Urgent fix needed at Nassau County jail

The state Commission of Correction found last year that Kevin Brown’s 2014 death at the Nassau County jail might have been prevented had he received “proper medical care and supervision.”

That was at least the fourth time the commission found Armor Correctional Health Services’ treatment of inmates inadequate since the company began providing care at the East Meadow facility in 2011.

Brown, 47, of Far Rockaway, died of heart failure. The report said Armor mismanaged his mental health diagnosis and his seizure disorder, failed to detect or manage his heart disease, and gave inadequate psychiatric care, among other shortcomings.

John Gleeson, 40, died at the jail in 2014, suffering from a swelling condition that can lead to breathing emergencies. A state corrections report on his case said the care provided to the Oceanside man was “incompetent and deficient,” and it questioned Armor’s treatment of inmates statewide, finding the company had a pattern of inadequate and neglectful care.

The state reports on two other deaths of inmates under Armor’s care are also disturbing. Both the state attorney general and the Nassau County Legislature have launched investigations into Armor. Adding to the alarm, a nurse employed by Armor was arrested earlier this month on felony charges of smuggling drugs and weapons to inmates.

The answer seems simple: Get a new provider. That change, undertaken in a timely and prudent manner, is part of the solution. But the issue is complicated by the jail’s past, the lack of oversight of prisoner health care in general across the state and the nation, the unsophisticated way the Armor contract is structured and the difficulty of providing quality care. It will take more than just firing Armor to fix this.

The history of the facility, which includes one building from the 1950s and another from the 1990s, is troubling. Both the jail and the medical care provided by the Nassau University Medical Center were under federal oversight after an inmate was beaten to death by corrections officers. The Justice Department found that the prison’s internal investigations, its use of force and its medical care needed overhauls. Federal oversight was eventually lifted after improvements at the jail. Things got better for a few years, and NUMC continued to care for prisoners. But in a 12-month period in 2010 and 2011, four inmates committed suicide, including one who hanged himself at NUMC.

In 2011, Armor began providing care after responding to a 2009 request for proposals. There have been benefits to the switch. The company brought the county savings of $7 million a year in health care costs, according to Sheriff Michael Sposato, and overtime to corrections officers has been cut by as much as $10 million a year under Armor, because so many more services are provided at the jail rather than off site. And Armor is liable for lawsuits related to medical care now. When NUMC provided care, the county took on the risk.

Medical facilities in the jail are basic but adequate, and the protocols seem sound when followed. But there have been too many deaths. And some of that may be due to a contract that is almost entirely flat-rate, paying Armor about $11 million a year regardless of how many health services it provides or the quality of its care outcomes. That can lead to disaster, because it means every service denied is pure profit.

County officials say they can’t fire Armor without cause immediately because Nassau would face penalties, although the contract doesn’t seem to say that. Nor does it explain why Nassau gave the embattled company a two-year contract extension in June. But the reality is that Armor can’t be fired immediately because someone has to care for the prisoners.

Four state reports citing Armor negligence in inmate deaths appear to give the county cause to end the contract, and ongoing investigations by the state attorney general and the county legislature are unlikely to contradict those findings. So the county ought to end its relationship with Armor as soon as it can issue a request for proposals and get a new contractor. Officials say such an RFP is being written.

But that’s not all that’s needed.

The contract needs to be structured to reward the provider for doing a great job, rather than simply paying a flat fee. A change in jail culture is required so inmate health is a top priority to corrections officers and management. And health care at the jail needs better supervision by County Executive Edward Mangano, the county legislature and two prison oversight committees that aren’t always on top of the issues. And, like all jails in New York, Nassau’s needs more consistent attention from the state Commission of Correction, which generally only monitors health care when problems arise.

Many of the inmates at the Nassau County jail haven’t been convicted of crimes — and even if they were, no one deserves to die because of haphazard medical care.