Commissioners approve change to jail medical staffing; one commissioner votes no over liability concerns

The Walla Walla County Board of Commissioners on March 23 approved a second amendment to the county’s professional services agreement with Ivy Medical PLLC doing business as Aspen Medical that reduces continuous on-site registered nurse coverage in the jail and substitutes a certified medical assistant (MA) during routine hours, with telehealth RN backup.

County staff and the Aspen Medical representative said the change was suggested because licensed practical nurses (LPNs) are increasingly scarce and many routine tasks (dressing changes, some blood draws, medication administration) can be performed lawfully by a certified medical assistant under RN supervision. “We’re contracted for an average of 30 hours a week; they anticipate it’ll be between 30 and 35. It’s largely a cost-savings measure,” a staff member explained. The presenter said Aspen’s CEO, Dalen, agreed this would better allocate RN resources across multiple facilities and that 24-hour nursing access via telehealth would remain available.

One commissioner said the proposal would save about $20,000 but warned that the savings could be negated if insufficient on-site expertise led to more emergency-room transports. Another commissioner pressed staff on liability and competence differences between MAs and nurses: “There’s a massive difference between the two,” the commissioner said, urging caution and careful monitoring. Staff responded that the clause allows the county and contractor to revert to LPN/RN staffing if the arrangement does not work.

The board debated whether there was sufficient real-world data from the 90-day transition period. A commissioner said he would vote no at this time but asked staff to return with a status update if problems arise. The formal motion to approve the amendment passed with two votes in favor and one opposed.

The amendment is described in the agenda materials as a second amendment to the professional services agreement between Ivy Medical PLLC (dba Aspen Medical) and Walla Walla County; the contract language changes staffing classifications to allow a certified medical assistant to perform specified duties under RN/provider supervision. The board recorded no immediate change to staffing hours; staff said RNs would still be scheduled periodically and telehealth nurses are available 24/7.

Next steps: the county will monitor outcomes, with commissioners asking for follow-up reporting and the option to restore RN/LPN staffing if patient care or liability concerns materialize.