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Quality of Jail Medical Care Questioned

Services: As Ventura County board considers renewing a health company's contract, critics call attention to inmate death statistics.


The Board of Supervisors will soon consider a new $22.9-million contract with a medical company that has treated local inmates since 1987 but has an unusually high rate of inmate deaths in Ventura County.

Law enforcement officials say they will ask the supervisors in January to approve a four-year contract with California Forensic Medical Group, a Monterey firm that provides health and psychiatric care in lockups for 21 California counties.

They cite low cost and high quality as chief reasons for rehiring the firm instead of accepting a rival $23.7-million proposal from Prison Health Services of Nashville, the nation's largest provider of health care in jails and operator of the medical facility at Rikers Island in New York City.

California Forensic "provides an excellent level of service, far higher than required by state standards," said Chief Deputy Kenneth Kipp, who oversees jail operations. Independent evaluators also give California Forensic good marks for medical care in local jails.

However, critics contend that California Forensic places profit above patient care and that the Sheriff's Department overlooks the situation because it is not liable for malpractice lawsuits. The health firm's insurance covers such losses, including two wrongful death lawsuits settled for a total of about $1.5 million in 1999.

Earlier this year, a Ventura County Superior Court judge harshly criticized California Forensic in a hearing for an inmate who requested temporary release partly to see his own doctor because of a painful swelling in his jaw.

"I have never been impressed with them, [and] I probably never will be impressed with them in the future," Judge Arturo Gutierrez said. "They seem to dodge the issue as far as medical care. They don't want to spend money to do it. My response is sue them."

Gutierrez could not be reached for elaboration, and Kipp said the judge did not respond to his letter requesting an explanation.

California Forensic co-owner Dan Hustedt said his company is responsive to inmates' needs.

"Anything that is going to severely affect an inmate's health has to be taken care of," Hustedt said. "We try to make the program as high quality as we can at all times."

But state records show that Ventura County's three jails have not fared well by one gauge of inmate care since California Forensic won the county contract 14 years ago, taking over for the county government's own hospital and mental health agencies.

The death rate for Ventura County jail inmates from 1987-2000 was fourth-highest among the state's 20 largest jail systems. Only Stanislaus, Los Angeles and San Francisco counties had higher death rates per year per 1,000 inmates. California Forensic also provides medical care in Stanislaus County jails.

For the seven years before California Forensic gained the Ventura County contract, typically one local inmate died each year. But that number has doubled on average during the firm's tenure, and peaked at six in 1997.

Of the 30 deaths since 1987, one was a homicide, eight were suicides and 21 were classified as deaths by natural causes. The inmates' average age at death was younger than 40.

Deaths in many cases were caused by chronic conditions, such as alcoholism and drug addiction, the coroner reported. Medical experts say the health of inmates nationwide worsened over the last decade as jails were flooded with mentally ill inmates and those with tuberculosis, hepatitis and AIDS.

Those trends are seen in Ventura County too. But a spate of 11 deaths in 1996 and 1997 focused attention on the quality of health care here.

Of particular note were the deaths of two young inmates, Raul Madera and Noel Perez. Each died after minor infections spread, and their families collected about $700,000 and $800,000, respectively. Attorneys maintained that California Forensic was understaffed and tried to keep costs down by not sending the inmates to a hospital until too late.

"They function like an HMO, and our concern was that medical care was falling through the cracks," said lawyer Sonia Mercado of Los Angeles. "They had just one doctor. The psychiatric care was also really wanting."

Ventura lawyer Earnest Bell, who has filed legal claims against the jail, insists that California Forensic delays costly hospitalization and surgery so it won't have to spend money on the treatment of inmates serving only a few months in jail.

Bell sued California Forensic last week in federal court, alleging that a former Ventura County inmate was kept from getting an abortion last year while in custody. The county and the firm denied the charges.

"Based on the number of people who call me from jail, I would say the treatment's bad," Bell said. "I would give them a D minus."

But Hustedt said his company is constantly reviewing treatment and responds when things such as inmate deaths occur.

"We react with changes based on our experience, and we do a lot of risk management and training," Hustedt said.

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