OAKLAND — Concerns over inmate care at Santa Rita Jail have increased public pressure for Alameda County to part ways with its current medical provider. With the contract set to expire, supervisors have begun to weigh their options.
For nearly a decade, Wellpath, a private health care provider formerly known as Correct Care Solutions, has treated inmates at the Dublin-based Santa Rita Jail. The company operates in correctional facilities across the nation and is responsible for the care of hundreds of thousands of people daily, making it one of the largest correctional health care providers in the country.
Strong condemnation of the company, which filed for bankruptcy last November, and the care it provides has been documented nationally in various lawsuits, statements from congressional leaders, advocacy groups, and inmates, and federal and local investigations.
In the Bay Area, groups like the Interfaith Coalition for Justice in our Jails, American Friends Service Committee and Families Advocating for the Seriously Mentally Ill have called on the county to not renew its contract with the company, pointing to the fact that more than 50 people have died in jail custody in the last 10 years, some by suicide or drug overdoses and others by homicide or natural causes.
They echoed their pleas during a May 16 joint meeting of the Health and Public Protection committees, which include supervisors Elisa Márquez, Nate Miley and Lena Tam.
“Wellpath has had close to 10 years to prove their ability in the jail and our deaths in the jail have been horrendous. There are a lot of reasons to seriously consider shifting away from a private company to a public-run or not-for-profit health care,” said Jean Moses, a member of the Interfaith Coalition for Justice in our Jails.
Audits into Wellpath’s services by the firm Forvis Mazars – which has conducted monthly reviews, quarterly evaluations and continuous monitoring – have routinely found that the company has continuously fallen short of the 90-95% compliance rate needed for a satisfactory rating. And while the health care provider has made some progress in a few areas, progress hasn’t stuck, according to a summary of Forvis Mazars’ latest audit presented to supervisors last week.
Areas of concern include incomplete documentation of patient care, insufficient chronic care management and supervised withdrawal treatment, and an “urgent need” for retraining and oversight of medical legal issues like restraints, seclusion and segregation practices and informed consent and right to refuse.
Wellpath made some improvements when conducting initial health assessments and receiving screenings, earning their highest scores of 81% and 85% respectively during the most recent evaluation, but the summary indicates those gains have not been sustained.
“Some progress has been made but improvements aren’t sticking over time,” said Faith Saporsantos, a clinical advisor with Forvis Mazars.
Aladrian Hillmon, a representative with the National Union of Healthcare Workers, the union representing health care staff at the jail, told the committee that jail health care workers tried to raise concerns about staffing and safety issues in the jail but faced retaliation and resistance from management.
“We are not in any way shape or form working with Wellpath. We are offering the best medical services to the patients that are within the jail despite what Wellpath is trying to do,” Hillmon said.
Cole Casey, senior vice president of operations at Wellpath, acknowledged the ongoing challenges of providing care in a correctional setting during the committee meeting, and noted patients in a correctional setting are particularly vulnerable.
But he also asserted that Wellpath’s staff is providing the best care they possibly can while facing systematic challenges outside of their control.
Specifically, Casey noted jail staff cannot see patients during the night due to a court injunction, keeping Wellpath employees from administering care, including withdrawal medication.
Conducting timely initial evaluations of inmates is also hindered due to the number of agencies that need to process an individual, Casey said.
As for documentation, Casey said the company is working on improving those practices but noted Wellpath employees cannot access the county Behavioral Health Department’s electronic health system, meaning key health details of many of Santa Rita’s population are missing from Wellpath’s records.
“We are fully committed to making ourselves available at your convenience. Our onsite care team remains deeply engaged and our leadership is both trusted and well-connected within the community,” Casey said.
Saporsantos and the other supervisors agreed that the county’s record keeping system has created communication challenges between the correctional facility and county health but Saprosantos said those issues are taken into consideration when grading Wellpath on their quality of care.
Those hurdles don’t explain why, for example, details on whether medications were given were missing from reports, Saporsantos said. Without accurate logs, verifying proper care is taking place can’t happen.
“Absolutely, that has to be taken into consideration,” Saporsantos said about the records system in an interview after the committee meeting. “There is, however, as we were isolating medical (care), still an opportunity for improvement.”
Whether or not Wellpath will be given more time to correct course and renew its $250 million five-year contract with the county is unclear. At least one supervisor, Miley, has publicly expressed interest in seeing the agency replaced, but a formal decision by the Alameda County Board of Supervisors is nearly two years away.
Finding a vendor to replace Wellpath could take, at minimum, 14 months, and more time could be needed if appeals are filed, said Kimberly Gasaway, director of the county General Services Agency.
Mario Gonzalez Brito, another representative with the National Union of Healthcare Workers, said health care workers are eager to collaborate on whatever procurement process is launched.
“Our members are dedicated public servants to the patients they serve,” Gonzalez Brito said. “We want to be copilots in this voyage. We don’t want to just be passengers.”
In need of more information before a recommendation on next steps can be made, supervisors agreed to hold another joint meeting in September. Before then, Marquez said she’d be open to holding a town hall with support from Sheriff Yesenia Sanchez sometime in July to allow for the community to provide more input.
“Access to quality health care at Santa Rita Jail is a fundamental responsibility and value for Alameda County,” said Marquez, Public Protection Committee chair, in a statement. “We are committed to holding ourselves and our partners to the highest standards and making the changes necessary to address gaps in care, staffing and coordination. This is about Alameda County and our shared values of dignity and accountability.”
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