Infectious Diseases Know No Prison Walls; Riddle: When Is Insurance Not Insurance? Perhaps When It’s Wellpath’s? KY Lawsuit Might Decide

Highlighted Stories

Editor's Note

This week’s first highlighted story comes from Oxford Academic and reviews both the progress made and the obstacles that remain in infection control within carceral facilities.

When COCHS began in 2005, we emphasized that individuals incarcerated in our nation’s jails and prisons are community members who are temporarily displaced. They return to the community—and whatever infections they carry or acquire while incarcerated do not respect prison walls. Public transportation, grocery stores, emergency rooms, or simply daily contact all become pathways for transmission.

In the twenty years of our existence—and roughly the same span since the original study on which this week’s article is based—carceral facilities have made significant strides in understanding their pivotal role in preventing infectious diseases. COVID-19, with its toll in jails and prisons, drove home the urgency of infection control as a matter of both public health and community protection.

As our subscribers know, COCHS maintains a healthy skepticism about regulatory systems in which one governmental entity oversees another. Few of these structures measure infection control as a core indicator of carceral-to-community safety. Too often, the focus remains on process rather than outcome.

Medicaid, while certainly procedural, embeds explicit standards for infection control and compliance. COCHS believes that any serious discussion of infection prevention in carceral settings—and the structures that ensure quality and accountability—ultimately leads back to Medicaid.

Turning to the second highlighted article: many jurisdictions require correctional healthcare vendors to maintain third-party insurance to cover medical negligence and wrongful-death claims. In Kentucky, however, Wellpath’s “insurance” seemed to amount to little more than window dressing. The company’s director of insurance acknowledged that its so-called “third-party insurance” was actually a fronting policy—a type of arrangement that offers no genuine protection against lawsuits. A woman whose brother died in a Kentucky prison is now suing the state attorney general and the corrections commissioner for allowing Wellpath to operate with such inadequate coverage. Similar allegations have surfaced in Georgia, where Wellpath’s practices have been described by some as outright fraud.

This issue brings us back to a long-standing COCHS theme: correctional healthcare vendors often claim they bear liability for poor health outcomes, but in practice, this could be seen as frankly, hokum. It becomes even more so when vendors appear to ignore or manipulate basic insurance requirements.

Finally, circling back to Medicaid: our hope for the 1115 reentry waivers has always been that Medicaid’s conditions of participation—unlike Wellpath’s insurance coverage—would be strictly enforced, ensuring real accountability rather than what seems to be symbolic compliance.

Infectious Diseases

At the end of 2022, 5.4 million people (1 of every 48 adults) were either in jail, in prison, or on probation/parole in the United States. One in 20 persons in the United States (5%) will be incarcerated during their lifetime. Among those newly admitted to carceral settings, the prevalence of active tuberculosis disease and infections from blood-borne viruses and sexually transmitted pathogens is substantially higher than in community counterparts. Efforts to prevent, mitigate, or control infectious diseases benefit those within carceral facilities and also surrounding communities. This review briefly explores some of the changes, challenges, and opportunities relevant to the prevention and control of infectious diseases in jails, prisons, and juvenile residential facilities. It also emphasizes the need for adequate education and training when planning and implementing interventions.

Wellpath & Insurance

The sister of Chad Lake Raymond, who died in a Kentucky prison in 2021, has filed a second lawsuit—this time against the state’s justice cabinet and top officials—for failing to enforce insurance requirements for its prison healthcare contractor, Wellpath. The suit accuses Attorney General Russell Coleman, Corrections Commissioner Cookie Crews, and others of allowing Wellpath to operate with insurance policies that could not pay settlements. The case mirrors other suits nationwide. In Georgia, the Cobb County Sheriff’s Office alleges Wellpath misrepresented its insurance coverage and then failed to pay negligence claims. Cobb County accused the company of obtaining an insurance contract through “false pretenses, a false representation, or actual fraud,” and the lawsuit is ongoing. In Kentucky, in addition to providing medical coverage for inmates, Wellpath was on the hook if a prison had to pay out a settlement related to medical negligence. Wellpath was required to have insurance of its own to cover those payouts in case it filed for bankruptcy. Attorney Greg Belzley argues that state officials either ignored or neglected to verify that Wellpath’s policies met contractual obligations. Bankruptcy filings by Wellpath’s insurance director, James Seitz, revealed that its “third-party insurance” was actually a “fronting policy” — a type of coverage that offers no real protection against lawsuits. The case underscores growing scrutiny of Wellpath’s financial integrity and of states’ oversight of private correctional healthcare providers.

Follow ups

Arizona

Editor's Comment: COCHS subscribers are well aware of the ongoing healthcare travails in Arizona’s prison system. In September, we included in the Follow Ups section an article describing how the court-appointed monitor found systemic failures in healthcare delivery. Federal Judge Roslyn Silver, who previously held the Arizona Department of Corrections, Rehabilitation, and Reentry (ADCRR) in contempt, is now considering placing the state’s prison healthcare system in receivership.

In the op-ed below, Ryan Thornell, director of ADCRR, argues against such a move. Notably, he makes no mention of the court monitor’s most recent report.

In an op-ed, Ryan Thornell, director of the Arizona Department of Corrections, Rehabilitation and Reentry (ADCRR) argues against the prison system's healthcare being put into receivership: .A federal takeover of our prison health care system, commonly called a receivership, is now being considered. A federal receivership is an extreme, last-ditch action reserved only for systems that are unwilling or incapable of reform. This is not the case in Arizona. Since 2023, we have pursued a new mission and vision that replaces outdated mindsets and ineffective systems with modern correctional practices throughout Arizona. Across our 15 prison complexes, we are building a safety-centered culture that empowers our staff to be more effective and ensures every individual is treated with respect, attention, and care.

New York

Editor's Comment: Below, Robert Brooks Jr., son of Robert Brooks, appeared in Albany the day after one of the correctional officers convicted in his father’s death at Marcy Correctional Facility was found guilty of second-degree murder. He was there to lobby for the passage of prison reform legislation. Previously, Robert Ricks, Robert Brooks’ father, has spoken out in favor of sentencing reform.

Robert Brooks Jr. visited the state Capitol in Albany to urge the passage of a package of prison reforms. He arrived a day after a jury returned one guilty and two not-guilty verdicts in the beating death of his father at the hands of correction officers in Marcy prison. Robert Brooks Jr. has become a rallying point for legislation in the aftermath of his father's death. The prison reform bill: requires video of in-custody deaths be shared with the attorney general; expands camera coverage in state prisons; mandates timely public and family notification for deaths in custody; expands oversight and the size of the state Corrections Commission; sets new autopsy standards with photos and X-rays; extends time for formerly incarcerated people to file claims; and requires quarterly public reporting on deaths and investigations.

ICE

The Nigerian man described being roused with other detainees in September in the middle of the night. U.S. Immigration and Customs Enforcement officers clasped shackles on their hands and feet, he said, and told them they were being sent to Ghana, even though none of them was from there. When they asked to speak to their attorney, he said, the officers refused and straitjacketed the already-shackled men in full-body restraint suits called the WRAP, then loaded them onto a plane for the 16-hour-flight to West Africa. Referred to as “the burrito” or “the bag,” the WRAP has become a harrowing part of deportations for some immigrants. The AP found ICE has used the device despite internal concerns voiced in a 2023 report by the civil rights division of its parent agency, the U.S. Department of Homeland Security, in part due to reports of deaths involving use of the WRAP by local law enforcement.

Women taken into custody by U.S. immigration agents while pregnant say they received inadequate care in a letter Wednesday that calls on the Trump administration to stop holding expectant mothers in federal detention facilities. The Department of Homeland Security has defended its care, saying pregnant detainees get regular prenatal visits, mental health services, nutritional support and accommodations “aligned with community standards of care.” The ACLU said that over the past five months it has met with more than a dozen females who were pregnant while in ICE custody -- including some who had a miscarriage while detained.

A Biden-era policy restricts ICE from arresting or detaining immigrants who are pregnant, postpartum or nursing, except in extreme circumstances. While President Donald Trump has not formally rescinded the policy, it’s clear from lawsuits, news reports and advocates for immigrants who are detained that it’s not being followed. Quantifying the exact number of pregnant, postpartum or nursing immigrants in custody has become impossible: This March, Congress let lapse a requirement that the administration report twice a year on how many of these immigrants are being held in immigration facilities.

At the Northwest Ice Processing Center in Tacoma, Washington, about 1,500 people in immigration detention await their day in court. Most are held for months, living not by the rising and setting sun but under the perpetual twilight of fluorescent lights. “We couldn’t tell if it was day or night,” said one former detainee who spent 10 months at the facility and whom the Guardian is not naming for fear of retaliation from US Immigrations and Customs Enforcement (Ice) and the Geo Group, the private company that operates the detention center.

Management and Training Corporation (MTC), which operates detention and correctional facilities nationwide, quietly acquired the Marana Community Correctional Treatment Facility this July from the Arizona Department of Administration. MTC was the previous owner before the state obtained it in 2013. The recent sale of the former Marana Community Correctional Treatment Facility expands the reach of the third-largest private correctional operator in the United States, effectively clearing the way for MTC to establish its sixth federal detention center and increase its immigration detention capacity. Shortly after President Donald Trump’s second term in the White House began, MTC hired Upstream Consulting, Inc., a D.C. lobbying firm, to advocate for “Funding for ICE detention beds.”

Ophthalmology

Nearly two-thirds of incarcerated individuals requiring ophthalmic follow-up care did not receive it, with a statistically significantly higher chance of missing their appointment when they underwent a procedure or required more urgent follow-up. Among incarcerated individuals with glaucoma, over 50% returned more than 1 month late. Several systemic barriers have been postulated, from delayed transportation and staff shortages to a lack of onsite equipment and frequent facility transfers. Moreover, there are also individual financial barriers. More than 90% of state prison residents are responsible for co-payments when they see a health provider.

State Roundup

Alaska

Alaska’s Department of Corrections provides limited access to medication for opioid use disorder. Inmates can access medication during pregnancy or people already taking medication can continue but only for 30 days. Inmates who test positive for illicit drugs have been denied medication, according to former inmates and community providers. But a representative for the department wrote in an email that those care decisions are made on a “case-by-case basis.” Megan Edge, the director of integrated justice at ACLU of Alaska, said treatments for opioid use disorder can also make someone test positive for opioids on a drug test. And she said ironically, Alaska DOC sometimes denies people care based on those results.

California

Three months after two men died in jail isolation cells, lawyers in a class-action lawsuit against San Diego County and the Sheriff’s Office are asking a federal judge to limit how long people with serious mental illness can be held in solitary confinement. The request for a preliminary injunction was filed in federal court last Friday, accompanied by more than a dozen sworn declarations from people describing their experience in administrative separation cells in San Diego jails. The 11 men and three women describe getting little to no mental health treatment, and almost no human contact. They’re let out of their cells for less than an hour a day, if at all. They say their toilets regularly overflow, causing a foul stench and filthy conditions. Trash piles up; there’s no scheduled cleaning, and access to supplies is limited.

Connecticut

He died in August 2024 after spending less than a month at Hartford Correctional Center in the custody of the state Department of Correction, according to a medical malpractice lawsuit filed on behalf of his estate Tuesday. The complaint filed in state Superior Court contends that although he had asked for treatment for a variety of symptoms, including that he was having difficulty walking and was throwing up blood, his family was told that he was "fine." One DOC nurse, Kenneth Bradley, who now is being sued along with the state and the director of prison health care, noted in his medical records that Baena's medical complaints were "psychosomatic," the lawsuit said.

Louisiana

A federal jury found LaSalle Management Co which runs Richwood Correctional Center in Louisisana liable for the death of Erie Moore who died of head injuries he received while in custody, and awarded the family more than $40 million in damages. Moore was a 57-year-old mill worker with no criminal history who was arrested for disturbing the peace. Moore became “agitated and noncompliant” while being taken into custody at Richwood Correctional Center.(The Richwood Correctional Center now serves as a federal immigration detention site operated by LaSalle. The company operates facilities in Georgia, Louisiana and Texas that have the capacity to hold a total of more than 13,000 inmates) The jury found that guards had used excessive force against Mr. Moore and that the there was a “custom or practice” of punishing inmates at Richwood by using chemical spray or taking them to an area of the detention center known as the Four Way that had no surveillance cameras.

Oregon

On stifling days last summer, Reyes Miranda baked in his cell, the metal walls so hot to the touch that he worried he’d burn himself. At night, he slept on the cool concrete floor for relief. Miranda lives on the fifth tier of one of the Oregon State Penitentiary’s hulking cellblocks, where corrections officials this year say temperatures soared up to 114 degrees. Two industrial fans in a far corner of the cellblock hardly made a difference for the men who live here.

Texas

The Harris County Jail, which has continuously stayed out of compliance with the state’s minimum jail standards for months, will receive another feasibility study in an effort to address aging infrastructure and capacity issues. Commissioners Rodney Ellis and Lesley Briones last week authorized the county’s negotiations with CGL Management Group, LLC for a feasibility study to address the county’s long-term capacity needs and evaluate facility conditions. Commissioner Tom Ramsey, who was the only other commissioner present during the discussion, cast the lone dissenting vote. The approval also comes as the Harris County Jail has continuously remained out of compliance with the state’s minimum jail standards this year. An Oct. 16 order from the Texas Commission on Jail Standards again placed the jail out of compliance because an inspection team found issues with four of five fire control panels.

A Bexar County Jail inmate was hospitalized earlier this month after contracting Monkeypox, according to the Bexar County Sheriff’s Office. Officials said the inmate was transported to University Hospital on October 11 and will remain there until medically cleared to return to the jail. Monkeypox is not airborne and can only spread through direct contact with a lesion, rash, or scab. It does not survive on surfaces.

Correctional Healthcare Providers

Advanced Correctional Healthcare

Seeking greater control and continuity in inmate medical care, Anoka County (MN) will move away from private health-care provider, Advanced Correctional Healthcare, next year and adopt a hybrid model combining county-employed nurses with contracted physicians and mental-health specialists. Under the plan, county nurses will provide 24-hour on-site coverage, while contracted providers will handle medical direction — including a licensed physician, a physician assistant or nurse practitioner for 20 hours a week, and psychiatric services for 10 hours a week. On Oct. 14, the Anoka County Board voted 6-0, with Commissioner John Heinrich absent, to approve a contract with The Wilcox Group, doing business as Goosebusters Inc., for up to $995,000 annually to provide medical direction starting Jan. 1, 2026.