Jail Health care Makes Obamacare Look Good, In Some Cases



July 3, 2014

People often say that good help is hard to find and apparently that’s also true when it comes to finding healthcare providers for jails.


On Tuesday, July 1, the two Guilford County jails got a new healthcare provider, Correct Care Solutions (CCS), which just signed a three-year, $11 million contract with the county.  The company is replacing Corizon – formerly known as Prison Health Services (PHS) – the longtime healthcare provider for the Guilford County jails that came under a lot of fire over the past decade for several high-profile incidents nationally – including two cases in Guilford County that each involved the death of an inmate.


It’s not clear if Corizon’s controversial history played into the decision for the Sheriff’s Department to go with a new provider on a contract that’s notoriously hard to fill – but, if so, the new provider currently has a cloud over its head as well.  Recently, CCS came under investigation for a high-profile death of an inmate in Kentucky who was on a hunger strike and died after proper procedures allegedly weren’t followed by CCS healthcare providers.


On a more positive note, the change in the Guilford County jails’ health care providers also brings with it an expansion in services to inmates.  Guilford County Sheriff BJ Barnes said the newly signed agreement with CCS calls for increased care for inmates with mental issues and substance abuse problems, as well as for those who need psychological services in addition to medical care.  Barnes said this week that the new company will have the most up to date equipment.


More treatment for mentally ill inmates and those who are substance abusers in the jail is something that Guilford County commissioners have been calling for for a long time, and it was one of the promises made when Barnes and other advocates of building a new jail were pushing for the construction of the jail that opened in 2012 and ended up costing county taxpayers about $90 million.


Barnes said this week that it must be understood that all of these jail and prison healthcare providers are working under very difficult circumstances with a notoriously unhealthy group of patients.  He said that, by their nature, jail populations contain a larger percentage of unhealthy individuals than society in general because, in many cases, inmates have substance abuse problems or a tendency to engage in behavior that is risky or that takes a toll on their health.


Barnes also said another thing to keep in mind with inmate health care is that the county is required to go with the lowest responsive bidder.


“This is the problem with all government projects – you look at price,” Barnes said.


Except for one brief period of less than a year, Corizon/PHS is the only healthcare provider Guilford County has ever had, but the county’s switch to CCS ends the county’s longstanding relationship with Corizon, which has been rocky at times.


Corizon came under fire in 2007 when Judy McDaniel Woodle, an inmate in the old county jail in Greensboro who was awaiting trial on petty theft charges, died from a hernia.  Woodle’s family sued the company and settled the case after nurses and doctors allegedly misdiagnosed Woodle, contributing to her death.


And 2013, the case of Christopher Armstrong made news when it became public three years after the fact.  After being held in the restraining chair for three days in 2010, Armstrong collapsed on the floor, and according to testimony from a detention officer, when the officers asked health staff for an oxygen tank, a nurse responded in a “rude and uncooperative tone” and asked why the tank was needed.  After an extended exchange, the nurses went to get the oxygen tank for Armstrong, but the tank was empty – it had not been recharged as it should have been – and another tank had to be located.  A nurse then had to come back later to find a breathing mask to use with the oxygen tank.  Efforts to revive Armstrong were unsuccessful.


In that case, Guilford County paid out $485,000 to settle the lawsuit, and Corizon was also reportedly sued – though the settlement amount Corizon paid isn’t known.


The new jail healthcare provider, CCS solutions, has also had some explaining to do recently.  In one high-profile case reported by the Associated Press and in USA Today, a Kentucky inmate starved to death while under the supervision of CCS.


An Associated Press article on April 21 reported on the case in Louisville, Kentucky, in which James Kenneth Embry, 57, who was serving a nine-year sentence for drug offences, starved himself to death in “a case that has exposed lapses in medical treatment and in how hunger strikes are handled at the facility.”


In December 2013, Embry refused most of his meals and, at the time of his death in January, the 6-foot tall man weighed 138 pounds.


A CCS prison doctor was fired and other staff disciplined after Embry died at the Kentucky State Penitentiary.


The Associated Press story stated, “An internal investigation determined that medical personnel failed to provide him medication that may have kept his suicidal thoughts at bay and didn’t take steps to check on him as his condition worsened.  The internal review of Embry’s death also exposed broader problems involving the treatment of inmates — including a failure to regularly check inmates on medical rounds and communication lapses among medical staff.”


News reports revealed that the CCS doctor at the center of that controversy had been sued by inmates in federal court 103 times since 1992.


It must be stated that similar stories can be found for all or nearly all of the healthcare companies that work in this industry, and one event, such as the one in Kentucky, is not necessarily indicative of a company’s general practices.


Barnes said that Guilford County’s selection committee reviewed all the factors, including the companies’ reputations, before making a decision.  He said the bid by CCS was significantly lower than the offer made by Corizon.  He also said that Guilford County had switched from Corizon/PHS to another company once before, but that move was quickly reversed after that provider, NaphCare, proved highly inadequate.


“Initially, the medical was handled by the [Guilford County] health department,” Barnes said.  “It got too big for them and we went to PHS.  We then went to NaphCare, and, in less than a year, they were kicked to the curb because they were not doing what they should have been doing by contract.  We went back to PHS, which merged and changed its name to Corizon.”


In the new bid process in recent months, one bidder, Southern Health Partners, was rejected for not properly filling out all the required information.


“The problem was they did not complete the RFP [request for proposals], which meant their bid would not have been accurate because the items they did not address would cost extra,” Barnes said.


The sheriff added that Southern Health Partners has never had a client the size of Guilford County before.  He said the company will likely try again for the county’s business when the new three-year contract with CCS comes up.


“We would have also been their biggest client,” Barnes said.  “They, like Corizon, are players in the corrections care business, and I suspect they will bid again in the future.  If we had allowed them to re-bid, it would not have been fair to the other bidders, which could have caused problems.”


Barnes said that overall he was pleased with PHS/Corizon throughout the years.


“They gave us good service,” Barnes said.


The sheriff added, however, that there were some concerns about the service Corizon was providing, and he wanted those issues addressed by the new provider.


“I wanted better documentation and more computerization,” Barnes said.


He said that, with Corizon, there were times when he wanted more information about a case and the company couldn’t get it for him immediately.


“I would call and say, ‘I want to know about such and such,’ and they would say, ‘I’ll get back to you,’” Barnes said.  “There’s no excuse for that.”


He also said he wanted “better technology” from the jails’ new healthcare provider.


Barnes said that, these days, many doctors in private practice carry a tablet computer with them for prompt record keeping and retrieval, and Barnes said he’d like to see more of that type of thing with jail health care.  He said that if someone gets checked into the jail who’s been in the county’s jail system before, that inmate’s past medical records should come up right away on a computer or tablet screen just as it does in private practice.


Guilford County Sheriff’s Department Major Chuck Williamson was on the selection committee for a new healthcare provider, and he said that the new contract includes dental care as well as medical care and psychiatric services.  He said that, of the three companies, CCS was found to be the lowest responsive bidder, and he added that Guilford County will pay a flat cost of about $3.7 million a year for the next three years.


Barnes said the transition from Corizon to CCS this week went well and he added that CCS has hired some of the Corizon workers who, Barnes said, will be under new leadership, new direction and have newer and better equipment.


 In addition to providing service to the county’s jails, CCS will also provide health care for the juvenile delinquents being held by Guilford County.








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