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After inmate deaths, SLO County wants to outsource jail medical care. Will it be safer?

Inmate death rate at SLO County Jail ranks 6th highest in California

San Luis Obispo County Jail had the sixth-highest inmate death rate of all California counties over the last five years, according to newly released data reviewed by The Tribune and The Sacramento Bee.
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San Luis Obispo County Jail had the sixth-highest inmate death rate of all California counties over the last five years, according to newly released data reviewed by The Tribune and The Sacramento Bee.

San Luis Obispo County leaders are recommending that jail medical services be outsourced to a private company — a proposal that comes in the wake of multiple inmate deaths that led to costly lawsuits and criticism of the county’s ability to provide quality care to ill inmates.

Sheriff Ian Parkinson’s Office outlined the recommendation in a staff report to the Board of Supervisors made public this week. The board is scheduled on Tuesday to vote on the plan and tell staff to begin contract negotiations. Which company the county would contract with has not yet been made public.

If adopted, medical, mental and dental services would be transferred to an organization that has “expertise with in-custody health care” and will be under the oversight of the county’s newly hired chief medical officer.

The transfer of responsibilities would eliminate 24 county jobs. Many of those employees will likely be offered positions in other county departments, but some nurses will face lay off, the report says.

Contracting with an outside organization to provide ramped up services would cost less — $6.3 million or less instead of the $9 million it would cost the county to provide the same level of services — and it would provide the county cover in lawsuits. Current service levels in the jail cost about $5.7 million.

As for the safety and quality of health care at the jail, county leaders said that outsourcing would better serve the inmates.

The sheriff was unavailable for comment. Public information officer Tony Cipolla said “the Sheriff’s Office will not be commenting on the proposal until the presentation next week.”

The county’s primary goal, according to County Administrative Officer Wade Horton, is to provide a level of care to the jail population that meets the national standards determined by the National Commission on Correctional Health Care and become nationally accredited.

Horton, who is a member of the committee of county leaders making the recommendation said, “we believe that by adopting the National Standards of Jail Health Care Services, we will promote, protect and better serve the inmates at the jail.”

The jail currently complies with state standards, but not national standards, which the report says “is the metric by which all inmate health is measured.”

Other benefits of outsourcing include that potential contractors have existing policies and procedures that can immediately be implemented and expertise with in-custody health care, the report says.

All neighboring counties outsource their jail health services, including Monterey, Fresno, Kings, Kern, Santa Barbara and Ventura counties, the report says. Each of those county jails have had inmates die in custody at a lower rate than San Luis Obispo County, according to California Department of Justice data.

Outsourcing would also provide guaranteed shift coverage by medical staff. That’s been a problem at the jail, where recruitment and retention of health care staff has been a challenge due to “several factors over the last two years” that have led to the loss of staff, the report say.

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The benefits of outsourcing jail medical services versus contining to provide them within the county, according to a staff report. San Luis Obispo County Sheriff's Office

Transfer of risk

An alleged lack of adequate medical services at the jail has the potential to cost the county big money in litigation.

The county is currently facing several lawsuits related to jail inmates’ treatment, including a wrongful death lawsuit brought by the family of a 60-year-old San Luis Obispo man who died of a heart attack in April 2017 shortly after complaining of heart attack symptoms.

According to the lawsuit filed by attorney James McKiernan, Kevin Lee McLaughlin’s death was the result of “having jail inmates treated by unqualified and/or ill-trained medical and non-medical personnel.”

According to the staff report, a benefit of outsourcing is “risk transfer,” and meeting the national standard “has been found to be protective in inmate health care litigation, which is one of the most high-risk areas for county governments.”

‘Mixed Emotions’

Atascadero residents Sharon and Carty Holland, parents of deceased County Jail inmate Andrew Holland, told The Tribune Thursday that they have “mixed emotions” about the possibility of contracting out jail health services.

In January 2017, Andrew Holland died after being left in a restraint chair for 46 straight hours when jail staff determined he posed a safety risk to himself and others. Diagnosed schizophrenic, Andrew Holland died of an embolism shortly after being let out of the chair.

Since their son’s death, Sharon and Carty Holland became the public faces of a movement to advocate for better treatment of inmates in the County Jail, and financially supported an unsuccessful effort to de-seat then-two-term Parkinson and District Attorney Dan Dow.

The Holland family and other mental health advocates marked the end of a 46-hour protest at the SLO County Government Center in downtown San Luis Obispo, after video was released showing the death of Andrew Holland in County Jail custody.

The Health Agency and the Sheriff’s Office have promoted changes they’ve made to the system, pointing to the hiring of the jail’s chief medical officer, extensive policy changes, a new medical facility at the jail and plans for a mental health unit as examples.

Still, the Hollands said Thursday that it appears not much has changed.

Carty Holland said it’s his experience that outsourcing work does not produce the best result, and that he’d prefer to see the current local health system “brought up to speed.”

“If there isn’t a mentality change, it won’t make a difference — what they’re talking about is changing it from the outside,” he said. “You can shuffle these (inmates) off to other organizations, but the sheriff and guards have to take responsibility to inject a different outlook into the jail. That has not happened, or you wouldn’t have people killing themselves inside the jail.”

He referenced Michael Nonella, a 48-year-old inmate who allegedly hung himself in his cell Sept. 1, days after his probation officer recommended a mental health safety assessment, which may or may not have occurred.

Both Holland’s parents said they also have concerns about a possible lack of oversight and transparency with an outside contractor.

Horton said that “the county will be subject to the same requirements under the Public Records Act to make public records available for inspection and copying, whether the records are maintained by the county or its contractor.”

“The county remains ultimately accountable for its delivery of medical service at our jail,” Horton said.

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Monica Vaughan: 805-781-7930; @MonicaLVaughan

San Luis Obispo County Sheriff Ian Parkinson sits down for his first in-person interview with The Tribune regarding inmate Andrew Holland's death at the County Jail.

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