Persistent Lack of Accountability In Correctional Healthcare: Oregon, San Diego & New Jersey; Follow Up To Trump's Public Safety Executive Order

Highlighted Stories

Editor's Note

This week’s highlighted stories come from Oregon, San Diego County, and New Jersey, involving outside parties taking a critical look at how correctional systems operate in respect to healthcare.

Oregon has been a frequent subject of recent Editor’s Notes and Follow Ups. Earlier this year, the state fired Dr. Warren Roberts, Chief of Medicine, and Joe Bugher, Assistant Director of Health Services. Complaints about healthcare delivered under their watch included delaying life-saving care, forcing providers to work outside their scope of practice, and fostering a hostile work environment. As previously noted, neither the governor nor the legislature exercised meaningful oversight over problems that were widely known. Now, a consulting firm hired by the state, the Falcon Group, has concluded that the care delivered by the Oregon Department of Corrections is fragmented, disorganized, and inefficient.

Like the Oregon prison system, San Diego County’s jail has often appeared in the Weekly Update. The jail has a documented history of regulatory violations and of the sheriff’s office ignoring recommendations from the Citizens’ Law Enforcement Review Board. A federal judge is now considering a sweeping lawsuit against the county, citing failures in healthcare delivery that have led to deaths from lack of insulin and dialysis. The lawsuit challenges nearly every facet of jail operations, including intake procedures, housing classifications, sanitation, surveillance, and suicide prevention.

Meanwhile, in New Jersey, the New Jersey Monitor tells the story of a dying man who requested compassionate release. State doctors, relying on 29-month-old medical records, denied his petition. The man appealed the decision to the state Supreme Court but died before the case was decided. Still, the court ruled in his favor, stating that while reviewing medical records may technically constitute an “examination,” the compassionate release statute also requires those examinations to be timely, which would seem to be a valid criterion in light of the man’s death.

In all three stories, external parties—a consulting firm in Oregon, a federal judge in California, and a state supreme court in New Jersey—were called upon to intervene in the oversight of correctional healthcare. This pattern reinforces why COCHS has long advocated for embedding Medicaid within correctional systems: to introduce an external focus on quality and access, and to establish a structure of accountability that doesn’t rely on tragedies to prompt change. As our subscribers know, negative outcomes remain far too common.

Oregon

The Oregon Department of Corrections plans to comprehensively restructure its troubled health services unit to improve health care for inmates and working conditions for staff, agency officials announced Tuesday. The pledge comes after years of mismanagement in the unit that bred a toxic work atmosphere among medical providers and substandard care for inmates suffering from ailments of all kinds, from asthma to genital herpes, cancer to traumatic head injuries. The Falcon Group, a consulting firm that specializes in corrections health care, completed a review of the agency’s delivery system. The firm delivered 67 findings and key recommendations to address care that it described as fragmented, disorganized and inefficient.

San Diego County

A federal judge is weighing whether a sweeping civil rights lawsuit alleging systemic failures in San Diego County jails should proceed to trial. At a hearing before U.S. District Judge Anthony Battaglia, attorneys for people incarcerated in the jails described a system plagued by preventable deaths, chronic understaffing and widespread lapses in care. The case, Dunsmore v. County of San Diego, began as a complaint from one man over conditions inside the downtown Central Jail. It’s since expanded into a class-action lawsuit alleging unconstitutional medical, mental health and safety practices throughout county detention facilities. “People are dying because they’re not getting their insulin. They’re dying because they’re not getting their dialysis,” Van Swearingen, one of the plaintiffs’ attorneys, told Battaglia.

New Jersey

State corrections officials wrongly relied on outdated medical records to deny release to an incarcerated man with brain cancer, the New Jersey Supreme Court unanimously ruled Monday, in a case that highlights systemic issues in how requests for compassionate release are evaluated. The man, identified only as M.R. in court documents, applied for release in February 2023. Two doctors based their conclusions—that he was neither terminally ill nor permanently incapacitated—on medical records that were 29 months old. An appellate panel later upheld the denial. M.R. died in custody in June 2024, one month after petitioning the state’s highest court to review his case. Justice John Jay Hoffman, writing for the court, noted that while reviewing medical records qualifies as “examinations” under the statute, the law also requires that such evaluations be timely. He added: “Due to the potential for dynamic and unpredictable changes in the condition of inmates suffering from rapidly declining physical or mental health … contemporaneity is essential.”

Follow Ups

Editor's Comment: No surprise, multiple responses have emerged to the president’s executive order (EO) on public safety, Ending Crime and Disorder on America's Streets, highlighted in last week’s Weekly Update.

The first two come from opposing members of Congress. On her official website, Congresswoman Nicole Malliotakis fully supports the EO, particularly its termination of federal funding for supervised heroin injection sites. By contrast, Congresswoman Delia C. Ramirez calls the EO and others issued by the Trump White House “authoritarian edicts” that incite violence.

Continuing the pro and con thread: on the website Washington Stand, Caily Shriver an intern for Family Research Council, welcomes the EO as a way to “save” Democratic cities and give Christians an opportunity to serve the needy. In an MSNBC op-ed, Max Burns takes the opposite view, expressing concern that the EO may violate medical privacy rights.

Turning to public safety voices, CBS News reports that Sheriff Alyshia Dyer of Washtenaw County (Ann Arbor, MI) believes the EO’s targeting of homelessness is implicitly racist and classist. Jim Tignanelli, president of the Police Officers Association of Michigan, believes the EO could yield positive outcomes.

Questions about implementation and funding are also surfacing. The Concord Monitor warns that New Hampshire’s fragile mental health system could buckle under the EO’s mandate to force unhoused people into treatment. The National Law Review notes that the Trump administration has historically cut mental health funding—and that the EO offers no new funds to expand treatment capacity. The article also points out that the EO closely echoes policy proposals found in Project 2025.

Leaving the EO, Oklahoma County Jail is back in the news. Our subscribers are well acquainted with the Oklahoma County Criminal Justice Authority’s failed attempts to block inspections by the Oklahoma State Department of Health—inspections the facility repeatedly failed. In this week’s update, the jail is reported to be testing electronic sensors designed to monitor the health of incarcerated individuals. Eight people have died in the facility so far this year.

Returning to a story highlighted in the June 24 Editor’s Note (Accountability? What Accountability? Correctional Healthcare Vendors and the Persistence of Questionable Care), we revisit Mississippi, where State Representative Becky Currie—a conservative Republican and registered nurse—continues to raise alarms about the care provided by VitalCore in the state’s prison system. In this week’s article from the Equal Justice Initiative, Currie is quoted pointedly asking: “Why are people getting sicker when we’re paying millions for medical care?”

That comment is particularly relevant to this week final Follow Up. Iowa is currently moving forward with an RFP to privatize correctional healthcare. As our subscribers will recall from last week, concerns have been raised that VitalCore may have an inside track—given that two former Iowa prison health administrators now occupy executive roles at the company. Before rushing ahead, perhaps Iowa officials should take a closer look at VitalCore’s record in Mississippi.

Trump's Executive Order

Elected Officials

Congresswoman Nicole Malliotakis is commending President Trump's recent executive order "Ending Crime and Disorder on America's Streets," which addresses the homelessness crisis through comprehensive public safety measures, including directing federal agencies to review and potentially terminate funding for illegal drug injection sites including those operated by OnPoint NYC. "Since 2021, New York City has allowed two illegal drug injection sites to remain open, and it's time to shut down these illegal facilities to protect public safety and the quality of life for all New Yorkers," said Congresswoman Malliotakis. "I thank President Trump for his executive order addressing homelessness and to end federal funding for all heroin injection sites — the very action my legislation would make permanent. I urge the Department of Justice to take immediate action and shut down these centers and put to an end once and for all their operations."

The newly issued executive order, Ending Crime and Disorder on America's Streets, continues the Administration's pattern of taking away from cities like Chicago, states like Illinois, and organizations that prioritize our collective well-being and solidarity. Instead, it incentivizes and rewards the cities that submit to its authoritarian edicts and pursue violence against our neighbors. Punishing people who are unhoused won’t solve the homelessness crisis created by a lack of legislative action to make housing affordable and accessible. Turning to methods that involuntarily institutionalize people suffering from mental health crises won’t provide a path to recovery, health, and stability. Their EOs destroy lives and harm communities.

Pro & Con

Caily Shriver, an intern for Family Research Council, writes: It looks like there’s hope for Democratic-run cities after President Trump’s executive order opened the gateway to cracking down on homelessness and drug abuse in America. “Ending Crime and Disorder on America’s Streets” — the title of Trump’s new EO — provides a pathway to recovery for the thousands of people in our country struggling with mental illness as they lie in our streets. The administration will give local governments the authority to commit individuals “causing public disorder” to “treatment centers, assisted outpatient treatment, or other facilities.” Although we are grateful to have a government that is willing to step in and help its people, Christians are nonetheless called to do their part in stewarding the gifts God has given them to those who are without.

In op-ed, Max Burns, a Democratic strategist writes: Last week, President Donald Trump signed an executive order legalizing forced institutionalization for people who are unhoused or mentally ill, and granting federal agencies sweeping new powers to violate those citizens’ medical privacy rights. The White House knows cash-strapped cities and states don’t have the money or the medical staff to rebuild the network of state asylums shuttered by President Ronald Reagan nearly 50 years ago. Trump’s executive order makes no provision for that problem because it isn’t really concerned with addressing homelessness or drug addiction. Rather, it’s a back door for the feds to collect an unprecedented amount of sensitive health data under the guise of helping those in need. In his order, Trump claims that federal law enforcement agencies need access to homeless and food-insecure Americans’ most sensitive health information in order to “provide appropriate medical care”.

Public Safety

A Michigan county sheriff is pushing back against an executive order signed by President Trump, saying "laws specifically targeting homelessness are also inherently racist and classist." In Michigan, Washtenaw County Sheriff Alyshia Dyer says the order treats homelessness like a crime. According to Washtenaw County's Continuum of Care program, 330 people did not have a permanent place to live in 2024, an increase from 226 in 2023. The county has been seeing an increase in homelessness over the last three years after a slight drop between 2020 and 2022. Jim Tignanelli, president of the Police Officers Association of Michigan, says the order has good intentions and could lead to some positive outcomes.

Implementation & Funding

Outreach coordinators and mental health advocates in New Hampshire are evaluating the potential impact of a new executive order that makes it easier for states to clear homeless encampments and mandate mental health or addiction treatment. If New Hampshire follows through, advocates worry the state’s already strained mental health system could buckle under the pressure. The number of people experiencing homelessness in New Hampshire on the night of an annual count rose sharply — from 1,605 in 2022 to 2,441 in 2023 — a 52% increase, according to a recent report by the New Hampshire Coalition to End Homelessness.

The E.O. frames homelessness and substance use as public safety threats and aligns with Trump’s campaign themes: tough-on-crime rhetoric, clearing homeless encampments, and rejecting “Housing First” in favor of treatment before housing. These priorities echo Project 2025, including a chapter by Ben Carson. After decades of deinstitutionalization, there are limited resources for treatment. Without many more treatment beds, increasing civil commitments would not be possible. The Trump administration’s efforts so far have involved cutting funds for mental health treatment, not offering to fund increased capacity. Most states would welcome federal money to expand treatment capacity, depending on the strings attached, but so far the Trump administration has not indicated that any such funding would be made available.

Oklahoma County

Inmate deaths at the Oklahoma County Jail have caught the attention of a global tech company, which is now testing radar technology—originally developed for space—inside the facility in hopes of preventing future fatalities. So far this year, eight inmates have died in custody. To help reduce that number, the jail is piloting radar sensors created by Integrity Communications Solutions. Since early July, six sensors have been in place at the jail’s high-risk medical unit, actively collecting data. These sensors track vital signs such as breathing and heart rate.

VitalCore

In its ongoing investigation, “Behind Bars, Beyond Care,” nonprofit newspaper Mississippi Today reports that sick people in the state’s prisons are suffering from medical neglect and mismanagement even as taxpayers pay more than $100 million to VitalCore Health Strategies, a private health care corporation. The situation prompted State Rep. Becky Currie to ask, "Why are people getting sicker when we’re paying millions for medical care?" The failure to treat illness is a result of deliberate decisions, Ms. Currie said. The widespread suffering is preventable and raises questions about where hundreds of millions of taxpayer dollars have been spent.

Iowa

Iowa's Department of Corrections is searching for a private health care company to manage medical facilities at the state's prisons, aiming to address higher drug costs and staffing shortages. The department says the nine state prisons are struggling to meet inmates' needs. The department hopes that contracting with a private company will ensure inmates receive consistent quality care. However, opponents express concerns that privatizing the system may lead to negative outcomes. "If you look around the United States and look at the quality of care that people receive or don't receive with private care, you'll see that this system doesn't work for the patient, and it doesn't save the state any money," said state Rep. Timi Brown-Powers, D-Waterloo.

ICE

For about three decades, CoreCivic housed inmates in Leavenworth, Kansas, often federal detainees awaiting trial. But in the final years records show jobs went unfilled and violence grew common. Now CoreCivic has applied this year for a permit in Leavenworth to reopen a prison as an ICE facility. But City leaders filed two lawsuits against the detention center’s private operator, CoreCivic, after conversations about a local permit fell apart. A judge temporarily blocked the company from housing detainees. All the while, supporters of the project have grown frustrated with what they see as an attempt to undermine President Trump and, in the process, deny Leavenworth hundreds of jobs. But some of the most passionate arguments against CoreCivic’s plan have come from people who used to work there.

A private US prison contractor that is expanding its immigrant detention business amid increased Immigration and Customs Enforcement (Ice) arrests is running a federal facility that is being investigated by the FBI for rampant drug trafficking and violence. Even some staff who work for the contractor, CoreCivic, are implicated in drug smuggling at the Cibola county correctional center (CCCC) in New Mexico that is owned and operated by the company on a government contract. The facility, about an hour west from Albuquerque, primarily houses people apprehended by the federal US Marshals Service (USMS) and local county detainees, with immigrants in Ice custody making up about 30% of the population.

A Liberian-born man detained by Ice in Georgia was put in solitary confinement after complaining about flooding in the common area outside his cell at the Stewart detention center that he said was potentially dangerous for his electronic prosthetic legs, the Guardian can reveal. Rodney Taylor recently spent three days in what CoreCivic calls a “restrictive housing unit” at Georgia’s Stewart detention center, after refusing to enter his cell because faulty air conditioning had left the floor in the area outside his cell covered with about an inch of water. That would be a potential disaster for Taylor, since his battery-powered, microprocessor-controlled prosthetic legs can’t get wet.

Studies

Older adults are a rapidly growing segment of the United States (US) prison population. This population also suffers disproportionately from chronic health conditions. Despite the growing number of older adults confined in US correctional facilities and their health risks, empirical attention has not kept pace with examining their experiences of segregation, and how experiences with segregation are related to health.

Opioid-related overdose is the leading cause of mortality among individuals recently released from incarceration in the U.S. Naloxone is an FDA-approved opioid antagonist medication designed to rapidly reverse opioid overdose. Despite evidence of its acceptability and effectiveness at reducing the risk of opioid overdose death after release from incarceration, only an estimated 25% of US jails provide naloxone upon release.

Data & Statistics

This report is the sixth in a series in response to the Death in Custody Reporting Act that requires federal law enforcement agencies to report information about the death of any person who dies while detained, under arrest, being arrested, or in the custody of federal law enforcement officers. It describes decedent, incident, and facility characteristics for deaths in federal custody and during arrest by federal law enforcement agencies during fiscal year 2023.

State Roundup

Alabama

An Atmore prison inmate claimed a local doctor cut off too many of his toes. Deamfus Kimble, who is an inmate at the Fountain Correctional Facility in Atmore, filed a civil complaint for medical malpractice in the circuit court of Escambia County, Alabama. Kimble said the infection from his spider bite spread, sending him to a doctor’s appointment where he immediately was taken back for surgery. Before surgery, Kimble said the doctor gave him the option to remove all his toes on the infected foot, but he agreed to have just his big toe removed.

Florida

Florida has seen a string of heat advisories in recent days, with heat indexes topping 110 in some areas. Concern about the heat has some people looking to Florida prisons, where the majority of inmates don't have access to air conditioning. Gov. Ron DeSantis' veto decision was disappointing for advocates who hoped better prison conditions could lead to a better chance for rehabilitation. Barney Bishop, CEO of the Florida Smart Justice Alliance, says he's not worried about the comfort of incarcerated people. But Jeff Brandes, who heads the Florida Policy Project, says, "What the wardens will tell you, and even the Department of Corrections will tell you is violence goes up during the summer" .

Louisiana

Governor Jeff Landry has declared a state of emergency at the Louisiana State Penitentiary at Angola to expedite the reopening of Camp J, a shuttered section of the prison once used for solitary confinement. The executive order, effective from July 25 through Aug. 23, suspends procurement and bidding rules to allow swift repairs to the facility, which closed in 2018 due to safety concerns. Camp J previously housed over 400 solitary confinement cells but was plagued by issues, including malfunctioning locks and high staff turnover.

Maryland

Three top officials overseeing Maryland’s juvenile detention facilities were fired this week after a state ombudsman published a report containing allegations of numerous problems inside those buildings, including contraband drugs, food quality concerns, staffing shortages and a sexual incident among three young people who were incarcerated. The report lays blame for the alleged problems at the feet of former juvenile services secretary Vincent Schiraldi’s team and encourages state officials to “determine a new direction,” a recommendation that underscores tensions between Schiraldi and Gov. Wes Moore’s (D) administration since the former secretary left his position in June.

New Jersey

The New Jersey’s Special Treatment Unit occupy a fraught and contentious corner of the nation’s criminal justice system, allowing for some sex offenders to be civilly committed to secure facilities even after they have served their full criminal sentences. Proponents of the programs — who first created them in response to sensational crimes committed by sex offenders who had been released from prison — have said they are needed to keep the public safe. Legal critics, however, have singled them out as violating bedrock principles of due process.

Pennsylvania

Racketeering charges have been brought against 10 residents of Pennsylvania and Arizona following a multi-year investigation into a contraband operation inside the Cambria County Prison. A federal grand jury indictment was unsealed Monday, outlining the charges brought against inmates and prison staff accused of bringing illegal drugs into the prison and trafficking it to other inmates. The grand jury alleges that contraband included cell phones, K2, suboxone, Tetrahydrocannabinol (THC), security tools and cigarettes.

This fall, the Centre County Commissioners will have the opportunity to decide whether to provide access to sunlight to our incarcerated citizens for the first time in 20 years. The Centre County Chapter of the Pennsylvania Prison Society joins numerous other groups and members of our community in urging our elected leaders to take immediate positive action. When the current county jail was constructed in 2005, its designers eliminated an outdoor yard. In a recent court case in San Francisco, the judge found the city was “recklessly indifferent” when it deprived county prisoners access to direct sunlight.

Tennessee

A Tennessee hospital says it never agreed to a request by state officials who face a court order to turn off a death row inmate’s heart-regulating implant before his execution next week. After a Nashville judge ordered the deactivation of Byron Black’s device, a Tennessee Department of Correction official said in a court declaration that Nashville General Hospital said they could disable it the day before his Aug. 5 execution at 10 a.m., but wouldn’t come to the prison on execution day, as the judge had ordered. The judge ultimately allowed some leniency, saying Black could be moved to the hospital the morning of the execution. Nashville General Hospital spokesperson Cathy Poole said the medical center did not agree to participate at all, saying the hospital “has no role in State executions.”

The Tennessee Supreme Court says the state’s prison system can execute Byron Black without deprogramming his heart implant. The court has also left the door open for the state’s Department of Correction to find a doctor willing to do it. Given the medical profession’s ethical codes on executions, that could be unlikely. It’s a tension that has intensified in the week before Black’s scheduled execution on Aug. 5.

Vermont

Nick Deml plans to step down next month as commissioner of the Vermont Department of Corrections. Since November 2021, Deml has led Vermont’s six prisons. He took over from interim Commissioner Jim Baker at a tumultuous moment, shepherding a department rocked by scandal and the Covid-19 pandemic. Overseeing Vermont’s prisons has historically drawn scrutiny, and Deml’s tenure was no different. A spate of deaths in 2022 and 2023 at Southern State Correctional Facility in Springfield called into question the medical care provided by the prison’s health services contractor at the time. An investigation by Vermont’s Defender General’s Office later found that medical staff with VitalCore Health Strategies appeared to struggle to perform CPR and use a defibrillator.

Technology

When prison administrators, lawmakers and advocates talk about “scanning” incoming mail, there are two separate things they can mean. One is the digitization of mail by copying the contents into an electronic format so prisoners can read it on a tablet. The other meaning is technology to physically test mail for signs that it has been soaked in, or otherwise contaminated with illicit substances. Incarcerated people and advocates have expressed concerns with both kinds of scanning, having to do with privacy, delays and the sentimental value of handwritten letters and physical keepsakes. This debate is part of a bigger discussion playing out in states across the country and in the federal government. A recently introduced bipartisan Senate bill would mandate that the Federal Bureau of Prisons perform both kinds of scanning at its prisons and jails systemwide.

Bio-tracked technology for behavioral profiling of inmates will soon be an option to help deputies and correctional officers do their jobs more effectively and with better outcomes for inmate safety from self-harm. As technology advances, bio-tracking will allow correctional facilities to monitor inmate behavior, mental health and physiological responses in real-time. Thirty agencies around the United States are already using biometric monitoring to prevent in-custody deaths. To implement biometric behavioral profiling tools, though, some limitations must be overcome. One major limitation is the lack of advanced biometric infrastructure in most jails and prisons across the nation.

For years, Colorado’s county jails operated in relative silos, struggling to share critical information across facilities. The need for real-time data exchange became increasingly evident as jails faced growing challenges in managing detainee information, health records and compliance with state mandates. The implementation of the Colorado Trusted Interoperability Platform (CTIP), the state is at the forefront of a groundbreaking initiative to unify jail management systems. The initial integration phases of CTIP have already shown promising results, with 20 jails representing 40% of Colorado’s jail population being integrated in 2025. Plans are in place to expand participation to 75% of the jail-incarcerated population over the next few years.

Correctional Nursing

Statistically, the early period of incarceration is when suicide, withdrawal complications, and medical emergencies are most likely to occur. Individuals are often stressed, sleep-deprived, detoxing, or unsure of how to access care in this unfamiliar system. Many have unaddressed chronic conditions, or no understanding of what medications they’re taking.

Correctional Healthcare Vendors

Wellpath

The Lexington County Sheriff’s Department dropped a man suffering from diarrhea and trouble walking into a cold January night after nearly two months of delaying his medical care, according to a lawsuit filed against the department. Cody Smith spent the better part of two months requesting medical care after finding blood in his stool. The lawsuit isn’t the first time the company, Wellpath Holdings, Inc., has been accused of routinely denying or delaying medical care. The county is in its third year of a three-year contract with Wellpath LLC, the largest commercial provider of health care in jails and prisons across 37 states, to provide medical services to inmates at a price tag of around $5 million annually.

PrimeCare

For the first time in nearly 40 years, Dauphin County Prison will have a new healthcare provider. County commissioners in a 2-1 vote Wednesday chose Virginia-based correctional healthcare company Mediko to take over the jail’s medical services. The move effectively ousted PrimeCare Medical, the controversial Harrisburg company that has overseen medical care at the jail since 1988 and was one of five outfits competing for the contract.

“John Doe,” a transgender male, claims his constitutional rights were violated while an inmate at the Montgomery County Correctional Facility. He filed a federal lawsuit seeking more than $150,000 in damages and remedial action on the part of jail officials. The jail is located in Eagleville, Pa. It houses male and female inmates. Doe’s 94-page lawsuit names various defendants, including the county, the jail’s warden Sean P. McGee and a private contractor that provides health care to inmates, PrimeCare Medical, Inc.

Quality Correctional Health Care/QCHC Inc

Five medical employees at an Alabama jail have been indicted in connection with the death of a mentally ill man who died of hypothermia after being held for two weeks in a concrete cell. A former jail medical supervisor, a jail health services administrator and three jail licensed practical nurses, are each charged with one count of conspiracy against rights and one count of deprivation of rights, according to the indictment. Walker County outsourced the jail’s medical care to QCHC Inc., a company which employed the indicted staff. Quality Correctional Health Care is contracted in 10 other jails across the state, according to the indictment from Tuesday.

The Dog Days Of Summer Are Upon Us
After a Brief Break COCHS' Weekly Update Will Resume On August 19