Medical inspection adds fuel to lawsuit against Monterey Jail.

An independent assessment of medical services at the Monterey County Jail rips into the practices of the jail and California Forensic Medical Group (CFMG), the state’s largest private correctional health care provider.

The jail’s health services program, including staffing, clinic space and clinical care, is “inadequate,” concludes Dr. Mike Puisis, a correctional medical expert, in a 72-page report. Puisis toured the jail for his evaluation last October.

The report is one of several expert reports released in late April as part of a lawsuit against the Monterey County Jail and CFMG for poor health conditions, overcrowding and other alleged deficiencies. CFMG is contracted to provide medical and mental health services.

The medical team, Puisis writes, is understaffed by at least 40 percent. There are 23 full-time equivalent positions, but the staff is so bare-bones there are problems if an employee takes a day off.

One registered nurse must regularly evaluate all new inmates in jail custody, evaluate sick-call requests, evaluate inmates in isolation cells and sometimes supervise the licensed vocational nurses. “This is not possible for a single RN to perform in an eight-hour day,” he writes.

The doctor also determined that many medical evaluations were either not performed appropriately, or not happening at all. Chronic illnesses are “significantly under-identified,” he reports.

Another factor is the layout and structure of the jail itself.

“I was told that none of the clinical space was originally constructed for its intended purpose,” Puisis writes. “This results in design features that are mostly not appropriate for clinical care.”

The clinic is cramped, and doctors often evaluate patients in a chair. If an examination table is needed, patients are moved to another room, which discourages proper exams, Puisis finds. The clinic examination areas were not hygienic, and the doctor saw no standardization of equipment and supplies.

But the jail’s health care provider is defensive. “There’s a lack of foundation as to what [Puisis] says,” CFMG attorney Peter Bertling says. “CFMG has been in the Monterey County Jail for almost 35 years. Their program has been approved and developed by consultants with the Institute of Medical Quality.”

Bertling contends Puisis’ staffing concerns are inaccurate. “[He] did not adequately or appropriately evaluate the staffing ratio or understand the staffing patterns because he did not ask the right questions,” he says.

An expansion of the jail is expected to be completed in 2018.