By Kelly Davis
The San Diego Union-Tribune
SAN DIEGO — San Diego County is poised to significantly expand the authority of its Citizens’ Law Enforcement Review Board through a proposed ordinance that would, for the first time, give the oversight panel jurisdiction over health care providers in the county’s seven jails.
The Board of Supervisors is expected to take up the first reading of the ordinance Tuesday, with a final vote scheduled for Sept. 30 . If adopted, the change would make San Diego County the first jurisdiction in the U.S. to grant a civilian oversight board investigative powers over correctional medical and mental health staff.
The reform would authorize the review board, also known as CLERB, to investigate actions taken by medical and mental health providers in the event of an in-custody death — an area of jail operations that has long remained outside of civilian review.
A summary of the proposal notes that “there are no known civilian oversight bodies with jurisdiction over health care providers in prison or jail settings.”
CLERB leadership has advocated for the change for years, citing the board’s inability to answer key questions when a person dies in custody.
The review board first voted to explore expanding its authority in October 2021, at the urging of then-Executive Officer Paul Parker. The board’s jurisdiction is now limited to looking into whether policy violations by sheriff’s deputies played a role in a person’s death.
“If we cannot look at the care provided to people in custody, we really are not getting the full picture,” Parker said at the time.
The proposal stalled after the resignation of Supervisor Nathan Fletcher, a supporter of stronger oversight, in March 2023. Parker resigned a year later, citing frustration with persistent roadblocks to reform.
But Supervisor Monica Montgomery Steppe, who was elected in November 2023 to the seat Fletcher previously held, has taken up the legislative effort to expand CLERB’s jurisdiction. Speaking at a December news conference outside the County Administration Center, she said she and her colleagues have a moral obligation to act.
“The individuals who have lost their lives are not just statistics,” she said. “We owe it to their families, their communities and our own collective conscience to ensure that these deaths are investigated thoroughly, transparently and fairly.”
She cited a 2022 state audit that documented 185 deaths in San Diego County jails between 2006 and 2020 and found that conditions were so dangerous, new laws were needed to protect people held inside.
“More disturbingly,” Montgomery Steppe wrote in a memo to her board colleagues, “after the report was published, the rate of in-custody deaths in San Diego County jails further increased. In 2021, there was a record of 18 jail deaths, which was surpassed a year later, when there were 19.”
Jail deaths have declined since Kelly Martinez became sheriff. There were 13 deaths in 2023 and eight in 2024. Eight people have died so far this year, including 35-year-old Steven Curren, who died just last week, one day after being taken into custody.
Public records and lawsuits show that many in-custody deaths involved serious health care lapses — medication being withheld, delayed care and failure to monitor people with serious illnesses.
The family of Elisa Serna won a $15 million settlement from the county and a jail medical contractor last July. Serna died Nov. 11, 2019, five days after she was booked into jail. Records obtained through her family’s lawsuit showed that she hadn’t been placed on drug- and alcohol-withdrawal protocols, even though she had been candid about her drug and alcohol use during the intake process.
Michael Wilson already suffered from congestive heart failure when he was booked into the downtown Central Jail on Feb. 5, 2019, but he never was given the prescription medications he relied on to stay alive. He died nine days later at 32 years old. Last November, his family was awarded $6 million.
And over the last two years, the county medical examiner has twice ruled the death of a person in sheriff’s custody a homicide due to neglect.
Keith Bach died Sept. 28, 2023, hours after his insulin pump ran dry. A nurse had requested an increased dosage, the medical examiner’s report says, but the approval was “pending review” at the time of Bach’s death. There is no record of Bach receiving any additional medical care
The other homicide ruling was made after the March 17, 2022, death of Lonnie Rupard, who had been diagnosed with schizophrenia and other mental health disorders. He died from malnutrition, dehydration and pneumonia, in what the county deemed a homicide by neglect.
“While elements of self-neglect were present,” Deputy Medical Examiner Bethann Schaber wrote of Rupard’s death, “ultimately this decedent was dependent upon others for his care; therefore, the manner of death is classified as homicide.”
CLERB leaders say surviving relatives have long urged them to investigate their late loved ones’ care in jail.
“Families of people who have died in custody come to every one of our meetings,” CLERB Chair MaryAnne Pintar told The San Diego Union-Tribune, “and they plead with us to look at how health care is provided in our detention facilities and how that may have played a role in the death of their loved one — but currently we have no authority to do that.”
Sheriff Martinez has repeatedly objected to the plan.
In a March 11 memo to county supervisors, she warned that expanding CLERB’s oversight to include medical providers could have unintended consequences.
“Compliance with an ordinance giving civilian investigative authority oversight in this area would result in a severe lack of appropriate medical care for a high-risk and vulnerable population,” she wrote.
Martinez said the county’s two health care contractors — NaphCare and Correctional Healthcare Partners — had warned they might terminate their contracts or seek significantly higher compensation if subjected to civilian oversight.
“Both providers stated they could potentially end their contract … or if they moved forward, they would have to mitigate risk to their operations by substantially increasing their costs,” she wrote.
In an August memo to the Board of Supervisors, Martinez proposed hiring a third-party administrator to oversee jail health care instead.
She cited a model she said existed in Los Angeles County — the Correctional Health Oversight Unit housed in the Office of Inspector General. No such unit exists.
The Sheriff’s Office later acknowledged the error but offered no explanation.
The union representing jail nurses and mental health clinicians has also raised concerns. At a CLERB meeting in March 2023 , SEIU Local 221 President Crystal Irving urged the board to engage with medical staff to better understand challenges they faced.
At the same meeting, jail nurse Ciani Palencia warned that expanding CLERB’s authority would worsen existing staffing shortages.
“Our staff is under a lot of pressure, a lot of scrutiny,” she said. “This will make it harder to fill vacancies and retain staff.”
Martinez echoed that concern in her most recent memo, saying the proposal would have “a chilling effect on the jail healthcare system.”
Pintar, the CLERB chair, says the ordinance is about targeted oversight, not disruption. She pushed back on claims that the proposed change would disrupt care or burden health care contractors.
“The proposal before the Board of Supervisors does not give CLERB oversight over the jail healthcare system, only over healthcare providers who are involved when there is a death in custody,” she said.
Pintar said the board has gotten funding to contract with outside subject matter experts to provide medical expertise. For fiscal year 2026-27, CLERB plans to add two more special investigators.
“CLERB is not trying to make the work of the Sheriff’s Office harder,” she said. “We’re trying to make it better, and make our jails safer. We want to save lives and protect families from the broken hearts we hear about at every one of our meetings. It’s so painful to hear, and this could lead to new solutions.”
Pintar also said neither of the jail system’s contracted medical providers had reached out to CLERB or the Board of Supervisors with concerns.
“This ordinance adds oversight over medical staff for death-in-custody cases only,” she said. “It should be our collective goal and hope that CLERB rarely has to exert this new jurisdiction. It’s certainly mine.”
What impact might civilian investigations into jail medical care have on staff retention and public trust?
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