Charleston County’s jail — now under investigation by the U.S. Department of Justice for eight deaths of incarcerated people in recent months — has turned the corner on inmate health thanks to a recent county agreement with a new for-profit medical care provider, officials say. But companies that provide such care often have plenty of skeletons in their closets.
In the five months that the Sheriff Al Cannon Detention Center (SACDC) has been using Vitalcore Health Strategies to provide medical care, the county has had no reports of non-compliance with medical quality standards, said Charleston County Sheriff’s Office spokesperson Amber Allen. Compare that to the 63 reports highlighted in a Freedom of Information request between May 2022 and March 2023 when another company, Wellpath, was providing health services.
“I think I can speak for the agency as a whole that we have been very pleased,” Allen said, praising Vitalcore for its mental health team. “We do take the health care of the people in our facility very seriously.”
The local jail is a pretrial center, which means the vast majority of people in custody, by law, are presumed innocent. Many cannot afford to pay bail. A disproportionate number are homeless or struggle with mental illness or substance addiction. The jail in January 2023 reported that of the 998 adults it housed, only 36 had been sentenced.
The North Charleston jail has used for-profit medical providers since 1996 to staff the infirmary and employ necessary medical practitioners who provide services for which the company is liable.
Vitalcore Health Systems has been under contract with the county since May 8, after the county’s agreement with previous provider Wellpath expired, and the company came under fire for numerous reports of medical neglect and quality non-conformance.
Vitalcore claims to be better than many companies in its industry.
“We have had a total of only 54 lawsuits,” the company said in its Charleston County proposal earlier this year. This is, according to Vitalcore, “unheard of.”
Vitalcore also claimed the company has made material improvements at the jail since its contract started.
“Since July, we have increased staffing by over 45% by hiring licensed health care providers from the surrounding community. Our contract requires 44 staff. We currently have 43 full-time staff, as well as three part-time and nine PRN [as needed] staff hired,” it noted in a statement this week to the Charleston City Paper.
SACDC Detention Captain Ezzard Luke, however, said jail personnel, including the health care workers, change frequently, resulting in a facility-wide staffing shortage. This week, the company was looking on Indeed for nine new staff members to fill six different positions — with Registered Nurse, Licensed Nurse Practitioner and psychiatrist listed as “urgently hiring.”
Deaths, conditions prompt jail investigation
The U.S. Department of Justice, however, isn’t as satisfied overall. On Nov. 2, it announced an investigation into SACDC due to ongoing concern about, among other things, the physical and mental health care the facility has provided. Since 2022, there have been eight reported deaths inside its walls.
Allen told the City Paper there’s a potentially complicating factor with providing health services at the jail: People who are arrested don’t usually enter jail in the best condition.
One person in custody died in the few months Vitalcore has worked at SACDC: 42-year-old Quinn Connor. The cause of death is still undetermined, pending results of an autopsy investigation, but documents state Connor didn’t get up for his 7:30 a.m. breakfast. He was covered by a blanket, documents stated, but this behavior allegedly was common. At 11:50 a.m., another incarcerated individual went to check in on him, but Connor was not conscious. He was declared dead 25 minutes later.
Luke defended the services provided in the detention center that some feel are inadequate. “When residents complain about the jail, I tell them, ‘Go to a jail in Kuwait. Go to Turkey. Go to Mexico.’ ’’ Luke said if family members in those countries don’t bring food to those incarcerated, they won’t be fed.
Lawsuits and medical negligence
Like Wellpath, a few of Vitalcore’s lawsuits alleged severe medical negligence resulting in wrongful death of an incarcerated individual.
Some observers say instances of medical negligence among third-party providers might be driven by profit incentives. Regardless of Vitalcore’s expenditures on medical services at SACDC, the county pays the provider $18.45 per day per detained person. Essentially, Vitalcore’s surplus revenue comes from the difference between this flat rate and the amount it spends providing care to its patients. And, according to a report in the New York University Law Review, under this system, “the easiest way to keep costs down is to deny care.” Or, the less a company like Vitalcore spends, the more it profits.
Vitalcore doesn’t hide its cost-saving measures. The group claimed it “has reduced off-site emergency costs at our other contract sites by as much as 30%,” saving its clients large amounts of money and generating a considerable revenue. While the company, established in 2015, rejected the ideal of “excessive profit,” it is currently churning out $325 million annually — a number it expects in 2025 to be more than $500 million.
And although Vitalcore cuts costs and increases profit margins, the company said it doesn’t cut corners: “Offsite emergency care will always be ordered when our professionals determine that it is necessary.”
Origin of problems
Charleston County has acknowledged in its call for contractor proposals that the standard of care provided by companies such as Vitalcore is fundamentally limited.
“Providing the entire inmate population with competent, professional medical care and treatment within the narrow budget constraints is, and will likely remain, a challenge given the banality of special needs of inmates,” the county said.
Ninth Circuit Public Defender Cameron Blazer, who represents many incarcerated clients, spoke of another problem.
“We sometimes get reports and medical records that reflect a client refused treatment,” she said, which doesn’t match the client’s testimony.
Blazer added there’s a “cultural inclination beyond the confines of jail to give a lot of credit and credibility to medical professionals.” This is compounded by “an inclination to discredit people who are involuntarily incarcerated.”
The public defender’s reports are corroborated by a documented 2020 National Commission on Correctional Healthcare violation. It stated there was “no evidence of signed informed consent for dental care or for psychotropic medications, nor was there evidence of signed patient refusals of examinations or witness signatures.”
And according to Blazer, denying care to incarcerated people is against the best interests of everyone. SACDC is a pre-trial facility, so most people will, at some point, re-enter society. And if their conditions aren’t initially treated, they might become chronic, which equals harder to treat — and a lot more expensive.
She said of those who “can’t bother to care” about incarcerated folks: “I would hope they would at least muster to care about their own pocketbooks.”
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