Overview
DOC did not always maintain documentation to support the following: that Individual Reentry Plans (IRPs) were reviewed with the inmates, signed by the inmates, and provided to the inmates before release; that physical and mental health appointments for post-release services were scheduled with external medical providers when necessary; and that DOC obtained signed Authorizations for Release of Medical Records (ARMRs) from inmates. Without an IRP, an inmate may be unaware of, and/or may miss, a needed appointment; may run out of necessary medications; and may be unaware of his/her current status with regard to health insurance coverage. In addition, inmates may lose continuity of care when appointments for known physical or mental health issues are not scheduled with medical service providers in the inmates’ areas of release. DOC also puts itself at legal risk by not maintaining copies of IRPs and signed ARMRs, since these provide evidence that inmates have received information and allow DOC to release medical records.
Of the 60 inmate files tested, 22 did not have evidence that the IRP was reviewed with the inmate, signed by the inmate, and given to the inmate before release from DOC custody. The IRP documents physical and mental health appointments for needed services provided in an inmate’s area; medication provided upon release and any prescriptions for refills; and MassHealth coverage, if the inmate is eligible.
For 5 of the 60 inmates tested, there was a request for a medical appointment or documented physical or mental health issue, meaning an appointment was necessary, but there was no evidence in DOC’s Inmate Management System (IMS) that appointments had been made for post-release services with external medical providers.
Finally, for 23 of the 60 inmates tested, there was an indication of a physical or mental health appointment needed or scheduled, but there was no evidence that an ARMR was obtained and signed.
Authoritative Guidance
In regard to IRPs, DOC officials told us that DOC provides an IRP to each inmate. The information on the IRP is also reflected in IMS with a note identifying when DOC had the conversation with the inmate. In addition, the DOC Reentry Services Operations Manual states that each inmate must sign a copy of the IRP and DOC must provide a copy to each inmate for his/her release.
In regard to physical or mental health appointments with external medical providers, Section 8(B) of “103 DOC 493—Reentry Policy” states,
The medical/mental health discharge planner shall schedule appointments with community providers and document the appointments in IMS.
In regard to ARMRs, Section 21 of “103 DOC 630—Medical Services” states,
When an inmate is being referred to an outside designated health care provider, the inmate should sign an authorization for release of medical records.
Reasons for Issue
DOC officials told us that some employees did not have appropriate reentry training and DOC did not provide enough job aids to properly assist them when they were not aware of reentry standards. DOC officials further explained that employees might work in reentry inconsistently and therefore might not be as knowledgeable about the standards.
Recommendations
- DOC should ensure that its staff is properly trained in reentry service standards and provide job aids for all aspects of the reentry process.
- DOC should evaluate whether it would be useful to have employees work solely in reentry rather than doing multiple jobs, thereby ensuring that these employees can focus on reentry and the applicable standards and timelines.
Auditee’s Response
Taking into account the Auditor’s findings, the DOC will review its current policies and staff training procedures for inmate reentry. DOC will also provide staff with accurate job aids required to complete the reentry process.
DOC will also review reentry staffing caseloads to ensure that staff can complete reentry tasks as required by DOC policy and procedures.
| Date published: | January 9, 2020 |
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