‘It’s scary in there’: Delayed and denied medical care a chronic issue at Sonoma County Jail
Freddy Busio Gonzalez’s arm still causes him so much pain he can’t sleep, put on his socks, carry his meal trays or exercise.
It was broken in a fight two days before he was booked into the Sonoma County Main Adult Detention Facility in January.
Five months after his injury, his most recent X-ray appears to show his arm is still misshapen, and the 38-year-old says he hears the bone clicking inside.
“I can’t feel my two left fingers,” Gonzalez said in a phone interview from the jail last month. “I can’t move around — it hurts.”
Gonzalez fears his arm won’t heal properly without more intensive medical intervention, including a procedure to set it, a cast or even a store-bought brace — treatment, he says, he’s been denied.
“They know my arm is messed up, and they choose to ignore it,” Gonzalez said.
While Sonoma County Sheriff Mark Essick denies the claims of inadequate care and says Gonzalez has had 10 medical visits in five months, the case is not an isolated incident.
In April, the union representing nurses with the company that manages health care for the Sonoma County Jail wrote a letter to the Sonoma County Board of Supervisors saying chronic understaffing has made it almost impossible for them to provide adequate care for the jail’s 600 to 1,000 detainees, who include both convicted inmates and those awaiting trial. At the time of the letter, nurses estimated 300 cases had gone more than 14 days without being addressed by a health care professional, even though protocol calls for detainees to be seen within three days of a complaint.
In a November audit, the county’s law enforcement watchdog agency identified health care as one of the primary problems the jail must address, and two attorneys who represent detainees have documented more than a dozen cases where clients have gone without adequate health care in recent years.
Essick says the jail’s health care provider, Wellpath of Nashville, Tennessee, has failed to provide the staffing required under its contract with the county. However, he disputes characterizations of inadequate health care in the system.
“We are not a hospital by any means,” he said. “We spend a significant amount of time, effort and money making sure inmates get the urgent care they need.”
A Wellpath company spokesperson blamed the staffing woes on the pandemic.
“The nation is in the midst of an unprecedented crisis in nursing and mental health staffing, which has been exacerbated by the COVID pandemic. Like all health care organizations across the country, we are experiencing staffing challenges as a result,” said Wellpath spokesperson Judy Lilley.
Lilley said the company is doing its best to “ensure sufficient staffing levels to provide quality patient care.” She did not respond to follow-up questions.
After Wellpath’s previous medical contract with the county expired last year amid charges of chronic short-staffing, it was awarded a new five-year contract in October. This time, though, it contained additional provisions for quarterly personnel reports to the Board of Supervisors — an attempt to compel Wellpath to fulfill staffing requirements.
In May, the most recent report showed “the problem is not completely resolved,” Supervisor Chris Coursey said.
Chronic short-staffing under Wellpath
Since the Wellpath contract took effect in November, the company has consistently filled less than two-thirds of its more than 40 contracted positions. The company continues to receive more than $8 million a year from the county under its contract, though Essick said it has paid back over $100,000 this year, adding this was “not a permanent solution.”
According to the April letter from the National Union of Healthcare Workers, total union medical staff in the jail shrunk from 82 to 60 employees between July 2021 and March 2022. Only 59% of the registered nurse hours Wellpath is contracted to fill were staffed between the end of 2021 and March 2022.
And six of 15 registered nurse positions were vacant since the new contract was signed. Those vacancies were either filled by per diem or overtime employees or went unfilled.
“Short-staffing has created a sustained domino effect of delayed patient care that may violate patients’ rights,” the union’s letter states.
Essick said those claims were “largely generalizations.” Though some full-time positions are vacant, he said, “We are still staffing a huge number of hours,” with per diem and overtime staffing making up a big chunk of the difference.
Under its contract, Wellpath is required to have around six nurses in the jail per day shift. But three nurses on staff told The Press Democrat they have often worked alone or alongside only one other medic while serving a detained population of 600 to 1,000.