A $36 million program designed to provide medical care to jail prisoners in Orange County, California is severely mismanaged, according to an internal performance audit. The audit found that the county Health Care Agency (HCA), which administers the jail’s medical program, produces unreliable data and statistics; that contracts with medical care providers are poorly monitored; that doctors receive excessive payments; that transportation delays result in detainees routinely missing their medical appointments; that controlled substances are not adequately accounted for; and that conflicts of interest among staff have persisted for years – all to the detriment of the medical care that HCA is supposed to deliver.

The audit findings did not surprise at least one civil rights attorney who had previously sued the county, Richard Her-man, who remarked, “You’re better off in the prisons [for medical care] than you are in the Orange County Jail.” If his assessment is accurate, it is very telling; healthcare in California’s prison system is so grossly inadequate that it has been placed under federal receivership to ensure that prisoners receive constitutional medical treatment.

According to the audit, HCA’s record keeping is so poor that the agency cannot account for nearly $10 million in medical service billings – about a quarter of its outlays. The audit team made recommendations for improvements that could save more than $3 million annually. While expressing appreciation for the audit’s suggestions, HCA officials remained skeptical about the prospect of actually realizing those savings. They noted the many challenges in providing medical care in a jail setting, as well as the difficulty of recruiting quality staff. No doubt those challenges are real. In 2008, while dispensing more than 4,000 doses of daily medication at the jail, HCA responded to over 175,000 sick-call requests.

Incredibly, despite uncovering “management, operational and administrative deficiencies,” the audit concluded that jail detainees nonetheless received the medical treatment they needed. Attorney Richard Herman disagreed with that conclusion, saying, “It’s simply not true. Sometimes, if they are lucky, [prisoners] get medical attention.” Meanwhile, County Supervisor John Moorlach called the audit “troubling.”

While HCA officials praised the work of their staff, Nick Bernardino, general manager for the Orange County Employees Association, criticized county executives and said, “They try to hide things as opposed to looking for solutions.” This was echoed in the refrain “Nothing can be done. Nothing will change,” which was repeatedly heard by the auditors during their investigation.

Yet change is needed. An Orange County grand jury criticized the jail’s medical program in a 2008 report chillingly titled, “Man down: Will he get up?” That report came one year after the Orange County Register reported understaffing and an alleged lack of training among jail nurses, following the death of prisoner Michael Patrick Lass in October 2007. Lass died after being Tasered by jail guards.

Source: Orange County Register