Jessica Cejnar Andrews / Tuesday, May 24, 2022 @ 4:48 p.m. / Jail, Local Government
Wellpath Rep Outlines Health Services Provided to the Jail, Juvenile Hall, Urges Del Norte to Renew its Contract in August
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About a month after photos of a trashed cell belonging to a mentally ill inmate went public, Del Norte County supervisors heard from the company tasked with providing medical care, including psychiatric medication, to jail inmates.
Though neither he nor supervisors spoke about the conditions in depicted in those photos, David Garzoli, Wellpath’s director of operations, told supervisors why he included in their agenda packet a copy of an Aug. 31, 2021 letter from the U.S. Department of Justice’s Civil Rights Division to the San Luis Obispo county administrative officer and sheriff.
“In 2018, the Department of Justice initiated an investigation into the care and treatment of prisoners in the San Luis Obispo County Jail,” Garzoli said. “The three-year investigation that followed culminated with a letter addressed to the county CAO and the sheriff of San Luis Obispo County. They found that the county had violated the 8th and 14th amendments citing a number of deficiencies in the jail’s operations, most of which were related to medical, mental health and ADA accessibility requirements. As part of San Luis Obispo County remediation to the problems, they discontinued the county-run medical and dental health programs and replaced those with Wellpath.”
Del Norte county was at risk for a similar intervention, according to Garzoli, who cited former sheriff, Erik Apperson. It was this risk that prompted Apperson to bring Wellpath to Del Norte County in September 2021, Garzoli said.
After being awarded the contract, Garzoli said he and Wellpath staff found the jail’s existing clinic to be a “filthy, cluttered and disorganized mess” filled with expired supplies and worn out and broken equipment.
“On day one we hauled away the old and broken debris and we set up a new clinic,” Garzoli said, clicking over to a picture of a more organized exam room.
Garzoli urged supervisors to renew Wellpath’s contract in August.
The nation’s largest correctional healthcare provider with offices in San Diego, Nashville, Tenn. and, soon, Denver, Colorado, Wellpath serves 348 facilities in its local government division, including the Del Norte County Jail.
Wellpath staff at the Del Norte County Jail provide care 16 hours a day and allows inmates access to a physician and a psychiatrist that operate remotely, Garzoli said. Though the psychiatrist provides medication, inmates with mental health concerns are referred to the Del Norte County Behavioral Health Branch, he said.
“When a new patient comes into the jail, our nursing staff conducts a thorough intake, medical evaluation to determine our patients’ needs,” Garzoli said. “In cases where we identify people who are at risk for mental health concerns we created a referral process to the Del Norte County Behavioral Health Department. We transmit that patient’s information to them so they can follow up with whatever therapy they think is appropriate.”
According to Garzoli, Wellpath’s policies and procedures meet the requirements of Title 15 the state’s Minimum Standards For Local Detention Facilities.
Garzoli also referenced a February 2022 request from California Attorney General Rob Bonta, who asked each sheriff to provide proof that their jail was in full compliance with Assembly Bill 732 regarding the care and treatment of pregnant and lactating inmates in their facilities.
“Since Wellpath was in your county, we promptly provided all our compliant policies to the sheriff at that time who transmitted those to the (state) Department of Justice to their immediate satisfaction,” Garzoli said.
Between Sept. 1, 2021 and April 30, 2022, the Del Norte County Jail has had an average daily population of 82 inmates, Garzoli said. Bookings during that time have ranged from a low of 141 in September to a high of 217 last month, he said.
The average daily population in Del Norte County Juvenile Hall has been five inmates with a low of two new intakes in December and up to 10 in October, Garzoli said.
Since Wellpath took over medical care at the jail, the number of nurse sick calls reached a high of 108 in December and a low of 59 in April. There were up to 17 doctor calls in December, Garzoli said.
As for calls for psychiatric services, which includes prescribing medication and renewing prescriptions, there were up to 44 patient encounters via telemedicine in October and a low of 18 encounters in April, according to Garzoli. The rest of the time, Wellpath averages between 24 and 29 psychiatric sick calls, Garzoli said.
Referrals to the Del Norte County Behavioral Health branch range from nine in September and February to 33 in April, Garzoli said. Typically, Wellpath staff between 25 and 27 mental health referrals a month, he said.
Though Wellpath staff “do our best to keep patients inside the facility and treat them,” inmates visited the emergency room eight times this year, according to Garzoli. There were two admittances to the hospital, one for COVID-related pneumonia and another in April for a fractured hip, he said.
Following Garzoli’s presentation, District 2 Supervisor Valerie Starkey and her colleague, District 3 Supervisor Chris Howard, mentioned inmates who are adjudicated incompetent to stand trial. They referred to a resolution supervisors approved in April that allowed the jail to provide medication to those inmates, even if it was involuntary.
“Most recently I think the last count was nine were waiting to be transferred out of the community,” Howard said, asking Garzoli if that would be part of the proposal he would submit when the county looks at renewing the Wellpath contract. “It seems to be one of the services that if we’re not providing service in there, we should consider. I’m not sure how we would approach this as a board, but I would certainly like to know the nuances if this is a service best provided by the county and Behavioral Health or if it’s best provided by a contractor like Wellpath.”
Garzoli said he made a presentation to County Administrative Officer Neal Lopez on Monday to renew Wellpath’s contract with the same level of services it offers to the jail and juvenile hall currently.
While Wellpath offers a robust mental health program, Garzoli said, mental health professionals are in extremely short supply and the supply that’s out there wants “top dollar.” It’s difficult for rural communities like Del Norte County to compete with other facilities “paying ungodly amounts of money,” he said.
“The bigger problem really comes from actually finding, hiring, recruiting and retaining those people,” he said. “When we are successful in doing that, ideally, we have a licensed clinical social worker or a licensed marriage and family therapist on site for however many hours a day we would be contracted for to see these patients, to do routine safety check, to give them therapy, in some cases group therapy, to keep them stable.”
While Wellpath does its best to provide in-person mental health care, staffing levels often force it to resort to Telehealth system.
“I can put a mental health professional from one of my other facilities on an iPad, a tablet, and get something going and have that therapist evaluate on what to do locally inside the jail,” Garzoli said.
Following Garzoli’s presentation, Del Norte County Sheriff’s Lt. Kyle Stevens, who oversees operations at the jail, Wellpath providing medical services has been a benefit.
“Having Wellpath staff there 16 hours a day with their ability to see any inmate that has a medical condition in the moment and make a decision on whether or not they need to go to the hospital is very beneficial,” he told supervisors.
Del Norte County’s chief of probation, Lonnie Reyman, said there is a stark difference with the care Wellpath provides to juvenile hall’s previous provider.
“We don’t always see eye to eye,” he told supervisors. “Imagine taking your kid to the doctor. That’s the role we play in a sense. You’re not always going to agree with what they say or recommend and we have to make the decisions. Ultimately, we’ve always gotten a sense that they do have the best interest of our kids in mind and they’re looking out for them.”
The nine inmates at the Del Norte County Jail who are adjudicated incompetent to stand trial are one of 1,929 statewide who are on a waiting list to be transferred to a facility run by the Department of State Hospitals, a DSH spokesman told the Outpost earlier this month.
The inmate whose jail cell was photographed is one of those incompetent to stand trial patients, according to DNSO Lt. Daniel Schneck.
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