Health Affairs: Opioid Settlement Money Should Not Be Used For Criminal Justice Upgrades

Highlighted Stories

Editor's Note

This week's highlighted article from Health Affairs examines a troubling pattern in how jurisdictions are spending opioid settlement funds. The article identifies two related concerns. First, a significant portion of the money has been directed toward criminal justice expenditures, including equipment and other law enforcement initiatives. Second, the authors argue that these expenditures depart from the spirit of the opioid settlements, which were intended to address the human and public health consequences of the opioid epidemic fueled by pharmaceutical companies. To that end, the article offers ten best practices for ensuring that settlement funds are used to reduce overdose deaths, expand treatment, and strengthen recovery services.

The authors note that many communities continue to face funding shortages for harm reduction programs. That observation raises a broader question. In recent months, we have covered several stories relating to the Executive Order, Ending Crime and Disorder on America's Streets, including changes to federal policy affecting harm reduction initiatives. Earlier this year, SAMHSA issued new guidance restricting certain harm reduction activities, and a number of organizations have reported reductions in federal support. Whether these developments are contributing to the funding shortages identified in the article is a question worth considering. When settlement funds intended to address a public health crisis are instead directed toward criminal justice responses, we see a familiar, reactive pattern: ignoring causes, responding to effects.

States, counties, and cities have secured about $58 billion through 2038 via litigation against companies that fueled the overdose crisis, with the expectation that the funds would expand treatment, housing, harm reduction, and other evidence-based public health responses. Yet jurisdictions across the country continue to direct settlement dollars toward policing and incarceration, despite broad consensus among advocates, researchers, and many state administrators that these uses are inconsistent with the spirit of the settlements. Over the past year alone, jurisdictions have approved expenditures including police cruisers, tactical equipment, license plate readers, jail body scanners, and drug-sniffing dogs, even as frontline community programs struggle to secure basic funding for naloxone distribution, syringe services, and outreach.

Follow Ups

Ending Crime and Disorder on America's Streets

Editor's Comment: We have already mentioned once President Trump's Executive Order, Ending Crime and Disorder on America's Streets. We thought this article below from The New York Times would provide our subscribers with background on the role the Cicero Institute and its billionaire founder played in the development of this policy.

The Cicero Institute, an upstart think tank founded by Joe Lonsdale, is a billionaire ally of President Trump. Mr. Trump’s executive order on homelessness is so fully reflected of Cicero’s agenda it was hard to tell where the group stopped and White House policy began. With homelessness near record levels, Republicans have embraced tough measures to clear the streets, and no group has led the way more than the Cicero Institute. Now it has commandeered Republican homelessness policy, upending debate over an intractable problem with life-and-death stakes and showing how rich donors can shape the safety net.

Wellpath Bankruptcy

Editor's Comment: Maybe we spoke too quickly a few weeks back when we suggested that, following the bankruptcies of Wellpath and YesCare, VitalCore might emerge as the dominant proprietary correctional healthcare vendor. YesCare appears to have largely floundered, but Wellpath is certainly not gone.

According to the Arkansas Democrat-Gazette, Arkansas is seeking authority to increase its contract with Wellpath by $11.5 million. Since 2024, the company has received nearly $230 million under the contract, and the projected cost over its ten-year term is estimated at approximately $1.6 billion. The only fly in the ointment appears to be State Senator Bryan King's concern that the contract has grown by more than $350 million—a criticism that reportedly drew the ire of Governor Sanders' office.

At the same time, Wellpath's bankruptcy continues to follow the company. In Nashville, Vanderbilt University Medical Center is suing Wellpath for nearly $900,000 in unpaid medical services provided to individuals incarcerated in the Davidson County jail. Subscribers may remember that, back in 2024, Wellpath's failure to pay contractors in Michigan and Georgia raised early questions about the company's financial condition before it ultimately entered bankruptcy.

A Colorado case illustrates that the bankruptcy is far from over. The family of a woman who died in the Jefferson County jail alleges that Wellpath negligently failed to provide adequate medical care. Wellpath argues that, because of its bankruptcy reorganization, claims should proceed against the Liquidating Trust established by the bankruptcy court rather than against Wellpath itself. The federal judge has, for now, allowed both Wellpath and the Liquidating Trust to remain in the case while she sorts out the procedural implications of the bankruptcy. A further complication concerns Wellpath's liability insurance. The plaintiffs argue that Wellpath may need to remain in the lawsuit in order to preserve potential insurance coverage. How the bankruptcy trust and Wellpath's insurance ultimately interact is not entirely clear from the article, but the case illustrates how bankruptcy can significantly complicate efforts to pursue claims against a correctional healthcare provider.

As a bonus article, we are including a helpful JD Supra piece advising proprietary correctional healthcare providers how best to defend against civil rights litigation. The emphasis is on documentation and recordkeeping. One might also suggest that improved standards of care deserve a place on that list.

A legislative subcommittee advanced a proposed $11.5 million increase in spending authority to a state contract with Wellpath LLC, the company that provides medical services in Arkansas Department of Corrections facilities. The increase in spending authority is needed to cover the remainder of a contract. In July, the Arkansas Legislative Councile approved an emergency $30 million increase in the Department of Corrections' spending authority on the Wellpath contract. Wellpath has been paid just shy of $230 million, according to state documents. The current contract began in 2024.

Vanderbilt University Medical Center alleges Wellpath breached contract and failed to reimburseit $880,643.80 in medical treatment provided to inmates in Davidson County (Nashville, TN). According to court records, VUMC provided care to nine inmates last year at Wellpath’s request. The complaint argues VUMC provided those services while Wellpath was still contracted with Metro Public Health Department. VUMC is asking a judge to order Wellpath to pay in full for those services in full. They are also seeking interest. Wellpath has previously been named in dozens of lawsuits nationwide, including a separate 2022 suit by VUMC.

A federal judge declined to dismiss the formerly bankrupt medical contractor, Wellpath, from a lawsuit over a detainee’s death in Jefferson County jail, but indicated she would do so if the plaintiffs’ attorneys go through the process to ensure they can collect damages for any successful claims. The surviving son and mother of Abby Angelo are suing Jefferson County, its sheriff, and multiple employees of Wellpath, LLC for Angelo’s death in custody in June 2021. Angelo died of a heart infection nine days after her arrest. In March, Wellpath moved to dismiss itself from the case, citing a Texas judge’s plan of reorganization in the company’s bankruptcy proceedings. Under the plan, debtors’ claims against Wellpath were discharged, and a liquidating trust assumed liability for personal injury and wrongful death claims.

Correctional health care providers, correctional staff, and detention facilities face growing legal exposure when medical care is challenged in court. As civil rights claims involving delayed treatment, inadequate care, and poor communication continue to rise, correctional health care documentation is not just a requirement, it is one of the strongest tools for legal defense. Thorough, timely, and accurate records can support early dismissal of claims, while incomplete documentation can significantly increase liability risk.

Local Jurisdictions & ICE

Editor's Comment: As we mentioned recently, GEO Group argued that it should be entitled to sovereign immunity because it was acting as a government contractor. The Supreme Court declined to accept that argument. In a somewhat similar vein, the Ninth Circuit has now rejected an apparent attempt by the Trump administration to shift constitutional responsibility for detainees to its private contractor, GEO Group. The court held that the government's constitutional obligations cannot simply be delegated to a private company. The two cases raise an interesting question about the relationship between the federal government and its detention contractors: while private companies may perform governmental functions, constitutional responsibility ultimately remains with the government.

Now to another Colorado ruling. You may recall that GEO Group challenged Colorado's new law requiring more frequent health inspections at its immigrant detention facility in Aurora. A federal judge partially agreed with GEO Group, ruling that House Bill 26-1276 could not be enforced in full against the facility. At the same time, however, the judge made clear that the ruling did not diminish the state's existing public health authority.

That distinction may prove important. As we reported previously, Colorado health officials sought access to the facility while investigating a possible case of tuberculosis, and GEO Group resisted requests to provide additional information. Whatever the outcome of the litigation over House Bill 26-1276, the broader public health question remains. As we commented last week: Communicable diseases do not stop at the walls of a detention facility, and the state's longstanding authority to protect public health extends well beyond the individuals detained inside

Three federal judges told the Trump administration what it didn’t want to hear: contracting out a detention center doesn’t contract out the Constitution. A Ninth Circuit panel — Judges Margaret McKeown, Michelle Friedland and Eric Miller — unanimously denied the government’s emergency motion to stay a preliminary injunction over conditions at the Adelanto ICE Processing Center in California’s High Desert, lifting the administrative pause it had granted while it considered the case. The government’s core argument was simple: don’t blame us, blame GEO Group, the private prison company that runs the infamously foul Adelanto day to day. The panel wasn’t having it.

A judge ruled that The GEO Group does not have to follow parts of a new state law requiring more frequent health and safety inspections at the U.S. Immigration and Customs Enforcement processing center in Aurora. GEO filed the lawsuit in early June to block the enforcement of the legislation, which expanded the state Health Department’s authority to conduct more frequent health and safety inspections at immigration detention facilities in the state. The new law imposes fines or even revokes licenses for refusing inspections. State officials argued that the changes in the law simply make treatment for all private detention facilities in the state equal. While the injunction addresses elements of the new law, it does not impact the state’s existing public health and safety authority, a spokesperson for Weiser’s office told The Denver Gazette.

ICE

A private prison company donated more than $1.4 million to President Trump’s political operation last month after his administration awarded contracts that could pay the company $165 million a year to house immigrants awaiting deportation. The donations from a subsidiary of the GEO Group were disclosed in a campaign finance report filed by MAGA Inc., a super PAC. GEO donated $1 million on July 16, three days after the company announced that it had signed a five-year contract with U.S. Immigration and Customs Enforcement that will pay the company $85 million a year to operate a 1,188-bed detention center in Hudson, Colo.

Senator Andy Kim of New Jersey spoke to Delaney Hall staff members and to detainees concerned about their access to medical care during a visit to the troubled migrant detention center. One of the three detainee deaths went unreported for weeks after federal officials transferred the man to a nearby hospital.Three Delaney detainees have died in the past eight months. The detention center is now run by Geo Group, one of the country’s largest private prison companies, under a $1 billion, 15-year federal contract.In June, New Jersey State sued the Geo Group after state health officials were denied access to Delaney’s medical unit. Gov. Mikie Sherrill of New Jersey said in June, “there is no legitimate reason why my health inspectors are being kept from full access throughout the building.”

Camila Toro de Paula, a 25-year-old transgender woman from Venezuela, has spent the past 11 months in a federal immigration detention center for men, where she said she has been assaulted, threatened and deprived of medical care. The case of Ms. Toro de Paula comes as the federal government has halted specialized care for transgender detainees inside at least 10 detention centers from Calexico, Calif., to Batavia, N.Y., according to public records. Officials no longer consistently provide transgender inmates with hormones and other gender-related care.

A federal judge t found that officials at immigration detention centers in Texas and California had likely housed children and other detainees at unsafe temperatures and had denied them soap and adequate sleeping conditions. Judge Dolly M. Gee of the U.S. District Court in Los Angeles said she was appointing an independent monitor and a special master — an expert assigned to assist her — as she tracks the government’s compliance with a 1997 legal agreement that sets basic standards of care for immigrant children in U.S. custody.

A Marana Town Council meeting turned tense earlier this month as council members and residents clashed over a planned ICE detention facility, with elected officials accusing critics of hateful rhetoric even as opponents warned the project echoes historical patterns of authoritarian scapegoating. The facility was purchased from the state in July 2025 by the Utah-based Management and Training Corporation, one of several for-profit prison companies that have been contracted by ICE to run detention facilities. The building, which MTC constructed in the 1990s, was a minimum-custody prison before closing in 2023.

This piece surveys a wave of hunger strikes and litigation targeting solitary confinement conditions in facilities across multiple states. The article touches on legal claims related to inadequate medical and mental health care in restrictive housing units, as well as the growing use of coordinated protest by incarcerated people to draw attention to conditions. Camp East Montana has been marked by three migrant deaths, accusations of inhuman treatment and documented poor management, which cost taxpayers millions of dollars in fraud and waste. The soft-sided detention center went up quickly. Acquisitions Logistics, with no experience managing a detention center, landed the management contract worth $1.24 billion.

BOP

It has always been difficult to get help inside federal prison. But in recent years, it has become nearly impossible, according to an analysis of federal data by The Marshall Project and NPR. The rate at which the bureau granted grievances has fallen from just under 7% in 2000 to less than 2% in 2023, the last full year of data available. A 1996 federal law requires prisoners to complete the internal grievance process before filing a lawsuit. If they fail to follow every requirement of that process, their case will likely be thrown out. As a result, the system blocks most people from ever taking their case to court, where a judge could order prison officials to provide relief.

State Roundup

California

A bill authorizing the California Department of Public Health to inspect residential detention facilities was halted in an Assembly hearing. Senate Bill 995, known as the Masuma Khan Justice Act, would create a uniform statewide system to regulate heating, ventilation, air, water and electrical systems in detention centers. It would also mandate adherence to occupational safety and health regulations in an effort to address reported deficiencies in access to mental health and medical care. While the bill received unanimous support in Senate votes and during committee hearings in both chambers, some said its provisions may have been duplicative of existing law.

Five inmates at the Butte County Jail in Oroville were taken to hospitals after apparently overdosing on opioids. Five inmates at the Butte County Jail in Oroville were taken to hospitals after apparently overdosing on opioids over the weekend, the sheriff's office said. All five inmates were taken to hospitals by ambulance for further treatment and evaluation.

Hawai'i

The head of the state prison system plans to overhaul part of the minimum security Waiawa Correctional Facility in Central Oʻahu to create a new space for prisoners with mental illness who are now being held in the state’s largest prison. The men who would qualify to transfer from Hālawa Correctional Facility to Waiawa would be minimum-security prisoners who are stabilized on their medications and are approaching their parole or release dates.

Maryland

A decade-old settlement requiring the state to improve medical care at a Baltimore jail was extended for the third time this June after the federal court found the state remained partially or fully noncompliant with several requirements. The 2016 settlement of Duvall v. Moore established a consent decree requiring the Department of Public Safety and Correctional Services to comply with a list of provisions related to facility maintenance and medical and mental health care for inmates at the Baltimore Central Booking and Intake Center.

New York

State facilities detain prisoners suspected of ingesting contraband in “special watch” cells for days or weeks. Incarcerated people call them by a different name — “shit rooms” — and say they’re ripe for abuse. The rooms stirred up limited controversy in 2019, when a formerly incarcerated man sued Elmira Correctional Facility for holding him in a “defecation room” for 61 days. Officers claimed that X-rays showed a “razor-type weapon” in his rectum, but they never recovered one. (Federal district and appellate courts dismissed the suit, asserting that the prison was maintaining “security.”)

North Carolina

At least two men at the 788-bed prison received diagnoses of scabies in July, according to N.C. Department of Adult Correction. Eradicating scabies from a prison requires a coordinated response that treats everyone, not just those who are symptomatic, he said. Failure to do so, particularly in crowded settings, can lead to a cycle of reinfections and more widespread outbreak.

South Dakota

South Dakota prisons struggle to prepare inmates for release, and the support systems meant to help them on the outside often fall short. South Dakota’s recidivism rate is 50%, meaning half of all inmates released from state prison return within three years. When someone leaves prison, the assessment says, coordination breaks down. Access to support depends more on personal relationships between inmates, staff members and outside organizations than on formal systems. About 91% of men and 97% of women in prison were diagnosed with substance use disorder upon admission. A report from the Council of State Governments suggests that the state should improve Medicaid enrollment for departing inmates and work to expand treatment access in rural and tribal areas.

Rikers Island

A man died in custody at a medical unit in Manhattan that houses inmates from the Rikers jail complex. The Mamdani administration opened the unit in April, billing it in a news release as “a fundamental shift in how New York City delivers care to incarcerated people” and “a major step” toward closing the Rikers Island jail complex.

Technology

The Massachusetts Department of Correction has launched a digital patient portal accessible through department-issued educational tablets across its state facilities. Developed in partnership with health care provider VitalCore Health Strategies, the program is the first patient portal of its kind created by the vendor for the agency. The Department of Corrections manages approximately 6,000 individuals across 13 state facilities.

Correctional Healthcare Vendors

PrimeCare Medical

Monroe County lawmakers are calling the decision to delay a state-ordered inquiry into the jail’s medical provider a “serious failure of legislative oversight” by one of their own. New York officials directed the Monroe County Legislature last year to investigate whether PrimeCare Medical remained fit to provide jail health care after a review blamed the company for a preventable inmate death. Eight months later, the inquiry still has not begun. Meanwhile, jail officials renewed PrimeCare’s $13.5 million contract just two months after the state report. The state report found PrimeCare medical staff neglected to pursue crucial tests and basic hospital interventions when 62-year-old Brian Harmon was suffering from a urinary tract infection and obstructed bladder in late September 2023.

Newly unsealed court records show PrimeCare Medical paid more than $1 million to the family of a Bucks County inmate who died of opiate withdrawal complications. Over the last decade, PrimeCare Medical and Bucks County combined have paid out $4.47 million to settle with the families of five defendants who died while incarcerated, according to unsealed settlement and county records.

Centurion

Delaware spends millions of taxpayer dollars on its prison healthcare annually to treat medical and behavioral issues for inmates. But according to a whistleblower lawsuit filed by two employees that worked for the state’s former prison healthcare provider, Centurion of Delaware, the company routinely billed the state for services it did not provide.

The Weekly Update Will Be Taking A Summer Break
Back On September 15