Overview
The Barnstable County Sheriff’s Office (BCSO) did not ensure that all inmates’ health appraisals were completed on time and that its health appraisals and admission medical screenings were documented. During the audit period, there were 1,228 inmates admitted to the Barnstable County Correctional Facility (BCCF) for 7 or more days, who were subject to an admission medical screening upon intake and a health appraisal between 7 and 14 days after admission. We found that 4 health appraisals in our statistical sample of 60 were not completed within 14 days of the inmates’ admission to BCCF. Based on the results of our sample, we estimate, using statistical projection techniques, that the healthcare vendor did not complete between 24 and 196 health appraisals within the required timeframe.
In addition to the untimely completion of the health appraisals, BCSO did not ensure that its healthcare vendor documented Medical Entrance Exam Reports (for admission medical screenings) and Physical Examination/Initial Chronic Disease Forms (for health appraisals) in each inmate’s medical file in the Correctional Electronic Medical Records (CorEMR) system. Specifically, we found that, out of a statistical sample of 94 inmates, 5 had no Medical Entrance Exam Reports in the system, and 3 of these 5 inmates had no Physical Examination/Initial Chronic Disease Forms in the system. Without these medical forms documented in CorEMR, there is no evidence that the admission medical screenings and health appraisals were completed.
Because BCSO does not ensure that its healthcare vendor completes the health appraisals within the required timeframe and documents each medical form in CorEMR, there is a higher-than-acceptable risk that inmates’ medical issues are not identified and treated, ultimately affecting the health and safety of all BCSO inmates.
Authoritative Guidance
According to Sections A and B of BCSO’s Policy 602.02 (Admission Medical Screening/Health Appraisal and Examination/Access to Healthcare),
A. ADMISSION MEDICAL SCREENING
- Every inmate, including transfers booked into the facility shall have an admission medical screening performed on arrival by a qualified health care professional. The findings of the screening shall be recorded in the electronic medical record by a member of the Health Services Department. . . .
B. HEALTH APPRAISAL/PHYSICAL EXAMINATION . . .
a. Each inmate committed to the facility for 30 days or more shall receive a thorough physical examination and the examination shall take place no later than seven days after admission. This time frame may be extended to within 14 days of admission for cases in which the admission screening was completed by a physician, physician’s assistant or a registered nurse.
Reasons for Noncompliance
BCSO management stated that during the audit period, its healthcare vendor did not have enough staff members to complete the health appraisals.
BCSO has not established any monitoring controls to ensure that its healthcare vendor completes health appraisals on time and documents the health appraisals and admission medical screenings.
Recommendations
- BCSO should establish monitoring controls to ensure that its healthcare vendor completes health appraisals on time and documents the health appraisals and admission medical screenings. Specifically, BCSO should designate an employee to monitor the healthcare vendor’s completion of health appraisals and documentation of health appraisals and admission medical screenings.
- BCSO should ensure that its healthcare vendor has enough staff members to complete the health appraisals.
Auditee’s Response
The Barnstable County Sheriff’s Office is actively seeking a solution to the problems we have encountered with our present medical vendor, Wellpath, which was contracted to provide medical care to our inmate population. Staffing is an on-going challenge not only for this vendor but for medical vendors and providers in general in Barnstable County. This leaves the BCSO with little option other than to reduce the payment owed to the vendor if the staffing matrix is not satisfied. The vendor’s staffing is monitored daily by shift and evidence was provided during the audit. . . .
Addressing the statement of, "BCSO has not established any monitoring controls to ensure that its healthcare vendor completes health appraisals on time and documents the health appraisals and admission medical screenings", the Barnstable County Sheriff’s Office has directly addressed [the Office of the State Auditor’s] concerns and we have been monitoring the health appraisals and admission medical screenings through the Audit and Compliance Department. We provided your office with evidence of this monitoring during the Audit. Over the course of the contract years with WellPath our own findings of non-compliance have been addressed directly with the multiple Health Service Administrators (HSAs) who were assigned to our facility as well as with the WellPath Administrators assigned to oversee the operations of the contracted medical care of our facility. We will continue to monitor the services provided by this vendor in order to ensure the contractual obligations are met and the vendor maintains an appropriate level of care for our inmate population.
Auditor’s Reply
Based on its response, BCSO has taken measures after the audit period to address our concerns on this matter.
| Date published: | March 16, 2023 |
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