Boston Globe - All eyes on the state's next move on prison health care

With private equity firms dominating the field, the law- suits just keep piling up.

Rarely has there been a brighter spotlight on prison health care in Massachusetts — and rarely has there been a greater need for it.

The Department of Correction remains under a fouryear settlement agreement with the Justice Department to provide “adequate mental health care and supervision” to those in “mental health crisis,” following a scathing 2020 report for failing to provide “constitutionally adequate” care. An aging prison population poses new challenges for addressing both the physical frailties of the incarcerated and the cognitive issues the system has not adequately planned for. And complaints about the existing levels of care and staffing of prison medical facilities by the current provider, Wellpath, have been all too common.

Today a contract worth well over $100 million a year to provide health care services to all of the state’s prison facilities (except Bridgewater State Hospital, which is under a separate contract with Wellpath) is out to bid. DOC officials, who have not made public the names of bidders or the final number of firms vying for the contract, which includes care for some 6,000 men and women in state custody, are expected to select the winning bid at the end of March for a contract that will begin July 1.

Adding to the drama has been the recent involvement of Massachusetts Senators Elizabeth Warren and Ed Markey, who zeroed in on the current contractor, Wellpath, and YesCare (previously known as Corizon), both of which are among seven vendors known to have filed bid intent forms, according to a public records request by Prisoners’ Legal Services of Massachusetts, a nonprofit advocacy group. The two giant for-profit corporations have attracted a fair amount of congressional attention — and not in a good way.

“We hope you will carefully consider the congressional oversight findings as you move forward with your decision and we trust that you will implement robust measures to monitor the performance of the contract that you select,” the two senators said in a letter to Massachusetts Correction Commissioner Carol Mici.

Wellpath, owned by a private equity firm, has been accused of delaying needed care to its incarcerated patients and failing to adequately staff the state’s facilities.

In response to the congressional inquiry, Wellpath executive vice president and chief legal officer Marc Goldstone acknowledged that, “Like every health care provider, whether public, non-profit, or for-profit, we are constantly working to address the impact of the nursing shortage that was exacerbated by the COVID-19 pandemic, as well as the effect of an overall aging patient population and the resulting increased need for healthcare resources.”

YesCare, according to the congressional report, was accused of manipulating “bankruptcy law with the aim of skirting accountability for the harms that incarcerated individuals have endured under Corizon’s care.” As of late 2021, the firm had been named as a defendant in more than 1,000 lawsuits alleging substandard care in the prisons it serves, according to a 2023 report by the Private Equity Stakeholder Project. The congressional oversight report noted that, “as a result of Corizon’s failures, many local agencies that hold contracts with Corizon have chosen not to renew those agreements.”

As of 2019, Correct Care Solutions — one of the two companies that were combined to form Wellpath — had amassed some 1,395 federal lawsuits brought by prisoners or their families, according to a report in The Atlantic. Locally some 30 federal lawsuits have been filed involving Wellpath as a defendant by prisoners or their families in the past several years.

Those lawsuits run the gamut from ignored “sick slips” and untreated skin rashes to the horrific — a case brought on behalf of two women incarcerated at MCI-Framingham, who alleged they were repeatedly raped by a prison guard over a period of five months and each time they “suffered a mental health crisis” Wellpath and prison personnel confined them “in solitary cells for prolonged periods of time” with “little to no human contact, no therapeutic treatment, no opioid use treatment.”

The medical care Wellpath provided “largely consisted of a 4-5 minute daily ‘wellness’ checklist completed by a Wellpath employee through a small opening in the cell door,” the suit said.

So, yes, when Warren and Markey say they are hoping for more oversight, adequate staffing, appropriate mental health care, and more opportunities for incarcerated patients to access outside care when needed, they couldn’t be more on target.

The next contract will include some modest improvements, such as specific performance measures, “pay-for-performance” incentives, and a provision for geriatric care.

But, the senators noted, it’s also important that incarcerated individuals have “meaningful channels” to “report problems with the contractor without facing retribution” and that the contractor should face penalties for noncompliance.

More oversight within the system would be a better — and faster — route than lawsuits.

There are more eyes on the state’s prisons than ever. Last week Attorney General Andrea Campbell, in a newly released Strategic Plan for her office, vowed to hold accountable “prisons, jails, and their vendors that deny access to basic rights such as constitutionally adequate medical care.”

But as one lawyer familiar with the congressional probe of prison health care noted, a provision for an independent outside monitor — someone who could enter any of the state’s prisons without advance notice and observe how health care is being delivered in real time — “certainly would be the gold standard.”

The ongoing Steward Health Care debacle has shown what the wonderful world of private equity has done to health care here generally. The same thing has been happening for years in prison health care — an industry dominated by two private equity-backed firms — Wellpath and YesCare — both possible bidders for the state prison contract.

Is this really the best Massachusetts can do?