Cochise County staff outline timeline, duties and costs as medical director contract ends

Cochise County staff told the Board of Supervisors on Aug. 18 that the county's contracted medical director for public health and the county jail will depart at the end of the contract in early September, and that a solicitation for a replacement will close Aug. 22.

Meghan Kennedy, the county's director of detention health, said, "Our current medical director through AVMed, his name is Doctor McLaughlin. They gave their notice of termination on August 1, so it'll end. That contract will end in early September." Procurement staff posted a request for supplier qualifications; county staff said they plan to review submissions and bring a recommendation to the board at the early September meeting.

The medical director's role covers detention health services and multiple public-health functions, staff said. "A medical director is a physician that oversees medical care and other designated care and services for an organization or a facility. And it is a statutorily required position," Health Director Barb Lang said. Staff told supervisors that the position provides oversight of the jail's on-call system, tuberculosis testing and treatment, disease surveillance, immunization programs, environmental-health coordination and other statutory public-health duties.

County presenters described elements that affect recruitment and cost. Staff said the physician who holds the DEA registration tied to the jail's controlled-substance ordering takes on legal liability for those medications. The county also relies on a local memorandum of understanding with Community Medical Services to provide methadone through virtual visits at the jail because the jail itself is not an opioid treatment program. Kennedy said the jail's medication-for-opioid-use-disorder program provides Suboxone in-house and arranges methadone through the partnering provider.

Lang told the board that malpractice coverage specific to correctional medical direction is an additional, significant expense. "It's about 50 to $60,000 a year annually," she said, referring to the extra malpractice premium providers must carry to serve as a correctional medical director. Staff said that premium is one reason the county expects the next contract to cost more than the previous arrangement and that any new contract could be higher depending on negotiations.

Staff also outlined operational details: the jail's nurse practitioner time is shared between public health (about nine hours per week) and detention services (about 31 hours); the current medical director performs periodic chart reviews rather than daily on-site supervision; and mortality reviews involve the medical director, while autopsies are handled under a contract with the Pima County coroner.

Supervisors were told the county hopes to avoid a coverage gap by negotiating a short extension with the current contractor if needed, but they were also warned a gap is possible. County staff said they will present any recommended contract or extension at the next regular board meeting. "We're hoping to have a gap. Hoping that. But there there is a possibility that we will have a gap," Kennedy said when describing the timeline and contingency planning.

The discussion also touched on the limits of the medical director's authority during public-health emergencies: staff emphasized that the board, not the medical director, determines whether the county declares a state of emergency, and that statewide emergency powers involve the governor and the Arizona Department of Health Services.

Next steps listed by staff: procurement closes Aug. 22; scoring and qualification review by county clinical and public-health staff; and a recommendation to the Board of Supervisors at the early September meeting. Staff noted they may seek a short contract extension from the current provider if the replacement is not in place by Sept. 1.