20 MONTEREY COUNTY WEEKLY september 14-20, 2023 www.montereycountyweekly.com found to have deviated from the implementation plan’s requirements included that of Sergio Gonzalez, who died in September 2021 amid an outbreak of the Covid-19 virus at the facility. Despite being treated for deep vein thrombosis prior to his incarceration— and being prescribed blood thinners by a Natividad Medical Center physician before being booked—a physician assistant at the jail decided that Gonzalez needed no such drugs, according to Barnett’s reports. While being monitored for a Covid infection, Gonzalez’s condition quickly worsened, and his death was later attributed to coronary thrombosis. Barnett noted that Gonzalez’s “risk for thrombotic events was increased when he became ill with Covid,” and also cited several circumstances in which his treatment fell short of the settlement requirements—including the treating physician assistant withholding Gonzalez’s blood-thinner prescription without oversight from a supervising physician. “In retrospect it is disconcerting that [Gonzalez] never received the prescription for [blood thinners]... even after complaining to a [Monterey County Jail nurse practitioner] that he had leg pain and swelling reminiscent of DVT, and after seeing the MCJ medical director for a six-month exam,” Barnett wrote. He added that, had Gonzalez received his prescription, “the risk of fatal blood clots such as occurred in the coronary arteries would have been reduced.” Gonzalez’s family subsequently sued the County last year for negligence and denial of medical care, among other allegations. A lawyer for the family says the case is ongoing. “I don’t think they took care of him,” Isabel Gonzalez, Sergio’s mother, says of the circumstances around her son’s death. “Maybe they could have saved his life. I don’t think they even cared, to tell you the truth…If they had taken the right steps, I think my son would still be alive.” In 18 of the 19 deaths at Monterey County Jail that they reviewed, neutral monitors determined that the fatalities “could have been prevented with adequate treatment and/ or involved violations of Wellpath’s obligations,” attorneys for the inmates claim. The reports also cite numerous non-fatal incidents where care has fallen short of standards. Inadequate women’s health care is common, including cases that occurred this year. In one instance in February, Barnett found that a 34-year-old female inmate who had requested help to terminate her 15-week pregnancy had not received a response from Wellpath staff for several weeks. According to attorneys, the woman did not receive assistance until the medical monitor “urged Wellpath to take appropriate action.” She was eventually able to obtain treatment in late March—just shy of the 23-week fetal viability mark that bars abortion in California in non-health-threatening circumstances. Another female inmate was admitted to the hospital in December 2022 after failing to receive timely treatment for heavy vaginal bleeding, according to filings. She was hospitalized again in March 2023, underwent a hysterectomy to address the problem, and had to go to the emergency room in April 2023 after her incision reopened and started bleeding. It subsequently became infected “after she received no medical care from Wellpath for four days,” per court filings. Beyond the medical reports, the mental health care standards at Monterey County Jail have proven just as lacking. Inmates’ attorneys note that for all but two of the 17 separate mental health quality indicators evaluated, monitors “have never found Wellpath substantially compliant” since the audits began in 2017. After a site visit this May, mental health monitor Dr. James Vess told the attorneys that he had, just that day, witnessed a patient suffering from a psychiatric crisis who “was made to wait for emergency medication because Wellpath had no on-site psychiatrist and could not reach one by phone,” court filings state. The problems extend to dental care as well. In 2021, dental health monitor Dr. Viviane Winthrop reported that over six visits to the jail in the span of four years, she had found that “little progress has been made towards implementing the mandates of the [settlement].” According to inmates’ attorneys, between October 2022 and January 2023, “Wellpath provided no dental care at the jail because it lacked adequate dental staff.” Staffing has proven a persistent issue at the jail. By October 2022, Wellpath lacked a full-time medical director at the facility, while also having no director of nursing or medical records manager. Barnett reported that the jail’s leadership had told him staff shortages “made it difficult to provide patient care…and perform quality assurance,” and contributed to Wellpath ceasing all initial health assessments for inmates from June to September 2022. By March of this year, the jail had recruited a new medical director but had only filled its director of nursing and health services administrator positions on an interim basis, while also lacking the required number of registered nurses and mental health clinicians, per filings. But even the Wellpath staff available on-site have drawn controversy. Last October, the Sheriff’s Office pulled the jail clearance of Wellpath employee Christina Cruz Kaupp, and placed Sheriff’s Cmdr. Dustin Hedberg on administrative leave, in relation to an investigation over missing narcotics inventory at the facility. The October 2022 medical monitor report alluded to such issues—noting that oversight of the jail’s pharmacy was “poor or absent,” as evidenced by expired or mislabeled medications and “delinquent controlled substance logs.” Wellpath has experienced challenges with staffing at other facilities nationwide, as well. Monitors overseeing the New Orleans jail consent decree have highlighted chronic understaffing; in Massachusetts, a report earlier this year evaluating a settlement between the state’s corrections department and the U.S. Justice Department described Wellpath’s mental health staffing as “unworkable.” A Cape Cod sheriff cited staffing levels as low as 20 percent in recently deciding not to renew the company’s contract. As the largest for-profit prison health care provider in the U.S.—with roughly 300,000 people under its care each day—Wellpath’s annual revenues are now estimated at around $2 billion. It is privately owned by Miami-based investment firm H.I.G. Capital, which has $58 billion in assets under management and has built a conglomerate of correctional services companies covering everything from food to communications. In a 2002 lawsuit deposition, Taylor Fithian, the Monterey physician who founded California Forensic Medical Group in 1984, acknowledged that he had written a letter to Yolo County Jail officials expressing concern over mounting medical costs at the facility. Still, according to a report in the Monterey Herald, he insisted: “I am in the business of being a doctor, but not in the business of making a profit.” Today, Fithian serves on Wellpath’s board of directors. His bio on Wellpath’s website notes that he started his company with the motto: “Always do the right thing.” Wellpath and Fithian did not return requests for comment for this article. During a site visit to Monterey County Jail in March 2023, the jail’s medical monitor met with Nieto and other Sheriff’s Office officials to discuss his findings. According to an email Barnett sent to attorneys involved in the settlement, Nieto and her team “clearly expressed their interest in participating in the process to promote compliance with the implementation plan.” “I believe the Sheriff wants to be ‘kept in the loop’ regarding these mat- “Maybe they could have saved his life. I don’t think they even cared, to tell you the truth.” Anabel Chavez Juan Carlos Chavez’s April 2022 death at Monterey County Jail, which was ruled a suicide, involved “departures from best practices” by the jail’s medical and mental health staff, according to monitors.
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