A closer look at why health care costs are rising in the jail.

Katie Rodriguez here. A couple weeks ago I wrote a story that revealed that Wellpath, who’s been the health care provider in the Monterey County Jail for nearly four decades, is no longer in the running for the next contract.

It was big news. Wellpath (which previously operated under the name California Forensic Medical Group) has had a long and contentious history in the jail, with a record of noncompliance and has faced thousands of lawsuits nationwide for poor inmate care.

While reporting that story, a couple details came to light I thought were worth digging into.

The first came during a County Budget hearing in May, when Undersheriff Keith Boyd said that there was a projected $7.2 million increase in health care costs, based on the market.

Health care costs are rising nationwide, both in and out of jails, driven by a number of factors like increasing labor costs, prescription drug prices, chronic disease and an aging population, according to KFF, a nonprofit focused on health policy. In general, health care inflation outpaces the rest of the economy.

I spoke with Chief Deputy Timothy Lanquist for a bit more information on what’s driving these increases here locally. Mirroring national trends, he says the demand for medical and mental health staff has gone up, along with wages for both county employees and private medical vendors. 

He adds that the jail is seeing more people coming in with co-occurring mental health and substance use disorders, requiring higher-skilled staff.

“Community standards are expected—and they're not cheap,” Lanquist says. “We're seeing an increased number of our incarcerated population that have mental health and substance use disorders. A lot of times, those go undiagnosed in the community or untreated until someone becomes incarcerated.”

Which brings me to my second question, which came from documents obtained by the Weekly: What’s causing these more nuanced spikes reflected in data included in the County’s request for proposals?

The County’s data shows specific medical needs that have risen in recent years in the jail. From 2019 to 2023: Hospital days rose from 3,893 to 6,042; emergency room visits increased from 283 to 503; mental health worker numbers rose from 9,470 to 11,860; psychiatric contacts went from 2,913 to 3,284. 

On site X-Rays? Rose from 3 to 146. 

Lanquist points to several factors driving these numbers: the pandemic, sicker populations of new inmates, and changes to the Wellpath contract that increased staffing and added a quality assurance amendment after being found in contempt of court.

“Medical standards are medical standards,” he says, adding that increased public awareness and destigmatization of mental health have played a role in expanding care for incarcerated people. “When you get a sicker population, your costs are going to go up.”

It makes you wonder what the data will reflect with a) adequate attention to inmate care and b) what post-pandemic conditions will continue to look like following 2023.

I was, however, curious about how much relatively newer drugs like fentanyl might be behind some of the spikes. The answer: It’s complicated. Opioids, methamphetamine and fentanyl all contribute to the picture, all of which are wrapped up in questions surrounding mental health care at large. 

“When you start looking [closer] at the driver, was it the substance or an untreated mental health disorder? It's not a one-size-fits-all,” he says. “You have to spend more time and resources really trying to drill down to see what the issues really are.”

For now, the Sheriff’s Office is in negotiations with the next health care provider, to start in January of next year. You can see which companies are on the table here.