Facing heightened scrutiny, sheriff proposes third-party review of jail healthcare. But its model has a problem.

Sheriff Kelly Martinez is asking county supervisors to consider a new model of jail oversight: hiring a third-party expert to oversee the doctors, nurses and mental health providers who staff San Diego’s seven jails.

In a recent memo, she touted the effectiveness of such a model.

She pointed to what she called the Correctional Health Oversight Unit, an arm of Los Angeles County’s Office of Inspector General, “tasked with reviewing medical and mental health care delivery within their county jails.”

Martinez described the unit as a “national example of independent, clinically informed correctional oversight.”

Only that unit doesn’t exist.

“The OIG has no unit as described in that letter,” said Max Huntsman, who heads the agency that oversees the Los Angeles County Sheriff’s Department.

When asked about the reference to the nonexistent entity, the San Diego Sheriff’s Office acknowledged the error but did not explain how it happened — or what prompted the sheriff to wholeheartedly endorse a jail oversight model that has no track record.

Martinez sent the Aug. 5 memo ahead of a Board of Supervisors vote next month on whether to allow the Citizens’ Law Enforcement Review Board, or CLERB, to review the actions of jail health care staff in death investigations.

The review board’s authority is currently limited to investigating in-custody deaths, officer-involved shootings and negligence or misconduct allegations against sheriff’s deputies and probation officers. For years, it has been forced to summarily dismiss numerous allegations against jail medical and mental health staff.

Former executive officer Paul Parker, who quit last year in frustration that the board’s recommendations weren’t being implemented, had for years urged county leaders to expand the review board’s jurisdiction.

“CLERB is not privy to the ‘big picture’ of in-custody deaths without the ability to investigate medical and mental health services provided to incarcerated persons,” said Parker in a March 2023 interview with The San Diego Union-Tribune.

His requests went nowhere until last December, when Supervisor Monica Montgomery Steppe introduced a measure that called for the Board of Supervisors to expand CLERB’s investigative authority to include jail nurses, physicians and other medical staff — including contractors — in its probes of in-custody deaths.

The proposal, which asked county staff to draft language to expand the review board’s jurisdiction, passed on a 4-0 vote despite protest from the sheriff. In a public statement hours before the vote, she said without evidence that the changes were being promoted by activists committed to doing away with jails.

“I believe much of the requested oversight and criticisms of our system are spurred by this movement,” she said. “There is an active narrative that we are not making changes or improving our system. This is a false narrative.”

In her Aug. 5 memo, Martinez urged the Board of Supervisors to delay the vote that would finalize Montgomery Steppe’s proposal.

Expanding CLERB’s oversight would have “a chilling effect on the jail healthcare system,” she wrote.

“I recommend we shift our focus from a reactive oversight CLERB model to a medically based third-party administrator,” Martinez said. “TPAs bring specialization, accountability and efficiency to a process by ensuring services meet professional and regulatory standards.”

Asked to provide an example of a jail system that uses a third-party administrator — beyond the cited L.A. County unit that does not exist — a Sheriff’s Office spokesperson declined further comment.

“We are seeking a process to evaluate our current processes,” he wrote. “We are asking the board to consider an alternative to a post-fatality investigation by a non-medical civilian oversight board.”

“With respect to the CLERB, who shares our goal of improving healthcare delivery in our jails, we believe proactive review of that delivery is a better model,” he added.

Montgomery Steppe declined to comment on the sheriff’s memo but plans to address it in a Monday press briefing, a spokesperson said.

Dr. Marc Stern, a physician and corrections healthcare expert, said he was unaware of any jail system that uses a third-party administrator but believes a model — if focused on process improvement — could work hand-in-hand with CLERB.

“Oversight aims to hold individuals or systems accountable and relies heavily on investigative tools to analyze adverse events, such as deaths,” he said. “Process improvement activities, while not ignoring accountability, are focused on identifying system weaknesses.”

While CLERB’s jurisdiction would be limited to investigating deaths, an entity like a third-party administrator could take a look at the root cause of deaths, serious injuries or lapses in care “and then figure out what we need to change in the system to prevent future adverse events,” Stern said.

Parker said that although Martinez was mistaken about the L.A. County OIG — which doesn’t conduct individual death investigations but instead looks at systemic issues — he was pleased to see it mentioned in her letter.

He has long supported the creation of a San Diego County Office of Inspector General that can monitor medical service providers, conduct jail inspections and audit Sheriff’s Office activities.

“San Diego has an opportunity to create the gold standard in oversight by forming a comprehensive OIG that combines the best practices exemplified by Max’s office with independent in-custody death investigations and the ability to make policy recommendations,” he said.

In her memo, Martinez said she was open to “any possible solution or support from CLERB,” but added, “I do not believe oversight, particularly of our contracted providers, is the answer.”

Alabama-based correctional medical giant NaphCare has been the San Diego jail system’s main contractor since 2022.

Last year, attorneys in a class-action lawsuit seeking to improve jail conditions uncovered confidential documents revealing that NaphCare had relied on unlicensed staff, ignored requests to repair or replace broken medical equipment and failed to fill hundreds of shifts.

The Sheriff’s Office had to twice order the contractor to fix the deficiencies.

A sheriff’s spokesperson said no new corrective action notices had been issued since January 2024.

CLERB Chair MaryAnne Pintar said Martinez’s third-party administrator idea could only work if the outside experts were to report to CLERB or another entity completely separate from the Sheriff’s Office.

She said the sheriff’s claim that giving CLERB oversight of medical personnel would have a chilling effect on the jail healthcare system “cannot be true,” because the plan only covers death investigations.

“CLERB already has oversight over law enforcement officers involved in death-in-custody cases, and in fact already receives medical information,” she said. “However, now we cannot provide oversight of those medical providers. That will change if this proposal goes into effect.”

In her memo, Martinez implied that only professional healthcare providers were equipped to evaluate performances by jail medical and mental health staff. Pintar said the civilian review board will have the resources to bring in outside specialists when necessary.

“CLERB is not trying to make the work of the Sheriff’s Office harder, we’re trying to make it better — and make our jails safer,” she said. “We want to save lives and protect families from the broken hearts we hear about at every one of our meetings.”

At its meeting earlier this month, CLERB passed the new rules that are required before the Board of Supervisors can consider the formal expansion of the oversight board’s authority. That could happen as soon as Sept. 9, Pintar said.

Martinez’s memo this month to county supervisors touts a series of reforms instituted in the years since her 2022 election.

Among other things, the sheriff said, the office hired 74 nurses since July 2024. It also created the position of certified nursing assistant and hired 17 people to perform those duties. She also said she hired and assigned 133 deputies to county jails since the beginning of last year.

But it’s not clear whether the additional deputies and nurses boosted existing staffing levels or filled vacant positions.

“During my time as sheriff I have committed to making meaningful changes, and we are showing substantial progress in advancing jail reform,” Martinez wrote.

“In-custody deaths, drug overdoses and suicides in jails have reached record lows, reflecting substantive and sustainable changes to improve jail safety and the well-being of individuals in custody,” she said.

But while the numbers of deaths has dipped — seven so far this year and nine last year, against 19 in 2022 and 13 in 2023 — people keep dying from neglect, according to sworn testimony recently filed in an ongoing class-action lawsuit.

Several men incarcerated in the Vista and Central jails signed sworn declarations saying that deputies and jail medical staff repeatedly ignored pleas for help from detainees Corey Dean and Karim Talib over the days and hours before they died.

Miguel Angel Lopez Altamirano said it was obvious to him that Dean, who was being held in one of the Vista jail’s administrative segregation units, required professional help as soon as he was placed in a nearby cell.

“He would rub feces on his face and into his beard. He would eat his own feces,” Lopez Altamirano said. “I thought he needed serious medical and mental health help. The deputies told me there was nothing they could do.”

Jesse Gonzales, who also submitted a sworn declaration about what he saw happen to Dean, told the Union-Tribune that Dean seemed to be in a state of acute psychosis for days.

“He was banging on the walls,” Gonzales said. “He was saying he didn’t feel well.”

Larry Lightning, who was in the same Central Jail housing unit with Talib in the days before he died — also an administrative segregation unit — said a mental health clinician barely spoke to the 82-year-old in the hours before he was found dead on July 28.

“The clinician was at Mr. Talib’s cell for maybe three minutes,” he said. “Once the clinician started to leave I got her attention and told her that Mr. Talib should be moved back to the medical unit because he was unwell. But Mr. Talib was not moved back to the medical unit.”

Gay Grunfeld, one of the lawyers representing plaintiffs in the class-action case, said the testimony was so serious she asked the judge to reopen the discovery process so the Dean and Talib cases can be investigated further.

The judge has yet to rule on the request.