A physician at the Fresno County Jail appeared before Fresno County supervisors last week, revealing how private-equity management company Wellpath makes decisions on inmates’ care.

Despite being run by a physician-owned company on paper — California Forensic Medical Group — inmate medical equipment, referrals, and diagnostic tests are evaluated for approval by Wellpath, Dr. Kanwar Gill, a physician at CFMG, told GV Wire.

California law has special protections against private, for-profit companies influencing medical decisions.

Despite this, nurses and administrators will counter a doctor’s orders, often with the costs figuring into the decision, Gill said.

Across the country, Wellpath faces hundreds of lawsuits alleging substandard care for inmates. Some of the lawsuits involve CFMG.

In April, Wellpath settled with the family of a man who was found dead in his cell for $2.5 million, Pleasanton Weekly reported. For three days, inmate Maurice Monk lay in his cell at the Alameda County Jail as guards piled up food and nurses piled up medications.

Alameda County also paid a $7 million settlement to the family, agreeing it would improve how it conducts observation checks. Now, Alameda County supervisors are considering putting the jail’s medical services up to bid when the contract expires in 2027, according to news reports.

Wellpath recently went through bankruptcy in part to resolve more than 1,500 lawsuits alleging deficient medical care, according to Reuters.

In 2022, one of Wellpath’s founders, Gerard Boyle, pleaded guilty to federal bribery charges, according to the U.S. Attorney’s Office.

He was sentenced to five years in prison for giving Norfolk County Sheriff Robert McCabe cash, entertainment, and travel gifts in exchange for contracts, extensions with no bids, and other favorable terms while the company operated medical services for the jail there.

County Is Reviewing Physician’s Concerns

Fresno County Communications Director Sonja Dosti told GV Wire that Fresno County is reviewing Gill’s claims.

“The County Administrative Office will always do due diligence when any claims are made against the county or any of its contractors,” Dosti said.

Wellpath officials did not respond to several emails and calls made by GV Wire.

“This is a matter of public integrity, legal compliance and patient safety and not a personal complaint,” said Gill at the board of supervisors meeting. “Fresno County contract of the jail services is with California Forensic Medical Group, a California-registered medical corporation, but in practice, the company making the decision isn’t CFMG, it’s Wellpath, a Tennessee-based for-profit corporation which is not licensed to practice medicine in California.”

Fresno County Jail One of CFMG’s Biggest Contracts

Wellpath became one of the biggest companies serving jails, prisons, and detention facilities when H.I.G. Capital merged two correctional facility medical group giants in 2018.

H.I.G. came to own CFMG when it bought Correction Medical Group Companies in 2013. CFMG provides medical services to nearly half of California’s counties, according to its LinkedIn account.

Gill still works for CFMG, though he has been put on leave, he told GV Wire. He said his problems began when Wellpath declared bankruptcy and diverted Gill’s and other physicians’ wages in the bankruptcy assets to help address its $644 million debt — even though CFMG and Wellpath are independent of one another.

Following the bankruptcy, Kip Hallman, a co-chair of Wellpath’s board of directors, said the company’s bankruptcy would not affect jail operations as CFMG and Wellpath were completely separate, according to the Santa Barbara Independent.

California has special protections against for-profit companies in the medical industry. The California Medical Board told GV Wire that Wellpath is not licensed to practice medicine in the state.

It directed GV Wire to the state’s Corporate Practice of Medicine guidelines that “prevent unlicensed persons from interfering with, or influencing, the physician’s professional judgment.”

The board did not comment on whether the company had complaints against it.

Medical Group Took Over Jail Services in 2018

Fresno County first contracted with CFMG for jail services in 2018, signing a $121 million contract. At the time, county supervisors stressed the need for employees for all shifts after allegations of inmate abuse and coverup from its previous contractor, Corizon Health.

In 2015, Fresno County created a remedial plan guaranteeing adequate health care to inmates after a lawsuit alleged conditions at the jail constituted cruel and unusual punishment.

In 2024, the county renewed CFMG’s contract, upping it to $394 million and making it one of the biggest contracts in the state. In that contract, CFMG noted difficulties in providing services to the jail due to higher staffing costs and the COVID-19 pandemic.

When asked, the Fresno County Sheriff’s Office did not comment on the measures it’s taking to ensure the terms of the contract are being upheld.

Gill, who has worked at the jail since 2019, said that Wellpath and its out-of-state managers often make medical decisions.

“These are decisions that require medical training and should be made by doctors, yet they were often dictated by administrators with no medical license,” Gill said.

Wellpath Routinely Overrides Doctor’s Orders: Gill

Getting booked into the jail provides many inmates with a chance to recover from drug abuse and heal, Gill said.

“When these guys come to the facility, they don’t do drugs, they have better care, they get their medicines on time,” Gill said. “Almost all of them, even the ones that the doctors on the outside were saying will die in 60 days, survive.”

But for physicians, getting treatment approved often means navigating Wellpath’s system, Gill said.

Non-physician officials at Wellpath routinely weigh in on clinical decisions. They scrutinize how many patients doctors see, how they document care, and when inmates should go to the hospital.

An inmate in his 90s suffered from low blood pressure and kept falling. Gill and the local medical director, who also works for CFMG, kept trying to get the inmate sent to the hospital for care. The regional director, who was on Wellpath’s payroll, kept refusing a level of care needed for the patient, Gill said. Gill finally refused to accept him back into the jail and that resulted in the inmate’s placement at a nursing home. The hospital’s physician agreed with Gill’s recommendation, he said.

Another inmate needed a special CPAP machine because of a breathing issue and a heart condition. The regular machine was pushing air into the inmate’s abdomen, preventing him from sleeping, Gill said. This machine cost about $200 more, but the health services administrator, on Wellpath’s payroll, would not authorize the payment, Gill said. The administrator, a nurse, was Wellpath’s only direct employee at the jail and was in charge of doctors.

Wellpath, CFMG Issues Not Limited to Fresno

U.S. Sens. Elizabeth Warren, Dick Durbin, Raphael Warnock and others wrote a letter to Wellpath’s and H.I.G. Capital’s CEOs, echoing many of Gill’s concerns.

“Wellpath routinely fails to provide time-sensitive medical care or denies care outright. For example, a 2021 Department of Justice (DOJ) investigation into Wellpath’s medical services at a California jail revealed significant delays in care and blanket denials of medical attention for incarcerated individuals scheduled to be released within weeks or months of the request for care,” the letter stated.

In 2015, CFMG settled with inmates who sued for substandard care at the Monterey County Jail, said Caroline Jackson, senior counsel with Rosen Bien Galvan & Grunfeld in San Francisco. Part of the settlement required a neutral investigator to monitor the medical group’s compliance, Jackson said.

In 2023, the investigator found CFMG failing to meet minimum standards of care. One requirement is that inmates get physical exams within 14 days of booking. The contractor often did not meet those minimums, according to a medical report filed by the investigator.

Specialty care recommended by emergency care consultants was often delayed including for high-risk pregnancies, the report stated. One inmate was sent to the emergency department five times because of a peanut allergy before any documentation was made. Another inmate had an open, weeping MRSA wound — a highly contagious infection — for more than a month after being admitted, the report stated.

“They don’t get on the jail’s radar as somebody who needs regular checkups, if you will,” Jackson said. “And so they will put in saying that they have a medical problem and it might be a week or more before they even get to see a nurse, longer than that until they get to a doctor. And so it can cause the medical problem to become much worse than it otherwise would be. So they suffer for weeks.”

The investigator continued to find CFMG not in compliance with the terms of the settlement. By 2023, a judge found CFMG in civil contempt. Eighteen months later, a judge found CFMG and Wellpath still not complying with the court order.

Wellpath’s 2024 bankruptcy gave it a stay from all monetary claims against CFMG, including those from the Monterey County case, according to a May memo filed with that court.

“The for-profit medical industry is a thorny beast and so it is concerning and it is not unusual for these outside contracted medical providers in correctional settings to not provide adequate care,” Jackson said.