was already dead. Willie Miller said Robert looked like he’d been in a fight.

Reports show Robert Miller’s neck was swollen and blood leaked from his ears and nose. For almost three years, his wife and her lawyers pressed county officials for copies of records connected to the man’s death.

The Texas Rangers released their 252-page report in April in response to Shanelle Jenkins’ summer 2021 wrongful death lawsuit. However, it was well past the two-year deadline in a civil suit. A federal judge dismissed the case, which the family is appealing.

Miller was arrested on July 31, 2019, after police responded to a complaint about panhandling near a homeless camp at the former Butler Place housing projects where he slept. The officers found Miller had misdemeanor warrants from at least three years earlier, including for public intoxication and panhandling and $4,000 in unpaid court fines. However, things escalated after Miller kicked a patrol car, leaving hundreds of dollars in damages.

Miller was booked in the Tarrant County jail at 2:02 p.m. Sheriff’s Sgt. Sheldon Kelsey and Officer Jason Wheeler wrote in their notes that Miller had mental health conditions, including PTSD, because of a past interaction with police. When asked if he wanted to harm himself, Miller replied no but said he wanted to “kill all y’all cops.”

According to the narrative summary by Kelsey, a handcuffed Miller tried to head-butt Officer Michael Tahmahkera after he was escorted to a room without cameras to change into a jail uniform.

Tahmahkera and Officer Jordan Beene tried to restrain Miller by his upper body, and Kelsey tried to restrain his feet. Tahmahkera pepper-sprayed Miller once and Kesley sprayed him twice. Wheeler put leg restraints on his feet, the report says.

The officer rinsed Miller’s eyes for 10 minutes, removed his clothes, and a nurse evaluated him, the report states. The Star-Telegram’s review of the ranger’s report found statements from sheriff’s officers who say Miller told a jail nurse “I can’t breathe” shortly after the officers sprayed him.

Reports show there is no record that Miller received medical care after he advised the nurse of his difficulty breathing. He was found unresponsive 38 minutes later and transported to the hospital for a possible drug overdose. Miller died about 12 hours later without traces of drugs in his system.

The Tarrant County Jail only has video footage of before and after Miller was pepper-sprayed. The Sheriff’s Office has held onto the tapes, citing an ongoing investigation. Details from the footage were not included in the Texas Rangers report because the investigator reportedly didn’t watch the footage and he asked a sheriff’s deputy to review it instead.

Tarrant County forensic pathologist Dr. Richard Fries wrote that Miller’s red blood cells were rigid, sticky and shaped like sickles or crescent moons instead of round and had little to no oxygen in them. However, sickle cell experts said the cells can transform after death if the person carried the sickle-cell trait.

Experts said Miller’s medical records show he had other issues but none of them was sickle-cell disease.

Hannah Lichtsinn, an internal medicine doctor and sickle-cell expert in Minnesota told the Fort Worth Star-Telegram that doctors at the Texas hospital tested Miller’s blood and noted his red blood cells were healthy, not anemic.

“I can tell you his kidneys were healthy until he had his cardiac arrest,” Lichtsinn said. “I can tell you that his blood counts were pretty normal until he had his cardiac arrest, and so was his liver. I can tell you that he wasn’t on drugs. And I can tell you he didn’t have sickle cell anemia.

Sickle cell anemia usually appears in patients by 6 months, and it is rare for adults to live without knowing they have it, research shows. Hospitals in Texas have been conducting mandatory newborn screening for sickle cell disease since 1983.

“His mom, when she was here, she took him to the doctor so much that it got me upset,” Willie Miller said. “Even if he had a light cough then boom, to the doctor. So I would’ve known about it.”

Medical experts said it’s impossible to live until 38 and be unaware of the presence of sickle-cell anemia. It’s a heredity disease that leads to pain, vision problems and immune deficiency, research shows.

Adults with severe cases of the disease have a life span of 20 to 30 years, according to the Centers for Disease Control and Prevention. The disease has been found in one out of every 365 Black births, the CDC reports.

However, the sickle-cell trait is almost entirely benign, according to research. CDC data shows one in 13 Black babies is born with the trait.

Miller’s case is not the first time that sickle cell has been used to explain the death of Black people in law enforcement custody.

The New York Times reported that the trait was falsely attributed to at least 45 in-custody deaths of Black people in the past 25 years. An initial autopsy for the country’s most infamous police killing referenced George Floyd’s sickle cell trait, history of heart disease and substance-use disorder after he died from a “medical incident during police interaction.”

Experts believe that close-range use of pepper spray is more likely to be behind Miller’s death. A CT scan showed that Miller had a high amount of inflammation and a buildup of fluid in his lungs. He had two cuts on his forehead, and both of his brow bones were swollen, according to reports.

Sven-Eric Jordt, a professor of anesthesiology at Duke University and an expert on the effects of pepper spray on the body, said it can severely damage the lungs and is more harmful to people with asthma. It can trigger an asthma attack or cause bronchoconstriction, a condition that blocks the amount of air flowing through the lungs. Reports show doctors at the Fort Worth hospital wrote that Miller had signs of bronchoconstriction.

“I think this is really a human rights issue and a human medical rights issue,” Jordt said. “If you basically have someone immobilized … when they’re in handcuffs like this person, do you need to pepper spray them? I’m really concerned that this pepper spray was used indoors.”

Local prosecutors have not considered criminal charges because of Miller’s cause of death. Jenkins and her lawyers plan to appeal the civil case.