THE COURT OF COMMON PLEAS COUNTY OF CUYAHOGA JUSTICE CENTER 1 200 ONTARIO STREET CLEVELAND, OHIO 441 13 November 7, 2018 Akram Boutros, MD. President and Chief Executive Officer MetroHeaIth System 2500 MetroHealth Drive Cleveland, Ohio 44109 Re: Cuyahoga County Jail Medical and Services Dear Dr. Boutros, The undersigned are the five Cuyahoga County Common Pleas judges who preside over the Mental Health dockets. We oversee individuals charged with crimes who have serious mental illnesses. Those individuals need Special medical and attention in the countyjail and they are not receiving it on a consistent basis. MetroHealth System isthe provider to the county jail and we are seeking your help to remedy an ever more dangerous and concerning situation. There is inadequate staffing to meet the needs ofthose with serious mental illnesses and we are concerned for their safety, our ability to adjudicate their cases, the safety of the jail personnel, and unnecessary costs related to transfers to Northcoast Behavioral Healthcare for restoration purposes due to a failure to evaluate, prescribe, and administer appropriate medications. Dr. Leslie Koblentz, the priorjail left in April of 2018 and has not been replaced. The position of Director of Nursing has been vacant for some period oftime. There is one nurse practitioner working four ten hour days as the sole person who can attend to the mental health population. She is clearly overburdened and cannot possibly attend to all the needs to examine and treat these individuals. The current backlog for appointments, just to be seen and evaluated, is in excess of four to five weeks which is unacceptable. It is our belief that this is a population that requires staffing twenty-four hours a day, but at the very least seven days a week. We have instances when medications are not ordered despite assessments specifying them or when a known individual with a history is brought in the jail and has proof of prescriptions. There also is an issue of refusing to continue an individual with successful and appropriate medications because they are not on the formulary list. Changing medications can have adverse effects on an individual?s mental health stability. An exception to this occurs when an individual has been restored to competency through a visit to Northcoast Behavioral Healthcare which has prescribed a specific medication and those medications are continued upon return to the jail, despite not being on the formulary. When individuals with serious mental illnesses fail to be appropriately evaluated in a timely manner and, when needed, medicated, we face decompensation of their condition, a worsening of their health, an inability to move forward with their criminal charges, difficulties with behavior in the county jail, and increased costs associated with treatment for restoration at Northcoast Behavioral Healthcare. These problems need to be addressed yesterday. We are asking for your immediate attention to and response to these pressing needs. We would welcome the opportunity to meet with you to discuss these issues. Hollie L. Gallagher Robert C. McClelland Deena R. Calabrese MHDD Court Chair MHDD CourtJudge MHDD CourtJudge Michael P. Shaughnessy Shannon M. Gallagher 1. MHDD Court Judge MHDD Court Judge CC: Armond Budish, Cuyahoga County Executive Jane Platten, MetroHealth System, Chief of Staff Judge John J. Russo, Administrative and Presiding Judge Greg Popovich, Court Administrator Andrea Kinast, Deputy Court Administrator and Director of Court Operations Christopher Russ, Deputy Court Administrator