There are certain words no one wants to see used to describe them in a performance audit. “Persistent noncompliance” would be two big ones. Those words were bandied about with considerable frequency in a report the county supervisors were given about the quality of health care — mental and otherwise — in the two county jails.
According to a performance audit conducted by the county’s Public Health Department of 29 combined quality assurance measures reflecting the adequacy of health coverage and contract compliance, the Main Jail rated “noncompliant” in nine measures and “persistently noncompliant” in five of the nine. For the new Northern Branch Jail, there were eight measures of noncompliance, five of which, the report stated, demonstrated “persistent noncompliance.”
The measure that generated the most alarm from the county supervisors was the extent to which Wellpath, the jails’ private health contractor, met its contractual obligation to medically assess inmates placed in safety cells every four hours: only 13 percent. Likewise, mental health professionals managed to check on such inmates within 12 hours — as the contract calls for — only 67 percent of the time of the time. The audit found that Wellpath met its post-suicide-watch follow-up mileposts only 67 percent of the time. Based on audit guidelines, a 90 percent score was required to qualify as contractual compliance. Given recent deaths of inmates placed in safety cells because of suicidal threats, these numbers were of heightened concern.
For several years, the supervisors and county administrators have been trying to wrestle chronic medical contract compliance problems into submission with mixed results. Last year, the supervisors discovered Wellpath had short-changed them to the tune of $500,000 in terms of staffing levels the contract called for.
To help Sheriff’s Office administrators get a grip on what’s a very complicated and medically challenging task, the supervisors authorized the Public Health Department to hire two new seasoned medical professionals with considerable correctional experience to assist, advise, study, and illuminate the staffing issues leading to gaps in jailhouse care. The two professionals, Dr. Carrick Adam and Aaron Stillwell, were on hand at the supervisors meeting and walked them through the results of their first quarterly report. They took pains to highlight how sometimes their numbers seemed more dramatic than they were. Staffing shortfalls remain a serious issue, Stillwell noted.
Stillwell and Adam have no direct authority over Wellpath personnel and can merely observe and advise. The work is demanding, the patients not easy, and the conditions of care less than ideal. Wellpath’s medical director, Stillwell noted, spends much of his time doing direct hands-on clinical work rather than playing the broad oversight role a typical director does.
Maureen Earls, a longtime mental health and criminal justice reform advocate with the League of Women Voters, urged the supervisors to consider giving the contract to the Public Health Department. Her remarks went unremarked upon.
