Sutter County Board of Supervisors - Filed 09-28-12

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The involved LVN, by failing to recognize the medical emergency and by not calling for an ambulance, acted inadequately in the treatment of the inmate. Response The respondent disagrees wholly with this finding. The facts as stated in the Grand Jury report are in question. The finding is a medical and legal conclusion and lacks proper foundation. The JNM did not take any interest or immediate action responding to the inmate's medical emergency which is inconsistent with RN training and not in compliance with the job description to provide professional nursing care.

Related Recommendations (1)

R1

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Clinical performance of the involved LVN should be evaluated by the RN supervisors on a regular basis and reported to the JNM. The JNM and the AD should then review oversight and performance of the LVN to determine if the LVN meets minimum nursing standards. Response The recommendation has been implemented. The performance evaluation of all LVNs is being transferred to the RN Supervisors as per their County job descriptions. The RN Supervisors are responsible for directing and evaluating assigned staff (i.e. LVNs), to include assigning work, handling employee concerns and problems, counseling, discipline, and completing employee performance appraisals. The performance appraisals will be reviewed by the Jail Nurse Manager and the Assistant Director of

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Response The respondent disagrees wholly with this finding. The facts as stated in the Grand Jury report are in question. The finding is a medical and legal conclusion and lacks proper foundation.

No recommendations for this finding

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Although the 2010-11 SCGJ recommended a December 31, 2011 completion date, only about half of the P&Ps have been finalized and made available on the intranet. There was no priority after the inmate death to immediately implement a policy that included vital sign parameters indicating when to call for an ambulance. Response The respondent disagrees partially with this finding. A specific Policy and Procedure and Vital Sign Flow sheet has been finalized and posted on the intranet and therefore was a priority. Respondent is working diligently to update all polices and procedures and place them on the intranet as time permits. According to the job description, the AD has direct involvement with JMS, not only for oversight of the JNM’s performance, but for the purpose of recognizing and improving — employee problems. With the disconnect amongst the JMS staff with the JNM, the AD is not attune to the problems at the jail medical clinic and/or not taking appropriate, decisive

No recommendations for this finding

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steps to resolve them. Response The respondent disagrees wholly with this finding. The statement about the purported problem or disconnect does not provide sufficient specificity to allow Respondent to adequately respond to the Grand Jury. The job description for the Assistant Director of FS.

Related Recommendations (1)

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Human Services for Public Health. The performance appraisal is to determine the level of performance of their job position. The responsibility to determine if the LVN meets minimum nursing standards lies with the State Licensing Board. When present during an emergency situation the JNM should assume full responsibility as the lead RN to ensure professional quality medical care. The JNM should be more accessible when asked for guidance by jail nursing staff regarding inmate care and be more available to assist as needed. Response The recommendation has been implemented. In the absence of the Medical Doctor or Family Nurse Practitioner, the Jail Nurse Manager, if present, will take the lead. When staff requests assistance related to an urgent situation, the Jail Nurse Manager will be expected to respond if present at the jail. The JNM must ensure all JMS staff is thoroughly familiar with the new JMS Policy #16- 506, which outlines parameters for abnormal vital signs and requires actions. Response The recommendation has been implemented. The staff have been trained at their regular jail medical services staff meeting and the RN Supervisors have been charged with ensuring that those staff not present at the staff meeting receive training of the policy and procedure and the use of the Vital Signs flow sheet. The AD should evaluate and make changes to ensure the person in the position of JNM is capable of fulfilling all job responsibilities. This could entail periodic feedback from the nursing staff, more direct observation, and frequent evaluations of the JNM’s leadership abilities. Response The recommendation has been implemented. The AD has and will continue to evaluate the position of Jail Nurse Manager to ensure that the person is fulfilling all job responsibilities as described in the job description. Every effort should be made by the JNM, AD, and HO to finalize and implement all P&Ps and make them available on the intranet. Thereafter, all P&Ps should be reviewed and updated annually. Response The recommendation has been implemented. The completion of the core policy and procedures continues to be a top priority and as each policy and procedure is completed and finalized, it is reviewed with staff and posted on the intranet. The intranet manual is available to the Jail Medical Services staff.

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Human Services is a combined job description for the Assistant Director of Human Services for Social Services, Public Health or Mental Health and generally refers to oversight of jail health services. However, it is agreed that the Assistant Director of Human Services for Public Health has responsibility for planning, organizing and directing operations of the Jail Medical program and supervision of the Jail Nurse Manager. The AD violated the conditions of the job description by enabling the JNM to be negligent of duties and responsibilities throughout the JNM’s entire tenure. This includes continuous noncompliance by not reviewing and updating P&Ps annually (Title 15 sec 1206 CA code), no in-clinic training program to assure standardized treatment procedures, and reluctance to act in the capacity of an RN. Response The respondent disagrees wholly with this finding. The JNM was not continuously out of compliance with his duties and responsibilities. The Jail Medical policies and procedures did receive review as part of the Health Officer’s annual inspection under and were identified in some of those inspections as requiring updating. Some of those policies and procedures require updating by the Health Officer as well as the Jail Nurse Manager and Nursing Supervisors within the jail. In regular weekly staff meetings, case management and concerns are routinely discussed for training purposes; The Jail Nurse Manager position does not primarily entail clinical nursing duties. The Jail Nurse Manager provides oversight and management of Jail Medical Services and clinical nursing duties. The Jail Nurse Manager has taken on shifts when no staff has been available to work the shift and has periodically scheduled himself to work shifts to oversee the performance of staff duties. There is no in-house training provided to JMS staff that is specific to their job. Response The respondent disagrees wholly with this finding. Every staff member, at the time of hire, receives an orientation and one-on-one training for working in the Jail Medical Services. CPR, HIPAA training and Custody Safety Training are specific to their job. Additional trainings that are specific to their jobs have been instituted. For example, the withdrawal from Alcohol Nursing Assessment Protocol has been completely revised, presented in the regular weekly staff meeting with follow-up at subsequent staff meetings to answer questions from staff regarding the new forms and procedures. Staff present at the meetings has been trained in the use of the CIWA-AR alcohol withdrawal monitoring scale and the RN Supervisors are responsible for training staff members not present at the staff meetings. A written training plan has been instituted with a specific policy developed regarding required training for staff according to classification. All JMS Management (JNM, AD, and HO) abrogated their responsibility by not conducting an M&M-like conference following the death of the inmate.

No recommendations for this finding

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Kesponse — The respondent disagrees wholly with this finding. Morbidity and Mortality-like (“M&M-like”) conferences have not been held because they are not required and the JMS is not a teaching hospital where M&M-like conferences may be appropriate. Moreover, this was not a death in custody. M&M-like conferences have not been held after adverse incidents at the JMS clinic. These discussions have been discouraged by the HO. M&M-like conferences are of great value as a teaching tool for patient management. Stifling any discussions of these cases is a detriment to the JMS since it deprives the nursing staff team of an outlet to reflect upon and review poor or avoidable outcomes. Response oo The respondent partially disagrees with this finding. Mortality and morbidity-like (“M&M-like’’) conferences have not been held because they are not required and the JMS is not a teaching hospital where M&M-like conferences may be appropriate. Moreover, this was not a death in-custody. Both the NCCHC visit and SCG] investigation independently came to many of the same conclusions concerning issues with the JNP. Response The respondent disagrees wholly with this finding. The Health Officer provided a copy of the National Commission on Correctional Health Care (“NCCHC”) report to the SCGJ on or about February 15, 2012. The SCGJ submitted its report on April 3, 2012. Therefore, the Respondents cannot determine whether the SCGJ findings were independent of the NCCHC report conclusions. None of the conclusions in the NCCHC report are the same as the SCGJ findings.

Related Recommendations (1)

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The JNM should encourage and foster a learning environment for the nursing staff. They should have opportunities to attend continuing education courses and arrangements should be made for in-house training relating to direct patient care, i.e., man down, suicide prevention, etc. Response The recommendation has been implemented. A written training plan has been instituted with a specific policy developed regarding required training for staff according to classification. This training plan is continuing to evolve as more training needs are identified. All regular staff are being scheduled to attend the Suicide Prevention Training offered by Sutter-Yuba Mental Health Services, a two-day training session, as it becomes available. The RN staff have attended a Physical Assessment all day training. In addition, it should be noted that the County Rules, specifically, Rules Governing Employee Compensation, Benefits and Working Conditions Section 30.7 Continuing Education for Licensed Vocational Nurses states that “Licensed Vocational Nurses who are full time regular employees shall be granted forty (40) paid hours per year to attend conferences and seminars pertaining to continuing education within their relevant fields of practice if such courses are of benefit to the County. Such courses must be approved by the employee's Department Head on the basis of job relatedness and minimum scheduling requirements.” This policy is administered on an equal basis for all covered employees, and requests for attendance to conferences and seminars are reviewed based on relevance to the fields of practice and job description. During the regular weekly Jail Medical Services staff meetings, staff are provided training related to policy and procedures and other training needs as they are identified. After a death or poor outcome at the jail clinic, the HO should conduct M&M-like conferences with the AD and all JMS staff present. The JNM, AD, and HO share the responsibility to schedule these discussions. Response The recommendation will not be implemented as stated because it is not warranted. M&M-like conferences are not required. The JMS is not a teaching hospital where M&M-like conferences may be appropriate. JMS should implement all NCCHS recommendations. Response The recommendation will not be implemented as stated because not all of the NCCHC recommendations are warranted and some of the NCCHC recommendations were identified by NCCHC as optional items for the County to consider. The NCCHC recommendations concern differing aspects of both administration and provision of health care at the jail. Attachment B COUNTY OF SUTTER Todd L. Retzloff, Assessor ASSESSOR’S OFFICE (530) 822-7160 August 28, 2012 Honorable Christopher R. Chandler Superior Court Judge 463 2" Street Yuba City, CA 95991 RE: 2011-2012 Grand Jury Report that pertains to the Assessor’s Office Dear Judge Chandler: . I have reviewed the 2011-2012 Sutter County Grand Jury Report, along with the findings and recommendations contained within it. I have attached my response to aforementioned report pursuant to section 914.1, 933 and 933.05. I want to first thank the Grand Jury for their time, dedication and effort to help make Sutter County the best it can be. I believe the annual reviews by the Grand Jury provide us with an opportunity to review our process and improve our service to the public. Finally, I would like to thank and express my appreciation to my staff of the Sutter County Assessor’s Office for their commitment to teamwork, professionalism and serving the property owners and citizens of Sutter County in these challenging times. Sincerely, Todd L. Retzloff, CCIM Sutter County Assessor 1160 Civic Center Blvd. * P.O. Box 1555 * Yuba City, CA 95992 * FAX (530) 822-7198

Sutter County Board of Supervisors - Filed 09-28-12

Findings and Recommendations 6 findings