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

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

Overview

The Essex County Sheriff’s Department (ECSD) was established as an independent state agency on July 1, 1999, after Essex County was abolished as a form of government by Section 1 of Chapter 34B of the Massachusetts General Laws. This law was then amended by 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 statutorily authorized functions of that office, are hereby transferred from the county to the commonwealth.

This 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 ECSD. Under the Sheriff’s direction, superintendents administer ECSD operations at ECSD’s facilities. As of June 30, 2021, ECSD had a total population of 911 inmates in its custody. ECSD’s facilities, along with their respective inmate populations, are listed below.

• ECSD’s administrative office and the Middleton House of Correction (HOC) are at 20 Manning Avenue in Middleton. As of June 30, 2023, there were 778 inmates housed in HOC (specifically, 488 pretrial male inmates, 289 sentenced male inmates, and 1 sentenced female inmate).
• The Essex County Prerelease and Reentry Center (ECPRC) is at 165 Marston Street in Lawrence. ECPRC houses male inmates with less serious records (i.e., misdemeanors) who are approaching the end of their sentences. As of June 30, 2023, there were 120 sentenced male inmates housed in ECPRC.
• The Women in Transition (WIT) facility is at 197 Elm Street in Salisbury. The WIT facility focuses on reintegration for minimum-security female inmates who are approaching the end of their sentences. As of June 30, 2023, there were 13 sentenced female inmates housed in the WIT facility.
• A Civil Process Office is at 360 Merrimack Street in Lawrence and another is at 45 Congress Street in Salem. These facilities are responsible for administering court orders and delivering legal documents that are essential to all statewide and civil cases that are within Essex County.
• The Lawrence Office is at 360 Merrimack Street in Lawrence. One of the functions of the Lawrence Office is to administer the Supporting Transitions and Reentry Program. This program provides clinical, vocational, and educational services to inmates in preparation for their reentry into the community.
• The Lynn Office is at 100 Willow Street in Lynn. Like the Lawrence Office, it also administers the Supporting Transitions and Reentry Program.

According to ECSD’s internal control plan,

The Essex County Sheriff’s Department’s top priority is to protect residents in the region from criminal offenders. This is accomplished by:

• Housing inmates in a secure and fair manner.
• Practicing correctional policies that comply with all local, state and federal laws.
• Using innovative correctional approaches that are in accord with the mission.
• Informing and educating the public about the department through the media, tours of the facility and public appearances by the sheriff, administrators, K-9 unit and uniformed personnel.
• Providing a professional working environment for the staff, which takes into account at all times their welfare, safety and opportunities for professional advancement.
• Providing rehabilitation and academic training to offenders while they are incarcerated, so they will not repeat their mistakes once they are released.
• Devising and structuring post-release supervision plans for offenders, to assist them in transitioning back into their respective communities.
• Partnering with local, state, and federal law- enforcement agencies in the development of campaigns and programs that fight crime and promote public-safety initiatives.

As of June 30, 2021, ECSD had 784 employees who supervised and cared for the inmates in ECSD’s custody. ECSD’s annual state appropriations were approximately $61.7 million in fiscal year 2020 and $75 million in fiscal year 2021.

According to ECSD’s website, ECSD offers inmates at all of its facilities the following programs and services:

• a detoxification program for pretrial inmates, which includes a 28-day substance use disorder treatment program and individualized care, such as physical, psychological, and emotional assistance, as well as religious services;
• rehabilitation services, including services such as treatment for and recovery from substance use disorder through cognitive behavioral therapy and medically assisted treatment;
• vocational training programs, including programs such as graphic design, food safety and sanitation, hairstyling, masonry, and telecommunication technologies; and
• education programs, including courses such as adult basic education, computer literacy, health and wellness, and English for English-language learners.

Offender Management System

ECSD 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,² booking numbers,³ booking dates, release dates, release types,⁴ and in-custody housing assignments.⁵ During the process of admitting an inmate, one of ECSD’s booking officers enters information from a mittimus⁶ into OMS.

Electronic Record Management Application

ECSD uses the Electronic Record Management Application (ERMA), a web-based medical record application administered by Wellpath (formerly known as Correct Care Solutions), ECSD’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 ECSD, to establish guidelines for notifications, investigations, reports, and documentation regarding the deaths of inmates or facility employees. According to ECSD’s “Policy 103 ECSD 222.00 Serious Illness, Injury or Death,” in the event of an inmate’s serious illness, injury, or death while in ECSD’s custody, at least one of the officers on duty notifies the central control unit.⁷ The unit then notifies ECSD’s contracted healthcare provider, ECSD’s emergency response team (which is made up of several ECSD officers), and NorthEast Emergency Medical Services to assist, administer medical care, and/or provide transportation to the hospital, if appropriate. 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 central control unit notifies ECSD’s Sheriff, the superintendent (or their designee) of the facility where the inmate was held in custody, the Security Investigations Unit (SIU), and the health services administrator⁸ of the inmate’s death. The superintendent (or their designee) notifies the Massachusetts State Police, the Essex County District Attorney’s Office, the Office of the Chief Medical Examiner (OCME), and the inmate’s next of kin of the inmate’s death.

Once members from the Massachusetts State Police arrive at ECSD, they, alongside SIU, secure the scene of the incident and conduct an investigation to determine the cause and manner of death. OCME conducts a postmortem exam.⁹ 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, each involved staff member must submit an incident report to ECSD’s superintendent (or their designee) by the end of their shift on the day of the incident. Any treatment and/or lifesaving assistance that were taken are documented in the inmate’s medical record. A designated officer collects the deceased inmate’s medical record, mental health record, medication record, guest visitation information, and any other pertinent documentation. The superintendent retains all of this documentation for the investigation. SIU may also conduct an investigation while assisting with the Massachusetts State Police’s investigation. The assistant director of SIU submits a written investigative report (which contains any documents that correspond to an incident, such as incident reports, external agency reports, medical records, logbooks,¹⁰ and photographs) to the director of security at the conclusion of an internal investigation.

After the death of an inmate, the health services administrator convenes a mortality review¹¹ within 30 days. If the mortality review results in recommendations, then the health services administrator is responsible for ensuring that all affected parties implement these recommendations immediately.

Healthcare Services

ECSD’s “Request for Responses (RFR)–Comprehensive Health Services to Essex County Sheriff’s Department (ECSD) Inmate/Detainees,” dated July 18, 2018, outlines the following responsibilities for ECSD’s contracted healthcare provider:

3.2  Role of the Contractor

The Contractor [in this case, Wellpath] shall provide services to all inmate/detainees residing in ECSD Facilities.

The Contractor shall be solely responsible for making all decisions with respect to the type, timing and level of services needed by inmates/detainees covered by [contracted healthcare services]. This includes, without limitation, the determination of whether an inmate/detainee is in need of clinical care, inpatient hospitalization, and/or referral to an outside specialist or otherwise needs specialized care. Except as herein otherwise provided, the Contractor shall be the sole supplier and/or coordinator of all medical, mental health, and dental services constituting [contracted healthcare services] under this Contract, and, as such, shall have the sole authority and responsibility for the implementation, modification and continuation of any and all health care for inmates/detainees.

The Contractor shall provide all means of addressing the serious medical, dental and mental health needs of the inmate/detainee population based upon clinical assessments of the individual inmates/detainees in a manner that is cost effective and consistent with community standards of care.

According to the request for responses, ECSD is required to conduct a process performance audit¹² of the quality of the healthcare services that the contracted healthcare provider performs at each facility. ECSD 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 results in penalties.

Quarterly Meetings

According to 103 CMR 932.01(3),

The county correctional facility [in this case, ECSD] 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.

Statistical summaries, as referenced in the above regulation, contain data related to inmate health records and provide 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 ECSD.

Admission Medical Screenings

According to Section 10 of ECSD’s “Policy 103 ECSD 220.00 Medical Services,” an admission medical screening is performed by a qualified healthcare professional (QHP)¹³ on each inmate upon admission to HOC 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.

A QHP records all findings of the admission medical screening electronically in ERMA, specifically on the admission medical screening form, which is then approved by a higher-level QHP. If an inmate refuses the admission medical screening, QHPs counsel the inmate on the benefits of the screening to encourage them to complete it.

Upon each inmate’s admission to ECSD, a QHP 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 staff members understands how to access healthcare services.

Physical Examination

According to Section 11 of ECSD’s “Policy 103 ECSD 220.00 Medical Services,” each inmate committed to the facility for 30 or more days receives a thorough physical examination within 14 days after admission, unless there is documented evidence of an examination within the previous 90 days. The physical examination is completed by a QHP 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. The QHP records the inmate’s physical examination data in the inmate’s electronic medical record in ERMA, specifically on the physical examination form, which is then reviewed and approved by a higher-level QHP.

Sick Call Requests

According to Wellpath’s “Nonemergency Health Care Requests and Services Policy” (HCD-100_E-07) for ECSD, to request access to healthcare, an inmate completes a Healthcare Request Form (HRF) 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,¹⁴ date of birth, and housing unit; and their signature and the date. The inmate then submits the HRF by putting it in a designated, secure lockbox (one of which is located in each housing unit). A QHP picks up HRFs daily to evaluate and triage each request. QHPs provide treatment according to clinical priorities and schedule follow-up appointments as needed. A face-to-face meeting with a QHP is required within 24 hours upon receipt of a HRF. All HRFs that are triaged as emergent are responded to immediately; health concerns that are beyond the responding QHP’s expertise are then referred to the most appropriate healthcare provider external to ECSD’s contracted healthcare provider. Throughout this process, each inmate’s individual medical file (including medical notes¹⁵) is maintained in ERMA.

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

3.   A booking number is a unique number assigned by ECSD to an inmate upon their admission to HOC. A new booking number is generated upon every unique admission to the facility.

4.   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.

5.   A housing assignment is an inmate’s specific unit, cell, and bed within HOC, ECPRC, or the WIT facility.

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

 

7.   The central control unit is a booth, operated by ECSD employees, in the center of HOC. It is the central site of control for radio communication devices and physical access throughout all of ECSD’s facilities. All communication into and out of ECSD’s facilities goes through the central control unit.

8.   According to Wellpath’s “Responsible Health Authority Policy” (HCD-100_A-02) for ECSD, the health services administrator is the designated Wellpath employee who “maintains a coordinated system for health care delivery.”

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

10.   A logbook is a record of an inmate’s transition from one location to another (e.g., from HOC to the WIT facility, or from an ECSD facility to an external hospital).

11.   According to Wellpath’s “Procedure in the Event of a Patient Death” (HCD-100_A-09) for ECSD, a mortality review “consists of both an administrative and clinical mortality review, as well as a psychological autopsy, if death is by suicide. . . . The clinical mortality review is an assessment of the clinical care provided and the circumstances leading up to a death. Its purpose is to identify areas of patient care or system policies and procedures that can be improved. . . . The administrative mortality review is an assessment of correctional and emergency response actions surrounding a patient’s death, regardless of the availability of autopsy results, and is conducted in conjunction with custody staff. . . . The psychological autopsy is a written reconstruction of an individual’s life. It is usually conducted by a psychologist or another qualified mental health professional.”

12.    This audit consists of reviewing various records regarding any medical, dental, mental, or other healthcare services performed by ECSD’s contracted healthcare provider.

13.   According to Wellpath’s “Responsible Health Authority Policy,” QHPs “include physicians, physician assistants, nurses, nurse practitioners, dentists . . . mental health professionals, and others who by virtue of education, credentials, and experience are permitted by law to evaluate and care for patients.”

 

14.   Each inmate is assigned a patient identification number. The patient identification number, which is used in ERMA, is the same as each inmate’s state identification number, which is used in OMS.

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

Date published:	April 18, 2024