Spokane County facing unfair labor practice complaints following decision to expand agreement with company providing care to detainees

Spokane County has been accused of unfair labor practices after renewing and expanding a medical services contract with a private company to treat county jail inmates.

In late January, the Spokane County Commissioners voted 3-2 to award a three-year, multimillion-dollar contract to Everhealth, a subsidiary of NaphCare, which has provided medical, dental and pharmaceutical care in the Spokane County Jail since 2017.

The vote split along party lines, with Commissioners Chris Jordan and Amber Waldref, both Democrats, voting against awarding the contract to NaphCare.

“I’m very concerned, because we’ve been told by our budget office here at the county that we’re expecting budget deficits in the next several years, multimillion-dollar deficits that we’re going to have to manage to provide the services that everyone in the county is looking for us to provide,” Waldref said. “This contract is costly; I’m not sure how we’re going to pay for it.”

The new contract expands NaphCare’s responsibilities to include behavioral health services, which county employees provided in the past.

Greg Beeman, a representative of the largest union for county employees, said that addition has left 10 employees out of a job. The county’s mental health team will be disbanded on April 30 to make room for NaphCare’s behavioral health specialists starting April 1.

Beeman said the union has filed two unfair labor practice complaints with the state, as well as two grievances with the county, all related to the county’s failure to negotiate with the union prior to awarding the medical services contract.

“They first started having conversations about this way back in March of last year,” Beeman said. “So we’re almost a year down the road, and they really only started talking to us beginning in early November. I think they were seriously behind the times on all this.”

The county failed to do its due diligence in working with the union prior to the contract being awarded, as well as in negotiating measures to mitigate the impacts on those being let go, Beeman said.

Last March, with NaphCare’s prior contract set to expire soon, Spokane County issued a request for proposals for medical, dental and pharmaceutical services. Not a single provider responded, Spokane County CEO Scott Simmons said.

Everhealth and parent company NaphCare declined to make anyone available for an interview, instead providing a written statement. Company officials declined to say whether they planned to interview any of the outgoing behavioral health team members for jobs.

Simmons said that after the first request for bids drew no interest, the county consulted with the National Commission on Correctional Health Care. The nonprofit organization advised that the best practices would include all services integrated under one operator.

“You have to have really, really tight handoffs on patient care and what the inmates are experiencing, and being able to have integrated solutions so that you don’t have any misses in information handoffs between shifts, between personnel,” Simmons said. “The flow of data, similar systems, are all beneficial to have under an umbrella approach.”

The county reissued its request, this time with behavioral health included. NaphCare was the only company to respond out of 19 providers that showed some interest, according to county records.

On Jan. 21, Mike Sparber, senior director of law and justice for Spokane County, came to the county commissioners with a choice: In a week’s time, they could award the contract to NaphCare or revert services back in-house, as they were prior to the initial agreement with NaphCare in 2017.

Sparber told the board the latter was a verbal proposal from the union. Simmons added in an interview that the county offered the union the opportunity to respond to the request for proposals and that the response was “very limited.”

Beeman contends that the proposal to revert to the pre-2016 model was only a “suggestion” of the options available to the commissioners. Union members have not provided medical services for roughly eight years, and have no control over the work conducted in the Spokane County Jail and Geiger Correctional Facility.

“This is kind of a strawman argument that they’ve created: ‘Well, this is the union’s solution or how the union is going to get it done,’ ” Beeman said. “That was merely us saying you do have a different option.”

NaphCare will be paid $15.9 million for the first year, $16.8 million for the second and $17.3 million for the third. That agreed-upon rate is in addition to a $700,000 contract extension to cover January while a larger contract was fleshed out, as well as $250,000 for an upgraded health records system.

The county will pay the company an additional $850,000 over the next three years for the implementation of an agreement between the state and the federal government to offer Medicaid coverage to youth and adult detainees up to 90 days before they are released.

The rate for the first year of services, with the January extension, transition costs and off-site medical claims included, is a nearly 62% increase from what the county paid last year for its in-house behavioral team and NaphCare’s medical services combined.

Part of that rise in costs may be attributed to the current legal landscape for providers who serve incarcerated populations. Like many companies that provide medical services to prisons and jails, NaphCare has faced dozens of lawsuits over the years.

In 2022, a federal jury awarded $27 million in damages to the family of a woman who died in the Spokane County Jail. Simmons said the county contacted similar municipalities to compare rates, and that the county’s increase is less than that of others in the state.

“I can’t say for certain that our contract increase as a result of a past settlement, but from any common sense and logical way to look at this thing, when businesses are faced with challenging litigation environments, and they do have unfavorable claims against them, it goes back into the cost of delivering services,” Simmons said.

Simmons said the rise is also due in part to the addition of more staff and services.

Waldref and Jordan voiced concerns about the large cost increase, and how the county will manage it amid financial challenges facing the county.

“I also share the concern about any potential impact for county employees in our jail’s mental health services department going forward,” Jordan said. “As the board knows, we have a really exceptional, dedicated, talented team of staff in that unit, and they’ve built relationships and partnerships throughout the criminal justice system over the years, including in juvenile detention, therapeutic courts and many other places.”

If the county commissioners had decided to bring services back in-house, it would have its own associated costs, Simmons said.

It would cost $9.4 million per year to staff to the levels prior to the new contract, according to county calculations. Also included in the county’s cost analysis is an estimated $500,000 to $750,000 in additional liability coverage, which would need an extra allocation of $10 million to create a liability fund. That’s on top of an estimated $350,000 to $500,000 for additional policy coverage, and upward of $1.2 million for IT costs.

Concerns about being able to fill all 52 positions, or 60 under the new contract, were also part of the equation for the commissioners, just as it was when NaphCare first arrived in Spokane.

The jail couldn’t find enough nurses in 2016, so the county signed a six-month, $2.6 million contract with NaphCare.

The county’s existing nurses initially worked alongside NaphCare staff. That didn’t last long. Nearly all of the original nurses left within months, citing concerns about the level of care and cost-cutting measures NaphCare had taken. The company eventually hired a few of those nurses.

Simmons said it would take a multiyear effort to get services to the level provided by NaphCare.

“Then you have to measure the successes, going back to retention, recruitment and doing things outside of our core competency,” Simmons said. “And we’re competing for the same group of people that those in the profession, that really focus on health care, do on a daily basis.”

Beeman said the union’s focus is on the mental health team, which is why they suggested keeping those individuals on by bringing all services in house. NaphCare is a for-profit company, so he understands their desire to expand services, and how the county was stuck between a rock and a hard place.

Spokane County’s difficult situation does not preclude it from taking the legally required steps of negotiating with the union about the request for proposals, and then the impacts for the union members on the behavioral health team.

“NaphCare is playing hardball with them, no question, but there may be other solutions for this,” Beeman said. “At the very least, we wish that they had started talking to us early on about this, so that for one thing, we might have been able to do more to cushion the blow for the affected employees, and figure out some things in a more timely manner.”

The county is working through the grievance process and impact negotiations with the union, which may go to arbitration in the coming weeks, Beeman said. The state’s Public Employment Relations Committee will run down the unfair labor practice complaints, and could have the power to send the county back to square one in securing a contractor, he added.

Simmons said there is not much he can disclose as the process is ongoing, but that the county is committed to seeing it through.

“At the end of the day, we care about our employees, and we want to make sure their well-being and impacts are at the forefront,” Simmons said.