SHERIFF’S MEETING RAISES CONCERN

Gore spoke with health contractor, later revealed idea to outsource services

Months before Sheriff Bill Gore announced he was exploring the idea of outsourcing all health care services for jail inmates, he and his top advisers sat down late last year with a top official of a potential bidder.

Wellpath, a corrections industry medical and mental health provider in Tennessee, is vying for a multimillion-dollar contract to work inside

San Diego County jails.

“Thanks again for taking so much time out of what I know is a very busy week for you,” Wellpath President Kip Hallman wrote to Gore in December. “I enjoyed the substantive conversation with you and your team.”

The sheriff replied early the next morning: “Thanks Kip. I’m sure that was just the first of many meetings to come. All the best. Bill.”

The meeting and follow-up emails do not violate county contracting policies, because the sheriff had not yet advertised for bids back then. But they are significant because they occurred months before the sheriff announced publicly that he is considering hiring a for-profit contractor to provide additional health care services in San Diego County jails.

Critics of the Sheriff ’s Department point to those 2019 discussions as evidence that Gore is determined to outsource more health care services in his jails, and that he may choose a contractor that has been accused in lawsuits of contributing to many inmate deaths.

Neither Gore nor his spokesman would answer questions this past week about the December meeting with Wellpath or the plan to turn responsibility for inmate health care over to a company.

“The San Diego County Sheriff ’s Department receives numerous requests for audio, video and written interviews on a variety of topics,” spokesman Lt. Ricardo Lopez wrote in an email. “Unfortunately we are not able to grant your interview request at this time.”

Instead Lopez provided a link to Gore’s report to the Board of Supervisors in August, when the sheriff sought and received permission to proceed with an outsourcing plan.

“Contracting out jail medical and mental health services would result

in the provision of high quality services (and) comprehensive care while meeting all state regulations and accreditation standards,” Gore wrote in August to the board, months after meeting with Wellpath.

The supervisors voted 4-1 to permit Gore to issue what is called a request for information — proposals from prospective bidders about their qualifications and how they would manage the workload.

Under its current practices, the jail system relies on 300 or more county employees to provide nursing and mental health services, and a handful of contractors that provide doctors, dentists and other health care professionals to treat inmates.

Prior to the coronavirus pandemic, San Diego County’s seven jail facilities averaged about 5,500 inmates in total a day. Now that some inmates were released to control the virus spread, the system houses about 3,800 people.

The Sheriff’s Department is considering using a single contractor to oversee the broad range of medical and mental services detainees require. That contract could be worth tens of millions of dollars; the county now invests $90 million or more a year on inmate health care.

Some of the county nurses and clinicians who would lose their jobs if the plan goes forward say they worry that privatizing medical services would lead to more inmate deaths and lawsuits.

“Once it goes into forprofit hands, they’re going to want to cut corners to meet their goals,” said Travis Anderson, who works as a nurse at the men’s central jail. “Inmates will suffer more because you won’t have that consistent care.”

Anderson was among 20 county workers who protested last week outside the downtown jail, where dozens of inmates have died or been injured in recent years due to lapses in medical or mental health care, according to lawsuits and some studies.

Wellpath said in a statement that there was nothing improper about the meeting with Gore late last year.

“While we have had conversations with San Diego County over the years, we have followed San Diego County procurement restrictions on communication following the release of the RFP,” or request for proposals, Hallman said.

Wellpath, a Tennesseebased firm that until recently was known as Correct Care Solutions, is one of the largest providers of medical and mental health care to prisoners in the United States. It serves some 300,000 people on any given day.

Margo Frasier, the former elected sheriff in Travis County, Texas, who now works as a criminal justice consultant, said outsourcing health care in local jails is generally a mixed blessing.

“I’ve seen situations where the level of care improved by contracting with a target group, and they should bring more to the table, some of these larger ones with national expertise,” she said.

“But the downside of it is they are profit-oriented, so they have an incentive to do whatever it takes to keep the contract and keep themselves from being sued, but not much more,” Frasier added. “They are in it to make money.”

According to the Dun & Bradstreet commercial data company, Wellpath has estimated annual earnings of $1.4 billion.

Treating inmates is generally more difficult than providing health care to the general public. Patients often arrive at county jails with existing medical or mental health issues, including addictions, that in some cases have gone untreated for years.

However, state and federal laws require jails and prisons to provide standard levels of care to incarcerated people — legal obligations that critics say have not always been met by San Diego County jails or Wellpath.

According to a six-month investigation by The San Diego Union-tribune last year, more than 140 inmates died in Sheriff ’s Department custody over the prior decade, an average of more than one inmate every month. Many of the deaths documented in the multiday series were due to lapses in medical and mental health care, advocates and family members said.

The San Diego jail-mortality rate was the highest among California’s six largest counties, the investigation found. Lawsuits resulting from mistakes and deficiencies inside county jails have cost taxpayers millions of dollars.

Gore has defended his department’s handling of inmate health care, saying he has hired additional workers, invested more in services and toughened policies and procedures to protect detainees. He also disputes the jail death rate numbers, saying San Diego County jails are not numeric outliers compared to other California jail systems.

Wellpath also has seen its share of death and injuries among inmates who rely on

the company for basic medical and mental health needs, news coverage shows.

A CNN investigation in June 2019 said the company — called Correct Care Solutions at the time — provided substandard care due to its focus on containing costs, leading to numerous deaths and other serious outcomes that could have been avoided with more staffing, better training and more experienced employees, the network said. It examined complaints at nearly 120 locations in 32 states.

“CCS employees have denied urgent emergency room transfers,” the CNN report found. “They have failed to spot or treat serious psychiatric disorders and have allowed common infections and conditions to become fatal.”

Wellpath told CNN that the well-being of patients is the company’s top priority, and its commitment to quality was evident in how many clients it retains year after year. It notes on its website that only 7 percent of legal complaints filed against the company result in a payment.

Hallman said in a statement to the Union-tribune that Wellpath strives to deliver the highest level of service in a difficult environment.

In San Diego, the union representing hundreds of county workers whose jobs are threatened by the privatization effort said Gore has bypassed rules spelled out in their collective bargaining agreement. In a “cease-anddesist” letter to Gore dated Oct. 15, David Garcias of the Service Employees International Union Local 221 warned the sheriff that refusing to meet and confer with union officials violates state law.

“It is our sincere hope that you will take this opportunity to reconsider your decision to unlawfully fasttrack your plan to contract out the jobs of hundreds of medical and behavioral health professionals who continue to serve patients and our community with dedication,” Garcias wrote.

The Sheriff’s Department, which has not responded to the warning letter, received up to 10 responses to the request for information issued this summer. It circulated a more formal request for proposals on Oct. 15, the same date of Garcias’ cease-and-desist letter.

According to the county’s purchasing and contracting website, responses are due by Nov. 19. The Sheriff ’s Department is free to award a contract; it doesn’t have to seek the Board of Supervisors’ approval, a county spokesman said.

Sheriff Bill Gore