Nov. 6—TRAVERSE CITY — Medical, mental health and psychiatric services at the Grand Traverse County jail are costing up to $400,000 more than what is covered by a contract signed by County Health Support Services.

County Administrator Nate Alger said the company ran out of money and has asked the county for between $100,000 and $400,000, which the county has not given them.

Alger said CHSS continues to provide services but is taking a loss.

The contracted amount for the CHSS proposal that has all services under one umbrella using local providers is $709,199, plus a $10,000 start-up fee. The 10-month contract was signed in February and runs until the end of December. CHSS submitted the lowest bid of four.

CHSS, which is not affiliated in any way with the county, is owned by Dr. Nazar Abdel Fattah, the medical director, Imad Farhat and Numan Ahmed. It formed in October 2021 with the specific goal of submitting a proposal to provide jail health services.

The company hired Kona Medical Consultants to take care of the business end, including accounting, payroll, hiring, start-up and more. Donovan Miske, executive director of Kona, presented the company's proposal to the county, was the contact person and signed the contract as the CHSS interim chief operating officer.

When contacted, Miske said the Kona contract with CHSS was terminated a couple of months ago.

"They owe considerable amounts of money to Kona, surgery centers, hospital labs, electronic medical records ... ," Miske said. "The entity that is CHSS is not paying its bills."

Miske said, at one point, Kona was paying for inmate prescriptions because CHSS had no money. Kona has never been reimbursed, Miske said.

"This particular group of people is wholly incapable of running a business," Miske said.

Fattah did not respond to an email request for information.

Miske became known to the county when he came forward offering Kona's services to do an audit of a two-year, $163,000 contract between the county and Northern Lakes Community Mental Health Authority in spring 2020. The contract was ultimately not renewed at the end of 2020.

Alger said that, during a board meeting, he had talked about having an audit done and that it was brought to board members because they have to approve purchases over $25,000, which Alger said the audit would likely cost.

Miske told Alger he could do it for much less money.

According to the audit done by Kona, the Northern Lakes contract was not ideal and should be rewritten. The report stated that it was difficult to know which inmates were given services and when because of the lack of clear documentation, which is "antiquated," because it's on paper.

There is no follow-up to monitor inmates after discharge, and communication is ineffective and infrequent, the report stated.

Kona charged the county $1,000 for the audit. Less than a year later, CHSS was founded and Kona submitted a bid for those same services in Grand Traverse County.

Another study commissioned by the jail in 2020 by NCCHCC Resources, a national company that sets standards for corrections, found that the program did not reach enough inmates, assessments were not being done and treatment planning was lacking. In addition, about half of the inmates assigned to the mental health caseload were not being seen.

The study also found there was little communication between Northern Lakes and Wellpath, which at that time delivered both medical and psychiatric services at the jail.

The findings were similar to what Kona found, Alger said.

Requests for proposals were sent out about six weeks ago for another company, with the county receiving two bids from CHSS and Advanced Correctional Healthcare, which provides health services for about half of Michigan's jails.

Two other companies submitted bids — TrueCare24 and Diamond Pharmacy Services — but neither attended a mandatory pre-bid meeting and so are not being considered, said Capt. Chris Barsheff.

A committee consisting of jail, sheriff's office and county administrators will recommend a company to the GTC board at a special meeting set for 8 a.m. Nov. 14 at the governmental center. The new contract will start Jan. 1.

Barsheff said CHSS came on board without any jail experience and had to learn on the job, while an established provider would have come in with best practices, policies and procedures and a business plan.

He said the company may have needed more time to get up to par.

"The business structure and the performance in some areas isn't what I would want it to be," Barsheff said. "In the amount of time they've been here we have not seen them meet our expectations yet."

The idea to have one company deliver all services was one that appealed to Barsheff, Alger and county board members.

"We wanted that company because they had a different type outlook that we wanted to try," Barsheff said. The agreement was that the contract would be renegotiated at the end of this year or the county would seek a different service provider.

Barsheff, Alger and board members knew it was a risk with an untried company, but it was a risk they were willing to take if it meant better services.

Services under the CHSS contract were to be delivered by experienced local providers, many of whom would work under a retainer fee. Barsheff said services on the medical side have been good, but the company has been unable to fill positions for the mental health services side.

Physical assessments were to be done for every inmate, but Barsheff said those are not being done because of decreasing staff numbers. Mental health assessments are being done by jail staff after implementation of a couple of assessment tools, he said.

In the contract, the company was to hire a behavioral health specialist and a licensed master social worker, both of which were to be full-time.

The contract also outlined that a psychiatrist would be in the jail for four hours per week; that has been increased to 12 hours per week to make up for the lack of mental health services, Barsheff said.

The psychiatrist also can review any inmate who is on psychotropic medications to continue them or adjust their dosages.

Barsheff said psychiatric services are better than they were under Wellpath, which had the previous contract.

The 2022 jail budget includes $780,000 for medical care and $196,000 for mental health services. Crisis services are provided by the six-county Northern Lakes Community Mental Health Authority, which are funded by an annual payment. For 2021 that payment was $682,200.