Nathan Fletcher: Explore effective health care for inmates but not at the expense of the taxpayers.

Although I am not sure who first said “an error doesn’t become a mistake unless you refuse to correct it,” we can all be sure of its wisdom. It is without question that there are challenges in the delivery of health care, including critical mental health and drug treatment services, in the San Diego County detention facilities.

These shortcomings are well documented through multiple investigations, studies and lawsuits. A 2018 report by Disability Rights California found the San Diego County jail suicide rate was five times higher than that of the state prison system, and an in-depth six-month investigation by The San Diego Union-Tribune found that the county’s jail mortality rate is the highest among California’s largest county jail systems. Sheriff Bill Gore has attempted to improve the situation in recent years, but there continue to be structural problems.

Inmates in our county’s detention facilities receive inadequate medical care because of a disjointed care system architected by Gore that includes both private contractors and public county workers. The failures of this system have been well-documented, and we all agree on the need for change.

The question before the Board of Supervisors is, do we double down on an approach that failed countless other jurisdictions by embracing the proposal from the sheriff for the complete privatization of all aspects of correctional health care delivery through a for-profit corporation? This approach would institutionalize an incentive for this contractor to increase profit by cutting cost and limiting care. And taxpayers would be left holding the bag for failure.

Health care for those incarcerated is a difficult endeavor, but there is a better way. I am calling on us as a county to evaluate a different approach with greater promise to not only deliver better outcomes for those incarcerated but also deliver more effective use of taxpayer dollars.

We do this by realigning the health care in our jails from a law enforcement approach to a patient-centered health care model that fully integrates with services available upon discharge and is overseen by the county Health and Human Services Agency. In addition to better patient outcomes, by embracing a continuity of care, particularly for mental health and substance abuse issues, we can slow the revolving door between jail, discharge, back in jail. We need a system of care driven by providing the appropriate care and preparation for release and reintegration into society. Not a system designed to limit care to maximize profit.

We must learn from the experience of others. Alameda County privatized care and has been sued multiple times due to inadequate medical care provided by the contractor. A recent “findings letter” by Disability Rights California pointed out the nexus between inadequate care and the lack of discharge planning, which leads to the “same individuals cycling unnecessarily between locked psychiatric facilities, jail and homelessness.”

In July, the county of Santa Barbara settled a class-action lawsuit filed on behalf of current and formerly incarcerated people due to the inadequate care of a contracted provider. This lawsuit alleged that the county’s contracting of health care in jails demonstrated an inadequate oversight of the health care of incarcerated individuals. This dereliction of duty led to dangerous and unconstitutionally unsafe conditions.

In another investigation on the issue, The Sacramento Bee reported that California jails contracting with one of the largest contractors in the state had a rate of suicides and drug overdoses 50% higher than those of other county jails in the state.

These cases are inextricably tied to the provision of care being contracted out to a private business, due to the perverse incentive to cut costs and increase profits by limiting care. The results can be dangerous and deadly. The model of giving complete control of a public function to a private for-profit entity will privatize the profit while spreading the costs of failure to the taxpayer.

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.

An error becomes a needless and avoidable tragedy when you adopt a failed strategy trying to correct it. We can do better.

Fletcher is a member of the San Diego County Board of Supervisors.

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