On September 26, 2023, the federal court for the Northern District of California found “clear and convincing evidence” that private for-profit prison and jail healthcare provider Wellpath, Inc., had violated the terms of a settlement agreement in a long-running case challenging its provision of healthcare to prisoners and detainees at California’s Monterey County Jail.

As previously reported in PLN, the suit was filed in 2013 alleging deficient medical, mental health and dental care at the jail by Wellpath, then known as California Forensic Medical Group. [See: PLN, June 2014, p.1.] A preliminary injunction issued in April 2015 was formalized four months later by the settlement agreement, imposing numerous requirements on Wellpath. Monitors were appointed to ensure compliance with settlement terms.

But more detainee deaths have followed—at least 25—pushing the jail’s annual mortality rate over two times higher than the national average. The Court entered orders in May 2020 and June 2022 directing Wellpath to develop “corrective action plans” to remedy deficiencies reported by the monitors, including insufficient staffing and inadequate medical and mental health care. However, the company failed to comply.

In May 2023 Plaintiffs moved to enforce the settlement terms, declaring that “[f]or more than seven and a half years, Wellpath has defied its Court-ordered obligations and provided systemically inadequate care” to those incarcerated at the jail, resulting in “daily pain and suffering, including serious medical and dental complications, untreated chronic illnesses, suicide attempts, and deaths.”

Plaintiffs also sought an order requiring Wellpath to show cause why it shouldn’t be fined $25,000 for non-compliance with each provision of the agreement on an ongoing basis. They noted the company’s “cycle of indifference, unkept promises, and patient harm will continue unless and until this Court orders Wellpath to come into compliance with its obligations and imposes consequences if [it] does not.” With respect to mental health care, the plaintiffs noted the jail’s annual suicide rate was “more than three times the average for jails in California.”

Prior to a hearing on the motion, on July 21, 2023, the Court ordered portions of the monitoring reports redacted and parts of the motion and supporting documents sealed to protect individual privacy rights. The following month the Court granted a motion to intervene on August 21, 2023, also granting in part a request to unseal the monitor reports that was filed by intervenors, who included the First Amendment Coalition, the Monterey County Weekly news organization and family members of prisoners who had died at the jail. They argued that the public “has a strong interest inknowing how their tax dollars are spent, and in evaluating the performance of public officials andcontractors, including Wellpath.” See: Hernandez v. Cty. of Monterey, 2023 U.S. Dist. LEXIS 146521 (N.D. Cal.).

Unsealed Reports

The unsealed monitor reports, totaling over 2,000 pages, provided damning evidence of Wellpath’s egregiously inadequate medical, mental health and dental care. One prisoner, David Sand, had a lengthy history of mental health problems, including schizophrenia. Booked into the jail in April 2022 for throwing a rock at a fire truck, he received no psychiatric care from Wellpath staff before he died seven months later, his legs slashed, his body and cell walls written on with blood. The cause of death: suicide by water intoxication.

The unsealed reports revealed case after case in which Wellpath staff failed to fulfill the firm’s contractually obligated mandate to provide jail detainees healthcare—even denying walkers or wheelchairs to disabled detainees and depriving those who were pregnant of prenatal care. One detainee who reported she was raped just before her arrest was denied a rape exam.

The monitor overseeing mental health care cited non-compliance in treatment plans, quality management and staffing. Further, according to one of the plaintiffs’ attorneys, Cara Trapani, “For nearly all of October 2022 to January 2023, Wellpath provided no dental care at the jail because it lacked adequate dental staff.”

Several deaths at the jail were attributed to the company’s non-compliance with its settlement obligations; Monterey County and Wellpath have paid out around $8.5 million in wrongful death cases over the past several years. In other cases, detainees did not receive timely medical care or any at all. Some prisoners who tested positive for tuberculosis (TB) were not isolated, while those who had chronic medical issues, such as HIV, were not seen by doctors until their condition deteriorated.

In granting the recent motion to enforce the settlement, the Court found the facts presented were “sufficient to meet Plaintiffs’ burden to show by clear and convincing evidence that Wellpath is not in substantial compliance with forty-three [out of 44] specific requirements.”

“Perhaps recognizing that the task would be impossible,” the Court added, “Wellpath makes no effort to show why it could not comply with the [settlement] requirements at issue.” To ensure future compliance, coercive sanctions were ordered “in the hope that a threat to its bottom line may galvanize compliance where other measures have failed.”

Accordingly, Wellpath was held in civil contempt and conditionally ordered to pay $25,000 for each of the 43 non-compliant settlement agreement provisions with which it remained noncompliant after six months. If there are continued deficiencies following each monitor report, additional $25,000 fines per provision may be imposed. Two provisions related to mental health medications, which had previously been discontinued, were also reinstated. See: Hernandez v. Cty. of Monterey, 2023 U.S. Dist. LEXIS 171877 (N.D. Cal.).

In 2022 Monterey County renewed its contract with Wellpath to provide healthcare at the jail for another three years, at a total cost of $44.3 million. Meanwhile, Voices of Monterey Bay reported in August 2023 that Wellpath co-CEO Tony Tamer had recently purchased a $25 million mansion in Miami.

The settlement agreement remains in effect; Plaintiffs are represented by attorneys with the National Prison Project of the American Civil Liberties Union (ACLU), the ACLU Foundation of Northern California and the firm of Rosen, Bien, Galvan & Grunfeld LLP. See: Hernandez v. County of Monterey, U.S.D.C. (N.D. Cal.), Case No. 5:13-cv-02354.  

Additional sources: Voices of Monterey Bay, Monterey County Weekly

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