Monterey County awards new $139 million jail health care contract Upstart firm to take over for troubled vendor

As if it wasn’t obvious that medical care in U.S. jails is sub par, terribly expensive and dangerously short of doctors, nurses and other practitioners, Monterey County officials on Tuesday awarded a five-year, $139 million contract to a fledgling jail health-care firm that got its start in one of the most dangerous jail systems in California.

The county contract with the new provider, Correctional Healthcare Partners (CHP) of San Diego, dwarfs the county’s expiring pact with the current contractor, Wellpath. The agreement increases the county’s annual cost from $15.1 million to about $27.8 million, assuming the company can greatly increase jail medical staffing as it promises. After five years, the contract calls for a series of shorter contracts in the range of $29 million annually.

Wellpath has operated in Monterey County for the past decade under special federal monitoring brought on by litigation over a pattern of clearly inadequate care. With its financial performance directly linked to scrimping on staffing and avoiding hospitalization or doctor’s visits for inmates, hundreds of men and women suffered from largely untreated illnesses, injuries and addictions. A rash of jail deaths under former Sheriff Steve Bernal abated to a large degree under current Sheriff Tina Nieto, but a string of out-of-court settlements with grieving families continues to tax the county’s already stretched budget. 

Aggravating issues in the jail, the federal monitoring has forced the Sheriff’s Office to fully staff the jail with correctional deputies, which at times has forced the department to inadequately staff other parts of its operation, such as investigations and patrol. Overall staffing levels have led to various degrees of disgruntlement among the sheriff’s staff. 

Nieto said recently that she would have preferred to go to an in-house health care system, with the county’s Natividad Medical Center and health department caring for the jail’s 900-plus inmates, but the county staff and bureaucracy are resistant and the potential for dramatically higher legal liability costs makes that impractical, said Nieto and others in county government. 

Several other California counties, including Santa Clara and San Mateo, use county-affiliated hospitals and county employees to provide health care to people in jail. The CHP contract requires the company to provide nurses and physicians as well as mental health practitioners and dental care. Under the new contract, medical staffing would nearly double.

Nieto didn’t mention the in-house option during her department’s presentations to the supervisors on Tuesday, but she expressed great confidence that her staff and other county officials had drafted a solid contract that incentivizes strong performance and that could disqualify the new vendor if it disappoints.

Undersheriff Keith Boyd told the supervisors that several companies bid on the county contract and that the staff provided them with “great transparency” about the county’s needs and procedures. The county, however, provided residents and taxpayers with almost no transparency about the process. While it was known that the county was negotiating a new contract, supervisors and other county officials refused to even acknowledge the existence of contract talks, saying any acknowledgment would violate confidentiality regulations. 

The board voted unanimously to award the contract following a meeting Tuesday that featured brief questioning of CHP’s chief executive officer, Peter J. Freedland, and a video version of a public hearing that included just two speakers, one unintelligible.

Despite a process that went on for months, the supervisors seemed to know little about CHP (not to be confused with the California Highway Patrol). The new provider says on its website: “With 30+ years of experience, Correctional Healthcare Partners delivers expert healthcare solutions within correctional settings.” However, the company was only formed in 2020 when it began operations as a subcontractor to another company contracted to provide health care at the deeply troubled San Diego County jail system, which has experienced more jail deaths than even the much larger Los Angeles County system, also a Wellpath client.

Freedland, who holds a masters degree in business administration as well as a medical degree, had been an emergency room doctor in Coronado for several years before going to work two years ago in the San Diego jail system under subcontracts with other health care providers. Most recently CHP has shared responsibilities with NaphCare. That Alabama-based company, like Wellpath, is among numerous correctional health care companies operated by profit-driven hedge funds. Its reputation nationally is on par with Wellpath’s. CHP’s chief operations officer, who previously worked in the San Diego jail system and elsewhere, was hired away from Wellpath.

In a memo to the Monterey County Board of Supervisors, Timothy Lanquist, chief deputy of the Sheriff’s Office, wrote that the new provider’s Monterey operation, to be known as CHP Monterey Inc., has “a proven ability to maintain a high level of stable staffing. Their experience in the California correctional medical services market has given them the ability to recruit and retain some of the most highly trained medical practitioners in the state of California.” Lanquist heads the jail staff and is accredited to inspect facilities as part of a national accreditation program. The new contract sets deadlines for the Monterey County jail to become accredited.

However, Lanquist’s comments about CHP’s experience doesn’t square with the company’s recent entry into the field. It is currently operating under a recent subcontract in San Diego County and only this fall arranged contracts with smaller sheriff’s departments in Yuba and Amador counties. A company spokeswoman said CHP also has two contracts in Washington state, but that could not be immediately confirmed. The company’s website includes tesmonials from Sheriff’s departments where they don’t have contracts — implying that it has contracts in other California counties where it does not.

Unfortunately for journalists, lawyers and others who follow correctional health care matters, another company in the field carries a remarkably similar name, Correctional Health Partners. It is based in Colorado, reportedly holds contracts with a few prisons in the Rocky Mountain states and is said to be pursuing contracts in California.

A county official who asked not to be identified said several other health care companies submitted bids for the Monterey County contract, including some who wanted as much as 30 percent more than CHP is to receive. 

Whether CHP Monterey’s costs reach the “not-to-exceed” figure of $139 million over five years depends on its ability to attract and retain employees, including physicians, nurses and mental health practitioners. The contract signed today calls for a staffing increase from the current desired level of 54 full-time equivalents to 90 full-time equivalents. It is an ambitious goal considering that many medical professionals bargain aggressively for premium pay in order to put up with the difficult work environment that jails provide. 

Wellpath often works with skeleton staffs throughout the country with employees often being remotely supervised from other counties. Former Wellpath nurses have told Voices there were times that only one nurse was on duty at the men’s jail in Salinas and there were times when no physicians could be reached for consultation. At times, they said, mandatory health screenings for incoming inmates simply did not happen. Freedland promised that all of that would be corrected.

Wellpath holds contracts with most of the county jails in California and nearly 300 more nationwide. It is an outgrowth of Monterey County’s previous provider, California Forensic Medical Group. It is owned by one of the country’s largest hedge funds and has been held at least partly responsible for hundreds of jail deaths around the country, as well as malpractice allegations that have led to a long string of lawsuits and multimillion-dollar judgments. The Tennessee-based company has recently come out of bankruptcy protection, a process that its critics attribute to large outstanding legal judgments rather than actual financial hardship.

As a result of litigation a decade ago, Wellpath has been operating under close scrutiny by professional monitors — doctors, dentists, psychiatrists and others — working on behalf of the federal court under a process known as the Hernandez settlement, named for one of the early victims of the company’s care. It isn’t known publicly if the federal court in San Francisco that oversees the health care operation has been advised of the change in contractors.

Litigation over medical treatment in jails is, of course, common. The county and Wellpath have jointly defended several malpractice judgments, several of which have topped seven figures. The county carries insurance to cover some of those costs and usually has negotiated with the aggrieved parties separately from Wellpath. The new contract with CHP contains a lengthy clause requiring the county and CHP to cooperate in defense of future lawsuits and to keep the existence of that agreement confidential.

Theoretically, jail and prison inmates in the United States should be receiving strong medical services —the courts have held that prisoners have a Constitutional right to at least adequate care because they are wards of the government. It hasn’t worked out that way, however. Many government agencies have higher priorities and many taxpayers who ultimately bear much of the litigation costs believe inmates don’t deserve any better. The fact that an estimated half of inmates in the U.S. are more mentally impaired than criminally minded seems not to sway public opinion, nor does the fact that a large percentage of people in jails are merely awaiting trial.

Despite Freedland’s pronouncement that jail health care has greatly improved in San Diego County, the San Diego County Board of Supervisors agreed in September after vigorous lobbying to create a citizens’ oversight panel to monitor health care and related matters in the jail system there. When Monterey County Sheriff Nieto campaigned for office, she said she would support a citizen’s oversight panel for her entire operation, but later reversed course after much of her staff objected.

Monterey County Supervisor Wendy Askew cautiously suggested that local officials consider such a panel or hiring of an inspector general to perform similar functions. Supervisor Glenn Church agreed that the county should consider the idea, but discussion was short because a representative of the County Counsel’s Office ruled the conversation impermissible as the subject wasn’t included on the day’s agenda.