Pima County supervisors voted to spend more money and time on jail health care as it works to turn around a yearslong crisis of deaths.

At a Dec. 3 meeting, county supervisors voted unanimously to spend more money on the contract with NaphCare to continue expanding the scope of care in the jail.

Nationally, at the state level, and previously in Pima County, NaphCare has been beset with controversies and lawsuits. But with increased investment and ongoing oversight, the county is trying to increase the level and quality of care for people locked in the jail.

“We’re on them like a rat on Cheetos,” the county’s deputy administrator Francisco García said of for-profit health care provider NaphCare.

County supervisors granted the company an additional $2 million through October 2025.

Pima County has gone through four private for-profit companies since 2002 to provide medical care in the jail. 

When current provider NaphCare began in 2021, there had been a yearslong spike of in-custody deaths. 

Since then, the number of deaths has dramatically decreased, issues with understaffing are being resolved and a new program is helping people struggling with addiction.

The county says those results are through close monitoring and financial auditing of NaphCare’s performance, as well as working to expand the scope of care in the jail — including connecting people to care and resources outside the facility. The county is continuing to seek to improve the quality of medical care in the jail, with a particular focus on people addicted to opioids. Additional funding, focused on further staffing the intake unit, aims to address medical needs presenting as people enter into the jail.

“A stake in their success”

Providing adequate health care in prisons and jails is a constitutional mandate. But delivering that care is a challenge, and prisons and jails struggle to attend to populations often undergoing medical and mental health crises. 

Three recent county memos address the challenges and consequences of health care in the jail. Two of the memos lay out amending the county’s current contract with NaphCare to increase staffing with additional county funds. The third memo describes the history and tracking of deaths in the jail. 

From 2020 through 2023 there were between eight and ten deaths in the jail each year, according to the jail mortality memo. So far in 2024, there has only been a single reported death in the jail.

The increase in funding will go toward hiring more staff, with a focus on the jail’s intake unit. The proposed six extra medical staff workers in intake has the goal of minimizing the number of people who are rejected from being booked into the jail and being sent to the hospital, according to the memo.

“While we recognize the need for more competent medical staff in the jail, our position continues to be that anybody who needs medical or mental health or drug abuse treatment needs evidence-based treatment in the community,” Liz Casey, community organizer and part of No New Jail Coalition, told Arizona Luminaria after the meeting.

“The jail is inherently deadly, so keeping more people in the jail for treatment will only lead to more harm, abuse and death,” she added.

The additional funds will be on top of NaphCare’s existing $62.8 million contract with the county, to be used to hire more nurses, mental health professionals and other medical staff specifically to assist with the jail’s medically assisted opioid treatment programs. The new $64.8 million contract covers the remaining 10 months of the contract.

“We watch (NaphCare) very closely because it’s a very expensive contract. We have a stake in their success,” García said of the amended contract. “Multiple times a week we are working with them, we are auditing them, reviewing the quality of their care.”

Supervisor Rex Scott, of District 1, told Arizona Luminaria that he was hoping the county’s relationship could “build on successes,” including reducing in-custody deaths. Overall, he said of contracting with NaphCare, “I think it’s a work in progress.”

Read more about Naphcare

A provider plagued with problems

For years, NaphCare has been embroiled in controversies. In 2021, the company paid a $700,000 fine to the federal government for overcharging for services. Earlier this year, the company was found to be noncompliant with a 2022 court case that revealed the Arizona Department of Corrections Rehabilitation & Reentry was violating the constitutional rights of people held in Arizona’s prisons by not providing them adequate medical care. The state contracts with NaphCare to provide that care.

“NaphCare is continuing to innovate and enhance health-care services within Arizona prisons by enhancing the TechCare system, expanding staff training, increasing patient digital engagement, and developing specialized care programs like opioid treatment. These initiatives aim to elevate compliance and set national benchmarks in correctional health-care quality,” a NaphCare spokesperson told Cronkite News.

In Pima County, over the first two years of working with NaphCare, Arizona Luminaria found that the county docked the company over $3 million for failing to uphold their contractual obligations.

Since the first two years of NaphCare’s work in the jail, however, the county has closely monitored NaphCare in attempts to improve as well as expand its care. Working with NaphCare to provide opioid treatment in the jail, according to preliminary reports, is part of the reason deaths in the jail have plummeted.

García said offering medical care for anyone incarcerated is difficult. 

“Jails in particular are even more challenging” of an environment in which to offer medical care, he said. They’re more transitory, and people have often very recently experienced some form of trauma. “Our goal is that people leave the jail healthier, more connected,” García said.

According to a March 29 memo Pima County Behavioral Health director Paula Perrera, “The people detained in Pima County detention facilities are mothers, fathers, sons and daughters, grandparents and grandchildren, aunts and uncles, friends and neighbors and while they are in our custody we are charged with providing them with timely access to quality care.”

“It is with this sense of duty and responsibility,” the memo continues, “that (the behavioral health department) administers the medical services vendor contract and is continuously searching and implementing innovative practices to provide the best care possible given both the constraints of a carceral setting.”

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John Washington covers Tucson, Pima County, criminal justice and the environment for Arizona Luminaria. His investigative reporting series on deaths at the Pima County jail won an INN award in 2023. Before...