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Unsealed Documents Expose Treatment Failures at San Diego Jail

by Anthony W. Accurso

In response to a motion filed by the ACLU, a judge in the U.S. District Court for the Southern District of California unsealed documents in June 2019 related to the failures of San Diego County Sheriff’s Department and its mental health provider, Correctional Physicians Medical Group (CPMG).

San Diego County operates seven jails, which regularly hold around 5,200 prisoners, about one-third of whom are on some form of psychotropic medication to manage a serious condition. This makes the jail system the largest provider of mental health services in the region. “There’s something wrong with that,” said Sheriff Bill Gore in a 2017 interview. “That shouldn’t be the case.”

The Sheriff’s Department awarded a five-year contract worth $21 million to CPMG, but canceled it in January 2017 after just 27 months. The company had been formed by Steven Mannis, an emergency room doctor who later admitted in a deposition that he had virtually no experience in psychiatry.

According to court filings, “No one was in charge of training” at CPMG. “The only alleged ‘training’ occurred at ‘Journal Club,’” a voluntary quarterly performance review for CPMG providers.

The unsealed documents relate to the death of Rubin Nunez in late 2015. Nunez was arrested after throwing a rock through a car window and was transferred to Patton State Hospital because he was declared unfit to stand trial. At Patton, the staff documented his schizophrenia and psychogenic polydipsia — a condition where sufferers drink water uncontrollably, sometimes leading to death.

In August 2015, Nunez was transferred to San Diego Central Jail to stand trial. When state hospital patients are transferred to other facilities, a discharge report containing relevant diagnoses is faxed and physically sent with the patient to the receiving facility. Nunez was housed in the psychiatric unit at the jail but, despite his medical records, was given unlimited access to water in his cell.

Five days later, his cell was covered in urine and bloody vomit but staff failed to transfer him to medical or cut off his access to water. He died hours later of swelling in the brain caused by excessive water intake.

Three dozen inmates have died in San Diego County since April 2014. A 2016 email to Mannis from Dr. Alfred Joshua, the sheriff’s medical director, linked CPMG to the death of Nunez as well as two other suicides. “Quite frankly, your lack of administrative and clinical control as well as lack of even knowing the facts that your CPMG providers were directly involved in each of these cases, is disheartening and aggravating,” the email said.

Joshua resigned from the county on June 30, 2018 after the county’s new provider, Liberty Healthcare Corp. of Pennsylvania, failed to stop such deaths.

 “California law makes these peer-reviewed records confidential, so physicians can discuss cases without public scrutiny,” Mannis said in a telephone interview in response to the ACLU’s request to make the relevant court documents public.

Judge Roger T. Benitez was not swayed by such concerns. “This court is not persuaded that peer reviews of medical care in county jails will cease to exist or be significantly less productive unless kept confidential, particularly in light of the public’s demands for and interests in accountability within its county jails and state prisons,” he ruled. See: The Estate of Nunez v. County of San Diego, U.S.D.C. (S.D. Cal.), Case No. 3:16-cv-01412. 


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Related legal case

The Estate of Nunez v. County of San Diego