| Jo Ann Henrie Foreman |
 COUNTY OF MENDOCINO Grand Jury |
Telephone: (707) 463-4320 |
GRAND JURY |
MEDICAL SERVICES AT THE MENDOCINO COUNTY ADULT DETENTION FACILITY The County of Mendocino is required by law to provide medical, dental, and mental health care services to the inmates of the Mendocino County Adult Detention Facility (Jail). The Board of Supervisors has contracted with California Forensic Medical Group (CFMG) to provide these services. The investigation noted non-compliance with contract provisions and health-care standards for detention facilities. Recommendations are provided to correct these problems. REASON FOR INVESTIGATION An annual overview of detention facilities is a Grand Jury mandate; in addition, complaints were received regarding medical and mental health care at the Jail. METHOD OF INVESTIGATION Documents reviewed included: 1. Board of Supervisors Agreement #90-353, pages 1-14; Exhibit A pages 81-113. and the April 3. 1996 amendment as provided by the Clerk of the Board who represented it as the entire contract with CFMG for health services at the Jail; policies and procedures relating to medical treatment requests; Jail staff job descriptions and Jail staffing pattern; and Monthly Workload Statistics (inmate headcount) for 1995-97. 2. California Medical Association (CMA) Accreditation Standards Manual and Health Services Accreditation Reports (1993, 1995, 1997). 3. Policies and Procedures Manual for the Jail pertaining to medicallmental health care. 4. Title 15. California Code of Regulations, Minimum Standards for Local Detention Facilities. Article 10: 1200- 1230. 5. County Department of Public Health (Public Health) Medical Health Report (1995-97), Environmental Health Report (1995-97) 6 Mendocino County Public Health Advisory Board 'Ad Hoc Committee Report on Health Services and the Criminal Justice System" (November 1997). 7. Board of Supervisors minutes and correspondence from the Sheriffs Department and County Counsel pertaining to medical care at the Jail. 8. Inmate and former inmate jail files and medical records. Interviews were conducted with the State Board of Corrections Detention Facilities inspector;personnel from Protection and Advocacy, Inc. (State review agency); a Mendocino County Environmental Health Inspector: a Public Health Nurse; members of the Board; representatives from patient rights groups; CFMG staff; Jail staff: members of the medical community; Jail inmates and former inmates: and an inmate family member. A lengthy observation of Jail facilities and operations was conducted. The County of Mendocino is required by law to provide medical. dental, and mental health care services to the inmates of the Jail. The County has contracted with CFMG to provide these services. Since awarding the contract in 1990, the Board of Supervisors has not set up independent professional monitoring of either the medical services being provided or the fiscal accountability per contract provisions. 2. Article XV of the contract states that the County Administrative Officer is delegated by the Board of Supervisors to act on behalf of the Board regarding the terms and conditions of the contract. 3. The original contract for health services between the County and CFMG in 1990-91 was for $525,000 For 1997-98, the contract total is $658,000. Yearly increases are based on San Francisco's Consumer Price Index (CPI). This amount is disbursed to CFMG in monthly increments. CFMG retains as profit the net proceeds after deducting the cost of health care for inmates. 4. CFMG provides a program manager [currently a Registered Nurse (RN)] 40 hours per week, 24-hour coverage by a Licensed Vocational Nurse (LVN), a psychiatric technician for 20 hours per week, a physician for 12 hours per week (on-call 24 hours per day), and a psychiatrist available 4 hours per week. 5. CMA standards established in 1994 for inmate populations over 200 per day in medium-sized facilities state that physician coverage should be five days per week, 20 hours total. The Jail population has exceeded 200 inmates per day since late 1993 and currently averages 240 per day. The increase in physician coverage should have begun in 1994, but has not been enforced by the Board of Supervisors, even though Article IV.A. of the County/CFMG contract states: "Contractor will provide health care services which meet CMA standards for health services in local detention facilities." The Institute for Medical Quality, a subsidiary of CMA, gave conditional approval for Jail health services in its bi-annual review in June 1997. The only statement under "Findings was: "A day 90 conditional accreditation with a full two year accreditation being awarded. providing evidence is submitted that the system has increased clinician coverage by two days per week." The cover letter to the Mendocino County Sheriff dated June 30, 1997, states that the award will extend for two years "providing there is evidence that the clinician coverage has been increased to five days per week." This physician staffing increase has not occurred. 6. The contract [Article II, Section G(1)(f)) requires an annual "reviewed financial report" of the cost of the health services provided "specifically to Mendocino County under this agreement." The annual reports should have been submitted by April 1. Only 1993 and 1994 unaudited reports have been submitted in the last seven years. No waiver for the subiyiission of these financial reports was found in Board minutes for the last six years. 7. The State Board of Corrections Detention Facilities Inspector stated that he relies solely on the annual inspection audit performed by Public Health as to the validity and quality of the medicallmental health service provided at the Jail. The Public Health Nurse who has the responsibility to rate the quality of Jail medical care service does not monitor or review the actual health services that are provided She stated that she had been trained to do a paper audit using a standard questionnaire. The Public Health audit is to verify that procedural manuals are on site and paperwork has been completed. The Public Health representative does not require verification of the correction of deficiencies reported in the bi-annual CMA accreditation. 8. The Intake Health Screen Questionnaire, which covers the inmate's current and recent medical conditions, is completed at booking by a correctional officer, rather than by a health care professional. It contains only information that is volunteered by the inmate. 9. The CFMG Quality Assurance Board composed solely of internal staff which reviews inmate care and grievances meets quarterly and does not review every complaint or Emergency Room admission. 10. According to the Contract, Article II.E(l)(k)."Contractor will implement a quality assurance program. Said program shall include a process of external review to be approved in writing in advance by the County's designee." 11. Numerous complaints were received by the Board of Supervisors and the Grand Jury alleging inadequate or inappropriate medical and mental health care. 12. The contract to provide health care services at the Jail has not been put out for bid since 1990. RECOMMENDATIONS 1. A medical professional independent of CMFG or the County should be retained to monitor health care at the Jail. (See Findings 1, 5, 7, 8, 9, 11.) 2. The Board of Supervisors should require compliance with the provisions of Article II.E(l)(k) . (See Finding 10.) 3. A quality assurance board should include a member from the Mendocino County Public Health Advisory Board. (See Finding 9.) 4. The Board of Supervisors should require CFMG to increase the physician on-site clinic time necessary for full accreditation. (See Finding 5.) 5. The Board of Supervisors should require the annual "reviewed financial reports" as required by contract from 1995 to present. Net costs and staffing costs should be compared with other detention facilities of similar population. (See Finding 6.) 6. The contract for services should be reopened for bid. The separation of mental health services from medicalldental services should be considered. (See Finding 12.) RESPONSE REQUESTED 1. California Forensic Medical Group (Recommendations 1 - 5). 2. Director of the Department of Public Health (Recommendation 3). 3. County Administrative Officer (Recommendation 1 - 5). RESPONSE REQUIRED 1 Mendocino County Sheriff (Recommendations 1 - 6). 2. Mendocino County Board of Supervisors (Recommendations 1 - 6).
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