Now we're ready, yeah.

Recording in progress.

Okay, good morning, everyone.

I'm gonna call the meeting to order for Alameda County Board of Supervisors special meeting.

This is a joint health and public protection committee meeting for Thursday, April 23rd.

Apologize for the delay, but one of our colleagues had another committee meeting this morning, so thank you for working so hard on behalf of the county.

Can we please start with a roll call?

Supervisor Miley.

Supervisor Town.

Present and Supervisor Marquez.

Present Liverpool.

Thank you so much.

Um, before I continue, can we please make sure that the audio and video is coming in clearly?

Those online, if you could raise your hand, if you could hear us.

Director Gasway, could you confirm since you're able to unmute?

Joint health and public protection committee meeting for Thursday, April 23rd.

Apologize for the delay, but one of our colleagues had another committee meeting.

I guess we're good.

We're good.

Okay.

Um, if the clerk could please share the announcement how the community can engage in public comment on the items that we're going to hear today.

For all participants, please state your name for the record prior to your presentation.

If you wish to speak on an item not on the agenda, please wait until Supervisor Marquez calls for public input on non-agendized items.

Only matters within the committee's jurisdiction may be addressed.

To notify the clerk you wish to speak for in-person participants, please fill out a speaker card and hand it to the clerk, me.

For online participants, please use the raise hand function when we are on the item that you wish to comment on.

For dialed in participants, please dial star nine to use the raise hand function.

You can dial star nine again to lower your hand.

The clerk will call your name when it is time for public comment.

If you are in person, please come to the podium to speak.

If you are online or dialed in, the clerk will call your name and allow you to unmute.

That concludes the clerk instructions for public comment.

Thank you.

Okay, thank you so much.

Um, so again, good morning and welcome everyone that's here in person as well as listening online or people that will be viewing the video in the future.

Um, we've called this joint health and public protection committee meeting because access to timely cabbie.

To timely quality health care at Santa Rita Jail is a fundamental responsibility and value for Alameda County.

Today's discussion builds upon our joint committee meetings held on May 16th and September 29th in 2025, where we took a deeper look at the state of the jail's medical care services, quality assurance efforts, and the county's procurement process.

Additionally, my office convened a listening session last July, where we heard directly from the community advocates, including those with lived experience with gaps in the care they received at Santa Rita Joe.

We're able to share their direct experience with us and the need for greater accountability.

Today's agenda items reflect the next phase of this work by bringing together procurement, quality assurance, and transformational system improvements, like the county's over 40 million investment in Epic Electronic Health Record implementation that the Board of Supervisors approved last month.

These are not isolated efforts, they are interconnected pieces of a broader strategy to strengthen how care is delivered, monitored, and improved over time.

It also reflects the county's commitment to the reimagine adult justice initiative that my office continues to advance in alignment in alignment with the vision set by the late public protection chair, Supervisor Richard Viet, and the Care First Jails Last Framework, also the result of Supervisor by his legacy, as well as the late Supervisor Wilma Chan to ensure that Alameda County public safety systems are grounded in cross agency coordination and accountability to ensure equitable access to care for some of our most vulnerable residents.

To the community members and advocates who continue to engage with us, we are here not just to receive updates, but more so to understand how gaps are being addressed by county staff and leadership.

This includes articulating how coordination efforts are improving and accountability measures being strengthened.

Your engagement remains critical at the at this work because as this work moves forward.

At the end of the day, we do this work even when it's hard because the responsibility is greater than administering a contract or managing an operation.

It is about ensuring that individuals in the county's custody, many of whom are among the most at risk patients countywide, receive the care and ongoing support required for their acute health care needs and stabilizing them so they can have a chance to successfully return to the community.

With that, we will begin with the first item.

And this is an informational item.

We're going to hear from Director Gastaway, and I believe she is joining us online.

So I'd like to welcome her and ask her to unmute herself.

And if she could please start with her presentation, and we will let me find the agenda.

Good afternoon, Supervisors Kimberly Gasway, Director of General Services.

Really quick, Director Gasway, before you start, um, we do have three informational items.

We will go ahead and take public comment after every item is heard, depending on how many speakers we will determine the time allocation.

So if you know that you want to speak on um informational item number one, this is an update from Director Gastaway with respect to the procurement process.

Please raise your hand or fill out a speaker card.

If you fill out a speaker card, can they just indicate if they're speaking on all three items?

You've already collected them though.

Okay.

So if you don't want to speak on this item, don't come up.

Just come up when your name is called on the item you want to speak on.

Thank you.

Thank you, Supervisor.

Again, Kimberly Gasway, Director of General Services Agency.

I'm here to provide an update on the procurement of the Santa Rita Jail Comprehensive Medical Services contract.

Um, this uh the current contract is um to expire on September 30th, 2027.

And this is just an update from the last presentation I gave, um, similar on the timeline.

And once we receive the full spec development and scope from the sheriff's department, then we uh move forward and estimate a 12-month procurement process given the complexity of this particular uh level of service.

Right now, the pre-procurement phase is where we develop the spec with the sheriff's department and their um consultants.

It is in progress.

We um estimating it's roughly at 89% or 85%.

There's a few items they're still working through the county council review and the posting that two months is actually um the review with council is happening concurrently.

So we are roughly we have about two more months to go to be all ready to post this procurement.

Following that, um, once it's posted, there's a mandatory bidders conference, and all of the bidders will need to pass a security clearance to visit the facility, and that's a roughly a month uh time period, an additional month after the conference, they submit their questions, we write um and post answers to those and issue any addendums, and their bids are due within that month time frame.

Then we review that for completeness and quality review.

We look at references and do that check.

That's about a half a month.

And at the same time, we start setting up the county selection committee.

Um, they sign conflicts of interest and they review the written proposals.

That's about a month.

Then they have um a time for vendor interviews, roughly I'm sorry, a half a month, and then the final abstract and the sheriff um concurrence for award recommendations, about a half a month.

Some of these can take a little less time, but we're being very conservative here.

Then there's a protest appeal period, and during um there's a certain amount of time that a bidder who was not selected when issue a notice to proceed is issued to all of the bidders.

Um if there is a protest, it's reviewed by the Office of Acquisition Policy within GSA that is separate from our procurement department, and they uh do a written response.

If they deny the protest, I want to point out I put a little footnote here.

If they deny the protest based on the um facts provided, then there is an appeal process.

That timeline is undetermined.

Oh, something there we go.

And so um it could significantly impact this award.

But if that doesn't happen and we move forward, then we negotiate the contract and that and bring it to the board for approval.

On the outset, the longest period of time that could take is five months, it could be less.

So we're looking at roughly 12 months from the end of June.

And we'll be ready to um award.

I'm happy to answer any of your board's questions.

Okay.

Uh thank you so much for that presentation and for quantifying where you're at in the timeline.

I really appreciate that 85% figure.

Um, I do have some questions, but I'm gonna call in Supervisor Miley.

Um thank you, Chair.

Um so um thank you, uh Director Gas away.

So before the RFP is finalized, um, I know this has been a very um controversial um uh item uh medical services at Santa Rita jail.

Um and I know it's come up uh by the public uh whether or not the board should review the RFP before it's finalized.

And I'm not saying we should, but I know we can.

So I just want to throw that out uh to the uh joint committee today if we want to modify this so that there's some review by the board of the RFP before it's you know it's it's publicized.

The other thing is we can look we can go through all this.

We can have people bid, we can have a selection, then at the end of the day, we get through this whole process, and then there's issues about the RFP, there's issues about this, that, and the other.

Um, and then either we'll make a determination to like we did with the uh EMS contract to not accept the recommendation and start over again, or uh to do something um that is um you know allows us to do it within the realms of legality.

So I'm just kind of looking at this and just throwing out to the committee, joint committee, so that um we aren't cognizant of the fact that if we want to look at this up front, we can, or we can wait until it goes through the normal process and we would review everything at the uh at the conclusion.

And it doesn't mean even if we look at it up front that it'll satisfy everything, but it might give a little bit more you know, comfort, but just raising that.

Supervisor Tim.

Um thank you, Chair.

I I know that in the state uh I'm sorry, in the EMS contract, we had a state LEMSA that was also uh reviewing the RP.

Is there a similar um entity or agency that does that for um prison health?

That might be a question.

I'm not oh sorry.

Go ahead, can really start.

Yeah, I'm gonna defer that.

I'll defer that question.

Anika, if you'd like to respond.

Oh, I was gonna say that might be a question for the sheriff's office.

I'm not aware of anything.

Does anyone from the sheriff's office know?

Lieutenant Murphy.

I'm Lieutenant Dan Murphy, I'm the contracts lieutenant.

Uh I'm the one that's overseeing the writing of this RFP.

Uh, to my knowledge, there is not a larger entity that reviews uh RFPs for uh jail or prison correctional health.

Uh we do use our experts to help us, and then as long with county council um and other county partners to help us craft the best RFP we can.

Thank you, Lieutenant.

Um, with respect to what Supervisor Miley raised with regard to the supervisors reviewing the RFP.

It county can county council uh address that is it a matter of making an appointment with county council and just sitting there one-on-one and reviewing it, or is there a process that it has to come back to the full board?

And if you review it, can any supervisor make suggestions and changes, or does that action have to come back to the board?

I want to have a better understanding of what he's raising.

This is Kathy Lee.

I'm from the Office of the County Council, and I work with GSA procurement.

It is not the typical practice to have an RFP along with uh specifications come to the board for discussion in part because as part of competitive procurement, you know, there is always the concern about drafting the RFP in a way that would direct it to be awarded to a particular um contractor consultant.

Um but there certainly is no prohibition on uh what Supervisor Miley is proposing with respect to an open and public discussion with the full board um regarding the needs that the RFP will uh uh be seeking a contractor for.

Um and uh, you know, certainly the supervisors um can weigh in on what the expectations are and the hopes are for a contractor for the agency to develop it um in collaboration directly with staff.

Um it really is you know up to the discretion of the supervisors.

However, I will say that it is not a typical practice because um we do try and avoid the potential complaint that someone could, you know, the supervisors might be drafting it or directing it in a way that would direct it to a particular contractor.

And through the chair, I just want to say, you know, in 25 years of being here, I think we've only done it maybe once or twice.

It's highly unusual for us to weigh in at the beginning, but I wanted to make sure we're aware that we could if we desire.

Yeah.

Um so I I hear you, but I I should have prefaced my comments with for me personally, um, it is really important that we maintain the integrity of this process.

We've been working on it for over a year or nearly a year, and so um I trust the process.

We we got input from community advocates from people with lived experience.

This item's been heard at this at this committee more than once.

And so I my preference is that we just continue with the approach that we've designed and agreed upon within the timeline um provided by Director Gasway.

Um, so I'll I'll let others weigh in, but that's how I would prefer to proceed.

Um, additional questions.

Um what I understood you say, Dr.

Gassaway is that uh best case scenario is we're releasing the RFP uh the end of June.

So the 22nd, I think is a Monday in June.

So hopefully by the end of that week, this RFP for scheduled to um be timely with it will be released.

I really appreciate the concurrent review by county council.

That's impressive, so there's no delay.

So thank you for doing that.

Um with respect to the protest appeal, I want to be clear.

Is there a firm deadline that people only have up to 30 days to protest?

Um, I believe it's less than that.

I have to look at the exactly the language, it's typically I believe five to seven days.

Council probably couldn't confirm that.

We just take the 30 days for us to review the protest and draft a response if we agree or do not agree with the merits of the protest.

Okay, and will that information be clearly outlined once the RFP is released, and then will that be discussed at the bidders conference?

All those details.

Yes, they have all that, all that information is in the RFP.

It is clear.

Okay.

And then are you able to state once the RFP is released, what's the turnaround time to submit a proposal?

Um, we've put 30 days in this timeline.

Okay.

And there are there any ways to ask for an extension, or is there any guidelines given to the typical, and I'm I'm speaking generically, I mean, once the bidder conference happens and we receive questions and answers, if there are concerns that are fleshed out as a result of that, there have been times in procurements where we do extend.

And when you extend, is that like one week, 10 days?

Can you kind of give us a sense of what that would look like?

You know, each procurement, some it's different, it depends on what the issue is, but it's typically it can be up to two weeks.

So and um help me understand who how will people be notified of these changes and updates?

Is it a matter of they attend the bidders conference?

You have a list of interested parties.

That's who you're only communicating with, or are updates also provided online?

Right.

So the procurement is posted, the answers to the questions are posted, and then any addendums would include extensions are also uh posted.

Okay, great.

So they're very the vendor community is very aware of that process.

Okay.

And anyone could find that information under GSA's um landing page?

Okay, perfect.

Any more questions for my go ahead, Supervisor Marley.

Yeah, thank you, Chair.

Uh, just two other things.

So with the uh protest and appeal, um does the appeal stop with GSA and the sheriff's department, or does the auditor uh weigh in as well?

So GSA Office of Acquisition Policy does the protest and the response.

If we deny the protest, there are times when the vendor can then appeal to the auditor's office.

Um I believe it's the Office of Contract and Compliance, and they review the appeal.

And so that timeline is undetermined.

So that's not so with this procurement.

This could possibly this could possibly go on appeal to the auditor, right?

That's correct.

And that in you're saying that's not reflected in the timeline.

That's correct.

Okay, I just want to bring that to the attention of the committee and the public, because I I thought this was a little uh brief here.

Um, because I think that could extend this as well.

And then the other thing is um uh back on the earlier question at a prior meeting.

I know I had asked whether or not uh if we wanted to bring this in-house if we needed to go through the procurement process.

I know I've talked with the agency director of a health care services agency.

I keep thinking health.

Alameda County Health, if for instance, and I'm gonna say an Alameda County Health is gonna do this, but if Alameda County Health wanted to take on the medical responsibilities of jail, would they have to go through this procurement process?

Is this uh the procurement process is to establish a contract, which would this is Kathy Lee again, which would not be required if we were using county employees.

Gotcha.

Thank you.

But the capacity wouldn't need to be there among the county employees.

Thank you for that clarity.

Um seeing no other questions at this time.

So I don't want to create confusion.

People probably already filled out your speaker card.

Um if you want to speak on this item when you're hear your name called, because I don't know if you indicated each item on the speaker card.

Um, how many speakers do we have in person online so we could determine how much time?

Four speakers in person, and looks like one person is raising their hand online.

Okay, let's do one minute since we're gonna take public comment for every agenda item.

Thank you.

Okay.

We'll start with Mickey Ducksbury, Richard Spielman, and John Lindsay Poland.

Okay, give me just one moment to set up everything.

Hi, it'll be dicey to get from two minutes to one, but I'll do my best.

We know that the current provider has had several years to improve.

They haven't.

What's most important in identifying a new provider is a good medical care.

I just want to make sure you understand I'm taking public comment for every item.

So we just heard the RFP.

Just on Director Gasway's presentation.

We have two more presentations.

So you have if you have any comments specific to what Director Gassaway just mentioned, but we have two other presentations.

So you're gonna be able to speak on every presentation.

So if this is an overall comment about the RFP for medical care in the jail, this is not the appropriate time.

If you um I'm sorry, it's okay.

Yes or no.

I so I want the public to be able to hear all the presentations, right?

So ideally you would hear a presentation, make your comment based off that presentation.

We have two more.

Okay.

So if you want to say your comments now, you're welcome to, but you would be doing that prematurely before hearing the other two presentations.

So it's your call.

But right now it's just one minute.

You have two more chances to speak.

Okay, I'll be very brief because I do have to leave.

Um no one in this room wants a medical provider that's filed for bankruptcy, had contract violations or lawsuits.

We know the other counties that have um let go of this current provider that Alameda has, and several counties are running their own health care.

We've provided all that information.

Um we think Alameda County should consider that as a possibility.

And now we do understand that the county is facing dire financial cuts, especially in health care.

We understand that providing better health care and medical care in the jail will cost more, but that's money well spent if it presents prevents unnecessary deaths and provides continuity of care.

So when people return to their communities, they're not on such shaky ground.

Um I mean, everybody in this room knows that um people need to be in better shape when they leave the jail than when they went in.

I believe that's the sheriff's department's goal, and only good medical care by a reputable organization can help make that happen.

Thank you.

Sorry for the confusion.

That's okay, thank you.

Good morning.

I'm Richard Spiegelman, the chair of the Interfaith Coalition for Justice in our jails, and an Alameda County resident for over 50 years.

I I wanted to say something about the timeline.

If you look at the timeline that the uh directors provided, you might assume that 12 months from now, I guess, there would be a provider ready to go get things started the next day in Santa Rita.

But I don't think that's right.

I think there are two things that are missing from the timeline.

And uh appreciate uh the director's comments or or the board's comments.

One is I think it may take a potential bidder more than a month to figure out what to do after the bidder's conference.

I assume this is a this is a big deal, and people have to figure out do they have subcontractors, you know, what's the risk, blah, blah, blah.

But an even bigger time period that isn't on the timeline is once the the uh contract is awarded, the successful bidder has to implement it.

And I would imagine for someone new that could take months.

So that needs to be, I think, put into the math.

Thanks.

Good morning, John Lindsey Poland with American Friends Service Committee regarding the RFP and through the chair, I'm hoping you might ask two questions of Director Gessaway.

Um, first is um we heard about the timeline, but not about the evaluation board that will be evaluating the bids.

So we know you can't disclose who personally is on the board, their names, but what are the profiles of those individuals?

We understand that Actura will be serving in that panel, but what are the other profiles that will be in that panel?

What is the lived experience?

Are there other counties that have been through this process?

Are there subject matters that um that they will have expertise in?

If if um Director Gassaway can um uh specify that.

The other is um whether the RFP has any provisions for the exclusion of bidders that have some defined or quantified history of litigation or of poor service outcomes.

If that is, if there's something like that in the RFP, which is being reviewed by council, we know there's already a draft.

That would be helpful to know.

Thank you.

Yes, hi.

Good afternoon, uh uh, Board of Supervisors.

On behalf of NUHW members who work at Santa Rita Jail, I'd like to thank you for taking this opportunity to talk about medical services contract at Santa Rita Jail.

We respect the procedure that needs to happen that our me must follow in the democratic process established under regulations and good governance.

Uh, but we also believe it's important as stewards of the public good that a few issues be made make sure that are in the RFP.

Number one, worker retention and transition requirements, making sure that the current employees who are employed remain employed at least for a period of 180 days if the contract was to change.

Uh, respect for collective bargaining agreement, the contractor, whenever the successful bidder should be, should respect the should respect the existing collective bargain agreement that exists there.

Whistleblowing procedures, we believe the contractor should establish clearer and finer uh definition in terms of uh whistleblower protection and a service-oriented care model should be the highest priority, and above all, performance and evaluation oversight.

Thank you again, uh, members of the public and the board of supervisors for your time.

Last two in person, Lonnie Hancock and Bob Britton.

Good morning, supervisors.

I'm really here for myself because I'm very interested in this process based on the fact that I did run policy and budget for correction systems for six years of the state legislature.

And I'm interested if uh Director Gathoway could discuss the outreach that she did putting this draft RFP together.

Um the Bay Area has several well-known, nationally known think groups that have done research and worked with other counties to who have had similar similar situations to ours.

Did we reach out to them?

Will there be any outside experts of the selection panel who can bring their experience to this?

And I am concerned about the 30-day bidder response time.

Because what if a consortium of our own, Alambeta County, federally funded and otherwise health clinics or the alliance wanted to put together an application?

Some right.

So how do we do the out are we going to ensure that that outreach happens?

I was actually told by one of these think groups that asked if we had talked with uh with UCSF or UC Davis, because in some states, the university medical schools, Texas, for example, I was told, uses the University of Texas Medical School to uh to do its prisons.

Now I don't know how this goes down to jails, but it could be relevant and helpful.

Um we're gonna have more time for public comment.

Thank you.

One last quick point.

Think about um think about all the the well intentioned restrictions we put because we don't want anybody to have a better chance than anybody else.

Thank you.

But one thing I learned again in government is sorry.

Well, you'll have more time to speak.

Time to speak later.

If you're interested in innovation, I'm Bob Britton.

I want to thank you for paying close attention to this process, particularly Supervisor Miley, uh, who is gets down to the details.

And in response to one of the questions that Supervisor Miley had about being able to review the R for the board being able to review the RFP.

Uh, I believe the county council responded that that uh the R the RFP couldn't include anything that might exclude a bidder.

And my question is similar to one posed uh by John Lindsay Poland.

Can't the RFP set performance standards that might exclude one or more potential bidders from bidding, not from not from bidding, but from being awarded based on their uh past performance in this agency or any other agency or any other state in the country.

And then a couple of questions about the uh the uh timeline that the director presented.

The um what is the meaning on the last item of negotiationslash board approval?

What does negotiation mean in that context?

And about the appeal process.

We learned the appeal processes to the auditor's office.

Does that include a hearing?

And is there an appeal beyond the auditor's office other than litigation?

Thank you.

There are no other speakers.

Thank you.

Thank everyone for your comments.

And as mentioned, you will have an opportunity to speak on the other two informational items on the agenda.

Um, Director Gasway, you heard lots of commentary.

I don't know if you're in a position to respond to some of those questions that were raised by public comments.

Um, yeah, I took notes on all of that.

And so there's a couple things.

Some of it is um related to how we're putting um the timeline.

There were several comments about that, and one of the things is we will certainly look at.

I heard several people have concerns about how long we're giving bidders to bid, so we'll discuss that with the sheriff's department.

And uh, they do have a consultant on board who's helping with this RFP, so we'll certainly circle back on that.

The um evaluation county selection committee, so we do get a proposal from we will get from the sheriff's department as well as the consultant on who should sit on that and what their uh background is.

They need to be subject matter experts, they cannot be in any way conflicted out from participating.

Um we have heard about lived experiences, so we are talking to the sheriffs about how that is addressed.

And um so I just wanted to say it's pretty extensive review of who sits on that selection committee, and we do uh our best to keep that confidential, mostly um so that they feel free to do their best on the panel and not feel like anyone can call them or be influenced.

The um other part is about outreach.

So we certainly do have an outreach program, and I'll be taking a look at that.

I don't have the details with that in front of me.

So I'm gonna talk to the staff and to the sheriff's department about um how that's taking place.

Um as far as the um performance standards are in going to be in there.

There's also reference checks.

There is a debarment policy that the county has.

So if there's certain criteria where a particular bidder could be debarred um from county contracts, I don't know that any in this category are on that list.

I actually think they are not, but there are performance standards and background checks.

Um I was asked what does the negotiation meeting mean.

So once we have the selected uh a potential bidder by the selection committee, then we uh send out notice to proceed.

Um I mean, notice to award, I'm sorry, notice to award, and then we uh begin negotiations with that um proposed uh contractor, and we look at you know just any of the details if it's the pricing or the timeline.

We also have a standard agreement, and so some of the terms they may have um questions about, such as you know, the insurance requirements, et cetera.

So we go through all of that with them and their council to finalize an agreement that is then brought to the board for approval.

Um I was asked about an appeal beyond the auditor.

So we have seen in my time here um a situation where the auditor upheld the denial of the protest.

And so based on the appeal, they agreed and did not want to move forward, but the board still has the final say.

So the board could hear that, and this happened with the contract supervisor Miley referenced, and the board could decide not to move forward with the recommended award.

And that uh whoever's protesting can also come to the board and speak publicly about their concerns.

Thank you.

That was extremely comprehensive.

Thank you for taking great notes.

Um wanted to see if you could address the concerns about workforce.

So the union um I need to look at what language is being put in there.

There will be a transition period, and so um it is not a typical for you know them to um hire back employees.

I don't have the details in front of me about what is in the RFP, but that certainly is a common um occurrence that they hire existing um workers.

There, as far as whistleblower pro protests, I also need to look at that.

Okay, thank you.

So we definitely need to get more of these questions answered, and my office will follow up on that.

I'm gonna ask um, I think Supervisor Cham has some additional comments or questions.

Um thank you, Chair.

I I wanted to follow up on uh Senator Hancock's question.

Um my recollection was when we went out to bid uh last time, we didn't get a whole lot of responses or like maybe two vendors and then with well past uh in bankruptcy.

I I don't know how what that looks like.

So um is how can we uh formulate or work with the consultant to do like some of the models that Senator Hancock talked about in terms of uh seeing if there's a consortium of University of California medical schools that could help uh also participate in the RP process or look at different models.

So it's my understanding.

Well, go ahead, Lieutenant.

I Lieutenant Murphy.

Uh so we I can't speak on a cursor.

We be we've done an extensive uh this comprehensive RFP process.

And I think everybody will be delighted because I've I have heard from all of you all and the other people listening.

I've heard from the board.

Um fortunately, when I before I promoted, I was involved heavily in RAJ and CARES First with the direction of the sheriff, and everything's been a comally put together put together.

Uh I know there are probably three or four vendors out there that are interested in this RFP.

Um, the word has gotten out, and a lot of things have shifted from when we posted last time.

There's a lot of different companies out there now than there were before.

Um, we've reached out to our other county uh sheriff's office who have done this RFP previously and and got their best practices before we started writing this and kind of see what they did.

Um I have no problem reaching out uh to this the schools and we can uh talk about that supervisor.

Um, but I really think everybody will be happy.

Uh we with this RFP as it comes out.

We we have it's a continued build upon uh what we started with some of our re-entry programs, and we understand we're designing the system in the jail uh with Calim coming on on live on July 1st.

Um, we now have Actura helping us.

Uh we have Epic coming online soon.

The the system is being developed, uh, and it's written in a way that I think everybody will be happy with where we're going in the future and the vision the sheriff has for the jail.

Thank you.

Um, just to get to timeline um Lieutenant Murphy, if you could please uh clarify um what is the current language um with the current provider if there needs to be an extension because it's gonna be key that there's a transitional period.

Should there be a new vendor in place?

Um, can you speak to the current contract?

Whether it's there's options for like three-month extension, six months do you know what that language entails?

Okay.

Okay, but those are the questions we're gonna have to start looking because this is a tight timeline and um hearing all the feedback from the community, and I appreciate Director Gasway being open to adjusting these timelines because we do want to give all viable applicants an opportunity to learn through the bidder's process and decide if they want to submit a proposal.

Um, so that we'll have to adjust the timeline.

And there are unknown variables with respect to appeals and having it elevate to the auditors.

So we do need to start factoring in um what is that that interim timeline look like.

So we definitely need to start having those discussions.

Um, thank you.

I'm gonna close out this item, but I will just say that um all the commentary is consistent with what we've heard in the past.

So my office will continue to work in collaboration with Director Gasway and the Sheriff's Department to uh do our best to track to implement as many of these suggestions as possible legally.

We're not gonna be able to do all of them, but I think there is a commitment to do as many as we can.

Um, so we will now move on to the second item, which is also an informational item with respect to Santa Rita Jail Medical Quality Assurance Udate.

We're gonna receive a presentation from Lieutenant Daniel Murray.

Back to health as well after he concludes his presentation.

Hello.

Uh so I just uh Lieutenant Dan Murphy again, the contract, Lieutenant Santa River of Jail.

Um, I'm gonna hand it over here to Actura pretty soon, but I just want to highlight kind of the history and where we are now.

So uh last fall, our contract with Mazars, which was our our previous quality assurance company ended, uh, and we didn't have a new quality assurance until the new year.

So I want to thank Dr.

Clannon and her team uh at Alameda County Health for helping us fill that gap.

Uh during that time, recommendations that the doctor and her team identified have been included into this current process.

This will be our first uh quality assurance report for the quarter report to the board.

Um, but I want to highlight that this is a baseline.

Um we are now using the 2026 uh uh national correctional health standards that it just came out.

So the previous reports, some things have changed and the metrics have shifted from from Mazar's.

So I do want to highlight that this is a baseline report.

But this report is we're only gonna go up from here.

The the end result is that Santa Rita Jail becomes accredited with the national correctional uh organization, and we just get better.

So before further ado, I want to hand it off to uh Mark Fisher and Dr.

Lee from Actura.

Welcome, thank you for joining us.

Hi, I'm Mark Fisher.

I'm the CEO of Actura Health.

Do you need me to advance the slides or you can say next slide?

Okay.

Uh thank you, Lieutenant, and good morning, supervisors.

Uh the title of today's briefing, a new chapter in health care oversight is intentional.

Ectora Health is not a rebranding of what came before.

We are a fundamentally different approach to health care oversight at Santa Rita Jail.

New company, new standards, a true partner to this board, the ACSO, and the people in custody.

Our job is simple to state, but hard to do to help ACSO oversee the medical care delivered inside Santa Rita Jail is safe, consistent, and something this council can stand behind.

In 2026, we are focused on two major milestones.

First, earning the NCCHC accreditation, a nationally recognized standard of excellence in correctional health care.

Second, preparing for the switch to EPIC, a new electronic health records system.

Both require serious preparation, and Actura Health is fully engaged on both.

Next slide, please.

Before I describe our approach, I want to be transparent about the handoff from Alameda County Health Interim Coverage.

It looks like in practical terms.

In 2025, the focus was on well passed corrective action plan activities.

This was the high prior the right priority at the time, but the approach was mostly reactive.

Find a problem and respond to it.

2026 is a different environment with higher stakes.

Here's the key thing to understand about NCCHC accreditation.

There is no partial credit.

Every single required standard must be fully met on the day the surveyors arrived.

One failure, just one, is enough to deny the accreditation.

So our approach had to shift from reacting to problems to preventing them before they happen.

That is the shift you will see reflected in everything we present today.

Next slide, please.

Let me introduce the team doing this work because of the quality of oversight depends on them.

I'm ACTURA CEO and executive sponsor.

My role is to keep the partnership mission focused and accountable to the board and the ACSO.

Dr.

Lee, who you will hear from shortly, is our physician advisor.

He supports provider level clinical review and is helping us prepare for the EPIC rollout.

Our managing clinical advisor holds active NCCHC general surveyor credentials.

That means the person guiding our entire review process understands NCHC surveys.

When we say a standard is not met, we're applying the same lens the actual NCCHC surveyors will use.

There's no guessing involved.

Our managing director advises on staffing and workflow risk, catching operational problems before they become compliance failures.

Our project manager makes sure every corrective action is tracked and every deadline is met.

We're a specialized team built for this population as a clinical oversight.

Next slide, please.

Everything we do runs on two gears.

Gear one is quality assurance, QA.

This is how we find where we are.

Each month we conduct detailed reviews of patient records using NCCH standards and their very detailed compliance indicators as our measuring stick.

We document what is working and what is not and produce evidence-based findings.

Gear two is continuous quality improvement, CQI.

This is how the gaps are fixed.

When QI, excuse me, when QA identifies a problem, CQI drives a structured process, figures out the root cause, makes a change, test it, and verifies that it holds.

Think of it this way QA without CQI is just a report.

CQI without QA is change, but change without direction.

Together, they're the engine of real improvement.

Next slide, please.

I want to be clear about something before we get into the numbers.

Actura Health is not here as an auditor or a regulator.

We are a partner.

A partner stays engaged and understands the day-to-day realities and works alongside the teams to help solve the problem.

Our approach rests on three pillars.

Pillar one is continuity and improvement.

We built on everything learned from the 2025 AC Health handoff, starting from where the data tells us we actually are.

Pillar two is accountability action.

Every finding is evidence-based.

Every corrective action has a deadline and an owner.

And we follow up to make sure it sticks.

Pillar three is transparency, one clear report, one voice, accessible to the ACSO, Well Path, AC Health, and this board.

Those pillars support one destination, a jail healthcare program that is safe, accredited, and ready for the Epic transition.

Next slide, please.

Our oversight work goes beyond monthly chart audits.

Two of the most consequential changes coming to Santa Rita jail are the medical services RFP and the switch to the Epic Electronic Health Records system.

And ECTRA Health is advising on both of these.

On the RFP, we are working to make sure the new contract includes the right quality and accountability protections, NCHC aligned standards, clear scope of practice requirements, and audit rights, and built-in corrective action mechanisms.

The RFP is not just a procurement document, rather, it is a quality protection tool for the people in custody and for this county.

On EPIC, switching to a new electronic health record system during an accreditation push is high risk.

Done poorly, it creates documentation gaps and compliance failures at exactly the wrong moment.

We are participating in planning meetings, plan to review clinical workflows, and help bridge the needs of medical and custody staff in the new system.

The goal in both cases is the same.

Build a system that can sustain compliance.

It's not just a one-time goal of achievement.

Next slide, please.

Before I hand off to Dr.

Lee for the clinical data, I want to address something directly.

Achieving full compliance in Santa Rita Jail is not something any single organization can do.

Here's a real example.

When a person arrives at SRJ in a behavioral health crisis, they need a medical screening within six hours.

They may need an urgent referral to adult forensic behavioral health.

They may need a housing accommodation.

No single organization controls all those steps.

If ACSO and AFBH are not coordinating with Well Path at Intake, the standard fails, and the patient does not get the care they need when they need it.

This is why the formation of a multi-partner quality committee is so important.

A standing group that brings WellPath, ACSO, AFBH to the same table on a regular basis, not a one-time meeting, rather a permit structure to track corrective action process across all shared standards.

Full compliance requires full alignment, not isolated single vigor fixes.

I'll now turn it over to Dr.

Lee to walk through the clinical performance data.

Thank you.

Welcome, Dr.

Lee.

Thank you.

Good morning, supervisors.

Um, Dr.

Eric Lee with Octoral Health as medical quality assurance.

Uh thank you for this opportunity to speak and present.

So let's go to the next slide, please.

So one thing before I start on this slide.

I want to talk and emphasize NCCHC and what it stands for, right?

So National Commission on Correctional Health Care.

It is a national standard.

Okay.

And it is just like hospitals are held to the standard of joint commission.

Just like physicians are held to the standard of board certification.

And the public deserves to know how hospitals and physicians are with maintaining those standards and how they score.

The NCCHC is a standard for correctional health care that the county, right?

That the Alameda County, the public, the patients, and all its residents deserve to know where Santa Rita Jail stands with regards to NCCHC.

Okay.

So that is why we are going down this road for accreditation.

Okay.

So with this slide, right?

There are no shortcuts to achieving accreditation.

It is a process that you have to adhere to.

There are no shortcuts, right?

If you want to pass an exam, you can't just look at it for two seconds, study it, and go in and take the test and expect to pass.

Okay.

Physician doesn't expect to go and sit for their boards and achieve board certification on the first try.

If they don't prepare for it and study and do all the necessary legwork to make sure they're in the best position possible to pass.

So this is these are the steps.

There are no shortcuts to this to achieving accreditation, right?

So number one, evaluate the baseline.

And we've been doing that on a monthly basis.

Number two, identifying those gaps and performing that root cause analysis of why the gaps exist and what are you going to do to address those root cause analyses.

Number three, if there are corrective actions to be issued, you issue them, and the leadership needs to address of how they're going to correct these issues and the gaps, and then we reassess.

But the last step, right, toward achieving accreditation successfully is you have to be able to sustain these changes.

They need to be reproducible month over month.

It is when you have improved and addressed the process and improve that, right?

That is how you're going to sustain better care down the line and achieve accreditation.

Let's go to the next slide.

So with NCCHC, there are seven sections.

Patient care and treatment.

And there's three reasons why we're doing this.

So standards most directly tied to immediate patient safety, like intake screening, initial health assessments, continuity of care.

These determine whether someone entering custody gets the medical attention they need when they need it.

But these are still considered essential requirements.

So failing one, as we mentioned earlier, failing one of these is grounds for denying accreditation.

And the third reason is these have historically represented opportunities for improvement at Santa Rita jail.

And our Q1 data confirms that these problems persist.

So before we get into the 10 standards in Section E.

This is just I want to provide you guys guidance here in terms of the dashboard, right?

So obviously on the left, you have fully met.

That's the only standard in which you pass one of the 10 standards within Section E.

There's partially MET, 75 to 99%, or there's not met, which is less than 75%.

Okay, so again, this nine essential standards out of the 10 require 100% to be fully met, and the important standard, which is the 10th standard, requires a passing score of 85%.

Okay, so let's go to the next slide.

So here's the dashboard.

In which there has been 100% compliance.

So this is one standard in which uh Santa Rita Joe would pass.

Let's look at the um I want to there's a couple areas that are partially met, and they're trending upward, which is encouraging, right?

And then one area you can see the trend month over month.

Um area I want to point out is item eight, nurse initiated protocols.

So there was noticed or scope of practice violations under California's nursing practice act, and this is an NCCHC compliance failure.

There is this is a uh there is a full nursing protocol evaluation included, which is to be uh addressed in the corrective action plan response due tomorrow.

Uh let's go to the next slide.

So this is another view of some of these measures, right?

And just to show you a different way or a heat map with trends month over month of how where the numbers lie based on our audit.

Um so some of these red areas again, right?

Where there's there's improvement one month, and then you notice that there's a decline the following month, and then it trends upward, right?

So this again indicates that you're not we're we have not achieved sustainment uh right, sustained improvement showing that we have a repeatable process showing that we have we have we're going to meet the standard, right?

So there are there are actions taken to address the poor performance, but we're not able to repeat it and sustain it over time, and that is again what we're focused on from the original slide that I was starting with with those five steps.

There are no shortcuts to assist to sustained improvement, right?

So this is again part of that struggle.

It's hard to be perfect all the time, but it's that's part of that whole process improvement journey.

Uh let's go to the next slide.

Again, another view of trends.

There are certain measures in which we are noticing improvement.

Okay, and you know, again, perfection does not happen overnight, Rome was not built in a day.

So there has to be targeted and focused attention to each of these different areas and and a plan of how we're going to improve and meet that 100% goal.

And that is what we're working with on uh with these monthly audits.

So they're continued dry run rehearsals in in uh for that final day when NCCHC sends the accrediting survey, and you only get one chance to pass, right?

And that so you want to be able to pass with all of these criteria.

Uh let's go to the next slide.

So there's three colors here, right?

And a lot of this, you know, another way in which you can look at this, right?

The pyramid, there's foundational items that happen at the bottom, triage escalation failures.

Um the middle tier.

There's outdated protocols in which there wasn't review or medications administered without documented orders, right?

This is this is with the scope of practice with regards to nursing protocols that I highlighted earlier, and then at the tip of this pyramid in red, are the items in which we notice this because it's the highest escalation.

This is this was what places us at highest clinical and legal risk.

And this is this is this is the stuff that ends up in the media.

You know, another way to look at this is this if you thought of this as an iceberg, right?

Again, what is the public see?

What do auditors see?

They typically see the tip of the iceberg, right?

And supervisors, you are typically notified of what is at the tip of the iceberg, but what is underneath the surface of the water is a massive iceberg in which there are lots of failures or things or opportunities for improvement that are not occurring underneath that surface of the water, right?

And so you don't if you want to address the problem at the tip of the iceberg, we have to do all that foundational work underneath a process improvement.

All right, so let's go to the next slide.

Um I'm gonna turn this back over to Mark for a closeout.

So thank you.

Thank you, Dr.

Lee.

Thank you, Dr.

Lee.

Um, as we move into quarter two, I want to leave the board with a clear picture of the proactive steps replacing the reactive fixes of the past.

Multidisciplinary PDSA, which is plan to do study act pilots, are already underway.

The teams are actively re-engineering how DACSO, well path, and AFBH coordinate on intake to reliably meet the six-hour receiving screening window.

This is not only a this is not a well path that we fix, it requires all three partners operating from the same playbook.

Targeted physician feedback.

We recommended that the same approach that improve the chronic care management be scaled to other underperforming standards, starting with initial health assessments, periodic mock surveys.

We will test staff knowledge and identify vulnerabilities before the actual NCC HC survey.

So nothing is a surprise on day on survey day.

The goal is for accreditation readiness to be the daily normal, not just a special project that gets activated when the survey is scheduled.

Next slide, please.

I will close with a theme that runs through everything Ectura Health does at Santa Rita jail.

Alignment, execution, and safety.

The GPS moves one data point at a time.

Each month you review is a coordinate update, showing exactly where we are, where the change needs to be, and exactly what the next step is.

We're not guessing, we're not hoping.

We're navigating using the data and the expertise at our disposal.

The destination is a healthcare program that is safe, defensible, constitutionally sound, not just improvement for the moment, but proof of sustained improvement, documented and verified month over month.

Actually health is honored to serve as the ACSO's partner in this work.

We are committed to the ACSO, to this board, and to every person whose care depends on Santa Rita jail getting it right.

Thank you.

And we're to continue to build and improve as we've seen historically on what we've done the last several weeks at Santa Rita jail.

This will only make us better.

The goal is Santa Rita jail becomes accredited, but so much more.

We have to provide those in our custody uh the same level of care as they receive on the outside.

And so things like this and identifying gaps only makes us better uh to approve upon those who are in the custody of the sheriff's office.

Thank you.

Thank you, Lieutenant Murphy.

Any clarifying questions at this time?

Supervisor Miley, go ahead.

Thank you, Chair.

Well, very impressive presentation.

So let me ask a few questions if you don't mind.

Uh so um Acura, how long have they been in contract with the Sheriff's Department?

Since December of last year, December of last year.

Okay.

So they've this is their three months.

They've done three evaluations.

Okay, all right.

And then I'm not familiar with the NCCH, but as the doctor pointed out, like you know, I can understand it.

So are there other uh jails in California that have this accreditation?

Yes, there are several.

I don't have them off top of head, but there are several get that have the accreditation and some that are getting.

So right now, there's three things.

So our map program at Santa Rita Jail is just got NCC HC audited about two months ago.

Uh they was previously accredited, so we're trying to get the medical portion accredited, and there is a mental health component that could be accredited as well.

Um, so we are trying to achieve the facility as accredited as a whole.

And the jails that are accredited, do they have any similarities either in California or nationally to our jail, our jail population?

The you know the the um incarcerated individuals that you have to deal with.

I'm trying to give a sense because I'm trying to understand expectations because what they've laid out here sounds really great.

I'm glad they're in contact or in contract with the sheriff's department, and it you know, and once again I always say, you know, um, let's not let uh perfect be the enemy of the good.

But this seems like we're driving towards perfection.

So I just want to understand in terms of my expectations.

Um they worked with jails of similar characteristics as our jail.

So each jail is unique uh throughout the entire country with uh for various reasons.

Uh, you know, lots there are a lot of jails in California that are much smaller than Santa Rita jail, much smaller population.

Uh, but we have such unique like classification system, all the programs we offer at San Antonio Jail is very unique to Alameda County.

So it's hard.

There are pieces of other jails that have similarities to us, but Santa Rita Jail is very unique in the country as a whole.

Um, so we're taking those lessons from other places and reaching out to other uh facilities to see what they're doing to meet certain areas that we need to meet.

So not there is not there's I can't recall you know another jail and get the exact answer, but we're trying to get pieces from everybody uh to make it work for Sandra.

Yeah, so the way I hear it, Lieutenant, is if we can make it work at Santa Rita jail that Acura and uh Alameda Health and whoever the partner is delivering the the um the medical services will basically be a standard bearer because Santa Rita jail is so unique.

And if we get this accreditation, it if if I understand it, we've got to meet all categories.

There's no if answer, but it's gotta be everything's gotta be met.

Sure.

Well, I think that would, yeah, this would be tremendous.

Well, the shift is already there, and as you can see with the how much how far we have come in the last several years of what the jail was five years ago is not the jail you see today.

Uh whether it's programs and services, all the things that we've accomplished that were identified in the consent decree, we've achieved and made the jail better.

The jail is better every day because of the things we do and the people that work there to make it better.

Uh Santa Rita Jail has really become a place of opportunity for many people and a true second chance.

And Sergeant Silva was just here last month, and she uh presented on all the programs that we are offering to the incarcerated women's population, and I've been here years before for all the other programs.

So Santa Rita Jail is truly becoming a place of hope and change uh that we can continue to see, and it's tangible.

Yes.

And you know, I was just out there and took a tour of the jail maybe within the last month or so, and I hadn't taken a tour in maybe a few years, although I've been out there to have meetings, and I was very much impressed uh with what was you know which what had taken place from the time I toured it many years ago to when I toured it recently.

Yeah, I was just very impressed.

Thank you.

It it takes a lot of time and effort.

This is a huge uh battleship we're trying to steer and and maneuver, and uh we have to use our county partners and community partners to help us achieve the ultimate goal.

Okay, and um let's see what Mr.

Fisher laid out and what the doctor laid out in terms of their the way they go about this is very you know, very intriguing and very fascinating and very thorough and comprehensive.

So I'm I'm impressed with it, very much impressed with it.

Um the one thing with with this is on one of the side slides, it talked about one vision, one team, the necessity of shared responsibility.

That uh does that, and I'm assuming it's a yes, but does that include the frontline workers, the folks who are delivering the services, the medical staff?

They're part of this conversation because in my meetings with in UHW, um the staff, they've had issues and and they've brought up things they thought should be done, and this that and the other, but sometimes it hasn't materialized.

So will they be part of this team approach?

So as they go out and they've gone, they do like site reviews and they'll do like workflow reviews where they've gone to our intake area and they've watched the nurses and interact with the nurses and had conversations uh because we have to we have to work with everybody and the line staff to identify the problems.

The line staff see things that maybe management doesn't.

So they get into the weeds of everything to look at the system as a whole.

Okay.

And I know when I was out of the jail many, many years ago, I know I there was issues with the assessment center and this and the other, and I think all of that's being um looked at and has been looked at, but that one uh and also back with the accreditation.

If the accreditation fails, uh because you get one shot at it, when can you come back maybe a year or two years when what what's the process?

Yeah, there is a reassessment time.

I don't know what it is obviously uh off the top of my head, but there is a time to be reassessed.

Okay, okay.

And I do like the fact that working with Acura, um they use uh the criteria that the um the the accreditation folks will use.

Um but it is troubling that one slide that it showed Q1 2026 Section E dashboard, and then as a doctor went through it, it kind of showed uh where we have met things and where we haven't sustained it either.

So I'm very um delighted to see that we're seeing this, and that we're gonna begin to see how we can address it.

So I think this and and that looks at transparency too.

Like I said, this is a baseline.

Some of the things that we're now evaluating were not being evaluated prior.

So this is basically it just went live this year.

Uh so we're moving forward.

So that's why some things, some metrics might be lower than others.

There's other reasons, but now we have now we understand like over being evaluated in this and we're moving forward, and we meet with Wellpath all the time.

But Actura, when they come monthly, we sit down as a group uh with public health and have this conversation.

Now two last questions.

Um I do like that analogy of the iceberg.

You know, what's above the surface, what's below?

I like that analogy.

Um but um and it's and it's monthly.

So the contract that you have with them, uh what's uh what's the duration of the contract and what's the cost of the contract?

So it's three years.

Uh I believe it's 1.2 off the top of my head for those three years.

Uh they are on site, on site, uh two to three days a month for their on site.

Uh, but they meet with us all the time on Teams, it seems like uh because they're also helping us with Epic, they're helping us with the RFP um review and input.

Um they're helping us with during our conversations.

They they because this is their field, there's ideas that we never thought of that we've helped build the the process.

So I'm not gonna get into the RFP process, but they've been a huge help.

Uh like once again, Bravo.

I take my hat off, so I'll be eagerly awaiting the transformation.

Supervisor Temple.

Uh thank you, Chair.

Um, this is a little reminiscent of my days of governing Alameda Hospital with the joint commission accreditation.

Uh so when you look at the NCCHC standards, and I I was gonna zero in on what Supervisor Miley talked about with the Q1 2026 section E dashboard.

Um I'm I'm focusing on some of the lower score uh standards like um the receiving screening and the continuity and quality of care.

In in those situations, are they is it an issue of staffing or is it an issue of technology or both?

I don't think it's an issue.

I think for what we identified, it's staff maybe not fills the form out left to right accurate all the way.

They miss a box, so therefore it's you know they get dinged because it's not fully completed.

I think having Epic be, you know, Epic is going to help us a lot with this stuff because there's built-in mechanisms and tabs to where they can't move forward with the next form until they hit all the required boxes.

Um there's various reasons why that is.

Some of it uh again, people miss the forms or systems were missed or processes happen.

I think with moving forward, uh it's going to only improve because this is we've identified some things in the forefront.

Well path has been more have been help helpful.

There's a we have a meeting tomorrow about uh addressing some of these, and they're coming up with corrective action plans, and some of it is they're thinking outside the box themselves.

We're looking at our intake process uh and and how we can achieve the time goal.

For example, the consent decree requires we get people out of uh our intake in eight hours.

Well, the new standard is six hours.

So now we're looking at our process, the sheriff's office as mental health and as our medical provider to how we can improve even more than what we were as a result of the consent decree.

So some of it's just looking at the processes, processes, and chork it, you know, changing things a little bit and making it better.

So this was a huge baseline for us and helped us identify gaps not only in the sheriff's office, but also our providers in the jail to look at things differently to improve upon.

Okay.

Well, I'm I want to echo what Supervisor Marley said.

I'm glad uh you're being proactive and trying to prepare and and identify where those gaps are.

Uh so we have a corrective course of action.

Um I wanted to understand better in terms of um how these standards get get melded into how we're gonna be looking at um a different provider or a new provider.

So we basically put those those standards out there, like those are what needs to be met.

Um there are mechanisms in the RFP that I can't that we have talked that I can't talk upon that will help ensure those are being met.

Um so we've looked at that and with recommendation from Actura, there's certain benchmarks or triggers that help ensure things are moving the way we want them to move.

Is the I don't want to get too far on the RFB, because I'm uh that's a touchy thing, and I'm sure Clay's looking at me over here like uh don't say anything.

So uh, but that we we've taken that into account, and we will ensure whoever our next provider is uh will meet these standards.

Okay, thank you.

Thank you for the updates.

Just also want to thank uh Dr.

Clan and Dr.

Moss for being instrumental during this transitional period from Mazars to now Ectura, and just really pleased with the approach and the analysis, and it hasn't even been well it feels like six months, but we're still in April.

But um, you've accomplished a lot in a short period of time.

And am I understanding correctly that you're also engaged in the RFP process?

You guys are weighing in providing expertise, okay?

That is a incredibly reassuring.

Um, Supervisor Miley flagged a lot of my questions.

So thank you for being so thorough.

But help me understand timeline.

When will we be ready for the accreditation process?

Um, is that determination based on us, or do they just do an announced visit?

Like what's the timeline?

So I think I gotta Dr.

Lee come up, but mostly it's one to two years, realistically, because we have to get kind of our all of our ducks in a row, and then we have to have a good, probably a good steady year, if not more, of showing we could do this continuously, and then we would reach out to that accreditation board and have them come to us uh and set that up.

So realistically, uh a year or two, um, maybe even three, depending on who our new provider is the transition because that might change things.

Um, plus I think we need to make sure Epic is on live and on board before we try because that's there's gonna be a huge learning curve there.

But that system, once it's live, working with uh uh uh Tom and his team, it's gonna change change the game of what we do, and it's gonna be amazing to where Highland could talk to the jail and the jail could talk to it's it's gotta change the game.

Okay.

Also just want to um compliment you.

You've been incredible every time you come and present here.

I just really appreciate your passion for the work.

I've met with you several times at Santa Rita Jail, and just really excited for your promotion and um your care and dedication to the people you work closely with.

So thank you for that.

I will also put a plug.

Um, thank you for man mentioning um Sergeant Silva's presentation in March.

But those that are interested in all things at Santa Rita Jail also highly recommend that everybody watch the presentation back in November of 2025 where we received incredible information.

I'll just highlight a couple key statistics.

Two years with zero suicides at Santa Marita Jail is huge.

And I might get this number wrong, but there has been um actions, uh, proactiveness at Santa Rita Jail to the extent that we've saved over last I heard it was 319.

I think it's higher now.

370, 370 lives.

I just looked at yeah, with three three high threes.

I'm gonna say that's high three hundreds of an exact number.

Yeah, and that's with um consistent monitoring, intervention, um, being able to get ahead of uh overdoses and just the whole proactiveness and approach.

So we are trending in the right direction.

This stuff is not gonna happen overnight.

Um appreciate the constant contact with the team, the uh monthly meetings and the the uh consistent huddles, but in the areas where the the ratings were low, how do you prioritize um like the medical screening, the dental care?

Give me a sense of when you do when we get this quarterly information.

What's the next step in terms of are we addressing staffing issues?

Just give me a sense of what's being done to see these numbers um continue to increase.

So when we get the report from Actura, we send it to Well Path, which is our current medical provider, and they have uh a 30 days to do a corrective action or give come back to us with the plan.

Uh and that's where we start having a conversation and as well as public health on is it the is it the system, the mechanisms in place?

Is it a staffing issue?

Is it just do we need to go to electronic or do you go to paper?

Is it as simple as they don't, you know, did they get dinged because they didn't fill this one box out, but they just need to fill the box out.

Like we look at the entire system.

Um, so moving forward, the number is going to go up.

I'm I'm very confident in that.

Uh, but it's a constant dialogue.

I have a great team, uh, great leadership all the way up to the sheriff.

That you know, we work together to come up with plans.

I have a meeting later today with the new California president of Wellpath.

They well path is restructured itself, then now California is its own division.

Um, so I we go directly to the president if need be to address a larger concern, whether it's staffing or there's some system in place.

Cal Aim is uh gonna go live and that's gonna help as well.

So there's certain things in the future that are gonna help the work things trend upwards.

Um and Cal Aim's going live in July.

July 1st.

July 1st.

Yes.

Um also want to know just to be um upfront with everyone and candid.

So giving a lot of kudos to uh deputies at Santa Rita Jail, obviously, partnership with behavior health as well as instrumental.

And my team and I did um visit Well Path, the medical clinic and learn more about their medical assistant treatment.

So that's also been significant work in progress in saving lives.

So it's just the entire ecosystem is more collaborative and working well together, so seeing significant improvements there.

But we're currently in the second quarter of Ecterra's evaluation of the care being provided at Santa Rita Jail.

So that will end in June.

When will the next report be available?

Uh so this is our first report because they started in January.

So this is our first quarterly report.

Uh so in June will be the next one that I will come and do that.

Is it typically in July, or like how long does it take to produce the report?

Is my question?

Uh that's like usually the 30 days is usually typically in July.

Yeah, so July would be the next report.

Would be the second report.

Correct.

Okay.

So we're gonna go to public comment.

Do you have any closing remarks?

No, okay, we're so much.

Thank you.

We're gonna go to public comment and we'll do one minute specific to the informational item we just received.

Oh, sorry, it's gonna be John Lindsay Poland.

He left.

All right, he left.

All right.

Um then I have Did you write?

If you could please wait till your name is called.

Um, Richard Spegelman.

Go ahead, you have one minute.

Oh, Richard Spiegelman from my CJJ.

Richard, if you could press the button, please.

No, you're good now.

You're you're sorry, press it again.

Okay.

Uh-huh.

Thanks.

This is Richard Spiegelman from ICJ again.

Um I want to say the metrics that were just presented look good.

And I'm a little, and I sort of get it that accreditation is this thing that one wants, but I don't quite understand what it gives us.

Uh, and I'm asking this question in in hopes of or looking for uh a positive answer and not something weird, like what really is in it for us to get accreditation.

Will that help us do our work better?

Will the outcomes change?

What do we expect from accreditation?

Do we get a gold star that we can hang that we don't have now?

It's just a little ambiguous in my mind.

Thanks.

Thank you.

And then Bob Brennan.

Bob Britton, I see JJ.

I wanted to thank the sheriff's department, particularly Lieutenant Murphy, and all of the staff that are working on this issue.

Um it's it's wonderful.

It does, however, feel a bit like deja vu all over again.

The last time we were here in a joint committee, uh health and public protection, uh, and we were talking about this topic.

Uh, there was a representative from Mazars for a minute.

I thought it was the same person as today who talked about the need to have corrective action, not just to rate them and mark them as failure.

Uh but the issue is still the same.

If we look at the ACTA uh ratings, the current provider is still failing at a 66% rate.

Six out of nine measurements not met.

Failure, in other words.

Thank you.

Lonnie Thank you.

I too was very impressed by the presentation.

I love the way things are visible and that we can get reports back and think so.

Thank you.

One question.

I can't find how many jails in California actually are accredited.

But if there are several, as the lieutenant indicated, can we find out who provides their health care?

How do they get it?

Is there a provider that's presiding over accredited jails?

Is there do they use their public health system?

Do they do something else?

So that would just be a suggestion, or if the lieutenant knows the answer.

Amy.

Hi, Doctor.

Hi, I'm Dr.

Amy Lang.

I'm the current uh medical director at Santa Rita Jail.

Um I trained in emergency medicine at Highland Hospital, and I've been working for Alameda Health System for the past eight years.

Um and I was drawn to this healthcare system because I I I it's my passion to serve underserved communities, and being in this health system led me to addiction medicine care, and then it led me to correctional health care in this current role that I feel is a great privilege to be in, and it serves my community, the community that I live in.

So I just wanted to express a lot of gratitude and partnership because the NCCHC released these standards in January of 2026, and as we could see, um, after one month, we our our partners at in custody and the medical team have already met one of those standards 100%.

So that's a lot of pride that I feel.

Um and I think that this partnership has already produced a lot of meaningful system wide change, and a big thing is the receiving screening, which we started before the 2026 standards came out.

Um and I'd love to present that data at some point to the board because we have a lot of great data in um joint with custody.

So I'm just excited for a lot of the meaningful change that's happening.

Um so thank you.

Dr.

Lin, can I ask you when you uh assume this current role that you're in?

I started in October of 2025.

Wonderful, thank you.

Thank you.

Elydrian Aladrian online.

Uh good morning, uh afternoon, supervisors and those uh from the sheriff department and in the building this morning.

Just wanted to um again state like those in the uh the chambers of stated great thanks to the supervisors and to the sheriff's department for taking the time to actually sit down to meet with our members to hear what their concerns are.

Um our hope is that that continues as we move forward with the RFP process.

I think it is definitely necessary for uh those folks to actually sit down with the the folks working within the medical clinic to actually talk to them besides going in and assessing what they're doing, but actually sitting down with them and setting up a meeting to discuss with these folks to figure out what their needs are uh within the clinic within the jail.

I think we're on the right track and the right process.

Um again, we let folks know elections matter, and you supervisors have definitely stepped up to the plate and made sure that folks that work with the Santa Rita as well as our community members that are uh within the jail have the services um that they need and that they're being provided uh to them.

So again, thank you.

No more speakers.

Thank you.

Thank you, everyone, for your community engagement.

We will definitely um continue to advocate that everyone has a voice in this process, and um Dr.

Lynn, my team will be in contact with you if you want to come and present to this body in the future.

We welcome that.

Um, we are now gonna move on to our next item on the agenda.

This is also an informational item.

This is an update on the Epic Electronic Health Records project, and we're gonna have a few presenters.

First presenter, Dr.

Mossesi coming up, and Asad Iqbal, interim director with health and business data analytics with Alameda County Health, and Tom McMillan, interim director information systems, also with Alameda County Health.

Welcome everyone.

It's already new and was gonna say good morning, but it's fast new.

So welcome.

Um thanks for pointing that out to me.

Good morning, uh good afternoon, uh supervisors.

Uh, I'm uh Dr.

Nick Moss, Alameda County Health Officer here to introduce our presentation on the uh EPIC electronic health record, and we will um we'll provide a general update and then some highlights um specific to Santa Rita jail.

Um, as you heard, it will be um Tom McMillan, our interim director of information systems and Dr.

Asad Igbal, interim director of health and business data analytics, giving the presentation.

Um they have been uh along with their team working for over a year to push this project ahead, coordinating with within our agency, the public health department and behavioral health departments, and then with the sheriff's office, GSA County Council, also Actura and Well Path, to um get us to the best possible outcome with the EPIC project for the people of Alameda County.

Um, and I just want to thank them for their um hard work and leadership.

So I'll turn it over to Asad.

Welcome, thank you for being here.

Oh, thank you so much for the opportunity.

Um good afternoon, honorable board.

Um my name is Asadir Bal, and I am the interim director of health and business art analytics.

Uh, we will be presenting an update uh to the board around the on the epic HR project.

Um McMillan uh ACH information system interim directory will be also uh co-presenting with me.

Um uh this slide outlines the um um the roadmap um uh for today's discussion.

We will begin with the some background how AC Health and ACSO reach to the decision or arrive for the decision for the pursuing the EPIC.

We will then also sharing with the board in terms of the partnership between the AC Health and the ACSO partnership structure itself.

From there, we will review the key milestones and the timelines and the budget expectations of the overall project itself.

And finally, then we will be concluding with the some projective status and the QA's for the board itself.

So before we uh start talking about where we are going, I think it is important to understand where we are today.

This slide is presenting the uh current state.

Uh today uh AC Health and ACSO operates under uh multiple disconnected systems.

Uh these system does not talk to each other.

Um Behavior Health has a system known as the Clinician Gateway, uh, which is end of life and it needs to be replaced.

Uh the billing is done separately by a smart care system uh which has a limited integration with the clinical systems itself.

Um at the Central Editajel, uh Core EMR operates independently uh and does not connect with the AC health uh systems there.

Uh this create the um higher silos um system does not communicate each other.

Uh providers does not have the uh uh full comprehensive patient history and uh it causes the gap in terms of the uh uh of the care delivery there.

Um the uh fragmentation uh as I mentioned that lays to the uh gaps in the care coordination in complete patient information and the potential for the serious adverse event.

Uh the um the um key takeaway of this slide is is that we uh uh our current state uh limits us in to deliver the safe uh coordinated uh whole person care.

Um can we move to the next slide?

So now we know the current state.

If we solve for these um uh challenges, then what the future state would look like for us.

Um in the future state, the the future is centered on the integrated single uh epic platform uh which connects um uh AC Health and the ACSO together.

Uh we um uh um instead of multiple disconnected systems, uh we move to a unified um electronic community uh member record.

Uh key capabilities are integration of uh behavior health, um uh public health and correctional health, uh connection to the external providers, uh uh using the um uh B area Epic network, uh, real-time access to comprehensive uh patient information.

This enables uh a single source of truth uh for the patient data, uh better care coordination across setting, including jail clinics and the hospitals, uh a true whole person care uh model for for that.

Um, this isn't just internal.

Um, the it allows uh Alameda County to connect with the broader uh Epic uh regional ecosystem, improving continuity of care um and beyond the county services there.

So, all in all, it will allow us to move from fragmented systems um to a connected community white health record, uh community-wide uh uh electronic record.

Next slide.

Uh with that future in mind, um, I would like to invite um um Tom McMellan to walk us through on the value proposition.

Thank you, Sad.

Welcome.

Good morning.

My name is Tom McMillan.

I am the interim information system director for Alameda County Health.

Can I ask you, can you move the speaker a little bit closer?

Try to adjust it.

Yeah, there we go.

Is that better?

Thank you.

Moving from a fracture state to a continuous community record.

That is really our value.

When we look at EPIC, we're going to have one repository that addresses all of our healthcare needs.

It gives us the tools, as we spoke to earlier with Actura to have those boxes as we touched on to capture the requirements to make sure that the check-ins, the assessments, the various things that are required, not only for common sense, but from a regulatory perspective to be successful with that.

It will, of course, as we said, modernize our tools, not only for the sheriff's office, but also for Alameda County Health.

Part of the EPIC suite will be evidence-based care tools that we part of the provider's care process.

They're going to be built in when the individual is present with the client, with the patient, with the inmate, regardless of where they are.

It will give us the tools to comply with all state and federal mandates.

We will have capacity to enhance our claims billing to make sure that we are able to take advantage of Cal Ames and all the other revenue streams available to us.

Whole person care in Sanity jail, whole person care across the community, connection across pay for health and physical health.

It's going to give us the opportunity to improve our care coordination across custody and in the hospital.

This is moving us forward into the next generation of technology and care opportunity.

It gives more efficiency.

We're merging several systems.

So our footprint and our overall expense will be reduced.

As an IS professional, our security profile will be reduced largely because there will be less things for people to look at to attack.

It'll be one protected system.

Continuing on real-time data access.

Clients go across Highland, they go pay for health, they go into Santa Riva jail.

All that information lives in EPIC.

It'll be seamlessly shared automatically.

The opportunity to reduce medical records is going to be huge.

All the medication lists, all the allergy, all the lab results, all those diagnostic tests are going to be right there.

It's interoperable.

Epic, of course, is the dominant EHR within the Bay Area, but it also interacts with non-EPIC systems.

So if a non-EPIC system is part of a standard, that information will be available.

So it's not just EPIC to EPIC, it's any participating entity.

Operational efficiency, big deal.

Revenue cycle management within EPIC is very strong.

It's going to give the revenue cycle teams more tools, more efficiency to be able to build Medicaid and Medicare.

Health analytics.

That is a big thing.

Well, we look at our population, we want to be able to understand real time what are our opportunities, where should we focus, where should our outreach be for chronic conditions, and of course, Calian compliance.

If we move to the next slide, please.

Patient empowerment.

Some folks in here probably have my chart.

Perhaps not.

Perhaps they have a different portal, and that's going to be available to the patients and of course to that patient's family, their care team at home.

That's a big deal.

Health equity, it's a top-tier technology.

It is going to be across our community.

It's going to be a new digital revolution for us.

Of course, the specialized Epic is very well known in the hospital space.

They did, of course, start in the amuletary space.

That's where their roots are.

They started with continuity of care.

And of course, they have experience with the injustice-involved individuals and of course individuals within custody.

And if you could go to the next slide, please.

We plan to start the vendor implementation.

Just a call out here, we cite third-party vendors.

Those are some of those care tools that will be available within EPIC that provide that content, that clinical contact that providers rely on.

We plan to be back likely in the fall to present any additional applications, third-party vendors, and/or requirements.

That's very normal within an EPIC implementation or any large-scale implementations.

We have a discovery to start the process, and then we may discover new items.

And in fall of 2027, we plan to go live on EPIC.

That'll be an amazing big day.

A lot of people are going to be very happy and tired.

And then comes the next evolution within this system.

We'll look at future adoption opportunities and continue to retire legacy systems.

If we go to the next slide, please.

High level overview of the budget and the distribution across the individual departments.

So I'll let absorb, let folks absorb that for a moment.

It's higher than the number I reported, so I like it.

Thank you.

All right, let's continue on to the EPIC governance.

Actually, perfect, thank you.

So it's a partnership model.

Epic is going to bring not only their software but also their domain subject matter experience in each of those areas.

They're going to work with us in identifying the workflows, understanding how we need to use EPIC and how we will be successful with it.

We've had lots of rounds of software demonstrations, those long sessions where people sit down and we ask questions and we get responses and we look at software, and that's going to continue to happen.

Part of our journey also included working with ACSO and of course back then MAZARs and now ACTURA Health.

And why don't we jump into the next slide, please?

All right, this is a high-level view of the EPIC governance model that we will use.

It's fairly standard across large-scale implementations.

So it's a multi-level governance structure.

Its goal is to ensure effective decision making across the environment.

Not just effective, but agile or quick decision making.

That body has the overall oversight over the project.

They will spend a good chunk of their time looking at how we are performing, making sure we're on time.

And if there's any additional scope or budget requirements, that would go to that body.

The advisory group is the core group across each of the departments participating that are going to provide a strategic guidance.

The PMO, of course, is going to be a number of project managers across each of the areas and including EPIC.

We of course have to include finance, but the real work will be done in the domain work streams, revenue access, clinical apps, populational health analytics, and anything that is patient-facing, such as my chart.

Interoperability, that connectivity where we're going to need to build out additional integration with, let's say, a lab core or some other diagnostic center that does not send data automatically to Epic.

There'll be a lot of work within that.

So not only will we have Epic to EPIC, EPIC to non-EPIC, but also Epic to Lab Corps and Questin or other laboratories.

Next slide, please.

This is a deep dive in the project steering committee.

So it is accountable for the overall scope, the project deliverable, the timeline, and the budget.

Pretty clear.

Any collision, any decisions that cannot be addressed within the advisory board or the PMO will come here and they will arbitrate on that.

They approve scope changes, budget changes, anything in relation to moving the budget or changing the timeline.

On the right, we can see the composition.

We have, of course, our agency director, uh, health officer, and we can continue through the list of the participants.

And if you can go to the next slide, please.

And this is the advisory group.

This is far more strategic and tactical in nature.

These are the people who are the division has they know their work.

They are the frontline responsible individuals.

They're going to provide a strategic guidance for the overall EPIC implementation effort.

They're going to be very active in the workflow design and configuration decisions.

Their staff actually will be the work group, those individuals that are hands-to-the-keyboard, client and/or patient-facing, they're the ones that know what they're doing.

That's where that information is going to come from.

So we can see the purpose and accountability, strategic guidance and alignment, clinical, financial and operational oversight.

We have change management leadership, quality assurance and risk mitigation, and then any recommendations from this body to the steering committee.

You can see the composition is fairly broad, and we can certainly go to this slide.

Perfect.

So the next steps, uh we are having a formal launch by attending training in Verona, Wisconsin.

This is a standard Epic approach.

We'll have folks there, and then we launched a project.

Next slide, please.

Thank you.

Thank you so much for the great update.

I'm very excited and impressed, I think.

I've been in this role for a little bit over three years, and it was one of the things I first talked and asked about when I learned more about all things related to Santa Rita Gel and behavioral health.

And so just really um proud of the progress.

This has been a goal of re-imagined adult justice, care first jails last, making sure that we have accurate and timely information for people in our care.

And this goes beyond Santa Arena Jail, even though that is a very important area of patient care, but it's also going to serve us under behavioral health services, substance abuse and treatment.

So it's extremely comprehensive and was noted a significant investment.

But I am I am confident that this will improve outcomes, save lives, reduce our liability as well at Santa Rita Jails.

So just a lot of positive things all around.

So just really excited to receive this information.

And it's an aggressive timeline, but glad to hear that it's scheduled to go live in fall of 2027.

Just want to be reassured that the system that we have that it will be able to interact with Alameda Health System, which we know is our largest provider of indigent care here in the county.

Just want to make sure that there's no barriers to be able to share those records.

Yes, that's correct.

And actually, as you saw, that there's um the vast majority of the providers in Alameda County are on Epic, so it actually enhances with primary care providers as well.

And this would be the same for young people in our care at juvenile hall in Camp Sweeney in terms of children's hospital.

Do you want to take that?

Yes, children's hospitals in Oakland, children's banning off.

Okay, can you come to the mic, please?

Just so the members of the public can hear.

Yes, children's is on Epic, I do.

It is.

Yeah, so they are on Epic, I believe, and that will be the native Epic to Epic record sharing that will happen automatically.

Okay, great.

In this moment, it sounds like we're on track, we're staffing up, we have expertise.

In this moment, do you foresee any barriers, any challenges with any delays?

Uh we are on track.

We have plans for the standard barriers.

I suspect there will be some other barriers that we'll have to mitigate.

Uh we are staffing up.

We have addressed staff augmentation for the brief period of the implementation as is defined by Epic.

Uh we ready to go.

Thank you.

Questions and comments from a colleagues.

Uh Supervisor Martin.

Okay.

Sorry, just one thing to add to what Tom just shared is that um uh you know we brought forward board letters to you all uh for the contract and some initial staffing, and just as things move, uh we do expect a few more board letters.

So just more has there been three so far.

I'm trying to track on my own as well.

I think two or three.

Okay.

The initial in February 2025, and then there was the March board letter, and then there was the April board letter from staffing, and we are expecting more.

We are trying to consolidate them as as many as we can to ensure that we are efficiently using our time as well.

Okay, thank you.

Supervisor Mellon.

Thank you, Chair.

So, yes, this has been a long time in coming.

Uh, and I recognize this isn't a panacea, but this is definitely going to be an asset to our ability to deliver health care um to vulnerable populations uh in the jail elsewhere.

Uh so I'm very pleased about it.

Um, a couple of things.

Um, and it's money well spent.

So I'm really pleased we're finally uh putting the money towards EPIC.

So Alameda Health Systems will be a part of this.

And on one of your slides, you talked, I think it was slide seven.

Uh a CH, ACSO, EPIC uh community value, and specialized immigration, Santa Rita Jail and Behavioral Health.

Uh because I want to make sure post-release.

So when folks are released from Santa Rita jail, and they go to roots, or they go to another federally qualified clinic, or they go to Law Familia.

They will be part of the EPIC system as well.

Uh I think part of the FQHCs are are on EPIC.

So they will have access to that.

I can't speak to Roots.

I'm apologizing, I'm not familiar with that.

However, part of our design is who should see the records within the community.

So that is, I believe that's where you're going.

Making sure that all the right people can have access.

Well, because that's essential because that will complete the loop.

You know, the assessment in the jail, uh when they're incarcerated, we do the assessment, everybody's got access to the record, they're getting good care.

Then when they're released, then they might not be going to you know Alameda Health Systems, they might be going to one of our federal qualified clinics, they might be going to Roots, which is um health uh provider that is not a federal qualified clinic out of choice, but they do a lot of this, La Familia.

I know they're uh looking to become a federally qualified clinic, but the point is a lot of the folks will not necessarily go somewhere because they they want to make sure that whoever's providing the service to them, the medical care, it's you know they feel trusted, they feel comfortable, and we want to have them continue it.

Once again, none of this is a is perfect and it's a panacea, but we're trying to set it up so we provide those paths for so if people want to continue with their care, they can continue with it, and if they don't continue with it, and then they're subject to being maybe detained again or whatever it might be, you know, we'll be able to pick it up real easily.

So I think that's just an important piece.

Um I want to make sure we flag that.

And I think uh people are hearing me.

Secondly, is um on the and I had questions about the steering committee.

Uh it said nine voting members, I count eleven.

Eight eight well, in one slide, it said the steering committee will have nine voting members with defined voting rights.

I count the composition that was on one slide, it showed eleven voting members.

So is it eleven?

Is it eight?

Is it nine?

What is page 13 shows eight, but it says nine.

So it's eight.

So why it's well put this line up again if you want.

Why does it have uh eleven as voting members?

Um that's most likely a data entry error on the individual who created the deck, that would be me.

So I'll need to review that and update that.

Okay.

And then my question too is and Supervisor Marquez asks this.

If Alameda County uh health, no, Alam um Alameda Health Systems, if they're an important um component, why aren't they on the steering committee?

Or and maybe they are and I just don't see them.

Is Supervisor, this is um the steering committee.

This is sort of uh in a look into our internal process.

So our instance of EPIC is going to be a county instance of Epic, so this is all the the team that's gonna be engaged in that.

Alameda Health System has its own instance of Epic.

Um, but the point that we're making is that Epic to Epic, there's a lot more ability to coordinate, but they're two they're still managed separately.

Okay, because my concern then is we've got our internal piece, Alameda Health Systems got their piece, there's other pieces.

It's all supposed to be integrated and up interoperable, et cetera, et cetera.

As a policymaker, as a county supervisor, my concern is I want to make sure it's interoperable and it's working countywide.

So how do I get assurance of that?

If I may uh I've actually been in apologies about updating you on this.

Uh I am in contact with the Alameda Health System Chief Information Officer and their vice president of applications and other individuals.

We are engaging in discussions on how can we make sure we are building an integrated system so they will be part of the process.

Okay.

All right.

I'm gonna remember that, and if they're hiccups down the road, there better be a good explanation for it.

I'm not I mean serious, yeah.

I really am.

There better be a good explanation for it.

Yeah, and I and I think that um, you know, some of the the complications, as you know, we did explore uh whether we would join AHS's system and part of the reason that we couldn't.

No, I'm not saying we need to join them, but my concern is we've got our Epic piece, they've got their Epic P's, you know, we got the Federal Clinics, we've got Roots, we got all these different pieces that have EPIC.

I want to make sure they're all talking to one another.

Yep.

Yeah that's our goal.

And that's what I'm okay.

All right.

I'm done.

Um thank you, Chair.

Uh Supervisor Miley asked a lot of my questions, but uh I'm just gonna ask some basic ones.

Uh I obviously very uh impressed with trying to get us into this world where we have uh seamless handoffs, that we have ways in which we can provide um continuity of care for um all of our community members, including just involved.

Um so when somebody uh leaves Santa Rita jail, do they typically all have cell phones?

I yeah, I can't speak whether they have mobile devices or not.

Well, the the reason I'm asking is because there's a digital divide and you have to take some responsibility for your own health care, whether it's setting up appointments or getting the kind of medication you need, especially for chronic conditions, and so uh is there um uh so as part of Cal AIM, they are re excuse me, released with a 30-day supply of medication, and usually with that, there usually is a follow-up community appointment lined up with that.

So though we don't follow through, we give them a good step to start continue the process.

Uh unfortunately, once they are released, uh that's kind of they're an adult and they need to follow through with that.

But we do everything we can, the sheriff's office and our county partners to get a 30-day supply of medication upon their release, and usually there's at least one, if not more, community appointments for them to follow up with their uh medical that they received inside.

That's part of the Cal AIM process.

Uh so I'm sorry, just retract that a second.

Yeah.

So if you're released, you get 30 days worth of medication, and uh you have to follow up with your provider.

So who who do they go see to get so there's through Cal AIM, there's been two identified like coordinators essentially, one's the Alliance and one's uh Kaiser, I believe.

Uh so we would refer that process to one of them, uh one of those two organizations, and then those organizations would filter it out to the community clinics and things like that.

So it's part of the process to for Cal AIM.

So usually they get a 30-day supply, and in pro in custody, they will usually get at least one appointment with one of those clinicians or one of those community or organizations.

And also those community organizations are inside Santa Rita jail.

Uh they come in as part of because they usually have an AB 109 component to them from some of them.

So they're inside trying to get to know the individual as part of the warm handoff.

Uh we just don't send them out the door and say best of luck to you.

We do everything we can to build in those mechanisms and steps.

So it's a as a it's a positive transition out of Santa Rita with somebody there to guide them uh in the community.

Okay.

Thank you.

Um I I have one last question, but it's more out of curiosity.

On the Epic Project Steering Committee, it it they list a number of deliverables as part of what they're accountable for.

How do they generate revenue?

Revenue generation was one of those items.

It is accountability for ensuring that the team implements the appropriate tools to generate the revenue.

It's a governance model in which they are observing it, but also uh again as part of Cal Aim is we're able to bill.

We've never been able to bill before.

So we will be able to bill this the feds and the state to recoup some of the Medi-Cal costs.

So that's why we're building in a revenue system at Epic, because for the first time uh effective January July 1st, we as a county will be able to build to recoup some of the costs that we incurred uh providing those medical services if they're covered under Medical.

Uh so to recoup the cost that um was provided with services to the individual and custody.

So within 90 days of their release, right?

We will aim only has the straddling within 90 days.

Yep.

So we'll be able to bill for those services to the state and in hope it's to get some of the money back to the county um to the county.

So that's why I think we built in the the ability to bill, uh, which is the revenue tag, because we've never been able to do this before, and so we want to make sure that it's in there because eventually if this continues to go, we don't want to use a third-party vendor, which we're currently using to bill.

We want to keep it with inside the county organization.

So that's why they're building that into the thing.

Okay.

Um I appreciate that.

I just know that sometimes um there are glitches in terms of our ability to bill based on diagnostics, DRGs and coding.

Absolutely.

Um but we want to make sure that it's what's it's in the system, the initial scope.

So in a year we don't come back to the board and be like we messed up and we need more money to fix it.

We're trying to get ahead of it and be proactive.

Okay.

Thanks.

Awesome.

Supervisor, if I could add one thing to the revenue generation.

So there's the Calais revenue generation, which is a new opportunity for the county.

But on the behavioral health side, um, particularly because we managed to manage care plans there.

Revenue generation is a critical component of that.

And so I think what you're seeing here is that you know we have all of the different systems set up so that um anytime you switch over from one system to another, there's potential for loss and glitches.

Um so really trying to minimize that as much as possible.

So what I'm hearing is the system will really maximize our ability to draw down Medi-Cal dollars.

Okay.

Wonderful.

Um public comment now, please.

One minute on this presentation.

There are no public commenters on this item.

Okay, we're sorry.

Hi everybody, it's me again.

Um, just to back up what Supervisor Miley was saying, too.

I really do hope that this um whole thing with Epic does go through.

Um, just to remind you all that our clinic is having to fax where their information over to Highland and to receive a fax back in 2026.

Um, this actually delays the patients getting their medication because they are waiting.

Well path is in waiting for Highland to send back that information regarding their uh prescription.

So a lot of times when they're doing their initial intake, they will not have their medications for a while because we're going through an antiquated way of getting the information back and forth from the jail to the county hospitals.

And also just to uh piggyback on the thing about Kaiser, um the way Kaiser works with MediCal, you have to have been a Kaiser patient before um you were put on Medi-Cal or um Cover California in order to receive Kaiser services.

So a lot of those folks in Santa Rita do not have access to Kaiser as easily as some folks would think.

So just to add in that information.

Thank you.

No other public commenters.

Okay, thank you, Elijah, for your comments and your engagement.

Um, we're now gonna open.

Oh sure, go ahead, go ahead.

Go ahead.

No, I was just gonna say if you're about ready to uh conclude today's we still have general public comment and I have some closing remarks or non-agenda items, correct.

Okay, so I just wanted to um before you uh go there, um just uh thank you, Chair Um Marquez for pulling together this joint committee meeting.

Um I'm sure Brenda worked on it.

You guys did an excellent job.

This has been one of the best meetings I've attended in a long time.

So thank you.

Very informative.

You stole my thunder, but um it's okay.

Um I I also I'll say it now before we get to our public comment.

But um, you should stand up, Miss Brenda Gomez.

She's my advisor in public safety, and she did an incredible job in pulling this um together.

This has been a priority last July when we thought we survived budget season.

Nope.

We gave ourselves more work.

That's what we do in district two to get things done.

So um this has been a process, and so just thank you to everyone who was involved in getting us here today.

Um really excited about the direction we're going and just really proud of our sheriff, Lieutenant Murphy, Captain Perez, everyone.

I don't know everybody's name, but all of you are incredible for staying focused and determined to advance this work.

I know it hasn't been easy and it's been a significant investment, but I think it's a worthy one, and I'm really excited to see the future outcomes of our community based off this significant investment.

So thank you to everyone who played a role.

Um, we're almost to the end, but we do have one more item on the agenda, which is public comment on items not on the agenda but under the purview of this committee.

So do we have any public comments?

There are no public commenters on non-indemized items.

Okay.

Also flagging that our next meeting um, I believe is May 21st, which is out of sequence.

We're moving it up a week because we have a budget special meeting the fourth um Thursday in May.

So we're gonna advance public protection meeting.

It's not a joint meeting.

It's not a joint meeting, no.

No, this is today is a joint meeting, but just flagging the next public protection meeting is May 21st at 10:30.

However, there will be a joint public protection and health committee meeting in July, but I don't know the date off the top of my head, but um we'll we'll share that out shortly.

But we'll we'll share that out shortly.

But thank you everyone for your engagement today and have a great afternoon.

This meeting's adjourned.