Healthcare Union Pushes for Additional Oversight of Jailhouse Contractor

While the Sonoma County Sheriff’s Office often points to successful audits of the county’s jail, it’s more often bad news emanating from the jail that makes headlines.

Over the past few decades, a string of jailhouse deaths, civil rights lawsuits and damning reports have drawn negative attention to the institution, which the Press Democrat once dubbed the county’s “largest psychiatric facility” as an increasing number of inmates with mental health issues cycle in and out of the jail. Now, we can add short-staffed healthcare workers to the list of problems.

In a series of letters to the Sonoma County Board of Supervisors, a group of healthcare workers who recently unionized with the National Union of Healthcare Workers alleged that the company which provides medical services to inmates has consistently failed to fill the number of positions specified in their contracts with the county in recent years.

After hearing the workers’ complaints, the Board of Supervisors on July 20 moved to increase the county’s oversight of the contractor’s practices.

California Forensic Medical Group, which currently holds two contracts with Sonoma County worth over $10 million dollars each year, is California’s largest jailhouse healthcare provider. CFMG, a physician-owned medical group, collaborates with Wellpath, a national management company, on the Sonoma County contracts. Both companies are owned by H.I.G. Capital, a private equity group based in Miami.

All told, NUHW estimates that the county’s contractors have racked up “over 4,000 unstaffed hours” between November 2018 and February 2021 under a contract for mental health service in the jail. NUHW says that staffing shortage often involves using licensed vocational nurses (LVNs) to do work which is meant to be completed by registered nurses, a practice which the union says is a violation of state nursing standards and the company’s contract with the county.

Asked to respond to the NUHW’s allegations, Judy Lilley, a Wellpath spokesperson, wrote, “The nation is in the midst of an unprecedented crisis in nursing and mental health staffing, which has been exacerbated by the Covid pandemic. Like all healthcare organizations across the country and in Sonoma County, we are experiencing staffing challenges, as a result.”

D. Martin, a registered nurse who has worked at the Sonoma County jail for five and a half years, told the Bohemian that additional oversight would not just benefit workers.

“As a public taxpayer, I want Wellpath to be held accountable for the contract that they have with the county. I think that’s what serves the public interest the best and serves the inmates the best,” Martin said.

CFMG currently holds two contracts with Sonoma County—one for general medical services in the jail and another for mental health services. The mental health contract, signed in 2017, cost about $4.7 million in 2018, with half of the money covered by state and federal funds. The general healthcare contract, which CFMG has held since 2000, is expected to cost the county around $8.7 million next year.

Outsourcing jailhouse medical services has become increasingly common, and Wellpath is thought to be one of the largest companies in the field. According to a September 2019 article in The Atlantic, “[Wellpath] works in about 550 jails, prisons, and behavioral-health settings in 36 states across the United States and Australia, and cares for nearly 300,000 patients on a daily basis.”

Today, the company has contracts with 34 of 58 California counties, according to Lilley, the company spokesperson.

Late last year, as CFMG’s 5-year medical services contract came close to expiring, Sonoma County issued a call for companies to submit bids to fill the next five-year contract.

Although one other company completed the application process, CFMG submitted the only “responsive proposal,” according to a July 20 staff report.

At a July 20 Board of Supervisors meeting, Essick said he believed the NUHW’s requests for audits could be met under the current version of the contract, which he said allowed for the Sheriff’s Office to conduct audits of the company.

Supervisor Chris Coursey responded that he was “reluctant to make a decision today that the existing audit procedures and provisions of the contract are adequate given the fact that none of this came up until now [after the NUHW employees came forward].”

“My preference would be to build in some regular audits and reports to the Board of Supervisors on staffing and whether they are following the terms of the agreement on staffing,” Coursey added later in the meeting.

Ultimately, the supervisors voted unanimously to extend the contract by six months, giving the county a chance to add additional oversight language into the contract.

Sheriff’s Office spokesperson Misti Wood says that the Board of Supervisors is expected to discuss an updated contract at a Tuesday, Oct. 26, meeting.

The county is currently facing one lawsuit related to the jail’s medical provider. Last year, the family of Nino Bosco, a 30-year-old musician who committed suicide in the jail in July 2019, filed a lawsuit against Sonoma County, the Sheriff’s Office and CFMG for failing to offer proper medical care for Bosco.

According to the lawsuit, Bosco was bipolar and suffered from schizophrenia. When he was booked in the jail on June 2, 2019, Bosco informed CFMG staff that he was taking psychiatric medication, was having hallucinations and had previously attempted suicide. On the night of July 17, after a series of suicide attempts and hospitilizations, Bosco was found dead in his jail cell having asphyxiated himself by forcing a sandwich into his windpipe.

The lawsuit, which is ongoing, blames Bosco’s death on the county and its medical contractor for “Providing inadequately trained and credentialed mental health care staff at [the main jail], such as nurses and technicians who lack the ability/authority to provide mental health care/treatment/medication to detainees, instead of providing properly credentialed nurses/doctors and, further, having said unqualified/under qualified personnel perform tasks that go beyond their licensure.”

Since 2010, 14 people have died at the Sonoma County jail, according to “death in custody” data filed with the state. Five deaths are listed as suicides, four are listed as drug overdoses and four are listed as “natural.” The cause of the death of a 34-year-old woman in October 2020 is still under investigation.

This May, KTVU reported that Wellpath has been sued over 500 times across the country in the past five years.

Will Carruthers
Will Carruthers is a news reporter for the Pacific Sun and North Bay Bohemian. Email tips to [email protected] Follow him on Twitter at @Carruthers_W.
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