LOUISVILLE, Ky. (AP) — A prison doctor has been fired and two other staffers are in the midst of being dismissed after an inmate at the Kentucky State Penitentiary starved himself to death, a case that has exposed lapses in medical treatment and in how hunger strikes are handled at the facility. Prison officials have asked prosecutors to investigate after The Associated Press began asking questions about the inmate’s death.

James Kenneth Embry, 57 and with just three years left on a nine-year sentence for drug offenses, began to spiral out of control in the spring of 2013 after he stopped taking anti-anxiety medication. Seven months later, in December, after weeks of erratic behavior — from telling prison staff he felt anxious and paranoid to banging his head on his cell door — Embry eventually refused most of his meals. By the time of his death in January of this year, he had shed more than 30 pounds on his 6-foot frame and died weighing just 138 pounds, according to documents reviewed by the AP.

An internal investigation determined that medical personnel failed to provide him medication that may have kept his suicidal thoughts at bay and didn’t take steps to check on him as his condition worsened. The internal review of Embry’s death also exposed broader problems involving the treatment of inmates — including a failure to regularly check inmates on medical rounds and communication lapses among medical staff.

The AP, tipped off to Embry’s death, obtained scores of documents under Kentucky’s Open Records Act, including a report detailing the investigation into Embry’s death, an autopsy report and personnel files. Along with interviews with corrections officials and correspondence with inmates, the documents describe Embry’s increasingly paranoid behavior until his death and the numerous opportunities for various prison staff to have intervened.

“It’s just very, very, very disturbing,” said Greg Belzley, a Louisville, Ky.-based attorney who specializes in inmate rights litigation and reviewed some of the documents obtained by the AP. “How do you just watch a man starve to death?”

According to the report of the internal investigation, Embry stopped taking medications for anxiety in May 2013. Seven months later, he told the lead prison psychologist, Jean Hinkebein, on Dec. 3 that he felt anxious and paranoid and wanted to restart those medications. But the psychologist concluded Embry didn’t have any significant mental health issues even though Embry repeatedly talked about wanting to hurt himself. Hinkebein and an associate considered his comments vague, and his request for medication was denied.

Seven days later, on Dec. 10, Embry began banging his head on his cell door and was moved to an observation cell where he refused meals and told the prison psychologist, “I don’t have any hope.”

He soon began refusing most food, though he drank tea on occasion while continuing to make threats to hurt himself in the ensuing weeks.

A nurse checked on Embry on Jan. 4, finding him weak and shaky, and advised him to resume eating. Embry responded that it had been too long for him to start taking food again. Nine days later, on the very day he died, an advanced practice registered nurse named Bob Wilkinson refused a request from other medical staffers to move him to the infirmary at 11:51 a.m. and said the inmate should be taken off a hunger strike watch, according to the internal investigative report. Guards found Embry unresponsive in his cell hours later, his head slumped to the side. He was pronounced dead at 5:29 p.m.