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Audit Criticizes Milwaukee County Jail’s Contracted Medical Services

by Derek Gilna

In August 2018, a comprehensive audit report revealed that the private healthcare provider at Wisconsin’s Milwaukee County Jail and House of Correction (HOC) was not in compliance with the terms of a court-ordered consent decree requiring specific staffing levels for medical personnel. The time period under review coincided with the term of controversial sheriff David A. Clarke, Jr., who resigned in August 2017.

The audit, conducted by the Milwaukee County Office of the Comptroller, found the county jail system’s healthcare contractor, Miami-based Armor Correctional Health Services, never reached the staffing threshold needed to adequately treat and care for the 2,100 prisoners held at the jail and HOC.

The county is under a consent decree requiring it to maintain healthcare staffing levels at 95 percent. Instead, Armor’s overall staffing level averaged 89 percent for the 22-month review period, from November 2015 to August 2017. Understaffed positions included a psychologist, registered nurse and psychiatrist, the audit found. The company was fined for the shortfalls, but the report recommended increasing the fines.

Following the release of the audit, which was conducted at the request of Milwaukee County board chairman Theodore Lipscomb, Sr., he expressed his disappointment with Armor.

“The audit confirms what many already suspected, [that] some of the most serious staffing issues that originally led the court to order this contract still persist,” he said.
Lipscomb added that the election of a new sheriff “provides a fresh perspective and the opportunity to rethink oversight of medical services, and the audit also identifies various improvements that should be made.”

The chairman has been a vocal critic of privatizing healthcare in the county’s jail system, which occurred while Sheriff Clarke was in office – especially after four prisoners died within a six-month period in 2016. [See: PLN, Sept. 2017, p.52]. Lipscomb said the county now has “a full menu of options, including bringing [healthcare services] back in-house.”

“The whole premise of contracted medical services was that it was supposed to rectify what had been struggles with employing and keeping some of those top medical positions,” he added. “Well, that hasn’t happened.”

After Clarke’s resignation, Governor Scott Walker appointed Richard Schmidt to succeed him as sheriff. In November 2018, both Walker and Schmidt lost their re-election bids. Earnell Lucas will assume the office of Milwaukee County Sheriff in January 2019.

At first, Sheriff Schmidt had recommended placing both the county jail and HOC under a single leader, but after losing the August 2018 primary he changed his tune.
“To put this under a new sheriff who does not have correctional background, it would be a very, very difficult thing for that person to do,” Schmidt said.

Armor’s contract, which it has held since 2013, is worth about $16 million a year – nearly 20 percent of the budget to operate the jail and HOC. The 2001 consent decree under which Milwaukee County operates resulted from a lawsuit that alleged substandard medical treatment of prisoners in the county’s jail system.

The August 2018 audit made 18 recommendations to improve Armor’s services and compliance under its contract, including increased fines.

A major recommendation was the call for a contract manager with “clinical expertise” to improve the review of invoices. The Sheriff’s Office was not performing spot checks of Armor’s invoices versus the company’s timesheets, making it impossible to verify that the county was getting what it paid for without a full audit review – a lengthy and expensive process.

“HOC management should perform spot checks on Armor invoices and periodically review check signers and signatures,” the report stated.

The audit also suggested that overall medical staffing requirements be broken down to specify requirements by job location and function. Armor’s existing contract failed to include that level of specificity, thus examining the sufficiency of staffing levels was not fully possible.

In addition, the audit recommended improvements to contract language related to the formulary (list of available medications), the grievance process, accreditation, peer review, booking area staffing and processing times, and quality assurance, among other issues.

Armor said it had maintained staffing levels at the two Milwaukee County jail facilities at more than 100 percent in both May and June 2018. Yet during the audit review period, it increased the percentage of staff it was forced to bring in from a third-party source – from 2.7 percent to 17.7 percent of total hours worked.

The company faces a pending lawsuit alleging it falsified records in the case of Terrill Thomas, a prisoner who died due to dehydration in his cell at the county jail in April 2016. Thomas’ death was ruled a homicide and three guards either resigned or were terminated. All three were charged in early 2018. [See: PLN, March 2018, p.59].
Armor faces numerous other lawsuits nationwide in connection with prisoner deaths and inadequate medical care. 




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