Courtney Astolfi
Advance Ohio Media, Cleveland
CLEVELAND, Ohio — Cuyahoga County Council on Tuesday is expected to vote on a $42 million contract with MetroHealth System to take over nursing and all other health-care operations in the county jails.
If approved by council, the three-year deal with an option for a 2-year extension, would require MetroHealth to fully staff medical operations at all three of the county’s jails by Oct. 31.
Under the agreement, more staff would be dedicated to inmate medical and mental healthcare, and medical staff would be overseen solely by MetroHealth. Currently, the county employs its own nursing staff, and MetroHealth manages the rest of the medical providers.
County Executive Armond Budish announced he was negotiating the deal with MetroHealth on the same day in November that the U.S. Marshals Service reported “inhumane” conditions at the jails, including a lack of adequate medical and mental health care. Eight inmates died in 2018.
Many provisions in the proposed contract correspond to problems identified in 2018 by the marshals, common pleas judges and jail medical officials.
Under the agreement, Cuyahoga County would pay MetroHealth $12.75 million annually for staffing, plus other expenses for medical supplies, pharmaceuticals, insurance, administrative duties and accreditation.
Medical staffing would be based on an average of 2000 inmates per day at the downtown jail, meaning the county would pay additional costs and more staff would be brought into the jail if the population increases as it did during the summer of 2018.
Here are other takeaways:
- The corrections officers providing security for medical staff would receive specialized health-care training and would be dedicated to the medical unit. The jail’s former director of ambulatory care told County Council in May that the former jail director scaled back security in the medical unit.
- The county would be required to work with MetroHealth toward accreditation from the National Commission on Correctional Health Care. Health care in the jail must meet the national organization’s standards by January 2020.
- The county would not be able to select or remove any medical staff member, and would have no control over clinical operations. The county would be required to promptly carry out any medical directives issued by MetroHealth’s jail medical director. Budish last year personally demanded MetroHealth remove its director of ambulatory care at the jail after the director told County Council members about the then-jail director interfering in health care.
- The county would be required to staff the jail with an adequate number of corrections officers, and the county would be required track how often inmates are locked in their cells due to staff shortages. The jail for years has used forced lockdowns because of shortages.
- MetroHealth would prioritize the hiring of a staff psychiatrist and psychologist, and would be prepared to start delivering those services by May 1. The five common pleas judges who oversee the county’s mental-health docket said in November that inmates with serious mental illnesses were not receiving appropriate care or proper medications, and that the jail lacked enough mental-health staff.
- Legally-required medical intake screenings would be required to occur at the sally port, which is the first place inmates go when they are brought into the jail. Those screenings were moved to a different area in the jail last year, making it more difficult to ensure inmates were screened. A state inspector in June faulted the county for failing to screen all inmates.
- At additional cost, MetroHealth would provide a dietician to plan healthy and appropriate meals. The marshals found some inmates were not receiving nutritionally adequate meals.
- MetroHealth would be able to weigh in on the county’s choice for jail director, review a credentials and interview candidates. Likewise, the county would be able to weigh in on MetroHealth’s choice for jail medical director. The former jail director, Ken Mills, often clashed with MetroHealth officials and meddled in medical operations, MetroHealth staff have told County Council.
- MetroHealth would provide staff to administer a medically-assisted treatment program for those with addiction issues.
- The county would work with MetroHealth on a new system to process health-related requests from inmates. The current system mixes health-related requests with unrelated requests and grievances. Inmates and jail staff told cleveland.com last fall that grievances often went unanswered or unaddressed for weeks or months. The new system would be in place within 30 days of County Council’s approval of the contract.
- The county would be required to submit jail policies related to inmates’ health and safety to MetroHealth for review and feedback.
- The county would be required to collaborate with MetroHealth in a variety of ways, including participating in a monthly meeting aimed at fixing problems with health care, attending a daily safety briefing to resolve safety concern, and conduct a detailed review in the case of an inmate death, serious injury, or an injury to medical staff.
- The county would be required to provide inmates with adequate hygiene supplies. The marshals found some inmates were denied basic items, such as toilet paper and toothbrushes.
- Medical staff would be required to be properly licensed. The marshals found that many members of the nursing staff, who were employees of the county, lacked proper credentials, or had allowed licenses to lapse.
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