The San Diego County Board of Supervisors voted Tuesday to look into two separate ideas for providing inmates with medical services -- one using the county's health agency and another using private companies -- though the decision will ultimately be made by Sheriff Bill Gore, an advocate for privatization.
The board voted 4-1 to approve a motion by Supervisor Dianne Jacob to begin looking for possible vendors for the county's health care needs in its jails and other facilities. It also directed the Health & Human Services Agency (HHSA) to develop a proposal for in-house medical care, which Gore will review.
In doing so, the board declined to move forward with a proposal from County Supervisor Nathan Fletcher, which would have limited Gore's options to only proposals giving control to medical and behavioral health services provided by the county-led Health and Human Services Agency.
A spokesperson for Fletcher said the board's vote allows Gore to make an unchecked decision about the future of the county's jail medical services that could lead to worse healthcare overall and threaten county jobs.
Fletcher criticized the board's decision, saying they missed an opportunity to correct a private, for-profit prison system that has a "record of failure."
"The road is littered with these entities who come in, try to suck all the profit out of the system, provide terrible outcomes and leave the taxpayers holding the bag," Fletcher said.
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"By providing quality care that is integrated with the care they will get out upon release, we could have set these individuals up on a path of wellness and restoration and save money and help break the cycle of incarceration, homelessness, addiction, mental health, reincarceration."
Gore said looking toward cost-saving strategies though private companies could help alleviate the department's $90 million annual health care bill for inmates.
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.
Gore responded to Fletcher's criticism in a letter Monday, 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."
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."
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