Das Williams First District, Vice Chair Board of Supervisors Gregg Hart County Administration Building Second District

The contract between the County of Santa Barbara and Wellpath allows a significant time lag between the identification of potential medical or mental issues and the initiation of treatment protocols, delaying the initiation of necessary care. The Board of Supervisors disagrees with Finding 3. In 2016, the Board retained a health care consultant, Health Management Associates (HMA), to develop a Request for Proposals (RFP) for health care services at the Jail. As a correctional health expert, HMA conducted a thorough review of the health services at the Jail and presented findings and recommendations to the Board. These recommendations formed the basis of the RFP and the ensuing contract with WellPath (CFMG at the time) that the Board approved in 2017. The amended contract requires that an arrestee be fully screened at receiving within two hours from arrival, absent exigent circumstances. If the screening identifies emergent health concerns, they are to be addressed within four hours, i.e., provide care or develop and implement a treatment plan. (Contract, Exhibit A, 1.1.) Thereafter, WellPath will perform an Initial Health Assessment as soon as possible but not later than 14 days from intake. (Contract, Exhibit A, 1.3.) At any time after intake, an inmate may request to be seen through the sick call process. Sick call requests are collected and triaged every 24 hours. (Contract, Exhibit A, 1.4.) Additionally, the Public Health and Behavioral Wellness departments are charged with conducting quarterly reviews of key contract performance metrics which conform to National Commission on Correctional Health Care (NCCHC) standards. Public Health reviews medical records for compliance regarding the following data I: Question #1 Question #2 Question #3 Question #4 Question #5 Attachment A The contractor The contractor will The contractor Contractor shall If the medications shall ensure that the ensure that all TB shall ensure that all ensure that for essential and Initial Health skin tests are chronic care medication psychiatric Assessments are placed as needed. If patients (including verification is conditions could done within 14 patient refuses then major mental completed within not be verified, the days of a patient’s alternate methods illness) are being 12 hours of a nurse shall confer incarceration. Was of screening TB seen in accordance Medical Intake with the On-Call the Initial Health shall offered? Was to the NCCHC Screening if the Medical or Mental Assessment TB Skin Test standard. If patient indicated Health Provider to completed within places, if needed, diagnosis and RX essential or establish, 14 days of during the Initial was verified, was psychiatric (not to document, and incarceration and if Health Assessment, the On-Call include Benzo’s or initiate a treatment they refused, is and if patient Provider contacted sleep aids) plan within 24 there refused was a Chest for continuation of prescription drug hours of arrival. Is documentation of X-Ray ordered? meds and patient utilization. Were there refusal? referred to Medical the verified documentation that Provider within 5 medications the nurse contacted to 7 days from “bridged” at intake the OCP and is intake for Chronic until the patient there Care evaluation was able to be seen documentation of a and on-going visits. by a provider? treatment plan ordered by the OCP? Further, in regards to mental health care the following data points are monitored: 1. Timeliness of psychiatric medication prescription after individual in custody, 2. Continuity of psychiatric medication - tracking whether or not clients taken into custody are maintained on same medication regimen, 3. Quantity of care - monitoring whether clients are seen at least three times a week by mental health team; and 4. Safety standards for those in crisis - ensuring whether a) those on suicide watch are reassessed every 6 hours and b) after 24 hours of being on suicide watch the County Crisis Services are contacted timely.

There is no on-site coverage by a Wellpath mental health professional from 11:00 PM to 7:00 AM daily, which can allow for urgent medical needs to go untreated in a timely manner. The Board of Supervisors partially disagrees with Finding 4. Although the County’s current agreement with Wellpath does not require on-site coverage by a Wellpath mental health professional from 11:00 PM to 7:00 AM daily in the Santa Barbara County Main Jail, access to a mental health professional is available on an on- call basis should it be needed during these hours. With the opening of the Northern Branch Jail in Santa Maria, thirty-two beds will be set aside for inmates who are experiencing a serious mental health crisis. Additionally, the Santa Barbara County Main Jail has received Attachment A accreditation from the National Commission on Correctional Health Care, assuring it is in compliance with the NCCHC’s Standards for Health Services in Jails.