Overview
SCSD did not implement our prior recommendations to establish policies and procedures over the monitoring of its healthcare vendor to ensure that the vendor complied with SCSD’s internal healthcare policies related to sick calls (SCSD’s Inmate Care and Treatment Policy S604).
We found that, for 10 (12%) out of 83 sampled records that indicated a sentenced inmate or a pretrial detainee requested a sick call visit, SCSD’s healthcare vendor did not comply with SCSD’s policy. Specifically, we found the following:
- One sick call request was not reviewed within 24 hours.
- Three sick call requests did not result in a face-to-face encounter with a qualified healthcare professional (QHP) within the required timeframe.
- Three sick call requests were not reviewed within 24 hours and did not result in a face-to-face encounter with a QHP within the required timeframe.
- Three sick call requests were not reviewed within 24 hours, did not result in a face-to-face encounter with a QHP within the required timeframe, and did not have notes from the QHP on the form.
Further, for the 18 sampled records that were not properly labeled as sick call requests but did have a sick call request form on file, we found that SCSD’s healthcare vendor did not comply with SCSD’s policy for two of the records. Specifically, we found that one sick call request was not reviewed within 24 hours, and one sick call request was not reviewed within 24 hours and did not result in a face-to-face encounter with a QHP within the required timeframe.
Because SCSD did not implement our prior recommendations to establish policies and procedures over the monitoring of its healthcare vendor’s administration of sick call visits, SCSD’s Inmate Care and Treatment Policy S604 was not properly followed. There is, therefore, a higher risk that sentenced inmates or pretrial detainees have not, and will not, have their healthcare issues properly resolved within the required timeframes or at all. Further, there is a higher risk that SCSD will not notice the failure of its vendor to comply with SCSD policies, and potentially the requirements of its contract with the Commonwealth, resulting in poor vendor performance going unnoticed and unaddressed.
Authoritative Guidance
Our prior audit report (Audit No. 2022-1449-3J) recommended, “SCSD should establish monitoring controls (i.e., policies and procedures) over its sick call process to ensure that its healthcare vendor complies with all the requirements of SCSD’s healthcare policies.”
Section 8.2.3 of SCSD’s internal control plan states,
If a deficiency in compliance or internal controls lead to a formal audit finding, then corrective action is taken to remediate the finding in a timely manner. The audit resolution process begins when an audit or other review results are reported to management and is completed only after action has been taken that does one of the following: corrects identified deficiencies, produces improvements, or demonstrates that the findings and recommendations do not warrant management activity.
Reasons for Issue
SCSD management stated that the controls in place were adequate for the supervision of the healthcare vendor at the time and that the lack of adequate care was the result of inadequate staffing by the healthcare vendor. SCSD management stated that they terminated their contract with the healthcare vendor, in part because of the inadequate staffing.
Recommendation
SCSD should establish sufficient monitoring controls (i.e., policies and procedures) over its sick call process to ensure that its healthcare vendor complies with all the requirements of SCSD’s healthcare policies.
Auditee’s Response
Since the previous State Auditor’s review, SCSD has contracted with a new medical vendor. Additionally, SCSD has hired two medical and mental health licensed staff to assist in the oversight and monitoring of the contract and required services. The current vendor has increased staff and compliance of the sick call process. Issues that arise are discussed and resolved with vendor management. Additionally, SCSD Contract Management staff and Administration meet with the vendor weekly.
Auditor’s Reply
We are encouraged by the steps SCSD has taken regarding this matter, but we encourage it to establish sufficient monitoring controls over the sick call process as recommended. As part of our post-audit review process, we will follow up on this matter in approximately six months.
| Date published: | December 24, 2025 |
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