SPRINGFIELD, Ill. (AP) — Illinois has awarded a more than $4 billion prison medical care contract to the same company it’s used for three decades, despite multimillion-dollar lawsuits against the firm and statewide complaints alleging substandard care.

Pittsburgh-based Wexford Health Sources was one of two companies responding to a request for proposals from the Illinois Department of Corrections, but it was not the low bidder. Wexford’s offer came in $673 million higher than one from VitalCore Health Strategies of Topeka, Kansas, according to a procurement announcement reviewed Friday by The Associated Press.

The initial term of Wexford’s contract is five years for $1.956 billion, with a five-year renewal worth $2.201 billion.

State officials’ decisions on contract awards are not based on cost alone. But Wexford has also been roundly criticized for its performance, facing numerous multimillion-dollar lawsuits that accuse the company of delayed or shoddy health care and backlash for relying on off-site doctors to determine whether and what treatment is necessary. Positions for medical professionals continue to suffer high vacancy rates.

A panel of experts appointed by a federal judge concluded in 2015 that the Corrections Department’s health care system was “unable to meet minimal constitutional standards.” Additional admonishments from the federal bench have subsequently followed.

Camille Bennett, director of the Corrections Reform Project for the American Civil Liberties Union of Illinois, called the decision to retain Wexford “disappointing and inexplicable.”

“Expert reports to the federal court have demonstrated that Wexford has failed to provide adequate health care to people in IDOC facilities across the state and failed to ensure the presence of an appropriate level of staffing,” Bennett said in a statement. “It is not clear how they are prepared to meet these needs going forward.”

Bennett testified before a state House committee last summer during which lawmakers urged the corrections department to find a suitable replacement.

The Associated Press sent multiple phone and email requests for comment to the Corrections Department, and a text message to a spokesperson for Gov. J.B. Pritzker. A telephone message was left with a Wexford spokesperson.

Currently, roughly one-third of physicians’ positions are unfilled, while the vacancy rate for nurses and dental professionals is about 50%, according to Alan Mills, executive director of the Peoples Uptown Law Center. The center’s lawsuit against Corrections over mental health treatment called for a total revamp of the state’s system of care but it’s still being litigated. A federal court monitor in the case in 2017 called psychiatric care in the prisons “grossly insufficient” and declared it is in a “state of emergency.”

“They’ve had years to turn it around, but they haven’t figured it out,” Mills said of Wexford. “We’re just throwing good money after bad.”

Wexford’s last 10-year contract expired in 2021 but has been extended since then.

Southern Illinois University School of Medicine began a pilot program in 2020 to provide health care in two prisons and officials said they were eager to see it play out with an eye toward expansion. An SIU spokesperson was unavailable Friday.