Don’t Try This At Home: Mixing Criminal Justice & Healthcare

Highlighted Stories

Editor's Note

Last week, in the Follow Up section—part of our ongoing coverage of New York’s prison system—we included an article proposing that judges should gain firsthand experience with conditions inside state prisons. From COCHS’ perspective, that proposal underscored a broader issue: the deep compartmentalization within the criminal justice system. Law enforcement, judges, healthcare providers, and county commissioners often operate in silos, with little understanding of one another’s roles or constraints.

As we reviewed this week’s articles, a related theme emerged—not just compartmentalization, but how conflicting interests within the system can negatively affect the health of incarcerated people.

The first highlighted article, from SCOTUSblog, illustrates this point. In New Orleans Parish, Sheriff Susan Hutson is resisting a long-standing consent decree requiring the construction of a mental health facility. The decree, approved in 2012, originated from a lawsuit alleging inadequate housing for people with mental health issues. Hutson argued that conditions at the jail had changed and that she should no longer be bound by the decree. Criminal justice advocates have long maintained that people needing mental health care should not be in jail in the first place. The Supreme Court declined to hear her appeal. Over time, the consent decree has become a political fault line between mayors and sheriffs—and, in Hutson’s case, a political liability, compounded by a widely reported escape earlier this year. She was defeated in this year's election cycle by Michelle Woodfork. The mental health facility itself still remains only partially completed.

The second highlighted story, from Justia, takes us to Alabama, where conflict arose between Walker County commissioners and a newly elected sheriff over a private healthcare vendor, Preemptive Forensic Health Solutions. Despite the company employing no physicians and multiple deaths occurring under its care, Walker County renewed the contract—over the sheriff’s objections. When a lawsuit was filed after one of these deaths, a district court ruled that the county bore no responsibility beyond funding healthcare services. The Eleventh Circuit Court of Appeals reversed that decision, holding that a county can still be liable if its policies amount to deliberate indifference. COCHS has long cautioned that outsourcing healthcare does not absolve jurisdictions of responsibility.

To illustrate just how prevalent the “hey-it’s-my-vendor’s-problem-not-mine” mindset is within the criminal justice system, consider the third highlighted article from Shelby County (Memphis, TN). A detained paraplegic man livestreamed on Facebook, showing the filthy conditions in the jail and the lack of medical care he received. The sheriff, perhaps attempting to deflect accountability for those conditions, stated in writing that “the Sheriff’s Office does not provide medical care in the jail”—noting that care is handled by an independent company, Wellpath, and that responsibility therefore rests with the mayor who contracted with that provider. At least in Walker County, Alabama, the sheriff attempted to address problems with the vendor by opposing county commissioner’s decision rather than resorting to what looks like buck-passing in Memphis.

The fourth and last highlighted article examines why poor health outcomes persist in correctional systems, once again pointing to private vendors—Wellpath, again! These firms have become de facto extensions of the justice system, sustained by privatization. The logic of this arrangement is now being tested at the highest level: as reported last week, GEO Group is asking the Supreme Court to grant it qualified immunity from prosecution by claiming the legal status of a government entity.

As COCHS has repeatedly argued, improving healthcare outcomes behind the walls requires a system that stands outside these internal conflicts—namely, Medicaid. Because it is not a component of the criminal justice system, Medicaid-based coverage would create independent, outcome-driven accountability—something easily lost amid the competing agendas of the system’s various parts.

In short, we shouldn’t expect consistent or equitable health outcomes from a criminal justice system mired in its own contradictions.

The Supreme Court on Monday turned down an appeal from the sheriff of New Orleans in a dispute over the city’s obligation to build a new facility for inmates with mental health issues. The dispute began more than a dozen years ago, when inmates at the prison in Orleans Parish went to federal court. They argued that the facilities there violated the Constitution’s ban on cruel and unusual punishment because they did not provide adequate housing for inmates with mental health conditions.

A man held for several months in an Alabama county jail died after allegedly being denied medical care. His mother, acting as the administrator of his estate, claimed the jail’s private healthcare contractor, Preemptive Forensic Health Solutions—an unlicensed provider without physicians—was grossly incompetent. Despite multiple inmate deaths and public concern during a sheriff’s election, the county renewed the company’s contract, retaining sole control over its continuation even after a new sheriff sought to end it. The U.S. District Court for the Northern District of Alabama dismissed the case, ruling that Alabama law limited the county’s role to funding, not administering, inmate healthcare, thereby shielding it from liability. The Eleventh Circuit Court of Appeals found that the county could be liable if its policy of retaining an incompetent contractor showed deliberate indifference to inmates’ constitutional rights.

Derrick McDonald, who’s paralyzed, posted a live video on Facebook from inside Shelby Conty jail’s medical unit.After being placed in the jail’s medical unit, McDonald said he had to alert people to the jail’s conditions. McDonald calls the jail conditions nasty, citing roaches and mold. But his biggest issue was not being changed for days. The Sheriffs Office responded with this disclaimer: The Sheriff’s Office does not provide medical care in the jail. The Mayor’s Office contracts with a medical company (Wellpath) to provide medical care to all County inmates. We are working with the company and the personnel the Mayor has charged with overseeing inmate medical care to thoroughly investigate the complaints.

Amid a lack of consistent health care standards in correctional facilities, firsthand accounts, mortality studies and lawsuits filed by prisoners and their advocates suggest that negative inmate medical outcomes are common—even though comprehensive data on preventable prisoner health problems is limited. In a 2025 study, University of Pennsylvania researchers found that 30% of inmates who died in custody from cardiovascular disease in 2019 did not undergo diagnostic testing and that more than 25% did not receive the medications for the conditions that caused their deaths.Legal challenges have mounted among for-profit companies that provide medical care in prisons and jails. Chief among them is Wellpath, the for-profit inmate health care provider. The company filed for bankruptcy in November 2024. Wellpath CEO Chief Executive Officer Ben Slocum said the company has “made significant investments to ensure our patients received the highest level of care.”

Follow Ups

Iowa

Editor's Comment: The Iowa Department of Corrections has decided not to accept bids from correctional healthcare vendors, effectively ending—for now—the privatization of healthcare in the state prison system. Will this bucking of a national trend last? Hard to say.

AFSCME Council 61, the union representing the state’s prison healthcare providers, saw the department’s earlier push toward privatization as an insult to its members. That threat alone prompted many to resign. When we last revisited this story, there were suspicions that former department employees who had gone to work for VitalCore may have helped advance the privatization effort.

The last article in this Iowa saga ties neatly to themes raised in this week’s Editor’s Note, connecting privatization to negative health outcomes. Given how many costly lawsuits jurisdictions now face, the supposed savings from privatization seem like counting pennies on the floor while lawsuit dollars fly out the window. In the future, Iowa might consider itself lucky for having avoided the privitization craze.

The state corrections department confirmed Wednesday it would not accept any of the bids submitted by companies that responded to a state request for delivery of health care services in Iowa’s nine prisons. An Iowa Department of Corrections spokesperson confirmed the agency’s decision. “After reviewing proposals and evaluating options for privatizing and improving health services, the Iowa Department of Corrections has decided not to move forward with a vendor,” said a department statement. The department has not disclosed which vendors that had responded to the RFP. The state corrections department in early July notified staff of its intention to seek a private company to provide health care services in Iowa’s nine state-run prisons. Roughly 300 Iowa Department of Corrections health care workers would have been impacted by such a change.

Iowa Department of Corrections confirmed that it would not privatize healthcare. Todd Copley, president of AFSCME Council 61, which represents health care workers in Iowa's prisons, previously called the idea "a slap in the face to the public employees who've kept Iowa's correctional health system running through crisis after crisis."

Medical employees and inmates have been awaiting a privatization decision since July, when the state first announced plans to explore privatizing prison health care. Not all employees waited for a decision. More than 60 of approximately 300 employees in Iowa’s prison medical care system resigned, according to two internal Iowa Department of Corrections staffing reports .

While there is no definitive source that details the extent of the privatization of prison health care in the U.S., a Pew Charitable Trusts study showed that by 2015 a total of 20 states had fully outsourced prison health care services to private companies and eight more states privatized at least a portion of those services. And in 2020, a Reuters review of health care data from 523 U.S. jails between 2008 and 2019 found that 62 percent had outsourced prison health care to private companies. The Reuters report found that, between 2016 and 2018, prisons who relied on one of the five leading private prison health care companies saw higher death rates than facilities with government-run health care services.

New York

Editor's Comment: With ongoing prison closures, staffing shortages, and mounting pressure from the Department of Corrections and Community Supervision on the governor to limit reforms, the perfect storm of correctional chaos in New York State shows no sign of abating.

And just yesterday, two new New York Times articles were added to these New York Follow Ups—once again reporting correctional officers assaulting incarcerated people, and once again complaints from these officers about the Humane Alternatives to Long-Term Solitary Confinement Act (HALT).

Time for heavy duty storm gear...

Another New York prison is set to shut down as Gov. Kathy Hochul’s administration continues to grapple with an ongoing staffing crisis at state lockups. The state Department of Corrections and Community Supervision confirmed it would close Bare Hill Correctional Facility in Franklin County and part of the Collins Correctional Facility in Erie County, forcing almost 300 workers to move to another premise. The announcement quickly drew outrage from the corrections officers union.

In an “aggressive recruitment effort,” next year’s budget allows for the lowering of the hiring age for correction officers from 21 to 18 and removes the New York State residency requirement for security staff. “As a result of this campaign, DOCCS has seen a 160% increase in individuals taking the Correction Officer exam; hiring is up 62 percent, and graduation from the academy is up 46 percent,” the department stated.

The state Department of Correction & Community Supervision is driving the pressure on Gov. Kathy Hochul to dilute reforms that strengthen prison oversight and accountability after a death in a state facility. Legislative staff and the governor's office are in deep negotiations over an omnibus bill passed to address a culture of prison violence after two incarcerated men — Robert Brooks and Messiah Nantwi — were beaten to death by correction officers in the last year. Lawmakers said DOCCS leaders feel the Legislature did not include the department in negotiations before passing the bill this spring — and Hochul is sensitive to the department's needs after firing more than 2,000 correction officers who participated in an illegal wildcat strike earlier this year.

Drawing on thousands of pages of court records, disciplinary data and interviews with dozens of current and former inmates, The Times identified more than 120 instances in the past decade in which guards were described as having punched, kicked or stomped on prisoners, smashed their fingers in cell doors, held their legs apart and struck their genitals with batons, and even waterboarded them — all while the prisoners were handcuffed or otherwise restrained.

New York State prison guards say that the Humane Alternatives to Long-Term Solitary Confinement Act (HALT), stripped them of a crucial tool for keeping order — because it barred holding certain inmates in solitary confinement. As a result, they have said, more prisoners who should have been held in isolation have been moving freely among the general population, causing fights and attacking the guards, leaving them with no choice but to restore order with force. HALT barred prison officials from placing any person with a disability in solitary confinement for any amount of time, and it forbade them from holding any person in isolation for more than 15 consecutive days. The New York State’s inspector general found that the law was not being followed in all prisons.

Compassionate Release

Compassionate release laws, otherwise called medical parole, are designed to allow release of incarcerated people with advanced illness who are no longer considered a public safety risk. Despite the promise of compassionate release as a humanitarian and cost-saving action, a staggeringly low number of people are released on medical parole. Eligibility for medical parole generally hinges on whether a person meets medical criteria and poses an ongoing public safety threat. Authority to make these determinations rests solely with the politically appointed commissioner of the state Department of Corrections (DOC) or a medical parole board. This places medical decision making in the hands of corrections officials who oftentimes lack clinical expertise.

ICE

After years of struggling to find enough workers for some of the nation’s toughest lockups, the Federal Bureau of Prisons is facing a new challenge: Corrections officers are jumping ship for more lucrative jobs at Immigration and Customs Enforcement. This is one of the unintended consequences of the Trump administration’s focus on mass deportations. For months, ICE has been on a recruiting blitz, offering $50,000 starting bonuses and tuition reimbursement at an agency that has long offered better pay than the federal prison system. For many corrections officers, it’s been an easy sell. “We’re broken and we’re being poached by ICE,” one official with the prison workers union told ProPublica. “It’s unbelievable. People are leaving in droves.”

Since Donald Trump’s return to office, the use of solitary confinement in immigration detention centers has surged. Facilities in Arizona account for much of this increase. As of September 21, Immigration and Customs Enforcement (ICE) was holding roughly 60,000 people; in the previous month, 1,151 detainees spent at least one day in isolation—the highest number ever recorded. Eloy Detention Center, opened in 1994 and operated under a DHS contract with the private prison company CoreCivic, illustrates the problem. A scathing October 2024 report from Detention Watch Network described Eloy as “one of the most controversial immigration detention facilities in the United States,” noting its unusually high number of deaths in custody.

Seven detainees at the California City Immigration Processing Center have sued U.S. Immigration and Customs Enforcement, alleging the CoreCivic-run facility is plagued by sewage leaks, bug infestations, and denial of food, water, and legal access. The suit, filed in the Northern District of California, claims detainees lack adequate clothing for cold desert nights and receive little to no medical care, even for life-threatening conditions. Those with mobility impairments allegedly go without wheelchairs and struggle to bathe or dress themselves. The plaintiffs seek class-action status on behalf of all detainees at the facility, about 75 miles east of Bakersfield. CoreCivic says the site provides “robust medical care.”

This week, Congresswoman Julia Brownley (CA-26) joined her Democratic Women’s Caucus colleagues in a letter demanding the urgent release and investigation of pregnant, postpartum, and nursing women currently detained by U.S. Immigration and Customs Enforcement (ICE) in contradiction to Federal regulations. The Members expressed their extreme concern to ICE Acting Director Todd Lyons and U.S. Department of Homeland Security (DHS) Secretary Kristi Noem after hearing reports of pregnant women detained and mistreated in several ICE facilities in Illinois, Louisiana, and Georgia.

Opioid Epidemic

Fentanyl and other drug addictions continue to challenge jail and medical staff this year as more people are using and dying of the drug inside the city’s jail system. Numbers from the Denver Sheriff’s Department show deputies and jail medical staff from Denver Health are using Narcan, the fast-acting medication that reverses overdoses, more often this year. Last year, Narcan was used in 76 incidents. So far this year, the jail has documented 84 incidents of Narcan use.

Individuals with opioid use disorder (OUD) hold varying perceptions of the three medications to treat OUD (MOUD). Data on these perceptions among those with criminal-legal involvement is limited. To optimize MOUD service delivery, especially in criminal-legal settings, it is essential to explore the preferences and attitudes of those with legal involvement. It remains unclear how and why MOUD preferences differ as influential factors evolve, including structural changes such as in illicit drug supply and in treatment policies like expanded take-home dosing. Importantly, the widespread presence of fentanyl in the US drug supply may critically impact MOUD experiences.

Mass spectrometry urine drug testing for patients with opioid use disorder and co-occurring polysubstance use provided evidence-based criteria substantiating the notable superiority of definitive testing at nominal additional cost by identifying significant additional instances of risky substance use necessitating harm reduction interventions for substances that would have remained undetected and untreated if testing were limited to presumptive immunoassay testing.

A life-threatening condition called sepsis kills hundreds of people in American jails and prisons each year has found, but inmates with a history of drug use are at particular risk. “Chronic intravenous drug use,” “extensive drug history,” and “suspected illicit drug withdrawals” are just some of the notes found among in-custody death records of inmates who died with sepsis between 2015 and 2023.

State Roundup

Arizona

As the courts and law enforcement systems and mental health issues, as well as substance abuse disorders, become increasingly entangled, criminal justice and health care experts have grown concerned that Pima County’s jail has become the dangerous default for people who need medical treatment, not incarceration. They argue delays in court-ordered treatment are violating the constitutional rights of incarcerated people with mental illness.

Georgia

The effects of Georgia’s policy of forced detransition for trans prisoners, currently on hold, were disastrous. In one Central Georgia prison, spoke to the manager of the medical unit who painted a picture of ballooning case loads and overwhelmed workers. “The mental health case load nearly toppled our appointment catalogs daily, because the offenders removed from the hormones were experiencing severe mood swings,” the manager stated. “There was no way to continue the care for other offenders with the influx of needed mental health sessions needed for those taken off the hormone replacement injections.”

Mississippi

To date, CoreCivic has contracted with four states, three counties, one U.S. territory and the U.S. Marshals Service to house people at the 2,672-bed Tallahatchie prison in Mississippi. In the industry of incarceration, CoreCivic is one of the two largest private prison companies in the United States, operating more than 70 facilities. The Tennessee-based company reported quarterly earnings this month of $580.4 million, up from 18.1% from the prior year quarter.

Missouri

For years, the public had no way to know just how many people died in Missouri’s prisons, a Marshall Project investigation found, because the state Department of Corrections wasn’t counting. Instead of annual totals, the department historically responded to public records requests with partial counts, cobbled together from multiple sources. News outlets and researchers unknowingly reported the incorrect numbers to the public: Did 125 incarcerated people die in 2023? Or 134? Maybe 137? Some states, like Illinois, share annual reports on prison deaths openly. But in Missouri, the prison system isn’t required to report year-end totals to anyone.

North Carolina

Leslie Cooley Dismukes, the new secretary of the state Department of Adult Correction, wants to prioritize reentry and reduce recidivism. But she has to solve a staffing crisis first. She wants each of the state’s prisons to become a “reentry facility,” where those within a year or two of their release date can access life skills training, mental health support, and one-on-one assistance focused on getting out—and staying out. So far, 24 prisons carry that designation; Dismukes certified three of them this year.

Ohio

Incarcerated women would have free access to feminine hygiene products in Ohio correctional facilities if Gov. Mike DeWine signs a newly passed bill into law. Ohio House Bill 29 passed unanimously in the House earlier this year and in the Senate during last Wednesday’s marathon session. The bipartisan bill — introduced by Democratic state Rep. Latyna M. Humphrey and Republican state Rep. Marilyn John — also requires correctional facilities to allow female inmates to shower once per day while menstruating. The federal government started offering free access to menstrual products for federal inmates starting in 2017 and 25 states have laws requiring free access to feminine hygiene products in prisons.

Pennsylvania

A nurse at Pennsylvania’s York County Prison told a pre-trial detainee, Willie Cunningham, who was suffering from appendicitis that he had heartburn and gave him Pepto-Bismol, according to a lawsuit filed on November 14 by the Pennsylvania Institutional Law Project. The suit was filed against York County, the facility’s then-medical provider, PrimeCare Medical, Inc., and three nurses who allegedly failed to treat Cunningham.

Texas

Luzerne County’s prison system remains the top departmental expense in the proposed 2026 budget, as it has been for many years. Spending for the county’s Correctional Services Division is budgeted at a proposed $33 million next year, which is a $1.5 million increase from this year’s budget. Medical services for prison inmates are primarily provided through Wellpath LLC. The county switched to an outside provider a decade ago because the administration determined partial outsourcing would be more cost-efficient. The proposed correctional budget includes $4.6 million for this service next year, or $351,133 more.

Utah

Low-income aid advocates, faith leaders and environmental groups came together to stand against state leaders’ proposal to put a 1,300-bed homeless “campus” in a field with wetlands near a small agricultural neighborhood in northwest Salt Lake City. One of the biggest objections advocates have is that the proposed campus is shaping up to be more of a prison where people will be forced into drug or mental health treatment. Gov. Spencer Cox recently called the campus a “top priority” in order to both bring more “compassion” and “accountability” to Utah’s homelessness system. State leaders’ vision (which has been years in the works) also coincides with President Donald Trump’s executive order issued in July, titled “Ending Crime and Disorder on America’s Streets.”

Two new legislative audits paint a picture of inadequate and flawed mental health care in Utah’s state prison in Salt Lake City. The reviews found employees failed to properly monitor those at risk of suicide, and the impact is illustrated in several examples of self harm, with one person taking their own life. Auditors said a psychiatrist who assisted in the audit process concluded “inmates are often abandoned” because of a lack of consistent follow-up in care. They also recorded examples of some getting the wrong psychiatric medications and others missing doses.

Rep. Steve Eliason wants to codify higher standards for mental health and substance abuse treatment in prison after two audits found the state failed to properly monitor, medicate and treat many with severe mental illness. A pair of wide-ranging legislative audits found inmates who were deemed “acutely suicidal” weren’t constantly monitored in 2024 and 2025. Some managed to harm themselves and one person died in a suicide. In response, the state Department of Corrections and the Division of Correctional Health Services said they’re putting together new policies, training and ways to review care, with plans to have some changes in place by next July and others by January 2027.

Wisconsin

Under scrutiny over prison deaths and living conditions, the Wisconsin Department of Corrections has received recommendations that aim to improve life in adult prisons, including solitary confinement, suicide watch, mental health care and basic corrections practices. In a statement, the advocacy group Ex-Incarcerated People Organizing (EXPO) said the report “confirms what directly impacted people and advocates have said for years: Wisconsin’s prisons are dangerously overcrowded, under-resourced and in desperate need of healing-centered reform.”

Correctional Healthcare Vendors

Wellpath

After a 40-year run as the Monterey County Jail’s health care provider, Wellpath’s tenure is coming to an end. The search for its successor has been a focus of County officials in recent months, but the real test – whether the next contractor can right a system long criticized for inadequate medical care – is yet to be determined. The Monterey County Board of Supervisors unanimously approved a five-year and five-month $139 million contract with Correctional Healthcare Partners (CHP), a San Diego-based company founded in 2020.

Video recorded inside the Oneida County Correctional Facility in upstate New York last year shows nurses and corrections officers crowding into an infirmary cell after a crucial minutes-long delay, criticizing faulty equipment and cracking jokes about their efforts as they administer CPR to an inmate dying on the floor. A federal lawsuit in the case, filed by Mr. Cater’s father, Terry Watson, in the Northern District of New York, names the county, the medical provider Wellpath Holdings Inc. and 10 nurses and corrections officers as defendants. Mr. Cater’s death was a result of the staff’s “negligence and medical malpractice,” according to the suit. Wellpath has faced dozens of wrongful death lawsuits and accusations that its employees have provided deficient medical care to prisoners.

Happy Thanksgiving!
COCHS' Weekly Update Will Resume on December 9th