Table of Contents

I. General references......................................................................................................................................................1

II. Articles and cases about standards of care for prisons...........................................................................................2

III. Market.....................................................................................................................................................................7

IV. Contracting practices...........................................................................................................................................10

V. Comparisons..............................................................................................................................................................10

VI. Staff/ Service Quality Issues................................................................................................................................10

VII. Litigation...............................................................................................................................................................12

VIII. Influence on law-making.....................................................................................................................................12

I. General references
A. Delivery System Organizational Structures by State (FY2015)

a.

B. Journal Articles
 Kelly Bedard and H. E. Frech, Prison health care: is contracting out healthy?, DOI:
http://dx.doi.org/10.1002/hec.1427
 Joel H. Thompson, Today's Deliberate Indifference: Providing Attention Without Providing
Treatment to Prisoners with Serious Medical Needs, 45 Harv. C.R.-C.L. L. Rev. 635 (2010)
 Ira P. Robbins, Managed Health Care in Prisons as Cruel and Unusual Punishment, 90 J.
Crim. L. & Criminology 195, 198-204 (1999)
 G. Nicholas Wallace, The Real Lethal Punishment: The Inadequacy of Prison Health Care
and How It Can Be Fixed, 4 Faulkner L. Rev. 265, 272 (2012)
 Aaron Rappaport, Litigation over Prison Medical Services, 7 Hastings Race & Poverty L. J.
261 (2010)
  Amy Vanheuverzwyn, The Law and Economics of Prison Health Care: Legal Standards
and Financial Burdens, 13 U. Pa. J.L. & Soc. Change 119, 119–20 (2010)
 Amy Petre Hill, Death Through Administrative Indifference: The Prison Litigation Reform
Act Allows Women to Die in California's Substandard Prison Health Care System, 13
Hastings Women's L.J. 223 (2002)
 John J. Gibbons & Nicholas de B. Katzenbach, Confronting Confinement: A Report of the
Commission on Safety an Abuse in America's Prisons, 38 (2006)
 Brian Heskamp, Note, The Prisoner's Ombudsman: Protecting Constitutional Rights and
Fostering Justice in American Corrections, 6 Ave Maria L. Rev. 527, 538 (2008).
 Richard Siever, HMOs Behind Bars: Constitutional Implications of Managed Health Care
in the Prison System, 58 Vand. L. Rev. 1365, 1379–80 (2005)
 Harold Pollack et al., Health Care Delivery Strategies for Criminal Offenders, 26 J. Health
Care Fin. 63 (1999).
 William Allen & Kim Bell, Death, Neglect and the Bottom Line: Push to Cut Costs Poses
Risks, St. Louis Post-Dispatch, Sept. 27, 1998, at G1.

C. Reports
 Special Master Report at 3, Balla v. Idaho State Bd. Of Corr., No. 1:81-cv-01165-BLW (D.
Idaho Feb. 2, 2012)
 http://mediad.publicbroadcasting.net/p/idaho/files/Report%20on%20ISCI
%20medical%20and%20mental%20health%20care.pdf
 Final Report of the Court Appointed Expert, Ron Shansky, MD et al., Lippert v. Godinez,
No. 1:10-cv-04603 (N.D. Ill. Dec. 2014)
 https://www.clearinghouse.net/chDocs/public/PC-IL-0032-0007.pdf
 First Annual Report of Monitor Pablo Stewart, MD at 4, 7–8, Rasho v. Walker, No. 07-cv-
1298 (C.D. Ill. May 22, 2017)
 https://www.clearinghouse.net/chDocs/public/PC-IL-0031-0026.pdf
 The Pew Charitable Trusts, Prison Health Care: Costs And Quality (2017)
 http://www.pewtrusts.org/~/media/assets/2017/10/
sfh_prison_health_care_costs_and_quality_final.pdf
 American Friends Service Committee (AFSC) on Prison privatization
 https://www.afsc.org/key-issues/issue/prison-privatization
 AFSC's Report (2013): "Death yards: Continuing problems with Arizona's correctional health
care"
 https://www.afsc.org/document/death-yards-continuing-problems-arizonas-
correctional-health-care
 AFSC's Report (2006): "Tolerating failure: The state of health care and mental health care
delivery in the Michigan Department of Corrections"
 https://www.afsc.org/sites/default/files/documents/Tolerating%20failure%20-
%20the%20state%20of%20health%20care%20and%20mental%20health%20care
%20delivery%20in%20the%20MDOC.pdf
 Grassroots Leadership’s report: “Incorrect Care: A Prison Profiteer Turns Care Into
Confinement”
 https://grassrootsleadership.org/sites/default/files/reports/
incorrect_care_grassrootsleadership_2016.pdf
D. News
 Paul von Zielbauer, As Health Care in Prison Goes Private, 10 Days Can Be a Death
Sentence, N.Y. Times, Feb. 27, 2005
 Michael LaFaive, Privatization for the Health of It, in 4 Mackinac Ctr. for Pub. Pol'y,
Michigan Privatization Report No. 2004-02 (Winter 2005)
 http://www.mackinac.org/article.aspx?ID=6910
 By 2004, thirty-two states contracted with private entities for some or all of their
prison health services.
  AFSC, “Prison health care in Arizona worsens under private prison company Corizon,”
Nov 4, 2013
 https://www.afsc.org/story/new-report-prison-health-care-arizona-worsens-under-
private-prison-company-corizon
 Bob Ortega, “Prison inmates in Arizona crying foul over medical care,” Arizona Republic,
Dec. 5, 2011.
 Bob Ortega, “Critics cast doubt on new Arizona prison health care contractor,” Arizona
Republic, April 16, 2012
 Craig Harris, “Arizona fines provider of prison health care,” Arizona Republic, September
28, 2012
 Pat Beall, “Privatizing prison health care leaves inmates in pain, sometimes dying,” Palm
Beach Post, Sept. 27, 2014 https://www.palmbeachpost.com/news/privatizing-prison-health-
care-leaves-inmates-pain-sometimes-dying/hiJMRmNG9YhE9JFTxfnZaN/
 Pat Beall, “Corizon’s prison health care pullout follows withering report,” Palm Beach Post,
Dec. 2, 2015 https://www.palmbeachpost.com/news/crime--law/corizon-prison-health-care-
pullout-follows-withering-report/AZnYZ6DryKaoWzpKsN2hkM/?
icmp=pbp_internallink_referralbox_free-to-premium-referral
 Abe Aboraya, “Emergency Situation Declared At Florida Women’s Reception Center,”
WGCU-NPR Southwest Florida, Nov. 5, 2015 https://news.wgcu.org/post/emergency-
situation-declared-florida-women-s-reception-center

E. Organizations devoted to the cause

 American Friends Service Committee
o https://afscarizona.org/campaigns/treatment-industrial-complex/
 Grassroots Leadership (Austin, TX)
o https://grassrootsleadership.org/programs/treatment-industrial-complex
 Southern Center for Human Rights (Atlanta, GA)
o https://www.schr.org/our-work/prisons-jails/healthcare
o class action lawsuits brought by SCHR
 Julia Tutwiler Prison for Women: Laube v. Allen
 Limestone Correctional Facility: Leatherwood v. Campbell
 Fulton County Jail: Foster v. Fulton County

II. Articles and cases about standards of care for prisons

A. National Standards governing correctional health care in US
a. Four sets of standards
i. American Correctional Association (ACA)
ii. American Public Health Association (APHA)
iii. Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
iv. National Commission on Correctional Health Care (NCCHC)
b. Comparative analysis of these four sets of Standards on healthcare in prisons and jails
i. *See NIC guidelines p155-57, p465-75
c. Comments on the effectiveness of those National Standards
a. Amy Vanheuverzwyn, The Law and Economics of Prison Health Care: Legal
Standards and Financial Burdens, 13 U. Pa. J.L. & Soc. Change 119, 119–20 (2010)
o “Individual institutional standards are no help. For example, the Pennsylvania
Department of Corrections states in their Management and Administration of Health
Care Policy that their health care providers must comply with ‘policy and procedures
[American Correctional Association] standards and applicable laws.’
o There is no firm definition of the actual standards enforced by the institution itself or
of standards required by law, and as shown above, the law itself is not clear on these
standards.”
B. Claims for medical malpractice
a. Prisoners can bring federal and state statutory claims for medical malpractice
[Brett Dignam, Medical Care Behind Bars, Trial, December 2014, at 34, 36]
i. See Carlson v. Green, 446 U.S. 14, 19-20 (1980): holding it “crystal clear” that Congress
intended the Federal Tort Claims Act and Bivens to serve as “parallel” and
“complementary” sources of liability.
b. The Federal Tort Claims Act (FTCA) allows federal prisoners to bring claims directly
against the government for negligent conduct and gives them a right to sue in federal court if
their administrative claim is unsuccessful.
c. Similar state statutes and claims exist in many jurisdictions.

C. Civil rights claim/deliberate indifference

a. The Eighth Amendment protects prisoners against cruel and unusual
punishment during confinement. [see VI. Prisoners' Rights, 47 Geo. L.J. Ann. Rev.
Crim. Proc. 1131, 1237 (2018) footnote 3074 and footnote 3075]
i. Alleged deficiencies in medical care and facilities require a showing of
officials’ deliberate indifference toward “serious medical needs” and
risks.
 Helling v. McKinney, 509 U.S. 25, 35-37 (1993) (“deliberate indifference” that poses
an unreasonable risk of serious damage to future health violates 8th
Amendment); Estelle v. Gamble, 429 U.S. 97, 105-06 (1976) (only “deliberate
indifference” and not accidents or inadvertent failure to provide medical care violates
8th Amendment); see also Erickson v. Pardus, 551 U.S. 89, 92-94 (2007) (deliberate
indifference claim stated when prison officials terminated inmate's medical treatment
for life-threatening liver condition); see, e.g., Perry v. Roy, 782 F.3d 73, 79-80 (1st Cir.
2015) (deliberate indifference claim stated when prison nurses failed to provide inmate
with constitutionally adequate standard of care after he received a broken jaw in fight
with prison guards); Nielsen v. Rabin, 746 F.3d 58, 63-64 (2d Cir. 2014) (deliberate
indifference claim stated when doctor only minimally examined prisoner after officers
told doctor not to treat prisoner and prisoner had multiple injuries); Jehovah v. Clarke,
798 F.3d 169, 181-82 (4th Cir. 2015) (deliberate indifference claim stated when doctors
disregarded various abnormal test results and failed to treat any symptoms
effectively); Coleman v. Sweetin, 745 F.3d 756, 765-66 (5th Cir. 2014) (deliberate
indifference claim stated when guards ignored defendant's broken right hip and inability
to move leg, lie in bed, or use toilet); Quigley v. Tuong Vinh Thai, 707 F.3d 675, 681-
82 (6th Cir. 2013) (deliberate indifference claim stated when inmate died following
treatment for depression because prison psychiatrist prescribed two different drugs
known to be potentially lethal when taken concurrently); Zaya v. Sood, 836 F.3d 800,
805-06 (7th Cir. 2016) (deliberate indifference claim stated when inmate suffered
broken wrist and doctor waited 7 weeks to schedule follow-up appointment); Barton v.
Taber, 820 F.3d 958, 964-65 (8th Cir. 2016) (deliberate indifference claim stated when
defendant with heart condition could not move on his own, became unresponsive, and
could not remain seated at questioning); Rosati v. Igbinoso, 791 F.3d 1037, 1039-41
(9th Cir. 2015) (per curiam) (deliberate indifference claim stated when prison officials
denied prisoner sexual reassignment surgery as treatment for gender dysphoria);
 Al-Turki v. Robinson, 762 F.3d 1188, 1193-94 (10th Cir. 2014) (deliberate indifference
claim stated when doctor refused to see patient experiencing severe pain, nausea, and
vomiting, despite knowing that symptoms could be the result of a life-threatening
condition); Goebert v. Lee Cty., 510 F.3d 1312, 1329-31 (11th Cir. 2007) (deliberate
indifference claim stated where jail's facility commander refused pretrial detainee's
request for medical attention for leaking amniotic fluids and indicated he automatically
disbelieved any medical complaint by inmate merely because “inmates had lied ...
before”); Brown v. D.C., 514 F.3d 1279, 1284 (D.C. Cir. 2008) (deliberate indifference
claim stated where doctor diagnosed inmate with gallstones and ordered him transferred
to hospital immediately but prison staff never complied though he continued to
 complain of pain). But see, e.g., Kosilek v. Spencer, 774 F.3d 63, 93-94 (1st Cir.
2014) (no deliberate indifference where officials worried that allowing sexual
reassignment surgery would create new security issues); Spavone v. N.Y. State Dep't of
Corr. Servs., 719 F.3d 127, 138 (2d Cir. 2013) (no deliberate indifference where no
evidence that prisoner would be seriously harmed if not granted medical leave,
and prison officials had no reason to believe that prisoner was receiving inadequate
treatment in prison); Byrd v. Shannon, 715 F.3d 117, 127-28 (3d Cir. 2013) (no
deliberate indifference where delays in receiving eyedrops for prisoner's glaucoma
caused by prisoner or pharmacy, not deliberate indifference by prison staff); U.S. v.
Clawson, 650 F.3d 530, 537-38 (4th Cir. 2011) (no deliberate indifference
where prison elected to treat prisoner's ADHD with medication other than that
prescribed by prisoner's psychiatrist); Sama v. Hannigan, 669 F.3d 585, 590-91 (5th
Cir. 2012) (no deliberate indifference when physician removed inmate's ovary and
lymph nodes during hysterectomy although removed organs were not cancerous
because physicians exercised reasoned medical judgment and determined surgery was
appropriate based on available information); Rouster v. Cty. of Saginaw, 749 F.3d 437,
447-51 (6th Cir. 2014) (no deliberate indifference where nurses, who lacked knowledge
of prisoner's medical history of ulcers, responded to complaints of stomach pain with
alcohol withdrawal treatment); Chatham v. Davis, 839 F.3d 679, 684-85 (7th Cir.
2016) (no deliberate indifference to inmate's serious medical needs
when prison warden failed to install emergency call button and inmate suffered fatal
asthma attack); Jackson v. Riebold, 815 F.3d 1114, 1119-20 (8th Cir. 2016) (no
deliberate indifference where delay in medical treatment had no demonstrated
detrimental effect); Simmons v. Navajo Cty., 609 F.3d 1011, 1018 (9th Cir. 2010) (no
deliberate indifference when prisoner committed suicide when over 1 month passed
since last attempt, prisoner received counseling and took anti-depressants, and nurse's
interactions with prisoner were “unremarkable”); Callahan v. Poppell, 471 F.3d 1155,
1159 (10th Cir. 2006) (no deliberate indifference when prison refused to allow inmate
use of wheelchair following injury because prison provided crutches and believed that
continued use of wheelchair would result in muscle atrophy and imperil inmate's ability
to walk); Pourmoghani-Esfahani v. Gee, 625 F.3d 1313, 1317-18 (11th Cir. 2010) (no
deliberate indifference when, after physical confrontation between deputy and inmate,
nurses promptly treated inmate).
 Deliberate indifference to mental health as well as physical needs is actionable. See,
e.g., Inmates of Allegheny Cty. Jail v. Pierce, 612 F.2d 754, 763 (3d Cir.
1979) (deliberate indifference claim stated for failure to attend to mental health
needs); Bowring v. Godwin, 551 F.2d 44, 47-48 (4th Cir. 1977) (same); Gates v. Cook,
376 F.3d 323, 343 (5th Cir. 2004) (deliberate indifference claim stated when death row
inmates received only limited mental health services in absence of privacy and received
psychotropic drugs which were inconsistently monitored); Gibson v. Moskowitz, 523
F.3d 657, 663 (6th Cir. 2008)(deliberate indifference claim stated when psychiatrist
prescribed psychiatric medication known to cause dehydration and ignored symptoms
until prisoner died of dehydration); Estate of Miller ex rel. Bertram v. Tobiasz, 680
F.3d 984, 990-91 (7th Cir. 2012) (deliberate indifference claim stated for alleged failure
of prison guards and medical staff to take steps to prevent prisoner's suicide despite
knowledge of his suicidal tendencies and history); Nelson v. Shuffman, 603 F.3d 439,
447-48 (8th Cir. 2010) (deliberate indifference claim stated when prison psychologist
prescribed trauma counseling sessions for rape-victim prisoner but never provided
them); Hoptowit v. Ray, 682 F.2d 1237, 1253 (9th Cir. 1982) (deliberate indifference
claim stated when prison physicians or facilities were inadequate to respond to mental
health emergencies); Ramos v. Lamm, 639 F.2d 559, 576-78 (10th Cir.
1980) (deliberate indifference claim stated when shortage of mental health staff
effectively denied access to diagnosis and treatment); Thomas v. Bryant, 614 F.3d
1288, 1316-17 (11th Cir. 2010) (deliberate indifference claim stated when officials
sprayed chemical agent on prisoner with mental illness, presenting an obvious danger to
his psychological well-being). But see, e.g., Kosilek v. Spencer, 774 F.3d 63, 91-94 (1st
Cir. 2014) (no deliberate indifference to inmate's gender identity disorder when
 Department of Corrections denied male-to-female sex reassignment surgery because
DOC solicited opinions of multiple medical professionals and concerns about safety
and security of inmate were reasonable); U.S. v. Clawson, 650 F.3d 530, 537-38 (4th
Cir. 2011) (no deliberate indifference when prison medical staff reasonably proposed
changing inmate's mental health treatment plan); Kitchen v. Dall. Cty., 759 F.3d 468,
482-83 (5th Cir. 2014) (no deliberate indifference when prison officers forcibly
removed mentally ill prisoner from cell because no obvious medical need to have
mental health professionals perform removal nor was there policy requiring
it) abrogated in part by Kingsley v. Hendrickson, 135 S. Ct. 2466, 2473-76 (2015);
 Clark-Murphy v. Foreback, 439 F.3d 280, 287 (6th Cir. 2006) (no deliberate
indifference when prisoner died of dehydration resulting partially
from prisoner's mental instability because officers assisted prisoner after he collapsed,
moved prisoner to observation cell, and recommended prisoner receive psychological
attention); Townsend v. Cooper, 759 F.3d 678, 689-90 (7th Cir. 2014) (no deliberate
indifference when prison psychologists placed mentally ill inmate on behavior action
plan after inmate made threats and attempted suicide); Orr v. Larkins, 610 F.3d 1032,
1034-35 (8th Cir. 2010) (no deliberate indifference where inmate in administrative
segregation continued to receive anti-depressant and anti-psychotic medications); Cano
v. Taylor, 739 F.3d 1214, 1217-18 (9th Cir. 2014) (no deliberate indifference where
“difficult,” “manipulative” inmate received regular attention
from healthcare employees in response to repeated complaints and suicide
threats); Campbell v. Sikes, 169 F.3d 1353, 1367-68 (11th Cir. 1999) (no deliberate
indifference where prison official spent considerable time with inmate, recommended
mental health counseling, and instructed medical staff members to monitor inmate).

ii. Officials’ “mere negligence” or medical malpractice does not constitute

deliberate indifference
 See Farmer, 511 U.S. at 835-37; see, e.g., Ramos v. Patnaude, 640 F.3d 485, 490 (1st
Cir. 2011) (no deliberate indifference when doctor did not promptly draw inmate's
blood, order test results, or treat inmate because doctor followed protocol and had
repeated interactions with inmate); Hernandez v. Keane, 341 F.3d 137, 148 (2d Cir.
2003) (no deliberate indifference because prison official acted on orders
of prison medical staff regarding inmate's medical condition); Giles v. Kearney, 571
F.3d 318, 330 (3d Cir. 2009) (no deliberate indifference when prison waited over 24
hours to take patient with punctured lung to hospital); Jackson v. Lightsey, 775 F.3d
170, 178-79 (4th Cir. 2014) (no deliberate indifference when prison doctor ignored
cardiologist's previous diagnosis, diagnosed prisoner with other less serious condition,
and significantly altered cardiologist's prescribed regimen because doctor made
legitimate medical decision about course of treatment); Whitt v. Stephens Cty., 529
F.3d 278, 284 (5th Cir. 2008) (no deliberate indifference when officers failed to report
detainee's answers to mental health questionnaire, violating protocol and failed to detect
signs of suicidal tendencies because detainee did not exhibit suicide risks); Burgess v.
Fischer, 735 F.3d 462, 477-78 (6th Cir. 2013) (no deliberate indifference when nurse
failed to inspect inmate's injuries beyond superficial bruises and scratches and failed
to record observations because inmate's injuries were not obvious); McGowan v.
Hulick, 612 F.3d 636, 641 (7th Cir. 2010) (no deliberate indifference when dentist
allegedly lied to prisoner to obtain consent for botched tooth extraction because doctor
chose one routine medical procedure over another); Allard v. Baldwin, 779 F.3d 768,
771-72 (8th Cir. 2015) (no deliberate indifference when prison health officials failed to
make proper diagnosis of prisoner's bowel obstruction because claim did not go
beyond negligence); Wilhelm v. Rotman, 680 F.3d 1113, 1123 (9th Cir. 2012) (no
deliberate indifference when doctor decided not to operate on hernia because alleged
failure was merely negligent misdiagnosis); Martinez v. Beggs, 563 F.3d 1082, 1090
(10th Cir. 2009) (no deliberate indifference when detainee who appeared only to be
intoxicated died of heart attack soon after arrest); Townsend v. Jefferson Cty., 601 F.3d
1152, 1158-59 (11th Cir. 2010)(no deliberate indifference when officers failed to assist
inmate suffering miscarriage because prison nurse assured officers there was
 no medical emergency); Franklin v. D.C., 163 F.3d 625, 636 (D.C. Cir. 1998) (no
deliberate indifference when prison failed to provide interpreters for Spanish-speaking
inmates during conversations with medical staff because no evidence of bad faith). But
see, e.g., Johnson v. Wright, 412 F.3d 398, 406 (2d Cir. 2005) (deliberate indifference
claim stated when prison officials “reflexively” followed prison policy barring certain
treatment for hepatitis C to inmates using drugs or alcohol when all treating physicians
unanimously recommended departure from policy);
 Palakovic v. Wetzel, 854 F.3d 209, 229 (3d Cir. 2017) (deliberate indifference claim
stated when inmate with history of self-harm and suicide attempts was placed in
solitary confinement in violation of prison's express written policy); Scinto v.
Stansberry, 841 F.3d 219, 230 (4th Cir. 2016) (deliberate indifference claim stated
when doctor failed to provide supplemental insulin to an inmate with diabetes as
proposed in doctor's alternative medical plan); Calhoun v. Hargrove, 312 F.3d 730,
734-35 (5th Cir. 2002) (deliberate indifference claim stated where inmate
had medical condition limiting him to 4 hours of work time and prison official who
knew of limit nevertheless made inmate work in excess of 4 hours, causing inmate's
blood pressure to reach near-stroke level); Dominguez v. Corr. Med. Servs., 555 F.3d
543, 550-53 (6th Cir. 2009) (deliberate indifference when nurse knew risks associated
with excessive heat but delayed treating inmate who complained of heat exhaustion,
vomited, and slipped into unconsciousness); Gomez v. Randle, 680 F.3d 859, 865-66
(7th Cir. 2012) (deliberate indifference claim stated when officials knew
of prisoner's injuries and promised medical supplies but waited 4 days before
administering treatment, causing unnecessary pain); Schaub v. VonWald, 638 F.3d 905,
916-19 (8th Cir. 2011) (deliberate indifference claim stated when detention center
director claimed that center could accommodate paraplegic prisoner but made no efforts
to provide medically necessary bed, shower, or toilet); Hearns v. Terhune, 413 F.3d
1036, 1039-42 (9th Cir. 2005) (deliberate indifference claim stated
when prison officials knew of religiously motivated violence, failed to protect inmate
from attacks by other inmates, and provoked attack by telling others of inmate's actions
and religious beliefs and leaving chapel unsupervised); Al-Turki v. Robinson, 762 F.3d
1188, 1193-94 (10th Cir. 2014) (deliberate indifference claim stated when doctor
refused to see patient experiencing severe abdominal pain, nausea, and vomiting,
knowing that symptoms could be the result of a life-threatening condition); McElligott
v. Foley, 182 F.3d 1248, 1256 (11th Cir. 1999) (deliberate indifference claim stated
when medical staff failed to diagnose prisoner further because doctors were aware that
prisoner was in tremendous pain); Brown v. D.C., 514 F.3d 1279, 1284 (D.C. Cir.
2008) (deliberate indifference claim stated when prison officials failed to transfer
prisoner suffering from gallstones despite prisoner's display of pain and doctor's order
that prisoner be transferred for treatment immediately).
 The requirement that prisoners demonstrate deliberate indifference poses an obstacle to
class action lawsuits alleging neglect of medical needs of inmates as a class. See,
e.g., Rouse v. Plantier, 182 F.3d 192, 198-99 (3d Cir. 1999) (class action rejected
where prison officials allegedly violated 8th Amendment “on a wholesale basis” with
regard to diabetic inmates who were denied insulin during their imprisonment because
individual plaintiffs required different levels of care). But see, e.g., Gates v. Cook, 376
F.3d 323, 344 (5th Cir. 2004) (class action allowed where death row prisoner
challenged conditions of confinement); Parsons v. Ryan, 754 F.3d 657, 684-86 (9th Cir.
2014) (class action allowed for group of prisoners challenging adequacy
of medical procedures that posed serious health risks).

III. Market
A. Market size
i. Private correctional health care companies provided states an estimated $1.9 billion in
correctional health care services in 2013
  cf. total spending on correctional health care across the states in 2013 was $7.6
billion.
 *Source: page 3 of
https://reason.org/wp-content/uploads/2014/07/ppp_correctional_health_care.pdf
ii. Prison health care expenditures can account for 20% of states’ corrections budgets,
making correctional health care a $10 billion industry
 Source: Arnquist, P. (2014a). Correctional Healthcare Industry and Profiles.
Cincinnatus Consulting. Prepared for Treatment Industrial Complex Convening
in Austin, TX 2014.
iii. Paula Arnquist, “Halting the Treatment Industrial Complex” May, 2014.
 Private companies have contracts for close to 1/3 of all correctional healthcare
spending, or $3 billion per year.
 Industry sources estimate total 2012 Correctional Health Care spending at $10
billion, including state, municipal and federal spending. Industry estimates put
the private correctional healthcare industry at around $3 Billion/year, or one third
of total correctional spending.
iv.
B. Market searches
a. Pitchbook (ownership and financing status)
i. https://my.pitchbook.com/?pcc=241282-45

C. Current companies
a. Corizon (merger of PHS and CMS)
i. Providing medical care and pharmacy services to 107 clients at more than 530 state
prisons, municipal jails, and other correctional facilities in 27 US states.
ii. serving 345,000 inmates
iii. financing status: Private Equity-Backed
iv. ownership status: Privately Held (backing)
v. Ultimate parent: Valitás Holdings, Inc
 Valitás Health Services is majority owned by Beecken Petty O’Keefe &
Company, a Chicago-based private equity management firm
 

 *see: https://www.prisonlegalnews.org/media/publications/Corizon
%20Contracts%20Contracts%20Audit%2C%202014.pdf
v. Annual Sales (Estimated) $241.81M
 *source: Hoover's Company Records; Fort Mill, (Jul 1, 2019).
vi. Review of Corizon’s performance and practices
 Corizon Needs a Checkup: Problems with Privatized Correctional Healthcare,
https://www.prisonlegalnews.org/news/2014/mar/15/corizon-needs-a-checkup-
problems-with-privatized-correctional-healthcare/ (March 15, 2014)
vii. News articles
 Numerous Lawsuits Filed Against Corizon Nationwide; Company Loses
Contracts, https://www.prisonlegalnews.org/news/2017/aug/30/numerous-
lawsuits-filed-against-corizon-nationwide-company-loses-contracts/ (August 30,
2017)
 On the Inside: The Chaos of Arizona Prison Health Care,
https://www.prisonlegalnews.org/news/2018/nov/6/inside-chaos-arizona-prison-
health-care/ (November 6, 2018)
 Florida prison news series (*Extracted from Grassroots Leadership’s report: “Incorrect Care:
A Prison Profiteer Turns Care Into Confinement”):
 Corizon lost their contract after a Correctional Medical Authority audit
revealed “life-threatening conditions” in the Florida Women’s Reception
Center, and a Palm Beach Post investigation exposed serious problems
with health care offered in Florida’s prisons.
 Pat Beall, “Privatizing prison health care leaves inmates in pain,
sometimes dying,” Palm Beach Post, Sept. 27, 2014
https://www.palmbeachpost.com/news/privatizing-prison-health-
care-leaves-inmates-pain-sometimes-dying/
hiJMRmNG9YhE9JFTxfnZaN/
 Most alarming, deaths increased by 10 percent and hit a ten-year record
high within months of Corizon’s takeover in 2012.
 Pat Beall, “Corizon’s prison health care pullout follows
withering report,” Palm Beach Post, Dec. 2, 2015
https://www.palmbeachpost.com/news/crime--law/corizon-
prison-health-care-pullout-follows-withering-report/
 AZnYZ6DryKaoWzpKsN2hkM/?
icmp=pbp_internallink_referralbox_free-to-premium-referral
 As a result of such inadequate care, the state re-bid its contract with
Corizon at the end of 2015.
o Abe Aboraya, “Emergency Situation Declared At Florida
Women’s Reception Center,” WGCU-NPR Southwest
Florida, Nov. 5, 2015
https://news.wgcu.org/post/emergency-situation-
declared-florida-women-s-reception-center
b. Wellpath (USA)
o formerly known as Correctional Medical Group Companies
o Ownership Status: Privately Held (backing)
o Financing Status: Formerly PE-Backed
o *See https://my.pitchbook.com/?c=55890-10

i. Correct Care Solutions

 acquired by Correctional Medical Group Companies (aka Wellpath), via its
financial sponsor H.I.G. Capital and OrbiMed through an LBO on October 1,
2018 for an undisclosed amount. The combined company will generate
approximately $1.5 billion in annual revenues.
*See: https://my.pitchbook.com/?c=54831-97
 Ownership Status: Acquired/Merged (Operating Subsidiary)
 Financing Status: Formerly PE-Backed
ii. Conmed Healthcare Management, LLC
 providing contract health care services to county jails.
 having contracts to provide basic and ancillary medical services to almost 40
adult county jails in Arizona, Kansas, Maryland, Oklahoma, Oregon, Virginia,
and Washington.
 founded in 1984 and went public in 2007 (acquired by Correct Care Solutions)
 Financing status: Formerly PE-Backed
 ownership status: Acquired/Merged
 Ultimate Parent: Wellpath LLC
 Annual Sales (Estimated): $44.39M
 https://pitchbook.com/profiles/company/55890-10

c. MHM Services Inc.

i. contracting with jails and prisons across the US to provide mental health and medical
services to inmate populations.
ii. operating in 11 states (usually via statewide contracts) and provides psychiatric staff, as
well as pharmacy and clinical management programs
iii. financing status: Corporate Backed or Acquired
iv. ownership status: Acquired/Merged (Operating Subsidiary)
v. Ultimate Parent: Centene Corporation
vi. Annual Sales (Estimated): $129.10M
 *source: Hoover's Company Records; Fort Mill, (Jul 1, 2019).
vii.
d. Wexford
i. providing health care services to inmates
ii. having contracts at more than 100 government-run facilities, including county jails, state
and federal prisons, juvenile, detention centers, substance abuse treatment centers,
psychiatric hospitals, and correctional centers for sex offenders
iii. serving about 90,000 inmates and patients through contracts in five states -- Illinois,
Mississippi, Ohio, Pennsylvania, and West Virginia.
 iv. founded in 1992
v. Annual Sales (Estimated): $133.70M
 *source: Hoover's Company Records; Fort Mill, (Jul 1, 2019)
vi. Ownership Status: Privately Held (backing)
vii. Financing Status: Formerly PE-Backed
viii. Related reports
 Final Report of the Court Appointed Expert, Ron Shansky, MD et al., Lippert v.
Godinez, No. 1:10-cv-04603 (N.D. Ill. Dec. 2014)
o https://www.clearinghouse.net/chDocs/public/PC-IL-0032-0007.pdf
o An medical team investigated Wexford reported that it “has been unable
to meet minimal constitutional standards with regards to the adequacy of
its health care program for the population it serves.”
 First Annual Report of Monitor Pablo Stewart, MD at 4, 7–8, Rasho v. Walker,
No. 07-cv-1298 (C.D. Ill. May 22, 2017)
o https://www.clearinghouse.net/chDocs/public/PC-IL-0031-0026.pdf
o This report ,issued in 2017, proved that the quality of care Wexford
provides in Illinois did not improve after the Lippert Report issued in
2014.

D. Financialization of healthcare
i. Private equity investors (not traditional NGO) 
ii.

IV. Contracting practices

A. Contractual payment models (*See PEW 2017 Report: Appendix C, Table C.5.)
a. “cost-plus (fee-for-service)” arrangements
i. Only 2 states (Montana and Pennsylvania) use this payment model
b. Capitation
i. 19 contracted-provision or hybrid states use this model
ii. Kelly Bedard and Frech’s journal article Prison health care: is contracting out
healthy? refers to capitated contracts, and refers to study suggesting that state prison
systems using capitated contracts for ambulatory care had 31% lower costs per
prisoner
c. Neither cost-plus nor capitation
i. 7 states: Alabama, Colorado, Louisiana, Maine, Michigan, Rhode Island, and West
Virginia
B. Contracts
i. Corizon Contracts Audit, 2014
 https://www.prisonlegalnews.org/news/publications/corizon-contracts-contracts-
audit-2014/
ii. RFP: Tennessee Department of Correction (November 2012)
 https://www.prisonlegalnews.org/media/publications/Corizon%20Technical
%20Proposal%20to%20TDOC%2C%202012.pdf
iii. Simone Aponte, 2 Investigates: Inmate’s Death at Santa Rita Jail Raises Questions
About Private Medical Company, KTVU
 http://www.ktvu.com/news/2-investigates-inmates-death-at-santa-rita-jail-raises-
questions-about-private-medical-company
 https://www.documentcloud.org/documents/2273507-contract-between-
corizonprison-health-services.html

V. Comparisons
A. Private services and Public services in state prisons
 a. Performance comparison
 Ex: privatization is not unique to healthcare; food/cleaning services
b. Contracts to run health and mental health care in state prisons are the largest source of profits
for private providers [according to 2013 reports provided by Michigan, Arizona, Maryland,
Florida, and Kansas]
 See Rebecca Larsen, Privately Run Health Care in Prisons: an Industry And
Health Impacts Analysis, Master Thesis
B. Private-operated prisons vs state-operated prisons: key differences
a. Example: Arizona's private prisons
 "Private prisons will not house prisoners with medical problems or mental health
needs because these services are expensive to provide. These prisoners are
concentrated in state facilities, placing the financial burden on the state."
o Source: "A Quality Assessment of Arizona’s Private Prisons"
https://www.afsc.org/sites/default/files/documents/AFSC_Arizona_P
rison_Report.pdf
 Arizona Department of Corrections, Biennial Comparison of “Private Versus
Public Provision of Services Required per A.R.S. § 41-1609.01, December 21,
2011;
o https://corrections.az.gov/sites/default/files/
ars41_1609_01_biennial_comparison_report122111_e_v.pdf

VI. Staff/ Service Quality Issues

A. Unqualified staff
 G. Nicholas Wallace, The Real Lethal Punishment: The Inadequacy of Prison Health Care
and How It Can Be Fixed, 4 Faulkner L. Rev. 265, 272 (2012)
 *Source: Aaron Rappaport, Litigation over Prison Medical Services, 7
Hastings Race & Poverty L. J. 261 (2010)
o Experts sent by the California Corrections Crisis Conference to observe
California prisons’ medical care service quality found the quality of doctors
in the institutions were horrifying.
o Quote the experts: “many of the prison physicians have prior criminal
charges, have had privileges revoked from hospitals, or have mental health
related problems.”
o The experts also found the medical care provided “show[ed] repeated gross
departures from even minimal standards of care.” They also commented that
the medical care provided “too often sinks below gross negligence to outright
cruelty.”
 prison healthcare in Georgia
 "In a recent interview, Young said the state struggles to hire qualified physicians
because it won’t pay what the average general practitioner can earn. Georgia
prison doctors make about $150,000 a year, about $40,000 less than the typical
GP.
 A 2014 investigation by the AJC found that one in five Georgia prison doctors
were hired despite state disciplinary orders for substandard care and other
transgressions."
 see: https://www.ajc.com/news/state--regional-govt--politics/settlements-prison-
doctor-lawsuits-top-million-could-higher/gTGdogyPngTMIKraPuJPSM/
B. Low service quality
 Exposé: Correctional Medical Services, Inc. of St. Louis
 In more than 5 months, an investigative team visited prisons and jails, gathered
hundreds of police, court and medical records, and other documents. The team also
 interviewed doctors, nurses, inmates, lawyers, scholars, prison and health experts,
and families of inmates who died behind bars.
 The team reported “more than 20 cases in which inmates allegedly died as a result
of negligence, indifference, understaffing, inadequate training or overzealous cost-
cutting.”
 One nurse implicated in the death of an inmate at a Florida jail said that, “we save
money because we skip the ambulance and bring them right to the morgue....”
 *See: William Allen & Kim Bell, Death, Neglect and the Bottom Line: Push to
Cut Costs Poses Risks, St. Louis Post-Dispatch, Sept. 27, 1998.
 Amy Petre Hill, Death Through Administrative Indifference: The Prison Litigation Reform
Act Allows Women to Die in California's Substandard Prison Health Care System, 13
Hastings Women's L.J. 223 (2002)
 Hill describes the various ways that women have died due to poor health care in the
California prison systems
 John J. Gibbons & Nicholas de B. Katzenbach, Confronting Confinement: A Report of the
Commission on Safety an Abuse in America's Prisons, 38 (2006)
 The authors find that in California, as late as 2005, one prisoner was dying every
week as a result of medical malpractice or neglect.
 Kelly Bedard and Frech, Prison health care: is contracting out healthy?, DOI:
http://dx.doi.org/10.1002/hec.1427
 The authors did a statistical analysis of mortality rates in state prisons from 1979 to
1990 and change in the percentage of medical personnel employed under contract.
 They found that a 13% increase in percentage of medical personnel employed under
contract increases mortality by 1.3%, which suggests that contracting out prison
health services is counterproductive.
 Joel H. Thompson, Today's Deliberate Indifference: Providing Attention Without Providing
Treatment to Prisoners with Serious Medical Needs, 45 Harv. C.R.-C.L. L. Rev. 635 (2010)
 Paul von Zielbauer, As Health Care in Prison Goes Private, 10 Days Can Be a Death
Sentence, N.Y. Times, Feb. 27, 2005
 “a half-dozen for-profit companies jockey to underbid each other and promise the
biggest savings”
 “As governments try to shed the burden of soaring medical costs...privatization of
jail and prison medical care has become a $2 billion-a-year industry.”
 A quotation of an expert’s observation: “the companies will take bids for amounts
that you just can't do it.... They figure out how to make money after they get the
contract”
 “When cost-trimming cuts into the quality of care ... governments often see no
alternatives but to keep the company, or hire another, then another when that one
fails - a revolving-door process that sometimes ends with governments rehiring
the company they fired years earlier.”
 Ira P. Robbins, Managed Health Care in Prisons as Cruel and Unusual Punishment, 90 J.
Crim. L. & Criminology 195, 198-204 (1999)
 the author describes features of managed care in prison, and the common fee-per-
offender arrangements
C. Administrative procedures and regulations interfering with staff’s fulfillment of the constitutional
health care standards
 Amy Vanheuverzwyn, The Law and Economics of Prison Health Care: Legal Standards
and Financial Burdens, 13 U. Pa. J.L. & Soc. Change 119, 119–20 (2010)
 Co-pay requirement as an example
o The author notes that the Pennsylvania Department of Corrections policy
says that no inmate shall be denied health care due to the inability to pay.
o But inmates in other states are forced to forego health care until they are able
to pay.
  See also Brian Heskamp, Note, The Prisoner's Ombudsman:
Protecting Constitutional Rights and Fostering Justice in
American Corrections, 6 Ave Maria L. Rev. 527, 538 (2008).
o Example: In some states, an inmate who needs preventive medical attention
has to wait until she/he has the co-pay money in her/his account, which could
deter the inmate from seeking the medical attention she/he requires.
 William Allen & Kim Bell, Death, Neglect and the Bottom Line: Push to Cut Costs Poses
Risks, St. Louis Post-Dispatch, Sept. 27, 1998.
 See also: Richard Siever, HMOs Behind Bars: Constitutional Implications of
Managed Health Care in the Prison System, 58 Vand. L. Rev. 1365, 1379–80
(2005)
 The team investigated Correctional Medical Services, Inc. of St. Louis found a
series of troubling effects of managed health care in prisons:
o intervention of distant administrators in the practice of medicine by doctors,
“often second-guessing their decisions on economic grounds,” which can
lead to delayed treatment or approval;
o a “culture of skepticism” that permeates correctional health care; the fact that
the National Commission on Correctional Health Care, which sets standards
and accredits prison and jail health care operations, “does not serve as the
watchdog that private companies claim...”).
o Moreover, Michael Vaughn, professor of criminology at Georgia State
University claims that “For every death there are hundreds of cases of
inmates in these correctional facilities who are receiving substandard care....”

VII. Litigation
A. Problems with the Prison Litigation Reform Act (passed in 1996)
a. The PLRA requires the prisoner exhaust all other administrative remedies prior to filing a §
1983 petition.
i. See 42 U.S.C. § 1997e(a) (2006)
b. Amy Vanheuverzwyn, The Law and Economics of Prison Health Care: Legal Standards
and Financial Burdens, 13 U. Pa. J.L. & Soc. Change 119, 119–20 (2010)
B. Kelly Bedard and H. E. Frech, Prison health care: is contracting out healthy?
a. Medical care is the most litigated issue involving prisons
C. Most are self-represented cases
a. “With respect to risk management, litigation is not a compelling issue within the prison
healthcare industry and Corizon views lawsuits as simply a cost of doing business. ‘We get
sued a lot, but 95% or 97% of cases were self-represented cases,’ ex-CEO Rich Hallworth
was quoted in an August 2013 article. He added that most lawsuits settle for an average of
less than $50.”
i. *See https://www.prisonlegalnews.org/news/2014/mar/15/corizon-needs-a-checkup-
problems-with-privatized-correctional-healthcare/

VIII. Influence on law-making

 “Companies such as GEO Group and Corrections Corporation of America (CCA) have often been
able to influence prison, immigration detention, and sentencing policy to ensure their interests are
met.” (from https://grassrootsleadership.org/programs/treatment-industrial-complex )
o GEO Group's lobbying activity
 “GEO Group and its successor health care company Correct Care Solutions, remains
deeply involved in the industry in large part because of their deep pockets. Although it
remains somewhat unclear where lobbying records for GEO Group, GEO Care and
Correct Care Solutions separate, each has made sizeable investments in Texas
employing the same lobbyists. Lionel Aguirre, Frank Santos, Jennifer Sellers and
Gabriel Sepulveda have all been hired by GEO Group, GEO Care and Correct Care
 Solutions, oftentimes working for all three companies at once*. Most notably, lobbyist
Frank Santos, whose relationship with the former Texas Health and Human Services
Commissioner, Kyle Janek, was at the center of Janek’s controversial resignation, has
been on the payroll since 2011.”
 *data source: Texas Ethics Commission, Lobby Report. Registered Lobbyists with
Employer/Client Contracts (2011- 2015)

 *Source: page14, Grassroot Leadership's report "Incorrect Care: A Prison

Profiteer Turns Care Into Confinement"
 Counter-acting forces?
o While the prison industrial complex is dependent on incarceration or detention in prisons, jails,
and other correctional institutions, this emerging “Treatment Industrial Complex” or TIC allows
the same corporations to profit from providing treatment-oriented programs and services. This
includes moving to capitalize on efforts at the state and federal levels to look at alternatives to
prison, a softening of criminal sentencing laws, and a new interest in evidence-based
practices in parole, probation, and sentencing.
 *see: https://grassrootsleadership.org/programs/treatment-industrial-complex
Law and Economics of Correctional Healthcare

A. Institutional factors and non-institutional factors causing market failures

 *see: Richard Siever, HMOs Behind Bars: Constitutional Implications of Managed Health
Care in the Prison System, 58 Vand. L. Rev. 1365, 1379–80 (2005)
i. Siever cites the following article for the discussion about institutional factors: Harold
Pollack et al., Health Care Delivery Strategies for Criminal Offenders, 26 J. Health Care
Fin. 63 (1999).
[1] “Many institutional factors can contribute to market failures within a prison health care system,
which requires a greater focus on health care adequacy.”
o “Long-term relationships between prison authorities and private contractors can
undermine competitive markets, a phenomenon observed in other contexts wherein a state
institution bargains with private organizations for essential services. The diminishing
competitive pressures result in greater latitude for contractors to earn monopoly profits, as
well as lesser incentives to address patient concerns.
o Another potential problem arises with “low-bidder” legislative mandates in many states,
which require that prison contracts accept only the lowest bidders. These regulations
arguably provide few incentives for quality, and may produce frequent turnover given the
poor profitability of contractors.”
[2] Non-institutional factors unique to the prison system hinder efforts to create market discipline
o “First, given the unique nature of the patient population, the recruitment and retention of
skilled medical personnel becomes problematic. Consequently, prison health providers
experience a higher rate of turnover and lower quality of resulting care.
o Second, social and political factors may contribute to less patient advocacy and regulatory
strategies that might assure quality care.”
[3]
Telehealth and telemedicine for correctional healthcare

 Ellen S. Rappaport, et al., Telehealth Support of Managed Care for a Correctional System: The
Open Architecture Telehealth Model, Telemedicine and e-Health. Jan 2018.
http://doi.org/10.1089/tmj.2016.0275
o https://www.ncbi.nlm.nih.gov/pubmed/28682706

 Young & Badowski (2017). Telehealth: Increasing Access to High Quality Care by Expanding the
Role of Technology in Correctional Medicine. Journal of clinical medicine, 6(2), 20.
doi:10.3390/jcm6020020
o https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5332924/