Thank you. Supervisor Miley. Supervisor Tam. Present. Supervisor Marquez. Present. Thank you. And if the clerk please provide the announcement with regard to how to participate remotely or in person. For in person participation, if you'd like to speak on an item, you can fill out a speaker's card at the front of the room and pass it to the clerk here and for remote participation. Follow the teleconferencing guidelines posted at www.acgov.org. And if you'd like to speak on an item remotely, please use the raise your hand function at the appropriate time. Thank you. I just want to make an announcement that we do have two items on the agenda today, their informational items. So we will take public comment on presentations one and two after those presentations have ended. And then after public comment, we're going to open up general public comment for items not listed on the agenda. Want to make sure that's correct from County Council wanted to flag that for me. Is that accurate? Yes. Okay. So, on Friday days, and this is really important that the public protection committee meeting as well as the health committee meeting have called this joint meeting. So I want to thank my colleagues for making themselves available on a Friday, and would like to start with some opening remarks. We have called this special joint meeting of the health and public protection committee because access to quality health care at Santa Rita jail is a fundamental responsibility and value for Alameda County. I want to thank Sheriff Sanchez for her commitment and partnership to ensure transparency, accountability and improving care for those in our custody. This includes protecting the integrity of this process, required to develop a future healthcare services contract. I also wanna thank her dedicated team within the Elimita County Sheriff's Office and the Forvis Mazers Consultants for their extensive preparation to support a comprehensive discussion about the state of healthcare services at Santa Rita Jail. This includes coordinating with Director Gasway from Alameda County's General Services Agency to include a presentation outlining the county's procurement process. Understanding how this process works is essential for effective oversight and future action. For context, the March 25th Public Protection Committee passed a motion to advance this critical conversation to a joint meeting with the Health Committee. I want to acknowledge Health Committee members Supervisor Tam and think her in advance for her participation. Today is the first time that the Forvis Masers third party audit findings will be formally presented in a joint committee marking another important step forward towards our shared goals to increase transparency and accountability in our public safety systems. To the community members and advocates who have continuously engaged our board, agency leadership and regional counterparts. We are here today to do more than listen. Our charge is to identify how we can make the necessary changes to address gaps in care, staffing, coordination, as well as opportunities to increase community collaboration. Your participation is essential to this process of improving medical care and promoting dignity for justice involved individuals. Like any other county service, I remain committed to holding ourselves and partners to the highest standards of care at Santa Rita Jail, especially given my role as a public protection chair. Thank you again to Sheriff Sanchez for her deep partnership as we continue to move towards this objective. Welcome again to all those who have joined us today in person and online. With that said, I would like to welcome our first presenter, Director of General Services Agency, Director Kimberly Gasway. And before I continue, can I do a quick audio and visual track to make sure that everyone participating remotely can hear me clearly? Do we have a thumbs up from those participating remotely? Can someone online use a raise your hand function? Okay, yes. We're good. Okay. Welcome, Director Gassoway. Thank you, supervisor. So I believe for the clerk, we do have a schedule that was one of the attachments on the agenda today and just some opening remarks. I'm here to present and generically help the procurement would work. It's not meant to be specific. Director Gasawave, can you speak into the micro-adjusted? It's highly unusual for us to present a procurement details in a public session before they're posted. So this is more to just give you information on how the process works. So currently the contract for medical services at the jail expires in September 2027. And so we are recommending at GSA that they begin the process of spec development now, because this is a complex set of services and there may be a number of things that they want to look at before they put together those specifications. So we did, myself said two months, it could take longer than that. So, but just generally speaking, the sheriff begins that process. Spectra development has several elements, which is in our Uniform Procurement Guide for any contract for services. The first is what is the intent and the objectives that they're trying to achieve with this procurement. So they'll write that out so that any better will understand clearly what is the purpose of this procurement and what is the problems or services that are needed that the Sheriff's Department is trying, Sheriff's Office is trying to solve. The next will be a background. They may give a history on the jail or their requirements as a Sheriff's Office to serve the population. How's that the jail from a medical perspective? And they may also include a description of their functions, you know, their role, health cares, role behavior. That's all for them to put together. Then they will also include bidders qualifications. This may be governed by any laws that there are subject to any authorities that have jurisdictions with policies and often funders also have certain requirements for minimum qualifications of services. So they'll need to vet that all of that information. Then they will outline specific requirements for providing the services. Those could be anything, the the types of services the days That those services are to be provided the number of staffing levels response times etc All that will need to be mapped out and then the deliverables including reporting requirements So it's a pretty extensive list of specs for this type of service that they'll need to put together. Putting that together departments for any complicated service, they do often look to outside consultants to help with that work. So if they do need to bring someone on, then it's going to take them longer in two months unless they have a company already under contract who could provide that service. So once they put all that together, they submit that to the General Services Agency and we package it in our standard templates that are in our uniform procurement manual and we have that all of that is reviewed by county councils what was our staff, there may be some questioning. We allocated right now for this complex of our procurement two months to understand GSA has counsel. Sheriff also has counsels, so making sure we're all aligned on how we're moving this forward. Then once the RFP is posted, there's a mandatory bidders conference that's posted online, so anyone who's interested in bidding on this procurement would attend that. And because it's at the jail, there will be a security clearance. So they don't always take about a month, but we have to get all the security clearance put through. Everybody's vetted before they can come on to site. And then during that conference, we describe the procurement and any other policies the board may have. And and then they also are able to ask questions. The intent is not to necessarily unless there are generic procurement questions to answer at that time. We take those questions. We write the responses and those are all posted. So all bidders have an opportunity to see the responses at the same time. Then after that we take a look at the bids come in. It's about a month that they have to submit those proposals. And then we look at a completeness to have they met all the minimum qualifications. Have they submitted their reference? We do do reference checks. And so all of that is about a couple weeks to go through all the packets. It depends on the number of responses we receive. Then we set up the county selection committee. There are uniform procurement manual does have guidelines that say who can and who cannot be on the selection committee. Things, let me look real quick. I had it open just so I can give you some high level understanding of that. So typically, it cannot be anyone who participated in the development of the RFP. So departments often do not like this, including GSA for carements, but the idea is you cannot influence who is selected. So you may have put it together, but you can't sit on it. Unless there are sometimes where we're able to dilute the committee enough that that person could not have influence. We also only allow one person from the user department to sit on the committee. So whoever's going to be responsible for this contract, they can whatever division within the sheriff's, they can only have one person. They can have someone else from the sheriff's office who is in a different unit who's not actively engaged in the service. We can have participants from other counties or other subject matter experts can sit on the panel as well, but no one can have a conflict of interest. There's a few other minor details, but that's the high level concept of the selection committee. Then we schedule meetings with the committee. They review all, they have to sign a conflict of interest form and confidentiality form. We do not give out the names of the selection committee in order to make sure that they are not in sort of like a jury panel, right? We don't want them to be able to be called or influenced by any of the bitters. And so we do keep that confidential for their sake and the integrity of the process. The selection committee then reviews all the proposals, then they meet to discuss it. There is a scoring that we will discuss with the sheriff depending on the objectives is the objective more around the qualifications and experience that may get more points versus price. Price does have to be reasonable in this type of a procurement but it is not generally in a qualifications proposal is typically not the deciding factor but there may be some points for that. So the selection committee will be briefed on all of that. They'll review. They will discuss the proposals. Then we invite the bidders. Sometimes in the procurement we say the top ranking bidders who are vetted. Sometimes we interview everyone. So that will also be decided as part of the process of developing this. They're brought in for interviews to the selection committee to present their proposals. Then there's a final review process. GSA facilitates the scoring and again, keeps everything confidential and packages that all together to present what to the Sheriff's Department, who is the highest ranked proposal. And then we discuss bringing that to the board for recommendation for award. The bidders are all notified of who we are recommending. There is a protest period that protest could be submitted to GSA. I'm completely not involved in the procurement because I also review protests. So I need to be very independent of that process. So if you say well they didn't do the process right or I was you know not giving enough points for whatever I need to be able to look at that to make sure my team followed all the rules the Sheriff's Department followed all the rules. So after that protest period they could if we deny their protest then they could appeal to the auditor's office and that could take some additional time. So while this says 14 months, it may, sometimes it takes longer. If I review the protest and I find that yes, there were problems with the way the procurement was run, I may tell GSA and the sheriff's department we have to start over. They don't like when I do that, but that has happened. It's pretty rare because we're trained, right? Supervisor. So anyway, but it could happen. Then we bring it to the board. We negotiate with the top-ranked bidder. All the other bidders are told their order of ranking and that negotiating are intent to award. We begin negotiations and if negotiations are successful, we bring it to the board for approval. Thank you, Director Gasway. I do have a few questions and I'll just read them for the record, but you were very thorough in your presentation that you answered most of them. So one of the questions I had was, when do you recommend the Sheriff's Office begin the specification development? You actually included that in your handout, and it says GSA recommends the Sheriff's Office begin scope specification development now to allow time for flexibility related to decision making. And then you elaborated on the process to develop a selection panel. So thank you for that. You also answered my question with respect to our non-county employees able to be part of the panel. You did say they are, but you also said subject matter expert. So can you kind of elaborate on who determines who gets to sit on the panel? So typically that's a good question we actually talked about that today and the sheriff's office said that's that's GSA so there are they put put forward who the panel is and we look at is this a person who works in this field or has experience in the field in some way to demonstrate that when they review the proposals they really can be a valuable asset. Often it's another county that we use. They're similar people who work in this field in incarcerated environments with medical services. We could. So there's a lot variables, but that's typically what we do. So someone with lived experience can also be considered? That if we could demonstrate that there is subject matter expert, then we could do that. Okay. And then another question I have is does Elimita County consult with other counties to inform their specification development? So it is typical on many of our procurements for us to speak to other counties review their procurement that they put out and the results of that. So that is not uncommon. Thank you. Those are all my questions. Do my colleagues have questions? Thank you. Chair Mark has I want it to just get a little bit of historical context on how we arrived at this medical services contract with our current vendor. So the prior process also took about 14 or 15 months. Is that your understanding? I'm not 100% sure it wasn't here at the time, but there was a procurement that was run in 2012. I believe it. I want to apologize, 2021. I'm sure the sheriff, this is Kathy Lee. I'm from the Office of the County Council. I'm sure the sheriff would be able to respond about the timelines. I believe there was a 2021 RFP and a contract awarded in 2022, although I don't have the dates at hand. Okay. And so it's only two months for spec development, sometimes depending on the complexity, that could take up to a year to take to happen. Was it a different vendor before or is it just thinks this the current vendor right there is a vendor well path. It's a collaboration. I understand that how many vendors responded to the RFP in you said 2021? I understand it was one. Just one? Okay. I just declared a clarification and I believe there are board materials on this. There may have been two responses but one may have been disqualified at the initial evaluation phase. Okay, so we've had this particular vendor since 2022, right? And prior to that we had a different vendor. No, well, Path has been our provider for a number of years? So they were the provider before we went out to bid in the 2021-2022. I can't remember if they were under CFMG or WELPATH, but they've been our provider for a number of years. What I'm trying to understand is this contract is for five years. Do we go out for an RP every five years and has this has well path been this vendor that responded to the RP every five years? So again I want to speak in general terms. So it is a five year contract. There is an option to extend either party, both parties would have to agree to that. So if you start now, whether or not, so we at GSA typically do advise departments when the five year term is coming up for them to begin their procurements. Okay, thank you. Surprisevisor Miley, but before you speak, just want to flag, we'll note all the questions and may take time to get responses for these questions, but we are noting your questions. So thank you for asking them. Supervisor Miley. Yeah, a few questions and comments as well. So thanks Kimberly for outlining that. And typically, or also, the board has no involvement in this process until it gets to the board of supervisors. Then once it gets to the board of supervisors, we have privy to practically everything. We might not have privy to the names of the people on the selection panel, but we'll know the categories of folks who served on that panel as well, right? That's correct. We make sure the board does not influence the procurement. If you ask us, we will give you information about the participant on the selection committee. Yeah, and we'll get information about the scoring, the value, and we can get into minutia. And then also, if it's protested, either for your Kathy, when it comes to the board, is that a Denovo, can new evidence be presented at that time? This is a services contract that is not awarded on the lowest responsive, responsible bidder basis and so your board has is ultimately going to award the contract and has discretion to award or not award. Great okay great and then Kimberly or Kathy under what circumstances would we not go out for an RFP I'm not talking about an extension are there any circumstances when we wouldn't do an RFP on this? I'm trending lightly, sir. So. It's supposed to sort taken in house. Would we do an RFP? I suppose behavioral health to get over. So the RFP process is to arrive at a contract. So a lot of the steps that Director Gasaway has outlined are required not only for the competitive process, but also for the ultimate award of the contract. When she describes scoping, that scope of services that's developed as part of the RFP will ultimately be included in the agreement to define the contractual relationship between the provider and the county. If the county is performing the services in house, there would not typically be a contract and there would not be an RFP process. Thank you. Those are my questions. Thank you and I know Dr. Gasway has another commitment so I will appreciate you being here and thank you so much for providing this detailed information and the staff. We have a lot of work to do. We have a lot of work to do. The staff director, guess way has another commitment. We appreciate you being here. Thank you so much for providing this detailed information and the attachment. We are now going to move on to public comment at to start with the sheriff's office? Okay, so I want to welcome Lieutenant Joseph Athianza with Elimita County Sheriff's Office. Welcome and thank you for being here two months in a row. All right. Good afternoon. Supervisor Miley, Supervisor Marquez, and Supervisor Tam. And also the public. Happy to be here presenting today on behalf of the Alameda County Sheriff's Office to promote transparency and public trust. I am Lieutenant Joseph Atiansa. I'm assigned as the contracts lieutenant at Centauri'm going to go over some of the the the the the ask other handouts for the public? Do we have copies? Yes, okay, great. Thank you. We're going to quickly go over some of the history of this contract, go over the RFP process that we went to in the timelines. Then I'm going gonna pass it over to our May's ours partners to go over the QA and quality, excuse me, continuous quality improvement overview. They're also gonna go through the progression of the QA and the CQI reports. And additionally, they're gonna go over the scores, which was a big ask from the last meeting to review the scores throughout the years that Will Path received. We're also going to review the corrective action plans that we've issued to the contract adventer and the current status of those corrective action plans to show the percentages and what has been corrected and what is not corrected. And then also I'm going to close out with some future considerations that I think is important for the board members and also the public to hear for when we do go out and look for the next RFP, some things that we need to be conscious about. And I'll go to the next slide, please. All right, so I'm going to briefly go over the history of the Comprehensive medical services contract and our medical quality insurance contract. I want to provide some context to some people that are not here or present for the first meeting that we had. So through California law, Title 15-B at Centered Agile are required and mandated to provide adequate medical care for our incarcerated population. So our well pathth Path contract was approved through an RFP process on 10-1 of 22, and that contract does expire 9-30 of 27. And Welfth Path at our facility, they provide a comprehensive healthcare services to the entire population. So that's anything from a sick call slip to where they have a cold or the flu all the way up to advance medical care, well path is responsible for providing those services to the incarcerated population. ACSO, we're also responsible for overseeing the quality of those medical services provided at S or J, which is why we wanted to contract with MaysRs, 7-1 of 2020 as a neutral third party to review the medical practices provided by WELPATH and to advise the Sheriff's Office on taking action if we need to do. And I'll go to the next slide please. Okay so monthly MazeR's reports are presented to ACSO and recommendations are presented. Quarterly reviews are presented by MazeR's to a multi-disciplinary team and what that means is we bring in a well-path ACSO Also our Alameda County Health Partners doctors physicians and clinicians from there will sit down collectively go over the findings and we will be advised by Maysars as well as Alameda County Health on Actions moving forward and recommendations So in 2024 2024, we expanded the Mays Arts contract to provide additional reports, corrective action, and an analysis to identify staffing gaps and issues of if there were further improvement needed. So we identified that there was a need to expand the contract because I found porn in this QA medical services to the incarcerated population was and so we did that in 2024. And I really want to emphasize that the Alameda Kennedy Sheriff's Office is dedicated to providing the best possible patient care for incarcerated population. And we can go to the next slide. Okay, I'd like to now introduce Faith from Mazar's, our contract with medical quality assurance provider. Faith is going to introduce herself and walk us through their process, as well as the historical data throughout the years on the reports that they compiled. Thank you and welcome Faith, Sarah, Sarah Passantos. I'm not sure if I'm pronouncing that correctly. Welcome, Faith. You almost had it, San Jose. Thank you so much. Can you hear me okay? Hello everyone, thank you. Lieutenant Asanza, for those of you who don't know me, my name is Faith San Jose. I am a master's prepared registered nurse and have special certifications in both rehab and correction health care. I'm certified by the National Commission on Correctional Health Care. That's the NCCHC, which sets the standard for how health care should be delivered in jails and prisons. I've worked in health care for over 15 years now, leading teams focused on patient care and quality improvement. Our health care quality team, including Dr. Lee, who cannot be here today, brings over 25 years of combined experience and California's managed care market, serving correctional facilities, state and federal regulators, hospitals, medical groups, and health plans. And as Lieutenant Natanzha mentioned, our team's help support medical consulting and quality assurance reviews at Santa Rita Jail, making sure that the care is provided is safe, effective, and meets professional standards, especially important in a setting where the patients are vulnerable and the environment can be high risk. So first, before we jump into Walpat's performance metrics, let's take a moment to go over the basics of how quality assurance and continuous quality improvement work together to help improve the quality of care by setting clear standards, checking regularly to see if things are working, and using data to make things better over time. And so this slide gives a quick recap of what we shared back in March about how QA, that's quality assurance, and CQI, continuous quality improvement work together. QA sets the rules and helps identify when something isn't being done right. CQI takes those issues and focuses on helping to fix the root problem in a lasting way, both use data to improve patient safety and quality of care. Now at Santa Rita Jail, we put this into action. We review 15 of the most complex patient charts each month through QA to identify high risk issues. Then we review 30 or more randomly selected patient charts as part of CQI to see how care is being delivered across the larger population. So in total, we review at least 45 patient charts every month. And if the same problems keep showing up in the Sheriff's Office, issues of formal corrective action, requiring well-path to submit a clear plan to fix the issue and demonstrate progress over time. Next slide, please. So now that we've gone over how QA and CQI work at Santa Rita Jail, let's take a moment to look back at how our role as a third-party team reviewing how the Jail's medical care has grown and changed over the past five years. So in 2020 and 2021, we started by just observing what was going on, and identifying big risk areas like how emergencies were handled, how patient complaints were tracked, and who are the patients for being properly monitored. That early work helped us design a better system tailored to the jail's needs. We created a scorecard to track how well the care being provided met required standards. By 2022, we officially started measuring performance in 29 specific areas, again for the 15 complex patients on a monthly basis. We grouped those into four main categories, so the first problems in alerts, specialty and ongoing care, chronic care, and patient monitoring. When we looked at the results, we saw that the performance was low, especially when it came to acting quickly on patient risks. So while 2022 gave us a solid starting point, it also highlighted the need for stronger follow-up and accountability. In 2023, that's when we added 30 CQI patient chart reviews each month to better assess care across the broader population. This foundation allowed us to provide more targeted feedback and better connect our reviews to patient safety. Next slide, please. In 2023, we started to see some early progress. Chronic care compliance even reached 79%. But that momentum didn't last. By mid-year, improvements stalled across the board. He issues like delays and intake, tracking grievances, and gaps in emergency documentation continued to hurt overall performance. That year, Wallpath only submitted one formal improvement plan, which did raise concerns about how seriously they were addressing our findings and where the real changes were happening. And so by the end of 2023, it was clear that voluntary fixes weren't enough. And so as a result, under Sheriff Sanchez's leadership, he made an important shift to hold well path to a higher standard. In 2024, we moved to formal corrective actions to raise accountability and drive real change. We narrowed our focus from 29 compliance indicators to the 10 most critical based on NCCHC standards. These included high risk areas like governance, patient care and emergency response, chronic care, and medical legal documentation, issues that had been underperforming for years, and the data backed this up. Governance compliance stayed at a low at 15%, patient care and emergency response at 48%, chronic care at 62%, and medical legal at 32%. For the first time, well-path was required to submit formal corrective action plans, also known as CAHPS, for which for each of these issues. For each CAHPS had to include a root cause analysis, a detailed timeline, and documentation to prove the changes were actually being made. This marked a shift from recommendations to clear enforceable standards backed by ongoing monitoring and follow-up. That shift left us, I'm sorry, that shift led us into 2025, where a focus now is on verifying real, sustained improvements at the front line of care and not just plans on paper. We'll show you what that looks like in the next few slides. Next slide please. And before we get into where problems still exist, it is absolutely important to recognize that Wallpath has made some real efforts to improve care, even though there's still some more work to do. On the left side of the slide, you'll see two positive steps taken in 2024. First, WALPATH updated their—updated how they screened for HIV and sexually transmitted infections. These updates now match national public health standards from the Centers for Disease Control of the CDC, and NCCHC, helping make sure patients are properly screened when they enter the facility. Second, in partnership with custody, behavioral health and the pharmacy teams, Walpatth introduced the medication Sublocate, which is a monthly injection used to treat opioid use disorder. This shift supports better patient stability, lowers the risk of misuse, and cuts down the need for daily dosing. Now looking to the right side of the slide, here's what the overall quality assurance data showed for early 2025. So governance, like tracking serious health problems or patient diagnoses, is only documented correctly 12% of the time. General patient care at 42% of the time, medical legal forms at 6% and chronic care like diabetes and high blood pressure performed at 83%. Now this matches what we've seen over the past few years where some areas improve, but the progress wasn't consistent. Performance goes up and down, and not all changes stick. The QA data showed preventable issues are still happening, and while some CQI studies showed early signs of improvement, those changes didn't always show up in daily patient care. That's why formal corrective action, along with real changes in everyday practice, continues to be essential. In the next section, we'll talk through trends, over time, what's working, where things have improved, and where we still need to focus. So next slide, please. I want us to note that these numbers just aren't data on a chart, right? They tell us where the system is doing okay, where it's still struggling, and where patients could be at risk if things don't improve. We'll start with QA, which is our basic checklist of whether care is being delivered the right way every day. This slide gives a snapshot of how things have been going since 2022. Remember QA informs CQI by reviewing 15 of the most complex patients each month. So even though we updated and narrowed our focus in 2024 to the 10 most important compliance indicators, we went back and lined up our older data so that we could do, you know, a fair comparison from year to year. That way we're looking at the same core categories over time. So governance and administration, patient care and treatment, special needs and services, and medical legal issues. What you'll see here is that the numbers are called grand averages, but this means as they combine all the monthly and quarterly results into one yearly average, and this will help smooth out the ups and downs and give a better overall picture. Our goal for each category is 90 to 95 percent compliance. This is the National Standard and Hospitals and Clinics and recommended by the NCCHC. So some key takeaways from the chart are for governance and administration, which includes flagging important health problems dropped from 37% in 2022 to just 12% in early 2025. This shows the issue isn't just about making plans, it's about following through. Second, patient care and treatment, like responding to sick calls, staying around the 40% range for about four years. That means efforts to fix didn't lead to lasting daily improvements. Special needs in chronic condition showed some improvement in early 2025, likely due to the targeted actions, but those gains hadn't been studied from month to month. And then legal medical issues, like making sure patients' patient rights forms are signed, dropped under 6%. It's a serious concern at that time and suggested that staff may not have had enough training or support in this area. Next, we'll shift from QA overview to the monthly CQI studies. Next slide, please. What these do is they take a deeper look at why, at the why behind the numbers so that we can figure out whether the changes have been made are really working. So remember CQI helps us dig deeper than QA to figure out what's working, what's not and why, and looks at 30 patients each month across the larger population. So this table shows how five important areas have performed from 2023 to early 2025. These areas were chosen because they directly impact patient care, like screening people at intake, managing withdrawal symptoms, and treating chronic illnesses. Just like QA, the goal here is 90 to 95 percent compliance. Any scores below that mean the process may not be working reliably and may need corrective action. So here's what we were seeing. Chronic care started at 74 percent in 2023 and hadn't improved in a consistent way. SEWA, for alcohol withdrawal and cows, for opioid withdrawal, both remain below 60 percent, showing ongoing safety concerns for patients going through withdrawal. Initial health assessments have shown some strong scores up to 93 percent. In receiving screening, it did hit 100 percent early on, which was great, and in 2024 it had dropped. Now it's since improved to 85 percent in early 2025, but still hasn't hit that sustained goal. So what all of this is telling us is that some progress has been made, but the improvements aren't sticking over time, which is a problem because if the changes don't become part of daily routine, it can directly affect patient care and safety. Now that we've looked at what QA and CQI data were telling us, the next part of the presentation will focus on what's being done to fix those issues. Next slide, please. Thank you. So we'll walk through the corrective actions, what they are, what they require, and how we're checking to make sure well-paths caps are actually being followed. So again, this is another recap that shows how we use the corrective action road map to fix serious issues, especially ones that affect patient safety or keep happening over time. It all starts with our monthly QA and CQI reviews that we talked about, where we look at records from at least a total of 45 patients every month to see where things are going wrong. If the same problems keep showing up, the sheriff's office issues a formal corrective action, a written notice that well-pathmas responded within 30 days, and the response must include a root cause analysis to figure out what's really causing the problem from their perspective, a resolution plan to include what they're going to do to fix it and proof of practice documentation to show they've started making those changes. And then after that, we review their plan, re-review patient records, and confirm whether those changes are actually happening, not just written down. The plan and findings are also shared with the Alameda County Health for more oversight. And so if the problem isn't fixed or if it comes back again we reassess or escalate the issue further. This roadmap helps make sure problem areas are taken seriously and improvements are actually happening. Next we'll show how this process was used to follow up on theA compliance indicators, and then we'll look at how it's being used for CQI as well. Next slide, please. Thank you. Again, another recap. This is the slide that just reviews the three QA corrective actions that were issued at the end of last year. The first is access to care. This means making sure serious medical, mental health, or dental problems are flagged in the system and followed up on in a timely way. The second is initial health assessments, where everyone coming into the facility should get a comprehensive health check within 14 days to catch any issues early. And third is non-emergency sick calls. Even if medical issues aren't an emergency, it still needs to be reviewed and responded to within 24 hours. Now again, these aren't just boxes to check we're looking for real world improvements like quicker responses to patients, better communication between staff, and complete documentation showing how care was delivered. As the data shows, well, PATH has started making changes, but there are still gaps. And none of these have consistently hit that 90 to 95% industry benchmark we're waiting for. Some of the challenges are due to system issues, like problems with the medical record system and not having a unified health, a unified electronic health record like Epic. So fixing them takes effective teamwork across medical, mental health, and custody staff. Real goal isn't just to meet rules on paper, right? It's to make sure that the patients are getting the care they need when they need it. So now that we've reviewed the QA side, let's move to CQI corrective actions. And then we'll take a deeper look at patterns over time to see if the changes are really making a difference. Next slide please. Thank you. Now let's look at the areas under corrective action on the CQI side, which focuses on how well care is actually delivered, not just, you know, whether the tasks are marked as done. There are four key areas, receiving screening, and making sure every person entering Santa Rita jail is screened right away for urgent medical needs. Medically supervised withdrawal and treatment, safely treating people going through alcohol or drug withdrawal using C-WARCOW as protocols, chronic care, and that's checking that patients with long-term conditions like diabetes or heart problems are getting proper follow-up from all healthcare teams. And initial health assessments, making sure that these assessments are not just done within the 15, 14 days, but also fully completed and documented. Each of these areas did have challenges, not just getting the work done, but making sure it was done well and clearly documented. And so that's why they were placed under corrective action. Even though well path has started working on fixes, we haven't seen that consistent, reliable results in all of the areas. Next, we're gonna review the current status of each corrective action in detail. So we'll walk through what's happened since corrective actions were issued and how well path is working to fix gaps in staffing and training and proof how things are done day-to-day and make better use of their existing tools, even when technology is limiting. Next slide, please. All right. And so let's start with quality assurance and QA. So while path was issued, I'm the more recent formal QA corrective action on April 2025 carried over from late last year. They submitted a response by May 1, and also an updated version on May 8. We reviewed both submissions, which included the causes of the issues, their action plans, and their chart review results. So to confirm improvement, we checked both the patient charts they submitted and conducted our own independent reviews through QA and CQI studies. What we saw was strong improvement in initial health assessments and non-emergency sick call requests, actually by over 200% better than before. Both well-passed, there are CQI studies and our independent spot checks and CQI reviews showed that the changes were working and being consistently followed now. While they haven't hit that 90 to 95% goal every time, the scores have continued to improve without dropping off. And because of that both areas are now marked as corrected. However, it is important to note that these indicators still need to be closely monitored going forward and if performance drops again it can reopen a corrective action. Access to care, how well medical problems and alerts are flagged, improved from just 7% to 50%. And while this is a big step forward, it is still far from where it needs to be. One of the barriers is that the current medical record system does not allow mental health issues to be flagged the same way that medical ones do. So even with that, I mean, there's still room for improvement in whether medical problems and alerts are documented. And so as a result, this area is marked as partially corrected and will remain under close review. Now onto the continuous quality improvement side. Corrective actions were issued on April 21, 2025. So within that 30 days, well, past. We have been through the same process. We have been through the same process. We have been through the same process. We have been through the same process. We have been through the same process. We have been through the same process. We have been through the same process 100%, now reaching around 90% compliance. And while that's good news, the results still do go up and down, with it not being consistent yet. The CQI studies for this actually show some delays with medical team follow-up. So for now, it's marked as partially corrected. Some of those issues may be related to some external factors, so we will keep monitoring this closely. Chronic care and medically supervised withdrawal and treatment at CWA cows are still not corrected. Both are areas that the CQI studies are showing, you know, struggling with missing continued documentation, follow-up delays, and identifying high-risk patients. Next slide, please. And so where do we stand today? I'll walk you through that quick update on this slide here before turning it back over to Lieutenant ANTIANza for closing remarks. I mean, now that we've gone over a corrective action activities, I mean, the slide gives a quick update on where things stand and what's coming next. On the left side you'll see a timeline of recent activities we just discussed. The next CQI cap review will happen after we receive well-passed cap response next week and review their proof that changes are in place and effective. The next QA corrective action will be issued in July. On the right side, you'll see again how oversight has tightened in 2025. There's now greater accountability requiring well-pathish real measurable progress. Timelines are shorter, so change has to happen faster. And Alameda County Health is also part of the oversight process to add another layer of review. And just as a reminder, everything is posted publicly on the ACSO transparency portal. The QA reviews, the CQI studies, corrective actions, cap responses, and our evaluations. So the community can see what's being done and how progress is being tracked. Thank you for letting me speak today. I'll now hand it back over to Lieutenant Nessianza to wrap up with final thoughts. Thank you for letting me speak today. I'll now hand it back over to Lieutenant Sianza to wrap up with final thoughts. Thank you. All right. Thank you, Faith, for that detailed review. I want to briefly speak about our QA process moving forward and some future considerations as it relates to the medical services at Santa Raida jail. So as we move forward through this process including our corrective action plan review, Sheriff Sanchez has emphasized the importance of transparency to the public regarding this issue. We will continue to post our reports on the public transparency portal for review. Regardless of the scores from Wolfeth you know good or bad we are going to post our reports on the Public Transparency Portal for review. Regardless of the scores from World Path, good or bad, we are gonna post those scores on our website. We can go to the next slide, please. Okay, I wanna review some of our future considerations as I move forward to the next RFP for our Medical Services Contract at Santa Rita Jail. Santa Rita Jail is one of the larger jails in the, and that does bring a complexity for a contracted medical provider. Historically, there have not been many companies that can handle this size or the complexity of the facility. So it's important to gather insight from experts and our partner jail facilities for our next contract. You know, whether that's a request for information to put out to other companies to see what companies are out there that can handle the complexity and the size of Sanery to jail. Also, you know, getting expert and public input to, you know, what does need to be in the next RFP? We've recently met with some community advocates. They're here in the audience today and they did voice, you know, some of the things that they did want to see in the RFP moving forward and we are going to consider that putting them in the future. Also, we're going to have a new electronic health record system, hopefully by then and that's going to be something that we're going to have to incorporate into this new contract. So that's going to be a lot of complexity moving forward and we're going to have to rely on experts and our partner facilities to kind of help us guide to where that needs to go. Things that we need to be conscious of the unintended impact, right? We don't want a disruption of the continuity of care. So when we do move to something different or if we get this new epic system, we need to ensure that there's not a drop of care to our incarcerated population and also all the improvement progress that we have made with Wal-Path in the Corrective Action Plan, we don't want to regress with somebody else. We've already made some progress. We want to keep them momentum going there. Since we've worked with faith team, including Dr. Lee Patten-Tamey, I've really gone a good understanding of the importance of quality assurance at Santerity Jail, and I need to emphasize that ASSO is dedicated providing the best possible patient care at Santerity Jail. And then lastly, I want to say that wall path is here in the audience and they have expressed interest in going over the data that Mays Arts has provided and also answering any questions that you or the public may have. Thank you. Thank you. Do you have some questions, like to see if there's a representative from Well Path that I know my colleagues have questions as well. Thank you. Yes. Hi, welcome. If you could just state your name and title, please. Hi, my name is Cole Casey. I'm the president of operations for WALPATH. Thank you and welcome. So the first question I have is obviously there's been consistent communication with the third party auditor and with the sheriff's department. Just wanted to hear your response. Unfortunately, the data has been consistently not meeting the standards. So I just wanted to hear from you your perspective as to why that is. Yeah, I've got a couple of documents here. We're not able to get on the agenda. And so we can pass those out to each of the supervisors. And I just first want to say, so I'm cold. I have with me today my regional vice president, our regional director of operations, our site medical director and our site health administrator. I completely understand and we understand the focus and attention on the work we do. Our work is incredibly important. And the population we provide care to is often at their most vulnerable when arriving at the jail. At well path, we believe in true care that submits itself to feedback and improvement. We are the only correctional health care provider, vendor or county operated, with a national committee for quality assurance accreditation for the public health program management and correctional settings Clinical quality improvement does not come without audits and honest conversation about areas for improvement supervisor Marquez you started with a Comprehensive conversation for us to have and I welcome that and believe it does need to be a comprehensive conversation We do have some concerns with the data and the methodology that Maysars does put together. And we don't believe that the Maysars report is a true representation of the care being delivered by well path staff and UHW Union members and ACSO staff. From context challenges to methodology concerns that our medical director will review in a minute if given the opportunity. We believe there is a different conversation or at least a more comprehensive conversation to be had. We've provided to each of you this document that I'd like to review a couple items within. Three parts are the Maysars report results, the staffing fulfillment per contract, and then lastly, the continued dialogue and engagement. First, the conversation on the MaysRs reports and the access to care, problems and alerts specifically. I wanna point out a distinction of our agreement in our contract with the Sheriff's Office. We are responsible for somatic medical care at the facility, which means that we are responsible for the health care, not behavioral health care or mental health care at the facility. That's important because the documentation of those problems is a dual effort, one by outameda County Behavioral Health and one by Well Path Medical Care. And so in this document that I've outlined, our compliance of ensuring that medical care problems are in two systems, is it 48%, Alameda County Behavioral Health is at 11% compliance. One of those challenges as stated by Faith from Maysars is the multiple electronic systems that we have to document within. We have Cori-Amar, which is our EHR, the jail management system, and then the Alameda County Behavioral Health System, which we do not have access to. When we are documenting a problem set, we fail on that measure if the diagnosis is not documented the same in all three systems. That is a challenge that can be solved with an EHR or continued integration of the systems. That is not a reflection of our providers getting out and seeing and caring for the population. The second piece is receiving screenings. When an inmate comes into the facility, they need to be evaluated by three separate agencies. First, Alameda County Sheriff's Office, behavioral health, and then also-tough. At times, our ability to conduct a timely receiving screening is limited by multiple factors, by multiple groups needing to see the individual. Approximately 65% of new patients are transferred to the reception center. In most cases, we do not have access to those patients until about eight hours after they arrive at the facility. We're actively working with our partners at the Sheriff's Office and with behavioral health to improve this workflow. As Faith said, improvements have been made and a lot of times it's us understanding and having that comprehensive conversation of what are the issues and why are we not meeting this and are there systematic changes that we could make to make this a more efficient process. Number three is the chronic care management. This is a reflection of our internal CQI study. It asks for patient goals in the last 12 months. Our medical providers have served our patients with over 22,000 problem-based primary care visits and over 3,100 primary care chronic visits. Chronic care visits. Patients are receiving high quality care, noncompliance is in this area driven by documentation deficiencies, not providers not going out and caring for patients. We're actively working with our medical provider team on education to make sure that they have appropriate documentation to meet the standard on a consistent basis. And then number four, medically supervised withdrawal, this is going to be a challenging one, whether we are your provider in the future or whether it's somebody else in the future. And the reason for that is the upshot injection that was issued in 2019. For the injunction, there's a restriction on Santa Rita jail staff ability to see patients during 11 p.m. to 5 a.m. On weekdays and 11 p.m. to 6 a.m. on weekends. During the hours outside the restriction, our overall compliance rate is 85% of completing medically assisted withdrawal, or supervisor withdrawal. During the restricted hours, our overall compliance drops to 44%. We are, again, working with the Sheriff's Office to figure out how to navigate and legal to figure out how to navigate that injunction. But when we are for that medically supervised withdrawal, we conduct three screenings a day and then 24-hour period. And when we have a blackout period, it's very hard for us to complete that third screening when it is medically appropriate and medically necessary. The second item that I want to talk about is staffing. When reviewing the staffing rates provided over the last 12 months, the table that I put below shows that we've consistently provided above contracted hours. This rate of the percentage is calculated by worked hours divided by contracted hours. Staffing cannot be measured alone by how many penalties are paid or assessed to well path for two reasons. Our contract pays at 150% hourly rate back to the county. And so for every hour missed that we have as a vendor, we pay it back to the county at $150 per cent rate. This over states any unfilled hours in any department. Our contract also allows for any single shift to be penalized $1,000 per shift per day per position. So on top of the 150% payback is also a $1,000 per shift per person per day. A base assessment of staffing needs to take into consideration all the hours provided as well as the penalties paid. I would also point out we have over 154 contracts across the United States. Alameda County has the best retention of their employees across all of those counties across the United States. Since May of 2024, we have not dipped below a 15% turnover rate of all staff, and since, not since November of 2024, has it been above 10% of a turnover rate. That is an unbelievably low turnover rate for anything anywhere in healthcare. Lastly, I understand this is the first time you're meeting me. This is the first time you're seeing me at this meeting. And I would would like to invite you or anybody to meet with our team. We are open to this, as I said, we're open to the conversation. I put our emails in this document and who we are. We see the most success in all of our counties when we partner well with everybody in the county. We have an ability to be a middleman that doesn't exist in a lot of environments. We have relationship and work directly with the Sheriff's Office. We have relationship and work directly with Alameda County Behavioral Health. We answer to and work with GSA. We work with the county legal department and we work with the board of supervisors. We sit in a very unique position to bring everybody to the table and say how could we do this better. I think one of the things that we could always be talking about is population health data that at meetings such as this, we could be talking about the challenges that are coming with substance use disorder and the programs that we have that improve that in the community. If the board would allow, I would love for our medical director, Dr. Assad,a to be able to speak. Yeah, I'm going to just hold off because this actually isn't listed on the agenda. So I want to, I did have a question for you, but we need to be very defined in the scope. But just want to see since you're still up here, do my colleagues have any questions? Go ahead, if youu. Me? I'll call on supervisor Miley Wilk Rotay and then Tam. Well, I appreciate seeing you. How long have you been on the job? I started last January. And why are you just reaching out to us now? I have two competent staff who have worked with me for quite a while, but a very thorough and representing my concerns and those of my constituents. And so if you can't see me, I've got two competent said, why are we just seeing you now? I met with one of your staff members in February, and I had attempted to meet with one of your staff members Daryl since the middle of 2024. I think I have meetings with Labor, I have meetings with the Sheriff's Department, I have not met with all paths in probably two years since there was been some turnover. So I find your report, your information, you're very interesting. I do recognize the electronic records is a big issue and a big concern, but I'm gonna wait and take some feedback from our staff and others about some of the veracity of what I see you've presented today. So thank you. Yes sir, thank you. Supervisor Tim. Thank you, Chair Marcus. And it's a pleasure to meet you. That's my actually first time being involved in all of this. I know the chronic care management compliance, you mentioned that the electronic health records has been a barrier and we are proposing and looking at the epic system to basically correct some of those issues. And you said it was a barrier to meeting full compliance because there isn't access to the records to provide the kind of care that's needed for chronic medical conditions. So when you talked about the contracts that you have, 154 contracts in the United States. Do you have contracts with other county jails in California that have the same issue or similar issues with the electronic health records? Yes. And how, what is our work around? So correctional health care is one of the just more unique spaces in the whole industry of health care delivery. There are evolutions or modifications that have happened in health care that still have not place in correctional healthcare. Um, and one of those is system integration to a, a new level. So one of the solutions, uh, that I actually talked to the sheriff's office about, um, last week that we are going to look into and figure out. I know that Epic is, you know, down the road and going, but one of the pieces that we wanna see is integration. And so what that means is right now, say a provider is responsible for documenting one in our EHR, QuarriomR, one in the jail management system, and then there, if there's a mental health diagnosis, then it's in the third system that is operated by an alimony to counter behavior of health. Those at times do not talk to each other on everything. They talk to each other on some things, but one of the things that we can look into is doing integration of that form to instead of having them document three times, the same thing three times, we have an opportunity to say could we have it document once and then be replicated automatically in the other two systems. And so that yes, that is something that we could look at. One of the challenges is at some of our other facilities, we don't have, we have a jail management system in EHR and that's it. We don't have always a third system that needs to be integrated as well. Does that answer your question? Well, I assume there are larger counties, for example, Los Angeles County would have hopefully a more sophisticated system than we do. They are fully self-operated. And so yeah, they probably do have a EHR, but there are not healthcare systems like Epic are typically built off of billing. Inside the correctional healthcare environment, there's no billing that takes place. And so sometimes those EHRs that are implemented in a healthcare environment aren't appropriate for a jail-based program because of the billing nuance. Okay, if that's a clear way to say that. Yes, I appreciate that. Do you also see similar compliance issues with some of your other facilities? Yeah, it can come and go Yes, there are there are CQI studies and and we conduct CQI studies on ourselves that present issues that that we have to solve and and it does Eben flow but honestly mostly based on staff consistency is typically where sometimes that happens. But yes, it is, but that's also why we do CQI studies. True healthcare CQI is when you ask questions that maybe you don't want to be asked, but you have to ask them because you want to make sure that you're providing quality care. And some of those other facilities, because I mean the experience we're having right now, obviously is one about communication and transparency and making sure we, the board, understands but the community understands how has it done at other facilities in terms of helping whether it's some of the advocates or concerned community members understand some of these challenges. One of the things that we do consistently across the board is we invite people to come and see what we do. I have worked in correctional healthcare for over four and a half years now. I had been in healthcare for eight years prior to that. I did not know that this world existed or that this correctional healthcare industry was an industry. But I think it's the best kept secret in healthcare because it is the most unique place for us to be able to provide care to patients who number one actually need it, number two actually want it. We interview our nurses all the time that say they leave left the ER because they were tired of fluffing pillows and they really enjoy coming to correctional healthcare because they get to care for patients who are incredibly grateful that we're actually paying attention to them. And that is that's our why because we believe that this is a space where we can make the most impact not only inside the facility but also out in society. Thank you. Thank you. Cool for answering our questions. Appreciate you being here and I'm sure we'll be in touch. Thank you. Thank you. I do have a couple questions. I don't know if you guys want to tag team it but for Lieutenant for faith, a couple follow up questions. First one is probably more for the consultant but as the experts that discuss the data with the Sheriff's Office and AC Health, when do you believe that the report will be ready for quarterly updates? I know that you're expecting a report back in July, but that has to be analyzed. So walk us through the timeline to have a significant update. Sure, I'm so the next CQI cap response from Wallpath is actually due next week and our team turns that around fairly quickly so we could likely have that shared with you. I would say before June. Before June. Before the CQI cap, the ones that we actually had provided the preliminary results to now the July QA quarterly that will the new issuance of the corrective action will have to have that 30-day time frame for a well-path to be able to respond And then again within a few weeks to be able to just turn that around and do the spot checks and documentation review. So I want to keep track of the care at Santa Rita Jail and so emotional be making later is to have frequent touch points come back to this committee. I'm thinking on a quarterly basis but from what I'm hearing from you would it be reasonable to get the next update in September? Yeah, I'm a deferred to Lieutenant Atanza and partnering with Alameda County Health, but yes. So the May's ours contract is actually currently the RFP process. So Alameda County Health is going to also take involvement in the cap updates, but we're in the process. So, you know, it could be a different company, depending on the outcome of the state. So, I think that's the way to go. I think that's the way to go. I think that's the way to go. I think that's the way to go. I think that's the way to go. I think that's the way to go. I think that's the way to go. I think that's the way to go. I think that's the way to go. I think that's the way to go. Do we know timeline with that decision will be made as to come back to the full board? And we do not know yet. Okay. But our Alamex County Health partners are going to assist in keeping up the status of the cap and passing over the information if we do have a new company takeover that contract. Okay, thank you. Do my colleagues have further questions? Yes, thank you. I'm not going to try to pronounce your last name, but did you see the report yet? I have not. Well, because I know we distributed it to everybody. This is your first time. Yes. Okay. So you don't at the moment you don't have any reaction to this. Some of those some of the issues that coal did bring up that I'm assuming are on the document and we have had conversations with Dr. Trinan and the team. I had mentioned some of it in my report as well that those are considerations absolutely that need to be kind kind of incorporated, that have been incorporated and need to continue to be incorporated in the reviews. And then I see FACES, MSN, MHA, RN, CRR, RN, CCHP up. So how long have you been in the business of this type of reviews of correctional health? So healthcare overall over 15 years. For healthcare overall, now corrections in particular at five years now? Five years, okay. Because clearly, I do think, you know know I would acknowledge the issue around electronic records and the complications that produce for the delivery of healthcare at Santa Rita Jail. That is the minimalist and we're going to get that resolved. But I was very fascinated with your the thoroughness of your review and the correctional plans that the Sheriff's Department and you have worked out with well path. So I'm going to just kind of hold judgment at the moment, but I just want to thank you for the work that you've done. This is very impressive. Thank you. Thank you. No further questions? We'll now open public comment. We'll have two minutes. We'll start with speakers in person. Then move on to those participating remotely. Richard Spiegelman. Good afternoon and Richard Spiegelman. Auckland resident. Thank you for this hearing. I think that most many people in this room have been concerned about the quality of health care at Santa Rita for some time now. It seems like progress toward opening up the RFP process is happening for which I'm personally quite thankful. and given that the current contract ends in the fall of 2027, and given who we heard from GSA about how long it takes to put a proposal together and then assess it, and then heaven forbid this should be a need to redo it. I mean, it could take many, many, many months. The main concern that I wanted to share is that the process gets started soon. And as I understand it from GSA's timeline, the first part is, wherever my notes are, and putting together what the procurement ought to involve from the sheriff's office's perspective and from being in conversations with them and being here today, I know that that itself is a process of understanding how other counties do it, what are the options. And now we hear what happens if Epic comes into this and that changes. And anyway, the point is I think in the GSA's timeline, a two month period was outlined for the sheriff's office to get together the requirements for a new contract. My guess is it will take longer than that. And it's really important that once the contract is awarded the new awardee has time to implement it in a responsible manner. So there's continuity of health care. So my argument or my proposal is that this committee or two committees bring forth to the full board. It's very, very soon the release of a new RFP so that everyone knows what schedule we're on. Thank you. Mickey Ducksbury and then Darrell Ray. Hi, my name is Mickey Ducksbury. I'm the chair at the Stop Descent Harm Group. I want to highlight some recent news about WELPATH because it's the same corporation that makes management decisions in Alameda County. I want to be clear, I don't think everybody's a demon here at all and people want the best, but there's large systems that impact negatively. A federal judge in Oregon ruled that Wellpath had, in quotes, intentionally destroyed email evidence in order to prevent its use at a trial and a wrongful death lawsuit. Company leaders in writing called it the purge, and they did so why were they facing other lawsuits. Michigan's Hospital Association cited Well-path, refused to pay more than $35 million of services that had already been provided that medical staff said were essential. But what's important today is not the magnitude of the corporate takeover of prison health care, which is a problem, but what it means for health of people inside of Alameda County jail. we've been recently made aware of several situations where medically necessary dental care was denied, and it was recently subject to a court hearing. We've been, we have heard from some staff that they feel afraid to refer people out for needed medical care because of constraints by management. These might need seem like small incidents, But we wonder how many people in Santa Rita jail have had medical issues that might require treatment outside of the jail, but were refused. The difference between a public health system and a for-profit system is that when push comes to shove, well pass primary concern is their bottom line. We have no doubt that there're a good staff trying to provide the best care at Santa Rita. But most counties in the Bay Area run their own healthcare. Isn't that what we want? We know that Sheriff Sanchez has had made many important changes at the jail. We think it's time for the supervisors to fully implement a healthcare model based on the best tenants of medicine instead of one based on product and standards. Thank you. To be called. Did you call the next? Okay. Good afternoon. Supervisors, Miley, Marquez, and Pam and Sheriff Sanchez. My name is Darrell Ray. I am a resident of Castro Valley and a member of Star King Unitarian Universalist Church of Hayward. Our Social Justice Committee has been following the Jail's problem with medical care for a number of years. And I'm glad that transparency has improved under Sheriff Sanchez. But more needs to be done. Well-path not done a good job and I believe that it is time to bring health care at the jail under direct county control. Most of the surrounding counties provide their own health care in their jails and we should do that as well. And I think it will be more cost effective, more transparent, better for those that are housed in Santa Rita Jail. So please do not renew well paths contract. Thank you. Mario from NUHW, Rabbi Cooper and Gene Moses. Good afternoon supervisors, my own supervisor, Miley. My name is Mario Gonzales Brito, I live in East Oakland. And I do want to make just a couple of points I am from the National Union Health Care Workers, we represent workers at the Santa Rita Jail, the clinic workers. And I want to make it very clear, nobody has the authority to speak on behalf of our members. I think there was an indication that they spoke on behalf of NUHW members who work at Santa Rita Jail. I'll make it very clear, nobody, we're a Democratic union, we have a process in which we deliberate, our members deliberate that process. Speaking of our members, our members are dedicated public servants to the patients they serve. As you all know, these are the most vulnerable patients within the county. We want to be cold pilots in this voyage. We don't want to just be passengers. We believe we're subject matter experts that can help provide and direct a vision of the kind of healthcare we want to see in Santa Rita jail. We ask you to tap to that resources. We also believe that transparency and daylight is the best disinfectant in terms of getting everything out there. We oftentimes we get the reports that you all produce and we share with our membership and our membership have more like to have an active voice in that process. We are making an invitation that we wanna be more involved and more engaged in this process. And I wanna thank every single one of you supervisors because when we ask to meet with you, you meet with us, you listen to our voices, and we appreciate that. That being said, the most important thing that I do want to make sure is that you understand, is that we're still going through our own deliberation as an organization. Our own members are trying to come up with solutions. So we ask that you not forget that our voices matter. And do not take away our agency away. We still want our union. We want our union contract to be respected. The four corners are with any RFP. The fundamental thing has to be worker retention and contract retention. Thank you so much. And I appreciate you all. Hi, I'm Rabbi David Cooper from Kayla Community Synagogue. And I'm only here because I read this article in the yorker from only three weeks ago. And I'd like to just quote, permit for your information. It's written by investigative reporter and was thoroughly a fact-checked. Recently law firm Budge and Hept had represented the parents of an 18-year-old named Mark Moreno. Mark's father had taken him to a county mental health crisis center during a serious episode. The council there found Mark talking to angels and turned him over to police for a ride to the hospital. Instead, officers took him to the county jail on two outstanding misdemeanor barns for traffic violation. The jail which had outsourced its medical care to a private company that's now called Wellpath put Mark in an isolation cell into a little action when he stopped eating and drinking. He died eight days later of dehydration, records show that he had lost 38 pounds. Wellpath settled the case for $4.5 million, but did not admit wrongdoing. Another part, three of the largest correctional health care corporations, cars and armor and-path, have filed for bankruptcy in recent years. Well-path, which filed this past November, has been hit with more than 1500 lawsuits, claiming inadequate medical care for incarcerated people. A big part of the industry's business model is filing for bankruptcy, cleansing their balance sheet of responsibility for their misconduct, and then starting all over again, Bianca Tilek, the executive director of Worth Rises, is the one who was quoted on that. Just on that boy, Mark Marano's death, the judge censored Well Path for obstruction of the truth through the permanent deletion of countless emails. So please read the whole article. Thank you. Sheriff's, Bas, Pat Schwinn, John Lindsay Poland. Good afternoon. My name is Jean Moses. I am a member of the Interfaith Coalition for Justice and our Jails. And I appreciate very much your moving forward on this topic. Clearly it's going to take some time to figure it out. So thank you for getting on it and for beginning the RFP process. As has been alluded to, I think that the provision of good healthcare in the county will be a collaborative effort. I would like to be sure that the public has an opportunity to have input into the RFP, and that the county take advantage of local experts that exist in the area. So I'm looking forward to the creation of collaborative environments in which various groups can get together and contribute to the best and the most cost-efficient healthcare possible for our county. I also wanted to mention that Well path has been the provider in San Rita Jail since 2016. The previous provider, Supervisor Tam, was a company called Corazon, which was tossed out because there were so many problems in the in the jail. And two things, one is that well-path has had close to 10 years to prove their ability in the jail. And our deaths in the jail have been horrendous. So, I mean, there I think there are a lot of reasons to seriously consider shifting away from a private company to public run or not for profit, healthcare. And I had something else to say, but I forget. So thank you very much. Hello, my name is Keras. I stand for autonomy, respect, equity and compassion for myself and others. I live in district five. I'm here to request that you put jail medical forward in terms of for the people, by the people, and not for profit. I teach health policy to medical school students, and one policy analysis framework we use is to ask ourselves who pays, who chooses, and who loses with any policy choice. So let's do that briefly with regard to jail medical. Who pays? Well, we pay, we're the taxpayers. But the person who writes your paycheck, if you're a clinician, at the jail, makes all the difference. The organization that you work for impacts how you're trained, how policies and procedures are followed or not, and the values and the culture and the priorities. Right now it's not reflecting our communities' values and priorities. Who chooses? You are bored, chooses, and the Sheriff's Office chooses. but we taxpayers also have a responsibility for that choice because it is our funding that is used. And then last, who loses? Of course, it's our neighbors and the jail who lose when poor care is delivered, but it's also their families, it's their employers, and it's our community. They're coming home to our community, and if they not as well as they can be our community suffers. I was able to volunteer recently with jail release support. A group of us stood on a windy cold night at the end of that long cement path that comes down from the jail and offered coffee cigarettes, a chance to charge your phone. 73 of our neighbors were released that night. They're coming back into our community and we need them to have good care inside. In addition, you're not going to be able to implement CalA effectively without the support of your county public health partners. In short, we need to have health care by the people, for the people, not for profit. Thank you. Hatchwin, you've heard a lot of very specific, very specific information. I don't want to reiterate that or try to add to it. I just want to say, I'm here to advocate for starting the process now to find a high quality healthcare provider for when the contract with well-path expires due to their document and clearly documented unsatisfactory care levels. I strongly urge that a QA firm such as Mesa's continue to be hired to monitor performance of whomever is providing the service. They would make corrective recommendations and evaluate performance with healthcare providers in the future. And I believe there should be a contract clause to allow the cancellation of any contract if performance is not acceptable. Thank you. Good afternoon, John Lindsay, Paul and American Friends Service Committee. This is one of well-passed biggest contracts on the country. If they don't receive the contract, we should expect them to protest, which will take longer than 14 months outlined by the GSA. In addition, we have not heard how long it would take for another provider to ramp up if they are chosen that adds additional time. That's a question that should be asked. If well path is fully staffed at the jail as they report, then their low compliance on the Mazar's ratings is even more shocking. Why, with their fully staffed, are they having such low ratings? We heard well path challenge the methodology and the data that Mazar's provided. I'd like you to hear a chance for Mazzar to respond to that. In addition, we also heard, well-paths say, that a lot of the low ratings are due to behavioral health. Dr. Trouble is right here. It would be great if she would be able to respond to that. The, we heard that 80% compliance is somehow a corrected action. It's supposed to be 90 to 95%. That should not be listed as corrected. Some of the criteria for an RFP might be not being litigated 1,500 times, or not failing on essential or important aspects of care. Another one might be 80% of services are you of funds are used for medical services as is required for medical. Waiting for the next CQI or a public meeting in July is kicking the can down the road. We strongly urge you to get this going now. Thanks. Katie Dixon, Yolanda one. Good afternoon. All right, we've got some new stuff in here. My name is Katie Dixon, and I live in District 5. Well, thank you all for getting this stuff on the agenda and really getting a conversation started with looking at the time right to replace our counties. Jill, medical care. We've heard all the beautiful talking points from everyone here, so I also't want to duplicate any of the talking points I think we just need to go ahead and in the contract will well path Thank you to the sheriff's office and the well-path workers and stuff like that for coming in present We appreciate them too Unfortunately, I think for well-path, you know, this is just really not your strong suit serving folks in jail. And that is not taking away from where your strong suits do lie. You know there is some stuff that I am just not good at like making pretty slides when I have to do like presentations and stuff. I am just not good with Campbell and making stuff and pulling pictures offline and making it look cute. That is just not my lane. That's not my strong suit. I'm on minds. It's filled with typos. I got the wrong picture. I turn it in late. It's just bad performance when you rely on me to make some nice looking slides. I am okay with admitting that. That is just not my strong suit. I think well path neither really just say, Hey, this is just not your strong suit. You're not doing a good job here. Please stop trying. It's costing people lives. It's costing us money time out of our day. I got a rush out of here to go do something else. I supposed to be picking up my beta breakers thing. Now I have to fight traffic. Hey, man, you guys need to give it up and you need to go provide health care somewhere else. I wouldn't even recommend you provided at the shelters for the dogs. I love my pets and will path. You just, this is just not your lane. Thank you, sir. Thank you. Good afternoon. I was surprised to hear them talk about the upshot injunction. I was the attorney who obtained the injunction. And the attorney for well-path has my number. He knows who I am. If they need to renegotiate to be able to provide health care. He can just pick up the phone and call me and no one has. So I don't think that's a valid excuse for a reason why care can't be provided. I think if you look at the death of Maurice Monk, his family has testified that they called for days and days saying he's ill, he needs his medication and they never got it to him. And well path is the only entity in that jail that is responsible for getting medication to inmates. Now, in my experience, and I'm sure some of the reports that you have seen, well path has been stubborn. They have not been willing to listen and accept responsibility for their actions. They've wanted to litigate to the very end. And even though the county has settled the more recent on case, well path is still asking for it to be taken to trial. And that was one of the cases that they went to bankruptcy on. So I have a 1,500 cases, 550 of them were wrongful deaths. These are not small numbers. And this is not accidental. It's not a systems era. It is a fundamental problem with the business model that Well Path has, which is profit motivated. When I took the deposition of Dick Durbin who is or at that time was the medical director, he did not know the criteria that Well Path had for going out of the institution to get medical care. He didn't know who made the decision or how long the decision would take. He would just send the decision to corporate and wait. And if you are an inmate who needs care and is ill, then you're S.O.L. So it is a fundamental problem and I think it's really time for us to do it RFP and to do it soon. Thank you. Assad, Trasna, Lonnie Hancock. Good afternoon supervisors. My name is Assad Traina. I'm a physician, board certified in internal medicine and addiction medicine and with a master of public health and health policy and management. The reason I work at Sanery to jail is because I wanted to work with underserved patients, and that's what I've done my entire career. The reason I specifically work in a jail is because I saw the opportunities to actually have a major impact in terms of improving the quality of healthcare in the facility. And I think that's what myself and the people who work there every single day do. I feel like a lot of the things that are being said just don't quite match up with the reality of what I see every day when I see patients. With regards to the Mizar's report, I'm especially grateful for the recent caps because I think they have pushed us to make significant improvements and that was shown in some of the data. But I also want to highlight that, and I've discussed this with the Mizar team as well as Lieutenant Atienza, there are some major methodological issues with that report, right? Not because I'm saying if there were no methodological issues it would be perfect. That's not what I'm saying. But what I'm saying is, if you take 15 of the most complicated patients in the jail and then you try to assess Metrics based on that population, it's not going to be representative of the entire population. So there needs to be a larger sample size. There needs to be a of the entire population. So there needs to be a larger sample size. There needs to be a less bias or a more random sample, and there's some other issues that I won't have time to get to. But I just want to make, basically, say that it doesn't really match up with my experience of diagnosing people with new HIV, with treating people for their abscesses, with giving people life-saving treatment for the MAT-Aid to Jail is the only jail in California that has a DHCS certified NTP program. That means we're licensed to give people methadone, the only jail in California that has that designation, which will be sublucade, buprenorphine, life-saving treatments, treat them for their opioid withdrawals and their opioid overdoses. So I'm personally very proud, I go home to my kids and my family every day and I feel proud about this work that I do at Senator Edagel and I hope I have the opportunity to express that a little bit more. Thank you. Good afternoon and thank you to the supervisors who are here at the sheriff. My name is Mon E. Hancock. I live in the fifth district. And my interest is that I worked on these issues, chairing the relevant committees in the state legislature for 14 years. So I did this rodeo before. Let me just say that you guys have a very large contract, $253 million over five years. The time is coming when you have to consider renewal. And you are dealing with a company with demonstrated poor performance in many areas, a company that It has filed for bankruptcy and a company, well, that is in a professional area that has now reached national crisis attention as shown by the New Yorker article. I was a little surprised when the GSA representative who was here indicated there was so little board involvement in developing the RFP and participating in the decision making. And I think that is something that you should be really looking at. And the motion that's asked for today is that you, as the leaders of the county, you set policy direction and say that you want an open RFP that looks at all the options, all the companies and contractors and also the public option which other counties are using and they have told us that it's extremely helpful in integrating systems and doing successful reentry to how the county doing that. And finally, there are thought partners out there for you. Talk to the other counties. Talk to some of the research institutes right here in the Bay Area that can tell you what should be on a contract and other things. Hopefully you'll be able to move forward on this. Thank you. Collar, you're on the line. You have two minutes, Mirna. Yeah, I fear everyone, my name is Mournish Worts in District 5. I'm with the Interfaith Coalition for Justice in our Jails. I want to commend everyone, community activists, sheriff's and sheriff's, sheriff's supervisors, and particular supervisor, Miley, for bringing us here to this joint committee meeting and really pushing this critically important issue forward. Here's what jumped out at me from the MESAR's report among many things. A stark drop in compliance in matters of, quote, restraint, seclusion and segregation as well as informed consent and right to refuse. From 90% compliance in 2022 to 32% in 2024 to something like 6% in the early months of 2025. This is just completely outrageous. I think there's all for all the reasons we've heard today, well, Beth has got to go. I urge you to direct those charts with drafting the new RFA to study the models of contra-costa, Santa Clara and others that have taken over management of health services in their jail, fully explore AHS, Alameda health systems and other possible public-private arrangements, and please bring in the expertise of formerly incarcerated people, community activists, and of course the nursing and medical staff that we've heard so eloquently from today. We've all seen the flood of new stories documenting how for-profit companies are destroying quality medical care, nursing care, psychiatric care, all across the country, and especially in carceral institutions. Please figure out a way to insulate medical care at Santa Rita from the profit motive. Our incarcerated brothers and sisters don't have the luxury of shopping around for a better doctor. Thank you. Collar, you're on the line. You have two minutes. Bar. Thank you. This is barbat. Well, I'm a resident of Berkeley. I'm representing the Berkeley friends meeting, also known as the Quakers. I've been reading about the issues in the Santerbury to jail for several years. And I really see the need for a new medical care provider. These statistics were not in the presentation, but I've read that since October of 2016, when Wellpath became the healthcare provider, 54 people have died in custody. This is an average of one death per every two months. And that, excuse me for those, cause of death is known about 20% of them have been suicides. There is no reason to renew the well path contract in 2027. A better system can be developed as other countries, counties have done, which Marin have just referred to. And we appreciate you starting that process without delay. The panel selects a new medical care provider in the jail should include someone who was formerly incarcerated and will know from experience what is needed as well as a community advocate. We urge you to work on getting a reliable medical care in our jail. Thank you. Collar, you're on the line. You have two minutes, Willan. My name is Willan Vandakam. I'm the resident of you to ask the committee to ask the committee to ask the committee to ask the committee to ask the committee to ask the committee to ask the committee to ask the committee to ask the committee to ask the committee to ask the committee to ask the committee to ask the committee to ask the committee to ask the committee to ask the committee to ask the committee to Office and committees for this meeting today. I think it's well known by now that the medical care provided by well-path is not the true care as it was called earlier in this meeting and not the comprehensive health care services that they promise and it's understandable because it's a corporation, it's about profit and not about health or care or people. And the lawsuits and the very thorough measures presentation that we had today are proof for that. It also means that the Sheriff's Office commitment to the best possible care for people incarcerated at the jail, Santa Rita jail, are falling far short. So I think it's illegal moral and financial failure. And I would say that these are all people have gots creation and they deserve humane care and not the harmful treatment or even death and think of all the families that happen. So I therefore totally support the recommendations that have been made to start the county on looking for a different provider and hopefully the county itself taken on the medical care at the jail to be responsible and accountable for the medical care and not some corporation that we have now. Thank you very much. Collar, you're on the line. You have two minutes, Ben. Hello, my name is Ben Oglevie and I live in Supervisor Miley's District in Castro Valley. I am a Unitarian Universalist and a member of Star King, UU Church in Heard. Our faith teaches that we are connected to one another in relationships of interdependence and mutuality. What hurts one hurts all. We believe that every person is inherently worthy and deserves dignity, love and compassion, even when they're in jail, perhaps especially when they're in jail. The moment we lock someone up, we become completely responsible for their care and we are letting them down. Well paths performance and providing care to our incarcerated community members has been tragically and unconscionably inadequate. I believe that a county-run solution has a better chance of providing the kind of care that our people deserve. Supervisors, I ask you not to renew well-pots contract and to start creating a better solution now. Thank you. Collar you're on the line you have two minutes Lindsay. Hi my name is Lindsay Shackinger I live in Berkeley I'm a member of FASME, families advocating for the seriously mentally ill. I just, you know, I think we have to move now to find another provider like many people have said. I don't think we can wait for well-path to come into compliance or not. The record is very poor. My question whether well-path is capable of complying with standards. And I looked at many of the Maze Arts reports and sometimes there would be an identified problem like they weren't identifying people who needed to be on 24 hours supervision properly. And then the next month, the same thing. And it just, it made no sense to me that people can't be trained or that procedures can't be written down that people can follow for these kinds of issues and many others. So thank you very much. And I think a county provider would be better also because they could work with Alamuda County Behavioral Health more seamlessly. And that's needed in the jail as well. Thank you. Collar, you're on the line. You have two minutes minutes Kathy. Hi, my name is Kathy Rodriguez and I am in Tam's district. I would like to say that I have worked in the jail facility for 27 years and some of the things that I heard today is very shocking to me because there's a scripture it's called Hebrews, Hebrews 13, 3, it says, remember the prisoners as though in prison with them and those who are ill-treated since you yourself also are in the body. Sometimes we forget that these prisoners are people. Had a sister who was, the share probably knows her, her name's Vicky Cerner Rodriguez. She was in and out of prison for 40 years and I was her advocate when she needed healthcare. And I've been in the system working with impacted youth and adults for over 27 years. There was a young man named Mario Martinez who died in San areida County jail because of lack of care. He had asthma attack and he ended up dying and actually my son was in a cell right next to him and watched the whole thing and I was very, very appalled by it. And this was under the care of well path. I think that we need to use the county. Highland hospital and work with them. I work in a facility that our county is over it. And we take it very seriously when it comes to inmates who are in prison and their care and when they want to see the doctor and everybody's like on it because you know that these people are individuals they need to be taken care of and they're not getting taken care of. How many grievances have been written and what is the outcome of those grievances? And what we need to do as well is every single inmate that leaves the facility is to do a survey on their health care. And then that way we'll know what's correct. Thank you. Collar, you're on the line. You have two minutes, Angela. Hi. Thank you for taking my call. Can everybody hear me? Yes, we can. Oh, okay, good. So I'm Angela Cray. And I'm here with ICJJ and stop the deaths in harm in the jail and also with the first unitarian church of Oakland. I live in District 3, Tam's district, and I'm coming to this meeting to speak from my direct experience as a volunteer in the San Francisco County jail for 10 years, where I had direct interaction with the incarcerated with the staff, and with the San Francisco jail health, which is run by the San Francisco Department of Public Health as a provider. And I just wanted to let you know what their mission statement is. It is to protect and promote the health of all San Franciscans, including the people in the jail. And I would say since they've been doing that since 1968, they're doing their job. I also wanna say that I volunteered for 10 years, and it was one of the highlights of my life, and I did not stop voluntarily. I stopped due to COVID. And if I were in the center, read a jail, I don't know how long I would have last to those deplorable conditions and with the amount of deaths and suicides. I had never heard of any grievances about the health care. I had never heard any deaths or suicides the whole time that I was there. And I just wanted to end with the mission of the jailed health, which is to provide comprehensive, kept compassionate and respectful care for incarcerated people. And I would just encourage you to make a decision where I, I, I, I, I faltered about saying compassion, but it sounds like it is possible to choose a compassionate and respectful care for the incarcerated. Thank you. Collar, you're on the line. You have two minutes, Elaine. Yes, it's me. Okay, good afternoon, superwizers. My name is Elaine Penn Penn. I live in Keshawari and Supervisor and the Mali-HL, the district. And I am the founder of the Director of the Mental Health Association for Chinese Communities. I'm here today and strongly support the counties in red to replace well-pressed as the medical medical pervertical provided in center-retard cell. This job has one of the highly stirred directs in California. We cannot invite the health that has happened under well-passed care. We also have our consumers have bad experience in the center-retard cell. As a mental health advocacy, as the everyday, how critical it is to have trust, community certainty and a reliable health care is playing inside jobs. The system is for our people and is for our families. I urge board to take take more action since a public or non-profit provider who can truly police did a healthy and family of those in custody. Thank you so much. Color you're on the line the line. You have two minutes, Karen. Hi, my name is Karen Chen. I live and work in Oakland. And I've been working with reentry service providers in the past three years. And I just want to thank the board of supervisors for the foremost and the share for being here today to bring attention to this issue and speak on it. I know it is an ongoing process. I want to share that in the time that I've been working with the reentry service providers, there's always been inconsistency and a lot of things, resources staffing. But one thing that has been got to since is the challenge of mental health services, provided in Santa Rita,, jail. I just want to bring that to light. I want to also voice how important it is to make this change as quickly as possible so that that transition can occur in that we need to reduce the gap where we're shipping from one system to another or one healthcare provider to another. I have a major concern that will just lose a lot of people if we one way any longer or two if there's too far of a gap between the transition from well path out of well path and whatever might come. And also just wanted to echo what has been said from a lot of the community members here. I think that it's clear that well-path while I'm sure their employees are, you know, mean well and want to care for the folks residing in Santa Vida Jail. The quality of care just hasn't been there just and we see that as a result of multiple preventable deaths in Santa Rita Jail. So thank you for your time. Collar, you're on the line. You have two minutes, Terry. Thank you. I'm Terry Dunn, a member of the Interfaith Coalition for Justice Center Jails and of Plymouth Church in Oakland. I appreciate the county's work on process, quality, and a formal corrective action plan. But well-paths chronic care management has not been corrected and other negative data has been shared. The data revealed suffering, unnecessary suffering of incarcerated folks. A jail sentence is not a sentence to medical cruelty. Whether intentional or an unintended impact of poor care, the result is the same. While it's good to hear how the RFP process can unfold, what we need is county run medical care. Marin, San Francisco, Contra Costa, Santa Clara, and Los Angeles counties are able to do it. How can elevated county develop a positive self-care plan? When can Alameda County develop the plan? Who will decide if our county provides care or ignores the success of our neighboring counties? And do high quality private providers actually exist to possibly bid? Today's testimony stated in the last RFP process it ended with only one option, well-path. We can't put ourselves in the position again of having no real options. Thank you. Collar, you're on the line. You have two minutes. Allison. Hello, this is Allison Monroe with Fasmi. My daughter was in Santa Rita several times. I feel okay. Sharing that with you because it was she was not there through any fault of her own. She was there because of delusions. She had serious mental illness and was often just not in our reality. And whenever my daughter was separated from me, I was very anxious that she would be cared for and not abused or put at risk and have a chance of getting into treatment and get back into recovery. And when a person is in jail, it's very hard for a family member to know it's going on to know that they're safe. I support a search for an alternative to well path. Well path has done poorly and monitoring has not been able to fix that. People with serious mental illness have died in San Areida and well path has been a fault. Well path is a for profit that has had bad reputation in many states. I don't know who else has said this, but I can't imagine that a for profit system. Treating people that are in jail, they're powerless, that don't share our reality, that are alone, that are und our particular way. We need a health care provider more responsive to the public. For what is worth my dollar always felt safe at highland. I think that's the most important thing to do. I think that's the most important thing to do. I think that's the most important thing to do. I think that's the most important thing to do. I think that's the most important thing is worth my, our always felt safe at Highland. And if, if AHS can do this job, I hope the RFP is written so that they have a good chance. Thank you. Um, Tisa, how many mark colors do we have? Four. or okay so I'm going to ask if anyone else would like to make a public comment. Please raise your hand now because we'll be closing public comment within the next minute. So if you want to speak, raise your hand now. We still have public comment for items not on the agenda. Power, you're on the line. You have two minutes, Christopher. Yes. I'm a resident of Palomita County in a taxpayer. I'm aware of the many transgressions of this company, which is making a profit off of the medical care provided at a rate of their $50 million a year contract is quite generous from this this county of Alameda and I request that the county consider other alternatives if they cannot find alternative providers on a pro for profit basis, it would be best if they use county employees and work with behavioral services of the county of Elimita for the mental illness needs of their patients, which are incarcerated. And the basic motive of a profit company is to get the lowest possible pay and get the most profit out of the services provided. The motive for hiring county employees is that they are sworn to uphold standards and they have a serious motive as career employees to be doing the best they can and maintain a really good reputation as an individual. And they would do that if they were working in Santa Rita prison. By giving the best possible observation of the people by documenting the condition of the patients and by giving them direct services. I recommend county services be replacing well-path. Color, you're on the line. You have two minutes, Sarah. Hi, I'm Sarah Terrell. I live in San Ranzo District three. I'm a member of Berkeley Friends Meeting Quakers. And why so much has been said that I could reiterate. I think the main things I wanted to say were, yes, starts this process immediately, you know, look very hard at alternatives to, to well. Something there's lots of issues and the profit motive is not good. Look at the county alternatives. Bring somebody formulally incarcerated to the table. That's primary importance. And then the other thing is I was just really touched to hear the words from the doctor who spoke. Tanya, whatever his name was, to hear his words. It's not his fault. It's not his fault that the people who are there in the facility trying to provide this care. I feel for them and I hope that the other direction is taken and something can be done to maintain their involvement and their livelihoods. doing the good work of trying to care for the people. It's uncultiable that the people in prison are putting up with these kinds of conditions and the deaths and poor care. Thank you for opening this up, but thank you for starting the process early. Color, you're on the line. You have two minutes, Masha'i. Yes, the Kai-Si. We're in the center for the Finnetic. I have a different Sunday. They need to count, count eight and 12 more time. Destiny, two of my Jews, sheriff's office. We have Seattle, strong urge for new health life, and we'll have. Persons, disabilities, conflict, love, health needs, deserves spot. So I'm not too increased or anxiety, no who hasn't. They'll do this. And to again, equally participate participate in the community requires health and wellness. to look at a chain of possibilities. That is policies, procedures in your contract, contractual endeavors that will inform a new You have to find with standards and procedures effectively. We're going to undergoing the crisis to the A.C.A And me as a caller. Just a second. The last caller is difficult to hear. I just want to offer if the last caller would like to email your comments, you can email them to district two. That's district number two. togov.org. I just offer that as an alternative because it was difficult to hear what you were trying to say. Thank you. Collar, you're on the line. You have two minutes of laterian. Last caller. Good afternoon, supervisors and sheriff Sanchez. All that are in the room as well. My name is a laterian Hillman representative for in UHW, the National Union of Healthcare Workers. Just wanted to clarify something that was stated earlier about a partnership between well-path and in UHW. We work together, our actually, our members actually, the staff is always advocated for patients, whether it had been Horizon, California, Forensic, medical that we were you were with before as well as well path. They actually have been working with the Board of Supervisors and the Sheriff's Office and have face retaliation from well path for coming forward. So we are not working in partnership. We are working despite the fact that they have tried to stop our members on many occasions from notifying you all and updating you about what is going on within the jail. Thank goodness we were actually able to vote in, Sheriff Sanchez, who has actually come to the table and listened to our members with an invitation to Elpath, which they have constantly refused to show up at the table to actually have these conversations with the Sheriff's Department, with Supervisor Miley and ourselves. Our members have constantly been the lookout to let you all know what is going on. They've wring the alarm on many of occasions about staffing issues, safety issues, issues with management and leadership within the jail that are in some cases completely untrained and unprepared to deal with the situations that our members bring forward to them and have unfortunately our members have dealt with tons of retaliation and disclose doors not willing to listen, not willing to make change and not willing to put the patients as a priority as our members have. So I just want to make sure that that is clarified. We are not in any way shape or form working in partnership with wild path. We are offering the best medical service to the members, I'm sorry, to the patients that are within the jail despite of what WELPATH is trying to do. WELPATH has tried to stop our members on many occasions from ringing the alarm, from letting you all know what's going on in the jail. Thank you for your time. Thank you. Thank you everyone again for your participation today. I want to acknowledge the presenters for their thorough and thoughtful contributions. Today's discussion made clear that the issues surrounding medical care at Santa Rita jail are not just technical. They are deeply human. We are talking about real people, many of whom are among the most vulnerable in our community. We are also reminded that procurement processes are not just administrative steps. They are critical moments of decision making that determine how care is delivered and who is held responsible. I want to thank Director Gasway for helping us better understand the mechanics of this process and how we can engage more meaningfully moving forward. As the Chair of Public Protection Committee, I remain committed to ensuring that our oversight is active, grounded in equity, and aligned with the values of our county. We will continue to engage our community members, justice impacted individuals, and system stakeholders in these discussions, as we work toward real measurable improvements. Again, thank you to Sheriff Sanchez, Lieutenant Atiansa, the team at Forvis Mazers, and all community members and advocates who continue to push this conversation forward. We have more work ahead, but I believe we are moving in the right direction and we'll continue to ensure that we all continue to ensure that we do that together. So thank you to all and earlier I misspoke, we actually can't make a motion. We're not allowed to take action as an action I must not be in agendas. So I'd like to offer some direction as the chair of this committee Thank you my colleagues for joining us today and would like to see if they are receptive to holding another joint Health committee as well as public protection committee in the month of September to receive Updates and follow up on the corrective actions and get any type of updates with next steps. So that is an ask I have with my colleagues if they are open to another joint meeting in September date to be determined. Can we not do it on a Friday afternoon? Probably not. We meet almost every day so scheduling is really hard. We'll try but not likely. Yes I'm open to another joint meeting of the Health Committee and public protection since this overlaps. Can I ask staff a few questions? Yes, and then I have one more thing. Yes, go ahead. I know Aaron will coordinate. So, first of all, with Alani, thanks for bringing up the board. Typically, we don't shape the RF keys. It's highly unusual for us to do that. We have done that with EMS contract because it's, you know, it's a very important contract. So we'll probably provide some input on this RFP. I know the sheriff is on top of it, because I've had conversations with her, so I know the RFP's gonna be much more extensive than what's occurred in the past, but typically we don't shape the RFPs, but we can. I'd like to see if Dr. Moss is here, if Dr. Moss has any input that he'd like to provide because you do evaluate health care out of the jail, right, Dr. Moss? And from the public, he's our public, our health officer. And I'd like to see if Dr. Moss has any reflections on what he's heard today. And then I'd also like to know whether or not from faith, are we holding well path to a higher standard than what we should be holding them to, or is this something that's reasonable within the industry? So those are a couple of questions if we could maybe have responded to. Faith, if you are ready to respond since they're deliberating. Thank you. So you can confirm that I understood the question correctly is if we are holding well path to a higher standard than what is expected across the industry? Across the industry, yeah. We're actually, them to the same standard across the industry, the the healthcare industry also understanding that this environment is high risk and that it's a vulnerable population. The 90 to 95% is best practice across all of healthcare again taking into consideration all of those limitations, whether it's with the medical record, the facility design, and again, the high-risk population. Does that answer the question? Yes, you did, thank you. So Dr. Maul. Sorry. Yes, so if I can borrow a minute, just pop quickly. When you do quality assurance assessments for county jails that have their own medical staff within their own system. How do they compare? So it's a it's a very complicated answer. It's challenging to do apples to apples comparison because of facility limitations, medical record limitations, or if the care is being provided together with medical and behavioral health are under one organization versus separated. Not an easy answer. I guess what I'm trying to understand is when you have those systems under one umbrella, they work seamlessly at a high level. However, there's that caveat of what is that medical record look like. It's, unfortunately, not that simple. I wish I had an easy answer. Okay, so do these other county jails that have their own medical services all have like epic or they have their own medical record. Some there are some it varies across the country. There are some that will actually have their medical record within Epic that actually do what's called the community connected in extension with Epic where the medical services within the jail that have Epic are extended from the medical services that are provided across within the county. Does that help? Thank you. Once we convene, the next meeting will be able to flesh out some of these questions as well. But Dr. Moss, do you have a response for Supervisor Miley? Yeah, and I'm asking Dr. Moss since he's our medical officer and kind of has a lot of authority if he has any reflections But I also want to make sure that the health care agency has heard what's happened here today And we know from county council we can take another route So I don't want you to be totally dismissive of that possibility in working with the sheriff's support Sure, and I think since our agency director is, interim agency director is here, I would defer to her to speak to the agency perspective on some of the things that have come up today. Also, I think as you know, Supervisor Miley, we are a committee from Alameda County Health is. And as was brought up in the presentations today is advising the sheriff on the medical quality oversight work that's being done. So Dr. Kathleen Klan and actually leads that effort for Alameda County Health and is on the line. So I just wanna make space for her to comment. And then she is, yeah. But I can also just, from my perspective, so I, as I think, you know, I lead our title 15 inspection that has to do with ensuring that health care and mental health care at the facility is meet state defined standards. We do that on an annual basis. And so through both of those avenues, I've had an opportunity to participate here. And certainly I think we are glad to be at the table and providing input to the sheriff on this process, it's an ongoing process. And I think that we have yet to see the full impacts of the sheriff's efforts to address care quality. And I also want to, in my experience, participating in these efforts, does I think reflect some of what you heard here today, which is there's clearly room for improvement even with the current provider, but also a lot of, I would say, excellent care and commitment to improving care where there are deficiencies. I just, you know, I want to share that. And then in terms of where this process goes, I think, I don't know if our agency director wants to come in and also I know Dr. Kathleen, Clannett wants to come in. Yeah, and I think it's important because you as our medical, as our health officer, Dr. Clannett, as our medical officer, I need, the board's going to be relying on you folks and the agency to kind of give us some guidance here. I think we would be grateful, others can chime in, we would be grateful for the opportunity to advise on the process as it shapes up. I'm gonna go ahead, Director Chandra. Sure, thanks, supervisor. So we have been following the situation closely. And I think one of the things that I do want to share in terms of several of the other counties that have been brought up that, you know, administer the jail health systems, they, we, Elmita County is a little bit unique in that we don't administer our own clinics or hospital system. And so in San Francisco, for example, they can extend Epic because they already had it for their other system. And actually, I don't know if they have Epic in jail in San Francisco, so I shouldn't speak to that. But I imagine in Contra Costa, they do, for example. So there is that component to it. And both our Behavioral Health team and Dr. Clannins's team as well as Dr. Moss. And we also have a public health role within the jail. And so we follow it closely and we partner with the sheriff to provide the best quality assurance that we can support. If you have specific questions about the Ames panel questions, Dr. Clannon and Dr. Chapman from Behavioral Health is also on. I just once again, I think Dr. Clannon, Dr. Moss, Dr. Treble, who's your doctor? Dr. Treble. Mm-hmm. Chapman, I mean, I don't want to taint what we need to do, but we're going to be relying on you folks to let us know if there's an appropriate option other than the private option. Okay. You know, I've had conversations about this in the past. So I think the board's going to really need to know that because you've heard from the public quite a bit on this. And then the other pieces I know I've had conversations once again with county council about this and the board will hear a briefing with the sheriff in closed session down the road. But I don't want to take anything at the moment. Thank you. I'm going to close out discussion because we do need to move along. I want to acknowledge Dr. Trouble. Thank you for being here. I'm not calling on everyone because we do need to move this item along. But I know that you're hearing all the input engagement and we do have a commitment to reconvene again in September. We will get everyone's availability in advance. I say Friday because everyone else sits on committees. So that's the only day that committees typically don't meet. So if we end up landing on a Friday, we will do it earlier, but every other day, every single one of us have multiple committees. So that's why it's really difficult to get scheduling. So in addition to reconvening a joint public protection and health committee meeting in September, date to be determined. I also want to state I've been in conversation with Sheriff Sanchez and I appreciate the fact that she is open to her and I will be holding a joint listening session with community members in July. So many people that have engaged in this topic will be facilitating a listening session to have an opportunity. Obviously two minutes isn't enough time to hear the community input. So those are the next steps and we will now close out this item and open up general public comment. This is on items that pertain to public protection and health committee, but not on the agenda. So if you call us talking about ROV and other stuff, I will ask you to not speak and I'll ask the clerk to mute you. So if you have topics on public protection or health committee, we will now open public comment. John Lindsay Poland. So yeah, I know you're meeting again next week. And I'm going to use it can be very frustrating as an advocate and a member of the public when there's been so much outpouring and then there's no action because it's an information item Right when the chair or whoever makes the decision that it's going to be an information item and not a decision item Makes that decision it restricts what the board or the committee is able to do and so I strongly urge you to make the Item next Thursday about care first a decision item It doesn't mean you have to make a decision, but it allows you to make a decision. In this case, you would have been able to make a decision about emotion, about anything else. And so I just as someone who is, as you know, we've been engaged in conversation about this, it can be very frustrating when it comes as an information item. And then at the end of it, you're not able to actually take an action which so many people in the community have been urging you to do. Thanks. I have no more speakers for public comment. Okay, thank you all for your participation. This meeting is adjourned and be out of lookout once we identify the next joint meeting in September. Thank you everyone. Have a great weekend. I'm going to go to the next slide. Thank you.