Grand Jury 2024-5aR Grand Jury Response 1 message

The failure of Wellpath, the medical provider contracted by the Sheriff to provide data from required Health Service Audits, has adversely affected inmate health and resulted in poor health care and lack of pharmaceutical services for inmates. __ AGREE __ PARTIALLY DISAGREE _X DISAGREE Response explanation (required for a response other than Agree): The Sheriff’s Office disagrees with this finding for the following reasons: - Wellpath completed the 2023 Annual Report. - The Sheriff’s Office and Wellpath were recently found to be in compliance with this subject on our most recent Title 15 Medical/Mental Health Inspection by Dr. Lee conducted on 5/22/24. - Even when the Sheriff’s Office was not receiving the annual report from Wellpath, they provided a Quality Assurance meeting every quarter. Those meetings were attended by Wellpath, Health Services Agency, the Public Health Officer, County Behavioral Health, and the Sheriff’s Office and discussed much of the same data included in the annual report. - We disagree with the statement that the incarcerated population have received poor health care and we do not believe they “lack” pharmaceutical services. The Grand Jury’s own report stated that 65% of the population was on medication. It should also be noted that the Sheriff’s Office transitioned to NaphCare from Wellpath on July 1st, 2024, to provide Medical and Mental Health Services in our Correctional Facilities.

The failure of Wellpath to implement a comprehensive discharge plan causes inmates to be released without community connection to medical treatment and medication. __ AGREE __ PARTIALLY DISAGREE _X DISAGREE Response explanation (required for a response other than Agree): The Sheriff’s Office disagrees with this finding for the following reasons: - A “comprehensive discharge plan” is the responsibility of more than the contracted medical provider (Wellpath or NaphCare). This plan would involve Probation, Courts, community partners, the Sheriff’s Office, and the contracted medical provider to provide a comprehensive plan, including community supports such as housing, employment, insurance, and medical/mental health care. - Wellpath or NaphCare’s responsibility for discharge planning is limited to Medical and Mental Health care. To this end, Wellpath’s discharge planner has been working within their limitations to ensure a smooth transition of care in the community for our incarcerated population. Individuals are provided a prescription to the pharmacy of the individual’s choice, are often scheduled follow-up appointments, and provided instruction on how to seek services in the community. - The Sheriff’s Office has embraced the state initiative CalAIM. We have two full-time positions that speak with all incarcerated individuals and offer to assist them with their application for MediCal. Through CalAIM grant funding, we have recently hired two new Reentry Planners that will help coordinate release of incarcerated individuals, to include coordinating medical and mental health care in the community. - The Sheriff’s Office has consistently worked to improve comprehensive discharge planning in the community, inviting our community/government partners to start planning for individuals prior to their release and while they are medically/mentally stable and in a safe environment. - During our conversations with Wellpath/NaphCare’s discharge planner, they noted several barriers they have come across including inability to schedule mental health appointments on behalf of our incarcerated individuals, inability to access pertinent information when an individual’s MediCal is suspended or turned off, and not being allowed to create a referral for individuals to certain services due to working for Wellpath or NaphCare. We have taken this information and are working with our partners to resolve these issues.

The failure of the Sheriff’s jail staff to properly address inmates' mental illness crises has caused mentally disabled inmates to be held in Safety Cells for excessively long periods. __ AGREE __ PARTIALLY DISAGREE _X_ DISAGREE Response explanation (required for a response other than Agree): The Sheriff’s Office disagrees with this finding for the following reasons: - Dr. Lee’s recent 2024 Title 15 inspection notes that we were in compliance with the use of Safety Cells, meaning we were utilizing them appropriately. - The Sheriff’s Office works with our contracted Medical and Mental Health providers when the decision is made to place an incarcerated person into a Safety Cell. Safety Cells are used for individuals in crisis and are only used when specified conditions are met and those conditions are within accepted use under the law, Board of State and Community Corrections (BSCC) regulations, and Sheriff’s Office policy. - Our Sheriff’s Office staff and contracted Mental Health providers are trained to deal with incarcerated persons in crisis. Mental Health staff on site are capable of providing the individual with tools and coping skills to help them out of their crisis. - Once Mental Health professionals clear the individual from the Safety Cell, the Sheriff’s Office places those individuals on a “step-down” procedure where they are still closely monitored and continue to be seen by mental-health professionals until Mental Health deem the individual is clear to be moved to regular housing. - For the small percentage of incarcerated individuals that do not improve with treatment from our contracted provider, the Sheriff’s Office has sought temporary release to a Lanterman-Petris-Short Act (LPS) clinic. The decision to release nearly always requires approval from a judge and can require coordination with other entities as well. - The Sheriff’s Office has daily Crisis Intervention Team (CIT) meetings where we discuss incarcerated persons that may be in crisis, including those in Safety Cells. These meetings include representatives of the Sheriff’s Office, our contracted Medical and Mental Health provider, County Behavioral Health, and Probation. The purpose of these meetings is to collaborate and discuss best methods of dealing with those in crisis, other high-risk incarcerated individuals, and discuss proper transition of these higher-risk individuals into the community.

The improper use of Safety Cells by the Sheriff’s jail staff to isolate inmates who are greatly in need of mental health care and/or have made suicidal statements causes a violation of required procedure. __ AGREE __ PARTIALLY DISAGREE _X DISAGREE Response explanation (required for a response other than Agree): The Sheriff’s Office disagrees with this finding for the following reasons: - The Sheriff’s Office does not improperly use Safety Cells. - Safety Cells are used for individuals that are at risk for self-harm, a risk of harm to others, or damaging property to the point they could be a danger to themselves or others. This is in compliance with the law, BSCC regulations, and our policy. - Dr. Lee’s recent 2024 Title 15 inspection noted that we were in compliance with the use of Safety Cells.

The use of Safety Cells for punishment has resulted in violations of Title 15 section 1055 and the Sheriff’s Policy and Procedures Manual policy 516.2. This may expose the Sheriff’s department to lawsuits. __ AGREE __ PARTIALLY DISAGREE _X_ DISAGREE Response explanation (required for a response other than Agree): The Sheriff’s Office disagrees with this finding for the following reasons: - Dr. Lee’s recent 2024 Title 15 Inspection specifically noted in the comments “Safety Cell is not used for punishment” and we were found to be in compliance with Safety Cell use. - The Sheriff’s Office is unaware of Safety Cells being used as punishment. - As this report cites, the Sheriff’s Office Corrections Policy 516.2 states, “A sobering or safety cell shall not be used as punishment or as a substitute for treatment.” - The Sheriff’s Office abides by this policy and denies using Safety Cells as punishment.

The practice of excluding mentally ill patients from 5150 hold and transfer until discharge results in a violation of both Title 15 and Sheriff’s Policies and Procedures manual policy 516.2. __ AGREE __ PARTIALLY DISAGREE _X_ DISAGREE Response explanation (required for a response other than Agree): The Sheriff’s Office disagrees with this finding for the following reasons: - Dr. Lee’s recent 2024 Title 15 inspection notes that we were in compliance with all regulations related to this topic. Furthermore, we passed all Title 15 inspections by the BSCC. - To release an individual to an LPS facility often requires coordination and approval by the Courts as well as coordination with outside entities. This takes time thus individuals often remain in a safety cell until that coordination takes place since they are in crisis and at risk of self-harm or harm to others. - Furthermore, the Sheriff’s Office works with the resources available to us. Mentally ill individuals, particularly those in acute crisis, can be challenging and there are limited community resources to deal with this problem; hence the importance of proper coordination when we release an incarcerated person to the care of a community provider. The Sheriff’s Office would invite the community to support a new Main Jail and/or a facility that would include a crisis-stabilization unit that could be recognized as an LPS facility to treat incarcerated persons in crisis. The Sheriff’s Office has seen an increase in incarcerated individuals with mental health disorders, an increase in the acuity of their disorders, and believes those trends will continue. An in-house treatment facility would allow the Sheriff’s Office to better serve this population while still maintaining public safety interests of the community.

The failure of Jail administrators to transfer inmates with suicidal ideation or in a mental health crisis to an out-of-county LPS facility adversely impacts inmate mental health care. __ AGREE __ PARTIALLY DISAGREE _X_ DISAGREE Response explanation (required for a response other than Agree): The Sheriff’s Office disagrees with this finding for the following reasons: - Dr. Lee’s recent 2024 Title 15 inspection noted that we were in compliant with all regulations related to this topic. - Incarcerated persons with suicidal ideation are placed in safety cells where the ability to harm themselves is removed. - These individuals are treated by our contracted Medical and Mental Health provider during that time with individual treatment to include providing them tools and teaching them coping skills to address their crisis. - If treatment is required beyond what our providers can provide, we evaluate the appropriateness of transfer to an LPS facility, in coordination with our community partners. An in-house LPS facility would allow the Sheriff’s Office to better serve this population while still maintaining public safety interests of the community.

The failure of the Crisis Intervention Team to issue a 5150 hold and transfer before an inmate is discharged adversely impacts inmate mental health care. __ AGREE __ PARTIALLY DISAGREE _X DISAGREE Response explanation (required for a response other than Agree): The Sheriff’s Office disagrees with this finding for the following reasons: - Dr. Lee’s recent 2024 Title 15 inspection noted that we were compliant with all regulations related to this topic. - The Sheriff’s Office does work with the Courts and our community partners to coordinate care of individuals in crisis and transfer them to an LPS facility.

The practice of placement in Administrative Separation (solitary confinement) causes inmates to suffer mental health problems including, but not limited to, anxiety, insomnia, paranoia, aggression, and depression. __ AGREE __ PARTIALLY DISAGREE _X DISAGREE Response explanation (required for a response other than Agree): The Sheriff’s Office disagrees with this finding for the following reasons: - The Sheriff’s Office understands that Administrative Separation can have a negative impact on incarcerated persons. - Placing some of these individuals that are in Administrative Separation around other individuals in the state they are in would jeopardize their safety and/or the safety of other incarcerated persons. - Many individuals request to be housed individually and to be separated from others. - The Sheriff’s Office recognizes that many of the individuals booked into the jail are suffering from substance abuse, mental health disorders, and/or medical conditions that they have been neglecting to care for. Sometimes, an individual is exceptionally unstable, requiring placement in administrative separation until they can stabilize to the point where it is safe to place them around other individuals. Regarding individuals that are placed on Administrative Separation, we take many steps to minimize the number and duration of individuals separated, to include but not limited to: - The Sheriff’s Office has recently amended our procedures that all newly administratively separated persons have a review by a team of Medical, Mental Health, Classification, and Jail Management/Supervisors on the next business day, but usually within 24 hours. This review is to ensure that Administrative Separation is appropriate, and that any medical or mental health needs are considered and addressed. - Secondly, for over a year, we have hosted weekly reviews of all individuals that are on administrative separation. Each individual is discussed by our Classification Team, Medical, Mental Health, and Jail Management for appropriateness of Administrative Separation as well as discussion about how to remove them from separation. This sometimes includes pairing individuals for socialization with other individuals that often do not want to program together but we do not believe are a risk to each other and incentivize groups that program together. - After these meetings, the individuals on Administrative Separation are provided with a document that includes how they can move to less-restrictive housing. - Jail Medical, Mental Health, Classification, a Jail supervisor, and Jail Management conduct “Rounds” three times per week on the Administrative Separation population. This group speaks with these individuals and amongst other things, monitor their behavior/attitude, their cell conditions, address any needs they have, and encourage them to follow rules and program with other individuals. Administrative Separation is never the goal of the Sheriff’s Office, however there are circumstances where it is necessary to protect the safety of the individual as well as other incarcerated persons and staff.

The failure of Jail administrators to transfer Inmates who are suffering from mental health crises symptoms to an LPS Facility adversely impacts inmate mental health care. __ AGREE __ PARTIALLY DISAGREE _X DISAGREE Response explanation (required for a response other than Agree): The Sheriff’s Office disagrees with this finding for the following reasons: - Dr. Lee’s recent 2024 Title 15 inspection noted that we were compliant with all regulations related to this topic. - The Sheriff’s Office routinely transfers incarcerated individuals that are in acute crisis to an LPS facility. - Despite a significant percentage of our population receiving medication for mental health disorders, the vast majority are not in crisis and with the care provided by our contracted medical provider are able to safely and appropriately manage their symptoms. - A small percentage of our incarcerated population does suffer from acute mental health disorders and struggle to manage their symptoms. Those individuals are under the care of our Medical and Mental Health providers. We discuss these individuals during our daily CIT meetings and involve our community partners in finding appropriate solutions. - When it is determined the one of these acute individuals is in crisis, meets the criteria for a 5150 W&I hold, and their care would be better treated at an LPS facility, we work with the Courts and our community providers to make that transfer.

Opening the closed unit at Rountree and increasing the number of re-entry programs would result in better conditions for inmates and less stress for the correctional officers. __ AGREE __ PARTIALLY DISAGREE _X DISAGREE Response explanation (required for a response other than Agree): The Sheriff’s Office disagrees with this finding for the following reasons: - The Sheriff’s Office intends to reopen the closed unit at Rountree when staffing improves. - Sheriff’s Office Correctional Officers have been on Mandatory Overtime (MOT) for over 7 years now. - If the Sheriff’s Office opened the closed unit, it would result in an additional 84 shifts of overtime every 6 weeks, meaning each Correctional Officer that is already assigned MOT, would have 1-2 more overtime shifts every six weeks. - It is not the Sheriff’s Office opinion that opening this unit would cause “less stress for correctional officers” based on this increase of MOT. - Opening this unit would not increase the number of re-entry programs as the number of programs/classes is finite. - The programs/classes allotted to this closed unit were reallocated across our facilities to benefit other housing units and incarcerated individuals.

Increasing the number of programs that focus on rehabilitation, education, and restorative justice to prepare for reentry would show positive improvement to public safety and a reduction in recidivism for reentering inmates. _X AGREE __ PARTIALLY DISAGREE __ DISAGREE Response explanation (required for a response other than Agree): The Sheriff’s Office is committed to programming for our incarcerated population. Our Programs division was recently recognized as a “mentor site” by the Bureau of Justice Administration (BJA) for its work in this field. This recognition resulted in our Programs staff hosting and providing training to individuals from other agencies across the country on how to successfully manage programming for incarcerated individuals. While we recognize the importance of programs, it should be noted (as it was during the tour with the Grand Jury) that the Main Jail has only two small classrooms for the entire facility, which is not nearly enough for our population. We believe a new facility, designed for better Medical/Mental Health treatment and Programming would help us improve on what we are already doing.

Jail programs like “Stepping Up” steers the mentally ill to community-based mental health care, reducing the number of mentally ill inmates in jail. __ AGREE _X PARTIALLY DISAGREE __ DISAGREE Response explanation (required for a response other than Agree): The Sheriff’s Office is supportive of programs that reduce the number of mentally ill individuals incarcerated. Further research of the Stepping Up program would be required to fully agree with this statement.

The current practice of reviewing inmate classification monthly is too long of an interval and may endanger inmates suffering from mentally illness. __ AGREE __ PARTIALLY DISAGREE _X DISAGREE Response explanation (required for a response other than Agree): The Sheriff’s Office disagrees with this finding for the following reasons: - Classification of incarcerated persons occurs within the best practices and is compliant with all regulations. - The mental health of an incarcerated person has no direct impact on an individual’s classification score.

The failure of Wellpath to recruit and retain adequate staff adversely impacts the overall effectiveness of the mental health services provided to inmates. __ AGREE __ PARTIALLY DISAGREE _X DISAGREE Response explanation (required for a response other than Agree): The Sheriff’s Office expects our medical and mental health provider to provide quality, consistent service to our incarcerated population. We are unaware of any specific incident of inadequate mental health services being provided, as a result of rotating mental health staff, that led to an adverse outcome.

The Santa Cruz County Civil Grand Jury was not permitted to interview inmates serving sentences at the Rountree Rehabilitation and Reentry Facility as required by the Bureau of State Community and Corrections. Speaking to some inmates about their experiences and opinions of the programs would have greatly enhanced the Jail investigation and report. __ AGREE __ PARTIALLY DISAGREE _X DISAGREE Response explanation (required for a response other than Agree): The Sheriff’s Office disagrees with this finding for the following reasons: - The Grand Jury originally requested to interview two specific individuals. - The Sheriff’s Office is cognizant of the fact that incarcerated individuals may not feel they have a choice to be interviewed, therefore we requested the Grand Jury supply a subpoena for the interview. - The Grand Jury then asked if they could speak to any incarcerated individual at Rountree which was an abnormal request. - The Sheriff’s Office again asked them to provide a subpoena as we had requested it for the two individuals originally requested, it seemed only appropriate to have them get one for anyone else.