INCORRECT CARE:

A Prison Profiteer Turns Care into Confinement

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FEBRUARY 2016

INCORRECT CARE:

A Prison Profiteer Turns Care into Confinement
FEBRUARY 2016
(Part of the Treatment Industrial Complex Series)

Written by:

Cate Graziani, MSSW, MPAff
Eshe Cole, Ph.D.

Grassroots Leadership
February 2016

Design by: Catherine Cunningham
Grassroots Leadership would like to thank the following people for their contributions to and review
of this report: Paula Arnquist, Caroline Isaacs and the American Friends Service Committee of
Arizona, Gyl Switzer of Mental Health America of Texas, and Josh Gravens of Organize Justice.

EXECUTIVE SUMMARY
As criminal justice reform sweeps the nation, an alarming
trend has emerged that could mean private prison profiteers
control a person’s fate for life, not just the term of a prison
sentence. The same private prison profiteers who built
billion dollar empires as partners in tough on crime policies
are adapting to reforms by rebranding themselves — as
humane treatment providers. The criminal justice system
has created ample opportunities for their expansion,
including mental health hospitals and civil commitment
centers, correctional healthcare, and community corrections.
This report will look specifically at one segment of their
expansion: mental health hospitals and civil commitment
centers, facilities that represent the potential for lifetime
confinement and long-term guaranteed profit.
In fact, the same for-profit company is making aggressive
moves to take over both types of facilities. Correct Care
Solutions, formerly known as GEO Care, a spin-off of GEO
Group, has deep roots in the private prison industry.
Although the company has shifted and changed numerous
times over the last few years, CCS currently runs seven
“treatment” facilities in Florida, Texas and South Carolina,
including five mental health facilities and two civil
commitment centers.
This report’s in-depth analysis of GEO Group, GEO Care
and now Correct Care Solutions’ involvement in operating
mental health hospitals and civil commitment centers
exposes serious concerns.

KEY FINDINGS
Profit motive drives private prison company involvement
in new markets
The incarceration rate for individuals with mental health
concerns has been steadily increasing, while overall
incarceration rates are on the downturn. The increase of
individuals with mental health needs in the criminal justice
system creates an opportunity for profiteering, as seen in
the dramatic growth of the correctional healthcare and
forensic mental health industry.1 In fact, the two largest
private prison companies, Corrections Corporation of
America and GEO Group, planned their calculated move
away from operating prisons toward 1) obtaining Real
Estate Investment Trust (REIT) status and 2) expanding into
community corrections.2 In order to maintain REIT status,
GEO Group created spin-off companies to operate their
“treatment” provision initiatives. Still intimately connected,
GEO Group created GEO Care, and together with Correct
Care, spawned Correct Care Solutions.3
Deep pockets and back room deals contribute to Correct
Care Solutions’ success
Strong connections to the private prison industry mean that
CCS and other TIC corporations employ the same political

tactics to secure contracts. Once areas of profit growth and
new contracts are identified, the companies hire well-paid
lobbyists who work with public officials to seal the deal.
These public officials are often under enormous pressure to
manage underfunded and outdated facilities, and private
for-profit companies take advantage of their position by
making false promises of cost savings and improved patient
care. Unfortunately, public officials are often all-too-eager
to believe them. CCS lobbyists routinely employ inside
strategies, making behind-the-scenes deals with public
officials, while limiting opportunities for public engagement.
In fact, GEO and CCS doubled their investments in Texas
lobbyists from 2011 to 2015.4
For-profit treatment facilities provide little more than
warehousing and incentivize locking people up
Similar to jails and prisons, privately run state hospitals and
civil commitment centers often provide little to no treatment
or rehabilitation. Patients in CCS facilities complain about
ineffective therapy offered by inexperienced staff and amidst
high patient-to-therapist ratios. In Florida, patients being
restored to competency in CCS facilities often cycle through
the state hospitals multiple times because their “treatment”
consists of no more than memorization of legal information
and medications that may be interrupted once sent back
to jail.5 Furthermore, the civil commitment facilities run by
the same for-profit companies that run prisons and jails
charge per diem rates for so-called treatment facilities. The
state pays less per person as more people fill the facility,
incentivizing policies that keep people confined, rather than
encouraging rehabilitation and release. In fact, participants
complain that program policies are designed to keep people
from being released.
The Treatment Industrial Complex failed Florida
Florida has the most concentrated treatment industrial
complex in the nation, with disastrous results. CCS runs
three of six state hospitals in Florida and the largest civil
commitment center in the country. In addition, a private
correctional healthcare company with a scandal-ridden track
record, Corizon Health, provided the state’s correctional
healthcare. As a result, Florida’s mental health hospitals are
under federal scrutiny for high rates of violence and patient
deaths and Corizon Health exited their contract early after
a record number of deaths in correctional facilities, leaving
the state in the lurch.6 Despite failures, Texas appears to be
following in Florida’s footsteps.
Part I of this report discusses the rising number of
individuals with mental health needs in jails and prisons
and how that has contributed to Correct Care Solutions’
move into the business of mental health care in Texas. Part
II discusses the same company’s role in civil commitment
facilities for individuals convicted of a sexual offense who are
required to undergo continued surveillance and treatment
after serving their sentence.

InCorrect Care | February 2016 | 3

INTRODUCTION
As sentencing reform has begun to curb the population in jails and prisons, private prison corporations are expanding
into new markets. According to the 2014 inaugural report, The Treatment Industrial Complex: How For-Profit Prison
Corporations are Undermining Efforts to Treat and Rehabilitate Prisoners for Corporate Gain, private prison companies did
not have to look far for their expansion.7

The “Treatment Industrial Complex” (TIC) can be described as
the movement of the for-profit prison industry into correctional medical care, mental health treatment, and
‘community corrections.’ Community corrections include corrections programs outside of jail or prison walls:
probation and parole services including halfway houses; day reporting centers; drug and alcohol treatment
programs; home confinement; electronic monitoring; and an array of supportive services such as educational classes
and job training.8
This report will look specifically at one segment of the Treatment Industrial Complex: for-profit operation of state mental
health hospitals and civil commitment centers for individuals convicted of a sexual offense. Although different in many
ways, these two forms of residential confinement are grouped together, “because they represent the highest level of
custody/supervision in the Treatment Industrial Complex (second only to incarceration in prisons, jails, and detention
centers).”9 In both types of institutions, individuals are still held against their will for substantial periods of time in secure
facilities and are not serving time for a conviction.
Another similarity is that,
Unlike prisons, from which over 90% of those incarcerated are eventually released, mental health hospitals and civil
commitment centers represent the potential for lifetime confinement, which spells long-term, guaranteed profits
for private corporations.10
Sadly, there is another similarity. Individuals convicted of a sexual offense and individuals with serious mental health
needs who have been charged with a crime are often marginalized, stigmatized and feared by the public. As seen in
the Prison Industrial Complex, the private prison industry exploits and profits off members of society who have been
systematically disenfranchised, particularly communities of color and migrant communities. The Treatment Industrial
Complex perpetuates the trend.11
Furthermore, the same for-profit company is making aggressive moves to take over both types of facilities. Correct Care
Solutions, formerly known as GEO Care, a spin-off of GEO Group, has deep roots in the private prison industry. Although
the company has shifted and changed numerous times over the last few years, CCS currently runs seven “treatment”
facilities in Florida, Texas and South Carolina, including five mental health facilities and two civil commitment centers.12
This segment of the company is called Correct Care Recovery Solutions, but the company also has contracts to provide
correctional healthcare in county jails, as well as state and federal correctional facilities. This report will trace the history
of Correct Care Solutions, bring to light their behind-the-scenes involvement in the privatization of state hospitals and
civil commitment centers in Texas, and expose the countless examples of abuse, neglect, and mismanagement in Correct
Care Solutions facilities.

Evolution of a Company

1997

Wackenhut
Corp starts
Atlantic Shores
Healthcare

InCorrect Care | February 2016 | 4

2002

Group 4 Falck
acquires Wackenhut
and is renamed
G4S

2003

Wackenhut Correections
separates from G4S and becomes GEO
Group; Atlantic Shores Healthcare
renamed GEO Care

2014

CCS acquires
GEO Care

PART I: THE PRIVATIZATION OF FORENSIC MENTAL
HEALTH IN TEXAS
Across the United States, the alarmingly high number of individuals with mental health and substance use
disorders in jails and prisons has become a major policy concern at the federal, state and local level. The
concern is justified - 50 percent of individuals in correctional facilities experience both mental health and
substance use disorders,13 compared to only 1 to 3 percent of the entire U.S. population.14 For these reasons, the
criminal justice system is often called the “de facto mental health system,” providing expensive and inadequate
treatment, if any at all.15
Another result of high rates of mental health disorders among those who are incarcerated has been an
increased demand for forensic psychiatric services across the country. Forensic mental health services
refer to services generated through criminal justice involvement. This category includes individuals found
incompetent to stand trial (IST) and not guilty by reason of insanity (NGRI). Forensic patients often have a
longer length of stay in an inpatient setting and are more costly.16 The alarming spike in forensic services has
created serious capacity issues for state hospitals. For example, in 1993, only 10.3 percent of state psychiatric
budgets were spent on forensic commitments; by 2007 that number had gone up to 26 percent.17 As the
population in need of forensic psychiatric services swells, privatization is an attractive option for states working
under rigid budget constraints. With this shift in demand, private companies with deep roots in the prison
industry have moved into the business of mental health treatment.
Texas provides a case study in many of the state hospital trends seen nationally. The Texas Department of State
Health Services reports that the percentage of forensic commitments to state hospitals rose 43 percent from
2001 to 2013.18 As state hospitals attempt to accommodate steadily climbing forensic commitments, fewer
and fewer beds are available for individuals not involved with the criminal justice system. In fact, 2014 was the
first year that state hospitals allocated more beds for forensic commitments than civil.19 In an attempt to free
up bed space, the Texas Legislature authorized funding for four outpatient competency restoration programs
and by 2012, twelve programs existed across the state.20 The alarming increase in forensic commitments comes
in the wake of extreme budget cuts to public mental health services in 2011.21 As advocates warned, lack of
community mental health services remains a driving force for the high number of individuals with mental
health needs in the jails and prisons.22
As the forensic population steadily grew and state hospital beds filled, wait times for individuals who were
court-ordered to receive mental health treatment increased to unconstitutional levels.23 Some individuals
found IST waited in jail for months for a treatment bed, all before ever being convicted of a crime. In response
to the crisis, Disability Rights Texas brought a lawsuit against the state of Texas in 2007, which resulted in a
2011 ruling that limited the amount of time someone could wait in jail before receiving treatment to 21 days.24
Despite these efforts to increase community capacity, Texas has been forced to find and create new forensic
hospital beds, sometimes even building new facilities.

TO PRIVATIZE OR NOT TO PRIVATIZE
Experts have debated solutions for Texas inpatient mental health facilities for a long time. It is a complex issue;
publicly run facilities often provide inadequate and harmful care in an expensive and aging infrastructure.
At the same time, the number of forensic psychiatric commitments has increased substantially over the last
decade, causing lawmakers and stakeholders to demand more inpatient capacity. In 2011, the libertarian
Texas Public Policy Foundation released a report lauding Florida’s state hospital system as the example that
Texas should follow, specifically recommending the privatization of Texas’ state hospitals.25 However, mental
health experts warn against privatization of forensic psychiatric treatment, raising concerns surrounding
quality of care. Lynn Lasky Clark, President & CEO of Mental Health America of Texas, long-time watchdogs
on the privatization of state hospitals, warns, “The most critical components of mental health care are patient
InCorrect Care | February 2016 | 5

safety and quality of care. Privately run facilities, operating with a profit motive, can put one or both of those
in jeopardy.” Advocates instead recommend an expansion of community outpatient services that are more
effective, less costly, and result in fewer people being involuntarily confined.26, 27
In addition, although research in this area is limited, so-called cost savings offered by private companies are
linked to compromised patient care. The 2010 Utah State Legislature Executive Appropriations Committee
found that the primary driver for cost savings in privatized forensic psychiatric care appeared to stem from
a reduction in overall staff compensation, associated with high turnover rates, which are associated with
increased harm to patients.28 In 2012, the North Carolina Psychological Association voiced strong opposition
to the privatization of state-operated forensic psychiatric treatment, specifically by GEO Group. Cost savings,
especially over the long term, were presented as unlikely and the NC psychologists raised concerns over
quality of care.29
Unfortunately, concerns go far beyond cost savings. In August 2012, the Associated Press reported three
gruesome deaths, including a patient who died in a scalding bathtub, at the South Florida State Hospital
operated by Correct Care Solutions.30 In 2015, Florida’s state hospital system was the subject of an investigative
report by the Tampa Bay Times and the Sarasota Herald-Tribune, described in greater detail on page 10.
Between 2008 and 2015, Florida’s state hospitals saw a 45 percent increase in violent and other dangerous
incidents yet no action was taken by the state or Correct Care Solutions. Roach infestations, sexual abuse, and
14 patient deaths due to violence and neglect are only some of what was revealed in the three-part series.31
Despite warnings, Texas built its first privately run forensic mental health hospital in 2011.

Montgomery County Mental Health Treatment Facility
In 2011, GEO opened the only privately operated, state-funded mental health hospital in Texas in 2011, now
run by Correct Care Solutions. Plans to build the facility started much earlier. In 2009, through a secretive,
last minute maneuver, the 81st legislature passed a budget rider authorizing $15 million for 100 additional
inpatient beds. The Dallas Morning News reported, “The new facility came as a post-session shock to mental
health advocates, who acknowledge the need for it. But they say they weren’t informed about it and never
would have signed off if they knew Florida-based GEO was operating it.”32
Governor Rick Perry signed the appropriation in June 2009 and Montgomery County signed a contract with
the state in May 2010. In 2011, GEO built the Montgomery County Mental Health Treatment Facility (MCMHTF)
in Conroe, Texas, a county with a history of working closely with private prison companies. Opening its doors in
March 2011, the facility has 100 beds with the potential to double in size. It provides only forensic psychiatric
services, serving approximately 1,000 individuals who were found incompetent to stand trial between 2011

Montgomery County
Mental Health
Treatment Facility,
photo courtesy of Correct
Care Solutions

InCorrect Care | February 2016 | 6

and 2013.33
GEO operates another facility in Conroe — the Joe Corley Detention Center, built in 2008. Both facilities
were part of a federal investigation regarding the procurement process and construction financing because
Montgomery County officials financed the $33 million Corley facility in part through federally tax-exempt
bonds, but were not detaining county residents there.34
The MCMHTF facility is the only one of its kind in Texas: the state contracted with the county, who then
contracted with GEO Care, now Correct Care Solutions. The original contract with the state totaled $15 million,
but was increased for the 2014-15 fiscal year to $15,417,450, in order to offer salary raises for certain frontline
staff.35 Although funded with general revenue, the Department of State Health Services does not consider the
facility a state hospital; rather, its capacity is referred to as “community beds.”36
Management issues at MCMHTF arose quickly. Within its first year of operation, GEO Care was fined $53,000,
half of the original penalty, after state inspectors found serious violations, including unauthorized restraint and
seclusion of patients, incomplete medical records, failure to show patient consent for medications, and failure
to report serious injuries to the state.37 Financial troubles also plagued the county. In June 2013, the county
issued a Request for Proposals (RFP) to sell the facility. GEO Care underbid the county’s RFP, offering only $35
million. In November 2013 the county rejected GEO’s bid.
Similar to trends in the Prison Industrial Complex, communities of color are disproportionately impacted by
the Treatment Industrial Complex. There is an over-representation of African Americans receiving treatment
inside the MCMHTF, as shown in Figure 1. The disparity is likely due to a combination of racial profiling and
discrimination in the criminal justice system paired with the over-diagnosis and confinement of African
Americans in the mental health system.38 Emerging research reveals that African Americans charged with a
crime are less likely to receive a competency evaluation than their white counterparts, but research is limited.
However, when evaluated for competency, African Americans are more likely to be found incompetent.39

Figure 1: Racial and Ethnic Makeup of Commitments MCMHTF, 201340

80
70
60

Montgomery
County Mental
Health Treatment
Facility

50

Percent

40
30

Texas Population

20
10
0

White

Black

Hispanic*

* Texas population includes non-white and white Hispanic in total

InCorrect Care | February 2016 | 7

UNSUCCESSFUL ATTEMPTS TO PRIVATIZE STATE HOSPITALS IN TEXAS
Despite major challenges, privatization did not stop with Montgomery County. Since 2011, GEO has officially
attempted to take over two existing state hospitals, while schemes to privatize other hospitals have also been
discussed behind closed doors.
Kerrville State Hospital, 2012
In 2011, amidst the forensic bed “crisis” and serious budget cuts, the Texas Legislature authorized the
privatization of one state hospital despite limited research, serious concerns from advocates, and instances of
abuse at the GEO-run MCMHTF. Through an RFP process, five companies requested information: MHM Services,
Inc., El Paso MHMR, and Liberty Healthcare Corporation (Liberty), Vodastra Solutions and GEO Care, Inc.
Ultimately, only GEO Care submitted a proposal to take over Kerrville State Hospital.
GEO’s bid for Kerrville was fraught with controversy. Grassroots Leadership’s investigative
research found that a former Chief Operating Officer at Kerrville State Hospital, Stephen
Anfinson, was employed by GEO Care as the Facility Administrator and CEO at MCMHTF at
the time that the company submitted its bid for Kerrville. Anfinson was not the only public
servant to leave his post to serve the interests of GEO. At least four other GEO lobbyists in
Texas came directly from government posts and have made upwards of $1.1 million lobbying
in the company’s interest.41
Grassroots Leadership, along with a coalition of faith, human and civil rights, and mental
health advocates launched a campaign to halt the award of a contract. In addition to
exposing the company’s record in Texas and beyond, the coalition mobilized Kerrville
community members to register their opposition to the sale of the state hospital with their
members in the state legislature and with the Department of State Health Services (DSHS). Two of the most
impactful letters to DSHS came from the Kerrville Economic Development Corporation and State Senator Troy
Fraser that both cited local economics and job loss as a result of privatization as top concerns.

Kerrville State Hospital, photo
courtesy of Texas Department of
State Health Services

Community outcry was heard. In a letter to the Governor’s office, then DSHS Commissioner David Lakey
rejected GEO’s proposal noting that although the RFP required that bidders cut costs by 10 percent, the
company would have cut overall staffing by 21 percent and psychiatric nursing assistant levels by 27 percent.
GEO’s proposal, Lakey wrote, would not “ensure a safe environment for patients and staff.” The proposal
received a score of only 64 out of 100 during the review process. Lakey has since resigned from DSHS, stepping
down in January 2015.42
Terrell State Hospital, 2014-2015
Despite the controversy and the ultimate failure of the proposed outsourcing of the Kerrville State Hospital,
there was another attempt to privatize one of Texas’ state hospitals in 2014. This time, it came amidst
major changes to the structure of state’s mental and healthcare service delivery. The Texas Sunset Advisory
Commission regularly reviews state agencies to assess functionality and efficiency. The Texas Health and
Human Services Commission (HHSC) was under review in 2014.
The Sunset Staff Report, which called for immediate action to address the “current crisis in the state mental
health hospital system,” did not include recommendations to privatize state hospitals.43 Yet then HHSC
Executive Commissioner Kyle Janek touted the release of an RFP to run Terrell State Hospital as a supposed
solution to the crisis. Testifying at one of many Sunset Commission hearings, Janek explained. “We are in the
business of operating facilities when we could contract with someone to operate those facilities,” he began. “I
don’t feel any hesitation if the private sector can run our facilities, I think they could offer something.”44
Weeks before the hearing, in June 2014, with no warning or public input, HHSC issued a surprise RFP for Terrell
State Hospital, a 316 bed facility outside of Dallas. This time, four companies expressed interest, of which GEO
Care was one. Rather than risk the same fate as Kerrville, this RFP was written differently. Instead of requiring
InCorrect Care | February 2016 | 8

bidders to reduce costs by 10 percent, HHSC asked bidders to serve more
individuals for the same level of spending.45
At the hearing, Commissioner Janek illuminated some of the decisions that
led to the way this RFP was drafted in 2014. He referenced the 2012 attempt
to privatize Kerrville State Hospital, revealing that he worked with the bidder
(GEO) to adjust the RFP this time around. GEO gave Commissioner Janek the
idea that rather than ask for a 10 percent cost reduction, HHSC could draft the
RFP to ask that the vendor serve more patients at the same level of spending.
Advocates remained concerned that the outcome would be the same: reduced
levels of spending per patient leading to compromised patient care. Although Terrell State Hospital, photo courtesy of Texas
Department of State Health Services
Commissioner Janek allowed GEO Care to provide input on the RFP, local
public officials were not notified and there were no opportunities for mental
health experts or the public to submit questions or concerns before the state moved forward with the RFP.
Shortly after the Sunset hearings, a scandalous $110 million dollar contracting debacle between HHSC and
Austin technology firm 21CT was exposed, resulting in serious examination of all HHSC contracting practices.46
Even still, HHSC released a tentative award announcement for Terrell State Hospital on October 20 2014;
GEO Care, LLC was the winning bidder.47 In response to the contracting scandal, legislators began calling for
action and state Senators John Whitmire and Robert Nichols called for an investigation into HHSC’s attempt to
privatize Terrell State Hospital. Consequently, in March of 2015, the State Auditor’s Office released a scathing
report, concluding that:
the Health and Human Services Commission did not ensure that its decision to tentatively award a contract
to GEO Care, LLC to manage selected operations at Terrell State Hospital provided the best value to the State.
The Commission and the Department of State Health Services (Department) did not fully comply with the
Commission’s contract planning and procurement processes.48
The audit’s list of mishaps included failure to conduct a preliminary needs assessment and a cost-benefitanalysis, tardy purchase requisitions, and failure to adequately verify the background, qualifications, and
experiences of vendors. In addition, there were a number of discrepancies in the bid evaluation process
including inconsistencies in scoring, lack of a minimum qualifying score, and failure to receive non-disclosure
agreements prior to negotiations.49
The next month, the results of an investigation conducted by the Austin American Statesman revealed that
there had been on-going communication between Commissioner Janek and Frank Santos, a well-paid GEO
lobbyist. Emails between the two revealed an early scheme that created a timeline to privatize the state
hospital. This plot was concocted before and without any legislative initiation and included suggestions
from GEO Care on the timeline and content for the RFP. While Janek attributed the numerous text and phone
contacts between himself and Santos to their personal relationship, many of the calls corresponded with
important dates in the RFP process. On June 5, 2015 Governor Greg Abbott announced Janek’s resignation as
HHSC Commissioner.50
The Statesman wrote,
The communications and internal memos obtained by the American-Statesman detail the behind-thescenes campaign of a private company to use its personal connections inside the Health and Human Services
Commission to make a profit operating mental health hospitals. It also raises questions about Janek’s role in
promoting the deal, which officials later complained was rushed and broke state purchasing rules.51
As a result of the HHSC’s failures to adequately manage their contracts, several pieces of legislation were
proposed during Texas’ 84th legislative session. Senate Bill 20 and its attached rider proposed by Senator
Nichols had the most impact on Texas’ state hospitals. The rider prohibits any attempts to privatize a state
hospital in Texas without Legislative Budget Board approval. The legislative oversight is key according to Sen.

InCorrect Care | February 2016 | 9

Nichols, who emphasized that “Before any agency chooses to dismantle something, we need to do a complete
analysis, to show if it can show savings without reducing services.”52
Although Correct Care Solutions’ attempts to take over public mental health hospitals were thwarted, CCS was
awarded a new Texas contract in 2015, again with little warning. The Bill Clayton Detention Facility in Littlefield,
Texas reopened in September 2015, now home to approximately 200 people locked up in the state’s new civil
commitment program.

Florida Treatment Industrial Complex
Florida has the most concentrated treatment industrial complex
in the nation. In 1998, GEO took over the South Florida State
Hospital, making it the first privately run psychiatric facility in the
U.S. GEO has expanded its operations since then; Correct Care
Solutions (CCS) operates three of Florida’s six state hospitals, a
total of over 800 beds.

In a recent joint investigation, the Tampa Bay Times and the
Sarasota Herald-Tribune shed light on horrific conditions in
Florida’s state-funded mental health facilities.53 Their findings
were akin to Albert Q. Maisel’s Life Magazine report, Bedlam
1946: Most U.S. Mental Hospitals are a Shame and a Disgrace,
published over 50 years ago.54 Roach infestations, sexual abuse,
and 14 patient deaths due to violence or neglect are only some of
what was revealed in this three-part series. Reporters found that
in the CCS-run South Florida State Hospital, “patients didn’t have
enough food to eat and were picking through trash cans for their
meals.”55 In response to the report, journalist, author and Floridanative, Carl Haissan, has called for the FBI to investigate these
“torture chambers.”56
Much of the deplorable conditions were attributed to the fact
that Florida slashed the state hospital budget — $100 million
in budget cuts — while DCF drastically relaxed rules regarding
injury and death, resulting in spikes in both. Violent attacks at the
state’s hospitals increased by 45 percent between 2008 and 2015,
yet staffing was cut by one-third. Staffing shortages contributed
to the severe beating of a 37-year-old patient at the CCS-run
North Florida Evaluation and Treatment Center, whose skull,
face and jaw were broken by another patient, while staff were
slow to respond. Furthermore, state regulators have been hiding
the full extent of this violence and neglect from the public. In
fact, multiple patient homicides were miscategorized as natural
deaths.57
The first privately run civil commitment center also calls Florida
home. GEO took over the multi-million dollar contract to run
the Florida Civil Commitment Center (FCCC) after an inmate
uprising in 2005, when it was run by Liberty Healthcare. In 2008,
GEO built the current FCCC facility.58 According to NBC, the
construction of the new FCCC in Arcadia increased GEO’s revenue
by $22.1 million. Now CCS, the company was awarded Governor
Scott’s Savings Award in 2012 for their “commitment to fiscal
responsibility by implementing bold and innovative cost-saving
business practices while increasing the effectiveness of state
government operations.” In 2014, the CEO of GEO, George Zoley,
hosted a $10,000-a-plate fundraiser for Gov. Rick Scott.59
Not only is Florida GEO’s inpatient “treatment” facility hub, but

InCorrect Care | February 2016 | 10

the company also runs five of the state’s seven private prisons.60
Clearly a strong supporter of privatization, the Department of
Corrections also contracts with a private company to provide its
correctional healthcare — Corizon Health, Inc. until 2015. Corizon
lost their contract after a Correctional Medical Authority audit
revealed “life-threatening conditions” in the Florida Women’s
Reception Center, and a Palm Beach Post investigation exposed
serious problems with health care offered in Florida’s prisons.61
Most alarming, deaths increased by 10 percent and hit a ten-year
record high within months of Corizon’s takeover in 2012.62 As a
result of such inadequate care, the state re-bid its contract with
Corizon at the end of 2015.63

Although Corizon continues to be expelled from states across the
county (MN, MD, PA, MN, Rikers Island), the company manages
to secure new contracts.64 During Texas’ 84th legislative session,
Corizon lobbied to have legislation introduced requiring the
Texas Department of Criminal Justice to explore whether a
private company could provide cost savings to the state.
In Texas and Florida, state leaders allow the same for-profit
companies to provide health and mental health care to
individuals in state custody, regardless of their poor track records.
Despite case after case of abuse, neglect and death, public
officials seem to be blinded by short-term cost savings and
political contributions.
As some allies and advocates have pointed out, privatization
might make sense considering the poor state of mental health
systems across the country. Both Texas and Florida have
historically provided sorely inadequate funding for mental health
and healthcare, creating expensive crisis service systems that
are in crisis themselves. Unfortunately, as Florida has painfully
illustrated, privatization does not improve care, nor does it
provide long-term costs savings. In fact, the private companies
are the only ones who benefit from the deal.

Florida Civil Commitment Center, photo courtesy of Correct Care Solutions

PART II: THE PRIVATIZATION OF CIVIL COMMITMENT
IN TEXAS
Civil commitment facilities also present a significant potential profit stream for private prison companies.
In this case, the term civil commitment refers to the process of continued monitoring, surveillance, and
“treatment” of individuals convicted of violent sexual offenses after serving their sentence. Correct Care
Solutions operates two civil commitment centers: a 720-bed facility in Arcadia, Florida and a 382-bed facility
in Littlefield, Texas. Florida’s facility was originally run by Liberty Behavioral Health Corporation, but GEO Care
took over the contract in 2006 after horrific conditions led to an inmate uprising. Then, in 2008, GEO Care built
a new and larger facility.
Individuals can be mandated for civil commitment when they have been convicted of more than one sexually
violent offense and have been deemed as suffering from a behavioral abnormality or personality disorder.
Those who are civilly committed have completed their prison sentences but are required to receive continued
treatment and active monitoring upon release. Civil commitment has generated controversy since its inception
in the 1990s, when states began to implement more severe sexual offense laws. As The Guardian wrote in 2013,
“You can be classed as a sexually violent predator based solely on the subjective opinion of a state-employed
psychologist or sex expert.”65 Many civil commitment programs are being constitutionally challenged
across the country due to the fact that very few or, in some states, no program participants are released.66 In
Minnesota, federal district Judge Donovan Frank ruled the program unconstitutional. In his written comments
he offered this explanation:
One reason why we must be so careful about civil commitment is that it can be used by the state to segregate
undesirables from society by labeling them with a mental abnormality or personality disorder. For example,
civil commitment might improperly be used to indefinitely extend the prison terms of individuals who have
been criminally convicted of a crime and who have finished serving their defined terms of imprisonment.
As the Court has observed previously, the fact that those committed to and confined at the Minnesota Sex
Offender Program are sex offenders, who may indeed be subject to society’s opprobrium, does not insulate
the criminal and civil justice systems from a fair and probing constitutional inquiry.67

THE FIRST 16 YEARS OF CIVIL COMMITMENT IN TEXAS
While at least 20 states have enacted laws that allow civil commitment programs, prior to the opening of
the Littlefield facility, Texas was the only state that used an outpatient halfway house model as opposed to
a more punitive secure lockup model. Previously, the state housed about 300 individuals in halfway houses.
Although no one in the program was ever re-convicted of another sexual offense, in all 15 years of the
program’s existence, no one had ever completed treatment and “graduated” from the program either.68 In
fact, civilly committed individuals were being sent back to prison for violating civil commitment rules, even
those not criminal in nature. This often resulted in a never-ending revolving door between prison and the civil
commitment program.
Although problems with the program had been ongoing, a clear crisis had emerged by 2014. Texas worked
with two private companies to provide housing for the outpatient civil commitment program: Avalon
Corrections (since purchased by Corrections Corporation of America) and GEO Group. Rather than entering
into contracts with these companies, the Office of Violent Sex Offender Management (OVSOM) used
memorandums of understanding (MOU) to provide housing services, totaling almost $4 million between 2012
and 2014.69 Due to the lax requirements associated with an MOU, it is no surprise that problems arose. In the
summer of 2014, Avalon threatened to release 67 men under their supervision if the state refused to increase
their pay from $44 per day per person to $77 per day and GEO Group indicated they would not renew their
InCorrect Care | February 2016 | 11

contract.70 In addition, the OVSOM received numerous community complaints when they relocated a number
of their clients to an Acres Homes boarding house, an east Austin neighborhood, and then secretly planned
to relocate to a remote location in Liberty County - all without notifying residents and community members.71
Then, the state released a RFP for “Community Residential Facility(s) to provide housing and related services for
violent sex offenders who have been civilly committed.”72 They were hoping to make a final award in October
2014.
Not only had the program been plagued with housing problems, but there were also a number of problems
with the OVSOM’s leadership. According to state Senator John Whitmire, former Executive Director Allison
Taylor worked mostly from home and failed to keep the necessary records for the agency.73 In April 2014, Taylor
resigned, replaced by Marsha McLane. In 2014, the agency was investigated by the State Auditor’s Office, the
Health and Human Services Commission Office of the Inspector General, the Texas Rangers, and the Texas
Public Integrity Unit. The resulting audit revealed numerous problems with the program.74 Namely, that the
office did not have control over its 53 contracts and 12 MOUs, resulting in thousands of dollars of wasted
taxpayer money and the ensuing housing crisis.75
In addition to the OVSOM’s management failures, the previous system for decision-making regarding sexual
offenses in Texas was further complicated by the fact that there was only one judge in the state responsible
for civil commitments of people convicted of a sexual offense, Montgomery County District Judge Michael
Seiler. Since the early part of 2015, Seiler has been recused from hearing eight civil commitment cases due
to allegations of bias.76 These eight cases accounted for half of the sixteen petitions in total made by defense
attorneys to have him removed from proceedings. As a result, Senator Whitmire requested that the Texas
Commission on Judicial Conduct investigate Seiler.77
Amid such controversy, a national complication emerged. Across the U.S., civil commitment programs came
under federal scrutiny. Most notable was Judge Frank’s ruling in Minnesota that declared the civil commitment
program unconstitutional because it lacked a clear path to “graduate” from the treatment program and be
released.78 Rather than risk federal involvement, Texas fast-tracked legislation to drastically alter the state’s civil
commitment program.

THE CURRENT CIVIL COMMITMENT PROGRAM IN TEXAS
Although Texas had not historically committed individuals convicted of a sexual offense in lockup facilities,
rumors that the state was headed in that direction began in June 2014. The beginning of an investigative
series, the Houston Chronicle reported that the state was considering using a Texas Juvenile Justice
Department facility that closed earlier that year.79
Around the same time, negotiations to repurpose the Bill Clayton Detention Center as a new civil commitment
center also began. The remote Bill Clayton Detention Center had lain empty for six years. Owing 13% of their
budget in bond payments each year, the city of Littlefield has tried to repurpose the empty facility before. The
problems in Littlefield have been persistent since building the $11 million jail in 2000. Littlefield has tried to
auction off the facility and fill it with prisoners from New Mexico, California, and even immigrant
children.80, 81
Despite the contracting scandal that thwarted the Terrell State Hospital contract, HHSC issued a request for
proposals for operation of a civil commitment center on June 4, 2015, the day before Commissioner Janek
resigned.82 After only one week of deliberation, the state awarded the $23, 688, 573 contract to Correct Care
Solutions on July 24, 2015.83 HHSC clearly fast-tracked the contracting process, noted by staff at the July 24 Civil
Commitment meeting, conveniently setting the award date just before SB 20 went into effect, which would
have required a more rigorous and transparent contracting process.84
Littlefield is now the home for nearly 200 individuals convicted of a sexual offense who have served their
sentences, but who have been indefinitely civilly committed. Although required to be a therapeutic rather
InCorrect Care | February 2016 | 12

Bill Clayton Detention Facility

The Bill Clayton Detention Center was built in
2000 and run by the GEO Group as a state prison
for juveniles, until the Texas legislature decided
to remove juveniles from the facility in 2003. GEO
housed adults there until the facility shut its doors
in 2009, after the company lost contracts to hold
prisons there from Idaho and Wyoming.

Randal McCullough, 37, committed suicide at Bill
Clayton after nearly a year in solitary confinement.
Soon afterward, the Idaho Department of
Corrections cancelled its contract with the GEO
Group and removed its prisoners from the facility.

Idaho’s audit uncovered a routine falsifying of
reports; guards claimed to be monitoring prisoners
at regular intervals, but were often away from their
assigned posts for hours on end. When the GEO
Group pulled out of the facility, it left Littlefield
residents without revenue and responsible
for an $11 million building project. The town
Littlefied facility, photo courtesy
unsuccessfully tried to auction the empty facility in
of San Antonio Express News
2011. Since then, Littlefield has tried to fill it with
prisoners from New Mexico, California, and even
immigrant children.

than punitive program, a company with roots in the private prison industry operates the facility. Correct
Care Solutions (CCS), a spin-off of the GEO Group, is the same corporation that operated the facility until
2009 and one of the two vendors who exited their housing contract with the Office of Violent Sex Offender
Management. This contract seems a consolation prize for CCS, who lost the bid to take over Terrell State
Hospital months before securing this contract.85
Josh Gravens, who was held in the Littlefield facility as a juvenile from 2000 to 2003, has traumatic memories
of the place and the so-called treatment he received. Then run by GEO, Gravens comments on the facility; “It
was a prison then and it’s a prison now.” Much like the treatment provided for individuals found incompetent
to stand trial, he points out, sex offender treatment involves information and memorization, not mental
health care. Regarding the new Littlefield facility, he explains, “ You can’t have a therapeutic relationship with
someone who holds the key to your freedom. If there is an incarceration component, there is no treatment.”
The opening of Littlefield comes alongside numerous changes for the civil commitment program. Attempting
to get ahead of the federal government after Judge Frank’s decision in June, Senator Whitmire introduced
Senate Bill 746 during the 84th legislative session.86 Signed by Gov. Abbott on June 16, 2015 and effective
immediately, the legislation accomplished a number of sorely needed reforms. Unfortunately, the bill also
removed the outpatient requirement from statute, allowing the state to confine all program participants in a
more restrictive lockdown facility, rather than in halfway or boarding houses in various parts of the state.
According to Senator Whitmire, the new program is designed to allow participants to move through the tiered
system, with prison-like confinement only at the front end.87 Unfortunately, the contract reveals no mention of
release until completing the fourth and final tier.88 On the one hand, if someone follows the rules and makes

Correct Care Solutions contract
to operate the Bill Clayton
Detention Center, Littlefield,
Texas.

InCorrect Care | February 2016 | 13

strides in their treatment, in theory, they could move through the tiers and eventually leave the program,
which has never happened to date.89 On the other hand, treatment components and policies governing length
of time spent in each tier remain undefined and anyone who is released will continue to remain under state
supervision and ankle monitoring.
Although some program participants are hopeful about the changes, others are skeptical.90, 91 The state asked
program participants to sign a waiver to voluntarily enter the new program, but 97 refused. The distrust of the
new program may stem from the program’s constitutionally dubious history. Although in theory there is now a
process for individuals to move through the program and potentially be released, the state’s contract with CCS
incentivizes keeping the Littlefield facility full. The state will pay CCS $128.70 per person per day initially, but
once the population increases to over 250 individuals, the state gets a break and will pay less than $100 per
person per day.92 CCS’s contract in Florida works the same way. The bed rate is $102.28 for up to 680 residents,
dropping 30 percent after that, to $69.90 per bed.93
Similarly to private prison and immigrant detention contracts, the state is incentivized to keep the number
of individuals confined in Littlefield high, rather than encouraging rehabilitation and release. This perverse
incentive is especially troublesome because oversight for the program will come only from the agency itself.
As evidence of this perverse incentive, a man housed in the Florida Civil Commitment Center revealed that CCS
files excessive disciplinary reports, which are then used against program participants. He writes,
There is something fundamentally wrong when my for-profit keepers can write as many disciplinary reports
against me as they please … and then use those disciplinary reports against me at trial to commit me and
during my annual review to keep me committed so my for-profit keepers can make money off me.94
With such a poor track record on the part of the agency and the private corporation running the facility,
participant skepticism seems completely warranted.
Since the opening of the facility, the new law and the program itself have been constitutionality challenged.95

GEO has doubled their lobbying investments in Texas over the
last five years
Figure 2: GEO Group, GEO Care, Correct Care Solutions Lobby Spending
Not surprisingly, private prison corporation GEO Group has
Range, Texas, 2011-2015
been involved in the privatization of state hospitals in Texas
from the beginning. Despite their poor track record of owning
and operating private prisons and detention centers in Texas,
2011
the company and its successor health care company Correct
Care Solutions, remains deeply involved in the industry in
large part because of their deep pockets. Although it remains
2012
somewhat unclear where lobbying records for GEO Group,
GEO Care and Correct Care Solutions separate, each has
2013
made sizeable investments in Texas employing the same
lobbyists. Lionel Aguirre, Frank Santos, Jennifer Sellers and
Gabriel Sepulveda have all been hired by GEO Group, GEO
2014
Care and Correct Care Solutions, oftentimes working for
all three companies at once.96 Most notably, lobbyist Frank
Santos, whose relationship with the former Texas Health and
2015
Human Services Commissioner, Kyle Janek, was at the center
of Janek’s controversial resignation, has been on the payroll
$100,000
$200,000
$300,000
$400,000
$500,000
$600,000
$700,000
$800,000
since 2011.
Lobbying Money
High

InCorrect Care | February 2016 | 14

Lobbying Money
Low

CONCLUSION
The creation of Correct Care Solutions illustrates a
calculated move by a for-profit prison corporation
into mental health and other “treatment” facilities, yet
CCS will soon have very little formal connection to the
for-profit prison industry. For these reasons, it remains
important to call attention to the link between these
companies, their history and the Prison Industrial
Complex. Therefore, this report uses the Treatment
Industrial Complex to retain that link and reference
the harm caused by a profit driven criminal justice
system. At the same time, private prison companies
will continue to find new opportunities for growth
and expand into new markets. Mental health and
civil commitment facilities are only one component
of the Treatment Industrial Complex, but the trend is
particularly troubling because of the potential to hold
someone indefinitely.
Due to deep pockets and inside information, TIC
companies are able to anticipate industry trends,
while advocates often only learn of a new contract
after it is too late. This report details how this plays
out on the ground. The crises and challenges that
face public officials and community leaders are only
dollar signs to corporations. A dearth of community
mental health services and a spike in the forensic
mental health population means increased revenue;
a civil commitment program in serious trouble is an
opportunity for growth and profit. These trends will
shift over time and private prison companies will
adapt, re-brand and continue to profit off of human
confinement and suffering.
However, there are ways to interrupt this cycle.
Hold public officials accountable. Although public
information requests are often thwarted, communities
have a right to be involved in the government decision
making process. Both elected officials and government
appointees are obligated to share information with
constituents, yet as seen in Texas and across the
U.S., private companies seem to be more informed
than local stakeholders. The 84th Texas Legislature
passed SB 746 with little opposition, a bill now being
questioned on the grounds of its constitutionality. In
the case of Terrell State Hospital, a contracting scandal
discovered through the Texas Sunset Commission and

investigative journalism caused enough scrutiny into
HHSC contracting practices that Correct Care Solutions
lost their tentative contract award. Furthermore,
outcomes in Florida offer proof that Correct Care
Solutions provides substandard and harmful services.
Elected officials cannot look the other way. Presenting
this information can help hold decision makers
accountable when the pro-privatization lobby is
strong.
Track the industry, including shareholder calls,
corporate lobbying and campaign contributions.
Publicly shared corporations hold public shareholder
calls, which offer a glimpse into the plans and
intentions of each company. In addition, lobbying
trails and campaign contributions expose for-profit
companies’ plans, sometimes before contracts are
secured. Understanding who they court can help
illuminate plans for a new facility and offer advocates
an opportunity to sound the alarm. By tracking their
investments, advocates can provide opportunities to
interrupt their tactics, getting to public officials first or
exposing their relationships.
End our dependence on the criminal justice system
and the companies that back that system. Private
prison companies have shifted and expanded their
reach in response to public policy changes aimed
at curbing prison populations. Unfortunately,
some reforms that attempt to create alternatives to
incarceration only re-create new forms of incarceration
and new avenues for profiteering. Under auspices of
providing treatment or more humane corrections,
these reforms often create “net-widening,” allowing
the criminal justice system further into people’s lives
and increasing opportunities for private companies to
further profit. In order to disrupt the Prison Industrial
Complex, and therefore the Treatment Industrial
Complex, public policies must move away from
surveillance and confinement altogether and promote
community-based solutions to public safety issues.
This report is part of a series on the Treatment
Industrial Complex. Look for an in-depth report on
community corrections and the Treatment Industrial
Complex in spring 2016.

InCorrect Care | February 2016 | 15

REFERENCES
1.	

Paula Arnquist, Unpublished research, Grassroots Leadership, 2014.

2.	

Treatment Industrial Complex: How For-Profit Prison Corporations are Undermining Efforts to Treat
and Rehabilitate Prisoners for Corporate Gain. November 2014. American Friends Service Committee,
Grassroots Leadership, & Southern Center for Human Rights. http://grassrootsleadership.org/reports/
treatment-industrial-complex-how-profit-prison-corporations-are-undermining-efforts-treat

24.	

Andrea Ball, “Judge: Mentally incompetent state inmates being kept in jail too long,” Austin
American Statesman, Jan. 26, 2012 (http://www.statesman.com/news/news/local/judge-mentallyincompetent-state-inmates-being-kep/nRjz7/)

25.	

Spencer Harris. “Mental Health: A Survey of State-Funded Delivery,” Texas Public Policy Foundation,
Nov. 29, 2011. http://old.texaspolicy.com/center/health-care/reports/mental-health-survey-statefunded-delivery

26.	

California Judicial Council Task Force for Criminal Justice Collaboration on Mental Health Issues, Final
Report: Recommendations for Changing the Paradigm for Persons with Mental Illness in the Criminal
Justice System, April 2011 http://www.courts.ca.gov/documents/Mental_Health_Task_Force_
Report_042011.pdf

27.	

Texas Department of State Health Services, Council on Sex Offender Treatment Civil Commitment of the
Sexually Violent Predator - Inpatient vs. Outpatient SVP Civil Commitment, April 2010 www.dshs.state.
tx.us/csot/csot_ccinout.shtm

28.	

Utah State Legislature Executive Appropriations Committee, Feasibility Study
on the Privatization of Portions of the Utah State Hospital and the Utah State
Developmental Center, August 2010 www.hendrickson-consulting.com/documents/
FeasibilityStudyonthePrivatizationofPortionsoftheUtahStateHospitalandtheUtahStateDevelopment.pdf

29.	

North Carolina Psychological Association. Letter to Gov. Beverly Perdue re privatization of forensic
treatment services, April 10, 2012 https://ncpsychology.org//pdfs/2012_NCPA_Position_on_
Privatization_of_Forensic_Unit.pdf

30.	

Kathleen Haughney, “State reviews deaths at private-run mental hospital in Broward,” Sun
Sentinal, July 25, 2012 http://articles.sun-sentinel.com/2012-07-25/news/fl-geo-hospital-badreview-20120725_1_mental-health-hospital-employees-three-mental-patients

3.	

GEO World Quarter 1 Newsletter. A GEO Publication for Employees and their Families, 2013 http://
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4.	

Texas Ethics Commission. Lobby Report, Retrieved Dec. 2015.

5.	

Michael Braga, Anthony Cormier, & Leonara LaPeter Anton, “Insane. Invisible. In Danger. The Definition
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projects/2015/investigations/florida-mental-health-hospitals/competency/

6.	

Ibid.

7.	

Treatment Industrial Complex: How For-Profit Prison Corporations are Undermining Efforts to Treat
and Rehabilitate Prisoners for Corporate Gain. November 2014. American Friends Service Committee,
Grassroots Leadership, & Southern Center for Human Rights. http://grassrootsleadership.org/reports/
treatment-industrial-complex-how-profit-prison-corporations-are-undermining-efforts-treat

8.	

Ibid.

9.	

Ibid.

10.	

Ibid.

31.	

11.	

Angela Davis, “Masked Racism: Reflections on the Prison Industrial Complex.” Colorlines, Sept. 10, 1998.
http://www.colorlines.com/articles/masked-racism-reflections-prison-industrial-complex

“Insane. Invisible. In Danger.” Tampa Bay Times & Sarasota Herald-Tribune, Fall 2015 http://www.
tampabay.com/projects/2015/investigations/florida-mental-health-hospitals/

32.	

12.	

Correct Care Solutions company website: http://www.correctcaresolutions.com/our-services/crcc/

Emily Ramshaw, “Troubled prison firm’s deal for new psychiatric hospital raises questions,” The Dallas
Morning News, July 11, 2009.

13.	

Lauren E. Glaze and Doris J. James. Bureau of Justice Statistics Special Report: Mental Health Problems
of Prison and Jail Inmates, U.S. Department of Justice, Bureau of Justice Statistics, 2006 https://www.
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33.	

Texas Department of State Health Services, Unpublished Data. Retrieved May 2014.

34.	

Nancy Flake, “Montgomery County’s mental health facility gets $53K in fines,” The Courier of
Montgomery County, July 20, 2012 http://www.yourhoustonnews.com/courier/news/montgomerycounty-s-mental-health-facility-gets-k-in-fines/article_0e4783ec-626f-53c5-be05-520e113b727a.
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14.	

Center for Behavioral Health Statistics and Quality. Results from the 2013 National Survey on Drug
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I0Uw&sig2=Ep4hQnaUR4L5nBX_B1m8pQ

35.	

Texas Department of State Health Services. Montgomery County Mental Health Treatment Facility
Contract.

36.	

Texas Department of State Health Services website: http://www.dshs.state.tx.us/mhhospitals/

37.	

Montgomery County Commissioner’s Court, Meeting Minutes, March 2013 http://www.mctx.org/dept/
departments_c/commissioner_s_court/docs/Full_Document_Package_031113.pdf

38.	

California Judicial Council Task Force for Criminal Justice Collaboration on Mental Health Issues, Final
Report: Recommendations for Changing the Paradigm for Persons with Mental Illness in the Criminal
Justice System, April 2011 http://www.courts.ca.gov/documents/Mental_Health_Task_Force_
Report_042011.pdf

Jonathan M. Metzl. The Protest Psychosis: How Schizophrenia Became a Black Disease, Beacon Press:
Boston, MA, 2010; 246 pp.

39.	

Texas State Government Effectiveness and Efficiency Report: Selected Issues and Recommendations,
Submitted to the 83rd Legislature and prepared by Texas Legislative Budget Board staff, January 2013
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Hubbard, K., Zapf, P. & Ronan, K. Competency Restoration: An Examination of the Differences Between
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40.	

Department of State Health Services, Unpublished Data. Retrieved May 2014.

41.	

Substance Abuse and Mental Health Services Administration, Funding and Characteristics of State
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Kymberlie Quong Charles, “Privatizing Kerrville State Hospital is Unconscionable,” Grassroots
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42.	

18.	

Texas Department of State Health Services, Self Evaluation Report Submitted to the Sunset
Commission. (Sept. 2013) http://www.hhsc.state.tx.us/sunset/Evaluation-Report.shtml

Reeve Hamilton and Alexa Ura, “Lakey Leaving DSHS, but Not Public Health,” The Texas Tribune, Jan. 7,
2015 http://www.texastribune.org/2015/01/07/lakey-prepares-new-role-focused-population-health/

43.	

19.	

Sunset Advisory Commission. Staff Report with Final Results. Department of State Health Services, July
2015 https://www.sunset.texas.gov/public/uploads/DSHS%20Final%20Results.pdf

Texas Sunset Advisory Commission. Staff Report with Final Results, July 2015. https://www.sunset.
texas.gov/public/uploads/DSHS%20Final%20Results.pdf

44.	

Texas Sunset Commission Hearing, Aug. 2014

20.	

Graziani, C., Guzman, M., Mahometa, M., Shafer, A. “Texas Outpatient Competency Restoration
Evaluation Report.” The Hogg Foundation for Mental Health, 2015. http://utw10282.utweb.utexas.edu/
wp-content/uploads/2015/09/EvaluationReport_091815.pdf

45.	

Texas Health and Human Services Commission. Request for Proposals (RFP) for Terrell State Hospital.
RFP No. 537-5-0000135376, http://esbd.cpa.state.tx.us/docs/537/111909_1.pdf

46.	

21.	

Mental Health America of Texas, “Saving Minds, Saving Money,” 2011 http://www.texmed.org/
WorkArea/DownloadAsset.aspx?id=20537

Austin American-Statesman, “Complete Coverage: 21CT,” 2014 http://www.mystatesman.com/flist/
news/complete-coverage-21ct/fmq/

47.	

22.	

Health Management Associates, “Impact of Proposed Budget Cuts to Community-Based Mental Health
Services,” presented to the Texas Conference of Urban Counties, March 2011 http://www.ttbh.org/
Documents/BudgetCutsCommunity.pdf

Texas Department of State Health Services website: http://www.dshs.state.tx.us/mhsaannouncements/

48.	

John Keel, CPA, State of Texas State Auditor, “An Audit Report on Procurement for Terrell State
Hospital Operations at the Health and Human Services Commission and the Department of State
Health Services,” Report Number 15-030, March 2015 http://www.sao.state.tx.us/reports/report.
aspx?reportnumber=15-030

15.	

16.	

17.	

23.	

Emily DePrang. “Judge Rules Mentally Ill Prisoners Must Not Wait,” Texas Observer, Jan. 30, 2012 http://
www.texasobserver.org/judge-rules-mentally-ill-prisoners-must-not-wait/

InCorrect Care | February 2016 | 16

49.	

Ibid.

50.	

Brian M. Rosenthal, “Another high-ranking official leaving the state health commission,” The Houston
Chronicle, May 4, 2015 http://www.chron.com/news/politics/texas/article/Another-high-rankingofficial-is-leaving-the-6239382.php

51.	

Andrea Ball, “Behind hospital deal, Kyle Janek and GEO lobbyists worked closely,” Austin AmericanStatesman, April 16, 2015 http://www.mystatesman.com/news/news/state-regional-govt-politics/
behind-hospital-deal-kyle-janek-and-geo-lobbyists-/nkwmP/

52.	

Roy Maynard, “Nichols questions hospital privatization,” Tyler Morning Telegraph, Dec. 27, 2014 http://
www.tylerpaper.com/TP-News+Local/211087/nichols-questions-hospital-privatization

53.	

“Insane. Invisible. In Danger.” Tampa Bay Times & Sarasota Herald-Tribune, Fall 2015. http://www.
tampabay.com/projects/2015/investigations/florida-mental-health-hospitals/

54.	

Albert Q. Maisel. “Bedlam 1946: Most U.S. Mental Hospitals are a Shame and a Disgrace,” Life Magazine,
1946 https://books.google.com/books?id=BlUEAAAAMBAJ&pg=PA102#v=onepage&q&f=false

55.	

“Insane. Invisible. In Danger.” Tampa Bay Times & Sarasota Herald-Tribune, Fall 2015. http://www.
tampabay.com/projects/2015/investigations/florida-mental-health-hospitals/

56.	

Carl Hiaasen, “Hiaasen: FBI should probe Florida mental hospitals,” Florida Today, Nov. 12, 2015 http://
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57.	

“Insane. Invisible. In Danger.” Tampa Bay Times & Sarasota Herald-Tribune, Fall 2015. http://www.
tampabay.com/projects/2015/investigations/florida-mental-health-hospitals/

58.	

Office of Program Policy Analysis & Government Accountability, “The Delays in Screening Sexually
Violent Predators Increase Costs; Treatment Facility Security Enhanced,” Feb. 2008, Report No. 08-10
http://www.oppaga.state.fl.us/reports/pdf/0810rpt.pdf

59.	

Andrea Praegitzer, “Violent sexual predators held indefinitely - for a profit,” NBC-2, June 9, 2015
http://www.nbc-2.com/story/29230766/violent-sexual-predators-held-indefinitely-for-a-profit#.
Vr5cfDYrJE4

60.	

Max Dixon, “New contracts give private prison giant nearly 80 percent of Florida’s private prison
market,” The Florida Times-Union, Dec. 16, 2013 http://jacksonville.com/news/2013-12-16/story/newcontracts-give-private-prison-giant-nearly-80-percent-floridas-private

61.	

Pat Beall, “Privatizing prison health care leaves inmates in pain, sometimes dying,” Palm Beach Post,
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71.	

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Lauren McGauphy and Anita Hassan, “Agency pursues housing contract for high-risk sex offenders,”The

InCorrect Care | February 2016 | 17

NOTES

INCORRECT CARE:

How a Prison Profiteer Disguises Confinement as Care
FEBRUARY 2016

(Part of the Treatment Industrial Complex Series)

For more information, please contact
Grassroots Leadership

info@grassrootsleadership.org or (512) 499-8111
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www.grassrootsleadership.org

A .pdf of this document is also available on the Grassroots Leadership website.