NaphCare splits with Spokane County on jail health care over legal concerns, no new contractor named

The contractor responsible for health care in the Spokane County Jail has severed its ties with the county, leaving local officials scrambling to find a replacement.

Spokane County will have until the end of December to find a new contractor, or to stand up its own medical services within detention facilities after NaphCare and subsidiary company Everhealth notified the county of their intent to end services.

Spokane County CEO Scott Simmons said the county learned of the contract termination at the end of June – just five months after the county commission approved a costly and expanded contract renewal with the Alabama-based company. NaphCare has provided medical, dental and pharmaceutical services in the county jail since 2016, but the late January renewal expanded the agreement to include behavioral health services.

The expansion of NaphCare’s responsibilities would have meant layoffs for the county’s 10 members of its in-house mental health unit, who Simmons said will now be retained after the cancellation.

Simmons said the county had an inkling the termination was coming; he received word earlier this year that NaphCare had walked away from renewal negotiations with counties across the state. In Spokane County’s communications with NaphCare after inquiring about those negotiations, Simmons said the company indicated it had no intention of opting out of its recent agreement.

“That was what we heard; we’ve been in conversation with them, working on all of the things that we’ve been looking to implement,” Simmons said. “And then June 30 came, and we got a termination letter from them.”

In a written statement, a NaphCare spokesperson told The Spokesman-Review that the company elected to terminate the contract due in large part to “the unreasonable exposure to litigation risks we face in this jurisdiction.”

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 if she received proper medical care. The county filed a lawsuit against NaphCare related to the 2022 case last week seeking a reimbursement for the attorney fees and costs Spokane County paid while the company launched a failed appeal attempt, but Simmons said the lawsuit and the recent contract termination are not related.

“That would have been done regardless of them giving us notice, because we had to secure our position under the statute of limitations, and while we’re working with them on getting that reimbursement made to us,” Simmons said.

NaphCare has also been found liable, and hit with multimillion-dollar award decisions, elsewhere in the state. In April, 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, as reported by the Tacoma News Tribune. That decision, which NaphCare plans to appeal, comes after a settlement of an undisclosed amount with the estate of a Bonney Lake man who died in the Pierce County Jail from an infection in 2015.

Pierce County Chief of Corrections Douglas Watkins said via email Tuesday that he could not comment on the entity’s “potential future partnership with NaphCare.”

“Several factors remain under consideration, and no final decision has been made,” Watkins said.

A NaphCare spokesperson did not offer much insight into the negotiations and agreements elsewhere in Washington. The spokesperson also did not disclose if the company is pulling out of the state entirely, writing in an email that NaphCare remains committed “to providing high quality, correctional healthcare services and technology for incarcerated populations in the State of Washington and across the country.”

Simmons said Spokane County’s contract included the option for either party to terminate the agreement with six month’s notice. Despite the company’s messaging to the contrary, Simmons said the county began making plans ahead of the termination notice for how to move forward without NaphCare, “just in the event that what happened did happen.”

Simmons said the county is in communication with a handful of companies that provide similar services, after touching base with other Washington county governments. The county hopes to find a replacement, rather than standing up its own in-house services again, due in large part to costs and administrative burdens, Simmons said.

“We’d already had those plans underway just as an extra precaution,” Simmons said. “We didn’t want to be put in the situation of not having a plan, so we’re working diligently towards narrowing that list down and finding a fit for our services.”

Finding that fit will likely take a herculean effort and plenty of cash, if recent history is any indication.

In March 2024, with the end of NaphCare’s previous contract in sight, Spokane County put out a request for proposals from companies interested in providing medical, dental and pharmaceutical services in the jail. Not a single company responded, Simmons told The Spokesman-Review in February.

The county made a second attempt in 2024 to draw interest, lumping behavioral health services in with a renewed request after the nonprofit National Commission on Correctional Health Care advised the county that best practices would include all services integrated under one operator.

NaphCare was the sole respondent of the 19 companies that showed some initial interest in the second request, as previously reported by The Spokesman-Review. The companies identified as potential replacements thus far are among those who did not respond to either of the 2024 requests, Simmons said. Regardless, he is confident the county can reach an agreement by the end of December.

The lack of competition in 2024, and potentially the jury award issued three years ago, may have had a direct impact on the additional costs the county would have had to shoulder under the renewed contract with NaphCare.

Under the multiyear contract approved in January, NaphCare will be paid $15.9 million for the first year, and would have received $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 2025 while a larger contract was fleshed out, as well as $250,000 for an upgraded health records system.

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 in 2024 for its in-house behavioral team and NaphCare’s medical services combined. The increase drew some pushback from county commissioners, with Commissioners Chris Jordan and Amber Waldref citing them as part of their reasoning for voting against the contract renewal earlier this year.

Waldref and Jordan did not respond to requests for comment ahead of publication regarding the recent cancellation of the contract. Commission Chair Mary Kuney and Vice Chair Josh Kerns, who approved the renewal in January alongside Commissioner Al French, also did not return a request for comment Tuesday.

The county commissioners will not meet again until Aug. 11, after their two week summer hiatus . French said he expects Simmons and county staff to “continue to move the ball” in the meantime. He hopes to avoid needing to stand up an in-house department to meet the county’s responsibility to provide care, citing the same staffing and cost concerns as Simmons.

“I hope we don’t have to go there, but if we have to, we have to,” French said. “We were there before, and I’m sure we can go there again. It’s just a little bit more challenging.”

Simmons said contracting out the work remains an attractive option for county leadership because in-house services would require a hefty investment, without the guarantee the county would be able to recruit and fill all positions.

The county looked into the possibility of standing up a unit when NaphCare’s contract was under consideration for the renewal and found the initial costs to be more than $20 million. Staffing and tech improvements would cost the county around $11 million, additional insurance and liability coverage another $1 million and a liability pool would need to be established at a minimum of $10 million.

That’s if the county was able to fill all positions, which it struggled with for years prior to privatizing medical care in detention facilities nearly a decade ago. Simmons said it would be hard for the county to compete against hospitals, clinics and more established health institutions in the region.

“Getting into a line of business that is highly competitive, has specialized needs – it’s not a core competency of ours,” Simmons said. “We believe it’s still in our best interest, and the individuals receiving services’ best interest, to have a third party that has competency in this area.”

Simmons believes that the many NaphCare employees currently working in the jail may also add some value for interested companies, as they may be asked to stay on during the transition.

“Transitions can be challenging, but being able to have employees who want to stay with what they’re doing for this new company and have a job with them, I think will be very advantageous for the company and for the county,” Simmons said.

NaphCare declined to share its intentions for the dozens of people currently employed by the company within county detention facilities, adding that they are “confident that Spokane County will work out a plan to ensure the smooth continuation of healthcare services and will strive to keep all current staff.”

“We are deeply grateful to our employees, clients, and community partners for their support and dedication,” a NaphCare spokesperson wrote in a statement. “Our top priority is providing resources and assistance to support this transition period.”

While the hunt is underway, local municipalities that rely on the county for contracted public safety services will have to wait to see how they may be affected. Additional costs for counties usually end up with the local municipalities and taxpayers, rather than with the state and federal levels.

“As a jurisdiction that receives their law enforcement and public safety services through the county, we would be very concerned that, should the county not be able to establish a contract with a new provider, there is the potential for a significant cost increase to the county and potentially to paying jurisdictions for these types of services,” Millwood Mayor Kevin Freeman said.

The scramble for a new medical services provider comes as Spokane County is facing larger budget challenges, including an estimated $20 million deficit by the end of the year. Simmons said the county is keeping a close eye on the eventual contract costs as it moves forward.

“I’m optimistic that the companies will be sharpening their pens and making sure that we get very good competitive bids on it, but certainly, it’s an overarching concern,” Simmons said. “We’ve got a finite amount of revenues, and we have to be able to provide a balanced budget for the commissioners to pass.”