Dan Weiss


As part of a decades-long national trend towards privatization, local governments have turned to private contractors to provide health care in American prisons and jails. Ostensibly, the driving force behind this phenomenon is a desire to cut costs in an era of expanding prison health care expenditures and contracting governmental revenue streams. Local government officials build the cost-cutting incentive directly into their contracts via fixed-rate payment structures and cost-sharing provisions for off-site emergency treatment. While these contracts encourage cost-reduction, they simultaneously discourage proper oversight; their indemnification clauses render local governments largely immune from financial consequences when contractors deny emergency care to inmates in crisis. The predictable and tragic result of this combination of incentives and disincentives is unnecessary injury and death. A § 1983 lawsuit against the contracting local government, however, could force officials to reform their prison health care contracts-to elevate the goal of quality health care provision to the priority it should be.