Santa Barbara County Jail Intake Screening Process

Conclusions 7

• CL1
  The Santa Barbara County Sheriff is using an antiquated paper system for maintaining inmate medical records at the Santa Barbara County Main Jail.
• CL2
  The Santa Barbara County Sheriff Staff, has not always followed procedures, policies, and protocols pertaining to the intake process of arrestees.
• CL3
  The Santa Barbara County Sheriff does not have adequate oversight methods in place for ensuring Corizon Health staff are following their medical intake procedures at the Santa Barbara County Main Jail before the inmate is transferred to custody officers for classification.
• CL4
  The Santa Barbara County Sheriff medical intake prescreening questionnaire is now being conducted by Corizon Health registered nurses; however, the Medical Process Overview Chart does not reflect this.
• CL5
  The Santa Barbara County Sheriff’s Custody Operations Policy and Procedures Manual regarding the intake process needs revision.
• CL6
  The Santa Barbara County Sheriff staff has not always confirmed arrestees were medically cleared by Corizon Health staff prior to classification and placement into the Jail population.
• CL7
  The 2015-16 Santa Barbara County Grand Jury (Jury) determined that there have been inconsistencies in the intake screening process at the Santa Barbara County Main Jail (Jail). The Jury finds the medical prescreening questionnaire is not sufficient for Santa Barbara County Sheriff Office (SBSO) staff to determine if an arrestee has major medical concerns. SBSO staff receive minimal medical training annually. There has been a lack of SBSO oversight of Corizon Health (Corizon) medical staff to ensure the orderly, safe, and healthy intake of arrestees into the Jail. There has been a failure of SBSO staff to consistently follow their own intake procedure. According to SBSO staff, they are already addressing some of these issues. A new Corizon Health Services Administrator (HSA) has been hired recently. The HSA is in the process of making changes that are addressing deficiencies in the medical intake procedure. Prior to the release of this report, the Jury learned that the SBSO staff are no longer conducting medical intake screenings. Corizon Registered Nurses are currently conducting all prescreening medical intake procedures. This process should continue and be documented on the medical process overview chart. FINDINGS AND RECOMMENDATIONS Finding 1 The Santa Barbara County Sheriff is using an antiquated paper system for maintaining inmate medical records at the Santa Barbara County Main Jail. Recommendation 1 That the Santa Barbara County Sheriff implement a computerized medical record system for maintaining inmate medical records at the Santa Barbara County Main Jail. Finding 2 The Santa Barbara County Sheriff Staff, has not always followed procedures, policies, and protocols pertaining to the intake process of arrestees. Recommendation 2 That the Santa Barbara County Sheriff follow the established procedures, policies, and protocols pertaining to the intake process of arrestees. 2015-16 Santa Barbara County Grand Jury 5 Finding 3 The Santa Barbara County Sheriff does not have adequate oversight methods in place for ensuring Corizon Health staff are following their medical intake procedures at the Santa Barbara County Main Jail before the inmate is transferred to custody officers for classification. Recommendation 3 That the Santa Barbara County Sheriff update Appendices A and B and add two signature blocks, one for medical clearance staff the other for the custody officer prior to classification at the Santa Barbara County Main Jail. . Finding 4 The Santa Barbara County Sheriff medical intake prescreening questionnaire is now being conducted by Corizon Health registered nurses; however, the Medical Process Overview Chart does not reflect this. Recommendation 4 That the Santa Barbara County Sheriff continue to use Corizon Health registered nurses to conduct all medical intake screening of arrestees entering the Jail and include this provision in all future contracts and in the Medical Process Overview Chart. Finding 5 The Santa Barbara County Sheriff’s Custody Operations Policy and Procedures Manual regarding the intake process needs revision. Recommendation 5 That the Santa Barbara County Sheriff update the Custody Operations Policy and Procedures Manual to reflect the new changes being implemented to the intake process. Finding 6 The Santa Barbara County Sheriff staff has not always confirmed arrestees were medically cleared by Corizon Health staff prior to classification and placement into the Jail population. Recommendation 6 That the Santa Barbara County Sheriff initiate a procedure to ensure that all medical intake procedures are properly completed prior to classification and that inmate classification not be allowed to occur without verification of the completion of medical evaluation and clearance. REQUEST FOR RESPONSE Pursuant to California Penal Code Section 933 and 933.05, the Santa Barbara County Grand Jury requests each entity or individual named below to respond to the enumerated findings and recommendations within the specified statutory time limit: Santa Barbara County Sheriff 60 days Findings 1, 2, 3, 4, 5, and 6 Recommendation 1, 2, 3, 4, 5, and 6 2015-16 Santa Barbara County Grand Jury 6 APPENDIX A Santa Barbara Sheriff’s Medical Pre Screening 2015-16 Santa Barbara County Grand Jury 7 2015-16 Santa Barbara County Grand Jury 8 2015-16 Santa Barbara County Grand Jury 9 APPENDIX B Intake and Receiving Screening CS1101 2015-16 Santa Barbara County Grand Jury 10 2015-16 Santa Barbara County Grand Jury 11 2015-16 Santa Barbara County Grand Jury 12 APPENDIX C MEDICAL PROCESS OVERVIEW 2015-16 Santa Barbara County Grand Jury 13 APPENDIX D CLINICAL OPIATE WITHDRAWAL SCALES (COWS) 2015-16 Santa Barbara County Grand Jury 14 APPENDIX E Receiving Screening Process 2015-16 Santa Barbara County Grand Jury 15

Observations 1

• OB1
  The Jail provides the following core set of prisoner intake functions:  Identifying the prisoner  Developing the prisoner’s record  Conducting medical and mental health assessments.  Determining the prisoner’s threat to public safety and his/her security requirements  Identifying sex offenders, sexual predators, and vulnerable inmates  Scheduling transfers to the long-term facility  Identifying and validating security threat group membership The intake process at the Jail operates 24 hours a day with approximately 40 to 60 arrestees arriving at the Jail daily. Many are under the influence of drugs or alcohol, have physical injuries, or are mentally ill. These factors make the intake process challenging for the SBSO and Corizon staff. According to SBSO staff, the Jail is understaffed, under-funded and not well designed to carry out all of their required responsibilities. Individuals who need significant medical attention at the time of intake are generally not accepted in the Jail. Instead they are taken to the local hospital for medical evaluation and stabilization. The intake screening would then be performed at the Jail when the inmate returns from the hospital. Once an inmate is admitted to the Jail the County of Santa Barbara is responsible for the cost of any outside medical care. 1 Jail Staffing and Operating Cost Analysis, Santa Barbara County, Final Report CGL Companies, October 2015 2015-16 Santa Barbara County Grand Jury 2 The Health Services Administrator (HSA), a Corizon employee, is a Registered Nurse (RN) and is responsible for the day-to-day operations of the medical programs at the Jail. The HSA has the authority to oversee the administrative requirements of the programs, as well as recruitment, staffing, data gathering, financial monitoring, and enforcing policies and procedures. Processing Procedures The inmate intake procedure is a twofold process that includes a medical evaluation and a classification procedure that requires the cooperation of both SBSO staff and Corizon staff. The first step starts with a “SBSO Santa Barbara Sheriff Medical Pre-Screening” questionnaire, (see Appendix A) used to determine if there are current health issues that require prompt attention. In the past, this prescreening was performed by custody officers. According to the contract, SBSO staff receives up to 24 hours of training on medical issues annually by Corizon. However, this training is not adequate for SBSO staff to make many medical decisions. Therefore, deputies are no longer doing the medical intake prescreening on new bookings. The Jury learned that as of April 11, 2016, Corizon RNs are now performing the entire medical intake assessments. This is intended to ensure that medical needs are being met at intake. The medical prescreening questionnaire is an assessment tool used to determine if the inmate is ambulatory, alert, sick, suicidal, intoxicated, on medication, or has a history of drug or alcohol abuse. The name of the arrestee is entered into the Jail Management System (JMS), an inmate management software package, to determine if the arrestee has a previous record. If so, and if the arrestee has a significant medical condition such as heart problems, diabetes, drug/substance abuse history or psychological issues that were identified and recorded, the JMS would “red flag” the inmate information for ease of future retrieval. During the pre-screening, the detainee is asked about medication or street drugs recently used. Depending on the types of medications the detainee claims to be using, the nurse attempts to verify the prescribed medication by calling the detainee’s doctor, clinic, or pharmacy. After conducting the medical prescreening using the SBSO questionnaire, the Corizon RN also evaluates whether the arrestee has significant medical issues that need to be addressed. This second medical evaluation uses Corizon’s “Intake and Receiving Screening form CS1101” (see Appendix B). Based on this evaluation the RN refers any arrestee with an urgent medical need to the Corizon contracted medical doctor (MD) for a follow up appointment. The Medical Process Overview, Medical Referral Sources, flow chart provided by SBSO staff (see Appendix C), does not reflect the new medical intake procedure and needs to be revised. An arrestee who discloses a history of drug or alcohol abuse is assessed with the Clinical Opiate Withdrawal Scales (COWS) (see Appendix D.) According to Corizon staff, if an arrestee is identified as having a history of substance abuse, there is a “protocol” to ensure they are monitored closely. For example, if it is determined that the arrestee is a habitual intravenous drug user, according to the Corizon staff “the inmate is to be placed in observation and medication ordered to help reduce withdrawal symptoms.” These procedures are not outlined in the Receiving Screening Process (see Appendix E). These protocols are only referenced in the Manual Section 303.Use of Sobering/Observation Cell. The Jury observed, that although SBSO and Corizon are supposed to work together, this cooperative collaboration has not always existed. SBSO staff has not always followed established oversight procedures to ensure Corizon staff are operating in accordance with their contract. Fundamental responsibilities may not be completed during a work shift. With proper monitoring, problems can be alleviated. SBSO staff does not have checklists or guidelines to reduce the risk of incomplete evaluation 2015-16 Santa Barbara County Grand Jury 3 by Corizon staff. The Jury recommends that the Sheriff Office update Appendices C and E. Additionally, two signature blocks, one for medical clearance staff the other for the custody officer prior to classification should be added to the forms in Appendices A and B. A critically important next step, after the arrestee is medically cleared, is classification. The classification which is conducted by SBSO Staff determines where in the jail the new inmate will be housed. During this time the inmate is issued a wristband that includes pertinent personal information and moved to a holding cell. Whether the inmate is a new arrestee, or a reoffender, they go through the same intake process. For the safety of all concerned, it is imperative that this two-step process requires close collaboration between Corizon and SBSO staff to ensure that inmates entering the Jail are medically cleared and classified before placement in the general population. Protocols When the Intake Screening Process is completed, information is documented in the JMS which includes general health concerns. Also documented are external observations of behavior, appearance, deformities, injuries, and skin lesions, which might be indicators of illicit drug use. Inmates entering the Jail are tested for tuberculosis if they are expected to be there longer than 72-hours. In the case of a female arrestee, gynecological and pregnancy issues are noted. If there are any concerns noted during the medical intake process, the Corizon staff takes necessary steps to reconcile these issues. The medical intake RN may refer the inmate/patient to the MD or Nurse Practitioner (NP), give them needed bridge medications, or initiate other treatments or protocols. The MD or the NP sees the patients that have been referred to them as scheduled by the intake nurse. This procedural change is an improvement that will result in inmate/patients receiving the most appropriate level of care whether it is urgent, emergent or routine. If the medical review is not conducted in accordance with written procedures, and discrepancies are not corrected, situations can develop with unforeseeable complications. Intake Process Failure During the intake review, the Jury observed that medical records in the Jail are stored using an antiquated, paper system. According to Corizon and SBSO staff, medical records are not computerized for quick access and both recognize this as a serious deficiency. If further information is needed during a medical intake, Corizon staff must manually retrieve medical records which are stored in paper form in the medical unit. Although the JMS flags chronic medical conditions, the information is frequently limited and insufficient to medically evaluate inmates with major medical issues. If the medical records were stored electronically, medical intake evaluations could be conducted after first reviewing their previous medical history in the jail. SBSO staff have established procedures and protocols on how to process inmates. However, the Jury found that at least in one case, the intake procedures were not followed and an inmate was released into the general population without a completed medical screening. It is vitally important that every step of the medical intake process be conducted for each arrestee. A deviation from the approved process may result in an arrestee’s significant medical needs not being met when in the custody of the county, resulting in an intake process failure and possible major liability. All medical screening forms need to be signed and dated prior to classification. The classification by a custody officer must confirm that medical clearance has been completed prior to placement of the inmate to the appropriate location in the Jail. 2015-16 Santa Barbara County Grand Jury 4 A combination of events, such as the arrestee not responsibly and accurately reporting their medical condition, Corizon staff not completing their medical evaluation, and/or custody staff not overseeing the Corizon process, could result in intake process failure. The Manual, Chapter 3, Section 303 (Use of Sobering/Observation Cell), outlines procedures to be used when an inmate is admitted to the Jail while under the influence of alcohol or other substance. Determining the level of intoxication or drug effect is subjective. When in doubt, in order to err on the side of safety, the use of sobering/observation cells is imperative. The consistent use of these cells ensures that inmates who are at risk are properly monitored.

Agency Responses 1

Government agencies' official responses to this report's findings and recommendations. Click on a response to see the structured breakdown.