A proposal to privatize jail health services comes with a potentially steep cost to inmates and the public
"Overall, our patient population has had little access to health care. For many people, we're the only show in town," Connolly noted.
Poh said some problems could spiral out of control if jail health staff didn't nip them in the bud. If an inmate is exhibiting signs of tuberculosis, for instance, they'll immediately get a mask and be sent to the hospital for screening. Sexually transmitted diseases are also a priority for treatment. "You don't want that person going out infected," Poh explained.
The city takes a proactive stance when it comes to treating inmates, Poh said, because at the end of the day, county jail is a revolving door. "Everybody leaves county jail. They're either going home, to a program, or to prison." If people are released back into the community with contagious, untreated health problems, the risk of exposure can spread beyond jailhouse walls.
San Francisco's current system is considered a first line of defense, in which inmates are "seen as members of the community who happen to be in jail right now," Paradis said.
Privatizing jail-health services would constitute a blow to a wider public health safety net in San Francisco that is already weathering painful cuts. At a June 15 Beilenson Hearing, a state-mandated opportunity for community members to explain the impacts of proposed health and human services cuts to the Board of Supervisors, people came out in droves to protest cuts to programs serving vulnerable residents.
Kristie Miller, executive assistant of the Standing Against Global Exploitation (SAGE) Project, told the Guardian that her organization serves 350 clients a year who are victims of human trafficking and commercial sexual exploitation. The organization stands to lose its mental health funding, so Miller had come out to speak against the cut. "It provides trauma-focused psychotherapy for survivors who've experienced a lot of abuse, violence, and exploitation," she said.
Jeff Schindler, chief development officer for the Haight Ashbury Free Clinics, said he was there protesting a 79 percent funding cut to his organization's 108-bed residential program on Treasure Island. "We won't have a place for people to actually go into residential treatment for their mental health and substance abuse issues," he said. "These are individuals who are going to get their needs met somehow, somewhere, and generally that's going to be at San Francisco General Hospital."
It's in this context that the proposal to contract out for jail health services is being proposed. "It's easy to dismiss prisoners as probably the least valued sector of our society," Deirdre Wilson, of the California Coalition for Women Prisoners, noted at a May 26 hearing. "But the right to health care is a human right."
FOR THE RECORD
According to an estimate prepared by the Sheriff's Department, the city could save anywhere from $11 million to $14 million by contracting out for jail health services, and Newsom's budget assumes a savings of "over $11 million per year."
However, the Controller's Office continues to revise that figure as the debate shifts and concerns are raised about the skill mix that a private firm would use. "We don't really know what it would cost to contract out, unless there was an RFP and a response to the proposal and some discussion about what the staffing requirements would be," Deputy City Controller Monique Zmuda explained at a June 17 hearing. She added that the potential range of savings spanned from $3 million to $11 million annually, depending on decisions that would have to be made about acceptable staffing levels.