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Audit

Audit  Audit of the Middlesex Sheriff’s Office—A Review of Healthcare and Inmate Deaths

Our office conducted a performance audit of certain activities of the Middlesex Sheriff’s Office (MSO) for the period July 1, 2021 through June 30, 2023.

Organization: Office of the State Auditor
Date published: December 19, 2025

Executive Summary

In accordance with Section 12 of Chapter 11 of the Massachusetts General Laws, the Office of the State Auditor has conducted a performance audit of certain activities of the Middlesex Sheriff’s Office (MSO) for the period July 1, 2021 through June 30, 2023. When designing the audit plan for examining employee settlement agreements entered into by MSO, we extended the audit period to July 1, 2018 through June 30, 2023.

The purpose of our audit was to determine the following:

  • Did MSO comply with and implement the requirements of Section 932.17(2) of Title 103 of the Code of Massachusetts Regulations (CMR) regarding the deaths of inmates in its custody?
  • Did MSO hold quarterly meetings with its contracted healthcare provider and review quarterly reports regarding inmates’ healthcare in accordance with 103 CMR 932.01(3)?
  • Did MSO administer mental health services to inmates in accordance with 103 CMR 932.13(1) and Section .08 of MSO’s “Policy and Procedure 613—Mental Health Services”?
  • Did MSO have internal policies and procedures in place for (a) the review and approval of employee settlement agreements, including the language used, and (b) the reporting of employee settlement agreements to the Office of the Comptroller of the Commonwealth (CTR)? For employee settlement agreements entered into from July 1, 2018 through June 30, 2023, did MSO follow these policies, and did it abstain from using non-disclosure, non-disparagement, or similarly restrictive clauses as part of employee settlement agreement language?

Below is a summary of our findings, the effects of those findings, and our recommendations, with hyperlinks to each page listed.

  
Finding 1
MSO was unable to provide evidence of the approval of extensions for the completion of clinical mortality reviews.
EffectWithout properly documenting extension approvals for clinical mortality reviews, MSO cannot substantiate that extensions were granted for these reviews. While we recognize the need for extensions to complete some clinical mortality reviews, extension requests should be properly documented to ensure that MSO can demonstrate to others, including external auditors, that it complied with its own policies.
Recommendations
 
  1. MSO should document, in writing, and maintain extension approvals for, clinical mortality reviews.
  2. MSO should update Section .09(7) of its “Policy and Procedure 617—Procedures in the Event of Death or Serious Illness of an Inmate” to include written documentation requirements for extension approvals for clinical mortality reviews.
Finding 2
MSO did not have documented policies or procedures regarding employee settlement agreements and supporting records, as would be best practice.
EffectA documented and written process to handle employee settlement agreements, especially for those containing non-disclosure, non-disparagement, or similarly restrictive clauses, can help ensure that employee settlements are handled in an ethical, legal, and appropriate manner.
Recommendation
 
MSO should develop, document, and implement a written policy related to employee settlement agreements, including prohibiting the use of non-disclosure, non-disparagement, or similarly restrictive clauses in its agreements, as recommended in the Governor’s “Executive Department Settlement Policy,” issued January 27, 2025.

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