Black Hawk County begins search for new jail health care provider

WATERLOO — Health care services for Black Hawk County Jail inmates will remain relatively unchanged but could be provided by a new company.

The Black Hawk County Board of Supervisors on Tuesday unanimously approved the release of a request for proposal on medical and mental health services at the county jail.

In September, the current jail health care provider, NaphCare, brought a new proposed contract to the county that included a 37.8% increase from its original contract. After that sticker shock — that would have set the contract at just over $1.8 million by June 2025 — supervisors decided to amend the contract to end Feb. 1, 2024. The contract that ends in February costs $1.4 million.

Black Hawk County Jail

Black Hawk County Jail

Jeff Reinitz

County Jail Administrator Nate Neff said he expects bids from other companies to come in around $2 million. Although that is more than the $1.8 million NaphCare would have received, Neff believes after June 2025 that number would increase even more. He said with any contracts there is usually a 3% increase due to cost of living, but “with inflation where it is,” he said, he expects it would be higher than 3%.

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“Now it’s not just us negotiating with NaphCare,” Neff said. “Hopefully the bid process keeps (other companies’) increases to a minimum.”

The jail, which has held 250 to 260 inmates on average for the past three years, has similar numbers to the Pottawattamie County Jail in Council Bluffs.

Neff said Pottawattamie’s budget is $1.15 million, but provides 66% of the medical coverage and 25% of the mental health care that Black Hawk County provides. There, he said, nurses are staffed from 5 a.m. to 11 p.m., whereas the Black Hawk County Jail is staffed 24 hours a day, seven days a week. Pottawattamie provides mental health care onsite for 10 hours a week, while Black Hawk County has 40 hours per week. Neff noted the Pottawattamie County jail found its amount of coverage is “not enough” and is planning on expanding to full coverage soon.

NaphCare, based in Alabama, has been the Black Hawk County Jail’s health care provider since 2000. The county sought bids in 2009 due to NaphCare proposing a $70,000 increase to the contract to provide 24-hour coverage. The board ended up going with NaphCare with a contract for just over $1 million in 2010, according to Courier archives.

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Neff said the RFP requests the chosen company continue what the jail provides currently. The only change would be a doctor or nurse practitioner being on site for a minimum of six hours per week, rather than nine hours.

The scope of work the company must provide includes 30 services, such as providing 24-hour medical, mental and dental health care; scheduling and coordinating health care services both inside and outside of the jail; medical and mental health screenings upon booking, including looking for suicide indicators; conducting a doctor’s clinic at least two times each week for a minimum of six hours; and providing sufficient staff for health care services with registered nurses, licensed practical nurses or certified medical assistants.

The provider will be responsible for onsite treatment costs, as well as offsite treatment expenses up to $25,000 per inmate per calendar year.

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“We provide a lot of care for a very vulnerable population,” Neff said. “We’re the only care they get and once they get out, if they’re regulated (on medication), there’s a lot better chance that they don’t come back in.”

He said this provides safety for the inmate, staff and other inmates. Mental health medication regulation also reduces the likelihood for suicide — which he said would cost the county thousands of dollars in addition to loss of life. Regulation also raises the chance of success for an inmate once they leave the jail.

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Neff said in May 130 inmates are on 299 different psychiatric medications. When said other county officials were surprised at the low number of medications prescribed.

“I think some of that can be attributed to the continuity of care that we have,” he said.

Eleven companies bid on the RFP in 2009. The county estimates it will approve the award Sept. 26.

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The board also unanimously approved:

  • A 28E agreement between Black Hawk County and the Black Hawk County Solid Waste Management Commission for the use of proceeds from the 2023 issuance of general obligation bonds.
  • A $570,291 bid for facility security services at the courthouse and Pinecrest Building for three years.

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