MARIETTA — Of all the county leaders present for Thursday’s meeting with the Cobb Legislative Delegation one was notably absent.
Cobb County Sheriff Neil Warren did not attend the annual session with Cobb lawmakers, when heads of county departments and school systems typically meet to discuss their legislative wish lists ahead of the next meeting of the Georgia General Assembly.
Instead, Louie Hunter, the sheriff’s legislative liaison, and Chief Deputy Sonya Allen fielded the legislators’ questions about the seven inmate deaths that have occurred since December 2018, as well as the mental health care inmates receive.
After the delegation meeting at Jim Miller Park, Hunter told the MDJ the sheriff had discussed his legislative priorities with many members of the Cobb delegation during a luncheon at the jail in September, and felt then he’d covered all of his concerns.
“We had seven or eight items on the agenda,” Hunter said Thursday of the September meeting. “The sheriff just felt that today was something that Sonya and I could have.”
Deaths and investigations at the Cobb jail
Sen. Jen Jordan, D-Sandy Springs, got straight to the point in her questions to the sheriff’s representatives.
The state senator wanted to know the status of investigations into the deaths of seven inmates over the last year.
“Have you all done a full investigation with respect to each of the deaths?” Jordan asked Hunter and Allen.
Hunter made a correction before delving into his answer: only one inmate died inside the jail, he said. The other six died at local medical facilities or other locations under medical supervision.
“After they experienced some kind of health crisis at your facility, correct?” responded Jordan.
Hunter confirmed Jordan’s assumption, adding that many of the inmates who enter the jail haven’t seen a doctor in years, and arrive with pre-existing health conditions or addiction issues that complicate their care.
“That may not show itself to our medical providers until it becomes a serious situation, but the minute those are identified, they are sent to our infirmary, and WellStar physicians see them there and recommend them to the emergency room,” he said. “Our stance has always been we don’t tell them how to do medical, and they don’t tell us how to run the jail.”
When Jordan asked again whether each death had been investigated and whether conclusions had been made, Allen chimed in.
The chief deputy said internal administrative and criminal investigations are always conducted when inmate deaths occur, and in the recent cases, she said policies had been followed and pre-existing illnesses led to many of the deaths.
Jordan further pushed the sheriff’s representatives on whether they’d asked an independent agency, such as the Georgia Bureau of Investigation, which routinely investigates incidents like officer-involved shootings, to “review the processes and to make sure that there isn’t something happening that shouldn’t be happening.”
Allen told the lawmaker that sheriff officials had reached out to the GBI and were informed that the agency no longer reviews the internal investigations of local authorities.
“They have other jurisdictions that aren’t as large as ours where they actually have to do the investigations, so they cut back on reviewing of larger agencies’ investigations,” Allen said. “This has been a longstanding thing. Not something that just happened.”
Allen also said that in one instance in December 2018, Sheriff Warren called GBI Director Vic Reynolds and formally requested that his agency come in.
Allen later clarified to the MDJ that the sheriff’s office doesn’t typically ask the GBI to review any of their internal investigations.
Jordan told the MDJ after her exchange with Warren’s representatives that she felt her question hadn’t been directly answered. She also said sheriff offices across the state function as their own constitutional offices with few opportunities for outside agencies to provide oversight.
“It’s my understanding that the GBI is one of those agencies that can come in and do an investigation when it comes to things like inmate deaths,” she said. “But usually, the only way the GBI will do that is if the chief judge of the Superior Court requests it, the district attorney requests it or the sheriff himself requests it. That was my question: whether or not the sheriff had in fact requested for the GBI to come in and do an analysis, because I think we can all agree that the number of deaths is troubling, and it’s really not something that we should be seeing or we have seen previously. So if there’s a problem that we need to fix, then obviously we need to figure out what it is.”
Jordan said it is her intention to “get down to the bottom of it.”
Confirming Jordan’s understanding, GBI spokesperson Nelly Miles told the MDJ the state agency investigates inmate deaths only when an investigation is requested by local authorities. But, she said, the agency does not review the local sheriff’s office’s own internal investigations.
Health care in the Cobb jail
Hunter said the “single biggest issue” facing the Cobb County Sheriff’s Office is the mental health of its inmates. About 40% of the jail population of 2,000 are on medication or receive care for psychological issues.
He said caring for these inmates is costing taxpayers around $22 million to $25 million per year. Peace Officer Standards and Training certifications are not enough for corrections officers to handle the challenges of mental health patients on top of their regular duties, he said.
Hunter also said many of the inmates with mental health issues should not be housed at the jail, but rather at facilities with tools and experts equipped to provide the 24-hour care those inmates require. He added that even transporting the inmates to their necessary appointments takes “hundreds, if not thousands, of man hours.”
“And they have to be taken by a deputy. So that’s a deputy who’s out of service. It’s a hard problem to deal with,” Hunter said.
Also as part of his presentation, Hunter informed the lawmakers that the sheriff’s office’s health services contract with WellStar Health System would be ending either this month or next. A new health care provider would be presented to the board of commissioners in the near future, he said, declining to provide a name of the company at this point.
“We’re in the contract process, but it should be finished within the next week to 10 days,” he said.
Hunter later told the MDJ that WellStar elected to end that contract, saying the health system told the sheriff’s office that providing health care services at the jail no longer fit the system’s business model.
“It was a great partnership for a really long time,” he said.
Hunter said WellStar provided the jail with all its health care services, from nosebleeds to long-term care. There will be no gap in care during the transition to the new provider, he said.
Rep. Sharon Cooper, R–east Cobb, chair of the House’s Health and Human Services Committee, took issue with the sheriff’s office announcement, saying that when she’d inquired about the status of the department’s health care dealings, she was under the impression the jail was losing its provider and a new one had not yet been selected.
Cooper added that, as she understands the issue, WellStar is no longer providing its services to the jail because of liability issues following lawsuits stemming from the recent deaths of inmates.
When asked about the contract termination, Leo Reichert, WellStar’s executive vice president and general counsel, did not reveal why the health system decided to discontinue the contract it has held with the sheriff’s office since 2004.
“In 2018, we began to collaborate with the Sheriff’s Office to help identify a new health provider for the Detention Center, while continuing to provide clinical services,” Reichert said in an emailed statement. “We have also offered our assistance to the Sheriff’s Office to ensure an appropriate transition to a new provider following the expiration of the WellStar contract in early January 2020.”
On Thursday, Cooper told Hunter she took issue with the announcement of a new pending provider, because when she’d recommended sheriff’s office officials begin a contract with providers from the state’s Federally Qualified Health Centers, federally subsidized community health centers that allow customers to pay on a sliding scale, the providers were told they could apply.
“Supposedly, the (application) process was open, but they were told it was already closed,” Cooper said. “It seems like that would be a perfect fit. ... We were trying to help and give them an alternative that would save them money.”
The Chatham County Sheriff’s Office already contracts with the FQHCs, which have 229 locations in Georgia, and has been “very pleased” with the results, she said. She said many locations also have physicians trained to provide mental health services.
FQHCs would not only provide the jail with the health services and medications it needs at a reduced cost, but it would also prevent the creation of a middle man out of the unnamed “national health care provider” the sheriff is contracting with, according to Cooper.
Liability coverage would also be taken care of by federal officials, she said.
“They’re better able to recruit physicians because of that, and they have really shown that they have better long-term outcomes with people with diabetes and so forth than our Medicaid program does,” she said. “They’re all over the country, and they’re our best kept secret.”
Hunter apologized to Cooper for the misunderstanding during the delegation meeting and added that the sheriff’s office will contract with the unnamed national health care provider, which will then have the opportunity to subcontract with providers, including FQHCs, to provide more specific care, including for mental health, HIV and others.
Allen and Hunter said the miscommunication may have occurred at the hands of the Cobb County Purchasing Department, whose staff is responsible for advertising whether the county’s request for service provider applications is still open.
“Looks like it was a really costly miscommunication,” replied Cooper.