Fletcher, Gore Clash on Outsourcing Proposal for Jail Health Care

Supervisor Nathan Fletcher joined community activists and county workers Monday to announce a proposal to have the Health and Human Services Agency administer medical and behavioral health services in jails, and prevent Sheriff Bill Gore from privatizing services.

Gore, who recently cited the Sheriff's Department's $90 million annual health care bill for inmates as a reason to look toward cost-saving strategies, will ask the Board of Supervisors on Tuesday to consider a request to look at possible vendors for the county's health care needs in its jails and other facilities. The meeting will be conducted via teleconference in response to the COVID-19 pandemic.

Fletcher and his coalition launched a petition called "Stop the Sheriff from Outsourcing Medical and Mental Health Services," contending that privatization could lead to worse healthcare overall and threaten county jobs.

"Instead, we need a system of care driven by providing the appropriate care and preparation for release and reintegration into society," Fletcher told reporters. "Not a system designed to limit care to maximize profit."

Along with having the Health & Human Services Agency manage healthcare needs at jails, Fletcher is also asking his fellow supervisors to halt all actions related to outsourcing until an evaluation is completed within 180 days.

The Sheriff's Department currently operates a hybrid system of private contractors and county workers. According to Fletcher's group, the county sees a suicide rate for inmates five times higher than the state prison system.

"We have been given a sneak preview of the outcome of (for-profit) care in jails and laying off county workers, and it is grim,'' said Genevieve Jones-Wright, executive director of Community Advocates for Just and Moral Governance.

"The sheriff has failed to meaningfully address his abhorrent record concerning the deaths in our local jails, and now he is putting forward a proposal that will exacerbate the loss of lives even further,'' she said.

David Garcias, president of Service Employees International Union Local 221, said Gore's plan "is to sell out their jobs to for-profit companies that provide substandard care and force the public to pick up their bill for lawsuit and settlement costs."

Gore responded to Fletcher's criticism with a letter addressed to the supervisor, stating that the board "has no direct authority over the jail," in terms of duties or operation.

"In fact, the penal code recognizes that a county sheriff may contract with providers of health care for the care of inmates,'' the letter says.

"As sheriff, I am consistently looking for ways to provide the highest level of medical services for inmates in the county jail system. "There is no reason to delay the process for 180 days."

In response to Fletcher's claim of poor healthcare outcomes for inmates and low morale among staff, Gore argued that his department "has worked diligently to improve timely access to care for our inmate population."

In a July 31 opinion piece in the San Diego Union-Tribune, Gore wrote it would be irresponsible of him "not to explore all available options" for inmate mental and medical health care, especially given fiscal pressures on the county caused by the pandemic.

Gore argued that the county already spends over $20 million on contracted services for inmates. "The only way to find out if that money is providing the highest value is to explore options," he wrote.

The sheriff also praised his department's medical services staff for their "exceptional work every day in a very challenging environment."

Read Gore's letter in full here.