According to autopsy findings, the diabetic inmate's insulin pump was likely beeping nonstop for nearly 24 hours, alerting that it had run out of medication.

A nurse ordered a higher dose, but approval was pending. Nineteen hours went by without any medical care to Bach, the San Diego Union-Tribune reports, even after his insulin pump’s alarm began going off and other prisoners asked Sheriff’s staff to help him. He was later found dead in his cell.

The alarm on his insulin pump was still beeping when an investigator from the Medical Examiner’s Office arrived at the Men’s Central Jail following his death last September. According to autopsy findings requested by The San Diego Union-Tribune and released this week by the Medical Examiner’s Office,

The Medical Examiner’s Office ruled 63-year-old Keith Galen Bach’s death as a homicide by negligence, and now the San Diego District Attorney is investigating it.