Correctional Health Care Providers: Pitfalls Of The Private Option

In the span of 24 days in May of 2017, two men died in Forsyth County's jail. Both succumbed after being denied medication that they desperately needed by the jail's private contractor. So begins a recent Atlantic Monthly article, “The Private Option,” by Marsha McLeod.

In it she chronicles the impacts on inmates when entire jail health care markets are dominated by a single private contractor, leaving county officials with zero alternatives, and the sole responsibility of holding its providers accountable. 

Forsyth County's correctional health care company is Wellpath. According to her article, it's estimated to be the country's largest, caring for some 300,000 patients in about 550 jails on a daily basis. Four weeks after the two men died, the Forsyth County Board of Commissioners met twice — once with a Wellpath representative — to decide on whether to renew its contract or sign with another company. McLeod describes the meetings as tense. 

“Commissioner Witherspoon, who was the commissioner at the time and is no longer, he was quite direct in his remarks,” says McLeod. “This representative was saying, ‘We are the best company to do this type of work,' and Commissioner Witherspoon said, ‘The amount of lawsuits that you have filed against you doesn't seem to suggest that you're the best company to do this.”

Then Sheriff Bobby Kimbrough was elected, and with multiple inmate deaths in Forsyth County alone and roughly 1,400 Wellpath lawsuits, he entered office determined to change the jail's health-care provider. 

“But [Kimbrough] didn't actually know that they were really the only company that had offered up their services to do this,” says McLeod. “So, he said to himself, ‘Okay, we have to reassess, and we're going to make this work. He started talking with the company's regional representative about some of the issues that they were having: staffing issues, lower-level nurses stepping in when the county had paid for more well-trained nurses, [and] positions going unfilled for quite a number of months.” 

McLeod says that Kimbrough soon became frustrated with the pace of change, contacted the corporate headquarter in Nashville, Tennessee, and “strongly requested” a face-to-face meeting in Winston-Salem with Wellpath's CEO.

She says, “[Kimbrough] greets him with about a dozen or so of his command staff and they sit in a conference room, and he said, ‘You know, we just threw all of our concerns at the company: Okay, you said that you'd have a [Registered Nurse] here, but you actually had a [Licensed Practical Nurse]. We've talked to the staff and they're working double shifts. They're tired. We're having mistakes happen, and some of them are having the wrong medications being passed out.'”

It was a productive meeting with the two men shaking hands afterward, exchanging phone numbers and vowing to fix it. Kimbrough says since then he's seen big improvements with staffing issues and their overall relationship with Wellpath. The county has installed a public health nurse with a doctorate in nursing practice to monitor Wellpath's compliance with its contract. McLeod says jail administrators who do not seek independent monitoring proceed at their own peril.

How engaged is the sheriff's office? How engaged is the local county? Do they know who their contractor is, and do they have a sense of who that person is, and what their contract is like? This is a big thing because as The Pew Charitable Trusts has found only about a third of requests for proposals that they studied actually had any kind of performance requirements for their contractor to follow for these types of jail health care contracts. For the other two thirds, there is no way to really measure other than what the company is saying they would do. So, because of that there's no way to penalize them if they're not. 

She adds that without those checks and balances, the challenge for holding correctional health care provider companies accountable is only going to get worse. As Wellpath continues to increase its market share, the story of Forsyth County is one she anticipates seeing in more and more counties across the country, especially where one contractor is the only show in town.

With this company only becoming larger, it remains to be seen whether more counties have the experience that Forsyth did where they received a single response and are hurting for choice. They're feeling like they're not sure about what the best course of action is and maybe don't feel like they have all the information that they need to make an informed — fully informed — decision about what model will be best for the inmates under their custody. It's hard to say what is going to happen other than that Wellpath is going to continue to grow and I think counties are going to continue to sort of get more wise to how they can protect themselves and really get the services that they are in fact paying for. 

EDITOR'S NOTE: This transcript was lightly edited for clarity.