Spokane County Jail staff members allege problems with medical contractor

Update, June 13, 2016: Spokane County Jail nurses, speaking on condition of anonymity, said they were told Wednesday morning that NaphCare has appointed one of its doctors to serve as an interim medical director until it finds someone to fill the role permanently.

Detention Services Director John McGrath said that doctor is Raymond Mondora, an osteopathic physician and surgeon in Las Vegas. Mondora has never been licensed to practice in Washington, but he submitted an application on May 13, said Dave Johnson, a spokesman for the state Department of Health.

Mondora is quoted in a June 30 story by the Reno Gazette-Journal as NaphCare’s “western region medical director.” According to the story, Mondora testified in court that he is also filling in as the Washoe County Jail’s medical director and visits that jail twice a week.

McGrath said NaphCare’s medical director is contractually obligated to spend only 4-6 hours a week at the Spokane County Jail.

The nurses said they had not heard Mondora’s name until Wednesday morning. A nurse practitioner has been managing them.

A message left for NaphCare spokesman Brad Cain was not immediately returned Wednesday afternoon.

Original story: Tensions are high at the Spokane County Jail following the departure of two medical directors and a “bumpy start” to the county’s contract with an Alabama company that provides treatment for inmates, Detention Services Director John McGrath said Tuesday.

After years of struggling to recruit and retain nurses on the county’s payroll, Spokane county commissioners in May signed a six-month, $2.6 million contract with NaphCare Inc. The company implemented its own records system and filled 13 full-time positions with its own staff, McGrath said.

Two months later, some are unhappy with NaphCare’s performance.

“Nothing has gotten better,” said one nurse employed by the county who spoke on condition of anonymity. Even with a skeleton staff, “I honestly think we were providing better care before NaphCare came in.”

Another nurse, also speaking on condition of anonymity, said the company has forced some inmates to wait several days after requesting medical attention. Dr. Criswell Kennedy, a former medical director at the jail, said the company routinely canceled his treatment orders from its headquarters in Birmingham.

“They canceled orders, and as a result of that, our diabetics were having real problems,” Kennedy said. “I made phone calls back to Alabama and said, ‘Well what do you want me to do?’ and they always said, ‘We’ll get back to you.’ ”

McGrath denied that inmates are receiving a lower standard of care.

“I have not heard that it’s taking longer to get inmates seen,” he said. “In fact, I thought we were getting them seen faster.”

Kennedy was removed from his position several weeks after NaphCare employees started working at the jail. The other medical director, Dr. Gilbert Escandon, resigned July 1 and now oversees the county’s juvenile detention center. Escandon declined to comment, except to say he was not consulted in the decision to fire Kennedy.

McGrath acknowledged differences of opinion between Kennedy and NaphCare. He said the company plans to install a new medical director, although he didn’t know when. Without a doctor, jail staff can’t issue new prescriptions.

Messages left for a NaphCare spokesman Tuesday were not returned.

Companies like NaphCare typically offer to hire a jail’s nursing staff when taking over medical operations. In this case, only two county nurses shifted to the company’s payroll, McGrath said.

Now public and private employees are doing the same jobs side by side, and jail administrators are in tense negotiations with the county nurses’ union.

Gordon Smith, a union representative, said county officials have been unwilling to pay nurses competitive salaries and benefits.

“There’s not that many nurses that come out of school and want to work at a corrections center anyway,” he said.

Meanwhile, it’s not clear whether the county commissioners plan to renew NaphCare’s contract. Commissioner Al French said the board will base its decision on feedback from McGrath’s department.

“That’s a conversation that the board hasn’t made a decision on yet,” French said.

The jail is authorized to pay up to 22 registered nurses and four licensed nurse practitioners. When it hired NaphCare in May, it had only 10 RNs and two LPNs. Three RNs had quit in anticipation of NaphCare’s arrival, intensifying the need for immediate help.

McGrath said the situation was changing rapidly, and jail administrators allowed NaphCare to “hit the ground running.”

He acknowledged it was not a smooth transition.

“It was a pretty bumpy start,” he said. “When it all came to fruition time, we didn’t have a great implementation plan.”

Kennedy, the former medical director, said NaphCare employees threw away supplies and equipment and nearly lost thousands of medical records while replacing the jail’s computers.

“They would have been lost if we hadn’t insisted that they bring back the computers with that software,” he said.

Kennedy said he thinks the commissioners “are under a mistaken impression that this contract protects them from lawsuits.”

Like most companies in the prison industry, NaphCare has faced numerous civil lawsuits. Earlier this year, the family of a Virginia man who died at the Hampton Roads Regional Jail sued the company for $60 million, alleging he starved to death in his cell under NaphCare’s watch. The company has denied any wrongdoing in Jamycheal Mitchell’s death last August.

The county jail also has faced lawsuits over medication practices.

Kennedy said he’s retired and doesn’t “have a dog in this fight anymore,” but he remains skeptical of the decision to hire NaphCare.

“They’re not saving any money, they’re not hiring any nurses and they’re getting all of their information from this company in Alabama that has a kind of questionable past,” Kennedy said.

McGrath said he’s worried more nurses will quit.

Said one nurse, “If NaphCare stays, I’m out.”