Weekly Update: May 14, 2024
Medicaid & Local Initiatives Addressing Mental Health Treatment In Criminal Justice


Highlighted Stories

Editor's Note
This week’s highlighted stories focus mostly on mental health stories within in correctional environments. These stories fall into two categories. The first category might be best described as stories that detail the failure of correctional facilities to address the needs of incarcerated people who suffer from mental illness, and in the second category, we find more hopeful stories about steps jurisdictions can take to address the mental health issues that are all too frequent within corrections.

The first story focuses on the death of a mentally ill individual, Markus Johnson, at the Danville Correctional Center in Illinois. The story tells how the proprietary correctional health provider, Wexford, allegedly failed to take action when Mr. Johnson declined his medication and was progressively decompensating. One of the reasons we focus on this story is because Illinois has submitted an 1115 waiver for Medicaid coverage of incarcerated people and the fact that there was no shortage of opposition to Wexford being awarded a $4 billion contract by the state to continue being the health care provider in Illinois. As we have stressed before in previous editor’s notes, Medicaid does have certain conditions of participation that must be met by all Medicaid providers. There is a certification process and Quality, Safety & Oversight – Enforcement requirements. And as last week’s editor’s note pointed out, in the story about the abuse in the Oregon State Hospital, CMS can investigate and demand a plan of action to address deficiencies.

Moving on to the New York State story, even though there is a law now in place to protect mentally ill patients from being placed into solitary confinement, that state’s Department of Corrections has apparently refused to implement this measure. In Rhode Island there is a case in front of a federal appeals panel concerning an individual who was placed in solitary confinement after overdosing on fentanyl. This person was denied mental health treatment and access to medication for addiction treatment. Prison staff ignored direct requests from a social worker to release the individual and one of the federal judges hearing the appeal found it difficult to believe that officials in charge of this prison did not know that it was a violation of the law to ignore or not treat a serious medical condition. These stories are examples of how resistant some in corrections are to changing practices even when their actions might be breaking laws. (In a similar vein, a federal judge in Brooklyn grilled attorneys for the Federal Bureau of Prisons about which medical staff lied about having administered antibiotics after an incarcerated person’s appendectomy and went on to warn that judges would no longer tolerate such deception.)

As noted above, all of today’s highlighted stories are not about the deficiencies within criminal justice when it comes to the care of people struggling with mental health issues. In Florida, Orange County (Orlando) is taking inspiration from Judge Steven Leifman’s initiative in Dade County, the Criminal Mental Health Project, and is planning to establish a similar program to reduce incarceration in Central Florida. In Michigan, the sheriff for Kent County has renovated that facility to provide mental health services and programs for women to help them during and after incarceration. And in California, Antioch, a city in the San Francisco Bay Area, established a community response team –the initial result being no deaths in police custody in the first year. These three examples point out different approaches in the face of America’s mental health crisis: courts establishing diversion programs to avoid incarceration, correctional institutions focusing on mental health to foster successful reentry, and a jurisdiction using a crisis response team to prevent deaths within police custody. The focus of these strategies is to address the all too common criminalization of people struggling with behavioral health disorders.

Criminal Justice & Mental Health
New York Times: When Prison and Mental Illness Amount to a Death Sentence
Markus Johnson slumped naked against the wall of his cell. Four men in black tactical gear pinned him, his face to the concrete, to cuff his hands behind his back. He did not resist. He couldn’t. He was so gravely dehydrated he would be dead by the next shift change. Mr. Johnson’s horrific downward spiral, which has not been previously reported, represents the larger failures of the nation’s prisons to care for the mentally ill. Many seriously ill people receive no treatment. Mr. Johnson’s mother has filed a wrongful-death suit against the state and Wexford Health Sources, a for-profit health care contractor in Illinois prisons. Prison officials and Wexford staff took few steps to intervene even after it became clear that Mr. Johnson, who had been hospitalized repeatedly for similar episodes and recovered, had refused to take medication.

New York Times: N.Y. Prisons Holding Mentally Ill People in Solitary, Lawsuit Says
When New York banned the use of long-term solitary confinement in its prisons and barred the practice entirely for certain people, including mentally ill prisoners, it was hailed as a groundbreaking measure that would fundamentally change life behind bars. But since the law took effect two years ago, prison officials have refused to implement it and have continued to hold incarcerated people with disabilities in solitary and in cells in specialized disciplinary units for most of the day, according to a class-action lawsuit filed in State Supreme Court in Brooklyn.

Courthouse News Service: First Circuit checks RI prison staff’s qualified immunity against solitary confinement claims
Jerry Cintron was placed in solitary confinement for 450 days because he overdosed on a fentanyl in prison. This confinement exacerbated his underlying mental issues and caused a severe physical and psychological deterioration. Prison staff ignored direct requests from a social worker to release Cintron from solitary. Civil rights lawyers urged a federal appeals panel to find that Rhode Island corrections officers violated Cintron's constitutional protections against cruel and unusual punishment. U.S. Circuit Judge William Kayatta asked the Rhode Island Solicitor General: “You’re saying that, at the time this happened, officials in charge of this prison did not know that it was violation of the law to ignore or not treat a serious medical condition such as what he’s alleged here?”

Daily News: Judge demands answers from Brooklyn federal jail officials over inmate’s medical woes
A judge is demanding the medical staff at Brooklyn’s troubled Metropolitan Detention Center explain in person why they didn’t give an inmate all his medication after an emergency appendectomy, then apparently lied about it to the man’s lawyers. Brooklyn Federal Court Judge LaShann DeArcy Hall called for a hearing after she grilled a Bureau of Prisons attorney during a status conference last week, repeatedly asking who at the jail “lied” that detainee Jonathan Goulbourne was given all five days of his antibiotic regimen. “At a certain point the MDC is going to have to understand that the judges of this court are no longer going to tolerate the mismanagement of the medical care of the defendants that are in their charge,” DeArcy Hall said an added, “this is not an anomaly. I am tired of hearing the defendants that are held at the MDC are not being provided with the necessary medical treatment.”

YouTube: Overhauling mental health care for inmates in Miami facility
Orange County (Orlando, FL) is looking to change its approach to mental health within the criminal justice system by emulating a program from Miami-Dade, spearheaded by Judge Steve Leifman. The initiative involves redirecting individuals with mental illnesses from jails to specialized treatment facilities. Judge Leifman's program in Miami-Dade, known as the Criminal Mental Health Project, has significantly reduced arrests and re-offending rates by providing alternative mental health treatment options. Inspired by these results, Orange County aims to implement a similar strategy to improve outcomes for those with mental health issues and alleviate the burden on its jail system.

WZZM: Kent County Jail invests in female inmates' mental health through $500,000 renovation, expansion project that is now open
The Kent County Sheriff’s Office has reopened its mental health unit within the correctional facility after months of renovating and expanding its current space. The sheriff’s office called the reopening a milestone, adding that the mental health unit will focus on therapy, case management and treatment. The goal is to ensure women can successfully get back into the community with the proper resources and services they need.

CBS: Antioch mental health crisis team touts positive results, no in-custody deaths after 1 year
Across the Bay Area, communities are looking for ways to deal with mental health crises without involving police. Antioch created its own private crisis response team, "Community Response Team" and after 12 months the city's mayor says results have been positive. Nobody has died while in police custody since the community response team was created.


CMS: Public Comment Sought: Regarding the MassHealth Amendment Demonstration
On May 3, 2024 Massachusetts submitted a request to amend its section 1115 demonstration entitled, "MassHealth Medicaid and Children's Health Insurance Plan (CHIP) Section 1115 Demonstration." Included in this waiver is language to provide certain Medicaid covered services (including medical, behavioral health, and pharmacy services) for up to 90 days prior to expected release to “qualified individuals” including all individuals in County Correctional Facilities (CCFs) and state Department of Corrections (DOC) facilities and eligible youth committed to the care and custody of the state Department of Youth Services (DYS).

CMS: Public Comment Sought: Michigan 1115 Behavioral Health Demonstration Extension Application Request Demonstration.
On April 11, 2024, Michigan requested to extend the Michigan 1115 Behavioral Health Demonstration for five years. This renewal application requests continued authority to provide residential treatment services for individuals who are receiving treatment and withdrawal management for substance use disorders (SUD) and are short-term residents in facilities that meet the definition of an institution for mental disease (IMD).

Opioid Epidemic

Corrections 1: Why FDA approval for fentanyl test strips in corrections is needed
Results of research about fentanyl overdoses during incarceration from 2013-2021 identified that among 179 overdoses, 138 occurred in jails and 41 occurred in prisons. However, a tool to help end the unprecedented overdose deaths in the correctional environment already exists: it is called a fentanyl test strip. Until the FDA approves the test strips for medical purposes, jails are forced to band-aid the epidemic by stocking Narcan in bulk — and with the increasing trend of mass exposure to fentanyl, multiple doses are required to save the lives of those affected. Some cases have referenced needing 10 doses or more per person to keep the victim awake.


Vox: America’s prison system is turning into a de facto nursing home
In state after state, prison systems have long been plagued by inadequate health care, resulting in the spread of treatable diseases and, in many cases, preventable deaths behind bars. But a key demographic trend threatens to make that problem even worse: Over the last several decades, America’s prison population has been rapidly aging, and prisoners’ health needs have become more significant as a result. The graying of America’s incarcerated population is effectively turning the US prison system into a de facto nursing home, leaving hundreds of thousands of older people in its care each year. The result is skyrocketing costs.

Data & Statistics

NIJ: Examining Policy Impacts on Racial Disparities in Federal Sentencing Across Stages and Groups and over Time
This study used publicly available federal sentencing data from the United States Sentencing Commission (USSC) to measure racial disparities for multiple race groups and stages of sentencing across time (fiscal years 1999-2021). The research team measured racial disparities between matched cases across three stages of federal sentencing, represented by two elements each; identified at which points in time the disparities changed significantly using time series plots and structured break analyses; and used this information to systematically review federal policies to identify which might have contributed to significant decreases in racial disparities.

State Roundup

CalMatters: How a suicide crisis led to change in one small California county jail
The June 5, 2023, fentanyl overdose death of Ignacio Garcia, 32, was the second in Tulare County jails last year, and the first on Lt. Hirayama’s watch. Those deaths followed the deadliest year in the jail’s history when eight inmates died in 2022, four of them by suicide. Tulare County, like many local governments, hires outside contractors to provide health care and mental health treatment to inmates and do not direclty report to Sheriff staff. So Hirayama tried to make a difference by focusing on the hourly checks. Guards are required to make on the inmates under their watch. No inmate has died in the Tulare County jail in the past seven months.

KFOR: Mold found inside Mabel Bassett Correctional Center, DOC working to fix the issue
Mold found inside the Mabel Bassett Correctional Center has one Oklahoma prison advocate worried about the health of inmates inside. Former inmate at the woman’s prison and now prison advocate, Cynthia Butler, says mold has been an ongoing issue at the facility for years. DOC official Kay Thompson says this issue was brought to their attention only two weeks ago and they immediately started tackling the problem.

Prism: Philadelphia city plan may force houseless people to choose jail or treatment
The city of Philadelphia has released a 100-day Public Safety Plan with a section focused on cleaning up the “open-air drug market” in the city’s Kensington neighborhood. The release follows recent reports that the city’s jails are violent and understaffed, leading criminal legal advocates to call for a different solution to protect vulnerable communities living on the streets.

KERA: Nearly 500 Texas prison inmates suffer from flawed punitive housing system, lawsuit says
Criminal justice advocates want nearly 500 Texas inmates certified in a class action lawsuit against the Texas Department of Criminal Justice, alleging the state’s prison system is assigning inmates to punitive, unsanitary housing for longer than allowed. In a petition Monday, the Texas Civil Rights Project alleged the state's prison system keeps inmates in higher-security housing units for much longer than the 10 year-expiration date while some live in unsanitary conditions that include flooding with raw sewage, pest infestations and other health and safety risks

Fort Worth Star Telegram: ‘Take action.’ Advocates urge release of Tarrant County inmate with mental health issues
Several Tarrant County residents speaking during public comments at the commissioners court session called for the release of an inmate, Kaiyere Campbell, who they said suffers from severe disability and requires mental health care instead of incarceration. Campbell’s inability to understand his situation was confirmed by court documents that show that he was found incompetent to stand trial. A doctor’s evaluation found that Campbell lacked “sufficient present ability to consult with defense counsel with a reasonable degree of rational understanding." Court records for Campbell include an order filed in February to transfer him to a state mental health facility, but he remains in the county jail, according to the jail log.

Rikers Island

New York Times: Adams Says Rikers, Staffed by ‘Professionals,’ Is Ready for Trump
A day after the judge presiding over Donald J. Trump’s trial said he would consider jailing the former president should he continue to violate court orders, Mayor Eric Adams said the city’s lockups stand ready. “Our amazing commissioner, she is prepared for whatever comes on Rikers Island,” said the mayor at an unrelated news conference. The prospect of Mr. Trump ending up on Rikers Island, New York City’s main jail and a notoriously violent, dilapidated facility, has already been the topic of discussion among federal, state and local officials. The New York Times reported in April that the possibility poses unprecedented logistical challenges for the U.S. Secret Service, which would have to protect Mr. Trump within Rikers Island.

Los Angeles County

Vera: “The County Jail Has Always Been a Murder Ground”: Stories from Men’s Central Jail
Fifty-two people have died in Los Angeles County jails since the start of 2023. The overwhelming majority of deaths have occurred in the notorious Men’s Central Jail (MCJ), which has been slated to close for years, yet remains open. The staggering number of deaths is a product of the LA County Board of Supervisors’ inaction. In March 2021, a county working group issued a report laying out a plan to close MCJ within the next two years. Yet, three years and dozens of deaths later, there is still no concrete plan in place to close MCJ.

San Diego County

CBS 8: San Diego County has paid $42 million for jail-related incidents since 2016
Since 2016, San Diego County taxpayers have paid more than $42 million to settle jail-related claims or lawsuits. According to public records, last year saw the largest annual amount with $17.15 million for those who were injured or died while in custod. As the taxpayers continue to pay to settle jail-related lawsuits, San Diego County Sheriff Kelly Martinez is moving forward with a $500 million plan to reform and renovate county jails to improve conditions inside for those with mental health and substance abuse needs. State auditors criticized the department in 2022 for its handling of inmate deaths which found 185 people died between 2006 and 2020, one of the highest totals among counties.

Correctional Contractors

MSN: The Slow Death of a Prison Profiteer: How Activism Brought Securus to the Brink
Securus is one of two corporations that dominate roughly 80 percent of the U.S. prison telecom industry, forming an effective duopoly that thrives on the captive markets found inside the nation’s lockups. Both companies are owned by private-equity firms: Securus, by Platinum Equity, and ViaPath (previously Global Tel Link), by American Securities. The slow death of the largest player in this space is not accidental. It follows six years of intense advocacy to expose the vulnerability of the prison telecom industry’s business model on both ethical and economic grounds. Organizers have waged a strategic war against Securus, educating investors and the public about the company’s predatory practices while successfully advocating for legislation and regulation to rein them in.

Correctional Health Care Providers

9News: Jail health care company faces constant lawsuits while taking in millions of Colorado taxpayer dollars
Nine inmates have died in 2022 in the El Paso County Jail under the care of Wellpath, a health care company for jails across the country that has been the target of increasing scrutiny for its practices, including by members of Congress. More than 50 lawsuits have been filed in Colorado's U.S. District Court by detainees and families of dead inmates since 2020. Common allegations found in many of the lawsuits accuse Wellpath of understaffing jails and accuse jail nurses of dismissing or not recognizing serious medical conditions.

Santa Barbara Independent: More Discontent over Mental-Health Services at Santa Barbara County Jail
The Santa Barbara County supervisors got another earful about the shortcomings of the mental-health care provided in the county jail and the extent to which the jail’s privately contracted health-care provider, Wellpath, has been allowed to violate the terms of its contract without consequence. Mental health advocates with the League of Women Voters exhorted the supervisors — and jail administrators — to keep Wellpath’s noncompliance front-and-center when negotiating a one-year contract extension. For Wellpath, this would be the second contract extension.

San Deigo Union Tribune: As deaths and lawsuits pile up, sheriff selects another medical provider for San Diego County jails
The San Diego sheriff’s current provider, NaphCare, has been repeatedly cited for violating terms of its contract. NaphCare failed to pay outside health providers, leaving the Sheriff’s Department unable to transport patients to those unpaid facilities. The Alabama-based correctional healthcare giant also kept staffing dangerously low, relied on unlicensed workers, failed to file required reports and repair or replace badly needed equipment. The Sheriff’s Department has found another firm to provide healthcare services, Correctional Healthcare Partners. Correctional Healthcare Partners has been serving as a subcontractor, providing medical staffing to NaphCare. But under the new agreement, Correctional Healthcare Partners would report directly to the Sheriff’s Department.