Let Gates Run County Jail’s Medical Unit, Jurors Urge

The Orange County Grand Jury recommended Wednesday that Sheriff-Coroner Brad Gates take charge of medical and mental health services at the County Jail, marking the latest round in a continuing controversy over inmate medical care that led to the resignation this week of the jail’s first full-time medical director.

In the first of an anticipated half-dozen reports on the jail scheduled for release over the next few months, the grand jury advised transferring responsibility for jail medical services away from the county Health Care Agency and entrusting it to the Sheriff’s Department, which runs the jail.

Advantages Seen

A single level of management would help alleviate problems of inadequate administration and low employee morale within the jail medical unit and would “consolidate the decision-making process and create a smooth flow of authority,” the jury argued.

Gates applauded the grand jury’s recommendations, and the Health Care Agency’s interim director, Robert Love, said they have “some merit,” particularly the proposal to hire a full-time administrator to supervise jail health care issues.

However, the jury’s recommendation raises new questions about possible conflicts of interest, since the Health Care Agency has so frequently been at odds with law enforcement officials in recent months over protecting the confidentiality of inmates’ medical and psychiatric records.

In a recent jail suicide case, for example, sheriff’s officials ordered mental health workers out of the jail after they refused to turn over the dead inmate’s psychiatric records for Gates’ review as coroner. Gates eventually won a court order to obtain the records, but the case sparked an inquiry into possible conflicts of interest in joint operation of the sheriff and coroner offices.

Under the grand jury’s proposal, a medical-mental health services administrator would oversee all medical care in the jail and report to Gates rather than to the Health Care Agency director.

“You can’t ignore that issue,” Thomas F. Riley, chairman of the Board of Supervisors, said of potential conflicts of interest. “Certainly, one of the safeguards, whatever we do, is to remove even the thought that that’s even a possibility.”

But grand jurors said Wednesday that they see no inherent conflicts in having the sheriff run the medical services department.

“For checks and balances, you’re going to have to take into account there being professionals on the job,” said Linda J. Linder, a former Los Angeles County sheriff’s deputy who now heads the grand jury’s criminal justice committee.

“These are professional people we are talking about who are working in the job. They have codes they have to live by, regulations they have to live by,” she said.

The present dual-agency system has “created an unworkable situation,” the grand jury said in its report. “The lack of cooperation between the two departments has divided the medical and mental health personnel and reduced the efficiency of the operations.”

The jury also was critical of the decision to establish a full-time medical director with both administrative and medical care responsibilities. “The medical function is given top priority at the expense of the administrative duties. The lack of direction has caused the loss of many competent employees and lowered morale significantly. This situation is unacceptable.”

Dr. Harold Haughton, hired in early 1984 as the jail’s first medical director following a number of jail health care concerns raised by previous grand juries, announced his resignation Tuesday after only a year on the job.

Haughton cited “personal and professional reasons” for leaving the job, effective June 15, but Love attributed the decision to “burn-out.”

“I think that job was set up for failure,” Love said. “Given the extreme overcrowding that exists in the facility, the number of staff that are involved in rendering medical care, it’s impossible for one person to be both the administrator and the person who’s overseeing the medical care of inmates in the jail.”

Long Hours Cited

Love said Haughton routinely arrived at work at 4:30 to 5 a.m. and worked weekends and holidays as well. The grand jury in its report said Haughton was carrying on responsibilities that warrant two full-time jobs and observed that jurors were “left with the distinct impression that a responsible administrator who answers to the sheriff would be supported by the employees and therefore improve morale.”

Ironically, last year’s grand jury foreman, Ellen Wilcox, said shortly after Haughton joined the county staff, “I think it’s probably premature to announce that Dr. Haughton is the best thing since sliced bread, but we like him very much.”

Haughton could not be reached for comment Wednesday.

Vacancies that continue to plague the jail medical department have been a problem, health care officials say. The jail currently has only two of four physicians’ positions filled and has had trouble attracting new doctors, partly because of low pay and partly because of “the image of working in the jail,” Love said.

Other Posts Vacant

Two nursing positions and one nurse practitioner position remain unfilled as well.

Gates said he is “very pleased and happy with the confidence they (the grand jurors) felt in my administrative staff to do the job properly” and said he advocated the shift in management.

“I’ve always found in my experience that the shortest line of administration usually provides the best results. In that sense, I think the recommendation is probably a good one. And I’m not saying the Health Care Agency hasn’t done a good job over there; maybe we’re just at a point where some changes need to be made.”

Gates concurred that there have been some problems with medical administration at the jail, however. “When you have a diffused administration with the working person receiving directions from two or three different angles, it always makes it difficult to get the job done smoothly. In that sense, I think the diffusion of leadership has created a problem.”

No Conflict, Sheriff Says

The sheriff said of the potential conflict-of-interest issue, “I don’t see that as a problem. We’ll establish the policies and the treatment level, and each of those areas will be done with the support of doctors in our community liaison groups, and whatever they recommend, we’re going to go along with,” he said.

Love said he did not want to comment on the conflict-of-interest issue. But he said he supports the grand jury’s idea of hiring a full-time administrator for jail medical services who does not have to see patients. “That’s something that we concluded several weeks ago, and that’s what’s necessary in order for the system to function properly,” he said.

One problem with transferring mental health services to the Sheriff’s Department is that the department would probably not be eligible for state mental health funds, and the county would have to pay for the services out of its general fund, Love noted.

“The grand jury’s premises are greatly oversimplified,” he added. “There is some merit to their proposal; organizationally, there are some factors that give it credence and others that don’t.”

Review Scheduled

The Health Care Agency has hired Bonnie C. Norman, former administrator of the Los Angeles County jail system’s medical services department, as a consultant to review medical operations at the Orange County Jail, Love said. Her report is expected later this month.

The grand jury noted that Los Angeles, San Diego and Ventura counties all have jail medical departments that report to the sheriff. “This procedure has proven to be effective and is highly recommended by those agencies,” the jury said.

In Orange County, the jurors said, “Our many interviews have convinced us that the people associated with the correctional facilities are not supportive of the administrative policies . . . .”