The El Paso County Sheriff's Office is re-evaluating a nearly two-decade relationship with its controversial jail health care provider, potentially dealing a costly blow to a private, nationwide contractor under scrutiny for claims of substandard care.

The possible loss of a contract worth more than $63 million over the past 15 years comes as Correct Care Solutions of Nashville, Tenn., faces six wrongful death lawsuits in Colorado and numerous others in at least nine states.

County administrators say they invited proposals from competitors in December and could select a new jail health care contractor by Monday or Tuesday.

The issue involves a company that has attracted claims of putting profits over patients - "a massive corporate machine" with "a trail of dead in its wake," in the words of Denver attorney Darold Killmer, who is involved in several pending lawsuits.

El Paso County Sheriff's Office spokeswoman Jacqueline Kirby wouldn't comment when asked if Sheriff Bill Elder's decision to seek competing bids has anything to do with the company's involvement in at least eight lawsuits filed over inmate deaths in Colorado in the past decade.

"This was not the result of any incident but occurred as part of our efforts to continually evaluate the services providers available and competitively bid our contracted services as each contract comes up for renewal," she said in an email.

Across Colorado, Correct Care Solutions and companies under its corporate umbrella are blamed for a string of preventable deaths. They include an inmate who shed 30 pounds and became delusional before dying of prescription drug withdrawal; a man who died in a pool of his vomit and blood from treatable conditions; and an inmate with the mind of a 6-year-old who died of seizures after jailers confiscated a medical device that could have prevented them.

In addition to the accusations it faces related to inmate deaths, the company has been named as a defendant in an additional 37 pending lawsuits in the state. Many are legal complaints filed by inmates without attorneys, a review of court records shows.

Lawyers involved in several of the wrongful death cases have cited a culture of "deliberate indifference" among Correct Care Solutions staff and a business model that makes money off patients who have no other options for medical attention.

"The problem is, it's hard to overcome the corporate culture of maximizing profits," Killmer said. "It will always be true that it will be cheaper to not provide medical care than to provide medical care."

Correct Care Solutions denies accusations that it understaffs its facilities and provides subpar care as a cost-cutting measure. Jim Cheney, a spokesman for the company, dismissed the claims as "advocacy and argumentation by trial attorneys who are promoting their clients' and their own personal financial interests by distorting the facts and our record of service."

Nationwide, Correct Care Solutions and the company it purchased in 2014, Correctional Healthcare Companies, are involved in more than 60 active, pending or open lawsuits filed in at least 15 states, according to a review of federal court filings.

"The suggestion that our business model is to cut costs and deny care in order to reduce expenses is false," Cheney said in a statement. "A company with such a business model would not last long in the correctional health care field; it would be unable to retain clients and to cover the resultant professional liability expenses."

Cheney added that the company contracts with 14 detention facilities in Colorado, serving about 4,000 inmates "under what can often be very challenging circumstances." Nationwide, the company serves more than 302,000 inmates at upwards of 400 local, state and federal detention facilities, according to its website.

The company's identity has shifted three times, as it changed in name or ownership, in the years it has served as the jail's health care provider. Killmer said the same executives are always at the helm, and the changes in title are an attempt to "limit their liability and camouflage the persistent pattern of neglect and indifference that emerges when the organization is evaluated as a whole."

Media reports suggest the company is under increasing scrutiny.

In Virginia, federal investigators are looking into the company's ties to the ex-sheriff of Norfolk County, which contracts with Correct Care Solutions for jail health care, according to The Virginian-Pilot.

In Nassau County, N.Y., contract negotiations with Correct Care Solutions were terminated in February amid media accounts of widespread lawsuits.

Who's watching?

In Colorado, no state agencies monitor jail health care systems to ensure that adequate services are provided, El Paso County officials confirm, but two private organizations regularly monitor El Paso County's facility: the American Correctional Association and the National Commission on Correctional Healthcare. The jail is audited by both organizations every three years based on a set of standards. If violations are found, El Paso County must correct the issues to the organizations' satisfaction to maintain accreditation. Losing the American Correctional Association accreditation could cost the Sheriff's Office its contract with the state Department of Corrections, which houses some of its prisoners at the jail.

The latest ACA audit, conducted in November 2015, found no health care violations. But in the year leading up to the review, inmates filed more than 400 grievances complaining about health care access or quality, according to the audit, which was provided to The Gazette by the Sheriff's Office. During that time, a dozen errors were logged in how medications were administered, as well as one "lapsed licensure and/or certification."

The most recent audit by the National Commission on Correctional Healthcare, conducted in October 2014, found four violations, including one involving an inmate death. National Commission on Correctional Healthcare standards require jails to issue reports on medical care provided and the circumstances leading up to the death occur within 30 days. In the case of an inmate who died of natural causes in February 2014, the assessment was not conducted until six months later.

The Sheriff's Office submitted revised policies to the National Commission on Correctional Healthcare, which renewed the jail's accreditation.

A legacy of litigation

The history between El Paso County and Correctional Healthcare Companies began in 1998, when the county contracted with Correctional Medical Services. Correctional Healthcare Management bought CMS in 2002, and later changed its name to Correctional Healthcare Companies in 2006. It wasn't until 2014 that Correct Care Solutions purchased Correctional Healthcare Companies.

The contractor has long been a source of legal strife for El Paso County.

In 2001, the American Civil Liberties Union sued the jail and Correctional Medical Services for the death of Andrew Spillane, a pretrial detainee who died of seizures related to alcohol withdrawal the previous year after being pepper-sprayed by deputies. About six months after the lawsuit was filed, the ACLU called for the county to launch an investigation to determine whether "systematic and ongoing deficiencies in the delivery of medical and mental healthcare" were responsible for a string of inmate deaths, many of them suicides.

The county settled the Spillane lawsuit for $40,000 in 2002. The company paid an additional $60,000 in the settlement, said ACLU legal director Mark Silverstein. 

Assessments by the U.S. Department of Justice, the National Commission on Correctional Healthcare and a citizen review panel also cited deficiencies in the jail's mental health care system in the three years that followed, according to the ACLU.

In 2011, the county agreed to pay $85,000 to the widow and daughters of Bruce Howard, a Fountain man who died of heart problems in a courthouse holding cell after he was reportedly deprived of medications for several days at the jail. Correctional Medical Services and Correctional Healthcare Management were also named as defendants in the case.

A sheriff's spokesman told The Gazette in 2014 that the jail's health care contractor struggled with basic responsibilities in the years following a 2011 National Commission on Correctional Healthcare audit, which cited nearly a dozen violations. They related to health assessments, continuity of care, chronic disease services and mental health evaluations. The Sheriff's Office later considered cutting short the contract, then-spokesman Sgt. Greg White said.

Another lawsuit came in 2015, when Christopher Spencer sued the jail and its health care provider over the loss of his toes, which had to be amputated after he developed gangrene during a jail stay two years earlier. He was denied medical attention after he was shot in the chest when he and three others were trying to steal marijuana, the suit says.

In the past 13 months, the county has shelled out more than $71,000 in legal fees to fight a claim by Philippa McCully, who sued the jail last year for excessive force and failure to provide medical treatment after jailers pulled her legs out from under her, tearing her ACL and fracturing her knee, during her five-day stay at the institution in 2014. Shortly after the takedown, a nurse hastily cleared her of injuries; she was not offered medical attention for roughly 80 hours. When a jail staffer offered to escort her to see a medical professional, she declined, believing she would soon be released and would see a doctor immediately after.

Correct Care Solutions is also named as a defendant in the suit.

Inviting competition

Seven companies, including Correct Care Solutions, responded to a request for proposals the county issued in December. An evaluation team of sheriff's officials and a county attorney are assessing the proposals for costs as well as the quality of services provided, according to the county's Contracts and Procurement division.

The county's procurement policy, approved by the Board of County Commissioners in 1976 when the department was created, follows a Colorado law that limits the life of contracts to five years. However, a spokesman for the State Controller's Office was not aware of authority that would allow the state to enforce a violation of state law.

The company's contract was renewed after the county issued requests for contractor proposals in 2002, 2007 and 2013. After county's detox facility was established in 2009, the county expanded its contract to include detox services.

Last year was the last full year of the jail's most recent contract with Correct Care Solutions, which ends June 30.

In a 2015 report, a consulting firm hired by the Sheriff's Office found the jail's health care contract "well-considered and complete, when compared to the contractual medical services provided in the detentions facilities of organizations of similar size and complexity of EPSO."

The assessment, prepared by KRW Associates, suggested that the Sheriff's Office should at least consider inviting proposals from competitors - if only to cut costs.

The Elder administration, the report said, "should ensure that all possible discounts and economies are considered in future contract discussions without diluting the level of medical services provided or increasing the liabilities to the community served."

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