Wristwatched: A New Frontier of Health Monitoring in Prisons

For over two decades, states have used electronic monitoring, or e-monitoring, to track and limit the movements of individuals on parole or pre-trial through wearable technology. This alternative to incarceration is a billion-dollar industry, with many third-party correctional contractors developing and providing technology to various jails, prisons and courts. Ankle monitors are perhaps the most widely known technology used on individuals on parole or pre-trial, despite the lack of evidence that using these devices decreases crime rates or recidivism. Many may not realize that the practice actually comes at a steep cost to the individual and society: e-monitoring can interfere with a person’s ability to obtain employment, re-integrate with their community, and the constant sense of surveillance can trigger severe mental health conditions including post-traumatic stress disorder and depression. More advanced ankle monitors even collect health data, tracking the wearer’s blood alcohol and cortisol levels.

Correctional technology companies continue to push boundaries, unveiling wrist-worn monitoring technologies to deploy in prisons and for non-residential e-monitoring. This trend is driven by the micro-monopolistic nature of the correctional technology market, where companies develop specialized products to secure limited contracts. Increasingly, carceral facilities are adopting these new systems, often spending millions of dollars on sophisticated sensor systems and wearables to surveil inmate populations. 

Even though many Americans spend good money to track their sleep, steps, blood oxygen levels and much more, these wrist-worn devices are no Apple Watch. Designed specifically for the carceral setting, the wristbands are made from hard plastic and are significantly more cumbersome than consumer smartwatches, ensuring they are tamper-proof and irremovable. These bracelet devices often combine GPS and biometric data tracking, notionally to protect inmate health and safety by alerting correctional workers to health crises or drug use. But this service comes at the expense of an incarcerated person’s personal privacy. Plus, the tracking bracelets are hardly a “service” to the inmates themselves—they are rarely optional, and the health information they gather is not available to them.

Correctional facilities justify the adoption of biometric tracking technologies by emphasizing the need to address alarming rates of inmate deaths, including those from drug or alcohol overdose and suicide, which are often attributed to insufficient monitoring and delayed medical responses. However the same jurisdictions that seek these technological solutions are typically the most fraught by understaffing and overcrowding issues. Crisis alerts are not effective if there is nobody to respond. Consequently, the shift to panopticon-tech in prisons shines a light on broader systemic issues including ethical privacy and humanitarian considerations.

Wearable E-Monitoring Devices In the Market

Talitrix: Inside The Walls (ITW)
Talitrix, a Georgia-based company, was one of the first to launch GPS/Biometric wristband technology in the nation. The notorious Fulton County Jail in Georgia contracted Talitrix to implement a new surveillance system called “inside the walls” in Atlanta jails, embedding hundreds of sensors into jail walls to communicate with wristbands. They issued inmates wristbands designed to track heartbeats, locations, and map inmate interactions. Talitrix ITW specifically introduced itself as a solution to staff shortages, capital constraints, and even inhumane treatment. Despite a $7.4 million payment to Talitrix, the rollout of the system was described as “a mess” by the Fulton County Commission, which ultimately pulled funding and rescinded the contract. At the time Fulton County shelled out millions for unproven health monitoring software, the jail lacked a full-time healthcare provider and was under investigation for criminal neglect leading to inmate deaths. The failed implementation underscores the need to address the basic needs and conditions of incarcerated individuals, rather than relying on technology to fix complex systemic problems.

4Sight Labs: from Custody Protect to Overwatch
4Sight Labs is a company no stranger to rocky roll outs. In 2021, Massachusetts came under fire for using 4Sight Labs technology called Custody Protect. The technology monitored heart rate to prevent people in solitary confinement from taking their own lives instead of ending the use of an inhumane form of confinement and providing mental healthcare to distressed inmates. The Custody Protect anti-suicide bracelet was rebranded, and 4Sight launched the Overwatch system in April of 2024, which is designed for remote, real-time monitoring of health metrics and alerts. This reupped Overwatch system is already being used in Kittitas County, Washington, as part of a pilot program. Similarly, Lincoln County, Missouri, is testing the system on ten inmates.

OMNI: Real Time Location System
Developed at Missouri State University’s e-factory, the OMNI system utilizes tamper-proof Bluetooth bracelets to provide precise location and heart rate data. Data is sent five times a second to the OMNI software platform, allowing correctional staff to monitor the locations, interactions, and health of thousands of inmates simultaneously. This system was deployed in Missouri this year, after being tested in Oklahoma. OMNI claims that the system was not designed for carceral healthcare, but it does monitor, and record heart rates and sends immediate alerts if a heart rate rises above or below a specific range. The company does not recommend this surveillance tech be used in place of quality, full-service healthcare that jails and prisons should be providing to their populations.

Even though OMNI does not market its product as a health system, in March 2024 Franklin County Detention Center commissioners approved a purchase of the system with a grant from the Missouri Department of Health and Senior Services. According to the county’s request for proposals, the system will provide contact tracing when a communicable illness is in jail. This implementation comes about a year after a man deemed fit for incarceration was found unresponsive in his cell when a nurse came to dispense medication to him. Despite recent implementation in local jails, it is unclear if the technology is successful at saving lives because OMNI does not have data to release.

Correctional wearables compromise health, causing emotional and physical pain.

Even consumer-grade wearables can cause discomfort if they are never removed or worn excessively. Wearing hard, plastic, unremovable devices for a prolonged period can cause health problems of their own, including swelling, numbness, bruising and blistering. These conditions not only cause immediate pain but can have negative impacts on mental health. Incidents of electric shocks from ankle monitors are stunningly common. In Florida, inmates are punished with reductions and gain time (time off for good behavior) and loss of privileges if they refuse to wear a wearable health monitoring wrist band. While consent is rarely considered in carceral settings, the purported purpose of e-monitoring technology is to benefit the inmate-patient—harshly penalizing inmates who do not consent to use of these devices undermines that stated goal.

Data harvesting could go unchecked due to regulatory deficiencies, posing a significant data privacy threat.

Uncovering the realities about the data practices of correctional technology companies is challenging, but investigations of contracts, bid proposals and news accounts indicate that that while data collection is broad, data analysis may be less sophisticated at this stage. However, researchers worry that with the major players in the industry owned by private equity, the sale of these companies—and the troves of private inmate data at their disposal—is almost a guarantee. Venture capitalists could acquire the carceral tech for the purpose of novel data-mining. Additionally, surveillance methods and techniques piloted for carceral purposes where the expectation of privacy is lower can be adapted for use in other populations in the future; for example, wrist-worn GPS monitors are now the fastest growing e-monitoring technology used by ICE. It is not a stretch, then, to think that soon populations like asylum seekers may be monitored for drug use the way parolees are.

Many of these health monitoring devices also track real-time location, creating substantial new vectors for surveillance and misuse. For example, such location data may be used to infer gang association from contact between incarcerated people or from proximity to prison fights—and, if the people involved are incarcerated awaiting trial, any inferences gleaned from their location or health data may later be used against them in court. Data from wearables could also be used to bolster jailhouse informant testimony, a widely criticized but prevalent form of evidence.

Correctional facilities punish drug use far more than they treat it, which raises concerns about whether health data will actually be used to get people health care. Further confounding the issue, corrections officers examining heart rate readings could misidentify health crises as instances of drug use. The odds of administration of proper officer training in jurisdictions struggling with staffing and funding issues is slim. Even when e-monitoring data correctly identifies drug use, screening for drugs in this manner just serves to criminalize further an already incarcerated population rather than address the problem at the source. Some detention centers, such as in Cobb County, Georgia, exclusively use the wristbands on detainees housed in their infirmary, which may reduce the chances of an inappropriate response to a heart rate notification.

Whether jail software companies handle biometric wristband data in a HIPAA compliant manner remains unclear.

Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), Correctional facilities that qualify as “health care providers” are required to protect digital health information. HIPAA also applies to providers’ business associates when they perform functions or activities that involve use or disclosure of protected health information (PHI). For example, requests for healthcare services via an electronic healthcare “ticketing” third-party app are PHI under HIPAA.

HIPAA covers biometric data collected by panopticon-tech wearables if it is linked to an individual’s health records, treatment or access to medical facilities. All the Biometric Wristwatches collect health information, which raises novel questions: would the documentation of an inmate’s heart attack or inferred drug use also be protected health information? Companies like Talitrix seem to think so, as they claim their products are HIPAA certified. Correctional Contractors, regardless of how they view their products, must comply with HIPAA standards if they handle PHI. This underscores the importance of ensuring that all parties involved in the management and processing of such data are fully aware of and compliant with HIPAA regulations to safeguard inmates’ health information.

Non-wearable biometric data collection technologies are the latest development in biometric surveillance.

There may be alternatives to wearables, and some inmate health monitoring companies, such as Reassurance Solutions, specifically advertise the lack of wearables as a privacy-protective selling point. In-prison cell health monitoring sensor systems claim to deliver resting heart and respiratory rates without wearables, cameras or monitors. The system works by collecting automatic monitoring data on a secure local network. However, these systems are extremely new, and ultimately raise the same data privacy and consent concerns as wearables.

Not every carceral problem has a technological solution, real change requires policy shifts that, while costly, are beyond purchase.

While incarcerated people are no strangers to a lack of privacy, the implementation of wearable biometric and GPS trackers takes surveillance to a new dehumanizing, punitive level. The funds that counties allocate to testing, installation and deployment of these systems would be better used providing social services to address recidivism at the root cause to decrease incarcerated populations. Avenues to reduce incarceration and e-monitoring at the same time exist, and jurisdictions should strive to reduce criminalization through methods that do not involve mass surveillance. Giving mass-incarceration a high-tech face lift serves only to bolster the appearance of change.