Luzerne County Council zeroes in on inmate health care practices

Luzerne County prison inmate medical care procedures and costs were discussed at length during last week’s County Council work session.

County officials have zeroed in on this issue as they attempt to curb rising expenses for the prison system, which has been the top departmental expenditure in the county budget for many years. Total spending is budgeted at $33 million in 2026 — an increase of $1.5 million from 2025 — to cover costs at both the prison on Water Street in Wilkes-Barre and nearby minimum offenders building on Reichard Street.

Representatives of WellPath LLC briefed the council on a range of inmate medical and mental health services provided as part of its contract.

The county switched to an outside provider a decade ago, concluding it would be more cost-efficient. The council voted earlier this month on a one-year contract extension with WellPath totaling $5.4 million for 2027, which includes costs for a medication-assisted treatment program for inmates with opioid use disorder covered by county opioid litigation settlement funds.

The county has a constitutional requirement to provide medical services to all inmates.

In Tuesday’s presentation, WellPath Regional Vice President Shane McElveen cited pharmaceuticals and off-site specialized medical services as two “unpredictable and uncontrollable” drivers of higher costs.

For future contracts, county officials must determine how much risk they’re willing to assume in dealing with these and other factors, McElveen said.

With a “full risk” contract, the provider is responsible for all services, which means the county must pay a higher fixed-rate premium, he said. On the flip side, a provider can charge a lower premium if the county is willing to be on the hook for treatment costs through a “management fee” arrangement, McElveen said.

The third option, which has been chosen by the county to date, is in the middle, with WellPath assuming much but not all of the risk, he said.

“It really is determined on the county’s financial priorities, your tolerance for risk,” he told council.

County Chief Solicitor Harry W. Skene verified the county has been assuming responsibility for outside treatment services that cannot be provided at the prison.

At a recent legislative hearing, county Manager Romilda Crocamo highlighted the aging prison population as a concern that must be addressed, saying older inmates with “escalating chronic health needs” are contributing to rising medical costs and challenging a prison staff “increasingly called upon to manage geriatric and end-of-life care in a setting never designed for it.”

McElveen concurred with her assessment and added that more inmates in general are “just sicker patients who have multiple issues and require extensive care and medication treatment.” That includes those with substance use disorder, he said.

“That is a trend, and it’s not going away,” McElveen said.

A retired county prison corrections officer, Councilman Steve Coslett said the WellPath contract helps control some costs, but outside medical visits increase overtime.

Overtime is impacted because multiple correctional officers must transport and guard each inmate requiring medical treatment for the entire time they are outside the prison. Outside treatment is necessary when the required level of care cannot be provided by the prison’s medical unit.

County inmates required 281 off-site medical visits in 2025 and collectively spent 922 days in the hospital, WellPath said. At one point last year, three inmates were on dialysis, each requiring three treatment sessions per week, prison officials had said.

Coslett said a system is needed to ensure an inmate with a “jammed finger” doesn’t get sent to the emergency room for five hours, requiring hundreds of dollars in overtime to be spent for two correctional officers to watch that inmate. He called for a meeting soon to discuss ways to provide more in-house care.

“We cannot continue to do this year after year,” Coslett said. “It’s a very big problem. I think it needs to be addressed now.”

McElveen said he welcomes continued discussion.

Councilwoman LeeAnn McDermott asked if an inmate with abdominal pain would be sent off site if the pain occurs overnight when a physician is not present.

Noting he previously worked as an emergency room registered nurse, McElveen said an on-duty prison nurse cannot “play doctor.”

Nurses have access to telehealth services to help in determining next steps when a provider is not on site, he said.

McDermott asked if some specialty follow-up visits can be performed remotely.

James Youells, who has worked as WellPath’s health services administrator at the county prison for four years, said remote access depends on the situation. In-person visits are often necessary to assess the status of issues such as fractures, breathing problems and diabetic neuropathy that is affecting limbs because it has not been taken care of “on the street,” he said.

Dialysis and cardiac care are other treatments “mounting in the aging population,” he said.

“They’re not taking care of themselves on the outside. They’re presenting with an acute problem, and as we deal with that acute problem, the underlying issues start to come to the surface,” Youells said.

McDermott said inmate health is the main priority, but she is also concerned about keeping costs down.

Youells said he is “open to collaboration” on ways to provide more specialist services in the prison and said WellPath workers understand the burden of sending two corrections officers to accompany inmates for outside treatment.

“We do our best to curtail that,” he said.

Other council members inquired about the company’s work to treat inmates with substance use disorder and mental health issues and efforts to connect inmates to services so they can continue receiving care after they are released.

WellPath’s presentation report is posted with the work session agenda at luzernecounty.org. A video recording of the meeting will be posted in council’s online public meetings section.

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