ICE ‘s Deliberate Indifference Meets Estelle v. Gamble; Big Profits For CoreCivic, GeoGroup & Management and Training Corporation

Highlighted Stories

Editor's Note

This week’s highlighted stories focus on ICE detention and, in particular, the healthcare provided—or denied—to people in ICE custody. The first story, from The New York Times, concerns a young man, Javier Tomas Muñoz Materano, who was not allowed to bathe for days at a time, developed a painful infection in his genitalia that later spread to his face, and repeatedly went without his prescribed medications as he was shuttled from facility to facility. At one point, the infection and lack of treatment were so severe that he temporarily lost the ability to walk. A federal judge ordered his release, ruling that ICE had shown “deliberate indifference” to his medical needs. Our longtime readers will recognize that phrase immediately: it is the constitutional standard established in Estelle v. Gamble (1976), which held that jurisdictions may not be deliberately indifferent to the serious medical needs of people they detain. It is noteworthy—and perhaps reassuring—that ICE is not exempt from this precedent. (Here is the judge’s full decision.)

The second article covers a “shadow hearing” convened by Rep. Pramila Jayapal to examine what she described as the inhumane treatment of people in ICE custody. The hearing also highlighted the enormous profits private prison companies continue to make from immigration detention. As we noted last week, CoreCivic recently reported an 18% profit increase and GEO Group 13%. The article also references Senator Jon Ossoff’s report documenting allegations of physical abuse, sexual assault, and mistreatment of pregnant women and children in ICE facilities.

The third and fourth highlighted stories come from Marana, Arizona, and Plymouth, Massachusetts. In Marana, local residents are organizing to prevent ICE and Management and Training Corporation (MTC) from reopening a shuttered state prison as a new detention center. In Plymouth, Massachusetts, community members are holding demonstrations to protest the sheriff’s decision to house ICE detainees in the county jail. (The Weekly Update has previously reported on other sheriffs’ partnerships with ICE.)

Returning to the first highlighted story from The New York Times, it is striking that—compared with the political, community, and congressional strategies deployed to hold ICE accountable—healthcare remains one of the few avenues with meaningful legal traction. Healthcare, understood as a constitutional right for detained people, derives its protections from the Eighth Amendment’s ban on cruel and unusual punishment. The prohibition against “deliberate indifference” remains perhaps one of the only consistently enforceable bulwarks safeguarding the health of people in ICE custody, regardless of whether they are housed in facilities operated by ICE itself or by private contractors such as CoreCivic, GEO Group, or MTC.

And even as COCHS finds it important to highlight the private prison industry—and the substantial profits that companies like CoreCivic, GEO Group, and MTC derive from ICE detention— it is equally important to note a detail that might otherwise be missed in the New York Time’s article but was made explicit in the Boston Globe story: many ICE detainees like Mr. Materano are held primarily in county jails. This brings us back to a central COCHS theme. For years, we have argued that only by integrating Medicaid into county correctional systems can we create a durable safeguard against violations of the Eighth Amendment’s prohibition on deliberate indifference. Medicaid’s regulatory rigor and clinical accountability—not the fragmented, often conflicting oversight of criminal justice agencies—offer the clearest path to ensuring that people in custody receive constitutionally adequate care.

Deliberate Indifference

A New York Times report recounts the ordeal of a young man, Javier Tomas Muñoz Materano, detained by ICE and shuttled among eight facilities across four states, where he was repeatedly denied basic care—sometimes unable to bathe or change clothes for days, and eventually developing severe genital pain, numbness in his legs, and temporary loss of mobility. After more than three months in detention and 10 transfers, his condition deteriorated so dramatically that a federal judge ordered his release in September, agreeing he had “a sufficiently serious medical condition” to warrant it. In a sharply worded decision, the judge detailed the graphic extent of his suffering and concluded that ICE officials had acted “with deliberate indifference” to his medical needs.

Profits & Private Prisons

A surging number of immigrant neighbors have been kidnapped by masked deportation agents “while those who pose a threat are free,” Rep. Pramila Jayapal (WA-07) said during a shadow hearing shining a light people who’ve been targeted and detained, oftentimes under inhumane conditions, under the Trump administration’s mass deportation agenda. The mistreatment of individuals while in federal immigration detention is not new and has only been worsening under the current policies of the administration. The number of ICE detainees has increased to a record 65,135 individuals while key oversight entities have been gutted and private prisons are seeing mega-profits thanks to lucrative federal contracts. This past summer, the initial findings from an ongoing investigation by Georgia Sen. Jon Ossoff revealed more than 500 credible reports of violations against immigrants in detention facilities. 2025 has become the deadliest year for detained immigrants in federal immigration custody in two decades.

Communities & ICE

The future of a former state prison in Marana remains unclear after it was purchased this year for $15 million, though discussions suggest it could become an Immigration and Customs Enforcement (ICE) detention center. Arizona's first private prison in Marana was shut down in 2023. The state sold it back to its original owner, Management and Training Corporation (MTC), this year. In October MTC said they were exploring opportunities with several public agencies. This uncertainty prompted residents to engage in a second community forum organized by coalition Pima Resists ICE (PRICE) to discuss and educate community members about MTC, their plans — as well as give Marana citizens an opportunity to voice their concerns about the facility's potential use.

Demonstrators gathered down the street from Plymouth County Correctional Facility — the lone remaining ICE detention facility in Massachusetts — to call for an end to the Plymouth sheriff’s office agreement with United States Immigration and Customs Enforcement. The Plymouth sheriff’s office last year extended its contract with ICE, which pays the sheriff’s office $215 per detainee per day to hold individuals facing deportation in part of the correctional facility. Detainees have accused the facility of civil rights violations and poor conditions, including allegedly limiting access to outside counsel and excessive use of solitary confinement. “Our Plymouth County Sheriff Joe McDonald is working with ICE and actually making the people less safe,” said Heidi Mayo, 73, a leader of Indivisible Plymouth, one of the organizing groups for the protest.

Follow Ups

Editor's Comment: As our subscribers know, the San Diego County Sheriff has faced a steady stream of criticism over the quality of healthcare in the jail system. Those concerns ultimately pushed the Board of Supervisors to expand the authority of the Citizens’ Law Enforcement Review Board (CLERB) to oversee healthcare at the jail (the long path to strengthening CLERB can be traced in last week's Follow Ups). The article below reports on a new agreement between the Sheriff’s Department and Paradise Valley Hospital to create a dedicated treatment area for people in custody. Whether this move is connected to CLERB’s newly enhanced oversight powers is anyone’s guess—but any improvement in access to care is welcome!

The San Diego County Sheriff's Office, in a continued effort to improve healthcare within the jail system, has formed an innovative partnership with Paradise Valley Hospital. This joint endeavor, announced last year, has resulted in the creation of a secure, dedicated treatment area within the hospital for individuals in the Sheriff's custody who require medical attention. The secure treatment area is designed to operate independently of the hospital services available to the general public and is accessible only to authorized personnel.

Substance Use & Trump Administration

During the first Trump administration, Congress passed the SUPPORT Act—expanding access to opioid treatment and overdose prevention—and created the 988 crisis hotline. The second Trump administration, beginning in 2025, has taken a different approach: moving toward a more law-and-order framework while simultaneously narrowing the federal government’s leadership role in mental health and substance-use services, even as it maintains some treatment-focused initiatives, including the reauthorization of the SUPPORT Act. This article supplies a tracker summarizing the administration’s actions to date, organized into four categories: Opioids; Mental Health; Federal Infrastructure; and Data/Guidance.

Studies

The continuous Medicaid enrollment provision adopted during the COVID-19 pandemic ended in March 2023, after which 24 million US residents were disenrolled. Prior studies suggest this “unwinding” was associated with increased discontinuation of buprenorphine, an effective treatment for opioid use disorder. In this cross-sectional study of prescription dispensing among 15 064 patients, buprenorphine dispensing decreased between June and November 2023 among individuals in North Carolina and South Carolina, which did not expand Medicaid. Medicaid expansion was associated with slowing of this decline in North Carolina compared with South Carolina.

Counties with the highest jail incarceration rates had 7%-10% more lung, liver, and colorectal cancer deaths with disproportionate impacts on men and Black residents. Incarceration operates as a structural driver of cancer disparities; targeted prevention, screening, and treatment efforts are urgently needed in high-incarceration communities.

University of Rhode Island Criminology and Criminal Justice Department Chair and Associate Professor Natalie Pifer was part of a multi-institution research team that conducted a study to better understand how extended and repeated stays within solitary confinement impacts prisoners both physically and psychologically. Prisoners with significant time in and repeated exposure to solitary confinement experience significant mental and physical impacts upon their release from solitary into the prison’s custody levels, such as general population, according to the study. Those impacts include hypersensitivity, where prisoners have difficulty experiencing many people in a space at once and, essentially, being “on edge.” Having high levels of anxiety and withdrawal also affects prisoners after being released from solitary.

Opioid dependence is highly prevalent within incarcerated populations, with one-fifth of all drug overdose deaths occurring among formerly incarcerated individuals. This scoping review aims to systematically assess the acceptability, feasibility, and effectiveness of naloxone interventions in prisons. Naloxone provision in carceral settings is acceptable, feasible, and effective in preventing opioid overdoses during incarceration and after release. Integrating naloxone into prison health systems, alongside staff training and peer engagement, is a critical step in reducing preventable overdose deaths and enhancing continuity of care post-release.

Health Issues In Corrections

In a Mississippi prison, a broken arm turned into an amputation. In a Minnesota county jail, a man showing stroke symptoms was allegedly ignored until he collapsed and died. In New York, a man detained by immigration officials — and later transferred between facilities more than 10 times over three months — temporarily lost the ability to walk due to untreated infections. In theory, all of these medical issues were treatable and “treatable” is usually a reassuring word. In prisons, jails, and detention centers, it often means something different. Medicines, procedures, and specialists may all exist, but people may not get access to them until permanent harm or even death occurs.

Illnesses are the main reason people die while in the custody of local jails or state and federal prisons across the country. Often described as “natural causes,” illnesses claim far more inmates than other causes like suicide, overdose or homicide – killing more than 30,000 prisoners between 2015 and 2023. Reports of these 1,780 deaths mention sepsis, a life-threatening condition triggered when the body has an extreme reaction to an infection. When caught promptly, sepsis can often be treated simply with antibiotics and fluids, doctors say. But medical care isn’t always prompt behind bars, and untreated septic shock can kill a patient within days or sometimes hours.

Timely reassessment of abnormal vital signs is a fundamental component of safe nursing practice. In correctional settings—where nurses often function with a high degree of autonomy and providers may not be immediately available—this responsibility carries particular weight. An abnormal vital sign is not an isolated data point; it is an indication that the patient may be experiencing physiological instability. Understanding when and how quickly to reassess allows nurses to detect deterioration early and intervene appropriately.

Transgender

The Department of Justice has instructed inspectors to stop evaluating prisons and jails using standards designed to protect transgender, intersex and gender-nonconforming people from sexual violence, according to an internal memo. This population is uniquely vulnerable to attacks while incarcerated, data shows, and advocates say the change will put such people in even more danger. The memo explains that DOJ is in the process of revising federal standards related to the 2003 Prison Rape Elimination Act (PREA) in order to align with President Trump's executive order on "gender ideology extremism."

Five transgender inmates are suing the Utah Department of Corrections and the Department of Health & Human Services over a state law that blocks their access to certain medical care in prison. The Utah Department of Corrections has not commented on the lawsuit. Health department officials declined to comment because the litigation is pending. In court papers, their attorneys — the American Civil Liberties Union of Utah and Lambda Legal — claim Utah’s law violates their Eighth Amendment right against cruel and unusual punishment and the Americans with Disabilities Act.

An inmate who identifies as female has filed a federal lawsuit against the New Hampshire Department of Corrections, accusing prison officials and guards of creating a harmful environment by incarcerating a transgender woman at the state prison for men in Concord. While detained in Strafford County Jail before the trial, Alon received injectable hormone therapy, razors and tweezers. That ended when Alon arrived at the men’s prison.

A federal judge has permanently ordered Georgia’s prison system to keep providing some kinds of gender-affirming care for transgender prisoners, although the state plans to appeal. U.S. District Judge Victoria Marie Calvert last week ruled that a new state law denying hormone therapy to inmates violated their protection against cruel and unusual punishment under the Eighth Amendment to the U.S. Constitution.

State Roundup

California

A new report on discipline in California prisons highlights slow handling of several sex assault cases filed against officers. In lawsuits, women have accused 83 officers of sexual misconduct. California has two prisons that primarily house women. At the larger prison, the Central California Women’s Facility in Chowchilla, former guard Gregory Rodriguez was found guilty of 64 counts of sexual abuse in January and sentenced to 224 years in prison. Thirteen incarcerated or formerly incarcerated women testified against him. A 2023 investigation found that women had made reports about Rodriguez as early as 2014. He worked at the prison until 2022.

As droughts, extreme heat, and other climate disasters increasingly plague California, people throughout the state have been subject to water restrictions. For many Californians, this means emergency regulations like limitations on lawn watering. But one group of people has been forced to bear the brunt of the state’s water restrictions: those in prison. Showers in prisons are often offered after breakfast, a time that conflicts with going to the yard to exercise, leaving people forced to choose between one or the other. If you miss the shower window and try to take one later in the day, an officer will likely issue a rules violation report.

Despite spending hundreds of millions of dollars to fill vacant medical and mental health positions at prisons and state hospitals, California has little to show for it, according to a new report from the state auditor. Job vacancy rates have increased since 2019 at the three facilities examined in the audit, as has the state’s reliance on pricey temporary workers. Atascadero State Hospital, Porterville Developmental Center and Salinas Valley State Prison had health-related vacancy rates topping 30% during fiscal year 2023-24. At Salinas Valley State Prison more than 50% of health positions were unfilled.

Colorado

The Department of Justice Civil Rights Division has launched a special investigation into conditions within Colorado’s Department of Corrections (CDOC) and Department of Youth Services (DYS)—the first such inquiry since President Trump returned to office. In a to Governor Jared Polis, Assistant Attorney General Harmeet K. Dhillon said the probe will examine whether there is a “pattern or practice” of civil rights violations, including inadequate medical care, unsafe or unsanitary housing, insufficient nutrition for youth, and the use of excessive force. Trump and members of his administration have publicly linked the investigation to their support of Tina Peters, the former Mesa County clerk who allowed unauthorized access to voting machines and data after the 2020 election.

A Denver Sheriff's Department deputy accused earlier this year by female inmates of sexual harassment has resigned. A second deputy is being disciplined for failing to report one of the inmate's complaints to superiors. Deputy Cristian Gondor resigned Sept. 19, four days before the department concluded its investigation into allegations of sexual misconduct. Two female inmates filed reports accusing Gondor of telling inappropriate jokes, hugging them, and describing his arousal.

Connecticut

Connecticut’s Office of the Child Advocate (OCA) released a report evaluating the impacts of solitary confinement on late adolescents, those aged 18 to 21, issuing a recommendation that “long term restrictive housing be prohibited for this age group,” due to the severely negative impacts that it has on their mental health. “Examining the conditions for this population, OCA found grave concerns, including lengthy periods of solitary confinement, frequent strip searches, lack of access to minimally adequate mental health services, and limited educational services,” reads the report. “DOC records depict stark mental health deterioration of some of these individuals who were often teenagers when they were first incarcerated. OCA is concerned that these findings implicate the legal rights of these late adolescents to adequate care and services.”

Florida

A prison inmate in Florida, scheduled for execution within a week, has filed a lawsuit against state officials, alleging that the Department of Corrections has been using expired drugs in lethal injections. He also claims officials used reduced doses during the previous four executions. The inmate, Frank Athen Walls, is set to be executed on December 18. With only days left before he is given a lethal injection, he filed a lawsuit challenging the state’s execution procedures.

New York

More than half the people in jail or prison in the U.S. have been diagnosed with substance use disorder (SUD). By law, inmates in New York State with opioid use disorder must be provided with medication-assisted treatment within 24 hours of intake. So it’s often incarceration that gives many of these people their first real chance at recovery. But once released, which can happen with little or no advance notice, these individuals are at a 10-times greater risk of overdose than the general population. A new partnership between the MATTERS Network based at UBMD Emergency Medicine, UB and the Erie County Sheriff’s Office is working to eliminate that risk. It does so by ensuring that upon release, people who need medication for addiction treatment (MAT) continue to receive it without interruption while facilitating linkage to treatment programs and support close to home.

Texas

An inmate on a medical treatment plan jail died Sunday, the 12th inmate death this year at the Bexar County jail. The Castle Hills Police Department is handling the death investigation in accordance with the Sandra Bland Act, which requires an outside agency to handle such cases. An internal affairs investigation by the sheriff's office is also underway. The inmate's death has been reported to the Texas Commission on Jail Standards, the sheriff's office said.

Harris County officials are warning that Texas's new bail rules could quickly refill local jails just as the county has finally started to bring its inmate numbers down. At yesterday's Commissioners Court briefing, county analysts told leaders that faster case processing is essentially the only thing standing between Harris County and a renewed jail crowding crisis. Officials zeroed in on two recent moves from Austin: Senate Bill 9, a bail reform package that tightens who can be released without cash, and Proposition 3, a constitutional amendment that voters approved in November that expands judges' power to deny bail in certain serious cases.

Virginia

Most sheriffs and jail superintendents will insist they do not use solitary confinement. We learned instead to substitute the phrase “administrative segregation,” which in most cases means the same thing: an inmate held for 20-24 hours a day in a cell about the size of a parking space, typically behind a heavy steel door with a tiny window and narrow slot that just fits a food tray. Because data about the number of people held in administrative segregation is not publicly available.

Drones

Two years ago, some health care professionals across the country began to receive calls from individuals they believed were law enforcement, requesting that they pay a fine for failing to appear in court. The calls were not from law enforcement but were from scammers -- primarily targeting women health care professionals. The multistate fraud scheme, announced by officials in Iowa, was run by an inmate in a Georgia prison who ran a call center using phones delivered by drones.

Telecommunications

The Kalamazoo County Commission is preparing a bid process for a new contract to provide phone and video services to those incarcerated at the Kalamazoo County Jail. The current contract, with ViaPath Technologies, has come under scrutiny and raised community concerns after a NowKalamazoo investigation found a large portion – sometimes a majority – of the fees paid to use the system were profits directed to county coffers.

Nevada has reduced some costs of incarceration through recent reforms—eliminating room-and-board fees, capping commissary markups, ending hygiene-product price gouging, and wiping medical debt upon release—but the state continues to develop new, more exploitative revenue streams. The latest example is the Nevada Department of Corrections’ tablet program, which allows ViaPath, its telecom partner, to charge incarcerated people exorbitant rates for digital media. While a premium Spotify-and-Netflix subscription outside costs about $360 a year, an incarcerated person who watches one movie and listens to one album per day on the prison system’s platform would pay roughly $3,000 annually—more than eight times as much.

Correctional Healthcare Vendors

Centurion

Ignored, misdiagnosed, left to die — Illinois prisoners’ health in hands of new provider with shoddy track record A Sun-Times review of more than 100 lawsuits against Centurion Health shows a recurring pattern: People in prison repeatedly complain about a health issue, are ignored by correctional and medical staff and their condition worsens to the point of dangerous complications or death. Centurion, one of the nation’s largest correctional medicine companies, was hired by Illinois officials despite having a record of providing inadequate health care. Over the summer, the company was brought in by Illinois officials to replace the state’s previous private health care provider, Wexford Health.

In Missouri Jefferson City Correctional Center incarcerated people report going weeks without medication, a lack of medical attention in solitary confinement and monthslong waits to get treatment or follow-up appointments for serious issues. Former and current staff at the prison lay the blame on Centurion Health, a private company that was awarded a contract in 2021 worth over $1 billion to provide health care for incarcerated people in Missouri. But staffing problems began to worsen in recent months after some personnel concerns. Employees allege that Centurion forced them to work long hours and extra shifts, creating a dangerous environment for them and their patients.

Inmates in Florida recommended for eye surgeries have been forced to wait years for procedures, state records show. Some procedures were delayed for so long that inmatesended up permanently blind. One died from other health issues after waiting more than six years for surgery on his corneas.More than 1,000 were on a wait list for surgery in 2024, state records show. The backlog prompted the nonprofit Florida Justice Institute in October to sue the Florida Department of Corrections and Centurion of Florida, the contractor paid to provide prison health care.

Season's Greetings

COCHS wishes all our subscribers the very best.
The Weekly Update is taking a holiday break and will resume after the new year.