Santa Cruz Grand Jury reassess medical services in county jails

Since Santa Cruz County outsourced its jail medical services to the California Forensic Medical Group (CFMG) back in 2012, the jail’s medical services have been enhanced and expanded the Grand Jury said.

However, the Grand Jury concluded that there is not enough reliability and transparency from CFMG and there is inadequate oversight by the Sheriff-Coroner’s office.

On Tuesday, the Grand Jury recommended using an independent expert and obtaining accreditation at each of the jail’s medical services to help the Sheriff-Coroner’s office increase oversight and transparency of its medical services. The Grand Jury also suggested a policy covering medically fragile inmates of any age.

It says by outsourcing medical services, governments are better able to estimate fixed, predictable medical costs, and avoid increased expenses associated with employee benefits and pensions.

But the Grand Jury also says onsite healthcare facilities potentially reduce security risks and costs involved in transferring prisoners to offsite medical facilities. A further benefit is the shift of most of the risk to the vendor when there are adverse medical outcomes.

Following the agreement between California Forensic Medical Group and the Santa Cruz County Sheriff’s Department that began September of 2012, the 2013/2014 Grand Jury conducted an investigation into five deaths at the Main Jail.

Due to the lack of substantive responses to the 2013/2014 report, the current Grand Jury decided that the management of medical services in the main jail justified further investigation. Since then, the Santa Cruz County Jail has experienced another in-custody death it says.

In the investigation, the Grand Jury focused on the Sheriff Coroner’s oversight of the CFMG contract with Santa Cruz County Main Jail and at the Blaine Street and Rountree facilities. They also focused on CFMG’s contract performance, CFMG’s compliance with Title 15 California Code of Regulations, Minimum Standards for Local Detention Facilities (Title 15) and California Medical Association Institute of Medical Quality (CMAIMQ) standards. Additionally, this Grand Jury reviewed the most recent in-custody death.

These were the findings of the investigation as reported by the Grand Jury:
1) F1. The office of the Sheriff Coroner has exercised minimal oversight of its contract with California Forensic Medical Group.

2) F2. The office of the Sheriff Coroner lacks independent medical expertise to oversee California Forensic Medical Group’s delivery of medical services to county detention facilities.

3) F3. The absence of quality assurance findings and corrective actions in the California Forensic Medical Group Annual Report of Medical Services compromises the ability of the Sheriff Coroner to oversee and ensure the quality of care in the county jails.

4) F4. Current procedures for monitoring inmates younger than age 65 do not identify their potential need for a higher level of care.

5) F5. The contract with California Forensic Medical Group lacks provisions for external review by authorized investigative persons or agencies.

6) F6. Without accreditation, contractual adherence to California Medical Association Institute for Medical Quality accreditation standards cannot be verified.

These were the recommendations in correspondence to the findings from the investigation as reported by the Grand Jury:
1) R1. The Sheriff Coroner should designate qualified personnel to oversee the medical services contract provisions and compliance with standards. (F1)

2) R2. The Sheriff Coroner should obtain independent oversight of its jail medical services by medically qualified personnel. (F2)

3) R3. The Sheriff Coroner should, upon contract renewal, require its contractor for jail medical services to provide site specific policy and procedure manuals to the County Health Officer and other authorized reviewers. (F5)

4) R4. The Sheriff Coroner should direct its medical care services contractor to include in its annual report quality assurance findings and corrective actions taken as required in the current contract for medical services. These annual reports should be available for review by authorized agencies. (F3)

5) R5. The Sheriff Coroner should require, at the time of contract renewal, that the jail medical services provider obtain and maintain California Medical Association Institute for Medical Quality accreditation for the Main Jail, Blaine Street, and Rountree detention facilities. (F6)

6) R6. The Sheriff Coroner should direct the medical care services contractor to develop and implement procedures to identify at intake and then monitor medically fragile inmates younger than 65 years of age. (F4)

The Grand Jury commended the Sheriff Coroner and California Forensic Medical Group for providing expanded onsite detention facility medical services. Medical services, such as dental care, medical imaging, and other procedures are now provided more efficiently and without the need for costly transport to offsite medical facilities.

They also commended the Sheriff Coroner and California Forensic Medical Group for the provision of expanded medical services at the Rountree Men’s Medium Security Facility. Inmates with medical needs, who formerly could only be housed at the Main Jail, are now eligible for housing at the Rountree Men’s Medium Security Facility.

Lastly, the Grand Jury commended the Sheriff Coroner for implementation of the Prudent Care for Incarcerated Seniors program, which provides an increased level of care, or alternative custody arrangements, for inmates age 65 or older.

The Santa Cruz County Grand Jury is a nineteen-member group of volunteers chosen from the voter rolls and driver registration records. Jurors serve for one year, although some may elect to serve a second year. The Grand Jury term begins each year on July 1 and ends the following June 30th. The Santa Cruz County Grand Jury office is located at 701 Ocean Street, Room 318-I.