Lawsuits, Studies Suggest Problems Are Common
Mortality data points to broad systemic issues affecting inmates who do not get needed medical care. In a 2025 study, University of Pennsylvania researchers found that 30% of inmates who died in custody from cardiovascular disease in 2019 did not undergo diagnostic testing and that more than 25% did not receive the medications for the conditions that caused their deaths.
Unaddressed drug problems and mental health problems—the latter often exacerbated by the conditions of confinement—contribute heavily to high prisoner death rates, with suicide consistently the leading cause of “unnatural cause” followed by deaths by drug or alcohol intoxications and homicides, according to the Bureau of Justice Statistics, an agency under the U.S. Department of Justice.
For years, U.S. cities have faced scrutiny for poor lockup conditions and lax medical attention for inmates in local jails. The state of California sued Los Angeles County in September 2025 amid a “shocking rate of deaths” in county jails—nearly 40% of which were caused by preventable circumstances over the past decade, the lawsuit states. The county has said it’s complying with multiple settlement agreements as it grapples with “a rising inmate population and an aging Men’s Central Jail,” and remains committed to providing humane care.
Groups representing the jailed inmates of New York City are suing the city’s Department of Correction, claiming that staff at the troubled Rikers Island complex have routinely failed to take inmates to scheduled medical appointments. A federal judge seized control of the jail in May 2025. According to ABC News, Mayor Eric Adams has since said conditions at Rikers have improved under his administration but that the city will comply with the court order. He added that “the problems at Rikers are decades in the making.”
Legal challenges have mounted among for-profit companies that provide medical care in prisons and jails. Chief among them is Wellpath, the for-profit inmate health care provider. The Nashville-based company has faced more than 1,500 lawsuits for medical negligence, wrongful death and personal injury.
After the company filed for bankruptcy in November 2024, Wellpath CEO Chief Executive Officer Ben Slocum said the company has “made significant investments to ensure our patients received the highest level of care.” The company announced a $15.5 million settlement with junior creditors, including those who sued over alleged substandard care, in April 2025, before emerging from bankruptcy the following month.
Funding, Staffing and Prison Health Problems
Avoidable prison healthcare issues are likely rooted in a “lack of adequate funding, which leads, in turn, to a number of subsequent problems,” Marc F. Stern, former Assistant Secretary for Health Care for the Washington State Department of Corrections, tells A&E Crime + Investigation. These include understaffing and the hiring of incompetent workers. In some states, physicians whose licenses were suspended or restricted may still be permitted to practice in correctional facilities.
“Most people don’t like to work in a jail or prison, and you have to pay them often a little bit more to be willing to work in that environment,” Stern says. “Unfortunately, we pay the same or less in the jails and prisons, and it can result in getting people who couldn’t get a job anywhere else.”
Compounding the issue is a lack of on-site prison mental health providers and other specialty care for inmates who experience chronic conditions at higher rates than the general population, says Alycia Welch, associate director for the Prison and Jail Innovation Lab policy resource center at the University of Texas at Austin’s LBJ School of Public Affairs.
“Women lack consistent, regular reproductive health care while they’re in prison or jail,” Welch tells A&E Crime + Investigation. “There’s a lack of geriatric physicians, and we know the population inside prisons is getting older.”
Access to care becomes more difficult because inmates’ medical records may not easily transfer from hospitals and clinics into jail or prison, and simply getting a medical appointment in prison or jail can be a complex, multi-step process.
Poor ventilation and sanitary lockup conditions, overcrowding and inmate stress exacerbate existing health problems among a disproportionately poor population that may not be able to afford medical copays that prisoners must pay in many states, even though they may amount to only a few dollars.
Care Delays and Medication Issues Can Be Deadly
This combination of multiple healthcare problems for inmates can have fatal consequences—including delayed care. In state and federal prisons, 22% of inmates with chronic conditions were not seen by health care providers during their first year of imprisonment, according to the Prison Policy Initiative, a think tank that advocates against mass criminalization and publishes incarceration research.
In a 2023 interview with National Public Radio, 41-year-old Jeffrey Ramirez said he waited over a year to see a specialist after finding a small lump on his left testicle in summer 2020. At the time, he was held at the Federal Correctional Complex in Butner, N.C, the site of a quarter of federal prison deaths in the United States, according to NPR.
It turned out that Ramirez, who was serving a 10-year sentence for intent to distribute methamphetamine and a related weapons charge, had late-stage testicular cancer. He died 11 days after speaking to NPR. The Bureau of Prisons declined to comment to NPR on Ramirez’s case but said it "makes a proactive effort to screen and identify disease at its earliest stages."
Though bad medical outcomes are common in cases of inmates with fatal diseases, they’re also prevalent for prisoners with drug problems, poorly managed infections and, at times, seemingly minor ailments.
“Because of these long times of response, things that are more acute then turn much more drastic,” Katherine LeMasters, assistant professor University of Colorado Anschutz Medical Campus, who studies health inequities in our criminal justice system, tells A&E Crime + Investigation. For example, an allergic reaction that’s typically resolved with an antihistamine can turn into a life-threatening condition if left untreated.
In fact, medication issues—including delayed access and potential contamination—are fairly common. Multiple diabetic inmates at Pasco County Jail in Land O’ Lakes, Fla., filed a class-action lawsuit against the facility in 2022, accusing a nurse, employed by Wellpath, of placing a needle used on an HIV-positive inmate into a vial of insulin and then injecting the contaminated insulin into other patients.
Wellpath said it terminated the nurse’s employment, provided appropriate follow-up to the patients and wasn’t aware of any health complications after the incident. The status of the litigation was unclear following Wellpath’s bankruptcy.
How to Improve Healthcare Behind Bars
Welch says correctional facility healthcare could be significantly improved with better prisoner medical screenings for mental and chronic health problems.
“When the screening and assessment process is not full, not comprehensive and not done by the right people, that’s one way in which medical mishaps can happen, because issues are not properly identified,” Welch says.
Better governmental oversight of inmate health is also important and could be accomplished with “a set of standards that governs all prisons and jails at the state or federal level,” according to Welch.
“Where care is provided behind closed doors, closed walls—that makes it ripe for mishaps to continue to happen and problems to not be addressed,” Welch says. “It’s only when there’s public transparency and when we hold prison and jail agencies and providers accountable for care that we will see improved health outcomes and improved medical care.”
