Santa Barbara County Stations Bill Brown Sheriff - Coroner Buellton Headouarters*

Published: September 13, 2023 5 pages

Ver PDF original

⚠️ Aviso de traducción: Este contenido ha sido traducido automáticamente. El texto original en inglés es la versión oficial. La traducción puede contener errores.

⚠️ Este contenido ha sido traducido automáticamente. El texto original en inglés es la versión oficial. La traducción puede contener errores.

Findings and Recommendations 2 findings

WellPath electronic medical records established that KP had a long history of substance abuse and severe mental health illness. When the Sheriff's Office custody staff decided to house KP with a cellmate, it did not have access to the full extent of KP's well established severe mental illness history. Inmates' safety and overall health would be better protected if those making classification decisions had access to inmates' vital medical and mental health information. Sheriff's Office Response: Disagree partially with an explanation. The Sheriff's Office agrees that inmate would be better served if custody staff had access to their medical records. Although, in hindsight, it was determined that there were indications in KP's health records, these were not available to custody staff contemporaneous to his death. There was also nothing within the records to establish that KP had been diagnosed with "severe mental illness." Recommendation 1a That Santa Barbara County and the Santa Barbara County Sheriff's Office promptly request that Santa Barbara County Counsel prepare a legal opinion as to whether, consistent with Federal and California law, WellPath (or its successors) may provide critical inmate mental health information to Sheriff's custody staff that have an appropriate need to know that information for inmate housing and programming. Sheriff's Office Response: This has been implemented. County Counsel has provided its opinion concerning whether WellPath (or its successor) may disclose mental health and substance abuse information.

Related Recommendations (2)

R1a

Page 3

That Santa Barbara County and the Santa Barbara County Sheriff’s Office promptly request that Santa Barbara County Counsel prepare a legal opinion as to whether, consistent with Federal and California law, WellPath (or its successors) may provide critical inmate mental health information to Sheriff’s custody staff that have an appropriate need to know that information for inmate housing and programming. Sheriff’s Office Response: This has been implemented. County Counsel has provided its opinion concerning whether WellPath (or its successor) may disclose mental health and substance abuse information.

R1b

That if County Counsel determines that WellPath (or its successors) has any legal authority to provide inmate mental health information, then Santa Barbara County shall amend the agreement between WellPath and the Santa Barbara Sheriff's Office to provide inmate mental health and substance abuse information sharing on an appropriate need to know basis. Sheriff's Office Response: Requires further analysis. To the extent such information can be legally shared, additional research would be needed to ascertain if a WellPath contract amendment would be required due to an expanded scope of work. If so, negotiations would then be needed, as well as Board approval and additional funding, once that process was completed. Even with an aggressive schedule, the full implementation of such an information-sharing procedure will likely take 8 to 10 months.

KP was severely mentally ill, was traumatized by witnessing his cellmate's attempted suicide, and should not have been rehoused alone, back into the same cell. Sheriff's Office Response: Disagree partially with an explanation. At the time he was in custody, there was no indication that KP, who denied mental health issues, was "severely mentally ill," or was "traumatized" by witnessing his cellmate's attempted suicide. KP was not "re-housed," rather he was returned to his assigned cell once the emergency had resolved. It was KP's cellmate who was rehoused. Due to COVID-19 intake quarantine protocols, it would have been inappropriate to rehouse KP with another inmate at that time. Furthermore, KP denied any previous attempts or considerations of suicide during his classification interview, upon which his housing assignment was based. The above notwithstanding, the Sheriff's Office agrees in hindsight that KP should have been evaluated and monitored by mental health staff following his cellmate's attempted suicide.

Related Recommendations (1)

That Santa Barbara County and the Santa Barbara Sheriff's Office ensure that inmates with severe mental illness and suicidal ideation histories receive immediate mental health professional care after they are exposed to traumatizing events, including, but not limited to, the suicide attempt of a cellmate. Sheriff's Office Response: This has been implemented. Immediately following the multi-disciplinary death review, which was conducted of KP's suicide, WellPath issued a written directive and conducted training to ensure that inmates are provided with immediate mental health professional care after exposure to traumatizing events, including, but not limited to, the suicide or attempted suicide of a cellmate. Sheriff's custody staff participated in that training, and a recently issued a critical incident follow-up communication directing custody staff to provide inmates so exposed with enhanced observation, access to mental health services, and access to religious services. Conclusion It is important to understand that our custody facilities house a cross-section of members of our society, reflecting the diversity and complexity of the people within our care. It is also important to recognize that the provision of medical and mental health services within custodial settings is a formidable challenge. Many of those who enter our custody arrive with significant pre-existing physical and mental health challenges, and, regrettably, some choose not to seek, or they reject, medical and/or mental health services during their time in our facilities. Considering the complexities involved, it is essential to underscore a crucial point: the healthcare services provided within our custody facilities often exceed the level of care that many people receive in the community while outside of our custody. While we acknowledge that the health care services provided in our jail system are not perfect, we do believe they are excellent. Nevertheless, our commitment to continual improvement remains unwavering. We understand that the well-being of those in our custody is not solely a matter of institutional responsibility, but rather a reflection of our community's collective commitment to humanity. While we acknowledge that deaths in custody are tragedies, just as they are anywhere else in our community, we hope this response to the Grandy Jury's report illuminates the multifaceted nature of the challenges we and our healthcare providers face. We remain steadfast in our dedication to improving conditions and services within our custody facilities, and to ensuring, to the best extent possible, that those under our care receive the best possible medical and psychological care and support. Our aspiration is that through our ongoing efforts, we can contribute to a broader dialogue on mental health, medical care, and the criminal justice system, ultimately fostering a community in which people receive the type of care and support they need, both within and beyond our custody facilities.

Conclusions 1

CL1

It is important to understand that our custody facilities house a cross-section of members of our society, reflecting the diversity and complexity of the people within our care. It is also important to recognize that the provision of medical and mental health services within custodial settings is a formidable challenge. Many of those who enter our custody arrive with significant pre-existing physical and mental health challenges, and, regrettably, some choose not to seek, or they reject, medical and/or mental health services during their time in our facilities. Considering the complexities involved, it is essential to underscore a crucial point: the healthcare services provided within our custody facilities often exceed the level of care that many people receive in the community while outside of our custody. While we acknowledge that the health care services provided in our jail system are not perfect, we do believe they are excellent. Nevertheless, our commitment to continual improvement remains unwavering. We understand that the well-being of those in our custody is not solely a matter of institutional responsibility, but rather a reflection of our community's collective commitment to humanity. While we acknowledge that deaths in custody are tragedies, just as they are anywhere else in our community, we hope this response to the Grandy Jury's report illuminates the multifaceted nature of the challenges we and our healthcare providers face. We remain steadfast in our dedication to improving conditions and services within our custody facilities, and to ensuring, to the best extent possible, that those under our care receive the best possible medical and psychological care and support. Our aspiration is that through our ongoing efforts, we can contribute to a broader dialogue on mental health, medical care, and the criminal justice system, ultimately fostering a community in which people receive the type of care and support they need, both within and beyond our custody facilities.

* This report's PDF did not contain easily extractable text and required Optical Character Recognition (OCR) for analysis. There may be minor errors in the extracted findings and recommendations due to OCR limitations with scanned documents.