Santa Barbara County Jail Achieves National Health-Care Accreditation

The Santa Barbara County Jail has finally won accreditation by the National Commission on Correctional Health Care, putting it on par with incarceration facilities nationwide in terms of higher standards of safety, training, health care, and special needs and services. The road to accreditation started in 2017 when the Board of Supervisors contracted with Wellpath to take over the jail’s medical services from a provider that was highly criticized by inmates, their families, and mental-health organizations. Ironically, in the same week that Santa Barbara’s accreditation was announced, its new provider was sued in the death of a mentally ill inmate in Ventura County’s jail.

Wellpath, previously known as CFMG (California Forensic Medical Group), was brought on to increase the jail’s health-services staff and decrease the time it took for inmates to be seen. National accreditation within two years was among the goals set out in the contract, which contained penalties for falling short. Wellpath and the jail had a 2019 accreditation in its sights, said Vincent Wasilewski, who is in charge of the jail as its chief custody deputy. But a major revision of the standards in 2018, scheduling difficulties, and the pandemic raised roadblocks; the full audit was completed in September 2020.

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The health-care provider also treats the teens at the county’s juvenile halls — in Santa Maria and at Los Prietos — which both received 100 percent accreditation for all standards in November 2020, Probation Chief Tanja Heitman said. “We had been accredited by the Institute of Medical Quality for a long time, so it wasn’t a heavy lift to comply with the NCCHC standards,” she said, “but one thing we had to do was show our kids had not only emergent dental care but also cleanings and fluoride treatments, and so forth, for six months,” which required transport coordination and sometimes follow-up with families once children were released. Her facilities held fewer kids because of the pandemic distancing rules, but Heitman said the highest rankings reflected the sense of purpose among her staff.

At the County Jail, the facility itself creates a number of issues. Built in the 1970s to hold fewer than 700 people, the main jail came to hold more than 1,000 inmates at a time. The same year the accreditation process started, the county was sued by Disability Rights California in a class-action suit that covered all inmates and sought to relieve “dangerous” conditions at the jail that ran the gamut from overcrowding to understaffing, inadequate health services, and a lack of policies.

As part of that suit, both sides agreed to a review of the jail by Dr. Scott Allen, an expert in medicine in detention facilities. In his report, Dr. Allen explained: “There is no separate or unequal standard of care for inmates of correctional institutions; there are merely logistical challenges and … modifications of standard medical approaches that are a direct result of the constraints of confinement settings.”

Just about everyone interviewed for this article asked, “Have you seen the jail?” before attempting to convey how badly the facility served its purpose. Deputies had once described the facility as a “Frankenjail,” recalled Aaron Fischer, an attorney with Disability Rights California, because of all the unsuitable spaces — like a broom closet or the law library — that had been repurposed as cells to accommodate too many inmates. Dormitories set up in the basement have little natural light, the line-of-sight for observation of inmates with mental-health issues is inadequate in some places, and they can rarely go outdoors — all are issues discussed in Disability Rights’ reports by people experienced in their fields.

Importantly, the settlement reached last year not only committed the county to work toward humane care for inmates but allowed Disability Rights experts to continue to visit the jail and monitor the changes. Fischer complimented Sheriff Bill Brown and his staff for working in a “receptive and transparent way” with them, though there had been some “heartburn” at first, he said ruefully.

The accreditation means medical-staff levels have improved — “Wellpath is onsite 24/7,” Wasilewski said. “For acute stuff, they respond immediately.” — and that inmates get health care or screenings more quickly, but issues from overcrowding remain inherent to the facility. “The most dungeon-like solitary confinement cells were to be shut down by January 1, 2021,” Fischer said, “which everyone thought would be doable because the Northern Branch Jail was supposed to be online by then.” Project delays have slowed construction of the 376-bed facility near Santa Maria, but the pandemic — which released low-level inmates and kept out people arrested on minor charges — served to reduce the main jail’s population from over 900 last February to about 630 today.

“It hasn’t hurt,” Chief Wasilewski said, with a short laugh, going on to explain that the smaller population during the pandemic allowed his staff to control the outbreaks that inevitably occurred. Wellpath and its national network were also instrumental in helping the jail design the new infection protocols. “We didn’t know what to do,” the chief confessed. “Wrap them in cellophane?” Now they test everyone who comes through the door and know if an inmate is positive before being admitted to the jail and quarantined. They decided to test custody deputies and jail staff, too, which helped keep any outbreaks from crossing into the wards.

COVID-19 also closed the jail to visits from inmates’ families, but before that happened, Families ACT!’s Suzanne Riordan said Wellpath’s changes had been noticeable. “In many respects, Wellpath has been a huge improvement for the Santa Barbara jail,” said Riordan, who leads the grassroots mental-health advocacy group. They have long advocated to improve health treatment at the jail, and she called the previous health-care contractor “scary.” Her group had met regularly with families outside the jail, and while not perfect, Wellpath has allowed families to talk with its staff about inmate care, she said, as long as the inmate had signed a health release form. Hearing from family members about an inmate’s medical history was important when an inmate might not be able, or willing, to explain it themselves, Riordan said.

Mental-health services were among the jail’s failings in 2017, and Wasilewski said improvements occurred there, too. “The accreditation is the gold standard for correctional health care that very, very few actually attain,” he said. Not only was the manual of standards an “inch thick,” but the staff and training guidelines extended to “both sides of the house here, Wellpath staff and my staff,” he said. “We are trained in so many hours of suicide prevention, first aid, all different types of topics.” In a large part, the accreditation indicates the jail operates at the highest standards, which can reduce the risk of bad outcomes, Wasilewki said, and the subsequent litigation that follows.

As part of the Disability Rights reviews, mental-health expert Dr. Roberta Stellman wrote in April 2017: “It should be evident to everyone that in recent decades the number of seriously mentally ill people incarcerated in jails and prisons has risen for many reasons. … The burden of providing treatment programming for this population is increasingly falling on the shoulders of community jails.” Her review refers to the issues that face caregivers in jails, from refusals of treatment to the intricacies of suicide watch, and recommendations to improve operations.

For an inmate deemed incompetent to stand trial, or IST, referral to a state hospital for mental-health treatment was difficult: The criteria for entry were steep and the involuntary committal process has been lengthy, Wasilewski said. One workaround that Riordan’s group was first opposed to but came to accept was in-jail treatment for people who were determined to be incompetent to stand trial on felony cases. The 10 beds in the jail-based competency unit enabled an inmate to start therapy — paid for by the state hospital system — right away rather than waiting the three to four months it could take to get into a state hospital. “Therapy, the whole program — we’re able to deliver it here,” Wasilewski said, avoiding the downward spiral an inmate-patient might otherwise experience.

From the facts given in a lawsuit filed last week, that spiral was occurring in an inmate under Wellpath’s care in Ventura County’s jail in May 2020. He was a troubled 18-year-old when arrested, his attorneys write, whose schizophrenia worsened during two years of incarceration. He’d tried to drown himself in the jail several times, and on the day before he died, the lawsuit alleges, he was removed from suicide watch and placed in special housing for a psychiatric evaluation. The next morning, however, despite deputy checks every half hour, with a blanket over his head, he killed himself, the lawsuit states.

Before Wellpath began its work in Santa Barbara’s jail, there had been 12 inmate deaths in the previous seven years. In the past four years, eight inmates have died, the Sheriff’s Office stated: one attributed to COVID, three to natural causes, and four by suicide. Even one death was too many, Wasilewski said, and he took each death as a personal failure. “I know the families,” he said soberly, but he said he also believed none had been preventable.

In achieving the national accreditation, Sheriff Brown gave full marks to Wellpath, calling the agency the department’s health-care partner in “providing high-quality health care to our inmates.” It could only be a daunting task to figure out what 600-plus patients needed on a daily basis, Wasilewski said, “and incredibly rewarding when it all works out right.” Not many of their caregivers, he suggested, had gotten into medicine with a jail facility in mind. “But they get here and see the challenges, and see how much good they can do,” Wasilewski said. “It really gets in their blood.”

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