County of Sacramento California*

Chronic understaffing of nurses has lead to an inability to consistently conduct nurse sick call Monday through Friday. This raises the likelihood that inmates who sign up for nurse sick call may not be seen for up to four days from the date of request to see a nurse. Since nurse sick call is the primary way for an inmate to be seen by a jail physician, this means that inmates who need to be seen by a physician have their care delayed, possibly leading to serious harm to the inmate. Response to finding Concur in principle. While Nurse Sick Call is the main vehicle for inmates to access health care, there are other methods by which they can be seen by a physician. Additionally, Nurse Sick Call is conducted in the afternoon and on weekends to make up for any week days that were missed.

Quality assurance and the overall collection of data about healthcare in the jail are conducted on an informal basis. This means there is an inability to measure success or failure and an inability to quantify the goals of the health care system. It also means that there can be limited oversight of the system, since it is difficult to determine exactly what is occurring. 2005 -2006 Grand Jury Response August 2, 2006 Response to finding Do not concur. There is a formal process by which statistical data is collected consistent with Title 15 requirements. Correctional Health Services has four Quality Improvement Committees which meet on a regular basis to review statistical data, and develop and implement new methods to improve health care delivery.

Several incidents in the past year highlight the risks to nurses during nurse sick call when they are alone while examining an inmate. Response to finding Concur. Custody staffing levels are currently insufficient to provide one-to-one security each time nurse sick call is conducted.

The current system of dispensing medication is a manual system that increases the risk of incorrect medications being given, does not allow for the avoidance of medications being 2005 -2006 Grand Jury Response August 2, 2006 given that might dangerously interact, and does not allow for inventory control. While the jail staff has indicated for several years that the system is going to be replaced, there have been difficulties with the process, and delays have occurred. However, the latest schedule indicates a new system will be in place, at least in the jail, by the middle of 2006. Response to finding Concur. The current manual system of dispensing medications is inadequate to serve a large inmate population.