JEFFERSON CITY — A blast of gunfire here in June 2018 struck Shavontay Estes in the chin, side and back. The drive-by attack left the 24-year-old paralyzed from the waist down.

During his recovery, Estes was charged with second-degree murder and various weapons violations for incidents that happened before he was shot.

Clark McVey, his public defender, hasn't gotten to all of that yet. He said he's been too busy addressing the bedsores that Estes may have developed in the Cole County Jail.

"I have heard people flat-out say that he is just getting what he deserves," McVey told the St. Louis Post-Dispatch. "We should all be given humane treatment. Furthermore, with Mr. Estes, these cases are pending. There has been no finding of guilt."

His client's condition illustrates the costly challenge that many jails face since increasingly becoming repositories for the infirm. In Missouri, one of about 20 states that doesn't have statewide jail standards, his situation is poised to go unnoticed beyond local authorities.

"Jail health care around the country is abysmal," said Lexi Jones, a policy analyst at the Prison Policy Initiative, a nonprofit organization in Massachusetts that advocates for investing in community services instead of jails. "Generally, the jail population has a lot of health needs, and they are not getting the appropriate health care."

Cole County Sheriff John Wheeler said he takes the health care of his inmates very seriously. Indeed, he said, the state has "failed to assist" on mental health treatment but overall there are medical protocols followed at his facility.

"We moved heaven and Earth any time that we could," Wheeler said. "And not just for him, for any inmate we'd do that."

The Cole County jail is a few blocks from the state Capitol. It has 202 beds used for a mixture of state and federal inmates. Wheeler said the jail has a much bigger budget and capacity than some of the tiny facilities in sparsely populated counties.

"If he was going to be in jail, I think he was fortunate to be in my facility," Wheeler said of Estes. "Because I believe we did take good care of him."

Wheeler provided a copy of a contract with Overland-based Advantage Nursing Services that indicates Cole County paid the firm $80 an hour for nursing service. Though Estes's name is not in the contract, Wheeler said Advantage Nursing was hired just for Estes. He said Cole County spent roughly $40,000 a month on the contract between Sept. 18 and Dec. 29.

"The nursing we provided, it's expensive but it's the cost of doing business," Wheeler said.

In addition to Advantage Nursing, he said the jail has a $194,000 annual contract with Advanced Correctional Health to provide eight hours of nursing each day for all inmates at the facility and doctor visits when needed.

Jessica Young, president of Advanced Correctional Health, said by email that the Peoria-based company is the largest provider of health care in jails across the country. It staffs doctors, nurses and mental health workers at nearly half of the jails in Missouri.

"Correctional health care is challenging, so it takes special people to do what we do," Young wrote. "Some challenges in treating incarcerated patients include: they do not (or cannot) access health care in the community, they are not aware of their medical history, or they don't realize the importance of their current medical condition."

She didn't respond to specific questions about Estes. Nor did Advantage Nursing Services.

"I can't confirm or deny anything," said Monica Geyman, who signed a Dec. 2 contract with Cole County on behalf of the firm.

As soon as Estes was booked into the jail on Aug. 30, he said, he struggled to get help. He said he stayed in a medical pod and slept on a mattress pad. He said he sometimes wouldn't see a nurse for hours and wasn't rotated enough. He said the jail installed a bar to help move himself but it didn't work well.

Estes' wife and mother said in interviews that they used to regularly change his diapers and roll him over to keep pressure off his hips. They said Estes didn't have bedsores before he went to jail.

According to a Nov. 21 doctor's report, Estes developed "wounds" over each hip prior to incarceration. The one on the right was "nearly healed" and the one on the left was "shallow" and measured 3 centimeters wide. Photographs and recommendations were included in the report. No. 1: keep stool and moisture out of the wound. No. 2: keep the wound free from pressure by having him sit upright in his wheelchair; if he is to remain in bed, consideration should be made to use an offloading mattress to prevent further pressure on his sores.

Still, his condition apparently worsened. In mid-December, Estes was taken to the hospital to have one of the wounds excavated. He was placed under full anesthesia for the procedure, his attorney said. Estes was given vacuum-assisted therapy to help care for the wound. He had a follow-up hospital visit before Christmas.

In a meeting on Jan. 7, Cole County Circuit Judge Jon Beetem told McVey and prosecutors that he agreed that Estes should be released from jail on his own recognizance so long as he was treated as an inpatient at Rusk Rehabilitation Hospital in Columbia, the same hospital that helped him recover from gunshot wounds in 2018.

"One of them had ruptured and actually was going gangrenous," McVey said his client told him at the time.

Estes provided photographs taken when he arrived at Rusk on Jan. 10. The photographs showed that the bedsores were significantly worse than the Nov. 21 doctor's report. The one on the right measured 3 centimeters, the one on the left measured 9 centimeters — about the size of an orange — and appeared to be deep, with a tinge of green.

"This is where $40,000 took me," Estes said of the monthly contract for nursing that the sheriff said was lined up for Estes. "To the hospital."

Judge Beetem recently approved a home plan for Estes. After the judge's decision, Estes was expected to leave Rusk and be fitted with a 24-hour GPS monitoring device. Estes and his wife are going through a divorce. McVey said Estes was going to stay with a cousin in Knob Noster, Missouri, whose partner is a nurse.

McVey said he now has more time to devote to the criminal case.