Alabama: When Correctional Leadership Breaks Down, Can Medicaid Fill the Gap?

Highlighted Stories

Editor's Note

This week’s highlighted stories come from Alabama: one from Autauga County, and two involving the Alabama Department of Corrections. Together, they raise questions about governance, accountability, and the conditions in which incarcerated people live and often suffer.

In Autauga County, the sheriff is suing the county commissioners over alleged neglect and unsafe conditions in the jail. This striking move highlights a theme COCHS has returned to repeatedly: governance is not monolithic. In counties across the country, internal political disputes can make it nearly impossible to determine who is truly responsible for the health and safety of people in custody. Without some external mechanism to ensure quality, it becomes unclear who is ultimately accountable for the health and well-being of people behind bars.

At least in Autauga, there appears to be some movement, however adversarial, to address conditions at the local jail. The situation at the state level is even more troubling. Governance in Alabama’s prison system has calcified into dysfunction. As the two following stories illustrate, the state continues to spend millions in taxpayer dollars settling lawsuits stemming from abuse and neglect behind prison walls—with little evidence that those expenditures have prompted meaningful reform.

Alabama has not expanded Medicaid and has not applied for a Section 1115 waiver. However, it is subject to Section 5121 of the Consolidated Appropriations Act of 2023, which allows for Medicaid coverage of juveniles in custody up to 30 days prior to release. (Notably, the definition of juvenile under Medicaid can extend to age 24, in contrast to traditional correctional definitions.) It’s still too early to know how Alabama will implement this provision—or whether advocates in places like Autauga County and at the state level will be able to use it as a lever for change.

But what remains clear is this: where governance falters, Medicaid could become an external force for accountability. Whether at the county or state level, it has the potential to realign systems that too often place cost savings and political deflection above care and safety.

Alabama

Autauga County Sheriff Mark Harrell filed a lawsuit against the Autauga County Commission, alleging “negligent or willful refusal” by the panel to maintain the county jail. In the 20-page lawsuit filed in Autauga County Circuit Court, Harrell said the commission “has repeatedly failed to grant the request of the sheriff to hire necessary staff” and “maintenance personnel to properly clean and maintain the jail, and to provide and maintain courthouse security and courtroom security.” In fact, Harrell, who has been sheriff since January 2023, alleges the neglect goes back as far as 2006, through previous administrations. “This is a statutory mandate. It cannot legally be avoided,” the suit states.

By legal, financial, and humanitarian standards, the Alabama Department of Corrections is failing. In 2018 at Ventress Correctional Facility, a corrections officer beat a handcuffed inmate within earshot of four nurses. That same year, another officer broke a restrained inmate’s jaw and left blood on the wall. In 2019, Steven Davis was beaten to death by officers at Donaldson Correctional Facility. Rather than face court battles, the department has quietly settled 94 excessive force lawsuits—helping push its legal costs past $57 million. Alabama seems willing to pay any price to preserve unchecked power. The corrections budget has grown from $544.1 million in 2021 to $826.7 million next year—up 52%, outpacing even Medicaid’s 44% growth. Alabama needs a prison system rooted in rehabilitation, not retribution—but for now, that remains politically out of reach. Fixing prisons is seen as costlier than ignoring them.

Most complaints are handwritten in ballpoint pen and mailed from prisons to federal courts. While the details vary, fear of correctional officers is a common thread. These allegations come from three civil rights lawsuits among 124 that Alabama’s Department of Corrections (ADOC) has settled since 2020. Most involve claims of excessive force in the state’s violent, overcrowded prisons, according to court records and state financial data. Since 2020, ADOC has spent over $57 million on legal costs—more than $17 million on defending officers and settling suits, and over $39 million on a few complex cases, including one from the U.S. Department of Justice. Rep. Chris England, D-Tuscaloosa, remarked: “It’s hard to imagine we intended to create a fund that just allows us to be in a perpetual state of lawsuits forever. When does the state of Alabama start demanding results?”

Follow Ups

Editor's Comment: In this week’s Follow Ups, we start once again with Wellpath’s bankruptcy. The first article—essentially a PR piece from the law firm Proskauer—details its role in negotiating a favorable settlement for unsecured creditors. Normally, COCHS wouldn’t highlight promotional content, but this piece offers a window into how proprietary correctional healthcare vendors navigate bankruptcy. The second article picks up on the fallout: advocates in Alameda County are calling for Wellpath’s immediate removal from Santa Rita Jail. The final article in this series comes from El Paso, where a lawsuit over a jail death was delayed until Wellpath emerged from bankruptcy last month.

The next three Follow Ups return to New York. In the first, the father of Robert Brooks, who died after being beaten by correctional officers, links his son’s death to the wildcat strike, suggesting it was a maneuver to avoid accountability. In Erie County, a newly released recording shows a correctional officer violently confronting an incarcerated person. And finally, a story on prison closures highlights how dependent some communities have become on correctional facilities as local economic engines.

Next, an article on co-pays in jails and prisons illustrates how these fees continue to create harmful barriers to care—even when exemptions exist. As we’ve noted in previous articles in the Weekly Update, co-pays can limit access and negatively impact health.

We close with two stories from California. A San Diego grand jury has once again found jail healthcare to be dangerously inadequate. As mentioned in a previous Editor’s Note, San Diego’s oversight efforts appear to yield little change despite repeated findings of substandard care. Meanwhile, in Sacramento, arrests of unhoused individuals are accelerating. As The Sacramento Bee points out, this punitive approach to homelessness is expensive. We've tracked similar articles in California since the Supreme Court’s Grants Pass v. Johnson decision, including in an Editor’s Note last year.

Wellpath Bankruptcy

The international law firm Proskauer was retained to represent the unsecured creditors' committee in the Chapter 11 bankruptcy case of Wellpath. Initially, Wellpath proposed to pay unsecured creditors less than 1% of their claims, based on a prepetition restructuring agreement with its secured lenders. These terms were incorporated into the first proposed Chapter 11 plan. However, following extensive negotiations, Proskauer secured a comprehensive global settlement that could provide general unsecured creditors with recoveries exceeding 50% of their claims. Commenting on the outcome, Judge Perez stated, “We ended up from a recovery standpoint at a place where I never thought we were going to end up at the beginning of the case... That’s, in my mind, an unprecedented result.”

More than two dozen Alameda County residents on May 16 again called for the Board of Supervisors to forego renewing its contract with the for-profit company Wellpath, a controversial firm that provides medical care in the Santa Rita Jail. The overwhelming call for another company or the county itself to take over medical care in the facility in September 2027 was the second public forum held to address Wellpath, a Nashville-based healthcare company that has faced more than 1,500 lawsuits nationwide. A study showed that Wellpath made some improvements in providing care in recent years but failed to meet national compliance rates for performing initial health screenings and assessments of inmates when they enter the jail. It also raised questions about Wellpath’s ability to deal with inmates’ chronic conditions, such as diabetes and heart problems, as well as alcohol and drug withdrawal.

El Paso County has paid $2.5 million to settle a lawsuit over the death of 48-year-old Cristo Canett, who was found dead in his jail cell in April 2022. Canett had gone to a local ER for stomach pain and alerted the halfway house where he was living, but an “escape” warrant was issued. Colorado Springs Police arrested him at the hospital before he saw a doctor. Attorneys say a nurse with Wellpath, the jail’s private medical contractor at the time, placed him in a general population cell despite his complaints of severe abdominal pain. He died within 24 hours from internal bleeding caused by an intestinal ulcer. Wellpath, one of the nation’s largest prison healthcare providers, declared bankruptcy in late 2024, delaying the lawsuit. The company emerged from bankruptcy last week.

New York

Robert Ricks, father of Robert Brooks, writes: I recently took a few teens I mentor to see “Sinners”, the new movie with Michael B. Jordan. As the credits rolled, one girl looked at me and said, “It was so sad. I’m tired of sad Black stories.” Yes, I am. I knew I was beyond tired when I watched my son, Robert Brooks, beaten to death by a swarm of prison staff inside Marcy Correctional Facility. Months later, corrections officers across New York staged an illegal walkout — not to protest the violence, but to avoid accountability. During that time, Messiah Nantwi was killed by staff at Mid-State prison, right across the street from where my son was murdered. New York’s prison crisis isn’t about staff shortages. We have one of the highest staff-to-incarcerated ratios in the country, 2.4 incarcerated people for every corrections officer —double the national average and four times the ratio in the federal prison system. The real crisis is a humanitarian one, rooted in overincarceration and unchecked brutality.

On Jan. 9, 2024, an Erie County Correctional Facility inmate and his girlfriend capped visitation with a kiss. Correction officers, however, believed this moment of intimacy between Terrance Cash and his girlfriend was a guise to pass contraband. “Open your mouth or I’m going to break them teeth,” a corrections officer said to Cash. The suspicion of correctional officers, and Cash’s refusal to re-open his mouth, led to them using a level of violence that the public rarely gets to see behind jail and prison walls. Videos show correction officers failed to heed initial orders to take Cash to a medical room, opting instead to allow one officer to use his metal flashlight on two occasions to pry open Cash’s mouth as others assisted or stood by watching the scene unfold.

The recently-enacted New York State budget gives Governor Kathy Hochul authorization to close three prisons in the state and Orleans County Legislature Chairman Lynne Johnson wants to make sure that the Orleans Correctional Facility and Albion Correctional Facility are not on that list. Although the budget did not state which facilities could be closed, Johnson sent a letter to the Governor’s Fingers Lakes representative underscoring the importance of the two facilities to the community. In the letter Johnson wrote, “According to the latest numbers released by the United State Census Bureau, Orleans County was fortunate to be one of a few upstate counties to actually see a population increase from 2023 to 2024. This modest gain could be wiped out with closing of our correctional facilities and a closure of either or both of these facilities would have very negative consequences for our community.”

Co-pays

In most states, people incarcerated in prisons must pay medical “co-pays,” which are essentially fees to access health care including physician visits, medications, dental treatment, and other health services. While these fees may seem reasonable at two or five dollars, research shows they actually act as barriers to health care for incarcerated people who typically earn less than a dollar an hour. Correctional facilities have countered critiques by including waivers and exceptions in their copay policies and insisting that no one is denied care because they can’t afford to pay. Review of these policies and evidence from a recent study show that these exemptions are so limited, ill-defined, and inconsistent that they fail to make the copay system fairer and less harmful for incarcerated people.

California

According to a new report from the San Diego County grand jury, the Sheriff’s Office does not track critical performance indicators and therefore is unable to enact data-driven reforms to better address the medical and mental health needs of people in jail. The failure is especially important, grand jurors said, because San Diego County jails have for years reported significant numbers of people dying in their custody. Jurors commended the Sheriff’s Office for “significant improvement in suicide prevention efforts and providing increased mental health treatment” after a 2018 investigation by Disability Rights California found “a system failing people with mental illness.” “However, much work remains to be done,” the new report says. Having a robust continuous quality improvement process “has the potential to improve operations and prevent deaths.”

Eighteen individuals were booked into the Sacramento County Main Jail on charges related to being homeless over a period of four and a half weeks, an analysis of recent booking data shows. Of those people, 12 went to jail on a “fresh arrest,” with no prior warrant issued. These 18 people collectively spent more than 370 hours — more than 15 days — behind bars. About 80% of them were arrested under Sacramento City Code. Using the average daily cost of housing a person in one of Sacramento County’s jails — the Main Jail downtown and the Rio Cosumnes Correctional Center near Elk Grove — jailing those 20 people for camping cost taxpayers about $3,100. That cost does not include any medical care or any periods that the unhoused people spent in police custody before being booked into jail.

Medicaid

A letter sent by our country’s mayors to lawmakers in Washington last week spotlighted how cuts to Medicaid will make our communities less safe. Written by The United States Conference of Mayors, the letter was a warning to lawmakers who are finalizing a bill that could decimate Medicaid. The mayors wrote that slashing the program would lead to more crime and reduce emergency services. “The cuts being considered by Congress will not only hurt Medicaid beneficiaries and our health system but also jeopardize public safety and the progress we have made in reducing violent crime,” according to the nonpartisan group, which represents 1,400 cities. The mayors wrote that cuts and eligibility changes to Medicaid will lead to an exponential increase in people suffering from mental health crises, substance abuse addiction, housing instability and more. Officers would need to attend to them, leaving fewer personnel and resources to prevent and solve violent crime.

Technology

State courts bear the immense responsibility of handling about 66 million cases a year, many of which require people facing civil or criminal matters to go to court for at least one hearing, and often several, to resolve their cases. Although most people show up for court, no-shows in even a small percentage of cases add up to millions of missed hearings that slow court operations and inconvenience court personnel, witnesses, and victims. In criminal and traffic cases especially, missed court hearings not only strain court efficiency but also can have cascading consequences: A missed hearing can result in an arrest warrant, driver’s license suspension, fine, and even jail time for the person charged in the case. Rigorous research has found that court date reminders are consistently effective at reducing missed court hearings. A recent review of the research found that reminders boosted court appearance in 11 of 12 studies, with relative reductions in the failure-to-appear rate ranging from 11% to 61%.5 Cases for lower-level offenses, such as misdemeanors and traffic violations, saw even more improvement when the reminders were sent.

The Thurston County Sheriff’s Office will install biomedical sensors in its jail so it can monitor people who are deemed “high risk.” The Board of County Commissioners approved the purchase of seven such sensors from Reassurance Solutions LLC for $48,268. These sensors can detect a person’s heart rate, respiratory rate and movement, even through clothing and blankets, according to county documents. If they work as advertised, these sensors will help jail staff respond more quickly to medical events such as drug overdoses and other emergencies.

The online system Wisconsin prisoners rely on to receive money from loved ones recently crashed, leaving them unable to pay for items like extra food and hygiene products. The Wisconsin Department of Corrections contracts a private company, Access Corrections, to allow people outside of prison to transfer funds to those inside. Those transfers occur through the company’s app, website, phone system, mail and in-person options. But multiple people told WPR and Wisconsin Watch they could not make deposits beginning this week.

Opioid Epidemic

In June 2023, Wisconsin Gov. Tony Evers and DOC officials asked federal authorities to conduct an investigation into an alleged illegal drug and contraband smuggling ring at Waupun Correctional. Last year, nearly a dozen prison staff resigned or were fired. Prison systems nationwide have long struggled with the presence of drugs making their way into the hands of prisoners. Between 2001 and 2018, inmates who died from a drug overdose or alcohol intoxication in state prisons across the country grew by more than 600%, according to data released by the U.S. Department of Justice's Bureau of Justice Statistics.

BOP

The Department of Justice (DOJ) Inspector General Michael E. Horowitz announced the release of an evaluation assessing the Federal Bureau of Prisons' (BOP) practices regarding colorectal cancer. The evaluation identified significant operational and managerial shortcomings that the BOP must address to ensure inmates receive appropriate screening and treatment for CRC. The failure to conduct annual CRC screenings, as outlined by BOP clinical guidelines, raises risks and could lead to worse clinical outcomes for inmates, potentially resulting in significantly higher healthcare costs for the BOP.

The family of a woman who died in a Waseca federal prison has filed a lawsuit alleging the facility failed to provide proper medical care for weeks, despite doctors advising she needed emergency heart surgery. Starsha Silva, 36, of Hawaii was diagnosed with severe valvular heart disease on May 2, 2023, during a consultation with Mayo Clinic doctors, who recommended she undergo open-heart surgery immediately before prison staff returned her to the Federal Correctional Institution in Waseca — a low-security facility. The lawsuit alleges a Bureau of Prisons case manager blocked the operation from going forward because prison policy required two officers to oversee the procedure and no one was available.

Mental Health

More than a third of 911 calls in New York City about people in emotional distress that were eligible for a response from mental health workers did not receive one, a new audit by the city comptroller’s office found. The program that sends the mental health workers, called the Behavioral Health Emergency Assistance Response Division, or B-Heard, began as a pilot in 2021 and does not cover the entire city. But often, B-Heard teams do not arrive at all, and police officers do instead, the audit found. The program has faced funding cuts and staffing problems for years. Among its most pressing challenges are hiring enough emergency medical workers and social workers to fully staff its teams. Mental health advocates are urging the city to allocate an additional $4.5 million to B-Heard to help close gaps in the program’s coverage and ensure that its teams are fully staffed.

State Senator Karina Villa passed a measure through the Senate to address the mental health concerns of defendants who have been determined to be unfit for trial languishing in county jails. “Our justice system is not equipped to care for every individual deemed unfit for trail in need of mental health treatment, resulting in worse mental health outcomes for these individuals,” said Villa (D-West Chicago). “This not only inhibits a person’s right to due process and a fair trial, but further increases the chances of an individual remaining in the system.” House Bill 3572 would clarify standards to determine whether someone unfit to stand trial should be diverted to outpatient state mental health treatment programs.

Two more prisoners at Hālawa Correctional Facility died in the past two months in what are believed to be the fourth and fifth suicides there since last summer, making the state’s largest prison a disturbing anomaly nationally that experts blame on longstanding operational flaws. The American Civil Liberties Union of Hawaiʻi is calling on state lawmakers to hold public hearings on the recent deaths to determine what steps the state Department of Corrections and Rehabilitation is taking to prevent recurrences.

Data & Statistics

Armstrong, a law professor at Loyola University New Orleans, launched the Incarceration Transparency project in 2019. The online database tracked deaths in every prison, jail, and youth detention facility in Louisiana and South Carolina from 2015 to 2021. The site also features a heat map of Louisiana parishes and the number of incarcerated people who have died in each area. The database also gives users a breakdown of the available information associated with each death. Armstrong’s data revealed that on the rise are preventable deaths, those not due to natural causes and often related to drug overdoses or suicide.

State Roundup

California

In a landmark effort to address the intersection of incarceration and homelessness, Sacramento County will begin reserving 70 shelter beds for individuals recently released from the county’s main jail. The initiative, aimed at providing immediate housing and reducing recidivism, is expected to launch in July 2025. The program will operate out of the Salvation Army’s Center of Hope on North B Street and will be funded through Proposition 47, the 2014 voter-approved measure that reallocates prison savings to support mental health, substance abuse treatment, and reentry services.

California Department of Corrections and Rehabilitation (CDCR) officials are investigating the alleged attempted homicide of a peace officer at California Medical Facility (CMF). On May 21, 2025, at approximately 10:10 a.m., incarcerated person Dannunzio Patron allegedly attacked a correctional officer with an improvised weapon during a cell extraction. Officers utilized physical force to quell the incident. During the incident, one officer sustained lacerations to his left forearm from the improvised weapon, and two responding staff members reported knee pain. The injured officers were transported to an outside medical facility for treatment.

Florida

A little over a week after the city of Jacksonville confirmed that it received an unsolicited proposal in March from three groups offering to build a new jail in Duval County. The proposal, which is about 100 pages long, includes renderings of the new jail and a statement that the jail should be designed in a way that “can handle future growth,” citing that the current jail holds about 2,600 people even though it was designed to hold just over 2,100.

Georgia

For three decades, Dougherty County’s current jail has been among the busiest in southwest Georgia, with the facility holding local inmates as well as those from other counties. On a recent day, of the 746 in the jail population, about 267 were individuals with mental health diagnoses. Of those incarcerated, the population with known mental health issues runs at about 30%. In essence, that qualifies the jail as the county’s largest mental health facility. By default, it is the only one.

Louisiana

Over a decade before the recent New Orleans jailbreak, the city’s jail went viral for videos showing inmates drinking, using drugs, gambling, and handling a gun — footage that led to a sweeping 2013 court order to reform what was then one of the country’s most violent jails. Twelve years and millions of dollars later, much of that reform remains unfulfilled despite federal oversight. Last week, a lone civilian guard left to get food, allowing 10 inmates to force open a faulty cell door, remove a toilet, and escape through a wall where bars had been cut. The dysfunction persists despite the 2015 opening of the $150 million Orleans Justice Center, intended as a fix. Months before the escape, an independent monitor had warned of “extremely inadequate” staffing and lax supervision — conditions that paved the way for the breach.

Michigan

An abandoned maximum security prison in mid-Michigan would be put up for sale under a proposal from state lawmakers. The Standish Maximum Correctional Facility is a 604-bed prison sitting on roughly 118 acres about 27 miles north of Bay City. Bill sponsor state Rep. Mike Hoadley, R-Au Gres, wants to see Standish Max put back into use with the hope that it’ll be retooled to meet the healthcare, mental health and law enforcement needs of the region.

Oklahoma

An Oklahoma Medical Examiner’s report is detailing the cause of death for a man who died inside the Comanche County Detention Center in August of 2024 Terry Dorrell was in jail for just 10 days before his death, brought in on unpaid court fees. According to the Oklahoma Medical Examiner’s report, Dorrell’s cause of death was multiple blunt and sharp force trauma. The report detailed those injuries, which included more than 20 stab wounds across his body.

South Carolina

The Department of Justice launched an investigation into the Charleston County jail over a year and a half ago, but where the investigation currently stands is unclear, raising concerns as more inmates continue to die behind the facility’s bars. The U.S Department of Justice announced on Nov. 2, 2023, that it would conduct civil rights investigations into the Charleston and Richland county jails after multiple inmate deaths. Specifically at the Charleston jail, the DOJ stated it would examine medical and mental health care, use of isolation and use of force.

Utah

More than 50 incarcerated individuals received free eye exams and glasses prescriptions during a daylong event held at the Utah State Correctional Facility. The exams were performed by eight optometric physician students and two faculty members from the Rocky Mountain University of Health Professions. Each diagnosis was reviewed and approved by faculty, who are licensed optometric physicians. Along with the exams, incarcerated individuals who needed corrective lenses were allowed to select a new pair of glasses.

Rikers Island

Three Indictments have been unsealed charging one current and two former correction officers employed by the New York City Department of Correction (“DOC”) at Rikers Island with healthcare fraud, mail fraud, and false statements related to healthcare matters. Todd Faustin, Jovanny Concepcion, and Steven Murphy were arrested and presented before U.S. Magistrate Judge Robert W. Lehrburger. U.S. Attorney Jay Clayton said: “As alleged, the defendants defrauded New Yorkers by making hundreds of thousands of dollars in fraudulent workers compensation claims. Today’s arrests demonstrate this Office’s continuing commitment to protecting New Yorkers from corruption at Rikers Island.”

Tasers

The use of Tasers/ECWs has decreased officer and suspect injury, but is not without risk. Correctional nurses who work in facilities that use this technology are called upon to assess and treat the physical results of deployment. It is important for them to know the proper assessment to conduct and those high risk patients for whom additional monitoring may be required, as well as the proper technique to use for the removal of barbs. Superficial skin injury and surface burns are the most frequent direct injury of a Taser/ECW activation. A weakened cardiac system may not withstand a Taser/ECW shock. Take all reports of chest pain and shortness of breath seriously. Pregnant or potentially pregnant females need added attention. The electrical voltage of a Taser/ECW activation can exacerbate a crisis situation.

Correctional Healthcare Vendors

Advanced Correctional Healthcare

Olmsted County (MN) filed a claim for damages against medical care provider Advanced Correctional Healthcare (ACH). Melvin Bush died in March of 2023 when deputies discovered he was not breathing during routine wellness checkup. The lawsuit, filed in January of 2025, alleges that Bush was not prescribed the correct medical care by Advanced Correctional Healthcare (ACH), a contractor which provides medical care at the jail.

According to the Federal Court docket, Shelby County, along with its contracted health care provider for the jail, Advanced Correctional Healthcare Inc., has settled the lawsuit brought by former jail inmate Nicholas Banning. While we suspect a substantial financial payout will be part of the settlement, those responsible will never be held accountable for their actions in the matter.

Centurion

Wexford Health Sources accused Tennessee's prison system and procurement office of unlawfully circumventing the state's contract bidding laws in a newly filed lawsuit. Wexford was lined up to become Tennessee's next inmate health care provider before the state canceled the contract at the 11th hour, leaving the current lucrative contract in place with health care provider Centurion. The Tennessee Department of Correction's history with Centurion has been marred by accusations of bid-rigging and improper sharing of confidential information between TDOC and Centurion executives, including criminal charges that ended in a guilty plea for one former Centurion official.

Turn Key Health Clinics/TK Health

A settlement has been reached with some parties named in the wrongful death lawsuit of a Jonesboro man who died in police custody in 2024. According to a petition filed May 18, a $900,000 settlement has been reached between the estate of Brock Tyner, who died in police custody last year, and Turn Key Health, the company that provides contracted nursing staff to the inmates and employees of the Craighead County Detention Center.

A Cleveland County Detention Center inmate died early Sunday morning, the 10th death in the last three years. In March, TK Health, formerly Turn Key Health Clinics, the medical contractor at the Cleveland County Detention Center, announced that it would not renew its contract with Cleveland County. The company said it would leave the jail on June 30. Cleveland County Sheriff Chris Amason told The Frontier in March he was already planning to seek new bids for the contract before receiving the letter from TK Health.