TRAVERSE CITY — Overburdened corrections officers, poor communication between outside health care providers, files of inmate health records one vendor called “a mess,” and not enough nurses to provide basic mental health care to Grand Traverse County jail inmates.
These are some of the issues raised Thursday, during a special meeting of Grand Traverse County Commissioners, scheduled to discuss the county’s 2021 budget.
None came as a surprise to Jail Administrator Capt. Chris Barsheff, who inherited a lineup of management challenges when he was promoted to the post in 2019.
“It’s been very painful for CMH to work with me because I’m very particular,” Barsheff told commissioners. “When I took over the jail, I recognized that things weren’t perfect, in the way care was integrated and coordinated.”
Barsheff replaced former Jail Administrator Todd Ritter, who was forced to resign following accusations of misconduct and dereliction of duty. Ritter was arraigned in August on felony charges, his case was bound over to 13th Circuit Court and a final conference is scheduled Nov. 20.
A consultant from National Commission on Correctional Health Care Resources, hired earlier this year by Sheriff Tom Bensley with commissioners’ go-ahead, found several areas of concern, as previously reported.
Elaine Kaiser, an administrator and registered nurse with Wellpath, the corporate healthcare provider the county pays $675,000 annually, confirmed some of NCCHC Resources’ findings and added others.
“The medical charts, they are a mess,” Kaiser told commissioners. “We have paper charts everywhere. We have seven files that are packed. We can’t fit anything else in them. We don’t have time to put organizers in there, we just need to get on to the next inmate.”
Wellpath is responsible for caring for inmates’ physical health; a $163,000 contract between the county and Northern Lakes Community Mental Health is designed to provide mental health services.
Tension between Kaiser and Joanie Blamer, acting director of CMH, was palpable.
“The medication that the auditors saw that they questioned the use of, higher than in most jails, that medication is not recommended by Wellpath,” Kaiser said. “Those medications were given by the county mental health group.”
The medications NCCHC identified as potentially being over-prescribed included Remeron, Vistaril, melatonin, Wellbutrin, Trazadone, Buspar, Seroquel – all sedatives, muscle relaxants or prescriptions with a history of overuse or abuse.
Kaiser went on to say that in cases of inmate deaths, NCCHC Resources’ evaluation recommended a medical review. If the death is a suicide, the jail does have “beautiful” guidelines Kaiser said, but there should be a “psychological autopsy” completed within 30 days, as the evaluation states.
“Wellpath does that,” Kaiser said. “It’s called a ‘Critical Care Event.’ The only missing component that we have is mental health. Unfortunately, mental health was not providing us with their records. They would pull their records and did not share information.”
Blamer of CMH disputed that, saying that according to their contract with the county, it was the county who was responsible for providing an inmate’s health record. All inmate healthcare records generated by CMH were scanned and logged.
“We did not withhold mental health records, I am not going to be able to stress that enough,” Blamer said. “I think in the process, this report, there were some serious communications errors that occurred.”
Blamer said representatives from NCCHC Resources did not interview her when they made a site visit in July, though the evaluation states they interviewed a CMH behavioral health specialist and a peer support specialist.
“The suicide guidelines that was noted as ‘beautiful’ by Elaine, are what we use in the jail,” Blamer said. “Those are the processes that we do. If someone is having suicidal thoughts, they call us, they’re placed on watch, our crisis workers go in, we do an assessment.”
Kaiser offered suggestions for improvement, following the NCCHC Resources evaluation.
Those include transitioning from paper medical records to electronic medical records; hiring a health services administrator to oversee both physical and mental healthcare in the jail regardless of which vendor was providing those services; hiring an office specialist to manage records and free up nurses to focus on providing health services; increase the hours of a part-time nurse to full-time and increase the hours of a consulting psychiatrist who currently provides two hours per week of tele-health therapy.
Transitioning to electronic medical records would likely cost about $30,000 with another $25,000 annual in management, storage and service fees, Kaiser estimated.
“It is a cumbersome procedure right now,” Kaiser said. “Copies of charts are shipped out cross country to our regional director. With electronic medical records, everything is done automatically. The physicians that we have are able to easily log right in to the medical records, they look at the charts and they make the recommendations that way.”
If the county wanted to streamline its inmate healthcare services, Kaiser said Wellpath would be willing to bid on the mental health services that CMH currently provides, though Bensley said he wasn’t sure “putting all our eggs in one basket” was a good idea.
Barsheff has been working with Wayne State University to implement the Stepping Up Initiative, a national effort to reduce the number of people with mental health issues in county jails. Key to beginning that work is the K6, a screening tool to identify needs at booking or soon after, Barsheff said.
The pandemic has slowed progress on the initiative, though Barsheff said it has not dimmed his resolve.
“I vow personally that things are going to get much better,” Barsheff told commissioners. “Like the sheriff said, we are going to take these recommendations very serious.”
Hovering in the background is a class action lawsuit filed against Wellpath in federal court by Detroit-area attorney Matt Robb, seeking punitive and other damages on behalf of two former Grand Traverse County jail inmates.
The plaintiffs are Cheryl Hall and Brad Lafuze, and the suit claims Welllpath policies “cut patients with mental illness off their psychotropic medication first and ask questions later” in order to increase profits.
Both are relatives of Greg Hall, who ran against Bensley in the November election.