Boone County Sheriff Dwayne Carey, who made the decision to switch to Advanced, said he was aware of the lawsuits when he vetted the company before choosing them. Carey did research online, met with company representatives and spoke to other county sheriffs in Missouri, whom he said recommended the company.

“Not a concern in the least bit,” Carey said of the company’s quality of care. “As I told one of the commissioners, you’re not getting both sides of the story.”

Carey said the Health Insurance Portability and Accountability Act of 1996, passed in part to protect the privacy of patients’ health information, prohibits him from discussing specific medical cases, such as those Advanced has been sued over.

The three-member Boone County Commission approved the contract with Advanced on May 17.

Carey, who is running unopposed for a fourth four-year term this fall, said the significance of the lawsuits is unknown because some could be without merit or Advanced might be named even if the company is not the party that is at fault. Health care was provided to inmates at the jail 16 hours a day before Advanced came on. The new $592,000 annual contract allows inmates to access care 24 hours a day from a doctor or nurse.

The Boone County Jail has a capacity of 210 and an average daily population of 187. The contract is expected to save the sheriff’s department $100,000.

Doctors rotate on-call coverage at the jail, and nurses are on-site all day. One doctor who works at the jail, Catherine Van Voorn, is a defendant in two state lawsuits in which she is accused of not prescribing the proper medication or not providing proper care. She also was disciplined in 2009 by the Missouri Board of Registration for the Healing Arts for improperly storing and labeling prescription medication. She’s also named in a federal lawsuit. Van Voorn could not be reached for comment.

Jessica Young, general counsel for Advanced, said privacy and confidentiality laws prohibit the company from commenting on allegations against particular employees, including Van Voorn.

“I will ensure that we have great personnel,” Carey said, adding that he is comfortable with the contract with Advanced. “No one can come to work in our jail without my approval.”

Private health care operations began in prisons in the early 1980s, and county jails and local lockups went that way soon afterward, said Alex Freidmann, managing editor for Prison Legal News, a monthly newsletter that focuses on issues related to incarceration. Experts and activists have had concerns for decades about the care that private, for-profit companies provide in jails and prisons, Freidmann said, because there can be incentive to reduce costs — by not prescribing expensive medications or providing costly care — to reap a profit.

Advanced, based in Peoria, Ill., operates in 278 jails in 17 states, all county or local jails. It is far from the largest private correctional health care company, Corizon Correctional Healthcare. Corizon operates in more than 500 prisons and jails and is responsible for about 345,000 inmates in 27 states and has been sued thousands of times.

States in which Advanced has suits pending in federal court include Missouri, Illinois and Kansas. One suit, in which Van Voorn also is a defendant, alleges that a woman who was eight months pregnant lost her child because she was not given proper care in the Cole County Jail in October when she complained of abdominal pain.

Though Carey is confident in Advanced, Friedmann, who has reported on issues relating to prisons, jails and the criminal justice system for 26 years, said private companies that operate in jails tend to care more about their shareholders than the inmates. Friedmann said he has heard of Advanced, calling it a small, regional company compared with behemoths such as Corizon, but he hasn’t reported on it.

“I cannot give you a single example of a successful” private correctional health care company, “meaning that prisoners receive constitutional, adequate medical care through a company that is designed to generate profit through its contract,” Friedmann said.

Young declined to discuss particulars of lawsuits with the Tribune and agreed to answer questions only via email, but she said the company denies all allegations in pending suits.

“We take criticisms of the care provided by our staff seriously, but the number of lawsuits filed is not concerning,” Young wrote in the email. “People who work in corrections understand that incarcerated patients file a disproportionately high number of lawsuits.”

According to a survey conducted by the National Institute of Corrections, Young said, Advanced can expect to face seven lawsuits per 1,000 patients it serves.

“Over the past decade, ACH has only been sued an average of one time per 1,000 patients served,” Young wrote. “This data speaks for itself.”

Health care in jails varies compared with prisons because of several factors. The variety of people, the frequent changes of inmates and the myriad health complications that can come into a jail daily add up to a significant challenge to continually monitor.

“Due to the turnover,” Friedmann said, “medical care in jail is arguably more important and more complicated than medical care in prisons.”