Artificial Intelligence & Correctional Healthcare

Highlighted Stories

Editor's Note

This is our first Editor's Note about artificial intelligence (AI) in correctional healthcare. We have only recently begun including articles about AI being used for specific correctional functions: cameras that monitor incarcerated people and an app designed to identify reentry resources. Both examples attracted our curiosity. But having witnessed many technological trends come and go, we regarded them as noteworthy but perhaps not much more. This week's highlighted article stands out because it is not about a product incorporating AI that happens to have a correctional application. Instead, this article from ScienceMag asks what AI could mean for correctional healthcare itself.

To summarize rather drastically: AI is likely to become an important technology in correctional healthcare. Its ability to analyze large volumes of data could help providers identify conditions that might otherwise be missed. At the same time, it could perpetuate existing inequities, discrimination, and neglect.

Let's look more closely at that ability to analyze enormous quantities of data. The authors recognize that gaps in medical records—a frequent problem among justice-involved populations—could adversely affect AI-generated recommendations. If artificial intelligence is the road correctional healthcare is going down, as seems increasingly likely, the quality and completeness of the data it relies upon become serious concerns. One way to address some of those gaps is to bring Medicaid further into correctional settings, thereby strengthening continuity of care and the connections between correctional and community healthcare systems. As we have also reported, however, gaps in correctional medical records do not always result simply from fragmented care. In previous Weekly Update articles, we have encountered allegations of records being falsified, altered, or deleted. AI can analyze the data available to it; it cannot analyze information that was never recorded or is no longer there.

The authors raise an equally important concern about inequity. Although AI could offer significant benefits within the unusual environment of correctional healthcare, technology by itself cannot overcome the perception that incarcerated people are somehow less deserving of care. Over the past ten months, for example, we have followed the healthcare crisis in Mississippi's prison system. That question of who is considered deserving of care can perhaps be seen in the allegations surrounding VitalCore's limited treatment of incarcerated people with hepatitis C.

COCHS recommends reading the article. It raises several other interesting issues that our brief paraphrasing cannot do justice. For our first venture into AI and correctional healthcare, however, we are left with a fairly simple observation. AI may prove to be a valuable tool, but it is no technological magic wand. It may help identify disease, analyze records, and improve clinical decision-making, but it cannot by itself repair fragmented healthcare systems, create missing data, or change institutional attitudes toward the people receiving care. Without addressing those structural problems, there is always the possibility that correctional healthcare with AI will simply become more of the same but with AI.

The high hopes for AI may be further tempered when viewed in a different correctional context: the use of AI-based risk assessment tools in sentencing. The next highlighted article, from the Kentucky Law Journal (2024), examines what COCHS believes to be one of the earliest applications of AI in criminal justice decision-making. As the article discusses, the use of AI-based risk assessment increased disparities, and allowing judges to depart from those assessments increased disparities still further. The future may be here, but so too is the legacy of the past.

Artificial intelligence is moving toward one of the most consequential—and least examined—frontiers in health care: correctional systems. The authors argue that algorithms cannot be treated as neutral tools in prisons and jails, where patients often have complex medical needs, limited control over their health information, and fewer opportunities to challenge clinical decisions. The larger message is that AI cannot solve inequity without confronting the institutional conditions that create it. Used cautiously and governed rigorously, AI may help correctional health systems identify unmet needs and extend clinical capacity. Used without accountability, it could make unequal care more efficient and harder to challenge.

In 2011, Kentucky enacted HB 463 which made using a pretrial risk assessment tool mandatory for judges when considering bail and pretrial release. The original intention behind HB 463 was to reduce the amount of people incarcerated in Kentucky, and to provide judges with an improved method of deciding which defendants are safe to release. Though risk assessment tools are well-intentioned, multiple recent studies have shown that the use of these AI risk assessment algorithms negatively impacts groups of criminal defendants. Specifically in Kentucky moderate risk black defendants were less likely to be granted pretrial release compared to white defendants of the same risk level. Additionally, disparities favoring white defendants were not observable prior to HB 463, but were evident afterward. Judges were also found to be more likely to deviate from the risk assessment tool’s recommendation for moderate risk black defendants than for moderate risk white defendants.

Follow Ups

Alabama/Mississippi

Editor's Comment: From a previous Editor's Note and a Follow Up from last week, our subscribers have become familiar with Alabama State Representative Chris England and his call for a criminal investigation of YesCare. This week, he is directing his attention to two contracts with attorney Bill Lunsford of the law firm Butler Snow.

Representative England has placed a hold on a $30 million increase to the firm's contract to defend the Alabama Department of Corrections (ADOC) against a U.S. Department of Justice lawsuit over violence in the state's prisons. He has also put a hold on a $3 million increase to another contract involving litigation alleging that ADOC provides inadequate mental healthcare (see second article). The first article goes on to detail the millions of dollars in other contracts Butler Snow has received from the state. It also notes that Lunsford was removed from an ADOC case after filing a court brief containing AI-generated material.

In the spirit of the Follow Up, we paused when we saw the name Butler Snow. Where had we seen that name before? Ah, yes. Mississippi, just last week. There, the state agreed to pay Butler Snow more than $700,000 to monitor prison healthcare and produce a report that apparently has yet to be delivered. Mississippi House Corrections Chairwoman Becky Currie has questioned why the state is paying for monitoring that she says the state health department could have performed for free.

Why indeed...

A state representative blocked two contracts between the Alabama Department of Corrections and a private attorney that would pay the attorney an additional $33 million, saying ADOC needed to provide answers on how it plans to resolve lawsuits in the future. Rep. Chris England, D-Tuscaloosa, put holds on a $30 million increase in one contract defending the department in a lawsuit brought by the U.S. Department of Justice over violence in the state’s prisons, and a $3 million increase in another lawsuit alleging DOC provides inadequate mental health care to those in its custody. Both went to Bill Lunsford, an attorney with Montgomery-based Butler Snow who received millions of dollars in legal contracts with the state, including one worth $4.68 million in Dec. 2024 and a $7.68 million one in June 2023. But England’s action blocked $33 million of the additional $38 million Lunsford stands to receive from ADOC. In August 2025, a district court judge in Birmingham removed Lunsford and two other attorneys from a DOC case after one of Lunsford’s colleagues filed an AI-generated court brief that fabricated imaginary court citations.

Whether Alabama will finally provide the mental health treatment that people who are incarcerated are legally entitled to receive will depend on more than bricks and mortar. It will require fundamental changes to how ADOC operates and delivers care to the people in its custody. Absent those changes, experts say, another path would be to reduce the number of people incarcerated in Alabama’s prisons, potentially easing the pressure on a system federal courts have repeatedly concluded cannot safely care for currently incarcerated people.

Arizona

Editor's Comment: In last week's Follow Up on Arizona's healthcare receivership, we discussed how difficult it is to implement change when the Department of Corrections and state officials so strongly resist it. Call us prescient. In the first article below, DOC Director Ryan Thornell argues that the department needs more time to improve conditions. In the second, Governor Katie Hobbs' administration weighs in, contending that Judge Roslyn Silver acted too quickly and should hit the pause button. In the third article, we see Judge Silver's response: no.

The head of the state prison system, Ryan Thornell, wants Federal Judge Roslyn Silver to give him a little more time to fix problems in its health care system before seizing control. In a new court filing, Ryan Thornell acknowledges that it has been nearly 14 years since inmates filed suit alleging unconstitutional neglect in the physical and mental health care provided at the Arizona Department of Corrections, Rehabilitation, and Reentry.

The Hobbs administration says a federal judge went for the nuclear option too soon when she turned over control of the state’s prison healthcare system to a receiver without exhausting other remedies in a lawsuit that has dragged on for 14 years, and is asking the judge to pause the receivership.

Federal Judge Roslyn Silver said that she won’t pause her decision to turn over control of the healthcare system in Arizona prisons to an outside supervisor because it’s clear to her that doing so is the fastest — and perhaps only — way to ensure that sick and injured prisoners don’t have their constitutional rights violated.

Food Poisoning

Editor's Comment: As our subscribers know, we have been following the salmonella outbreak at the Broome County (NY) Jail. The blame now appears to be falling squarely on the food service provider, Trinity Services Group.

In a previous Follow Up, we suggested that the same dynamic we often see between proprietary correctional healthcare providers and correctional facilities could also be playing out with food service providers. In both cases, services are contracted out, at least in part, in an effort to reduce costs. In most cases, contracts need to be given to the lowest qualified bidder. Whether the savings produced by this process are prudent is another question. As with proprietary correctional healthcare vendors, when outcomes are poor, lawsuits quickly follow. And those lawsuits are not limited to the contracted provider; they often extend to the sheriff and the county as well.

Constrained by a process that encourages or requires the selection of the lowest qualified bidder, it is often the case that saving money can be expensive.

A group of inmates incarcerated in the Broome County Correctional Facility filed a class action suit against the County of Broome, Sheriff Fred Ashkar and Trinity Food Services Group, Inc. for alleged negligence in relation to an outbreak of salmonella in the jail in May.

Medicaid

Senator Edward J. Markey (D-Mass.), a member of the Senate Health, Education, Labor, and Pensions (HELP) Committee, and Senator Jeff Merkley (D-Ore.) today reintroduced the Equity in Pretrial Health Coverage Act, legislation that would protect the continuity of federal health benefits under Medicaid, Medicare, Children’s Health Insurance Program (CHIP), and Veterans Affairs for Americans who have been detained while they await trial and, in many cases, remain in custody because they cannot afford bail.

ICE

Federal officials recently started threatening to seek criminal charges against two elected county sheriffs who have declined to give immigration agents broad access to inmates subject to deportation. The threats to prosecute the two sheriffs, in Minneapolis and Chicago, cities that have experienced some of the most intense immigration enforcement of the Trump era, are a new salvo in the president’s campaign against state and local officials who refuse to embrace his administration’s crackdown. The warnings have been conveyed in a series of letters that federal agents began hand-delivering in early July to Sheriff Dawanna Witt of Hennepin County, Minn., which includes Minneapolis, and Sheriff Tom Dart of Cook County, Ill., which includes Chicago. Both are Democrats.

Today, ICE money is turbocharging LaSalle's operations. Using complex intergovernmental service agreements, LaSalle partners with small-town sheriffs and rural municipalities to run multijurisdictional prisons that operate with little oversight. Sometimes LaSalle builds the prison from scratch; other times it just assumes operational control. It pockets profits — and often restricts access to the prison complex.

Hospice

Launched in 2024, the end-OF-Life Care Behind Bars website fills a critical information and advocacy gap for a unique, often overlooked population. While general prison healthcare has gained attention, keeping pace with research on palliative care within correctional facilities remains a challenge for busy professionals. As a dedicated advocacy, teaching, and research hub, this site streamlines access to essential knowledge.

State Roundup

Connecticut

Correction Ombuds DeVaughn Ward published a report earlier this month: Between October 2025 and June 30, 2026, roughly a third of the 1,974 complaints received by the office pertained to health services. The office receives and reviews complaints about prison conditions from incarcerated individuals themselves, as well as from family members, attorneys, legislators and others.

Maryland

The founder of Maryland’s legislative Black Caucus heard whispers of a “secret cemetery” holding children’s graves, so in 1972 he walked into the woods to see for himself. Among weeds and crawling vines, then-state delegate Troy Brailey found cracked gravestones marking the burial plots of Black boys who died during the late 19th and early 20th centuries at a state juvenile detention facility with a documented history of abuse and neglect.

Michigan

Advocates and family members are demanding Gov. Gretchen Whitmer release prisoners from the Women’s Huron Valley Correctional Facility following the deaths of five inmates there since mid-May. Protesters gathered at the state Capitol lawn before marching to the Michigan Department of Corrections headquarters, where they called for the release of inmate Krystal Clark, the transfer of medically frail prisoners, and a complete shutdown of the facility.

North Carolina

New documents offer details about the proposed settlement of a class-action lawsuit over solitary confinement of juveniles in North Carolina. Plaintiffs originally filed suit in 2024. They initially sought a class action challenging solitary confinement in juvenile detention facilities across North Carolina. The settlement addresses both temporary room confinement and administrative room confinement.

Pennsylvania

While still in its early stages, legislation to conduct a study of mental health treatment in Pennsylvania’s county jails has been proposed in Harrisburg with bipartisan support. Sponsored by Democratic Rep. Sean Dougherty, the mental health study would pull funds obtained from the Johnson and Johnson lawsuits conducted during Gov. Josh Shapiro’s term as attorney general, to inform future state policy. 'We’re hoping to use the opioid trust money on this," said co-sponsor Rep. Jamie Flick, a Republican and member of the Shapiro-appointed Opioid Task Force. "Money that was gathered from big pharma that was getting our neighbors and families addicted."

Texas

The Bexar County commissioners threw their official support behind efforts to improve medical services and healthcare provided at the Bexar County Adult Detention Center. The screenings would happen in the facility and be performed by health professionals from University Health (UH). Improvements also include UH hiring additional nurses.

Correctional Healthcare Vendors

VitalCore

The family of a woman who died of cancer has reached a legal settlement with a Mississippi prison system healthcare provider she sued in federal court claiming it failed to diagnose and treat her disease until it spread. Susie Balfour died of breast cancer last year at the age of 64. Her lawsuit said exposure to cleaning chemicals in prison might have led to her cancer, and that prison health providers delayed or failed to schedule follow-up cancer screenings for Balfour even though they had been recommended by prison physicians. She only learned about the disease two weeks before her 2021 release from prison after serving more than 30 years.

Wellpath

Wellpath, the healthcare company contracted to provide medical assistance within Shelby County's jails and corrections center, said it would permanently end operations in Memphis. Wellpath has been a target of constant criticism within Shelby County's penal system. Members of the Shelby County Commission have said the company provides inadequate care, and the company has been named in multiple lawsuits after inmates have died within the jail. Note: Our subscribers might recall that last year a paralyzed, incarcerated man exposed conditions at the jail through a live stream on Facebook.

New court documents reveal a pair of settlement approvals totaling more than $4 million in the 2023 death of 28-year-old D’Angelo Brown, a man who died at MUSC after being found unresponsive in his cell at the jail. The Charleston County coroner ruled his death a homicide, the result of gross medical neglect. Court documents state Brown spent 125 days in a solitary cell in the jail’s behavioral management unit. The jail’s former health care provider, Wellpath, LLC, which is also now bankrupt, and the estate of a jail doctor, Robette L. Drago, as personal representative of the estate of Paul Drago, M.D., deceased, settled for an additional $2,099,378.

Turn Key

Bradley County Commissioners approved a resolution that authorizes County Mayor D. Gary Davis to enter into a health services agreement with Turn Key Health Clinics, LLC for a term of three years with two additional one-year optional renewal periods. Under that agreement, that company will provide inmate health services at the Bradley County Jail and Workhouse for a year-one annual base cost of $1,780,782.45. Turn Key Health Clinics is the current medical provider at the county jail. Davis said its proposal was the “lowest and best bid” of the four bids that were submitted.