Being Jailed In San Diego Shouldn’t Be a Fatal Mistake
As the sun sets on Republican control of the County of San Diego, Sheriff Bill Gore is making a move toward outsourcing healthcare for jail inmates. The GOP majority on the five member Board of Supervisors is threatened by Terra Lawson-Remer’s strong challenge to incumbent Kristen Gaspar. Another seat in the South Bay is a Dem on Dem contest, so that’s not a factor.
There are dueling op-eds in today's Union-Tribune, with Gore arguing for taking outsider bids and Supervisor Nathan Fletcher --currently the sole Democrat on the board-- saying there is a better way.
Next year --hopefully-- the prospect of heading down the road toward outsourcing vs staying with the current mess will have vanished. Hence the big hurry by the executive responsible for overseeing a facilities with a reputation of having the highest rate of suicide per capita of any in the state.
The San Diego County Sheriff’s Department operates seven jails with about 5,500 inmates on any given day. Over the course of a year, that works out to about 80,000+ people. The Sheriff's Department says it spends $90 million on medical/mental health care annually.
Currently, health care responsibilities are divided up between 26 individually contracted providers and 300+ employees. It’s a jumbled mess where medical decisions can and are overridden by law enforcement officers’ opinions.
A Union-Tribune series concluded that the county (which is self-insured) paid almost $8 million in legal claims and judgments to relatives of inmates who died in custody over the decade ending in 2018 -- a nearly four-fold increase over the prior 10 years before Bill Gore became Sheriff. Of those dying while in county facilities, 80% had yet to be convicted of the crime putting them behind bars.
After several years of critical news stories about health care in county correctional facilities, the Sheriff is proposing to pave the way for a private contractor to do the job.
From Sheriff Gore’s op ed in the Union Tribune:
The process of reviewing the information provided by any vendors that may respond to our Request for Interest and comparing it to the service model we currently provide will, I am sure, be of enormous value to both the population in our jails and the taxpayers. It may very well be our current processes are validated and we stay with our proven model, perhaps even improve upon it.
This might, on the surface, seem to make sense. However, the track record of corrections caregivers nationally is worse than dismal. The contracts used to provide such care typically are written for an annual flat rate, giving providers a very real incentive to reduce costs by not providing services in order to maximize profitability.
And the current processes Gore refers to have exactly zero chances of being validated, provided that neutral observers are allowed to evaluate activities.
If there is a problem with management of the San Diego County jails it lies with the current administration. Sheriff Gore is an elected official who, thanks to a quid pro quo (unlimited campaigning capability) with his workforce, has the job for as long as he wants it. And he’ll make sure that any successor won’t be looking too hard at past practices.
Supervisor Nathan Fletcher is urging Chief Administrative Officer Helen Robbins-Meyer to “discontinue any actions related to outsourcing medical services” in county jails until the evaluation is completed and report back in six months.
We should explore a more effective system of care by integrating all aspects of jail health into an integrated and coordinated system of care overseen by the county Health and Human Services Agency. We must leverage the expertise of our highly trained medical staff who are acutely positioned to focus on better outcomes and connecting individuals upon release with services outside of the jail, thereby creating a seamless mental health, substance abuse and medical continuum of care, and proactively supporting inmates’ rehabilitation and reintegration holistically.
After several decades where privatization was considered a panacea for government inefficiency, the insertion of private interests into the provision of public goods and services doesn’t look so good, particularly as applied to the criminal justice system.
And if corporate control of basic services is such a good thing, why is our health system so irretrievably broken?
Ben Tarnoff at The Guardian:
No word is invoked more frequently or more fervently by apostles of privatization than efficiency. Yet this is a strange basis on which to build their case, given the fact that public services are often more efficient than private ones.
Take healthcare. The United States has one of the least efficient systems on the planet: we spend more money on healthcare than anyone else, and in return we receive some of the worst health outcomes in the west. Not coincidentally, we also have the most privatized healthcare system in the advanced world.
By contrast, the UK spends a fraction of what we do and achieves far better results. It also happens to provision healthcare as a public service. Somehow, the absence of the profit motive has not produced an epidemic of inefficiency in British healthcare. Meanwhile, we pay nearly $10,000 per capita and a staggering 17% of our GDP to achieve a life expectancy somewhere between that of Costa Rica and Cuba.
On the macro-level I can only hope that the United States has learned its lesson regarding the mythology of businessmen running things thanks to Donald Trump.
Oh, and maybe next time we have “insurgent” candidates running for law enforcement related positions, maybe we should give them serious consideration.
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ICYMI-- From last week
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