Weekly Update: June 06, 2023

COCHS Weekly Update: June 06, 2023

Highlighted Stories

Editor's Note
Up until now these Editor’s Notes have been concerned with the issues surrounding payment and services for Medicaid coverage within corrections. This week’s Editor's Note now turns to the minimum health and safety standards a provider in corrections must meet to participate in Medicaid. These requirements, the conditions of participation, will need to be closely attended to when incarcerated people’s health care is covered by Medicaid. For this reason, we would first like to direct our subscribers’ attention to two CMS documents, Certification Process and Quality, Safety & Oversight - Enforcement, and second to this week’s highlighted articles below describing some of the conditions that can occur in correctional facilities.

How exactly health care facilities in corrections could meet conditions of participation is beyond the scope of this Editor's Note and will probably vary greatly, institution by institution. What we want to emphasize is the process any institution needs to follow, whether in or outside of corrections, to become certified to participate in Medicaid. As explained in the Certification Process document, State Survey Agencies conduct a certification process which includes investigations and fact finding. Once this investigation is completed a State Survey Agency passes on the evidence gathered to the CMS Regional Office to make a certification determination. Since health care delivery in corrections can be complicated, what State Survey Agencies would investigate is up to debate. Each facility and/or correctional health care provider will have the opportunity under the State’s 1115 to determine which services and in what locations they will seek Medicaid reimbursement.

If an institution meets the conditions of participation and is certified, it must continue meeting conditions of participation. In Quality, Safety & Oversight - Enforcement, there are listed many reasons for termination. Two in particular might present challenges within corrections: if an institution 1) refuses to permit examination of fiscal and other records (including medical records) necessary for the verification of information furnished as a basis for claiming payment under Medicare (which holds for Medicaid); or 2) refuses to permit photocopying of any records or other information necessary to determine or verify compliance with participation requirements. This requirement for record transparency might be problematic because correctional institutions and/or correctional health providers have been known to be reluctant to release records (see San Diego Union Story below).

The transition from local jurisdictions being the payer for correctional health services to Medicaid being the payer under an 1115, involves more than simply determining what services will be covered by Medicaid and how they will be paid. The discussion above and the accompanying articles below highlight an additional aspect of a Medicaid provider –that is, facility compliance with health, safety and quality metrics.

KTLA (YouTube): Health care workers protest L.A. County jail conditions
A group of correctional health care and social workers protested conditions inside the Los Angeles County Men's Central Jail. They described systemic problems that included overcrowding, under staffing and other inhumane conditions.

San Diego Union Tribune: ‘The public has an interest’: Federal judge orders sheriff to release internal records on jail deaths
A federal judge has ordered the sheriff’s department to unseal internal records on people’s deaths in jails, siding with The San Diego Union-Tribune and other media outlets seeking documents previously turned over to a plaintiff’s lawyers in litigation that was recently settled. But the documents, which are related to deaths and injuries sustained by 12 people in San Diego County custody, will not be immediately released to the public.

WWNO: Orleans jail monitors find falsified records, understaffing at facility
Monitors tasked with overseeing the New Orleans jail are concerned that WellPath staff tasked with doing check ins on detainees on suicide watch were falsifying time sheets to suggest they were making in-cell observations when in fact they hadn’t.

Bloomberg Law: Prison Warden Must Defend Inmate’s Unsanitary Confinement Claim
An Illinois prison warden can’t escape an inmate’s claim that she ignored the unsanitary conditions in his cell which led to medical issues, a federal court ruled. Robert Simmons, a prisoner at Shawnee Correctional Center, alleged that mold in his cell caused his respiratory issues. Warden Lu Walker moved for summary judgment, arguing that Simmons failed to “demonstrate that a sufficiently serious medical condition arose from the conditions of his cells.”

Daily Beast: Man Died of ‘Severe Neglect’ in Bug-Infested Georgia Jail Cell, Lawyers Say
A man found unresponsive and covered in bug bites inside a squalid Georgia jail cell died as a result of “severe neglect” from the facility’s staff, his family’s lawyers said Monday after commissioning an independent autopsy. In September, Lashawn Thompson was found in his cell in the psychiatric wing of the Fulton County Jail malnourished, dehydrated, and his body “infested inside and out with insects,” attorneys Ben Crump and Michael Harper said.

The Guardian: Incarcerated people use TikTok videos to expose Alabama’s prison conditions
Last year 270 people in Alabama’s prisons died. The deaths included 19 homicides. Those in prison, their family members and prison advocates have used TikTok to highlight severe understaffing, overcrowding, violence, drug use and a lack of adequate medical and mental healthcare and basic necessities have fueled a crisis in the state’s prisons for years.

FOX 26: Harris County jail inmate talks about current facility conditions, lack of medical care
As more deaths are reported at the Harris County Jail, a current inmate spoke exclusively to FOX 26 about the current conditions in the facility. Jawon Bridges says his pod is currently in quarantine after a reported shingles outbreak. He says it is the same pod Robert Terry, Jr., the 32-year-old man who died in custody on May 16, was in. His cause of death has not been released and is under investigation by the Texas Rangers.

News4Jax: Man dies after going days in Duval County jail without medication, family says
The family of a Jacksonville man says he died in November after going two days in the Duval County jail without the medication he needed to survive. Dexter Barry’s attorney and his family claim his death is the result of a systemic problem. Police footage shows Dexter Barry in the back of a police car on Nov. 18, 2022, telling the officer he has to have his medication. “I take rejection medicine for my heart transplant,” he said. “I can’t miss no doses.”


WHIO: Turner, local sheriffs discuss restoring Medicaid benefits for inmates with bipartisan bill
A bill co-sponsored by a Dayton congressman is aimed at removing unfair Medicaid exclusions for pre-trial detainees. Congressman Mike Turner, along with Montgomery County Sheriff Rob Streck and Clark County Sheriff Deb Burchett, spoke Tuesday about the Due Process Continuity of Care Act. The Department of Health and Human Services will provide states with the funds to cover the cost of implementing the bill if it gets passed.

Opioid Epidemic

Health Affairs: Buprenorphine Treatment For Opioid Use Disorder: Comparison Of Insurance Restrictions, 2017–21
Despite its efficacy for treatment of opioid use disorder, barriers to buprenorphine prescribing persist, including insurance restrictions. Approximately half of Medicare Advantage formularies had quantity limits on immediate-release buprenorphine tablets. But resaerchers have also found decreasing prior authorization requirements for buprenorphine in recent years, with only a small percentage of formularies still requiring prior authorization.

Theravive: New Study Looks At Peer Support For Incarcerated Individuals
A new study looked at peer health navigation experiences before and after prison release amount people with opioid use disorder. The team interviewed 39 adult inmates diagnosed with opioid use disorder who worked with peer support specialists before and after their release from state prison. Participants appreciated working with someone with a shared experience; they appreciated that they could use that shared experience to build a trusting relationship with someone who was there for them no matter what.

Mirage: Reentry Services May Stabilize Substance Use Risks After Prison Release
After the release of more than 2,000 individuals in late 2020, reentry services helped with substance use disorder, Rutgers researchers say. Contrary to expectations, the risk for relapses, overdoses and deaths related to substance use disorder didn’t increase after a large-scale prison release in New Jersey. The Garden State has robust reentry supports for incarcerated people with substance use disorder, which may have lowered post-release risks.


Stat: ‘Worse than what we thought’: New data reveals deeper problems with the Bureau of Prisons’ Covid response
Federal Medical Center Devens seemed a better candidate than most prisons for an early Covid-19 vaccine rollout. But Devens wasn’t the first, or even the second, federal prison to start vaccinating its residents. It was tied for last. FMC Devens did not vaccinate a single resident for Covid-19 until Feb. 11, 2021 almost two months after its counterparts across the BOP prisons got started.

Bureau Of Indian Affairs

NPR: Report finds Bureau of Indian Affairs is falling short on prison reforms
Last year, the Bureau of Indian Affairs said it was reforming tribal jails. The announcement came after an NPR investigation found at least 19 people had died in the jails since 2016, often due to a lack of medical care or poor staff training. The bureau promised dozens of reforms, but a new federal report says inmates continue to die.

Racial Disparities

Pew: Racial Disparities Persist in Many U.S. Jails
By the year 2000, Black people made up almost half of the state prison population but only about 13% of the U.S. population. Far less is known, however, about racial and ethnic disparities in the country’s approximately 3,000 local jails. In 2022, Black people made up 12% of the local populations but 26% of the jail populations on average across the 595 jails from the JDI sample for which race data was available for the entire year.

Solitary Confinement

Solitary Watch: Most Accurate Report to Date Finds 122K People in Solitary
A report from Solitary Wathc and Unlock the Box shows that at least 122,840 people are locked daily in solitary confinement in U.S. prisons and jails for 22 or more hours a day. Previous reports have offered an incomplete picture of how extensively the discredited practice is used and the number of people it affects. Often, these counts omit individuals who are held in solitary confinement in jails or who are held for less than two weeks.

Colorado Sun: "Moral Injuries" Solitary confinement intensifies problems for incarcerated people. It also changes the Colorado therapists who send them there.
Clinical staff working in jails and prisons often feel a moral injury when their ethical obligation to a client comes into conflict with the jail or prison policy. Many clinicians, particularly those who work in county jails, are expected to decide when a person, especially those with mental illness, should be placed in solitary confinement. These kinds of evaluations create a no-win ethical dilemma for the clinician. The only ethical choice left is to refuse to complete this kind of evaluation at all.

Nevada Current: Lawmakers consider restrictions on using solitary confinement in prisons
Nevada lawmakers are reconsidering limits on how state prisons use solitary confinement after similar legislation failed to pass during the 2021 legislative session. The bill, which defines “segregation” or “solitary confinement” as more than 22 consecutive hours in a cell, would limit the use to 15 consecutive days, after which a multidisciplinary treatment team, would conduct a review to determine where to place the inmate.

State Roundup

Sacramento Business Journal: County approves $4.1 million to convert Sacramento motel into residential substance abuse treatment center
Sacramento County has approved $9.1 million to kickstart the creation of 112 new inpatient beds for people recovering from substance use disorders. Local operator Sacramento Recovery House Inc. was awarded the other $5 million to open a 32-bed treatment facility.

Los Angeles Times: State orders L.A. County to move nearly 300 youths out of ‘unsuitable’ juvenile halls
State regulators on Tuesday gave Los Angeles County two months to move roughly 300 youths out of its two troubled juvenile halls, taking the unprecedented step after finding the county had done little in the last month to come into compliance with a long list of state regulations. The unanimous decision by the Board of State and Community Corrections leaves the county scrambling to vacate. In voting to declare the halls “unsuitable” the state board put an end to a years-long back-and-forth with local officials over improvements.

KTVU (YouTube): 2 Alameda County sheriff's deputies, juvenile detention officer face criminal charges
The Alameda County District Attorney's Office has filed felony criminal charges against two sheriff's deputies and a juvenile correctional officer in separate cases. The charges range from falsifying records to performing sex acts on a minor.

Prison Policy Initiative: Excessive, unjust, and expensive
In the United States, the number of people under the surveillance of probation and parole systems is nearly twice the number of those behind bars. Community supervision, which refers mainly to probation and parole, is “too big to succeed.” In Connecticut, as in other states, excessive consequences for these noncriminal violations can result in incarceration. This approach disproportionately burdens communities of color and is a costly endeavor for the entire state.

Atlanta News First: Mother of man who died of hypothermia in DeKalb County Jail files lawsuit
The mother of a man found dead inside the DeKalb County Jail last year has filed a lawsuit against the jail, claiming negligence. When Toni Walker thinks of her only child, she’s reminded of the long agonizing death he likely experienced inside the DeKalb County Jail. Walker said her son, who she referred to as Lamar, was diagnosed with schizophrenia at 17. Jail records provided to Atlanta News First show the jail was aware of his mental state at intake.

Atlantic Journal Constitution: Fulton jail’s medical provider seeks security, citing dangerous conditions
Naphcare, the company that provides health care for Fulton County inmates says the jail is so dangerous, it wants security guards to accompany its clinical personnel behind bars, records show. Staff have been assaulted, a patient has been stabbed. According to the company, Fulton’s lockup was the most dangerous of the more than 70 jails it services.

WRAL: Justice Department should investigate beatings at Georgia jail, attorney says
An attorney for two men whose beatings by guards were recorded by security cameras at a county jail in Georgia called Wednesday for the U.S. Justice Department to investigate what he called a systemic pattern of sheriff's officers abusing detainees. “They are beating people indiscriminately inside this jail,” civil rights attorney Harry Daniels told reporters.

Iowa Capital Dispatch: State contests ruling on workers’ right to be heard on safety issues
The state of Iowa is challenging a ruling that it violated prison workers’ right to be heard on issues of personal safety and assaults on the staff committed by inmates. In a petition, Attorney General Brenna Bird argued that state agencies are under no legal obligation to meet with their employees over workplace safety concerns. During a labor management meeting, union representatives, Neil LeMaster and Todd Eaves raised employees’ concerns about their workplace conditions. They alleged thatg warden Patti Wachtendorf refused to answer their questions.

New Hampshire
InDepthNH.org: House Finance Subcommittee Wants to Hold Medicaid Expansion Bill for a Year
A House Finance Committee’s subdivision wants to hold a bill reauthorizing the state’s Medicaid expansion program for a year. The committee Division III voted down party lines to retain Senate Bill 263 although the Senate passed the bill unanimously and the House passed it 193-166 last week with no limitation on the program’s length.

New York
Washington Post: America should fund rehab for schizophrenia — not jail and ER
Roughly a quarter of the unsheltered homeless in the United States are people with untreated mental illness. Many with schizophrenia or bipolar disorder languish in urban single-room occupancy hotels or board and care homes. Despite all efforts, the problem only gets worse. Why? The painful answer is that society has failed to ensure that people with serious mental illness, especially those of color, get the care that could help them recover.

North Carolina
NPR: How the Mental Health System Affects North Carolina’s Jails and the People That Work There
If you ask sheriffs in North Carolina about the state's mental health system, they might tell you their jail is evidence it’s broken. Problems in North Carolina’s mental health system overflow into its hospital emergency rooms. The state’s jails are also on the frontlines of the mental health crisis.

NC Newsline: Changing prison medical release law could make 1,000+ people eligible
NC Senate Republican leaders included a provision deep within their budget that would broaden North Carolina’s medical release law that offers sick, elderly and dying incarcerated people a path out of prison so they can spend the end of their lives outside the confines of a cell.

AP: Oklahoma lawmakers sign off on $1M settlement over inmate’s death
Oklahoma lawmakers on Tuesday signed off on a $1.05 million settlement with the family of a state prison inmate who died of appendicitis in 2018 despite five visits to the prison’s medical staff in the week before his death. Attorneys for Joshua England’s family say the 21-year-old citizen of the Choctaw Nation reported severe abdominal pain and classic appendicitis symptoms that worsened during his five separate visits with medical clinic staff in May 2018.

VT Digger: Incarcerated man alleges Springfield prison superintendent ignored report of sexual abuse by officer
A person who was incarcerated at Southern State Correctional Facility in Springfield has sued superintendent Mike Lyon, claiming Lyon ignored his attempt to report a corrections officer’s sexual abuse against him. The inmate wrote that when he tried to tell Lyon about a female corrections officer sexually touching, kissing and propositioning him, the superintendent tried to remove himself from the situation in order to protect himself.

VT Digger: Newly signed law seeks more transparency, accountability in Vermont sheriffs’ departments
Sheriffs currently have the option of charging up to 5% of a contract’s value, then adding that full amount or a fraction of it to their own salaries. Whatever’s left is rolled into their department’s budget. The new law allows sheriffs to keep using the fee to increase their salaries — or those of their staff — as long as they follow a forthcoming model policy. Willful failure to comply would be regarded as misconduct.

Rikers Island

The City: City Jails No Longer Announcing Deaths Behind Bars, Angering Watchdogs
The city Department of Correction has abruptly stopped notifying the media when an incarcerated person dies and will no longer do so in the future. Over the past two weeks, the DOC has failed to notify the public about at least two deaths. Under the Adams administration, the DOC has also blocked real-time video surveillance access from Rikers and other city lockups to members of the Board of Correction, which oversees the agency.

The City: Detainee at City’s Floating Jail Was on Life Support for Two Weeks After Guard Tackle
A man locked up on the city’s jail barge was on a ventilator for nearly two weeks after he was tackled by a group of correction officers when he refused to leave an elevator and then ran through a main gate. After he was tackled to the floor, Carlton was unable to walk and was then brought to Lincoln Hospital, in The Bronx, where doctors put him on a respirator, according to multiple people familiar with his situation.

Los Angeles County

Los Angeles Daily News: ACLU seeks ban on head strikes by deputies in LA County jails
The ACLU of Southern California is seeking a federal court order barring Los Angeles County sheriff’s deputies from striking jail inmates in the head except for rare instances that require deadly force. A motion was filed before U.S. District Court Judge Dean D. Pregerson also asks that the Sheriff’s Department adopt a “zero tolerance” policy for deputies who lie about using excessive force on inmates or fail to report it.

San Diego County

San Diego Union Tribune: County supervisors approve $7.2M to shift focus from incarceration to treatment, other services
The San Diego County Board of Supervisors unanimously agreed Tuesday to make a $7.2 million investment in programs that would route people who commit low-level crimes into services rather than jail. The initiative, called Safety Through Services, is the product of an 18-month study that looked at who ends up in San Diego County jails, why and the best approaches to keep them from returning.

End Of Life Care

CorrectionalNurse.net: When Prison is an End-of-Life Sentence: Hospice in Corrections
Terminal illness is an increasing possibility as incarcerated persons age and remain in custody. This can be a time of great sorrow, loneliness, suspicion, pain, and suffering for incarcerated individuals. They may have great fear of dying alone, in pain and without support. Every correctional facility will inevitably have an incarcerated individual who is diagnosed with a terminal condition.

Correctional News: Aging Inside the System with Dignity
Seven years from now in 2030, there will be around 400,000 geriatric-age inmates within the criminal justice system. The Sentencing Project surveyed departments of corrections from all 50 states, which revealed that more than 55,000 Americans are incarcerated in state and federal prisons with no chance of parole.

Correctional Health Care Vendors

Vermont Journal: LTE Inmate healthcare in Vermont
Members of the Vermont Just Justice organization held a rally at the statehouse to bring awareness to the accepted practice of denying healthcare to incarcerated individuals. VitalCore that recently provided health care in Vermont states: “VitalCore controls costs by ensuring that the patient receives the right amount of care the first time.” Now, Vermont has signed a contract with a new/old healthcare provider: Wellpath another for-profit, for $33 million annually. In addition to wrongful death suits and more than 1,000 federal lawsuits against this company. Wellpath has provided substandard care due to its focus on containing costs, leading to numerous deaths and other serious outcomes.

The Appeal: People in Massachusetts Prisons Say For-Profit Medical Company Leaves Them Without Teeth
Incarcerated people in Massachusetts reported that they had to wait years just for Wellpath, the state’s prison medical provider, to give them dentures or basic dental care. Next year, Wellpath’s contract with the state expires, and advocates say they hope it’s not renewed.

Yahoo: Lawsuit over botched pregnancy diagnosis at Lackawanna County Prison can proceed, judge rules
A woman who alleges she nearly died after the Lackawanna County Prison medical staff failed to timely react to a pregnancy complication can proceed with a federal lawsuit against the prison's former medical provider, a judge ruled. Jacquelyn Parker filed suit in 2020, alleging Correctional Care Inc. staff ignored clear signs she was suffering from an ectopic pregnancy — a life-threatening condition in which a fertilized egg implants itself in a woman's fallopian tube instead of her uterus.

TribLive: Controller questions Westmoreland County Prison medical costs
Westmoreland (PA) Controller Jeffrey Balzer criticized an additional $175,000 expense that must be paid for medical services at the county prison. The extra fee is required under a contract county commissioners approved with a new medical provider last summer. Commissioners last July cut ties with Wexford Health Sources, which for more than a decade served as the primary medical provider for inmates at the county prison in Hempfield. The county instead signed a new five-year, $20.9 million contract with PrimeCare Medical Inc..