El Paso County and its jail health care provider were warned at the end of last year that poor performance on an audit has put one of the facility's widely-recognized credentials at risk.
A survey of the jail last fall by the National Commission on Correctional Healthcare found critical violations of the accrediting agency's standards, including suicidal inmates who were not adequately supervised, lapses in documentation showing that practitioners were properly trained and sick calls that were going unanswered for a week or more, according to a letter that the Sheriff's Office provided to The Gazette last week.
Sheriff's officials said the shortcomings were addressed within a month following the auditors' visit and that they expect the NCCHC will renew the jail's accreditation around late April.
But if the jail's new health care provider, Armor Correctional Health Services, fails to pass the audit, Undersheriff Joe Breister said the county might consider canceling the Miami-based provider's contract, which is worth up to $40 million over five years.
The NCCHC's decision in December to put the jail on probation was the latest sign of trouble for Armor and came about six months after the county opted to switch from its longtime provider, Nashville, Tenn.-based Correct Care Solutions, in a move that officials said would cost the county nearly 40 percent more but result in better care for inmates.
Following the NCCHC's survey of the jail last fall, the county informed Armor Nov. 1 that it could be subject to a $100,000 fee for failing to maintain its accreditation - which could affect the county's "reputation, professional standing, and ability to attract and retrain qualified personnel."
Armor has not paid the county any fee, Breister told The Gazette last week.
In a Dec. 15 letter to the county, the NCCHC's vice president of accreditation, Tracey Titus, called probation a "very serious matter" and told the county it had until April 9 to submit a report detailing how it's corrected the deficiencies.
The Gazette requested a draft report of the audit and any correspondence between the Sheriff's Office and the NCCHC in early December and was told by sheriff's spokeswoman Jacqueline Kirby that the report would not be available until the first quarter of 2018.
Earlier this month, Armor sent the accrediting agency a report detailing the changes made to correct the problems cited in the audit, Breister said.
If the NCCHC decides that the adjustments are not enough to rectify the violations, the county and its health care provider may submit another report detailing further corrective action three months later. And, if the NCCHC still declines to renew the jail's accreditation, Armor has one final shot: The contractor may submit a third report three months after that, Breister said.
If Armor never passes the audit, the Sheriff's Office might consider putting the contract out to bid again, depending on the severity of the violations and whether they can be corrected, Breister said.
"I think it's too early to say," Breister said.
Armor has said the violations discovered in the audit were largely due to problems inherited from the previous provider, whose contract ended in July.
"Armor had been servicing the El Paso County Jail for 78 days when the NCCHC audit commenced. When the company began serving the jail, there were many challenges to overcome," Armor spokeswoman Yeleny Suarez said in an email. "The majority of the NCCHC standards were passed at the time of audit, and now all standards have been brought current."
When the survey of the jail was completed, there was a "significant backlog" of inmates waiting to be seen by a medical professional and only one nurse was assigned to sick call for the jail's roughly 1,600 inmates, according to a report attached to the letter. Records reviewed by auditors showed that inmates who requested medical attention or health services often waited a week or more before receiving a response.
At the time of the inspection, Armor was short-staffed because many of the nurses who worked at the facility under Correct Care Solutions left with the past contractor, Breister said. The facility is now at full strength and can handle requests in a timely manner, he said.
Initial health assessments, too, were not being conducted on time. Auditors counted more than 50 overdue assessments that were well past the two-week time frame that NCCHC standards allow for the reviews.
During those health assessments, patients were not being routinely tested for communicable diseases, such as sexually transmitted diseases - which NCCHC requires, unless the local health department deems those tests unnecessary. Breister said the jail's medical staff did not have paperwork from the health department showing that the tests weren't needed, but that documentation is now on file.
When the survey was conducted, many inmates reported as suicidal were not being observed constantly or routinely, according to the letter. Armor responded to the auditors by saying many of those inmates are housed in highly-visible cells.
This violation occurred because the Sheriff's Office was not aware that NCCHC had changed its standards, requiring all "acutely suicidal" inmates to be watched one-on-one by a deputy, Breister said. The jail has since changed its classification system for suicidal inmates and corrected the error, he said.
Auditors also found no evidence that new hires were trained on the facility's nursing protocols or that orientations for new staff members covered essential information, such as security policies and emergency situations, according to the audit.
Breister said that new employees were being trained, but Armor was not keeping proper documentation of that instruction and has since adjusted its protocols to do so.
Health records - including consent and refusal forms, results of specialty consultations and hospital stays - were not being scanned into Armor's electronic records system in a timely manner, making those documents difficult to access for clinicians, auditors found. This made it difficult for clinicians to immediately follow recommendations from other health professionals after an inmate returned from a hospital or other outside provider.
Breister said Armor has caught up in processing those documents.
In response to the county's Nov. 1 letter of concern, Armor Senior Vice President Vickie Freeman ticked off a laundry list of tasks that its predecessor had failed to address before its tenure ended: more than 300 overdue health assessments, 1,500 requests or complaints from inmates related to medical care, 12,000 pages of medical records that needed to be scanned and 12 vacant positions.
Before the switch, the contract had gone for nearly two decades under Correct Care Solutions and other companies under its corporate umbrella, which were paid about $63 million over 15 years. Armor and Correct Care Solutions are two major players in the correctional health care industry, which is ruled by a relatively small number of big companies. Like their corporate counterparts, they both face lawsuits claiming their business models encourage skimping on medical care to maximize profits, leading to inmate deaths in jails across the country. The companies have denied wrongdoing.
County officials have attributed the price hike that came with Armor's contract to rising health care costs, better-defined standards for care and other factors.
The contract requires that the jail maintain its accreditations with the NCCHC and other agencies, including the American Correctional Association, that regularly monitor the performance of its medical contractor.
Facilities must meet all of the NCCHC standards designated as "essential" to receive accreditation, and the jail only met 82 percent in the last audit, according to a report attached to the Dec. 15 letter from the NCCHC.
This is not the first time the jail has been at risk of losing its accreditation.
The jail's last NCCHC audit in October 2014 found several violations, including deficiencies in mental health programs offered at the jail and a required death assessment that was not conducted until more than six months after the inmate died of natural causes. The Sheriff's Office received an initial report back from the organization in early 2015 and, after submitting revised policies to the NCCHC, its accreditation was renewed that April.
Contact Rachel Riley: 636-0108