Local governments across the country have turned to private companies to provide medical and mental health care in their jails, as a way to contain rising costs.
One of the fastest growing in the middle of the country is a company called Turn Key, which has expanded into a multimillion-dollar company with contracts to provide medical care for more than 75 jails — and 23,000 people — in 10 states.
But an investigation by The Marshall Project and The Frontier found that 50 people who were under Turn Key’s care died during the past decade, and unearthed company policies and practices that have endangered people in jail — especially those with mental illness.
A woman in Colorado died after a bag of drugs she’d hidden in her body burst, while a Turn Key nurse allegedly dismissed her symptoms and refused to call an ambulance, the investigation found. A man in Arkansas died after medical staff didn’t give him medication to prevent deadly symptoms of alcohol withdrawal and didn’t call an ambulance until he became unresponsive. Another man in Arkansas died after medical records show he wasn’t given the seizure medication he needed, and he was strapped to a restraint chair and covered with a spit hood.
In dozens of cases, Turn Key employees didn’t send people to the hospital when they were in crisis, catatonic or refusing to eat or drink. The company staffed mental health and other medical positions with low-level nursing assistants trained to perform basic tasks like taking vital signs, but not to diagnose or assess medical conditions.
Medical doctors and more advanced-level nurses working for Turn Key frequently consulted over the phone for a limited number of hours per week instead of making in-person visits, according to government records and documents obtained through lawsuits.
The company also often restricted the kinds of medicines it would provide people in jail, not giving them long-acting psychiatric drugs and prescriptions they had received before their arrests.
While the population of people it treated in jails doubled over a span of six years to more than 20,000, records show Turn Key only had four doctors, three psychiatrists and 10 nurse practitioners on staff. Some oversaw care at multiple jails in different states.
The company has staffed its jails with mostly licensed practical nurses or certified medical assistants, according to depositions and internal documents. These workers can get licensed with a year or less of schooling and are trained to perform basic tasks like checking pulse rates, not to assess medical conditions.
In many cases, on-the-ground workers failed to recognize severe health problems, and did not seek counsel from doctors and more senior nurses who consulted remotely, the investigation found.
Some sheriffs raised concerns about the company not providing the proper medications for people in jail with mental illness.
“I have been told that Turn Key does not prescribe those types of medications,” one Texas sheriff wrote in a 2022 email. “This is causing a cascade of problems not only for their safety and well-being, but for the staff and facility as well.”
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