SANTA CRUZ >> In the wake of the sixth death in Santa Cruz County Jail in three years, a Santa Cruz County Civil Grand Jury report released Wednesday recommended changes in the way correctional officers and medical staff handle inmates who are withdrawing from drug use.
The grand jury recommended that jail staff evaluate inmates with a checklist to determine if they are in opiate withdrawal and if they need care, supervision, or a trip to a hospital.
The report also recommended that the county, rather than a private medical group that provides care at the jail, pay for emergency care at a hospital care because those costs may have been a disincentive to transport inmates to a hospital.
“There have been improvements, but we feel there are some additional things to be done for basic medical care in the jail,” said Jeff Palsgaard, the civil grand jury foreman.
The report was prompted by the case of Krista DeLuca. DeLuca was a 23-year-old Live Oak resident who died in jail in September 2015 after about four days of nausea, vomiting and respiratory problems. DeLuca was withdrawing from “chronic heroin use” and asked jail staff to go to a hospital, according to the coroner and grand jury report.
“What the grand jury found to be so disturbing in Ms. DeLuca’s case was that she was under medical care during the four-day period in which she slowly died,” the civil grand jury wrote. “DeLuca died after four days of vomiting, depleting her body of essential minerals and hydration, ultimately inhaling her own vomit and developing pneumonia.”
When she asked to be taken to a hospital, a nurse instead “prescribes Gatorade and deep breathing exercises,” according to the report.
That day, she was transferred from an ordinary jail cell to a holding room on “medical watch for dehydration.” The next day, a physician’s assistant gave DeLuca a shot to control vomiting and her symptoms briefly improved, according to the report.
She was given a suppository to control vomiting the following morning and died later that day.
Part of the problem in DeLuca’s care was that the jail’s Chemically Dependent Inmates Policy does not specify what symptoms necessitate immediate transfer to a hospital, according to the report.
“Also missing from this policy is the use of an objective opiate withdrawal screening tool such as the Clinical Opiate Withdrawal Scale,” which is the standard tool used in federal prisons, according to the grand jury. “This simple 11-item questionnaire provides an objective measurement of the stage and severity of an inmate’s opiate withdrawal and helps staff with treatment decision making,” according to the report.
Santa Cruz County Sheriff Jim Hart said Wednesday that jail staff in March started a new policy “for chemically dependent inmates, including policies and procedures for handling acute detoxification,” Hart said.
TRANSPARENCY
“The Sheriff’s Office recognizes that any death occurring in a custody setting is tragic and requires a thorough examination to determine if staff fulfilled their responsibilities and prevent future occurrences,” said Hart.
However, the Sheriff’s Office and the California Forensic Medical Group with whom it contracts have never made public a full report of DeLuca’s death. Earlier stories in the Sentinel and Wednesday’s grand jury report inch closer to it.
DeLuca was the third person to die in jail while withdrawing from opiates since 2012, according to earlier civil grand jury reports. She is the second person to die during opiate withdrawal since the California Forensic Medical Group took over nearly all medical care in the jail in October 2012.
Nationally, 82 percent of local jails averaged no deaths annually from 2000 to 2013. About 12 percent of jails reported one death annually, and 6 percent reported multiple deaths, according to the U.S. Bureau of Justice Statistics.
Because California Forensic Medical Group is a for-profit company, Palsgaard said the grand jury cannot investigate the company directly. The company is based in Monterey and provides inmate care at jails in 27 California counties including Monterey.
PRIVATE CARE
As a term of Santa Cruz County’s current contract with the medical group, the medical group is required to pay up to $15,000 per inmate for emergency medical care if the inmate is admitted to a hospital. The grand jury said that clause might have been a disincentive for medical staff to admit patients to a hospital. They asked that it be deleted from future contracts.
Sheriff Hart said Wednesday that the clause will be deleted and the county “will pay for all medical expenses incurred by inmates when transferred to local hospitals.”
The county’s contract with California Forensic Medical Group ends in September and is due for renewal. A request for proposals went out this year and the Board of Supervisors is due to vote on a new contract in the coming months.
The grand jury report also recommended that the jail obtain third-party certification from the California Medical Association for its facilities.
“Because the sheriff is ultimately responsible for inmate health care, he should consult with a third party to make sure those standards are being adhered to,” Palsgaard said Wednesday.
Hart said that he agreed that oversight is “critical,” but he said he is satisfied with quality assurance measures taken by an independent physician, the Santa Cruz County Health Services Agency and the Board of State and Community Corrections.
The Santa Cruz Civil Grand Jury investigates local governments, special districts and schools. Seven reports have been released so far this year on transparency problems in Soquel Union Elementary School District, problems with the County Mental Health Advisory Board, county retirement costs, civil asset forfeiture, the county Domestic Violence Commission and school safety and emergency plans.
June 8, 2016
Santa Cruz Sentinel
By Stephen Baxter
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