Prison Health Contracts to be Rebid

Feb 23, 2015

Florida Department of Corrections Secretary Julie Jones announced Friday she intends to rebid contracts worth about $1.4 billion with private companies to provide health-care services to the state's 100,000 inmates.

Department of Corrections Secretary Julie Jones
Credit The Florida Channel

Jones's announcement came amid increased scrutiny of Florida's prison system, the third-largest in the country, after reports of guards abusing inmates, a rising number of unexplained inmate deaths and lawsuits from investigators who claim they were retaliated against after exposing wrongdoing.

Lawmakers have recently focused on problems with medical services provided to inmates by Wexford Health Sources and Corizon Health. The for-profit companies took over prison health care nearly two years ago after a drawn-out court battle over outsourcing ordered by the Legislature in 2011.

Jones has been highly critical of the state's current five-year deals with the companies and began exploring ways to rebid or cancel the contracts shortly after taking over as head of the department last month.

Under the current agreements, Wexford is being paid $48 million a year until Dec. 20, 2017, to provide health services to about 15,000 inmates at nine prisons in South Florida. Corizon, which provides health care to more than 74,000 inmates in North and Central Florida as well as part of South Florida, receives $229 million per year. The Corizon contract was set to expire on June 30, 2018.

Rebidding the contracts is expected to drive up costs because the department will want more services.

"We are anticipating a cost increase. But we're also adding electronic health records, liquidated damages and other enhancements to the contract that will help us in the delivery of health care services," department spokesman McKinley Lewis said.

Senate Criminal Justice Chairman Greg Evers ordered Jones to redo the current contracts after he visited several prisons in his Panhandle district and found they were understaffed by doctors and nurses, a common complaint in other states where Tennessee-based Corizon does business.

Staffing was one of a variety of issues Jones outlined in a news release Friday announcing her intention to open a contracting process known as an invitation to negotiate "prior to the beginning of 2016."

Jones is seeking "enhanced elements" to the current contracts that will include "the ability to ensure that appropriate staffing is provided by our contractors that enables a proper mix of administrative and institutional-level direct care, the presence of medical staff who possess the proper skills and qualifications to provide quality care to our inmate population and clinical oversight and supervision."

Jones wants the contractors to perform internal audits of staffing levels, which will also be monitored by the state Correctional Medical Authority and the department's health-services staff.

She also intends to demand higher penalties for the companies if they fail to meet minimum staffing or standard-of-care levels.

In addition, the secretary is asking companies to use electronic health records "to support decision making and improve provision of comprehensive medical, dental and mental health services while ensuring continuity of care," she said.

Last year, 346 of the state's 100,000-plus inmates died behind bars. More than half of those deaths --- 176 --- were initially unclassified, meaning state investigators had no immediate explanation for the causes of death. According to the Department of Corrections website, 146 inmates died due to heart attacks, cancer, gastrointestinal diseases or other medical problems.

"I am confident in the ability of this department to meet the health care needs of our inmate population through a partnership with private health care providers. Through this procurement process, the department will take steps toward being better able to ensure that the health care services required to be delivered to our inmate population are done so in a professional, expeditious and quality fashion,” Jones said in the news release.

Evers was cautiously optimistic about Jones's announcement.

"In the past year since the Florida correctional health care has become fully privatized, inmates' deaths have increased a staggering 10 percent. I'm encouraged to see that FDOC is responding to this health care crisis in our health care system. It's been a terrible deal for the Florida taxpayers. Floridians deserve better," Evers, R-Baker, said. "It is my hope and expectation that this time FDOC will rebid these contracts in an open and transparent process that includes proper accountability and oversight. We will be watching this process very closely to make sure that FDOC is not giving us whipped cream and telling us it's ice cream."

Both companies have pledged to continue to provide services throughout the rebidding process.

“We are pleased to see Secretary Jones doing exactly what she promised to do when she took over leadership of the Department of Corrections --- making whatever changes are necessary to ensure the best outcomes for the state, its taxpayers, and its inmate population. This new procurement process will allow additional flexibility and increased cooperation between the state of Florida and its partners, and we believe we are well-positioned to continue as the state's principal correctional health provider," Corizon Health Chief Executive Officer Woodrow Myers, Jr., said in a statement issued Friday.

Corizon, which employs 1,700 workers in Florida, is also "proud of the improvements we’ve made in recent months, for instance enhancing reporting on healthcare metrics and adding more staff at no additional cost to the state," Myers wrote.

Wexford President Dan Conn said in a statement that his Pittsburgh-based company is committed to working with Jones.

"We are confident Wexford Health has been meeting the many requirements of our contract with the State of Florida and know the overwhelming majority of concerns expressed by the secretary and legislators don't apply to the inmates under our care in Florida," Conn wrote. "The opportunity to rebid the contract will give us a chance to take Florida prison health care to the next level and implement additional cost-saving clinical programs not possible under the current contract, such as discounted drug pricing programs and electronic health records. Wexford Health looks forward to continuing our partnership with the Department of Corrections now and into the future.”

The rebidding of the contracts is the latest turn in Florida's decades-long struggle with inmate health care.

In the mid 1970s, lawyers launched a a nearly 20-year court battle, known as Costello v. Wainwright, over prisoners' health care, resulting in the appointment of a special master and nearly a decade of federal-court oversight of health services in the Department of Corrections.

The Correctional Medical Authority was created in 1986 as part of the settlement in the Costello case. The state's prison health system stayed under federal oversight until 1993, when a judge decided that the federal government could relinquish its role as long as Florida remained committed to using monitors, like the authority, to ensure that prisoners' rights were not being violated.

In the midst of deciding to privatize prison health care in 2011, lawmakers effectively shuttered the authority by eliminating its $717,000 budget. That same year, Gov. Rick Scott vetoed a measure that would have eliminated the agency altogether, calling it a "valuable layer of oversight." The next year, House and Senate leaders allocated $580,000 to revive the agency, shrunk from 12 workers to six with an oversight board of seven governor-appointed members.

Critics of the revived authority say the agency no longer has the power it held when U.S. District Judge Susan Black agreed to end federal oversight.

Disappointment in the current health-care contracts began not long after the privatization was fully implemented in late 2013.

Less than four months before Scott, who pushed for the privatization, was re-elected last year, former Corrections Secretary Michael Crews quietly agreed to pay Wexford and Corizon another $3.2 million to stay on the job for another year.

Two months after he inked the contract amendments, Crews threatened to stop payments to Corizon, saying the company failed to follow through after audits revealed shortcomings in multiple areas, including medical care, nursing and staffing.

The threat of another Costello-like class action lawsuit and federal oversight is an additional incentive for lawmakers to try to rectify prison health-care issues, which one lawyer who represented the inmates said are worse now than when the case was settled.

"Once those bids come in, if the private health care providers can't do it at a cost we can afford, then it may be cheaper because of the inadequate health care the inmates are receiving. The state may have to look at taking it back over," Evers said.