Barely two months after the ink dried on a five-year extension to a contract worth at least $32 million, the California Forensic Medical Group (CFMG) faces scrutiny at Sonoma County’s Main Adult Detention Center after three recent deaths—including a suicide—over a period of three weeks.

County corrections officials confirmed that three people died at the Santa Rosa jail, and another sick inmate died at Sutter Hospital after being transferred there from the North County Detention Facility.

The county has promised an investigation of the deaths to determine if there’s anything connecting them.

“It is an anomaly to have the incidents clustered in such a short time frame,” says Sgt. Cecile Focha, public information officer with the Sonoma County Sheriff’s Office. “In response, we are taking a progressive stance to analyze the circumstances and evaluate the current custodial and medical procedures.”

Rhonda Jean Everson died
Oct. 18 in a cell she’d been placed in while going through withdrawal, and was reportedly in the cell from Friday night through Sunday, when she was found dead.

Mikol Stewart was found hanged in his cell Sept. 28, and Diego Armando De Paz died in his cell Oct. 8. The fourth inmate, Charles Weathers, died at Sutter Medical Center Sept. 23 after being transferred there from the North County Detention Facility.

A review of documents raises questions about factors that may have played a role in the cluster of deaths:

• An understaffed jail where officials are forced to work up to 60 overtime hours a month.

• Gov. Brown’s “realignment” solution to the state’s overcrowded prison crisis, which has put additional pressure on county lockups’ mental and medical-health services. Realignment was Brown’s 2011 solution to a U.S. Supreme Court order to depopulate its unconstitutionally overcrowded state prisons by moving prisoners to county facilities.

• The county’s for-profit medical-services provider and its eye on the bottom line and a healthy return for investors.

The Monterey-based CFMG is the largest for-profit provider of mental and medical health services in the state. According to its website, CFMG contracts with 65 detention centers in 27 counties around the state—serving 16,000 inmates while providing medical health services to roughly 90 percent of the state’s local lockups.

Napa County also contracts with CFMG for medical services in its lockups. Marin County relies on county health workers to provide the services.

The state leader in outsourced inmate health services operates under the umbrella of a huge global private equity firm. In 2013, CFMG entered into a “strategic investment” with H.I.G. Capital, which has offices in San Francisco and an asset portfolio of about $17 billion. According to the Monterey Herald, it signed several jail contracts soon after the “strategic investment” with H.I.G. Capital.

One of the obvious questions for investigators is whether sick inmates pay the price for a healthy return on investment—but it’s unclear whether they’ll ask it.

They should. California Forensic Medical Group is in the midst of a federal lawsuit that originated in 2013. Company founder Dr. Taylor Fithian and CFMG, according to an April report in the Monterey Herald, are “the target of a high-profile federal lawsuit alleging unconstitutional and ‘systematically’ poor medical care at Monterey County Jail.”

That story, by reporter Julia Reynolds, noted that the Monterey lawsuit was of a similar nature to a 2004 lawsuit in Yolo County that CFMG lost. In Monterey, Reynolds cited a federal court deposition given by Dr. Mike Puisis, a medical-corrections expert: “It appears that [Monterey County Jail] is systematically denying necessary medication to patients with chronic disease.”

California Forensic Medical Group did not respond to a request for comment by deadline.

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The 2013–14 Sonoma County Grand Jury report offered recommendations that “focus on the sheriff’s office, encouraging it to continue efforts to address the impact of realignment and to address the needs of inmates with health problems.”

In a recent Facebook post, the Sonoma County Sheriff’s Office wrote: “The Grand Jury and the Sheriff agreed that the State’s Realignment Program continues to pose challenges to our adult detention facilities. Also, inmates with medical and mental health issues make significant demands on [Main Adult Detention Facility] staff and facilities. In addition to these issues, the mandatory overtime is an increasing burden for correctional personnel.”

According to documents reviewed by the Bohemian, the county re-upped its service contract with CFMG in August, with a first-year outlay of $6.5 million. The extension allows for annual increases pegged to the consumer price index, which means the latest contract is worth at least $32 million—in a jail inadequately staffed by overworked corrections officials forced to work overtime.

Business has been good for CFMG in Sonoma County. Its 2000 contract was for $3.1 million a year; by 2014, it was charging taxpayers $6.5 million annually for healthcare services.

Both the Sonoma County Behavioral Health Department and the Sonoma County branch of the National Alliance on Mental Illness (NAMI) provide mental health services to the jail, which makes the deaths more puzzling, given the level of attention paid to county inmates with mental health issues.

Sheriff’s department spokesperson Focha stresses that “there is close communication about an individual’s medical and mental health to insure that he/she is provided quality, appropriate resources and continuity of care.”

Courtney Puckett is the program coordinator for NAMI Sonoma County, and she applauds Sonoma County for what she calls proactive and innovative approaches to its mentally ill inmates. Puckett cites several outreach programs and other efforts officials have made to keep inmates healthy while they’re incarcerated. The alliance provides clinicians to the jail as part of its nonprofit mission; it doesn’t get paid.

“Our general concern, whether it’s at the national, state or local level, is a cultural one: the criminalization of mental health,” says Puckett. “But we truly believe that the county health department and the sheriff’s department are using innovative approaches. Our county has taken a lot of steps in the right direction,” she says. Part of the reason, she says, is because of a well-documented history of mental and medical health scandals at the jail.

“They’ve said, ‘It’s an issue, address it, and be proactive about it,'” says Puckett.

After a string of deaths at the Sonoma County jail in the late 1990s, the county ended a contract with the St. Louis–based Correctional Medical Services and re-contracted with CFMG in 2000 (the company had earlier provided medical services for several years). The CFMG contract was renewed in 2008, and again in August. The county renewed the contract while acknowledging that CMFG’s bid was higher than two others under consideration and that the higher bid was the result of higher average salaries and benefits paid out by the company.

Was everything done to prevent the jail deaths? How did Stewart manage to hang himself?

Corrections officials, under best practices standards set out by the

U.S. Department of Justice, should be trained in the use of a “cut-down tool,” used when inmates try to hang themselves. Focha says correctional deputies are trained, and that the equipment is “readily available to personnel” at both adult detention centers.

Focha says that Stewart had been held in a “mental health module for a period of time” before apparently killing himself in his cell, and that Everson was in a specialized unit for inmates undergoing withdrawal when she was found dead.

Focha could not answer a question about how often Everson had been checked on over the weekend by deputies or other staffers, citing the ongoing investigation.

Best-practice guidelines stress that inmates under mental duress are supposed to be monitored at least once every half-hour. This might be a challenge at a jail where, as the Sonoma Grand Jury reported, the ratio of prisoners to guards is 60 to 1 at the main lockup. A 10-to-1 ratio was cited as the “standard” by author Janice Van Cleve, who has written extensively on the privatization of American corrections facilities.

Focha says CFMG personnel were assigned to treat the four inmates who died, but couldn’t provide any more detail. “There is a current investigation pending. We are not providing details about specific tasks and personnel.”

Focha was asked if the sheriff’s office was concerned about whether CFMG had fulfilled its contractual obligations, in light of the four deaths. “We are confident in our practices, procedures and tools regarding the working relationship with CFMG,” she responded, noting that the jail is considered a “model institution with best practice systems in place.”