Steps Taken: Custody Health Services (CHS) has revised its triage guidelines regarding estimation of the time-sensitivity of an evaluation by an appropriate provider, in an appropriate setting, based on a patient’s dental, medical, and mental health conditions.
All medical, mental health, dental, and medication history/records are documented in HealthLink to ensure that all CHS providers are aware of a patient/inmate’s needs.
CHS works with the DOC staff to ensure that inmates are made aware of their medical and dental appointments. When necessary, CHS staff also explains the consequences of refusing treatment to encourage inmates to keep their appointment. To help remind inmates about their appointment and improve compliance rates, medical, dental, outpatient, and psychiatric appointments are being posted in inmate housing units one day prior to the scheduled appointment as of May 1, 2019.
CHS is working on opening an optometry clinic at the Elmwood facility, and would work with the Sheriff’s Office to reduce the need to transport inmates to the Main Jail facility for optometry services.
CHS will continue to monitor wait times for appointments and provide ongoing Quality Improvement reviews to ensure that inmates have timely access to healthcare.
The Sheriff's Office partially agrees to this recommendation, as some meal times vary for inmates in 8A-Acute Psych, SMI, etc. However, the facilities could not sustain the negative operational impacts that would result from a permanent change to the meal schedule. For example, court schedules, inmate hygiene, and out of cell activity/program time would suffer. To change the breakfast schedule would have an impact on weekly operations due to court schedules. Altering the lunch & dinner schedule would have an impact on out of cell activity/program time. The recommended changes also occur during shift change for deputies, so there will likely be an impact to staffing. This would also require a reorganization of food production services and an alteration to staff schedules and vendor deliveries.
For the Sheriff’s Office, this summarized recommendation has been completed to the extent possible. Work is still ongoing by Custody Health Services.
On October 22, 2019, the Board approved a third amendment to an agreement with South Bay Emergency Physicians Medical Group, Inc., relating to providing physician staffing services that also includes expanding medical services hours in the custody setting to twenty-four (24) hours per day, seven (7) days per week. The custody staffing services section of the agreement is for a total amount of $3,752,406.
On December 10, 2019, the Board approved a referral requesting a plan and timeline for a Custody Health Services staffing study regarding provision of services in the County jails and recommendations for improving the medical and infirmary standards. Additionally, Custody Health Services, as part of the staffing study report, is conducting a benchmarking study of staffing levels for jails systems that are of similar size to the County of Santa Clara. The study should be completed by early Spring 2020 and a report will be submitted for the Board's consideration of the recommendations for the Budget Workshops in May 2020.
Budget Status: The Board allocated $2.5 million as part of the FY 2016 Adopted Budget and $2.0 Million as part of the FY 2017 Adopted Budget for HealthLink to be implemented in Custody Health.
As part of the FY 2020 Adopted Budget, the Board approved one part-time (0.5 FTE) Optometrist position to expand optometry services in the jail facilities ($96,663) and funded 3.5 Medical Unit Clerk positions to support the Intake Booking area to ensure proper and timely processing and scheduling of dental, medical, and behavioral health appointments ($341,680), and added one Dietetic Technician to effectively manage increased medical and religious diets ($101,426).
As part of the Fiscal Year 2019-2020 Mid-Year Budget Review, the Board approved an ongoing cost increase of $1,381,406 in the budget allocation for overhead charges to the Custody Health Services budget for services provided by the Santa Clara Valley Medical Center Hospitals and Clinics.
On October 22, 2019, the Board approved the Third Amendment to an Agreement with South Bay Emergency Physicians Medical Group, Inc, relating to physician staffing services that also includes expanding medical services hours in the custody setting to twenty-four (24) hours per day, seven (7) days per week. ($3,752,406).
As part of the FY 2019-2020 Mid-Year Budget Review, the Board approved the transfer of one-time funds in the amount of $750,000 from the Reserve to Implement Jail Consent Decrees to Custody Health Services budget to fund the agreement with South Bay Emergency Physicians Medical Group, Inc.
As part of the FY 2021 Adopted Budget, the Board approved the following:
Funding for the Space Feasibility Study of the Main Jail North booking area, along with exam rooms adjacent to booking to allow for a more efficient booking process ($225,000).
Elimination of the ongoing Reserve to Implement Jail Consent Decrees ($3,000,000).
Delete 3.0 FTE positions in the Food Services Unit: Baker, Dietetic Assistant, and Food Services worker ($313,696). The Food Services Unit will modify the staff schedule from 12 shifts to three shifts.
Add 1.0 FTE Medical Unit Clerk position to support the Custody Health Services Department’s discharge process, review release prescription orders, and issue vouchers for transportation resources ($109,925).
Delete 1.0 FTE Rehabilitation Officer II position in the Inmate Screening Unit to screen inmates for in- and out-of-custody programs ($181,738).
FY 2021 Adopted Budget: Delete 3.0 FTE Rehabilitation Officer positions ($545,214).
Transfer 1.0 FTE Chief Psychologist position from the Santa Clara Valley medical Center to the Custody Health Services Department.
Delete 2.0 FTE vacant Psychiatric Social Worker II position funded by Public Safety Realignment (AB109).
Delete 1.5 FTE Clinical Nurse positions.
Reduce ongoing funding of miscellaneous Services and Supplies by $205,894.
Reduce ongoing contract services funding supporting psychiatric services by $1,209,844. This action will limit the contractor’s ability to provide critical services in Intake Booking and the Acute Inpatient Psychiatric Unit
As part of the Fiscal Year 2020-2021 Mid-Year Budget Review, the Board approved an increase in expenditure appropriations by $878,426 within the Custody Health Services budget to ensure around-the-clock medical services at the jails and increase expenditures appropriations for personnel to cover overtime in the Custody Health Services budget by $4.8 million.
February 9, 2021: Delete 1.0 FTE Rehabilitation Officer II position related to the Voluntary Separation Incentive Program as part of the Fiscal Year 2020-2021 Mid-Year Budget Review ($206,474).
February 9, 2021: Delete 4.5 FTE Psychiatric Social Worker II positions within Custody Health Services relating to the Voluntary Separation Incentive Program ($762,089).
February 9, 2021: Delete 0.8 FTE Psychiatric Social Worker II position within Custody Health Services as part of the Fiscal Year 2020-2021 Mid-Year Budget Review ($135,482).
Source Report(s): Sheriff’s Jail Reform Plan, Blue Ribbon Commission on Improving Custody Operations, Healthcare Gap Analysis – Wilcox, Human Relations Commission
Responsible Department(s): Sheriff’s Office, Custody Health Services
Master List Nos.: 112, 172, 329-331, 389-390, 395, 397, 607, 609, 612
Review Date: FGOC reviewed on January 26, 2017.