In Custody Mortality: Is it a performance metric? Surprising answer...

Highlighted Stories

Editor's Note

This week’s first highlighted story comes from Missouri, where the state is paying Centurion $212 million to provide prison healthcare. In testimony before the Missouri House Corrections Committee, Trevor Foley, director of the Missouri Department of Corrections, stated that the death of an incarcerated person is not included in Centurion’s contracted performance standards. Instead, the state evaluates performance using process measures—timeliness of physical exams, dental visits, screenings, and similar benchmarks. What appears to be happening in Missouri is a contractual separation of clinical process from health outcomes.

As our longtime subscribers know, COCHS has consistently advocated for bringing Medicaid into correctional settings. One reason is that when the Centers for Medicare & Medicaid Services (CMS) audits health plans, it relies on the National Committee for Quality Assurance’s HEDIS measures—the primary standardized tools for comparing health plan performance. HEDIS measures are a core component of Medicaid’s Core Sets, helping states identify performance gaps and track quality improvement. While HEDIS does not treat mortality as a standalone metric, outcomes are embedded throughout its logic. When a population shows worsening health outcomes, the system itself is expected to respond and improve.

Correctional healthcare’s lack of outcome-based accountability runs counter to this logic. Toward the end of the Missouri article, a former Texas coroner notes that when deaths are classified as “natural,” it often remains unclear whether adequate care was provided. When death itself is excluded as a performance measure—as Foley’s testimony confirms—it raises the concern that vendors like Centurion, who are not subject to NCQA standards, may have little structural incentive to examine systemic failures or pursue meaningful improvement. (See the final article in this Weekly Update. That story concerns Kansas, where Centurion is the state contractor and has been reported to have been fined nearly 5,000 times.)

The second highlighted article, from Vermont, shows a similar struggle. Lawmakers pressed the Department of Corrections and its contractor, Wellpath, for clearer accounting of rising healthcare costs. The DOC–Wellpath contract is primarily driven by a per-member-per-month (PMPM) rate multiplied by the average daily population (ADP). This is a budgeting mechanism, not a quality framework. Revenue is tied largely to how many people are incarcerated, not to whether care improves health. Although the contract includes pay-for-performance elements, the incentives appear symbolic rather than transformative—unlikely to alter staffing levels, access to care, or clinical decision-making. Legislators’ calls for clearer accounting suggest that meaningful quality data remain opaque, undermining continuous quality improvement.

Taken together, these articles underscore how far correctional healthcare remains from conventional healthcare standards. Unlike Medicaid-managed care, which is audited and benchmarked through HEDIS, correctional systems rely largely on compliance-based models focused on contractual obligations rather than outcomes. This siloed approach obscures quality and frustrates reform. As COCHS has long argued, bringing Medicaid into corrections would not solve every problem—but it would make that silo far less impermeable.

Missouri Department of Corrections Director Trevor Foley testified before the Missouri House Corrections Committee that inmate deaths are not used to evaluate the performance of the state’s private prison healthcare contractor, Centurion Health. The contract’s 14 performance standards focus on process measures—such as timelines for dental visits and physical exams—but do not include mortality. During the hearing, Foley also downplayed reports that Centurion medical staff had walked out of the Jefferson City Correctional Center in October. In 2024, a record 139 people died in Missouri prisons: 74 from natural causes, 34 from unknown causes, and 23 from accidents, including drug overdoses. ML Smith of the Missouri Justice Coalition told lawmakers she has tracked 108 deaths through Nov. 30 and argued that Centurion is not meeting its contractual obligations, nor is the department enforcing consequences. Separately, Texas County Coroner Marie Lasater, reported that when a coroner lists a death as resulting from natural causes, it doesn’t necessarily mean the person received adequate care.

Members of the House Corrections and Institutions Committee pressed the Vermont Department of Corrections and its contractor Wellpath for clearer accounting of recent increases tied to the Wellpath medical services contract. Aviva Tabra, the department’s executive director for health, wellness and engagement, told the committee that payments are calculated from a per‑member‑per‑month (PMPM) rate multiplied by an average daily population (ADP) used to set the annual budget. Lawmakers also pressed whether the contract contains incentives to improve efficiency and health outcomes. Tabra said there are "pay‑for‑performance" metrics and continuous quality‑improvement requirements, but that the potential supplemental payments tied to performance are small relative to the total contract budget.

Follow Ups

Oversight

Editor's Comment: An article from the Los Angeles News returns us to a familiar COCHS theme: the limits of oversight. In 2023, California enacted SB 519, creating the In-Custody Death Review Division within the Board of State and Community Corrections to investigate all jail deaths statewide. Yet the board has reportedly never met. The obstacle appears to be counties refusing to provide medical records and investigative materials. Once again, we see how oversight can be thwarted—even when mandated by statute.

We have seen this pattern before. In our December 10, 2024 Editor’s Note, we cited Oklahoma County, where officials blocked the State Health Department from conducting surprise jail inspections. Only after the Oklahoma Supreme Court ruled in the state’s favor did the county relent.

Returning to California, this raises a broader question about accountability. As subscribers will recall, the CalAIM 1115 Demonstration: Justice-Involved Reentry Initiative is scheduled for statewide implementation by October 1, 2026. If incarcerated individuals are enrolled as Medicaid beneficiaries, their healthcare rights would extend beyond the reach—or paralysis—of oversight bodies that fail to function. Medicaid’s regulatory framework could introduce a level of transparency and enforceable standards that purely legislative oversight has struggled to achieve.

A state office created in 2024 to scrutinize local investigations into jail deaths has yet to complete a single review of the more than 150 people who have died in custody in California’s county jails over the past year-and-a-half. That’s because it hasn’t received the records needed to fully analyze the deaths, according to the Board of State and Community Corrections, a regulatory body appointed by the governor to oversee the state’s jails and juvenile halls. SB 519, signed into law in October 2023, established the In-Custody Death Review Division within the BSCC following a series of deadly years in San Diego, Riverside and Los Angeles county jails. Such internal investigations can take months, sometimes even years to complete. In early discussions, the counties made it “clear they would not send nonpublic information,” such as medical records or investigatory materials, according to Jana Sanford-Miller, a spokesperson for the BSCC.

New York

Editor's Comment: In the first article of this New York Follow Up, State Sen. Julia Salazar again calls for reform within the New York State correctional system. In a recent report, she asserts that correctional officers are not being held accountable for the maltreatment of incarcerated people. The next article, an op-ed by Mary Buser, a former correctional nurse, notes that Sen. Salazar plans to introduce legislation this session titled the End Health Professionals’ Complicity in the Torture of Detained or Incarcerated Individuals Act. The bill would require healthcare professionals to report abuse of incarcerated individuals by correctional staff.

The op-ed raises an issue COCHS has not previously emphasized: the problem of dual loyalty among healthcare professionals working in correctional settings. As Buser recounts from her experience at Rikers Island, reporting abuse can expose medical staff to retaliation. The final article reports on the last prosecution stemming from the beating death of Robert Brooks. Michael Fisher has accepted a plea deal that includes six months in jail.

State Sen. Julia Salazar released a report that asserts conditions in New York’s prisons remain dire, with inmates regularly neglected and abused, and correction officers not held accountable for wrongdoing or investigated for misconduct or alleged criminal violations. “Misconduct toward incarcerated individuals by correctional officers is commonplace — and so are the cover-ups,” she said. She contends that “medical neglect, discrimination, and inhumane conditions are all the norm.” On Senator Salazars senate website are listed the key findings of the report: New Report Finds New York Prisons Fraught with Endemic Violence and Disregard for the Law

Op-ed by Mary Buser, co-director of Social Workers & Allies Against Solitary Confinement, writes; In the upcoming 2026 New York State legislative session, a critical bill — End Health Professionals’ Complicity in the Torture of Detained or Incarcerated Individuals Act will be considered. Sponsored by Sen. Julia Salazar and Assemblymember Anna Kelles this bill requires health care professionals to report abuse of incarcerated individuals at the hands of correctional staff. An immediate question would be why is a law needed to ensure ethical behavior by the helping professions. The assumption is that they would naturally report or otherwise intervene in any brutality. Inside correctional facilities, powerful forces inhibit normal ethical behavior, something I learned in my five-year tenure in the Rikers Island mental health department. In my second week at the jail, I encountered a man who’d been badly beaten, who confided that he’d been beaten by guards. In response I sought out my supervisors, envisioning them picking up the phone immediately. Instead, in one sentence they laid out the reality of working in a jail: “We are guests in their house.” What this meant was that guests who questioned their hosts’ actions face retaliation. We were to do nothing.

Michael Fisher, a former Marcy Corrections Officer, took an unexpected plea deal amid a jury deadlock in Oneida County Court on Friday. Fisher, who was initially charged with manslaughter, was on trial for five days. He was offered six months in jail for pleading guilty to reckless endangerment. He was the final former CO to go to trial in the case of the death of inmate Robert Brooks

ICE

More than 1,400 people are currently held at the California City Detention Facility, run by the private for-profit prison company CoreCivic in the middle of the Mojave Desert. Democratic U.S. Sens. Alex Padilla and Adam Schiff conducted an oversight visit of the facility. In remarks to reporters, both highlighted what they described as inadequate medical care at the site. “The most frequent feedback we got was the inadequacy of the medical care they are receiving,” said Schiff. He described meeting a diabetic detainee who he said has not received treatment for her condition in two months. A spokesperson for CoreCivic, says that the site has robust medical and mental health care on site, including around-the-clock access to those services.

Management and Training Corporation (MTC), which operates immigration detention and correctional facilities across the country, bought the former Marana prison in July from the Arizona Department of Administration for $15 million. MTC was the prison's previous owner before the state acquired it in 2013. The prison continued to operate until it was shuttered in 2023. Since November, organizers and Marana residents have been asking city council members to meet with them to talk about the potential opening of a detention center in Marana. But Marana Mayor Jon Post had one thing to say to the crowd: “The Town Council’s hands are tied.” “None of us want it. There's not a council member on here that wants it, but our hands are more tied than you know,” Post told the frustrated residents. “This is not something I want for a community. We don't want this division. Nobody wants division in their community.”

As New Mexico’s 30-day legislative session begins on January 20, 2026, Democratic lawmakers, backed by Gov. Michelle Lujan Grisham, are prioritizing legislation that would prohibit state and local governments from contracting with U.S. Immigration and Customs Enforcement (ICE) to house immigration detainees. The bill would bar public entities—including counties—from entering or renewing intergovernmental service agreements (IGSAs) with ICE for immigration detention. New Mexico hosts three ICE detention facilities in rural counties.

Medicaid

Vermont's Department of Corrections and Wellpath officials described on Jan. 15 how new Medicaid policy changes and operational improvements aim to reduce gaps in care when people enter and leave custody. Aviva Tabra (Vermont DOC) summarized the Medicaid reentry changes that will suspend, rather than terminate, Medicaid during incarceration and enable automatic reactivation on release. "That should happen within 24 hours," Tabra said of reactivation. The change, together with DOC/Wellpath screening and enrollment work, is intended to reduce coverage gaps at release and allow the state to bill Medicaid for some pre‑release services up to three months before a person’s release.

Incarcerated Women

The female prison population continues to rise, with prisons worldwide failing to meet international human rights standards. Many are overcrowded, poorly resourced, and unsafe, especially for women. Women in prison are an obstetric group at high risk, with deficits in perinatal care leading to preventable maternal and child morbidity and mortality. Women who enter prison during pregnancy frequently experience long-standing social and structural inequities.

Juveniles

Garrett, a 16-year-old boy from Brooklyn, has spent about four months in solitary confinement. According to a lawsuit, filed last week in the Southern District of New York, Garrett was confined to his cell for 22 to 24 hours at the Industry Residential Center, near Rochester. He was denied access to education and interaction with his peers, and he often did not have use of a bathroom, according to the lawsuit. The facilities are for youth up to 21 years old who are convicted of a crime in family or the youth part of criminal court. The system is intended to be rehabilitative, but youth are often held in solitary confinement as a form of punishment.

Ninety-four percent of children sentenced to adult time experienced multiple traumas in their early years. Eighty percent of girls survived sexual abuse, a large percentage overall are commercially trafficked. Yet in all but 10% of cases, this childhood trauma was not even considered in court when minors were tried for crimes. The Prison Rape Elimination Act prevents kids from being held in the same environments as adults in prisons. So usually the kid just gets held in adult jails until they turn 18, or they get held in indefinite solitary confinement. That creates issues that make kids so much more vulnerable to victimization.

The Mary Davis Home has faced allegations of illegal solitary confinement and denying children mental health treatment for more than a year. The Galesburg (IL) Juvenile Detention Center recently got sent to the drawing board for a second time after a judge ruled their mental health plan doesn’t meet standards. In early 2025, the Illinois Department of Juvenile Justice did its yearly tour of the Mary Davis Home. Officials noted some improvements, but found key inconsistencies when they audited confinement practices. Several studies, including one in Cook County showed an average of 60-70% of kids who enter a juvenile detention center have a mental illness. He said an even bigger problem is that most of the kids have never been treated before.

Opioid Epidemic

Less than 24 hours after the Trump administration informed more than 2,000 addiction and mental health programs nationwide that it was immediately terminating almost $2 billion of their funding, the administration reversed course and reinstated the money. An administration official said that the money was being restored, but declined to say why. The decision followed furious lobbying by lawmakers from both parties to restore the cuts and a letter to the health secretary, Robert F. Kennedy Jr.

Officials at the Centers for Disease Control and Prevention suggested overdose-prevention funding recipients may no longer be allowed to promote the message to “never use alone”, according to details of a meeting held this month the Guardian obtained. The purpose of the meeting was to bring recipients of Overdose Data to Action (OD2A) CDC funding into compliance with Trump’s executive order, Ending Crime and Disorder on America’s Streets.

When we talk about the opioid crisis, we picture street corners, rural clinics, or harrowing overdose statistics. We rarely picture the county jail. Yet, the intersection of mass incarceration and the opioid epidemic has created a hidden human rights catastrophes – the criminalization of medical withdrawal. Every year, hundreds of thousands with Opioid Use Disorder (OUD) pass through correctional facilities. The medical gold standard for treating this chronic condition has been Medication for Opioid Use Disorder (MOUD), such as methadone or buprenorphine (Suboxone). These medications stabilize brain chemistry, curb profound cravings, and allow individuals to function normally. However, in the majority of U.S. jails, this life-saving standard of care often stops at the sally port.

Medications for opioid use disorder, methadone, buprenorphine, and naltrexone, are the most effective treatments for reducing relapse, overdose, and mortality. Recently, technological advancements are increasingly used to integrate genetic, clinical, and psychosocial data in OUD care. Precision medicine refines, not replaces, evidence-based medications for OUD by accounting for individual biological and psychosocial variability. Opioid use disorder is polygenic, with genetic factors contributing substantially to vulnerability but no single causative gene identified.

Staffing Crisis

The correctional officer's staffing shortage in New Jersy is not unique. The problem has been documented in all 50 states. The number of corrections officers nationwide fell by about 20% between 2017 and 2022, according to data from the Safer Prisons, Safer Communities campaign. “Nobody wants to be a corrections officer anymore,” Terry Schuster, New Jersey’s corrections ombudsperson, testified at a legislative hearing. Recruiting is really hard for all law enforcement agencies right now, and the Department of Corrections is no different. Employees and advocates say the effects are visible throughout the system: longer shifts, programs trimmed back or scrapped entirely, fewer privileges for incarcerated people and a heightened sense of volatility on housing units.

The South Dakota Department of Corrections aims to cut its turnover rate by 12 percentage points in the next year, in part by offering recruits a better idea of what they’re in for. The number of open security staff positions has plummeted in recent years, Corrections Secretary Nick Lamb told the Legislature’s Joint Appropriations Committee. But security staff turnover has nearly doubled since 2020, from 17% to 33%. About 45% of those who leave officer positions do so within their first six months, he said.

The leader of the North Carolina Department of Adult Correction warned lawmakers Thursday that the state’s correctional staffing situation was “dire” and “dangerous” and that more funding is needed. Leslie Cooley Dismukes the secretary of the Department of Adult Correction warned that the vacancy rate for correctional officers is higher and remains at unsustainable levels, leaving us with fewer staff to run safe prisons. Gov. Josh Stein said more than a third of North Carolina’s correctional officer positions are unfilled and some facilities have vacancies that exceed 50%.

State Roundup

Alabama

The Alabama Department of Public Health would have more authority to enforce state health codes in state prison and local jail kitchens and cafeterias under a bill pending in the Alabama Senate. The legislation says the department can create rules for food safety in jails, but can’t shut down a facility without the approval of the body operating it. Sen. Larry Stutts, R-Tuscumbia, said his Senate Bill 84 is needed because currently the ADPH inspects the facilities, but any issues are only reported to the warden with no obligation to remedy.

Connecticut

The state Department of Correction is seeing "recurring failures" affecting conditions of confinement, including unsanitary conditions, repeated lockdowns used to deal with staff shortages, and delayed medical care, according to a conditions of confinement report issued by the corrections ombudsman. According to state DOC Ombudsman DeVaughn Ward, he observed and received "consistent" reports of unsanitary and degrading living conditions that included "mold-contaminated ventilation systems, rodent infestations, sewage odors and backups, broken showers, inadequate ventilation, and prolonged denial of hygiene supplies and shower access

Lawmakers said they’re concerned about findings in a recent audit report showing failures by state prison staff to distribute medications on time, inform individuals who were released about money left in their accounts, and provide proper training for employees. An audit report released in July found the Connecticut Department of Correction had administered medications to incarcerated individuals late — or, in some cases, not administered them at all. DOC Commissioner Angel Quiros told lawmakers that the department has struggled to fill positions for nurses and prescribers.

An investigation by the Connecticut Office of the Inspector General found that “significant medical errors” were made when prescribing methadone to Ronald Johnson and Tyler Cole, two young men who died from the combined effects of methadone and other prescribed medications while incarcerated at Garner Correctional Institution.

Mississippi

A health inspection of the Neshoba County Jail was conducted recently following an inmate's complaint about living conditions. The inmate complained about sewage backing up into sinks and showers, mold in showers, cold meals, lack of medical care, inmates sleeping on the floor, and not having access to clean clothes. Neshoba County Sheriff Clark then requested the Health Department conduct a full investigation. Their report found widespread plumbing and water pressure problems throughout the facility.

Nevada

Two rural Nevada prisons were designated as having a “critical labor shortage” amid continued struggles in recruiting correctional officers and physicians that result in major prisoner health issues being treated off-site. A decision from the state Board of Examiners — consisting of the governor, attorney general and secretary of state — will allow Ely State Prison and Lovelock Correctional Center to bring back retired state workers to fill the vacant positions through the end of June. They could receive retirement income on top of their new salary because of the labor shortage label.

Oregon

The Oregon Department of Corrections will pay $2.3 million to settle a wrongful death lawsuit filed by the mother of a 22-year-old man, Grayson James Allen, who died by suicide while being held in solitary confinement The complaint said the agency ignored Painter's documented history of suicidal ideation and self-harm and his significant mental health issues. The suit said others in custody in the disciplinary segregation unit, where Painter was placed, reported correctional officers encouraged Painter to kill himself.

Texas

Correctional staff at a private Louisiana jail facility ignored a Houston man’s pleas for medical attention in the days leading up to his death from an infection caused by strep throat, a newly filed lawsuit asserts. It’s the third to be filed in connection to Harris County Jail inmates who died after being outsourced to LaSalle, one of the privately owned, out-of-state detention facilities that receives millions of dollars from contracts with the county. Medical and correctional staff are alleged to have repeatedly ignored 29-year-old Erik Carlson’s strep throat infection and notifications from his bunkmates of his illness, according to the lawsuit.

The Dallas County Jail just pulled off something it has rarely managed in recent years: a full state inspection with zero required fixes. After a long stretch of regulator citations and complaint-driven reviews, county officials say the clean bill of health reflects real, day-to-day improvements. The clean inspection comes after a long run of critical findings from state regulators. Records show the commission found Dallas County noncompliant in 2018, 2021 and twice in 2022.

San Antonio officials moved to support a feasibility study that could lay the groundwork for a diversion center in Bexar County aimed at steering people with mental illness or intellectual and developmental disabilities (IDD) away from the criminal justice system and into treatment. San Antonio and Bexar County are the only major jurisdiction in Texas without an established jail diversion program.

Virginia

A class action lawsuit alleging that the Virginia Department of Corrections has violated its “Step Down” program by arbitrarily keeping people confined solitarily for long periods of time will be allowed to move forward, a federal district judge ruled this week. While Virginia does not have what is colloquially referred to as “solitary confinement,” Virginia law does have “restorative housing.” This is when incarcerated people are placed in restrictive or isolated housing, typically for safety or punishment reasons due to behavior issues.

Rikers Island

Mayor Zohran Mamdani announced his administration’s commitment to advancing Just Home, a first-of-its-kind housing initiative to serve formerly incarcerated New Yorkers with complex medical needs on the campus of NYC Health + Hospitals/Jacobi. “From our earliest days providing care in our city’s jails, we at Correctional Health Services recognized the critical need for stable and supportive housing, close to medical care, that would allow some of our most clinically vulnerable patients to leave Rikers and return to a safe and dignified life in the community,” said Senior Vice President for NYC Health + Hospitals/Correctional Health Services Dr. Patsy Yang

One of the thorniest challenges facing Mayor Zohran Mamdani as he takes office is the crisis on Rikers Island. At least 15 people died in custody last year, or while receiving medical care shortly after their release. Soon, a federal judge will appoint a remediation manager, who will run many aspects of the jail system and work to reduce violence. Mamdani signed an emergency executive order directing jail officials to figure out how to follow several city rules they’ve been violating — namely, a law that restricts the use of solitary confinement. New York City mayors have allowed the Department of Correction to violate certain local laws or rules because they said not enough staff were available to properly run the jails.

Reentry

Alaska reflects a broader national pattern. Despite the fact that people recently released from incarceration are among the populations most vulnerable to fatal drug overdoses, many jails and prisons across the country still do not provide medication for opioid use disorder (MOUD). Dr. Sarah Spencer of the Ninilchik Community Clinic underscored the risk: “There is no population that’s at higher risk than people who have been recently incarcerated,” she said. The Alaska Department of Corrections has stated that its goal is to expand access to MOUD and that it hopes to pilot a more comprehensive treatment program by February 2026.

Unmanaged stress can be the biggest factor leading formerly incarcerated persons to return to crime and drug use. That’s according to a new study by a UT San Antonio criminologist whose research is shifting the focus on the causes of recidivism, finding that stress is a more reliable predictor than many other factors, including mental health issues. The findings highlight that while mental health struggles play a role, it is predominantly the day-to-day stresses of reentry that determine an individual’s success.

Technology

Persistent unemployment is a critical criminogenic factor linked to higher recidivism rates. In an effort to build career pathways for returning citizens in the trades, the Michigan Department of Corrections designed and operated a first-of-its kind immersive skilled trades training program called the “Vocational Villages” prior to parole within select state prison facilities. These Villages leverage technologies such as virtual reality and robotics to optimize the opportunity to provide the equivalent of master-level trades credentials in 14 different trades.

The Tippecanoe County Jail (IN) has announced new technology in its jail cells for better response to medical emergencies. The new tech, called Cell Guardian, uses radar, thermal imaging and computer vision to monitor a person while in their cell. The sheriff's office says it will be used for suicidal inmates and inmates going through drug detox and medical conditions.

Correctional Health Care Vendors

VitalCore/Wellpath

Oakland County (MI) moved to replace its jail medical services contractor after the previous provider, Wellpath, entered Chapter 11 bankruptcy. County procurement staff told the committee they issued a competitive solicitation and received four proposals; the evaluation committee recommended VitalCore Health Strategies as the most responsive and responsible bidder.

Wellpath

A federal judge has approved a plan to divide among current and past inmates of the Monterey County jail nearly $2.5 million in fines to be paid by the jail’s longtime health care provider. As many as 35,000 people will be eligible to claim a share of the pot, which works out to only about $70 apiece if all apply. Former prisoners who spent months or years in the jail system will qualify for more, short-timers for less. The money is coming from a national medical company, Wellpath. The company’s years working for the Monterey County Sheriff’s Office featured inadequate admission examinations, delayed doctors’ visits, neglected prescriptions and token psychiatric care.

Wexford

Wexford the provides medical and mental health care to New Mexico prison inmates is asking a judge to stop the state tax department from seizing money from its accounts to collect an alleged $4.2 million in unpaid taxes. Wexford is asking the court to "halt and unwind" the state's levy against its assets, and offering to place funds equal to the disputed amount in a court registry to be held pending resolution of the case.

Centurion

Darren Powell worries he could die in prison — and not because he’s serving a life sentence. He worries about dying due to a lapse in his medication. Powell, a type 2 diabetic at the Norton prison, went to refill his medication but it wasn’t ready. Medical staff first told him it was because he didn’t request new medication. Then his wife was told a shipment was delayed. Finally, medical staff said he requested his medication too early. The healthcare vendor for Kansas Department of Corrections is Centurion which has been the state’s contractor since July 2020. Centurion was fined almost 5,000 times between January 2021 and May 2022, totaling $900,000 in fines in 16 months. In 2025, Centurion was fined $1 million from just January to September.