Franklin County Sheriff’s Office - Finding 1

The Franklin County Sheriff’s Office should ensure that all inmates receive initial health assessments on time.

Overview

The Franklin County Sheriff’s Office (FCSO) should ensure that all inmates’ initial health assessments are completed on time. During the audit period, there were 669 inmates admitted to the Franklin County Jail and House of Correction for 30 or more days. According to both 103 CMR 932.07 and FCSO Policy J-E-04 “Initial Medical Screening,” FCSO was required to provide these inmates with initial health assessments within 7 days of admission, if the receiving screening was completed by a licensed practical nurse, or within 14 days of admission, if the receiving screening was completed by a physician, physician’s assistant, or registered nurse. We found that 2 (4%) inmates out of 50 inmates in our sample whose receiving screenings were completed by a registered nurse had their initial health assessments rescheduled to a time after the allotted 14 days without a documented reason.¹³

Because FCSO did not ensure that all inmates’ initial health assessments were completed within the required timeframe, there is a higher-than-acceptable risk that inmates’ medical issues were not identified and treated, ultimately affecting the health and safety of all FCSO inmates and staff members.

Authoritative Guidance

According to FCSO Policy J-E-04 “Initial Health Assessment,”

All inmates receive an initial health assessment within 7 calendar days of the receiving screening. This time may be extended to 14 calendar days after admission if the staff member completing the receiving screening is a Registered Nurse. The Provider may re-schedule the health assessment if the inmate is unavailable, e.g. at court or in the hospital.

Reasons for Issue

FCSO management stated that, during the timeframe in which both of these instances took place, the physician’s assistant who generally conducts inmate initial health assessments was unavailable, and that another medical provider who was covering for the physician’s assistant rescheduled the appointments. FCSO was unsure why there was no documented reason as to why the appointments were rescheduled.

Recommendations

1. FCSO should establish monitoring controls to ensure that it either completes initial health assessments on time or documents the reason for rescheduling them, especially for any outside the required timeframe.
2. FCSO should ensure that its healthcare department has enough staff members to complete the initial health assessments in the required timeframe.

Auditee’s Response

During the audit period, our Nurse Practitioner was on site once per week, and this schedule, while normally sufficient, did at times create instances where an assessment would be out of compliance. In the event that an assessment could not be completed, the earliest it would be addressed was the next week. This issue was known to us prior to the audit and we have already hired a Nurse Practitioner to be on site two days per week to ensure that this would not continue to be an issue. The medical department monitors the timeliness of the initial health assessments to ensure that we remain in compliance with the Department of Corrections, the National Commission for Correctional Healthcare, and our own policies.

Both of the inmates who had their initial health assessment completed outside the 14 day period did have it completed on day 15. While out of compliance, the Health Services Director requests that the time period they actually ended up being completed in be included in the finding. The way it is written [in the draft report] leaves the time they were actually completed ambiguous.

Auditor’s Reply

We acknowledge that one of the two inmates in our sample whose receiving screening was completed by a registered nurse did have their initial health assessment on day 15. However, the other inmate did not receive a health assessment until day 20. While outside the allotted 14 days, these two health assessments were completed by FCSO.

Based on its response, FCSO is taking measures to address our concerns regarding this matter. We encourage FCSO to consider both of our recommendations to ensure that the issues identified in this finding do not reoccur in the future. As part of our post-audit review process, we will follow up on this matter in approximately six months.

13.    According to FCSO Policy J-E-04 “Initial Medical Screening,” an inmate’s initial health assessment may be rescheduled if the inmate is unavailable because they are at court or in the hospital, which would be documented in the inmate’s medical records as an acceptable reason for postponement. 

Date published:	November 25, 2025