Fresno County to seek contract with jail health services firm

The Fresno BeeMarch 21, 2014 

Paxil and Prozac on the top shelf and other medications in blister packs seen in a storage cabinet at the Fresno County Jail's dispensary in downtown Fresno.


Fresno County officials want to contract with a Tennessee company to take over jail and juvenile corrections medical services under a five-year contract that could reach nearly $99 million.

On Tuesday, Fresno County supervisors will discuss a contract for Corizon Health, the nation's largest jail medical services company. It's similar to a plan approved by Tulare County last year, when supervisors voted to hire Corizon.

The contract, which would include mental health services, would be for three years with a two-year extension if Corizon meets the county's expectations. The two additional years would raise the contract total to $98.8 million. If approved, Corizon would begin providing Fresno County Jail's medical services on June 23.

The county's medical treatment is the subject of a lawsuit filed by the Berkeley-based Prison Law Office on behalf of several jail inmates. The case is in settlement negotiations.

Treatment of mentally ill inmates was the focus of The Bee's watchdog report "Locked In Terror" last August, which chronicled that inmates were not given psychiatric drugs, were deemed incompetent to stand trial and then shipped off to state hospitals, often more than once. In November, the California Medical Board filed an accusation against the jail's former lead psychiatrist.

County staff say the contract will not raise costs. But county unions oppose the switch and intend to tell supervisors that the change will hurt county workers. The move to Corizon would eliminate 114 county jobs -- 104 from public health and 10 from behavioral health. Only 65 public health and nine behavioral health jobs are now filled.

If the plan is similar to one in Tulare County, most county employees will be hired by Corizon.

Supervisor Henry R. Perea said that some employees also will get jobs in other county departments, but "the vast majority will be hired by Corizon."

He said there may be a way to contract out jail medical services while keeping psychiatric care and juvenile justice services with the county.

"There is no question we had to do something different, we were having major issues at the jail," he said.

Even though jail medical services became more stable in the past year under new leadership, all inmate services should be integrated under one umbrella, said David Pomaville, the county's public health director.

Before the county sent out its request for bids to private contractors, a plan was proposed by county staff that would have cost $5 million more than Corizon's bid, according to county staff reports.

The bid also was lower than one from Monterey-based California Forensic Medical Group. CFMG runs jail medical services in Madera County and was Fresno County's top choice but was $2.9 million higher annually than Corizon.

Pomaville said he expects nearly everyone now working for the county will be hired by Corizon, and that salary and benefits will be competitive.

Medical employees are in demand, he said, and workers at the jail should have an advantage in applying for jobs with Corizon because they know the facility, have experience and are already cleared to work there.

Tulare County officials said 80 employees were affected by the change last year from county-run medical services to Corizon. Thirty-seven accepted jobs with Corizon and 41 went to work for the county's Health and Human Services Agency.

During a hearing in September to discuss the proposed change, members of the California Nurses Association employed in Fresno County's corrections facilities said the county will lose control over its operations by contracting services.

Saving money is a good goal, but the county is moving its money to a private company that will profit by doing the work for less, critics say.

"It's a scheme that is typically not good for the public and taxpayers and enriches a private corporation without proper oversight," said Don Nielsen, legal counsel for the California Nurses Association in Fresno.

The money the company makes will come from paying employees less and giving them fewer benefits, Nielsen said.

"They will hire a substantial number of the same people," Nielsen said. "But the only way to do it for less is to make employees work for less, because there is nowhere else to make a substantial cut; they will squeeze profit out of the employees."

Service Employee International Union leaders said they will be at Tuesday's hearing to oppose the county's plan. They did not comment further.

The owner of an Idaho medical services firm who also writes a blog about jail medical issues said most employees should not expect the same level of benefits as they got in the public sector. He said most make the transition from public to private entity seamlessly.

Dr. Jeffrey Keller, whose company operates in 14 small county jails in Idaho, said competitive wages and benefits are important. But corporate benefits, he said, will not likely match those offered by a county.

Keller said it's common for an outside company to hire former county employees because they know a jail and are trained. But a small percentage of employees occasionally show their disdain for the corporate structure.

"I haven't run into a municipal employee who said he is looking at better benefits," Keller said. "I've never met one who says, 'This is going to be a great deal.' "

But, he said his company pays higher than average rates to attract top staff and avoid recruiting and training expenses.

"I don't want turnover," he said. "It takes two years to really train a new employee how to do corrections medicine. I want them to feel that if they walk away they will take a big cut in pay."

Other critics question whether a private company will provide the same level of care for inmates and would have the same stake in caring for them as local government.

Santa Barbara County's jail has used a contractor for about 20 years because the health department wanted out of the jail medical services business, said Ken Shemwell, an undersheriff who oversaw the 1,000-bed jail before retiring.

Santa Barbara's contract ensured a higher level of jail staffing for medical services, said Shemwell, who serves as a consultant on California legislation and local politics for Corizon. Corizon merged with the jail medical services company that operated in Santa Barbara County.

"They do not provide service at the expense of the inmate," he said. "They provide quality service and they run a tight ship."

He said Corizon will treat every illness or injury it can in the jail and shorten hospital stays as much as possible.

"They don't scrimp on care," he said. "There is too much liability for the company and the county."

But a critic said Corizon was brought in last year to improve care in Arizona's prison system, but services there remain substandard. Don Specter is director of The Prison Law Office, which has filed lawsuits against Fresno County and Arizona's prison system.

Often, he said, a contractor is only as good as the amount of money the government is willing to provide.

"They get a certain amount every year and they agree to provide a certain number of staff," Specter said. "Most private companies will do what you pay them to do."

In the Prison Law Office's investigations, Fresno County and Arizona don't provide "the minimally adequate level of care that the constitution requires."

It's imperative, he said, that a government agency have defined performance requirements for a contractor and that the contractor is monitored and held accountable.

But he is encouraged by progress being made in Fresno County during the past year. "They have changed some personnel and that has helped, but we haven't really redone an investigation."

If you go

The Fresno County Board of Supervisors meets at 9 a.m. Tuesday in the Fresno County Hall of Records, Tulare and M streets

Proposed Corizon contract with Fresno County Correctional Medical Services Hospitalization / Specialty Care

2014-15: $15,674,580 / $3,110,026

2015-16: $15,886,334 / $3,152,040

2016-17: $16,410,584 / $3,256,058

2017-18: $16,952,133 / $3,363,507

2018-19: $17,511,553 / $3,474,503

Five year total: $82,435,184 / $16,356,134

Total: $98,791,318

The reporter can be reached at (559) 441-6166, or @beebenjamin on Twitter.

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