Goldenson, who heads jail health services for the San Francisco Department of Public Health, was selected to monitor health services at the jail last year after the previous doctor was removed for failing to file reports.

Jail officials said they’re committed to addressing the issues raised by Goldenson, but noted it will take some time for him to become fully acquainted with jail operations and vice versa. For example, some items highlighted by Goldenson as needing improvement were described as fine by the previous jail monitor, said Vince Goldsmith, health services manager for the jail.

“He doesn’t know us that well and we don’t know him that well,” Goldsmith said. “We both agreed we needed to capture some additional statistics for him to look at.”

The lawyer representing inmates who sued the jail said he didn’t see a lot of improvement when he compared the previous report to this one.

“We certainly want to see Piece County make the necessary improvement and get across the finish line,” attorney Fred Diamondstone said. “The court order has been in effect for 12 years and it’s time to achieve compliance.” Diamondstone was quick to praise some aspects of care, however, such as communication between the jail and mental health providers in the community.

Goldenson’s inspection Nov. 15-16 found more than 20 areas in which medical services at the jail did not live up to national accreditation standards. The jail isn’t bound to them, but is using them as a “road map.”

Staffing problems affected how quickly inmates seeking medical care are seen, the report says.

If an inmate wants to be seen for routine medical care he writes a request, known as a “kite.” The kites are picked up at night, sorted and reviewed by nursing staff. The inmates seeking care – 70-80 each day – are referred to a triage nurse the next morning. Two nurses are supposed to serve the main jail building and two the new jail, but one of the positions at the main jail has been vacant since last March.

Additionally, there’s no one available to fill in when another nurse is sick, on vacation or another type of leave, Goldenson notes.

Nursing supervisor Mary Scott said that “during time of high absenteeism, this level of staffing was almost ‘disabling,’” the report notes.

During Goldenson’s visit, there was only one triage nurse for both facilities one day and only two on duty the next day. Weekend staffing was also reported to be problematic.

He also found that inmates being housed in special units, such as administrative segregation, were not being checked on as frequently as required under the jail’s policies.

A nurse is supposed to come around and check on them three times a week, but those rounds were happening only 60 percent of the time.

Still, jail officials said, the inmates can always request medical services through kites and guards will alert medical staff if they notice something amiss.

The staffing issues are compounded by the lengthy hiring process at the jail, Goldenson wrote. Outside of the jail, health care professionals are usually hired within a month of applying for a job. But because of the jail’s background screening process, it can take up to six months to hire someone. Reports going back more than 10 years have recommended speeding up the process.

The jail’s Goldsmith said backgrounding goes fairly quickly when focused on hiring medical staff instead of trying to fill the high demand for corrections officers and deputies. Currently, there is one medical opening and three applicants being looked at, he said -- though Goldenson noted overall staffing levels may need to be raised.

Having dental care available one day per week was “totally insufficient,” Goldenson wrote. During his visit there were 21 inmates on a priority care list, many of them had been there for more than three weeks. A patient with a broken tooth had been waiting for 44 days and another with a cracked molar with an exposed root had been waiting 10 days, he reported.

The jail had already doubled the number of days a dentist is on site to once a week, Goldsmith said.

“Pierce county is a big meth county,” he said. “People who use that drug have a lot of dental problems.”

And while agreeing than 44 days was a long wait with a broken tooth, the jail is looking closer at all of its needs before deciding whether to hire a full- or part-time dentist, Goldsmith said.

The other major area of concern was the mental health services offered at the jail.

“Even with the dedicated mental health staff, however, we have serious concerns regarding the mental health program at (the jail),” Goldenson wrote.

His main concern, again, was staffing.

“Even if all the positions were filled, staffing may not be adequate to provide an appropriate level of mental health care,” the report says.

Staffers reported to Goldenson that while the number of inmates who have been treated for mental heath issues before coming to jail has been increasing, the number seen for mental health treatment at the jail has been decreasing.

An important thing to bear in mind, Diamondstone said, is that the health of jail inmates and the health of the community are related to each other.

“If they have tuberculosis or (drug-resistant) staph infections, they can be easily passed around in the jail environment and come back to the community,” he said.

Ian Demsky: 253-597-8872