SANTA BARBARA COUNTY GRAND JURY 1995-96

FINAL REPORT

COUNTY AGREEMENT WITH PRISON HEALTH SERVICES, INC.

Released May 31, 1996

INTRODUCTION

As a result of the death of an inmate in November 1994, and another inmate death in May 1995, at the Santa Barbara County Jail, the Grand Jury noted there were some deficiencies in medical services by the medical provider at the Santa Barbara County Jail. As a result of those findings, the l995-96 Grand Jury elected to look into the operation of the medical services at the Santa Barbara County Jail.

Until July l, l995 the Santa Barbara County Health Care Services provided all medical services to the Jail. Santa Barbara County and Prison Health Services, Inc. (PHS) entered into a contract for PHS to provide medical services at the Santa Barbara County Main Jail, and the Santa Maria Branch Jail, effective July 1, 1995 through June 30, 2000.

OBJECTIVE

To review the contract for quality assurance, oversight and compliance.

APPROACH

The Grand Jury conducted interviews with the following:

The Grand Jury reviewed and evaluated written policies on standard procedures, staffing plans, and pharmacy inventory control records and documents. It also reviewed agendas and minutes of meetings relative to this contract.

OBSERVATIONS

In 1992, costs associated with providing health care treatment to jail inmates escalated to the point where it may have been more cost effective to contract the medical services to an outside provider. It was also found that Santa Barbara County Health Care Services, the provider at the time, wanted to discontinue providing medical services at the jail. In the summer of 1993, a committee was formed to investigate the possibility of contracting out the jail medical program. The committee consisted of representatives from Santa Barbara County Health Care Services, the Administrator’s Office, the Probation Department, and the Sheriff’s Department.

A request for proposal (RFP) was developed and sent to 11 providers that specialize in jail health care services, excluding mental health care. Six companies responded to the RFP with proposals. After evaluating the six proposals in January of 1994, the county committee selected Prison Health Services (PHS). However, because of the total cost, the committee decided to recommend against privatization. Before the committee could make a recommendation to the Board of Supervisors, PHS came back with a “best and final offer,” which was $96,000 per year lower than its original proposal. As a result of this reduction the committee recommended acceptance of the PHS offer. Final negotiations began with PHS in January 1995, and the agreement was signed March 1995. The Jail Commander is the county’s designated representative and is responsible for administering the contract. The Santa Barbara Probation Department decided it was not feasible for them to be a participant in the contract.

The Grand Jury noted that the Agreement for Services Between the County of Santa Barbara and PHS was generally well prepared. Monthly reports have stated that there are significantly fewer grievances by inmates since the implementation of the contract with PHS.

Despite the overall improvement in medical care, the Grand Jury found several deficiencies in the terms of the contract; it also found instances of non-compliance with the contract. These are as follows:

The Grand Jury also discovered that the following services required by the contract were not provided:

In the nine months since the county’s agreement with PHS, there have been no official adjustments or amendments to the contract.

FINDINGS AND RECOMMENDATIONS

FINDING 1: The contract Santa Barbara County entered into with PHS on July 1, 1995 for medical services excluded mental health care.

RECOMMENDATION 1: The 1996-97 Grand Jury should conduct a study to determine the cost-effectiveness of the contract considering the separate costs of mental health care to the county.

FINDING 2: The contract provides a scope of services that include the Santa Barbara Main Jail and the Santa Maria Branch Jail. It is not practical to have on-site services provided at the Branch Jail in Santa Maria.

RECOMMENDATION 2: Item II, Scope Of Services, should be amended in compliance with section XXIV of the contract to read that no on site services are to be provided at the Santa Maria Branch Jail. Such services should continue to be provided at nearby hospitals.

FINDING 3: The Grand Jury found that the nurse staffing level had been altered without an amendment to the contract.

FINDING 4: In reviewing the Monthly Performance Standard Review Committee minutes, the Grand Jury noted that the mandatory 14-day health appraisals were not performed to the level required by the contract. FINDING 5: California Medical Association accreditation was not accomplished within six months of the commencement of the contract as required by Exhibit C, Section D of the contract. The Grand Jury found that the contract is ambiguous as to how often a penalty should be assessed. FINDING 6: The contract clearly states all pregnant inmates shall be examined within two hours of booking. There is no PHS staff on duty at the Santa Maria Branch Jail, which makes it impractical to provide this service. FINDING 7: The Jail Commander is the county’s designated representative as the administrator of the contract. FINDING 8: Levels of service provided at the Santa Maria Branch Jail and staffing levels at the Main Jail were changed by PHS staff without officially amending the contract.

AFFECTED AGENCIES (California Penal Code Section 933c requires that comments to Grand Jury findings and recommendations be made in writing within 60 days by all affected agencies except governing bodies, which are allowed 90 days. The Grand Jury requires all responses be submitted on computer disk along with the printed response):