New jail health director details services, gaps and reentry priorities

Dr. Lisa Bridal, San Francisco's new jail health director, told the Health Commission on June 21 that jail health operates on a $31,000,000 budget, serves roughly 15,000 unique patients a year and maintains an average daily census of about 1,250. She said the program provides 24/7 nursing coverage, primary care six days a week and behavioral-health coverage every day and described the jail system as "an integrated multidisciplinary health care delivery system."

Why it matters: Bridal said 65 percent of people in the jail stay fewer than seven days and 86 percent are pretrial, which creates turnover and narrow windows to intervene. That churn, she told commissioners, makes the jail a critical place for public-health interventions such as medication continuity for chronic illness and initiation or continuation of medication-assisted treatment for opioid use disorder. "We provide continuation of methadone maintenance for people when they come in," Bridal said, adding that buprenorphine is used for detox and as a bridge to community maintenance.

Key facts and services: Bridal outlined program details that commissioners pressed for during questioning: a staff complement of about 163 FTEs; clinic, dental and pharmacy services (the presentation cited nearly 200,000 pharmacy fills last year); a Hibis program that provided about 8,900 HIV/Hep C/STD tests and served 345 unique patients with HIV last year; and four pharmacist-managed clinical programs (anticoagulation, hypertension, diabetes and psychopharmacology). She said the jail provides prenatal and labor support through a UCSF partnership and a volunteer doula program.

Gaps and constraints: Bridal highlighted operational limits that she said the department is working to address: data fragmentation across dozens of databases that complicates reliable reporting, limited psychiatry capacity (described as 1.2 full-time-equivalent psychiatrists for the jails), and uneven continuity of medication at intake and discharge. Commissioners asked about hunger-strike management, 51—5 psychiatric holds, and the reasons roughly 613 people were referred immediately to Zuckerberg San Francisco General'hospital for stabilization; Bridal described clinical criteria for triage and the use of ZSFG for people who are too medically complex to remain in jail.

Linkage and reentry emphasis: Multiple commissioners pressed for better warm handoffs to community care. Bridal said the department is in early planning on formal reentry linkages and that some patients are "linked and out of care" rather than never served; many jailed patients are former health system patients whose care has lapsed. She described the opportunity to expand medical case management models used in Hibis to other medically complex patients so discharge plans will include medication supply, appointments and transportation vouchers.

Next steps and oversight: Commissioners asked for more detail about cost breakdowns by short-term vs. long-term patients and for data improvements tied to the health network'wide electronic health record implementation. Bridal and staff pledged follow-up reporting and said some changes (telepsychiatry pilots, strengthened reentry navigation) are under exploration. The commission took no formal action on the presentation itself; staff will provide further updates as requested.