HILLSBORO, Ore. (The Tribune) — Washington County is ratcheting down costs and imposing stricter rules on health care contracting at its jail, after a recent audit revealed staffing shortages from its medical contractor and a lack of oversight from the county.
A new Request for Proposal for jail health care services was issued Nov. 25 by the Washington County Administrator’s Office (CAO). Bids are due Jan. 16 for inmate care beginning July 1.
The current provider, Corizon Health Services, lost its contract two years early.
On Nov. 24, County Auditor John Hutzler released a final audit of jail health care services showing Corizon had not provided adequate staffing for inmate care.
“We estimate the value of the minimum specified staffing that the county didn’t receive between July 1, 2008, and June 30, 2012, to be at least $350,000,” according to Hutzler’s audit.
“After we raised concerns about Corizon staffing in an interim report last year, the county extended Corizon’s contract for only two years rather than the four, which the contract would have allowed,” Hutzler said. “That extension will expire June 30, 2015.”
Corizon is eligible to bid again, under significantly changed terms. The new contract should leave little doubt about expectations, checks and balances, and the ramifications of falling short.
Whoever wins the contract will be subject to new accuracy checks from a third-party auditor who will check hospital billings.
More than a dozen changes have been made to the document, including tightened performance and service requirements, new budget controls and clearly spelled-out minimum staffing requirements by position, day and shift.
Rapidly rising costs
The audit makes clear that Washington County also was at fault for the contract confusion at the jail. Among its findings:
- The jail’s health care contract was not administered in accordance with the county’s guidelines and best practices.
- Certain terms of the contract did not adequately protect county interests.
- The county didn’t forecast and include sufficient funds in the jail’s budget to cover its costs from 2007 to 2010.
The county has been outsourcing the jail’s health care services since it opened in 1998.
The jail can accommodate 572 inmates and is one of the largest jails in the state, with the capacity to book, lodge and release more than 18,000 new arrivals each year. It’s not a prison, so inmates typically spend less than a year in the facility.
Prior to 1998, Washington County’s inmate medical care was handled at the old County Jail on Lincoln Street, by the county’s Department of Health and Human Services.
The CAO suggested an audit be scheduled for 2012 after noting “significant increases in jail health care costs and significant overruns of the jail health care budgets from 2007 through 2010.”
Washington County Jail’s health care services increased substantially from $1.2 million in 1999 to nearly $4 million in 2013, with disproportionate leaps of approximately $500,000 to $1 million each time the contract was rebid.
The county had opened health care bids three times since 1998, awarding the contract to the same vendor each time, Prison Health Services, which merged with Corizon Health Services in 2011.
Checks and balances
The jail’s health care contract was administered by Health and Human Services until an interim audit released last year blamed HHS for failure to monitor Corizon’s performance. The responsibility has since been reassigned to the county’s Department of Support Services, Finance Division.
Other suggestions from the earlier audit already have been implemented, including adding dedicated staff resources from the county and forming an Operations Team to ensure quality, timely, efficient delivery of inmate health services.
In the written response to Hutzler’s audit, County Administrator Robert Davis, Assistant Administrator Don Bohn and Sheriff Pat Garrett said:
“The county and sheriff’s office are keenly aware of the constitutional, statutory and moral obligation to provide quality and timely health service to all persons in our custody … as well as the additional goal of providing these services in an efficient and cost-effective manner.”
The CAO and sheriff’s office agreed with all Hutzler’s suggestions except one, which said the jail may not assess fees to inmates for its mandatory intake health screening.
Sheriff Garrett disagreed, saying that the current $10 fee “is supported by state and federal law, complies with the national Commission on Corrections Health Care standards, and helps control jails costs,” recouping about $70,000 per year.