For sheriffs, healthcare for inmates can be a burden. For one doctor, it has been the opportunity of a lifetime.

Local officials face a major challenge: asking for-profit medical providers to provide jail healthcare on the lowest possible budget

An illustration of Doctor Carlo Musso of CorrectHealth

Illustration by Mike McQuade

This story is part of a collaboration between Atlanta magazine and the Telegraph in Macon. Blau’s reporting was supported by the Association of Health Care Journalists, the Commonwealth Fund, and the Fund for Investigative Journalism. Margaret Pfohl and Jade Abdul-Malik contributed reporting.

The lives of doctors often revolve around their patients. On a brisk week in early December 2014, Carlo Musso was no exception.

On Tuesday, he headed south on Interstate 75 beyond the edges of Atlanta’s sprawl. Not far past where the city fades to country, he pulled off the highway and drove toward the Georgia Diagnostic and Classification State Prison in Jackson. There, beyond the razor wire and sentry towers, a single patient awaited him. Robert Wayne Holsey, a 49-year-old inmate, had just a few hours left to live. Nineteen years earlier, Holsey had killed a sheriff’s deputy after a robbery at a convenience store outside Milledgeville. Now Holsey’s long fight for a reprieve was nearly over. Georgia law required a doctor to oversee his execution. That doctor would be Musso.

What followed that evening resembled a routine medical procedure. A nurse checked Holsey’s veins and set a line. As a lethal dose of pentobarbital was pumped into Holsey’s body, Musso monitored the man’s heartbeat on the electrocardiogram. Holsey’s eyes closed. He drew one last breath. At 10:51 p.m., Musso declared Holsey dead, filled out the death certificate, and headed back to Atlanta.

Two days later, Musso sat inside a Vinings law firm where he faced questions about the death of another man. In 2010, Michael Dooling Jr., a 42-year-old painter, had been booked in the Henry County Jail for a probation violation. Dooling was a smoker who had survived a heart attack and stroke. The jail had a constitutional responsibility to provide medical treatment to him, as American jails do to all inmates. Jail records show that, not long after he was booked, Dooling informed a physician’s assistant that his doctor recently had told him he needed a pacemaker. But then, a month into his incarceration, Dooling suffered a heart attack and died. His parents sued the jail, as well as CorrectHealth, the private company that treated Henry County inmates. The federal lawsuit also named Musso, CorrectHealth’s founder and president. The lawsuit alleged that his company had failed to provide Dooling with both life-saving surgery and his full set of medications.

By this time in late 2014, the company Musso had started in 2000 had grown exponentially, and was now overseeing care for 15,000 inmates at 40 correctional facilities across four states. Lawsuits like Dooling’s were not unusual. In fact, since Musso became a jail doctor, he and the companies he’d created for each jail had all together been sued at least 90 times. But in all those lawsuits, CorrectHealth had never lost in court. And they wouldn’t lose this one. (A judge would ultimately dismiss the suit, ruling that Dooling’s parents didn’t show enough evidence that their son’s constitutional rights were violated.) Nor would they lose the lawsuit stemming from the death, one day after Musso’s deposition, of yet another man, Demetrie Jones, a Cherokee County jail inmate who also was behind bars on a probation violation. Jones had HIV and had been diagnosed as bipolar, but CorrectHealth medical staff had ruled him fit to join the jail population, though he was still monitored by medical staff. On his second day, Jones complained he was having trouble breathing. On the third, a CorrectHealth doctor suspected Jones had pneumonia but didn’t immediately send him to the hospital. By the next morning, he was dead.

CorrectHealth’s litigious history is emblematic of the profound challenges that come with treating inmates. Within the nation’s healthcare system, few populations are as vulnerable or complex as those behind bars, who are at the nexus of competing priorities. On the one hand, they are entitled to healthcare funded largely by taxpayers, but on the other, that same healthcare is being farmed out to private companies, who are incentivized to maximize profits. In some ways, Musso is a pioneer, not just recognizing the dysfunction of the system, but offering an answer to a fundamental problem that vexes county sheriffs: How do we provide quality care on the lowest possible budget?

What started as a simple curiosity became the business opportunity of a lifetime. At 40, Musso traded in the stability and safety of a hospital career to care for patients few wanted to treat. In doing so, he engineered an unlikely reinvention from an unremarkable physician into one of the South’s most influential correctional doctors. This improbable second act would enrich Musso—since 2000 his companies have secured more than $360 million in government contracts—and offer a textbook example of how to build and grow influence through political lobbying, philanthropic donations, and old-fashioned personal networking. His contacts even led him to become a doctor on site for executions, and to open an assisted living facility to treat aging parolees. But the steady rise of his medical empire has undoubtedly benefited from the lax oversight by the very governments that hire him.

“I have no issue with the medical care [our inmates] receive,” says Janis Mangum, the sheriff of Jackson County, Georgia, which runs one of the more than 45 detention facilities where CorrectHealth provides healthcare to inmates. “I’ve never had a problem.”

Every year more than 10 million people are booked into America’s 3,160 jails. Incarceration is all about removing and restricting rights, but it does grant one unconditionally: healthcare. For most of our nation’s existence, this protection did not exist. In November 1973, a Texas prisoner named J.W. Gamble was injured when a 600-pound cotton bale fell onto him. He filed a handwritten lawsuit, which went all the way to the U.S. Supreme Court. He lost. But future inmates won: Justice Thurgood Marshall wrote that any jailer who showed “deliberate indifference” to an inmate’s serious medical need violated his constitutional rights. Further cases clarified that inmates should receive “adequate” care that’s “reasonably commensurate with modern medical science.” But the notion of what’s “adequate” remains a fungible concept, prone to the whims of shifting budgets and moral priorities. What, for example, constitutes adequate care for an overweight inmate with hypertension and diabetes? What about a headache? A bad cold? Against the societal backdrop of an ever-growing indifference to the plight of the accused and the convicted, sheriffs, jailers, and wardens have been content to let private companies determine the answer.

When Stanley Tuggle became Clayton County’s sheriff in 1996, he struggled with what is, in effect, an unfunded mandate. Three main options existed: contract with local doctors, hire them outright, or partner with a hospital. But as America’s jail population doubled between 1984 and 1996, and as finding enough jail doctors became more difficult, for-profit correctional healthcare providers stepped in. Tuggle decided to give one a try, but grew dissatisfied with the company’s heavy use of “rent-a-docs”—subcontracted general practitioners who, he felt, lacked deep knowledge of his jail’s inner-workings.

One day in the late 1990s, while checking in on a sick inmate at Clayton General Hospital, Tuggle bumped into Musso, a young emergency room physician who lived in Jonesboro. Many of his ER patients—including people who experienced homelessness or used drugs—Tuggle also saw in his jail. When Tuggle brought up his healthcare provider problems, Musso expressed interest in jail medicine. “I told him he was nuts,” Tuggle says. “Why get into medical care in a corrections setting when you’re working in a hospital?” Musso had never before practiced medicine behind bars but understood the importance of it—as a boy, he’d watched his father, a doctor, treat inmates. So, when Musso persisted, Tuggle suggested he submit a bid.

After losing the first bid, Musso tailored his proposal to one of Tuggle’s priorities, Tuggle recalls. “I wanted good healthcare service, but I wanted it within my facility,” Tuggle says. “He built his healthcare services around the idea of doing everything in-house.” In October 2000—four months after forming Georgia Correctional Health, LLC (GCH)—Musso became Clayton’s jail medical provider. Initially, Musso did a little bit of everything: hiring staff, establishing treatment protocols, purchasing medical equipment, and ordering prescription drugs. He also treated inmates, who typically face high rates of chronic diseases like hypertension, asthma, diabetes, and addiction. Though the average jail inmate is locked up for just 25 days, offering a brief window for medical intervention, Musso felt he could “make a tremendous impact on people and on public health,” he told the New England Journal of Medicine in 2006. “I loved it.”

When Clayton built a bigger jail, Tuggle says, Musso helped map out a new infirmary that would bring more medical services such as dental and mental healthcare in-house. Musso even found a way to move dialysis services to the jail, eliminating the need for deputies to transport patients out of the facility three times each week. Soon, Musso used his Clayton jail experience as inspiration for pitching other counties on his company’s services. His sales proposals would tout his company’s expertise at “cutting costs all while improving the quality and efficiency of healthcare delivery” inside jails. Indeed, one of the benefits of privatization is that it brings costs down, thanks to economies of scale. Private companies not only offer specialized care at a lower cost by spreading overhead across multiple jails, they also purchase multimillion-dollar insurance plans that allow sheriffs to offload some legal risk. But lax federal and state oversight, along with the lack of local funding, creates an incentive to skimp on healthcare, according to David Fathi, director of the ACLU’s National Prison Project. Accrediting groups like the National Commission on Correctional Health Care and the Medical Association of Georgia have drafted guidelines designed to improve healthcare delivery for inmates and prisoners. But few—including roughly a quarter of the jails working with CorrectHealth—are accredited. Nor, unlike most hospitals, are they required to be.

“[A death-penalty] patient is no different from a patient dying of cancer—except his cancer is a court order.”

“Jails and prisons officials want to believe that for an unbelievable low price they can get high-quality healthcare,” says Dr. Owen Murray, vice president of the University of Texas-Medical Branch’s correctional managed care program. “It’s not like any of these companies are so innovative that they can bring substantial cost savings. There are fixed costs: staffing, drugs, and levels of off-site hospitalization.”

In a written statement to Atlanta magazine, Musso said a physician-owned company is less likely to “put profits over clinical care” than is a corporation run by “number-crunching” businesspeople. “Our ultimate decision point isn’t ‘What makes the most profit?’ It’s ‘What’s best for the patient?’” Musso touted an early success—helping Tuggle lower the number of costly ER visits, though Musso did not offer supporting data. Tuggle, for his part, appreciated Musso’s work enough to refer GCH to other sheriffs, such as Jeff Wigington of Rockdale County. By 2002, Musso had secured contracts with three more jails—including Wigington’s. Musso had moved almost entirely away from hospital work, focusing on sheriffs, whose support he needed to keep growing his young company.

In 2003, Musso received a phone call from a state Department of Corrections official whom he has not named publicly. Would Musso oversee Georgia’s lethal injections? the official asked. Musso was uncertain. As a doctor, Musso had been taught to do “no harm” to patients and, as he explains in the 2017 documentary The Sandman, he saw executions as arbitrary, expensive, and unnecessary. But Musso was also curious, and asked to visit death row to witness an execution.

The experience left him “incredibly sad,” he told the New England Journal of Medicine. He recalled feeling powerless to comfort the condemned man. Later, Musso read the position of the American Medical Association, which stated a physician “should not be a participant in a legally authorized execution.” But to do nothing, Musso ultimately reasoned, was like abandoning a terminally ill patient.

“When we have a patient who can no longer survive his illness, we as physicians must ensure he has comfort,” Musso told the New England Journal of Medicine. “[A death-penalty] patient is no different from a patient dying of cancer—except his cancer is a court order.” Having a death-row doctor, he felt, would ensure that someone like Robert Wayne Holsey received what Musso called a “painless” death instead of a tortured one, as had occurred in other states, where botched lethal injections had caused inmates to experience convulsions, spasms, and gasp for air.

Musso’s involvement was perfectly legal, though it should have remained secret under state law. But because activists had outed past death-row doctors, Musso was up-front about his role—a job that paid $18,000 per execution to a team of providers that operated under Rainbow Medical Associates, another one of his companies. (Musso donated his portion to a children’s shelter.) Protesters gathered outside his house, challenged his medical license, and asked the AMA to revoke his membership. At times, he conceded in interviews, his role went against his basic reflexes as an emergency physician to prolong life. But he made no apologies.

Any backlash over Musso’s death penalty work did not impede GCH’s growth. Medical ethicist Dominic Sisti says that Musso showed a “dual loyalty”—a willingness to serve the needs of inmates and their jailer. Between 2002 and 2006, Musso grew the company’s portfolio from four jail contracts to more than 20—including seven in metro Atlanta’s 29-county region—as well as several state prisons.

Following Hurricane Katrina, Musso became the medical provider at Jefferson Parish Correctional Center, a large jail south of New Orleans. The out-of-state expansion effectively triggered a companywide restructuring that positioned it for more clients and more growth. He hired an in-house lawyer in part to shield the company from legal risk and trained his staff on ways to avoid litigation, according to company records. Musso also folded GCH under CorrectHealth Companies, an umbrella organization that included individual companies for every detention facility, a tactic used to distribute risk. As he shifted away from personally treating patients, Musso spent more of his time tracking inmate medical problems, managing off-site treatment costs, and finding new clients.

Between 2006 and 2016, CorrectHealth doubled its number of jail contracts to oversee medical care in more than 40 facilities, becoming the largest private correctional medical provider in Georgia and Louisiana, while expanding into Kentucky and Tennessee. By then, the correctional medicine sector had become a $12 billion industry. National companies swallowed regional competitors, morphing into publicly traded firms like Corizon and Wellpath, which now each oversee hundreds of jails. As more counties outsourced jail medical services—most of Georgia’s 159 counties now rely on for-profit companies—Musso extended a personal touch. When sheriffs had concerns, Musso answered directly. When they participated in charity golf outings, his company would buy a foursome.

As much as sheriffs liked Musso, larger companies threatened to underbid CorrectHealth. Like every company in the sector, CorrectHealth faced a dilemma posed by lax government oversight: Spend too much on patient care, risk losing a bid; spend too little, then corners get cut, and the risk of litigation is increased. “Below a certain price point, you won’t have the resources you need to serve the patient,” Musso said in his written response to Atlanta magazine, “and we won’t do that.” Consider something as fundamental as staffing. With no minimum standards, the ratio of medical personnel to inmates is essentially dictated by cost. But counties typically offer fixed-price contracts, which create an incentive to understaff, says Savannah attorney William Claiborne. At the 100-bed McDuffie County Jail, officials pay for just one full-time nurse, along with a doctor who offers one hour of medical care each week. For larger clients like the Chatham County Detention Center, CorrectHealth assigns a doctor or nurse practitioners to the jail, but staffs it mostly with licensed practical nurses.

“Every dollar you don’t spend, you keep,” Claiborne says. “Until you remove that incentive, you’re going to have denials of care. It’s not a flaw, it’s a feature.”

Most counties that work with CorrectHealth do not insist on compliance measures such as fines for understaffing or missed intake screenings. Nearly all of the jail medical contracts do, however, require CorrectHealth to maintain “complete and accurate” patient records and to make available records pertaining to the delivery of healthcare. In interviews with 12 sheriffs and jailers that work with CorrectHealth, most said they were hands-off when it comes to analyzing their medical provider’s performance and only intervened when a serious complaint came across their desks. Jeff Alvarez, chief medical officer at NaphCare, a private jail medical company, says he relies on monthly reports to determine treatment quality within jails and to fix problems. “If you don’t have reports, you can’t judge the care,” he says. “It’s very hard to have oversight.”

CorrectHealth’s publicly available reports do not always show diligent tracking of the treatment it provides to inmates. Monthly reports spanning two years from 27 of 45 facilities in Georgia and Louisiana contained blank spreadsheet cells that should have contained data of how many patients received treatment for chronic care, mental health, dental work, and other specialty care. Asked why the reports were incomplete, Musso wrote that they were simply outdated and that “there’s no missing data.” The company declined subsequent requests to disclose updated data, saying that information was privileged. Without this kind of information, Brenda Twitty still has questions about the death her son, Corey Martin. Martin died of an accidental drug overdose in March 2018, five days after charges against him were dropped and he was released from the Forsyth County Detention Center. Martin, a cancer survivor, had been diagnosed with a new tumor but told his mother that CorrectHealth had not immediately provided him with oncology treatment. Since Martin’s death, Twitty has asked for his individual medical records, but the jail denied her requests, citing privacy laws. As for the publicly-available monthly reports, data on how often inmates were provided with specialty care is missing for six of the seven months Martin was in jail. (Musso declined to answer questions about any individual case.)

Between 2014 and 2018, CorrectHealth was sued at least 79 times by inmates and inmates’ families over allegations of untreated pain to denial of care that, the plaintiffs argued, may have saved lives. Of course, all medical providers face lawsuits, whether they’re hospitals, clinics, or private practices. For Musso, getting sued is just “part of being in this business,” he said in his written statement. But over the five years ending in 2018, CorrectHealth was sued at a rate, adjusting for the number of inmates they each serve, roughly twice that of its largest competitor, Wellpath, according to an Atlanta magazine analysis of CorrectHealth’s lawsuits. (The rate was compared against a similar analysis of Wellpath’s lawsuits from a recent New Yorker investigation.) Musso says the comparison “isn’t apples to apples” because his larger competitors tend to serve a higher percentage of prisons.

Former patients, family members, or lawyers involved in 14 separate lawsuits allege delays or denials of care. Timothy Byrom says surgery delays meant another doctor had to rebreak bones in Byrom’s hand and fuse them to his wrist. Macon resident Ernest Henderson says that delayed skin infection treatment led to gangrene, which forced doctors to amputate a portion of his foot. When a shower overflowed in the Walton County Jail in 2017, Monroe resident Jessica Wooten slipped and fell, landing on her hip. A nurse provided muscle relaxers, but Wooten was denied additional requests for treatment, according to Wooten’s lawyer. Nearly three weeks after the fall, with Wooten threatening a lawsuit, CorrectHealth sent Wooten to a hospital, where x-rays confirmed a hip fracture. Wooten had four surgeries—the first in custody and the rest after her release. Overall, Wooten says, she incurred $500,000 in medical bills, forcing her to declare bankruptcy. Wooten’s lawyer has sent an ante litem notice, which informs potential defendants of a forthcoming lawsuit, to Walton County.

“My only regret is that I didn’t take CorrectHealth to court. The owner of the company should be held accountable.”

At least 22 of the more than 160 lawsuits against Musso’s companies involved wrongful death claims. McDonough pastor Doug Drucker said his daughter, Wendy, was not allowed to bring her antipsychotic medications into the Henry County jail—a fact supported by jail records. The 2014 lawsuit alleged that Wendy Drucker suffered three days of convulsions and a 104-degree fever in custody before being hospitalized. She suffered cardiac arrest at the hospital. According to the lawsuit, she died from neuroleptic malignant syndrome, a life-threatening condition that is treatable if detected early enough. “If she went to the hospital on time, they could’ve administered a drug to save her life,” Drucker says. “They didn’t want to spend the money.” (The Drucker family settled the case for an undisclosed sum.)

Joshua Belcher, a 32-year-old musician, tried to hang himself in August 2017 inside a cell at the Jefferson Parish Correctional Center in Louisiana. Belcher was placed on suicide watch while he detoxed off heroin, meth, and alcohol. Two days later, Belcher told a social worker he no longer was having suicidal thoughts and was hopeful for the future. He was “feeling good.” The social worker, an employee of CorrectHealth, took Belcher off suicide watch. Two days later, Belcher ended his life by hanging himself with a sheet. His parents later learned their son was one of three people to commit suicide in a two-month period at the jail, which had just one psychiatrist present for four hours each week for a facility that on average that year held 950 inmates. The Belcher family is suing CorrectHealth in federal court in Louisiana, alleging a “policy of failing to prevent inmates who exhibit signs of suicide risk from committing suicide.”

Musso in the mid-2000s adopted a strategy to “aggressively” deflect legal risk, according to company documents. Attorneys have pursued protective orders to prevent proprietary company information from getting released during litigation and persuaded judges to seal records. Lawyers have sat in on mortality review meetings—allowing CorrectHealth to claim attorney-client privilege over sensitive records—and drafted affidavits for sheriff’s deputies who are codefendants in lawsuits. That broader strategy, too, doubled as a sales point: CorrectHealth last year boasted in a proposal for Muscogee County’s business that the company has “NEVER had a verdict rendered against it.” Musso won the five-year, $3.4 million contract.

Another family member who settled, Wanda Turner, was the mother of Demetrie Jones, the Cherokee County inmate who died on December 13, 2014. That morning at 4:50 a.m., 35 minutes after he first collapsed, a CorrectHealth nurse peered into Jones’s cell, surveillance footage shows. After five seconds, she walked away. Eleven minutes later, she again peered inside his cell, but walked away. It wasn’t until a shift change, more than 90 minutes after Jones collapsed, that the same nurse entered Jones’s cell. By then, it was too late. The autopsy cited acute pneumonia related to AIDS as the cause of death. Turner’s lawyers eventually deposed CorrectHealth providers and obtained video footage of her son’s final moments. But instead of pursuing a trial, Turner took her lawyer’s advice and settled with CorrectHealth for an undisclosed sum—a choice she second-guesses to this day. “My only regret is that I didn’t take CorrectHealth to court,” Turner said. “The owner of the company should be held accountable.”

Some plaintiff attorneys, who front legal costs in exchange for a portion of any award, say two factors push even the strongest jail medical cases toward settlement. First, lawyers must reckon with the fact that, should their case go to trial, jurors are likely to be unsympathetic to their clients, given their criminal records. And the burden of proof for a deliberate indifference claim in federal court is higher than malpractice lawsuits, which are typically filed in state court and focus on whether a practitioner deviated from the standard of care. (Claiborne says judges toss state suits because jail contractors, under Georgia law, can claim sovereign immunity, a centuries-old doctrine that prevents governments from being sued without their consent.) During a recent jail medical conference presentation, Alison Currie, an attorney who represented CorrectHealth in the Turner case, estimated that correctional facilities and their medical providers lose in court fewer than 1 percent of cases, in part because many inmates file lawsuits alleging denials of minor treatment. To drive this point home, she quoted a judge’s past ruling that involved Illinois inmates who said they were denied care for the sniffles and a headache: “The constitution is not a charter of protection for hypochondriacs.”

Sometime around 2016, Musso phased out of his role supervising lethal injections. Leaving behind lethal injections allowed Musso to focus on a new chapter of his medical empire: CorrectLife, a subsidiary of CorrectHealth Companies, builds and operates assisted-living facilities designed to serve former prisoners as they age. The first of these is the Bostick Nursing Center, a 280-bed facility in Milledgeville. Musso has said he intends to open additional locations in other states—including one currently in the works in Missouri.

CorrectLife was borne out of Musso’s experience with elderly patients. Even though Georgia’s state prison population is declining, the number of prisoners 60 and older has increased 20 percent since 2011. As those inmates were released, few assisted-living facilities opened their doors, in part because they saw them as a threat. Frail prisoners nearing the end of their sentences often could not be granted early release by the parole board until they had a bed secured. Musso believed that CorrectLife could save taxpayers money, while also providing more dignified care to aging prisoners.

For years Musso had eyed the Bostick Prison, a shuttered 700-bed state prison, as the site of his first CorrectLife facility. Between 2011 and 2012, state records show, Musso discussed with corrections officials a potential deal: The state would invest $8 million in renovations, and Musso would lease the building for $580,000 per month. The following year, after dropping its renovation plans, state officials placed the 16-acre property on the market. Musso, the lone bidder, purchased it for $50,000—half of its appraised value of $100,000. Musso demolished the prison. In its place, he built a $20 million, 110,000-square-foot facility. At the 2014 groundbreaking, Musso was joined by then Governor Nathan Deal and state Senator Burt Jones, a Republican from Jackson.

Deal and Jones were among the many elected officials who received campaign contributions from Musso and his companies. Through personal and corporate contributions, Musso has given more than $470,000 to political causes since 2006. (Deal, through a representative, told Atlanta magazine that Musso’s contributions of nearly $20,000 did not influence his administration’s decisions. Jones did not respond to requests for comment.) Musso has not only donated to politicians; he’s hired them. He employed Georgia state Senator Lester Jackson, a Savannah Democrat, as his dental director. And he’s contracted with Ron Stephens, a Republican state lawmaker, to provide pharmacy services at the Chatham County Detention Center. (Jackson and Stephens did not respond to requests for comment.) Between 2012 and 2019, Musso, personally and through his company, has donated more than $27,000 to individual Georgia sheriffs that are his clients.

CorrectHealth also contributed at least $250,000 to the Georgia Sheriffs’ Association. (Musso says his sponsorship money went to the Georgia Sheriffs’ Youth Homes, which provide shelter for abused and neglected children.) The 2015 GSA annual report features a photo of two sheriffs handing Musso an award for his “continued generosity of giving.” One of those sheriffs was Donnie Craig, who in 2017 hired CorrectHealth to treat inmates at his jail in Pickens County. The annual contract is worth more than $250,000.

No example better illustrates the extent of Musso’s influence than what happened in Chatham County. In 2016, after seven Chatham County jail inmates died under Corizon’s care, the county hired CorrectHealth. The contract, worth $7 million annually, required the company to be overseen by Steve Rosenberg, an independent jail monitor. CorrectHealth’s tenure got off to a rocky start that included missed intake screenings and insufficient staffing—which led Rosenberg to recommend to county officials that they levy a $5.2 million fine against CorrectHealth.

CorrectHealth wanted Rosenberg gone, claiming in a letter to Chatham’s county manager that he was “bullying” one of the CorrectHealth nurses to tell Musso to provide higher-quality care. So, evidently, did newly-elected sheriff John Wilcher. The veteran lawman had cut off Rosenberg’s jail access because the monitor wouldn’t report findings directly to the sheriff. “I can’t fix something if I don’t know it’s broke,” Wilcher complained to the county officials who hired Rosenberg. Wilcher strongly supported Musso, one of the sheriff’s largest donors. In October 2017, when Chatham commissioners unexpectedly ended CorrectHealth’s contract, Wilcher accused the county manager of “trying to micromanage” his jail. He also questioned Rosenberg’s judgment. “I don’t need nobody to oversee me,” Wilcher told county officials.

Under pressure to avoid a lapse in medical coverage at the jail, Chatham commissioners reversed course, offering CorrectHealth a temporary extension. Leveraging the county’s predicament—switching companies would create a lapse in providers—CorrectHealth agreed to stay so long as Rosenberg no longer provided oversight. The county never collected the $5.2 million penalty that Rosenberg suggested. CorrectHealth last year won a three-year, $22 million contract, which no longer penalizes the company for missed screenings. Wilcher hired a new monitor who reports directly to the sheriff’s office.

Not all sheriffs have been happy with CorrectHealth’s services. In 2011, DeKalb County fired CorrectHealth, claiming its employees didn’t always show up for work, causing delays to patient care, and asserting that there was too much nursing turnover. In 2015, seven months after Demetrie Jones’s death, Cherokee County bid out its jail medical contract. (The Cherokee County sheriff’s office declined to comment on the cause for the switch.) In 2017, Clarke County rebid its contract after CorrectHealth’s dentist, a subcontractor, failed to come in as scheduled, and Sheriff Ira Edwards wrote in an email that he felt that Musso didn’t adequately address the problem. Edwards ultimately rebid the contract. “This is a great example of why it is best at times to go with the highest bid,” Edwards emailed one of his deputies.

In 2012, a decade into Rockdale County Jail’s contract with CorrectHealth and after five years without a single in-custody death, three inmates died there. One, who had complained of severe abdominal pain, was prescribed a laxative. The inmate, whose name was Albert Wilder, later began vomiting blood and was placed in observation but wasn’t given x-rays or any other diagnostic tests. He went into sepsis and died from a perforated ulcer. Wilder’s death was preceded, seven months earlier, by the death of Thomas Colardo. The 66-year-old Conyers resident, who had a platelet disorder that prevented his blood from clotting properly, started bleeding from his nose and rectum. Five days after the bleeding began, a physician ordered a nurse to draw blood, but the procedure didn’t occur for another five hours. Colardo was finally taken to the hospital, where he fell into a coma and died. In a deposition, Sheriff Wigington said that he called Musso after learning of Colardo’s death, and told the doctor: “I hope you all are looking into this.”

“[We’re] looking into everything,” Musso replied, according to Wigington’s deposition.

The following year, Wigington lost his reelection bid to current sheriff Eric Levitt, who replaced CorrectHealth. At the time, one of Levitt’s deputies told the county commission that the change was needed because “an ounce of prevention is worth a pound of cure.” Wigington defended CorrectHealth’s performance as the jail’s medical provider. Wigington pointed to another inmate that died under the care of Correct Care Solutions, which replaced CorrectHealth. A civil grand jury blamed the man’s death on Correct Care, as well as on the jail staff.

“Every company has issues at some point,” Wigington said. “They changed providers, and they had new deaths.”

Six years after CorrectHealth was replaced, Rockdale is locked in a costly legal battle with Colardo’s attorneys. As his companies closed out one of their most successful years—they earned more than $45 million in jail contracts in 2019, and a second CorrectLife facility is in the planning stages—Musso says he wants to look ahead, declining to revisit the circumstances that led to lost contracts or lingering wrongful death lawsuits. “It’s part of being in this business,” Musso wrote, “even when you provide excellent care every day.”

This article appears in our January 2020 issue.