Crazy Weather: Climate Change & Death In Corrections; Oops Moment In Deep Red State's Medicaid Cutbacks

Highlighted Stories

Editor's Note

Crazy weather. In the eastern half of the country, heat waves are followed by plunging temperatures. In the West, 90-degree days are followed by the unexpected return of the rainy season. From a COCHS perspective, what is even crazier is that we have never before made climate change the subject of an Editor’s Note.

What prompted this realization was the first highlighted story from Texas, where a federal judge, Robert Pitman, is deciding whether to hold the state to an agreed timeline for installing air conditioning in prison facilities because of the increasing likelihood of triple-digit temperatures. This same story also appeared in the March 31 Weekly Update. At that time, Judge Pitman declined to order the immediate installation of temporary air conditioning, even though he had already written that conditions were “plainly unconstitutional.”

That story led us back through earlier reports on extreme heat and the lack of air conditioning in correctional facilities. (Previous Weekly Updates can be found in the COCHS Archive.) In 2025 alone, there were articles from Florida, Connecticut, North Carolina, and Missouri. In 2024, a family in Illinois sued the state and Wexford over the treatment of a man who died during a heat wave; temperatures at Stateville were reported to have reached 120 degrees. An MIT report also noted that rising temperatures were affecting incarcerated populations not only in Southern states, but in the Pacific Northwest as well.

At the other end of the thermometer is the specter of people dying—or nearly dying—of hypothermia. Atlanta News First reports that the mother of Anthony Lamar Walker is suing DeKalb County over the freezing death of her son, a story we included in a 2023 Weekly Update. Next door in Alabama, AL.com reports that a mentally ill man nearly died of hypothermia. Looking back through prior Weekly Updates, we were struck by the grim fact that freezing to death in custody is not unheard of. Another mentally ill man, Anthony Mitchell, froze to death in Alabama’s Walker County jail.

So yes, it has been crazy weather. COCHS realizes we do not exactly need a weatherman to tell us that wild weather has serious consequences for incarcerated populations; we only needed to look back through our own Weekly Updates. Going forward, we will be paying closer attention to climate-related stories, alongside our continuing focus on healthcare, policy, Medicaid, and proprietary correctional healthcare companies. (On the proprietaries, see our Follow Ups section.)

Rising Temperatures

As Texas moves to install air conditioning in all of its prisons by 2033, a federal judge, Judge Robert Pitman, who raised constitutional concerns about triple-digit temperatures pummeling inmates will decide whether to hold the state to that timeline even though it currently lacks funding to pull it off. A bench trial beginning Monday in the US District Court for the Western District of Texas will analyze the state’s $1.3 billion plan to cool all prison facilities following heat-related deaths of at least two dozen inmates and illnesses of hundreds more.

Hypothermia

The mother of a man found dead inside the DeKalb County Jail last year has filed a lawsuit against the jail, claiming negligence. When Toni Walker thinks of her only child, she’s reminded of the long agonizing death he likely experienced inside the DeKalb County Jail. “They treated him like a piece of trash,” Walker said as tears rolled down her face. “In my heart, in my spirit, I think he was hollering out.” Anthony Lamar Walker, 34, was arrested on Dec. 18 on charges of aggravated assault and possession of a firearm by a convicted felon. He was found dead in his cell eight days later – naked and wet. The DeKalb County Medical Examiner determined the cause of death was hypothermia and ruled it an accident.

A second Alabama jail inmate struggling with mental illness was found near death, with hypothermia, after being left for hours on a concrete cell floor, a lawsuit alleges. The case centers around Joshua “Caleb” House, a man who, in 2024, was locked up in a jail in Calhoun County. “Once again an Alabama man, through the deliberate indifference of those entrusted to care for him, was found in jail with a body temperature of 72 degrees, which should have killed him, but somehow he survived,” his attorney, Jon Goldfarb said in a statement.

Editor's Note

This week, after a long spring break, our subscribers are getting two Editor's Notes for the price of one. We return to the subject of Medicaid cuts in Idaho. The governor and state legislators had been warned by the Idaho Sheriffs' Association that cutbacks to Medicaid would have serious consequences for public safety — and yet, as the Idaho Capital Sun reports, it took four deaths before the governor and legislators reversed some of those cuts. The New York Times saw this as a potential warning for other states facing similar Medicaid reductions. Will the well-worn phrase "mistakes were made" be how this period of cutbacks is ultimately remembered?

Idaho

Idaho Gov. Brad Little on signed into law a bill to restore Medicaid mental health treatment programs that the state cut to comply with the governor’s order for budget cuts. The mental health programs’ reinstatement follows warnings by health providers and sheriffs, two lawsuits, admissions that the cuts likely won’t save the state money long-term, and denials by state officials that services for people with severe mental illness were cut. We acknowledge the State’s budget challenges which are self-inflicted by an overly aggressive tax reduction stance of the Legislative Branch and a complicit Executive Branch continuing to reduce tax revenue creating a budget shortage,” Bonneville County Sheriff Samuel Hulse, the president of the Idaho Sheriffs’ Association, wrote to legislative leaders and the governor in December. He warned the cuts “represent a significant public-safety concern.”

This article from the New York Times goes into greater depth about the deaths and cuts to Medicaid that the Idaho Capitol reported and also sees Idaho as a possible warning to other states contemplating drastic cuts to the program: In Idaho, unlike other parts of the country where battles are playing out over health care, it was Republican legislators who led the charge. They cited the four deaths, but also laid out a financial argument — that stripping services for severely mentally ill people will simply reroute them toward jails or emergency hospitalizations, which cost the state far more. “They realized, well, that was a mistake,” said Sheriff Sam Hulse of Bonneville County, a Republican. “You started seeing deaths occurring in the community. We started seeing the numbers in the crisis system rise. The very thing we told them would happen was beginning to happen.”

Follow Ups

Wellpath

Editor's Comment: Another week, another Wellpath article — or should I say the "New Wellpath LLC"?

A whistleblower has come forward claiming that Wellpath falsified medication logs at the Eastern Kentucky Correctional Complex — the very same facility where Britney Jones filed suit against the company after her brother died in Wellpath's care. That lawsuit proved to have a cascading effect: Kentucky's Department of Corrections has since filed suit against Wellpath as well. Meanwhile, Wellpath was contractually required to carry insurance covering liabilities in the event of bankruptcy — insurance that Wellpath's own insurance director acknowledged was merely a "fronting policy." One wonders what the point of a requirement is when the company charged with meeting it gets to define what meeting it means.

But back to those falsified medication logs. In what may or may not be a coincidence, we would remind our subscribers that in our October 15, 2024 Weekly Update, we reported that Wellpath — while providing care in Jackson County, Oregon — was found to have intentionally destroyed email evidence to prevent its use at trial.

A former mental health therapist at a Kentucky prison says the state’s prison health care provider falsified inmate medication logs, according to a federal whistleblower lawsuit. Daniel Farley, a former Wellpath employee working at the Eastern Kentucky Correctional Complex, also claims he was directed by supervisors to administer treatment to inmates who refused care, and some staff members supervised clinical staff despite not having proper licensing.

YesCare/Tehum Care/Corizon

Editor's Comment: These stories about proprietary correctional healthcare providers just don't let up.

We return, once again, to YesCare/Tehum Care/Corizon (please, not another name change). This article from the Detroit Free Press caught our eye — not because the company lost yet another lawsuit, this time for failing to reverse a colostomy — but because of the argument made by YesCare's attorney in response to the plaintiff's claim that the company had been cutting costs. Nonsense, said the lawyer: Medicaid would have covered the surgery.

What he is referring to is the fact that in some states, an incarcerated person receiving inpatient care of more than 24 hours may be covered by Medicaid, provided the individual is otherwise eligible. It's a reasonable point, as far as it goes. The problem is how little distance it actually travels. The attorney's statement underscores a broader gap: the difference between knowing that Medicaid coverage for incarcerated individuals exists in certain circumstances, and actually having the institutional knowledge, policies, and procedures in place to ensure that eligible individuals receive it.

A jury awarded damages to Kohchise Jackson, who suffered for more than two years with a colostomy that the former prison healthcare provider Corizon refused to reverse. Corizon, which split into YesCare and Tehum Care, was accused by Jackson's lawyer of refusing to pay for the reversal surgery as a cost-cutting measure. Corizon's lawyer countered that this was illogical, arguing that Medicaid would have covered the surgery. During the trial, a top Corizon official, Isaac Lefkowitz, refused to answer questions, invoking his Fifth Amendment right against self-incrimination. Jackson's lawyer urged the jury to send a message to correctional healthcare vendors, arguing they had the power to hold them accountable. He also called on jurors to return a substantial verdict and "claw back that taxpayer money."

Ending Crime and Disorder on America’s Streets

Editor's Comment: In a previous Editor's Note, we included an article on how the Department of Justice would grant the Veterans Administration the authority to initiate guardianship proceedings for homeless veterans, known as Safe Harbor Guardianship Pilot Program. Under questioning from Rep. Mark Takano, Thomas O'Toole, MD, the VA's acting assistant undersecretary denied that there was a connection between Safe Harbor and the executive order (EO), Ending Crime and Disorder on America's Streets. However, internal VA documents suggest it is aligned with the EO.

VA has entered into an agreement with the Department of Justice that would give them the authority to place some veterans under guardianship if they are unable to make their own healthcare decisions. While VA officials say the move is necessary to transfer veterans from acute-care beds into long-term programs that are more appropriate for them, internal VA documents released by Democrats link the initiative, named Project Safe Harbor, to an effort by the Trump administration to give states more power to remove homeless people from public spaces. Democrat, Rep. Mark Takano (D-CA) asked Thomas O’Toole, MD, VA’s acting assistant undersecretary for health whether Project Safe Harbor was directly linked to an executive order released by President Donald Trump in July titled “Ending Crime and Disorder on America’s Streets.” When O’Toole denied the connection, Takano produced internal VA documents laying out the “Safe Harbor Guardianship Pilot Program.” The documents describe the program as a high-priority VHA pilot that is aligned with the executive order and leans heavily on the program’s potential for targeting homeless veterans.

Arizona Receivership

Editor's Comment: The Arizona Capital Times reports that negotiations with the federal judge to define the scope of the receivership in Arizona are ongoing. Not surprisingly, the state wants to limit it to three years, while the plaintiffs want full control over the delivery of healthcare — including oversight of the Arizona Department of Corrections, Rehabilitation and Reentry (ADCRR) contract with NaphCare, which was recently banned from New York State. Meanwhile, a second article from the Arizona Capital Times reports that healthcare complaints continue to dog the ADCRR.

Two plans for a takeover of the Arizona Department of Corrections, Rehabilitation and Reentry (ADCRR) health care system are now before a federal judge, but the state’s appeal muddies the timeline for implementation. Plaintiffs in the long-running lawsuit and the ADCRR have since submitted their respective visions for a receiver’s power. Plaintiffs’ attorneys, Prison Law Office, make the case for full control over ADCRR policies, procedures, protocols, systems and practices for health care delivery and must be given authority to oversee the department’s contract with its health care vendor, NaphCare. An attorney for the ADCRR makes it clear that by filing the motion , the state is not conceding to the receivership and does not waive any prior objections to the appointment of a receiver. But, if a receivership holds up at the appellate courts, the department seeks a three-year timeline, limited scope, compliance with existing state laws and a line of stopgaps allowing for some continued control.

The Arizona Department of Corrections, Rehabilitation and Reentry, and its rotating vendors have been tied up in a class action lawsuit over inadequate health care since 2012 in the case now dubbed Jensen v. Thornell. But as the court record grows, the number of individual inmates pursuing their own relief and damages expands, too. As of April 9, more than 250 cases in Arizona District Court named the department’s current health care vendor, NaphCare, as a defendant. In lawsuits new and old, inmates lean on findings from the class action to support their cases. Each claim illustrates the minutiae of how the health care system continues to fail inside Arizona’s prisons. Federal judges have issued three orders now finding unconstitutional care and levied three contempt sanctions against the department, totaling $2.5 million.

New York

Editor's Comment: The father of Robert Brooks — the man murdered by correctional officers — wants the state to establish an independent entity to perform autopsies on people who die within state correctional facilities, including county jails. This brings to mind legislation in California: the Forensic Accountability, Custodial Transparency and Safety (FACTS) Act , which ended the practice of allowing sheriffs to oversee medical investigations into deaths that occur in their custody.

And still, the financial impact of the 2025 wildcat strike continues to become evident. The state has had to pay $1.6 billion in overtime.

The father of Robert Brooks, the incarcerated man beaten to death by former officers convicted of murder, is joining a push for funding in the budget to create a new state entity that would perform independent autopsies of people behind bars. But counties are fighting the proposal. But many leaders in many of the state’s 62 counties are against the proposal. Stephen Acquario, executive director of the state Association of Counties, said the pain of Brooks’ murder and the failures that led to his death cannot be ignored, but the creation of the office would unnecessarily spend millions to duplicate what already exists at the local level. Assembly Correction Committee chair Erik Dilan, who carries a bill to create the new office, fought to get the proposal in the chamber’s budget.

New York’s prison staffing crisis helped push correctional overtime spending sharply higher in 2025, with the state Department of Corrections and Community Supervision accounting for nearly half of all overtime pay statewide, according to a new report from State Comptroller Thomas DiNapoli. State agencies spent more than $1.6 billion on overtime last year, a nearly 23% increase from 2024. State employees logged nearly 26 million overtime hours, earning about $300 million more than they did the year before.

ICE

This week, Alameda County will vote on a resolution to prevent the former Dublin women's prison from becoming an ICE detention facility. It comes a year after the Dublin City Council passed a resolution seeking to do the same. "Build it and ICE will fill it." That's one of the slogans used by those who want to keep ICE out of Dublin. In late 2025, the Dublin City Council voted unanimously to oppose the repurposing the former prison. In January, the Alameda County Board of Supervisors passed a policy prohibiting ICE from using county-owned property for operations.

The immigration detention center closest to Los Angeles has placed dozens of people in solitary confinement each month since June, according to the most recent data from U.S. Immigration and Customs Enforcement. In May 2025, the Adelanto ICE Processing Center had 14 people in isolation. When the Trump administration’s mass deportation effort revved up in June 2025, the number of detainees in solitary confinement there more than tripled. By July, it was 73; by August, 105.

Before GardaWorld became a household name in the immigration enforcement industrial complex, it was moving cash between banks. Now it’s moving people. The Montreal-based private security conglomerate — through its U.S. arm, GardaWorld Federal Services LLC — has quietly muscled its way into one of the most lucrative and consequential federal contracting arenas: the mass detention and processing of migrants inside the United States. In March 2026, the Department of Homeland Security awarded GardaWorld a contract to convert a warehouse in Surprise, Arizona — an industrial building never designed for human habitation — into an ICE processing and detention center capable of holding roughly 1,500 people. In South Florida, GardaWorld is a central contractor at the facility the public has come to know as “Alligator Alcatraz” — the state-run detention site carved into the Everglades. Court documents identify the company as providing “detention operations” there, with contracts reaching up to $80 million.

Democratic Senators Jon Ossoff (GA) and Dick Durbin (IL) are investigating reports of people in Immigration and Customs Enforcement (ICE) detention being held in extreme solitary confinement in conditions that equate to torture. The Florida detention center named “Alligator Alcatraz” by President Trump and his allies is known for its brutal conditions. In a letter to Homeland Security and ICE leadership, the senators highlighted instances of people being placed in an outdoor isolation cage known as “the box,” where they are “held in stress positions with hands and feet tightly shackled… in direct sunlight with no access to food or water.” Senators Ossoff and Durbin are demanding that ICE discontinue use of the box and any other solitary measures for punishment or discipline.

U.S. Rep. André Carson said Thursday that accounts from immigration detainees inside Miami Correctional Facility contradict official assurances about conditions — and that delayed medical care and a lack of emergency systems may have contributed to at least one recent detainee death. Carson, an Indianapolis Democrat, spoke outside the Miami County prison after touring the facility with staff earlier in the day and meeting privately with detainees.

Local hospitals are treating significantly more U.S. Immigration and Customs Enforcement detainees under the Trump administration, federal data show. At least 59 ICE detainees received care at San Diego County hospitals from January to mid-October of last year, up from 29 during the entire prior year, according to ICE agency data obtained by the Deportation Data Project via a public record request and analyzed by The San Diego Union-Tribune. Nationwide, hospital ICE detentions rose from about 1,300 in 2024 to 1,900 from January to mid-October of 2025, the data show. ICE has since stopped releasing data detailing detentions at hospitals in response to the project’s record requests, so such data is not available after October.

BOP

The Federal Bureau of Prisons denied a potentially vital doctor’s appointment to an imprisoned Florida woman with signs of breast cancer, drawing a sharp rebuke from a judge who noted that the Justice Department’s own inspector general recently investigated the prison system for delaying “urgent medical appointments, leading to the death by treatable cancer of an inmate.” In his order releasing the woman from home confinement on April 9, U.S. District Judge Roy Dalton Jr. compared the American prison system to the Soviet Union’s brutal gulags, noting that law enforcement agencies remain recalcitrant even in the face of court orders and official investigations.

Opioid Epidemic

Providing medications for opioid use disorder during incarceration has been shown to reduce the risk of death after release. But methadone, one of the most effective treatments, is tightly regulated and typically must be dispensed through licensed treatment programs, forcing many jails to rely on outside clinics to supply daily doses. The study found a median driving time of about 31 minutes nationwide, but access was far more limited in rural areas. Jails in rural counties were an average of 85 minutes from the nearest treatment program, compared with about 11 minutes in large urban counties. The longest distances were concentrated in parts of the Great Plains as well as in states such as Nevada and Alaska.

Reform

The Brennan Center reviews reforms to correctional systems throughout the country. Restoring Promise redesigns housing units and programming for young adults between the ages of 18 and 25, realigning corrections policies and practices with a commitment to human dignity. This program demonstrated a 73 percent reduction in the odds of violent incidents and an 83 percent reduction in the odds of restrictive housing stays. Other reforms discussed include the Maine Model of Corrections, Last Mile, and the Vocational Village program in Michigan.

Aging & Dying

In 2018, Massachusetts offered a glimmer of relief for sick people in prison. The state was one of the last in the U.S. to adopt a medical parole law. It offers compassionate release to incarcerated people who are dying or permanently incapacitated and are no longer considered a threat to others. The measure, however, hasn’t worked in many cases. Some people have died waiting for a response, while others granted parole died still in custody. In the first eight years of the program, most petitions were denied.

As lifers are getting older, the rising age of prisoners is driving sharp increases in healthcare costs across the country, including in Pennsylvania. Medical costs for women increased to more than $15,000 per inmate per year last fiscal year, and the state spent nearly $367 million on healthcare for the entire prison system.

Nutrition

During a recent unannounced food services inspection conducted at six federal prisons across the United States, the Department of Justice discovered mold, broken freezers, insect infestations, and missing knives. Because no federal law establishes nutritional standards for prison meals, a patchwork regulatory system—comprised of retroactive plaintiff actions, internal policies from the Federal Bureau of Prisons (BOP), and private-sector agreements—governs prison food. The BOP’s authority over prison food is largely administrative rather than statutory. Although federal law requires the agency to provide for inmates’ “subsistence,” Congress has not prescribed detailed nutritional standards. A recent case suggests that the quality of prison food might implicate the Eighth Amendment’s protection against “cruel and unusual” punishment. In Prude v. Clarke, the inmate plaintiff sued Milwaukee County jail personnel under that statute, arguing that the jail’s provision of only nutraloaf—a dense bread often made up of a blend of mismatched ingredients and used as a disciplinary measure—amounted to a constitutional violation.

Suicide

Up until 2019, monitoring the people in the suicide watch cells at South Central Correctional Facility in Tennessee was a job for staff. This meant for each shift watching each prisoner under observation, an officer making somewhere around $20 per hour had to be pulled from their post elsewhere in the facility. So it saves quite a bit of money to decide that prisoners can do it for less than $1 an hour instead—especially these days, when there are usually about five times as many people on suicide watch as there were back then.

Studies

Incarceration is a large-scale social determinant of health, with broad and enduring dynamics that produce long-term health damage far beyond prison walls, argued LDI Senior Fellow Jason Schnittker, PhD, at an April 7 University of Pennsylvania seminar titled “Behind Bars, Beyond Health: Equity and Incarceration in America.” The event was part of Penn Medicine’s 11th Annual Health Equity Week, organized by the Center for Health Equity Advancement.

Black women’s mental well-being during reentry from incarceration remains critically understudied. This critical scoping review examines the extent and nature of research on Black women’s mental well-being post-incarceration, how mental well-being is conceptualized in the literatur. Findings reveal that research on Black women’s mental well-being during reentry remains fragmented, with limited geographic scope, narrow demographic representation, and inconsistent theoretical and methodological grounding. Many studies reduce mental well-being to pathology, emphasizing trauma, mental illness, and substance use while overlooking holistic well-being, structural determinants, and culturally grounded healing practices.

Leading scholars have called for substantial investments in integrated data systems to link objective and reliable data from healthcare records to justice records to better capture exposure and health outcomes, as well as to understand and intervene on potential health effects and mechanisms for which parental incarceration impacts children and families over time. Although progress in this direction has been slow, the few case examples have shown promise: one adult health care system in the US has linked hospital claims data to adult arrest data and one state (Wisconsin) has developed a repository of linked administrative records (Wisconsin Administrative Data Core), including linked data from child welfare, criminal legal, education, public assistance, housing.

State Roundup

Arkansas

The Investigative Reporting Lab at Yale and the Arkansas Advocate conducted a statewide survey of jail medical and mental health coverage, revealing a fragmented system that relies heavily on private providers. Across Arkansas’ 75 counties, nearly every jail hires a private provider to deliver health care — ranging from an individually contracted nurse to a large health care company with dozens of staffers. Eighteen Arkansas jails contract with TK Health, formerly Turn Key Health Clinics LLC, an Oklahoma-based provider that serves jails in 13 states. A joint investigation by The Marshall Project and The Frontier found that at least 50 people died under TK Health’s care between 2014 and 2024. In Arkansas, TK Health first made headlines in 2021, after 51-year-old Larry Price Jr. died from acute dehydration and malnutrition in the Sebastian County Jail.

Connecticut

People incarcerated in Connecticut often wait months to see a specialist, even after prison doctors have determined they need treatment, according to the state's independent correction ombuds. As of mid-March, more than 1,500 people in prison who need off-site treatment were waiting for an appointment, the Office of the Correction Ombuds (OCO) found. Everyone on the list had already been referred to a specialist and approved for treatment by corrections medical staff, yet some had been waiting more than two years, according to OCO.

Georgia

A lawsuit by the family of a man killed by his cellmate while incarcerated in a Georgia prison has ended in a $4 million settlement with the state. David Henegar was 44 and in the Georgia Department of Corrections’ Johnson State Prison near Wrightsville in 2021 when he first began telling prison officials he was afraid his cellmate would hurt him. He was beaten to death over five hours by his cellmate while staff ignored his screams and cries for help, according to a lawsuit his family’s attorneys said Georgia has settled for $4 million.

A Georgia mother said her mentally ill son died of hypothermia while in the custody of a DeKalb County jail, and she is seeking accountability. A federal lawsuit alleges deputies knew he was cold and failed to protect him. Anthony Lamar Walker, 34, was arrested Dec. 18, 2022, on a charge of aggravated assault. Eight days later, on Dec. 26, he was found dead in his cell. The DeKalb County medical examiner determined the cause of death was hypothermia.

Louisiana

The Louisiana Legislature has forwarded a proposal that would allow terminally ill inmates to be released up to 120 days before their expected death, doubling the current 60-day window for early release. Under current law, considerations for early release apply only in situations where death is expected within 60 days of diagnosis or if a person is incapacitated.

A federal appeals court has found that prisoner health care at Louisiana State Penitentiary at Angola met standards set by the Eighth Amendment, overturning a lower court’s 2023 order that would have required the prison to make certain improvements. The Department of Corrections had already made many of the improvements sought by prisoners and their advocates during the nearly 11 years since the class action suit was brought against the state, Judge Edith Hollan Jones, of the U.S. Fifth Circuit Court of Appeals, stated in the majority opinion handed down on March 30.

Mississippi

Three Mississippi prisons needed more employees to ensure safety for incarcerated people. But the East Mississippi Correctional Facility, Marshall County Correctional Facility and Wilkinson Correctional Facility received no new help despite Management and Training Corporation receiving a contract worth $7.4 million in taxpayer money with the Mississippi Department of Corrections, Mississippi State Auditor Shad White alleges.

Ohio

After Jennifer Wade died in the Cuyahoga County jail last year, a county spokesperson said that she had suffered from preexisting medical conditions. But new body camera videos — which were never provided to the inspectors — show that Wade was left lying on the concrete floor of her jail cell for hours before anyone sounded the alarm. Even then, more than 20 minutes lapsed before nurses began to administer CPR. “From a medical perspective, it was absolutely egregious care that doesn't require any sophisticated medical knowledge,” said Eric Jaeger, a paramedic, emergency medical services educator and attorney in New Hampshire. “You just have to have taken a basic CPR class to understand: Unresponsive. Not breathing. Begin CPR.” Marc Stern, a correctional health care expert said that “vital signs don't lie” and that anyone with the most basic training could check Wade’s neck for a pulse.

Oklahoma

On average, in the Tulsa County jail there are between 45 and 60 people awaiting treatment because they have been found incompetent to stand trial. Across Oklahoma, this limbo is the norm. In March 2025, Oklahoma entered into a federal consent decree aimed at ending long delays in its competency restoration system. Under the agreement, the Oklahoma Department of Mental Health and Substance Abuse Services was required to reduce wait times, expand treatment capacity, and improve coordination across the system. But a year later, federal court monitors and a U.S. district judge said the state is still falling short.

Texas

In response to commissioners' concerns, the sheriff's office in February announced plans for the new hospital wing in partnership with Harris Health. The jail also added a first-of-its-kind medical division, made up of roughly 10 detention officers who focus solely on ensuring incarcerated people make it to medical appointments, with plans to expand the team. Its opening comes after the county saw 20 in-custody deaths last year, twice as many as in 2024. Fifteen of the deaths were ruled natural by the county medical examiner and attributed to causes such as meningitis, sepsis and cardiovascular disease.

Rikers Island

After years of delays and cost overruns, the city plans to finally open part of a quarter-billion dollar unit at Bellevue Hospital for seriously ill detainees on Rikers Island, THE CITY has learned. The Mamdani administration also plans to close the North Infirmary Command, the original Rikers Island hospital constructed in 1932, according to multiple sources briefed on the plan.

Today, New York City Mayor Zohran Kwame Mamdani announced the opening of the City’s first Outposted Therapeutic Housing Unit at NYC Health + Hospitals/Bellevue — a major step towards the Mamdani Administration’s commitment to closing Rikers Island. The 104-bed unit will serve people in custody with complex medical needs by transferring the most clinically vulnerable detainees from Rikers Island into a therapeutic setting with closer access to specialty care. It is the first of three planned Outposted Therapeutic Housing Units across the city.

Technology

The Paulding County Sheriff's Office is installing a new $600,000 high-tech monitoring system inside the county jail to track inmate health and prevent medical emergencies. The devices will be mounted on cell walls to detect the movement, heartbeats, and breathing rates of inmates.

Correctional Healthcare Providers

Wellpath

Brunswick County commissioners voted Monday to extend a $2.2 million contract with Wellpath, the controversial national health care provider. The company provides medical care to inmates at the Brunswick County Detention Center. The one-year extension to the 2024 agreement passed 4-1, with commissioner Pat Sykes the lone dissenting vote. It includes a 2.7% increase in the annual fee the county pays the company, bringing the total annual cost to $2.23 million. Sykes said her concerns about the company date back several years. They include dozens of federal lawsuits against Wellpath, with accusations of neglect and wrongful death, and a 2024 bankruptcy filing.

Wellpath has issued layoff notices to 89 employees who provide medical and mental health care at Placer County’s jail facilities, according to county and labor filings. The cuts affect staff at the Auburn and South Placer jails, as well as the county juvenile detention center, just as Placer County moves to bring in a new contractor for inmate health services. Families and advocates say they are watching closely to see whether the changeover disrupts access to medications, mental health treatment and emergency care inside the jails.

Wexford

A 73-year-old prison inmate has filed a lawsuit saying he suffered a second heart attack because of neglect by prison officials. FeldonJackson’s suit says he did not receive prescribed medications following heart surgery in 2023 while housed at the now-defunct Lea County Correctional Facility, and that caused him to have a second heart attack about two weeks later. He is now in the geriatric unit at Central New Mexico Correctional Facility. The suit names the state Department of Corrections, private prison operator Geo Group and medical care provider Wexford Health Sources. Jackson’s lawsuit is among dozens in recent years accusing the state and its inmate medical provider of providing unconstitutionally inadequate care.