The state’s last prison health care contract brought despair and congressional scrutiny. Our investigation indicates that the new vendor is off to a troubling start.
James Ware first learned about the nodule on his lung three years ago. He had been sent from the Massachusetts Correctional Institution (MCI) in Shirley to Shattuck Hospital in Boston to get imaging for another medical issue; the test just happened to capture an image of the spot.
Ware didn’t get a diagnosis until he finally had a biopsy this February, after years of being shuffled back and forth between the prison and local hospitals for periodic imaging tests. By that time, the news was devastating: Stage 4 lung cancer.
The post-appointment medical report, which Ware’s attorney provided, was blunt: “He has likely been living with his lung cancer for years and has had inadequate follow-up and surveillance. In this setting, he now has advanced disease and is not a candidate for any local therapy.”
For the majority of those years wasted on delayed care, Ware’s health care—like that of all Massachusetts prisoners—was in the hands of a company called Wellpath. The private-equity-owned behemoth has been a major player in the multi-billion-dollar correctional care industry. But last year, Massachusetts declined to renew the contract as Wellpath attracted increasing controversy. The company was hit with more than 1,500 lawsuits nationwide for alleged medical negligence or wrongful death of inmates, and Massachusetts Senators Elizabeth Warren and Ed Markey had scrutinized the vendor over reports of poor care in the commonwealth. Wellpath later filed for bankruptcy.
Last summer, Massachusetts opted for a new prison health care vendor, the Kansas-based VitalCore Health Strategies. For Ware, the transition meant that for eight months between last July and his biopsy in February, VitalCore repeated the same pattern as its problematic predecessor.
“It doesn’t matter which one it was, either Wellpath or these new people [VitalCore],” Ware told me on a phone call this spring. “What they like to do is delay, delay, delay, delay, delay and hope that you don’t complain.”
I spent the past year examining VitalCore’s performance thus far in Massachusetts to gauge how much of a difference the switching of companies made for the state’s prison health care system, if any. Through analysis of public records and interviews and correspondence with more than two dozen sources—incarcerated people, recently released prisoners, attorneys, and former VitalCore staff—it appears that, a year into its five-year, $770 million contract, VitalCore has struggled to improve significantly in several critical areas including:
- Staffing levels
- Mental health care
- Workplace culture
- Specialty care and follow-up appointments
- Medical record keeping
I contacted VitalCore with detailed questions about the accounts and allegations in this article. The company responded with the following statement: “VitalCore is not able to provide information on patient care issues or current litigation. VitalCore is committed to providing healthcare at a community standard level in partnership with the Massachusetts Department of Correction (DOC) and our community healthcare partners.”
I also sent the DOC detailed questions. A department spokesperson responded with the following statement: “In correctional settings, the success of the rehabilitative mission relies on a system’s ability to provide quality and compassionate care. We continue to work in close partnership with our contracted medical provider to address the challenges of caring for a population that often has complex and significant health needs.”
The department’s statement also noted a division of the DOC that is dedicated to monitoring contract compliance and ensuring adherence to the national accreditation health care standards established by the American Correctional Association.
For its part, VitalCore has staff roles dedicated to performance improvement, but the prisoners I spoke with said they haven’t seen much change for the better.
New prison health care contractor, different concerning track record
When VitalCore was awarded the contract last year, Massachusetts hailed it as a step in the right direction after Wellpath’s poor performance. One state official praised VitalCore’s “deep commitment to delivering holistic healthcare to incarcerated individuals” in a May 2024 press release announcing the selection.
VitalCore CEO Viola Riggin added: “Our mission is to prioritize the dignity and health of all under custodial care … guided by evidence-based and trauma-informed best practices.”
But VitalCore’s history implies otherwise; namely, the company has had legal troubles in other states. In one case, a 48-year old man with documented heart problems collapsed and died in a New Mexico jail in 2018 after staff failed to properly monitor his worsening health. Another man died at the same facility two years later after VitalCore medical staff failed to help him safely detox from alcohol and heroin.
In Vermont, a man was killed by his prison cellmate in 2022 after a VitalCore mental health staffer determined the latter was no longer a threat to others—just days after he had said he was hearing voices that wouldn’t go away. VitalCore was also sued last year in Vermont by its former chief medical officer of operations, who alleged the company forged his signature on key documents sent to state officials.
Staffing level problems
From the beginning of VitalCore’s contract in Massachusetts, the company had noticeable gaps in its medical staffing.
“We were drowning,” said Jason Sylvia, the former director of nursing at Old Colony Correctional Center, describing work conditions under the new health care vendor late last summer. “The morale was so low, even the people that would pick up extra time, it was just—the holes in the schedule were getting greater and greater.”
Sylvia said that he and other nurses who picked up the slack felt especially strained over time: “We started scrambling, because we were like, If we keep losing people, we’re gonna be working here a hundred hours a week.”
Part of the reason for the loss of staff was the reopening of Brockton Hospital in August 2024. That facility poached some talent, but Sylvia said there were additional factors.
Wellpath had reportedly informed employees before losing the contract that it was going to increase pay across the board to attract new staff. But according to Sylvia, the new vendor didn’t honor the raise, and instead VitalCore announced that executives would need several months to review the local job market before making decisions about compensation. Meanwhile, he said, employees became frustrated because it was clear that VitalCore had money, based on its $770 million five-year contract with Massachusetts. (Neither VitalCore nor the DOC responded to a specific question about these allegations regarding staff pay.)
VitalCore also lacked a proper process for attracting new employees, according to Sylvia. He said that Wellpath, for all its problems, at least had a recruitment team to process applicants, and recalled with a laugh: “With VitalCore, we had to ask, like, Hey, have we gotten any applications? … You’re trying to fix the holes in the schedule, manage all the patient issues, grievances, and all the other stuff that goes on in prison, and then on top of it, we had to be our own HR team to try to hire people.”
Staffing gaps weren’t exclusive to Old Colony, where Sylvia worked. State data shows that the overall staffing rate for VitalCore remained relatively low for at least the first eight months of the contract:
- In the first week of August 2024, just a month after taking over the contract, the percentage of all medical positions filled across all facilities was 65%
- Four months later, in the first week of December 2024, that metric had only increased to 71%.
- By mid-February 2025, almost eight months after taking over the contract, the fill rate was just 74%. (I attempted to obtain more recent data, but my records request has not been fulfilled by the DOC.)
State records obtained from the DOC by Prisoners’ Legal Services also show that three facilities did not even have a medical director—the top medical staffing position at any facility—for months after VitalCore took over the contract. MCI-Norfolk had a vacancy for that position from last summer until it was filled in January 2025. Old Colony and Souza-Baranowski Correctional Center in Shirley had vacancies for that position from summer 2024 until at least mid-February (the most recent data I was able to obtain). The DOC did not answer specific questions about medical director vacancies.
The level of understaffing resulted in VitalCore making large payments to the state each month to pay back for staff hours that were not filled—between $1.4 and $1.7 million per month last fall. The prior vendor, Wellpath, also had to issue monthly payments for under-delivered worker hours. But VitalCore’s payments last fall were roughly $300,000 more per month than Wellpath’s average payments toward the end of its contract, potentially indicating that the new vendor has yet to fully address the chronic understaffing issues that plagued Wellpath in the Bay State.
The situation left health care providers with an impossibly high patient load. A former VitalCore employee who spoke on the condition of anonymity due to fear of repercussions from the company said that it was common for a provider to have 500 patients or more under their care.
Low staffing levels also negatively impacted patients. A prisoner named Patrick Grier relayed his observations about health care delays in a letter sent in March.
“There has been a lot of mental health crisis calls since the change [in vendors] and I believe the lack of staff is a part of that,” he wrote from Old Colony Correctional Center. “I think the clinicians we have do good work but they are overwhelmed and need help.”
Grier said that last fall, he noticed that new prisoners had to wait for months to receive mental health care. By contrast, when he first arrived at the prison five years ago, Grier said he was seen by a professional within a few weeks.
As of June 30, 2025—the date marking VitalCore’s first full year in Massachusetts—80% of contracted positions were filled by permanent VitalCore staff, according to the DOC.
Reports of inadequate mental health care
There is a long dark history of mental health care concerns in Mass prisons. In 2022, the state Department of Correction reached a settlement agreement with the US Department of Justice after a federal investigation revealed systemic failures in the treatment of prisoners in mental health crises who posed a danger to themselves.
The investigation, published in 2020, includes graphic depictions of staff failing to stop inmates on so-called “mental health watch” from hurting themselves. One time, employees neglected to prevent an inmate from drinking his own urine. Another time, an inmate cut himself so badly that blood pooled on his cell floor as officers simply allowed it to happen. Three other prisoners told federal investigators that “correctional officers gave them razors specifically to self-harm.” Investigators also found that four of the eight prisoners who had died by suicide from 2018 to 2020 had been on mental health watch.
The conclusion: the DOC violated prisoners’ constitutional protection against cruel and unusual punishment.
After the explosive DOJ findings, an independent monitor was assigned to track the state’s adherence to the settlement agreement. Dr. Reena Kapoor, a professor at Yale School of Medicine, published her most recent compliance report in March. It describes some recent improvements, including significant drops in the rates of attempted self-harm by individuals on mental health watch. But the author also specifies issues needing “urgent attention”—for instance, mental health care at Souza-Baranowski prison has gotten worse in recent years, according to nearly every data point being tracked. (Dr. Kapoor declined to comment beyond what is in the reports.)
Dr. Kapoor’s report does credit VitalCore for a “significantly revamped” mental health staffing roster compared to Wellpath—but the improved headcount mostly reflects an increase in bachelors-level staff members, like social workers and substance use disorder counselors.
“Most direct clinical care is provided by inexperienced mental health clinicians who do not yet have a license to practice independently,” the report noted. “Many of MDOC’s clinicians appear to be checking boxes on forms about ‘risk assessment’ and ‘treatment planning’ without understanding that these concepts are more than just asking a prisoner, Are you going to be safe?”
The report specifically called for more psychiatrists at Souza-Baranowski, MCI-Norfolk, and the facility from which Grier wrote in such distress, Old Colony in Bridgewater.
Mental health care in Massachusetts prisons: Justin’s story
Justin Rodriguez was sent to an isolated cell last summer after a heated verbal dispute with a security officer. He said the several-day stint in July—roughly three weeks after VitalCore became the vendor—put him in emotionally and physically challenging conditions without any meaningful help from mental health staff.
“The light is on 24/7 so I had to sleep with the light on,” Rodriguez said. He described his roughly four days on mental health watch in an isolated “back cell” in the Health Services Unit (HSU) at MCI-Norfolk: “The heat might be the worst thing.”
The temperature in the region hit the upper 80s that week. He continued: “There’s no ventilation—it’s hot air. The only water you have access to is the sink water, but that’s hot.”
Rodriguez said that some security staff members gave him ice upon request—but then they stopped, saying that the cubes were deemed a security threat.
He recalled not being let out of the HSU cell for those four days, except for when he was briefly brought to a separate room for quick wellness checks. Rodriguez emphasized that mental health staff never addressed the root of the issue that led to him being there.
He said that what had started as an officer questioning him about his bunk bed soon escalated into racist remarks and threats to lock him in an isolated disciplinary unit. Rodriguez became visibly upset and staff declared him to be under the influence of drugs—something he firmly denies—and sent him to mental health watch.
“They misdiagnosed me,” he recalled. “This was the part that really upset me … [They’ll say], Because he’s so animated or aggressive or excited, that there’s something more to this. He’s under the influence, or, He’s aggressive, he’s violent. It’s a generality versus … addressing the actual issue of the moment.”
Rodriguez added that missteps by mental health staffers are bad on their own, but are exacerbated when they’re overshadowed by the burdensome carceral setting and its priorities.
“One of the things I’ve noticed over my entire years [in prison] … is that there’s no agency for mental health staff when they’re dealing with procedure and protocol in an actual, live situation,” he said. “It’s DOC, it’s safety-and-security-first-everything—which I understand, but that compromises a lot of health at the same time.”
Ten months later, Rodriguez was sent to a different isolated section known as the Behavioral Assessment Unit for several days for an infraction he disputes. He told me his name was eventually cleared—but only after he spent four days over the Memorial Day weekend in the isolated unit.
In response to a detailed list of questions about Rodriguez’s story, the DOC said it is barred by privacy laws from communicating the health status or diagnoses of individual prisoners.
Workplace culture problems for prison health care staff
Another source described problems with the workplace culture among prison health care staff that they say have not improved under the new vendor.
Jordan Gomes, who was incarcerated at MCI-Shirley until his release earlier this year, relayed his observations as someone who used to work on the Health Services Unit at that facility. His last several months of incarceration overlapped with VitalCore’s first few months of holding the contract.
Gomes was a “companion” in the HSU, where he provided care to men who were sick and sometimes dying. He described a job that was physically and emotionally demanding.
“I really had to travel with a lot of these men through some of their trauma,” Gomes said. “Everybody in here is hurting.”
Gomes said the workplace culture in that Health Services Unit was characterized by staff that were often dismissive or disdainful of the prisoners they treated—regardless of whichever medical vendor was contracted at the moment.
“VitalCore Health Strategies talks about a ‘patient-first approach’ is one of their strategies,” he said. “Newsflash, everybody—that’s not how prison HSUs work.”
Describing the general tone of conversations he heard among medical and correctional staff where he worked, Gomes said, “In this specific transition [from Wellpath to VitalCore], you would hear things like, Oh, this is what they want their staff to do? Compared to what we know how to do?”
The former incarcerated HSU employee added that the negative workplace culture in the prison impacted even small details.
“People like the staff, the nurses—they don’t pay for any of the products that Wellpath or VitalCore has already purchased to keep up the inventory,” Gomes said. “It’s not coming out of their personal paychecks, and they would act as if it was theirs.”
“When I asked, Why can’t I get another packet of wipes [for a patient]? they would say, Well, the new contract vendor, they want less to go out. And so they would just blame it on the vendor. So now you have beef with an invisible person that you don’t even see.”
The DOC did not specifically respond to a question about Gomes’ depiction of the HSU, beyond its official statement noting the importance of “quality and compassionate care.”
Delays in specialty care and follow-up appointments
Prisoners also relayed experiences under VitalCore in which delays in care that started under the previous contractor simply continued under the new one.
James Ware, the prisoner at MCI-Shirley with Stage 4 lung cancer, had difficulty getting follow-up care this spring from VitalCore after receiving his diagnosis. One of his doctors wrote in a March 14, 2025 appointment summary that he wanted to give Ware the medication Repotrectinib, which can extend a patient’s life by an average of 36 months. Getting the prescription filled proved to be difficult for an incarcerated patient due to insurance coverage.
“If he was a standard outpatient, we would be able to easily fill it through our pharmacy via MassHealth,” Ware’s doctor wrote in a patient note, adding that the medical team was communicating with the prison to find a solution.
April came and Ware still hadn’t received the medication, according to Kate Piper, a paralegal for Prisoners’ Legal Services who has advocated on his behalf. Piper provided an email she sent on April 2 to a DOC official and two high-ranking VitalCore employees in Massachusetts about the lack of progress. It read in part: “If you choose not to initiate Mr. Ware on the treatment ordered by his oncologist, you can expect a lawsuit.” Two weeks later, the DOC official wrote back that his office had reached out to VitalCore and the medication had been prescribed. Ware said he got his first dose on April 11.
Meanwhile, Ware said that he missed two appointments in April and May because prison staff simply failed to transport him. Both times, he sat in his cell, waiting to get picked up and driven to the hospital. Ware made up both appointments the following week, but other problems persisted. In July, the prison temporarily ran out of his medication, which he’s supposed to take twice daily.
“No one knows what to do. I may be dead by the time I see a parole,” he wrote to me.
Two days later, the prescription was filled again, and all seemed resolved—at least for the time being. Ware said it’s common for prison health care services—under both contractors—to simply fail to refill prescriptions on time.
VitalCore and the DOC declined to answer questions about Ware’s case.
Ware isn’t the only one who has experienced these troubles. Piper said she has many especially ill clients at MCI-Shirley, who are typically sent to Leominster Hospital for specialty care. The physicians there will order follow-up appointments, “but [the patients] are not getting those follow-up appointments,” she said on a call in May.
“Someone’s medical grievance might be partially approved, rather than just denied, and they’ll say, Yes, you’re entitled to this care, and then the person will never get that appointment or will wait months for it,” Piper added.
Troubles with the medical record system
In the background of these difficulties, there have also been problems this past year with the patient medical records system.
Alex Delgado, a prisoner at MCI-Shirley, wrote the following in March after surveying 25 of his fellow inmates about the transition from Wellpath to VitalCore: “Many [individuals] report a loss of records which has hindered viable treatment coming from the new company.”
The problem apparently stemmed from the fact that the switch in vendors also required changes to the state’s electronic health records system. Wellpath used its own trademarked system, so when Wellpath left, the DOC had to find a replacement. The department chose a subcontractor known as SapphireHealth.
Jason Sylvia, the former nursing director at Old Colony, said it was clear from the rollout that the Sapphire system was not familiar to the VitalCore staff. Public documents from VitalCore’s application to run the state prison health care system show the company had proposed a different subcontractor—CorEMR—to run the records system.
Sylvia said the SapphireHealth software caused major issues because it didn’t have any of the same forms as the previous system: “It was day-to-day operations stuff that we didn’t have any forms for.”
The forms that did exist lacked sections to document key information, including areas on the page where staff could write their own notes as needed, Sylvia added. Another former employee who spoke to me on the condition of anonymity for fear of reprisal described similar problems, saying that when providers ordered labs, they “didn’t go into a queue,” but rather were often lost to “the ether.”
VitalCore was alerted by staff to the problem, and the company did work with SapphireHealth to create new forms. But that process moved slowly, and communication was poor, according to Sylvia. Facility staff were not alerted when a new form was created; they would have to stumble across it in the vast system.
Training was also reportedly lacking. “We had one person who came in [from SapphireHealth] the night that we transitioned, and he was there throughout the next day, and then he was gone. That was our training,” Sylvia said.
I contacted SapphireHealth about these allegations. They responded with the following statement: “SapphireHealth cannot comment on details as to our agreements and work with specific clients. We can say that Sapphire Health works closely with our Healthcare partners to deliver a custom solution based on the needs of the facilities and patients they serve.”
These ongoing issues potentially violated the contractual agreement between VitalCore and the state, which stipulated in one document that the vendor had to implement an electronic health record by the start date of the contract: July 1, 2024. I asked the DOC about this point; the department responded that it continues to work with VitalCore and Sapphire to customize the software.
Compounding these problems with the record system, there have also been reports of VitalCore staff hampering access.
“Some prisons are virtually non-responsive to our records requests for medical records [on behalf of our clients],” Kate Piper said in May, more than 10 months after VitalCore took over the state contract.
She acknowledged that the delay wasn’t universal, since she found the records clerk at one prison—MCI-Gardner—to be responsive and communicative.
“That’s how I know it can be done quickly,” Piper said. “At Shirley, we wait months, and we follow up multiple times, and we continue to wait. And that’s where a lot of our very ill clients are, so that’s really one of the most important places to get records from.”
The revolving door of prison health care vendors
In response to questions for this article, VitalCore wrote that the company is “committed to providing healthcare at a community standard level in partnership with the Massachusetts Department of Correction and our community healthcare partners.”
But even as the company works to improve upon shortcomings, the track record so far suggests that many problems get recycled from one vendor to the next, from delays in care, to patient record software hurdles, to mental health care being hampered by the carceral culture of prisons.
This apparent revolving door of contractors isn’t just a Mass phenomenon. Elsewhere in New England, Vermont flipped the other way around, bringing in Wellpath following a string of inmate deaths under VitalCore.
Delgado said there was a recurring theme in his surveys of fellow prisoners at MCI-Shirley: “The common fear is that farming out human rights obligations to private companies causes profit to overrule treatment.”
Reflecting on his past as a gang leader in Springfield, he compared the ruthless lifestyle of his youth to the modern health care hustle.
“I wish I had been kinder to others,” Delgado said. “I’m repulsed by the former reality that it was easy for me to have operated under a similar kind of cruelty.
“At least I no longer make a business out of it.
“Can’t say that for others.”
