After years of attempting to privatize prisoner medical care, the Georgia Department of Corrections has at finally done so—and chosen a contractor with a reputation to match its own.
The Nashville-based company Wellpath, which contracts with local detention centers, federal and state prisons, and carceral psychiatric and treatment facilities, has been named in around 1,400 federal lawsuits as of 2018. Allegations include malpractice, patient injury and wrongful death. An outpouring of reports has continued to follow the company. Wellpath was selected to operate in 70 carceral facilities across Georgia for the express purpose of slashing costs, according to documents obtained by the Atlanta Journal-Constitution in 2021.
In GDC’s 35 state prisons, which are suffering a severe understaffing crisis, Wellpath replaces Georgia Correctional HealthCare, a subsidiary of state-run Augusta University, which had operated GDC health care ever since the department’s first attempt to privatize failed in the mid-1990s. GDC was dissatisfied with the rising cost over the years. Due to budget cuts, Augusta had not faced external audits since 2005.
Three GDC medical staffers told Filter that they became aware of Wellpath’s takeover in early July, when the company began to schedule trainings and meetings. A meet-and-greet was held for those staffers who had submitted their up-to-date credentials.
According to multiple prisoners and staff, Wellpath pervasively characterizes denied treatments as “costly” and “unnecessary.”
“The hovering!” a nurse practitioner told Filter in October. “They’re always calling and emailing … double-checking your work, vetoing clinical decisions, recommending ineffective [treatments]. And the pressure for audit readiness is intense.”
He estimated that since Wellpath’s takeover, his approved treatment referrals drop from 90 percent to around 30 percent. The company often sends back denials, he said, with “directions for what is in my opinion an alternative, likely less effective, treatment.” The day before, he related, a prisoner diagnosed with severe degenerative disc disease and neural foraminal stenosis had been given a “ridiculous” recommendation of physical therapy.
According to multiple prisoners and staff, Wellpath pervasively characterizes denied treatments as “costly” and “unnecessary.” Neither Wellpath nor GDC responded to Filter‘s requests for comment by publication time.
Tio*, 53, has been fighting for eye surgery since his vision began to fail in 2018. He has been blind since mid-2021, but surgery could restore up to 70 percent of his vision. He resubmitted a request for the procedure in August 2022, but Wellpath denied it, stating that nothing could be done. He was only approved for reassessment after a relative threatened to sue.
Jimmy*, 57, needs cataract surgery on both eyes. He was cleared to receive surgery from an outside specialist in March 2020, which was then delayed due to the pandemic. “Dozens of men from this prison have had the same issue resolved via day trips to local clinics, yet I keep getting put on the [Augusta State Medical Prison] list, with no explanation as to why and everyone claims to [not] know who makes the decision,” he told Filter. “But we all know that ultimately it’s Wellpath.”
Wellpath determines who gets what treatments and where. Augusta State Medical Prison [ASMP] is notorious for botched procedures. GDC prisoners know it for its leaky roofs, asbestos and standing fecal water from an antiquated plumbing system, and widely view it as a facility where patients are “experimented” on by medical students in training. Prisoners and staff alike told Filter they’ve perceived an increase in surgeries booked at ASMP, instead of private facilities, since Wellpath’s takeover.
“Tylenol [with codeine] is the best we can provide,” the nurse practitioner said. “And that’s special approval, non-formulary.”
Jimmy has also lived with a hernia for the past 18 years, and another hernia for 14 years. In March, before Wellpath, he saw a friend taken to an off-site provider to get two hernias repaired and returned to their dorm the same day. Jimmy then completed the diagnostic and consultation requirements for the exact same treatment, which a medical staffer requested in August.
“Wellpath responded to [the staffer’s] inquiry on my behalf with: 1) Nobody does that; 2) I would have to go to ASMP; and 3) I’ve lived with them this long—can’t be bothering me,” Jimmy said.
Jimmy described how his abdominal wall has deteriorated to the point that it no longer holds his small intestine from pushing into his scrotum. He can only bear to stay on his feet for about five minutes at a time before he has to manually push his intestines back into place. He is in constant pain. All medical staff continue to refer him back to the GDC grievance process, which he has already completed.
For prisoners in pain, the nurse practitioner told Filter that medical staff can no longer order any “serious” painkillers, even less-demonized opioid analgesics like tramadol and non-opioids like neurontin (Gabapentin), and even for acute post-surgical pain.
“Tylenol [with codeine] is the best we can provide,” he said. “And that’s special approval, non-formulary.”
Staffers and prisoners also reported widespread frustrations with ERMA, Wellpath’s proprietary electronic health record database. One prisoner told Filter that ERMA informed his facility’s medical staff that he needed general anesthesia surgery to remove a chemotherapy chest port, which he does not have. He has never had cancer nor any other condition associated with chemotherapy.
Wellpath appears to be in the process of overhauling ERMA. The implications of this for prisoner care are not yet clear.
“Big companies don’t usually care for people, they care about pleasing stockholders,” the nurse practitioner said. “I don’t think politicians here in Georgia, like the governor, have shown in the past that they care about prisoner welfare, health, or even about corrections generally. Why should this company?”
Photograph via Arkansas Department of Corrections