Miami Herald - January 14, 2005
Wanda J. Demarzo, wdemarzo@herald.com

When Sheriff Ken Jenne brought in a newly formed company to provide medical care to Broward County Jail inmates, he said he was seeking "new blood" to improve one of his department's most critical functions.

But the transfusion provided by Armor Correctional Health Services may carry significant risks: The company, which was incorporated only weeks before it won the Broward contract, is led by a management team drawn largely from competing prison healthcare providers with often spotty records.

The company's head, Doyle H. Moore, founded Prison Health Services (PHS) in 1978, and served as president until 1991. He held other leadership roles with the company from 1996 through August 2004, when Moore left the job of executive director of client services.

Four other Armor executives also worked for PHS prior to joining the company. Mary Jo Cheuvront was vice president of business development for EMSA, a subsidiary of PHS. Angela Goehring was health services administrator with PHS and the administrator of managed care from 1997-99 for EMSA. And Brenda Barshinger was the director of clinical information management for PHS.

Armor's corporate medical director, Dr. John May, also worked for PHS, which has contracts in several states. He was PHS's regional medical director in Indianapolis from August 1998 to March 2000.

The companies had drawn harsh criticism in the past. In March 2001, for example, Broward Circuit Judge Susan Lebow, slammed the company for denying an inmate his psychiatric medication, calling the company "directly responsible" for the inmate's attack on a deputy.

Private correctional healthcare long has been a delicate business. While profits can be handsome, the risks are enormous. In Broward's jails, hundreds of inmates suffer from hypertension, diabetes, asthma, tuberculosis and HIV, the virus that causes AIDS. In addition, the jail dispenses psychotropic drugs to an average 1,100 mentally ill inmates each day -- nearly one-fifth of the jail's population. Deaths can result in lawsuits and scandal.

Wexford Health Services, Inc., which had provided healthcare in Broward jails between 2001 and the end of 2004, had been sued three times: for allegedly failing to diagnose and treat a broken and infected jaw, for allegedly failing to prevent a doctor from sexually assaulting a female inmate, and for allegedly failing to measure the amount of painkillers in an inmate's system, causing him to drop dead in a parking lot 90 minutes after his release.

When BSO sought proposals for its healthcare contract, officials said only that the department was seeking new blood.

CHOICE DEFENDED

Sheriff's officials have defended their choice for the healthcare contract, saying Armor has gathered together a talented management team at a good price to taxpayers.

"We wanted to focus on the qualifications of the individuals within the company," Col. James Wimberly, executive director of BSO's Department of Detention and Community Control, told The Herald.

Prison Health Services was was formed in 1978, with Moore listed as a founder.

The company was in trouble by 1985, when Palm Beach County jail inmate Mario Abraham died after languishing in his cell for five days with a broken neck before PHS employees treated him. A grand jury at the time called the company's care of the man "grossly inadequate and incompetent."

Prison Health Services won the three-year contract to provide healthcare to Broward County inmates in February 1987 with a $10.6 million proposal -- more than $1 million lower than the closest competitor. When the contract was finally signed eight months later, the minimum payment to Prison Health Services had jumped to $12.9 million. In 1990, the Broward jail contract was renewed. The next year, in July 1991, a report was released by Dr. Charles Rosenberg, former chief of staff at the Veterans Administration hospital in Miami who studied Broward's jails for 10 weeks.

HARSH ANALYSIS

Calling medical care "a disaster waiting to occur," Rosenberg listed 119 specific instances of healthcare failure, including sick prisoners waiting two weeks to see a nurse, and frequent delays in treatment because medical records were lost.

Rosenberg stated in the 1991 report that nine inmates had died in the last two years, all from medical problems, six from AIDS and one after a heart attack.

Two years later, in July, 1993, a five-member committee picked EMSA Correctional Care over PHS for a multiyear inmate-healthcare pact in Broward.

EMSA ran into trouble as well. In 1996, Broward medical examiners ruled that "the absence of .... medical care" was "a substantial factor contributing" to the death of a 22-year-old woman - in the Broward jail following her first arrest, for shoplifting.

That same year, the sheriff of Pinellas County ended a $4.1 million contract with EMSA when he concluded the company's medical staff was responsible for the death of a 24-year-old prostitute. The company also was accused of fabricating patient medical records. The two competitors joined forces in 1999, when PHS bought EMSA -- bringing PHS back to the same Broward jail where the company had lost its contract six years earlier.

In February 2001, Lebow ordered EMSA's medical director and treating physicians to appear before her to explain why the mental health of two inmates was allowed to deteriorate after their psychiatric medications were withheld. In both cases, EMSA was under orders to provide medications to the inmates.

One of the two inmates attacked a sheriff's deputy Feb. 15 following a hearing.

In the last two years, nine inmates died at the Palm Beach County Jail leading to a spate of lawsuits alleging shoddy medical care.

A report last June by the New York Commission on Correction blamed the company's cost cutting for an inmate's death after his prescribed medication was withheld. And on Sept. 30, the Palm Beach Sheriff's Office dropped its contract with PHS after the company came under fire for its inability to control an outbreak of staph infection at the county jail. Critics also alleged the company had denied medications to patients, the Palm Beach Post reported.

FAT CONTRACT

With Moore listed as the company's chief, Armor took over healthcare management at the Broward jail Dec. 1, after beating out three competitors to provide inmate healthcare, including dental and mental health.

The contract was for $127 million.

"There is no requirement that the sheriff go through this bidding process to select new vendors," BSO spokeswoman Cheryl Stopnick said via e-mail. "He does so to generate healthy competition among quality vendors, and to get the best level of service for the taxpayer's money."

Armor Correctional's brief tenure at the jail already has raised eyebrows.

Though BSO's bid request required bidders to include detailed financial records, Dr. Jose Armas, president of Armor, submitted financial records of an affiliated company, Medical Care Consortium Inc. instead.

And the contract Armor CHS entered into with BSO Nov. 29 stated the company had all necessary professional and medical licenses, including licenses for pharmacy services.

But the firm did not have a pharmacy license, which is required by state regulators in order to stockpile medications. A state inspector conducted an emergency inspection of the jails that allowed the board to issue temporary pharmacy licenses to the company. until a permanent license was granted.

CRITICISM UNFAIR?

Dana Clay, Armor's spokeswoman, insists that, though the company's new, its executives, doctors and administrators have extensive healthcare experience.

"To be concerned that healthcare will be turned over to a novice company that doesn't know what's it's doing is unfair. There are two experienced elements in the company: an experienced management team and an experienced healthcare team," Clay said.

Still, the company's failure to perform basic requirements at the outset troubles attorneys with the National Prison Project of the American Civil Liberties Union in Washington D.C., a group that has spearheaded a decades-old lawsuit challenging conditions at the Broward jail.

"That they didn't have the licensing in order when they took over is of great concern to us," said Eric Balaban, a project attorney.

"It's a rocky beginning for them and points not only to a problem with the company but with BSO for not making sure the company was ready to take over the jail healthcare system."

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