The 2015-2016 Santa Cruz County Civil Grand Jury Requires that the Santa Cruz County Sheriff-Coroner

There is no publicly available comprehensive report identifying the cause of Krista DeLuca’s death, the activities of the Sheriff-Coroner’s Office, and the activities of the medical services provider related to her death. X AGREE PARTIALLY DISAGREE – explain the disputed portion DISAGREE – explain why Response explanation (required for a response other than Agree): A comprehensive report was completed, however much of the report is restricted by State and Federal law to protect the rights of the deceased and her family.

There is no independent county oversight, by a qualified medical professional, of both the medical services provider (CFMG) and the contract. AGREE PARTIALLY DISAGREE – explain the disputed portion X DISAGREE – explain why Response explanation (required for a response other than Agree): Sheriff’s medical oversight includes audits by the Health Services Department (HSD), quarterly quality assurance meetings with the medical provider, HSD, the Sheriff’s Office and an independent physician, biennial inspections by the Board of State and Community Corrections, daily multi-disciplinary collaborative review meetings between partners and other professional reviews, as well as the annual Grand Jury investigation.

The 2012–2016 contract does not allow the Sheriff’s Office to retain additional independent medical providers but the Watch Commander can override the medical service provider’s decision and escalate to a higher level of medical care in life-threatening emergency circumstances. X AGREE PARTIALLY DISAGREE – explain the disputed portion DISAGREE – explain why Response explanation (required for a response other than Agree):

The 2012–2016 contract requirement that the jail medical services provider pay up to $15,000 per inmate admitted to a hospital may be a deterrent to admitting inmates in need of hospital medical care. AGREE PARTIALLY DISAGREE – explain the disputed portion X DISAGREE – explain why Response explanation (required for a response other than Agree): The Sheriff’s Office does not believe the $15,000 payment clause deterred hospital admissions. The Sheriff’s Office did however recognize the potential appearance of conflict through our internal review process and we plan to remove the clause from the 2016 contract proposal.

The Health Services Agency completed the required 2015 annual Title 15 inspection of the Main Jail but did not identify if the facility was in compliance with the Detoxification Treatment requirements (Title 15, Section 1213). X AGREE PARTIALLY DISAGREE – explain the disputed portion DISAGREE – explain why Response explanation (required for a response other than Agree): This issue was identified by our internal review process and corrected in March of 2016. We are now in compliance with the requirement.

There is no documentation that the Santa Cruz County facilities have been evaluated for compliance with the CMA-IMQ medical accreditation standards for detention facilities. X AGREE PARTIALLY DISAGREE – explain the disputed portion DISAGREE – explain why Response explanation (required for a response other than Agree): The new 2016 contract requires the medical provider to be CMA-IMQ accredited.

The Chemically Dependent Inmate Policy lacks objective measurement tools for assisting the medical staff with their clinical decision making and determination of when a patient requires a higher level of medical care. AGREE PARTIALLY DISAGREE – explain the disputed portion X DISAGREE – explain why Response explanation (required for a response other than Agree): In March of 2016, the medical provider adopted new policy and procedures for handling acute detoxification of chemically dependent inmates, which include objective measurement tools to assist clinical decision-making.

The Chemically Dependent Inmate Policy does not include procedures and symptoms necessitating immediate transfer to a hospital or other medical facility. AGREE PARTIALLY DISAGREE – explain the disputed portion X DISAGREE – explain why Response explanation (required for a response other than Agree): The medical provider updated their policy and procedures in March of 2016 with objective tools that specify symptoms necessitating immediate transfer to a hospital.

The Chemically Dependent Inmate Policy and the Sheriff’s Medical and Mental Health Care Procedure Manual lack guidance for when an inmate should be transferred to a hospital for a higher level of care or when an inmate should be placed on IV hydration. AGREE PARTIALLY DISAGREE – explain the disputed portion X DISAGREE – explain why Response explanation (required for a response other than Agree): The medical provider’s March 2016 updated policy includes guidance for when an inmate should be transferred to a hospital for a higher level of care or when an inmate should be placed on IV hydration.

The Detoxification of Chemically Dependent Inmates, Federal Bureau of Prisons Clinical Practice Guidelines, February 2014, contains useful information related to recommended standards for the medical management of withdrawal from addictive substances. X AGREE PARTIALLY DISAGREE – explain the disputed portion DISAGREE – explain why Response explanation (required for a response other than Agree):

The Sheriff’s Office at times refers to placing at-risk inmates in the infirmary, when in fact they are placed in the Observation Unit. The Observation Unit is not an infirmary. The Grand Jury finds this misnomer to be misleading to the public and endangering of the public trust. AGREE PARTIALLY DISAGREE – explain the disputed portion X DISAGREE – explain why Response explanation (required for a response other than Agree): The Sheriff’s Office, through our internal review process, recognized the term infirmary was an inaccurate description of the Observation unit and deleted the term from official forms and correspondence prior to the Grand Jury Report. The Sheriff’s Office does not believe the internal use of the term Infirmary was misleading to the public nor endangered the public trust.