When a sheriff called Joe Arpaio began forcing prison inmates in Phoenix, Arizona, to wear pink underwear, he became a national talking point.

The move was among a raft of hard-line policies which also saw prisoners housed in tents in a city where daytime temperatures can approach 48C and forced to work in chain gangs.

It saw Arpaio dubbed: “America’s toughest sheriff.” It has also garnered him a high-profile compensation lawsuit. A federal appeals court ruled this week that the pink underwear seems unconstitutional, and may have contributed to the death of a mentally ill inmate.

Eric Vogel, 36, a paranoid schizophrenic, died of an acute heart attack in 2001 after running five miles in a bid to flee one of Arpaio’s officers. Weeks earlier, he had been detained on suspicion of burglary.

Despite being deemed in need of psychiatric care, he was held down, stripped naked and forced to dress in the pink uniform by four sheriff’s deputies.

Vogel’s family say he became convinced he had been sexually assaulted and was terrified of custody.

“Pink underwear sounds funny until you have a paranoid schizophrenic who thinks he’s being prepared to be raped,” said their attorney.

They sued for wrongful death, claiming his subsequent paranoia directly caused his fatal panic attack. A jury rejected the claim in 2010, but on Wednesday, a federal appeals court ruled important evidence had been withheld.

Vogel’s family was improperly prevented from presenting testimony from two coroners, who both concluded the pink underwear was a “likely” factor in his death, the Ninth Circuit Court of Appeals ruled, adding that forcing it on inmates yet to be convicted “seems without legal justification.”

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