A Miami-based correctional health care provider found a fresh start in El Paso County, winning a jail contract potentially worth up to $40 million eight months after it was banned from jails and prisons in New York state following a string of inmate deaths.
Armor Correctional Health Services Inc., a defendant in dozens of pending lawsuits nationwide over prisoners' civil rights and allegations of substandard care, will provide medical services to the jail's average daily population of roughly 1,500 inmates beginning July 15.
It will replace a similarly controversial provider, Correct Care Solutions of Nashville, Tenn., in a transition that illustrates what one criminal justice expert calls the "pingpong" effect: In the world of for-profit correctional health care, one embattled provider is often cut loose only to clear the way for another.
"Due to the contract violations or inadequate care that's being provided, they'll get rid of (one) company," said Alex Friedmann, associate director of the Florida-based Human Rights Defense Center. "Then they'll bring someone else in and they'll find that - unfortunately, because all of the companies have the same business model - they tend to have the same problems."
An Armor spokeswoman defended the company's track record, saying the physician-owned operation focuses squarely on patient care. "Negative outcomes" are inevitable when a health care provider is responsible for tens of thousands of patients nationwide, many of them suffering from opiate addictions and other onerous health challenges, Yeleny Suarez said in a written statement. These complex medical problems, dumped on the doorsteps of jails and their privatized providers, often cut into staffing and resources that could otherwise be used to administer day-to-day health care to an already "vulnerable population," she said.
Suarez declined to comment on lawsuits over inmate deaths filed against Armor in at least four of the eight states where it operates, saying the company doesn't discuss legal matters.
County officials said the switch in contractors was not a result of problems with Correct Care Solutions, but, instead, an attempt to get taxpayers the best bang for their buck.
The contract will be prorated for the first six months, not to exceed $3.7 million, after which it can be renewed annually for up to five years.
Under Armor's contract, the county will pay nearly 40 percent more for inmate medical services than it had been paying Correct Care Solutions, but the amount also would have increased if the county stuck with Correct Care, said county procurement specialist Ron Neely. County spokesman Dave Rose attributes the escalation to rising health care costs, better-defined standards for quality of medical services and a jail population that continues to inch upward.
Despite rising health care costs, Armor remains a financial juggernaut, with revenues of more than $540 million from 2010 to 2013, pocketing a yearly average of more than $88 million in profit, according to tax returns provided by Fort Lauderdale, Fla., attorney Greg Lauer, who is litigating a case against the company.
Critics say correctional health care companies have a simple strategy for remaining profitable: cut services.
"They know all the tricks. They make it so they can skimp here and skimp there and ultimately provide less effective health care," said Dr. Jody Rich, co-director of the Center for Prisoner Health and Human Rights at Brown University. "To relegate a basic function of a state to an entity that's focused on making profit really doesn't smell right to me."
Lawsuits and payouts
Armor faces more than 100 pending lawsuits filed in state and federal courts nationwide - many of them alleging negligence, medical malpractice or violations of inmates' civil rights.
In October, it was barred from contracting with jails in New York under the terms of a settlement with the state attorney general, who sued the company for failing to provide adequate care. The company also agreed to a $350,000 payout - a small fraction of the millions of dollars the company has been ordered to shell out or agreed to pay in lawsuits stemming from similar claims. In April, a federal jury ordered Armor to pay more than $7 million to the family of an inmate - a combat veteran who suffered from PTSD and addiction issues - who hanged himself at a jail in Nassau County in New York five years earlier.
The company agreed in 2015 to a $100,000 settlement in a lawsuit filed over the death of Tommie Lee Jones, who died at a jail in New York's Niagara County, according to Newsday.
In 2013, it ponied up $800,000 to the family of Allen Hicks Sr., who died in a jail in Hillsborough County in Florida a year earlier after suffering a stroke that went untreated for roughly 36 hours, the Tampa Bay Times reported.
Armor was also involved in a 2015 settlement with the family of Raleigh Priester, a mentally ill man who shed 120 pounds before starving to death while in custody in Broward County three years earlier. Terms of the settlement are confidential.
But Lauer, who represented Priester's family, said the payouts are small compared with the company's bottom line.
"It's cheaper to pay off the lawsuits and the liability then actually do things the right way and take care of people," Lauer said.
Moving into Colorado
Armor is part of a small group of big companies that are capable of providing medical services for hundreds of inmates at a time, experts in privatization and correctional health care say. It's not quite the size of industry titans Corizon Correctional Health and Correct Care Solutions, both of which provide care to hundreds of thousands of inmates in dozens of states, according to In the Public Interest, a research and policy organization that tracks privatization in various industries.
The newly chosen provider was founded in 2004 in Broward County by Dr. Jose Armas, who is also the sole shareholder, according to tax returns Lauer provided. It has since expanded to eight states, providing care to roughly 40,000 inmates in jails and prisons. Its largest presence is in its home state, where it has roughly 1,300 employees working at 19 jails, company spokesman Suarez said.
El Paso County will be Armor's third client in Colorado, where it has contracts with Weld and Larimer county jails. Both counties also made the switch from Correct Care Solutions to Armor this year, although officials say the shift wasn't related to complaints over performance.
Weld County and Correct Care Solutions are facing a lawsuit over the death of Barton Grubbs, an inmate who downed two bottles of pills shortly after his arrest in 2014.
Some counties have chosen Armor after facing lawsuits over subpar care, according to media reports. Lee County in Florida selected Armor in 2014 - roughly three years after the county and its then-contractor, Corizon, were sued by the sister of an inmate who suffered permanent brain damage trying to hang himself in the shower, reported the Naples Daily News.
Profits vs. care
Inmate defense attorneys, medical experts and privatization specialists acknowledge that there are problems across the board with correctional health care, whether it's administered by a private company or public entity. But some agree that the issues are exacerbated by the corporate profit incentive, and the outcome often isn't worth the lower costs contractors sometimes offer.
"You can get cheap private care, but the quality and quantity suffer," said Roland Zullo, a researcher at the University of Michigan who specializes in privatization. "If you instead look at the value of it, which is what you get for what you pay for, privatization does not work - certainly not for this service."
It's a struggle that is seldom short-lived. Public agencies are typically reluctant to hire their medical staff after they've put health care out for private bid, added Zullo, who has studied private and public correctional health care models in Michigan.
"Once a political body makes a decision to privatize, it becomes very difficult for them politically to admit that it was a mistake. So when it fails, the usual response from them is, 'We'll give it another try,'" he said.
Not all industry experts concur that the money motive is an inherent flaw in privatized correctional health care systems.
Dr. Marc Stern, former health services director for the Washington state Department of Corrections, believes pinning the blame on for-profit providers is unfair. Issues with privatized health care often arise from a lack of oversight, he said.
No federal agencies monitor jails to ensure that health care is adequately provided. Some states, such as New York, have formed boards or commissions to oversee conditions at correctional institutions, but Colorado has no such regulatory body.
"If we focus on private companies being the problem, I think we're focusing on the wrong problem," said Stern, who now teaches at the University of Washington's School of Public Health. "We just, as a community, don't put enough money into correctional health care."