King County audit finds gaps in jail behavioral health medication access and release supplies

On July 15, auditors from the King County Auditor’s Office presented findings from an audit of behavioral health medication practices at King County’s downtown jail to the Whatcom County Incarceration Prevention and Reduction Task Force behavioral health committee.

Basil Hariri of the King County Auditor’s Office summarized the audit’s primary finding: “We generally found that jail health services treats patients with acute symptoms quickly within 24 hours, but those with less obvious symptoms can wait a month or more, and are often released before seeing a provider.” He said most behavioral-health medication orders are placed within two days of booking and most doses are administered within 24 hours of ordering, but some medications required a psychiatric clinic appointment and those appointments often occur after release.

Auditor Elise Garvey described two other core findings: medication changes or discontinuations can cause negative side effects and communication about those changes is sometimes limited, and jail health provided a medication supply at release to fewer than 20 percent of patients prescribed behavioral-health medications in 2023. “Given the current wait times to see a community provider in the area, [a seven-day supply policy] is not always sufficient,” Garvey said, noting that patients and advocates reported many people were unaware they could request medications at release.

The auditors noted operational complications specific to jail health: medication verification requires pharmacy contacts or access to electronic medical records (Epic), correctional staffing shortages can delay escorted appointments, and nurses use paper administration logs that complicate analysis of actual medication receipt. The audit identified racial disparities in medication-order timeliness and recommended jail health review causes and address inequities; Hariri summarized that “black folks received medication in a less timely manner” in the analysis covered by the report.

The auditors made 12 recommendations to improve access, transparency, and monitoring. Key suggestions presented to the committee included developing a documented plan to reduce psychiatric clinic wait times for patients in general population housing, revising prescribing guidelines with risk assessments and stakeholder input, improving communications to patients (including those with limited literacy), expanding pathways to provide medication at release without relying on proactive patient requests, and transitioning from paper administration logs to an electronic medication administration system to enable analysis.

Committee members asked whether jail health could provide longer release supplies and whether the audit analyzed post-release outcomes or recidivism; auditors said release-supply decisions reflect risk assessments and some program exceptions exist, but jail health lacks robust capacity to track patients after release and the audit did not analyze recidivism. Auditors emphasized that some long clinic wait times are driven by short jail stays and by the need to prioritize higher-acuity patients.

The audit cites standards from the National Commission on Correctional Health Care (NCCHC) and uses King County and state data to provide regional context. The auditors recommended follow-up work and said jail health agreed with all 12 recommendations.

Ending: The committee thanked the auditors and agreed to consider selected audit recommendations in local comparisons and in diversion/reentry discussions; staff said they would follow up about potential local applications of the audit’s recommendations.