Audit of the Bristol County Sheriff’s Office—A Review of Healthcare and Inmate Deaths Overview of Audited Entity

This section describes the makeup and responsibilities of the Bristol County Sheriff’s Office—A Review of Healthcare and Inmate Deaths.

Overview

The Bristol County Sheriff’s Office (BCSO) was established as an independent state agency on August 6, 2009, pursuant to Chapter 61 of the Acts of 2009. According to Section 4 of this chapter,

All functions, duties, and responsibilities of the office of a transferred sheriff pursuant to this act including, but not limited to, the operation and management of the county jail and house of correction and any other statutorily authorized functions of that office, are hereby transferred from the county to the commonwealth.

The transition was completed on January 1, 2010. The Sheriff became an employee of the Commonwealth but remained an elected official and retained administrative and operational control over BCSO. Under the Sheriff’s direction, superintendents administer BCSO operations at BCSO facilities.

According to BCSO’s internal control plan,

The Bristol County Sheriff’s Office is an organization of public safety professionals committed to serve and protect the people of Bristol County. The Bristol County Sheriff’s Office holds itself accountable to the principles of integrity, professionalism, compassion and teamwork.

BCSO operates the Bristol County House of Correction and Jail at 400 Faunce Corner Road in North Dartmouth. This multibuilding facility was opened in 1990 and can hold approximately 1,200 inmates. This facility is used for the care and custody of pretrial and sentenced inmates. This facility was also used to house federally arrested individuals² who were undergoing deportation proceedings with United States Immigration and Customs Enforcement (ICE); however, on May 20, 2021, ICE terminated its contract with BCSO and transferred the federally arrested individuals from BCSO to an ICE facility in Plymouth County. In 2002, the Bristol County House of Correction and Jail opened the Women’s Center, which is used for the care and custody of its female inmates.

BCSO also operates the Ash Street Jail and Regional Lock-Up at 226 Ash Street in New Bedford. This building was built in 1888 and can hold approximately 200 inmates. This is the location of its regional lock‑up facility, where Bristol receives and holds regionally arrested individuals³ from state and local police agencies until the individual’s court date.

As of June 30, 2022, there were 713 inmates in BCSO’s custody, including six regionally arrested individuals, 480 pretrial inmates, and 227 sentenced inmates.

As of June 30, 2022, BCSO had 700 employees (which includes 536 correctional officers) who supervised and cared for the inmates in BCSO’s custody. BCSO’s annual state appropriation was approximately $54.2 million both in fiscal year 2021 and in fiscal year 2022. BCSO also received the following funding to support its programs for these fiscal years.

Program	Fiscal Year 2021	Fiscal Year 2022	Total1
Opioid Use Disorder	$    274,698	$     338,736	$   613,434
Adult Basic Education	144,803	180,942	325,745
Second Chance Act1	63,820	255,279	319,099
Skills Capital Grant2	189,034	110,251	299,285
Title I Neglected or Delinquent Students3	140,711	129,043	269,754
State Criminal Alien Assistance4	107,568	107,568	215,136
Residential Substance Use Disorder	74,100	78,100	152,200
Litter Detail5	28,825	57,414	86,239
Safe and Successful Youth Initiative6	41,395	34,496	75,891
Project ROAR7		19,600	19,600
Total	$ 1,064,954	$  1,311,429	$ 2,376,383

1.   The Second Chance Act assists inmates and their families in various ways, such as by facilitating healthy interactions, offering parenting education, and providing guidance for reentry into the community.

2.   The Skills Capital Grant provides funds to eligible schools and institutions to buy technical equipment.

3.   The Title I Neglected or Delinquent Students program helps inmates under the age of 21 obtain a high school diploma if they do not have one.

4.   The State Criminal Alien Assistance is a program that reimburses correctional facilities for expenses related to undocumented federally arrested individuals.

5.   The Litter Detail involves a contract with the Massachusetts Department of Transportation, where inmates help maintain the cleanliness of local highways.

6.   The Safe & Successful Youth Initiative provides reentry services to inmates under the age of 21.

7.   Project ROAR is a reentry program that provides inmates with case management services before and after release (for up to one year).

 

The Commonwealth was reimbursed for services that BCSO provided to house and transport federally arrested individuals before the termination of its contract with ICE. This reimbursement came in the amounts of $828,111 for housing services and $795,042 for transportation services, for a total of $1,623,153 in fiscal year 2021.

According to BCSO’s Facility Narrative, BCSO offers inmates⁴ at both facilities the following programs and services:

• education programs, including courses such as adult basic education, civics, and mathematics;
• substance use disorder programs, including recovery groups, substance use disorder recurrence prevention, and cognitive behavior therapy;
• religious services for inmates who follow Islam, Judaism, Wicca, and Christianity, among other religions;
• social and rehabilitative services, which focus on topics such as anger management, basic life skills, human immunodeficiency virus education, grief and loss support groups, and mental health education;
• vocational programs, including small engine repair, automotive, culinary arts, and food safety and sanitation;
• reentry and health services, including a veteran support group, parenting education, support groups for topics such as human immunodeficiency virus and domestic violence; and
• prerelease work programs, including highway litter control, graffiti removal, and community assistance with projects like landscaping and leaf removal.

BCSO also has healthcare service contracts in place with a healthcare provider, Correctional Psychiatric Services, to provide all inmates with behavioral assistance. The Facility Narrative states that the Dartmouth Behavioral Unit (for male inmates) and the Women’s Behavioral Unit (for female inmates) provides the following:

Specialized placement for those inmates who engage in repeated disruptive and self-harming behaviors that impairs daily functioning in general population and segregation. [Both units] provide enhanced mental health treatment and behavioral interventions to inmates who demonstrate an ability to maintain behavioral control, engage in self-injurious and/or obtain frequent disciplinary sanctions.

Offender Management System

BCSO uses a system called the Offender Management System (OMS) to track and manage information on inmates in its custody. The information maintained in the system includes inmates’ names, genders, ethnicities, dates of birth, Social Security numbers, booking numbers,⁵ booking dates, release dates, release types,⁶ commitment identification numbers,⁷ and in-custody housing assignments.⁸ During the process of admitting an inmate, one of BCSO’s booking officers enters information from a mittimus⁹ into OMS.

Electronic Health Record System

BCSO uses the Electronic Health Record (EHR) system, a web-based medical record system administered by BCSO’s contracted healthcare provider, to manage inmates’ medical records, appointment scheduling, and off-site healthcare.

Inmate Deaths

Section 932.17 of Title 103 of the Code of Massachusetts Regulations (CMR) requires agencies with county correctional facilities, such as BCSO, to establish guidelines for notifications, investigations, reports, and documentation regarding the deaths of inmates or facility employees. According to Section 12.08.07 (Death of an Inmate) of BCSO’s Policy 12.08.00 (Terminal Illness, Advance Directives and Death), in the event of an inmate’s serious illness, injury, or death while in BCSO’s custody, at least one of the officers on duty notifies the security team and BCSO’s medical response team, which includes the medical director and staff members of the contracted healthcare provider, to assist and administer first aid, if appropriate. While this happens, the medical director informs the Southcoast Emergency Medical Services Department of the situation so that it can report to BCSO’s facility to provide emergency medical aid and/or transportation to the hospital. This lifesaving assistance continues until either the inmate’s condition improves or a physician at the hospital calls the inmate’s time of death.

In the event of an inmate’s death, the officer on duty notifies select BCSO personnel, which includes its Sheriff, superintendent, watch commander, and Special Investigations Unit (SIU), as well as the health service administrator¹⁰ and the medical director, of the death. SIU then notifies the Office of the Chief Medical Examiner (OCME), the Massachusetts State Police, and the Bristol County District Attorney’s Office, while the superintendent (or their designee) notifies the inmate’s next of kin of the inmate’s death.

Once the Massachusetts State Police arrives at BCSO, they, alongside SIU, secure the scene of the incident and conduct an investigation to determine the cause and manner of death. While the Massachusetts State Police handles the investigation, OCME conducts a postmortem exam.¹¹ After this, OCME completes and signs the death certificate, then releases the body to the inmate’s next of kin.

Following the death of an inmate, involved staff members must submit an incident report to the watch commander by the end of their shift on the day of the incident. Any treatment and/or lifesaving measures that were taken are documented in the inmate’s medical record. SIU may also conduct an internal investigation while assisting outside law enforcement’s investigation. The chief of special investigations submits a written investigative report (which includes details from the logbook¹² entries of round(s)¹³ leading up to an incident) to the Sheriff at the conclusion of an internal investigation.

After an inmate’s death by suicide, the health service administrator convenes a mortality review¹⁴ within 30 days. This procedure is considered complete when OCME provides BCSO with an autopsy report. BCSO’s superintendent and medical director, along with the health service administrator, review recommendations resulting from the mortality review.

Healthcare Services

The contract “Agreement for Inmate Medical Services” between BCSO and its contracted healthcare provider, dated July 2019, outlines the following responsibilities for BCSO’s contracted healthcare provider:

Provider, [in this case, Correctional Psychiatric Services] for and in consideration of the compensation hereinafter set forth, covenants and agrees to provide professional comprehensive health services to all pretrial and sentenced inmates, ICE detainees or prisoners confined in the correctional and detention facilities operated by [BCSO], including but not limited to all types of medical, mental health, dental, laboratory, pharmaceutical, hospitalization/in-patient care, outpatient/medical clinic care. . . .

BCSO’s “Agreement for Inmate Medical Services” with its contracted healthcare provider also states that BCSO may conduct a comprehensive audit to monitor the contracted healthcare provider’s quality of performance. This audit consists of reviewing medical, dental, and mental health services to ensure that the contracted healthcare provider (1) meets or exceeds the standards as required by both the National Commission on Correctional Health Care and the American Correctional Association and (2) fully complies with all requirements set by the Massachusetts Department of Correction and all other professional or regulatory standards. BCSO is also required to monitor and review the contracted healthcare provider’s staffing level. The contracted healthcare provider’s failure to meet or maintain compliance with the contract will result in financial penalties.

Quarterly Meetings

According to 103 CMR 932.01(3),

The county correctional facility [in this case, BCSO] shall require that the health authority [in this case, the contracted healthcare provider] meet with the Sheriff/facility administrator or designee at least quarterly and submit the following:

(a)   quarterly reports on the health care delivery system and health environment; and

(b)   annual statistical summaries.

The statistical summary, as referenced in the above regulation, contains data related to inmate health records and provides a comprehensive overview of medical services delivered to inmates during the year.

The contracted healthcare provider documents and maintains meeting minutes. These meetings cover quality improvement, emergency drills, mortality review findings, and other statistical reports used to monitor trends in the delivery of healthcare at BCSO.

Intake Medical Screening

According to Section 12.02.04 (Intake Medical Screenings Procedures) of BCSO’s Policy 12.02.00 (General Inmate Medical Procedures), an intake medical screening is performed by a qualified healthcare professional on each inmate within 24 hours of the inmate’s admission at the BCSO facility to ensure that their health needs are identified and addressed. The screening consists of a questionnaire and observation to identify potential emergencies and to ensure that newly admitted inmates’ illnesses, health needs, and medications are identified for further assessment and continued treatment while in custody.

All findings of the intake medical screening are recorded electronically in the EHR system, specifically on the Receiving Screening Form, which is then approved by a qualified healthcare professional.

When needed, BCSO provides special accommodations, such as the use of a translation service, to ensure that any inmate who may have difficulty communicating with a qualified healthcare professional understands how to access healthcare services.

Physical Examination and Initial Health Assessment

According to Section 12.02.06 (Comprehensive Physical Examination and Health Assessment) of BCSO’s Policy 12.02.00, each inmate committed to the facility receives a thorough physical examination within 14 days after admission, unless there is documented evidence of an examination within the previous three months. The initial health assessment is completed by a qualified healthcare professional and includes, but is not limited to, reviewing the inmate’s medical record, examining the inmate for any signs of trauma or disease, conducting laboratory and/or diagnostic tests, and reviewing findings and any follow-up services with inmates who require further treatment. This qualified healthcare professional records the initial health assessment in the inmate’s electronic medical record on the health assessment form in the EHR system, which is then reviewed and approved by a higher-level qualified healthcare professional. In addition, inmates have the right to refuse the entire initial health assessment, or any portion of it.

Sick Call Requests

According to Section 12.02.09 (Clinical Services) of BCSO’s Policy 12.02.00,

Sick call is the process whereby an inmate can initiate a request for health care services on a daily basis. An inmate’s access to sick call is considered a right, not a privilege. Inmates shall have reasonable access to a health care practitioner during a scheduled sick call. An inmate’s custody status shall not preclude their accessibility to participate in scheduled sick call.

To request access to healthcare, an inmate completes a Sick Call / Medical Encounter Request Form (MERF) with the following information: the type of service requested (medical, dental, or mental health); the nature of the problem or request; their personal information, including their name, patient identification number, date of birth, housing unit; and their signature and the date. The inmate then submits the MERF by putting it in a designated, secure lockbox (one of which is located in each housing unit). A member of the contracted healthcare provider picks up MERFs daily to evaluate and triage each request within 24 hours. Qualified healthcare professionals provide treatment according to clinical priorities and schedule follow-up appointments as needed. A face-to-face meeting with a qualified healthcare professional is required within 72 hours upon receipt of a MERF. All MERFs that are triaged as emergent are responded to immediately; health concerns that are beyond the responding qualified healthcare professional’s expertise are then referred to the most appropriate contracted healthcare provider. Throughout this process, each inmate’s individual medical file (including progress notes¹⁵) is maintained in the EHR system.

2.   A federally arrested individual is a person who has been arrested by a federal law enforcement department. BCSO's facility holds the individual before they appear in court.

3.   A regionally arrested individual is a person who has been arrested by a local law enforcement department. BCSO's facility holds the individual before they appear in court.

4.   For the purposes of this audit report, we use the term inmate to refer to regionally arrested individuals, federally arrested individuals, pretrial inmates, and sentenced inmates (unless stated otherwise).

 

5.   A booking number is a unique number assigned by BCSO to an inmate upon their admission to the Bristol County House of Correction and Jail. A new booking number is generated upon every unique admission to the facility.

6.   The release type is the way in which an inmate is discharged from a facility, such as bail, death, parole, or completion of their sentence.

7.   A commitment identification number is a unique number assigned by BCSO to an inmate. It follows the inmate through their time (which includes any recommitment) in one of BCSO’s facilities. The commitment identification number in OMS transfers to and matches a personal identification number in the Electronic Health Record system.

8.   A housing assignment is an inmate’s specific unit, cell, and bed within one of BCSO’s facilities.

9.   A mittimus is a written, court-issued document that follows an inmate through their time in the criminal justice system.

 

10.   According to BCSO’s Policy 12.02.00 (General Inmate Medical Procedures), the health service administrator is an employee of the designated contracted healthcare provider who “is responsible for the overall, daily management of the inmate health care system, as well as for all contracted health care personnel.” During our audit period, this role was filled by an employee from the contracted healthcare provider.

11.   A postmortem exam is an examination of the deceased’s body to determine the cause of death.

12.   The logbook catalogs the different activities or occurrences (e.g., routine rounds or responses to inmate calls) that occurred during a shift.

13.   Rounds are routine routes taken by officers to count inmates and check on their wellbeing.

14.   According to BCSO’s Policy 12.08.00 (Terminal Illness, Advance Directives and Death) and discussions with BCSO’s management, a mortality review consists of clinical and psychological reviews regarding an inmate’s death by suicide. The purpose of the review is to assess the clinical care provided, the circumstances leading up to the inmate’s death, and staff member emergency responses.

15.   Progress notes are records of the encounters that occur between the contracted healthcare provider and an inmate.

Date published:	February 2, 2024