you you you you you you you you Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Recording in progress. Good morning, everyone. Thank you for your patience. I'd like to call this meeting to order. This is Alameda County Board of Supervisors Public Protection Committee meeting for Thursday March 27. Can we please start with a roll call? Supervisor Miley? Supervisor Marquez. Present. Thank you. And if the clerk could please provide the instructions to the public to participate in person or remotely when speak at the public comment. For in-person participation, the meeting site is open to the public. If you'd like to speak on an item, you can fill out a speaker's card on the front of the room and hand it to the clerk or remote participation. Follow the teleconferencing guidelines at www.acgov.org and use the Raise Your Hand function at the appropriate time. Thank you, Tisa. Again, good morning and welcome everyone. I'd like to thank you for joining us today. I want to begin by expressing my appreciation for the Alameda County Sheriff's Office and for this measures consultants who are here today to provide a critical presentation about the quality of health care services provided at San Arita jail. For context, this is the first time this committee has been formally provided third party audit findings and I want to underscore its importance as we work to promote transparency and positive outcomes within our county's public safety services and systems. I also want to thank our local community members and advocates for their engagement and dedication to this effort. Your participation matters and reminds us of our shared values around dignity, accountability, and making tangible improvements in care for justice involved individuals. As Chair of the Public Protection Committee, I remain deeply committed to fostering dialogue about the status of services and outcomes occurring at Santa Rita Jail. This includes ensuring all stakeholders, public and private are held to the highest standards of care. Thank you again to Sheriff Sanchez and her staff for their collaboration throughout this entire process. Partnership is essential to advancing effective oversight work, including taking further action around the findings from our third party quality assurance consultants. With that said, I would like to welcome today's presenters. This is an informational item update on medical consulting and quality assurance Alameda County Sheriff's Office with respect to Santa Rita Jail. Our presenters today are Lieutenant Joseph Atheanza, Elimite County Sheriff's Office, Faith, support Santos, and Dr. Eric Lee. And I believe Lieutenant Joseph Atheant is going to kick us off. Welcome. And we do have a PowerPoint presentation. It should be uploaded on the website. And I believe there are copies in the back of the room. But if we could get started and let's just make sure if someone can please give me a thumbs up that's participating remotely, let's make sure that the audio and visuals are coming in clearly. Thank you so much. Welcome. Good morning, Supervisor Marquez and Supervisor Miley. Happy to be here presenting on behalf of the Alameda County Sheriff's Office and to promote our practices at Santa Rita Jail to increase transparency and public trust. I am Lieutenant Joseph Atienza. I am the Santa Rita Jail Contracts Lieutenant and part of my duties is to oversee the Wallpath contract and ensure contract compliance. And we can go to the next slide. So just to go over our agenda today, on some of the key areas that we're gonna overview, we're gonna go over our health care services contract. Some of our contract provisions just to overview what is required of Wallpath within the contract. Our quality assurance practices and then I'm going to introduce our MazeR's team who does third party oversight for our contract and quality assurance. We're also going to go into some contacts our quality of care and how that operates as well as our purpose in consulting our medical quality assurance. We're also going to go over our quality metric and findings and some of how our reports work. And then we're also going to go over our next steps and expectations, call to action and what we should be doing moving forward in the future to ensure we provide the best quality of care at Santa Rita Jail. Go to the next slide, please. OK, so just to go over some history of health care inside of Sanerity Jail, we are required by Title 15 to provide adequate medical care to our incarcerated population. And for that, we entered into contract with WALPATH, which was approved on 10-1 of 2022, and that expires 9-30 of 20-27. And WALPATH provides a comprehensive healthcare services to the entire jail. So they do everything from passing out pills to our car shed population all the way to advance medical care for people that have extensive medical history and they coordinate all that. ACSO doesn't have any part in providing the medical care to the incarcerated population. We rely on our contracted partner of Walpat to do that. And just to highlight, ACSO is dedicated to providing the best possible patient care for incarcerated population. And we are responsible for overseeing the quality medical services provided at San Juan de Gilles by our contracted medical provider well path. Okay, so these are highlighting some of the contract provisions that are outlined in our well path contract and we put these provisions in here to ensure that we are providing adequate high quality medical care within Santa Rita jail. So just to quickly review some of these, they have agreed and signed into contract to cooperate with any county oversight to comply with any third-party neutral companies to address the quality of care inside of the facility and they also have to answer to any advisory boards or county established boards when it comes to medical quality assurance or the quality of medical care inside of the facilities. We also we haven't established county quality board that overseas are third- reports as well. So we have multi-layered approach to ensuring the quality of the gel is adequate. We go to the next. Okay, so to go over our quality of care contract, we wanted to contract with Maysars on 7-1 of 2020 and what maize ours does is they prepare prepare month of reports after reviewing well-pass practices and the quality of care that it's provided at Santa Rita Jail they will present those monthly reports and we will get into further what those reports are with our team here but they will send those recommendations to ACSO and we will get into further what those reports are with our team here, but they will send those recommendations to ACSO and we will also meet quarterly with a multidisciplinary team consisting of ACSO, well-path, Alameda County Health to review their practices and to give recommendations to ACSO on moving forward or any corrective action plans. And in 2024, we actually expanded our Maysars contract to incorporate additional reports, corrective actions, and a staffing analysis because we identified the need and the importance of assessing the quality of care inside of San Juan de Gilles, so we expanded that contract to address all those things. I'm going to now call up our Mays Arts partners to give them their introductions and to go over the reporting practices within the facility. Welcome. Thank you. Thank you, Lieutenant Asanza. Good morning, everyone. Can you hear me? Perfect. Thanks for having us. My name is Faith Sopper Santos. I'm a master's prepared registered nurse with over 15 years of experience in health care, including leading teams to improve quality of care. I'm also certified in rehabilitation and correctional health care through the National Commission on correctional health care, the NCCHC accrediting body. I'm here with my colleague, Dr. Lee, who is a health care executive, correctional health care and informatics expert. Dr. Lee has over 10 years of experience in clinical care and health care systems improvements focused on integrating technology to improve patient safety and operational efficiency. We are a part of the Forbist Mazar's health care consulting group. Our team is decades of experience from working with health care organizations, correctional facilities like Santa Rita Jail, and state regulatory agencies. We're here because of our quality experience, of course, and because quality matters. In correctional health care, that means making sure care is safe, ethical, and effective for a vulnerable population. The ACSO recognized that improvements were needed to ensure the community standards of care are met at San Rita Jail and for our accountability. And so that's why we're here to help support for accountability. And so that's why we're here to help support that mission. The ACSO saw the health care delivery needed to improve. I'm so sorry, could you please advance to the next slide? Apologies, thank you. The ACSO saw the health care delivery needed to improve because of, because poor care can have serious consequences. Where care doesn't meet the standards, it can harm patients. So here are some examples of what can happen if quality care isn't given. Delays or lack of care can mean missing important diagnoses and treatments. Poor mental health care can increase the risk of suicide. Not controlling infections properly and spread diseases. Next slide please. And so it's crucial to maintain high standards and healthcare to keep incarcerated individuals safe and healthy. Here are some more examples of what can happen when quality of care doesn't meet the standards, where poor management of chronic diseases can make health issues worse. of teamwork can create dangerous gaps in care as well. And not having enough staff can delay treatment leading to serious or deadly outcomes. Slow emergency response can prevent patients from getting help in time. And poor communication among healthcare teams and custody teams can cause delays that may result in lasting harm. And so this is why the ACSO is committed to making quality care a top priority. By working together, we can ensure safe and consistent care to protect everyone's health and well-being. Next slide, please. Having a third party group like Forvis Mizaris to check quality is important because it keeps things honest and clear. Our job as an outside partner helps the ACSO build trust and get expert advice without being influenced by any of the inside pressures. We look at what's working well and what needs fixing, without being a part of the system, so our reviews are fair and unbiased. This helps make sure that the medical care meets community standards. Again, by working together, we're creating a culture of safety, of responsibility, and continuous improvement. This partnership helps us not just meet the standards, but keep improving. Next slide, please. And so for Vizmazars is supporting this quality framework through a variety of services, including our on-site observations of how well-path provides medical care in real time and giving actionable recommendations. Also auditing medical charts every month to identify problems and issue corrective actions to fix them. Also helping make medical processes more efficient and better coordinated. Helping the different multidisciplinary teams work together, both healthcare and custody, especially with those complex patients. Supporting efforts to keep improving quality of care and promoting the use of a single electronic health record, like Epic, to share important healthcare information and make care more consistent. And so by focusing on these areas, we help improve patient care delivery. Next slide, please. So to make lasting improvements in healthcare, it's important to understand first how QA, or quality assurance, and CQI, continuous quality improvement work together. QA on the one hand is like setting the standard. What it does is it makes sure that healthcare services follows the rules and meets quality standards through regular checks and reviews. It shows us what's working well and where we need to do better. And then on the other hand, CQI takes a step further by using what we learn from QA to make changes that improve care and outcomes. So it's not just about meeting the basics. It's about constantly getting better. The key is that QA and CQI, they go hand in hand. You can't have one without the other if you want lasting improvements and better patient care altogether. So I explain all of this. It's important because this is what our team puts into practice. Every month we conduct two types of audits. QA medical record audits of the 15 most complex patient cases to spot problem areas. And then we take that information, what we learn from those QA audits and conduct the CQI audits. And about 30 or more patients. And what we do there is we dig deeper, find the root causes, and then make recommendations so that changes will last. And then as you see, and we'll talk about it more, if the QA and CQI audits keep showing the same problems that put patients at risk, then a corrective action is issued. This corrective action holds well path accountable to fix the issues and helps ensure that improvements stick and are monitored over time. So next what we'll do is we'll look at how we carry out these three steps of QA, CQI, and corrective actions in more detail. Next slide, please, thank you. So for quality assurance, QA, every month, we do the QA audits of 15 of the highest risk and most complex patients as I've mentioned. We randomly choose these patients from groups that are more likely to need extra care, like those dealing with, like as you can see on the slide, suicide risk, chronic health issues, emergency transfers, care coordination, grievances, women's health, and medication assisted treatment for substance use. The goal is to make sure these patients are getting the right care from the right providers at the right time, especially in areas where the risk is higher. After that, we take what we learn from quality assurance and we move it to the continuous quality improvement audits. Next slide please. This is where QA hands off to CQI. And so for the CQI audits, we review, as I had mentioned, an additional 30 or more patient records each month to dig deeper, find the root causes of the problems, and make recommendations for changes that will stick. What you're looking at here is the method that we use. It's a trusted method called the Plan Do Study Act or PDSA model. And what this does is it tests and confirms well-paths process changes in their own internal quality audits that NCCHC accreditation requires. And so the PDSA model, it follows four steps. Plan a change, try it out, study the results, and then make adjustments if needed. What this approach does is that it helps ensure changes are effective and lasting. So again, this reinforces that QA and CQI, they work together to keep improving quality care. Next slide, please. Thank you. In the reports that are now available to the public, you can see that when QA and CQI audits keep finding the same problems that put patients at risk without that sustained improvement, we issue a corrective action to well-path. This makes sure that the steps that are taken fix the problems, right? And as I'd mentioned before, because the ACSO and Alameda County Health are committed to quality, together we've issued two corrective actions to well-AT that they are currently working on. One for QA and one for CQI and so we'll go over these in the next few slides. Now before we do that I'm so sorry. Before we do that I did want to show that this slide shows the corrective action world map for how the process works. So first what happens is we identify the problems right and then And then issue a corrective action. Well, Path has 30 days to respond with a plan to make changes and that's also called the corrective action plan or a cat. We then check to see if the changes were made and if they're working. If not, the issue may be escalated for further action. What this process does is it helps make sure that the improvements are made, tracked, and maintained over time. So what this means is that the cap requires well-path to not only figure out the root cause of the problem, make changes to fix it, but put those changes into action and then show that the process is improved. Thank you. What this slide shows is a quick overview of the QA Corrective Action. And so here, there's the three focus areas. The first being access to care. And this is making sure any medical problems and alerts are correctly identified. Next is initial health assessments or IHAs, and that they're completed within a 14-day time frame. Third is the non-emergency healthcare requests and services, and this is ensuring that patients are seen within 24 hours after making a sick call request. I will acknowledge while WALPATH has been making some improvements on these corrective actions, there is still more work that needs to be done. Next slide please. This slide gives a quick overview of the CQI correct action. And here there are four focus areas. The first being receiving screening, making sure that all individuals coming into Santa Rita Jail are checked right away to find and treat any urgent medical problems. Next is medically supervised withdrawal and treatment. This is where safely managing patients who are intoxicated are going through withdrawal. Third, chronic care, providing ongoing care for patients with long-term illnesses and serious health conditions, making sure they get the right support from different healthcare teams. And similarly, but more detailed than the QA cap, keeping up with standards by completing IHAs not only on time, but that they are complete and consistent. So while we have seen some progress and improvements from well path for both the QA and the CQI corrective action efforts, it's clear there's still more work to do and to reach and maintain full compliance in all of these areas. But what needs to happen is we need to continually work together to close the gaps and reach full compliance. I do hope that this high level overview of QA, CQI and corrective actions has given you a better understanding of the work that's being done to support the commitment from the multidisciplinary teams to ensure quality of care at Santa Rita Jail, at the Santa Rita Jail population. Now, Dr. Lee, what he'll do is he'll share an overview of the recommendations we've made over the years and next steps. Thank you. Thank you. Welcome, Dr. Lee? Morning, supervisors. Can you? Everyone's everything's good? Okay, you guys can hear me okay. So I'm Dr. Eric Lee. Thank you again for having me here this morning. So let's talk about this slide. There's a lot going on in this slide. And the key takeaways I want you to understand what this is that for change improvement, quality to happen, there's usually three components necessary. It's people process and technology. People's about 80% of that equation. People can be resistant to change. There may be change management issues, the training, that's the toughest part to overcome because people buying human nature tend to be difficult or resistant to change. They're used to doing things the way they want to do it. But you have to understand for things to get better, things have to change. Process is about 15% of this equation. When you train people, they have to then understand how to do the new process. They have to fully understand it and bake it into their new routine and habit of what they're going to do. If the process is harder, it's going to be harder to sustain that change, and you're going to be going and fighting an uphill battle. You got to remember to do these five things. Did you make a checklist? How am I supposed to do that when I'm supposed to do these other 20 things? The last thing is technology. That's about 5% of it. People tend to think that technology has a much bigger role to play, but configuring the technology is fairly easy. It's human beings that are the variable and all this. You have to account for all the different variations, all the different flavors, all the different varieties of why, and that's what makes us unique as human beings, as to why we're different and how we present differently. So when you take into account all of these processes, requirements, items that are listed on this slide, how are you going to remember every time I need to make an improvement? How am I going to decrease cognitive burden or cognitive load so that some of these things are automated? It should be intuitive. It should be usable. And as I'm going to talk about in the subsequent slides, you're going to see that it's not. It's not as intuitive as it should be. Let's go to the next slide. So let's talk about expectations here, right? This caring for patients in a correctional environment is extremely challenging. You think that taking care of patients, even in a civilian setting, you go to any hospital healthcare system out here in the community, there's communication that needs to take place between physicians at different specialties, providers, nursing, therapists, right? They tend to be more of a clinical staff. Now you're adding custody to this. They're not clinically trained. They don't have degrees in patient care. You're adding the behavioral health or the mental health component to this. And as we know, as we all know, our incarcerated patients have a higher behavioral health need. It makes it more complicated, it makes it more complex, and how you're going to reach out and interact and communicate with them. And what needs to be pointed out in this is that you have all of these different swim lanes or silos. And is the communication happening intuitively amongst all of these different parties? Or is it fragmented? And are they fighting an uphill battle? How many times are you going to remember to pick up the phone and call someone? Are you always going to text someone? Are you always going to do this? So how can you make sure the information exchange is seamless so that the information is right there when you need it at the right time? So I just want to point out that this is, again, there's an increased set of challenges here, but it's not insurmountable. It can be improved upon. There are ways to deal with this. Let's go to the next slide. So before I go into this next slide, I just wanted to disclose, right? There's no financial relationships with Epic. There's no, these are, these slides are created by independent experts. We're not, you know, we have no relationship with Epic. Let's go to the next slide. So there's a lot on this slide, but what I want to point out here is I want you to imagine yourself in a world where you no longer have access to email. You're back to writing letters by snail mail. You're back to facts. Are you going to be as efficient in what you need to do on a daily basis? Are you going to be able to order things off the internet if you don't have e-mail? Are you going to be able to get those confirmations? Another example. If you had to build something and you had two tools in your toolbox. You had a screwdriver and a hammer. And yet you had 50 screws you had to deal with. In this day and age folks have powered screwdrivers, right? You can actually go through it and be more efficient in what you need to do to get things done or to get things built. What I want to point out here is that there's a lot of manual work that's still being done. So let's turn it on to a clinical variation here, right? So every time there's a new patient that arrives at Santerita jail, if you want to verify something like vaccines, what's their vaccine history? Nurse actually has to log into a portal to get that. It's not available in the current electronic health record system because it's not connected to the California immunization registry. So how many extra steps do I need to do to find out what vaccines this patient's received? Did they receive the flu vaccine? Did they receive the COVID vaccine? Right? So there's extra work that has to be done. When really, if I have this patient identified in an electronic health record system, it should take about 15 to 20 seconds for me to pull that information in and see it immediately of what vaccines this patient has received. The same goes for medications, right? This is a more important topic. They're on five prescription medications. They went to Walgreens, CVS, RIDAID, WalMart, Costco, the matter. They're all electronically connected. They all send electronic messages, but the current electronic health record system is not capable of displaying these medications that the patients received or filled in the past. So what work has to be done? You have to ask the patient if they're willing to correspond, what pharmacy did you get your medications at? Okay, let me call the pharmacy. Let me talk to the tech. Let me talk to the pharmacist. Okay, what are the medications? And how long does that conversation going to take? In reality, right? In this day and age, how long should that take? Again, if I have the chart open, I have the patient in front of me, it should take me about 15 seconds to see those medications of what they're currently taking and what they took in the past and what their allergies may be. So I want you to appreciate this is an uphill battle that our clinicians have to face every day. So no matter how much you try to do that, you need to understand what medications are taking. You need to understand what vaccines they've had. You don't know, you don't know, all of these sorts of things, it takes time. And in an eight hour shift or a 12 hour shift, how much time then do you have left to do the other things that need to be done to improve care? Or how can we decrease that burden, automate things, get the information in front of them readily accessible, so they can move on and do those other things that need to be done. So I just wanted to highlight, that's just tip of the iceberg, right? There's other things on here, and I could talk for hours about some of these other things. But let's go on to the next slide. Oh, before I move on, sorry. So you see the words call the action on the top of this slide, right? I'm hoping that the examples I've pointed out just highlights that. Like we, as Faith had talked about, we see quality issues, we see people process improvements, and it's been a journey, but we've seen significant improvement in those areas. What we have not seen is an improvement in the technology. I would estimate there's probably 15 to 20 years of technical debt, technological debt, as we face right now. So I want you to think back 20 years ago of what the landscape environment was like, what you were dealing with. How would you renew your motor vehicle registration with the DMV? And the improvements of how it is today, they tell you what the wait time is. They tell you you can do a lot of it online and renew yourself. Not have to go to the DMV, pull a ticket, wait three hours to get something done, right? So I want you to think back 10, 15, 20 years ago, what it was like then, and that's the healthcare environment of what they're dealing with from a technological perspective today. Let's go to the next slide. So moving forward together, right? So, you know, I think these hands stacked on top of each other is synonymous with all of the different teams that we've seen in the past five years of this contract. There was always the intent to do the right thing, but if the communication was not being communicated across the teams and they were happening in silos, sometimes they're redundant, sometimes they're, they're happening across three different teams and they're all counterproductive because they're not communicating with each other. What we've seen in the past five years is an increased collaboration across the different teams. And it's really wonderful to see, yet some of these components are still separated and would be addressed by having an electronic health record that could communicate across the various systems and the various teams that need this information readily to be able to make a difference. So let's go to the next slide. I believe that brings us to the end. Thank you. Thank you, Dr. Lee. I believe that completes the presentation. Now going to open questions from the committee. I have a few questions and I'll defer to my colleague, supervisor, Miley, and then we will open up for public comment. So the first question I have is, and I'm not sure if the lieutenant or consultants are going to be able to answer this question, so it could be collective response, but I wanted to know what is the current well-path staffing level and is it deemed adequate and appropriate? So we have a staffing matrix which is mutually agreed upon in our contract. And we audit that staffing level daily. So we have a team that actually goes through Wulpat's data on who's working in those positions and we actually audit it daily. And if there is a vacancy, we will assess a staff reimbursement and seek that from Walpat. Additionally, if the seat is vacant for an extended period of time, we will collect a penalty from Walpat. So it is in their best interest to staff the contract appropriately. Also additionally, we contracted with May's ours in 2024 to do a staffing analysis, not only to make sure that they have enough staff, but to ensure that they are utilizing the staff appropriately in the positions that they need to be, and we should have that report shortly, and we will make that available to the public. Thank you and what are the penalties for noncompliance with their contract? So if a shift is left vacant, we will assess 150% of that hourly wage and again on top of that we will assess a thousand dollar penalty per position per day to ensure that that seat does not stay vacant for an extended period amount of time. We will send the staffing reimbursements to WELPATH. It kind of varies, but it's normally on a quarterly basis, and we will actually collect the money from them. So it is in their best interest in the contract language for them to staff the jail appropriately. Do we know how many fees have been how much the value of the fines collected do we have that number? Yes so in 2024 the contracts unit has recovered $2.1 million from Wal-Path and staffing reimbursements and penalties. And that's just for 2024. Just 2024. Okay. Do we have figures for the previous years? I do not have those in front of me. Okay, we could get those at a later date though. Yes. Thank you. And then I'm going to ask you are the sheriff. I'm not sure who would be best equipped to answer this question. But can you describe the next steps involved with the RFP process for medical services at Senator Edgel. So, our contract's not up with the RFP process for medical services at Centereda Joe. So our contract's not up with the well path until September of 2027. Because it is a rather large contract, we do have to consider when we start having discussions related to when we open up. Because when we do open up the contract, we wanna make sure that we are making it available to anybody who could provide services in the jail. I know that we have had some I think requirements for only a California-based medical provider that can put in for this contract in the past, but we're going to build out the RFP in a different way this year. So we're really going to look at some of the things that we're looking for because I think that most people don't know yet. We're doing things differently in Santa Rita Jail. So we're incorporating a lot of services and reentry services in the jail that we haven't had before in the past. So the services that are being provided by medical as well as our mental health partners is more robust and we have some higher expectations. So we want to make sure that we capture all of that. In the next RFP, there are options to extend the current contract. But because we have so much that we are asking, it's only fair to make sure that we incorporate that into our next contract. So there are discussions as far as when we start that process, and even though we have a contract that ends in 2027, I think that we have to start thinking about that now, but I can't tell you a date in this to when that would happen. And can you just explain to the public the collaboration that needs to occur with GSA or General Services Agency? Oh yeah, absolutely. So all we do is we allow for our staff and incorporating our quality medical assurance provider to be a part of that process, to show what we're looking for, but GSA ultimately is responsible for pushing that information out, building that RFP with us and collaboration and partnership with us. But as you know, the Sheriff's Office are not medical experts. So we're going to rely on our medical expert team, which would include ACH and MASRs to help build that RFP out. Thank you. I have just a couple more follow-up questions. This one's for our consultants with MASRs, as well as a lieutenant. Based on your assessment, what in your opinion are the care and overseeing it and doing a quality assurance audit for the past five years. And I do want to point out that there's been a tremendous amount of progress made in the past five years. So even though we want to always focus on the negative, and it's important to focus on the negative, because without looking at the negative, you're not going to improve, or you're not going to know what you need to improve. But the process is of how you actually look at the care and measure it, and in the past five years, standing up a QA and a CQI process and issuing a corrective action plan and then diving into it and continuing to measure the performance is not something that was previously happening. And it really does not happen as widespread as it should in correctional systems across the country. That's, okay, that's a huge issue, okay, and that's a different issue for a different day. But what has happened in San Areida, jail, there's been a tremendous amount of progress that Elimita County should be proud of and the sheriff's office should be proud of because of this culture and it goes from the top down. So I wanna start with that. But when it goes back to corrective action and reevaluation, you can't reach perfection overnight. It's a journey, right? And so there, I will say there has been a substantial amount of progress. Yet, what is hampering, I think, sustained improvement is the technological debt that they face. Again, as I alluded to earlier, how many times do I have to remember the training that I got two weeks ago was we have the technology today that if I download an app from the App Store and I open it up, I'm not waiting for a tip sheet or a training guide. Who looks at that stuff? I'm just logging in and I'm going through and I'm like, oh, here's the drop down and navigating my way. my way. Most of us can do that. Now, some of us are going to need help. And the training needs to happen. But there has to be more usability and intuitiveness into the technology that's being used to decrease how many things I have to remember. And right now, I think to me, that is one the largest barriers that that's happening right now. Thank you for raising and flagging that and just to let the public know that our former elementary health director did flag this for us in January. She emphasized and we've known about this the importance of epic so I definitely want to share the public that This is being looked into and I know we're going a lot of things to do with the public and I know that we have a lot of things to do with the public and I know that we have a lot of things to do with the public and I know that we have a lot of things to do with the public and I know that we have a lot of things to do with the public and I know that we have a lot of things to do with the public and I know that we have a lot of implement that. I do have a couple more questions, but I'm going to pause and ask my colleague if he would like to chime in and then I'll just wrap up my questions and then we will open up to public comment. Sure, I'll just start where you left off. So the issues around epic and electronic records are health care services agency or out mean health care, I mean health, they're actually moving forward with purchasing that system. It'll be part of the jail. That's why I think there needs to be a joint meeting of public protection in the health committee so that that issue can be fairly flushed out. We recognize the need for epic. I mean, we don't have to be convinced of that. That needs to take place for quality care. Out of the jail, I've had conversations with the sheriff about this on numerous occasions. Furthermore, over the last couple of years, I've been meeting with the sheriff in the National Union of Healthcare Workers who work with Wallpath and provide the medical services in the jail around the quality of services that are being provided to those incarcerated at the jail. I have not been pleased. In fact, I've wanted to have the county move ahead, and I'm going to say this, move ahead and see if a well-path was in breach of contract, but we haven't been given the type of assurance to take that action. So, but I'm very pleased that this issue is here at this committee. We're sitting right on it. The public's concerned about it because in the past, when this contract was we explored whether or not Alameda health systems you know H.S. should be providing the medical care out of the jail as opposed to a private provider. Alameda health systems and I've talked to some of you about this at the time a number years ago when this contract was led, they were not prepared to move forward with having to take on this obligation. In conversations I've had with them over the last year or so, they are more interested in a better place to entertain that. I've asked County Council to let us know whether or not we even need to go to an RFP. If we can have this obligation taken on by the Allemity Health Systems, as opposed to a private provider, if we have to go to RFP, we want to make sure that the document is open enough so that they can apply as well. I mean health systems and we have a public provider potentially providing the service as opposed to a private provider. It's quite frankly I can say, I'm not mentioning my words. I've not been pleased. I've met with a well-pathed but it's been a few years since they've even met with me. The other thing I think is important to recognize is that the sheriff, she's made remarkable improvements with her team. We've met with the National Union Healthcare workers. We meet with him probably every three to four months just on well path and what's going on there. We have to be careful around what they're doing as a union with what they're contracting with well path and our relationship with well path.ELPATH. But the point of the matter is the fact that this is here is really fantastic. I think I've asked my staff to talk with Supervisor Marquez's staff about holding a joint meeting on this because it's more than just the jail. We need to have Alameda be here, health here. We need to have Alameda County. here which healthier, we need to have out of me to county. Health here, which is all direct reports to the Board of Supervisors, so we can flush this out to determine the directory we want to go. And then the final thing I want to say, as I think it's extremely important that if we are going to go to RFP, two years is not a long time, sure, it's funny, that we need to have the sheriff come back and give us with GSA a timeline on what needs to happen and when. Because I don't want to see an extension. I really don't. So that's everything I got to say. I don't have any questions because I'm very thoroughly briefed on this. Can I say a few words to before we go to public comment? So I just want to make sure that you know we're we're not, you know, bashing our well-path partner. I do want to say that we've been meeting and I think it's clear that there are different expectations from the last two years that may have been before. And I think it is only right to give people an opportunity to correct or improve after set expectations have been made very clear. And so there has been conversations with the NUHW and then follow up conversations with our well path managers team. So they've been receptive and they have responded. And so I want to give you some credit for doing that, right? There is an opportunity for improvement and I think that we're seeing some response now through our CQA and CQI reports and the work that's being done by Maysars. So I just want to make sure that it's clear that we are holding WellPath accountable and we're doing it in a that's responsible. And it's really, you know, it's on the well-path team to come through. And one thing I also want to point out too, is we meet with NUHW because as was pointed out earlier, leadership means the world. And your team will follow you based off of how you show them that you value them and you care about the work that they do. One thing that we've heard today is technology will give your staff the ability to focus more on the quality of care as opposed to the manual labor that's involved with doing the work itself. Because that's the administrative stuff. The same thing that I bring to the table when we're talking about bringing tools to our staff and keeping them actually out in the field and doing good work and not behind a desk, filling out reports. So it's really about the leadership and coming through as a leadership team and making sure that we're building a work environment that is kind of where we're all working together, right? And it's not just separated between silos and mental health and medical and custody. It's really us doing the job together. So I think they have an understanding of what the expectations are now. We'll see, you know, how they perform. And I think it's, they have the capacity to do so. And, you know, it is what it is. I think that sometimes healthy competition is the driving force, but I just wanted to make sure that I shared that. Thank you, Sheriff. Appreciate your comments. Just have one more question for the folks with Maysars. Wanted to know if you're also evaluating-paths work and other counties and if so what is their performance record and how does it compare with the care provided at Senator Rita Jail. At this time no there's There's, forbiz mazaars is not evaluating work in other counties. Thank you. We're now going to move on to public comment. Let me ask our clerk. How many speakers do we have in person as well as remote? No remote? Okay. Let's go ahead and hold public. the okay. Okay, let's go ahead and hold public comment two minutes each if you could please call up two to three people at a time so they could get in the queue. Mickey Duck's very Lonnie Hancock by Britain. Hi, I'm not going into my minutes. I'm not going into my minutes. I'm handing our report to the board. My name is Mickey Ducksbury and I'm the chair of the stop desk and harm group, which is an out offshoot of the interfaith coalition for justice in our jails. We are very appreciative supervisor Marquez and your staff for the support of this meeting to discuss well-path, which is owned by a global and best-versed firm and has consistently shown inadequate performance in our county jail. The recent bankruptcy has stayed over 1,500 lawsuits pending across the country. We have serious concerns about the quality of health care and the jail at a cost of $252 million over five years. As KTVU reported on Tuesday and this morning on air, the evaluations by the Mays Arts Group shows a failure rate far below industry standards. We interviewed heads of detention health care and marine Santa Clara and contra costa, all of whom provide their own health care and their jails. Contra Costa work closely with their sheriff to redesign medical and mental health services and only deputies that are trained to work with the mental yield or placed in that module. Marin County considered outside vendors to reduce costs, but the analysis concluded that no significant savings would be achieved and the quality of service would decline. So, in a Claire County provided their own health services forever and they've said that they have excellent support from their board and full collaboration with the sheriff. Even though these counties have different demographics, if they can manage to provide health care in their jails, so can Alameda County. It will take immense political will and leadership, and we hope it can count on both of you to bring a full motion to the board. I want to end by lifting up Marie Smonk's main, because it was after seeing the video cam of his horrific death that we began to look into WELPATH, and their pattern of inadequate care across the country, WELPATH's allegiances to their shareholders. I know Alameda County can do better than this. Thank you. I understand someone going to be a person who is not going to be a person who is not going to be a person who is not going to be a person who is not going to be a person who is not going to be a person who is not going to be a person who is not going to be a person who is not going to be a person who is not going to be a person who is not going to be a person who is not going to be a person who is not going to As these reports we're looking through we're Ensured in 2024 so when were these corrective actions taken we would like to know those things We are requesting that the border supervisors Really looking to discuss in these inadequacies revealed by the maize earth's group reports and take Decision of actions state of New York and the state of New York and the state of New York and the state of New York and the state of New York and the state of New York and the state of recommendations. In several other Bay Area counties, Marin, Contra Costa, Santa Clara and San Francisco, the county provides medical services in their respective gels. These counties can do it so can Alameda County. It will take leadership and most importantly, political will for us to really explore this as a path, as a real solution. Again, people are dying in Alameda County jail as a result of well-pass inequities. I also want to land on this last talking point. I want to uplift Maurice Monks' death as well. Again, that video really showed that the culture and well path and the Sheriff's Department has towards the people in the care of their, the people in their custody and the care. That video showed well path nurse throwing pills on the floor as this man laid their lifeless. We've seen that over days. We really need well-path health accountable. These deaths is a someone's hands and where I'm blaming it on well-path. Thank you so much. Thank you. Good morning. My name is Lonnie Hancock. I've worked with some of the wonderful research and advocacy groups that are here today. I want to thank both you supervisors for the questions you asked, the comments. I think we know we got a problem. We have an underperforming health care contractor. Turns out the largest in the country, currently filing for bankruptcy protection in Texas, which is known for sympathy to corporate bankruptcies, because there's over a thousand lawsuits that have been brought against it for low performance. And the cost in human tragedy and financial settlements has... that have been brought against it for low performance. And the cost in human tragedy and financial settlements has been quite large here at Alameda County. Now the good news is there are options. As mentioned, three other counties directly provide healthcare to the jail. And talking with those leaders in those counties, they say that it has led to better coordination and sort of desilowing of services. There's also, three or four other four-profit contractors. And there's even a couple of nonprofit contractors that say they plow the savings back into the system. There are consultants that specifically work with counties to make sure they ask the right questions, have the right accountability and data points to ensure good practice. So thank you for your leadership. I think the full board, the sheriff, and the county administrator need to collaborate, and we could have some go to the conference. I'm going to go to the conference. I'm going to go to the conference. to continue doing monitoring here. And I appreciate very much the transparency and the forms that Sheriff Sanchez has moved forward on. But I want to point out for the sake of the board that you're putting yourself in jeopardy, putting the taxpayers of Alameda County in jeopardy if you don't take action on this. You have the reports for five years now they've been in material violation of their contract. We heard from the lieutenant that they've paid what 1.2 million in penalties for staffing. I don't know if that's in the term of the contract or just the last year. 1.2 million, that's great, but what about the people who have died during that time in the custody of the jail? If you take a look at the contract, which I was able to get through a public records act request with Wellpath, the Exhibit A1, which lists specific requirements of the contracts and penalties. I want to point out that it says chronic failure to comply with the aforementioned error requirements may result in a recommendation by the sheriff to the Board of Supervisors to find the contractor and material breach of contract. They've been in a material breach of the contract since the beginning. There really has been no improvement. The last two months of the May's ours, audits that we analyze show 100% failure. Collar, you're on the line. You have two minutes. Thank you. Color you're on the line. You have two minutes. Thank you. Reverend Laurie Manning, pastor at Skyline United Church of Christ in Oakland. Members of the Public Protection Committee. I appreciate the thoughtfulness of today's session. progress made in Cenerita Jail and for the advocacy, for the need for Alameda County wide health systems integrated electronic medical records. I speak today not just as a faith leader but as a voice for those who cannot speak for themselves. Thinking about grace lately, the kind that catches us when we fall, the kind that sees us that are worst and loves us anyway, the kind that heals. I've also been thinking about grace and its absence. When I read about Hector Hernandez and Maurice Monk and so many others that case of Hector Hernandez who died alone in a cell in center Rita Jail from pneumonia. An infection that outside those walls would have meant antibiotics, fluids, rest, recovery. Inside, I'd be profan and indifference. His father told reporters, I used to pray to God, please take care of my son inside the jail. I hope that he never needs medical attention because he's going to meet you. My God. What a heartbreaking prayer, what a devastating prophecy, Alameda County jail has been one of the highest rates of in-custody death in our state. And well-path, the company we're paying $49 million a year annually to provide health care has been sued over 1500 times nationwide. It's strange we live in one of the welcomes regions in America, home to world-class hospitals and medical innovation, but we can't seem to provide the basic care for those in our county jail. Collar, you're on the line. You have two minutes, Allison. Hello, Allison Monroe here from FASME, families advocating for the seriously mentally ill. I support the exploration of alternatives to well path, because my work with some of the activists here today looking at stories of people who died in the jail in the last several years. Many of these people are seriously mentally ill. Convinces me that we might we have to do better when taking care of people's serious mental illness in the jail. And that care seems to be available from other sources. Having is great that that we might start using Epic in the jail and have a unified software system for medical records in the county, but Epic is just software. Anybody can use it. And using Epic will not solve the kind of problems that we saw in the deaths of our family members in the jail. So we need to consider alternatives and it's correct to do so. Thank you. Collar, you're on the line. You have two minutes, Willem. Thank you, supervisors and Sherith for allowing me to speak today. My name is Willem Fahindicam. I'm living in Elamida and I'm a member of the Interfaith Coalition for Justice in our Jails. And it represented even that coalition of the first congregational church in Berkeley. As a person of faith, I believe in the need to treat other people with respect and dignity. And this is not happening at the Center Rita Jail, that's shown by the Mazas report and sadly enough by the many deaths in the recent years. So I therefore urge you after also also what we heard today to not renew the contract with WELPATH and to explore alternative and better healthcare services at the jail. And please, old as well well-fed as a future healthcare service accountable to the full extent for what they are doing. Thank you. Reverend B. K. Woodson, Rabbi Berkowitz, and Darrell Ray. Welcome. Thank you Reverend Reverend Brian K. Woodson, senior passing there. Christian connection. We're really excited. I'm grateful for the work that Sheriff Sanchez is doing. I'd like the progress that's being made. But we are here. We have jobs. We have work. But we have taken time out of our jobs and our work to be here because this is so important. We know that there are hundreds who know what we know who would be here if they could. And thousands more who would be here if they knew what we know. It's very, very simple. Well, path has not performed and must be replaced. Just that simple. It's not difficult. Well, path has proven incapable of doing what they said they could do. And with all due respect to Dr. Lee and the presentation from Mazar, all the improvements that they say are underway or should be underway, these are things that Well, Path they could do when they got the contract. So the county, I agree with Supervisor Miley, the county should do this work. Alameda Health Systems should provide this. It's crazy that $2.1 million in one year in fines. These are the things that were caught. And that metric of staffing doesn't even take in the principal work of the care of the community citizens that are in Santerita jail. That's the metric, not just with somebody at their desk. So people are dying. This is important. It's very simple. If we were, if well path was selling us balloons and the balloons had holes in it, how many balloons were we going to buy? If they're selling us parachutes and the parachutes are killing people, why are we going to keep buying parachutes from these people? Our members are dying. Our community members need you to act and fire well-pair. I'm Rabbi Allen Mercoitz. My message will be concise. I'm a great fan of not fighting one's way through an open door. The county sponsored audit is tragically clear in documenting well-pass failures. And when well-pass fails, we know that people die and people suffer in the extreme. The decision, it's very, and it's also very rare that life gives you as supervisors managing a county A complex issue that I think has a really simple way forward The decision The if question about well-path should be the simplest decision that you as supervisors confront. Of course, what to do after that is where the complexity lies. And so I encourage you to not fight your way through an open door. Well path has shown us exactly who they are. They've shown it here and they've shown it across the country. And you have the opportunity to make a really simple decision, which will of course then necessitate really hard work, but that hard work will result in lives being saved and human suffering being spared. Thank you. Good morning. My name isl Ray. I'm a member of Star King, UU Church in Hayward, and also one of the leaders of the Peace and Justice Action team, which is our social justice group within our church. I've been following this issue for a number of years, and frankly, I'm following some very eloquent speakers, so I'm not sure I can do it justice, but I just wanna say that I'm not a big fan of outsourcing, I don't think it works to the benefit, especially in this case, which is life and death decisions being made essentially by a outsourced for profit company. And obviously it has problems. And I think it's pretty clear that the county should take over the health care in the jail. There's been too many deaths. There's been improvements, I think our sheriff has been doing a good job of making things more transparent. And part of that transparency is showing that we still have a problem with with well paths. So thank you very much for listening to me today. Okay. Collar, you're on the line. You have two minutes, Meg. Yes. much for listening to me today. Collar, you're on the line. You have two minutes, Meg. Yes, good morning supervisors and in the public. This is Meg Bowerman from Interfaith Coalition for Justice and Jails and in the faith in action East Bay and St. Colomba. The previous speakers have been indeed eloquent and echo what I want to say. I will keep it brief. I'm a former nurse. It pains me. It pains me to see what has happened in our jails. If this had happened at my former institutions, UCSF, Children's Hospital, it would have ramifications and changes would have been made. So please do the humane thing. Well-path needs to go. I didn't hear any deadlines today, perhaps you mentioned them, but this needs to happen for him to lay there for three days. And in the autopsy, he had bed sores. My brother never in his life had bed sores. I called up there multiple times trying to get the medication into his body and they kept giving me a run around. They gave me an email knowing no one was going to go to spam. The day that they gave me a fax number, I called his public defender and said, can you fax this over? I don't have a fax machine. One hour later, someone knocked on my door and told me my brother was deceased. That same day, they gave me the fax number. I'm sorry I want to get that out there, but they need to go. It's been people dying after my brother. It's been people dying before my brother. It's a lot. Everybody has loved ones. They love their family regardless. If they have mental issues, regardless if they're just strong minded, it's wrong for you to treat a person that has mental issues a different type of way. They said that he did not have medical. I go to the doctor with my brother. He had a full physical before all it has happened. It was no reason for my brother to die. Later for three days. I think he looked like there more. And they let that man just later and die. Please get them people out of here. Caller, you're on the line. You have two minutes. Allegrae. Hi, good afternoon. Ladies and gentlemen, my name is Eladrian Hillman, political organizer with the National Union of Healthcare Workers. Just calling on behalf of our workers to clarify a couple of statements that was made when it comes to Maysars. There was some information given that said that our members in the medical facility, our medical unit, actually call over to get the medical records from the county for any potential patients that are brought into the facility. That's actually not true. There's actually a process of the faxing requests. There are no phone calls made. So and I don't know how long it's been since any of you have actually sent a physical fax, but this is a requirement of our members to fax information over to Highland to out of base any of the county facilities to get the information pertaining to the patient's medical records. So this at some points can take up to a week or two in order for our members to get that information. And in the meantime, the patient is going without their medication. Also wanted to express our gratitude to supervisor Miley, supervisor Marquez, and Sheriff Sanchez for being willing to sit down with us quarterly to listen to our members. It takes taking a lot for them to actually trust the process and the system because of the the amount of backlash that they get from well path for speaking up and being advocates for the patients within the system. So I want to actually thank you all for being able to sit down and actually see what's going on and hear what our members are going through and actually do something about it so that we have the members of our community get the services that they need and that they actually deserve. Thank you. Elizabeth Soley, Richard Speegel King, you, you. And in our faith, we believe in the inherent worth and dignity of every person. And we try to keep love at the center of all we do. The yellow shirt people side with love. So my sense is that you're all well aware of the problem and that you are committed to fixing it. So I'm just gonna pray for your wisdom and that you side with love in your decisions. Thank you. Good morning, I'm Richard Spiegelman. I live in Oakland. I chair the Unifaeth Coalition for Justice and I want to express my appreciation for this hearing today. Alameda County has had a high rate of fatalities over the last 14-15 years that we've been keeping track. We think about a third of them we're due to suicides. Clearly could have been intervened or prevented with appropriate oversight. But one of the issues about looking at Wallpath is that there aren't many data available. There are stories, some of them in the newspaper, and the Mays' reports are the exception. They do provide data. They demonstrate rank failure to meet industry benchmarks or satisfactory compliance. Some of my colleagues in the stop deaths and harm group circulated a little more. Some of the reports earlier today I hope everybody has had a chance to look at them. But when you see these failure rates that are I mean't know if you can see that. I don't know if you can see that. I don't know if you can see that. I don't know if you can see that. I don't know if you can see that. I don't know if problems, a CNN investigation of Wal-Path highlighted the deaths and near-death experiences of inmates from around the country. Wal-Path has had several years to improve its performance as evidenced by the Mezzars reports they have not. And their declaration of bankruptcy raises a new concern in this county. Will they cut corners to meet their financial needs? Will they not send people out for emergency services or follow up care in hospitals or from doctors offices? These things will put many inmates in the county at risk. Thanks. Peace and blessings to all. My name is Takawa Bonner and I'm the housing advocate for all of us a nun which is a project of legal services for persons with children. Today I respectfully He asked this board to review the inadequacies that have been revealed in the Mazaar Groups report and then make a definite and reduce a definite result that would whole well path accountable. Thank you. Color, you're on the line. You have two minutes. Good morning. My name is Ben Oglevy. I live in Castro Valley. And I too am a member of Star King Unitarian Universalist Church. My UU faith calls me to speak out on behalf of the most vulnerable members of our community. And incarcerated people are among our most vulnerable partly because their care is entirely in our hands. They are at our mercy. And also because many of them have health challenges, including mental health or substance abuse issues. As many speakers have said today, well paths performance has been abysmal. They failed consistently on most performance indicators. This is a systemic problem for them as evidenced by all the lawsuits against them. They are trying to dodge accountability for their inadequate performance by hiding behind bankruptcy proceedings. Clearly, this is not a company with integrity. It's not a company that cares about the people they are supposed to be caring for, our people. They are failing our people. We as a community are failing our people. The presentation today talked a lot about quality standards and quality processes, and yet, well-paths performance continues to be abysmal. There are contract penalties if they fail to provide specified staffing levels. What about contract penalties for failing key indicators for consistently poor performance? Well-path is not doing the job. Our people deserve better. Thank you. Collar, you're on the line. You have two minutes, Janice. I thank you for allowing all of us to speak today. Supervisor Miley, Supervisor Marquez and the sheriff. I just want to elaborate off of what a laterian human was saying. The reports that we get from. you guys, we don't see them often. So this is our, a lot of us, I have many of our first times actually seeing this May's ours report. That's one of the ways that Will Pass has actually filled us. Also too, it's gonna take a lot more change than just those Mazar's reports. We need to have people administrative in there that is actually going to have open ideas. Healthcare is a ever-changing field. And we can't have individuals in there that just have one particular mindset. If you are going to work in healthcare, you have to have an open mind. There's many diseases, many mental illnesses, things that are coming across this jail that we cannot handle. We need better technology. We need better ideas. We need people that are open to those ideas as well. I registered nurse there working for well-past. So I know exactly how this actually works. I also want to speak to the medical records. Epic is going to be a great system for us. So that's just a little bit of encouragement for you guys. we need it. When it comes down to getting medical records from the intake point, if we're able to access all of that information, like Ms. Dr. Lee was saying in Epic, that will cut down on all of the delays, the medical records. If this patient was seen at Highland, we could see that. If this patient has medical mental issues, we can see that in the system. If they have medications that they need, we will see that in the system. Elizabeth Katz, Robert Bowden, Susan Sigell. Hi, I'm Elizabeth Katz. I live in Oakland and I volunteer at Stop Deaths and Harm and with ICJJ. I'm here to Talk about the upside. Okay After 30 years of public health work mostly with the state of California. I've rarely seen such a pivotal moment, an opportunity to make things better for a population, to Alameda County, to improve the health, not just of the vulnerable people that pass through arrest and jail, even for brief time. And by the way, there's 25,000 plus of them every year. There's a lot of people, and it's an incredible opportunity to improve the health of communicable disease, mental health, everything. So this is a special moment when we have an opportunity With the leadership is in place, the budget is in place, the timing is in place. We have this chance to make a change for the county. I exhort you to recognize this opportunity may not last forever. Things change. Do it now. So when a person is arrested and a lot of people that hasn't had medical care for years, they haven't been tested for HIV. They could spread HIV. They haven't got their flu shot. They might have tuberculosis. They haven't an immediate need for mental health care. If they have an opportunity to be lifted up at that moment, this will benefit the entire population of Allen Eccleany. and even reducing a deck ship, producing alcoholism, getting those treatments has an incredible positive result for the community. Thank you so much. Thank you. Good morning. My name is Robert Bowton. I am the end custody coordinator for all of us in the U.S. which is a project of legal services for prisons with children. I'm here this morning to ask you to consider alternatives to health care services and the reader. Why? Because there's a lot of people in Alabama that have mental health issues. A lot of people are dealing with opiate addictions. And these people find themselves offered their center of the county jail. They deserve to be monitored frequently. They deserve the opportunity to heal. Without this, it's going to be death. That's as simple as that and it's to continue to be deaf. And this is the result of having well, have monitored them. So I'm actually going to make a change today. Thank you. Susan Sago, Gene Moses, Terry Owen. My name is Susan Siegel. I'm a retired nurse. As a nurse, my responsibility was to be an advocate for my patients. The detainees at Santa Rita include those accused of minor crimes, of serious sometimes violent crimes, and a far too high percentage whose only crime is mental illness. But what they all have in common is that they are human, where once somebody is child, and when they are ill, they are patients. My former employer, UCSF Benioff Children's Hospital in Oakland, staffs at clinic at juvenile hall. Adult prisoners deserve that same caliber of care. They need cardiologists, endocrinologists, mental health professionals. They do not need a for-profit corporation like WELPATH. Specializing in prisoner care is if that were a diagnosis in itself. They do not need WELPATH with its long history going back to when it was correct gear solutions of providing inadequate staffing and underqualified staff, resulting in numerous lawsuits and federal investigations. In these times, we can no longer count on the federal government for any oversight because they've made it clear they don't care. It's up to us on the local level to do what's right. In Alameda County we already took a huge step in voting A her out of office. Now we need to take the next step. I urge the board not to renew its contract with well-pap and to seek a provider dedicated to giving care. Thank you. Good morning. I am Jean Moses, a member of the Humanity Community Church and of the Interfaith Coalition for justice in our jails. Thank you very much to supervisors, Marquez and Miley, and to share some chez and your staff for being here today to have this discussion which is definitely overdue. We fired our last for-profit health care provider six or eight years ago and replaced them with well-path with the expectation that the quality of health care would be improved. As the largest provider of in custody health care services in this country, well path should be more than capable of doing its own quality assurance and continuous quality improvement. With all due respect, I really don't think that they should need Dr. Lee as their apologist. The monk family sued well-path as well as Alameda County when Maurice died at Santerita jail. Alameda County has settled this lawsuit but well-path has held them at bay continuously and avoided it so that they could go into bankruptcy and the Maurice Monk's family has joined over a thousand other lawsuits, which will probably never be settled or we will be settled for some tiny amount because well path has transferred their assets to another subsidiary so they don't have to be accountable. This is not who we want to have our health care. Thank you for being open to replacing well-path. Doing so is complicated, and I especially appreciate that you're beginning to consider this early because it will take time to figure out whether we can take this process in-house. And so thank you for starting early in advance to the end of their contract. My name is Terry Owen. I've worked for many years at Stanford Cancer Center. I did tumor registry work and we had a cancer committee devoted, multi-disciplinary with physicians and staff devoted to quality improvement. So unlike some folks here maybe all of that presentation about quality improvement was made perfect sense to me, the studies and whatever. So my question is how many well-path generated quality improvement studies have been put in place annually in order to raise this abysmal score? My guess is that perhaps none, because we would, with quality is a full, providing quality is a full-time job, and people have to be devoted to it, and they have to care about it. So, if you put up a slide about how a quality goes from, you know, identify the problem and create the study, take the data and do this and that. That's all very well if you're doing it. Mesa apparently shows us that quality is a huge issue. And so the other thing, and of course, I'm also familiar with Epic. And I would assume, I would have assumed, since 2014 electronic medical records have been mandated for federal plans, Medicare and Medicaid, that there would be one in place. But I would wonder how that nurse visit on the video was documented in the medical record. Lev Moses, Terry Dunn, Yolanda Wayne. Hello and thank you supervisors and everyone who's here. It's worth repeating that according to California Department of Justice data, Alameda County, one of the richest, wealthiest locations on the planet, hosted jail that had one of the highest rates of in-custody deaths in the state of California. Since 2020, that means 25. And I'm curious about what that means for improvements. How many times does a company, organization, or individual have to show who they are, their intentions and priorities before they are taken seriously? How many more people will have to be harmed? How many more will have to deal with humiliation before or after death, before we can say that their intentions are not what we're needing as a community. For example, not having computer systems in place is not an accident. We don't accidentally not update our computer systems. I also fear people aren't receiving, as someone had already mentioned, their HIV meds, cancer meds, and hormones. People who receive poor care are more likely to commit more crimes. Mental health issues are pushed to the edge, to the edge, and have had impacts all of us in our community. So beyond jails, we're spending more money to take care of the people who were harmed the ones they get out. It really is as simple as the Reverend State, and well-path has to go. The question now at this time with so much, not just with this, is what is your legacy going to be? Who do you want to be remembered as and how are you going to show up for this community? And I guess that's it. I'll just stop here and trust because I believe in your intentions, I have faith in your in your intelligence that you're going to do the right thing. So thank you. Good morning. I'm Terry Dunn. I'm a member of the Interfaith Coalition for Justice Center Jail's and of Plymouth Jazz and Justice Church here in Oakland. I have a basic question. How bad is too bad? What is the baseline? At what point is well-pathed, simply just qualified if an RFP goes out from bidding and from being able to have an opportunity to game their way back into a contract. They shouldn't be able to come back with some low bid and come back in. It's wonderful that there's a commitment to improving, but when we talk about abstract terms like violations and contracts and penalties, What we're actually talking about is human suffering. We're talking about people dying. And it can be an improving trend, but that's still people dying and people suffering. And that's inhumane. And it's our job as people to care for each other in the best way possible. Can any for profit organization put the public first? The shareholders are first. So I appreciate the sheriff talking about starting the process soon. Let's make sure that we include the public health option. Our county is more than capable of providing high quality care. This shouldn't just be an RFP process, it should be a process that includes county health. So please study all the options for our true needs. Thank you. Thank you for having this hearing. I think there's no reason to even consider a well-path. They're in bankruptcy because as they represent, there are 1,500 med-mail cases pending against them in the United States, including multiple wrongful death cases. And therefore, they're seeking protection from the bankruptcy court. To allow someone who has that many med mal cases to come back in to deliver medical care would be ludicrous. The other thing that you need to know is I don't know who drafted the contract that that exists between well path and the county. But in 2023, I had an expert, a professor from UC San Francisco, an expert in healthcare financing who evaluated the contract. And her opinion was that the contract incentivized well path deny healthcare. And that medical, that expert report has been floating out there. I'm sure the county council has it, the contract attorney that you hired has it, and I'm sure that nobody here has ever seen it. So if you have a contract that disincentivizes providing healthcare, and I don't know who drafted it, why would you have that company back? There are many alternative ways of doing it. All you have to do is look at a sample medical record that San Francisco Public Health takes in of an inmate and compare it to the medical records of inmates in Alameda County and it tells you how much time wealth path does not spend and how much care San Francisco gives, which is why their death rate is much, much lower. I don't have the time to give you all the details, but I'm happy to discuss the details in depth of what is wrong and what wealth path is not done. Thank you. Mirana Schwartz, Renee Castle, John Lindsay Poland. Good morning. I'm Mirna Schwartz. I'm a member of the Kihila Community Synagogue and a member of the Interfaith Coalition for Justice in our Jails. I came here today really to support my colleagues who've done such tremendous work in bringing this issue forward and to thank you supervisors for holding this important hearing. But I moved by what I've heard today just to make a few points. First of all, I was shocked to hear the $2.1 million number assigned to the fines for staffing shortages and violations. And I would urge you supervisors to get some more information about that. Follow-up on what those shortages were, or who was affected over what time period. Health care is about people ultimately. I believe that electronic records are important, but health care delivery depends on people, and it depends on the culture that those people bring to the environment. So listening to this, I was thankful for hearing the name of more, the memory of Maurice Monk raised by so many who spoke and by his sister and it reminded me of having been asked two years ago to talk about the deaths in the jail and the situation with Maurice Monk in particular to my synagogue. And I was sitting here remembering how solemn occasion that was and the collective grieving that went into that and the disbelief in the kind of culture that could have licensed what happened. Well, path is responsible for its share of the sick culture that allowed for that. They have never been held responsible. They're trying to evade responsibility enough is enough. Hello, my name is Rene Castle. I'm with the Star King Church. Will Path is a full service provider. It is for them as professionals being paid very well to identify and use the appropriate technology and tools. Will Path does not get to consistently fail to meet the terms of their contract and then blame that failure on a lack of appropriate technology or anything else. There is no excuse. I saw beautiful slides about the corrective process and how that process did lead to improvement. What we're missing were any slides describing any kind of results or metrics. There was not a single graph or any metric over time or anything compared to performance in other places. It seems to me that there was no clear assessment precisely because the performance of well path has consistently been so abysmal. I strongly urge the board of supervisors to look for alternatives and not renew the well path contract. We can do better. John Lindsay Pullen, American Friend Service Committee. Thank you both for holding this hearing and for your comments and questions. The Missouri's people said that there have been improvements and this is true. But in the Missouri's reports that had been posted, one of those improvements is on suicide watch, which went from 41% to 50%. So Reverend B. K's observation about the failure rate of parachutes is extremely relevant here, 50% noncompliance. In other areas, things got worse in the Mazar's reports. Alerts after intake went from 35% compliance to 15% compliance. Order execution went from 50% compliance to 34% compliance. There are many other categories in which compliance went down. So I think that also that you heard that the Sheriff's Office is monitoring every day the staff levels, but you did not hear what the staff levels are nor what the expected levels are under the contract. So yes, I agree the decision to replace well path is easy. And in fact, I would ask that you ask the county council about whether they are in breach of contract as you suggested earlier, which could actually open up the possibility for an earlier replacement of well path, because I worry about what will happen in the next two and a half years under well paths watch. There are, I also would suggest that any replacement, any new contractor, whether it is, Alameda Health Systems or an outside contractor, that there needs to be a contract oversight, you need to hire and train staff that do contract oversight, that does not appear to be the case currently, and there needs to be a timeline for decision. Honestly, there needs to be more than a timeline, there needs to be a commitment to explore who will replace well path, and that commitment needs to be transparent and open to the public. Thank you. There are no additional speakers on this item. Thank you, everyone. Appreciate your patience and engagement on this important topic. I wanna thank our presenters for providing a comprehensive and timely update. Today's conversation is not just about a contract, it's about the lives and well-being of the people entrusted to our care in Alameda County. Mayzers, their party findings underscore the need for systemic change. We have an obligation to act. This means ensuring meaningful space to work together, even when there are hard questions so that Alameda County System of Care truly reflects our values. I'm committed to that process that requires all stakeholders moving forward together with diligence, compassion, and urgency. So on that note, I've heard a lot of themes today. One thing I know that we've already been discussing and would like to see if my colleague supervisor Miley is the Chair of the Health Committee, myself being the Chair of Public Protection, I want to make a motion to recommend that we bring forward a board letter. I know you talked about a joint health committee meeting, so kind of wanted to get your ideas whether or not you felt need to be a joint health committee because we've already already been discussing the need for Epic for some time trying to expedite this process so that it could be aligned with our budget discussions for fiscal year 26 but potentially advancing a joint letter to explore how to get that funded and online as soon as possible. That is one motion that I like to make and have other comments, but wanted to get your feedback on that. Yeah, I think having a joint meeting of both committees would be helpful because there's overlap between public protection and health care. And I'd like to get all the issues in our committees so we can deal with it all because this is informational today. So we really can't take any action and I've other comments to make but I'm gonna hold it at that. That's why I think a joint meeting ASAP would be the appropriate thing so we can deal with all this comprehensively. Do you feel that we could find a date within four to five weeks? Sure. Okay. Oh yeah. Okay, so that's one commitment within that joint meeting on a separate issue. I also want to make sure that we're conducting a three month review on the corrective action. I want to provide an update to the public in terms of what has been going on. We also have the state of the Jail's address that we typically do in November. I feel that it's too far out to wait until November to get an update. So I want to get a status report on specifically what is occurring with the corrective actions. We'll also have a chance to provide questions in advance that we asked about staffing. The staffing analysis should be done within that time period as well. So I want to present those items back to this body and also look at next steps by then we should have more concrete information with respect to many of the questions that were raised today with respect to the timeline of an RFP or potentially alternative options before we get to that point. So just want to make sure that we have another follow-up conversation to flag these issues. So does that timeline work for the Sheriff's Department coming back within three to four months so that's one request the other request is a joint health and public protection meeting specifically to discuss the need for epic within four to five weeks. Well I was hoping you do with all. We have the reports ready though though, the staffing analysis. Within four to five weeks. Yes. Okay, so if we could couple everything and bring all those topics back in a joint health committee and public protection committee meeting, that would be my preference if that works for everybody else. Yes. Okay. So I will make a formal motion. Move that. Yeah, second. Okay. Let's do a roll call just so it's documented. Supervisor Marley? Yes. Supervisor Mark Hans. I. Thank you. And I know that the surprise and Marley has some comments as well. Yes. First I want to thank all the speakers for coming and speaking today. You know, just so you know, I'm as impatient as you are because I've been here for a while. I've seen a lot of this unfold over the years and that's why I've been meeting with the union, meeting with the Sheriff's Department on these matters for quite a while. So the fact that this was held today, I was very, very delighted because I felt we needed to provide some transparency around this because I've actually been trying to push and raise the issue of whether or not there's been a material breach, whether or not we could hold them in breach of contract. And I don't want to say more than I can say publicly, but the point is if we go down that route, obviously we have to be able to back it up. Then if we go down that route, we've got to have a replacement. You know, we just can't throw them out and not have a replacement to provide the services. So as someone pointed out or a few point out, it's complicated. The issue is whether or not they've done a good job. I don't think that's complicated. I think that's, to me, it's clear as day and I'm very frustrated and impatient about that. But we need, and I'm glad to raise my kisses here and all this from all of you and others because we the board needs to decide how we're going to move forward on this. And that's why I think holding a joint meeting of the two committees, you'll have three supervisors, the supervisor, Lee and Tan here as well because I serve on both committees, this committee and health care, then we can take all this comprehensively and direct and make it an actual item and directly want to what we want to have occur. Because I'd like to know once again whether we need to even have to take this out the bed, whether we can just potentially pursue an option with the help of me to health systems or another provider. I think if we do another provider, we might have to go out to bed if it's nonprofit, for profit. But I'd like to know our options there. I don't know all the options. County Council doesn't know the options at the moment. So I need them to bring that to us. I need to understand more precisely the committee collectively. What would the timeline be? Because I've been here long enough to know. We can say two years and then we'll get an extension with all math. That's going to be another two years. And I know she's very impatient, more so than me, younger too. We can be talking about this five years from now. And before we have another provider in place, I've been here long enough to know that. So I want to understand what the timeframe is, what our options are based on an RFP, or if we don't do an RFP, if county council needs to talk to us in close session about a breach, they can have the three of us meeting close session with the sheriff to talk about that as well prior to the meeting or during the meeting, but we need to understand all that and have GSA talk to GSA about this as well. So they're in the loop so we can really get our hands around this. I have no, like I said, I've talked to well-path in the past, but it's been at least a year or more since I've talked with him. And it's not because I haven't been willing, it's just we haven't, and I've got staff thinking talks with him as well. But I haven't been pleased with him. And I do feel as someone who's spiritual like many of you. I mean, the measure for society is how we treat the least among us. And obviously they are considered the least among us, along with others, homeless, etc. So we need to provide them with really adequate care. And I've said that before when they're in jail. But we need to make sure that happens. Additionally, I think it's important that we Let me look supervisor, Kes, with the sense of urgency. And I think you want to do that. And that's why you set a month to six weeks or whatever. Yeah. And thank you for bringing up GSA because we need to include them in that meeting as well. Yes. County Council. You're all here. Yeah. So I just want to emphasize how invaluable community input has been because you're definitely driving the direction of this agenda. You know, we have our own thoughts concerns, but this has been very helpful to ensure that we're addressing as many concerns that were raised today at our next meeting. So that gives us some time to prepare for that agenda, Sunny, then I know my team will work in coordination with your team as well to ensure that we have ample time, date, and I know my team will work in coordination with your team as well to ensure that we have ample time, date, and announce to the public when that next meeting is. So as mentioned in the beginning, this is step one, but really appreciate everyone's commitment to working collectively to find a path forward to ensure that anyone in our care is treated humanely with respect and gets the quality care that they deserve. So thank you all for your input and engagement. I'm going to see if my colleague has closing remarks because we still have public comment. As I said just thank you for bringing this today. Thank you. So we're now going to move on to item number two. This is public comment. This is for items not on the agenda but under the purview of this body. So as I've mentioned before, if you start discussing things that have nothing to do with public protection, we will ask you to wrap up your comments quickly since this is only under the items that come to public protection. So, clerk, do we have anyone in person or online that would like to make a public comment? I have no speakers for public comment. Thank you very much. This meeting will be adjourned shortly. Our next meeting is on Thursday, April 24th. Thank you so much for your engagement and attention on this important topic. Thank you everyone. Have a good day. Thank you, everyone. Have a good day. Thank you. Recording stopped.