New Health Care Provider Picked for Oregon Jail after Audit Criticizes Corizon

by Mark Wilson

A Birmingham, Alabama health care company has taken over medical care at the Washington County jail in Hillsboro, Oregon in the wake of a scathing audit that led county officials to terminate a contract with Corizon Health two years early. The audit found that a lack of county oversight of the Corizon contract resulted in inadequate prisoner medical care and cost the county hundreds of thousands of dollars.

Birmingham-based NaphCare, Inc. assumed control over health care at the jail on June 1, 2015 under a contract to provide services to the approximately 570 prisoners at the facility.

“We are eager to embark on this partnership with NaphCare. They are an organization that shares our commitment to value-driven service while providing progressive medical care within our jail,” Sheriff Pat Garrett said in a statement.

In addition to selecting a new provider for jail health services, county officials stripped the Washington County Department of Health and Human Services of its responsibility for overseeing the contract, instead appointing the county Finance Department to do so.

A 34-page report issued by County Auditor John Hutzler in November 2014 deliberately avoided directly evaluating the quality of prisoner healthcare at the jail, instead pointing out inadequacies based on what the audit found in the county’s monitoring of the Corizon contract.

“Evaluating the quality of care provided to inmates was beyond the scope of this audit, and we express no opinion on the quality of care provided,” the report stated. However, it added, “We did review the processes implemented by the contract administrator to monitor quality of care and concluded they did not provide the County with reasonable assurance that quality care was being provided.”

News reports published in The Oregonian described lawsuits against the Washington County jail, including one filed by former prisoner Alexander Heap, 34, alleging medical negligence. Heap filed suit in federal court in March 2014 against the county, Corizon and several jail medical workers and guards, claiming he was mistreated during his approximately three-month incarceration at the facility.

His complaint alleged the jail had a defective health care policy, and that jail staff and Corizon were negligent and intentionally inflicted emotional distress by denying and delaying medical treatment.

 “This is not unusual behavior at Washington County jail,” the complaint said. “The jail does not give inmates or pretrial detainees medical attention when it is needed, instead ignoring inmates’ medical issues.” Heap settled his lawsuit with Corizon in February 2015. See: Heap v. Wortham, U.S.D.C. (D. Ore.), Case No. 3:14-cv-00105-ST.

In another lawsuit filed in May 2014, former prisoner Marco Antonio Jiminez Ramos claimed he was forced to take the wrong medications while he was held at the Washington County jail over a five-week period starting in mid-March 2013, which caused a myriad of additional health problems. His lawsuit accused jail officials of violating his Fourth, Eighth and Fourteenth Amendment rights.

“Defendants’ unlawful acts and omissions caused plaintiff extensive damages, including vomiting blood, defecating blood, loss of appetite, extreme panic attacks, pain and suffering, humiliation, mental and psychiatric problems, anxiety, nervousness, fear, trauma, emotional distress, paranoia, depression, nightmares, and related serious medical needs,” the complaint stated. Ramos settled his suit in December 2014. See: Ramos v. Washington County, U.S.D.C. (D. Ore.), Case No. 3:14-cv-00778-BR.

Instead of citing health care inadequacies directly, Hutzler’s audit focused on staffing violations that created inadequate conditions at the jail, using a budgetary analysis to make the point. The audit found that Corizon and jail officials had violated the terms of their contract by failing to properly monitor prisoner health care.

“The contract ... required that all jail healthcare services be reviewed and evaluated for quality of care through established and regularly performed audits,” the report stated. “We found no evidence that these audits had been performed. Although [Corizon] represented that it had a quality assurance program, it did not report the results of its quality assurance audits to the MAC (Medical Audit Committee) or the contract administrator.”

Further, Hutzler cited the contract administrator – an individual he later refused to name – for failing to ensure that Corizon kept an adequate number of qualified employees on duty at the jail during all shifts. As a result, the administrator “did not require the contractor to report staffing in sufficient detail to determine whether staffing specifications were met or whether the staffing actually provided was adequate to ensure quality of care.”

Consequently, the audit continued, Corizon was paid for health care services it did not provide. “We estimate the value of the minimum specified staffing that the county didn’t receive between July 1, 2008, and June 30, 2012, to be at least $350,000,” Hutzler wrote. The county was forced to pay additional costs for outside medical care when Corizon staffers were not on duty.

“Failing to enforce minimum staffing requirements may also have increased other County costs for jail healthcare,” the audit stated. When the Medical Director’s hours dropped more than five hours below what was required by the contract, “the average number of referrals to external physicians was 42% higher, and the average number of deputy transports for medical care was 48% higher,” according to the report. “Deputy transports, and additional hospitalizations, ER visits, external referrals and pharmaceutical expenses resulted in additional costs to the County beyond the contract fee.”

The audit further found that the contract with Corizon created cost overruns because it was not administered in accordance with the county’s guidelines and best practices, it contained certain terms that did not adequately protect the county’s interests, and the county didn’t forecast and include sufficient funds in the jail’s budget to cover all costs.

Corizon was entitled to a four-year extension of its $8 million two-year contract, but the audit led county officials to cut the extension in half until competitive bids could be sought to improve medical care at the jail.

One condition of Washington County’s new contract with NaphCare is that the company is subject to accuracy checks from a third-party auditor who will examine hospital billings. The contract also tightens budgetary controls and health service requirements, and includes specific staffing criteria for day and night shifts at the jail. Such contractual provisions are a good idea considering that NaphCare, a for-profit company, has the same business model as Corizon and thus the same financial incentives to skimp on staffing and medical care for prisoners.

Sources: The Oregonian; www.oregonlive.com; www.naphcare.com; “Audit of Jail Healthcare, Final Report,” Washington County, Oregon (November 24, 2014), available at www.co.washington.or.us

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