The prime contractor delivering health care services in San Diego County jails failed to pay outside hospitals and other specialty providers, limiting the Sheriff’s Department’s ability to send sick and needy people in custody into treatment, newly disclosed records show.
NaphCare, the Alabama correctional medical giant brought in to manage treatment in the troubled county jail system, also relied on unlicensed staff, ignored requests to repair or replace equipment and failed to fill hundreds of shifts, according to the documents.
“As of April 17, 2023, there are $9.3 million dollars of unpaid bills due to hospitals,” a formerly confidential corrective action notice from the Sheriff’s Department to NaphCare says.
“Of the total outstanding claims, $4.6 million dollars are past due the 30-day threshold,” the December 2023 report adds. “Due to a lack of payment, some community providers do not want to see or accept our patients.”
The 23-page report was produced as part of a lawsuit filed by a collection of civil rights lawyers against San Diego County in 2022.
The litigation was initially filed in February 2022 on behalf of a group of disabled patients who are trying to force the sheriff to do a better job providing sign-language interpretation, wheelchairs and other assistive devices needed to comply with the U.S. Americans with Disabilities Act.
The case has since grown into a class-action lawsuit that affects all prior, current and future men and women in San Diego County jails, a system that has one of the highest mortality rates in California.
The corrective order lays out a long list of deficiencies in the performance by NaphCare, which was awarded the primary contract for health services in San Diego County jails two years ago.
The document is labeled confidential but was filed in San Diego federal court earlier this year as part of the class-action lawsuit.
The December order is the second such demand issued by the sheriff in the past year. It references an April 2023 notice of deficiencies that it said were not fully corrected before the close of last year.
“We received your response dated May 5, 2023, but it did not address some deficiencies or provide a plan for correcting some of those that were addressed,” the sheriff’s corrective action notice from December says.
The Sheriff’s Department declined to comment on the correction orders it issued to NaphCare last spring and again last fall — or the quality of health care practices in its jails. A spokesperson said department policy precludes any public discussion of ongoing litigation.
But Sheriff Kelly Martinez and other department officials have said in recent years that they have taken steps to better protect people incarcerated in San Diego County jails.
Among other things, the department has increased its staff and budget, especially among health care providers. It also has upgraded facilities and invested in new equipment aimed at improving booking practices to more effectively identify people who may need treatment.
Martinez also has touted additional training for deputies working the jails.
“In the last year, we have made a lot of progress,” the sheriff said last summer, when the department staged an open house to showcase many of the changes implemented in county jails in recent months. “Mental health (treatment) is even more important in jails.”
NaphCare issued a statement saying the company is working closely with the Sheriff’s Department and is confident that it is moving in the right direction.
“NaphCare’s mission is to improve and save lives,” it said. “We aim to ensure that every patient we treat within the San Diego County Jails receives community standard of care to support a healthy return to their community.”
The company has been the subject of repeated lawsuits challenging the level of care it provides in state prisons and county jails across the United States.
Earlier this month, for example, a federal judge in Arizona presiding over a case seeking to improve conditions for the nearly 25,000 people in state prison said the medical and mental health NaphCare provides was “fundamentally lacking,” the Associated Press reported.
Under the private company, the Arizona prison system doesn’t have enough staff and needs to increase salaries for new and existing workers, experts monitoring its health care operations told the court. NaphCare already was issued $2.5 million in contempt fines in the 12-year-old case.
The Alabama correctional health contractor also serves the jail system in Pima County, Ariz.
Officials there docked NaphCare more than $3 million for failing to meet a slew of terms and conditions in its contract with the region surrounding the city of Tucson, according to local news reports.
San Francisco lawyer Gay Grunfeld is one of the lead attorneys driving the class-action lawsuit against San Diego County. She said the sheriff and other officials should have known about NaphCare’s questionable record.
“Given the broad range of areas in which NaphCare is failing the county, it is not surprising that we continue to receive regular reports from our clients, the certified class, of delayed and substandard medical, mental health and dental care,” she said by email.
“Nor is NaphCare creating the contractually required policies and procedures that the county needs to come into compliance with national standards and to address the high death rate and unconstitutional care,” she said.
The NaphCare chief legal officer acknowledged under oath in the class-action case that the company may not be complying with all of the terms in its San Diego County contract.
In a deposition earlier this month, NaphCare lawyer Justin Barkley was asked if his company were conducting site-level reviews for the local jails. “Not to my knowledge,” Barkley replied.
Asked if he were aware the individual reviews are required, Barkley said: “I don’t know that I’m aware it’s in the contract. It’s certainly part of our policy that we would do it. I would — you know, it’s my expectation it should be done, yes.”
Health care practices inside San Diego County jails have been a significant factor in the persistently high number of deaths in custody and other medical outcomes that left men and women in sheriff’s care sick or injured.
The Sheriff’s Department has seen a growing number of in-custody deaths and other misconduct or negligence claims against deputies and jail medical workers in recent years.
The deaths and injuries have resulted in a spate of lawsuits against San Diego County that have cost taxpayers at least $60 million in recent years, records show.
NaphCare has been contributing to some of the deficiencies inside county jails, the sheriff’s corrective action notice says.
In addition to keeping staffing dangerously low, not paying other providers, relying on unlicensed staff and failing to replace or repair medical equipment, the company also failed to implement the county’s Medical Assisted Treatment program for people with opioid addiction as required, the notice says.
It also says NaphCare failed to provide reports as called for in the county contract, failed to conduct required meetings and did not implement a continuous quality-improvement plan as called for under the 2022 agreement.
There were other problems in the level of care delivered by NaphCare.
“As of March 9th, there was no Gynecological Provider (GP) and Las Colinas and no replacement was present,” the corrective notice said. “Contractor refused to pay for abortions, as they deemed it ‘elective.’”
The lawsuit that generated the public release of the sheriff’s corrective action notice issued to NaphCare is known as Dunsmore v. San Diego County Sheriff’s Department. The lead plaintiff is Darryl Dunsmore, a previously incarcerated man who suffered from ankylosing spondylitis, a form of inflammatory arthritis that sometimes left him immobilized.
Dunsmore needed a wheelchair and a modified spoon to eat, but deputies confiscated the items “because they decided he did not need them,” the lawsuit said.
At one point, he became distraught and was stripped of his clothes and placed into an isolation cell, where because of his disability he was unable to access the toilet, the suit added. He was forced to eat with his hands; he also had to urinate and defecate on the floor.
“He often made a mess in the cell and was forced to sleep among his own feces and other trash,” the complaint said.
Last June, in response to the Dunsmore civil rights case, county officials reached an agreement to modify showers, toilets and beds in local jails to help improve conditions for the disabled men and women in sheriff’s custody.
But the terms of the agreement will take months and years to implement, and the case remains active and scheduled for trial next year.
