Accountability? What Accountability? Correctional Healthcare Vendors and the Persistence of Questionable Care

Highlighted Stories

Editor's Note

Accountability. How are incarcerated people protected from questionable care delivered by proprietary correctional healthcare vendors? This week’s three highlighted stories examine strategies ostensibly designed to enforce accountability—but each, in its own way, fails to deliver.

Our first story comes from Fresno County, California. A niche fact about California: the state prohibits the corporate practice of medicine. So what’s a for-profit correctional healthcare company like Wellpath (fresh out of bankruptcy) to do? Enter HIG Capital. Once upon a time, HIG owned both Correct Care Solutions (CCS) and California Forensic Medical Group (CFMG), a physician-run corporation providing care to multiple California jails. In a tidy reorganization, CCS became Wellpath, which now handles day-to-day administrative operations for CFMG—at least in name. But as one CFMG physician told GV Wire, it’s Wellpath—not CFMG—that determines which treatments, diagnostics, and referrals are approved, hinting that the firewall meant to protect medical decisions from corporate influence may be more symbolic than functional. Fresno County, which switched to CFMG in 2018 after alleged abuses under Corizon/YesCare, may not have found the fix it hoped for.

Our second story returns to Mississippi, where VitalCore Health Strategies provides care for the state’s incarcerated population. (Subscribers may recall from our January 30, 2024 Editor’s Note that when Wellpath departs, VitalCore often arrives, and vice versa.) During a visit to the Mississippi State Penitentiary, Rep. Becky Currie—a registered nurse and chairwoman of the House Corrections Committee—was horrified to learn of an incarcerated man with untreated Hepatitis C who had progressed to life-threatening liver disease. In response, the Mississippi Department of Corrections suspended $2 million in payments to VitalCore. But soon after, the department requested an additional $4 million in “deficit appropriation” funds for the same program. As Currie put it, the new funds effectively canceled out the financial penalty, amounting to a bailout.

Finally, we head to Chesapeake Correctional Center in Virginia, another VitalCore client. There, Kristen Bailey, recently postpartum, exhibited symptoms of severe illness: fever, vomiting, hallucinations, and altered mental status. It was not medical staff, but fellow inmates, who alerted her family. A VitalCore physician misdiagnosed her condition as opioid withdrawal and administered Narcan—twice. Bailey was left untreated for hours and ultimately diagnosed with an anoxic brain injury caused by oxygen deprivation. She has since filed a $5 million lawsuit against VitalCore and the jail.

Across these three stories and the Follow Ups below, we see the spectrum of supposed accountability mechanisms: corporate structuring to evade practice restrictions, fiscal penalties that evaporate, and civil litigation that comes too late. As COCHS has argued consistently, real accountability comes not from performative reforms or reactive penalties, but from embedding standards—like those tied to Medicaid—into the very structure of care delivery. Medicaid brings not just funding, but enforceable expectations and the right to grievance outside the correctional hierarchy. Whether that vision survives the Senate’s current budget debate remains to be seen.

Wellpath/CFMG

A physician at the Fresno County Jail appeared before county supervisors last week, revealing how private-equity firm Wellpath makes key decisions about inmate care. Although the facility is officially run by the physician-owned California Forensic Medical Group (CFMG), medical equipment, referrals, and diagnostics are actually subject to Wellpath’s approval, according to Dr. Kanwar Gill a physician at the jail. California law restricts for-profit companies from influencing medical decisions, but nurses and administrators often counter doctors’ orders, with cost being a major factor. “The jail contract is with CFMG, a California-registered medical corporation,” Gill said, “but in practice, decisions are made by Wellpath, a Tennessee-based for-profit not licensed to practice medicine in California.” Fresno County contracted with CFMG in 2018 through a $121 million deal after cutting ties with Corizon Health, the previous contractor accused of inmate abuse and cover-ups.

Vital Core

During a visit to the Mississippi State Penitentiary, Rep. Becky Currie—chairwoman of the state House Corrections Committee and a registered nurse heard firsthand accounts of medical neglect from incarcerated individuals. One man told her he had developed liver disease after years of untreated Hepatitis C, despite repeatedly requesting medication. This same man was hallucinating due to dangerously high blood ammonia levels and had reportedly been told he had just three months to live. In response to Currie's concerns, Mississippi Department of Corrections Commissioner Burl Cain suspended $2 million in state payments to VitalCore Health Strategies, the private contractor responsible for providing prison healthcare. However, MDOC has since submitted a request for an additional $4 million in “deficit appropriation” funds to cover a shortfall in the same medical program. According to Currie, the request effectively cancels out any financial penalty intended for VitalCore, amounting to what she characterized as a bailout for the company.

Kristen Bailey, a Virginia woman, has filed a $5 million federal lawsuit alleging that medical staff employed by VitalCore Health Strategies at the Chesapeake Correctional Center ignored her worsening medical emergency last summer, resulting in permanent brain damage. Bailey, who had recently given birth, began experiencing neurological symptoms—altered mental status, vomiting, fever, and seizure-like activity—but claims she was not properly evaluated for hours. Inmates reportedly called her family to say she was “burning up with fever and vomiting.” Nursing staff didn’t document an exam until nearly 8 p.m., and it wasn’t until after 10 p.m. that Dr. Alex Taylor evaluated her, misdiagnosed her condition as a drug overdose, and administered Narcan twice. He declined to send her to the emergency room. By 4 a.m., Bailey was found lying in urine, partially undressed, and showing severe neurological impairment. She was finally transported to Chesapeake Regional Medical Center, where she was diagnosed with anoxic brain injury caused by oxygen deprivation.

Follow Ups

Editor's Comment: Today’s Follow Ups once again begin with Oklahoma County, Oklahoma. As noted in the June 10 Follow Up, the Oklahoma Supreme Court recently upheld the authority of the State Department of Health (OSDH) to conduct unannounced inspections of the county jail—inspections the Oklahoma County Criminal Justice Authority (OCCJA) had vigorously opposed. The new OSDH report, issued after the Supreme Court decision, gives the jail a failing grade. Perhaps the OCCJA should redirect its vigor to accepting that the Oklahoma Supreme Court has made them accountable.

The next story concerns the aftermath of Wellpath’s bankruptcy. In Arkansas, a legislative panel has delayed approval of a proposed 10-year, $1.6 billion contract with Wellpath. The Senate President Pro Tempore has expressed some frustration with his own efforts to hold Wellpath accountable, saying the company assured him it would not file for bankruptcy—right before it did.

From New York State, we turn to legislative reform. Lawmakers have passed a prison oversight bill now awaiting action from Governor Hochul. The bill incorporates 24/7 camera surveillance to establish accountability—a direct response to the killings of Robert Brooks and Messiah Nantwi. Fourteen officers have been charged in connection with the brutal beating and murder of Brooks, with several having already reached plea deals.

Oklahoma County

The Oklahoma County Detention Center has failed another health inspection, with the report highlighting significant safety concerns and a lack of protocol adherence by staff. The Oklahoma State Department of Health's report lists multiple issues, including a lack of safety checks, sanitation concerns and missing records for several inmates. The State Department of Health also identified problems with property management and staffing shortages, noting that the staff-to-inmate ratio remains dangerously low.

Wellpath Bankruptcy

An Arkansas legislative panel voted to delay action on proposed changes in the scope of work for the state Department of Corrections' medical services contract with Wellpath LLC of Nashville, Tenn. until the panel's August meeting. Lawmakers said they want to question Wellpath officials about their testimony to state lawmakers before the Legislative Council in September approved what eventually could be a 10-year $1.6 billion medical services contract with Wellpath. The proposed contract modification would change the scope of work, but the changes will not increase or reduce the cost paid to Wellpath, according to bureau records. Senate President Pro Tempore Bart Hester, R-Cave Springs, said Wellpath filed bankruptcy weeks after telling him that that wasn't going to happen.

New York

The New York State Legislature passed a package of prison reforms on the last day of the legislative session, sending the bills to the Gov. Kathy Hochul's desk. However, the governor has not indicated if she plans to support the package or not. The package, dubbed the Prison Reform Omnibus Bill, would institute a number of new transparency, accountability and regulatory guidelines for reporting the deaths of incarcerated persons. The bill would require 24/7 video surveillance of common areas in correctional facilities, timely notifying of the death of inmates to their families as well as publishing notices of inmates’ deaths to the Department of Corrections and Community Supervision within 24 hours. In February of this year, a group of 14 officers were charged in the brutal beating and murder of 43-year-old Robert Brooks, which was captured on body-worn camera footage that the Attorney General’s office later released.

Medicaid

In a letter to the House of Energy and Commerce Committee, multiple organizations including National Conference of State Legislatures, Council of State Governments, United States Conference of Mayors, National Association of Counties and National League of Cities submitted the following: On behalf of the nation's state and local elected and appointed government officials, we respectfully urge your support for bipartisan legislation that amends the Medicaid Inmate Exclusion Policy (MIEP) of the Social Security Act §1905(a)(A), which revokes federal health benefits for adults and juveniles both during and prior to conviction. By amending this policy, the Reentry Act (HR 2586) and the Due Process Continuity of Care Act (HR1510) will facilitate a crucial path forward for programs that improve health outcomes and reduce rates of recidivism.

Five national associations have signed on to bi-partisan legislation seeking to amend components of the federal Medicaid Inmate Exclusion Policy (MIEP) for incarcerated individuals. Changes would allow coverage for eligible detainees 30 days prior to release and for those yet to be convicted of a crime. Recently the National Association of Counties (NACo) was joined by state and local government partners in sending a letter to leaders on the US House of Representatives Energy and Commerce Committee, urging support for bipartisan legislation to reform the Medicaid Inmate Exclusion Policy (MIEP).

This bill reduces systemic barriers for individuals returning to the community from incarceration by requiring the New York State Department of Corrections and Community Supervision (DOCCS) to provide proactive support in accessing critical public benefits and safety net programming. Benefits navigators would assist people in applying for a range of benefits prior to release, ensuring their access to stabilizing supports during the first weeks and months of reentry. Many people lack support in navigating complicated benefits applications, leaving them without vital resources like SNAP (food assistance), Medicaid, or HEAP (energy assistance).

In an Op-ed, John Bowman, Dream.Org’s Kentucky senior campaign organizer, writes: Our prison and jail systems need the Due Process Continuity of Care Act, because it will help maintain Medicaid coverage during pretrial incarceration. It’s up to Congress to follow through and pass this important piece of legislation, to shift from a model that prioritizes severe punishment to one that prioritizes care and continuity. People are struggling and deserve a chance to get better, not get worse, simply because they were arrested. Keeping health care coverage active during pretrial incarceration isn’t just the right thing to do morally, it’s smart policy. It prevents needless suffering, reduces recidivism, and eases the burden on emergency services and hospitals. It helps people transition from jail back into their communities with the support they need to stay healthy and free.

ICE Detention

As federal immigration agents carry out mass raids across Southern California, the Adelanto ICE Processing Center is filling rapidly, reigniting longstanding concerns about conditions inside. In less than two months, the detainee population at the facility—located about 85 miles northeast of Los Angeles—has jumped from around 300 to over 1,200, according to the ACLU of Southern California. As the state’s largest immigration detention center, Adelanto has long faced criticism over inadequate medical care, harsh segregation practices, and poor mental health services. Now, critics—including some staff—warn that conditions have grown increasingly unsafe and unsanitary. ICE and GEO Group, the private prison company that runs the facility, have not responded to questions about the reported conditions.

A state judge on Friday indefinitely blocked Mayor Eric Adams from letting federal immigration authorities open an office at the Rikers Island jail complex in New York City, a priority for the Trump administration as it seeks to expand its immigration crackdown. The City Council had sued the Adams administration on April 15 in an effort to halt the return of the Immigration and Customs Enforcement agency to Rikers Island. The Council argued that letting ICE into the city’s largest jail facilities, a decade after the agency was banned from Rikers, would lead to mass deportations.

Mental Health

A Napa County facility built to help low-level offenders transition out of jail never served its intended purpose. Now, after years of delays and a $16 million payout to terminate state bond obligations, county officials are giving the site a new mission: mental health and addiction care. The Board of Supervisors approved plans to convert the county’s 72-bed reentry facility — constructed in 2019 but never fully opened — into a behavioral health treatment center focused on serious mental illness and substance use disorders. By the time original reentry facility, a $23 million project funded in part by $13 million in state lease-revenue bonds, was ready to be occupied by incarcerated individuals in 2022, only about a dozen people in Napa County’s jail met the criteria for reentry placement. The transformation, officials said, reflects evolving public safety models and shifting state policy — and offers an alternative to jail for individuals experiencing mental health or addiction crises.

An Ozaukee County committee approved the first step toward a county jail expansion to provide improved inmate medical and mental health care and to nearly double the jail’s Huber work-release capac. Sheriff Christy Knowles’ proposes to spend $21,940 to contract with Milwaukee-based Venture Architects to develop a pre-design plan “to understand the project’s scope, needs and constraints before commencing actual design work,” she said in a memo to the committee.

Under pressure from jail officials and mental health advocates, Minnesota lawmakers will spend $75 million over the next two years to get individuals suffering from mental illnesses out of jails and into psychiatric treatment. Lawmakers last week authorized a $700 million infrastructure package to fund roads and bridges, clean up drinking water and invest in universities. Among the largest projects is a plan to add bed space at a state-owned psychiatric hospital to help more quickly transfer people languishing in detention who have been committed to state psychiatric care.

The number of Missourians languishing in jail while they wait for a spot in a state-run psychiatric hospital continues to climb, with nearly 450 people stuck in limbo in need of mental health treatment. Individuals on the waitlist have been charged with crimes but not convicted. Many are detained for longer than they would be if they’d received the maximum sentence for their charges.

Women

California passed the nation’s first prosecutor-initiated resentencing law in 2018. Few women benefited from these laws. Some criteria that prosecutors were using to identify candidates for resentencing had the unintentional effect of excluding women. The criteria left little room for these nuances, and overlooked other societal harms. Women are disproportionately unsafe in prison; while they make up just 7 percent of the federal and state prison population, they account for more than one quarter of victims of sexual abuse by prison staff.

The New York State Senate on Tuesday passed a piece of prison reform legislation that aims to promote the “health, safety, and human rights of incarcerated pregnant individuals, incarcerated birthing parents of children and their children.”If signed into law, the Compassion and Reproductive Equity (CARE) Act would require basic care for pregnant and postpartum incarcerated people and their children. The legislation aims to implement more comprehensive healthcare requirements for labor and delivery, timely access to medication, and adequate access to water and food as recommended by a physician.

Juveniles

A Washington Post investigation reveals that D.C. juvenile court officials have lost track of at-risk young people at critical moments, as they have perpetrated crime or fallen victim to it, according to a trove of confidential documents and interviews with parents, guardians, former probation officers and court-involved teens. Rather than a secure way to track those suspected of crime, The Post found, it is a flawed system that relies on children as young as 12 to charge and maintain their own devices and that has been slow to act when they go dark. Five young people died while wearing ankle monitors under court supervision during a six-week span in the fall of 2023, according to previous comments from court and local officials.

Aging

The U.S. prison population is aging. With nearly one in five incarcerated individuals over the age of 50, correctional facilities are increasingly functioning as de facto long-term care providers. Among the many challenges this shift presents, two significant and often under-recognized issues are delirium and dementia. Incarcerated older adults, including those in prisons, jails and detention centers, are uniquely vulnerable to both conditions, and correctional health systems must adapt to manage the complex needs that arise.

Prisons globally face an ‘ageing epidemic,’ releasing unprecedented numbers of older adults into the community. Research highlights substantial challenges in reintegrating this underserved and marginalised group. Urgent work is needed to understand their needs and develop effective social, criminological, and public health solutions. This study aimed to create a transdisciplinary, strengths-based conceptual framework to understand and begin addressing the reintegration needs of older individuals leaving prison.

Veterans

Nearly one-third of the US's war veterans have been arrested or jailed at some point in their lives – a new programme using horse-therapy is attempting to tackle the underlying trauma they have suffered. The Veterans Accessing Lifelong Opportunities for Rehabilitation (Valor) programme, established in 2018, currently works with roughly 40 veterans from across Texas. It provides a range of services including mental health counselling and group counselling for anger management as well as support groups for veterans with combat-related Post-Traumatic Stress Disorder (PTSD).

AIDS/HIV

The Vanderburgh County Sheriff’s Office (Evansville, IN) has partnered with Matthew 25 AIDS Services to provide free, confidential HIV and Hepatitis C testing to individuals currently incarcerated at the facility. This joint initiative demonstrates a shared commitment to public health by expanding access to early diagnosis, education, and medical care for those most in need. Testing is conducted on-site by trained Matthew 25 staff using quick and reliable finger-prick tests, with results available in as little as 15 minutes. Individuals who receive a reactive result are immediately offered support services, including counseling, medical referrals, and case management to ensure access to appropriate follow-up care.

A Louisville woman is suing the metro government and a jail healthcare provider after allegedly being denied HIV treatment and experiencing harassment during her time at the Louisville Metro Department of Corrections. Sasha Sloan has been in and out of jail over the past decade while battling addiction. She said she informed jail staff that she was HIV positive and needed access to her medication, but during multiple stays between 2017 and 2024, she alleges her requests were ignored. (The jail has recently changed healthcare providers, with YesCare replacing Wellpath.)

Data & Statistics

Recognizing the disparate health status of correctional populations compared to the general population, national agencies have called for research to better understand disease epidemiology and healthcare needs of individuals in jails. This paper introduces the Registry of Electronic Archives in Correctional Healthcare (REACH) database – a largescale, multivariable living database derived from electronic healthcare records (EHR) of individuals discharged from jails across the nation beginning in 2013. REACH database has the potential for answering important questions about health status and healthcare services for jail populations, including questions about epidemiology and correctional healthcare.

State Roundup

California

The union representing 25,000 California prison guards struck a deal for a new contract that gives Gov. Gavin Newsom some financial relief in the short term but includes a mix of bonuses and raises that would kick in over time. Newsom in May signaled that he’d be asking state worker unions to delay raises when he announced a budget proposal to close a $12 billion deficit. He was seeking $767 million in savings from public employee unions. All together, the deal for correctional officers is expected to cost the state $600 million over the next four years, according to a summary released by the California Department of Human Resources. It includes two raises of 3% each with one taking effect next month and the second one in July 2027.

Our reporting — which included interviews and surveys from nearly 100 people, and a review of thousands of pages of records — revealed troubling concerns and observations of the prison’s water quality for the last 20 years. Despite illness, warning signs, complaints and lawsuits, the California Department of Corrections and Rehabilitation (CDCR) as well as local government health agencies all denied responsibility for ensuring the prison’s drinking water is safe. the prison water was tested, and “most of the substances for which they tested the water were present only at ‘nominal’ levels. But bizarrely, one drinking water sample contained oil and grease.

Connecticut

A Bridgeport resident has filed a lawsuit against the Department of Correction, alleging that the department failed to provide timely treatment for his cancer, resulting in the need for multiple rounds of chemotherapy and the removal of his bladder, lymph nodes and prostate. During an intake exam with the prison’s medical department, Glenn London informed them that he had been seen at the VA medical center because he was urinating blood. The center, he said, had advised him to follow up with the urologist and mentioned a possibility of bladder cancer. But in the months that followed, London claims, the Department of Correction failed to get adequate treatment for him. When he was finally brought to the University of Connecticut Health Center in August 2023, they found a cancerous mass the size of a golf ball, according to the lawsuit.

Hawai'i

As physicians and national experts on the detrimental health implications of solitary confinement, we urge Gov. Josh Green to sign Senate Bill 104 into law and to go further to end solitary confinement. Research shows that even one or two days in solitary can lead to significantly heightened risk of death by accident, suicide, violence, overdose, and other causes. Research also proves that solitary worsens safety, and that people who spend any time in solitary are more likely to be re-arrested after returning home.

Minnesota

The day Ryan Andrew Wodziak hanged himself in his jail cell, Hennepin County deputies ran late on several wellbeing checks, and fraudulently filed paperwork recording one check that never occurred, according an inspection report from Minnesota’s Department of Corrections. Jail staff also failed to complete mandatory paperwork while booking Wodziak into the facility, including conducting a mental health assessment to identify his psychiatric needs, the report says. Now, two years later, Wodziak’s parents are suing the jail and the hospital whose doctors treated him, Hennepin Healthcare, alleging the institutions failed in their duties to properly care for the severely mentally ill 36-year-old and should be held liable for his suicide.

Montana

Gov. Greg Gianforte last week vetoed a bill that would have reimbursed local jails in Montana for holding inmates waiting for a bed at the state mental hospital. The governor cited the need for a long-term solution and pointed to other state actions aimed at resolving the issues lamented by county sheriffs. Local officials agreed that House Bill 643 offered limited relief. Still, they said the money was necessary to help with the costs of housing an increasing number of mentally ill inmates waiting in jail, often for long periods.

New York

A man has been indicted on felony charges for allegedly attacking and injuring Auburn Correctional Facility officers two years ago. Nashane A. Peterkin, 26, attacked several officers while he was being admitted to the prison’s medical unit on July 9, 2023, New York State Police Public Information Officer Lynnea Crane told The Citizen in an email. Peterkin tried to choke a sergeant, punched an officer in the face and bit another officer’s thumb, “causing significant injury.”

North Carolina

Prison officials launched the Peer Observer Program as a suicide prevention strategy recommended by the department’s Suicide Prevention and Self-Directed Violence Workgroup. The group convened after a spike in suicides in 2018, when 11 people died in custody — up from six the year before. A 2005 peer-reviewed evaluation paper on the federal peer observer program called it a “win-win solution.” The researchers found people spent less time on suicide watch when watched by another incarcerated person without compromising the standard of care. The researchers also found that observers themselves felt personal gain from being able to help.

Oklahoma

The Oklahoma Department of Corrections will spend about $74 million over two years to outsource its food service operations to the Trinity Services Group, a Florida-based company that feeds more than 300,000 prisoners and pretrial detainees daily. The contract, which includes an initial two-year term and three one-year options to renew, allots Trinity just over $5 per prisoner, per day to cover food costs, staff wages and administrative support from a field office in Oklahoma City. Prisoners will receive hot meals for breakfast and dinner and a cold sack lunch. Prison food experts and formerly incarcerated people criticized the decision, noting that poor food quality, unsanitary conditions and staff misconduct have plagued several states that privatized their prison food service.

Oregon

Oregon’s state health agency is appealing a ruling by federal Judge Adrienne Nelson that found the agency in contempt. Under that ruling, issued June 6 in US District Court, Oregon has started racking up fines of $500 per day for each person who has to wait in a local jail cell for more than a week before admission to the state’s psychiatric hospital.

Texas

It wasn’t a joke. Lawyers for Hidalgo County acknowledge that jailers blamed a female prisoner’s severe abdominal pain on spicy snacks—but deny they were joking. The county also denies delaying medical care that led to Melissa de la Cruz’s death in April 2023. “Defendant denies that such suggestion was made jokingly,” reads the county’s 28-page response to a wrongful death lawsuit filed by de la Cruz’s children. The suit, filed April 16 in McAllen federal court, claims the jail ignored her worsening illness for days before “dumping” her at a local hospital, where she died of sepsis nearly two weeks later. Jail medical staff had attributed her gastric pain to eating Hot Cheetos, Takis, and pickles from the commissary.

Wisconsin

Wisconsin Gov. Tony Evers included a prison accountability office in recommendations for the upcoming state budget. That proposal was tossed out by the state Legislature, along with hundreds of others made by Evers. And so far, prison reform advocates haven’t found a Republican sponsor for a separate bill. The proposed Office of the Ombudsperson for Corrections would conduct investigations, inspect prison facilities and make recommendations to prisons in response to complaints. The proposal would cost about $2.1 million from 2025-2027.

Wyoming

The Wyoming Department of Health is considering directly compensating county jails for housing and treating inmates awaiting a mental health assessment at the state psychiatric facility. Stefan Johansson, director of the state health department, estimated in a report to the committee that, based on the current demand for mental health services, the agency would need roughly $3 million per biennium, assuming a $100 per diem reimbursement rate.