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⚠️ Este contenido ha sido traducido automáticamente. El texto original en inglés es la versión oficial. La traducción puede contener errores.
Findings and Recommendations 12 findings
F1
There is no clear demarcation of responsibilities between corrections and the medical provider except to state that detention does not make medical decisions. 6
Related Recommendations (1)
R1
Create a clear delineation of program responsibilities between corrections and the medical provider.
F2
Audits are not independent. The vendor self-audits. The outside auditor is hired by the provider. Quarterly quality meetings are voluntary and attendance is sporadic. There is no agenda. No minutes are kept. Cooperation in decisions between departments depends on good will.
Related Recommendations (1)
R2
Conduct a study to determine the most efficient and economical method to address jail medical issues.
F3
Until January 2006, the county was not involved in negotiations with outside providers regarding pricing. A third party vendor hired by CFMG negotiated what discount arrangements there were.
Related Recommendations (1)
R3
Consider retaining a consultant, possibly an actuary, who is able to do a cost benefit analysis on the alternatives for handling jail medical costs.
F4
No empirical, objective, and quantifiable standards are in place for measuring the success of the program.
Related Recommendations (1)
R4
Consider the use of a physician-monitor to review and assess the quality and appropriateness of medical care.
F5
No empirical, objective, and quantifiable standards are in place for determining what is the most effective and economical method of handling jail medical services.
Related Recommendations (1)
R5
Examine the possibility of obtaining catastrophe insurance coverage for jail medical.
F6
The county has no verifiable statistical information of the actual cost of the program to the vendor.
Related Recommendations (1)
R6
Audits should be conducted by an agency independent of the medical provider.
F7
There is no preferred provider list in place.
Related Recommendations (1)
R7
Make quarterly quality meetings mandatory, with an agenda, attendance log, and minutes, which shall be kept for future reference. All affected departments will send a representative, if the department head cannot be present.
F8
Record keeping is to a great extent manual, making it difficult to make changes or to evaluate alternatives.
Related Recommendations (1)
R8
Negotiate contracts with off-site providers pursuant to SB 159 regarding pricing. A study conducted by the County Administrator (actuarial consultant) will be used to determine whether a contract or no-contract agreement is most advantageous for the county.
F9
Non-prescription (OTC) drugs are administered only by professionals.
Related Recommendations (1)
R9
Develop quantifiable, objective, and empirical standards for measuring the success of the medical program.
F10
Required additional insured endorsements are not on file.
Related Recommendations (1)
R10
Develop quantifiable, objective, and empirical standards for the most effective economical method for handling jail medical services.
F11
No study is being conducted to examine the potential impact of the changing realities facing the county detention facilities.
Related Recommendations (1)
R11
Develop a method for determining the actual cost of the medical program to the county. 8
F12
The reason for entering into a flat contract was to pass on the expense risk associated with health care. Cost overruns demonstrate that was not the result. When the county agreed to increase the contract by $685,000, they re-absorbed that risk. Conclusions It is clear that the original contract with CFMG was adopted in a hostile climate of negative media exposure, adverse public reaction to situations in the jail, and the concern about potential litigation. Under these circumstances, using CMA accreditation as a primary driver for a successful jail medical program might well have been justified. Time has moved on, however, and realities have changed. While potential litigation is always a concern, a Santa Clara survey of eight counties throughout the state indicates it is far from a primary concern. The survey further indicates that some counties have chosen to forgo meeting Title 15 and/or CMA standards in consideration of budget restraints. All counties surveyed show budget reductions and the rising cost of care to be the primary drivers. The challenges presented by the dual obligation of providing health care to inmates, and doing it in the most effective and economical way is being dealt with by county officials whose primary obligation is to provide a safe and secure community. Sonoma county statistics parallel those indicated in the survey. For the period 2000 through 2005, the average number of claims going beyond detention center administration was seven per year. Out of the forty-three claims, 29 were handled without cost to the county. While there were spikes in 2001 and 2004 in litigation costs, overall costs, even in those years remained within acceptable parameters. Health care, especially for inmates, presents challenges quite outside the scope of their primary function. The general standard set by Title 15 is that the medical care in the jail reflects that in the community. All information received by the grand jury indicates that the standard of care in the jail greatly exceeds that of the community. Changing circumstances mandate close attention to inmate medical care, especially in light of the past several years of severe cost overruns. Expert monitoring and oversight by the county have become mandatory. If that is not accomplished, it is reasonable to expect that down the road the county jail medical will have at least one “Million Dollar Inmate.” The County Administrative Office has also expressed interest in the “catastrophe” medical challenge and has begun a project to examine the issue. Commendations The grand jury reviewed possible overtime costs for transportation issues utilizing custody staff in overtime pay for fiscal year 2004/2005. A laudatory note must be given to the Sheriff’s transportation staff for conducting over 240 inmate transports, which incurred only 6.5 hours of overtime. This overtime was charged on two instances for a single inmate.
Related Recommendations (1)
R12
Require expense-based information to be used to determine whether the contract price is commensurate with the cost of services rendered.
Additional Recommendations 5
These recommendations are not explicitly linked to specific findings.
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R13Develop a list of preferred physician providers.
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R14The Sheriff’s Department and Information Systems Department should explore and develop technological improvements in tracking county jail medical services.
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R15The Sheriff’s Department and medical provider should develop alternative methods of distribution for other-than-prescription medications - specifically distribution through commissary or vending machines.
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R16Obtain from the medical provider the required insured endorsements.
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R17Create a task force to examine the changing realities effecting health care in the county detention facilities. Required Responses to Findings None Requested Responses to Recommendations None Required Responses to Recommendations Sonoma County Sheriff – R1, R2, R4, R6, R7, R8, R9, R10, R11, R12, R13, R14, R15, R17 Board of Supervisors – R11, R12, R17 Sonoma County Administrator – R1, R2, R3, R5, R8, R9, R10, R11, R12, R17 Sonoma County Risk Management – R1, R4, R5, R15, R16, R17 Information Systems Department - R14 9
Conclusions 2
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CL1 Page 7It is clear that the original contract with CFMG was adopted in a hostile climate of negative media exposure, adverse public reaction to situations in the jail, and the concern about potential litigation. Under these circumstances, using CMA accreditation as a primary driver for a successful jail medical program might well have been justified. Time has moved on, however, and realities have changed. While potential litigation is always a concern, a Santa Clara survey of eight counties throughout the state indicates it is far from a primary concern. The survey further indicates that some counties have chosen to forgo meeting Title 15 and/or CMA standards in consideration of budget restraints. All counties surveyed show budget reductions and the rising cost of care to be the primary drivers. The challenges presented by the dual obligation of providing health care to inmates, and doing it in the most effective and economical way is being dealt with by county officials whose primary obligation is to provide a safe and secure community. Sonoma county statistics parallel those indicated in the survey. For the period 2000 through 2005, the average number of claims going beyond detention center administration was seven per year. Out of the forty-three claims, 29 were handled without cost to the county. While there were spikes in 2001 and 2004 in litigation costs, overall costs, even in those years remained within acceptable parameters. Health care, especially for inmates, presents challenges quite outside the scope of their primary function. 7
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CL2 Page 8The general standard set by Title 15 is that the medical care in the jail reflects that in the community. All information received by the grand jury indicates that the standard of care in the jail greatly exceeds that of the community. Changing circumstances mandate close attention to inmate medical care, especially in light of the past several years of severe cost overruns. Expert monitoring and oversight by the county have become mandatory. If that is not accomplished, it is reasonable to expect that down the road the county jail medical will have at least one “Million Dollar Inmate.” The County Administrative Office has also expressed interest in the “catastrophe” medical challenge and has begun a project to examine the issue.
Commendations 1
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CM1 Page 8The grand jury reviewed possible overtime costs for transportation issues utilizing custody staff in overtime pay for fiscal year 2004/2005. A laudatory note must be given to the Sheriff’s transportation staff for conducting over 240 inmate transports, which incurred only 6.5 hours of overtime. This overtime was charged on two instances for a single inmate.
No Responses Found 4
Government entities assigned to respond to this report. No response documents have been linked in our database.
County of Sonoma
Agency
Sonoma County
County
Sonoma County Board of Supervisors
Elected County Office
Sonoma County Sheriff
Elected County Office