Spokane County saves money, staff and bolsters services in new jail medical provider agreement

Spokane County officials say they have found a palatable solution to a deal that turned sour with the former jail medical services provider.

The June decision by Everhealth and subsidiary NaphCare to sever a long-held contract to provide medical care to county inmates had county leaders scrambling to find a replacement before the end of December.

Notice of NaphCare’s departure came after the company, which has held the contract since 2016, agreed to a three-year renewal that allowed it to take over behavioral health services provided by county employees, which meant laying off the 10 people on the in-house team at the time.

That contract took several months to iron out and arose out of Spokane County’s limited options at the time. Standing up an entire medical team of its own would be expensive, time-consuming and hard to sustain, but NaphCare was the sole respondent to multiple attempts to field bids.

The NaphCare contract received approval despite disagreements among the county’s governing board, with Commissioners Amber Waldref and Chris Jordan voting against the renewal.

Now a Virginia-based company, Mediko, will take over medical care for county inmates in February at a lower cost. The deal also includes nine more staff members and no layoffs of county employees.

“Providing medical services in our detention facility has been an evolution, and we have gotten better each time,” Commissioner Al French said ahead of the contract approval.

Mediko will receive nearly $15.8 million for providing medical, dental and pharmaceutical care in Spokane County detention facilities for the first year, which will grow by 3% annually to $16.7 million in 2027, $17.2 million in 2028 and $17.75 million in 2029. Those totals are less than what NaphCare was set to receive.

The savings become more dramatic when considering NaphCare’s requested rate increase, including a 35% bump in the second year of the three-year contract that would have brought the cost to $22.6 million in 2026 and $23.3 in 2027, said Spokane County project manager Ken Mohr.

That additional staff will ensure county inmates have access to medical providers on weekends, according to Mediko founder and CEO Dr. Kaveh Ofogh.

Ofogh, a former emergency room teaching physician, said Mediko will offer interviews to all current NaphCare staffers during the transition.

“We have already started the interviews, and then we typically select almost 80, 90% of them based on the interview outcome,” Ofogh said in an interview Tuesday.

Ofogh said his company has never been found at fault in a lawsuit alleging wrongdoing.

Like many companies that provide medical services to prisons and jails, NaphCare has faced dozens of lawsuits across the country, including in Spokane County. In 2022, a federal jury awarded $27 million in damages to the family of a woman who died in the Spokane County Jail after her estate’s attorney successfully argued she would have lived had she received proper medical care.

NaphCare was found liable and ordered to pay another multi-million dollar award in Washington last April, when a federal jury awarded $25 million to an ex-inmate of the Pierce County Jail after a neglected blood clot in his leg led to an amputation below the knee.

A company spokesperson told The Spokesman-Review in July that the company decided to terminate the Spokane County Jail contract due in large part to “the unreasonable exposure to litigation risks we face in this jurisdiction.”

Earlier this week, Ofogh made the long trip from the company’s headquarters to express his appreciation and desire to work with the county directly to the commissioners at the Tuesday meeting.

Correctional care, and “serving an underserved population,” is his life’s passion, he said.

Founded in 1996 as a one-man shop, Ofogh said Mediko now contracts with local governments in more than seven states and boasts more than 700 employees. He considers those detention facilities his clinics, and the inmates within as typical patients.

“I believe they have someone who loves them out there,” Ofogh said. “Our job is not to judge them, and based on our Constitution, they are entitled to receive adequate, timely and proactive health care services.”

Ofogh’s plans for Spokane County, and contractual commitments, include a bolstering of addiction treatment services for county inmates – a front-of-mind issue locally after three inmates in separate wards were believed to have experienced an overdose while in the Spokane County Jail on Monday, two of which were fatal.

The men who died had been booked Sunday and Dec. 7, and the woman involved who survived an overdose was jailed Dec. 10. Few details have been made available as the Spokane County Medical Examiner and Sheriff’s Office investigate.

Ofogh said he believes strongly that addiction is a disease that should be confronted and treated. He is planning to expand the medication for opiate use disorder (MOUD) program to be available to all county inmates, not just those who were currently receiving addiction treatment before being detained as it was under NaphCare.

“If we don’t treat this disease, then individuals will have the craving to seek, to search, to get those drugs by any means they can,” Ofogh said. ” … I believe that by doing that proactively, that will significantly reduce the number of attempts individual inmates will have to use fentanyl or other very strong substances.”

Waldref and Jordan pointed to expanded staffing and bolstered addiction treatment services as reasons for support of the Mediko agreement. They thanked Ofogh for making the trip for the contract vote, and county staff for securing and ironing out the details of the deal.

“I think those are all really important priorities,” Jordan said.

French added that he looks forward to the partnership and improving the quality of care provided to those incarcerated, particularly surrounding addiction services.

“That will be an addition, and I think, an enhancement, so that we can not only protect our inmates, but also help them transition, especially from opioid and other addictions, so that they can enter into the community as a healthy individual,” French said.

Correctional care can be a challenging field, Ofogh said, but it also provides opportunities to improve people’s lives while they are incarcerated.

“When they come to the jails, they are coming with more chronic and serious medical and mental health conditions, including poor substance abuse that were undiagnosed or under-diagnosed prior to incarceration,” Ofogh said. “So here in correctional facilities medical departments, we have a golden opportunity to diagnose and address these medical conditions, including opioid addiction.”