2004-2005 Santa Clara County Civil Grand Jury Report Does Santa Clara County Pay Too Much for Adult Inmate Healthcare?

Conclusions 51

• CL1 Page 24
  The cost of adult inmate healthcare in Santa Clara County, about $38.3 million per year (or $9,100 per inmate per year for an average daily population of 4,200), is high by a number of measures. The County is spending about $16.4 million more per year ($3,900 per inmate per year) on inmate healthcare than on healthcare benefits for a comparable number of County employees. Although this is not a perfect comparison, no other quantitative information was available from County officials as they have not done any comparison of their costs against other similar entities. The responsible County managers cannot explain this difference in any adequate, quantitative way.
• CL2 Page 25
  Adult inmate healthcare involves both the Custody Health Services organization of SCVHHS and Custody Services within DOC. By design these organizations have distinct reporting lines, in that the Director of SCVHHS reports to the County Executive, whereas the Chief of DOC reports to the Board of Supervisors. This reporting structure makes inmate healthcare cost assessment, management, and accountability difficult. There appear to be no clear incentives for SCVHHS and DOC to provide more cost-effective inmate healthcare. Since DOC has no way to influence the inmate healthcare budget negotiation, its role appears to be simply that of a placeholder to provide a fiscal home for the budget line item and to work out the Memorandum of Understanding regarding inmate healthcare procedures.
• CL3 Page 25
  The previous findings and recommendations are significantly based on the lack of management data about inmate healthcare practices and operations. Current IT-based record systems in DOC and SCVHHS are inadequate, are uncoordinated, and are deployed to only a limited extent, if at all. Most record keeping is still manual. Current systems do not facilitate continuous medical record access for inmates during interfacility transfers. Systems in SCVHHS provide limited access to reports from specialty services, often with slow response times, but do not track physician and nursing orders. They do not allow collection and careful tracking of quantitative measures of utilization, adherence to standards of care, outcomes, etc. for cost management and medical controls. The SCVHHS Pharmacy Services group is an exception to this finding and serves as an example of what can be accomplished with appropriate and professionally implemented information services.
• CL4 Page 27
  County of Santa Clara Charter and Ordinance Code; Title A, General and Administration; Division A20, Law Enforcement And Sheriff's Department; Chapter III, Department Of Correction; Section A20-38, Department recognized and Section A20- 40, Director recognized. [Establishing code for DOC and the appointment of its Director by the BOS.]
• CL5 Page 27
  County of Santa Clara Charter and Ordinance Code; Title A General and Administration; Division A18, Health and Welfare; Chapter I, Santa Clara Valley Health and Hospital System; Article 1, Organization; Section A18-1, Agency recognized and Section A18-2, Executive Director. [Establishing code for the SCVHHS and the appointment of its Executive Director by the County Executive Officer.]
• CL6 Page 27
  Helmuth, Obata, and Kassabaum, Inc. Advance Strategies, “Santa Clara County Adult Custody Healthcare Study; Summary of Findings & Recommendations,” Study started in October 2003 and completed 28 April 2004, under contract to the CE’s Office.
• CL7 Page 27
  Communication from CE to the BOS Public Safety and Justice Committee, “Adult Correctional Health Care Study”, 13 May 2004 [Provides responses to HOK
• CL8 Page 27
  Memorandum of Understanding between SCVHHS and DOC, “Provision of Health Care Services to the Inmates Incarcerated in the Santa Clara County Jail Facilities,” Draft of 9 Dec. 2004.
• CL9 Page 27
  Memorandum from Division Manager, Department of Human Resources, County Employee Services Agency, “Benefit Plan Rates – Fiscal Year 2005,” 25 June 2004, and email communication of historical benefit plan rates, 14 March 2005.
• CL10 Page 27
  CA Penal Code Section 6030 et seq. [provisions governing inmate healthcare]
• CL11 Page 27
  CA Code of Regulations, TITLE 15, Division 1, Chapter 1, Subchapter 4, “Minimum Standards for Local Detention Facilities.”
• CL12 Page 27
  CA Code of Regulations, TITLE 15, Division 3, Chapter 1, Article 8, “Medical and Dental Services.”
• CL13 Page 27
  Memorandum from DOC Financial Services Manager, “Medical Co-pay Study for DOC,” 27 Oct. 2003.
• CL14 Page 27
  Gordon L and Lelchuk I, “Mayor trying to trim SF jail costs,” SF Chronicle, 1 June 2004.
• CL15 Page 27
  Memorandum from Chief Financial Officer SCVHHS to BOS, “Response to Budget Referral #8A, Characteristics of Unreimbursed Services in VMC/Custody Health,” 25 May 2004
• CL16 Page 27
  Branson v. Winter (Superior Court County of Santa Clara, No. 78807) (1981). 27 Documents (cont’d.)
• CL17 Page 28
  Ochoa v. Superior Court (Santa Clara County), 703 P.2d 1 (Cal. 1985)
• CL18 Page 28
  U.S. Department of Labor, Bureau of Labor Statistics, Consumer Price Indexes, , accessed 3 April 2005.
• CL19 Page 28
  Annual Reports FY 03/04 for Main Jail, Elmwood Men’s Dentention Facility, and Correctional Center for Women, SCVHHS Adult Custody Health Services.
• CL20 Page 28
  Sierra Systems Group, Inc., “Adult Custody Health Services, Business Process Review and Strategic Plan – Project Charter,” 31 Jan. 2002.
• CL21 Page 28
  Sierra Systems Group, Inc., “Adult Custody Health Services, Current Situation Analysis,” 25 March 2002.
• CL22 Page 28
  Sierra Systems Group, Inc., “Adult Custody Health Services, Transition Plan,” 26 July 2002.
• CL23 Page 28
  County of Santa Clara, Procurement Department, “Request for Proposal #0143 for Offender Management System (OMS) and Jail Medical Information Management System (JMIMS),” 25 Aug. 2004 (Including Attachment 1 for OMS System Requirements and Attachment 2 for RFP for JMIMS System Requirements).
• CL24 Page 28
  Memorandum from Chief DOC, transmitting adult inmate ADP data for 1992-2004, 6 Dec. 2004.
• CL25 Page 28
  Fisher WH, Packer IK, Banks SM, Smith D, Simon LJ, Roy-Bujnowski K, “Self- reported lifetime psychiatric hospitalization histories of jail detainees with mental disorders: comparison with a non-incarcerated national sample,” J Behav Health Serv Res. 2002 Nov; 29(4):458-65.
• CL26 Page 28
  Miami-Dade County Grand Jury, “Mental Illness and the Criminal Justice System: A Recipe for Disaster/A Prescription for Improvement,” Circuit Court of The Eleventh Judicial Circuit Of Florida in and for the County of Miami-Dade, Final Report for 2004 Spring Term, Filed 11 Jan. 2005.
• CL27 Page 28
  The Sheriff’s Star, September / October 2004.
• CL28 Page 28
  Ditton PM, “Mental Health Treatment of Inmates and Probationers,” US Department of Justice, Bureau of Justice Statistics (Washington, DC: 1999), NCJ 174463. Interviews
• CL29 Page 43
  Increase handling of emergency responses at jail sites
• CL30 Page 43
  Add on-call responsibility to jail docs
• CL31 Page 43
  Consider on-site dialysis services
• CL32 Page 43
  Increase use of once/twice daily meds to reduce contact requirements
• CL33 Page 43
  Set realistic policy for antipsychotic meds
• CL34 Page 43
  Evaluate scope, site, and delivery changes to mental health based on cost/benefit analyses
• CL35 Page 43
  Consider outsourcing pharmacy or other aspects of custodial healthcare delivery Management and Organizational Option Recommendations
• CL36 Page 43
  Define, collect data regarding, and report indices of care utilization, outcomes, and cost for CHS
• CL37 Page 43
  Expedite and coordinate IT improvements for delivery and coordination of CHS
• CL38 Page 43
  Better integrate and coordinate budget setting and management
• CL39 Page 43
  Consider alternative programs to reduce population of inmates requiring care and “frequent flyers” with substance abuse and mental health problems.
• CL40 Page 43
  Improved coordination at CEO level of standards (formulary, care guidelines, mental health approaches); measurable indices of care, outcomes, and cost; policy alternatives for Board of Supervisors; and strategic organizational and management efficiency improvements. Other Observations:
• CL41 Page 43
  Reporting structure for DOC and SCVHHS inconsistent – DOC reports directly to the Board of Supervisors and SCVHHS reports through the CEO (Exhibit 1.A)
• CL42 Page 43
  Stakeholder viewpoints are inconsistent – DOC emphasizes control and security of inmates and jails and SCVHHS emphasizes quality of care for all patients at SCVHHS sites.
• CL43 Page 43
  Information systems are still largely manual, outdated, and unintegrated. Summary of County Executive Response to HOK Study (June 2004)
• CL44 Page 43
  References Memorandum of Understanding between Dept of Corrections and Santa Clara Valley Health and Hospital System which states that, “community standards of care will be adhered to and afforded to the inmate population.”
• CL45 Page 43
  Administration agrees that impacts of “adopting policy-driven, fiscally prudent approaches that positively impact the County” must be assessed regularly and county-wide. 43
• CL46 Page 44
  Administration will continue to provide the link necessary for departmental collaboration and cooperation.
• CL47 Page 44
  Administration does not agree with issuing an RFP to determine cost reference for outsourcing some or all inmate health care. This effectively refuses the HOK
• CL48 Page 44
  Administration agrees that review by some unspecified means is needed for use of pharmaceutical agents (especially psychotropic drugs), including cost issues.
• CL49 Page 44
  Administration does not agree with recommendation to examine expansion of inpatient psychiatric services.
• CL50 Page 44
  Administration agrees with need for specific, measurable indices of performance, quality, and costs for custodial health care services. Discussion suggests action on updating the MOU and putting in place IT services to help with management oversight but no details are available.
• CL51 Page 44
  Administration agrees with need to pursue cross departmental approaches to mental health and substance abuse. 44

No Responses Found 2

Government entities assigned to respond to this report. No response documents have been linked in our database.