A year after its first attempt at privatizing prison health care was scrapped because of questions about the contractor, the county Prison Board is expected to try again this week to recommend an outside provider for inmate medical services.

The Prison Board, which includes the county commissioners and other top officials, has narrowed the field of four candidates to CFG Health Systems of New Jersey and PrimeCare Medical of Harrisburg.

While officials didn't want to disclose exact costs, county Purchasing Director Barry Hitchcock said the range of prices is slightly higher than last year's bids of $15 million to $30 million over five years.

Partly that's because the county's request for proposals includes health coverage at the Youth Intervention Center as well as the county prison.

An effort in 2006 to contract care to Armor Correctional Health Services fell apart when District Attorney Don Totaro, a member of the Prison Board, learned that one of Armor's executives had been convicted of tax evasion, although Armor's bid documents included an affidavit stating that the company's officers did not have criminal records.

Should the Prison Board recommend one of the two top bidders at its Thursday meeting, and should the county commissioners approve the deal, Lancaster County would join a growing number of jurisdictions that have been outsourcing inmate care.

One of the reasons for privatizing here is concern over litigation alleging inadequate care. But that factor also results in many leading companies in the field carrying lawsuit baggage.

PrimeCare Medical has its share, including a 2004 grand jury report in Lackawanna County that cited "failure to adequately treat inmates for serious medical conditions" at the county jail.

Spokesmen for PrimeCare, however, said the references came at the end of a lengthy report and did not result in any legal action against PrimeCare.

PrimeCare had 13 lawsuits pending in 2006, from a population of 16,725 inmates, the spokesmen said.

CFG, which does not serve any prisons in Pennsylvania, according to its Web site, has less of a record to track.

"Most medical providers have had lawsuits against them, which is the nature of the business, to some extent, with the majority of civil suits in our nation coming from inmates," said Jean Bickmire, administrative director of the prison reform group Justice & Mercy.

"However, that does not mean that these concerns are not valid."

Second time around
The record of Armor Correctional Health Services ended the Prison Board's first effort to outsource medical care.

After the board recommended Armor, which submitted a bid of $17 million over five years, in June 2006, Totaro announced that executive Doyle Moore had a 1994 tax evasion conviction that wasn't disclosed in Armor's proposal. Guarini also told the board he had known Moore since the 1970s.

Last August, the Prison Board voted to start over.

Guarini said the second "request for proposals" was tweaked.

"The RFP was much different as for detail and was presented in a clearer but concise manner, with a pre-release review by a noninterested medical individual," he said. "Reviews were by a larger team and independently scored."

Totaro and then-chief services officer Jim Laughman said last year that the original bid documents the county used came from Armor.

"The new process has been very thorough and transparent," Totaro said Friday. "A broad committee of nine members was established to research the potential vendors, and they have carefully scrutinized the candidates."

Hitchcock, the purchasing director, said he couldn't disclose prices because of ongoing negotiations. But he said the second round of bids is a "little higher" than the first, with the highest, from one of two eliminated firms, at $30 million for five years.

The 2006 quotes were $15 million to $30 million over five  years.

The prison medical department is chronically short-staffed and struggles to care for the bulging jail population, which stood at 1,161 Friday. Prison Board members estimated last year that it would cost at least $2.9 million a year to hire a full medical staff.

Health care for juveniles at the Youth Intervention Center is included in the second request for proposals. The prison "remains the lion's share of the expense," Hitchcock said.

Companies that submitted proposals are CONMED, Prison Health Services, CFG Health Systems and PrimeCare Medical, he said.

Hitchcock said the top two bidders were identified not on the basis of cost but on "an evaluation of technical merit and past performance."

Any company recommended by the board would have to be approved by the county commissioners.

"The companies out there have been researched," Guarini said. "It is true, though, that any of these companies is only as good as the local personnel they put on site, just as any county also would be by the personnel they would employ.

"I think the process has resulted in viable, capable finalists."

PrimeCare, with 21 years in business, handles 27 facilities in 23 Pennsylvania counties. It also has contracts at 21 prisons in West Virginia.

CFG, which couldn't be reached for comment Friday, was founded in 1997, according to its Web site, and has contracts with at least four New Jersey correctional facilities.

"We do not have any notable concerns with either health care provider but know very little about CFG Health Systems, truthfully," said Bickmire, of Justice & Mercy.

"We are in agreement that Lancaster County may be able to get better medical care through a medical care provider than having prison medical care, which is very expensive.  We just demand accountability."

Managing risk
One of the biggest headaches in prisoner care, and one of the major factors in the county's pursuit of privatized treatment, is litigation.

And as governments increasingly turn to the private sector to operate inmate medical services, the vendors are running into legal issues as well.

"Counties do not want to carry the liability for medical care and so contract out," Bickmire said.

"Private companies need to make profits and so they need independent evaluators to make sure that they provide the needed medical care to inmates, as is their constitutional right.  County prison boards should be the oversight, but many times they also have a vested interest in the medical contractor and so may not intervene in the medical process."

That's why Justice & Mercy and other prison advocates want to make sure any firm contracted to care for inmates here has a clean bill of health.

The advocates don't have much information on CFG, a newer entry into the prison health field.

PrimeCare, one of the older companies in the business, has emphasized quality assurance for the last five years, according to Joshua Lock, who handles risk management and quality assurance for the firm.

In 2002, PrimeCare was responsible for 10,415 inmates and had 29 lawsuits pending. In 2006, its inmate load was 16,725, with 13 lawsuits.

"That decrease happened when the president of PrimeCare [Dr. Carl A. Hoffman Jr.] committed to the creation of a position overseeing quality assurance and risk management," Lock said.

More than half the lawsuits come from West Virginia prisons, he said; of the Pennsylvania cases, half come from just three counties. The last time the company paid on a lawsuit settlement was 2005, Lock said, for $2,372.98.

"We track this data because of the commitment that was made to manage risk and control quality," he said. "We got the message; we committed ourselves to change."

In Lackawanna County, Lock said, the 2004 grand jury report, which focused on wrongdoing by county officials, mentioned prison health care only briefly near the end. PrimeCare was involved because a nurse was accused of failing to report injuries to inmates who had been assaulted in jail.

The nurse was fired, Lock said, and the grand jury report led to a Republican majority on the Lackawanna board of commissioners.

The prison medical contract went to Correctional Care Inc. in 2004; according to the (Scranton) Times Tribune, one of the GOP commissioners had a prior business relationship with the owner. PrimeCare sued and won a $675,000 settlement from the county.

Lock said he understands why prison advocates are concerned about quality of health care by private companies, but he said allegations of poor care are inaccurate.

"Do you think 23 counties would risk exposure by reposing their trust in us to provide prison health services if they were not convinced that we could do so in a cost-effective and an efficient manner?" he asked.

"PrimeCare is very excited to have been chosen as one of the finalists for the contract," said Todd Haskins, vice president of operations.

"We are very, very hopeful we'll be the successful candidate. We pray we'll be able to do a great job."

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Helen Colwell Adams is a staff writer for the Sunday News. Her e-mail address is hcolwell@lnpnews.com.