“If they want to send the letter and draw the line that says that they’re not going to renew the contract, that’s their story,” Elder said in a recent interview. “Suffice it to say, (the contract) would not have been renewed either way.”

Correctional health care experts say the company’s threat to walk away is a textbook example of what can go wrong when ongoing issues turn into serious allegations.

“This is just Armor trying to avoid the embarrassment of getting fired again — it is like the boyfriend who says, ‘You can’t break up with me because I am breaking up with you first,’ ” said Greg Lauer, a Florida attorney who is litigating one of the many lawsuits that the company is facing alleging inadequate health care at jails nationwide.

Doubt over the relationship comes just months after the family of a woman who died following a medical episode at the jail in October threatened to sue the Sheriff’s Office and Armor for $5 million, saying staff ignored her pleas for help amid the crisis.

The El Paso County Coroner’s Office has attributed the death of 55-year-old Susan Cespedes to complications related to obesity and diabetes, but the Cespedes family contends that her death could have been prevented if her complaints and other red flags in her vital signs hadn’t been overlooked.

The county, too, has charged that missteps by Armor have endangered the jail’s inmates. In an April notice to the contractor, the county said those missteps had left an inmate without vital medications and led to a spate of hepatitis A that infected several people at the jail with the highly contagious disease this spring.

But the company, which claims to have spent hundreds of thousands of dollars to fix problems with the jail’s medical system, has also floated a possible reconciliation.

“Armor has welcomed productive dialogue with the El Paso Sheriff’s Office and is awaiting feedback regarding its intent to work toward a continued relationship,” company spokeswoman Teresa Estefan said in a statement.

Such squabbles are typical among the few corporations that dominate the correctional health care industry and the local jails that they serve, said David Fathi of the American Civil Liberties Union.

“When things aren’t going well, this kind of bickering and finger-pointing between the agency and the contractor is pretty common — particularly when there’s been a catastrophic event, like the death of Ms. Cespedes,” said Fathi, director of the ACLU’s National Prison Project, which wages legal battles to improve conditions in jails and prisons across the country.

Armor has argued that the problems it has faced during its tenure at the El Paso County jail stem from the poor performance of the county’s previous medical contractor.

Correct Care Solutions, which served the facility until summer 2017, has since merged with another company to form Wellpath.

When Armor took over the contract in 2017, it unexpectedly inherited a system that was out of compliance with national standards and a “serious backlog of critical task” — including more than 1,500 medical requests — that was unlike anything the company “had ever seen,” Armor CEO Otto Campo said in the May 9 letter to the sheriff.

Curing those deficiencies took “herculean efforts,” including bids to recruit nurses and other practitioners and additional training for the jail’s medical staff, Campo said in the letter. Those measures, largely taken at the company’s expense, helped the jail narrowly avert a loss of a national health care accreditation, he wrote.

Armor offered the Sheriff’s Office a rebate if Elder pledged not to terminate the contract, according to Campo’s letter. But Elder didn’t accept, instead responding in a way that Campo said was “both surprising and disappointing in light of where we started and given all we have done and accomplished.”

Sheriffs have cut ties with Armor and other correctional health care contractors amid accusations that the companies put profit ahead of patients. Armor was previously banned from New York by the state’s attorney general after a string of inmates died under its care there.

In other cases, for-profit providers have stepped back after concluding that the efforts to improve health care at a facility simply aren’t worth the expense, prison privatization expert Alex Friedmann said.

“They really have no interest in providing adequate medical care, necessary medical care,” said Friedmann, associate director of the Florida- based Human Rights Defense Center. “Their interest is in making money. If they can’t make money, or make enough money, then they will go somewhere else.”

The upcoming split with Armor leaves Elder with six months to find another way to provide health care to the jail’s average daily population of more than 1,600 inmates. He’s considering alternatives to another corporate contractor, he said.

“We are meeting with local groups to talk about how we might be able to develop community partnerships that provide a much better continuity of care both inside and outside of the facility,” Elder said.

The switch to Armor in 2017 led to a nearly 40% increase in the cost of providing medical services for inmates. Sheriff’s officials said the company would administer better care.

But an audit discovered a backlog of sick calls and other lapses by Armor just months into the new contract. The county continues to face threats of lawsuits over subpar health care.

“I’ve not been satisfied that our contractor relationships have been in the best interest of our inmates — the incarcerated citizenry — and that it’s in the best interest of the county when it comes to what we spend doing it,” Elder said. “I think we can do better.”

The county is paying Michigan-based consultant Health Management Associates $85,000 to assess weaknesses in the jail’s health care system and what can be done about them. The firm has provided the sheriff’s legal counsel with a confidential “draft report,” sheriff’s spokeswoman Jackie Kirby said in an email.

A few local governments across the country are using different models to provide medical care to inmates, including partnerships with public hospitals and developing their own in-house inmate medical services.

“We’re looking at hospitals, we’re looking at health care providers, we’re looking at anything we can,” Elder said.