Proprietary Correctional Healthcare Providers: A Case Study In Oklahoma; Update: Mental Health Parity and Addiction Equity Act; More Election News

Highlighted Stories

Editor's Note

This week’s highlighted stories return to a familiar location and previous themes. The location is Oklahoma City, Oklahoma County and the themes are: 1) the general ineffectiveness one branch of government supervising another branch of government for the provision of healthcare services within corrections; 2) the quality of healthcare delivered by proprietary correctional healthcare companies; 3) the merry-go-round that occurs when jurisdictions replace one proprietary correctional healthcare company with another.

As a bit of a refresher, back on August 6th the Weekly Update included a story reporting that the Oklahoma County Criminal Justice Authority (OCCJA), which operates the Oklahoma County Jail, had filed a lawsuit against the State Department of Health, claiming they do not have the power to conduct unannounced jail inspections. Fast forward to this week's update, Turn Key Clinics, the healthcare provider in the Oklahoma County jail has given 30 day notice to terminate its contract with the county even after the OCCJA approved a 1-year, $7.4-million deal with Turn Key Clinics. Turn Key Clinics claims the reason they terminated their contract was due to understaffing on the part of the OCCJA leading to insufficient levels of security personnel, and that health care providers were unable to access patients to meet the company’s standard of care. However, advocates and investigations have found that under Turn Key Clinics watch at least 50 people have died at the jail and the company restricted what types of medicine providers could prescribe to their patients. Especially in the cases of patients with mental health issues, the company refrained from dispensing long-acting psychiatric drugs (see fourth highlighted article detailing a lawsuit Turn Key Clinics settled in Sebastian County, Arkansas over the death of a mentally ill man who died of dehydration).

It is hard to make sense of what exactly is going on in the Oklahoma County jail. Certainly, there are suspicions raised when inspectors are prevented from entering an institution and certainly suspicions are further increased when a healthcare provider that claims to be protecting patients is also accused of harming those very same patients. But it is not COCHS’ role to try an unravel this extremely messy situation. For us the important thing is getting people proper care. Standing in the way of this goal as in many cases throughout the country is correctional intransigence (see last week’s Editor’s Note ) combined with what appears to be questionable levels of care provided by a proprietary correctional healthcare provider and chronic understaffing of correctional facilities. This situation has left Oklahoma County with the task of finding a new correctional health care provider within 30 days.

As our subscribers may remember from our January 30th Editor’s Note, a departure of one correctional healthcare provider creates a merry-go-round of correctional providers and often with unknown or little improvement in healthcare delivery. The last highlighted article is from Douglas County (Lawerence, Kansas). There, the sheriff has terminated his contract with Advanced Correctional Healthcare because of “dissatisfaction with its services” and is replacing it with --drum roll-- Turn Key Clinics. As for Advanced Correctional Healthcare, it would not be surprising to see that company search for a new opportunity --perhaps somewhere in Oklahoma?

Turn Key Clinics & Oklahoma County

Turn Key Health Clinics will leave the Oklahoma County Detention Center in 30 days, the company said in a letter to jail officials. The reason for Turn Key’s termination is that due to chronic, severe and well documented understaffing on the part of the jail to provide sufficient staffing levels of security personnel, Turn Key’s health care providers are unable to access patients. Turn Key’s ability to see patients “has deteriorated substantially” since the Criminal Justice Authority took control of the jail from the Oklahoma County Sheriff in 2020. The Oklahoma County jail trust approved a 1-year, $7.4-million deal with Turn Key. An investigation found that Turn Key employees didn’t send people to the hospital in dozens of cases when they were in crisis, catatonic or refusing to eat or drink. The investigation also found the company staffed mental health and other medical positions with low-level nursing assistants trained to perform basic tasks like taking vital signs, but not to diagnose or assess medical conditions.

Advocates like Mark Faulk of the People’s Council for Justice Reform have long criticized Turn Key, blaming the provider for deaths and health emergencies at the jail. “The group of people including families who had the courage to speak up are the reason they are leaving,” Faulk said. “It has nothing to do with whatever excuse they might give you now." Faulk said he was relieved to hear of Turn Key’s departure but frustrated over the short notice given to the jail. “If they really cared about humanity and the people in there, they wouldn’t have given them just a 30-day notice,” Faulk said.

At least 50 people who were under Turn Key’s care died during the past decade, an investigation by The Marshall Project and The Frontier found. Investigations unearthed company policies and practices that have endangered people in jail — especially those with mental illness. Until last year, the company often restricted the kinds of medicines it would provide people in jail, not giving them long-acting psychiatric drugs and prescriptions they had received before their arrests.

Turn Key Clinics & Sebastian County, Arkansas

A man who died of starvation and dehydration in an Arkansas jail after a year in solitary confinement should have been hospitalized long before he was discovered emaciated and unresponsive in his cell in August 2021, jail officials said in depositions for a legal suit that led to a $6 million settlement for his family. Larry Price's family reached a $6 million settlement Tuesday with Sebastian County, where he was incarcerated, and with Turn Key Health Clinics, the Oklahoma City-based company that provides the jail's medical care. The 51-year-old's suffering and death could only be compared to "instances of torture and non-consensual medical experimentation under the Nazi government in World War II," according to a report by emergency physician Matthew DeLaney, an expert hired by the attorney representing Price's family to review evidence in the case.

Advanced Correctional Health & Lawrence Kansas

The Douglas County Sheriff’s Office has been authorized to end its current medical services contract for jail inmates due to its dissatisfaction with the provider. At their meeting on Wednesday, county commissioners authorized the Sheriff’s Office to sign a contract with a new provider, Turn Key Health Clinics, for inmate medical services. The office wanted to end its contract with Advanced Correctional Healthcare because of dissatisfaction with its services and recent corporate changes. The Sheriff’s Office has been in a contract with Advanced Correctional Healthcare since 2016.

Mental Health Initiatives

On September 9, 2024, the U.S. Departments of Labor, the Treasury, and Health and Human Services issued a final rule (the “Final Rule”) under the 2008 Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act to require health plans and insurers to provide documentation proving that they cover benefits in a manner that does not discriminate against beneficiaries with mental health or substance use disorders. This Insight discusses how the Final Rule changed from the proposed rule issued in July 2023, the next steps for enforcement, and the implications for employers, insurers, third-party administrators, pharmacy benefit managers, and managed care organizations.

Although Santa Clara County was one of the first in the nation to create a behavioral health court, criminal offenders with mental health and drug problems sit in jail for months before getting treatment. That could change this week. County officials launched a pilot program with a separate court calendar that could fast-track defendants for mental health treatment as early as their arraignment hearing. This program could help reduce the time people sit in jail as they await guilty plea outcomes before options such as jail diversion or Mental Health Treatment Court become available.

2024 Election

“Now she wants to do transgender operations on illegal aliens who are in prison.” That’s what Donald Trump said about Vice President Kamala Harris in last week's debate, that prompted head-scratching. But what did it mean? It appears to have been a reference to a 2019 ACLU questionnaire about rights for incarcerated people that Kamala Harris filled out in her for run for president.

A measure on the November ballot proposes to change the state constitution to ban the practice of forced labor in jails and prisons. Proposition 6 would wipe out a legacy of enslavement that dates back centuries. Vote YES on Proposition 6. If the measure passes, correctional officers will no longer be able to order an inmate to work. Prison jobs would be voluntary. Prisoners could not be disciplined for refusing a work assignment. California’s constitution mirrors the 13th Amendment of the U.S. Constitution, which allows for involuntary servitude as punishment for crimes.

Juveniles

The Justice Department announced today that it has reached an agreement with the Connecticut Department of Correction addressing conditions for children at Manson Youth Institution, an adult correctional facility housing children charged in the criminal justice system. The agreement resolves the department’s investigation of Manson under the Civil Rights of Institutionalized Persons Act and the Violent Crime Control and Law Enforcement Act. In December 2021, the department notified Manson that there is reasonable cause to believe that conditions for children at Manson violate the Eighth and 14th Amendments and Individuals with Disabilities Education Act, and that these violations are pursuant to a pattern or practice of resistance to the full enjoyment of rights protected by the Constitution and federal law.

Webinar

The second session of the Diagnosis of Incarceration speaker series will critically examine existing frameworks guiding healthcare practices in carceral facilities and how the structure of these institutions hinder or help incarcerated individuals access essential healthcare needs. Expert panelists will help to highlight the gaps between established protocols and the lived experiences of patients to identify areas where the system falls short and leaves substantial room for improvement.

Opioid Epidemic

In this cohort study of fatal overdose and fentanyl spread through Oregon’s unregulated drug market, decriminalization of drug possession was not associated with an increase in fatal drug overdose rates in Oregon in the 2 years after its enactment. The findings of this study suggest that when evaluating the association of public policies with overdose mortality, it is critical to account for the role of fentanyl as the principal driver of the overdose mortality epidemic in the US.

Topics in Criminal Justice

Nancy Rodriguez, University of California Irvine professor of criminology, law and society, shines a light on the lack of prison violence metrics that could help advance safety. "For the 800,000 persons currently confined and the 200,000 state and federal correctional officers who work within U.S. prisons, the threat of violence is a routine feature of daily life," she writes. "Accounts from incarcerated persons and staff detail the ever-present threats to safety in prisons and the human toll of this violence."

State Roundup

California

The wife of a California prisoner will receive $5.6m after being sexually violated during a strip-search when she tried to visit her husband in prison, her attorneys said Monday. After traveling four hours to see her husband at a correctional facility in Tehachapi, California, on 6 September 2019, Christina Cardenas was subject to a strip-search by prison officials, drug and pregnancy tests, X-ray and CT scans at a hospital, and another strip-search by a male doctor who sexually violated her, a lawsuit said. Of the $5.6m settlement, the CDCR will pay $3.6m and the rest will be paid by the other defendants, which include two correctional officers, a doctor and the Adventist Health Tehachapi Valley hospital.

California, the epicenter of the U.S. homelessness crisis, is cracking down on people living outside, taking an aggressive new stance to dismantling and clearing homeless encampments in the wake of a watershed U.S. Supreme Court ruling in late June. The sweeps have taken off under Democratic Gov. Gavin Newsom, who issued an executive order requiring state agencies to remove encampments and encouraging local governments to do the same. Newsom’s hard-line stance is undermining his signature Medicaid initiative, known as CalAIM, which dedicates $12 billion over five years in part to helping homeless people receive health care, housing, and social services.

Maine

At the Somerset County jail in rural Maine, prisoners addicted to opioids used to receive a daily pill to keep cravings in check. But as soon as they were released, their access to the medicine ended. As their cravings surged, they were re-entering society at high risk for withdrawal, relapse and overdose. Hoping to change those grim outcomes, Sheriff Lancaster decided to try providing a different — and far less common — form of the medication, buprenorphine: an extended-release shot that subdues urges for about 28 days.

Minnesota

Crow Wing County commissioners face a dilemma. This year, Cass County terminated its longstanding contract in place since the jail was constructed in 2007 to house prisoners at the Crow Wing County Jail creating a $1 million shortfall. An ongoing discussion since mid-summer has been whether money from the national opioid settlements with the state of Minnesota could be used to offset ongoing medical expenses from the jail operation.

Ohio

The Supreme Court of Ohio Reentry Task Force was charged with studying the challenges surrounding reentry after incarceration when Chief Justice Sharon L. Kennedy formed the group in April 2023. Today the task force released its final report. It makes 16 recommendations to support holistic approaches for improving outcomes for formerly incarcerated individuals. Programs that help people successfully transition out of prison or jail also benefit society by deterring relapses into crime and by enhancing public safety, the report stated.

Texas

Texas inmates and nonprofit groups are suing the state over the blistering heat inside its prisons, asking an Austin judge to declare the conditions unconstitutional and require Texas to keep temperatures under 85 degrees Fahrenheit. Complying with such a ruling — which could come at any time following a hearing last month — could cost the state more than $1 billion, officials have said.

Virginia

An officer at the Virginia Peninsula Jail (VPRJ) has been charged for bringing contraband into the facility. An investigation revealed that the officer provided contraband to at least one inmate incarcerated at VPRJ. He faces up to a year in jail and/or a $2500 fine.

Wasington State

Corrections officers traveling to Norway may visit Bastøy prison, a place of fascination for many. No fences surround the facility, situated on an island. People held there, serving the final years of their sentence, live in group cottages and roam the island as they perform jobs like farming and ferry operation. Even Norway’s high-security prisons exhibit big differences from their American counterparts. Washington Way administrator Courtney Grubb marveled at how incarcerated people could shop for food at grocery stores and cook for themselves.

Correctional Health Care Vendors

YesCare, Corizon, Tehum Care

State Sen. Billy Beasley, D-Clayton, is accusing the company contracted to provide health services for state inmates of not paying tens of thousands of dollars worth of invoices to a local first responder. Beasley brought up his concerns when lawmakers were presented with a new $2 million contract with YesCare to treat inmates with substance use disorders via medication-assisted therapy. The company currently has a $1 billion contract with the state of Alabama for inmate health care services. Alabama’s contract with YesCare was controversial among some lawmakers. YesCare had previously run a different company that also provided health care for inmates, the Texas-based Corizon, which between 2016 and 2021, lost over 25 contracts due to lawsuits alleging medical negligence and malpractice.

Wellpath

Once again, the Santa Barbara County supervisors found themselves collectively squinting to figure out how to improve health care in the county jail, this time with the focus on the six inmate deaths that occurred there between December 2022 and December 2023. Of the six, five died within three days of being booked. Two were overdoses. Two were suicides, one by an inmate who had repeatedly threatened to kill himself yet somehow managed to throw himself off a second-story railing to the ground below. To many of the grand jury findings, the sheriff’s response was that protocols had been in place at the time of the deaths but had not been followed by health-care workers with Wellpath.

Sen. Roger Hauck on Tuesday urged Attorney General Dana Nessel and Auditor General Doug Ringler to launch formal investigations into unpaid medical bills related to Michigan’s prison health care system, focusing on contractors Wellpath and Grand Prairie Healthcare Services. “The state contracted with Wellpath and Grand Prairie to provide health care for inmates, but local providers are being left with unpaid bills,” said Hauck R-Mt. Pleasant. “The attorney general must investigate these companies and hold them accountable.”

Lifelong county resident Nicholas Overfield developed AIDS and died at the age of 38 shortly after a two-month stint in the county jail in 2022. Nick had been diagnosed with HIV in 2017 and had been prescribed an antiretroviral medication to keep his condition from worsening, according to his mother. A lawsuit, which names Wellpath and El Dorado County Sheriff's Office, claims Nick's requests for medication were ignored, with a doctor delaying his first visit for two weeks despite medical records on file indicating his need for antiretroviral medication. While in custody, Nick's health deteriorated rapidly. Staff twice found him disoriented and lying on the floor of his cell, unable to stand.

Quality Correctional Care

A new effort to remove the current medical provider at the Allen County Jail comes after Carmel-based Quality Correctional Care (QCC) asked for more than a 10% allocation for next year’s budget. Opponents of the construction of a new jail asked the commissioners Friday at their weekly meeting to search for alternatives to QCC, which they find deficient in medical treatment and mental health care. Federal judge Damon R. Leichty ruled in March 2022 that the current jail violates inmates’ constitutional rights, triggering plans to build a new $300 million jail on Meyer Road.