EVERETT — Inadequate staffing, overcrowding and a health policy in need of “comprehensive reform” combine to pose medical risks for inmates at the Snohomish County Jail.

Those are some of the findings outlined in a 100-page federal report released Monday. The sheriff’s office asked for an outside perspective following two high-profile deaths involving inmates who were both in their 20s.

The study was done by Kenneth A. Ray, a consultant for the National Institute of Corrections considered an expert on jail administration, policies and operations. He offered advice on medical care, mental health and suicide prevention. His report did not examine specific cases involving inmate deaths.

In essence, he said more corrections employees are needed to provide medical care to fewer inmates, and their work needs to be guided by better policies and procedures.

“The jail health care program (medical and mental health) is seriously understaffed for this size jail, its layout, annual admissions and average daily population,” Ray wrote. “Additionally, authorized correctional staffing levels appear inadequate to ensure consistent and timely access to health care services for the same reasons.”

Ray described the jail as having “chronic long-term crowding,” and has been at or near its capacity for almost a dozen years. The demands of serving so many people “poses significant health and personal safety risks for the staff and inmates.”

Officials should take “immediate steps to reduce jail crowding” while examining future space needs and ways to reduce jail use.

That’s something the sheriff’s office already is addressing.

Starting Nov. 1 it began booking fewer people who have been arrested, but not convicted, of nonviolent misdemeanor offenses, such as petty thefts. Suspects in felony drunken-driving cases and in domestic violence assaults will continue to be booked into the jail.

The changes have come because “We’ve got to try to address the overcrowding issue,” sheriff’s spokeswoman Shari Ireton said Monday.

The consultant also urged the county to explore “alternative housing options” for inmates with serious medical and mental health needs.

Ray’s report also found fault with some jail record keeping. He reviewed several inmate health care charts and noted missing assessments, “very few intake health screens and a plethora of various disorganized health-related documents.”

The National Institute of Corrections is a branch of the federal Department of Justice and has been reviewing operations and medical treatment at the jail at the county’s behest.

Monday’s report addressed medical issues. A September report examined jail operations and found several weaknesses, including questions about the jail’s handling of mentally ill inmates and booking practices. It urged Snohomish County Sheriff Ty Trenary to make a number of changes.

The national institute’s review had been requested in March by John Lovick, who was then sheriff. Lovick later was appointed county executive and Trenary took over in July.

Eight people have died in the jail since 2010. Litigation over at least three of the deaths could end up in courtrooms.

Lyndsey Elizabeth Lason, 27, suffocated at the jail in 2011 when her infected lungs slowly filled with fluid. Other inmates said Lason had pleaded for medical care. A $10 million wrongful death claim is pending.

Michael Saffioti, 22, died at the jail in July 2012 from bronchial asthma triggered by severe allergies. His family has hired Seattle attorneys to press for answers. He was booked into the county jail as a courtesy because people were concerned that his health would be at greater risk in the city of Lynnwood’s jail. A judge there had ordered Saffioti locked up for misdemeanor marijuana possession.

The family of Bill Williams, 59, also has raised questions about his death in September 2012. Arrested for shoplifting, the mentally ill man collapsed and died after being shocked twice with an electronic stun gun.

When Trenary took over mid-year, he quickly looked for ways to improve medical care at the jail. He had a medical team from Pierce County study Snohomish County Jail operations. Based on those recommendations, Trenary pushed for the hiring of a doctor at the jail. Previously, medical care was limited at the jail to that provided by nurses.

Trenary’s plans include additional nurses and mental-health professionals, transitioning to electronic medical records and enhanced health screening of inmates before they’re booked.

The sheriff also underscored the need to review inmates accepted under contract from other jurisdictions. The contracts generate money for the jail, but the inmates often have medical and psychiatric problems. Trenary has said he wants to bring the average daily population at the jail down by about 125, to 1,025.

Sheriff’s spokeswoman Ireton said the jail’s new health services director will be reviewing and proposing changes to existing health care policies that cover everything from drawing blood to administering medications.

“We need to ensure that all the policies and procedures are in one place and they are all evidence based,” Ireton said. “We are trying to go through all of them with a fine-tooth comb and put them into one place so they are all easy to get to.”

Trenary also plans to discuss with county leaders and mental health professionals strategies to keep non-violent, mentally ill offenders out of jail. Over the years, the jail has served as a de facto detention center for people whose struggles with mental illness have brought them into contact with police for minor offenses. Those people haven’t received treatment.

Ray, the federal consultant, recommended forming a “mental health coalition” to become “a voice to advocate for an appropriate level of mental health services at the jail.”

For all its challenges, Ray said the Snohomish County jail is, “overall, a well-managed and professional correctional facility. Despite several opportunities to improve jail health care services, jail officials and staff continue to focus on doing the very best they possibly can within limited fiscal realities and crowded conditions.”

A sheriff’s office press release about the report, including a link to the document, can be found on the department’s website at http://bit.ly/1bTBIvJ.

Eric Stevick: 425-339-3446, stevick@heraldnet.com