Appendix Armor?s Response

 

  

Armor Correctionei Health Services, his.
4960 SW 72nd Ayeooe, Suite-400

7-  3355
Aime: imam}, Fior: '1 ?i

Cameos? wee Senses, Fr;

September 12, 2016

Ms} 10mm Greene
Director of Fieid Audit
Oiificeof'the Compirolleif
Nassau County

240 Old Country Road
Wheels-NY 1150?!

Dear Ms.- Greene:

Thank you for the opportunity to respond to the Comptroiler?s review (Review) and
findings regarding Armor?s sewice at the Nassau County Correctional Center As
you may be aware, certain parties, with their own agendas, have been using various
platforms to voice opinions and perceptions that appear to be disingenuous. These parties
have not sought the truth by offering its the opportunity to respond to their assertions, and
we appreciate the courtesy ofyour offer.

We acknowledge and agree with some of the findings and recommendations oi?tile Review.
However, it does contain incomplete information, misstatements, incorrect assumptions,
and conclusions we believe are inaccurate. in addition, some ofthe recommendations had
already been" implemented prior to thisi'eport. i have summarized these items b?eiow and
xvii! pzrovide'any additional information that may  needed to fui'ther clari?n

On page 2 and Exhibit iil on page?, the figures listed as Aenor?s 
misleading. The numbers moorteci do not re?ect coz?poi'ofe support costs and
provision for Federal income-Toms, jni?inoifs?actual lietincome and
2015 was $299,346, $448,138,1aml $792359}, z?espectiveiy.? Armor?s net-income as 
percent of revenue for 2013, 2014,3nd'2015 were actually 2.28%, 
6.21% respeeiiveiy,

2. Page 2, footnote .4 cites the Suffolk) Nears ass source'for?infoymatioo about our 
contract. We are perplexed why we Were? not asked of the Niagoretraosition. What
is represented in the Review is Arniorjniad'ea conscious decision not to
extend the Niagara. comma. This-Was done Withio?a Boomer that snowed the
Niagara Office Suf?cient RFP.
Armor (lid fictsobioit a bid to respond iofthe aoeor?ly
transition to awe} :1 the dif?colties with recruiting and employee.retention dining the
holiday-season. We ea've'incmdee :1 letter: Of from the successor

 

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medical whigh {loeume?t both the efforts that Armm?expended, as well as
the '1"_es_L_zlting sma 0th transition.

3. The is sometimes ixiisused in the Review to describe the medical
services unit as a x-vlzole. The in?rmazy is a speci?c area within themedical services
unit that Armor" established to nm'nage care for patients who needed greater
attention than would be available'in the. galleml population, but not so great that it
required hospital establislnnentand cil'cctiveoperation of the.
"in?rmaz?y are material Contributions to the significant. reductions in off-site cafe and
County expense fonovertime.

1L midi: Finding 1 Employee Turnover

a. We acknowledge the turnover rates noted in the Review.- However,-these'
statistics should beplaced in appropriate cozit?xt.- National turimvel? rates
threughout the medical prefesslon are higher than in most other 
"and {m'noverl?or these pesltiens in correctional'se't'tings'is signi?cantly
-highe2?_given_the_ extraordinasy challenges of the work and {besetting
Repm?ting Ar?mor?s tumbver rate withcm't providing more speci?c reference
poilits is misleading. 

Armor expended signi?cant human and ?nancial resources in its efforts to
nmiiz'tain appi'epriate medical staff. in fact, as has been clearly 
on average Armor exceeded the contractual staffing requlrements by at least
5.0 WES-over the life of the contract at 1116051; {0 Avatar of over $1.5 minim},
which was notljilled to Nassau Sheriff?s Of?ce. It is well 
the commencement of the contract that certain cerl?eetional staff were not in
favor 0F privatization efthe correctional healthcare and lzaveconsistently
created obstacle?s and-at times ac?ted'hostile tosvards medical staff.

Over the last year, this situation has been compounded by the inaccurate and
one43ided reporting in themedh. It Should be noted'?hat these abusive

- matrices continued throu?gheuti the contract in spite of multiple efforts
by Sheriff Spes'ato and other members ef NCSO leadership to curb Such

bene?tin-

b. We": challenge theetate'ment (in page 7311' the paragraph following tlxejbullets.
that'f?No oz'gauizatiozrc?an meet its mission of qualitycm?e with 60% tilrzjo'veir
rates.? 

While we ?eknewledgezihe Challenge-that signi?cantturnpver presents, this"
is a Subjective statement and Of?ce does not have the
p'rol'essim?ral expertise to make Such a blanket statemem.

 Regarding the Irec??llhendatidn t0 rely less on" part?time and per die'm 

workers: Arlee? agrees th at permahe?r empl oyt?esaremfeferable to per"
(Hemistaff. ?owevei?, maintaining a streng per <liem pool is an important

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_z'esource_to help ensure availability ol?staff in the event tltat'permane'nt staff
. is not available Availability of PRN/ongcall/per client employees a
variety of situations, such as:-

?amed Leaves-
Leaves
Emergencies
24/? Staf?ng Needs.
Training



Most ?RN/on~call/per cliem employecsappreciate their status. because 01? the
"greater flexibility and Clintrol it offers illem and typically their increased rate
fof pay. 

Another benefit'of PRN/on-call/pez? diam is that the employee 
employer relationship is already established and when permanent positions
become available, a pooljof maimed, vetted prospectsis readily available. This
helps to reduce recruiting costs and iocrea-se retention rates. __Th'ose
employees are already trained; understand the faculty operations, aod are
typically Committed tothe organization. I

Regarding full time employees, there is no discernible difference in the
quality of Work between full-time and part-time workers-in fact, litany more
workers are requesting part-time selledules than in the of the
most important issues in recruiting and retaining medical staff is the; ability
to meet their schedule needs. 

This recommendation should be eliminated.

(1-. Armor has been conducting exit interviews since the beginning of "the
"contract, whenever possible, The he '11ng we have itleh?l?le?tl include those
re?ected in our responses above, as well as an indication Offear'w

-_retributlon from corrections of?cers and '3 general lad; ofs?curity, This is
validated by the currentcorrections Unioo PreSltlent when he publically
commented aboutcontraband; It; is his stow-thrills responsible for security.

.5. Audit ?nding 3 - S'aekgz?otmd and Reference Checks-

Regarding page 19, paragraph 4. minor applicants mast first pay for their
?ngerprinting; 'O'n'ce the ?ngerprints are completed and the batikground
check is mag-toe results az'e'sent'to the'Sh?rlfl?Ts Of?ce. The Record 'OfAz?i'eSt's
and PrOs'ecu'tlonszAP) sheet is reviewed and we are isotilled by the Sheriffs
Oll?ic? whether or not the applicant can be hired, Initially we were noti?ed by
phone, but we now receive clearance infomnatlou by email and place the
documentation?in tho employee?s personnel?le. 

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Appendix Armor?s 

 

It is? important to note that, although this change does improve
documentatmn, it was net a genuine security issue, since no individual can
even entergthe facility property withoot ?rst-being cleared by the Sheriff's
O'??ice. There is no opportunity for any employee to begin Work Without ?rst
getting clearance from the Sheriffs Of?ce.

13. Regarding page 10, paragraph 6. Reliance on any purported "?ndings" put
forth by the its reporting is misplaced. The reports consist of
bellerplate predatermined "Outcomes attributing fault to private'modicai
providers statewide, and are consistently inaccurate With respect to the facts
and applicable medicine-in the cases they address. Further, Armor lms'?zot
beenjaffordecl ample opportunityice-Challenge the reports.

To cite the "evidence-ofpos'sibie inadequate medical care" as support
foryourconclusion is not appropriate,?Todate, no confines permitted on 
report to housed as evidence in any latvs?it brought against Armm'.? 0n
the other hand, reports haw: been precluded from evidence due to the
nature of the reporting and its extensive relianm on unsw?om hearsay,
among other things, 'st 

   

Further, the statistical date obtained by indicates Armor
exceeds the performance of otller'New?York jails.

While we reiterate'ouz? acknowledgement oftlie dif?culties in lil?liit?liil??
staff} neither year report, nor any otlier'presentation effects demonstrates
that on? hiring practices were?deficient. We emphatically cl-i'alie'nge that
Concmsion. 

Regarding Audit. Recommendations oz": pages Iii-11.1% noted above, items
"'de and are already in place. With regard to it is against NCSQ policyl
'for- the Sheriff?s Of?ce to provide Armor with copies of the background
checks.
6. Audit ?nding 4 - Standards] Policy Compliance

We challenge thisi?mtiing. Armor?si?olicyand Procedure Mental-has already
been updated to-iziclude the 2014- Standards. 

1). Regarding Audit Recommendations on'poge and 
Procedure Manual does have the revised dates listed in the bog-when
indicated, and the entire manual is signed oii'by the HSA am: Medical
Director These signatures are on the coversheet, not each policy.

7-. Antiit ?nding 5 - Rearmed inmate Health Costs

The Review significantly understates the total savings realized bythe County:

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Appendix Armor?s Response

 

The report i?zfom'the' Couhty's' Office or Legisiatiw: Budget
Review (01.8 docm'nented $25.7 miilion niedicai expenses for the M110
in the year befm?e Armor; In the most l?c'c'ent contract year (2015-16), {he
{Icunty reimbursed Az'l'ncr a total of $13.2 miliion a' decrease of
50%; 

 

Expanses

in miliiozfz's

 

 

 

 

 

 

 

Prior to Armor Armor 2013416

 

Further, the able to realize thesesavings while

Siinuitaucausly experiencing an increase in the overall Quality ofcare.
By improving ef?cienciE-s and reducing unnecessaly expenses, Armor saVed
approximately $58 million m1- the past ?ve yearsl (per the OLBR .
report]. 

2). These mtmbers do no: consider inflation or the fact. that the Costs
increased by approximately the last foul'ycars' of its'cczitract, whereas 
Armor?s cost to the County decreased by 11% it} the ?rst {cur years of
cur- contract.

 We take to the characterization of our heaith care as anything
less-than adequate, 

Audit '?ndii?zg 6 Medical 

a. only patients that-are 
for inpatient Care. Our Current; recqg'ds; in'ccmpiiznicc Withreguiaticns
applicabie toin'c?ifccratcd indiyi'dii?ls. We do nbtbiil M?dicaid/Mcdicare 01'
any entity; At'mcr has re'pcatc'diy? diSCuss?d the impichientation of 

 

I Calcgilatcd a: {licfxiifl?eziCQCQ of actreclicna? ccnicr contractuai expcuscs 3;:ch couccsicgal expense pa; inc
OLBR {cyan in 20.11 ($46.4 millicu) as conipnr'cii to each ol?lhe'sub'scmient four years.

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Appendix Armor?s Response

 

with however the facility physical infrastruao're has contimzally been
a barrier. it has been on {he Medical Audit committee "agenda sili'cejZO 11.

Regarding Audit Recommendations on pages 15-16; item axis noted above,
internal facility limitations currently prevent the installation of an
electronic medical record. Item b: As Stated challenge the ?ndings
and conclusions ofthe SCOC. Item we aickil'oivie?i'ge the need to improve
CQI process. 

.Audit?nding 8 Equipment

.3.

We aclm owl edge that at the timeoftlie Rolliew, we were not able ?0 provide
an updated equipment list. However, we challenge the issue raised in the
first bullet point on page 18. Armor?s site medical director has a thorough
working knowledge oi?the medical equipmentavailable and therefore can,
and does, make determinations regarding appropriato on-site Care. 

b. To date, Armor has not billed the County for equipment purchases-as

elloWed by the contract. in the hear more, Armor will an
invoice {with appropriate documentation} for reimbursable expenditures.

Audit ?nding 9 Review oi?fosite Medical Expens'os



The heading is misleading and implies that Armor is not meeting one of its
responsibilities. amm- gloes employ medical professionals to review all off-
site expenses. it is the. County that does. not.

"The ?rst paragraph mis's'tates the "?nancial responsibility for costs over

$?50;000c Armor is responsible for 60% and the County-is resraonsible for
40%. 

11. Audit finding 10 ?'Errors ?rst?tistioal Reporting-

El.

b. Armor has repeateciiyrequested that the County/make thenecessaiy changes 1

We acknor?edge' the formula error asinclicated in the Review and have taken
steps to correct such arrests in the future; 

to thephysicol plant required to implement an EMR. this Esme has
"been, "and romains', beyond Al'l'?dl?s control. 

12. Audit ?nding 11 State Commission Recommendations

a. ?As stated previously; Arniortak?s strong exceptioobotli to 

as we]; as their co'ocl'usio'o's._ We responded to each 0f the 
reports and we did not agree withiheizf ?ndings. Sixot?the 12 patients-

3.exp_ir_ed_ while at. NUMC i-iri'th an average length of Staybet?-yeen  andw days. I

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Appendix Armor?s Response

The  investigation process is botlz'iocomplete and biased. in support of
{bio statement,  otter the following:

9 Their investigators are not medical experts in the ?eld of correctional
health in jails and/or prisons and they have made it clear, in statements
to our statT, that they (to not approve of privatized health care.

5 fi?hei'r'interviows ofstal?fare not recorded. They take notes during the
intowiews and then pass'thls information on to a panel'tlmt bases their
report on second-hand infal'mation.

a They did not conduct either an entrance or an exit conference with
"Armor?s administration to verify any process, policy or procedure. (Note:
ill the ?rst death, 96/11/2012, the SCOC "reported on Armor'Nurse to the
State Board of Education for "Pt'a'c'tiCin'g outside-the scope of his liCense.?
This allegation Was inveStigatecl by the 3308 "end found to be baseless.
The nurse is still practicing?at the and the legal case of the inmate
death has been digni?ed.)

It should also be nototl that. Exhibit of the Review incorrectly reports the

number of deatiis at the facility. in the 69?: years between 200:} and m-itl?

2011, NHCC experienced 18 (loathe, not '15. in Atmor?s 51/4 Years, 1tire-have
experienced 13.-

13. What is not included in theiReviex-v is any-indication ofthe tremendtiusmedia and
560.6 bias towards privatizatioiz of correctional medical care, For example,

9 The media has not published a single article reportng Ai?mor?si?e?sponse to the
New York?Attorney General complaint which was served on? August'zci,
2016;.Such an article should include the following:-

c.

. 

The inmates, andthe families of inmates-routinely make blatantly
false statements about Ai?mor?s medical care. However, Arm'or'is legally
barred from those false acotts'ations behattseithey involve
private medical information. Justice 't'ecoguized tltisunfait?ness; and on
Attgu?tjz'a??i? ordered the NY AG to obtainjHiPPAA waivers from all (if?the

who tile-NY AG wos?t?lattning Armor" did not.? properly treat so that.

Armor could publicly respond to tho'aliegations._ Armor- looks forward to the
NY AG 'COmplying'with the. Court?s directions so that it can put these false
claims to: rest. 

The NY AG admitted that it had not r'eViewe'd the medical records {if the 

'Ezid'iirt_tlt1als who it allegeaArator did not properly treat; stating that they
weave not medical exportebf course-,3: would-not take-a medical expert to

levies-vote recorrlaanci ?nd that that Armor did not prescribe.

"drags are false, "whoa the i?e'ord's show tl-iat'the patients did, in tam, receive

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y;

Appendix Armor?s Response

all of thesedrugs. Siniileriy, it'does not take a medical expert to review
documents that prove tiizit accusations that iitlii?tes were; net'seen by
doctors or Specialists atyer?dtss times is simply false, whet: 
re?ect'the date, medieai professional, diagnesisf treatment plan, etc. Armor
has submitted some of the proofthat these'aliegations are false; but at this
point, is legain barred from disclosing them publicly.

The NY AG has not utilized a singie?expert as a licensed

physician}, to support-their allegations. in" was not until after the NY AG

made its allegations, and mm sewed its responm (precluded at this time
from?lingthe response due to HEPAA restrictions), that the for the
?rst time asked for the fill] med-lea! records oftiie individuai inmates. it
NY AG simplyacCepted as factt?mtever they were told,
without any follow up or furtheriiwe$tigation;

This is supported by the fact that the NY AG submitted a transcript of a 
purported votce mail from an individual whe Stip'posedly cia'imecl that Armor
did not properiy pretride Care to him at the However, there has net?fer
keen an initiate'with that name at the during the time Armor has been
providing services.

Whiie Armor is currently preeluded by law {rem responding to allegations of
treatment of individual patients, the press. and the NY AG should actually
look at the accusatiens tosee if they" have any merit. For. examine, in 
aliensng Armor'of failure to previde proper" medicai care, relies on
gelatin that Armor shouicihatfe prescribed high ievelsoi? Xanax and
morphine to a patient. if the press or the NY AG wel?eto Consult With "any
reputable physician, they would learn that such high levels qftiiese (irtigs are
inappropriate for'anyone who is netin hospicecare. In fact, given the current
public health crisis of of epieids, it is inexcusable that the

NY AG?vGiild criticize. Arm'ei? for such a 'I'ettSOneble? and responsible decision.

Documents on which the NY- AG relied to claim that. Armor?s own personnei

"admitted"; to improper care, were actually documents produced by Armor to .

the AG, which the NY AG then aitered to add the supposeti ?fatiinissions?
on whiehit {10w relies. The NY AG has since?acktiewledged that it altered the
doeuments and that 210 such ffadmisiste'n's" by Armor exists. -

.- Ne gysda somehow learned of and eontactetl Armor foreomnrent onthe

complaint seven\daysbefere'the'h? noti?ed Arm-er and one day
before the complaint Was eVen'tiled'.

. Recent atticiesjregarding the Comptreiter?s refusal-to pay are inaccm?ate.
They do not-re?ecttiie correct caicttlatetlamounts-and do? not diS?ciose
th'atthe Sherifi?s?QI'fice requested we not-attempt to obtain 
(toe to physical plant ii__m_i_jtetions._.

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Appendix Armor?s Response

The media Quotes Brian'Sullivam the ?resident.ofthe Nassau Correction
{)f?cer Union in assigning blame to both Armor and the'Siwl'i??sQf?ce,
butoddly'siient to holding security of?cers accountqbie. For
example, when a former Armor employee was accusedof pa'eyiding
intimates with contraband, the media quoted Mr. Suiliykan opinions, but
made nomention of the faihu'e' of the correctional ef?eers.

Again, thaiik you for this opportunity to respond to-t?he Review.

Sincerely,

Karen Davies
Senior Vice President

Cc; Bruce A, Teai
Sheriff MiChael Sposato

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