The Department of Correction (DOC) was established under Section 1 of Chapter 350 of the Acts of 1919 and Section 1 of Chapter 27 of the Massachusetts General Laws. DOC is responsible for operating the Commonwealth’s prison system. According to its intranet site, DOC’s vision is “to effect positive behavioral change in order to eliminate violence, victimization and recidivism” and its mission is “to promote public safety by managing offenders while providing care and appropriate programming in preparation for successful reentry into the community.” As of June 2018, DOC was responsible for 8,741 inmates housed in 16 correctional facilities (see Appendix A) across the Commonwealth and had approximately 4,600 employees. DOC’s state appropriations for fiscal years 2017 and 2018 were $593,413,000 and $645,035,000, respectively. DOC obtains accreditation through the American Correctional Association, the National Commission on Correctional Health Care, the state Department of Public Health, and the state Department of Mental Health to confirm compliance with applicable regulations. In our audit, we reviewed inmate access to healthcare, including sick call requests, reentry healthcare services, and women’s specific healthcare services related to pregnancy and annual preventive examinations.
During the audit period, healthcare at DOC facilities was provided by a third-party vendor (Massachusetts Partnership for Correctional Healthcare, LLC) through a Commonwealth of Massachusetts Standard Contract. This contractor was selected through the competitive bid process using the state’s online procurement management system.1 The contract term was for five years (July 1, 2013 through June 30, 2018), with two options to renew the contract for up to two years each. The role and obligations of the contractor are outlined in the Request for Response (RFR) “Comprehensive Health Services to Massachusetts Prison Population (RFR 14-DOC 9004—Prison Health Services)” and include but are not limited to the following:
- The Contractor shall provide a comprehensive program of medical, dental and mental health services to all inmates and civilly committed persons, male and female, adult and minor, residing at all Facilities or otherwise committed to the care and custody of [DOC]. . . .
- The Contractor shall provide Inmates with humane health care in accordance with Community Standards [see Appendix B] throughout the term of Contract.
- The Contractor shall operate the Program based on a contractual staffing plan using only licensed, registered, certified and professionally trained Personnel, or other Personnel whom [DOC’s Assistant Deputy Commissioner for Clinical Services] deems qualified on a case-by-case basis to provide Services under this Contract. . . .
- The Contractor shall maintain complete and accurate records of care in accordance with applicable standards, and . . . collect and analyze health care statistics on a regular basis for provision to the Health Services Division [of DOC] in accordance with reporting requirements set forth herein. . . .
The contractor, or the respective Medical Contractor and Mental Health Contractor, shall be solely responsible for making all decisions with respect to the type, timing and level of Services needed by Inmates covered by the Program. This includes, without limitation, the determination of whether an Inmate is in need of clinical care, inpatient hospitalization, and/or referral to an outside specialist or otherwise needs specialized care. . . . The Contractor . . . shall have the sole authority and responsibility for the implementation, modification and continuation of any and all health care for Inmates.
DOC monitors the contractor’s compliance with contract requirements by conducting internal audits of medical and mental health records. During these internal audits, DOC officials review areas that include, but are not limited to, intake/transfer (accuracy of notes related to inmate problems), timeliness (frequency of contact with inmates), existence and accuracy of treatment plans, and documented need for specific medications. DOC conducted 131 internal audits during the audit period. According to the RFR, a minimum of 90% compliance is necessary for a contractor to be considered compliant with the contract requirements. If there are areas of noncompliance, the contractor must submit a corrective action plan to DOC, which schedules a follow-up audit within 90 days. If there are still areas of noncompliance after this audit, DOC may impose a financial penalty.
DOC did not take the option to renew this healthcare contract; as of July 1, 2018, DOC began a new contract with Correct Care Solutions, LLC.
Sick Call Requests
According to Section 10 of DOC policy “103 DOC 630—Medical Services,” “access to daily sick call is an inmate’s right and not a privilege.” Each of the 16 DOC facilities has written sick call procedures for processing inmate sick call requests, and all inmates at each facility (including inmates in restricted housing) have access to the Sick Call Request Form (SCRF). To request access to healthcare, an inmate completes an SCRF, selecting a type of service requested (medical, dental, or mental health); stating the nature of the problem or request; and adding his/her name, inmate commitment number, and signature, as well as the date. S/he then submits the SCRF in a designated drop box located in the facility. It is DOC’s responsibility to process the SCRFs daily and to schedule appointments as necessary. DOC maintains SCRFs in inmates’ individual medical files.
According to Section 491.07(2) of Title 103 of the Code of Massachusetts Regulations, DOC must give inmates unimpeded equal access to the grievance process to address their complaints. An inmate can file a grievance for any reason using the designated form; all inmates, regardless of housing unit, must have access to grievance and appeal forms. DOC must provide a response to an inmate’s grievance, and the inmate may appeal the response by filing a designated appeal form to the appellate authority.2 The appellate authority must respond to the appeal and make a final determination on the matter.
For both the grievance process and the sick call request process, non-English-speaking inmates can request translation in up to 140 different languages. If an inmate cannot complete a form because of language/literacy barriers, the inmate can request assistance through his/her assigned correctional program officer.
DOC is responsible for providing reentry services to all inmates to ensure successful transition from the inmate population into the community. For each inmate, DOC creates an Individual Reentry Plan that addresses post-release housing; eligibility for the state Medicaid program (MassHealth); employment opportunities; community resources; and physical or mental health services, which include providing medications and scheduling physical and mental health appointments upon release.
There are certain healthcare services that are specific to female inmates, such as certain preventive exams and prenatal and postnatal care. The preventive exams include pelvic and breast exams and mammograms. Generally, these appointments are scheduled when an inmate arrives at a DOC facility, but the inmate can refuse the services. The purposes of the preventive exams are overall health and early detection of cancer. Pregnant inmates are given necessary medical services, tests, and periodic health monitoring and evaluations (unless the inmate has refused them). DOC must provide pregnant inmates with appropriate clothing, sanitary materials, and nutrients necessary to maintain a healthy pregnancy. Postpartum inmates must receive a postpartum depression screening upon return to DOC custody; they are also eligible for mental health services related to postpartum depression if the issue presents itself after that screening. Additionally, the use of restraints is not allowable without due cause during the second and third trimesters of a pregnancy or during post-delivery recuperation.
|Date published:||January 9, 2020|