Midterm Election Special

Highlighted Article

Editor's Note

As a few of our subscribers may remember, two years ago several Weekly Updates featured stories and comments about the 2024 election, both before Election Day and after the results came in. Now that the 2026 midterms are fast approaching, we thought we would take a look at several elections with connections to correctional healthcare.

In Oklahoma, the Republican candidate for attorney general, Jon Echols, is a co-founder of TK Health, formerly Turn Key Health Clinics. As our subscribers know, TK Health is one of the many proprietary correctional healthcare providers we cover, although it is considerably smaller than companies such as Wellpath, VitalCore, and Centurion. We cannot recall another candidate for statewide office with such a direct connection to the correctional healthcare industry.

That connection has become an issue in the campaign. Family members of people who died in facilities where TK Health provided healthcare have raised concerns about whether, as attorney general, Echols would pursue criminal investigations involving the company. The concern is not entirely hypothetical: the Oklahoma attorney general has authority to seek criminal indictments through the state's multi-county grand jury.

TK Health has appeared frequently in the Weekly Update. We followed the company during the long-running problems at the Oklahoma County jail, where Turn Key complained that the facility was dangerously understaffed before abruptly ending its contract in September 2024. Then in May 2025, we also highlighted a Marshall Project investigation highly critical of the company's record at the Cleveland County jail. Since then, Turn Key Health Clinics has rebranded itself as TK Health. Now one of its founders is running to become Oklahoma's chief law enforcement officer.

Moving on to New York brings us to another of our recurring stories. Back in March, we noted that the Humane Alternatives to Long-Term Solitary Confinement (HALT) Act might become a political football. It has. Republican gubernatorial candidate Bruce Blakeman, who recently received the endorsement of the New York State Correctional Officers and Police Benevolent Association, has come out strongly in favor of reversing the HALT Act.

The endorsement itself is noteworthy. This is the first time NYSCOPBA has endorsed a candidate for governor, and 95 percent of the union members who participated in the vote supported Blakeman. The continuing crisis in New York's prisons—staffing shortages, the aftermath of last year's correction officer strike, and disputes over the HALT Act—has therefore found its way directly into the gubernatorial campaign.

In Iowa, Democratic gubernatorial candidate Rob Sand wants prison employees to be classified as public safety workers, which would expand the issues they are permitted to negotiate through collective bargaining. Readers may remember that in 2025 the Iowa Department of Corrections considered privatizing healthcare delivery in the state's prisons, a proposal strongly opposed by AFSCME Council 61, the public-sector union representing both correctional officers and correctional healthcare workers. Sand announced his proposal during a forum organized by AFSCME Council 61.

Finally, we at COCHS would be naïve not to recognize the broader concerns surrounding this election. The last highlighted article reports on former Republican California gubernatorial candidate and current Riverside County Sheriff Chad Bianco. Earlier this year, Bianco seized more than 650,000 ballots cast in Riverside County in the November 2025 election. The California Supreme Court has now unanimously ruled that the seizure violated state election law and ordered him to return the ballots.

Oklahoma Attorney General's Race

The Republican candidate for attorney general, Jon Echols, is facing growing criticism from Oklahoma families and civil rights attorneys, who are raising questions about his continued ties to a controversial company he co-founded. TK Health, which Jon Echols helped launch as Turn Key Health Clinics, is contracted to provide medical care in detention centers throughout Oklahoma and other states. Dozens of lawsuits have accused the company of providing inadequate care and violating the constitutional rights of inmates. Lawyers and families of people who died in jail custody have expressed doubt about whether Echols would be willing to pursue prosecution against employees of a company he helped start, should a case ever rise to that level.

New York Governor's Race

Republican gubernatorial candidate Bruce Blakeman promised he’d ease restrictions on solitary confinement— as he picked up the endorsement of the correction officers union. Blakeman joined with members of the New York State Correctional Officers and Police Benevolent Association outside the state Capitol, with the labor group’s leader saying members were rejecting Democrat Gov. Kathy Hochul over an ongoing crisis in state prisons. “They’ve been speaking for the last three years, screaming at the top of their lungs that they need help,” COPBA President Chris Summers said, adding members voted 1,380-78 to back Blakeman over Hochul. The candidate, who is now serving as elected Nassau County executive, said in addition to rolling back the so-called HALT Act restrictions as governor, he thinks bumping pay for correction officers is reasonable.

Iowa Governor's Race

Democratic gubernatorial candidate Rob Sand at AFSCME Council 61 said he would support classifying prison employees as public safety workers to give them access to more bargaining rights under Iowa law. Neil Lemaster, who works at the Iowa State Penitentiary in Fort Madison, said Iowa prisons are overcrowded and understaffed, putting prison employees in more potentially dangerous situations. Lemaster said while private-sector jobs offered better pay, he made the choice to work in the state prison system because of access to Iowa Public Employees’ Retirement System (IPERS). But, he said, low wages, increased overtime and unsafe working conditions have made him feel “trapped” in his job.

Seized Ballots

The California Supreme Court ordered a county sheriff to return about 650,000 ballots he had seized from election officials as part of an investigation into voter fraud that state officials said had no basis in fact. The state’s highest court determined that Sheriff Chad Bianco had no authority to take the ballots on congressional redistricting that were cast in Riverside County during California’s 2025 special election.

Follow Ups

1115 Reentry Demonstrations

Editor's Comment: Last week, we highlighted CMS's approval of Section 1115 reentry demonstrations for Louisiana, Minnesota, and Nevada and its renewal of Washington, D.C.'s demonstration. CMS has now approved Maine's Whole Person Care Waiver, which includes pre-release MaineCare services for people leaving jails and prisons.

As with last week's approvals, CMS authorized coverage beginning up to 60 days before release. Required services include case management and reentry planning, medication treatment for substance use disorder, certain clinical consultation services for youth, and medications provided at the time of release.

One aspect of Maine's announcement particularly caught our attention. The state makes a point of noting that the Maine Sheriffs' Association has been deeply involved in shaping the reentry waiver and that its support has been crucial to the effort.

The Centers for Medicare & Medicaid Services (CMS) recently approved Maine's Whole Person Care Waiver, expanding MaineCare's ability to support people before they leave jail or prison, reimburse traditional healing services for Wabanaki communities, and strengthen access to substance use disorder and serious mental illness treatment. The waiver reflects years of collaboration among Maine DHHS, the Department of Corrections (DOC), the Wabanaki Nations, county correctional facilities, the Maine Sheriffs' Association, health care providers, advocates, people with lived experience, and community partners across the state.

Arizona

Editor's Comment: Dare we even say it? Is the struggle over appointing a receiver for Arizona's prison healthcare system finally over? As you probably could tell from last week's Follow Up, we at COCHS expected this story, as it has for so long, to continue for quite a while longer.

But last Thursday, the Supreme Court denied Arizona's request to block receiver Annette Chambers-Smith from taking over healthcare operations in the state's prisons. Justice Elena Kagan denied the state's request for a stay, clearing the way for Chambers-Smith to assume control on October 19.

We wish Chambers-Smith the best. Now comes the far more difficult part: improving healthcare in Arizona's prison system. And one of the thing we will be observing closely are the resources required to implement these changes.

The U.S. Supreme Court has rejected Arizona's eleventh-hour bid to block the upcoming start of a court-ordered takeover of healthcare operations in its prisons after the state was found to have provided constitutionally inadequate care to incarcerated people and dragged its feet for over a decade in making required improvements. Justice Elena Kagan denied the state's request Thursday, leaving an outside corrections professional set to take over healthcare management for 25,000 incarcerated people on Oct. 19. Under a 2014 settlement, the state pledged to overhaul medical and healthcare services for prisoners but was soon accused of failing to make promised improvements. That led to more than $2 million in contempt-of-court fines and the eventual revocation of the agreement by U.S. District Judge Roslyn Silver.

AI

Editor's Comment: In the August 11 Weekly Update, our two lead articles examined the potential use of AI in correctional settings. Our comments focused largely on the inequities and harms that AI could potentially introduce or exacerbate. This Follow Up from the University of Colorado School of Medicine looks more closely at the other side of the equation, citing the experience of Lawrence Haber, MD, and the potential benefits of AI in correctional healthcare.

As we have seen repeatedly in articles included in the Weekly Update, staffing shortages are a persistent problem in correctional settings. Dr. Haber believes AI could help healthcare staff manage some of the gaps those shortages create. In behavioral health, for example, AI-assisted screening could help identify people who may be developing a mental health crisis. Other potential uses include multilingual translation, clinical documentation, and facilitating consultations.

Serendipitously, considering last week's and this week's CMS announcements approving Section 1115 reentry demonstrations, the article also discusses how AI might assist during the transition from incarceration back into the community.

Given the many, many articles all of us have been reading about AI lately, we expect the technology to appear more frequently in the Weekly Update—particularly as we begin seeing actual implementations rather than proposals about what AI might someday do.

So far, AI hasn’t been extensively integrated into health care in correctional facilities such as prisons, jails, and detention centers. Correctional health care is a complex landscape, partly because incarcerated people have a disproportionately high rate of health problems, but they also have reduced access and fewer options in health care compared to non-incarcerated people. In other settings, AI has shown some promise in helping more people access health care. Experts say this technology also could inadvertently worsen systemic inequity and mistrust through algorithmic bias. But if these concerns can be addressed, and AI can be implemented with care, could it potentially improve health care for people in the justice system?

ICE

For close to a decade, a federal immigrant detention center in Imperial County has avoided paying a large share of its property taxes by claiming that it should qualify as a charity. Now, California is bringing that arrangement to an end and preventing similar ones in the future. Gov. Gavin Newsom signed Senate Bill 420, which prohibits detention centers in California from receiving the Welfare Exemption — a tax break that’s typically reserved for charities.

Rumors were spreading for weeks in the spring of 2022. At Arizona State Prison–Marana, the talk centered on an employee of Management and Training Corporation, or MTC who was having sex with an incarcerated person. Despite widespread knowledge of the allegation, there were no reported incidents of sexual abuse or harassment. In 2023, Arizona State Prison–Marana was closed and languished in dormancy. after selling the prison back to MTC, the Marana facility is slated to reopen as a U.S. Immigration and Customs Enforcement detention center. Critics of the plan say the failure of MTC to properly deal with the sexual abuse allegations, raise serious questions about the company’s running a massive immigration detention center.

Congresswoman Adelita S. Grijalva released the following statement after it was reported that Management and Training Corporation would be opening a detention center in Marana within the next 60 days. This time, it’s turning to a private company with a record of overseeing prison conditions including alleged sexual abuse, inadequate food, extreme heat, and prison riots so serious that both Democratic and Republican governors have terminated contracts with them.

Congressman Joaquin Castro will host a field hearing Friday examining the impact of mass deportations and a proposed ICE warehouse on San Antonio's East Side. Bexar County Sheriff Javier Salazar is among those scheduled to testify, along with immigration law experts. Acting ICE Director David Venturella and a representative from GardaWorld Security have also been invited to testify.

Federal immigration officials are moving ahead with plans to turn an East Side warehouse into a detention center for as many as 1,500 people a day, despite months of opposition from San Antonio leaders and residents. ICE paid $66.1 million in January for the nearly 640,000-square-foot building at 542 S.E. Loop 410. In August, it awarded GardaWorld Federal Services a $17.3 million contract to renovate the property and provide services for its operation. Bexar County Commissioner Tommy Calvert is urging opponents to join an Oct. 3 march.

Since January 2025, at least 57 people have died in ICE detention. At least 10 of those died by suicide between January 2025 and May 2026. Those suicide deaths are higher than what has traditionally been seen at detention centers. During the 8 year period between 2008-2016 there were 6 total suicides in ICE detention. Then between 2017-2020 there were 9 suicides with 6 in 2020 during the start of the COVID pandemic. Then from 2021 to 2024 there were 2 total suicides. The rate of suicides per 100,000 people were at their highest in both 2020 and now in 2026 at 17.7 and 18, respectively. The unprecedented number of suicides shows that authorities are failing to properly look after the tens of thousands of people taken by the Trump administration’s aggressive deportation campaign.

OBBBA & OUD

From 2023 to 2024, the decline in drug overdose deaths was nearly 27 percent. The historic expansion of Medicaid-funded treatment was also a potentially important enabling factor. The One Big Beautiful Bill Act is expected to strip Medicaid coverage from approximately 1.6 million people with substance use disorders. Because Medicaid covers nearly half of nonelderly adults with opioid use disorder (OUD), coverage losses of this scale are a major threat to the primary payer for addiction treatment.

SAMHSA grantees offering MOUD, such as buprenorphine and methadone, must require clinicians to review each patient’s treatment plan annually—already best clinical practice—and discuss the option of discontinuing medication treatment. The language describing this requirement suggests that people with opioid use disorder are staying on MOUD for longer than is beneficial. In fact, evidence overwhelmingly suggests that the opposite is true. New requirements stipulated in the SAMHSA letter add wasteful administrative burdens for providers and are counterproductive given that the problem to be solved is MOUD underuse, not overuse.

Ending Crime and Disorder on America’s Streets

U.S. Department of Health and Human Services (HHS) Secretary Robert F. Kennedy, Jr. today announced in Houston, Texas the eight communities selected to receive funding through the new Safety Through Recovery, Engagement, and Evidence-based Treatment and Support (STREETS) program. Administered by the Substance Abuse and Mental Health Services Administration (SAMHSA), STREETS will provide $96 million over four years to help communities build coordinated systems of care for people who are homeless and have serious mental illness, substance use disorders, or co-occurring disorders. STREETS advances President Trump’s Executive Order on Ending Crime and Disorder on America’s Streets and the Great American Recovery, co-chaired by HHS Secretary Kennedy and White House Senior Advisor for Addiction Recovery Kathryn Burgum.

Capital Punishment

The execution of Tennessee death row inmate Christa Pike was halted after the state of Tennessee administered two failed rounds of its lethal injection protocol and federal public defenders filed an emergency appeal to end the execution and get Pike medical care. Pike was taken by ambulance to a hospital for treatment, according to a spokesperson for the U.S. Campaign to End the Death Penalty, but the group did not know her medical status.

The head of the agency that botched the execution of Christa Pike was brought to Tennessee three years ago to save the state’s death penalty. But the official, Frank Strada, had overseen three problem-plagued executions when he was a top prison official in Arizona, and his troubled record has become a focus of inquiries into how Ms. Pike ended up still alive after what should have been a lethal injection this week.

Tennessee’s embattled prison chief, Frank Strada, will step down later this month after overseeing the botched execution of Christa Pike. Mr. Strada has been at the center of national backlash over Tennessee’s second failed attempt at lethal injection this year and has faced bipartisan calls for his resignation. His departure comes ahead of an independent investigation into what went wrong.

Florida prison officials are refusing to give a “profoundly sick” 74-year-old man medical care while he waits for his scheduled execution October 13, drawing objections from more than 100 doctors. The man, William Lee Thompson, is the first known gravely ill prisoner who has been forced to live on death watch. Thompson was diagnosed with dementia and has required extensive hospital care in recent months for sepsis, systolic heart failure, severe malnutrition and multiple decubitus ulcers. He was released from UF Health Shands Hospital on the hospital’s understanding that he would return to the prison’s medical unit. But less than 24 hours later, Gov. Ron DeSantis signed Thompson’s death warrant, which resulted in Thompson’s removal from the prison’s medical facility.

COVID-19

Prison is a notoriously bad place for anyone with chronic illness because of the difficult living conditions and inadequate medical care. There are no reliable data on how many people in prison across the country have Long COVID, or, critically, what kind of care they are receiving. In 2020 and 2021, prisons had extraordinary rates of SARS-CoV-2 infection. During the first year of the pandemic, the rates of SARS-CoV-2 infections as well as mortality were several times higher in the prison system than in the general population. Continued circulation of COVID-19 means continued risk for reinfection, which can significantly impact health, including setting back the baseline of those who already have Long COVID.

Alternative Medical Care

The main drivers of rising correctional healthcare costs are clear: higher pharmaceutical prices, an aging prison population, costly specialist medical staff and overcrowding. Overcrowding alone is estimated to add $1.2 billion to the $80 billion that state departments of corrections spend annually. As for aging populations, in 2000, inmates over 55 years of age represented 4% of the incarcerated population. According to a 2022 study by the American Association of Naturopathic Physicians for the Oregon Legislature, naturopathic or integrative approaches can lower costs for certain chronic conditions, especially when they emphasize nutrition and lifestyle changes; exercise programs; smoking cessation; stress reduction; and prevention of disease progression. This extensive study found that these approaches may reduce medication use, hospitalizations or future cardiovascular risk in some patient groups.

Transgender

The Trump administration on asked the Supreme Court to revive for now a Bureau of Prisons policy cutting off certain medical interventions and social accommodations for transgender inmates. The Justice Department's emergency appeal stems from a federal district court order issued last month that continued to prohibit the Bureau of Prisons from enforcing its new rules against any inmate who is or will be diagnosed with gender dysphoria.

Visitations vs. Video

More than a decade ago, the sheriff in Solano County, Calif., found a new way to make money at his jails: video calls between inmates and their family and friends. The sheriff’s department received nearly $150,000 from video calls at its jails. Video calls are costly and glitchy. The calls cost $5.70 per 30 minutes, having recently been lowered from $9. At two of the county’s jails, families are allowed two free video calls per week through on-site kiosks at the detention facilities. The details of the contract with iWebVisit.com emerged recently in legal filings as part of a lawsuit brought by people with loved ones behind bars in Solano County. The contract was explicit about the profit potential for the county sheriff’s department. Alec Karakatsanis, a lawyer whose group Civil Rights Corps has been part of the legal effort to restore visits nationwide, said he expected the cases to eventually reach state supreme courts.

Rikers Island

New York City Department of Correction Commissioner Stanley Richards addresses the future of Rikers Island and the transition to borough-based jails, federal oversight, limits on solitary confinement and the challenges facing officers. As the first formerly incarcerated person to lead the department, Richards said "people first" is the guiding principle of his leadership.

A Rikers Island detainee suffering from clear signs of medical distress waited for roughly 3 ½ hours in a clinic holding pen without being seen because jail officers didn’t tell medical staff he was having a medical emergency, a scathing new report released Friday shows. John Price, 49, died from pneumonia with a MRSA infection, as he waited for care inside the Eric M. Taylor Center on March 28, the Board of Correction review revealed.

More than half of people held in New York City jails receive mental health services during their incarceration, testimony heard in a City Council hearing last week revealed. The reliance of incarcerated individuals on mental health services shows the role Rikers Island plays as a major site of psychiatric care — and raises questions about whether jail can provide the long-term treatment many people need.

Correctional Health Care Providers

Staffing Network Holdings

Attorney General Phil Weiser today announced a $2.86 million settlement with Staffing Network Holdings, L.L.C. over allegations that its former subsidiary, Quality Placement Authority, LLC, knowingly overbilled the Colorado Department of Corrections for health care staffing services in violation of the Colorado False Claims Act. QPA, which merged into Staffing Network Holdings in 2022, submitted hundreds of invoices charging the Department of Corrections higher travel rates for thousands of nursing shifts filled by local health care providers who did not qualify for those rates. To support the higher charges, QPA used false out-of-state addresses and falsified maps that made local providers appear eligible for travel rates.

Wellpath

The family of an inmate, Thomas Ricke, who died inside the Elkhart County Correctional Center has filed a federal civil rights and wrongful death lawsuit against the county, Sheriff Jeff Siegel, private medical contractor Wellpath and several others. The complaint claims Ricke died of dehydration after untreated mental health crisis. Ricke had diagnosed schizophrenia and bipolar disorder and was admitted to a detention center in Marion County on April 28. The suit claims staff failed to provide him with a psychiatric evaluation for over a week, offered no treatment plan, and never administered psychiatric medications as his condition rapidly deteriorated into acute psychosis. The lawsuit accuses Wellpath, formerly known as Correct Care Solutions, of cutting medical care to underbid competitors.

We Are Observing The Mid-October Holidays
The Next Weekly Update Will Be Published On October 20