Audit of the Dukes County Sheriff’s Office—A Review of Inmates’ Healthcare Services Overview of Audited Entity

This section describes the makeup and responsibilities of the Dukes County Sheriff’s Office—A Review of Inmates’ Healthcare Services.

Overview

The Dukes County Sheriff’s Office (DCSO) was established as an independent state agency on August 6, 2009, pursuant to Sections 3 and 4 of Chapter 61 of the Acts of 2009. This legislation made the Sheriff an employee of the Commonwealth of Massachusetts; however, the Sheriff remains an elected official with administrative and operational control of the department.

According to DCSO’s website,

[DCSO] will consistently strive to improve the quality of life in our community. We pledge and commit to work together with local and state agencies through our specialized services. Our commitment includes the operation of a safe, secure rehabilitative Correctional Facility and a Regional Emergency Communications Center. Our beliefs will never be compromised in the pursuit to uphold the laws of the Commonwealth of Massachusetts and the Constitution of the United States of America. . . .

• We dedicate ourselves to the highest standards of excellence.
• We will be morally and ethically accountable in the performance of our duties and throughout the community. . . .
• We are committed to providing quality service through well trained and innovative staff. . . .
• We are committed to fair and impartial service within the Office Of The Sheriff and throughout the community.
• We value cultural and ethnic diversity and ensure that all persons are treated with equality, courtesy, and dignity.

As of June 30, 2022, DCSO had 42 employees, including 16 correctional officers. In fiscal years 2021 and 2022, DCSO’s state appropriations were approximately $3.9 million each year. DCSO’s main administrative building is at 9 Flight Path in West Tisbury, and the Dukes County Jail and House of Corrections (DCJHOC), which was constructed in 1875, is at 149 Main Street in Edgartown. DCJHOC is used for the care and custody of female and male regionally arrested individuals,³ male pretrial inmates, and male sentenced inmates. DCJHOC can house a maximum of 40 male inmates who are both awaiting trial and serving sentences of up to two and a half years. As of June 30, 2022, there were 13 inmates⁴ in DCSO custody, including 3 pretrial inmates; 8 sentenced inmates; and 2 regionally arrested individuals, all of whom were male.

According to its website, DCSO offers its inmates education programs and services, which include career counseling, literacy courses, and English courses for English‑language learners. It also offers a labor program where inmates perform a variety of services, such as landscaping and construction for the Martha’s Vineyard community.

Offender Management System

DCSO 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, state identification numbers,⁵ booking numbers,⁶ booking dates, release dates, and in-custody housing assignments.⁷ During the process of admitting an inmate, one of DCSO’s booking officers enters information from a mittimus⁸ into OMS.

Correctional Electronic Medical Records System

DCSO uses the Correctional Electronic Medical Records (CorEMR) system, a web-based application, to record inmates’ health information, such as medical history, ongoing and past treatments, mental health conditions, medications, and scheduled appointments.

Healthcare Services

During the audit period, DCSO’s in-house healthcare employee provided most healthcare services. DCSO’s health service administrator was its health authority⁹ during the audit period and was in charge of the in-house healthcare employee and healthcare service delivery for inmates. DCSO contracted with various local medical providers for dental, mental health, and vision services.

Quarterly Meetings

According to Section 932.01(3) of Title 103 of the Code of Massachusetts Regulations (CMR),

The county correctional facility [in this case, DCJHOC] shall require that the health authority 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.

Statistical summaries, as referenced in this regulation, contain data related to inmate health records and provide a comprehensive overview of medical services delivered to inmates during the year.

The health authority 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 DCSO.

Admission Medical Screening

According to 103 CMR 932.06, DCSO’s in-house healthcare employee is required to perform an admission medical screening for each inmate upon admission to DCJHOC before placement in its general population to ensure that each inmate’s health needs are identified and addressed. An inmate’s medical record should include a completed admission medical screening.

This admission medical screening consists of a questionnaire and observation to identify potential emergencies or any newly admitted inmates’ illnesses, health needs, and medications for further assessment and continued treatment while in custody. Also, the admission medical screening determines whether the inmate can be assigned to the general population, isolated, or quarantined sections of the jail.

The in-house healthcare employee records all findings electronically in the CorEMR system. Upon each inmate’s admission to DCJHOC, the in-house healthcare employee communicates (both verbally and in writing) to the inmate how they can access healthcare services. This communication can include special accommodations, such as the use of a translation service, to ensure that any inmate who may have difficulty communicating with employees understands how to access healthcare services. An inmate’s admission medical screening is complete when a booking officer completes a medical questionnaire, which is filed in OMS, and the in-house healthcare employee completes a nursing assessment, which is more in-depth and is maintained in the CorEMR system.

If the booking officer determines that an inmate is in emergency condition at the time of admission, the inmate is transported by either ambulance or DCSO transport vehicle to the Martha’s Vineyard Hospital Emergency Department for evaluation and treatment. Any inmate who is determined to have a communicable or infectious disease (such as COVID-19 or influenza) is quarantined until they receive medical clearance.

In addition, an inmate has the right to refuse the admission medical screening by signing a Refusal of Medical Care form.

Health Assessments

According to 103 CMR 932.07(1),

Each inmate committed to the facility [in this case, DCJHOC] for 30 days or more shall receive a thorough physical examination. Said examination shall take place no later than seven days after admission. This time frame may be extended to within 14 days of admission for cases in which the admission screening was completed by a physician, physician’s assistant or registered nurse.

If the inmate’s medical file indicates that they received a health assessment within the last 90 days at DCJHOC, the health assessment is not required. Otherwise, the in-house healthcare employee completes the health assessment, which includes, but is not limited to, reviewing the inmate’s medical record, examining the inmate for any signs of trauma (mental or physical) or disease, conducting laboratory and/or diagnostic tests, and reviewing findings and any follow-up services with any inmate who requires further treatment. The in‑house healthcare employee first documents the inmate’s health assessment data in a health assessment form and then in the inmate’s electronic medical record in the CorEMR system. In addition, inmates have the right to refuse the entire health assessment or any portion of it.

Mental Healthcare Services

According to 103 CMR 932.13(1), “Written policy and procedure shall require post admission screening and referral for care of [inmates with mental illnesses or intellectual disabilities, or limitations,] whose adaptation to the correctional environment is significantly impaired.”

A contracted healthcare provider provides mental healthcare services for DCSO inmates. This provider offers routine mental health services using mental health questionnaires. In addition, the mental health clinicians visit DCJHOC for in-person care as needed.

DCJHOC’s mental healthcare services include evaluations, treatment, and advice in treating inmates with a history of mental health issues by conducting behavioral telehealth appointments, as well as prescribing psychiatric medications to inmates. These services are provided by mental health clinicians, including psychiatric nurse practitioners who focus on the treatment of severe mental disorders by applying the appropriate treatment with prescription medications. Mental health services are available at all times to address psychiatric emergencies and issues that may arise.

Sick Call Requests

According to 103 CMR 932.09(1),

Written policy and procedures shall provide for continuous response to health care requests and that sick call, conducted by a physician or other qualified health personnel, is available to each inmate as follows:

1. In county correctional facilities with less than 200 inmates, sick call shall be held a minimum of three days per week.

Inmates request access to healthcare by completing a sick call request form and including the type of service requested (medical, dental, or mental health), the date the inmate completes the form, and the nature of the problem or request. They submit the sick call request form by either putting it in a medical request box¹⁰ or handing it directly to either the in-house healthcare employee or one of the correctional officers¹¹ during a medication pass, which occurs at least twice a day. The in-house healthcare employee or a correctional officer checks the medical request box daily to pick up and evaluate sick call request forms and triage the requests.

The inmate is required to be present for the in-house healthcare employee to assess the sick call request and determine the proper action to triage the inmate based on their condition. In instances where the inmate’s medical condition affects their mobility in a way that prevents them from being assessed at the designated DCSO medical area, the inmate is assessed in their cell.

The in-house healthcare employee provides treatment and schedules follow-up appointments according to clinical priorities. All requests that are triaged as emergencies are responded to immediately by the in-house healthcare employee or correctional officers; problems beyond their expertise are referred to the most appropriate contracted healthcare provider(s). According to DCSO management, the in-house healthcare employee obtains and reviews sick call requests forms at least three times a week and correctional officers obtain sick call requests forms during the other days of the week. Additional contracted healthcare providers are also ready to provide on-call services at all times to triage sick call requests. The in-house healthcare employee maintains medical records in the CorEMR system for each inmate.

3.    A regionally arrested individual is a person who has been arrested by a local law enforcement department. DCSO’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, pretrial inmates, and sentenced inmates (unless stated otherwise).

 

5.    A state identification number is a unique number assigned to each inmate in the criminal justice system.

6.    A booking number is a unique number assigned by DCSO to an inmate upon their arrival to DCSO’s facility. The booking number in OMS matches the personal identification number in the Correctional Electronic Medical Records system.

7.    A housing assignment is an inmate’s specific unit, cell, and bed within DCSO’s facility.

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

9.    According to Section 932.01 of Title 103 of the Code of Massachusetts Regulations, “The health authority may be a physician, health administrator, or health agency whose responsibility is pursuant to a written agreement, contract, or job description.”

 

10.    A medical request box is a secure lockbox in each housing unit for inmates to place sick call request forms.

11.    Correctional officers receive basic medical training annually by trained healthcare professionals through the sheriff’s academy.

Date published:	March 4, 2024