Planning For Jail Health Care Services: the Challenges, Risks and Opportunities

Transcription

1 Planning For Jail Health Care Services: the Challenges, Risks and Opportunities 2016 General Services Conference Leadership By Design: General Services for the Next Generation April 4th, 2016

2 Your Presenters Brenda Epperly RN, MSN. Kitchell Consultant Former health care executive to the federal court appointed receiver of California prison medical system Former Director of Mental Health for California DOC NCCHC Correctional Health Care Professional and Accreditation Surveyor Jared Goldman, JD Partner, Best Best & Krieger, LLP Counsel to federal court appointed receiver of California prison medical system Advised receiver at all stages of court supervised turn-around, including $ 2 billion capital improvement program Former Deputy County Counsel, County of Santa Clara

3 Today s Presentation Goals Convey Importance of inmates having access to all health care services Role quality of care plays in risk avoidance Importance of documenting what you do Discuss levels of medical and mental health services provided in a county jail system Pros and cons to building a Correctional Treatment Center (CTC)

4 What is Correctional Health Care? Anyone who is incarcerated has the right to treatment of serious health care conditions Correctional health care includes: acute and chronic medical, mental health, dental, mobility and optometric conditions It also includes accommodation of disabilities, including physical, mental, learning, speech, audio and visual disabilities

5 Eighth Amendment of the U.S. Constitution The Eighth Amendment prohibits the imposition of cruel and unusual punishment A prison or jail violates the Eighth Amendment when he or she acts with deliberate indifference to the serious medical/mental health needs of an inmate

6 Americans with Disabilities Act (ADA) and the Rehabilitation Act of 1973 The ADA prohibits public entities from discriminating against a disabled individual or, by reason of the individual s disability, excluding them from participation in, or denying them the benefits of, the services, programs or activities of the public entity The Rehabilitation Act prohibits any program or activity receiving Federal financial assistance from subjecting a disabled individual to discrimination or, by reason of their disability, excluding them from participation in, or denying them the benefits of, the program or activity

7 Major Health Care Lawsuits in CDCR Coleman v. Brown, 1990 Mental Health Care Armstrong v. Brown, 1994 Disability Accommodation Budd v. Cambra, 2001 Unlicensed Care Plata v. Brown, 2001 Medical Care Perez v. Brown, 2005 Dental Care

8 Coleman v. Brown (Inadequate Mental Health Care) Insufficient number and types of beds Addressed by a Continuum of treatment areas Case Management in GP Enhanced Outpatient Crisis beds (licensed) Acute Psychiatric (licensed) Insufficient treatment space Addressed by building new and remodeling current space CHCF Stockton New treatment space in nearly every state prison

9 Armstrong v. Brown (Disability Discrimination) Inmate areas were not designed or constructed in accordance with accessibility standards Inmates with mobility impairments housed in noncompliant/non-accessible housing Mobility impaired inmates could not: Fit their wheelchairs into their cells Turn around or maneuver within their cells Use showers and toilets or use them safely

10 Plata v. Brown (Inadequate Medical Care) Facilities required fundamental repairs Insufficient and inadequate maintenance Lack of adequate clinical spaces (e.g., nurse triage at one facility was performed in a broom closet) Clinic Deficiencies Not enough hand washing sinks Inadequate lighting for exams Lacked or had insufficient sanitation standards Lacked exam tables and space for exams Medical care system went into Receivership in 2006

11 Perez v. Brown (Inadequate Dental Care) Facilities: Lacked adequate dental staffing Lacked adequate tracking and documentation Lacked adequate policies and procedures Dental operatories lacked adequate equipment and sanitation After several years this suit was resolved

12 Budd v. Cambra (Providing licensed care in unlicensed space) Providing 24 hour nursing care in unlicensed infirmaries Not enough acute care hospitals New regulations under Title 22 Building several Correctional Treatment Centers (CTC) Policies to clarify outpatient verses inpatient care Outside contracts for acute care services

13 Overcrowding (Plata and Coleman court findings) Inadequate number of infirmary beds Day to day operational chaos Increased risk for transmission of infectious illness Negative impact on recruitment and retention of staff Interruptions in medical care

14 Overcrowding Overcrowding is the primary cause of the unconstitutional medical and mental health care to which California prison inmates are subjected Courts then imposed a population cap of 137% of design capacity

15 Inadequate Facilities Uncontained sewage Broken utilities Multi-use offices Inadequate exam rooms Inadequate record storage Unsafe medication storage Non-confidential space for healthcare

16 So how does the CDCR problems affect the counties? More inmates and longer sentences in the county jails = increased demand and more complex patients Inmates lawyers have developed significant expertise in CDCR litigation, which is now being applied in the counties Inmates lawyers are particularly skilled at identifying and proving any existing noncompliance Litigation, resulting from non-compliance, ultimately creates a loss of autonomy and authority for the county

17 Counties currently in litigation for Health Care issues Northern California Southern California Fresno Alameda Riverside Los Angeles Monterey

18 Fresno County Hall, et al. v Mims, et al. (2002) Allegations include: Mentally ill inmates are housed in isolation in high security cells in lieu of receiving mental health treatment in clinically appropriate setting Seriously mentally ill inmates at risk of suicide are housed in cells that are not suicide resistant (e.g., cell construction include bars that can be used as noose tie off points) Sight lines in certain housing units make it nearly impossible to observe suicide attempts Housing in certain units is unfit for mentally ill inmates due to poor temperature control, lack of light and facility plumbing

19 Fresno Settlement Terms Implementation of remedial plan, including broad mandate for adequate staffing and space Appointment of 3 court experts to monitor progress Monitoring of facilities by inmates counsel 4 year duration, unless inmates counsel prove continuing violations Fresno pays all costs of experts and $40k per year for costs of inmates counsel (excluding further litigation costs).

20 Alameda County Legal Services for Prisoners with Children et al, v. Ahern, et al. (2012) Allegations include: Disabled inmates with mobility impairments are housed in units lacking accessible toilets and showers Narrow doorways prevent inmates with wheelchairs from getting in or out of cells without assistance General visiting area is accessible only by stairs Inmates with disabilities are segregated from the general population by housing them in the infirmary, thereby denying access to rehabilitative programs, religious services, and outdoor exercise

21 Monterey County Hernandez et al. v. County of Monterey et al. (2013) Allegations include: Jail population nearly 150% of capacity, increased risk of prisoner on prisoner violence and compromising health care services Insufficient clinical space and treatment in non-confidential settings Jail not licensed to provide inpatient mental health care and defendants failed to transfer patients requiring such care; suicide hazards in certain housing units Some wheelchair bound inmates housed in units without accessible showers and toilets; recreation yards accessible by stairs only; some disabled inmates housed in isolation cells due to lack of accessible units

22 Monterey Settlement Terms County must develop implementation plans in several areas, including health care procedures, staffing & ADA Expert monitors to be retained who will report if county is substantially complying with implementation plans Inmates counsel to monitor jails 5 year duration after approval of plan, but inmates counsel may extend if County is not in substantial compliance County to pay $4.8 million in pre-settlement fees and costs, and $250,000 per year in ongoing monitoring fees and costs, excluding fees and costs related to further litigation/enforcement

23 Riverside County Gray et al. v. County of Riverside (2013) Allegations include: Delays and denials of access to care Substandard medical and mental health care Substandard medication management and administration Severe staffing deficits Poor records administration Failure to accommodate inmates with mobility impairments (i) in specialized or sheltered housing; and (ii) in the provision and confiscation of assistive devices

24 Riverside Proposed Settlement Terms Parties developed a detailed remedial plan, which the County must implement Court experts to be appointed to monitor compliance Inmates counsel to inspect jails up to twice per year and to be provided with ongoing documentary discovery 4 year duration after approval of plan, but inmates counsel may extend if County is not in substantial compliance County to pay $1.25 million in pre-settlement fees and expenses, and $150,000 per year in ongoing monitoring fees and expenses, excluding fees and costs related to court experts, or further litigation/enforcement

25 Los Angeles County Department of Justice (1997) Current Allegations include: Fails to provide sufficient suicide prevention practices to protect prisoners from self-harm Serious deficiencies in the mental health care delivery system Inadequate supervision and deplorable environmental conditions This information taken from the June 2014 DOJ report

26 Los Angeles Settlement Terms Parties developed a detailed remedial plan, which the County must implement County to establish a Compliance Coordination Unit to coordinate compliance activities County to prepare self-assessment reports every 6 months Independent monitor appointed to prepare monitoring reports every 6 months Duration ongoing until substantial compliance with plan achieved County to pay costs of monitor

27 What is Licensed Care? Here are a few examples: Suicide watch over 23 hours Application of restraints for a mentally ill inmate Surgical care with anesthesia Close monitoring of diabetic inmates requiring insulin 3-4 times a day IV hydration or IV therapy that is ongoing Invasive medical procedures such as a feeding tube Restraint or isolation of a suicidal inmate to prevent self-harm

28 Correctional Treatment Center (CTC) Do you need one? Assess your population for frequency and intensity of medical or mental health care Check any waitlists, backlogs and repurposed beds as indicators of the need for higher levels of care Evaluate the cost and availability of county inpatient facilities Evaluate your litigation risk for not meeting patient needs Discuss with your health care providers

29 Are YOU at risk for healthcare litigation? Here s where to look Access to care Quality management Confidentiality Illegal use of unlicensed beds Poor continuity of care Poor emergency response No specialty care services Untrained/undertrained or insufficient staff Lack of policies ADA issues Custody/healthcare staff relationships Wrong patients in the wrong beds Access to health records

30 Todays County Jail Challenges Longer sentences with fewer acceptable deferrals of care Older and sicker populations Not enough of the right kind of beds Old or inadequate facilities Lack of planning and experience Lack of experience with health care lawsuits

31 Thank you for your attention today Questions/Comments Contact for your presenters Brenda Epperly (707) Jared Goldman (916)