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

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

Overview

The Hampshire County Sheriff’s Office (HSO) was established as a state agency on September 1, 1998, after Hampshire County was abolished as a form of government by Sections 1 and 12 of Chapter 34B of the Massachusetts General Laws. This legislation made the Sheriff an employee of the Commonwealth of Massachusetts; however, the Sheriff remained an elected official with administrative and operational control of the department.

According to HSO’s website,

Our primary mission at the Hampshire Sheriff’s Office Jail and House of Correction [(HJHC)] is providing care and custody for inmates. In doing so, we uphold the HJHC philosophy, which is to promote reintegration while protecting society and holding the offender at the lowest level of security consistent with public safety. We strive to operate a clean, safe, and humane facility, manageable in size with an appropriate range of services, which recognizes the individual needs of each offender.

As of June 30, 2021, HSO had 170 employees, including 96 full-time correctional officers. In fiscal years 2020 and 2021, HSO’s annual state appropriations were $14,884,490 and $15,633,762, respectively.

HSO’s main administrative building and the Hampshire Sheriff’s Office Jail and House of Correction (HJHC) are both located at 205 Rocky Hill Road in Northampton. HJHC is used for the care and custody of female and male regionally arrested individuals,³ female and male pretrial inmates, and male sentenced inmates. As of June 30, 2021, there were 112 inmates⁴ in HSO’s custody, including 47 regionally arrested individuals, 47 pretrial inmates, and 18 sentenced inmates.

According to its website, HSO offers inmates the following programs and services:

• Education, which includes courses such as adult basic education, literacy, math, and English for English-language learners;
• Treatment groups, which focus on topics such as substance use disorder education, anger management, substance use disorder recurrence prevention, parenting, and mentoring;
• Amherst College’s Inside Out Program, which gives inmates a chance to take credit-bearing college courses each semester, with 12 inmates studying alongside 12 students from Amherst College;
• A monthly reentry roundtable session that helps inmates transition from HJHC back to the public through partnerships with different community service providers;
• A recovery and wellness center operated by HSO that provides treatment to individuals incarcerated for operating a vehicle under the influence and related offenses; and
• Dormitory-style housing, which consists of two 60-person units within one of HJHC’s five buildings with a television, space for leisure activities (e.g., reading books and playing board games), and a kitchen.

Offender Management System

HSO 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, HSO’s booking officer enters information from a mittimus⁸ into OMS.

Correctional Electronic Medical Records System

HSO 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.

Inmate Deaths

Section 932.17 of Title 103 of the Code of Massachusetts Regulations (CMR) requires county correctional facilities such as HJHC to establish guidelines for notifications, investigations, reports, and documentation regarding the deaths of inmates or facility employees. In the event of an inmate’s serious medical emergency while in HSO’s custody, at least one of the officers on duty assesses the emergency; administers first aid, if appropriate; and notifies the shift supervisor. If the situation does not appear to be life threatening, the shift supervisor only needs to contact HSO’s in-house healthcare employees, who then assist with the medical emergency. If the situation appears to be life threatening, the shift supervisor notifies HSO’s in-house healthcare employees and, if necessary, sends the inmate—accompanied by an HSO correctional officer—to the Cooley Dickinson Hospital in Northampton. The shift supervisor notifies HSO employees of the emergency following the chain of command, starting with the assistant deputy superintendent for security, then the deputy superintendent, and lastly, the Sheriff. After a medical emergency, any employees who responded to it work together to complete a single “Man Down” Drill Evaluation Form,⁹ which the shift supervisor approves.

In the event of an inmate’s death, the shift supervisor notifies the Sheriff of the inmate’s death (if the Sheriff is not already aware of it). The Sheriff then notifies the District Attorney’s office of the inmate’s death. The shift supervisor either notifies the inmate’s next of kin by phone or reaches out to the local police department to request that it notify the inmate’s next of kin. If the deceased inmate was in custody for a crime that involved a victim, then an HSO employee sends a notification to any victim(s) as soon as possible. This notification informs victims about any change of status regarding the inmate, such as the inmate’s release or death.

The shift supervisor documents all notifications in the main control log¹⁰ and submits the corresponding “Man Down” Drill Evaluation Form to the deputy superintendent. After the deputy superintendent completes their review of the log and the form, they conduct a debriefing/mortality review¹¹ within 30 days after the inmate’s death.

Healthcare Services

Healthcare Services

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

Quarterly Meetings

According to 103 CMR 932.01(3),

The county correctional facility [in this case, HJHC] 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 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 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 HSO.

Initial Medical Screenings

According to 103 CMR 932.06, HSO’s in-house healthcare employees are required to perform an initial medical screening for each inmate upon admission to HJHC. This occurs before an inmate is placed in HSO’s general population to ensure that each inmate’s health needs are identified and addressed. This initial 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 are recorded electronically in the CorEMR system, which is then approved by the health authority.

Upon each inmate’s admission to HJHC, in-house healthcare employees communicate (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.

Health Assessments

According to 103 CMR 932.07(1),

Each inmate committed to the facility [in this case, HJHC] 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 complete health assessment within the last 90 days, then no examination is required. Otherwise, an in-house healthcare employee completes a health assessment, which 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 inmate’s health assessment data is first documented in a health assessment form and is then recorded in the inmate’s electronic medical record in the CorEMR system by an in-house healthcare employee. In addition, inmates have the right to refuse the entire health assessment or any portion of it. If this is the case, an inmate signs a refusal form, which is held in their medical file.

Sick Call Requests

According to HSO’s Policy 4.3.2 (Medical Requests/Sick Call), in order for an inmate to request access to healthcare, they complete a sick call request form (HSO’s Health Service Request Form) and include 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 box¹² or handing it directly to one of the in-house healthcare employees during a medication pass, which occurs at least twice a day. An in-house healthcare employee checks the medical request box daily to pick up, evaluate, and triage sick call request forms.

An 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 an in‑house healthcare employee; problems beyond their scope are then triaged to the appropriate contracted healthcare provider(s). While in-house healthcare employees conduct regular sick calls daily, additional contracted healthcare providers are also required to provide on-call services at all times. In‑house healthcare employees maintain medical files 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. HSO’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 HSO to an inmate upon their arrival to HJHC. 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 HJHC.

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

 

9.   A “Man Down” Drill Evaluation Form is an incident report that summarizes the events that occurred during a medical emergency.

10.   The main control log catalogs the activities or occurrences (e.g., routine rounds or responses to inmate calls) that took place during each shift.

11.   A debriefing/mortality review is an assessment of the clinical care provided to an inmate and the circumstances leading up to an inmate’s death.

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

Date published:	November 16, 2023