Financial issues, Improper staffing, a lack of oversight and poor management are just some of the issues revealed in a new audit on healthcare inside the Osceola County Jail.
The findings raise some serious concerns for local leaders who are now questioning whether to scrap the private third-party company that provides those services in order to improve healthcare for inmates and save taxpayer money.
What led up to this?
Armor Correctional Health Services already has been removed from Lake and Flagler county jails, and an audit submitted to Osceola County Commissioners June 10 reveals problems close to home, too.
In late 2014, Osceola County signed a five-year contract worth $21.8 million that put Armor in charge of operations like dental and medical care along with claims management services for the jail’s 900 inmates – all of whom are awaiting trial or serving sentences of 12 months or less.
The move was meant to save the county money, yet healthcare costs at the jail have increased every year since Armor was put in charge, auditors found.
No specific event, allegation or suspected risk prompted the audit, according to a county officials.
The investigation’s scope spanned four years, with auditors reviewing documents, looking over contracts and interviewing staff to find inefficiencies and room for improvement.
Osceola County lost out on money
The 19-page report reveals that Armor owed the county money.
Under its current contract, the private company is fined if certain staff positions aren’t filled. But Armor reports its own staff deficiencies – with no oversight review from the corrections department.
When auditors pulled six months of staff reports and payroll, the numbers didn’t add up for any of them.
In February and March 2018, auditors determined Armor owed the county $4,846 for incorrectly reporting staffing levels.
Also, Armor must maintain a staff turnover rate of 15 percent or less, as per its contract. But auditors found turnover rates of 48 percent in 2015, 113 percent in 2016 and 93 percent in 2017. Key positions like the director of nursing was replaced four times in four years.
Armor self-reports other fines, including a $100 fee each time inmates wait more than 14 days to receive a physical exam after entering jail.
However, Armor didn’t need to show documents proving how long it really took.
“Armor could be understating untimely examinations to conceal inadequate healthcare services and reduce the amount of monthly fines,” the audit stated.
Waiting to see a nurse and other concerns
Inmates at the Osceola County Jail often complained about not getting medication on time – or at all – and lengthy wait periods to see a nurse.
The audit revealed a complete lack of oversight from the medical director and correction department staff when inmates filed complaints through the jail’s grievance policy system.
Correction department staff admitted during interviews that Armor employees weren’t properly trained on how to respond to grievances.
Not all inmates have health insurance, but billing ones who do can help save the county money.
Yet, the audit revealed Armor failed to do this, too.
“Inadequate contract management and noncompliance may have resulted in unnecessary healthcare costs paid by the county that could have been paid for by third-party insurance,” the report stated.
Armor and correctional department staff both said they didn’t know billing third party insurance was required.
Should Armor’s contract be renewed?
Osceola County paid $190,536 more this year for healthcare services through Armor than it did when county staff did the job in fiscal year 2013-14.
County Commissioner Viviana Janer voiced concerns about the company during a June 10 meeting and suggested bringing healthcare services back in-house when the company’s contract expires in September.
“There are some big red flags in my opinion raised by this audit report,” Janer said.
Fellow board member Commissioner Fred Hawkins Jr. asked if hidden costs may exist if the county takes over, like government employee retirement benefits.
“Is it apples to apples is what I want to make sure,” he said.
Hawkins said he wants to see another report before September on possible county costs along with steps taken by Armor to correct audit issues.
Janer agreed but remained skeptical about renewing Armor’s contract.
“I do believe that when people are under our care…we have a petitionary duty to ensure that they are well taken care of,” she said. “I don’t see that happening over the course of this contract.”
On Monday, Hope Hicka, spokesperson for the Osceola County Jail, said staff is still in early discussions about whether to keep Armor’s contract.
“We will make that determination at the appropriate time,” she said.
Some action has been taken
During the same meeting, County Auditor Horace Nwachukwu noted that concerns have been addressed with jail administrators, who agreed with audit findings.
Some corrective action has taken place since, Nwachukwu said.
The audit noted extra training and regularly checking to see if inmates have health insurance.
It outlined numerous recommendations as well.
Armor has also paid back money it owed the county.
On Monday, Hicka said staff plans to speak with Armor about shortcomings revealed by the audit, including high employee turnover rates.
The corrections department is also hiring a Healthcare Administrator to assist in determining next steps for the jail, Hicka said.
A spokesperson from Armor responded in an email Monday, stating that the company “is reviewing the audit and will appropriately address any issues directly with the sounty.”
Lake and Flagler counties ditch Armor
Founded in 2004, Armor Correctional Health Services is a Miami-based company offering medical, dental and mental health care to jail and prison inmates across eight states.
Earlier this month, Lake County announced it would switch to a different jail healthcare provider after two inmates died under the care of Armor.
In February, Flagler County’s sheriff announced he was terminating a contact with Armor Correctional Health following the death of a 23-year-old inmate.
When the possibility of a contract with Armor was first brought before Osceola County Commissioners in July 2014, several jail health workers spoke out in opposition. They expressed concerns that patient care would suffer and that the company wouldn't deliver on its $677,000 cost savings touted by the deputy county manager.
At the time, the 3-2 vote split along party lines, with Hawkins, a Republican, voting in favor of the move, and Democrat Brandon Arrington voting against it.