How Much Have Taxpayers Overpaid Santa Barbara County’s Jail Health-Care Contractor?

Every three months or so, the county supervisors host a carefully curated food fight with Sheriff Bill Brown over operations of Santa Barbara County’s two major jails. Typically the supervisors want to know why the jails cost so much to operate? How much overtime is really needed? And why can’t the sheriff hire enough custody officers so that “forced overtime” is no  longer so necessary. Mostly, they want to know how many mentally ill inmates in jail could be safely diverted into treatment programs and out of incarceration. 

But this week, Bob Nelson mostly wanted to ask about money, not programs. 

Specifically, Nelson wanted to know how much money the county was owed by Wellpath — the private contractor providing jail health services — because the company failed to provide the level of staffing called for in its $13-million-a-year contract with the County of Santa Barbara, as reported by last year’s grand jury.

The grand jury also found that the Sheriff’s Office failed to exert adequate administrative oversight and control over Wellpath, never once sanctioning the company for failure to meet the terms of its contract. Wellpath, for example, is required to prepare an annual staff report detailing its caseload, hours worked, and on what. Currently, it is still behind on two annual reports. 

Commander Ryan Sullivan disclosed that the first five months of last year have now been audited. Another seven months remain to be reviewed.

Money was due the county, Sullivan acknowledged. 

How much? Nelson asked.

To date, Sullivan replied, $200,000. But that was just for five months. 

Nelson did the math. That’s $40,000 a month, he figured. And that, he calculated, translates to “half a million dollars a year” that county taxpayers are shelling out for services that were not rendered. 

He asked Sullivan how many years’ worth of such audits the department was conducting. “We focus on the last contract year,” Sullivan replied. 

“Why don’t we go back further?” Nelson pressed. “I’d go back as far as typically allowable.” 

Since Wellpath’s contract with the county originated in 2017, that’s seven contract years with the potential for reimbursement for providing less staffing than required. If auditors found $200,000 during a time Wellpath officials knew they were being scrutinized, Nelson wondered, what might the auditors find when company officials thought they were flying below the radar? “We’re talking potentially millions of dollars,” Nelson stated. “That’s real money,” he added.  “That’s not something I can just turn a blind eye to.”

The Only Game in Town

In conversations afterward, Nelson said he wasn’t sure how far the statute of limitations allowed the county to dig and press. He estimated the number was four years.

Nelson’s pointed questions came at a meeting when the supervisors were reviewing a recommendation to extend Wellpath’s contract for an additional nine months. To address chronic staffing shortages — and comply with its settlement to a lawsuit filed by Disability Rights California over the quality of care afforded mentally ill inmates — Wellpath and the Sheriff had proposed adding 16.6 full-time-equivalent health-care positions. This additional staffing would help increase the net cost of services by $2.3 million. 

The supervisors and county’s administrative staff have long made clear their seething impatience with Wellpath. The problem, they discovered, is that a small handful of companies dominate the prison health care field, and Wellpath faces no credible private competition. 

While some supervisors have floated the idea of giving the contract back to the Public Health Department — which provided health-care services before 2017 — Sheriff Bill Brown has made clear that the sheriff and the sheriff alone is constitutionally charged with running the state’s county jails. 

In response to previous criticisms about the quality of health care in the jail, the supervisors authorized two new, high-ranking positions (1.5 full-time) in Public Health to oversee the quality of clinical care provided in the jail. Brown has agreed to this but has stressed their focus is on the clinical details, not on jail administration.

Of all the supervisors, Supervisor Das Williams exhibited the most inclination to join Nelson in asking the tough questions. The taxpayers shouldn’t be asked to pay for the same service twice, he said. 

Taking a tone of muted incredulity, Supervisor Laura Capps repeatedly questioned how and why it was that the supervisors were being asked to approve a new nine-month contract extension before being able to see the results of this year’s final report.

“A Perverse Disincentive”

Supervisor Joan Hartmann asked for a 10-year report on mandatory jail overtime payments necessitated by the department’s inability to achieve anything resembling full staffing. What is full staff anymore? Hartman wondered. Does anyone even know? And if Wellpath has not demonstrated an ability to meet its current staffing obligations, why should anyone have confidence the company will be able to meet the increased burden of hiring 16.6 staff? 

Supervisor Nelson said the county was in effect rewarding the company by paying it even more for having not lived up to its existing contract. He described this behavior as “a perverse disincentive.” 

Supervisor Hartmann expressed bewilderment that the sheriff could write in his most recent response to the grand jury report that there was an unresolved difference of opinion about the methodology deployed to conclude that Wellpath failed to live up to its staffing minimums and that the sheriff failed to ensure adequate contract compliance. 

Sullivan clarified that the difference of opinion has since been resolved since the writing of that response. But Hartmann cited that difference when expressing misgivings about retroactively exploring just how noncompliant Wellpath was on staffing levels over the years. Given the difference of opinions on methodology, she worried, the whole endeavor might be “a waste of time.” 

Sullivan reminded the supervisors of all the major milestones that have rocked the county jail since 2019. That was the year, Sullivan noted, that Medically Assisted Treatment (MAT) — a euphemism for methadone treatment — was first provided at county jail. The demand for MAT has skyrocketed since, and today there is a waiting list 40 inmates long at the Northern Branch Jail. No waiting list exists for the Main Jail in South County.

Logjams and Staffing Issues

The jail has also initiated a highly successful jail-based program designed to “restore” the competency of inmates deemed too mentally ill to be able to assist with their own defense. Because the state’s psychiatric hospitals are choked with unprecedented waiting lists, county jails have been forced to absorb the burden of caring for this population, which finds itself caught in legal limbo. Given the space constraints of county jails, this has been a major issue of concern, with local judges finding state hospital administrators in contempt for not addressing the log jam. 

In the past, Brown has rebuffed criticisms leveled at Wellpath, describing efforts by company employees as nothing less than heroic during the COVID outbreak, which wreaked total havoc on the county jails across the country. And two years ago, the county settled a major civil rights lawsuit brought against county jail operations by a state agency watchdogging the quality of incarceration. Well before the George Floyd murder, Santa Barbara law enforcement agencies reported challenges recruiting and retaining law enforcement officers; after George Floyd and the call for criminal justice reform his murder unleashed, it got a whole lot more challenging.

Of all the supervisors, Steve Lavagnino expressed the greatest unease about pursuing an aggressive audit of Wellpath’s compliance. The board’s stormy relations with Sheriff Brown seem to have settled down, Lavagnino noted. What lasting good can be achieved by dredging the past for further evidence of noncompliance? Lavagnino wondered. It’s hard to move forward, he noted, when you’re looking back. “It’s not a recipe for moving forward,” he noted, “as partners.”

The supervisors will receive a report on Wellpath’s other seven months of audit results later this year. At that point, the supervisors can decide how far back they really want to go.