Five Risks to Watch in Correctional Healthcare in 2025

Correctional healthcare comes with constant challenges, from new risks to shifting regulations. In 2025, emerging trends and persistent issues are reshaping the landscape—demanding smarter strategies and proactive solutions.

Navigating these challenges isn’t just about staying on top of legal, ethical, and financial risks—it’s about finding solutions that ensure quality care for those in custody.

This article is part of OmniSure’s series on 25 Trends in Risk Management for 2025. With this article we’ll explore five significant risks correctional healthcare providers and administrators need to keep an eye on this year. From the complexities of care coordination to the challenges surrounding female reproductive health, these risks require immediate attention and careful risk management strategies.

Whether you're a healthcare provider, a correctional facility leader, or a medical malpractice underwriter, understanding these risks will help guide better decision-making and outcomes for those in your care.

1. Care Coordination, Hand-offs, and Transitions: A Complex Web

Effective care coordination is the cornerstone of quality healthcare, yet it remains one of the most difficult areas to manage in correctional settings. These facilities often rely on multiple providers for medical, mental health, and substance abuse care. As a result, the potential for communication breakdowns between these entities is high, and gaps in information sharing can lead to serious patient harm.

The Impact of Communication Breakdowns

A lack of coordination can result in missed diagnoses, incorrect treatments, or exacerbated medical conditions. Here are a few scenarios that illustrate the risks involved:

• Missed Medical Diagnoses: A psychiatrist might attribute severe confusion or agitation to an escalation of mental illness without realizing these symptoms stem from a physical issue like a urinary tract infection. This misinterpretation can delay proper treatment and worsen patient outcomes.
• Polypharmacy Risks: The use of multiple medications, often prescribed by different providers, to treat patients with multiple chronic conditions such as cholesterol, high blood pressure, and diabetes, can lead to unintended problems and safety concerns. Falls, cognitive impairment, and interactions in which a medication prescribed for one condition actually worsens or causes a new condition are common, requiring closer medical supervision. If these risks aren’t communicated among all members of the care team, patients may face preventable complications.
• Inadequate Patient Monitoring: Psychiatric medications, such as methadone, can significantly impact an individual’s physical health, including insulin levels for diabetics or blood pressure for those with hypertension. Without proper coordination between the psychiatrist and the medical team, a life-threatening issue like hypoglycemia could be overlooked, especially if a medication dosage change triggers a cascade of adverse effects.

Coordination With Hospitals: A Growing Concern

Hospital care for incarcerated patients presents another layer of complexity. Correctional healthcare providers need to ensure that clear, structured communication protocols are established between correctional facilities and hospital staff. This includes everything from initial admission to discharge planning, which is handled much differently than when the patient discharges to the community and has unencumbered access to any outpatient services needed for follow up care.

The need for clear, actionable protocols was emphasized by the American Society for Healthcare Risk Management (ASHRM) in 2024 during discussions with healthcare experts from OmniSure. In fact, OmniSure created a sample policy to help hospitals improve communication, and ASHRM requested another session on this topic for its 2025 conference.

Problems and Solutions for Post-Release Care Transitions

Despite the challenges related to transitioning individuals from correctional healthcare to community-based care after release, there are some solutions. These solutions focus on improving care coordination, reducing risks like substance abuse relapse and mortality, and implementing strategies for better outcomes. Correctional facilities, healthcare providers, and professional liability insurers [KO1]?can use these recommendations to enhance reentry processes and ensure safer, more effective transitions, and fewer adverse outcomes.

Problems:

-Lack of Coordination: Correctional healthcare providers often fail to connect their patients with community healthcare services, leading to gaps in care after release.

-High Mortality and Relapse Rates: Recently released individuals face elevated risks of suicide, overdose, and relapse due to inadequate support and resources.

-Insufficient Discharge Planning: Many correctional contracts do not include provisions for case management and care transitions, leaving critical needs unaddressed.

-Limited Community Resources: Finding and coordinating with capable community partners is challenging.

Solutions:

-Establish Care Protocols: Collaborate with corrections departments to identify high-risk patients and plan for their transition to community care.

-Schedule Follow-Ups: Arrange intake appointments and provide technology access for telehealth options.

-Streamline Medication Access: Supply enough medication at release or ensure prescriptions are ready at pharmacies, with clear instructions for patients.

-Facilitate Insurance Enrollment: Reinstate or enroll patients in medical coverage and assist with Social Security benefits before release.

-Apply Case Management: Advocate for funded reentry case management and document all requests to support patient care and reduce liability.

These measures aim to improve continuity of care, reduce risks, and support better outcomes for individuals transitioning from incarceration.

Complexities in ICE Facilities

Immigration and Customs Enforcement (ICE) facilities add a unique layer of complexity to healthcare hand-offs. Frequent policy shifts and legal uncertainties make transitions more complicated, requiring providers to balance medical needs with security and legal mandates.

Detainees often arrive with limited medical history, language barriers, and untreated conditions, forcing healthcare teams to act quickly with incomplete information. Coordinating care between ICE facilities, local hospitals, and follow-up providers demands meticulous documentation and strict adherence to federal guidelines.

Providers must also navigate ethical concerns, ensuring that detainees receive appropriate, continuous care despite any bureaucratic obstacles and the evolving U.S. immigration policy.

For example, according to a recent article in Reuters, the Trump administration plans to lower detention standards to encourage more U.S. sheriffs to provide jail space for detaining immigrants. According to Trump's border policy coordinator, Tom Homan, the administration seeks to allow sheriffs to use their state-level standards instead of the stricter U.S. Immigration and Customs Enforcement (ICE) guidelines, reducing federal inspections.

Actionable Steps:

• Implement more integrated care systems that ensure communication between all healthcare teams—medical, mental health, and specialists.
• Develop clear communication protocols for transferring incarcerated individuals to hospitals or outside care facilities.
• Establish discharge planning at intake to ensure smooth transitions when individuals leave the facility.

2. Death by Suicide: A Preventable Tragedy

Suicide remains a critical concern in correctional facilities, demanding more than just standard prevention programs. Intake screening plays a crucial role, but many at-risk individuals slip through the cracks due to inadequate assessments or lack of follow-up. In fact, the period following arrest—especially for pre-trial detainees—is the highest risk time for suicide.

Stress, withdrawal from substances, and untreated mental health conditions intensify the risk, especially in the first 24 to 72 hours of detention. Experts emphasize the need for continuous monitoring, improved staff training, and better communication between medical and security teams.

While suicide prevention programs are common, experts argue that facilities need to take a more nuanced approach, incorporating additional insights into their suicide prevention efforts.

Understanding Suicide Risk Factors

The Columbia Suicide Severity Rating Scale (C-SSRS) is a widely used tool for assessing suicide risk. However, experts suggest expanding the scope of suicide risk assessments to incorporate insights from Dr. Thomas Joiner's Interpersonal Theory of Suicide. According to Joiner's theory, social isolation, perceived burdensomeness, and acquired capability play critical roles in an individual's suicide risk.

Collaboration and Resources

The National Commission on Correctional Health Care (NCCHC) and the American Foundation for Suicide Prevention (AFSP) have released valuable resources on suicide prevention that can help facilities enhance their programs. Additionally, criminal defense attorneys may play an unexpected but vital role in identifying suicide risk, as they often have the closest contact with individuals during the early stages of incarceration.

Actionable Steps:

• Train correctional officers and healthcare staff to recognize not only the clinical signs of suicide risk but also behavioral indicators related to social isolation and perceived burdensomeness.
• Ensure that suicide risk assessments incorporate Joiner’s interpersonal theory to provide a more complete picture of an inmate's mental state.
• Implement comprehensive suicide prevention training for all involved parties, including attorneys, healthcare staff, and corrections officers.

3. Failure to Treat Substance Use Disorders (SUD): A Growing Crisis

Substance Use Disorders (SUD) are prevalent in correctional facilities and continue to grow in significance, particularly in the wake of the opioid epidemic. Failure to adequately treat individuals with SUD can have severe consequences—both for the individuals in care and for correctional healthcare providers who may face legal ramifications for inadequate treatment.

Opioid and Alcohol Withdrawal: A Life-Threatening Issue

Withdrawal from substances like alcohol and opioids can be life-threatening if not managed properly. Withdrawal symptoms can include seizures, delirium, and even death. Providing medically supervised withdrawal and detoxification is essential to preventing complications and protecting both the patient and the facility from harm.

Medication-Assisted Treatment (MAT) for Opioid Use Disorder

Medication-Assisted Treatment (MAT) has proven to be highly effective in managing Opioid Use Disorder (OUD), yet many correctional facilities still fail to provide MAT or continue a patient’s prescribed treatment regimen. This failure puts individuals at increased risk for overdose, particularly in the two weeks following release when the risk of fatal overdose skyrockets for those who haven't had continued MAT.

Poly-Substance Abuse:

Many substances of abuse do not have FDA-approved medications specifically designed for their treatment. Stimulant Use Disorder (StUD), for example, does not have a designated MAT. However, it’s still important to monitor and address symptoms to decrease complications, including depression, anxiety, insomnia and risk of death by suicide. To help lay out plans for tackling SUD, the American Society of Addiction Medicine (ASAM) has ?online guides that cover everything from disorder identification to patient recovery. Specifically, there is a guide that helps clinicians treat those suffering from StUD (Stimulant Use Disorder) and those at a higher risk of developing StUD.

Actionable Steps:

• Request proper healthcare for incarcerated patients from correctional authorities to ensure quality care and legal protection
• Keep records of requests using official letters, meeting notes, or agreements. If certain care isn’t possible, explain why and work together on the best alternatives.
• Share reliable information with correctional staff about substance use disorders and treatment guidelines.
• Track what information was shared and with whom to show ongoing efforts to improve care.

4. Female Reproductive Health: Addressing Unique Needs

Reproductive healthcare for incarcerated women is an area of correctional healthcare that is fraught with challenges, and the situation is becoming increasingly complex due to legal and political changes.

Abortion Access and Reproductive Health Complications

In states where abortion is banned, correctional healthcare providers face an increasing risk of exposure to pregnancy-related complications, including those arising from denied or delayed abortions. Similarly, healthcare providers may hesitate to treat women experiencing miscarriages or ectopic pregnancies for fear of legal consequences, leaving patients at serious risk for life-threatening conditions.

High Severity of Obstetrics’ Claims

Obstetrics and gynecology claims are among the highest severity claims in medical malpractice. Correctional facilities face significant challenges in providing adequate obstetric and gynecologic care, increasing both health risks and legal exposure.

Delayed prenatal care, inadequate monitoring, and limited access to specialists contribute to poor maternal and fetal outcomes. High-risk pregnancies often go unmanaged prior to incarceration, leading to complications such as preterm labor, preeclampsia, and infections.

Postnatal care also suffers if facilities are unable to provide follow-up exams or mental health support for postpartum depression. Inadequate policies, poor documentation, and gaps in emergency response can raise the risk of malpractice claims.

While there are no professional liability claims studies specific to correctional healthcare signaling the average cost of an OB complication, there are studies in other healthcare settings and “Claim severity for OB Claims is 68% higher than the over Hospital Professional Liability severity,” according to the Aon/ASHRM Hospital and Physician Professional Liability Benchmark Analysis from October 2024.

Actionable Steps:

• Ensure clear protocols and training for staff on handling reproductive health issues, including those arising from pregnancy complications or the delay or denial of certain types of care.
• Develop a comprehensive policy for managing high-risk pregnancies and other reproductive health issues, with a focus on minimizing legal exposure and ensuring patient safety.
• Stay informed on the evolving legal and political landscape surrounding reproductive rights and adapt facility policies accordingly.

5. Contract Language: The Details Matter

Ambiguous or poorly worded contracts can be a significant source of risk in correctional healthcare, particularly when it comes to issues of liability and insurance coverage. Facility leaders and healthcare providers must carefully examine contract language to ensure they are not inadvertently increasing their liability exposure.

Indemnification and Insurance Coverage

Indemnification clauses in contracts can require healthcare providers to defend the state against claims that arise all or in part due to the provider’s performance. This could create an unfair liability, particularly if the state is partially responsible for the circumstances giving rise to the claim. Similarly, discrepancies in insurance coverage requirements between different contractors can create “deep pockets” that increase financial risk for some parties.

Immunity and Waivers

Contracts may require correctional healthcare providers to waive immunity protections, which could expose them to greater legal risks. It is critical to assess the implications of such clauses and negotiate where necessary to ensure that liability is fairly distributed.

Actionable Steps:

• Review and negotiate indemnification clauses carefully to ensure that healthcare providers are not unfairly held liable for state negligence.
• Ensure that insurance coverage requirements align across all contractors to prevent disproportionate financial exposure.
• Scrutinize any immunity or waiver clauses to understand their implications and seek legal advice where necessary.

Proactively Managing Correctional Healthcare Risk in 2025

The risks facing correctional healthcare in 2025 are significant, but they are not insurmountable. By proactively addressing issues like care coordination, suicide prevention, substance use disorder treatment, female reproductive health, and ambiguous contract language, correctional facility leaders, underwriters, and healthcare providers can mitigate potential liabilities and prevent adverse outcomes for incarcerated individuals.

As the landscape of correctional healthcare continues to evolve, staying ahead of these risks will be critical in providing quality care while safeguarding both patients and providers. Effective risk management, clear communication, and a commitment to continual improvement will ensure that 2025 is a year of progress for the healthcare systems within correctional settings, and for the individuals they treat.

5 Key Strategies for Managing Risk in Correctional Healthcare in 2025

1. Partner With a Risk Management Company

-Work with experts to identify and address risks unique to correctional healthcare.

-Ensure compliance with regulations and improve care coordination.

2. Establish Oversight Committees

-Create teams with healthcare providers, officers, and administrators to monitor quality.

-Set protocols for high-risk scenarios like suicide prevention and chronic illness management.

-Partner with local hospitals to improve transitions of care and reduce the risk of adverse outcomes.

3. Stay Updated on Government Policies

-Track legal changes to avoid compliance issues and legal penalties.

-Be prepared for increases in the need for health screenings and/or changing protocols for treatment as a result of ICE activities.

-Adapt to new or changing regulations on patient rights and healthcare access.

4. Follow Best Practices

-Train staff in evidence-based care and update protocols regularly.

-Engage with professional organizations and stay informed on new healthcare trends.

5. Listen to Frontline Healthcare Workers

-Encourage staff feedback to identify risks early.

-Use regular meetings and surveys to improve risk management strategies.

By adopting these strategies, correctional facilities can enhance safe care, reduce legal risks, and improve overall healthcare outcomes.

OmniSure Is the Right Choice for Your Risk Management

With OmniSure, you get a risk management partner with solutions built to fit your needs and grow with you. OmniSure helps you stay on top of risks, stay informed, reduce risk, and control losses—so you can focus on what you do best. Our tailored solutions can help you navigate today’s most difficult risks.

Ready to talk? Reach out for a consultation today.

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