Jail Faces Mental Health Unit Probe: Santa Clara County Facility May Need State License

Posted on Fri, Jun. 10, 2005
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Jail faces mental health unit probe

SANTA CLARA COUNTY FACILITY MAY NEED STATE LICENSE

By Pete Carey

Mercury News

The place where Santa Clara County's Main Jail cares for its most severely mentally ill prisoners has been operating without a state license for five years since the state said its cells were too small to provide safe emergency care.

Now, the state Department of Health Services is investigating whether the acute psychiatric care unit should be licensed in response to questions from the Mercury News. A spokeswoman for the department, which issues correctional treatment center licenses, said its investigations can take several weeks. If the state finds the jail needs a license, it could cost the county millions to renovate or move the unit.

The Public Interest Law Firm, a legal advocacy group that once sued the county over its lack of a license, says state oversight and licensing would assure that the inmates get the best care possible. The county's own jail health care consultant last year cited concerns about the lack of a license. But jail health officials aren't convinced.

``We don't see it as a problem,'' said Maryann Barry, associate director of Adult Custody Health Services. ``We know that we are providing the level of care that meets the criteria for licensure.''

Unit wins praise

The psychiatric care at the jail has been praised by consultants and some mental health advocates worry that a denial of a license would force an expensive move or even a shutdown of the unit -- a 43-bed section of the eighth floor that treats and stabilizes inmates who are a danger to themselves or others.

The problem illuminates a dim corner of custodial health care -- a licensing law for jails and prisons that was a top priority for legislators in 1988, then was put on hold for a decade while regulations were drawn up. Ever since, correctional institutions have struggled to meet them.

``It is a huge issue statewide that these physical plant regulations are so onerous,'' said Linda Deacon, deputy county counsel in Santa Clara County. ``The physical plant specifications look like those for community care facilities, not jail cells.''

Under California law, state and county jails that provide inpatient medical or psychiatric care are supposed to have a correctional treatment center license. Yet only one county jail in California -- Los Angeles -- has obtained one.

In 1999, the county asked the state to inspect the jail's medical facilities, which were built before state licensing regulations went into effect in 1998. But state inspectors said they could not license the psychiatric unit because its cells didn't meet the standards for space. The county has not sought a license since then.

Santa Clara County attorneys now say they don't believe they need a license because the jail's acute psychiatric care unit has a separate designation to hold mentally ill prisoners for short-term treatment and stabilization.

The county's jail consultant, HOK Advance Strategies, said last year the quality of care in the acute psychiatric unit was ``very high,'' but the firm also noted problems. Some cells were unused due to broken equipment, locks and toilets, and there was ``not enough support space for staff, other functions, to use them all even if all were in working order.'' Jail officials said Thursday that these problems have been quickly fixed.

Issue came up before

This is not the first time the county has faced the licensing issue.

In 1991, the jail was sued by the Public Interest Law Firm for not licensing its medical and psychiatric units. Although a judge ruled that the county should obtain a license, the case was dismissed because the state had no licensing regulations at the time.

Eight years later, the state determined that the acute psychiatric unit's cells were little over half the size required, lacked access to patients and did not have enough space to maneuver a stretcher. The inspectors found no problems with the jail's infirmary, which they noted could be licensed with or without a mental health component.

Before the state's 1999 inspection, a consultant estimated it would cost $4.6 million to renovate the jail's health care facilities to meet state standards -- even more if a new psychiatric facility had to be built.

The state says it wasn't aware that Santa Clara County's jail had an inpatient psychiatric unit.

``We did an on site inspection in June 1999 at Santa Clara County Jail,'' said Brenda Klutz, the department's deputy director of licensing and certification. ``We provided them with information -- if they decided to become a licensed correctional treatment center, here's the issues they need to resolve. If they choose not to, but are providing the type of care that requires inpatient services, they need to find other ways of providing the health care.''

Klutz acknowledged that the definition of inpatient care ``is a real gray area.'' She said her agency has never received a complaint about the jail.

Conflicting views

Deacon said there's a ``very strong argument'' that the unit doesn't need a license because it has been designated as a Lanterman-Petris-Short Act facility by the county mental health department and the board of supervisors. That authorizes the jail to provide short-term, emergency psychiatric treatment. The average length of stay in the unit is six to eight days. The county also rents empty beds to neighboring counties for about $1,200 a day.

``Our position is that the county should license their mental health facility and their health facility, that DHS oversight would be extremely helpful in monitoring the quality of the services,'' said Kyra Kazantzis, director of the Public Interest Law Firm.

This year, the county will spend about $25 million on jail medical and psychiatric care.

``We try to have a high level of inpatient care regardless of whether we have a license or not,'' Supervisor Jim Beall said. ``It's not like we haven't provided high quality care there.''

Although enhancements to care come with state licensing -- state supervision, standards and staff levels -- many corrections officials view the requirements as unrealistic. A license usually requires adding staff and meeting physical requirements that can cost millions of dollars.

``It is not to be undertaken lightly,'' agreed Lt. Stephen Smith, operations officer for the Los Angeles County Jail's medical services bureau. ``You better count the cost.''
Contact Pete Carey at pcarey [at] mercurynews.com or (408) 920-5419.