Upshaw won a 2006 Casey Medal (single story 75,000-200,000) for this story.

Keisha Brown wasn’t an easy person to write about. She skipped school and called in bomb threats, abused drugs and alcohol, stole and ran away from home — all before she was old enough to drive. While at juvenile lockup, she admitted to raping another inmate. At first glance, she wouldn’t garner much sympathy, and her death wouldn’t receive much press. But there were compelling reasons to look past her criminal history and tell the story of a girl who felt ignored and alone, even in the last moments of her life.

Initially, my editor asked me to write a follow-up to a brief that ran the weekend Keisha died. I visited her family and read a letter she had written her grandmother. “Things are getting a little shaky for me. I plan on hanging in there though. ... I been sick a lot lately,” Keisha wrote. “These nurses suck here. My back hurts a lot. When I breathe a certain way it hurts in my left rib. They tell me I’m not hurting but I stay strong anyhow.”

That last line haunted me. The facility she lived in off and on for two years had a troubled past — children had accused employees of abuse and the federal government had cited the state for numerous problems there. An autopsy later revealed that Keisha had been suffering from blood clots in her lungs for at least two days, and possibly as long as two weeks, before they finally killed her. Had employees really ignored the 17-year-old’s pleas for help? Only her file could answer that question. But in Arkansas, like most states, juvenile and medical records are private.

I wrote the follow-up and then asked Keisha’s mother to request her daughter’s file from the state’s Department of Human Services. My editors, meanwhile, agreed to let me keep digging. The file I received included several thousand documents detailing Keisha’s medical, criminal and psychological history. I created 250 inches of timelines to keep the information straight — one for her personal history and one for her medical treatment and requests for medical care.

What I read bothered me. I know journalists shouldn’t feel — they should just observe, one of my colleagues has said many times. Compassion means crossing a forbidden line. But compassion led me to this story. The image of Keisha dying — collapsing repeatedly, struggling to breathe, begging for help that was not given — was difficult to get out of my head. And had I not been disturbed by Keisha’s letter, and later what I found in her file, I may not have spent two months writing and editing, “Teen cried for help, got little.”

Much of what I wrote came directly from Keisha’s file. It was flush with Keisha’s recollections and color from her time at the facility, information rarely available after someone’s death. Few of the facility’s employees would talk to me, and none on the record. To reconstruct scenes, I relied on the file, investigation reports, interviews and a surveillance video that showed Keisha as she lay dying.

Watching the video became a turning point. It was a grainy, black-and-white video with no sound but it was powerful nonetheless. The recording began with Keisha walking to a table in the cafeteria. Though I had the luxury of hindsight, it was obvious that Keisha was very ill. She could barely move and kept her head on the table most of the time. Her body seemed limp. I kept thinking: This girl is dying. The tape ended with Keisha in the infirmary. The camera was positioned so that I only saw her calves and feet. A couple of unidentified employees stood at her feet talking and laughing when she was first brought in. As a reporter, I obsess about being fair and not blowing stories out of proportion. After watching that tape, I knew that my approach to the story was appropriate. More importantly, I knew that I had to tell readers what happened that day.

Though obtaining documents proved frustrating (much less so after Keisha’s mom stepped in), the most difficult aspect of this story was writing about a girl with an insatiable thirst for attention who some had cast aside as a troublemaker. There was so much more to Keisha, who had been sexually abused at an early age. She had made bad choices but she also earned her GED at 17. She had stopped getting into trouble and she had plans for the future. But even if Keisha hadn’t changed, her past did not make her less of a person. Still I wanted to be fair to those who worked with her — since I only knew Keisha on paper. So I put it all out there — her flaws, her crimes, the abuse she suffered, her repeated requests for care, her declining health — so readers could decide for themselves if her treatment was appropriate.

The response was overwhelming. Legislators called for change. Readers expressed anger and sympathy. The company that runs the facility disciplined and/or fired several people. The medical system for juvenile lockups, which state officials acknowledged had “widespread problems,” has been improved. Six facility nurses now face losing their licenses to practice.

And after years of Keisha feeling unwanted and abandoned, people finally cared about her.