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County Supervisors OK Crafting Plan For Inmate Care, Possible Outsourcing

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County supervisors voted 4-1 Tuesday to have the chief administrative officer direct the Health and Human Services Agency to develop a plan for in-house medical care of jail inmates and possible outsourcing of those duties as well.

Speaker 1: 00:01 The San Diego Sheriff's spends $90 million a year on healthcare services for inmates of the counties jails. Meanwhile, the County has also spent about 8 million over the past decade on legal claims from jail inmates and their advocates often tied to inadequate care this week at the Sheriff's request and Eagle County supervisors decided to explore whether to shift the responsibility for jail inmates, mental and physical health, to private contractors, San Diego union Tribune, investigative reporter, Jeff McDonald has followed this issue for months leading up to yesterday's vote and joins us now, Jeff, thanks for being with us. Thanks for having me. Okay. So yesterday the supervisors acknowledged that there is a problem. What is the problem? Is it the quality of the healthcare and the jails or the cost of healthcare in the jails?

Speaker 2: 00:46 Well, I think the, uh, the sheriff would say the cost and some of the advocates would say the quality of service that the inmates receive. Uh, there've been a number of cases where inmates have died and been injured due to lapses in medical or mental health care in San Diego County jails. Some of those inmates and their families have filed lawsuits against the County and recovered damages as a result of their injuries or death

Speaker 1: 01:11 Reporting. In fact has shown that the death rate of the County jails is the highest in California. How, how would you say the current medical and mental health care is contributing to the deaths of inmates?

Speaker 2: 01:22 Deli Davidson. I spent six months looking at the jail deaths last year and, and, uh, even though a number of the, they have a high suicide rate, a inmates die, they die of natural causes. They die of accidents, uh, accidental deaths, uh, San Diego has, as you said, the highest rate among the largest counties in California, that we examined a lot of the deaths are natural. Uh, but the problem with that is that they, uh, they're classified as natural, even though they're succumbing to diseases that are often treatable. And so the problem is that they're not getting adequate medical and mental health care in jail. And that leads to the inmates deaths in many cases

Speaker 1: 02:02 Who provides mental health care and medical services to the inmates now. And how could that change if, uh, what the supervisors are exploring takes place.

Speaker 2: 02:11 It's state law, that when you take someone into custody, you have to provide for their food and housing and medical, uh, health care. Uh, so the sheriff is responsible for that when he books people into the County jail. Uh, right now there's a patchwork of about 300 nurses and other administrative staff who work for the County of San Diego and work inside the jails, uh, on the medical services Bureau. They also have a couple of dozen, more than two dozen, uh, contractors that provide specialty services like, uh, physicians, dentists, pharmacists, uh, experts like that. So right now they have a combination of private contractors and public sector employees who deliver the services to the counties, inmates, what the Sheriff's trying to do now, or what he's exploring is the idea of bringing in one general contractor who would run the whole, um, the whole, uh, division and be responsible for all medical services. Now the unions don't like it because it would cost the County several hundred jobs, about 300, uh, personnel. Many of them testified yesterday against the, uh, uh, the idea of moving forward with the outsourcing.

Speaker 1: 03:26 Well, let's talk about how County employees in the union that represents them, are reacting to this proposal to, to outsource these jobs. Here's FCIU local number two 20 ones. President David Garcia,

Speaker 2: 03:37 Contracting out essential healthcare services will lead to worse care. And the loss of our skilled workforce outsourcing has led more liability lawsuits and large settlements around the country. This is more expensive, not less now here, of course, proposing they're bringing the model to San Diego while the rest of the country moves away from it.

Speaker 1: 04:03 The suggestion, the board agreed to also ask the counties health and human services department to bid on providing the jails with medical and mental health care. Uh, I remember when the county's waste disposal services open to bids from the private sector and the County employees bed came in lower. So might that happen again here?

Speaker 2: 04:22 Uh, yes, that might happen again, but the dispute is, um, more ideological than just who's gonna be delivering the services. Uh, what Nathan Fletcher wants to do is to take the medical and mental health services responsibility away from the sheriff, because he doesn't believe the sheriff is being diligent enough and delivering those services. He wants to put it under the purview of the health and human services agency. So maybe health and human services could deliver those services cheaper. But the dispute between the sheriff and the supervisor also extends to who would control those, uh, those folks, the sheriff of course, wants to retain authority over who's ever in charge of healthcare for his inmates. Uh, Nathan Fletcher is saying that that obligation and responsibility should be taken away from the sheriff and given to the social workers who do that kind of work every day, all day. What's the Sheriff's reaction to that. His answer to that is that state law dictates that the Sheriff's department is responsible for the inmates, all, all the care and, uh, and, uh, practices within the jail. So he's not willing to give up that responsibility. So that's something of a loggerheads that we'll have to see how that unfolds

Speaker 1: 05:27 In your reporting so far. Jeff, would you say it's the mental or the physical health care? That's the most problematic at this point?

Speaker 2: 05:34 Oh, that's a difficult question. Uh, there, I would say equally, so we've seen cases where, you know, simple diseases, very easily treatable diseases result in deaths. And then the medical examiner will say, well, this person died from diabetes. It'll get recorded as a natural death, but most people don't die from diabetes. Uh, so that's, that's a pretty pervasive among the desk that we examined over the 10 years between 2009 and 2019, that in a series of published last fall, that said you had the Sheriff's department is the biggest provider of mental health services in the region, a point which he made before the board of supervisors in his argument yesterday. So clearly that's a pervasive issue as well.

Speaker 1: 06:18 So when will the bids come in and a decision to be made on whether to contract out the health services in the jails?

Speaker 2: 06:24 Well, they were a little, um, should I on specific timelines, Nathan Fletcher had asked for, uh, arresting this process for three days to give health and human services time to put together a proposal. Sheriff didn't like that. Of course the expectation is that he'll move forward straight away with, um, soliciting that the potential bids, and then using that information to write up a request for proposals, which is a more formalized, uh, basically a contract, a solicitation, uh, that could happen as soon as this year. It's interesting that the board of supervisors just scheduled the change, uh, two seats, this, this, uh, this November. So maybe this year, if wants to get this done before the board changes. And, and maybe not that didn't come up in the discussion, but it's certainly a open political consideration,

Speaker 1: 07:12 Thanks as always for your reporting. Well, thank you. I'm great. Dick that's Jeff McDonald, investigative reporter with the San Diego union Tribune.

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Maureen Cavanaugh and Jade Hindmon host KPBS Midday Edition, a daily radio news magazine keeping San Diego in the know on everything from politics to the arts.