Deadbeat Proprietary Correctional Healthcare Vendors; JAMA: Medicaid & Justice Involved; BJA & Oklahoma Medicaid Re-entry Project; Yale & BU Studies

Highlighted Stories

Editor's Note

One of the reasons COCHS decided to include editor's notes with the Weekly Update was to identify not only policy initiatives affecting healthcare within correctional settings but to also identify trends that we observe arising through the multiple stories we highlight each week. One trend that we have recently identified is best described as the deadbeat proprietary correctional healthcare vendors. The last two weeks there were stories from both Michigan and Alabama where proprietary correctional health care providers have left the states where they are providing or have provided healthcare services holding the bag on unpaid bills. In Alabama, a state senator is accusing YesCare of not paying tens of thousands of dollars worth of invoices to local first responders. In Michigan Grand Prairie Healthcare Services in partnership with Wellpath has failed to pay off-site health care providers such as hospitals, doctors and pharmacies roughly $35 million for services provided to incarcerated people. As the first highlighted story below reports, the Michigan Department of Corrections is now forced to sue these companies for breach of contract.

One of the many ironies of these stories is that proprietary healthcare providers promote their healthcare service as a cost saving measure for jurisdictions. Their high rates (see the second highlighted store, Wellpath is receiving $1.6 billon from Arkansas) are often justified as a fair recompense for removing form jurisdictions the financial burden of expensive lawsuits that might occur due to the negative health outcomes in correctional facilities. But as the multiple stories we have included over the years in the Weekly Update have shown this reasoning is usually not born out by the facts. The vast majority of lawsuits do not give jurisdictions a free pass. Within correctional institutions the coordination between correctional staff and healthcare providers can be complicated and blame for adverse health outcomes can often be ascribed to both parties. Jurisdictions find that they along with the correctional healthcare company they have contracted with are required to pay considerable amounts to formerly incarcerated people or their survivors.

This additional wrinkle where proprietary are basically stiffing subcontractors further calls into question the belief that proprietary correctional healthcare vendors provide cost saving. In Michigan healthcare providers that Grand Prairie Healthcare Services and Wellpath have not paid have increased their rates they charge to the Michigan Department of Corrections by 150% to 200%. Other providers are either requiring up-front payment or are refusing to work with the department altogether. Jurisdictions who are relying on the proprietary correctional health care vendors to cut costs may find themselves as the old adage goes, “counting pennies on the floor while dollars fly out the window”.

Moving onto other topics, included in the highlighted article section of the Weekly Update there is a JAMA article which presents a study that found that in states where Medicaid has been expanded, data seems to link the expansion to better health outcomes for formerly incarcerated people. Also falling under the Medicaid rubric, the Oklahoma Health Care Authority, along with participating states, announced funding from the Bureau of Justice Assistance to improve re-entry for Medicaid eligible individuals with the goal of enhancing care transitions.

The last two highlighted articles are studies from Yale and Boston University. The Yale study found that people in jails are more likely to have uncontrolled cardiovascular disease risk factors as opposed to people in prison. The article from Boston University has identified that formerly incarcerated people have a higher elevated risk of suicide and this risk seemed most prevalent in the 18 - 29 age group.

Unpaid Bills & High Rates

The Michigan Department of Corrections has sued its former health care services provider, arguing the company breached its contract with the state when it failed to pay subcontractors for roughly $35 million in medical services provided to prisoners. The lawsuit filed in Ingham County Circuit Court against Grand Prairie Healthcare Services and Wellpath alleges the companies breached a $590 million, five-year contract with the state when they failed to pay off-site health care providers such as hospitals, doctors and pharmacies roughly $35 million for services rendered to prisoners.

The Arkansas Legislative Council gave final approval Friday to a $235.5 million Department of Corrections medical contract that prompted lawmakers to request action be taken to ensure procurement rules comply with state law. The contract reviewed by lawmakers this week represents the first two years of a potential ten-year $1.6 billion contract with Wellpath to provide comprehensive medical, dental, pharmacy and mental health services for inmates and offenders in the custody of the Department of Corrections.

Medicaid

This study examines whether Medicaid expansion in Rhode Island was associated with mortality among persons who were formerly incarcerated. They linked 10 years of incarceration release data to death certificate data and conducted an interrupted time series analysis with a comparison group to evaluate immediate and sustained changes in postrelease mortality rates among persons who were formerly incarcerated in Rhode Island compared with North Carolina, which had not expanded Medicaid during the study period. The study found a persistent decrease in deaths due to all causes, overdose, and homicide. Also in JAMA see the investigation specifics Medicaid Expansion and Mortality Among Persons Who Were Formerly Incarcerated.

The Oklahoma Health Care Authority, in partnership with the Oklahoma Department of Corrections and the Oklahoma Department of Mental Health and Substance Abuse Services, will represent the state in the Medicaid and Corrections Policy Academy, an opportunity funded by the Bureau of Justice Assistance. Participating states will develop action plans to enhance care coordination by addressing gaps in stakeholder engagement, screening, case planning and data sharing. This opportunity focuses on improving care transitions and reentry outcomes, allowing states to pilot new approaches to better serve Medicaid-eligible individuals leaving correctional facilities.

Studies

This study found that individuals released from jail are more likely to have uncontrolled cardiovascular disease (CVD) risk factors than those released from prison. Those released from jail, compared with prison, had lower scores for smoking and blood pressure control on average and increased odds of having at least one uncontrolled CVD risk factor. "Place of incarceration matters: those coming out of jail have particular health risks, perhaps due to more rapid transitions in care," said Emily Wang, MD.

This study based on data from more than 260,000 formerly incarcerated people in North Carolina between 2000 and 2020, found that certain groups disproportionately experience a higher and sustained post-incarceration risk of suicide, including female individuals, White, and Hispanic/Latino individuals, and adults in the 18-to-29 age group. The study also showed that formerly incarcerated people had higher rates of non–firearm-involved suicide mortality than firearm-involved suicide mortality, which is contrary to trends in the general population.

BOP

The federal Bureau of Prisons says it has increased staffing in recent months to make up for staggering shortfalls at the troubled the Metropolitan Detention Center in Brooklyn. Judges have continued to raise alarms about “dangerous, barbaric conditions," rampant violence and multiple deaths. Some judges have refused to send people to the jail. Senior Bureau of Prisons officials known as the Urgent Action Team is focusing on bringing the facility back to adequate staffing levels and ensuring it is in good repair.

U.S. Senators Jon Ossoff and Marsha Blackburn are launching a bipartisan inquiry to protect Federal prison staff from sexual assault and harassment. According to a February 2023 report, 40% of 7,000 BOP surveyed staff stated they had been sexually harassed by an inmate. As part of their inquiry, the Senators requested that BOP release information about their inmate-on-staff sexual assault and harassment reporting procedures, correctional methods, and staff assistance programs, including statistics and data from FCI Atlanta, formerly USP Atlanta, and Federal prison facilities around the country.

Climate Change/Heatwave

After a summer of record-breaking temperatures, scientists predict that 2024 could end up being the hottest year on record. For people in U.S. prisons and jails — who often lack access to even the most basic cooling measures — conditions behind bars exacerbate the risks of dangerously high temperatures. Several courts have ruled that extreme temperatures in prison violate the Eighth Amendment’s provision against “cruel and unusual” punishment. But these rulings have not led to a widespread adoption of air-conditioning or other methods to cool prison facilities or prevent heat-related deaths.

Asthma and heat stress were the cause of death for a man who collapsed while incarcerated at Stateville Correctional Center during a string of hot days in June, according to the Will County coroner’s office. Michael Broadway, 51, had complained about hot conditions inside the prison in the weeks leading up to his death, one of Broadway’s relatives said in July. Terah Tollner, a lawyer for Broadway’s family, said Broadway would still be alive today if medical staff “provided adequate treatment.”

Women In Corrections

In recognition of Prison Banned Books Week, (September 15-21), the Prison Library Project in partnership with OHG's Purpose Group announced the launch of their new women's health literacy campaign, "Contrabanned." Many state prison systems systematically ban women's health books, often labeling depictions of the female anatomy as "sexually explicit." The Prison Library Project created a first-of-its-kind women's health book that overcomes this illogical ban because each of the 250 pages were sent as letters to those who are incarcerated. While books may be banned, letters are not.

Data & Statistics

A new BJS report, Jails in Indian Country, 2023, provides statistics from BJS’s Annual Survey of Jails in Indian Country on the demographic characteristics, most serious offense, and conviction status of persons held in Indian country jails. It also describes facility characteristics, including capacity and staffing. This report, the 21st in a series that began in 1998, supports the mandate established by the Tribal Law and Order Act of 2010.

State Roundup

Arizona

Mohave County announces the commencement of construction for a pioneering effort targeted at reducing inmate recidivism. The Reach Out facility, equipped with a detox center, will provide a safe and secure environment for individuals needing assistance to rehabilitate or those mandated by the judicial system to undergo detoxification. Strategically located just steps from the release point of jail inmates, the new facility will provide immediate access to a re-entry program and detox center.

California

The Mendocino County Board of Supervisors passed a resolution last week to allow the county to use $7 million of Measure B funds to construct the behavioral health wing at the Mendocino County Jail. The county has tried to help inmates with mental illnesses as best as it can, but hospitals are often at capacity and don’t have sufficient space for inmates who need treatment. Mendocino County has one of the highest suicide rates in all of California, according to a California Health Care Foundation

Sacramento County Sheriff Jim Cooper on Thursday called for the California legislature to pass stricter laws that punishes those selling fentanyl as a large amount of the deadly synthetic opioid is smuggled into his jail facilities. The sheriff, who spoke at a news conference at the Main Jail in Downtown Sacramento, said his deputies have confiscated 500 grams of fentanyl that recently arrested inmates tried to smuggle into his two jail facilities this year. Cooper’s news conference on comes as California voters decide whether to approve Proposition 36, a November state ballot measure that will undo a handful of criminal justice reforms that were approved by voters in 2014’s Proposition 47. Gov. Newsom lashed out at Prop. 36, which he said has less to do with addressing retail theft and is more of “a drug policy reform” that increases a drug possession charge to a felony.

Connecticut

Seven inmates are on a hunger strike over a lack of mental health and medical care and what they say are excessive lockdowns at MacDougall-Walker Correctional Institution. Jacky Robinson Jr., who also participated in a previous hunger strike in June, said he's again refusing to eat, this time to protest frequent lockdowns and a lack of consistent access to phones and tablets through which incarcerated people can contact friends and family.

Delaware

At the September Delaware County Jail Oversight Board meeting, George W. Hill Correctional Facility Warden Laura K. Williams said the prison has seen a notable increase of inmates with behavioral health concerns. Since May, the prison has gone from 758 inmates with any mental illness to 914 inmates in August. They may or may not be receiving medication, Williams said. For patients with serious mental illness, the number increased from 414 inmates, 33% of the population, in May to 492 inmates, 41% of the population, in August.

Florida

A first-of-its-kind mental health facility is now a big step closer to opening in Miami-Dade County. The facility aims to help people with severe mental illness, who are caught in the criminal justice system. County commissioners decided to move forward with the next steps to opening the facility. The commission gave the go ahead for the mayor to negotiate contracts for an operator and provider for the new Miami Center for Mental Health and Recovery. Faculty creator Judge Steve Leifman said, "This is a huge step forward in getting this building open and I'm quite confident by early next year we will be open".

Indiana

A federal judge on Tuesday issued an order that will require the Indiana Department of Corrections to provide a transgender inmate with gender-affirming surgery. Richard Young, a judge for the U.S. District Court in the Southern District of Indiana, granted a preliminary injunction in the ACLU of Indiana's case representing a transgender inmate serving a murder sentence in a male state prison. The Indiana Department of Corrections argued in court that there is a "disagreement as to whether there is widespread medical consensus that gender-affirming surgery is a 'safe and effective course of treatment.'"

Massachusetts

Citing two decades-worth of complaints about overcrowding, inadequate health care and other mistreatment, a new report alleges Plymouth County Correctional Facility staffers engaged in a pattern of abuse against immigrant detainees. The documents revealed a range of issues, including insufficient access to legal counsel and the punitive use of solitary confinement. Plymouth is the sole county in Massachusetts that retains an agreement with U.S. Immigration and Customs Enforcement (ICE) to detain and house immigrants in its jail.

Missouri

Missouri corrections officers drenched an inmate with pepper spray and ignored his pleas for help for four hours, responding only when his screaming stopped as he died in the Tipton Correctional Center, a federal lawsuit filed this month alleges. The events that led to Brandon Pace’s death on April 7, 2023. The 11 counts in the lawsuit seek damages for wrongful death, civil rights violations and Missouri Sunshine Law violations for refusing to turn over any of the records, including video recordings, of the events prior to Brandon Pace’s death.

North Carolina

The N.C. Department of Adult Correction charges $5 for medical and dental services that are initiated by an incarcerated person and $7 for a self-declared emergency visit, according to the prison system’s copay policy. The fee is not charged if staff determine that an actual emergency occurred. While these fees may seem small, advocates say they can be a financial barrier in the context of low prison wages, leading some people to delay or even avoid care.

Oregon

Mail sent to Oregon prisoners is about to get less colorful. That’s if Department of Corrections officials adopt a slate of proposed rules cracking down on crayons, markers and greeting cards. If approved, the rules would allow only typed mail or handwritten letters in pen or lead pencil. The proposed crackdown comes as Oregon confronts a tide of drugs entering its dozen prisons — often through the U.S. mail. Prison officials have detected street drugs in crayon markings and markers, soaked into card stock and colorful envelopes or slipped along envelope seams of the nearly 1 million pieces of mail sent to Oregon prisoners each year.

South Dakota

Family members and friends of people in state prison packed a downtown library meeting room in Sioux Falls for the first meeting of a group that aims to put pressure on the Department of Corrections to address their concerns. The organizers of South Dakotans Impacted By Incarceration told the attendees that their plans include regular meetings, advocacy and outreach to those in power. Outbreaks of violence at two state prisons and multiple lockdowns, including a lockdown currently in place at the penitentiary, have occurred since March.

Vermont

Emotions ran high at a legislative hearing, where lawmakers heard from Vermont’s Department of Corrections, as well as the state employees’ union and correctional officers, themselves, about working conditions in Vermont’s prisons. Those testifying before the Joint Legislative Justice Oversight Committee described a seemingly intractable cycle: Prisons, already understaffed, must contend with corrections officers calling out on their scheduled days to work. “They’re exhausted,” said Steve Howard, the executive director of the Vermont State Employees Association, the union which represents state employees.

Washington State

The department writes: Solitary confinement reform is essential to improving conditions of incarceration for those in our care and custody, as well as our staff. Temporarily separating people from others who are incarcerated remains necessary at times, whether for investigative purposes, in response to violent incidents, due to risk for danger to self or others, or for max custody classification of individuals deemed too dangerous for general population. However, we also understand that solitary confinement, as it has traditionally been used, may have negative effects for those people experiencing it. Twenty-three hours of isolation per day, absent meaningful human contact accompanied with lack of programming, and the overall restrictive prison environment can contribute to mental health challenges and difficulty returning to the general population.

In 2003, an organization called the Sustainability in Prisons Project, or SPP, emerged from Evergreen State College in Olympia. The project's goal was to bring science and conservation education to the 12 state prisons across Washington. SPP has since been welcomed into each facility, including Airway Heights Corrections Center. Programs at the Airway Heights prison include forestry and firewood donation programs, plus recycling and refurbishing computers. The gardens at Airway Heights Corrections Center are experimental grounds not only for composting and conservation techniques, but for understanding how greenspace, access to nature, and science education can impact mental health, recidivism rates, and rehabilitation in prison.

Rikers Island

Michael Nieves sliced his throat with a razor around 11:40 a.m. on Aug. 25, 2022. For the next 10 minutes, correction workers at the Rikers Island jail complex stood by his cell and watched him bleed without providing medical care. In addition to the failure to provide immediate medical care, the attorney general’s investigation found systemic issues at Rikers had contributed to Mr. Nieves’s death. Medical workers who responded to the emergency weren’t informed that Mr. Nieves was bleeding intensely, so they didn’t bring gauze or bandages.

San Diego County

Keith Galen Bach had been dead for hours. The alarm on his insulin pump was still beeping when an investigator from the Medical Examiner’s Office arrived at the Men’s Central Jail following his death last September. According to autopsy findings requested by The San Diego Union-Tribune and released this week by the Medical Examiner’s Office, the pump was likely beeping nonstop for nearly 24 hours, alerting Bach, who had Type 1 diabetes, that it had run out of insulin. “The death is due to complications of a natural disease,” the medical examiner wrote. “However, considering the inaction (i.e. neglect) characterizing the events leading to inadequate care … the manner of death is classified as homicide.”

Healthcare Provider Experience In Corrections

Healthcare environment has an inherent stressfulness that may be even more intense in the correctional environment, where healthcare is not the primary mission. Bullying and incivility should be addressed at the organizational level and the interpersonal level. Organizational strategies include the development of a “zero tolerance” policy, staff training, and encouraging staff to report incidences of bullying and incivility immediately.

Proprietary Correctional Health Care Vendors

Turn Key Health Clinics

A new lawsuit says video backs up claims the “Cookie Queen,” Shannon Hanchett, was abused while in the Cleveland County Jail. The revised lawsuit alleges Cleveland County Detention Officers and Turn Key Health Clinics staff refused care, falsified records and mocked Hanchett as she went through a mental health crisis.The filings say a Turn Key Health Services Nurse falsified a document stating that Hanchett refused to have her vital signs taken.

Centurion

A state judge has ordered a former New Mexico prison medical care provider to pay $100 per day for illegally withholding public records from the Human Rights Defense Center for about four years. First Judicial District Judge Kathleen McGarry Ellenwood ordered Centurion Correctional Healthcare to pay the penalties — the maximum allowed under the state’s Inspection of Public Records Act — after determining the company had withheld the records “intentionally and in bad faith.” The sanctions are expected to total about $150,000

Quality Correctional Care

The mother of a Lynnville, Indiana, man who died after spending 10 days in the Vanderburgh County jail is suing the county, claiming her son's death was caused by "systemic failures" in the facility. The lawsuit lists Quality Correctional Care, which provide healthcare services to the jail. According to the lawsuit, Jacob Ziliak's autopsy would reveal severe staph infection and organ failure as his cause of death.