Weekly Update: August 22, 2023
Integrating Medicaid Into Corrections: Confronting Staffing Shortages, Safety & Security

COCHS Weekly Update: August 22, 2023

Highlighted Stories

Editor's Note
In June 6th’s Weekly Update, we devoted the editor’s note to discussing the issues of health and safety within a correctional environment and how Medicaid with its facility requirements may require a cultural shift. Each state that has applied for an 1115 waiver of the inmate exclusion policy is now grappling with what and how quality will meet the standards of care expected of Medicaid providers. This week’s highlighted stories frame that issue from the perspective of security staffing --the relationship between adequate correctional staff and the maintenance of safety and security. Simply put, given the staffing shortages, a safe environment might be difficult to ensure for those behind the walls whose health care is covered by Medicaid. As the New York Times article below illustrates, the lockdown in a prison in Wisconsin due to correctional staffing shortages not only negatively impacts security but also gives rise to environmental hazards. These compliance issues are like pieces of a very intricate jigsaw puzzle that would need to fit together in order that Medicaid coverage is possible in corrections.

Correctional Staffing Shortages
New York Times: Inside a ‘Nightmare’ Lockdown at a Wisconsin Prison
One thousand inmates incarcerated at Waupun Correctional Institution, a maximum-security prison in southeast Wisconsin, have been confined mostly to their cells for more than four months. More than half of the prison’s 284 full-time positions for correctional officers and sergeants remain unfilled, state data shows. The shortages have severely hobbled the facility’s ability to operate safely. What is happening in Waupun illustrates a reality at prisons across the country: Lockdowns, once a rare action taken in a crisis, are becoming a common way to deal with chronic staffing and budget shortages.

Mission Local: SF jail health officials say they need more staff—not more money
Supervisor Matt Dorsey sparked controversy this month after he asked the mayor for a major budget reallocation: Moving the entire $18.9 million budget slated for a drop-in opioid treatment center to fund health services in jail instead. But the Department of Public Health already runs an in-jail treatment program — and has done so for decades. Instead, the jail is facing a problem endemic to public agencies from the police department to the school district: Too few people are interested in taking already-funded positions.

Corrections 1: W.Va. gov. signs bill to increase pay for COs
Gov. Jim Justice signed several bills into law aimed at increasing pay for correctional officers and reducing staff vacancies in prisons across the Mountain State. Thebills signed by Justice will directly increase efforts to fill vacant positions at the state's correctional facilities. The special session came a year after Justice declared a state of emergency and called on the state National Guard to assist at the state's jails and prisons, which have a vacancy rate of more than 30 percent.

Safety & Security
AMA: 5 things to know about a career in correctional medicine
Dr. Charles Lee spent a decade working as a correctional physician. Currently president of the American College of Correctional Physicians, Dr. Lee now audits correctional facilities to optimize care. “Every time you talk to a correctional officer in a correctional facility and you ask them, ‘What's the main issue here?’ The answer would be “safety and security,” Dr. Lee explained. “If you don't have safety and security, you're dead in the water. Medical must work with custody.”


The Hill: Inmates at California women’s prison sue federal government over sexual abuse
Eight inmates at a San Francisco Bay Area lockup — dubbed the “rape club” by prisoners and workers alike — filed a lawsuit against the federal Bureau of Prisons, saying sexual abuse and exploitation has not stopped despite the prosecution of the former warden and several former officers. The lawsuit seeks a third party to oversee the prison to ensure inmates have access to a confidential place to report abuse. It also asks that all victims be given access to medical and mental health care and legal counsel.


New York Times: Sentenced to Life as Boys, They Made Their Case for Release
In 2008, the Equal Justice Initiative found 73 children who had been given sentences of life without parole when they were 13 and 14 years old. And all of the people who received those sentences for crimes other than homicide were children of color. In 2010, the Supreme Court abolished sentences of life without parole for minors charged with crimes other than murder. In its decision in Miller v. Alabama, the Supreme Court struck down all mandatory sentences of life without parole for juveniles. But the court hadn’t abolished all life without parole sentences for children — only ones where state laws made the sentences mandatory. And while child lifers now had a chance to make a case for their release, prosecutors could still seek new life sentences.

Los Angeles Daily News: Another LA County juvenile facility found deficient by state regulators
Less than a month after state regulators forced the closure of two of its juvenile halls, Los Angeles County has once again failed a critical inspection that could lead to the shutdown of another juvenile facility by early next year. Inspectors from the Board of State and Community Corrections, the regulatory agency overseeing juvenile halls in California, found that staff do not perform safety checks or search rooms frequently enough, despite a fatal overdose at that facility in May.


Inside Climate News: Suicide Watch Incidents in Louisiana Prisons Spike by Nearly a Third on Extreme Heat Days, a New Study Finds
The number of suicide watch incidents in Louisiana prisons increased by 30 percent on extreme heat days, a recently published study in the JAMA Journal found. Researchers from Emory University analyzed data from 2015 to 2017 to examine how the heat index related to suicide watch incidents in six prisons. At the time, only one had air conditioning.

US News & World Report: In America's Prisons, Suicide Risk Rises Along With Temperatures
Punishing heat is a fact of life inside America’s prisons without air conditioning, and it is taking a serious toll on prisoners' mental health. When the outside thermometer hits 90 degrees Fahrenheit or more, a new study shows that prison suicide risk jumps 36%, in comparison to when temperatures are in the 60s.

State Roundup

Corrections 1: Ex-Ala. prison sergeant convicted on federal charges in beating of inmate
A federal jury on Thursday convicted a former Alabama prison sergeant in the assault of an inmate. Devlon Williams assaulted an inmate, identified only as D.H., in the main hallway of the healthcare unit. Witnesses at trial testified that Williams repeatedly punched and kicked D.H., who was on the ground and not resisting or posing a threat to any person or corrections officer. Williams continued the beating by hitting D.H. multiple times with a collapsible baton.

KCBX: Record numbers of inmates are dying in California
An inmate in San Luis Obispo County died of cancer last week. In May, two inmates in Santa Barbara County died in one week, one of a possible overdose. Inmate deaths are on the rise across the state. Six California jails had a record number of deaths last year.

US News & World Report: Another Person Dies in Atlanta Jail That's Under Federal Investigation
A 66-year-old man has died in the medical unit of a jail in Atlanta that's currently under federal investigation. He was the sixth person to die this year in Fulton County custody. The U.S. Department of Justice opened an investigation into the conditions of the jail, citing Lashawn Thompson’s September 2022 death as one of dozens in the facility during the past few years. Thompson, 35, died in a bedbug-infested cell in the jail’s psychiatric wing.

Rough Draft: Commissioner calls for immediate action after third death in Fulton County Jail
The large number of deaths at the jail requires immediate action by Fulton County, Commissioner Khadijah Abdur-Rahman said in a statement released Friday afternoon. She said operational deficiencies including inadequate staffing, insufficient training, negligence in medical care, and the lack of mental health support are “key factors contributing to this alarming situation.”

Oregon Live: Oregon’s women’s prison in crisis – ranging from treatment of prisoners to chronic understaffing, outside review finds
Prisoners at Oregon’s only women’s prison say they face retaliation for complaining about sexual misconduct, pay exorbitant fees to call their children and are forced to wear ill-fitting bras because of paltry commissary offerings.

Willamette Week: Multnomah County’s Dysfunctional Jails Have Turned Deadly
The Multnomah County (Portland) jails’ struggles to adapt to a series of interconnected crises: the influx of the deadly new drug fentanyl, the increasing severity of inmates’ mental illnesses, and a staffing crisis that some say has made the jail more dangerous. Mandatory overtime has skyrocketed and morale has plummeted. “People are complaining that they’re getting hit with overtime four days a week,” Evanoff says. “They’re tired and yawning and just look so lethargic.”

Fox 13: Deaths at county jail raise questions about potential salary hike for sheriff
At least three people have died in the past several weeks while in custody at the Shelby County Jail (Memphis). The deaths have occurred since Nov. 1, of which two may be due to suicide, according to Shelby County Commissioner Tami Sawyer. The sheriffs office, which controls operations at the jail, still is not releasing details about the deaths, raising transparency concerns among those working closely with inmates. And there is additional concern the amount of those dying in recent weeks inside the jail could actually be higher

Texas Standard: Tarrant County inmate’s ‘unnecessary death’ spotlights mental health crisis in jails nationwide
Georgia Kay Baldwin’s jail cell was only inches from her bunk, but authorities suspect she died of dehydration. Baldwin’s mental illness was so severe that, on July 27, 2021, a judge ordered her transfer from jail to a state psychiatric hospital. Baldwin would never make it to one. The long wait at state psychiatric hospitals leaves people like Baldwin stuck in legal limbo and in jail.

Rikers Island

New York Post: Rikers Island inmate charged over stabbing mental health clinician in the face with ‘makeshift dagger’: prosecutors
A Rikers Island inmate charged in a fatal knifing aboard a Manhattan subway train has been indicted for allegedly stabbing a mental health clinician at the lockup.


Scientific American: This Therapy Helps Formerly Incarcerated People Return to Society
Supervision to Aid Reentry (STAR) Program, which uses cognitive-behavioral therapy (CBT) and an approach called recovery-oriented cognitive therapy (CT-R) to help former prisoners reorient back into society and avoid recidivism. CT-R is a therapy similar to CBT but with a specific focus on motivating a person to make better choices. Rather than trying to change negative feelings and behaviors through CBT, CT-R helps patients access and enhance positive aspects of their personality and their existing skill set.

Mental Health Initiatives

CBS: First-of-its-kind mental health facility to treat those caught in criminal justice system
The Miami Center for Mental Health and Recovery will open its door in about six months. It will offer treatment and work to rehabilitate people with serious mental illnesses who are caught in the criminal justice system. The center is the next phase in trying to fix a broken system and Judge Steve Leifman with the 11th Judicial Circuit of Florida has been part of the project since the beginning. He says the county spends $636,000 per day or $232 million per year to house an average daily population of 2,400 people with mental illnesses. By contrast, the state spends just $47.3 million annually to provide community-based mental health services to about 34,000 people.

San Antonio Report: No longer an ‘afterthought,’ Bexar County leaders set sights on mental health issues in jail’s population
Statewide figures show some light at the end of the tunnel, as the state and Bexar County have taken steps to reduce the lag time between when an inmate is deemed incompetent and when they are transferred to a hospital to receive the care they need. Inmates who have been found incompetent to stand trial are often the most vulnerable and also the most dangerous population, Sheriff Javier Salazar said earlier this year.

Correctional Health Care Vendors

Armor Correctional Health Services
Pensacola News Journal: Pensacola firm wins $16M from Santa Rosa Jail healthcare servicer for malpractice death
Pensacola-based law firm Zarzaur Law announced a $16 million win in a medical malpractice suit for a Santa Rosa County Jail inmate died in 2016. A Santa Rosa jury erred on the side of Misty Williamson's family after she contracted pneumonia and died due to malpractice by employees of Armor Correctional Health Services, a company contracted to perform medical services by the Santa Rosa County Jail from 2012 to 2018

Marshall Project: Prison Healthcare Means Not Knowing What’s Slowly Destroying My Body
My deterioration started that January with a slight weakness in my right leg that was soon followed by twitching and cramps. A Wellpath nurse practitioner examined me at the health services. But over the next four months, Wellpath failed to schedule an appointment. Its health services administrator told me that the clinic wasn’t accepting appointments because of COVID-19. But the clinic told my lawyer that they had repeatedly requested that I come in. I believed the clinic.

Santa Barbara Independent: Santa Barbara Grand Jury Probes Myriad Problems Around County
In July 2021, a Santa Maria man died by suicide while in custody at the Santa Barbara County Main Jail. According to the grand jury report, 35-year-old Kean Ardie San Juan Pinon (identified as “KP” in the report) hung himself in his jail cell just one day after his cellmate’s attempted suicide. The report described Pinon as suffering from mental disorders and “suicidal ideations.” However, Wellpath “did not share this mental health history with the Sheriff’s Office custody staff” because Wellpath believed that sharing such information was illegal on the grounds of doctor/client privilege.

Monterey County Weekly: Newly released documents detail Monterey County Jail’s failure to improve health care.
The release of previously sealed court reports documenting the state of medical and mental health care at Monterey County Jail has revealed an institution failing to meet the standards of a 2015 class-action settlement over inmate conditions, according to neutral monitors tasked with inspecting the facility. The reports emerged after attorneys representing the jail’s inmates won a court battle over their release against the County of Monterey and Wellpath, the jail’s contracted health care provider.

Northern Public Radio: Civil rights lawyers call on Illinois to fire private prison health care company
Illinois lawmakers heard testimony from civil rights lawyers and family members about the dismal state of health care in the state’s prisons: people in wheelchairs left sitting in their own waste, bedsores and falls because of improper assistance and virtually no therapy for people with severe mental illness. Since 2011 Illinois has paid the private company Wexford Health Sources well over $1 billion to provide medical care to people in the state’s prisons. But according to an independent monitor, the company has failed to provide proper care, leading to suffering and preventable deaths.

YesCare (formerly Corizon)
Casper Star Tribune: Wyoming Department of Correction's health care provider responds to inmate's lawsuit
The state’s correctional health care provider, YesCare, denies that refusing an inmate hip replacement surgery constitutes a “deliberate indifference to serious medical needs,” as he continues to seek a jury trial. Warren Rathbun accused YesCare of violating his constitutional right to be free of cruel and unusual punishment in May after the provider allegedly denied him needed surgery for almost a year, the civil rights complaint states.