Technological Deliberate Indifference? State Correctional Systems Using Paper Health Records

Highlighted Stories

Editor's Note

Today’s highlighted stories focus on the adoption of electronic health records (EHRs) in several state prison systems. The first story reports on the rollout of EHRs in Virginia, North Carolina, and Georgia. The second, which might normally have appeared in the state roundup section, concerns an incarcerated person in Washington State who died after a poorly diagnosed case of liver cancer — a failure that cost the state $6 million in a settlement with the family. A report following the death criticized the state for lacking an EHR, and the department now claims it is “working toward an EHR.”

Here at COCHS, our message to these prison systems is simple: “Welcome to the 21st century — about twenty-five years later.” The first article practically gushes over these three southern states adopting technology as though this were a bold new idea. From COCHS’ perspective, this feels more like technological deliberate indifference. Were all these complex systems really on paper until now? And Washington State “working toward” an EHR — whatever that means — hardly inspires confidence.

This speaks volumes about how isolated correctional healthcare remains. Back in 2009, the Health Information Technology for Economic and Clinical Health (HITECH) Act — part of the American Recovery and Reinvestment Act — launched a nationwide push toward EHR adoption. Many correctional institutions were aware of these efforts, and some had even implemented EHR-like systems well before the HITECH Act. COCHS' CIO has published multiple issue papers and peer-reviewed articles on the adoption and implementation of electronic healthcare technology within carceral facilities:

• Jails And Health Information Technology: A Framework For Creating Connectivity
• Meaningful Use and Corrections: Unknown Opportunities
• Prescribing and Dispensing Medications within Correctional Environments: The Role of Health Information Technology
• The Impact Of Policies Promoting Health Information Technology On Health Care Delivery In Jails And Local Communities
• Health Information Exchange between Jails and Their Communities: A Bridge That Is Needed under Healthcare Reform

So no — these implementations are hardly new or groundbreaking. They are long overdue.

EHRs

Paper charts are quickly becoming a thing of the past in prison infirmaries across the South. In Virginia, North Carolina and Georgia, corrections officials are swapping clipboards for keyboards, bringing in electronic health record systems (EHR) to make it easier for doctors and nurses to look up patient histories and spot health issues sooner. In Richmond, that shift is taking shape with the Virginia Department of Corrections’ (VADOC) full rollout of DOCHealth, a new EHR system designed for the state’s incarcerated population. The system first went live in women’s facilities in November; this month, VADOC completed its statewide expansion to men’s facilities. A recent news release called the DOCHealth launch “a transformative moment” in correctional health care. The system provides improved continuity of care through comprehensive medical histories and real-time access to critical health information, with the enhanced ability to track chronic conditions and treatment compliance. Virginia’s move toward digital health care is part of a broader trend. Just across the border, the North Carolina Department of Health and Human Services rolled out an Epic-powered EHR in August, at all 13 state-operated health-care facilities. Meanwhile, the Georgia Department of Corrections implemented NaphCare’s TechCare 5.0 across 62 correctional facilities in just nine months, it announced in August.

Washington state has agreed to pay $6 million to settle a wrongful death lawsuit over lapses in the cancer diagnosis and treatment of Michael Sublet who died at Monroe Correctional Complex. Ed Budge and Andrea Woods, attorneys who represented Sublet's family in the lawsuit, said the case is another that points to the need for better medical care at DOC — both to prevent needless suffering and further expensive lawsuits that are borne by taxpayers. A required fatality review conducted after Sublett’s death found DOC lacked a standard process for reviewing important test results from outside medical providers. The review also noted the ongoing problem of DOC not having electronic health records. The prison system still relies on paper records that can contribute to medical errors. DOC is getting $11.9 million in the most recent legislative session to work toward an electronic health records system.

Follow Ups

Dauphin County, Pennsylvania

Editor's Comment: The Dauphin County/Mediko/PrimeCare article is fascinating for what it implies but does not quite say. The article briefly notes that Mediko, the new provider for the county prison (Pennsylvania calls its jails “prisons”), has no ties to county commissioners. This comment refers to the fact that former county commissioner and prison board chair Jeff Haste received more than $350,000 from PrimeCare Medical while in office.

Equally striking is one commissioner’s defense of Mediko’s contract price, claiming it will save the county money over time by reducing litigation costs. While that may be true in some areas of care delivery, correctional healthcare is extraordinarily complex. The relationship between correctional staff and healthcare providers is often anything but seamless. Over the years, the Weekly Update has reported numerous cases in which jurisdictions — together with their vendors — have paid out millions in settlements resulting from communication failures and systemic breakdowns that led to serious harm or death.

A new healthcare provider for Dauphin County Prison (DCP) is raising some questions and concerns. The contract was approved for the county to enter a three year agreement with privately owned company, Mediko, at an annual cost of over $13 million —a price that raised alarms for Commissioner George Hartwick. Commissioner Justin Douglas didn't deny the heftier cost of the contract, he did point out that Mediko would significantly lessen the risks of litigation and, therefore, save taxpayers money. He also stated it's a healthcare provider that has no ties with any commissioners—something he said would ensure less corruption within the prison system. And regardless of what contract commissioners would have gone with, Douglas stated that the price would have been more expensive than the previous prison healthcare contracts (PrimeCare) the county had entered.

Iowa

Editor's Comment: Next stop: Iowa! We at COCHS are watching with great interest the Iowa Department of Corrections’ reported plans to privatize healthcare in its prisons. The article below comes from a union website rallying opposition to the move. As noted in an earlier Follow Up, questions have been raised about what is driving this initiative: former DOC employees now work for VitaCore, and the language in the RFP closely mirrors that of VitaCore’s existing contracts. As the song from The Music Man — set in Iowa — reminds us: “You gotta know the territory!”

Union rallies for Fort Madison prison workers: Prison health care workers unionized with AFSCME Council 61 held a rally Wednesday against a proposal from the state that would outsource prison health care across Iowa. “Whenever we see privatization, it’s not about looking out for the good of citizens,” said Charlie Wishman, president of the Iowa Federation of Labor. “(This proposal by the State is) about introducing a profit motive into taking care of people.”

Ending Crime and Disorder on America's Streets

Editor's Comment: We return to President Trump’s much-discussed executive order, Ending Crime and Disorder on America’s Streets. The New York Times article below focuses on one of its central components: the civil commitment of homeless individuals with substance use disorders. The Times notes that roughly two-thirds of states, including the District of Columbia, already have such laws on the books. For those interested in how systems function, the article provides a useful overview of how civil commitment works — who decides and who pays. Speaking of payment, the article points out that the administration’s cuts to Medicaid will make accessing treatment even more difficult. These contradictions are likely to generate many more articles — and much debate — in the years to come.

The sight is increasingly common: people openly using drugs, menacing pedestrians, and littering sidewalks and parks with needles and foil. President Trump recently proposed forcing them off the streets and into treatment. The idea is not as far-fetched as it seems — at least 34 states and the District of Columbia already allow involuntary rehab for severe substance use disorders. Research, however, is limited. A 2024 study found no significant difference in opioid overdose deaths between states with civil commitment laws and those without. These laws are lightning rods, raising a deeper question: is addiction an illness or simply personal choice?

New York State

Editor's Comment: Back to New York State — and specifically the HALT Act, which was designed to curb the overuse of solitary confinement. A committee of correctional officers, unsurprisingly less than enthusiastic about the HALT Act, has proposed changes to make it easier to place individuals in solitary. The NYCLU has pushed back, noting that the committee was composed entirely of correctional officers who opposed the HALT Act from the start. Over the past three years, numerous advocacy organizations have filed lawsuits against the Department of Corrections for allegedly failing to fully implement the law’s provisions. As noted in last week’s Follow Up section, mentally ill people at Marcy Correctional Facility are still being kept largely in their cells — a practice that has now triggered class action litigation. Solitary confinement has become a recurring topic, as the next section of this Weekly Update makes clear.

A committee formed after this year’s strike by New York correction officers to review the use of solitary confinement in state prisons has recommended multiple proposed amendments to the Humane Alternatives to Long-Term Solitary Confinement Act, or “HALT” Act. The committee’s recommendations include giving the department the flexibility to place an inmate in segregation for up to 15 days for “recidivist misconduct” when they are in the prison’s general population. They suggested three incidents within a 30-day period could trigger that provision, which they said would be invoked “in cases where it has been determined that alternative interventions have failed, and the ongoing misbehavior creates an unreasonable risk to safety or disruption to the operation of the facility.” The NYCLU criticized the committee that reviewed the solitary confinement law for being comprised entirely of what they said are opponents of the HALT Act. The committee was comprised of representatives of the corrections department, several unions whose members work in state prisons, the governor’s Office of Employee Relations and the state Division of Criminal Justice Services.

Solitary Confinement

Use of solitary confinement in immigration detention is soaring under the Trump administration. Immigration and Customs Enforcement placed at least 10,588 people in solitary confinement from April 2024 to May 2025. The researchers at Physicians for Human Rights analyzed individual cases in New England and found "systemic use of solitary confinement for arbitrary and retaliatory purposes," such as requesting showers, sharing food or reporting sexual assault.

In Nevada, as much as one-tenth of the state's entire prison population is currently in solitary confinement. And while the use of solitary confinement in prisons has grown in recent decades, especially with the advent of supermax and private prisons, there's growing concern over its efficacy.

This study constitutes the first examination of solitary confinement exposure during prison and illicit drug and alcohol test failure upon release to the community. The unique data used here allowed us to link prison experiences to drug test results on over ten years of parole populations in Pennsylvania. Drug test failure was common among those on parole and especially for those with severe SUD. Solitary confinement during incarceration was associated with higher odds of test failure

ICE

A federal judge ordered the Trump administration to continue improving conditions for migrants being held in a Manhattan federal building, writing that he was intervening to protect detainees from potentially “unconstitutional and inhumane treatment.” The judge, Lewis A. Kaplan, had already ordered the Immigration and Customs Enforcement agency on Aug. 12 to improve conditions at the building, 26 Federal Plaza, where migrants were being held in squalid and cramped conditions, according to a lawsuit filed by a migrant detained there.

Nineteen people detained at an immigration detention center that the Trump administration opened within Louisiana’s infamous Angola prison were entering their fifth day on hunger strike on Sunday, according to advocacy groups. Those striking at the Immigration and Customs Enforcement (Ice) processing center set up at Angola’s former Camp J are demanding access to medical and mental health care – including prescription medications, according to the Southeast Dignity Not Detention Coalition (SEDND) and the National Immigration Project (NIPNLG).

The horrifying conditions of ICE detention facilities in New Mexico are not a secret. Deeply committed advocates here in our state and nationwide have been calling this reality out for years. On Sept. 5, the Board of Immigration Appeals, the quasi-judicial body under the Department of Justice striped all immigration judges of the ability to award a bond to a person in a detention center who entered the United States without permission. This means that most people arrested by ICE will be effectively stuck inside the detention center for the duration of their removal proceedings with no meaningful opportunity to be released. As New Mexicans, we have very little control of the Board of Immigration Appeal’s decisions and the $45 billion allotted for the expansion of ICE detention under the Big Beautiful Bill. But we do have a say about whether to expand ICE detention in our state. Although our governor has decided not to put a bill limiting local immigration detention contracts on her call for the Oct. 1 special session, this issue should be front and center at the 2026 legislative session.

State Roundup

California

When California lawmakers extended indoor heat protections for workers across California last year, unfortunately, they stopped at the prison gate, leaving tens of thousands of correctional officers and thousands of their coworkers to clock in for their shifts in record-breaking heat with no guaranteed safeguards. In July 2024, the Division of Occupational Safety and Health adopted an indoor heat regulation that requires employers to provide drinking water, cooling areas, and active monitoring for signs of heat illness when the temperature reaches 82 degrees. The Occupational Safety and Health Standards Board initially approved the rule in March 2024, but Governor Gavin Newsom’s administration halted implementation over prison costs.

A sheriff who is a leading candidate for governor of California hid the causes of a mounting epidemic of jail deaths behind a culture of cover-up and retaliation, a former captain in the department said in her first interview since she filed a lawsuit outlining her claims. Riverside County Sheriff Chad Bianco ordered Captain Victoria Flores not to answer questions from a civil grand jury investigating jail conditions, Flores alleges. Another of her bosses told her not to leave a paper trail about a detainee’s overdose.

Kansas

Drug-soaked paper was smuggled into at least one Kansas prison, according to state officials, who cited the ordeal as the reason for changing print newspaper subscription policies. In late August, the Kansas Department of Corrections suddenly canceled subscriptions purchased by outside parties for those in state custody, confounding newspaper publishers across the state. Officials cited “dangerous contraband” and a need to preserve safety but did not go into specifics. Emily Bradbury, the executive director of the Kansas Press Association, said concerns remain for Kansas newspaper publishers and media professionals. She has heard from more publishers across the state who have seen canceled subscriptions following the policy change.

Texas

Ostensibly, medical care in American prisons should look just like medical care offered outside prisons. But decades of litigation and scandals have shown that correctional healthcare occupies a space wholly its own. Issues of funding, security, staffing, and bias all complicate the provision of care behind bars. Nursing expert Angela Clark, a University of Texas at Austin professor emeritus who’s testified in court about medical conditions in correctional settings, said the allegations “show a pattern of not meeting expected national standards for advanced practice nursing in a correctional setting.” She said that some allegations—withholding seizure medication, not facilitating a bottom-bunk bed for a one-armed man, and treating patients with hostility—were “especially troubling.”

On any given day in the Bexar County Jail, over 100 inmates aren’t waiting for a lawyer or a court date. They’re waiting for a hospital bed. Some have already spent months behind bars, found incompetent to stand trial and struggle with mental illness. Stabilized with medication inside a cell, they remain in limbo because Texas doesn’t have enough forensic psychiatric beds — secure hospital beds reserved for criminal defendants who need mental-health treatment before their case can move forward.

Vermont

In just two years, Vermont’s prison population has risen by almost 300, from 1,366 in September 2023 to more than 1,650 today. At the same time, Vermont’s prisons have experienced persistent staffing shortages.In July 2024, Vermont’s bail laws changed, allowing judges to increase the amount of bail for defendants who were accused of crimes while out on release in other cases. In the past, the state utilized prisons’ gymnasium space for extra beds. The department is already utilizing temporary plastic beds on the floor of cells. Through the state’s contract with CoreCivic, one of the country’s largest private prison companies, Vermont sends just under 130 men to Tallahatchie County Correctional Facility in Mississippi — about half of 2019’s out-of-state population.

Technology

Marking a defeat for Dane County Sheriff Kalvin Barrett, the County Board rejected a proposed contract Thursday that would have hired a for-profit company to provide communication services to jail residents for at least three years. Some board members who opposed the contract suggested extending the county’s existing jail communications contract with ViaPath Technologies for one year. They said the extension would allow time to work toward providing a free communication service, where the county would pay for services rather than jail residents or their families. The proposed contract with Smart would have obligated the county to use its email, text and other messaging services for at least three years, with options to extend to five years. Smart declined negotiating a shorter contract.

With minimal public notice, the Oklahoma Department of Corrections and Securus Technologies agreed to an amended contract on Aug. 29 that raised the cost of phone calls from state prisons from 6 to 14 cents per minute. The rate hike was allowed thanks to a June 30 order from the FCC delaying new rules intended to make phone and video calls from correctional facilities more affordable.

They’re not stylish and they’re prone to false alarms, but jail officials across the country are turning to biometric bracelets to keep people from dying in custody. A company called 4Sight Labs has created medical monitors that measure vital signs like heart rate and breathing. When locked onto the wrist, the device is designed to alert the jail’s staff of a medical emergency. Across the U.S., Sanders said 61 local jurisdictions are using the technology or are in training to implement it in their jails.

Correctional Healthcare Vendors

Editor's Comment: We are starting this week to put most of the Follow Up stories connected to correctional health care vendors in this section of the Weekly Update. Frankly 90 percent of these stories could easily qualify as some type of follow up.

Looking at the first story in this section, we see Wellpath again makes its mark on healthcare in Santa Barbara in the form of a blistering grand jury report. Also it is reported that State Assemblymember Gregg Hart, a former Santa Barbara county supervisor has introduced legislation requiring third-party review of all in-custody deaths. The sheriff, however, dismisses it as a “solution in search of a problem.” But is it realy a solution in search of a problem when articles like Six Deaths in Custody: What Can Be Done? have recently appeared in the Santa Barbara Independent? COCHS would like to point out that the sheriff's opinion underscores a theme we often emphasize.: correctional intransigence to oversight.

Finally, we close this Weekly Update with a story about NaphCare and Pima County, where supervisors unanimously voted to renew NaphCare’s contract to provide jail healthcare. Readers may recall that last week’s Follow Up section highlighted two other jurisdictions — San Diego and the Arizona Department of Corrections — that also rely on NaphCare and have experienced persistent problems with healthcare delivery. This Pima County story is particularly striking given that earlier this year The New Yorker ran a widely discussed article about starvation in correctional facilities — its central case focused on a woman who experienced extreme starvation while in Pima County custody, under NaphCare’s care.

Wellpath

The county supervisors showed little appetite for the grim minutia unearthed by three blistering reports on jailhouse deaths that last year’s grand jury concluded could or should have been prevented. It’s little wonder. The family of one of the victims, a Santa Ynez woman with a history of suicidal thoughts who hung herself with a 12-inch telephone cord in an observation room within eyeshot of the jail intake desk, has put the county on notice it intends to sue for multiple millions of dollars. While no supervisors asked specifics about the gory details of the deaths, some expressed considerable enthusiasm for a bill authored by State Assemblymember Gregg Hart — a former county supervisor — that would require a third-party review of all in-custody deaths. In the past, Sheriff Bill Brown dismissed this idea as a solution in search of a problem. Wellpath has hired 22 additional medical personnel at a cost to the county of $7 million

NaphCare

Pima County Supervisors voted unanimously to extend the county’s contract with NaphCare, the private, for-profit provider of medical care in the Pima County jail Tuesday — but the deal includes a new provision allowing the county to terminate it with 120 days’ notice. After months of discussion about possibly taking the jail’s health care “in house” — meaning the county would stop outsourcing medical services and instead hire its own staff to run the program directly — supervisors continue to contemplate how that would work and how much it would cost. The prior three-year contract averaged out to $21.6 million the county owed NaphCare each year. The new contract extension, for $53.8 million over two years, is $26.88 million per year, or a 24% increase in the annual rate. NaphCare has struggled for years to meet its contractual obligations, with consistent problems of understaffing and not providing medical care required by the contract.

COCHs' Weekly Update is taking a break during
the Jewish New Year and Yom Kippur.
We will be back on October 7.