Pima County Supervisors voted unanimously to extend the county’s contract with NaphCare, the private, for-profit provider of medical care in the Pima County jail Tuesday — but the deal includes a new provision allowing the county to terminate it with 120 days’ notice.
After months of discussion about possibly taking the jail’s health care “in house” — meaning the county would stop outsourcing medical services and instead hire its own staff to run the program directly — supervisors continue to contemplate how that would work and how much it would cost.
The supervisors voted to extend the county’s contract with NaphCare by two years.
“There is an opportunity for the board to exit the contract,” said Jan Lesher, Pima County administrator.
The discussion at the Sept. 16 Board of Supervisors meeting touched on challenges with staffing, provisioning equipment, medical care information technology, as well as costly insurance expenses.
Supervisor Matt Heinz, of District 2, who has long been pushing to bring jail health care in-house, told Arizona Luminaria after the meeting, “I was told this was impossible. I’m really excited to see where we’re at now in this conversation.”
He said that while insurance costs were a concern, in Maricopa — which provides its own medical care in its jail system — the county very rarely has to rely on an insurance provider to cover the costs or settlement of major lawsuits.
The prior three-year contract averaged out to $21.6 million the county owed NaphCare each year. The new contract extension, for $53.8 million over two years, is $26.88 million per year, or a 24% increase in the annual rate.
Finances are one reason supervisors are exploring providing in-house care.
“I don’t believe we should have private outsourced health care for our inmates,” said Heinz.
The transition would be collaborative
According to the contract extension, if “Pima County elects, at its sole discretion, to assume direct responsibility for the provision of correctional health services, in whole or in part, currently provided under this Agreement, the County reserves the right to terminate this Agreement.”
The contract states that NaphCare would agree “to cooperate fully with the County to facilitate an orderly and efficient transition to healthcare services.”
Such cooperation would include transition planning meetings, providing access to records and reports, facilitating the transfer of medical equipment and supplies, assisting the transition staff, and “continuing to provide uninterrupted services until the effective date of termination.”
The contract also affirms that the county and NaphCare “shall work collaboratively to develop and implement a written transition plan within thirty (30) days of the County’s termination notice.”
The contract was signed by Brad McClane, NaphCare’s CEO, on Sept. 3.
A long way to go
Supervisor Jen Allen, of District 3, is another supporter of bringing jail health care in-house.
“I strongly believe there should not be a profit motive tied to providing health care to folks in the Pima County jail,” she said.
NaphCare has struggled for years to meet its contractual obligations, with consistent problems of understaffing and not providing medical care required by the contract.
While the county will continue to explore the possibility of moving the jail’s medical care in-house, Supervisor Andrés Cano, of District 5, wanted to be clear that no decision has yet been made.
Matt Pate, deputy director of the county’s Detainee and Crisis Systems Department, said at the Sept. 16 meeting that staff have realized “the size of this task to this county.” He said because of the complicated nature of the potential shift, county staff will be meeting monthly to continue to study the possibility.
“The first thing we really need to figure out is the question of liability,” Pate said, adding that the county’s current insurance provider does not cover correctional medicine.
He stressed that each county that provides in-house medical care does it uniquely, with some counties opting for a hybrid model and contracting out for some services.
Allen asked Pate if there was anything in the new contract that specified best practices to reduce jail deaths. She said that in recent years the jail had one of the highest per capita death rates of any jail in the country.
Pate said that there was nothing to address preventing jail deaths in the contract, but noted that the county works with health care professionals who want to deliver quality care. He said the reduction of deaths is more procedural than contractual, noting the county’s response to the fentanyl epidemic and changes in the way they conduct jail intakes to prevent deaths.
“Our practices have led to decreases in death and increases in safety,” Pate said.
“Two things are true: We’ve gotten a lot better with correctional health practices, but we still have a long way to go.”
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