Good morning, everyone.

If you could please take your seat, we're gonna go ahead and get started.

I'd like to welcome everyone in person and participating remotely to Alameda County Board of Supervisors special joint meeting with Public Protection Committee as well as Health Committee.

This is the morning of September 29th.

I'd like to welcome everyone, and if we could please start with the roll call.

Supervisor Tam.

Present.

Supervisor Miley, excused Supervisor Marquez.

Present.

Thank you so much.

And if the clerk could please share the announcement once we get to public comment after we hear the informational items for those that would like to make a comment in person or online.

For in-person participation.

The meeting site is open to the public.

If you'd like to speak on an item, please fill out a speaker's card in the front of the room and hand it to the clerk for remote participation.

You can use the raise your hand function, and we will have comment after both items.

After both informational items as well as public comment.

Thank you so much, Tisa.

Again, good morning to everyone in person and online.

We have called the special joint meeting of the Health and Public Protection Committees because access to quality health care at Santa Rita Jail is a fundamental responsibility and value for Alameda County.

For context, on March 25th, 2025, the Public Protection Committee passed a motion to advance this critical conversation to a joint meeting with the health committee.

The first joint committee meeting was held on May 16, 2025 and featured presentations by the Alameda County Sheriff's Office and neutral third-party health care consultants, Forvis Mazars, to discuss quality assurance findings and improvement recommendations for medical services at Santa Rita.

Today, Alameda Health Alameda County Health will discuss its assessment of Well Path's corrective action plan submitted in July.

Alameda County Health is currently serving as an interim third-party reviewer as the Sheriff's Office develops its next RFP for medical quality assurance services.

I want to thank Sheriff Sanchez for her commitment and partnership to ensure transparency, accountability, and improvement in care for those in our custody.

This includes protecting the integrity of the procurement process required to develop the next jail medical services contract.

I also want to thank her dedicated team and Alameda County Health's leaderships team for their extensive preparation to support a comprehensive discussion about the state of health care access and quality at Santa Rita Jail.

In July, in partnership with the Sheriff's Office, my office also convened a listening session that brought together a broad group of stakeholders, including Alameda County Sheriff's Office, the Alameda County Health Officer, County Behavioral Health Department leadership, including Forensic Services, County Council, the National Union of Healthcare Workers, a representative with lived experience around the impacts of the criminal justice system, and community coalition advocates.

This was a very candid and collaborative dialogue, helping all stakeholders with better understanding of the county's responsibilities, process, and coordination opportunities ahead.

To the community members and advocates who have continuously engaged our board, agency leadership and regional counterparts, please know this.

We are here today to go beyond listening.

Our charge is to identify how we can make the necessary changes to close gaps in care, strengthen cross-agency coordination, and ensure opportunities for the community to meaningfully engage with our shared objectives.

Your participation is essential to this multi-prong process to improve medical care at the jail and improve and more importantly, protect the dignity for justice involved individuals.

Like any other county service, I remain committed along with my colleagues to hold Alameda County and its partners to the highest standards of care at Santa Rita Jail, including a comprehensive and sound procurement process.

Thank you again to Sheriff Sanchez for her deep partnership as well as Health Chair Supervisor Miley and Supervisor Tam as we continue to move towards that goal.

With that said, I would like to introduce our first informational item, procurement timeline for comprehensive medical services at Santa Rita Jail.

I'd like to welcome Director Gasway, who is participating remotely.

Welcome, Director Gasway.

And let's just um before I advance, can someone give us a thumbs up that the audio is coming in clear online.

Yes, I can hear.

Perfect.

Thank you.

Thank you, supervisor.

Um, so we have a uh slide deck to put online on the screen.

Please confirm.

I think we're gearing that up.

Okay.

So I'm Kimberly Gasway, director of GSA and also the county's purchasing agent.

And I'm here to um talk about the current medical services contract, which expires uh September 30th, 2027, and the procurement methods we're going through right now to procure the next services.

So this is a um basically a generic timeline for a procurement of this um complexity.

And so the first thing is in the past presentation, we had a timeline for spec development, but in conversations with the sheriff's department as well as our procurement team, I changed the date to for spec development to be determined.

They are the sheriff is already engaged with the procurement department to work on the spec development and um in discussions about how the process will run through, but they are just now, they are in the process of working on that.

Additionally, they're looking at bringing on a consultant to help review the specifications to ensure it meets um the needs of the jail population.

So once they finalize that, a procurement of this type typically can take up to 12 months.

Some of our less complex procurements take less time.

So this is just a rough order of what we think how long we think it will take.

So we're more than um, because we're almost two years out, we have plenty of time to get this procurement done as well as offer up a transition time between the current provider and the new provider who is selected.

So we finalize the specification.

County council reviews the posting before it goes online, and that could take back and forth not always two months.

Our council is pretty timely in responding to us, but we did put that in just in case.

Um there's a mandatory bidder's conference, and everyone will need site clearances to go to the jail, and that could take up to a month to schedule the event, get all the clearances.

After that happens, there's a QA period where the uh proposers could submit questions, we get responses.

Sometimes those are also reviewed by council, and then we issue an addendum to the proposals, and the bids are then due typically within a month.

Then once we get those, we do a completeness check, qualifications, reference check, and that can take a couple weeks.

And the CSC County Selection Committee is set up, and conflicts of interest are signed and written proposals.

They begin evaluation that can take a few weeks.

We um once that happens, then we have a county selection committee does a vendor interview.

Uh scheduling that on everyone's calendars can take a couple weeks.

And the final abstract and sheriff concurrence to award recommendation, we review it with the sheriff's department and then tell them what we're going to recommend for award.

Then begins we send out notices to the proposers of our notice of intent to reward award, and then there's a review protest and a decision.

So this is a protest appeal period that all bidders who may uh protest the selection have time to submit those and us to review them.

And then it's um we negotiate the contract and bring it to the board for approval.

Now, this timeline does not take into account the if we get an appeal.

So after we say there's a protest and we review it, and if the protest is denied, then the bidder has an opportunity to appeal that um protest that goes to the auditor's office.

And um, and um so that could impact the timeline.

That's my presentation.

Thank you, Director Gasway.

Um, can you speak to I'm not sure if you have this information, but with your experience working closely with the auditor's office?

Can you give us a rough estimate if there is a protest, how long it typically takes the auditor to make a decision?

Are they bound by any specific regulations like within 30 days, 60 days?

Can you elaborate on that process?

So GSA Office of Acquisition Policy reviews the protest first, and um then we send a response, and that response could be that we uphold the protest.

Um, so then the procurement um we have to start over if we do if we deny the protest um after reviewing all the information.

So that could take quite a bit of time up to a month, that's why that's in there, but then it goes the protester can appeal, and I do not know the auditor's timeline.

Sometimes they're quick, it depends again on the points put up in the protest, but it that could take a significant amount of time.

Okay, thank you.

Um who would be representing the sheriff's office today?

I have one clarifying question with respect to the specification and scope.

Is that Captain Prez?

Welcome, if you could please give your name.

How are you doing?

Lieutenant Dan Murphy, Sheriff's Office.

Thank you for being here.

Um with respect to uh the sheriff's office still developing the specifications and the scope.

Um, can you give us a status update if that work has been started?

Do you know how long that's gonna take?

So work's already been started, it started in July.

Uh we meet regularly to go through the scope and build it out.

Uh, one thing we need to highlight is this contract will be larger than anything ever before.

It'll have Cal Ames in there, the Epic rolling out Epic, uh obviously the consent decree plus uh RAJ and CARES First Jails Last, plus anything else as we go through and build out uh the early access, the stabilization program as well.

So it's a very robust process and system.

Uh we're bringing in experts not only from inside the county, but also outside the county.

Uh we have county council on the team.

We have obviously GSA, the Sheriff's Office, uh, plus Dr.

Clannon and her team are going to be providing input.

Uh, we are currently in the RFP process for getting a new third-party auditor, and once they are selected, they will be part of the procurement uh and creating the RFP as well.

Thank you so much.

Appreciate that.

Um, Supervisor Tim, do you have any questions or comments at this time?

Uh thank you, Chair Marquez.

I uh appreciate the timeline.

I I think I'm we were here in May, and we went through the um medical quality uh report from May SARS.

What I was trying to understand is this is a five-year contract uh that we have currently with this vendor, and you talked about uh there's a lot that have emerged in the last five years, whether it's RAJ, you know, Cal Aim, and then getting the new uh data system with Epic.

Uh how um how has the prior um contracts been um processed in the past?

Like the are they every five years and has it been with the same vendor since I guess since we've got I would have to go back in historical.

I know we've changed uh medical providers several times over the last even my tenure and before then.

Um so I can't I don't have the specific data on how often we've changed vendors, um, and I can get that, but I know we've changed vendors several times since I've been in the sheriff's office.

Okay, I um the the part that wasn't clear to me was uh when the vendors changed uh in the past, whether things that were significantly different, uh, like you said, this time around, we have some new regulations and new uh undertakings uh with the data program, but in the past that we experienced something similar.

I'm just trying to get a handle on the timing and whether or not we we've built in sufficient time, uh, even though it's two years out.

Yeah, um, I think one thing I can I can't speak on the until all of them, but I know COVID was written into the last contract, right?

Because that was a big thing going on at the time when that was being implemented.

Um so I'm sure everything has as time have gone on and things have changed, things have been implemented to make those changes, just like now.

Just now we're gonna have a huge change because we have so many more programs and services uh that are coming to the jail.

Uh so this will be a very robust uh system and RFP.

Okay, I appreciate that.

Um, because you had mentioned specifically uh what we went through with COVID, right?

And we we had to do specific um protocols in terms of isolations and and monitoring and testing, and you know, we obviously um had to learn from that experience and how we are gonna be going forward because we we never had that happen in the past.

Correct, yeah.

Yeah, we didn't have COVID before.

So just like everything we've learned, and we've reached out again, like the early access system.

We've reached out to the state and given guidance for best practices and things like that.

Same thing with Cal Aim as well.

Uh we get guidance from the state.

Uh this RFP will prepare us uh for generations to come.

It's another layer of how we're building and changing what the jail is and what it represents.

Uh the jail is being seen as a place for second chances with our vocational program and all the other services that we're providing.

This is just another layer uh in order to help the the individuals in our custody upon their release.

So we it's gonna be very robust and we're gonna make it uh very multidisciplinary, where our partners with whoever our medical provider is with AFBH and the Sheriff's Office and whoever else comes in, the community organizations as well.

But it's still a five-year contract.

Correct.

I believe that's how they're written out, and that would be more of a GSA.

I believe it is a five-year contract because of it takes a lot to switch over providers uh in place.

Okay, thank you.

Thank you by thank you, Supervisor Tam.

Thank you, Lieutenant Murphy.

Um, don't go far because you're on the next item.

Just wanna remind the public these are informational items.

We are now gonna um hear informational item number two.

This is an update on medical quality assurance monitoring at Santa Rita Jail.

The presenters are Lieutenant Daniel Murphy with Alameda County Sheriff's Office and Dr.

Kathleen Clannen, medical director with Alameda County Health.

Just gonna remind the public after hearing this second item, we will take public comment for two minutes, and then we also have public comment at the end of the agenda for items under the purview of public protection or health committee, but not on today's agenda.

So you could raise your hand and we will get to you after this second presentation.

Good morning, everyone.

Again, Lieutenant Dan Murphy, the sheriff's office.

So we'll go over uh kind of the background of the contract.

Uh, but Supervisor Marquez highlighted it, so we'll go through that quick.

Uh, the quality assurance process, the validation results, conclusion, and our next steps.

Uh again, this was highlighted by the supervisor.

Um, so just real quick.

Uh we con we were here in May.

We presented our findings.

The board asked for follow-up, and this is why we're all here today.

So, what were the scope of this is Title 15 uh as well as other state and federal laws that were required to give medical um services to those incarcerated.

Our current contract will be up in September 30th of 2027.

Uh, so I said earlier, we we are already in the process.

This is a very big uh contract for us, uh, and we're already in the process because we know how long this process will take.

So previously we hired a third party quality assurance, uh, which was Forbes Mazar's at the time.

Uh, they have since their contract is ended.

We're in the RFP process for another third-party uh auditor.

Um, but until that per that group organization is selected, uh Dr.

Clannen with public health has agreed to step uh have her team and they've stepped up to ensure that no lapse is occurred in the third-party auditor.

Uh so I'll hand it over right now to Dr.

Clannon.

Good morning, Dr.

Clannon.

Good morning.

Next slide, please.

So as Lieutenant Murphy mentioned, I'm here representing Alameda County Health as we are substituting for the Mazars report that you heard in May, filling that gap.

So just a quick reminder, particularly for the public about the quality assurance process.

It starts with standards for care being set by national accrediting bodies, in particular, the National Commission for Correctional Health Care or NCCHC is one that's used across the country.

And WellPath, sometimes Mazars, but typically Well Path identifies specific areas of care that are high risk or places that are troublesome, hard to meet.

They measure how well we're doing it on those standards at Santa Rita via a chart review that's done.

Then they pick out, oh, Mazars in this case, would pick out a few areas where the scores are not what we wanted them to be that seem areas that might affect safety.

And those are areas that are assigned for a corrective action.

The focus areas rotate based on performance.

If it gets to a point where the scores are looking good, then that particular area may be moved out to a watch error to a watch list as we focus more on additional areas.

Then WellPath changes what it's doing in order to perform to improve performance, remeasures the results, and then finally the third-party reviewer rechecks the same charts, the same charts on the same individuals that Wellpath measured in order to make sure that what WellPath is reporting is accurate.

Next one.

The first one is quality assurance, and in general, that one focuses on small numbers of folks who have particularly high risk illnesses or conditions.

There's a deep dive that's done on the chart, trying to assess all the different aspects that could put this individual at risk, and it's medically complicated folks.

And then there's continuous quality approvement, typically areas that affect large numbers of people, maybe everybody who's coming in.

They oftentimes focus on screening and prevention tasks, the things that would apply to everybody.

And then in that case, there's a focus chart review done, not on everything, but on the relevant things from a larger number of charts.

And we did both of those things on behalf of the sheriff's office in this review.

Next one.

So that says all of the different relevant important things that are going on with this person's health recorded in the chart to be available so that the person can receive adequate care.

So that's what access to care means in this context.

The initial health assessment, I think is pretty obvious.

And then the informed consent pieces specifically about medications.

If a person says refuses to take a medication that's being offered, then there's a process for making sure to document that the individual knows what the consequences could be of that in terms of their health.

And then that should be documented in the chart.

Next one, those are the quality assurance focus areas.

And then in terms of the CQI areas, the quality continuous quality improvement.

There's screening in the receiving area.

So that's a quick screen looking at that should happen for everyone coming in to look at anything that could be an immediate danger.

Is this a person who has diabetes who's on insulin?

Is this a person who might have a seizure?

Is this a person withdrawing?

Things that require immediate attention and thought in terms of where that person needs to be for the next hours.

There's chronic care, the different aspects of providing care to someone who has a chronic illness, and then a specific focus on withdrawal, in particular from either opioids or alcohol.

Withdrawal from alcohol can be very dangerous, actually can be deadly, and withdrawal from opioids is really dramatic and is something that we can intervene to assist people.

So and those two things happen typically begin within the first 24 hours that people are incarcerated.

So there is a focus on them.

So those are kind of the areas of care that Mazaras reported on and were their focuses when they talk with you in May.

Next one.

Our involvement is Alameda County Health, included reviewing the previous Mazar's reports so that we could make sure that this one links to those and is understandable to you and to the to the public who are interested in this.

We met with Wellpath to understand their findings from previous reports and also their most recent report from July.

And then we did with the assistance of an experienced nurse who does the same chart reviews for NCCHC, and with the guidance of a few people I'll talk talk about in a second, we did a review, a validation review.

So we went back through again the same charts, the same people's information to see if what WellPath was reporting, if we agreed with it.

Our group includes myself, the health officer, the director of public health nursing, and our also our chief medical office for behavioral health.

Not all of those people were involved in this particular review, because we are being attentive to issues around the procurements underway.

We also relied on two subject matter experts.

We have a physician who's in correctional health in a neighboring county, and also a nurse chart reviewer that I mentioned before who has many years of experience.

So next one.

In terms of the review, the results of our review.

And the next one.

So I want to just orient you to how these reports are looking.

We tried to mirror the way that Mazars constructed their reports, but with a little a few changes.

So you can see there the topic, the subject matter of the area is listed over on the left.

These are all were selected by Mazars at the beginning of the year because they identified that these were places that needed attention and needed to improve.

And then finally in the final column, there's what did we find?

And when we looked at our validation.

So a couple of additional things I want to say that there are blanks next to restraint seclusion and the informed consent.

Those, there were two other items that Mazars reported to you on to you reported to you on in May.

Those are retired because the scores reported, you may remember that Mazar's reports them as corrected, that the scores lifted to a point where they were no longer on a watch list, they're now on a yellow list, so we'll go back to them.

But that's why these two new ones were rotated in as being the next areas for focus.

And so this was an initial review that Wellpath was reporting to us.

So you see the scores.

What we found was that we agreed with every chart that was reviewed.

We agreed with what WellPath was reporting.

A couple of notes, what we identified as new to this process that's struck me as illuminating, I guess, is uh as you know, well path and behavioral health have different electronic health records that requires for the first issue the problems and alerts requires that problems be listed be entered twice by a person who finds out that there's a problem, once in the in the well path record and once in the behavioral health record, if the patient has both those kinds of problems.

And it is difficult to get people to do that to double document.

So the good news is that an action that you've already taken and supported is in terms of the replacement with a unified medical record will likely result in improvements actually in all three of these items.

You remember that is if a patient or an incarcerated person refuses a medication being brought to them.

Is it documented in the chart that they that there was a refusal, that it was witnessed, and that the person was told, hey, if you don't take your blood pressure medicine, this is what could result.

What we found when we looked in there is that the refusals were being documented in a very high percentage of the charts, but it was missing associated kind of documentation, in particular the reason for the refusal.

Why is this person saying that they don't want their medication?

And then also a witness signature, which is typically one of the deputies saying that they were there and saw that this occurred.

So it's a complex process actually to get to get consent and uh to sorry to document that there has been informed consent that a person is refusing because it requires several people to do this documentation.

Next one.

Also for chronic care.

Each of those is a very complex uh segment.

Receiving screening has 17 elements that need to be met for it to be considered a yes, and chronic care has 14 elements.

And what you can see here is that the chronic care percentage stayed essentially stable, but there was a decrease in performance from July of last year to July of this year, and from the those results reported to you in May.

And in the case of the receiving screening or a validation and report, we found a couple of charts in which we disagreed with what Wellpath had said.

Again, a note that for the screening in receiving, what we discovered was that it was happening within 24 hours in a high percentage, but that the struggle or the difficulty was around achieving it during the eight-hour timeliness standard, which is required by NCCHC, and which is actually very important because those items being screened for are timely.

Then the final CQI report.

This one is for alcohol withdrawal and opioid withdrawal monitoring.

Um is a 24-hour activity.

People are withdrawing, and they need to be monitored for any dangerous consequences of that.

And what we can observe is that again we did not see improvements across the board between last time and and uh between the January results and our current results.

And in general, when we looked at try to identify why that was happening, the major fallout was again that documentation of why an inmate was refusing the either medication or monitoring.

So what it consists of is the nurse would go in, ask the person how they were, observe their behavior and other signs, would also take blood pressure and ask them if they wanted medication in order to address symptoms, and in particular on the night shift, if people don't want to be disturbed, they may be refusing.

We did not see documentation that the nurses were taking the next step in order to observe and see what was occurring.

So, next one, and the next one.

Thanks, Lisa.

So our overall impressions.

We were able to confirm to confirm that the report that WellPath was submitting showed that that what they were reporting was accurate.

We saw evidence that time and effort were being invested by Well Path in making improvements.

We saw that in the form of training, logs of training of their staff and other evidence of different management interventions.

We also saw, as you will have also, that we're not seeing sustained improvement on these areas of focus.

Some go up, but then they come back down again.

We don't see a steady or even unsteady progress toward improvement and being able to retire all of these measures and move on to new things to focus.

So, in my opinion, um the likely uh difficulties that are being experienced.

One is that it's a complex environment to make change in.

There's uh ACSO, Well Path, and also AFBH, which is the behavioral health arm of my own agency, all of them touch these processes and all need to be in alignment about how to change them.

Big changes are harder when you have multiple um multiple large organizations touching a process.

The lack of unified EHR, which you have addressed, thank you.

That support is going to make a big difference.

The general difficulty of making large system changes, and that's what's required really to address a lot of these things, and then the difficulty of managing a 24-7 365 workplace.

It that I have been in charge of doing that before, large hospital systems, and it's very, very difficult to make sure that the nighttime health care is the same as the daytime health care.

Um, and uh in particular, we saw that uh documentation was uh was really a struggle and making sure that that was consistent and that uh the culture in the organization uh is attentive to that.

So next one.

I think that's it for me.

Thank you, Dr.

Clannon.

All right, so upcoming.

Um so obviously, like I the RFP for a third party consultant is out.

Uh Dr.

Clan and her team will still be involved of this process, even when the third party is decided.

Um, we are like we're very developing a very robust and complex, using our lessons learned from now, plus where we see the future of our agency and the facility going with Cal Aim and Epic, as I stated earlier, uh, in through this next RFP.

It'll be one of the most complex RFPs that we've done in partnership with procurement.

And we are going to work with county council and look at the current provisions we have to establish penalties and things like that with the lack of movement.

Um, and again, that will that'll be with county council's input.

Thank you, Lieutenant Murphy.

Um, just a couple clarifying questions before I defer to my colleagues.

Um, can you tell us when the MAZARS contract ended?

Was that June 30th?

I believe it was yes, June 30th.

June 30th.

Okay.

And then what's the deadline for the RFP to close for the new quality assurance evaluator?

I don't know that off the top of my head, it's soon.

Uh, it's out though now.

It's out, yes.

Okay.

Um, those are all my questions.

Now I have many more, but I want to be respectful and also um defer to my colleagues.

Want to welcome Supervisor Miley and see if there are any others that have questions at this time before we open up public comment on items one and two.

Supervisor Tam.

Um, thank you, Chair Marquez.

I appreciate the presentation.

Helps me appreciate the complexity of working with multiple departments.

And so I my questions kind of fall in two categories.

One is when you're talking about people that refuse monitoring or refuse medication.

Do we have the uh do you think we have the appropriate staffing and expertise to make those assessments on reasons why, like if somebody was obviously intoxicated and not capable, is it a matter of checking the box or they're able to sign signatures or how what's the level of um, I guess, uh staffing that we have in terms of making those assessments?

Uh if I I think if I understand the the question um correctly, supervisor.

It would be a nurse who is actually bringing the medication, so that is that's the the kind of individual, the credentialing of the individual um who uh brings medications to people, and then usually there's the a second person who would be one of the deputies who can witness is there as a witness if uh if a medication is refused.

If the person says fine, I'm I thank you for bringing my meds and takes them, then that's recorded as a medication delivered.

It's in the case of a refusal that those other things come into play.

And these are uh nurses that are part of the well path.

Um staffing, okay.

And and when we talk about the other side, uh you you're you're saying it's important to have consistency when it comes to enforcement and the document uh requirements, and you know, we sometimes we struggle with the siloed effect in the county with the sheriff, the behavioral health, Alameda County Health, and uh and obviously in a third-party provider.

Um, how do you uh I know you're you're look doing a look back assessment, but how do you think we can best address uh that part because the enforcement is also a key part of making sure that we have the appropriate level of care and having the quality assurance that we need from our provider, so um there are uh it comes down to um to management of employees, which uh many of us have been in in have either been the employees or the managers where this is happening, and if there becomes a culture of what people learn from each other is we don't fill out that blank on the form, or we don't check that we don't have to do that, then it becomes difficult to change that.

So a lot of effort to change that culture when if that's what people have in their minds, and uh the way that we see that WellFath has approached that is the way I would do it too, which is you start out by sitting down with the staff who are doing it on the night shift on the whatever wherever it's happening, and you listen to them, you talk to them, why is this not happening?

And then you make it clear that no, this needs to happen, and the reason for it.

Um, and the reason for it is that when you skip those things, you the that's where safety lies is when you follow your procedures.

That's that's how you stay safe, and that's how things don't fall through the cracks.

But on a day-to-day basis, it can seem very routine and tedious to do those things.

So you go over that again with people, you reinforce it, and then the manager every day in the morning, this is well path is doing this now in the morning.

They look back and see, are there any charts?

And can I identify the person, the nurse who needs to be reminded about this?

So it's that the unsexy, you know, day-to-day work of working with employees and making sure that the priorities are high.

The next phase of that, the thing to back that up, what you'll see is um I can't I can't think of a this is a serious matter, and the the analogy that comes to my mind is not serious, but there's a whack-a-mole problem.

If what you focus on will get better for a period of time because people are all thinking about it, and then when it gets good and you move to the next topic, then the performance on that one can sink back down again, and you see this kind of jagged line of performance, and that's what we see.

So, what I believe I see in this system is that Well Path has been trying to has been working to fix these problems, has relied on primarily on education of staff on written protocols, and on feedback to individual staff.

Those things are necessary, but they are not sufficient.

And the next level is to build in systems that make it easy for people to do the right thing and hard to do the wrong thing.

And your um assistance with getting uh a new unified medical record.

Current medical record does not remind people, it allows them to close a chart to say I'm done with this without, you know, with blanks in it, right?

In fact, a lot of this is paper process actually, not in the record.

And we all know in our lives, right?

Have situations where if you don't fill out a form, you know, if you there's a required field that will not allow you to complete whatever that transaction is, there none of that system help is right now behind these processes.

So I I apologize, that might have been more than you really wanted to know, Supervisor Cam.

But no, that's helpful.

Basically, you're talking about the need for a systems approach and built in coordination so you have warm handoffs between different expertise.

But we just need to have that oversight.

Thank you.

Thank you.

Um Dr.

Clan, if you could stay up there because I'm gonna piggyback on her questions.

I had a similar one.

So with respect to the refusal to take medication, obviously you're not just going to a patient once in offering the medication, that's continuous, right?

Whatever the dosage, the time frame is, that's consistent touch points.

It's not just one time they refuse and you don't ask again.

Just want to make sure.

Um, uh I'm gonna say that you're that we would certainly want that, and that um I don't I don't remember seeing in the charts what that what that process looks like.

So um if it's uh an urgent medication, some medications, you know, can even be skipped for a whole day without difficulty, but um uh where I remember seeing this discussed was in the medications for withdrawal, where it is an urgent matter, okay, and there there is uh there is uh a requirement for people to go back within the same shift.

Okay, but I couldn't tell you exactly how many hours, for instance.

So it may depend on the medication.

Okay, thank you for clarifying.

And then I'm gonna ask um our interim AC Health Director if we have an update with respect to the status of EPIC.

I know we talked about that in the past.

If you could please provide any updates.

Yeah.

Good morning, supervisors.

Um, so we are continuing, uh, your board approved us to enter into a sole source negotiation agreement with EPIC.

We're continuing through those.

Our plan was to bring that to the board sometime this fall, and it's looking like we may need to adjust the timeline a little bit.

Um, but we're having some internal conversations and uh we'll bring that update to you soon.

Part of the issue is that um there have been uh additional regulatory requirements related to the behavioral health components, and so we're finding the need to do a little bit more due diligence on making sure that um it can meet our needs there.

Um how confident are you that we'll be able to approve a contract by the end of the year?

I think it's probably more likely first quarter, first quarter next, okay.

Um and you know, the implementation timeline for Epic would always have been uh sometime in 2027, it would be the go live.

Uh so that could still be aligned with the RFP process.

Great.

Thank you for that clarification.

Supervisor Miley.

Yeah, thanks.

I apologize for being a little late.

So uh just want to make sure the uh presentation was just this.

That's it.

Okay.

Yep.

So we'll follow up on a few questions in EPIC was one of them.

So we anticipate that we'll have an epic um electronic medical records operational by the time we do an um we have an um whatever who will be taking over medical services at the jail.

Yes, that's the goal.

That's gonna be um actualized because I think that's been Dr.

Clan has pointing out we've heard from other reports too in the past, that's been a problem in terms of delivering care.

Yes, uh, so once the um contract is approved, it takes about a year for implementation build-up.

Um, and then there's a go live uh about a year later.

So we do anticipate it to be a complicated build, but it there should be a system in place as the as the next uh.

Okay, and um so we want to make sure we get timely updates on how that's progressing because I do feel that's been a significant um problem, I think once again in terms of delivering uh care to the um inmates at Santa Rita jail uh from any provider then another question that I've asked in the past and I don't see any reference to it here in the report but um uh with the RFP if the county decides we don't want to have a private provider we want to have a public provider uh we want to do the take on this responsibility internally it's not for the sheriff's departments for county council uh do do we need an RFP process for that and I've asked this of county council before so hopefully you have an answer.

Yeah uh this is Kathy Leam from the office of the county council as I uh mentioned at the last joint meeting if you are using internal county employees then um you would not need to have an RFP for that we don't typically procure that uh the it's for outside contracts there could be a negotiated MOU in order to enable the but the you know the budget and the funding um but that would not be pursuant to RFP typically if it's um would that also apply if the Alameda Health Systems uh Alameda Health Systems is a public hospital authority and is separate from the county so that would not be an internal county function that would not be an internal county contract that would not be an internal county even though they're a public entity they they are a public entity and uh you know there are cases where the board waives competitive procurement for public entities but it would be a contract with an outside provider they would have to go through the procurement process that would be your legal opinion uh I would say that there would need to be a contract with an outside provider whether it's through the procurement process through waiver of competitive procurement but there would it would be a documented procurement okay and I'm not presuming they'll um they'll want to do this but I need you know we need to have some clarity on that if um they should decide so I just want to so if they should decide to go through uh to want to have this responsibility will they have to go through a procurement process or can they uh contract directly with the county without a procurement RFP process.

We would need to follow the county's procurement ordinance which does permit the board to waive competitive procurement in some instances um but there would need to be a negotiated contract with um any entity that is outside of the county um now uh with the procurement uh have we decided the scope and specifications who's gonna put that together is that just going to be the sheriff's department or we'll be doing that in conjunction with Alameda um uh Alameda County uh health so we are we are setting up the own scope with uh we have Clay Christensen from county council we have GSA and we also with the sheriff's office and we Dr.

Clan and his team is a multidisciplinary approach so we're building it out we're also seeing what's out there uh that other counties have done um plus we're adding Cal Aim Epic uh the consent decree obviously the early access what recommendation cares first jails last to put in the RAJ um and even best practices that align with the visions of 2036 so we're really making this a comprehensive thing.

Okay.

So Wellpath has had the contract since 20 uh the dates are on the slide they had it since 2020 but did they change their name so I think when the when the previous contractor when the well pet took over most of the staff stayed I so I don't know if the company changed the name but a lot of the staff stayed so I'm just trying to understand if it's the same entity but a different name I I don't I don't believe so, but we have to look into it, sir.

Okay, all right.

Um, and then so a lot of um stakeholders are going to be involved in putting together the scope of this RFP.

And you hope to have the scope finalized before the end of the year the that is the hope, sir.

Yes.

Looking at the timeline here.

We've been working on it since July.

Uh we meet regularly uh and we're you know building it as we go.

We have experts not only from the county but outside, we even risk management.

Like every little thing we can think of, we have we want this to be a very robust and complex.

Right.

Because I know the sheriff um really wants to do a very good job with this going forward.

Um then the uh evaluation team.

What do you foresee?

Who will be on this you know the evaluation and selection team, not what people, but what type of entities will be on that team.

Just the scoring, the selection, the interviewing, the questioning, the evaluation.

I don't I don't think we're there yet in the process.

We'll we will have uh, and I can't say who will be on the actual selection panel yet.

Yeah, I'm not saying individuals, I want to know categories.

Uh we will have obviously from internal the sheriff's office, probably someone in the health field.

Uh and then uh the third person, I I don't know you off the top of my head.

Just three, I believe so.

Whatever GSA will recommend, boss.

Let me add to that.

So GSA is the one that develops the panel that will do all the inquiries and and whatnot.

So GSA works with us, but we're not the ones that do the selection.

GSA will do that selection.

Okay.

Um GSA isn't here today, okay.

I'm not sure.

Oh, good.

Oh, she's got a hand up, okay.

Can she respond?

So we um in partnership with Health and Sheriff, look at what the subject appropriate subject matter experts.

That's the requirement.

I would typically for procurement of this size definitely recommend up to five selection committee members, sometimes um similar to our construction projects.

We do um have select sometimes more than one selection committee depending on the topic.

So we may break it up into different smaller groups and then bring all the scores together.

So I need to look at the full scope, the subject matter expertise in those categories and put the panel together.

Uh we also have restrictions on like certain members of the sheriff's department will not be allowed to be on the selection committee to make sure we're not inappropriately or have the appearance of you know any favoritism.

So we also often ask um for people from other counties or maybe from the state that have similar contracts, okay.

Yeah, because this procurement is extremely important procurement, similar to the EMS um ambulance procurement.

Um so we will make sure we do it as um as well and as robust as possible.

So um what I'm curious to know what's the uh the protest and appeal process.

Can you walk us through that?

Kimberly, say that again, sir.

I'm apologize.

The appeal and protest process.

Yeah, so um earlier I did share that um if there is there is a protest period that uh once we issue a notice of intent to award that all bidders have a timeline, could be five, seven days to protest, then um that goes to the Office of Acquisition Policy and GSA, it's independent of procurement.

They review the the merits of the protests and uh talk to county council, send a response.

If we do not uphold the process, then we bring the procurement forward to the board.

The bidders do have an opportunity to appeal that decision to the auditor's office.

So if they submit that appeal, the auditor reviews the procurement, the original points of the protest, um, and that's on the auditor's timeline, and then that after the auditor completes her review and makes her findings, uh then it comes to the board.

So if the auditor um agrees with the Office of acquisition policy that the protests will not be upheld, then it comes to the board.

If the auditor believes there are um supports the protests, then we may have to start the procurement over.

Okay.

We usually get go ahead.

They usually contact me to let me know their findings, and we may make a decision to start over.

It just depends on the outcome of that.

Okay.

And as I said, typically the board doesn't um get involved with the procurement process prior to the uh getting to the board, particularly in terms of looking at the uh RFP, uh before it's issued.

I'm not suggesting we we look at this RFP before it's issued, but you know, clearly there'll be a lot of eyes paying attention to this whole process once it does uh commence.

Um have we done any analysis of, because I know it was mentioned other jurisdictions, other counties in the state or the nation around um their vendor for inmate medical services.

There are several vendors through.

Oh, go ahead, Director.

I was going to defer to you.

I was gonna say that I believe the sheriff is having those conversations.

There are several vendors out there within the state that our other county uh sheriff's office uses.

Um so there are others out there.

And what I'm looking for is best practices.

Do we know any best practices either in the state or nationally?

It's a very very complex question because facilities are different in size, capacity, population, and then the different services being delivered.

We have a more robust system, and we're proud of that here in Alameda County.

We're building that out.

So our processes are different from what other facilities are.

So the conversations have been, I've been having those conversations with different sheriffs, but we definitely have a large facility where it it's it's apples and oranges, really.

Okay, all right.

Those answer my questions.

Thank you, Supervisor Miley.

I just have a couple more questions.

I think um, I don't know if you want to tag team it or if Dr.

Clannon might be able to respond.

Um, but looking at the presentation, um, on slide 14, um, compliance with the eight-hour screening standard dropped from 73% last year to 35% this year, even though 95% are completed within 24 hours.

Do you know what factors are driving the decline and how will the eight-hour requirement consistently be met?

Um actually I think it that slide um 15.

Right?

Yes.

Nope.

Sorry, 14, sorry, apologize.

Yeah, um, 14, thank you.

What I know about that is that so the receiving screening happens in the in the area before people are assigned to a housing unit, and there are multiple kinds of screens that need to occur during that time.

One is performed by the sheriffs that have to has to do with uh which housing unit they would be should be in.

There's a behavioral health screening, which is separate from the general medical one and then the medical one.

And I know in discussion with Well Path that they have uh deferred doing their screening in order to allow those other two things to happen, and have uh been in favor of a process in which that screen could be done when people are have arrived at their housing unit, which is more comfortable, less noisy, there's a lot of advantages to that.

And uh what we noticed was that um that caught has been causing the timeliness part of that standard not to be met.

So getting all those things done within the eight hours, um and you know, trying to do most screening in the the housing unit has caused this this difficulty and and that I think it's a great example of where they there are some unintended consequences of changes that were uh that were made, and it's gonna require everybody working together to be able to resolve this.

Thank you for that background and clarification.

Um on slide 15, OIPOD withdrawal monitoring compliance is as low as 8% on the night shift compared to 41% on the morning shift.

What steps are being taken to address this disparity and to improve consistency and reliability of monitoring on all shifts.

So one thing that I have not done is actually spoken to those staff.

And that would that I'm curious, those numbers make me very curious and concerned, but curious and want to know from them what's happening.

But uh what I would say is that the actions that I know from these reports have been taken by Well Path is to do day-by-day screening in which a manager immediately responds the next day if if um this standard is not met overnight to do counseling with the individual nurses involved.

Um, and also there has been additional um uh training, education, feedback to the group.

Great, thank you so much.

Um, we're now going to move on to public comment, and this is public comment on item one and two.

So just to repeat item number one is an informational item regarding the procurement timeline for comprehensive medical services at Santa Rita jail.

And item number two is also an informational item update on medical quality assurance monitoring at Santa Rita Jail, and we will um give the community two minutes to speak.

If you're here in the room, please fill out a speaker card.

If you're online, please raise your hand.

Richard Spiegelman.

Good morning.

Thank you for this conversation and this opportunity.

I'm Richard Spiegelman.

I've lived in Alameda County for 55 of the last 57 years, and I chair the interfaith coalition for justice in our jails.

Um, a lot to think through about the two presentations.

I just want to say a couple of things about the schedule of the procurement.

I I think it's pretty clear what the times are that are required to get from step one to two to three, and so on, and I get it that no one can quite yet say what the date will be that the first step will happen, but I would encourage someone, GSA perhaps, to put dates at the bottom of the list.

When's the date by which this thing needs to happen in order to provide enough transition time, even understanding that there could be an appeal that could mess that up?

Let's see some dates to aim for.

So that's my thought on that.

Um the RFP process, I think it's really important that the county, I mean, I was impressed, Lieutenant, with what you said about all the complexity going on.

I really encourage you to get a good consultant, maybe from outside the county who's done this kind of work with a variety of counties to see help you see what are you missing, or what do you have to think about in this incredibly complex list of things you're trying to get through?

Uh secondly, I wanted to encourage you to think about the RFP somehow conveying that a certain percent, maybe 90% of the funds that go to the contract should be used for direct medical services rather than profit or administration.

Something to help this county be the best it possibly could be.

I think the RFP needs to uh find a way to disqualify a bidder with a history of unacceptable prior performance, whether documented by Mazars or the County or any other information that we have about bidders.

Thank you so much.

Connor, you're on the line.

You have two minutes, John.

Hi, this is John Lindsay Poland.

Um, two points.

First, uh a bit of context.

Nationally, uh the best medical outcomes come from reduced jail time.

That's the best medical outcomes.

Um uh nationally, every year in custody reduces a person's life expectancy by two years.

So, and and we know that in Santa Rita jail, more than 90 percent of the people in the jail are unsentenced.

So there are other programs before the county, including those of reimagining adult justice and the care first, um, that would contribute to that end, and therefore better medical outcomes for the people who are or could be in Santa Rita jail, including the pretrial release program, the grant for which is now being discussed for between the district attorney's office and the public defender's office.

Second point, and I think this is what Supervisor Miley in some ways was getting at, is that the board should really give direction on the criteria for the RFP, not not for not on who should be chosen.

And for systems change, I noticed that Dr.

Clannon's list of causes for these very poor percentages, did not include incentives.

So this comes to the point that uh Richard Spiegelman was just making that the percentage of uh of uh funds that is used to actually provide services should be high rather than having a fixed contract amount that gives an incentive to providers not to send people out for services, not to staff up.

Staffing is obviously a key component here.

If you need more information as a board to weigh in on that criteria, I would urge you to get that information, whether it is from another presentation or from the consultants that the sheriff's office is hiring, because you really we need you to weigh in on this criteria.

Thanks so much.

Mickey Duxbury.

Good morning, supervisors and Sheriff Sanchez and Dr.

Clannon and everybody from the Sheriff's Office.

I really appreciate the opportunity to speak here as I always do.

And it might seem that we say the same things over and over again.

So I'm going to try to say something a little different today.

I think everyone in this room, whether the sheriff's department, elected officials, behavioral health, agrees that we want much improved health care in the jail.

I was talking to a woman in a wheelchair at church yesterday about this meeting today, and she said, make sure you tell them that the people that are most vulnerable to inadequate treatment in the jail are disabled and they're seriously mentally ill.

And I know everyone in this room knows that.

We're asking for is very simple.

You cannot and good moral consciousness continue to contract with a corporation that is known nationally as one that is denied much needed care in order to increase their profits.

And it should be very clear that the RFP must include criteria that disqualifies a bidder who has a history of poor performance.

This jail, as you everybody knows here, more than me, even is a revolving door.

Most people in the jail will be back again.

They return to their communities with poor health or worse health than that revolving door, just goes faster and faster.

And this revolving door, the medical care juncture of that door really needs to change.

We have provided each of the supervisors and the sheriff's department with the names and contact info for all the medical, the heads of medical care in Contra Costa Marin, San Francisco, Santa Clara counties, because they have made it possible to provide quality health care, increase the likelihood that people have a plan before they get out, increase the likelihood that they enter into programs, increase the likelihood that they go home in better shape than when they went in.

That's a lot to ask for jail.

And we understand that some of this has to be solved in the streets and not just on the jail.

But we also sent the name of a nationally known expert in constructing RFPs for jails and prisons, and I really strongly ask that you speak to them.

Thank you very much.

Caller, you're on the line.

You have two minutes.

Alison.

Hello, this is Alison Monroe.

I appreciate these detailed efforts to try to make good care at the jail a reality.

Um Dr.

Clanon's discussion I found especially real of how a person might be required to fill out an intake form and capture certain information at an intake, and wouldn't actually do it.

Ideally, care would be done by people who we have eyes on, people we know, people who aren't responsive, responsible to us, whether it's inside or outside the jail.

And I appreciate how terribly complicated it can get to make that a reality.

But we will thank you very much.

Caller, you're on the line.

You have two minutes, Jean.

Good morning.

This is Jean Moses from District 5.

And I want to thank Supervisor Marquez and everybody else, but particularly for emphasizing the value of community involvement in this process.

I urge the board to move forward with all due speed.

The people in our jail are being under risk every day.

And furthermore, there is certainly could be a protest.

And with such a complicated contract, we could conceivably have to redo the RFP.

So speed is of the utmost importance.

When someone has been chosen, as has been said in the past, a new provider will need time to ramp up.

Our experience with Wellpath and with Corazone, the company that provided medical services prior to 2017, has have amply demonstrated that a for-profit company is not the way to go for our county.

We should follow the example of Marin or Conta Costa in Santa Clara and San Francisco and go for a not-for-profit alternative.

I also appreciate what Sheriff Sanchez mentioned in terms of the size and complexity of our need, and that really further emphasizes that we have to keep this process moving and that we have to hire the best possible consultant, which I believe is probably the one that Mickey just uh referred to.

Um thank you for emphasizing the value of community involvement.

I think it's pretty clear that community is also working very hard on this, and I would ask that Director Cassaway please add specific times for the community to get information on what's going on and provide input so that the time frame should allow input from the community and an update to the community as well.

Uh lastly, I want to read I want to emphasize what John Lindsay Poland said, and please keep trying to keep people out of the jail and provide services in the community.

Thank you.

Your time's in.

Caller, you're on the line.

You have two minutes, Bob.

Yes, I'm Bob Britton with the Interfaith Coalition for Justice in our jails.

I agree with all of the comments of the public comments thus far.

I'll try not to repeat them.

Um I have a couple of questions, and I know that typically the policy is that you don't respond to questions uh at this point, but you could put them in your uh memory banks to try and uh refer to them when the time comes, either today or in subsequent hearings.

I want to thank Supervisor Miley very much for asking the question I had about the possibility of a public agency, whether it was the county itself or another public agency such as AHS being able to be awarded the contract um, perhaps without bidding.

And I wanted to point out that the NCCHC uh standard uh that we're trying to reach is quite high for these items.

It's 98%.

So I'd give a little more context to the terrible, terrible, terrible uh performance of well path to date.

And then whether it's well path or whether it's another for-profit uh entity bidding, uh I would urge that um a high failure rate be a disqualification for any entity that's bidding.

And then uh I'm uh wondering at what point do elements of the RFP become public or does it or subject to a public records act request?

And uh uh the bids submitted.

Does that ever become public or subject to a public records act request?

Thank you.

Caller, you're on the line, you have two minutes, Willem.

This is uh Willem Feinde Camp, and I'm a resident of District Three, and a member of the Interface Coalition for Justice in our jails, uh Board of Supervisors and Sheriff and others, thank you very much for having this hearing.

I appreciate that we um can voice our opinions about this.

And I think after all that we have heard also today, there is ample evidence that Wellpad is not providing the care that the people in our county jail deserve.

And so there's also no good reason for renewing the contract with them.

We know that all the promises they make are uh given in by their profits and not by the care for the people that are in our jails.

And I what I heard this morning, especially too, also from you, Sheriff, is that you intend to have good care for the people in our jail because that's what they deserve.

And so I recommend that you take the care of the people who are in our jails uh in our jail, that you take it in your own hands, and that uh we get no bidders with poor performance, but all and also that you provide as much transparency as possible and continue to have the public, the community, I would say rather involved as much as possible.

Thank you very much for what you're doing.

We have no more speakers for items one and two.

Thank you.

Supervisor Marley.

Yeah, just to weigh in on a couple of uh either questions or comments from the public.

Oh, first of all, let me apologize once again.

I thought the meeting started at 10.

I was looking at my schedule, I suppose 9:30.

So ask questions I've already covered, excuse it, or excuse me.

Now the RFP.

The RFP will be subject to the public once it's publicly released.

Is that correct?

County council.

Once it's publicly released, then the public can have access to the RFP.

So this is Kathy Lee again, and I I see Director Gasway also has her hand up.

But I will say that in general, GSA does post the RFP publicly, and it is publicly available upon its release.

Okay.

And then should the board want to weigh in on the content of the of the RFP?

Once again, I'm not saying we should, but then you know we've got a whole new board here, and that's highly unusual, but we have done it in the past.

Uh, I think the board needs to make that that call.

And I don't know the comfort level of my colleagues if they're comfortable wanting to weigh in on the content of the RFP before it's released.

Obviously, anyone who uh the community or whoever else uh provides input into the RFP, they cannot uh bid on the RFP.

Uh folks can you know, obviously give us uh suggestions and things of that nature, but they if they are actually involved in the shaping of the RFP, they cannot bid on it.

Um I don't know if if uh we what type of criteria we might want to establish, but I don't want to prematurely um prejudice any potential applicant um from applying.

I want to make sure we have a fair uh um uh process.

The um one of the speakers mentioned a national expert.

Uh I asked my staff, you said you have a national expert that looks at these type of RFPs, JPES.

Did you did you?

Okay.

Yeah, make sure my my staff gets it because I asked them and I don't think we've seen it.

Okay, right, thank you.

Those are all my comments and responses.

Thank you.

Um, so just want to thank everyone again for their participation today.

Um we heard loud and clear that medical care at Santa Rita Jail is more than a service provision, it's about continuously evaluating and improving processes to promote positive health outcomes.

It's about centering justice-involved individuals like any other county patient and continuously strengthening systems of care to promote dignity and well-being.

Procurement is not simply an administrative exercise.

It is how we begin to embed equity in our community and a process that is rooted in public transparency and accountability.

We still have much to do, but step by step, we are growing our knowledge base and partnerships required to move in the right direction.

We will continue to coordinate with all key stakeholders within the county and across the community to ensure this roadmap includes informed goals and comprehensive metrics that will drive quality care and improve healthcomes for our justice involved patients.

Again, thank you to Sheriff and her office, her team, AC Health, GSA, and our advocates who continue to promote this collective progress.

Also, want to acknowledge Erin Armstrong and Brenda Gomez.

They were instrumental in getting our presenters geared up for today.

So thank you for your hard work.

I am going to respectfully ask my committee members.

I think we've done an excellent job since May with tracking these issues.

So I'd like to ask for another joint PPC and health committee meeting either in January or February, once we have more information in terms of next steps with the rollout.

We could also discuss the criteria at that time and hopefully have updates on EPIC.

So that is my request to bring this item back in either January or February once we have a better sense of the timelines.

Is there a second?

I'm fine with it, but I don't think we need a motion.

No, we don't need a motion.

Okay, just direction.

Okay.

I'm not hearing anyone opposed to that direction, so we'll accept that.

And our office will be in coordination with the presenters to track next steps.

So now we will move on to general public comment.

So this is public comment under any items under the purview of public protection committee or the health committee, but not on today's agenda.

So are there any members of the public that would like to make a comment in person or online?

Angela Upshaw.

Good morning, everyone, Supervisor Tam, Marquez, and Miley.

My name is Angela Upshaw, and I am the chief program officer for Insight Housing.

We're a service provider homeless services for the past 55 years, and I'm here to respectfully request that the board considers two critical actions to improve the efficacy and sustainability of our vital shelter and interim housing programs.

First, we urge the board to transition all existing shelter and interim housing contracts from the Social Services Agency, SSA, to the Office of Homeless Care and Coordination, OHCC.

Given OHCC's ongoing and close work with these programs, their deep operational knowledge, and their central role in this county's overall strategy to address homelessness.

They are best positioned to provide the improved oversight, coordination, and support that these vital programs require.

Second, we asked the board to significantly increase the current bednight rate to a minimum of $97 per night.

This is an urgent necessity.

As was discussed at the May 12th joint social services and health committee meeting, SSA proposed raising the rate from 3642 to 4843.

This proposed increase is still significantly below the actual operating costs, which are between $87 and $98 per night.

The rate is insufficient to meet the escalating operational costs, including staffing, security, case management, housing navigation, food support, and maintenance, which jeopardizes the stability and quality of care provided.

Investing in a realistic rate of $97 per night is an investment in successful outcomes for our unhoused neighbors.

Thank you for your consideration.

We have no more speakers for public comment.

Thank you, everyone.

This meeting is adjourned.

Have a great day