Private Contract for Jail Health Care Okayed

A Milwaukee County Board committee has approved a contract with private company for inmate medical care in correctional facilities, but also approved a framework to move medical care operations in-house by 2021, something the County Board has wanted for years.

The current contract for inmate medical care with Armor Correctional Health Services ends in April. At that time, Wellpath LLC will take over medical services in corrections facilities. The two-year contract with Wellpath approved by the Finance and Audit committee is worth roughly $39.7 million. During this period, Milwaukee County will research and organize an in-house medical care operation that will take over at the end of the Wellpath contract.

It has been the stated policy of the county board since 2013, when Armor first started running the medical care operations for inmates, that medical care should be provided by the county, not a private contractor. And this has now become a high-stakes issue. Armor is facing charges related to the dehydration death of Terrill Thomas, and falsifying medical records, The Milwaukee Journal-Sentinel reported. But, as Deputy Inspector Aaron Dobson of the Milwaukee County Sheriff’s Department, a commander of the Milwaukee County Jail, noted: “We did self-operation in 2013 and prior, and we failed, we failed miserably.”

At that time, County Board members were displeased with switching to a private vendor and under an apparent single source contract, as the request for proposal process keeps the applicants confidential until one is chosen for the board to vote upon.

Now, five years later, the county board has taken concrete action to move the county towards in-house medical care for inmates. Along with approving the Wellpath contract, the committee approved $300,000 to plan the transition to county-operated care, thanks to an amendment from County Board Chairman Theo Lipscomb. The board also approved allocating more than $373,000 for a contract monitor — a third party that will oversee the contract with Wellpath, looking for efficiencies and ensuring they fulfill the requirements of the deal.

Lipscomb would have preferred the county make that transition now, saying at a Judiciary, Safety and General Services Committee meeting in January that the administration of Milwaukee County Executive Chris Abele has know since 2013 when it first contracted with a private company that it was the stated policy of the board to bring medical services back in-house. “So our action last month did not come out of the blue,” Lipscomb said.

In December, when the county board moved to bring the services in house, the administration said experts from the National Commission on Correctional Health Care (NCCHC) did not think the county could make the transition before Armor’s contract was up in April. After conducting an analysis in the intervening month, Dr. Brent Gibson of NCCHC said it would likely take three to six months just to gather the information necessary to plan the transition back to in-house.

“Provision of healthcare is very complicated,” he said. For example, Gibson noted, when the county made the switch in 2013 there was a period of time when there were two different systems for medical records, and staff were transcribing them from one to the other.

To maintain effective medical care, Gibson said a “conservative” timeline for the county to bring operations in-house was two to three years. Knowing this, the committee had before it on Friday three options to contract with Wellpath: a one year, two year or five year contract. And it chose the two-year contract. The full board still has to vote on the contract.

In analyzing insourcing costs, the county found that in the first year it will be roughly $2 million more than the private option. Lipscomb, however,  questioned the validity of some cost estimates, noting that just during this last budget cycle, the county under budgeted for the House of Corrections by more than $4 million.

How Did the County Get Here?

When the county switched to a private contractor, it didn’t happen overnight. Private medical care started in the corrections facilities in 2013, but this was the legacy of a lawsuit that began in 1996, when an inmate named Milton Christensen sued Milwaukee County over the inhumane conditions he and others were experiencing in the county jail, according to Milwaukee County Corporation Counsel Margaret Daun. What followed was a type of settlement called a consent decree, under which the court maintains jurisdiction over the matter to ensure the county continues to comply with the terms of the settlement.

This was bad luck for the county, since one year after the litigation was filed in the Christensen case, Congress passed the Prison Litigation Reform Act, which disfavored settlements by consent decree, Daun said.

“A court micromanagement of correctional facilities was a suboptimal circumstance that could in fact lead to a consent decree continuing, ad infinitum, with no end in sight. Sound a bit familiar?” Daun said.

By 2012, county corrections had been under the consent decree for more than a decade, but still was handling medical care in-house. That same year, then Sheriff David Clarke requested that the court issue an order declaring that he had the “unilateral constitutional authority” to make the medical service be provided through a contract with Armor. “It was that specific in his request,” Daun said.

The court shot down Clarke’s request, but then, after the only physician left in the jails that could legally prescribe medication had resigned, the court ordered the county to contract with Armor in order to meet acceptable levels of healthcare.

Of the many moving pieces that are required to bring the medical services back under county control, the Christensen Decree has become pivotal. Daun said that as long as the consent decree exists, the county requires the court’s permission to move medical services in house.

Daun believes her office must work to bring the consent decree to a close. And she is currently requesting that the court allow the requirements in the consent decree to be achieved through accreditation by the NCCHC.

This would involve a number of experts examining the operations and comparing them to established NCCHC guidelines. As opposed to the county continuing to attempt to meet the recommendations of the court appointed monitor, Dr. Ronald Shansky. Without this change, Daun noted, the court can continue under the Christensen decree to prescribe compliance so exacting it leaves Milwaukee County in a constant state of partial compliance. 

Yes, it’s a complicated issue, and one the full board must consider at its next meeting.

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