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NaphCare: More Proof That Privatized Healthcare Deals Death and Misery to the Incarcerated to Enhance Profits

by David M. Reutter

A settlement approved by the federal court for the Eastern District of California on January 16, 2024, recalls an all-­too familiar jail story. A wheelchair-­bound detainee named Gregory Cantu was denied anti-­seizure medication after arriving at Kings County Jail in Hanford on a probation violation. Despite numerous requests from Cantu and his parents, the medication was not provided. Six weeks later, he was found dead from a fatal seizure on April 19, 2019.

The jail’s healthcare was being provided under contract from Alabama-­based NaphCare, though the neglect that Cantu’s survivors alleged he suffered has been attributed to any of numerous other players in the business of providing private, for-­profit healthcare to the incarcerated, and for the same reason: Money.

When a county like King’s County cedes jail healthcare to a private firm like NaphCare, it gives up control over that vital function in order to save money. In turn, NaphCare and other firms who take these jail and prison contracts are incentivized to cut costs—and though all parties involved invariably deny it, the easiest way to cut costs is simply not to provide care.

But the same tough-­on-­crime polices that exploded the U.S. prison population from 197,245 in 1970 to 2,068,800 in October 2021 have left the country with prisoners who are older, sicker and in need of more mental health services than those on the outside. Added to that is an opioid drug epidemic that leaves jails with significant populations dealing with serious preexisting medical or mental health conditions while also undergoing withdrawal.

In Cantu’s case, there was just a disabled detainee, jailed for a nonviolent probation violation, who then never got the anti-­seizure medication he needed to stay alive. Did someone make a decision that it’s cheaper to pay the occasional settlement to a family like his if it sues? The final tab was certainly light, considering that the detainee/patient died: for his minor child, identified as “G.C.,” $25,000 was paid by NaphCare and another $2,500 by King’s County, including costs and fees of $8,407.25 for Cantu family attorney Stacey Cutting with Bish Law in Newhall. See: Cantu v. Kings Cty., 2024 U.S. Dist. LEXIS 7787 (E.D. Cal.).

Whether in local jails or prisons, guards and administrators are ill equipped to make medical decisions. For that reason, until the 1970s, carceral health care was minimal, offering little more than first aid, a 1972 American Medical Association survey found. That changed in 1976 as prisoners successfully alleged that “deliberate indifference” to their medical needs violated their constitutional guarantee of protection from “unnecessary and wanton infliction of pain.” See: Estelle v. Gamble, 429 U.S. 97 (1976).

Saving Money Is Key

The consequence of that ruling was the emergence of the carceral healthcare industry. But for a medical professional, working in a jail or prison most likely was not on the radar. That left government officials with a recruitment problem that resulted in understaffing. They also faced tight budgets with dramatic rises in the complexity and costs of care as severe sentencing laws put more people away for longer terms, and the incarcerated population continues to age. Enter the medical profiteers, who touted a cure to the problem. Essentially, they said: Pay us and we will take full responsibility for all aspects of the administration of detainee and prisoner health care. Plus, they promised to do it cheaper and pass along the savings.

A few companies now dominate carceral health care, including not only NaphCare but also Centurion Health, Wellpath Holdings, PrimeCare Medical and Armor Correctional Health Services, as well as Corizon Health, which has now been split between new prison healthcare contractor YesCare and Tehum Care Services, a firm seeking to discharge much of Corizon Health’s debt accrued from prisoner lawsuit verdicts and settlements, as PLN has reported. [See: PLN, Jan. 2024, p.29.]

NaphCare was founded by James McLane, who in 1989 was a pharmacist at a hospital that provided pharmaceuticals to county jails. The experience spurred McLane to found Correctional Pharmacy Services. In 1993, the company’s name was changed to National Prison Care, and it is now known as NaphCare, with estimated annual revenue of $483 million. In 2020, NaphCare provided health care to over 80,000 prisoners in 53 city and county jails and federal prisons throughout the nation.

A 2010 survey by Reuters found nearly half of U.S. jails had turned to privatization. By 2018, privatization overtook 62% of jails. Reuters found that larger jurisdictions often work with the local health department to provide publicly managed care. Small to midsize jurisdictions are more likely to turn to private contractors. Officials there consider privatization the smart move. “It makes sense to have someone whose specialty is to come in and take care of inmates,” said Commissioner Helen Stone of Georgia’s Chatham County, which includes Savannah. “Saving money” is the key.

Being rid of headaches that detract from police functions they see as their core mission has led many Sheriffs to embrace privatization of medical care. “It is a package deal and everything is done for you,” said Capt. Jessica Pete, about medical contractor MEnD Correctional Contract, which has provided services to Minnesota’s St. Louis County Jail since 2012. “We are getting fantastic care.” That may or may not be true in St. Louis County. The story in many other jurisdictions is one of pain, misery, and even death.

Eaten Alive by Bugs in Atlanta Jail

On August 3, 2023, the County Commission of Georgia’s Fulton County unanimously voted to approve a $4 settlement with the estate of a pre-­trial detainee who died in the mental health wing of the county lockup (FCJ), where NaphCare was the contracted care provider.

That’s also where LaShawn Thompson, 35, was held for observation after his arrest for misdemeanor simple battery on June 12, 2022, for spitting on an officer who found him sleeping in a park. FCJ records showed detention guards and NaphCare medical staff noticed Thompson’s deteriorating health but did nothing to help him before he was found dead in his cell on September 13, 2022, literally “eaten alive” by bed bugs and other vermin, an autopsy revealed.

“He was found on the floor of the jail infested with bedbugs and lice,” explained Michael Harper, the Thompson family attorney. “He was neglected. He lost a lot of weight. He was dehydrated. It was just a horrible, awful death due to negligence.”

A NaphCare incident report indicated that every person in the mental health unit had lice or scabies or both. More than 90% of the detainees had developed cachexia, a wasting syndrome that is typically seen in patients with advanced-­stage cancer. The unit’s detainees, among the most vulnerable of some 3,000 held at FCJ, were not receiving necessary medication or engaging in normal activities such as eating, using the toilet, or showering, the report also noted. Yet none of these conditions were noticed or addressed until after Thompson’s death.

“The fact that people held in the custody of Fulton County were so malnourished and ill that they are experiencing muscle wasting commonly seen in people with late-­stage cancers is horrifying,” said Terrica Ganzy, Executive Director of the Southern Center for Human Rights. She called FCJ a public health nightmare.

Fulton County Commissioner Khadijah Abdur-­Rahman said she believes that NaphCare reached a similar settlement with Thompson’s family, though none was docketed or reported. That’s usual in payouts by private contractors, whom courts often don’t hold to account under freedom of information laws, despite the fact they take public money to provide a public service.

Thompson’s estate was represented by Atlanta attorney Michael Harper. He said the family would not issue a statement on the settlement, which was reached without filing a lawsuit—in itself an indication just how indefensible the jail’s position was. Abdur-­Rahman kept the most important issue at the forefront: “No amount of money can bring back the life of a loved one,” she said. See: Est. of Thompson v. Fulton Cty., Release and Settlement Agreement (2023).

An October 2022 report by the state chapter of the American Civil Liberties Union found FCJ unmanageably overcrowded, burdening the county with “costly lawsuits and complaints alleging prolonged detention, neglect, and inhumane conditions in its jails.”

The federal Department of Justice responded to the death by opening an investigation on July 13, 2023, into the jail and its “access to medical care and mental health care, use of excessive force by staff, and conditions that may give rise to violence between people incarcerated,” as PLN reported; meanwhile Sheriff Pat Labat used the death to “call [for] building a new Fulton County Jail and Criminal Justice Complex.” [See: PLN, May 2023, p.16.]

NaphCare has provided healthcare and mental health services at FCJ since 2017 under an initial contract for $20.7 million that has been renewed five times, rising to $27.1 million as of September 21, 2022. An amendment would add another $4.8 million. While Thompson’s death hung like dense fog over its meeting, county Commissioners nonetheless extended NaphCare’s contract. Both parties spoke of cooperation to improve the quality of care.

“The concerns that have come to light in recent months have not magically gone away or been resolved, but we are making progress,” said Sheriff Labat. “My intent remains to provide the best standard of care for inmates while also ensuring there are no gaps in service.”

“Stingy With Care”

Always lurking in the background of conversations about carceral medical care are fiscal realities. “You’ve got counties being greedy, not wanting to spend money on medical care, and companies saying, ‘We can do this, we can do it cheaper for you,’” said Robert Greifinger, former chief medical officer for the New York state Department of Corrections and Community Supervision. “How do companies achieve these economies? Part of it is being stingy with care.”

One proven profitable policy is to avoid hospital trips. Such a provision is often embedded into a contract with incentives or fines if a set number of trips is exceeded. Before Corizon Health took over medical care at the Chatham County Jail (CCJ) in Georgia, its predecessor spent more than $1.3 million annually on hospital trips. Corizon reduced the number of trips, and its profit at CCJ soared from 14.6% in 2011 to 21.5% in 2012 and 24.2% in 2013. At the time, Corizon Health was a publicly owned corporation, so such information was available. Because NaphCare is a private company, financial details are not so readily found. Nevertheless, its contracts reveal a business model that seeks to replicate Corizon Health’s success in cutting hospital trips.

The NaphCare contract with Boston’s Suffolk County House of Correction capped hospital trips to 80 per month for its 1,499 detainees, with a $100 penalty imposed for every additional trip. The family of Roderick Pendleton, 51, pointed to that policy as a contributor to his death in 2015. An autopsy found he died from an untreated bowel obstruction, a serious condition that frequently requires surgery.

“He was way beyond sick,” a detainee told investigators looking into Pendleton’s death. “I was just thinking—why don’t they just send him to the hospital?”

In the past decade, 127 deaths due to medical causes have been recorded in Massachusetts jails, most of which use private medical vendors. In the wake of Pendleton’s death, NaphCare admitted that it underbid the contract. The Suffolk sheriff told NaphCare to stick to its original bid. In 2018, NaphCare paid the Sheriff $1,300 for exceeding the contractual cap on outside hospital visits. Additionally, the Sheriff fined NaphCare $2.4 million for understaffing.

In nearby Essex County, NaphCare received $1,000 in monthly bonuses if it ordered no more than 15 emergency ambulance trips. Another $1,000 monthly bonus was paid if there were under 30 referrals to off-­site physicians. These types of terms were found in the contracts of all three companies that dominated the Massachusetts carceral medical service industry over the last 10 years.

“It’s hard to imagine a more blatant and inappropriate disincentive to provide care than a financial penalty,” said David Fathi, director of the ACLU’s National Prison Project in Washington D.C.

Incarcerated individuals have no other health care options available to them. Over more than three decades, PLN has published thousands of reports that detail instances when medical staff or guards had knowledge that a prisoner or detainee was in pain, yet the judgment of an underqualified or deliberately indifferent licensed “medical professional” caused guards not to intercede because the prisoner was determined to be malingering. This regularly resulted in serious injury or death.

“The biggest problem, not only with NaphCare, but with these other contractors is they try to do as least as possible under the contract,” said attorney Cal Potter, who represents a Las Vegas woman whose complaints of severe abdominal pain were ignored by NaphCare staff until her condition degraded to require emergency surgery. The woman went into septic shock from an abscess in her digestive track and almost died. “You see a lot of these situations where they use physician assistants instead of a doctor or (licensed practical nurses) instead of a registered nurse,” Potter said.

Staffing Not Easily Addressed by Contract

Staffing is an issue at Nevada’s Washoe County Jail (WCJ). That problem and an increase in deaths came after Sheriff Chuck Allen took office in January 1, 2015, and he sacked the previous medical contractor in favor of NaphCare. Of 13 deaths at WCJ between then and 2017, 10 were detainees who died after NaphCare was awarded a $5.9 million annual contract to provide for their care. The 13 deaths are more than the total deaths at WCJ in the eight years prior to NaphCare coming on board. It had a death rate that is five times higher than the national rate in local jails.

Allen expressed frustration with NaphCare’s staffing tactics. When the old contractor left WCJ, some staff remained, but many left due to a lower salary. “We lost a lot of our institutional knowledgeable in the staff working here,” Allen said. “We had it addressed immediately with NaphCare and they started increasing wages.”

Like most all carceral care contracts, WCJ’s contract specifies minimum hours for doctors, nurses, physician assistants and mental health providers to be present. Neither Allen nor NaphCare General Counsel Brad Cain disputes that NaphCare meets or exceeds the total number of contracted hours. But not everyone agrees due to deficiencies in specific areas.

“I struggle with that [statement]. If you give me more hours with a (registered nurse), a (licensed practical nurse), or an (emergency medical technician), but you don’t give me enough mental health providers, that’s a problem,” said WCJ Captain Heidi Howe. “Right now we have a full time psychiatrist, we do. But we are supposed to have mental health care seven days a week and that’s not happening.”

The lack of properly trained staff impacts the delivery of procedures NaphCare sells as part of their solution. “Any inmate identified as being at risk of withdrawal of a specific class of substances is enrolled in NaphCare’s detoxification program, and the assessment and treatment protocols used by NaphCare personnel are nationally recognized and accepted as the appropriate standard of care for these issues,” Cain said.

Patients facing detox are in a fragile health condition, with a high risk of heart attack. When a detainee is forced to go “cold turkey” without weaning off the drugs slowly, it only worsens the situation. “The problem with cold turkey is the side effects make you more susceptible to morbidity and mortality,” said Dr. John Dimuro, Nevada’s former Chief Medical Officer.

Keely Darmody fit the criteria to be enrolled in the intoxication program, but it is evident that she was left to suffer the painful effects of withdrawal. Darmody, 25, had developed a drug habit as a means to cope with her bipolar disorder, and she was arrested in August 2016 for possessing drug paraphernalia. She was released but soon returned to WCJ for failing a drug test. NaphCare became responsible for treating her evident withdrawal symptoms.

Five days later, Darmody was found unresponsive on her “cell floor with a garbage can full of vomit at her side,” reported the Reno Gazette Journal. “She spent the last three days of her life vomiting until she was so dehydrated she died.” An autopsy found that Darmody had a high level of methamphetamine in her system, suggesting she consumed drugs while in jail. Jail command staff had no explanation for that possibility.

Richie West was arrested for operating a pain pill ring out of his father’s car dealership. While at WCJ, he was enrolled in NaphCare’s detoxification program. But West overdosed on the methadone that NaphCare’s Dr. Mark Hahn had prescribed him. Court records state that West received two doses of Narcan to revive him. NaphCare terminated Hahn after the incident. Dr. Dimuro noted that West was a challenging case because of his addiction to pain pills and the fact he had a gastric bypass, which prevented him from digesting normal doses of pain medication. “On a general scale, it worries me that non-­pain physicians are doing the weaning,” Dr. Dimuro said.

“These companies are inherently motivated to make money. That’s why they’re in the business,” said Andrew Harris, Professor of Criminology and Justice Studies at the University of Massachusetts in Lowell. “There are going to be situations where care is going to be withheld, very often with negative consequences for the patients.”

Reality Belies a Shiny Marketing Image

PLN’s archives are filled with reports of profiteers in the carceral medical care industry who incorporate into their bidding equation the costs of litigation and contractual fines. So while penalties cut into NaphCare’s bottom line, the question is whether those penalties act to compel compliance with contractual obligations. There is no quick, easy answer to that question, for it is difficult to determine if the fines are just considered a cost of doing business.

However, at least one profiteer has publicly acknowledged that litigation is considered just another expenditure. “This is a litigious environment,” said Kip Hallman, President of carceral medical care provider Wellpath Holdings. Government officials “see us as being a solution to that problem.”

There are “extreme challenges” in providing medical care to the incarcerated because of “high rates of chronic complex illnesses, drug and alcohol abuse, and mental illness,” said Cain. “Unfortunately, even with top-­notch health care personnel, appropriate policies and procedures and advancements in technology, and vigilant prevention efforts, not every inmate death is preventable.”

Marketing image and perception are essential to success in business, so NaphCare has a strong public relations staff that does a great job of portraying the company as the solution to the “extreme challenges” that carceral medical care presents.

“NaphCare remains committed to our mission to improve and save lives,” said Communications Director Stephanie Coleman. That statement is consistent with the compassionate care NaphCare promises on its website.

“Our commitment to excellence has no compromise. We deliver unmatched care, raise the bar of customer service and hold our products—and ourselves—to the highest standards because our partners, patients and [employees] deserve nothing less,” the website declares. “Care isn’t just in our name. It’s at our core. We are caring professionals who respect the dignity and rights of all members of society. United by this belief, we work as a team to improve each and every life we touch.”

However, NaphCare sent Eileen Taylor, a physician assistant at Massachusetts’s Essex County Jail in 2016 and 2017, a different message about her incarcerated patients. “Don’t send them out [to see outside physicians] unless you absolutely, positively have to,” she was reportedly informed by superiors. “NaphCare’s driving force was money. It superseded everything else.” That, sadly, often included basic human compassion.

Taylor, who has a worker’s compensation claim against NaphCare and is part of a group suing the company over pay, said costs were often cited by the firm as a reason for denying requests for diagnostic needs such as urgent blood tests. Other orders, she said, would be changed by NaphCare’s off-­sight centralized medical staff.

Kevin Chamberlain, a detainee who arrived at the jail in 2017, was a 66-­year-­old Vietnam War veteran. Jailed 43 days for a probation violation for driving under the influence with a suspended license, he spent nearly the whole time in the infirmary.

“He was screaming about being in pain,” recalled Taylor. “Maybe they’ll con you 90% of the time, but you better watch out for the 10% of the time that they’re not.”

Indeed, Chamberlain had a history of heart trouble and blood clots. “He’d call me at night, and he would cry,” said his wife, Susan. He told her, “I’m not going to make it.” Susan’s visits were denied because guards said, “He’s not medically cleared.”

Taylor recalled Chamberlain as cantankerous, but she said he wasn’t a person given to exaggerating his symptoms. He was left to languish until he was found unresponsive in his cell on March 28, 2017. Efforts to revive him failed. An autopsy said he died of heart disease and untreated blood clots.

A growing number of lawsuits against NaphCare casts doubt whether its stated mission to “blaze the trail” and “go above and beyond” to “treat everyone how we want to be treated” drives the company. Or is it, as Taylor said, that the “driving force [is] money?”

“Massive” $24 Million Punitive Damages in Washington Case

A federal jury sitting in the District Court for the Eastern District of Washington State sent NaphCare its own message about the care provided to Cindy Lou Hill, 55, at Spokane County Jail (SCJ); it awarded her estate nearly $27 million in July 2022, as PLN reported, including $24 million in punitive damages against NaphCare. [See: PLN, Oct. 2023, p.27.]

In August 2018, Hill was found in a fetal position on her cell floor, screaming from intense abdominal pain. Her cellmate dragged her across the room to the door because she couldn’t reach it on her own. NaphCare Nurse Hannah Gubitz determined Hill was suffering heroin withdrawal and had her moved to a medical cell. But her condition was not brought to the attention of a doctor nor was she taken to a hospital. Guards checked on her, but she had no more medical evaluations, refusing the last one offered to her just two-­and-­a-­half hours before she was found dead. An autopsy revealed a ruptured duodenum that became infected and killed her.

According to the federal Bureau of Justice statistics, Hill was the eighth person to die in SCJ within 14 months. But one of the “benefits” to a government of privatizing healthcare is to reduce liability risk. In Hill’s case it didn’t work; federal District Judge Mary Dimke ruled in May 2022 that Spokane County couldn’t dodge responsibility for Hill’s death, after finding that six hours of critical surveillance video had been deleted “with an intent to avoid its litigation obligations.” SCJ saved footage showing Hill’s transfer and from the hour before her death, too. But the video in the middle wasn’t saved, and the county couldn’t explain the gap to Dimke’s satisfaction.

“Spokane County offers the Court no explanation—credible or otherwise—about why someone at Spokane County Detention Services made the intentional choice to preserve video from 8:43 a.m. to 9:15 a.m. and 4 p.m. to 6:30 p.m. yet chose to allow the portion from 9:15 a.m. to 4 p.m. to be permanently destroyed,” she wrote in the ruling.

“It’s massive,” said Ed Budge, the attorney for Hill’s Estate, about the verdict. “It was absolutely the right decision. The jury recognized that a message needed to be sent.”

Spokane County was pushed into its initial six-­month $2.6 million contract with NaphCare in 2016 because it could not find enough nurses for its own medical staff. While the contract solved those staffing issues, multiple nurses said publiclythat NaphCare’s takeover and cost-­cutting measures were leading to lower-­quality care. For example, detainee Bryan Monnin went 40 days with an untreated elbow injury; detainee Patricia Swiger went weeks without getting her medication; and detainee Kurt Warren had MRSA for weeks before he was treated. NaphCare nurses ignored Warren’s infection, which spread and eventually required surgery.

The county currently pays NaphCare $7 million annually to provide medical care at SCJ. Despite the big settlement after Hill’s death and other published failures in providing care, county commissioners have voiced no concerns about NaphCare’s performance.

NaphCare Avoids Getting Sucked into Ohio Jail Injury Case

In most instances of neglect or deliberate indifference, government officials usually support their contractors. The Sheriff’s Office in Ohio’s Montgomery County took a different tact when facing liability for injuries to former detainee Joseph Guglielmo. The homeless veteran sustained injuries that left him in a wheelchair when he was allegedly beaten brutally by guards in January 2015 as other guards blocked the view of a camera. Guglielmo sued Sheriff Phil Plummer and the county. The Sheriff then filed a third-­party complaint accusing NaphCare of deliberate indifference to the detainee’s serious medical need.

The Sheriff’s legal complaint made other attempts to distance jailers from Guglielmo’s injuries, saying he entered the jail with head injuries from fighting with Dayton police and incurred additional injuries from banging his head against a wall. As for the scuffle with guards, the Sheriff insisted they used “reasonable” force and it was a NaphCare nurse who provided deficient care when she gave Guglielmo an ice pack and had him placed in an observation cell after the altercation. He was later found unresponsive in his cell before he was taken to a hospital where he underwent surgery and spent two months in a coma, from which he emerged wheelchair-­bound and with cognitive impairments.

Fortunately for NaphCare, the federal court for the Southern District of Ohio didn’t buy the county’s arguments and granted its motion to dismiss the county’s third-­party complaint in December 2017; represented by attorneys with the Brannon Law Firm in Dayton, Guglielmo went on to settle with the county for $5.6 million in June 2019. See: Gulglielmo v. Montgomery Cty, 2017 U.S. Dist. LEXIS 198853 (S.D. Ohio); and 2019 U.S. Dist. LEXIS 93854 (S.D. Ohio). Perhaps fortunately for the county, NaphCare apparently holds no grudge; it still provides healthcare to detainees in the county jail.

PLN has published numerous reports about NaphCare and allegations of deficient medical care, compiling a library of 96 complaints, briefs, and articles. One report covered avoidable deaths of dozens of prisoners in its home state of Alabama due to NaphCare cost-­cutting measures, while another detailed 42 more state prisoner deaths to complications from untreated HIV; the state DOC canceled its contract with the firm in 2003, after just two years. [See: PLN, Oct. 2003, p.1; and Aug. 2005, p.28.]

For every big prison healthcare failure, there are hundreds, if not thousands, of smaller instances of unnecessary pain, suffering and death. The only thing that changes are the names and locations. Meanwhile, NaphCare continues to represent it is going “above and beyond” to provide compassionate care. However, the federal government caught NaphCare cheating and imposed a six-­figure fine.

“Specifically, the United States alleged that, when certain physicians did not indicate the type of service performed on onsite visit sheets, NaphCare charged the government at higher-­level services than were provided,” the U.S. Department of Justice (DOJ) said, announcing a 2021 settlement that required NaphCare to pay $694,593 to settle a False Claims Act complaint for services between January 2014 and June 2020 at the federal Bureau of Prisons (BOP) lockup in Terre Haute, Indiana. “The settlement also resolves allegations that, for two other physicians at BOP’s facility in Victorville, California, NaphCare similarly submitted claims that included higher-­level services than those that were actually performed.”

A report issued by DOJ’s Office of the Inspector General (OIG) in 2022 questioned the cost effectiveness in pricing BOP’s medical contracts. “Because the BOP’s award pricing structure consists of premiums on Medicare rates, as well as a percentage markup on out-­of-­network costs, we found that the awards provided little incentive for NaphCare to reduce healthcare costs or ensure accurate invoices, as higher medical bills resulted in larger contractor payments,” the OIG report stated.

OIG also found that BOP’s “insufficient oversight” contributed to “unallowable and unsupported” expenditures, as well as “wasteful pharmaceutical costs and interest payments.” NaphCare struggled with “challenges in fully accomplishing award deliverables”—i.e., complying with terms of its contract—but BOP struggled with “untimely approval for healthcare visits.” The prison agency “also did not properly complete required contractor performance assessments,” the OIG report stated.

A New Chance in Arizona

Despite this dismal performance track record, the Arizona DOC awarded NaphCare a five-­year $1.4 billion contract on May 27, 2022, representing a 74% increase in the amount of money the state pays to provide health care for each prisoner every day. DOC was compelled to make changes after the failure of Centurion Health to satisfy the federal court for the District of Arizona that it was providing a constitutionally minimal level of care; in fact, the Court found the provision of healthcare was frankly awful, as PLN reported. [See: PLN, December 2022, p.1.]

Arizona officials have bet that NaphCare has learned from its mistakes, like the big one in Alabama two decades ago, and is now ready to manage the state’s 40,951 prisoners—even though when Alabama cancelled NaphCare’s contract in 2003, the firm was responsible only for 27,727 prisoners.

A closer look at procuring officials reveals a cozy relationship with NaphCare. DOC Director David Shinn was a former Warden at BOP’s Federal Correctional Institution in Victorville, California, where NaphCare was hit with a False Claims Act violation. Larry Gann, DOC’s Assistant Director of Medical Services Monitoring Bureau who participated in the procurement process, testified about his background in federal court in November 2021, revealing that he worked for NaphCare as Director of Nursing at a Nevada prison in 2006. For the next nine years, he worked in various capacities for NaphCare, becoming a vice-­president in 2015. Gann said he turned the company’s situation around at the Nevada prison while gaining profitability. Shinn seems sold that Gann and NaphCare can pull Arizona out from under federal court oversight, too.

“In considering our selection of a new healthcare partner, providing maximum savings to the Arizona taxpayer and providing the highest-­quality care for the inmates in our custody were top priorities,” Shinn said. “We believe NaphCare was the best-­possible choice in these areas.”

Statistically speaking, DOC faces long odds to win that $1.4 billion bet. A Reuters News “review of deaths in more than 500 jails found that, from 2016 to 2018, those relying on one of the five leading jail healthcare contractors had higher death rates than facilities where medical services are run by government agencies.” That analysis covered deaths not only from illnesses and medical conditions but also from suicide, drugs and alcohol. It found that jails and “publicly managed medical services” in prisons averaged 12.8 deaths per 10,000 incarcerated people, while lockups where healthcare was provided by NaphCare or another of the five largest players in the carceral healthcare field had an extra 2.3 to 7.4 deaths per 10,000. Those rates were “18% to 58% higher, depending upon the company.”

Finally, the Reuters News report found that jails where NaphCare and Armor operated “had the highest death rates”—20.2 and 18.8 deaths per 10,000 people incarcerated, respectively. Rates for the other top-­five profiteers were 16 per 10,000 for Corizon, 15.9 for Wellpath and 15.1 for PrimeCare.

The losers in this equation, of course, are the prisoners and detainees who fall victim to carceral medical care profiteers. They are regularly left to languish in an isolation cell and suffer excruciatingly painful deaths or life-­changing medical catastrophes—typically after prevention and intervention would have reduced the seriousness of an injury or prevented death. The evidence often shows the prisoner pleaded for medical care and was ignored, accused of malingering or given ineffective remedies. Sadly, very few cases result in a verdict or settlement to compel one of these profiteers to compensate for injuries caused. Instead, when one contractor fails and public heat is applied, jurisdictions believe the solution is just to find another provider.

In the small constellation of carceral healthcare giants, NaphCare is the brightest current star thanks to its big contract with the Arizona DOC. That shine is greatly diminished, though, by the company’s dubious distinction as the deadliest private prison healthcare provider.

The question now is this: Will NaphCare become the trail blazer it claims to be, with its doctors and nurses treating prisoners as they themselves wish to be treated? Or will it remain at the altar of carceral health industry profits, offering up sacrifices of human misery and death? PLN will update developments as they are available.  


Additional sources: Arizona Republic, Atlanta Journal-­Constitution, Center Square, Dayton Daily News, Reuters News, Seattle Times, Spokane Spokesman-­Review, WABE, WAGA, WBUR

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Cantu v. Kings Cty

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