Consent Decrees & Lax Enforcement: Understanding Jail Intake; Will Medicaid In Corrections Inhibit Medical Record Falsification?

Highlighted Stories

Editor's Note

This week’s three highlighted stories focus on the jail in Sacramento, California. The first, from The New York Times, reports on the death of David Kent Barfield, an elderly homeless man who died while in custody. The following two articles provide context on the jail’s conditions and a grand jury’s criticism of the county for failing to make the improvements required by the Mays consent decree.

We are highlighting this series to examine three key issues: first, the longstanding problem of consent decrees and their lack of enforcement—Sacramento County Jail has been under the Mays consent decree since 2020; second, the process used to determine whether an individual is medically fit for incarceration; and third, concerns around transparency and the falsification of medical records.

The Mays consent decree was approved by a federal court in 2020. However, according to a grand jury report detailed in The Sacramento Bee, Sacramento County has consistently violated its provisions. The report suggests there has been little to no enforcement of the decree. Although the consent decree was approved during the Trump administration, it is unclear whether the Biden administration’s Department of Justice had done anything to enforce it.

When a consent decree goes unenforced, it directly impacts the lives of those it was meant to protect. This brings us back to Mr. Barfield and the process by which individuals are booked into jail.

When someone is arrested, law enforcement must first determine whether to take them directly to jail or to an emergency room for medical evaluation. In most cases, officers bring the individual to jail, where it becomes the jail’s responsibility to assess whether they are medically safe to detain. If the jail determines the person is not fit for detention, custody is transferred back to law enforcement, who then take them to a hospital (see COCHS' Intake Process flowchart).

In Sacramento County, this decision was made by a nurse. However, in other jurisdictions, correctional officers themselves may make this determination, as a nurse may not always be on duty when an individual is brought into a correctional facility.

In practice, unless an arrestee is bleeding, has a broken bone, or is in obvious distress, law enforcement in most jurisdictions defaults to taking them to jail—leaving medical screening to the jail staff. In Mr. Barfield’s case, this process failed. He was deemed safe to detain despite significant questions about whether that determination was correct.

The third issue we wish to raise is the allegation that the nurse falsified records. Whether or not this allegation is accurate, it highlights a broader problem: without Medicaid coverage behind the walls, there is no transparency in an inmate's medical record. Had Mr. Barfield been a Medicaid beneficiary receiving services under the program, he—or his estate—would have had access to his medical record, allowing for independent verification of its accuracy. (It should be noted that, due to California’s 1115 Waiver, Medicaid coverage is already being implemented in some county jails and is expected to be available statewide by October, 2026.)

This story underscores multiple system failures when it comes to incarcerating elderly homeless individuals—people whose needs are clearly not being met in a community setting. With jails often serving as providers of last resort, the lack of Medicaid services only exacerbates the challenges these individuals face on the streets.

Sacramento County

A Sacramento man suffering from a drug overdose was neglected by a police officer, medical workers and sheriff’s deputies over the course of more than two hours before he died at a county jail last May, according to reports from court-appointed monitors. That man, David Kent Barefield Sr., 55, was among seven detainees the Sacramento County Sheriff’s Office reported dying at its facilities last year — and one of three who died at its main jail in the span of about a month.A police officer had dragged Mr. Barefield about 100 feet over the concrete floor of the parking garage to get to the jail entrance. Once Mr. Barefield was inside, a certified nursing assistant had difficulty checking his vital signs, and should have alerted a registered nurse to examine him but did not make that request. At around 2 a.m. a nurse cleared him to be held at the jail but failed to complete a medical screening and later falsified his intake papers.

Sacramento County’s housing and handling of inmates is in violation of federal law and an agreement to improve mental-health and medical conditions for inmates, a civil grand jury found. Federal law requires inmates who are suicidal to be housed in cells without so-called blind spots, so deputies can monitor them on security cameras 24/7 to make sure they are safe. But instead, the county is placing most suicidal inmates in cells not entirely visible to cameras, including booking cells, where they may stay for over six hours, the report found. The other violation relates to a 2019 county settlement of a major class action lawsuit regarding jail conditions, called the Mays Consent Decree. But over three years later, the county has not made many of the vital required improvements and the county has no “immediate plans” to address the many violations of the decree, the report found.

Delays in improvements mandated in a 2020 consent decree resulted in at least six preventable detainee deaths at Sacramento County jails, according to a grand jury investigative report on June 2, 2023. The grand jury’s Report said the County was stonewalling on the promised changes, pointing to a letter to the County’s Board of Supervisors dated September 1, 2022, stating that “conditions in the Jails remain deplorable.” Supervisors in December 2022 then approved a new “Intake and Health Services Facility” to remedy finally the ADA and HIPPA violations. But they said it would take five years or longer to complete. According to the Report, that left no “immediate plans to address the many outstanding violations,” even though “[v]igorous interim plan execution is vital to avoid the threat of federal receivership, increased liability for non-­compliance, preventable illness for the jail staff and inmate population, and higher costs” due rising interest rates.

Follow Ups

Editor's Comment: This week, we are introducing a new section in the Weekly Update: Follow Ups. The purpose of Follow Ups is to connect current stories with past reports that have appeared in the Weekly Update. COCHS believes it is important for our subscribers to recognize that most of the stories we cover are not isolated incidents—they are part of a larger historical context. Many have lengthy backstories that reveal patterns and suggest trends occurring across the country.

This week’s first Follow Up comes from Oregon, where the state has now fired its Medical Chief of the Department of Corrections. Another article reports that the department has hired a consulting firm to "fix prison healthcare."

The second Follow Up concerns the bankruptcy of MEnD Correctional Care.

In an Editor's Comment from January 28, 2025, we questioned the effectiveness of oversight—particularly in Oregon, where lawmakers in the state’s Judiciary Committee, supposedly responsible for legislative oversight, failed to question the Director of Oregon’s Department of Corrections about healthcare conditions in the state’s prisons. As we noted in that Editor's Comment, multiple stories in the Weekly Update throughout 2024 raised serious concerns about the care incarcerated patients were receiving in Oregon, as well as troubling questions regarding the Medical Chief.

It remains to be seen what the consultants will propose to fix healthcare in Oregon—and, just as importantly, how those proposals will be implemented.

Now, turning to MEnD Correctional Care: Anoka County, Minnesota, has had to pay $2.6 million to a former inmate to settle a federal lawsuit. The lawsuit alleged that MEnD Correctional Care refused to provide him Suboxone for opioid addiction.

We highlight this all-too-common story because it reflects a long-term trend: correctional healthcare provider bankruptcies. Back in December 2022, we included an article detailing the chaos caused by numerous Minnesota counties losing their jail healthcare provider, MEnD Correctional Care. At the time, we had no idea this bankruptcy would be the start of a larger pattern—one that now includes Tehum Care/Corizon/YesCare and Wellpath.

Oregon

The two former health care leaders at the Oregon Department of Corrections routinely delayed medical treatment for people in custody, and retaliated against health care staff when they raised reasonable concerns about the care of patients across Oregon’s 12 prisons, according to an internal investigation. The findings come as Chief of Medicine Dr. Warren Roberts and his boss, Assistant Director of Health Services Joe Bugher, were fired on February 3. The health leaders have been on leave since Dec. 5. Less than two weeks later, attorney Jill Goldsmith, who was hired by the agency to investigate, delivered an 84-page report. It found that Roberts oversaw bureaucratic policies that led to significant delays in life-saving health care deemed necessary by nurses and doctors who work in the state’s prisons.

The Oregon Department of Corrections plans to pay an outside consultant, Falcon Correctional and Community Services, an estimated $550,000 over the next year to assess the prison system’s troubled health care system. The Oregon Department of Justice late last year also hired Falcon to help prepare for legal action regarding the prison system. In that contract, the state agreed to pay Falcon up to $250,000.

MEnD Correctional Care

Anoka County has paid nearly $2.6 million to settle a federal lawsuit brought by Deyonta Green, a former inmate who was found unconscious and seriously injured in his cell after jail staff denied him opioid withdrawal medication for days. When Green, of Champlin, was booked in the Anoka County jail at the age of 25 in February 2022, he informed staff he had a prescription for Suboxone due to his opioid addiction, and had injected heroin earlier in the day, according to the lawsuit filed in April. But contracted medical staffers refused to give him his medication despite several requests, including calls and emails from his family and probation officer. At the time, Anoka County contracted with MEnD Correctional Care, a for-profit private health care provider that later filed for bankruptcy as more Minnesota counties dropped the company amid claims it failed to provide adequate staffing or appropriate care to inmates.

Consolidated Appropriations Act, 2023

Medicaid has long been prohibited from covering health services for incarcerated people. The Consolidated Appropriations Act of 2023, signed by President Biden in 2022, marks the first change to that policy since Medicaid’s inception in 1965. It took effect Jan. 1, 2025. Over 60% of incarcerated youth are eligible for Medicaid or CHIP, but implementing the law will require major changes to how correctional facilities provide care. The federal CMS under Biden has not clarified how it will enforce the law, and it’s uncertain whether a Trump administration would require states to comply. In 2018, President Trump signed a law mandating Medicaid enrollment for eligible youth upon release to prevent coverage gaps. Biden’s law builds on that, requiring correctional facilities to provide health screenings and services to those youth, including those eligible for CHIP.

Opioid Epidemic

Amid an epidemic of drug overdoses that’s finally showing signs of slowing in California, public health experts are improving access to drug treatment in prisons and jails, which are often awash in fentanyl and other smuggled drugs. Nationally, drug and alcohol overdose is a top cause of death in jails and the leading cause of death for those who have been recently released. Thousands of other people imprisoned in county jails may soon have access to such ‘medication assisted treatment’ in the next two years. At the direction of Gov. Gavin Newsom, the state’s Medicaid program is beginning to pick up part of the tab for the costly treatment.

Food In Corrections

Mr. Reina, 56, is a cook on Rikers Island, New York City’s notorious 415-acre jail complex in Queens. He says he’s frustrated by the poor quality of the meals, in which every ingredient and recipe has been dictated by the city Department of Correction. Most vegetables and fruit arrive at the jail canned or frozen. Salt is off the table, banned since 2014 for health reasons. But the food is getting its most significant overhaul in roughly 15 years. A year ago, the city received a $100,000 grant from the Carbon Neutral Cities Alliance, a group fighting climate change, to develop plant-based recipes for Rikers and retrain its cooks.

Transgender Ban

A federal judge issued a temporary restraining order blocking the Bureau of Prisons from enacting President Trump’s executive order to house transgender women with male inmates and stop medical treatment related to gender transitions. Judge Royce C. Lamberth, of the U.S. District Court for the District of Columbia, said that three transgender prisoners who brought a suit to stop the order had “straightforwardly demonstrated that irreparable harm will follow” if their request for a restraining order were to be denied. Judge Lamberth was appointed by former President Ronald Reagan.

State Roundup

California

If women needed gynecological care at an all-female prison in southern California, their only option was to see the sole gynecologist on staff — a doctor now accused of sexually and physically abusing scores of patients. Dr. Scott Lee performed abusive, invasive and unnecessary exams on pregnant women and others incarcerated at the California Institution for Women in Chino, a new federal class-action lawsuit says. Lee’s patients endured harmful pelvic examinations, pap smears, sexualized digital penetration, physical restraint and retaliation, along with being denied medical care at the facility, where he was the only gynecologist from 2016 to 2023, according to a complaint filed Feb. 2.

Florida

It may seem unconventional but a program at the Orange County Jail involving yoga, arts and role-playing is helping inmates with mental illness reduce the symptoms of depression and other disorders. Called New Start, the program was formed to address the needs of the jail’s mental health population who have been cleared from sub-acute mental health areas. Senior Community Corrections Officer Barbara Vega facilitates the program. Vega, who is certified in Crisis Intervention Techniques, says creative outlets are healing because they help people get in touch with and express feelings that might otherwise remain buried or ignored. She even coordinated an inmate talent show in October 2024.

Missouri

James Pointer’s life sentence in the Missouri Department of Corrections ended abruptly last week when he bled to death from an opening in his leg used to administer dialysis treatments. Pointer, 76, was housed at the Moberly Correctional Center, where the state prison agency keeps offenders with kidney disease because it has a dialysis center. The death was made public a former corrections officer, Déna Notz, who founded an organization called Collectively Changing Corrections. Notz shared an email from a man incarcerated at the Moberly prison who saw Pointer bleeding.

New York

An autopsy has found that the death of a New York State prison inmate who was handcuffed and shackled while corrections officers attacked him was a homicide, Gov. Kathy Hochul reported. Ms. Hochul said the determination should prompt the swift filing of criminal charges against those involved in the death of the man, Robert Brooks, 43, at the Marcy Correctional Facility in December. She referred to the killing as a “murder” and “horrific.”

A sick man was released from a New York prison on Friday after suing the state for keeping him long past his parole date. Steve Coleman, who is 67 and has advanced kidney disease, was granted parole in 2023 after serving 43 years for murder. But he remained incarcerated for 21 more months because the Department of Corrections could not find a nursing home to accommodate his dialysis care. Experts said that many paroled prisoners across the country are in a similar limbo, stuck inside because their state cannot find them medical care elsewhere.

Oklahoma

Rep. Justin Humphrey, R-Lane, has filed House Bill 1343, which would abolish the Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS) and move the agency's functions under the Department of Corrections (DOC). Humphrey said he's heard from many Oklahomans who are upset at the introduction of the measure, which he said he filed as a way to outrage Oklahomans. "I hope everyone who has gotten angry and voiced concerns over me suggesting this move will remain outraged upon learning that Oklahoma already is sending many of our mental health patients to prison and jails," Humphrey said. "We need to be asking why the Oklahoma Department of Mental Health is not providing adequate inpatient beds for Oklahoma's growing demands for long-term mental health inpatient needs."

Oregon

The husband of Barbara Stillwell, who died after allegedly overdosing on drugs someone offered her inside the Lane County Jail in 2023, is suing the county and its medical provider, claiming that the county failed to prevent drugs from entering the facility and to provide adequate medical care. The lawsuit, filed in Lane County Circuit Court, alleges that the county failed to stop fentanyl and methamphetamine from entering the jail and did not adequately train jail staff to watch for signs of drug use or overdoses.

Pennsylvania

Family First Health was awarded the grant from the U.S. Department of Health & Human Services’ Health Resources and Services Administration to improve access to primary care for individuals reentering the community from incarceration at the York County Prison. The grant was awarded on November 18, and the program officially began on December 1. Since then, Family First Health has been working in collaboration with the York County Reentry Coalition to establish a framework for this initiative, officials said. The focus of the program will be on chronic health condition identification and coordination of management with Prime Care, the jail’s medical provider; prevention, screening, diagnosis and treatment for Hepatitis C, HIV, and other infectious diseases.

South Carolina

Brad Sigmon is set to be the fourth inmate executed in the state since September, according to a Friday death warrant from the state Supreme Court. Brad Sigmon, 67, is scheduled to die March 7. By state law, executions take place four Fridays after a death warrant is issued. Sigmon is one of three men on death row who have exhausted their appeals and are expected to receive death warrants in the coming months. Sigmon’s attorneys have already made a failed attempt this year to halt his execution, claiming that the drugs the state uses for lethal injection were not as effective as officials said during the previous three executions carried out.

Washington State

Substance abuse was a concern for 75% of inmates admitted to the Yakima County jail last year, according to a presentation from the jail's director, Jeremy Welch, given to county commissioners on Monday. The jail has made headlines recently for a lawsuit filed against the county in connection with the 2023 death of inmate Hien Hua, who reportedly died from a heart attack during a mental health crisis after being beaten by corrections officers. Welch reported that while mental health and homelessness continue to be challenges for inmates, nearly 5,000 of the 6,600 inmates booked in 2024 reported struggles with substance use.

Correctional Healthcare Providers

Armor

The family of a 54-year-old heart-transplant patient who died after a short stay in the Duval County jail settled a federal lawsuit over his death for $300,000. Dexter Barry, who received a new heart in 2020, repeatedly told the officer who arrested him that he was a heart transplant recipient and needed to take his anti-rejection pills multiple times a day. Records from the Duval County jail obtained by The Tributary in 2023 showed that Armor Correctional Health Services, the company that operated medical care at the facility at the time, noted Barry’s need for his life-sustaining medication was “urgent” but it never arrived at the jail during Barry’s two-day jail stay. During Armor’s contract, the lawsuit says the company’s staffing levels were so low that the then-corrections director asked for volunteers from the Jacksonville Fire & Rescue Department to help.

Centurion

Centurion Health is being sued—again, and by multiple parties—for failure to offer the appropriate medical care the company is contracted by the Missouri Department of Corrections [MODOC] to provide prisoners. In virtually every state Centurion has received a prison healthcare contract, the for-profit enterprise has faced legal reprimand. It happened in Arizona, Idaho, Minnesota, New Mexico, Tennessee, and Vermont, to list just a few. Missouri appears to be no exception. Centurion secured a lucrative $1.4 billion contract to provide care to incarcerated persons where “the good of the people” is to “be the supreme law” three years ago under dubious conditions that led to an immediate legal challenge.

Southern Health Partners

A federal wrongful death lawsuit against Summit County Sheriff Kandy Fatheree was dismissed this week and is expected to be refiled in state court as a malpractice case against medical agencies. In the suit filed in the U.S. Northern District Court of Ohio, evidence produced during discovery showed. Fatheree was likely not at fault as the Summit County Jail provided medical services to an inmate who died during a 13-day stint in jail. The federal lawsuit accused jail staff of failing to give him his prescription medications for his mental health and seizure disorder. During his 13-day stay, jail staff refused to allow his family to visit or deliver his medications. The federal lawsuit also named Southern Health Partners and Summit Psychological Associates as defendants. The case will be refiled in Summit County, but without the sheriff named as a defendant but as a medical malpractice lawsuit against private medical agencies who allegedly did not provide sufficient care.

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