KY jails must provide sufficient health care to inmates. But what counts as sufficient?
Phillip O’Hara was 40 when he died inside the Laurel County Corrections Center. His Oct. 2021 death was listed as “natural” in autopsy records, caused by hypertensive cardiovascular disease.
O’Hara’s cellmates called his mother before his death, urging her to get outside medical treatment for her son. They tried to get the attention of guards and medical personnel, but staffers ignored their pleas, according to a lawsuit filed by O’Hara’s mother, Linda.
O’Hara began to feel ill, and a medical provider was called to render aid. O’Hara’s blood pressure was dangerously low. He struggled to breathe. He was nauseous and vomiting.
But no further testing was performed on O’Hara, according to the lawsuit. He was not transported to a hospital to evaluate his condition.
He died a day later.
Linda O’Hara sued the detention center in February 2023, arguing they were indifferent to the known medical needs of her son’s preexisting heart conditions, leading to his death.
And the lawsuit argues that O’Hara’s treatment wasn’t an exception, but rather part of a pattern at the Laurel County Corrections Center.
Kentucky law requires jails to provide health care for inmates. But as jails across the state grapple with funding constraints and limited training requirements for staff, experts question: What qualifies as sufficient health care?
Since 2020, 234 people have died in Kentucky jails, according to data obtained by the Herald-Leader. About 70% of them had not been convicted of a crime.
Paul Croley, a wrongful death attorney in Kentucky, said in his experience, corrections staff often don’t know the difference between an inmate suffering from withdrawals and a serious medical emergency, both of which can be life-threatening.
Many corrections officers have little to no training at all, putting guards in situations to make medical decisions that should be left to EMTs, nurses and doctors, Croley said.
“Many of these guards have little more than a high school education,” Croley told the Herald-Leader. “Although some have military training, the extent of their medical awareness training would be a basic CPR class that any high school lifeguard could get. That’s simply not enough when it comes to making life and death decisions for people.”
What is the medical standard for KY jails?
State law dictates that people in Kentucky jails are entitled to the same health care they would receive while outside jail. Kentucky’s Department of Corrections is tasked with ensuring jails across the state comply with minimum health and life safety standards.
But those standards become murky when people arrive with a chronic health condition that isn’t immediately identifiable. Sometimes jails don’t know about — or don’t treat the symptoms of — the health problem until a person’s condition has deteriorated.
Jail personnel must be trained in first aid, and the jail must have readily available first aid kits. At least one staff member must be trained in CPR.
However, some of the Department of Corrections’ own investigations have shown that some staff listed in wrongful death lawsuits did not have adequate training.
Jails are also tasked with providing health care coverage to inmates who would otherwise be on Medicaid, the primary federal health insurance option for people with limited income and resources. Detainees are kicked off the program when Medicaid is notified they are incarcerated.
Since Medicaid’s implementation in 1965, it has featured an “inmate exclusion policy” that serves as a federal prohibition on allocating Medicaid dollars for jail and prison inmates. The policy applies to all incarcerated people, regardless of whether they’ve been convicted.
So that leaves local governments, which fund local jails, to provide medical, dental and psychological care for inmates.
The state pays for services only after they exceed necessary routine or diagnostic care, according to state law. “Necessary care” is defined as non-elective procedures that cannot be put off without hazard to the life or health of the inmate.
They typically hire a private company to provide those services.
But Kentucky provides little guidance about how much jails should spend on contracted health care services, and the figures vary widely.
In Madison County, for example, 16% of its 2024 jail budget — $820,000 of the $5 million budget — is allocated for medical care. In Fayette County, which has a $55 million jail budget, that number is 20%. In Rowan County, it’s just 10%.
Laurel County budgeted $800,000 — about 7% of its $11 million budget — for medical services in 2024, according to documents obtained through the Kentucky Open Records Act.
But Laurel County has a different funding mechanism than most jails in Kentucky.
Nearly 25% of Mosley’s staff is county medical personnel. The jail operates its own pharmacy and uses an electronic health records system. Those two features alone cost nearly half a million dollars a year, Mosley said.
With a 664-bed capacity, Laurel County Jailer Jamie Mosley said the facility is “financially self-sufficient” because of reimbursements paid by the U.S. government for housing federal inmates — roughly half the jail’s population.
Phillip O’Hara was one of those federal inmates.
Attorney: Jails ‘motivated by profit’ for health care
Louisville lawyer Greg Belzley has litigated on behalf of inmates and victims of police misconduct since 2009. He said Many jail deaths in Kentucky are attributable to inadequate medical attention.
It’s the same trend that’s seen outside jail, he said — that medical providers see the patient “not as a human, but an opportunity for monetization.
“The same thing goes on in jails and prisons, to a greater degree,” he said. “We want to turn it over to the private sector, which is motivated by profit.”
A February 2025 report from the Prison Policy Initiative, a nonprofit that advocates for criminal justice reform, supported Belzley’s criticism: Correctional health care systems are tailored to the corrections departments, the study found, not the incarcerated people they treat.
The systems are built to focus less on patient care, the report found, and more on avoiding lawsuits.
The problems are especially glaring, Belzley said, when considering how many deaths are inmates being held while awaiting trial.
“The idea that we would stick American citizens, who remain entitled to presumption of innocence, and tell them, ‘You are stuck with what you get’ is mind-blowing to me,” he said. “I couldn’t understand why we would do that, and don’t understand why we continue to do it.”
Bryan Sergent, the attorney for Linda O’Hara, who sued after her son died in a Laurel County jail, said insufficient jail health care is a symptom of a larger problem. He said society loses sight that people who are incarcerated are human, and they deserve to be treated as such.
“We don’t look at them as people anymore. We dehumanize them,” Sergent said. “I don’t think dehumanizing them and not giving them basic human rights is the way to get to rehabilitation. That is one of the goals of prison — not to just punish.”
What can the DOC do?
The state agency that regulates jails, the Department of Corrections, is required to inspect each Kentucky jail at least twice a year to ensure the facilities are complying with state standards.
But Morgan Hall, spokesperson for the department, noted that they’re not tasked with setting those standards.
State lawmakers set the standards, while local jails — including elected jailers — enact rules in their respective jails to comply with state standards.
But John Rees, the director of the Kentucky Department of Corrections from 2003 to 2008, said in an interview that state jail standards are “vague and non-specific.”
When the department inspects jails, it’s supposed to make a record of instances where jails don’t meet jail standards. But he said that rarely happens in practice.
“The administration has to take action,” Rees said. “The Department of Corrections takes little or no action and hasn’t done so in several years.”
Former Madison County Jailer Steve Tussey, who retired this year after serving in the role for about five years, agreed.
Jails are required to report “extraordinary occurrences” — like an inmate’s death — to the state within 24 hours.
The state then reviews the report to determine if the circumstances violate state standards like overcrowding in living areas, plumbing fixtures needing repair, and poor sanitation in living areas.
But what does the state do if there is a violation?
“I guess in the follow-up, quite honestly, most of the time, nothing,” Tussey said.
State law outlines that if the Department of Corrections finds a violation that requires further action, the jail must send a corrective plan to the state for approval. The state should then follow up to see if it was implemented.
If the jail fails to fix the violation, it may be cited as a violation on subsequent inspections until the issue is resolved. If the violation persists, the DOC can request standards be enforced by way of the Franklin County Circuit Clerk. Any person who refuses the orders is held in contempt.
For most serious cases, the Department of Corrections can order a jail to close temporarily or permanently.
But those are rare.
The last threatened closure was in 2020, when the Bell County jail was cited for failing to repair its smoke evacuation system. The Department of Corrections eventually postponed its closure order after they were assured the problem would be fixed.
In 2017, the Estill County jail was ordered to close for a faulty sprinkler system. It remains closed today.
This story was originally published February 28, 2025 at 5:00 AM.
