Findings and Recommendations |
Response |
Actions Completed |
Actions Pending |
| 1. The County entered into a contract with Prison Health Services on 7-1-95 for medical services which excluded mental health care. The 1996-97 Grand Jury should conduct a study to ascertain the cost effectiveness of the contract considering the separate costs of mental health care to the county. | The 1996-97 GJ chose not to pursue. | ||
| 2. The contract
provides a scope of services which include the SB Main Jail and the SM Branch
Jail. It is not practical to have on-site services provided at the Branch
Jail in SM. 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 SM Branch Jail. Such services should continue to be provided
at nearby hospitals. |
This is accurate. This has been clarified in the proposed amendments to the contract submitted to the Board of Supervisors. S | Contract amended on March 21, 1996. | |
| 3. The Grand Jury found that the nurse staffing level had been altered without an amendment to the contract. | On occasion there needs to be flexibility with work schedules. Some minor modifications were needed and were approved by Jail Executive Staff. S | ||
| 3a. Staffing levels should not be altered without an amendment to the contract. | After initial phase of the contract and some minor adjustments, the staffing level was submitted along with other amendments to the BOS for approval. S | Contract amended on March 21, 1996. | |
| 3b. The Jail Commander should regularly review the staffing plan to ensure quality assurance. | This is done on an ongoing basis and discussed at the monthly meetings. S | ||
| 4. In reviewing the Monthly Performance Standard Review Committee minutes, the Grand Jury noted that the mandatory l4 day health appraisals were not performed to the level required by the contract. The Jail Commander or his representative(s) should continually monitor all requirements as set forth in Exhibit A, Scope of Services, of the contract, and ensure the county is protected. This is for risk management purposes, as well as to ensure compliance with the contract. | CHCS conducts monthly audits for compliance of performance standards. This now includes a computer printout which provides the medical staff with an up-to-date list of those who are in custody and due for the fourteen (14) day evaluation. This is then reviewed by Health Care Services and the Sheriff's Department Business and Financial Bureau and penalties assessed if warranted. S | An independent monthly audit conducted by Dr. Edelstein of CHCS shows the majority of the l4 day evaluations have been performed. An accurate way of monitoring this area has been developed. | |
| 5. CMA Accreditation was not accomplished within six months of the commencement of the contract as required. The GJ found that the contract is ambiguous as to how often a penalty should be assessed. The Jail Commander should require a minimum level of attainment and maintenance of full CMA accreditation penalties of $25,000 per month starting June l996 until full compliance is met and maintained as is required by the contract. | This was also made part of the amendment to the contract approved by the BOS and PHS. They should be held accountable only for those areas for which they are responsible and not those which are beyond their control. The amendment calls for the penalty to begin in July l996. On June l3, l996, we were advised we received a two (2) year accreditation by CMA. S | Two year accreditation was received in June of 1996. |
| 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 SM Branch Jail which makes it impractical to provide this service. The Contract language should be changed to read: "Pregnant inmates who are received at SM Branch shall be taken to a nearby hospital for examination and evaluation within two hours of booking. | The amendment to the contract which was agreed to and approved reads as follows: "Pregnant and Postpartum Inmates: Provisions shall be made to care for the special needs of pregnant and postpartum women. Required services include, but are not limited to: intake health screening within two (2) hours of booking or upon transfer and admission to the Main Jail; development and use of the Pregnant Female Protocols by health care staff ; referral and coordination with a methadone treatment program; prenatal education and counseling with established written agreements to assure the continuous availability of full range routine and emergency obstetrical services, as well as management of high risk conditions. S | Contract amended on March 21, 1996. | |
| 7.The Jail Commander is the County's designated representative of the contract. He should perform the oversight to ensure the filing of all incident and medical reports for injuries and deaths in accordance with PHS's standard operating procedure. Copies of all incident reports should be sent to Risk Management. | This is on an ongoing basis. Those incidents requiring notification of Risk Management are completed and forwarded as required by Policy. S | ||
| 8. Levels of service
provided at the SM Branch Jail and staffing levels at the Main Jail were
changed by PHS Staff without officially amending the contract. The Jail Commander should be assured that any changes to the contract are properly amended and signed off. This must be done before the changes are implemented. |
PHS did not change the staffing level without the permission or knowledge of the Chief Deputy of Custody Operations. It was only after careful consideration and the determination that it was in the best interest of the inmates, that the Chief allowed the modification. Once the change took place and the situation was monitored for success, we recommended the change to the contract which went forward. There needed to be a period of adjustment to determine the needs and adjust the workload to have as little impact on the organization as possible. S |