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

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

Overview

The Norfolk County Sheriff’s Office (NSO) was established as a state agency on January 1, 2010, pursuant to 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. The Sheriff serves a term of six years.

According to NSO’s website,

The Norfolk County Sheriff’s Office serves the public safety needs of the residents of Norfolk County and the Commonwealth of Massachusetts while prioritizing professionalism and accountability, character, opportunity, and community for both employees and our programming.

During the audit period, NSO had 4,350 inmates in custody.¹ As of June 30, 2021, NSO had 316 employees. In fiscal years 2020 and 2021, NSO’s state appropriations were $32,843,581 and $35,543,400, respectively. In fiscal years 2020 and 2021, NSO had a budget of $33,218,581 and $35,823,830, respectively.

NSO serves the 28 municipalities in Norfolk County.² Both its main administrative building and the Norfolk Sheriff’s Office Jail and House of Correction (NJHC) are located at 200 West Street in Dedham. NJHC is used for the care and custody of male pretrial and sentenced inmates. During the audit period, three individuals served as Sheriff of Norfolk County.

Offender Management System

NSO 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,³ booking numbers,⁴ booking dates, release dates, and in-custody housing assignments.⁵ During the process of admitting an inmate, one of NSO’s booking officers enters information from a mittimus⁶ into OMS. This booking officer then notifies NSO’s in-house healthcare employees that the inmate is ready to receive an initial medical screening.

Correctional Electronic Medical Records

NSO 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. Qualified healthcare professionals also use CorEMR to document and track inmates’ sick call requests.

Inmate Deaths

Section 932.17 of Title 103 of the Code of Massachusetts Regulations (CMR) requires county correctional facilities, such as NJHC, to establish guidelines for notifications, investigations, reports, and documentation regarding the deaths of inmates or facility employees.

According to Section 622.08 (Discovering an Unresponsive Person) of NSO’s Policy CSD 622 (Death Procedures), if an inmate is found unresponsive, an NSO employee alerts the facility shift commander and NSO’s in-house healthcare employees of the inmate’s condition, so that all relevant parties can conduct lifesaving measures, if the situation calls for and allows it. This alert also prompts the facility shift commander to contact external emergency healthcare providers and NSO management, which includes NSO’s on-duty assistant deputy superintendent of security. Then, NSO’s on-duty assistant deputy superintendent of security notifies the Sheriff, NSO’s legal department, the designated NSO investigator, and the Norfolk District Attorney’s Office. Section 622.08 of NSO’s Policy CSD 622 requires staff members to secure the unit and safeguard the area so that it remains unaltered until both NSO and the Norfolk District Attorney’s Office conduct and document an investigation.

In the event of an inmate’s death, NSO notifies the Norfolk District Attorney’s Office and the inmate’s next of kin of the death. The Norfolk District Attorney’s Office then initiates an investigation into the death and notifies the Office of the Chief Medical Examiner of the death. The Office of the Chief Medical Examiner then conducts an autopsy. NSO requests copies of the autopsy report after its completion. After the completed autopsy, the Office of the Chief Medical Examiner releases the body to the inmate’s next of kin.

After the death of an inmate, the Sheriff, the superintendent, the in-house healthcare employees, and the investigators from both NSO and the Norfolk District Attorney’s Office convene a clinical mortality review⁷ within 30 days. If the clinical mortality review results in recommendations, the medical director and the assistant deputy superintendent of health services are responsible for ensuring that all affected parties implement these recommendations immediately.

Healthcare Services

During the audit period, most healthcare services were provided by NSO’s in-house healthcare employees. NSO’s assistant deputy superintendent of health services was its health authority⁸ during the audit period and was in charge of in-house healthcare employees and healthcare service delivery for inmates. NSO contracted with various external healthcare providers for dental, mental health, and vision services.

Quarterly Meetings

According to 103 CMR 932.01(3),

The county correctional facility [in this case, NJHC] 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, clinical mortality review findings, and other statistical reports used to monitor trends in the delivery of healthcare at NSO.

Initial Medical Screenings

According to 103 CMR 932.06 and Section 601.13(1–2) (Receiving and Screening Procedures) of NSO’s Policy CSD 601 (Medical Services), NSO’s in-house healthcare employees are required to perform an initial medical screening for each inmate upon admission to NJHC. This occurs before an inmate is placed in NSO’s general population to ensure that each inmate’s health needs are identified and addressed. The 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. A qualified healthcare professional records all findings resulting from the initial medical screening in the CorEMR system, specifically on the Medical Entrance Screening Form, which is then approved by the health authority.

Upon each inmate’s admission to NJHC, 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 NJHC employees understands how to access healthcare services.

Sick Call Requests

According to 103 CMR 932.09(1),

Written policy and procedure 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.

Inmates request access to healthcare by completing a sick call request form (NSO’s Request Slip for Medical Care/Sick Call) with the following information: the type of service requested (medical, dental, or mental health), the nature of the problem or request, and the date the inmate completes and signs the form. The inmate then submits the sick call request form by either putting it in a medical request box⁹ or handing it directly to one of the in-house healthcare employees during a medication pass, which occurs at least twice a day. There is no limit to how many times an inmate can submit a sick call request form. An in-house healthcare employee checks the medical request box daily to pick up, evaluate, and triage sick call request forms in accordance with 103 CMR 932.18, which states,

(2)  The medical record file shall contain, but not be limited to, the following items: . . .

     (h)  place, date and time of health encounters; . . .

     (k)  all findings, diagnoses, treatments, dispositions.

In addition to gathering and recording the inmates’ sick call request forms, a qualified healthcare professional conducts a face-to-face meeting with an inmate within 24 hours upon receipt of a sick call request, as required by Section 601.15(1)(b) (Sick Call) of NSO’s Policy CSD 601 (Medical Services).

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; health concerns beyond their scope are then triaged to an appropriate contracted or external healthcare provider(s). While in-house healthcare employees conduct regular sick calls each day, additional contracted healthcare providers are also required to provide on-call services at all times. In-house healthcare employees maintain each inmate’s medical file (including updating the medical tasks screen¹⁰ and any medical notes¹¹) in the CorEMR system.

1.   For an inmate to be in NSO’s custody means that NSO has the authorization from a court to incarcerate an inmate until the court orders their release.

2.   The municipalities in Norfolk County are Avon, Bellingham, Braintree, Brookline, Canton, Cohasset, Dedham, Dover, Foxborough, Franklin, Holbrook, Medfield, Medway, Millis, Milton, Needham, Norfolk, Norwood, Plainville, Quincy, Randolph, Sharon, Stoughton, Walpole, Wellesley, Westwood, Weymouth, and Wrentham.

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

4.   A booking number is a unique number assigned by NSO to an inmate upon their admission to NJHC. The booking number in OMS matches the personal identification number in the Correctional Electronic Medical Records system.

5.   A housing assignment is an inmate’s specific unit, cell, and bed within NJHC.

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

7.   According to NSO’s Policy CSD 622, a clinical mortality review “is an assessment of the clinical care provided and the circumstances leading to the death.”

8.   According to 103 CMR 932.01, “The health authority may be a physician, health administrator, or health agency whose responsibility is pursuant to a written agreement, contract, or job description.”

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

10.   The medical tasks screen is where a qualified healthcare professional documents the initial sick call request made by the inmate.

11.   Qualified healthcare professionals use medical notes to document information such as the face-to-face meeting(s) held with an inmate after their submission of a sick call request. The qualified healthcare professional who addressed the sick call request enters medical notes in the inmate’s medical file manually.

 

Date published:	July 26, 2024