If St. Louis chooses to privatize healthcare at the Buzz Westfall Detention Center and Family Court Juvenile Justice Center, the county could end up announcing a deal with a contractor any day now.

According to documents obtained by Shadowproof, St. Louis “anticipates selection of an apparent successful proposer at the beginning of October 2015.” A contract could go into effect approximately six weeks after the selection, following a review by the County Council.

The document, titled “Answers to Proposers Questions,” was filed in August of this year and provides greater detail into an opaque bidding process for a lucrative contract to provide medical services to over 1,000 inmates in St. Louis. It also serves as a window into the serious and expensive healthcare needs currently facing the county.

The St. Louis County Department of Public Health declined to provide further information on the individual bids or interested parties, stating “responses to the RFPs and related documents are closed records at this time.”

The adult facility has an infirmary with twenty-eight beds, eleven of which are for medical care and the rest for psychiatric care. One psychiatric bed includes a “special needs cell.”All infirmary beds are typically in use.

St. Louis County does not have a mental health director for its jails, and the contracted Chief Medical Officer “works closely with contracted psychiatrists” to organize mental health treatment for inmates.

The Juvenile Detention Center does not have an infirmary or medical housing, but does have a clinic that operates Monday through Friday, 6:30 AM to 3:00 PM. One half day per week is allotted for psychiatric care for juvenile detainees.

While this might not sound like a very large medical operation, it can generate large expenses.

The county explains it is exploring privatization for “cost containment, quality control, and the deployment of universally accepted optimum performance standards for the delivery of corrections medicine as identified by the NCCHC and ACA.” The county says it is open to evaluating all “cost saving pricing models,” such as shared or capped risk models.

There are notable areas for which contractors are not responsible for covering expenses, such as in the case of “extraordinary and/or experimental care,” elective care defined as “care which if not provided would not, in the opinion of the medical director, cause the inmate’s health to deteriorate or cause definite and/or irreparable harm to the inmate’s physical status.”

While it may make sense to protect the contractor from having to pay for whatever medical procedure an inmate wants, this distinction has been abused in the past to keep inmates, who are seriously ill, from receiving proper treatment.

The document states there have been five lawsuits dealing with the Buzz Westfall Detention Center in the last three years, but they have not made any settlement payouts. It also indicates the county is not currently under investigation or review by any government agency for health care services provided. No actions are bound by any consent decrees.

The contractors had a lot of questions about cost containment and liability because such decisions directly impact their profits. They will be on the hook for ambulance services and the disposal of bio-hazardous medical waste. They will be responsible for paying for treatments associated with bleeding disorders.

A table outlining annual expenditures for the last two years shows that staff, medications, and offsite care are the biggest costs facing the jail medical program.

Although the figures include a small number of juvenile inmates, all of whom have their medical needs covered by Medicaid, offsite care expenses totaled $1.5 million for 2013 and 2014. Staffing costs more than doubled in that same year. And, even though pharmaceutical costs fell by more than $100,000, they still totaled nearly $836,000.

The county spent $800,000 on inmate hospitalization in 2014, and $320,000 as of June 29th. 

For mental health and psychotropic medications, the county spent $293,000 in 2013, $440,000 in 2014 and $231,800 as of June this year, putting them on track to spend more this year than the year before. The county also revealed it spent over half a million dollars on HIV/AIDS treatments from Jan 1 2014 to August 15, 2015.

In the past year, the county has seen 212 inpatient offsite hospital days, 51 outpatient surgeries, 55 ER referrals resulting on hospitalizations, and 300 trips to the ER. There have been 298 ambulance transports, 58 dialysis treatments, and 524 outpatient referrals. The average number of sick calls per day is 11 at the Buzz Westfall Justice Center and 4-5 per day at Juvenile Detention.

In 2014, there were ten suicide attempts at the jail and one attempt at the “hospital post.” There have been ten attempts this year so far, one of which was successful.

The document reveals the detention centers are understaffed — positions have been left unfilled and staff appear to be covering for one another.

In response to a question on current health service vacancies, the county responded:

Current vacancies are 2.4 Registered Nurses. Due to the potential for privatization, a Lead Nurse is covering the Utilization Review Coordinator position and a Psychologist and Office Services Coordinator positions are not being filled until further notice.

When asked if use “Telehealth,” which is technology that allows doctors to communicate with patients remotely (a cost-saving measure), the county said it would be willing to entertain” the idea.