Durbin, Warren, Ossoff Lead Colleagues In Raising Concerns With Wellpath Over Inadequate Health Care Services In Prisons And Jails Nationwide

Letter

Dear Mr. Slocum, Mr. Mnaymneh, and Mr. Tamer:
We write to express deep concern with reports that Wellpath is providing inadequate health care
in prisons and jails across the United States.

Wellpath is the largest prison health contractor in the country, serving around 300,000 patients
in at least 34 states. Wellpath is owned by the private equity firm H.I.G. Capital and was created
in 2018 through a merger of Correct Care Solutions (CCS) with Correctional Medical Group
Companies. Wellpath's predecessor CCS was named as a defendant in roughly 1,400 federal
lawsuits over the decade leading up to the merger -- with many cases resulting in some form of compensation to plaintiffs. Since its creation, Wellpath has been the target of multiple federal
investigations and lawsuits, and the company has faced growing public scrutiny.

A host of federal investigations, press reports, and reports by incarcerated people have revealed
apparent deficiencies in Wellpath's care. Some of the most serious complaints against Wellpath
include the following:
● Delayed care and denial of care: Reports indicate that Wellpath routinely fails to
provide time-sensitive medical care or denies care outright. For example, a 2021
Department of Justice (DOJ) investigation into Wellpath's medical services at a
California jail revealed significant delays in care and blanket denials of medical attention
for incarcerated individuals scheduled to be released within weeks or months of the
request for care. Similarly, a Department of Homeland Security (DHS) investigation into
Wellpath's predecessor CCS found that detainees lacked "timely access to proper
medical care." Further reports indicate that Wellpath staff have even failed to respond to
urgent care needs, including for patients going into labor, seeking to terminate a 15-week
pregnancy, requiring an emergency room transfer, or suffering from an emergency drug
withdrawal. And in some cases, incarcerated individuals have died after not receiving care -- such as the reported case of a pretrial detainee with breathing problems who was
transferred to a new jail without his CPAP machine and died after Wellpath medical staff
declined to provide another one.Monitors at a California jail found that 18 of the 19
deaths reviewed at the facility could have been prevented if Wellpath had followed its
obligations to provide timely and adequate treatment.

● Involuntary treatment: Wellpath has also allegedly performed procedures and
administered medications without patients' informed consent and without following the
company's protocol for involuntary treatment.For example, at one South Carolina jail,
incarcerated individuals were reportedly injected with an opioid treatment drug without
their consent. At another, monitors found that Wellpath staff forcibly administered
psychotropic medications without following the established protocol for the involuntary
administration of medication.

● Inadequate staffing: Reports suggest that Wellpath has failed to meet contractually
required staffing levels and hires under-qualified medical professionals. For example, a
2021 DOJ investigation found that Wellpath staffed an inadequate number of medical
professionals at one of its facilities, putting incarcerated individuals at "substantial risk of
serious harm." Similarly, a 2018 DOJ investigation into Wellpath's predecessor found
that incarcerated individuals were simply not sent to outside medical providers due to
medical and security staffing shortages. And a 2015 investigation by DOJ's Office of
the Inspector General (OIG) found that a Federal Bureau of Prisons (BOP) facility in
Texas that contracted with Wellpath's predecessor CCS "had significant issues staffing
its health services unit." In 2023, a Georgia jail feared it would be forced to cease some
medical operations altogether due to serious personnel shortages in intake, medication
distribution, and the main clinic. Likewise, an audit at a California jail found that
Wellpath provided no dental care for months because it lacked adequate dental staff, and stopped conducting intake screenings due to a shortage of nursing staff. A CNN
investigation even found that Wellpath staff shredded and hid medical requests at some
facilities due to a lack of available medical staff. There are also reports of Wellpath
employing licensed vocational nurses in roles that require registered nurses with more
advanced training. Monitors in Louisiana have similarly found that Wellpath has relied
on under-qualified professionals, some of whom failed to follow routine medical
protocols.

● Negligent care and failure to follow doctors' treatment plans: At times, Wellpath's
medical staff have allegedly provided negligent care. For example, one monitor found
that Wellpath staff were not consistently looking in patients' mouths when assessing
whether they needed dental care. And there are numerous reports of Wellpath staff
failing to provide treatment prescribed by a physician. Wellpath has canceled off-site
specialist visits recommended by doctors and discontinued medications without a medical
justification. In one case, an incarcerated patient was apparently hospitalized due to
seizures after Wellpath failed to administer her prescribed medications. In another case,
Wellpath discontinued a medication that an incarcerated individual had been taking for
20 years and denied his grievance simply because he raised multiple issues in the
grievance at once.
● Failure to follow internal company policies: There are also reports of Wellpath staff not
following the company's own protocols. For example, at some facilities, Wellpath staff have, in violation of company policies, reportedly failed to: perform mortality reviews;
notify a physician when patients showed abnormal vital signs; develop individual
treatment plans for patients with mental illnesses; and assign different staff members to
review an initial grievance and an appeal. Additionally, contrary to Wellpath's policies,
some staff have failed to monitor for attempts at self-harm or suicide, and some have
even falsified logs by stating that they performed welfare checks. Wellpath has also
reportedly failed to abide by its own plan for implementing a court-approved settlement
agreement, including failing to timely respond to sick call requests, refer incarcerated
patients to outside providers as needed, or even schedule internal quality improvement
meetings.
● Inadequate mental health care and inappropriate use of restraints and solitary
confinement: There are reports of Wellpath inappropriately responding to mental health
issues by prescribing antipsychotics without clinical justification and defaulting to the
use of physical or chemical restraints in response to mental health crises. Wellpath has
allegedly also abused the use of solitary confinement for incarcerated people with mental
health issues. For example, a 2020 DOJ investigation revealed that, under Wellpath, "Massachusetts' prisons subjected incarcerated people in mental health crisis to prolonged periods of restrictive housing conditions, instead of providing them constitutionally adequate mental health care and supervision." Meanwhile, Wellpath has refused to give incarcerated individuals their prescribed mental health medications and, according to a DOJ investigation, the company "seems to discourage routine follow-upmental health care."

Wellpath's payment structure incentivizes cutting costs by minimizing the number of healthcare
services provided and opting to provide less resource-intensive services. In its state and local
contracts, Wellpath is typically paid a set rate based on the average daily population at the
facilities where it provides care, with caps on the total amount that it can be compensated.
While some contracts increase Wellpath's compensation for emergency services such as
ambulance runs or decrease compensation for failures such as not triaging sick call requests, pay
generally does not increase with the volume, quality, or complexity of medical services
provided. Some Wellpath contracts also appear to incentivize the company to reduce the
number of transfers to hospitals or to employ fewer staff members. Meanwhile, in at least one
contract that did permit reimbursement for specific services provided, the DOJ found that
Wellpath's predecessor CCS was overcharging the BOP by inflating its billing rates in
invoices.

While Wellpath asserts that its cost-cutting measures do not compromise the quality of
services, extensive evidence suggests otherwise. Nationwide, the privatization of prison health
care has been associated with instances of reduced quality of care, higher death rates, and less
transparency. The more recent trend of private equity firms such as H.I.G. Capital purchasing
prison healthcare providers -- along with food, commissary, and telecommunications providers
-- has supercharged the profit incentive to compromise service quality.

Meanwhile, the consolidation of prison healthcare providers into fewer and fewer giant
contractors has left local and state governments with few private alternatives to Wellpath. Some
governments have turned back to the public provision of prison health care, or to university or
nonprofit providers as promising alternatives.

To help the public better understand Wellpath's conduct in jails and prisons and whether the
company is able to provide adequate care, we request that you provide the following information
no later than January 8, 2024:
1. A list of all locations where you (or a subsidiary) operate to provide care for incarcerated
or detained individuals. For each location, please provide:
a. The number of patients you (or the subsidiary) are contracted to provide care for.
b. The number of patients you (or the subsidiary) have provided care for during the
contract period, per calendar year.
c. The number of referrals for outside care that you (or the subsidiary) have made
during each calendar year of the contract period.
d. The total value of the contract.
e. The pay structure for each contract.
f. Any incentives built into the contracts, such as bonuses or increased payments
based upon cost savings, staff reductions, or quality of care.
g. Whether the federal, state, or local contracting partner receives any portion of
unspent funds.
2. For each contract, please provide information on required staffing levels at each facility.
a. What percentage of the required staffing have you provided in the last 12 months?
Answer by providing raw data by position/role. Please identify if any roles are
filled by individuals who fill more than one role (ex: if one physician fills both an
attending and a supervisory role).
b. What percentage of your current staff positions are unfilled?
c. In which facilities do you provide a medical doctor on site 24 hours per day (if
any)?
3. When seeking a new contract, do you typically promise to cut healthcare operational
costs?
a. If so, how do you ensure the quality of care remains unchanged while cutting
costs?
b. Please provide any marketing or pitch materials provided to potential clients.
4. How do you assess the quality of care provided?
a. Provide any internal policies used to evaluate your standard of care.
5. What protocol does Wellpath follow when providing medical screenings during the
intake process?
a. How does Wellpath screen for behavioral health issues?
6. What is the protocol Wellpath (or a subsidiary) utilizes when determining whether or not
a patient should be referred for outside care?
7. How much have incarcerated individuals been charged for copays on average in your
facilities over each of the past five years?
a. Please provide this copay information for each facility where you operate and
specify what portion of the copay goes to Wellpath versus the facility or agency.
b. Have you tracked changes in the percentage of incarcerated people seeking care
based on the amount of the copay charged? If so, what changes have you
identified?
c. What does the company do when an incarcerated person requires medical
attention but cannot afford the copay?
8. How does the availability of security guards or scheduling of court dates affect access to
health care in the facilities where you operate?
9. What role does Wellpath play in determining whether individuals should be placed in
solitary confinement based on mental health conditions?
a. Is there a status that a Wellpath provider of mental health services could assign to
a patient that would result in a transfer to solitary confinement?
10. What is Wellpath's policy for identifying and treating drug or alcohol withdrawal?
a. What training, if any, are Wellpath staff given for recognizing the symptoms of
drug or alcohol withdrawal?
11. Do Wellpath staff provide medication-assisted treatment (MAT) to individuals with
opioid use disorder?
a. If MAT is provided, how do Wellpath staff ensure that the medication is
administered safely and in the appropriate dosage?
b. If MAT is provided, what is the protocol for providing counseling alongside the
medication?
12. How many healthcare-related grievances have been filed in each of the facilities where
you operate in each of the past five years?
a. What have been the topics of those grievances?
b. For each of the past five years, what percentage of grievances have been
substantiated?
c. What percentage of grievances did not receive any reply for three months or
more?
13. What steps must an incarcerated person take to request non-emergency medical, mental,
or dental treatment?
a. What is the median turnaround time for Wellpath staff to process a request for
non-emergency care?
b. What is the median amount of time between a request for non-emergency care
and the receipt of care from a healthcare provider?
14. What steps must an incarcerated person take to request emergency medical, mental, or
dental treatment?
a. What is the median turnaround time for Wellpath staff to process a request for
emergency care?
b. What is the median amount of time between a request for emergency care and the
receipt of care from a healthcare provider?
15. List the lawsuits filed against the company over the past five years.
a. For each, indicate the outcome of the lawsuit (settlement, dismissal, jury verdict,
etc.).
b. For all cases resulting in settlements, please indicate the dollar amount for which
the case settled.
c. Please also list each lawsuit against the company in the past five years related to
miscarriages caused by medical neglect.
16. Does the company indemnify employees who are found liable for unlawful conduct
committed in the course of employment, including negligence, malpractice, intentional
torts, and constitutional violations?
17. How does the company decide where to allocate money in its operating budget?
a. What are the top five line items in your budget and how much is spent on each?
b. How has this allocation changed over the last five years? Please provide the
breakdown for each of the last five years.
18. What number of staff do you currently employ, in each of the following categories:
doctors, physician assistants, nurse practitioners, registered nurses, licensed practical
nurses, licensed mental health professionals?
a. What percentage of doctors are licensed to practice medicine in the state where
they are working for Wellpath?
b. What percent of doctors have lost their license to practice medicine in a state
other than the one where they are working for Wellpath?
c. What is your company's protocol for checking the licenses or other credentials of
employees in each of the following categories: doctors, physician assistants, nurse
practitioners, registered nurses, licensed practical nurses, licensed mental health
professionals?
d. Are there any differences between the qualifications required for doctors in your
facilities and doctors operating in the local community? If so, what are the
differences?
19. What types of preventative care do your medical providers offer?
a. What process must an incarcerated person go through to access preventative care?
b. What types of prenatal care do your medical providers offer?
20. What types of dental, mental, or medical care are your providers not permitted to perform
without additional approval (if any)?
a. What is the process of securing approval?
i. Who must approve that care?
ii. How long does this process take?
b. For each type of care, what percentage of requests by providers to perform a
procedure are not approved?
21. Does Wellpath participate in any voluntary accreditation system at any of its facilities? If
so:
a. Who provides the accreditation?
b. What information do you make available to accreditors?
c. In how many of the five most recent accreditation cycles did an accreditor do a
site visit to any of your facilities?
22. What are Wellpath's internal policies for responding to deaths in custody?
a. How many deaths have occurred in your facilities in each of the past five years?
b. During each incident, were the company's mortality policies followed? Were the
contracting agency's policies followed?
c. Under what circumstances (if ever) is a mortality review conducted by an
independent entity?
23. What are Wellpath's internal policies for responding to suicide attempts in custody?
a. How many suicide attempts have occurred in your facilities in each of the past
five years?
b. During each incident, were the company's relevant policies followed? Were the
contracting agency's policies followed?
c. What is Wellpath's protocol for providing mental health care to an individual
after a suicide attempt?
24. What are Wellpath's internal policies for responding to requests of pregnant and
incarcerated individuals for outside appointments?
a. What is the median length of time a pregnant individual must wait between intake
and their first PCP visit?
b. How quickly after a pregnant individual reports concerns must they be taken to
the hospital?
Thank you for your attention to this important matter.

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