Claw backs Rare, Lawsuits Common: The Hidden Toll of Proprietary Jail Healthcare

Highlighted Stories

Editor's Note

This week’s highlighted stories come from across the country, but they all share a common thread: the strained and often dysfunctional relationship between public entities—states and counties—and the proprietary firms they contract to operate correctional facilities or provide healthcare within them.

In Oklahoma, the state continues to wrestle with the future of the Lawton Correctional Facility, which is owned and operated by the GEO Group. As subscribers may recall from our Weekly Update of November 21, 2023, this facility was the subject of a lawsuit following the death of an incarcerated man who died from life-threatening injuries while medical staff failed to intervene. That tragic event raised serious questions about healthcare delivery at Lawton. Now, broader concerns are surfacing—not just about care, but about the facility’s role as a local employer and economic engine.

In Lackawanna County, Pennsylvania, county commissioners are conducting a review to determine whether Wellpath fulfilled the terms of its healthcare contract. While contracts with proprietary providers often include performance benchmarks—such as staffing ratios—rarely do counties attempt to claw back funds when vendors fall short. A similar situation arose in Santa Barbara County, as noted in our Weekly Update from March 18, where the public health department found Wellpath to be “persistently noncompliant.” But financial penalties are not being sought.

These examples point to a larger pattern—one that raises serious questions about these partnerships. Too often, jurisdictions find themselves locked into relationships where performance failures are met with limited accountability. Regardless of which proprietary firm is involved, the outcomes feel dishearteningly familiar: cost-cutting over care, followed by lawsuits.

COCHS has long argued that if Medicaid were fully brought into the correctional environment—through 1115 waivers or implementation of the Consolidated Appropriations Act of 2023—it could begin to disrupt this cycle. But as we’ve cautioned since the 2024 election, that remains a significant “if.” Still, if Medicaid were to gain a stable foothold behind the walls, it could create structural incentives for better care.

GEO Group

After last year’s contentious contract negotiations narrowly avoided a public safety problem, Oklahoma appears poised to allocate $312 million of cash reserves to purchase a Lawton prison owned by the GEO Group, which currently receives a per diem rate to house about 2,300 state inmates. “We have three options as I see it,” Senate Appropriations and Budget Committee Chairman Chuck Hall said. “One is to purchase the facility. Two is to try to negotiate a per diem rate increase so that they would continue to provide the service. Or three, we allow the thing to shut down, lose 400-plus jobs for those hard working men and women in the in the correctional system down there, and we relocate those prisoners to existing facilities.”

Wellpath

Lackawanna County's commissioners ordered a performance audit of the county jail's former healthcare provider to settle up nearly $1 million in disputed billings. The commissioners hired Boyer & Ritter to evaluate the accuracy of healthcare provider Wellpath's billings and to determine if Wellpath met its contractual staffing and operational requirements. Wellpath, which worked for the county between 2021 through the end of 2024, was dogged by lawsuits and filed for bankruptcy protection late last year in Texas. The county did not renew Wellpath's contract at the end of last year, though it was one of the companies that submitted a proposal. Instead, the government hired Florida based provider Armor Health at a cost of roughly $14.7 million over three years, a county spokesman said.

Follow Ups

Editor's Comment: This week’s Follow Ups begin with growing dissatisfaction in New Jersey—not with a proprietary correctional healthcare provider, but with University Correctional Health Care, a nonprofit operated by Rutgers University. While nonprofit status and university affiliation may sound like a safeguard, similar models in Ohio and Texas have shown that poor outcomes still occur. Like their proprietary counterparts, these university-run systems are often siloed and disconnected from broader healthcare networks, increasing the risk of substandard care.

Next, we return to Cleveland County, Oklahoma, where Turn Key Clinics has again made headlines by abruptly terminating its contract—this time while rebranding itself as TK Health. This shift appears to follow a long pattern in correctional healthcare: companies attempting to reinvent themselves. PHS became Corizon, then Corizon Health, and now YesCare. Similarly, CCS rebranded as Wellpath, which also absorbed California Forensic Medical Group. As the French say, “plus ça change, plus c’est la même chose.”

Finally, from New York: a correctional officer has pleaded guilty to manslaughter in the beating death of Robert Brooks. The case underscores the continuing fallout from the state’s correctional staffing and oversight crises, which we have tracked closely in previous updates.

New Jersey

University Correctional Health Care is a nonprofit operated by Rutgers University. Instead of providing care directly or through a private provider, New Jersey grants UCHC responsibility for providing medical, mental-health, and dental care to roughly 20,500 adults and juveniles in New Jersey's jails and juvenile facilities and on parole. UCHC and its staff have been named in numerous lawsuits, with adult and juvenile inmates and detainees alleging neglect, abuse, and maltreatment. In 2016, the former medical director at Northern State Prison in Newark, New Jersey, was fired and had his medical license suspended for five years after he failed to do even basic testing for an inmate suffering from fainting, disorientation, and muscle weakness.

Turn Key Clinics/TK Clinics

The medical contractor at the center of a joint investigation by The Frontier and The Marshall Project is exiting the Cleveland County Detention Center after almost two decades. TK Health, formerly known as Turn Key Health Clinics, said in a letter dated March 6 that it would not renew its contract with Cleveland County. The company said it would leave the jail on June 30. The company declined to answer why it decided not to continue to serve the Cleveland County jail.

New York

A correctional officer pleaded guilty to manslaughter in connection with the December death of inmate Robert Brooks, whose brutal beating at the Marcy Correctional Facility was recorded by officers' body cameras. Christopher Walrath, 36, was one of six guards charged with second-degree murder in the beating. He pleaded guilty to first-degree manslaughter during a hearing at state court in Utica. The plea deal calls for him to get a 15-year prison sentence. Walrath and his attorney did not comment while leaving the courthouse. He is the first of the six guards charged with murder to take a plea deal.

Juveniles

The latest discussions on a proposed expansion to Buchanan County’s (MO) juvenile justice are centered around Medicaid. States have not been able to draw from federal Medicaid funding to treat youth held in local detention centers, but beginning January 2025, states will be required to provide some of these services to youth returning home from incarceration.

Opioid Epidemic

The Bibb County Sheriff's Office is confirming that three inmates were taken to Atrium Health Navicent after suffering a suspected overdose behind bars. They confirmed that deputies were conducting a block check around 11 pm Thursday when they found three female inmates unresponsive and potentially suffering an overdose. The sheriff's office says that the deputies administered Narcan — a life-saving medication that can reverse the effects of an overdose — before the inmates were taken to the hospital.

Hays County has announced as part of its ongoing commitment to addressing the opioid overdose crisis and supporting community harm reduction efforts, the Hays County Jail has installed a Narcan vending machine on its premises. The vending machine will be available to the public and discharged inmates, ensuring timely access to this critical intervention for themselves or their loved ones in the event of an overdose. This initiative was made possible through a partnership between the Hays County Sheriff’s Office, the Behavioral Health Program of the Hays County Health Department, and the Texas Integrated Community Opioid Network (ICON).

BOP

President Donald Trump says he is directing his government to reopen and expand Alcatraz, the notorious former prison on a hard-to-reach California island off San Francisco that has been closed for more than 60 years. Trump’s directive to rebuild and reopen the long-shuttered penitentiary was the latest salvo in his effort to overhaul how and where federal prisoners and immigration detainees are locked up. But such a move would likely be an expensive and challenging proposition. Bringing the facility up to modern-day standards would require massive investments at a time when the Bureau of Prisons has been shuttering prisons for similar infrastructure issues.

Two former Federal Bureau of Prisons (BOP) employees have been sentenced after an inmate’s medical needs were ignored in a federal prison in Prince George County, resulting in his death. Former BOP lieutenant Shronda Covington and former BOP nurse Tonya Farley were sentenced for their conduct surrounding the death of 47-year-old “W.W.” in early Jan. 2021. Covington was found guilty of violating W.W.’s civil rights. She “wilfully failed” to get W.W. medical attention during her shift, “even though she knew that W.W. had serious medical needs.” Both Covington and Farley were found guilty of lying to federal investigators about what happened to W.W.

ICE

Across the country, doctors, nurses and social workers are increasingly concerned that people with serious medical conditions, including injuries, chronic illnesses and high-risk pregnancies, are forgoing medical care out of fear of being apprehended by immigration officials. Since the Trump administration announced plans for mass deportations and rescinded a Biden-era policy that protected spaces like hospitals, medical clinics and churches from immigration enforcement, doctors said they have seen sharp increases in patient anxiety and appointment no-show rates.

The National Center for Youth Law and Democracy Forward are suing the Trump administration to halt the use of new rules they say have kept migrant children in federal custody and separated from their families for months as the children’s mental health deteriorates. The Trump administration has implemented a raft of new security regulations since January that require families who want to reunify with children to provide proof of income and a U.S. identification and, in many cases, to take a DNA test.

State Roundup

California

When people who rely on psychiatric medication are booked into a San Diego County jail, they are forbidden to bring their prescriptions with them, leaving them to decompensate as they go days or weeks without treatment. When a person in jail expresses a desire to self-harm, they are stripped naked, put in a safety cell and forced to defecate and urinate into a metal grate. The conditions in these cells are so harsh that people lie about being suicidal to avoid them. In San Diego jails, decisions that affect mentally ill people are regularly made by command staff rather than healthcare professionals — a practice that can jeopardize the well-being of people behind bars. These and other findings are the conclusions of Dr. Pablo Stewart, a correctional healthcare expert, who spent three days early last year touring San Diego County jails and interviewing staff and those in custody in preparing a report for attorneys suing to force reforms.

Florida

For nearly two hours, Michael Watkins lay doubled-over in agony on the floor of his Marion County Jail cell, begging for help from his jailers, according to witnesses and family members. Watkins, 37, eventually was taken to AdventHealth Ocala Hospital, where he died on Jan. 31, 2021, after undergoing emergency surgery for an obstructed bowel. In recent months, a whistleblower has come forward, alleging that she was wrongfully terminated from her post at the jail. Mary Coy, a certified jail auditor, worked at the jail from February 2018 until August 2024, when she claims she was wrongfully terminated from the Marion County Sheriff’s Office for bringing forward concerns about the quality of care provided by Heart of Florida Health Center, the agency contracted for all inmate medical care.

Minnesota

St. Louis County Jail houses nearly 1,400 inmates annually, and about 35% are flagged for mental health concerns. Those with severe mental illness may misinterpret commands, perceive nonexistent threats, and respond with confusion, fear, or aggression. Even routine tasks can escalate quickly when inmates can't separate reality from delusion. The jail, built in 1995, was designed for a different population, with a direct supervision, communal layout once seen as progressive—meant to build rapport and reduce tension. But with one in three inmates now facing untreated or poorly managed mental illness, often worsened by substance use, that model has become a liability. Its openness increases staff exposure, fuels volatility, and limits the ability to stabilize those in crisis.

Missouri

There are 430 Missourians across the state in jails waiting to be moved to state psychiatric hospitals, up from around 300 at this time last year. The average time those people wait in jail before receiving treatment has held steady at 14 months, according to Missouri Department of Mental Health data. Those individuals were arrested, found incompetent to stand trial and ordered into mental health treatment designed to allow them to have their day in court — a process called competency restoration that generally includes therapy and medication. Testifying before the Missouri House Health and Mental Health Committee earlier this week, Valerie Huhn, the state mental health agency’s director, called the issue the “most critical” of the department’s various waitlists for services.

North Carolina

A decade after a federal judge ordered North Carolina to adopt a plan to give juvenile offenders serving life sentences a “meaningful opportunity” for parole, a lawsuit making its way through the court system says the state has failed to follow through. North Carolina’s system has changed several times, and starting in 1994 the state eliminated parole altogether in favor of a different system called “structured sentencing,” which sets a minimum sentence and allows the Parole Commission to set the terms of release for felons once they reach that mark. Those imprisoned prior to 1994 are still subject to the state’s older system, which Sussman described as a “constitutional mess,” particularly for juvenile offenders.

Texas

Family members of people who died in the Tarrant County jail were in Austin on Thursday to plead with members of the Texas Commission on Jail Standards to take action and help find answers about what happened to their loved ones. It was Tamra Ramsey’s first time to speak before the commission. Her husband, Vernon Ramsey, died in the Tarrant County jail in December.

Utah

After nearly 40 years on death row, a judge will soon determine whether Ralph Menzies’ dementia is advanced enough to spare him from being executed by firing squad. Lawyers for the 67-year-old convicted murderer say his brain is so damaged he can’t form a “rational understanding” of why the state is pursuing the death penalty — prosecutors for the Utah Attorney General’s Office say while Menzies might be impaired, he is still “clearly competent.”

Rikers Island

Mayor Adams’ office said that his team has looked into the possibility of building a mental health facility instead of a jail on the Manhattan site selected to become one of the four borough-based lockups meant to replace Rikers Island. Liz Garcia, a spokeswoman for Adams, confirmed the talks about the Manhattan location after the mayor told reporters in a press conference that the Brooklyn borough-based jail site would be an “excellent place” to build a mental health facility instead of a detention complex. Garcia said Adams meant to refer to the Manhattan borough-based jail site in Chinatown.

Reentry

Individuals who have served prison sentences face challenges in reintegrating into society, with recidivism often used as the primary indicator of reintegration success. This systematic review analyzed 38 studies with adult participants who had served a sentence or were in the last year of prison, identifying criteria for successful reintegration after release and risk and protective factors. Success factors cover intrapersonal (health, drug abstinence), interpersonal (social support, community involvement), institutional (institutional and community support), and community domains (employment and housing).