County jail improvements made

San Diego County Sheriff’s Department

Sheriff Kelly A. Martinez begins her term with a commitment to improving jail conditions. In 2022, under her leadership as the Undersheriff, several improvements were made.

Her focus is to continue making much needed improvements to county jails that will incorporate renovations to aging facilities, adding staff to support the current workforce and existing programs, as well as anticipated changes and opportunities that will improve healthcare and reduce recidivism.

Throughout 2022, the following improvements were made:

Accountability and partnerships

The Sheriff Department's Critical Incident Review Board reviews all in-custody deaths. CIRB expanded its responsibilities to include reviews of natural deaths that happen in county jails.

Acting Sheriff Martinez and Director Paul Parker of the Citizen's Law Enforcement Review Board signed a Memorandum of Understanding that for the first time allowed trained CLERB staff to respond to death scenes related to in-custody death incidents and deputy-involved shooting cases where death occurs or is likely.

The Sheriff's Department created a Correctional Healthcare Workgroup. This marks an unprecedented partnership between the Sheriff's Department and the County Health and Human Services Agency. The workgroup was formed to study best practices in Correctional Healthcare. This collaboration between Sheriff’s and HHSA personnel and outside consultants will study best practices and provide recommendations for implementation to the Sheriff. Those recommendations will incorporate continuum of care models for individuals pre-custody, in-custody and post-custody, reducing community care impacts.

In early 2023, the Sheriff's Department will partner with the Department of State Hospitals to implement the Early Access Stabilization Services Program. The State of California has created an EASS program where mental health providers will support county jails to treat individuals who have been deemed incompetent to stand trial and are awaiting placement in an inpatient psychiatric bed in a DSH facility or a Jail-Based Competency Treatment Program.

Staffing

It is a top priority of the Sheriff to fill vacant jail staff positions and to retain current employees by offering new incentives, such as increased pay for working night shifts.

A Certified Nurse Assistant position has been added to the Sheriff's workforce. These nursing assistants will support registered nurses and licensed vocational nurses and allow them to focus on other duties related to caring for people who are housed in Medical and Psychiatric Stabilization Units. The Sheriff's Department will add the new job classification of mental health case management clinician to further support healthcare goals.

Medical and mental health care

To further streamline and organize the Sheriff's jail healthcare, a five-year initial term contract with Naphcare was initiated. This contract consolidated the contracts into one, with Naphcare providing medical and mental health service within our facilities. The contract provides additional staff and services on an as-needed basis and ensures individuals in our custody are evaluated and treated in a timely manner.

The contract expands our ability to offer in-house specialized services. Additionally, this partnership has helped standardize policy/practice review and implementation. The Sheriff's Department has started revising policies and procedures with the intent of implementing them into jail operations in early 2023.

With the assistance and guidance of Naphcare, we anticipate beginning the National Commission on Correctional Health Care accreditation in January 2023 with estimated accreditation taking place in late fall 2023.

By contracting with Naphcare, we have increased our access to medical and mental health care. These changes allow jail medical staff to initiate or continue medications sooner by accessing StatCare, a telemedicine provider, when a provider is not on-site and a consultation is needed. This system is used to reduce wait times for medical and mental health requests when appropriate.

The partnership with Naphcare has allowed the Sheriff's Department to share pharmacy records via Sure Script to minimize the amount of time patients go without their prescribed medications. These assessments help ensure proper identification of healthcare needs and the ability to provide follow-up care in a timely manner.

Mental health clinicians, psychologists, psychiatrists, and psychiatric technicians now have access to Cerner Community Behavioral Health, an electronic records system that facilitates their review of patient records while assisting with community care coordination.

The implementation of a medication-based detoxification program for opioid and alcohol withdrawal was the beginning of a Medication-Assisted Treatment Program for in-custody individuals suffering from substance use disorder. Those participating in the detoxification program are offered counseling and behavioral health services on a broad scale.

The MAT Program will expand in January 2023, with a small, focused treatment program, complete with in-depth group counseling and behavioral health services. The goal is to continue the growth of this program with the introduction of CalAIM (California Advancing and Innovating Medi-Cal), which allows us to partner with community providers on continuing care for those intent on recovering from substance use disorder upon their release from custody.

Sheriff's Medical Services has already started work on transitioning to a "primary care" nursing model. This model provides a patient-centered approach to treatment where nursing staff conduct medical appointments with patients within their respective jail housing units instead of a centralized clinic. This leads to better access to care and shortened wait times.

Due to the age of county jails and infrastructure that was not built for this care model, it will not be available at every detention facility. Renovations and other changes are needed before transitioning to the primary care nursing model across the entire county jail system.

To improve access to healthcare, the Sheriff's Department has updated the medical request form for incarcerated persons and added 24-hour face-to-face assessments once a request has been received per NCCHC standards. A follow-up visit with a provider is scheduled upon receipt of two requests from an incarcerated individual regarding any condition. Voluntary urine drug screenings have also been implemented during the booking process, which allows for more immediate withdrawal protocols.

All medical refusals require counseling from jail medical staff to ensure the individual clearly understands the impact of their refusal, which is thoroughly documented. The forms are then scanned into the electronic health care system.

Mental health refusals require intervention on the part of a mental health provider. If the appointment is with a mental health clinician, professional providers will visit the incarcerated person and have them not only sign the refusal in person, but ensure the patient is immediately rescheduled for a follow-up visit.

The form is also scanned and entered into the patient's electronic health record. Subsequent refusals may require additional follow-up. If the refusal is for a psychiatric appointment, the rescheduling process is handled by Naphcare and may include in person or telepsychiatry appointments.

Improved intake processes

New intake protocols have been introduced requesting urine samples from those arrested who show signs of substance abuse. This process is voluntary. The results help providers to start prescribing these individuals with medications to help improve care and safely manage withdrawal symptoms.

We have implemented in-depth mental health care screening for every individual during the booking process. This includes utilizing Qualified Mental Health Professionals and tools like the Columbia Suicide Severity Rating Scale to better evaluate suicide risk and refer people to the appropriate mental health resources sooner. This is documented in our electronic healthcare record keeping system for referral and tracking.

We have also incorporated scoring based on the Clinical Institute Withdrawal Assessment Alcohol Scale and Clinical Opiate Withdrawal Scale. This scoring allows for better treatment and management of withdrawal symptoms.

Narcotics detection and interdiction

We have expanded the use of narcotic detection dogs in county jails, including the ability for every dog to detect the presence of Fentanyl.

Naloxone has been placed inside all detention facilities, including on individual staff members and availability to individuals who are in custody. This harm reduction measure has saved lives and reversed the effects of overdoses in the jails. Since becoming available, people in-custody have used Naloxone eight different times to administer the life-saving medication to other individuals.

We have also centralized the mail delivery process which is not only more efficient but creates more thorough screening for drugs and other contraband. The Sheriff's Department is purchasing more body scanners, which will further support drug interdiction efforts.

We have acquired more TruNarc devices, which allow for on-site narcotics testing in all detention facilities. The ability to detect and identify narcotics plays an important role in medical treatment, as well as ensuring the safety of those in our custody and jail staff.

Improvements in technology and infrastructure

In 2022, the Sheriff's Department finalized plans and funding necessary for renovations and improvements at our seven detention facilities. This includes much needed repairs, infrastructure improvements for technology and enhanced safety for everyone at our county jails.

Body-worn cameras were deployed for the first time in the jails. This deployment began at the Las Colinas Detention Facility and will be expanded further as renovations and infrastructure improvements are made.

An electronic monitoring device is being tested to detect when an individual may be under medical distress. This pilot program has been disappointing mostly due to infrastructure restrictions; however, we continue to explore technology that will assist with health monitoring.

Wellness checks

Wellness checks and recurring visits with our higher risk and more vulnerable members of the jail population were initiated as a weekly routine. The participants in this program benefit from more frequent interaction with service providers.

The visits bring a multidisciplinary team of sworn, medical, mental health and reentry services staff to the incarcerated individual. Service providers can meet with these patients in their actual living environment. This helps staff members determine the collaborative care needed to treat their patients. The wellness checks also allow deputies to conduct hygiene inspections while maintenance staff can address any mechanical concerns found in the housing units.

Sheriff Martinez is committed to improving San Diego County jails. She is committed to transparency and accountability and communication with the public. This update and media information is in furtherance of those goals.