Tuesday, August 17, 2010 | Another "no-confidence" vote is making the rounds among the staff at the Orange County Correctional Medical Services division, which provides primary and specialty medical care for thousands of inmates across the county's jail system.
This is the same division that has triggered a series of grand jury reports in recent years along with a critical look last year from the county performance auditor after two controversial deaths.
Both inquiries into the Correction Medical Services division found problems with equipment, staffing and communication from managers. And a year later, the union representing medical workers at the jails says things have gotten worse. The no-confidence vote hovers at 96 percent, officials disclosed this week.
Staffers are experiencing historic low morale, union officials argue in official letters sent to the Health Care Agency this summer. Doctors won't take the job, and nurses are being left alone in the field and are confronted nightly with needlessly dangerous situations.
County officials, including CEO Tom Mauk, acknowledge communication problems but question the veracity of the 96 percent no-confidence vote. In general, they say, the union is misrepresenting the problems facing nurses and doctors in the jails.
Officials point to a low death rate compared to other jail systems in the United States. However, a 2009 performance audit did find that the county has paid out over $1.2 million in recent years to defend 55 claims and lawsuits stemming from problems with jail medical care.
Union officials say county leaders are flirting with disaster.
"There currently are no regular, full-time physicians employed in CMS [Correctional Medical Services]. Two part-time contract physicians serve the approximately 5,000 inmate patients at the jails," wrote Lisa Major, assistant general manager at the Orange County Employees Association, in a May 13 letter to Heath Care Agency Director David Riley.
"This alarming attrition rate creates a hazardous situation not only for the patients and patient safety but also for the nursing staff," Major wrote.
The no-confidence petition circulated among the jail medical staff -- the second petition since 2007 -- directly takes aim at the Health Care Agency leadership for failing to address staffing shortages and failing to provide inclusive leadership.
"The perception persists that licenses are threatened due to the likelihood of errors as a result of the demands placed upon existing personnel to maintain a high level of care with limited access to physicians and other clinicians for support, direction and assistance."
A 2009 performance audit at the jail found that many of the problems facing medical staff are longstanding and have potential for significant problems. "Since the 2002 state budget deficit, which resulted in significant program reductions, CMS [Correctional Medical Services] has had difficulty fulfilling its mission in an efficient and effective manner," concluded the report.
While staff members do achieve "quality inmate care," the audit found that they operate "in an environment laden with management, operational and administrative deficiencies, the cumulative effect of which increases risk exposure to the county."
Among specific issues identified by the grand jury and the performance audit include chronic under-funding and a top-heavy management staff for nurses that doesn't provide enough front-line workers and complicates overall staff shortages. Other major problems revolve around physician review of medications, software database problems that heighten accounting issues, and conflicts of interest.
Mauk acknowledged the problems outlined in the performance audit, but said that most of the issues being raised now are the result of the staff having to get used to new management and a lack of communication.
In a June 30 letter, the Health Care Agency's Riley blasted Major and OCEA for "its negative campaign against the agency."
Riley wrote to Major that "issues are often misrepresented and unsubstantiated."
One issue where there is major disagreement is over the safety of Module K in one of the county jail facilities. Major has gone on record saying the nursing staff -- because of bad management staffing -- has serious concerns about supervision and safety in the unit. Riley wrote back calling her concerns a "misrepresentation."
Mauk questioned the validity of the 96 percent signature rate on the petition of no-confidence. He also said this episode of discontent was probably more closely related to the recent appointment of a new medical director.
New managers typically change how things are done, Mauk said. And that triggers friction, which has to be managed. Yet Mauk acknowledges that the nurses' vote is likely a signal that managers aren't handling things as well as they could be.
"Communication," was one word he used to describe what's lacking.
"The employees have legitimate concerns," Mauk said. "My challenge is to make sure they get heard by management."
That's what Mauk said the last time the issue of nurse staffing arose in Correctional Medical Services, retorted OCEA Director of Communication Jennifer Muir. "We think there needs to be a cultural shift," she said.
Both sides argue they want more collaborative efforts. Management wants a "best practices" committee and criticizes OCEA for its opposition. OCEA, in turn, said that doctors and nurses want real empowerment in figuring out how to best deliver care.
The discord at the jails has the potential to become more acute when more inmates come to the jail via the "beds for feds" contract the county sheriff recently inked with the federal government.
"If staff at the jails doesn't feel they have the support to do their job correctly, then any influx of new patients can't be good," Muir said.