Monday, June 2, 2008

Grand Jury gives passing grade to jail health care


A Santa Barbara County Civil Grand Jury investigation into the quality of health care at the county jail found that while deficiencies exist, inmates generally receive quality care.
“For the most part, jail health staff perform efficiently and appear to care about the inmates,” the report said.
The investigation cites a number of shortfalls in the inmate health system as cited by the Institute for Medical Quality, which accredits health care facilities.

In August 2007, the institute denied accreditation for the county jail based on six deficiencies. These include: outdated policies and procedures in a jail policy manual; problems with routine audits; lack of procedures for monitoring patients with mild symptoms of detoxification and follow up; medical staff were not afforded an opportunity to review two autopsies of inmates who died while in custody; lack of written, individualized treatment plans, especially for mental health patients and lack of exercise for inmates.
Sheriff Bill Brown said some of these deficiencies have been corrected and the remainder are being addressed. He said he’s hopeful the jail will be accredited later this year.
“There were a few issues and we’re working to resolve those and I’m confident we will get them resolved,” Brown told the Daily Sound yesterday. “By and large the staff does an outstanding job.”
The business of providing health care in the jail is substantial. According to the report, the total health and mental health budget at the county jail last year topped $4 million, or roughly 10 percent of the jail’s total budget.
While the county’s Department of Alcohol, Drug and Mental Health Services provides for mental health care, the majority of jail health needs are outsourced to a firm called Prison Health Services (PHS).
Nearly $1 million of the total health budget is spent on mental health care, which includes hospitalization of mentally ill inmates at the county’s psychiatric health facility.
Last year, $400,000 was spent on medication for inmates, a number that is expected to rise as the cost of pharmaceuticals increases. The number is compounded, the report says, because MediCal and Medicare do not pay for medical services or medication for jail inmates.
As a result of the lack of accreditation from the Institute for Medical Quality, Brown said he sought a report by the National Institute of Corrections (NIC), which gave a more positive review.
The NIC recommended that additional funding be made available for two full-time psychiatrists (at the moment there is only a part-time psychiatrist), to fund a full-time discharge planner to facilitate community transition for mentally ill inmates and discontinue a practice of charging inmates a $3 fee for medical visits even when a doctor does not see them.
During the Grand Jury’s investigation, the report says several inmates complained directly to Grand Jury members about the quality of health care.
“Common themes were lack of attention to inmates’ ailments or pain, delays n getting medical attention, and rude or uncaring attitude of some health care staff,” the report said.
The report says jail health staff acknowledged the absence of a “good bedside manner” in some instances.
A number of inmates that suffer from serious illness often end up in Santa Barbara Cottage Hospital, where the cost of services can skyrocket. In one instance, the Grand Jury found the county paid $1 million for an inmate’s cancer treatment.
The Grand Jury report also addresses the need for additional dentists at the jail — the result of deterioration of teeth from use of methamphetamines.
Another problem touched on in the report is a lack of follow-up medical treatment after inmates are released. It says inmates with ailments ranging from severe psychiatric problems to hypertension and diabetes are not given a follow-up plan, and medical staff at the jail is often not aware when an inmate is released.
Brown said some of the deficiencies cited by the two reviewing agencies are a “symptom” of chronic jail overcrowding, an issue that has regularly been the subject of lengthy and oftentimes scathing Grand Jury investigations.
The report said the main county jail has a bed capacity of 618 while the medium security facility has a capacity of 161. But the average daily inmate population is often over 900, the report says.
Because many of the deficiencies with the jail’s healthcare system hinge on increased funding, Brown said they won’t likely be addressed anytime soon because of the county’s current fiscal crisis. As it is, the Sheriff’s Department is expected to cut 28 employees from its staff this year, Brown said.
All things considered, Brown said he feels quality of health care at the jail has improved during his tenure and will continue to do so.
“I think the care that has been provided in our jail is very good,” Brown said. “I think that compared to what type of medical care most of the inmates receive outside of the institution … it’s excellent.”
The Sheriff’s Department and Department of Alcohol, Drug and Mental Health Services are required to formally respond to the report in the next 60 days.

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