A Jacksonville Sheriff’s Office vehicle parked outside of the Police Memorial Building. [Andrew Pantazi/The Tributary]

The last time Jacksonville quietly signed a contract with a jail medical care provider, 71 people died within five years, the jail was put on probation by a national medical accrediting agency, and the provider hid that it had been convicted in connection to the death of an inmate in another state.

Yet Jacksonville leaders did it again, signing another massive no-bid health care contract. 

The Jacksonville Sheriff’s Office signed the new contract with a different for-profit company in July without opening a bidding process or telling the public until after it was done — and only after reporting by The Tributary forced the Jacksonville Sheriff’s Office to announce its decision. 

The Sheriff’s Office hasn’t said who wrote the contract with NaphCare or what makes Sheriff T.K. Waters certain that medical care under a new private company will be better than it was under Armor Correctional Health Services, the former provider.

The Tributary requested records related to the contract procurement, but the city and Sheriff’s Office only provided the contract.

Both NaphCare and its predecessor, Armor Correctional Health Services, are fraught with controversy: hundreds of federal lawsuits filed against them, gruesome and preventable deaths of inmates and millions of dollars worth of fines for not upholding contractual standards. 

READ: Jacksonville’s jail death rate tripled after privatizing medical care

Susan McCampbell, the president of the Center for Innovative Public Policies who is frequently tasked by federal courts to oversee problematic jails, said it is possible for sheriff’s offices to contract with private companies successfully. 

But in order to be successful, cities and counties need to include medical professionals in the drafting of any medical-related contract, she said.

The Jacksonville Sheriff’s Office wouldn’t say who wrote the new contract.

The NaphCare contract mirrors the Sheriff’s Office’s old one with Armor almost exactly, raising questions about how the jail will ensure medical care improves, especially given NaphCare’s track record of settled lawsuits, fines from frustrated sheriffs’ offices and even an ongoing federal investigation.

When asked if Waters would sit down with The Tributary to discuss his review of NaphCare, a spokesperson said, “You may circle back to this six months after NaphCare is up and running.”

Mayor Donna Deegan’s office referred questions to JSO and declined to comment. Deegan previously said that she entrusted Waters with the decision of how to handle jail medical care.

Naphcare’s other jail contracts

When Waters announced his decision to sign with NaphCare, he said he did a “deep dive” into the company and was confident about their ability to care for Duval inmates. 

Waters hasn’t said what that deep dive included or why he felt confident despite all the negative headlines that have followed NaphCare.

There’s the Georgia man who entered a NaphCare jail with no disabilities and left unable to walk, bathe himself or use the bathroom because staff ignored his pleas for medical care 

There’s also the story of the Seattle woman who, in 2018, died after spending four “torturous” days naked in her cell while having a mental health crisis that was ignored when NaphCare employees “covered the window of her cell so they did not need to look at her, put towels in front of the door so her vomit would not leak into the hallway,” according to a settled lawsuit that cost taxpayers $2 million.

When reporters asked Waters about a man who died in a NaphCare jail after allegedly being “eaten alive by bed bugs,” the sheriff said issues like that happen in jail facilities.

“But at some point, you have to look through it very carefully and make sure that you’re making the right decision,” he said. “I think we did. And I’m looking forward to the opportunity to have them serve our inmates.”

That death helped spark an ongoing U.S. Department of Justice investigation into conditions at that jail.

Despite saying he had announced the new contract to remain transparent, Waters didn’t detail what he found or what his deep dive entailed. He only said the company came “highly recommended” by Hillsborough County Sheriff Chad Chronister. The Tributary asked the Sheriff’s Office for copies of emails between Waters and Chronister, but the office said there were none.

The city’s NaphCare contract is nearly identical to the one the city inherited when it piggybacked off of Broward County’s Armor contract.

“Some jails get into trouble because they borrow contracts from other jails,” McCampbell said. “It’s the worst possible scenario when the potential vendor says, ‘Oh, here’s the contract. How about you look at this?’”

And, sometimes, contracts aren’t strong enough on the details of how a company will be held accountable when something goes wrong, she said.

The Sheriff defended his decision to sign with NaphCare to Action News Jax, saying the issue with Armor was JSO’s internal audits, not the contract. “The issue was the auditing system wasn’t what it should have been, and that’s from our end.”

“We’ve addressed that, and we’ve changed that, and they’re going to be held accountable if there’s a problem,” the sheriff told the station. 

On Tuesday, Waters expanded on those comments, shifting blame to the former internal auditor while speaking on WJCT’s First Coast Connect.

“There were some shortcomings,” Waters said. “We changed the auditor, and we have a new auditor, and they’re raving about them right now.”

The former Health Services Compliance Manager resigned on June 26, citing “personal reasons.”

Waters told the radio station that the contract includes an extra line that would allow JSO to renegotiate prices if the city wants a change in service, but did not explain what that meant. NaphCare also has stiffer penalties than Armor did if employees fail to meet contractual obligations, including a $5,000 fee if they don’t retain state and national accreditation.

But other jails have had a hard time getting adequate care from NaphCare even after using fines.

Pima County has fined NaphCare $3.1 million since February 2022 for failing to uphold its end of the contract. Yet NaphCare remains chronically understaffed and continually fails to meet contractual standards of care, Arizona Luminaria reported. 

In one wrongful death lawsuit, an Arizona family claimed NaphCare officials failed to safely detox incarcerated people and safeguard them from obtaining illegal drugs inside the jail.

Those stories mimic issues present in Jacksonville’s jail under its previous medical provider. 

The city recently paid a $10,000 settlement to the family of 28-year-old Lina Odom, who died in 2018 after medical staff allegedly mismanaged her withdrawal symptoms. Armor agreed to pay a $170,000 settlement in her death. 

Since January 2022, at least seven people have died of an overdose while held in the Duval County jail, according to reports from the county medical examiner and the Sheriff’s Office. Of those deaths, at least four occurred after someone got drugs from within the jail. The Sheriff’s Office has denied records requests for more information, citing ongoing criminal investigations.

A DOJ investigation

In 2019, the auditor for Fulton County, Ga., reviewed NaphCare’s track record in the county jail. The audit examined 50 intake files and found that 8% of inmates didn’t receive a pre-booking screening or mental health screening, and 17% did not receive a 12-hour examination. 

This review is similar to one the Armor-run Duval County underwent in March. The National Commission on Correctional Healthcare found that staff did not finish initial health screenings – which are supposed to be done within four hours of an arrest – about 65% of the time. The review also found staff did not complete 30% of 14-day health screenings.

The review went so poorly that the agency put the Duval jail’s accreditation on probation. 

While Waters wouldn’t answer The Tributary’s questions about that inspection, on First Coast Connect, he said the review was “why I changed providers.” He still wouldn’t say what JSO was doing to ensure its death investigations were more thorough — which the accrediting agency dinged JSO for. He also wouldn’t say how the Sheriff’s Office rectified other issues brought to light during the inspection.

The day The Tributary reported on what led to the jail’s probation, two Jacksonville legislators called on the Department of Justice to investigate deaths at the jail – similar to the investigation the DOJ is already doing at the Fulton County jail with a NaphCare contract.

“People in prisons and jails are entitled to basic protections of their civil rights,” Attorney General Merrick B. Garland said when he announced the Fulton investigation. “We launched this investigation into the Fulton County Jail based on serious allegations of unsafe, unsanitary living conditions at the jail, excessive force and violence within the jail, discrimination against incarcerated individuals with mental health issues, and failure to provide adequate medical care to incarcerated individuals.”

When Rep. Angie Nixon and Sen. Tracie Davis announced their request to the DOJ, they cited the Tributary’s reporting about the sharp rise in jail deaths.

At the time, Davis said, “The pattern of failure to care for human lives is abhorrent and irresponsible. The actions by Armor warrant investigation and correction.”

Nichole Manna reports on the criminal justice system in Jacksonville. She has previously covered criminal justice at newspapers in Texas, Kansas, Nebraska, North Carolina and Tennessee, but is originally...