The jail is required to provide health care to inmates in a reasonable and constitutionally sound way, said Mesa County Sheriff’s Office Capt. Art Smith, who oversees the jail.

“In order to receive accreditation you have to be in compliance with all their national standards,” Smith said.

The death of an inmate in the jail earlier this year has spurred conversations about inmate health care.

Alizon Lopez was found dead in her cell in May, three months after the audit had been conducted. The Mesa County Coroner’s Office said she died by fentanyl intoxication.

“Fentanyl is certainly of great concern to us, should be of great concern to everyone,” Smith said. “It’s extremely dangerous. More dangerous than people think it is.”

Smith declined to discuss specifics of the case because the Drug Enforcement Agency is in charge of the investigation, but he did speak generally about what happens when an inmate dies.

“Any time you have that type of incident, you take a look at the cause of what happened,” Smith said.

The National Commission on Correctional Health Care standards state in the event of an inmate death, a clinical mortality review should be completed within 30 days and an review should also be conducted.

“All deaths are reviewed to determine the appropriateness of clinical care; to ascertain whether changes to policies, procedures, or practices are warranted; and to identify issues that require further study,” the standards state.

A clinical mortality review assesses the clinical care provided and circumstances leading up to a death, according to the commission standards, and an administrative review assesses correctional and emergency response actions surrounding a death.

The clinical review should be conducted by a physician not involved with the inmate’s treatment, according to the standards, and is conducted “to determine the appropriateness of the clinical care provided and the effectiveness of the clinical policies and procedures relevant to the circumstances surrounding the death .

Generally, a clinical mortality review asks at least three key questions:

1. Could the medical response at the time of the death be improved?

2. Was an earlier intervention possible?

3. Independent of the cause of death, is there any way to improve patient care?”

According to the commission, the administrative review looks at the incident and facility procedures used, training received by involved staff and emergency response.

It also could include recommendations for changes in policy, training, medical/mental health services, operational procedures and physical plant.

In the case of Lopez’s death, Smith declined to comment on whether anything was changed because of the active criminal investigation.

Five people have been indicted by a grand jury in Lopez’s death: Efrain Velez, Vanessa Vasquez, Anna Munday, Karlie Locke and Kimberly Selan, all of whom were inmates at the time of Lopez’s death and have been charged with distribution of fentanyl resulting in death .

A jury trial is scheduled to begin March 6.

Smith said the jail has screening processes designed to keep things like fentanyl out, and that fentanyl is something his department takes seriously.

“The first thing when someone shows up at jail is they go through a rigorous process to make sure they’re not bringing anything dangerous to themselves, other inmates or us,” Smith said.

The Mesa County Jail received its accreditation after fixing a few documentation issues found by the audit.

Auditors look at a variety of standards that pertain to inmate health care.

Those standards are not available for free to the public, but can be purchased from the national commission’s website.

The Daily Sentinel borrowed a copy of the standards from the Mesa County Sheriff’s Office for this article.

The National Commission on Correctional Health Care is not a government entity, rather it’s an independent nonprofit organization originally founded by the American Medical Association.

“NCCHC’s accreditation program uses external peer review by a team of correctional health care experts to determine whether the jail, prison, juvenile facility, or OTP being surveyed meets the relevant standards.

“The survey process is rigorous but collaborative, with a goal of quality improvement. To that end, NCCHC is impartial, unbiased, and dedicated only to recognizing and fostering quality in correctional health care.

NCCHC is the only accrediting body authorized by the Substance Abuse and Mental Health Services Administration that focuses on corrections,” the commission’s website states.

The organization’s standards include access to care, privacy, medical autonomy, health records and grievance processes.

They also include standards on healthy lifestyle promotion, infectious disease prevention and control, clinical preventative services, medical surveillance of inmate workers, suicide prevention, contraception, communication of patients health needs, patient safety and staff safety.

Other sections of the standards cover health training for correctional officers, staffing, credentials, clinical performance enhancement, medication administration training, inmate workers, orientation for health staff, pharmaceutical operations, clinic space, diagnostic services, medical diets, patient escort, emergency services, hospital and specialty care, receiving screening, transfer screening, initial health assessment, mental health screening and evaluation, oral care, nonemergency health care, nursing assessment, quality of care, discharge planning, patients with chronic disease, mental health services, medically supervised withdrawal , pregnant inmates, response to sexual abuse, care for the terminally ill, restraint and seclusion, segregated inmates, psychotropic medication, informed consent, and research.

“If you haven’t been part of it, you don’t see or realize how involved it is,” Smith said.

Inmates at the Mesa County Jail have health issues just like any random sample of 500 people in the community would have, plus a disproportionately high number of substance abuse issues, mental health issues and significant injuries.

“It’s medical care, it’s dental care, pharmaceutical issues, infection control, all of the above,” Smith said.

“All of that is to make sure people maintain their health until they leave here to go back out in the community or leave here to go to another facility,” Smith said.