The public was presented a rare look at the $3.5 million healthcare services provided at the county prison during discussion at the Thursday, Jan. 4, meeting of the Lebanon County Commissioners.
Tom Weber, CEO of Harrisburg-based PrimeCare Medical, highlighted services his company provides one week after a commissioner requested the county’s current $3.5 million contract be reopened for bid.
Before the 2024 budget was approved at a special meeting on Thursday, Dec. 28, commissioner Jo Ellen Litz asked her colleagues to explore rebidding the healthcare contract for inmates housed at the county prison since the population is lower than when the last contract was negotiated.
“I think putting it out for bid keeps everybody’s pencil sharp, and will help us with the budget,” said Litz at that time.
County administrator Jamie Wolgemuth said Lebanon County put out a Request for Proposals (RFP) to privatize healthcare services at the county prison in 2019.
In June 2019, the county contracted with PrimeCare Medical under a 42-month agreement to the end of 2022. For 2023, the agreement increased by 1%. For 2024, the county negotiated a 3% increase, which is the current $3.5 million deal that will expire at the end of 2024, unless renegotiated.
In response to Litz’s request, Weber said he wasn’t there to dissuade them from rebidding the contract, but wanted to give an account to the public for the services his company provides to inmates.
“It obviously seems logical that if you have less facilities, you may need less services,” said Weber. “Unfortunately, what a truism that has occurred with the reduction in jail populations is that the individuals who are allowed to get out early are those who either have means or have had very few or infrequent brushes with the law, leaving behind those that often have serious mental illness issues as well as long and persistent substance or polysubstance abuse.”
Weber noted the contract isn’t about the number of people in the prison but about how often services are rendered. He said his staff provides 982 man hours a week, or over 48,450 hours of healthcare services annually at Lebanon County Correctional Facility.
“Despite the reduction of population, there has not been a concomitant reduction in the amount of services that we have to provide,” said Weber. “In addition, correctional healthcare, as was recognized at the last commissioner’s meeting, is really a nuance. And we are in somewhat of an unusual situation of late. Society demands require that there are more services made available for those that are incarcerated than can be made available in the community.”
An example is Medicated Assisted Treatment (MAT), which Weber said “is now being compelled upon all individuals who are in correctional facilities.” One component of MAT is to provide opioids to addicts to reduce cravings and withdrawal as part of the treatment program.
“Whereas in the community, those individuals who are suffering from that unfortunate disease, absent insurance or some other means for payment, do not have readily available treatment,” said Weber. “But in the facility we do. So we’ve been asked and have been providing those services as well.”
Weber also highlighted an increase in mental health services within the prison. (LCCF warden Tina Litz told LebTown last year that over 60% of Lebanon County inmates receive some form of mental health services.)
“The reduction in community mental health services, it is again readily recognized throughout at least this commonwealth that your county correctional facilities have turned into your mental health treaters. It’s an unfortunate situation,” said Weber. “Statistically true that those who suffer from mental health illness remain incarcerated longer than those that do not. Usually it’s not as a result of any severity of the charges that they have, but instead as a result of the inability to find community placement for them.”
Weber said prison medical staff “runs the gambit from physicians to psychiatrists, to two mental health counselors, to dentists, to mid-level providers, as well as nurses, both RNs, LPNs, as well as medical assistants.”
“For last year, we completed over 1,400 intakes. So when anyone is incarcerated within the first four hours, we perform an intake on them,” said Weber. “That intake, ours, is the foundation of our treatment plan for that individual, whether they be with us for a weekend or whether they be with us for two years. … That process takes 30 to 45 minutes per individual.”
In 2023, prison medical staff treated 334 individuals for detox from substance abuse.
“Those individuals will require three visits a day just to make sure that they’re doing OK,” said Weber. “It’s our philosophy to treat withdrawal prior to any symptoms occurring. So the moment they come in and flag is likely to detox from some substance, they’re gonna be automatically prescribed medications, as well as followed on that regular basis for a period of 7, 10, 14 days to make sure that they’ve come through that withdrawal.”
Other 2023 statistics shared by Weber include:
- 239 individuals in an MAT program with a consistent 23 to 30 patients a month receiving treatment.
- 63% of the population received medical medications, and 965 individuals underwent 14-day drug treatment physicals.
- 2,254 COVID tests conducted.
- 1,603 visits by the psychiatrist, and over 3,400 visits with a mental health professional.
- 51% of the population receives psychotropic medications.
- 142 patients were on a suicide watch.
- 510 dental visits were performed.
“One of the most proud statistics in the whole year that we had in 2023, we had 11 grievances filed against the medical department at the prison,” said Weber. “Two of those were founded. I think when we have several hundred thousand patient encounters a year, that level of grievance, complaints alone, is remarkable. And then to only have two of them founded shows what a fantastic job is being done over there by our staff.”
Weber noted that timely response to healthcare needs – particularly with mental health – is critical.
“We performed In our facility, if you ask for mental health treatment, you’ll be seen within 72 hours,” said Weber. “I would beg anyone in the community to decide that they need to see someone for mental health and see if they can be seen within three days.”
Weber also provided cost-saving stats with the commissioners totaling millions of dollars.
He said the pharmacy that was replaced by his company has reduced costs by $40,000 per year for a savings of $2.16 million since 2019. Millions more have been saved in 4.5 years since his company also accepts allowable limits for medical treatments. $6.3 million in savings has been realized with the combination of pharmacy services and accepting allowable limits.
“So again, I’m not here to dissuade you from putting the matter out for RFP. In fact, there are reasons that it would be beneficial for us to do so,” said Weber. “But I do want to make sure if you go through that process, you recognize the nature of the services that are required to keep your patients safe as well as recognizing that perhaps staying local isn’t the best thing in terms of some service provider.”
Following his presentation, Litz asked Weber several questions, including if his company includes Lebanon County in a risk pool for any lawsuits it faces (it doesn’t) and whether his employees live in Lebanon County (they do).
“That’s what I thought was going on with him,” said Litz after thanking him for making this presentation. “So these are pieces that I’ve never been privy to before, so I needed to ask.”
Commissioner Phillips seemed surprised by Litz’s comment.
“Well, I’m shocked that this has taken four years to get to these questions. When you (Weber) appear at our prison board meetings regularly, you’re available, you’re accessible,” Phillips stated.
Weber apologized to the commissioners, saying he’s done a poor job of communicating in the past the services his company provides to the county prison’s inmate population, adding he came to the meeting to correct that oversight.
During the Dec. 28 meeting, Kuhn, who chaired the meeting since Phillips was participating by phone, said he wasn’t opposed to looking at an RFP for healthcare services at the county prison as requested by Litz.
“Before we accept bids, I would welcome the opportunity to discuss a thorough RFP to identify exactly what we need before going out for bid,” Kuhn said at the time.
That conversation ended with the commissioners requesting that Wolgemuth obtain sample RFPs for consideration. It is unclear whether that will happen now following Weber’s presentation.
In other county business, the commissioners voted to:
- Apply for a 2023-24 Violence Intervention and Prevention program grant for the district attorney’s office totalling $870,416. The goal is to fund one open position within the county detective’s bureau, as already approved by the county commissioners, and potentially another position for a gun violence task force. Two of the task force’s goals are to identify potential gun violence incidents and perpetrators before an event occurs and respond to incidents after they happen.
- Accept a hotel tax grant for Mount Gretna Arts Council for $5,000 of a projected $13,500 project for a vinyl wrap logo on the Campmeeting’s water tower welcoming visitors to the borough.
- Approve $6,000 of a requested $7,500 for the Pennsylvania Chautauqua Foundation to help fund the visitors center in Mount Gretna in 2024 through the ambassador program. The total cost of that project is $13,500.
- Reappoint Robert Funk for a one-year term on the board of the Lebanon County Health Facilities Authority through Dec. 15.
- Approve the minutes of their Jan 2 meeting, the treasurer’s report and personnel transactions. Under personnel transactions, the commissioners agreed to shift differentials within central booking for second shift at .50 cents per hour and .45 cents per hour for third shift, effective Dec. 24, 2023. This increase applies to central booking employees, and supervisor and booking agent positions.
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