Alameda County's Santa Rita Jail holds roughly 2000 detainees on any given day and is one of the largest jails in the country. Credit: Pete Rosos

The medical director of Alameda County’s jail was fired last year after a summer spike of COVID-19 cases when her employer discovered that she had been using her position to supply herself with opioid drugs. Her firing was first disclosed last week after her license to practice medicine was suspended. 

According to the findings of the Medical Board of California, former Santa Rita Jail medical director Jessica Waldura wrote fake prescriptions to obtain opioid pain medications for herself during the spring and summer of 2020. By early August, her supervisor noticed that she was leaving work early and sleeping on the job. She was fired, her case was referred to the medical board, and she entered a rehabilitation program.

As the jail’s top medical official, Waldura helped shape its response to the COVID-19 pandemic, and the fact that she was wrongfully taking and using prescription drugs raises questions about her job performance before she was fired.

Waldura did not respond to questions sent to her and her attorney. 

Judy Lilley, a spokesperson for Wellpath, the jail’s for-profit healthcare provider, confirmed that Waldura is no longer employed by Wellpath but did not respond to questions about whether the former medical director’s drug abuse problems affected Wellpath’s ability to effectively care for its patients, saying it is the company’s policy not to discuss personnel matters publicly.

Alameda County Sheriff’s Sgt. Ray Kelly, a department spokesperson, said that Wellpath did not disclose the reasons for Waldura’s termination to the sheriff’s office as it was a “private personnel matter,” and that the sheriff’s office did not investigate. “I’m told she was replaced and there was no concern over health operations, even during COVID,” Kelly said. 

Overall Kelly said Wellpath has done an “outstanding job” during the pandemic and Waldura “is just one piece of an operation—she’s not going to stop the machine from moving.”

In the first few months of the pandemic, Waldura was in charge of shaping the jail’s outbreak control plan, a detailed document that guided Santa Rita’s procedures to control the spread of COVID-19. But internal company documents show that the directions in the plan and CDC guidance were not consistently followed in the jail’s early response to the pandemic.  While the jail later on improved its response under pressure from a federal judge, it still had a large outbreak that summer, just a few weeks before Waldura was fired. 

There have not been any deaths in the jail from COVID-19, and it appears to have so far avoided a massive outbreak like in San Quentin State Prison last year, when the virus infected more than 2,000 prisoners. But there have been 659 confirmed cases in Santa Rita since the start of the pandemic, and the jail had outbreaks again in December and January. Most recently, Santa Rita had an outbreak affecting 28 staffers that started after a Wellpath nurse who spread misinformation about vaccines tweeted that she had contracted the virus.

Wellpath was slow to implement CDC guidance in the early days of the pandemic

Health care in Santa Rita Jail is provided by Wellpath, a for-profit company with an estimated $1.5 billion in annual revenue that is owned by the private equity firm HIG Capital. According to its website, Wellpath handles health care at nearly 400 jails nationwide and more than 140 state and federal prisons. For-profit medical providers, and Wellpath in particular, have been accused of negligent care.

As the coronavirus pandemic spread in early 2020, Wellpath prepared by developing an Outbreak Control Master Plan for Santa Rita Jail, which was approved March 9 by Waldura and administrator Jen Diaz. But Santa Rita was slow to implement some basic safety measures. It didn’t start taking the temperature of everyone who entered the jail until March 17, the same day as a countywide shelter-in-place order took effect.

The jail’s first documented COVID-19 case was a Wellpath nurse who tested positive on March 25. The housing unit where the nurse worked was not locked down until a day later. In its initial statement, the sheriff’s office said the nurse used a mask at all times, so it was not necessary to quarantine the housing unit. But by the time the sheriff’s office issued a statement, internal company communications show that Wellpath had discovered that the nurse may not have used a mask consistently and then put the housing unit under quarantine. Meanwhile, a Wellpath administrator went home with a 100-degree temperature.

On March 27, as concerns spread within the jail, the sheriff’s office started showing an educational video to jail detainees featuring Waldura, in which she said, “Most people who have COVID-19 have a very mild illness. Some people have no symptoms at all, and those people who are infected with it tend to recover very quickly with no problems.”

YouTube video

In the video, which was obtained through a public records request, Waldura also ignored the danger posed by asymptomatic carriers and advised detainees that wearing masks was unnecessary.

“You’re in a safe environment right now,” Waldura told detainees on the video. “You are in a locked-down environment, that means you are protected actually from the outside world. We’re the ones who are bringing stuff from the outside world and we’re putting you at risk. So, we are wearing masks not because we are necessarily sick, very few of us have any symptoms of any kind.”

“You don’t need to worry so much about transmitting to each other because if you don’t have any symptoms really there is pretty much no risk of that,” she said erroneously.

Waldura’s statements contradicted CDC guidance

On March 23, one week before the video of Waldura was played for jail detainees, the CDC issued guidance for correctional facilities warning of asymptomatic carriers and recommending mask use for quarantined inmates under certain circumstances. “Because many individuals infected with COVID-19 do not display symptoms, the virus could be present in facilities before cases are identified,” the CDC guidance said. 

Wellpath had also by then acknowledged the value of masks. During a Wellpath staff conference call on March 18, Wellpath discussed giving sick inmates surgical masks, according to notes from the meeting.

Wellpath did not respond to questions about whether the video was consistent with corporate messaging about the virus or best practices at the time. 

“We follow recommendations from the Centers for Disease Control and Prevention (“CDC”) and the World Health Organization (“WHO”) and work closely with local public health authorities,” Lilley, the Wellpath spokesperson, said in a statement last year. 

In late March and early April 2020, the number of inmates in the jail was significantly reduced through coordinated early releases. This reduced the spread of the virus in Santa Rita Jail by lessening crowding. However, testing rates also were low and some detainees complained that they were sick but were not given a COVID-19 test. They also said that they did not receive adequate supplies of masks, cleaning supplies and hand sanitizer. Others reported that they hid their symptoms or refused to be tested for fear of being placed in isolation.

Under the scrutiny of a federal judge in a class action lawsuit over the jail’s mental health care, the sheriff’s office and Wellpath stepped up their efforts to contain the virus by testing everyone who entered the jail. But cases were rising again by late July, when Santa Rita experienced its largest outbreak during the pandemic, at one point reaching 110 active cases, according to data compiled by Darby Aono, a law student at the University of California at Berkeley who has been tracking COVID-19 in Santa Rita.

Waldura wrote prescriptions to opioids for herself throughout the pandemic

It’s unclear from the state medical board records when Wellpath administrators first noticed problems with Waldura’s job performance. According to a complaint filed by the state Attorney General’s Office, Waldura told a medical board investigator that she had a history of substance abuse but was sober for 32 years before suffering a relapse. 

Waldura was hired in May 2015 as a HIV and transgender medicine physician for the jail. She became addicted to ketamine, an anesthetic often used recreationally, in the fall of 2018. She “continued to use ketamine despite physical and psychological problems, withdrawal, and problems at her job,” the medical board found. Despite that, she was promoted to medical director in July 2019. 

By March 2020, her withdrawal symptoms and the pain in her nose from snorting large amounts of ketamine had grown so severe that she was using Norco, an opioid painkiller, to dull the symptoms. She used a Wellpath prescription pad to write five prescriptions to Norco for her mother between March and August 2020 that she used herself.

By early August, Wellpath supervisors noticed a change in her behavior, including that she was taking naps at a desk at work and leaving early, and the company had concerns that she was practicing medicine while impaired. She was fired on Aug. 5 and the company emailed a complaint to the medical board on Aug. 7. Waldura then entered a rehabilitation program. Her medical license was suspended a year later, effective Aug. 25, 2021. She is eligible to petition for reinstatement of her license after two years.

The jail’s control of the pandemic appeared to improve over the next few months. But it had another spike in cases in December, when the number of inmates in the jail started to rise again. Cases were rising throughout the country that winter and nationally grew into the worst wave of the pandemic yet. But the jail’s peak of 109 active confirmed cases never exceeded the previous outbreak in July. 

There was another spike in staff cases this summer

A screenshot from Lignell’s Twitter account advocating using ivermectin (a drug used to treat parasites like worms) on people exposed to COVID-19. The Food and Drug Administration warns that using ivermectin without a prescription is dangerous and it does not treat COVID-19.

Santa Rita has so far managed to avoid another mass outbreak even as the delta variant continues to spread. But it did have a recent outbreak among staff. One of the first staffers to be infected was a Wellpath nurse who has used social media accounts to spread misinformation about vaccines.

Heidi Lignell documented her COVID-19 diagnosis on Twitter, where she goes by “Jail RN” and frequently shared misinformation and conspiracy theories to her more than 3,000 followers. She reported feeling symptoms on July 18 and being tested at work the next day. On July 21, Santa Rita reported its first positive staff case since May. Twelve more staffers tested positive in the next week. Twenty-seven staffers tested positive by the end of August.

Lignell has repeatedly overstated the dangers of COVID-19 vaccines, which have been shown to be overwhelmingly safe and effective with over 5.3 billion doses administered globally. On July 14 she tweeted, “Just HOW MANY PEOPLE HAVE TO DIE BEFORE THEY DEEM THE JAB UNSAFE??” On July 26, she retweeted a video suggesting, without evidence, that COVID-19 vaccines were linked to the deaths of children. On July 29, she disclosed that she had given her adult daughter ivermectin, a drug typically used to treat parasites in animals that has not been approved or proven to be effective against COVID-19.

But at the end of her bout of COVID, she still said she would not get vaccinated. She wrote, “Day 10 and feeling weakness and fatigue. Finally got my smell and taste back!! I still have no strength to cook or anything. I’d still rather be like this than have the vaccine.”

When contacted Monday through her LinkedIn account, Lignell responded that she was not interested in discussing her public statements about vaccines and the pandemic. 

In order to confirm Lignell ran the “Jail RN” Twitter account, The Oaklandside sent an email to Lignell’s work account this week and called her and left a voicemail asking to speak with her about her role at Santa Rita Jail and her comments on Twitter. Lignell responded six hours later in a Twitter direct message asking not to be contacted. “I did not cause outbreak,” she wrote. “I contracted covid from another employee. I am now vaccinated and that’s the end of story!” 

Lilley, the Wellpath spokesperson, declined to comment directly on Lignell’s public statements. “Wellpath respects its employees’ right to their own views, so long as they don’t affect their ability to do their jobs,” she wrote. “We continue to actively encourage vaccination for all eligible Wellpath team members, and we will comply with California’s new vaccine mandates for healthcare workers.”

Most Santa Rita staffers are unvaccinated

It is not clear to what extent other Santa Rita staffers share Lignell’s views, but most sheriff’s employees who work there are unvaccinated. According to data provided by the sheriff’s office, only 496 of 1,184 sheriff’s employees working in Santa Rita Jail, 42%, were confirmed to be vaccinated as of late August. Meanwhile, most detainees are unvaccinated as well, only about 25%, which is lower than in San Francisco or Santa Clara County’s jails.

The sheriff’s office also has many employees who don’t work at the jail and provide policing services in contracted cities or unincorporated areas of the county. As a whole, the sheriff’s office has an even lower vaccination rate: only 547 of 1,707 employees, 32%, had been confirmed to have received the vaccine as of Aug. 23.

As of Sept. 30, a statewide order will require all healthcare workers to be vaccinated unless they have a religious or medical exemption.  Kelly, the sheriff’s spokesperson, said that he expects Alameda County to require all county employees to get vaccinated, following Contra Costa County, which this week issued a mandate effective Oct. 4. The Deputy Sheriffs’ Association of Alameda County, the union that represents deputies, did not respond to questions about whether it would oppose a mandate, like its counterpart in San Francisco. But the Alameda County firefighters’ union has announced that it opposes any vaccine mandate.

“A lot of people are vaccinated and our sheriff has been adamant about the vaccine,” Kelly said. “I think at the end of the day people are going to have to make a decision, which is, a good career, or am I so anti-vax that I’m willing to walk away?”

Scott Morris is an independent journalist in Oakland covering policing, protest, and civil rights.