Additional nursing and behavioral health staff, accountability measures, and continued compliance with a legal settlement surrounding jail health care are some of the amended measures baked into Santa Barbara County’s contract extension with jail health care provider Wellpath. The Board of Supervisors unanimously approved these changes during its June 25 meeting.
“I do think, even as I’ll acknowledge that I’ve been a critic of the previous contract, this is much improved,” 1st District Supervisor Das Williams said during the meeting.
In 2023, the Santa Barbara County grand jury highlighted deficiencies for the county and the company when providing behavioral health care in the jail system, like staffing shortages leaving gaps in mental health coverage and inadequate communication between agencies regarding an inmate’s mental illness history.
The county’s contract with Wellpath didn’t have a monitoring system in place that holds the company accountable to provide the medical and mental health services it agreed to in the contract. In order to understand the issue, the Sheriff’s Office commissioned an analysis of health care staffing levels and what was needed.
Moving forward with this nine-month extension, Wellpath will add 16.6 full-time equivalents—including additional nursing staff, psychiatric technicians, discharge planning liaisons, medical assistants, a nurse practitioner, a substance use disorder counselor, and a facility coordinator—to help monitor and provide improved services to inmates with mental illness. These changes will also enable the company to continue to comply with the Murray settlement—a class action lawsuit about the Main Jail’s deficiency in providing behavioral services, Sheriff’s Office custody Cmdr. Ryan Sullivan told the supervisors.
The contract now includes modified liquidated damage provisions for staffing vacancies, he said, explaining that if a staffing vacancy exists for more than 30 days, Wellpath will owe the county $200 per day per position. Additionally, there’s “enhanced language” around reductions for staffing shortfalls—if someone is out, those hours are credited back to the county in order to recoup money the county would have spent on that service.
“If they had a position vacant in excess of 30 days, if it were vacant for another 30 days on top of that, the liquidated damages provision would add up to $6,000,” Sullivan said. “Six-thousand dollars on top of the credit back of the hours they missed, assuming they didn’t cover every single hour vacant with per diem or overtime. I think it’s financially incentivizing the contractor to provide those staff members and try to get those positions filled.”
When the contract expires, the county will issue a request for proposal (RFP) for health care services in the jail starting April 1, 2025.
“We wanted to be prudent about how we did this; we didn’t want to just separate from our provider Wellpath, who has provided excellent services in many instances, and just jump to a different provider,” Sullivan said. “We wanted to go through the option of providing additional staffing we felt they needed—they felt they needed—in order to provide an increased level of care and then methodically work through an RFP process that would allow them to bid as well as any other vendor that wanted to come forward.”
Through a staffing analysis from the 2023-24 contract year, the Sheriff’s Office identified potentially $200,000 that could be credited back to the county, Sullivan said.
“That’s about $47,000 a month in excess payments to Wellpath over the life of this contract. This year alone could potentially be half a million dollars. Why aren’t we looking back further?” 4th District Supervisor Bob Nelson said. “We paid Wellpath for services they didn’t provide, and it seems it would be prudent for us to credit back the county those dollars.”
While Nelson said he appreciated the contract’s improvements and accountability provisions, he wanted to see if the Sheriff’s Office could dig as far back as contract law allows to identify additional credits.
“I understand we’re on a good path, and I’m excited about that, but I think that there’s been revenue that Wellpath realized that they didn’t have to do the work for, and that’s not something I can turn a blind eye to,” Nelson said.
After some discussion, the supervisors agreed to continue looking into the matter when the 2023-24 annual report returns with more details about staffing levels.
This article appears in Jun 27 – Jul 7, 2024.
