2014­2015 Grand Jury Response Packet Medical Services at the Jails Santa Cruz County Sheriff­Coroner

The office of the Sheriff­Coroner has exercised minimal oversight of its ​ contract with California Forensic Medical Group. AGREE ​ PARTIALLY DISAGREE ­ explain disputed portion below ​ ​ x DISAGREE ­ explain below ​ ​ Response explanation (required for responses other than “Agree”): The Sheriff and designees are actively involved in oversight of the medical services provided by CFMG. At the request of the Sheriff­Coroner and pursuant to the provision of Section 101045 of the California State Health and Safety Code, the Public Health Division of the Health Services Agency conducts an Annual Inspection of the County Detention Facilities. A supervisor attends a joint medical, mental health and custody Crisis Intervention Team meeting five days a week. A facility commander frequently attends the meeting, and the chief deputy occasionally attends the meeting. The chief deputy and the facility manager regularly attend the quarterly multi­disciplinary quality assurance committee. The chief deputy frequently consults and works with CFMG management to review and/or modify procedures to improve medical services, reduce risk and prevent negative outcomes. The facility manager frequently meets with CFMG medical supervisors to review and/or modify procedures to improve medical services, reduce risk and prevent negative outcomes. The watch commander and jail supervisors daily interact with CFMG medical providers in a collaborative approach to provide medical services to inmates. The facility manager and chief deputy overseen the Suicide Response Team, a collaborative team comprised of Corrections, County Mental Health and CFMG Medical.

The office of the Sheriff­Coroner lacks independent medical expertise to ​ oversee California Forensic Medical Group’s delivery of medical services to county detention facilities. AGREE ​ x PARTIALLY DISAGREE ­ explain disputed portion below ​ ​ DISAGREE ­ explain below ​ ​ Response explanation (required for responses other than “Agree”): Although the Sheriff­Coroner does not directly employ or contract a physician to oversee the medical services contract, the County Health Officer, a licensed physician, as well as other county medical and health officials, regularly participate in quarterly quality assurance meetings and perform independent reviews on an annual basis. At the request of the Sheriff­Coroner and pursuant to the provision of Section 101045 of the California State Health and Safety Code, the Public Health Division of the Health Services Agency conducts an Annual Inspection of the County Detention Facilities.

The absence of quality assurance findings and corrective actions in the ​ ​ California Forensic Medical Group Annual Report of Medical Services compromises the ability of the Sheriff­Coroner to oversee and ensure the quality of care in the county jails. AGREE ​ PARTIALLY DISAGREE ­ explain disputed portion below ​ ​ x_DISAGREE ­ explain below ​ ​ Response explanation (required for responses other than “Agree”): Quality assurance review meetings occur quarterly and attended by representatives from several disciplines and authorities other than medical professionals associated with CFMG including the County Health Officer, the County Director of Nursing; the County Behavioral Health Manager; the County Psychiatrist; the Sheriff’s Chief Deputy. At the request of the Sheriff­Coroner and pursuant to the provision of Section 101045 of the California State Health and Safety Code, the Public Health Division of the Health Services Agency conducts an Annual Inspection of the County Detention Facilities. As a component of CFMG’s Quality Management / Assurance Management Program, CFMG contracts a local physician to peer review medical practices and participate with The Local Medical Peer Review Committee conducts routine audits of medical services.

Current procedures for monitoring inmates younger than age 65 do not ​ identify their potential need for a higher level of care. AGREE ​ PARTIALLY DISAGREE ­ explain disputed portion below ​ ​ x DISAGREE ­ explain below ​ ​ Response explanation (required for responses other than “Agree”): Existing medical screening procedures apply to all arrestees, regardless of age, to identify any arrestees or inmates who require medical evaluation or care.

The contract with California Forensic Medical Group lacks provisions for ​ external review by authorized investigative persons or agencies. AGREE ​ PARTIALLY DISAGREE ­ explain disputed portion below ​ ​ x DISAGREE ­ explain below ​ ​ Response explanation (required for responses other than “Agree”): The Minimum Standards for Local Detention Facilities Title 15 Regulation 1205 – Medical and Mental Health Records requires the health authority to maintain medical records, confers the physician­patient confidentiality privilege and requires controlled access to records. CFMG maintains a Standardized Transfer of Medical Information policy. The policy manual provides for various types of reviews, including In­Custody Death Review; Local Medical Peer Review and Quality Assurance Review. Specific legal authority for access to medical records need not be repeated in policy. The Public Health Division of the Health Services Agency conducts an Annual Inspection of the County Detention Facilities, during which representatives of the Agency reviews CFMG policies. As a component of CFMG’s Quality Management / Assurance Management Program, CFMG contracts a local physician to perform external peer review of physician practices. The Local Medical Peer Review Committee conducts routine audits of medical services.

Without accreditation, contractual adherence to California Medical ​ Association­ Institute for Medical Quality accreditation standards cannot be verified. x AGREE ​ PARTIALLY DISAGREE ­ explain disputed portion below ​ ​ _ DISAGREE ­ explain below ​ ​ Response explanation (required for responses other than “Agree”):