Keep a closer eye on the Nassau County jail

There isn’t a lot of suspense about whether the hugely expensive contract between Nassau County and the Nassau University Medical Center for inmate health care services will be approved by the legislature on Monday. County Executive Edward Mangano has put no other option on the table.

The suspense will be over how well NUMC is able to provide the care, how the county will come up with all the money, and what the Nassau Interim Finance Authority, the state fiscal watchdog, does about the increased expense.

Armor Correctional Health Services became the provider in 2011 after NUMC refused to bid on the work. In the six years since, at least five deaths at the jail have been due to inadequate medical treatment, according to the state Commission of Correction.

The deaths led to an outcry, but repeated attempts to find another health care provider for the approximately 1,200 inmates failed, despite Armor’s threat to exit the contract early. In May, with no other options available, the county signed a three-month extension with Armor at a 66 percent increase over the previous $11 million annual rate.

The NUMC contract is structured very differently from Armor’s. This time the financial incentives are to provide more medical service rather than less. Armor got $11 million a year as essentially a flat fee — the fewer services it provided, the more money it made. NUMC’s deal is estimated at $42 million for two years, nearly double Armor’s original rate, but that’s a guess. Mangano says the county will settle up with NUMC on a regular basis, adjusting the payment if more or fewer services than estimated are provided, then adding an administrative fee of 16.7 percent. And the county will be on the hook for liability lawsuits.

Much of the increased cost comes from the switch from the private sector to the Civil Service Employees Association, public union workers who get better pay and benefits.

NIFA, the state board charged with overseeing the county’s disastrous finances, might balk at the new expense, but the board would have a hard time rejecting the only option to provide care. A county spokesman said the increased cost will be made up through non-personnel spending cuts in other departments. But wasn’t NIFA already told that spending was cut to close to the bone?

Then there is the county’s responsibility to provide adequate care to the inmates, many of whom are awaiting the disposition of their cases. When NUMC provided care in the past, there were also terrible problems, including a rash of suicides and Justice Department findings that correction officers’ handling of inmates who needed medical attention, as well as the care itself, needed to be improved and closely monitored.

In the past, two jail oversight committees have done very little while wrongful deaths have occurred. Hospital and county officials, including the judges who order incarceration, must keep a better watch this time around.