The primary contractor providing medical services at the San Diego County Jail has failed to pay outside hospitals and other specialized providers, limiting the Sheriff's Department's ability to send sick and indigent people in its custody to treatment. Newly released records reveal that the restrictions were in place.
Nafcare, the Alabama correctional health giant to manage care in troubled county jail systems, also relied on unqualified staff, ignored requests to repair or replace equipment, and canceled hundreds of shifts, according to documents. I couldn't fill it.
“As of April 17, 2023, there are $9.3 million in unpaid bills owed to the hospital,” the previously confidential corrective action letter from the Sheriff's Office to Nafcare states.
The December 2023 report added: “Of the total outstanding invoices, $4.6 million is past the 30-day deadline.” “Due to lack of payment, some community health care providers do not want to see or accept patients.”
The 23-page report was produced as part of a lawsuit a group of civil rights lawyers filed against San Diego County in 2022.
The lawsuit was originally filed on behalf of a group of disabled patients seeking to force sheriffs to do a better job of providing sign language interpreters, wheelchairs, and other assistive devices needed to comply with the Americans with Disabilities Act. It happened in February 2022.
The case has since evolved into a class-action lawsuit, affecting all past, present, and future men and women incarcerated at San Diego County Jail, one of California's deadliest prisons.
The remediation order lists a long list of deficiencies in the performance of NafCare, which was awarded the prime contract for medical services at the San Diego County Jail two years ago.
The documents, which are classified as confidential, were filed in San Diego federal court earlier this year as part of a class action lawsuit.
The December order is the second such request made by the sheriff in the past year. This refers to an April 2023 notification of deficiencies that were not fully corrected by the end of last year.
“We received a response dated May 5, 2023, which did not address some of the deficiencies and did not correct some of the deficiencies that were addressed,” the sheriff’s corrective action notice in December said. There was no indication of any plans to do so.”
The sheriff's office declined to comment on the corrective orders it issued against Nafcare last spring and last fall, or on the quality of medical care at the prison. A spokesperson said department policy prohibits publicly discussing ongoing litigation.
But Sheriff Kelly Martinez and other officials said they have taken steps in recent years to better protect people incarcerated at the San Diego County Jail.
Among other things, the department specifically increased staffing and budgets for health care providers. We have also upgraded our facilities and invested in new equipment to improve our booking practices to more effectively identify people who may need treatment.
Martinez also touted additional training for deputies working in prisons.
“We've made a lot of progress in the last year,” the sheriff said last summer when the department held an open house to highlight the many reforms implemented at county jails in recent months. “Mental health (treatment) is even more important in prison.”
Nafcare issued a statement saying the company is working closely with the sheriff's office and is confident it is moving in the right direction.
“NafCare's mission is to improve and save lives,” the company said. “We aim to ensure that every patient we treat within the San Diego County Jail receives community standards of care to support their healthy return to the community.”
The company has been the subject of repeated lawsuits challenging the level of care it provides in state prisons and county jails across the country.
For example, earlier this month, a federal judge in Arizona, presiding over a lawsuit seeking to improve conditions for about 25,000 people in state prisons, said the medical and mental health services provided by Nafcare were “fundamentally lacking.” Associated Press reported.
Experts overseeing medical operations at Arizona prisons said in court that they are understaffed under a private company and need to increase pay for new and existing staff. Nafcare has already been fined $2.5 million for contempt in a 12-year-old lawsuit.
The Alabama Correctional Health Contractor also serves the Pima County, Arizona prison system.
Nafcare officials have withheld more than $3 million from Nafcare for failing to meet numerous conditions in its contract with the greater Tucson area, according to local news reports.
San Francisco attorney Gay Grunfeld is one of the lead attorneys leading the class action lawsuit against San Diego County. He said the sheriff and other officials should have known about Nafcare's questionable record.
“Given NafCare’s widespread failures across the county, it is a shame that we continue to regularly receive reports of delayed and substandard medical, mental health and dental care from our certified clients. “It's not surprising,” she said. Email.
“NafCare also does not develop the necessary contractual policies and procedures that the county needs to comply with national standards and address high mortality rates and unconstitutional care,” she said. Ta.
NaphCare's chief legal officer acknowledged in the class action lawsuit that the company may not have complied with all terms of its contract with San Diego County.
In a deposition earlier this month, Nafcare attorney Justin Barclay was asked whether his company conducts field-level inspections of local jails. “Not to my knowledge,” Barclay replied.
Asked whether he was aware that a separate review was needed, Mr Barclay replied: It's certainly part of our policy to do that. I would — you know, I expect I should, yeah. ”
Medical procedures within the San Diego County Jail continue to be a major contributing factor to the high number of in-custody deaths and other medical outcomes resulting in illness or injury to men and women in the sheriff's care. .
The Sheriff's Office has seen an increase in in-custody deaths and other allegations of misconduct and negligence against sheriffs and jail health care workers in recent years.
The deaths and injuries have led to a flurry of lawsuits against San Diego County, costing taxpayers at least $60 million in recent years, records show.
The sheriff's corrective action notice says Nafcare is responsible for some of the deficiencies within the county jail.
In addition to keeping staffing levels dangerously low, failing to pay other health care providers, relying on unqualified staff, and failing to replace or repair medical equipment, the company maintained county health care for people addicted to opioids. The assistance program was not implemented as required, the notice states.
It also says Nafcare failed to submit reports as required by the county contract, did not conduct required meetings and did not implement a continuous quality improvement plan as required by the 2022 agreement. .
There were other problems with the level of care provided by NaphCare.
“As of March 9, the Gynecology Provider (GP) and Las Colinas did not exist, and no replacement physician was available,” the correction notice states. “The contractor refused to pay for the abortion, saying it was 'elective.'
The case that led to the release of the sheriff's corrective action notice issued against Nafcare is known as Dunsmore v. San Diego County Sheriff's Department. The lead plaintiff is Darryl Dunsmore, a formerly incarcerated man who suffers from ankylosing spondylitis, a type of inflammatory arthritis that at times left him immobile.
Dunsmore needed a wheelchair and a modified spoon to eat, but officers confiscated those items “because they determined he did not need them,” the complaint said.
At one point, he became distraught and was stripped and placed in an isolation cell, where he was unable to go to the bathroom due to his disability, the suit added. He was forced to eat with his hands. He also had to urinate and defecate on the floor.
“He frequently soiled his cell and was forced to sleep in his own feces and other trash,” the complaint states.
Last June, in response to the Dunsmore civil rights lawsuit, county officials reached an agreement to renovate showers, restrooms, and beds at the local jail to improve conditions for disabled men and women in sheriff's custody. did.
However, it will take months or years for the terms of the agreement to be implemented, and the case remains ongoing, with a trial scheduled for next year.
