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Privatizing Jail Medical Service is Bad for Care, Employees and Incarcerated Individuals


Sup. Fletcher, mental health experts, and restorative justice advocates push back against Sheriff Proposal
Sup. Fletcher says Board of Supes deserves options, encourages exploring HHSA administering medical   

Supervisor Nathan Fletcher together with mental health experts, county workers and restorative justice advocates today announced a proposal to examine having the County’s Health and Human Services Agency administer medical and behavioral health services in jails; and prevent the San Diego County Sheriff from privatizing services. They also launched a petition called “Stop the Sheriff from Outsourcing Medical and Mental Health Services”.  

“Outsourcing all medical services to a private contractor has the potential to worsen the existing system of care, threaten county jobs and further exacerbate bad outcomes for incarcerated individuals,” said Supervisor Fletcher. “Instead, 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.”

Today the Sheriff’s Department operates a hybrid system of private contractors and county workers. The problem with this system has produced jail suicide rates five times higher than the state prison system and the high death rates among California’s jail systems.

"We have been given a sneak preview of the outcome of profitizing care in jails and laying off county workers, and it is grim. The Sheriff has failed to meaningfully address his abhorrent record concerning the deaths in our local jails, and now he is putting forward a proposal that will exacerbate the loss of lives even further, Geneviéve Jones-Wright, Executive Director, Community Advocates for Just and Moral Governance (MOGO) “As a Community, we have been talking about a reimagining of the role of law enforcement and the need to move to a better and more holistic approach to how we provide care and respond to our community members. Sheriff Gore's proposal is out of step with community standards of human decency, while Supervisor Fletcher's proposal presents an avenue that will ensure a coordinated restorative healthcare model inside our jails and the continuity of care with County and community-based providers upon release."

Workers in the jails indicate the reporting structures are disjointed and the lack of integration can lead to mistakes. Medical and mental health clinicians working inside County detention facilities are not put in a best to carry out their daily duties. 

“Front-line healthcare workers in the Sheriff’s Department are risking their lives during the COVID-19 pandemic and being forced to work mandatory overtime. How does Sheriff Gore propose to thank these employees?

“Sheriff Gore’s plan is to sell out their jobs to for-profit companies that provide substandard care and force the public to pick up their bill for lawsuit and settlement costs. Sheriff Gore is proposing this plan despite having the highest inmate death rate of large counties in the state. This is insulting to the workers we represent and the hard work they do for patient care,” said David Garcias, President SEIU Local 221. 

Evidence has shown there is a nexus between inadequate care and the lack of discharge planning by private administrators, which can lead to the “same individuals cycling unnecessarily between locked psychiatric facilities, jail and homelessness. 

“San Diegans need to ensure there is quality mental health care for those who are incarcerated, with an understanding they  will be returning to our communities,” said Daphyne Watson, MSW, Executive Director of Mental Health America San Diego. “All too often our jails and prisons have become de facto psychiatric facilities of which they are ill prepared.  Treatment is something which needs to be started while incarceration and continued upon release.  We need to ensure a  continuity of care, availably, comprehensive treatment care to address the needs of individuals. Mental illness needs to be treated as an illness and we can care for these individuals in a humane way.”

Counties in California such as Alameda and Santa Barbara that have contracted their medical services in detention facilities are embroiled in lawsuits, and are having to rebuild their medical and mental health care programs after investing significant taxpayer dollars in private contractors. 

“San Diego taxpayers are paying close to $68,000 per bed. During COVID our jail population has decreased by about 1900, while violent and property crime in the county have significantly decreased,” Laila Aziz, Director of Operations, Pillars of the Community. “It’s time to close down facilities like George Bailey whose capacity is almost 1900 and invest this cost savings of 129-millon per year into evidence based best practices that save lives and prevent people from entering the jail system.” 

Malcolme Morgan, who also participated in today’s press conference, is an organizer with Pillars of the Community. He has personal experience with a private jail system, and sees the proposal to privatize medical services in jails as a problem.

The Proposal

On Tuesday, the Board of Supervisors is being asked by Supervisor Fletcher and those who support his proposal, for there to be more options to choose from, instead of just proceeding with privatization. An approval of the Supervisor’s policy will: 

  1. Halt all actions related to outsourcing all jail medical until we receive an evaluation of the HHSA version. 
  2. Evaluate the feasibility of our Health and Human Services Agency administering medical and behavioral health services at detention centers and return to the Board within 180 days with the evaluation.