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Better Jail Health Care

March 18, 1985

There is growing and justified concern over the quality of the medical services provided prisoners in the Orange County Jail.

Improvements must be made, and efforts are under way to make them. But we can't see how last Wednesday's grand jury proposal to shift the responsibility for medical and mental-health services at the jail from the county Health Care Agency to Sheriff-Coroner Brad Gates would help.

On the surface it seems reasonable enough. The sheriff runs the jail, and having a single level of management and authority would make for a smoother operation. Perhaps. But smoothness isn't everything, and shifting control to the sheriff is not the only way to get better jail health care.

At present the jail's medical director is both administrator and doctor. Those are both full-time jobs, and the grand jury's recommendation to separate them and hire a full-time administrator is a good one. The jury's suggestion that the administrator report to the sheriff-coroner rather than the Health Care Agency, however, is not.

There are several problems inherent in such an arrangement. One is that conflicts of interest are bound to arise. There have been incidents in recent months in which the sheriff wanted information that the health agency refused to provide because of its concern about the confidentiality of inmates' medical and psychiatric records. Those records would be much more vulnerable if the administrator in charge was working for the sheriff and had to tell his or her boss "no."

And, as Supervisor Bruce Nestande has noted, although the jury panel cited the counties of Los Angles, San Diego and Ventura as having medical teams that report to the sheriff, it failed to note that those counties also have independent coroners' offices. The separate offices provide an important safeguard against conflicts of interest that could result when the sheriff keeps the medical records and an inmate dies. And in Los Angeles and San Diego the sheriffs are not responsible for mental-health services.

But the most compelling argument for not shifting the jail's medical services to the sheriff-coroner comes from Dr. Eugene A. Ericson, chairman of the county Mental Health Advisory Board, who contends that sheriffs and doctors have different approaches to caring for criminals. As Ericson sees it, a sheriff is primarily oriented to maintaining law and order, "warehousing" people in the jail, and just has a much "different mind-set" than care-givers.

This is a distinction that must not be ignored, because it is that care-giving, and the inmates' physical and mental health, not who has administrative control, that should determine how the jail's medical services are structured.

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