Santa Barbara County Courthouse

Conclusions 21

• CL1 Page 109
  The Los Prietos Boys Camp at its current staffing level can care for up to 50 youth yet the number of juveniles held is less than this number.
• CL2 Page 109
  No similar camp program for female juveniles exists in Santa Barbara County.
• CL3 Page 109
  Freedom 4Youth offers a post incarceration mentorship program that is only available to youth who live in the South County.
• CL4 Page 109
  No standard calculation methodology exists within Santa Barbara County for measuring juvenile recidivism.
• CL5 Page 133
  The Santa Barbara County Sheriff’s Custody Operations Policy and Procedures Manual regarding the intake process needs revision.
• CL6 Page 134
  The Santa Barbara County Sheriff staff has not always confirmed arrestees were medically cleared by Corizon Health staff prior to classification and placement into the Jail population.
• CL7
  2015-16 Santa Barbara County Grand Jury 99 LOS PRIETOS BOYS CAMP  Justice System Savings Per High School Graduate31 – Each high school graduate saves the State of California and local government an average $21,370 in justice system costs, and the Federal government saves an additional $10,580 in justice system costs. The statistics are even starker when broken down by gender and ethnicity. For example, each Hispanic male high school graduate saves the State of California and local government an average $33,870, and the Federal government saves an additional $16,590.  Cost to Victims – As discussed above, each cohort of high school dropouts causes $9.5 billion in costs to the victims of their collective crimes.32 31 Belfield & Levin, The Economic Losses from High School Dropouts in California, The California Dropout Research Project (August 2007), at p. 27 and Table 13. 32 Id. 100 2015-16 Santa Barbara County Grand Jury CITY OF SANTA BARBARA CITY OF SANTA BARBARA Commissions, Committees, and Boards SUMMARY The 2015-2016 Santa Barbara County Grand Jury (Jury) was asked to investigate potential conflicts of interest among the City of Santa Barbara's (City) appointed commissions, committees, and boards and the influence of their members on the City's policies. The City has functioning advisory groups to the City Council, Charter Boards, and Commissions required by Article VIII of the City Charter. The City also makes appointments to four groups created by California State law. The Jury looked into the very large number of these advisory groups, their responsibilities and their influence. The Jury considered the following questions: Do conflicts of interest exist; have some of these entities outlived their usefulness; do some of them have overlapping mandates? The Jury concluded that the answer to these questions is sometimes yes.
• CL8 Page 132
  The 2015-16 Santa Barbara County Grand Jury (Jury) determined that there have been inconsistencies in the intake screening process at the Santa Barbara County Main Jail (Jail). The Jury finds the medical prescreening questionnaire is not sufficient for Santa Barbara County Sheriff Office (SBSO) staff to determine if an arrestee has major medical concerns. SBSO staff receive minimal medical training annually. There has been a lack of SBSO oversight of Corizon Health (Corizon) medical staff to ensure the orderly, safe, and healthy intake of arrestees into the Jail. There has been a failure of SBSO staff to consistently follow their own intake procedure. According to SBSO staff, they are already addressing some of these issues. A new Corizon Health Services Administrator (HSA) has been hired recently. The HSA is in the process of making changes that are addressing deficiencies in the medical intake procedure. Prior to the release of this report, the Jury learned that the SBSO staff are no longer conducting medical intake screenings. Corizon Registered Nurses are currently conducting all prescreening medical intake procedures. This process should continue and be documented on the medical process overview chart. FINDINGS AND RECOMMENDATIONS 2015-16 Santa Barbara County Grand Jury 111
• CL9 Page 133
  SANTA BARBARA COUNTY JAIL Finding 1 The Santa Barbara County Sheriff is using an antiquated paper system for maintaining inmate medical records at the Santa Barbara County Main Jail. Recommendation 1 That the Santa Barbara County Sheriff implement a computerized medical record system for maintaining inmate medical records at the Santa Barbara County Main Jail. Finding 2 The Santa Barbara County Sheriff Staff, has not always followed procedures, policies, and protocols pertaining to the intake process of arrestees. Recommendation 2 That the Santa Barbara County Sheriff follow the established procedures, policies, and protocols pertaining to the intake process of arrestees. Finding 3 The Santa Barbara County Sheriff does not have adequate oversight methods in place for ensuring Corizon Health staff are following their medical intake procedures at the Santa Barbara County Main Jail before the inmate is transferred to custody officers for classification. Recommendation 3 That the Santa Barbara County Sheriff update Appendices A and B and add two signature blocks, one for medical clearance staff the other for the custody officer prior to classification at the Santa Barbara County Main Jail. . Finding 4 The Santa Barbara County Sheriff medical intake prescreening questionnaire is now being conducted by Corizon Health registered nurses; however, the Medical Process Overview Chart does not reflect this. Recommendation 4 That the Santa Barbara County Sheriff continue to use Corizon Health registered nurses to conduct all medical intake screening of arrestees entering the Jail and include this provision in all future contracts and in the Medical Process Overview Chart. Finding 5 The Santa Barbara County Sheriff’s Custody Operations Policy and Procedures Manual regarding the intake process needs revision. Recommendation 5 That the Santa Barbara County Sheriff update the Custody Operations Policy and Procedures Manual to reflect the new changes being implemented to the intake process. 112 2015-16 Santa Barbara County Grand Jury
• CL10 Page 134
  SANTA BARBARA COUNTY JAIL Finding 6 The Santa Barbara County Sheriff staff has not always confirmed arrestees were medically cleared by Corizon Health staff prior to classification and placement into the Jail population. Recommendation 6 That the Santa Barbara County Sheriff initiate a procedure to ensure that all medical intake procedures are properly completed prior to classification and that inmate classification not be allowed to occur without verification of the completion of medical evaluation and clearance. REQUEST FOR RESPONSE Pursuant to California Penal Code Section 933 and 933.05, the Santa Barbara County Grand Jury requests each entity or individual named below to respond to the enumerated findings and recommendations within the specified statutory time limit: Santa Barbara County Sheriff 60 days Findings 1, 2, 3, 4, 5, and 6 Recommendation 1, 2, 3, 4, 5, and 6 2015-16 Santa Barbara County Grand Jury 113
• CL11 Page 135
  SANTA BARBARA COUNTY JAIL APPENDIX A Santa Barbara Sheriff’s Medical Pre Screening 114 2015-16 Santa Barbara County Grand Jury
• CL12 Page 136
  SANTA BARBARA COUNTY JAIL 2015-16 Santa Barbara County Grand Jury 115
• CL13 Page 137
  SANTA BARBARA COUNTY JAIL 116 2015-16 Santa Barbara County Grand Jury
• CL14 Page 138
  SANTA BARBARA COUNTY JAIL APPENDIX B Intake and Receiving Screening CS1101 2015-16 Santa Barbara County Grand Jury 117
• CL15 Page 139
  SANTA BARBARA COUNTY JAIL 118 2015-16 Santa Barbara County Grand Jury
• CL16 Page 136
  SANTA BARBARA COUNTY JAIL 2015-16 Santa Barbara County Grand Jury 119
• CL17 Page 141
  SANTA BARBARA COUNTY JAIL APPENDIX C MEDICAL PROCESS OVERVIEW 120 2015-16 Santa Barbara County Grand Jury
• CL18 Page 142
  SANTA BARBARA COUNTY JAIL APPENDIX D CLINICAL OPIATE WITHDRAWAL SCALES (COWS) 2015-16 Santa Barbara County Grand Jury 121
• CL19 Page 143
  SANTA BARBARA COUNTY JAIL APPENDIX E Receiving Screening Process 122 2015-16 Santa Barbara County Grand Jury
• CL20 Page 144
  LOMPOC UNIFIED SCHOOL DISTRICT
• CL21 Page 145
  LOMPOC UNIFIED SCHOOL DISTRICT Problems on the Board SUMMARY The 2015-2016 Santa Barbara County Grand Jury (Jury) completed an investigation into the Lompoc Unified School District (LUSD) after receiving complaints concerning a perceived conflict of interest involving a member of the Lompoc Unified School District Board of Education (Board) and his spouse, an employee of LUSD. The complainants reported that they came to the Grand Jury because they feared retaliation if they spoke out publicly on the issue, having already been subjected to threats of termination and other workplace hostility. The Jury found that there was at least the appearance of a conflict of interest. Consistent with its role as “the public’s watchdog” in civil matters, the Jury deferred to the Santa Barbara County District Attorney the question of whether any criminal laws were broken. The Jury also found that the Board lacks adequate internal financial controls regarding transfers from the General Fund and payments of travel expenses. Finally, the Jury found that the Board did not adequately oversee staff attendance, allowed unethical behavior, and permitted a hostile work environment to exist.

Observations 7

• OB1 Page 124
  Twenty groups for which ethics and conflict of interest training is mandated by California State law (Assembly Bill 1234, enacted in 2005); and City Resolution 14-068.
• OB2 Page 124
  Fourteen groups which are exempt from AB 1234 but are still required by the City to conform to ethics requirements by City Resolution 13-006.
• OB3 Page 124
  Remaining groups who are exempt from the AB 1234 law but are required by the City’s Code of Conduct to follow all State conflict of interest laws. The Jury was told that appointment to the advisory boards and committees is inherently a political process and having committee members representing “special interests” is not uncommon, and not necessarily undesirable. The Jury was also told that a separate analysis might be required to determine if a conflict of interest exists in a given situation. The selection process can result in politically motivated appointments. A volunteer’s employment in a field closely related to their advisory role may well enhance their livelihood and be a gift to the public good. A "personal financial effects" rule requires a volunteer to abstain from discussion and voting in select situations. Although, the decision-making authority of the various committees, commissions, and boards is varied, the level of concern for conflicts of interest should not vary. Volunteer groups are often advisors to the City Council. The burden of objective and impartial decision-making is on the City Council, whose members answer to the public. The City Council members have had mandatory ethics training and make open-meeting public decisions that the voting public can scrutinize. The Council should consider whether the same conflict of interest and ethics training required of Council members should be added as a requirement to the remaining advisory groups, as well. The City of Santa Barbara's advisory groups are subject to the Brown Act. They conduct announced meetings with an agenda and are all open to the public. Meeting minutes are recorded by a City employee and posted on the City's web site. Each advisory group has a City employee as a liaison along with support staff, who are also City employees. The City bears the cost of each advisory group and their support staff. Is there a “sunset” provision in place? The Jury determined that no provision exists for eliminating advisory groups that may have outlived their usefulness. As a result, bureaucratic inertia may set in and the committees just continue in existence, accomplishing nothing other than expending the time of support staff and tax payer money. The Jury recommends City Council review the functioning of the committees and their mandates every five years. Are all of these committees necessary? Do their mandates overlap? The Jury’s answer to the first question is, probably not, but this decision is up to the City Council. The community may not need, for example, separate advisory committees for Airport Public Art oversight, Arts Advisory (except the airport), and oversight of the Arts and Crafts 104 2015-16 Santa Barbara County Grand Jury CITY OF SANTA BARBARA show. The purpose of the website is to provide data to prospective volunteer committee members to help them decide whether to apply. On the other hand the Water Commission site is well done and contains much useful information. FINDINGS AND RECOMMENDATIONS Finding 1 The City of Santa Barbara has at least 38 commissions, committees, and boards, some of which may have outlived their purpose. No review process exists concerning their relevance.
• OB4 Page 129
  The Jail provides the following core set of prisoner intake functions:  Identifying the prisoner  Developing the prisoner’s record  Conducting medical and mental health assessments.  Determining the prisoner’s threat to public safety and his/her security requirements  Identifying sex offenders, sexual predators, and vulnerable inmates  Scheduling transfers to the long-term facility  Identifying and validating security threat group membership The intake process at the Jail operates 24 hours a day with approximately 40 to 60 arrestees arriving at the Jail daily. Many are under the influence of drugs or alcohol, have physical injuries, or are mentally ill. These factors make the intake process challenging for the SBSO and Corizon staff. According to SBSO staff, the Jail is understaffed, under-funded and not well designed to carry 1 Jail Staffing and Operating Cost Analysis, Santa Barbara County, Final Report CGL Companies, October 2015 108 2015-16 Santa Barbara County Grand Jury
• OB5 Page 130
  SANTA BARBARA COUNTY JAIL out all of their required responsibilities. Individuals who need significant medical attention at the time of intake are generally not accepted in the Jail. Instead they are taken to the local hospital for medical evaluation and stabilization. The intake screening would then be performed at the Jail when the inmate returns from the hospital. Once an inmate is admitted to the Jail the County of Santa Barbara is responsible for the cost of any outside medical care. The Health Services Administrator (HSA), a Corizon employee, is a Registered Nurse (RN) and is responsible for the day-to-day operations of the medical programs at the Jail. The HSA has the authority to oversee the administrative requirements of the programs, as well as recruitment, staffing, data gathering, financial monitoring, and enforcing policies and procedures. Processing Procedures The inmate intake procedure is a twofold process that includes a medical evaluation and a classification procedure that requires the cooperation of both SBSO staff and Corizon staff. The first step starts with a “SBSO Santa Barbara Sheriff Medical Pre-Screening” questionnaire, (see Appendix A) used to determine if there are current health issues that require prompt attention. In the past, this prescreening was performed by custody officers. According to the contract, SBSO staff receives up to 24 hours of training on medical issues annually by Corizon. However, this training is not adequate for SBSO staff to make many medical decisions. Therefore, deputies are no longer doing the medical intake prescreening on new bookings. The Jury learned that as of April 11, 2016, Corizon RNs are now performing the entire medical intake assessments. This is intended to ensure that medical needs are being met at intake. The medical prescreening questionnaire is an assessment tool used to determine if the inmate is ambulatory, alert, sick, suicidal, intoxicated, on medication, or has a history of drug or alcohol abuse. The name of the arrestee is entered into the Jail Management System (JMS), an inmate management software package, to determine if the arrestee has a previous record. If so, and if the arrestee has a significant medical condition such as heart problems, diabetes, drug/substance abuse history or psychological issues that were identified and recorded, the JMS would “red flag” the inmate information for ease of future retrieval. During the pre-screening, the detainee is asked about medication or street drugs recently used. Depending on the types of medications the detainee claims to be using, the nurse attempts to verify the prescribed medication by calling the detainee’s doctor, clinic, or pharmacy. After conducting the medical prescreening using the SBSO questionnaire, the Corizon RN also evaluates whether the arrestee has significant medical issues that need to be addressed. This second medical evaluation uses Corizon’s “Intake and Receiving Screening form CS1101” (see Appendix B). Based on this evaluation the RN refers any arrestee with an urgent medical need to the Corizon contracted medical doctor (MD) for a follow up appointment. The Medical Process Overview, Medical Referral Sources, flow chart provided by SBSO staff (see Appendix C), does not reflect the new medical intake procedure and needs to be revised. . An arrestee who discloses a history of drug or alcohol abuse is assessed with the Clinical Opiate Withdrawal Scales (COWS) (see Appendix D.) According to Corizon staff, if an arrestee is identified as having a history of substance abuse, there is a “protocol” to ensure they are monitored closely. For example, if it is determined that the arrestee is a habitual intravenous drug user, according to the Corizon staff “the inmate is to be placed in observation and 2015-16 Santa Barbara County Grand Jury 109
• OB6 Page 131
  SANTA BARBARA COUNTY JAIL medication ordered to help reduce withdrawal symptoms.” These procedures are not outlined in the Receiving Screening Process (see Appendix E). These protocols are only referenced in the Manual Section 303.Use of Sobering/Observation Cell. The Jury observed, that although SBSO and Corizon are supposed to work together, this cooperative collaboration has not always existed. SBSO staff has not always followed established oversight procedures to ensure Corizon staff are operating in accordance with their contract. Fundamental responsibilities may not be completed during a work shift. With proper monitoring, problems can be alleviated. SBSO staff does not have checklists or guidelines to reduce the risk of incomplete evaluation by Corizon staff. The Jury recommends that the Sheriff Office update Appendices C and E. Additionally, two signature blocks, one for medical clearance staff the other for the custody officer prior to classification should be added to the forms in Appendices A and B. A critically important next step, after the arrestee is medically cleared, is classification. The classification which is conducted by SBSO Staff determines where in the jail the new inmate will be housed. During this time the inmate is issued a wristband that includes pertinent personal information and moved to a holding cell. Whether the inmate is a new arrestee, or a reoffender, they go through the same intake process. For the safety of all concerned, it is imperative that this two-step process requires close collaboration between Corizon and SBSO staff to ensure that inmates entering the Jail are medically cleared and classified before placement in the general population. Protocols When the Intake Screening Process is completed, information is documented in the JMS which includes general health concerns. Also documented are external observations of behavior, appearance, deformities, injuries, and skin lesions, which might be indicators of illicit drug use. Inmates entering the Jail are tested for tuberculosis if they are expected to be there longer than 72-hours. In the case of a female arrestee, gynecological and pregnancy issues are noted. If there are any concerns noted during the medical intake process, the Corizon staff takes necessary steps to reconcile these issues. The medical intake RN may refer the inmate/patient to the MD or Nurse Practitioner (NP), give them needed bridge medications, or initiate other treatments or protocols. The MD or the NP sees the patients that have been referred to them as scheduled by the intake nurse. This procedural change is an improvement that will result in inmate/patients receiving the most appropriate level of care whether it is urgent, emergent or routine. If the medical review is not conducted in accordance with written procedures, and discrepancies are not corrected, situations can develop with unforeseeable complications. Intake Process Failure During the intake review, the Jury observed that medical records in the Jail are stored using an antiquated, paper system. According to Corizon and SBSO staff, medical records are not computerized for quick access and both recognize this as a serious deficiency. If further information is needed during a medical intake, Corizon staff must manually retrieve medical records which are stored in paper form in the medical unit. Although the JMS flags chronic medical conditions, the information is frequently limited and insufficient to medically evaluate 110 2015-16 Santa Barbara County Grand Jury
• OB7 Page 132
  SANTA BARBARA COUNTY JAIL inmates with major medical issues. If the medical records were stored electronically, medical intake evaluations could be conducted after first reviewing their previous medical history in the jail. SBSO staff have established procedures and protocols on how to process inmates. However, the Jury found that at least in one case, the intake procedures were not followed and an inmate was released into the general population without a completed medical screening. It is vitally important that every step of the medical intake process be conducted for each arrestee. A deviation from the approved process may result in an arrestee’s significant medical needs not being met when in the custody of the county, resulting in an intake process failure and possible major liability. All medical screening forms need to be signed and dated prior to classification. The classification by a custody officer must confirm that medical clearance has been completed prior to placement of the inmate to the appropriate location in the Jail. A combination of events, such as the arrestee not responsibly and accurately reporting their medical condition, Corizon staff not completing their medical evaluation, and/or custody staff not overseeing the Corizon process, could result in intake process failure. The Manual, Chapter 3, Section 303 (Use of Sobering/Observation Cell), outlines procedures to be used when an inmate is admitted to the Jail while under the influence of alcohol or other substance. Determining the level of intoxication or drug effect is subjective. When in doubt, in order to err on the side of safety, the use of sobering/observation cells is imperative. The consistent use of these cells ensures that inmates who are at risk are properly monitored.

No Responses Found 1

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