Faced with a nationwide shortage of psychiatrists, the San Luis Obispo County Health Agency will abandon immediate efforts to hire a staff psychiatrist for the County Jail, instead filling the position with a nurse practitioner. The Health Agency also will hire a half-time staff medical doctor for the jail, replacing contract doctors, as it struggles to keep doctors from leaving for full-time work elsewhere.
The changes come as the county is under heavy criticism for the recent deaths of two County Jail inmates.
County Health Agency Director Jeff Hamm said the two new hires, approved Tuesday by the county Board of Supervisors, are in response to state-mandated staffing levels and not related to the inmates’ deaths.
The county’s difficulty in filling vacancies, however, illustrates the problems of providing medical and psychiatric care at the jail.
Under the Health Agency, the Public Health Department provides medical care and the Behavioral Health Department provides mental health services at the inpatient psychiatric health facility, the county’s three outpatient mental health facilities and County Jail.
On Jan. 22, jail inmate Andrew Chaylon Holland, 36, died after being restrained to a plastic chair for nearly two days despite a judge’s order that he be treated at the county’s psychiatric facility. His death was caused by an intrapulmonary embolism, or a blood clot in the lung, but was ruled “natural” by the county coroner.
Holland’s family disputes that finding, blaming his death on his treatment in the jail.
Last Thursday, Kevin Lee McLaughlin, 60, died in a jail dormitory after complaining to a deputy of shoulder pain at about 2 a.m. About an hour after a jail nurse sent him back to his bed, McLaughlin was found unresponsive and struggling to breathe. On Monday, his family told The Tribune that the Sheriff’s Office said the preliminary cause of death was a heart attack.
On Tuesday, Hamm declined to comment on McLaughlin’s death but said health officials are reviewing their procedures and policies following the deaths.
Hamm said the choice to hire a mental health nurse practitioner — an advanced practice registered nurse who can assess, diagnose and treat patients but must be supervised by a physician — is because of the county’s inability to attract another qualified staff psychiatrist. The department currently has six psychiatrists on staff.
“It’s not optimal in terms of staffing efficiency, but it’s better than the alternative of not being able to provide the (treatment) at all,” Hamm said.
A report released last month by the nonprofit National Council for Behavioral Health found a 10 percent drop in psychiatrists working in the public sector between 2002 and 2013 because of an aging workforce, low pay, burnout, onerous paperwork and restrictions on sharing medical information.
Hamm said the Behavioral Health Department still has two vacancies for full-time psychiatrists, and the department has been filling these vacancies with contract psychiatrists. These staff members, as well as the new practitioner, are physically present at the county’s inpatient mental health facility five days a week and on call 24/7, Hamm said. They also cover the county’s youth and adult outpatient services and perform calls to County Jail.
The county also has historically had trouble retaining part-time medical doctors at County Jail, Hamm said, because physicians often leave for the full-time salary and benefits offered at Atascadero State Hospital and California Men’s Colony.
The jail’s medical care clinic is currently staffed by two supervising nurses, 19 nurses and seven licensed psychiatric technicians, as well as contract doctors and nurse practitioners. Services at the clinic include medical screenings at inmate booking, follow-ups, routine care and administering medication.
The Public Health Department historically provided physicians at the jail for 20 hours a week via one or more contract physicians working one to two shifts per week.
Though the county approved a full-time physician position Tuesday, the Health Agency is only immediately looking to hire a doctor at half time. The position at half time will be cost-neutral, according to the staff report. A full-time physician would cost the county about $153,000 more than the half-time contract physicians.
Together, the nurse practitioner and the half-time doctor could save the county about $66,000 in the 2017-18 fiscal year, according to the county.