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

This section describes the makeup and responsibilities of the Plymouth County Sheriff’s Department.

Overview

The Plymouth County Sheriff’s Department (PCSD) was established as an independent state agency on January 1, 2010, 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.

This act transferred to the Commonwealth all functions, duties, and responsibilities of PCSD, including assets, liabilities, debt, and potential litigation, except where specified. PCSD’s Sheriff became an employee of the Commonwealth but remained an elected official and retained administrative and operational control over PCSD.

According to PCSD’s Internal Control Policy 301, its mission is to “protect the public from criminal offenders by operating a safe, secure and progressive correctional facility while committing to crime prevention awareness in the community.”

As of June 30, 2021, PCSD had 602 active employees, which included 295 correctional officers. For fiscal years 2020 and 2021, PCSD’s annual state appropriations were approximately $58 million and $65 million, respectively. PCSD also received the following funding to support its programs for these fiscal years.

Program	Fiscal Year 2020	Fiscal Year 2021	Total
Residential Substance Use Disorder	$   26,000	$   21,000	$   47,000
State Criminal Alien Assistance Program	196,642	196,642	393,284
Substance Use Disorder—Alcohol	56,000	0	56,000
High School Equivalency—Adult Basic Education	1,936	0	1,936
Total	$ 280,578	$ 217,642	$ 498,220

 

PCSD is responsible for operating all aspects of its facilities, including the Plymouth County Sheriff’s Administrative Building at 24 Long Pond Road in Plymouth. It also oversees the Plymouth County Correctional Facility at 26 Long Pond Road in Plymouth, which administers correctional and educational services and programs for inmates. As of June 30, 2021, PCSD had 582 inmates, 204 of whom were pretrial detainees,² 106 of whom were sentenced, and 272 of whom were listed as other³ detainees.

According to PCSD’s “Facility Narrative,” a document describing the department and its programs, there are 11 different programs and services provided for inmates, which include the following:

• Education, which includes career counseling, literacy courses, and English courses (for English-language learners)

• Enrichment, which includes acquired immunodeficiency syndrome education in inmates’ housing units, human immunodeficiency virus classes during admission, and an incarcerated veteran transition program
• Vocational training in areas such as culinary arts, hospitality, and painting
• Religious services in Spanish, Portuguese, and English
• Re-entry services, which include providing counselors to inmates to assist them throughout their sentences; help them transition back into the community; and make referrals to community resources, such as housing assistance and job opportunities.

Offender Management System

PCSD uses a system called the Offender Management System (OMS) to track and manage information for inmates in its custody. The information maintained in this system includes inmates’ names, genders, ethnicities, dates of birth, Social Security numbers, state identification numbers,⁴ booking identification numbers,⁵ booking dates, release dates, release types,⁶ and in-custody housing assignments.⁷ During an inmate’s admission process, PCSD’s booking officer enters information from a mittimus⁸ into OMS.

Correctional Electronic Medical Records System

The Correctional Electronic Medical Records (CorEMR) System is a Web-based application that is used to record all health-related inmate information such as medical history, treatments, mental health status, 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 PCSD’s to establish guidelines for notifications, investigations, reports, and documentation regarding the deaths of inmates or facility employees. In the case of an inmate’s serious illness or injury while in PCSD’s custody, the officers on duty notify all available correctional officers, and medical officers,⁹ to the scene to perform emergency medical aid. The communications department¹⁰ notifies external emergency services and the Massachusetts State Police. Upon arrival to the facility, the Massachusetts State Police secure the scene and conduct an investigation to determine the causes and manner of death, when applicable. Emergency services transfer the inmate to Beth Israel Deaconess Hospital in Plymouth. The superintendent notifies the inmate’s next of kin.

Inmates are pronounced deceased at the hospital and then transferred to the Massachusetts Office of the Chief Medical Examiner. The office retrieves the body, conducts a postmortem exam,¹¹ and releases the body to the next of kin.

All officers who witnessed or responded to a death (or serious illness/injury) must complete an incident report to document their findings and experience.

Once all officers document and submit their incident reports, mortality and clinical reviews are conducted within 30 days of an inmate’s death. PCSD has a clinical review team, which includes the health services administrator¹² and shift commander,¹³ performs a mortality review and/or in-depth clinical review. The clinical review, which is conducted for cases of suicide, is to determine whether changes in the inmate’s clinical psychiatric management could have prevented the suicide. The superintendent also issues a summary of the incident and forwards it to the Sheriff. In addition, PCSD conducts a mortality review, in accordance with PCSD’s Procedure 622 (Serious Illness, Injury & Death), to determine whether there was a pattern of symptoms that could have resulted in earlier intervention or diagnosis of mental illness. The superintendent creates a Final Death Packet with the summary of the incident and the clinical and mortality reviews, and then forwards it to the Sheriff.

Vendor Healthcare Services

During the audit period, PCSD contracted medical services from Correctional Psychiatric Services. This vendor works alongside PCSD-employed medical staff members to provide constant care to inmates. Correctional Psychiatric Services provides medications for inmates who are enrolled in PCSD’s opioid use disorder program and provides dental services, vision services, and mental health services. All other healthcare services are provided by in-house medical officers, who are employed by PCSD.

Vendor Quarterly Meetings

According to 103 CMR 932.01(3), county correctional healthcare vendors must meet with the Sheriff, the facility administrator, or a designee selected by PCSD at least quarterly and submit quarterly reports on the healthcare delivery system and the health environment, as well as annual statistical summaries.¹⁴ The healthcare vendor documents and maintains meeting minutes that document the quarterly meetings. The meetings cover quality improvement, emergency drills, mortality review findings, and other statistical reports used to monitor trends in the delivery of healthcare at PCSD.

Medical Receiving Screenings

According to Section 4 of PCSD Policy 630 (Medical Services), all PCSD inmates are required to have a medical receiving screening by a medical officer upon arrival. The purpose of the screening is to determine whether the inmate has any medical needs and whether any of those needs must be immediately addressed. The screening consists of questions about the inmate’s medical history, medication history, mental health history, vaccine history, and more. It also includes a structured inquiry to identify potential emergencies and to ensure that inmates with known illnesses, prescriptions, or other health needs are identified for further assessment and continued treatment while they are in custody.

A medical officer documents the medical receiving screening in the Medical Intake Screening Form, held in the inmate’s medical record in CorEMR. The Medical Intake Screening Form is then approved by a qualified healthcare professional.

Intake Physical Examinations

According to PCSD’s Policy 630, each inmate committed to the facility for 30 days or more is required to have a complete intake physical examination within 7 days of their arrival to the facility. This timeframe is extended to within 14 days of admission for cases in which the medical receiving screening was completed by a physician, physician’s assistant, or registered nurse. No intake physical examination is needed if there is documented evidence of a medical examination within the previous 90 days or if an inmate leaves PCSD custody within 14 days.

A medical officer completes the intake physical examination, 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 medically indicated tests, and reviewing findings and scheduling any follow-up services with inmates who require further treatment. The medical officer collects inmates’ medical information and records it in the inmate’s medical record in CorEMR.

According to PCSD Policy 630, an inmate has the right to waive the intake physical examination by signing a Refusal of Medical Care Form. If an inmate is transferred from another correctional facility or returns to PCSD within three months of their last intake physical examination, their intake physical examination will be updated as needed.

Sick Calls

To request access to healthcare, an inmate fills out a Sick Call Request Form, which the medical officer scans and uploads as a Portable Document Format file into CorEMR. The Sick Call Request Form includes the type of service requested (medical, dental, or mental health), the date the form is completed, the nature of the problem or request, and their name. They submit the Sick Call Request Form by putting it in a secure lockbox in their housing unit or handing it directly to a medical officer during a medication pass, which occurs at least twice a day.

Medical officers collect the Sick Call Request Form daily to evaluate and triage each request within 24 hours. Medical officers provide treatment and schedule follow-up appointments according to clinical priorities. According to PCSD Policy 630, “It is the policy of the Plymouth County Sheriff’s Department that . . . sick call be conducted at least five (5) days each week by the licensed facility physician . . . in the Health Services Unit.”

All Sick Call Request Form that are triaged as emergencies are responded to immediately, and problems beyond the medical officer’s scope are referred to appropriate healthcare providers. The inmates’ medical files are maintained in CorEMR.

2.    A detainee is a person held in-custody before their trial.

3.    Other detainees include United States Marshals Service and Immigration and Customs Enforcement detainees. PCSD has a contract with the federal government to hold detainees for these agencies.

 

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

5.    A booking identification number is a unique number assigned by PCSD to an inmate upon their arrival to PCSD’s 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 housing assignment is an inmate’s specific unit, cell, and bed within PCSD’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 PCSD Procedure 622, medical officers are “qualified health Care Professionals assigned to the Medical Unit who, under direct supervision of a licensed physician, provide health care services to inmates.”

10.    The communications department is staffed by employees of the facility. The communications department has radio communication devices and access to controls at PCSD’s facility. All communication in and out of the facility goes through the communication department.

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

12.    The health services administrator is responsible for the organization and planning for the delivery of services in PCSD’s Health Care Unit.

13.    A shift commander is a correctional officer who has the duty for the security and care of inmates, as well as staff members.

14.   The statistical summary contains data related to inmate health records and provides a comprehensive overview of medical services delivered to inmates during the year.

Date published:	March 15, 2023