Editor’s note: This article was updated on July 25 to clarify that the county would’ve paid $73,000 more for another year of Yvette Esparza’s services, had the commissioners renewed her contract. Whereas the county paid $284,000 for Esparza’s current contract, the renewed year-long contract would’ve cost a total of $357,000.

With room for 58 inmates, the Island County Jail is small by most standards, but the responsibility to provide inmates with sufficient medical care is anything but.

“We’re a small jail but we still have to define a minimal level of care,” Sheriff Mark Brown said.

What that level of care should be was the focus for Brown and other county officials last week.

At a work session July 13, Brown and Chief Jail Administrator Jose Briones met with the county commissioners to review the jail’s current medical service model and how the facility should provide health care in the coming year.

The meeting came more than a year after an inmate, Keaton Farris, died from dehydration in the jail, and just as the contract with an advanced registered nurse practitioner, or ARNP, is set to expire.

Prior to Farris’ death last April, the facility operated with one registered nurse, or RN, who worked 40 hours a week under the supervision of an on-call physician’s assistant, or PA.

The PA had no set schedule and made only occasional jail visits, said Brown.

Following the young man’s death, the county contracted ARNP Yvette Esparza to treat inmates at the jail 12 hours a week while remaining on-call 24/7.

Esparza initially had help from a licensed practical nurse, or LPN, and a nurse’s assistant, both working 40-hour weeks.

Because of the nursing assistant’s limited range of abilities, Briones said, that initial arrangement didn’t cut it.

“Yvette noticed that, when she wrote an order, a nurse’s assistant could only take a temperature or pass medication,” he said.  “You have to at least be an LPN to provide treatment.”

If Esparza, or the LPN, weren’t at the jail when treatment was needed, the only option was a costly trip to the hospital, Briones said.

“Moving forward, we decided it would be best to transition to two LPNs, both working 40 hours a week alongside Yvette,” Brown said.

“This is the current model the jail is operating under. And that’s the model that we’re hoping to continue.”

With Esparza’s contract expiring Aug. 31, the commissioners are faced with either renewing her contract for a year or extending it to the end of 2016 to allow the sheriff’s office time to formulate a request for proposals.

“It provides a contract that says we’re looking for these specific services and we’re looking for it in these cost ranges,” Briones said of the Request for Proposals.

Once the RFP is announced, medical providers may submit bids for the contract.

“It keeps everything very transparent so that we’re not just picking whoever we want and whatever rate that person says,” said Briones.

The commissioners approved Brown’s request to extend Esparza’s contract through Dec. 31 at a cost of $7,333.

Had the commissioners renewed Esparza’s contract another year, they would’ve paid $357,000 total, a $73,000 increase from her current contract with the county.

“That would be very unusual for us to do a budget change for such a large amount,” Commissioner Helen Price Johnson said.

“I think a negotiation on a contract for next year is a separate item than what we would consider today,” she added.

Though the extension allows Brown and Briones to send out an RFP, all three commissioners raised concerns for what model it should outline.

Commissioner Jill Johnson said she was worried about making a decision on jail services without having complete information or metrics on the needs of the jail.

“These are the kind of policy choices that we have never been involved in any discussion about in terms of what we’re able to fund, what we need to fund, and what the appropriate level of services is versus what the ideal level of service,” she said.

Commissioner Rick Hannold called for more “solid metrics” on the costs of differing levels of medical services.

“I feel that we should provide what we’re responsible to provide, but also I feel very strongly that we should not be providing services that are better than what someone in the general community is able to get,” he said.

The suggested model falls within the jail’s current budget, said Briones.

The commissioners noted that Brown and Brione’s plan for one ARNP and two LPNs may be the right fit, but data is needed on the potential savings from minimizing inmate trips to the emergency room.

The final decision should be based on an understanding of what the medical services at other jails of comparable size look like, said Hannold.

Other jails may have a much lower standard than what Island County should provide, Briones responded.

About 80 percent of the jail’s population enters the facility with drug and alcohol dependency, he explained. Close to 40 percent suffer from serious mental illness.

“That’s what we call a critical type of population that we really want to provide the right kinds of services for,” he said. “You really have to look at your population to determine what services you should provide”

“We feel that having nursing coverage and an ARNP three times a week gives us the balance of care that we need to provide,” said Briones. He told the commissioners he’s in the process of collecting the data to back their proposed staffing model.

Brown and Briones are slated to present that data and an RFP at the commissioner’s next work session, Wednesday, Aug. 10.

If approved, the county will set a timeline for receiving bids for the 2017 contract.

“There’s a lot of healthy debate regarding the care of inmates in our facility, and there should be,” Brown said.

“We look forward to continuing those discussions and ultimately hitting our goal of having our model work in a way that is productive and good for all us.”