Tragedy, Technology, Transparency: Opening the Black Box of Correctional Healthcare

Highlighted Stories

Editor's Note

Last week (Fireworks in Minnesota: Sheriffs & Jail Healthcare Vendor Battle Mental Health Reform), we explored correctional healthcare as a “black box”—a system sealed off from community providers and shielded from meaningful accountability. This week’s stories continue in that vein but suggest something new: that the walls of the black box are not always impenetrable. There are fissures which are being driven not just by public pressure, but by technology.

We begin in New York, where the city’s Department of Correction stonewalled access to footage documenting the death of Michael Nieves, who died by suicide at Rikers Island after staff failed to respond in time. It took a lawsuit from the New York Times to obtain the footage, three years later. The incident, and the subsequent legislative push by the City Council to require greater transparency around in-custody deaths, reveal just how far correctional systems will go to obscure harm. The DOC’s policy on medical emergencies was reportedly “unclear” at the time of Mr. Nieves’ death. Now, the department is drafting new guidelines. But the delay, both in treatment and transparency, speaks volumes.

Technology, however, is making concealment harder. We’re reminded of the 2024 murder of Robert Brooks, when corrections officers beat him to death believing prison clinics weren’t under surveillance. They were wrong. Cameras, like lawsuits, can serve as levers for truth but they can also help avert tragedy in the first place.

We see this preventive potential in two other stories this week. In Washington State's Chelan County, the jail has now installed 68 ceiling-mounted medical sensors capable of detecting changes in heart and respiratory rates. In Alabama’s Tuscaloosa County, a similar investment in vital sign monitors, funded in part by opioid settlement dollars, is giving staff an early warning system for hidden medical emergencies. These tools shift the conversation from post-mortem review to preemptive care.

These are small steps, and surveillance is no substitute for systemic reform. But technology has a way of undermining the privilege of opacity. Where once there was silence, there is now data. Where once there were black boxes, there are now digital eyes. And that, in our view, is a development worth tracking.

Rikers Island

As calls mounted for a federal court takeover of the Rikers Island jail system in New York City, what happened to Michael Nieves stood out as a case study in that system’s dysfunction. Mr. Nieves, 40, was being held in the troubled jails on arson and other charges — his trial date repeatedly delayed by the pandemic and a series of mental health assessments — when he used a shaving razor to cut himself near the jugular vein and bled out on the floor as jail staff members waited for medical assistance. A city medical examiner found that the officers’ inaction contributed to Mr. Nieves’s death, but that he could have died even if he had immediately received emergency aid. The State attorney general’s office declined to charge the officers, noting in a report that the correction department’s policy on tending to severely bleeding inmates was unclear. Three years later, the department is building out a new “medical emergencies” curriculum, a spokesman said.

The City Council on Monday passed a bill that they say will bring transparency to the way the city’s Department of Correction announces and shares information about detainee deaths. The bill, which was sponsored by the former chair of the Council’s Criminal Justice Committee, Carlina Rivera, would require the DOC to make a number of changes to its notification policies regarding the deaths of detainees in its care. The first draft of the legislation began to percolate several years ago, when former DOC Commissioner Louis Molina reversed the agency’s policy to notify the media after a detainee had died. The bill also would require the DOC to notify the Office of the Chief Medical Examiner and the BOC within three hours of learning about a death in custody. It would also require the agency to notify the detainee’s next of kin and their attorney within 24 to 48 hours, documenting each attempt at contact. All together, the legislation aims to address the attempt by Molina in 2023 to halt in-custody death notifications to the media.

Chelan County

The Chelan County Regional Justice Center has installed an additional 44 medical sensors, bringing the total number of sensors in single-occupancy cells to 68. The county jail began installing medical sensors, from Kentucky-based Reassurance Solutions, in August 2024 to detect sudden changes in the health of inmates. The sensors are waterproof, roughly the size of a smoke detector and are installed on cell ceilings. The sensor technology monitors vital signs such as heart and respiratory rates to warn staff of a collapse from overdose or other medical emergency. Opioid settlement dollars were used to purchase the additional sensors along with contributions from Douglas County and statewide county risk pool grant funding. The purchase, installation and maintenance of the sensors through 2028, was a total cost of $359,400.

Tuscaloosa

The Tuscaloosa Sheriff's Office is set to receive additional funding to improve conditions for inmates and assist staff in managing medical needs. The funding will be used to purchase upgraded medical equipment, specifically 11 wall-mounted devices that monitor heart and breathing rates of inmates. These devices will be installed in single-inmate cells, primarily occupied by those with pre-existing medical conditions requiring extra attention. Hastings said, "It gives our employees an added benefit of being able to catch these medical issues that arise out of nowhere and provide the care that's needed." Part of the funding comes from an opioid settlement fund, while additional support will be required from the county.

Follow Ups

Editor's Comment: The first two articles in this week’s Follow Ups concern the Request for Proposals (RFP) recently issued by the Iowa Department of Corrections, which seeks to privatize healthcare services in the state’s prisons. As noted in last week’s Update, this proposal has met strong resistance from unions and some elected officials. The RFP cites Iowa’s aging prison population and high rates of chronic illness as a rationale for privatization. But as our subscribers well know, such statistics are common across correctional systems and not unique to Iowa.

One might assume the move toward privatization is driven by the belief that it will lower costs—but the RFP is not explicit. Both articles raise concerns about the assumption that market forces alone will ensure quality care. The oft-repeated claim that “bad actors” will be weeded out through competition has not held up in practice. As we’ve reported extensively, proprietary correctional healthcare companies frequently rotate through facilities, often despite troubling track records. We explored this cycle in Proprietary Correctional Healthcare Vendor Merry-Go-Round, and in this week’s final section, Correctional Healthcare Vendors, is an article that covers Illinois replacing Wexford (itself the subject of numerous complaints) with Centurion, a company carrying its own fraught history.

We also return to New York, where State Senator Mark Walczyk—representing District 49 in the state’s rural north—has voiced sharp criticism of the state’s decision to cancel health insurance for correctional officers who participated in last year’s wildcat strike. His official website accuses Governor Hochul of taking away the health insurance of “the kids of correctional officers,” and he calls for a repeal of the HALT Act, which limits the use of solitary confinement. Senator Walczyk’s district includes three correctional facilities: Cape Vincent, Gouverneur, and Riverview—each a major economic driver in an economically strained region.

Our coverage has largely focused on the impact of these events from the perspective of incarcerated individuals and their advocates. But Senator Walczyk’s statement is a reminder of how difficult correctional reform can be, even after the murder of Robert Brooks by correctional officers at Marcy Correctional Facility. The senator is responding to his constituents, as is his role in a representative democracy. Yet the state must balance that local pressure with its obligation to the broader public. These overlapping demands require a delicate balancing act—one that state governments, not known for agility, often struggle to perform.

Iowa

Iowa has issued a request for proposals (RFP) inviting private healthcare companies to bid on providing services in the state’s nine correctional institutions. The RFP notes that Iowa’s prison population is aging, with roughly two-thirds of incarcerated individuals managing chronic conditions or requiring ongoing medical or mental health treatment. These statistics are cited as part of the rationale for considering a private healthcare provider. Supporters of privatization argue that market competition improves quality by weeding out poor performers. While appealing in theory, this has often not been borne out in practice. Across the country, correctional healthcare vendors have repeatedly secured new contracts and renewals despite troubling care records, negative media attention, rising healthcare costs, and ongoing litigation.

In an op-ed, Jenifer Secrist, writes: Iowa Department of Corrections health care employees embody the heart and spirit of Iowa. Privatizing IDOC health care sends a message that hardworking Iowans are insignificant and that their sacrifices during the pandemic, and every day, do not matter. Let’s consider the implications of privatization on the quality of health care for Iowa’s incarcerated individuals. The transition from a public system to a private entity often leads to reduced standards, diminished care, and a lack of accountability. Such a move is not just a mistake — it is a moral failure that reflects poorly on our values as Iowans.

New York State

On his official website, Senator Walczyk expressed concern following reports that some correctional officers discovered their health insurance had been revoked months after returning to work. Families became aware of the issue when they were unexpectedly turned away during medical visits due to lapsed coverage. The senator noted that he had reached out to Commissioner Daniel Martuscello to better understand the process behind the cancellations, particularly regarding the denial of COBRA coverage. He questioned the Department’s position that labeling striking employees as AWOL and classifying the strike as “gross misconduct” justified the coverage denial, raising concerns about the impact on affected workers and their families.

Medicaid

San Mateo County Correctional Health Services will save an estimated $2 million annually in healthcare costs for incarcerated individuals by participating in California Advancing and Innovating Medi-Cal (CalAIM), a statewide initiative aimed at improving healthcare access for Medi-Cal beneficiaries. By leveraging CalAIM reimbursements, the County will reduce the financial burden of providing medical care in its jails while reinvesting the savings into staffing and services to enhance healthcare for incarcerated individuals.

HARP reviews what the Medicaid changes in the “One Big Beautiful Bill Act” (OBBBA) mean for the work that state Medicaid agencies and correctional leaders are doing to strengthen access to services and continuity of care for people who are leaving prison and jail. Because it’s a big bill, we’re taking some time to assess its full implications.

ICE

The Department of Justice asked sheriffs across California to provide lists of inmates in state jails who are not U.S. citizens, and warned that if they did not voluntarily comply, the department would “pursue all available means of obtaining the data.” The request from the Justice Department also asked for information on crimes the inmates committed and their scheduled release dates. The move comes as Immigration and Customs Enforcement has been under pressure from the White House to increase its arrests of undocumented immigrants and after weeks of federal immigration raids across Southern California.

Two former prison facilities in Kern County could soon augment the federal government’s immigrant detention capacity as the Trump Administration looks to ramp up its mass deportation campaign. The facilities would open with the blessing of Congress, which earlier this month approved historic new funding through the Big Beautiful Bill. The California City facility is set to reopen under the management of the Tennessee-based private prison operator CoreCivic. With 2,560 beds reported by the company, this would become the state’s largest detention facility to house immigrants without legal status.

Incarcerated Women

The vast majority of the incarcerated worldwide are men, representing almost 94% of the prison population or 10.8 million prisoners in 2022; during the same year, 700,000 women were held in prison. The female prison population remained relatively stable between 2012 and 2022, staying below 7% during the entire decade. More recent statistics, however, indicate a “troubling” increase in the female prison population. These statistics do not negate the need to address the needs specific to female prison inmates. Prison policies and practices generally remain male-centric and often fail to address the gender-specific needs of incarcerated women. The needs of older women in prison have been under researched and are often unmet.

If you work with female incarcerated individuals, you are likely to regularly care for pregnant patients. It is estimated that 6-10% of incarcerated women are pregnant at any time in the criminal justice system as almost 80% of female incarcerated individuals are of child-bearing age. There are plenty of reasons to be uneasy about caring for pregnant incarcerated women. Many have had past complicated high-risk pregnancies, with preterm births, multiple emergency cesarean sections, miscarriages, or stillbirths. In addition, there are often additional concerns of substance abuse, minimal medical or prenatal care, and undiagnosed medical conditions.

Capital Punishment

Tennessee’s next execution is scheduled for Aug. 5, and this time, there are even stronger fears about the death becoming torturous. The man slated to undergo the needle, Byron Black, has a sophisticated device implanted in his chest. It doles out powerful shocks if the heart goes out of rhythm. His attorneys and medical witnesses say that is extremely likely to happen as he dies, so the implant would jolt him continuously as he died, causing immense pain. The Tennessee Department of Correction could bring in an expert to disable the device. But attorneys for the state and their medical expert witnesses argue that’s unnecessary. They cast doubt on the likelihood that Black’s device would be triggered during the execution.

Tennessee officials must deactivate a death-row inmate's implanted heart-regulating device to avert the risk that it might try to shock him during his lethal injection, a judge ruled Friday. The order by Nashville Chancellor Russell Perkins comes ahead of the Aug. 5 execution of Byron Black.

Studies

In a new article published in JAMA, JCOIN researchers found that 27.6% of United States jails offer all three FDA-approved medications for opioid use disorder (MOUD)—methadone, buprenorphine, and naltrexone—to select individuals, and 16.9% offer them to anyone with opioid use disorder (OUD). Providing MOUD during incarceration creates an opportunity to initiate care and supports continuity of treatment as individuals transition back into the community. The study authors reported that even within jails that offer some form of MOUD, many people do not receive recommended care while detained due to policy, regulatory, financing, staffing, and/or educational barriers.

Rural jails face unique challenges in screening and providing treatment for a steadily increasing percentage of the United States population with mental health and substance use disorders. Since many of these individuals will recycle through the criminal justice system, prompt identification and connection to treatment are paramount in stopping the revolving door of incarceration for drug-driven crime. The current study sought to examine the pathways and delays to accessing mental health and substance use disorder treatment within a rural jail in South Carolina. Nearly five thousand arrestees were eligible for treatment screening, but fewer than one in six were screened.

State Roundup

Alabama

As the deadline approaches, Alabama officials are working on a proposal to overhaul mental health care in Alabama prisons, which a federal judge ruled so “horrendously inadequate” that it violates the U.S. Constitution’s ban on cruel and unusual punishment. U.S. District Judge Myron Thompson ruled in June that Alabama was failing to provide adequate care and ordered the state to work on mediation until Sept. 1. Alabama Gov. Kay Ivey said last week that the state is in discussions about hiring additional mental health and correctional staff, and building new prisons. Dozens of inmates filed the lawsuit against the prison system in 2014, claiming the state was failing to provide basic medical and mental health care.

California

In 2021, Jeff Reisig, the district attorney of Yolo County, partnered with computer science experts at Stanford University, deep in Silicon Valley, to adopt a tool aimed at removing racial identifiers from case files before prosecutors make charging decisions. At the beginning of this year, California adopted race-blind charging as a statewide policy, after a law passed in 2022 went into effect. Now, seven months into the program's statewide rollout, race-blind charging is showing both promise and limitations. But concerns remain, particularly about funding and implementation, and whether race-blind charging might inadvertently hinder other reforms that depend on recognizing racial disparities. As of the Jan. 1 deadline, not all California prosecutors' offices were in full compliance. Several cited funding shortfalls and IT hurdles that delayed implementation.

Colorado

Five Denver Health employees and the organization itself will stand trial on claims that they provided a constitutionally deficient level of medical care to an elderly jail detainee, Leroy Taylor, who died from severe health problems, a federal judge ruled. In a July 16 order, U.S. District Court Judge Charlotte N. Sweeney agreed a jury could find the defendants knew of a substantial risk of harm to Taylor, yet disregarded it. She added that jurors would also consider whether Denver Health's own practices and training were behind the alleged violation of Taylor's rights.

Michigan

The 41-year-old incarcerated woman believes mold at Michigan’s only women’s prison is poisoning her body, growing in her lungs, eating through her ears, and slowly destroying her health while prison officials deny her proper care. Her face has become swollen and contorted. Michigan Department of Corrections officials have repeatedly insisted Clark is receiving proper care. But medical records, court filings, and a federal judge’s order suggest otherwise.

Ohio

Exclusive video shows critical life-and-death decisions being made as two prisoners overdosed simultaneously inside the Lorain County Jail. Law enforcement officials suspect the inmates lost consciousness after ingesting fentanyl. “Without medical intervention, the prognosis is almost always fatal,” said Corrections Inspector General (CIG) Ryan Kolegar. Kolegar is the sheriff’s independent investigator, suspects another prisoner smuggled fentanyl into the facility during the booking process, then distributed the drug

South Carolina

The Charleston County Sheriff’s Office says that with stronger mental health comes stronger deputies, and they’re wanting to make sure their corrections officers are mentally equipped, too. This comes as the Charleston County Finance Committee is reviewing a $113,100 grant Thursday night to provide all employees at the Al Cannon Detention Center with a mandatory one-on-one mental health session with a clinician from the Medical University of South Carolina.

Wyoming

Over the past three years, staff at the Laramie County Sheriff’s Office have been preparing to open a new pod of 25 cells — 15 for men and 10 for women — catered toward helping the most severe cases of mental illness in the jail. Currently, those inmates are housed in cells in the jail’s booking room. This allows 24-hour monitoring in an artificially lit room with check-ins every 15 minutes or so, especially for the inmates on suicide watch. On July 24, those inmates will be transferred to the new $700,000-plus pod of cells that focuses on supporting the inmates’ mental health.

Reentry

Working in psychiatric hospitals in Philadelphia, I met many patients in crisis who had been incarcerated at some point in their lives. Studies show that Black men who have experienced incarceration have higher rates of PTSD, depression and psychological distress compared with Black men who have never been incarcerated. Many formerly incarcerated men described experiencing or witnessing violence, including being beaten by correctional officers and witnessing close friends get assaulted or killed.

Correctional Healthcare Vendors

Wexford

The medical care of the nearly 30,000 people locked up in Illinois state prisons is in limbo, after the Illinois Department of Corrections announced negotiations with its chosen health care provider hit an impasse. In 2023, IDOC awarded a new $4 billion contract to Wexford Health Sources. The move drew outcry from attorneys who represent incarcerated people because the private company has a track record of substandard care and preventable deaths. The state revoked its selection of Wexford and inked a short-term emergency contract with another provider, Centurion Health, to run the department’s troubled health care system.

Prime Care

A federal judge has admitted making a mistake and has reinstated PrimeCare Medical Inc. as a defendant in the lawsuit over the 2019 death of a Dauphin County inmate. U.S. Middle District Judge Matthew W. Brann Friday granted in part a motion for reconsideration filed on behalf of the estate of Ty’rique Riley. In April Brann had granted summary judgment to the medical provider at the Dauphin County Prison thus removing it from the case. Noting all summary judgment motions have been resolved, Brann said he will endeavor to swiftly move the five-year-old case to settlement or trial.

TK Health

After 16 years of partnership with the Cleveland County Detention Center, TK Health, formerly Turn Key Health Clinics, ended its contract with the jail on June 30 following years of complaints, failed health inspections and numerous deaths within the facility. Rep. Jon Echols (R-Oklahoma City), who is currently campaigning for Oklahoma Attorney General, and his business partners founded TK Health as ESW Correctional Care in 2009 to provide nursing staff for the detention center, later shifting to become a medical provider for jails. Cleveland County Board of Commissioners announced its contract with Redemption Correctional Healthcare Solutions as the new health care provider during a June 16 meeting.