After ‘a death spiral’ in private staffing, sheriff moves to in-house care model

BOURNE — Sheriff Donna Buckley ended the Barnstable County Correctional Facility’s contract with private medical care provider Wellpath two months before the contract was set to expire at the end of this month. Buckley said this week that the county jail moved to in-house medical care on Aug. 14.

The for-profit vendor, owned by a private equity firm and operating in prisons across the country, had proved unable to meet its staffing obligations since 2020, Buckley said.

“We had no other choice,” she said. “We cannot afford to have all our cards with Wellpath and have them not show up.”

According to Buckley’s office, Wellpath had been operating at the jail at 20 percent staffing capacity, leading to what the sheriff called a “death spiral” —the burnout of clinicians working up to 16-hour shifts.

Wellpath’s deficiencies were in plain view before Buckley’s predecessor, Sheriff James Cummings, a Republican who held office for 24 years, outsourced the jail’s health care to the company. The Atlantic reported in 2019 that in the previous decade Wellpath had been sued at least 1,395 times in federal courts by inmates or families for medical malpractice and negligence.

In October 2019, a year before Cummings gave the contract to the company, its founder and former CEO, Jerry Boyle, was indicted on charges of bribing the sheriff in Norfolk, Va. with cash, travel, loans, personal gifts, sports tickets, and campaign contributions from 2004 to 2016.

Reestablishing In-House Care

The Barnstable County Sheriff’s Office had its own in-house health care team until 2015, when it contracted private vendor Correctional Psychiatric Services (CPS) to provide mental health care. CPS expanded to provide all health care to inmates in 2017. That contract went to Wellpath in 2020.

The sheriff is now working to establish a health services department with its own licensed clinicians, nurse practitioners, mental health clinicians, and a recovery coach. The coach position was established by a federal grant awarded to Barnstable in 2020 and which Buckley said the previous sheriff had not used.

Buckley asserted that she is not ditching Wellpath because of the quality of services. Instead, she said, the problem has been with the “levels of services and expectations under the contract.” Those, she said, “were a reflection of the previous sheriff’s comfort level.”

Buckley said that she has rehired staff who previously worked at the jail under Wellpath. “Despite the model not working,” she said, “the staff were exercising Herculean efforts to try to provide services.”

Buckley added that “our model adds more services into the mental health piece, which is a huge factor in someone’s ability to be successful when they are released.”

Buckley said the jail’s medical team is “fully staffed.” But according to the sheriff’s website, there are job openings for nighttime registered nurses and practical nurses, a mental health clinician, a recovery coach, and a licensed clinician to assist inmates with substance use disorder.

Buckley said that Wellpath had failed to keep up with requirements regarding the timeliness of medical exams. This failing was the subject of an audit conducted by the state auditor last March, which revealed that the sheriff’s office did not ensure that inmates received health appraisals on time between 2019 and 2021, before Buckley was elected.

The jail’s policy requires inmates to undergo screening within seven days of admission. The audit found that up to 196 health appraisals were not completed in the required timeframe.

The sheriff’s office at the time told the state auditor that its health-care vendor did not have enough staff members to complete health appraisals on time, according to the audit. Buckley said that under her predecessor’s deal with Wellpath, the sheriff “had no control over the circumstances if they failed to perform.”

“Because BCSO does not ensure that its healthcare vendor completes the health appraisals within the required timeframe,” the audit found, “there is a higher-than-acceptable risk that inmates’ medical issues are not identified and treated, ultimately affecting the health and safety of all BCSO inmates.”

Tragedies Foretold

Last year, the U.S. Dept. of Justice reached a settlement with Mass. Dept. of Correction (MDOC) in which the DOJ found that MDOC violated the constitutional rights of incarcerated people experiencing mental health crises in Massachusetts state prisons.

The DOJ accused MDOC of inadequate supervision of inmates, lack of mental health care, and the abuse of solitary confinement.

Last summer, three men died in solitary in the Barnstable County jail, two from suicide and one from a drug overdose. There had been two suicides at the jail in 2017, the same year that the sheriff first contracted out medical services. Before that, there had not been any suicides in the jail in over a decade.

Wellpath is one of the nation’s largest providers of inmate medical care, according to Prison Legal News. It is owned by the Miami private equity company H.I.G. Capital and operates in more than 350 prisons, with responsibility for the care of more than 135,000 adult and juvenile patients.

Wellpath serves all Massachusetts state prisons, according to the Mass.gov website. But according to a 2020 report by WBUR, the company had contracts with just two other county jails in the state besides Barnstable: Worcester and Essex. Those counties continue to have contracts with Wellpath.

Wellpath and other players in what the report calls “a multi-billion-dollar industry with little public scrutiny” enter into contracts with jails that include incentives to curb costs and reduce hospital trips. At the time of that report, Wellpath had $1.6 billion in annual revenue.

When private health-care vendors focus on financial incentives rather than quality of care, “there is a huge economic incentive to deny or delay care,” said Michael Horrell, a senior attorney and health-care and disability project director at Prisoners’ Legal Services of Massachusetts.

“Every dollar that they don’t spend on health care is a dollar that is going to their bottom line,” Horrell told the Independent. He said that in counties that operate in-house health-care models, “we get fewer complaints. That’s an indication of whether it’s working.”