Early one morning this spring, staff at a Santa Barbara county jail heard screams coming from one of the cells. A 57-year-old inmate was moaning and hyperventilating. She said her “guts are all twisted up”.
Rather than sending her to the ER, medical staff chalked her pain up to opioid withdrawal, since they had taken a prescription opioid away upon her arrival days before, a grand jury investigation later found. They placed the inmate – referred to as CF in the grand jury’s report – on mental health observation and gave her Tylenol. Even as the cell floor became covered in vomit, staff ignored her requests to go to the hospital. The documentation that should have been filled out to explain why her request was not honored was never completed.
The grand jury determined that CF’s stomach had perforated days before her excruciating death in March. Medical staff had taken her inability to walk from her cell to the exam room as “a refusal of treatment”, according to the investigation. Twenty minutes later, CF was discovered “unresponsive in her cell, slumped over, with lips that had become blue in color”.
An autopsy report and investigation concluded that CF would have had a 90% chance of survival if she had received immediate treatment. Instead, medical staff had attempted to revive her with Narcan, which only revives people who are experiencing overdose.
Wellpath, one of the nation’s leading health providers to prisons and jails, was the contractor responsible for healthcare at Santa Barbara county’s Northern Branch jail, where CF died. The grand jury’s report is the latest in over a decade of government investigations into two behemoths in the prison health industry – Wellpath and Corizon – which are both backed by private equity investors.
Since 2014, in eight cases involving these two private equity-backed healthcare companies examined by the Guardian, investigators from the Department of Justice, New York City department of investigation and other local investigators, have found their negligence so severe that it violated inmates’ eighth amendment rights protecting them from substantial risk of harm, including preventable death. Staff shortages are often a contributing factor – a 2023-24 Santa Barbara county grand jury investigation into Wellpath-managed jails found that staffing shortages led to delays in care.
Despite these issues, the private prison healthcare industry has only continued to grow – it was estimated to be a $9.3bn business in 2022. Both Corizon and Wellpath continued to contract with jails, prisons, immigration and juvenile detention centers around the country until they faced so much liability – both from lawsuits and other complex business issues – that both landed in bankruptcy court over the last two years.
The Guardian approached Wellpath and Corizon’s new iteration, YesCare, for comment about alleged medical neglect. Wellpath said in a statement that it provides “safe and effective care” to patients. YesCare did not provide a comment.
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Both companies were still operating in some form while restructuring in Chapter 11 bankruptcy proceedings, and had reorganization plans confirmed in bankruptcy court this year that allowed them to settle many of their debts and continue their prison contracts.
Colleen Grogan, a professor at University of Chicago’s school of social work, said the reason for Wellpath and Corizon’s continued existence, despite facing scrutiny, is simple: “These private equity firms have a ton of political power, and prisoners are the most vulnerable. The political power dynamics are about the worst they can be.”
Corizon formed in 2011 from a merger between two existing prison healthcare companies. By 2016, Corizon had been sued 660 times for malpractice, including many wrongful death and personal injury suits. During that time, a US Department of Justice investigation into conditions at New York City’s Rikers Island found that adolescent inmates at the facility had their constitutional rights violated due to the high risk of violence from Rikers staff and other inmates. Corizon medical staff sometimes failed to report injuries from prison staff use of force, and would avoid calming inmates being forcibly removed from their cells, even though it was part of their job. The investigation also raised concerns about the poor quality of mental healthcare Corizon provided at Rikers, which may have violated the federal Americans with Disabilities Act. In 2015, a New York City department of investigation report on the same facility found “significant breakdowns” by Corizon Health. “Corizon staff improperly removed inmates from suicide watch or otherwise failed to supervise inmates with serious mental illnesses,” the report said. “Two of those inmates died while unsupervised.”
Corizon lost its contract with Rikers Island in 2015, but it still remained a market leader. Corizon’s then CEO claimed at the time that Corizon provided oversight rather than directly employing medical staff. The remarks contradicted the New York City department of investigation’s findings.
In 2016, an independent medical expert investigated Corizon’s performance with the Alabama department of corrections and found that in some cases medical providers employed by the company attempted to manage care “for which they have no experience”, which could result in harm to patients. In a media report at the time, Corizon said that it provided quality care to its patients.
In one case, a patient was briefly hospitalized for a groin infection, but returned to the prison quickly. Over the next six months, the expert’s report said, the infection spread to his entire right leg, and began to ooze and become discolored. When he returned to the hospital, his doctor recommended a surgical consultation, but Corizon’s regional medical director called to have him returned to prison instead, the report said. He died of septic shock.
As lawsuits against Corizon piled up, a new market leader emerged when the private equity firm HIG merged together multiple companies to form Wellpath in 2018. During this time, the market was growing, but the number of competitors was shrinking.
Erin Fuse Brown, a professor of health services at Brown University, said private equity was known for buying up competitors. Private equity firms, she said, were able to grow their market shares in prison health because they have deep pockets that allow them to handle the risk that comes with an industry so prone to legal liability – and to provide a variety of services all at once so prisons and jails do not need to look for additional contracts.
“They basically are saying, ‘we can provide this whole thing, soup to nuts,’” Fuse Brown said, adding that once they land those contracts, private equity firms will aggressively cut costs to further edge out competitors and maximize profits.
Those cost cutting measures tie directly to alleged civil rights violations, according to Caroline Cohn, a staff attorney at the National Consumer Law Center. Multiple contracts from Wellpath and Corizon, as well as Wellpath’s own promotional materials, show both companies charged facilities per inmate per day.
“When private healthcare companies receive a fixed fee per person, their financial incentive is to spend less on the care they’re providing to incarcerated patients,” Cohn explained. “The impact on quality of care is predictable, and there are hundreds of lawsuits, complaints, and news stories documenting just how horrific this care often is.”
As Wellpath became the dominant player, accusations of constitutional violations stacked up against them as well. Department of Justice investigations into the Massachusetts department of corrections in 2020 and the San Luis Obispo county jail in 2021 both found that Wellpath staff violated inmates’ rights by failing to adequately monitor inmates facing mental health crises – including those who were self-harming – and by in some case placing them in solitary confinement for prolonged periods rather than offering treatment.
In 2019, according to the federal investigation, one Massachusetts inmate died by suicide after hanging himself in an isolation cell. It was his seventh attempt in the prison. After one attempt, “he made statements about sacrificing himself to prove how bad the system is.” Before he died, the investigation found, mental health staff employed by Wellpath “took his word that he would not harm himself and granted his request to leave mental health watch without addressing his risk factors”.
In 2023 an order from San Jose, California’s district court required that records pertaining to Wellpath’s performance in Monterey county jails be unsealed – these reports show multiple preventable deaths, and at least one lost limb.
“Prison health is the perfect market for private equity because they are serving a literally captive audience,” said Brendan Ballou, former special counsel to the Department of Justice’s anti-trust division and author of the book, Plunder: Private Equity’s Plan to Pillage America. He said “tough-on-crime” legislation “had made it harder for prisoners to have their rights vindicated”. For example, the 1996 Prison Litigation Reform Act requires incarcerated people pay filing fees if they want to initiate a lawsuit, and to “exhaust all remedies” available to them in prison before seeking justice in civil court, even if those remedies are difficult to access. Supreme court rulings in 2006 and 2020 added additional hurdles for inmates seeking justice.
And private equity firms have another layer of protection from liability, according to Ballou. Past court rulings make it difficult to hold private contractors liable for wrongdoing in prisons, and “corporate veil piercing law”, which protects private equity firms from being held responsible for the actions of their investments, makes it very difficult for victims to go after the firms behind the prison health companies that allegedly hurt them. So private equity firms know that even if their prison health investments face a lot of liability, they can remain relatively untouched.
When federal investigations implicated Wellpath in constitutional violations, they would center their regulatory firepower on Wellpath’s government clients and not Wellpath itself. Even then, the sanctions were not severe, mostly coming in the form of recommendations for improvements, including better training for mental health staff. Department of Justice settlements with the Massachusetts department of correction and San Luis Obispo county did not include any fines or punishment for Wellpath, although the company did eventually lose its contract with the Massachusetts department of correction. Inmates and their loved ones who suffered from Wellpath’s alleged negligence did not receive any compensation under these settlements. Both the Massachusetts department of correction and San Luis Obispo county denied any wrongdoing.
A Wellpath spokesperson said in a statement that “Wellpath is committed to our patients and the communities we serve. Our company and our thousands of frontline caregivers are dedicated to providing safe and effective care to our patients.”
The controversies may have started to affect the companies’ bottom line – both filed for bankruptcy in the last two years. Corizon’s 2023 bankruptcy was controversial – they attempted a maneuver known as a “Texas two-step”, in which a company splits the company in two, putting its assets into one company and its liabilities in another, which files for bankruptcy. A group of senators, led by Elizabeth Warren wrote a letter accusing the company of using the bankruptcy court to “evade liability”. In a response defending the bankruptcy, company leadership claimed Corizon was so loaded with liability in 2020 that investors sold it to Flacks Group, a private equity firm that specializes in distressed assets, for about $10m – the same amount the company paid out in a wrongful death suit the previous year, and a pittance for a company that had recently reported $800m in revenue.
Both Wellpath and YesCare, the surviving half of Corizon’s split, had Chapter 11 reorganization plans approved in bankruptcy courts this year. Both companies still have contracts in prisons and jails across the country.
As for CF, the inmate who died in a Santa Barbara county jail – the grand jury’s investigation did not do much in the way of justice for her. Despite the horrific death the report describes, the only consequence for Wellpath is that the county will conduct a thorough assessment of its services in the jail. Even if Wellpath does lose its contract, there won’t be a lot of other options to choose from.
YesCare’s press office did not respond to the Guardian’s request for comment.
