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Behind the Bars

Sonoma County wants new mental-health lockup to better serve inmates in crisis

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INCARCERATION SITUATION Sonoma County is applying for $40 million from the state to add on to the main jail.
  • INCARCERATION SITUATION Sonoma County is applying for $40 million from the state to add on to the main jail.

There's a Steve Martin gag from the 1970s where the comedian comes up with fake book titles like How to Make Money off the Mentally Ill.

The joke now finds an unfunny home in the private-equity group H.I.G. Capital, which has a reported 80 percent ownership share in the California Forensic Medical Group (CFMG), the dominant provider of for-profit medical and mental-health care for prisoners in the state.

Monterey-based CFMG has contracts in 27 counties, including one in progressive Sonoma County. The Monterey Herald reported last year that the company's annual revenues are likely in the $50 million–$100 million range. (As a private company, CFMG's financials are not public record.)

The company's profits in turn feed an investor-led private-equity fund whose political activities are dominated by contributions to decidedly non-progressive Republican candidates. More on that in a minute.

CFMG has been under intense scrutiny for its medical and mental-health services. Close to home, three people died late last year at the main Sonoma County lockup over the course of three weeks. The deaths occurred against a backdrop of grand jury and media investigations from around the state that laid bare CFMG's checkered record—and a woefully understaffed county jail. A January article in the Sacramento Bee found that "[i]n a 10-year period ending in May 2014, 92 people died of suicide or a drug overdose while in the custody of a jail served by CFMG." The figure was "about 50 percent higher than in other county jails."

One person in the Sonoma County jail died while he was in a so-called mental-health module. Another died in a cell while she was withdrawing from drugs. The county said at the time that the deaths were unrelated, and that CFMG was on the scene and in a position to assess or treat the inmates, according to an emailed response to a set of questions sent to Sonoma County Sheriff's Office spokeswoman Cecile Focha. Now the county wants to build a new jail for inmates in mental crisis, and is drawing a clear line between medical and mental-health staff.

Because of ongoing fallout from "realignment"—where the state basically depopulated its prisons on the backs of county lockups—the county is now applying for a $40 million state grant to build a new mental-health jail connected to the main facility. Realignment has flooded county jails with low-level offenders, many of them poor and sick.

The Bohemian wrote about the jail deaths back in November. The Sheriff's Office told us then that county and CFMG health workers work closely together to ensure inmate safety.

Back then, Focha described the dynamic between county and CFMG employees when dealing with inmates in mental stress: "No person is placed in a safety cell before a mental-health evaluation, only after. During placement, there is licensed medical [staff] present, as well as mental-health professionals."

The state has made available funds to upgrade county lockups since 2007, totaling about $2.2 billion. Brandon Martin, a research associate at the Public Policy Institute of California, believes this will be the last money the counties will get from the state for prison expansion; he expects to see 35 to 40 counties competing for a share of the $500 million.

Sonoma County is not guaranteed any of the funds (and needs to come up with another $8 million to build the jail extension). But even if the county builds the new jail for the mentally ill, "over the lifetime of the jail, there's nothing to say how you can use the space down the road," says Martin.

Martin also says the jail addition might mean a new contract for CFMG. Its current contract paid out $6.5 million in fiscal year 2014–15; it could pay out as much as $32 million over the course of the contract.

"If Sonoma [County] wins and builds a facility for just medical and mental health, you might see an upgrade in their contract," he says.

Don't count on it, says Sonoma County administrative analyst Mary Booher. "Staff does not anticipate any changes to the contract with CFMG if we are awarded funding to construct this facility," she says in an email.

She explains that "CFMG is responsible for the provision of health services, while behavioral health services for our inmates are provided by county behavioral health staff. The proposal approved by the supervisors is based on behavioral health providing the services to the population in the new facility."

Booher says a new jail would increase the overall county bed count by eight. A unit in the North County Detention Facility would be closed.

"So there will be no increase in contract costs for the CFMG contract for medical health services," Booher says, adding, "CFMG does not provide any mental-health services, nor is that planned in the future, in the existing or any possible future facilities."

"They will, however, continue to be the medical-health provider for all inmates in our adult detention system, which will include the new facility, if funded, at least for the term of their existing contract . . . CFMG may be providing services to these inmates in either the new facility or the existing facility, depending on the needs of the patient."

While CFMG doesn't supply mental-health staff, Focha told the Bohemian last year that "there is close communication about an individual's medical and mental health to insure he/she is provided quality, appropriate resources and continuity of care."

Fair enough, but let's consider the activities of CFMG's investor owners alongside CFMG's documented failures to provide adequate care. You'd be forced to ask: Why is Sonoma County still doing business with CFMG at all?

In 2012, the year before its investment in CFMG, H.I.G. Capital created its Community Intervention Services subsidiary to "acquire, develop and operate a national network of specialized mental-health and substance-abuse facilities and community-based programs." The subsidiary immediately purchased a Boston network of mental-health-service providers called South Bay. That move mirrored to an extent what private corrections corporations such as the San Francisco–based GEO Group have done, says Martin, as he describes a "proliferation of companies trying to cover all areas of the criminal justice system."

Also in 2012, according to data on OpenSecrets.org, H.I.G. directed $382,000 to GOP presidential candidate Mitt Romney. While CFMG was coming under fire for the quality of its care, H.I.G. was kicking $1.1 million in the direction of privatization-mad Republican candidates (out of a total of about $1.4 million they spent in that year's election season). These guys like to cover their bets, so President Obama received a token $13,000.

Then, in 2014, H.I.G. donated $2,000 each to Tom Cotton and Joni Ernst in their successful Senate runs. Let's raise some eyebrows together here: Cotton's the guy who wrote the mullahs in Iran to scare them off the Obama nuclear deal; Ernst is the Iowan who bragged of lopping off hog testicles while demanding that Obama be impeached, Social Security be privatized and people with guns shoot the government if they don't like it.

Kinda crazy.

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