by David M. Reutter

Jails face a monumental task in the provision of medical care. Those who’ve just been arrested are often experiencing withdrawal from drugs or alcohol. Other pre-existing medical conditions are routine and routinely severe. Then there are the mentally ill, who land in jail because communities lack resources to treat their conditions—even though jails and guards also lack training and expertise to provide adequate care. Into the breach step privately contracted providers, promising to fill the need. But their results belie that promise, demonstrating only that profit comes before service.

How else to explain the marketing materials distributed to prospective customers by jail healthcare contractor Turn Key Health Clinics LLC? In those, the firm bragged that after taking over healthcare at Oklahoma’s Tulsa County Jail in 2016, emergency transfers to hospitals fell by an eyepopping 77% in just a few months. The number of days detainees spent hospitalized also cratered by 35%. Did they suddenly get healthier? Or were they simply denied care?

The answer seems obvious, yet jails continue to turn to private providers like Turn Key. For one, it comes with a staff of credentialed personnel already employed, so sheriffs don’t have to vet and hire their own. The second benefit is financial: a promise to define costs so that they fit into a municipal budget, with the contractor often bearing the brunt of legal liability, too.

Over the course of more than three decades of publishing, PLN has regularly reported on profiteering private medical companies that “specialize” in providing care in prisons and jails. Jail populations are vastly more transient than prison populations, and detainees often require more immediate assessment and care. So hiring a private company with experienced professionals might result in efficient delivery of adequate care. But that outcome is more often the exception rather than the rule.

Lapses begin during jail booking, which takes place in a high-­activity area where arrestees are processed into the lockup even as other detainees are processed for release. The booking process is usually completed by a guard who records the reason for arrest and screens the arrestee with a health form that asks routine medical questions. Red flags are then forwarded to the medical department. But depending upon the size of the jail and available staff, the detainee may or may not be seen immediately by a medical professional for further assessment. In some cases, screening by a medical professional may not occur until days after intake, endangering pre-­existing care or that which is emergently needed. 

Once the booking screening process is complete, detainees are placed in a holding cell. Amid the hustle and bustle of the jail, guards often do no more than make periodic wellness checks via video or walkthrough. “It is a very, very hectic and busy place,” said Rhett Burnett, Turn Key Health Clinics’ director of client relations, describing conditions inside Oklahoma’s Cleveland County Jail, where the firm holds the medical care contract. Detainees report that as long as they are still breathing and not hanging from a bed sheet, the response to most any inquiry is, “We will get to you.”

The next move for most detainees is to a classification cell, where they are assigned a security level and await transfer to join others of similar classification in the jail’s general population. Problematic cases are often diverted into isolation or in a medical cell.

Jail officials, for the most part, leave provision of medical care to their medical contractors. As PLN has reported, the law immunizes guards from an allegation of unconstitutional deliberate indifference to a detainee’s medical needs so long as they are relying upon the advice of a medical professional—even in circumstances where the need for immediate care would be obvious to the average layperson. It is in this chaotic environment that a few companies have realized they can thrive, though they are almost always accused of denying care to maximize profit.

It’s difficult to understand why a firm like Turn Key would want to undertake such an apparently thankless task. But with an estimated 60% of county jails contracting for medical and mental health services, the market value may total $4 billion annually. That has attracted a few firms which have grown large enough to dominate it—firms like Wellpath, YesCare (formerly Corizon Health) and Armor Health. But smaller firms like Turn Key prosper in gaps their larger competitors leave open.

Founded as ESW Correctional Care in 2009 in Oklahoma City, the firm now called Turn Key Health Clinics is a regional company that holds “correctional healthcare” contracts with 100 facilities in 10 states; all told it provides care for about 25,000 detainees. Turn Key was co-­founded by Jon Echols, 44, a GOP Oklahoma state representative, and Trent Smith, 44, who gained statewide fame as a tight end on the University of Oklahoma’s 2000 national championship football team. The firm began as a medical staffing company before morphing into a medical provider for jails. Currently, Turn Key employs about 800 staffers, many part-­time or employed for short-­term work.

“A Very Litigious Environment”
Turn Key may be a small company, but it is growing by following the same business model as its bigger peers—cutting costs with a smaller staff of lower-­level professionals pressed into providing higher-­level services, according to numerous lawsuits filed against the firm. The plaintiffs in those cases claim that the result for detainees is often denial or delay of services. For them the litigation represents lives lost, bodies maimed or careers cut short; for Turn Key, as for other carceral healthcare profiteers, it is just another cost of doing business.

Between 2015 and 2023, Turn Key faced 160 lawsuits, with about 30 still pending as of April 2023. The bulk of these cases, 80 in all, were filed in Arkansas, with another 71 filed in Oklahoma; many of the latter allege poor care provided at the Oklahoma County Jail, as PLN reported. [See: PLN, Mar. 2024, p.1.] Other cases were filed in Texas, Colorado and Montana. Turn Key Chief Administrative Officer Danny Honeycutt shrugged off the lengthy docket, saying that “[w]e live in a very litigious environment.” He also noted that the number of suits is low compared to the firm’s competitors, so “[i]f that’s the barometer for assigning competency, you’re going to see that Turn Key leads the nation in this industry.”

That doesn’t make Memphis attorney Brice Timmons feel better. “These lawsuits are the cost of doing business for companies,” he said; rather than winning, the goal is often simply to wear down a plaintiff’s resources and patience. Since “[t]he ability of these individuals or the families to continue dealing with protracted litigation diminishes every day,” Timmons said that plaintiffs often accept settlements for “pennies on the dollar.”
Of those 160 lawsuits filed against Turn Key, 30 involved deaths. The company won judgments in three of the fatality cases, agreed to settlements in three others, and 13 others were pending in April 2023. The remaining suits were dismissed, many never reaching a ruling on their merits before dying for failure to pay court fees or meet deadlines.

“It’s not surprising to me that a lot of these cases get dismissed on technicalities because it’s really challenging to navigate all those technicalities when you’re fighting for yourself with no support while confined,” said Emily Galvin Almanza, a co-­founder of Partners for Justice, a New York-­based nonprofit that supports public defenders and people facing criminal charges.

But Turn Key attorney Austin Key called the litigation facing the company frivolous. “Allegations do not equate to evidence, and we believe this is reflected in our litigation record,” he said, adding that the firm is “proud of the exceptional care that is provided by our devoted health care providers.”

Unsurprisingly, attorneys whose clients allege they were harmed by the company disagree. “The idea that a lot of frivolous cases are filed against Turn Key may be true in certain instances, but the big federal cases against Turn Key coming from reputable attorneys, those are not frivolous,” said attorney Chris Hammons with Laird, Hammons, Laird in Oklahoma City. “Those are allegations that are backed up by real evidence, real facts, and they are passing scrutiny with a federal judge.”

Lawsuits may be an inaccurate barometer of a company’s performance, since they tell only the story of cases that result in litigation. But the bar that detainees must hurdle in cases challenging jail healthcare is high, especially in Oklahoma. Federal courts there are part of the Tenth Circuit, which refused to extend from excessive force to provision of healthcare the Supreme Court’s decision in Kingsley v. Hendrickson—that pretrial detainees, unlike prisoners, need prove only that a defendant jail official objectively showed deliberate indifference to their rights, without also showing subjective intent, as PLN reported. [See: PLN, Apr. 2022, p.56.]

“We’re here to provide healthcare, and to assume that we would cut corners or that we would not provide a service that is needed would be to impugn the integrity of the medical professionals who are there to help,” insisted Honeycutt.

However, legal complaints often illuminate what occurs behind the steel and concrete that shrouds jails from the public eye. Many of the cases against Turn Key betray disregard for the healthcare profession’s basic vow to “do no harm.” A former employee with extensive nursing experience resisted pressure from off-­site managers who sought to impose cost reductions at an Oklahoma jail. Speaking anonymously for fear of retaliation, this employee said, “I would call [and tell] the physician, like, ‘I really feel like this guy needs to go to the emergency room.’ They would be like ‘No,’ and wouldn’t listen to me. Then, I would just go above their head and be like . . . ‘I’m setting eyes on the person. I’m telling you, from my viewpoint, this guy needs to go to the emergency room, or this girl needs to go to the emergency room.’ And then that’s when they’d be like, ‘Well, if that’s what you feel like needs to be done. Let’s do it.’”

Examining the “Exceptional Care” Given James Buchanan
Such persistence by jail medical caregivers is the exception, though. In September 2016, James Buchanan “suffered multisystem trauma after being hit by a car” while riding his bicycle in Muskogee, Oklahoma. At booking into county jail on November 3, 2016—on charges unrelated to his biking accident—a medical questionnaire noted that the crash left him with broken ribs, a collapsed lung, burnt fingers and a neck problem. He also reported taking anti-­inflammatory muscle relaxers.

The following day, Buchanan was seen at “sick call” and requested transfer to a hospital due to severe pain. Turn Key providers asked him to sign a medical release form for his prior medical records, but those were not sought until 10 days later. Meanwhile nurse Delana Myers told Buchanan to lie down, and she gave him Naproxen for pain; Dr. William Cooper, now Turn Key’s Chief Medical Officer (CMO), approved the prescription.

Buchanan was again placed on sick call for shoulder pain on November 6, 2016, but he was not seen. The next day he was moved to a jail general population pod, though by that point he had lost use of his left arm. About three days later, he began losing range of motion and feeling in his right arm. Every time a nurse or guard came by the thin mat where he lay on the dayroom floor, he informed them of his condition and his pain, requesting to see a doctor.

During the night shift on November 11, 2016, Buchanan complained to Nurse Rosemary Kotas of decreased range of motion in his upper and lower extremities, tingling in his legs and constant pain. Dr. Cooper was called again and told that Buchanan was complaining he could not walk. Dr. Cooper scheduled an appointment to see Buchanan on November 14, 2016. But before that, on November 12 or 13, 2016, Buchanan lost feeling in his legs.

On the evening of November 14, 2016, other detainees carried him to the dinner table. When he urinated on himself, a guard ordered Buchanan to get up and take a shower. After the guard then saw on video that Buchanan had been carried to the table, Nurse Kotas was called. She arrived around 8:10 p.m. and found Buchanan had an elevated heart rate and high blood pressure. Once more Dr. Cooper was called, and he ordered transport to a hospital.

Buchanan was subsequently diagnosed with quadriplegia and a cervical epidermal abscess. An extended hospitalization and multiple surgeries followed. Physical and occupational therapy and intravenous antibiotics helped Buchanan to recover significantly from his symptoms. He then sued Muskogee County and Turn Key, but the U.S. District Court for the Eastern District of Oklahoma granted Defendants’ motion for summary judgment. Buchanan appealed.

The U.S. Court of Appeals for the Tenth Circuit noted that the district court had accepted Dr. Cooper’s argument that he “could only make treatment decisions based on the information available to him, which was limited”—even though an expert, Dr. Wilcox, opined that Buchanan’s worsening pain and inability to move his lower extremities were “red-­flag warnings.” The Court said that Dr. Cooper need not be aware that Buchanan suffered a specific ailment but “rather that he was aware [that Buchanan] faced a substantial risk of harm to [his] health and safety.”

Given this, the Court continued, a reasonable jury could conclude that Dr. Cooper was deliberately indifferent to Buchanan’s serious medical need by delaying his care, since he could have sent “Buchanan to the hospital or, since Dr. Cooper was on-­call, [come] to the jail to evaluate him.” Thus that part of the lower court’s ruling was reversed on October 24, 2023. See: Buchanan v. Turn Key Health Clinics, LLC, 2023 U.S. App. Lexis 28156 (10th Cir. 2023).

The parties notified the district court that they had reached a settlement on August 9, 2024, but as with many settlements involving private contractors, details remain secret. Buchanan is represented by Tulsa attorneys Donald Smolen of Smolen Law and Daniel E. Smolen, Byron D. Helm and Robert M. Blakemore of Smolen & Roytman, PLLC. See: Buchanan v. Cooper, USDC (E.D. Okla.), Case No. 6:18-­cv-­00171.

Withdrawal Deaths and Amy Lynn Cross
When on-­call doctors rely second-­hand on observations of a nurse onsite at a jail, that’s a problem, one that lies at the rotten heart of the privatized jail medical industry. Honeycutt may speak of Turn Key’s medical “providers,” but the reality is not always plural. When Turn Key obtained the medical care contract for Oklahoma’s Cleveland County Jail in 2009, the agreement called for just one nurse for the jail’s 250 detainees. By 2023, Turn Key was still contractually required to provide only one nurse, though the jail’s population had doubled to 500 detainees. Granted, hourly reports show that two nurses and a medical assistant are on duty most weekdays; but weeknights and weekends—peak times for jail bookings—are staffed with a single license practical nurse.

“That’s a very minimum level of care,” declared Richard Forbus, a former jail commander and spokesman for the National Commission on Correctional Health Care. He called that level of staffing “very, very low for the acuity of care you have with people that are in a jail typically.” When that minimum level of care meets the corporate imperative to control costs—not to mention the total disregard shown by some individual care providers toward their patients—the result is a deadly mix.

Alcohol withdrawal has long been a problem among those placed under arrest, but opioid withdrawal has recently raised its ugly head. Both are deadly if left untreated. Seemingly any competent medical provider should make such an urgent care need a priority. Withdrawal treatment, however, costs money. Turn Key has a protocol for withdrawal, which leaves decisions in the hands of its medical professionals. Often, though, these “health care professionals” deem the detainee a faker and ignore the withdrawal symptoms.

At Colorado’s Weld County Jail, Amy Lynn Cross reported her drug use to Turn Key Registered Nurse Beatriz Ortiz during booking on drug-­related charges on September 3, 2021. Specifically, Cross said she was a frequent user of opiates, benzodiazepines and IV drugs. She reported using methamphetamine and Xanax off and on for the previous two weeks and said that she also took fentanyl pills—“too many daily.” Cross said she had suffered withdrawal symptoms and had mental health issues.
Otriz noted that Cross appeared to be under the influence of fentanyl and was irritable. She ordered withdrawal protocols and medications. Cross was placed in a medical cell the next day as she began experiencing serious withdrawal symptoms. At 4:49 and 8:00 p.m. on September 4, 2021, guards called and asked nurses to provide Cross care because she was exhibiting worrisome symptoms.

Nurses Kristen Miller, Jane Shoenecker, Kyrie Kuhn, Brittanie Flores and Kat Gigliotti responded to the first emergency call. Cross was found to have a pulse of 152, elevated blood pressure and respirations, plus a low oxygen level. As recorded in her medical records, Cross was sweaty, animated, jerky, refusing to cooperate; but she also requested to go to a hospital.

Cross, according to a civil rights complaint later filed on her behalf, was “exhibiting textbook signs and symptoms of methamphetamine toxicity, overdose, and cardiac distress.” But Miller sent Cross back to her cell. Cross herself then requested to go on suicide watch to ensure guards monitored her condition.

LPN Erica Alcarez was informed by Miller at shift change that Cross was coded for an “unknown issue.” Around 6:30 p.m. that same day, Alcarez found Cross lying on the floor of her cell, breathing rapidly and foaming at the mouth. Ortiz arrived, and the nurses came to the incredible conclusion that Cross was “gathering spit in her mouth and making bubbles,” and “refusing to speak to medical and closing her eyes tightly.” Alcarez later recalled for investigators that Miller said Cross “is acting a fool,” adding “we are not sending her out” and citing the demand of Nurse Practitioner Terry Sipola. The nurses also told Cross that she could not have withdrawal medications without providing a urine sample.

During an 8:00 p.m. emergency examination, nurses found Cross with brown mucus all over her face from foaming at the mouth. She was not verbal, but they said that she “was grunting or mumbling like she understood and was trying to respond”—even as her fingers turned blue. Guard Kendra Betz repeatedly called for medical attention, climbing the jail’s chain of security command because she could not tolerate “the lack of attention from medical staff.” But Betz was told only to document the situation and chose one of three options: trust medical staff; call them again to the pod; or call a “Code Five” medical emergency. However, medical staff prohibited the last option, ordering instead that direct calls be made to them.

When Betz called nurses at 11:15, Alcarez found Cross’ breathing was shallow, her blood pressure low, and her extremities had changed color. Yet rather than calling an ambulance, Alcarez called Ortiz. By the time she arrived, Cross had no pulse. Still the two nurses waited another four minutes to call a Code Five medical emergency and six minutes before calling for an ambulance. When paramedics arrived, Alcarez and Ortiz told them that Cross “did not have any complaints throughout the day prior to this”—ignoring events of the day and evening. They also said that her medical problems did not begin until 20 minutes before paramedics arrived.

Cross, a 41-­year-­old mother of three, was declared dead at 12:01 a.m. on November 5, 2021. An autopsy revealed a bag of methamphetamine that was secreted in her body had broken, releasing a toxic level of the drug into her system. Jennifer Bauder, as personal representative of Cross’ Estate, sued Turn Key, Ortiz, Alcarez, Miller, Sipola, the Sheriff and Weld County, alleging in the complaint that Cross exhibited classic symptoms of drug toxicity and withdrawal that went untreated.
The case remains pending, and PLN will update developments as they are available. Bauder is represented by attorneys Anna C. Holland-­Edwards, Erica T. Grossman and Rachel C. Kennedy of Holland Holland Edwards & Grossman PC in Denver. See: Est. of Cross v. Turn Key Health Clinics LLC, USDC (D. Colo.), Case No. 1:22-cv-03143. Turn Key, meanwhile, lost its contract at the jail in December 2023.

More Suits in Arkansas
The family of Eusebio Castillo Rodriguez, who died from alcohol withdrawal that went untreated for five days, sued Turn Key and officials at Arkansas’ Union County Jail in January 2023. Rodriguez was arrested for DUI and released on April 27, 2022, only to end up back in the lockup on June 8, 2022, when a court employee mistranslated what the Spanish-­speaker said and provoked the judge. Rodriguez’s daughter, Amanda Castillo, informed jailers of her dad’s diabetes and hypertension when she dropped off his medications. But he got no medical screening for 26 hours—and then was left in a general population area without medication by staffers who decided that he was drunk.

When Castillo called on June 10, 2022, she noticed her father’s severe alcohol withdrawal symptoms and urged jailers to treat him. They didn’t. But they moved him from his cell on June 12, 2022, because his pained moaning was keeping other detainees awake. Early that same morning, he was finally moved to the jail medical unit while staff secured a release order. Once that arrived, and Rodriguez was legally no longer their problem, a deputy attempted to wrestle him into a Sheriff’s vehicle for transport to a hospital. Eventually he gave up and called an ambulance. Meanwhile jailers gave the runaround to Castillo and her dad’s domestic partner, Cary Rios, insisting that he’d been released and had left the jail on his own. By the time they confessed what had happened and his family found him, Rodriguez was being transported to a Little Rock medical center, where he died days later.

With the aid of Little Rock attorneys Angela Schnuerle of Galvis Law and Michael D. O’Quinn, Castillo and Rios filed suit against Turn Key, along with Sheriff Ricky Roberts and his jailers, as well as the Association of Arkansas Counties Risk Management Fund (AACRMF). The attorneys called in a prison and jail medicine specialist, Dr. Thomas Fowlkes, who decried the way jailers “intended for Mr. Rodriguez to be merely dumped off at the hospital with no apparent concern for his wellbeing and without taking any responsibility for the serious medical condition which developed directly as a result of their lack of medical care.” As for Turn Key’s protocols and treatment, Fowkles found both “far below the standard of care.”

The case remains pending against all defendants except AACRMF, which the federal court for the Western District of Arkansas dismissed on July 26, 2024, reasoning that the jail was not a “medical provider” under state law so its insurer was not obliged to cover a malpractice claim. See: Est. of Rodriguez v. Union Cty., 2024 U.S. Dist. LEXIS 132769 (W.D. Ark.).

At Arkansas’ Sebastian County Jail, Larry Eugene Price, Jr., a mentally ill pretrial detainee, came under Turn Key’s care while awaiting his day in court. As PLN reported, the 6’2”, 185-­pound Price was placed in solitary confinement and languished there for a year, his mental illness untreated as he slowly starved to death. When a guard found the unresponsive Price lying in a pool of standing water and urine on August 29, 2021, the detainee weighed just 90 pounds. Paramedics wheeled his dead body out of the jail, and an autopsy found Price died of acute dehydration and malnutrition. [See: PLN, Oct. 2023, p.14.]

A suit was filed on behalf of his estate in federal court for the Western District of Arkansas, which largely granted its motion to compel Turn Key to disclose documents and emails relevant to Price’s death on April 5, 2024, awarding $15,892.50 on May 9, 2024, to the Estate’s attorneys, Edwin Budge, Erik Heipt and Hank Balson of Budge & Heipt PLLC in Seattle. The case remains pending, and PLN will update developments as they are available. See: Est. of Price v. Turn Key Health Clinics, LLC, 2024 U.S. Dist. LEXIS 63366 (W.D. Ark.); and 2024 U.S. Dist. LEXIS 84695 (W.D. Ark.).

Still More Suits in Oklahoma
Turn Key faced more lawsuits in Oklahoma for deaths from untreated withdrawal effects. In one, the firm paid an undisclosed settlement on top of $12.5 million paid by Garfield County for the 2016 death of Anthony Huff, 58. As PLN reported, he was denied care for hallucinations and put in a restraint chair for over 55 hours following an arrest for public intoxication, after which—in a rare display of justice—jail administrator Jennifer Shay Niles and former guard Shawn Caleb Galusha were sentenced to 55 hours in jail for second-­degree manslaughter. [See: PLN, Sep. 2019, p.46; and Oct. 2020, p.26.]

At the Creek County Jail, Ronald Garland, 56, also ended up in a restraint chair in the days before his death from untreated intoxication in 2017. A suit filed by his mother, Janice Bush, was settled in June 2021 by the County and Turn Key for a total of $770,000, though Turn Key’s share was not disclosed. The payout included $415,043.60 in costs and fees for Plaintiff’s attorneys from Bryan & Terrill Law PLLC in Tulsa. See: Bush v. Bowling, USDC (N.D. Okla.), Case No. 4:19-­cv-­00098.

Another Oklahoma detainee, Michelle Caddell, allegedly died as the result of Turn Key’s failure to provide adequate medical care at the Tulsa County Jail. Cadell began complaining of vaginal discharge on June 22, 2019, adding pain complaints on July 5, 6, and 7 of that year. After Turn Key’s Dr. Gary Myers evaluated Caddell on August 5, 2019, he ordered blood work which revealed an elevated white blood cell count indicating something was wrong. Myers determined all was normal, though, and no follow-­up was required. Lab cultures came back on August 15, 2022, also showing factors indicating disease. But Caddell was given only Ibuprofen, the private medical provider’s wonder drug.

Caddell continued to complain of pain and excessive vaginal bleeding. Myers said her frequent sick calls “do not fulfill medical logic.” A test on September 23, 2019, showed abnormal uterine bleeding and a sharp drop in hemoglobin levels from six weeks earlier. An obstetrician opined on September 27, 2019, that Caddell had invasive cervical cancer. A pap smear was ordered but never conducted as Caddell went without treatment from October 3 to October 30, 2019—when excessive bleeding finally resulted in transport to a hospital. It was then confirmed that she had stage three cervical cancer. In a typical move to avoid the costs of medical care, Caddell was released from custody to die.

Her estate sued the County and Turn Key, and the federal court for the Northern District of Oklahoma granted Defendants summary judgment; however, the Tenth Circuit reversed that on January 20, 2023. “Treatment with Tylenol and accusing Ms. Caddell of fabrication was not only woefully inadequate but also plainly inconsistent with the symptoms presented,” the Court wrote. “More to the point, Dr. Myers entirely failed to monitor her afterwards to determine if his treatment plan, if it even can be described as such, was working.” See: Lucas v. Turn Key Health Clinics, 58 F.4th 1127 (10th Cir. 2023).

Back at the district court, amazingly, Defendants asked for sanctions. Why? Because Plaintiff failed to recite all treatment that Cadell received. Denying that request on March 4, 2024, the district court said that “Plaintiff was required only to show that Dr. Myers failed to provide proper treatment or failed to provide access to someone capable of properly treating her”—and requiring more “is not necessary—indeed, it is not appropriate.” See: Lucas v. Turn Key Health Clinics, LLC, 2024 U.S. Dist. LEXIS 36929 (N.D. Okla.).

The parties are currently scheduled for a settlement conference in October 2024, and PLN will update developments as they are available. Caddell’s estate is represented by attorneys with Smollen Law, PLLC, along with another Tulsa attorney, Laura L. Hamilton. See: Lucas v. Turn Key Health Clinics, LLC, USDC (N.D. Okla.), Case No. 4:20-­cv-­00601.

Still another lawsuit against Turn Key alleged that while detained at Oklahoma’s Canadian County Jail in 2020, Lesley Hendrix, 27, was not treated when a rash developed on her legs. Hendrix had been jailed for four years on murder charges stemming from the death of a child she was babysitting. A week after trying to get Turn Key to treat her ailment, “Hendrix collapsed and was found down,” according to a complaint later filed by her widowed husband, Danny Yelton. He alleged that Hendrix was in “severe septic shock, caused by necrotizing fasciitis,” a flesh-­eating disease. She died the next morning on October 12, 2020. The case is still pending, and PLN will update developments as they are available. Yelton is represented by Tulsa attorneys A. Laurie Koller and Eric A. Mareshie. See: Yelton v. Bd. of Cty. Comms. Canadian Cty., USDC (W.D. Okla.), Case No. 5:21-­cv-­01001.

In yet another case, Michael Edwin Smith, 50, blamed Turn Key when he left Muskogee County Jail on a stretcher, permanently paralyzed just two weeks after a March 2016 arrest on suspicion of scamming a Walmart out of merchandise. His federal civil rights lawsuit alleged that Turn Key staff failed to act when he complained of severe back and chest pain, though he had been diagnosed prior to his arrest with pelvic cancer and was due to begin chemotherapy.

“I kept telling them I was going paralyzed. The doctor laughed at me and told me I was the boy who cried wolf,” Smith said. “They told me I was going to be on lockdown until I walked.” Smith lay in his own feces and urine in an isolation cell for a week because he was unable to walk, bathe, or use the bathroom on his own. He died from his cancer in October 2017, so he didn’t live to see his case settled in December 2019. PLN has requested those details and will provide an update when they are available. See: Myers v. Muskogee Cty. Bd. of Cty. Comms., USDC (E.D. Okla.), Case No. 6:17-­cv-­00090.

Service to be Proud Of
Despite its legal record Turn Key continues to cast blame upon the people to whom it is accused of denying care, saluting the brave face its medical professionals present in the face of such rebellious and devious detainees.

“When you go to work and somebody spits on you and calls you every name in the book and you still provide care to them, that’s very impressive to me,” said Dr. Cooper, Turn Key’s CMO. “You talk about there are some bad outcomes, but so many lives are saved every day in this business and that makes me very proud.”

Judge Robert McAdoo in Oklahoma’s Ouachita County disagreed with Dr. Cooper’s rhetoric and acted to terminate Turn Key’s contract there in June 2023 due to a “lack of service.” According to Judge McAdoo, Turn Key was “not doing what they said they would do. It’s a mutual agreement, and that’s why we are terminating.” A local doctor, as well as physician assistants and nurse practitioners agreed to accept a replacement contract.

Such shuffling of medical providers reveals another aspect of privatized jail and prison care: It is a cyclical business, not in the typical sense that it has seasonal peaks and troughs, but because jails often cycle their healthcare contracts between companies. When one profiteer is dumped, another steps up to bid for the contract; only rarely do state or county officials reassume control of the service.

“We just decided it was time to look at who else was out there just because of some of the issues [that] we got with the current vendor,” said Sheriff Lou Vallario, after Turn Key purchased the contract to provide healthcare at Colorado’s Garfield County Jail from Correctional Health Partners LLC (CHP).

CHP was on the hot seat following the April 2021 death of detainee Oscar Canas, 19, who was over-­administered detoxification drugs. Turn Key subsequently acquired CHP in July 2022, but Sheriff Vallario defended the decision to effectively facilitate that acquisition because Turn Key “picked up where that contract left off from the original.” What he didn’t say was that such a revolving door might allow companies like Turn Key to earn a profit despite shoddy care.

Settlement of a suit filed on behalf of Canas’ estate by attorneys Stephanie M. Frisinger and David G. Maxted of Maxted Law LLC in Denver was reportedly nearing completion in August 2024, and PLN will update developments as they are available. See: Portillo v. Vallario, USDC (D. Colo.), Case No. 1:23-­cv-­00942.

As summed up by David Fathi, Director of the National Prison Project of the American Civil Liberties Union, “The fundamental problem with private health care in prisons and jails is that the usual mechanisms of market discipline that we count on in the rest of the world—the idea that if a company gives bad service, if it injures or kills people, it’ll eventually lose customers and go out of business—that market discipline doesn’t exist.”

Turn Key is just another small company vying for a bigger bite of the prison industrial complex, clamoring with a few others around a trough full of nearly half a million U.S. jail detainees. Most of them are impoverished, but they are not the “customers” in this perverted marketplace. Who is? The taxpayers stuck with the tabs for these healthcare contracts and legal payouts when detainees are harmed by substandard care. Only when those taxpayers demand better will companies like Turn Key improve.  

Additional sources: Camden (Ark.) News, KNWA/KFTA, KOKH, KWTV, Glenwood Springs Post Independent, Newsweek, Oklahoma City Journal Record, Oklahoma Watch, Oklahoman, Sacramento Bee, Sustainable Journalism Foundation, The Marshall Project, Yukon Progress News