Overview
The Bristol County Sheriff’s Office (BCSO) did not ensure that Sick Call / Medical Encounter Request Forms (MERFs) contained all information and that sick calls were triaged on time. During the audit period, there were 17,245 sick call requests submitted by the inmates at BCSO’s facilities. In our testing, we selected a random, statistical sample of 60 MERFs and found that 7 MERFs did not indicate the date they were received by the contracted healthcare provider and that 21 MERFs did not have a triage date. Because of this, we could not determine whether each inmate was seen by a contracted healthcare provider within the required timeframe.
In addition, out of our sample of 60 MERFs, we found that 4 MERFs did not indicate the immediacy of needed intervention, while 1 sick call was not triaged within 24 hours.
If BCSO does not ensure that MERFs contain all information and that sick calls are triaged on time, then there is a higher-than-acceptable risk that some inmates may not have their healthcare issues properly resolved in a timely manner or at all.
Authoritative Guidance
Section 12.02.09 (Clinical Services) of BCSO’s Policy 12.02.00 (General Inmate Medical Procedures) states,
- Sick Calls. . . .
[3]b. Each day, a qualified health care professional on the 3-11 Shift shall collect [i.e., triage] all Sick Call Slips submitted by inmates within the past 24 hours. . . .
[3]c. An inmate who has submitted a Sick Call Slip shall be visited by a qualified health care practitioner, following the established priority system. . . . These inmates shall be visited by a health care practitioner within 48-72 hours, absent a possible emergency. . . .
[3]d. Health care practitioners conducting sick call shall document their encounters onto the Progress Notes section within the medical chart. . . .
Reasons for Noncompliance
BCSO has not implemented effective monitoring controls (i.e., policies and procedures) over its sick call process, and it does not appear to conduct periodic evaluations of BCSO’s internal controls to ensure that its contracted healthcare provider includes all information on MERFs and triages sick calls on time.
Recommendation
BCSO should implement effective monitoring controls (i.e., policies and procedures) over its sick call process and it should conduct periodic evaluations of its internal controls to ensure that its contracted healthcare provider includes all information on MERFs and triages sick calls on time.
Auditee’s Response
As pertains to the findings of the draft audit it is always our goal . . . to be 100 percent compliant. Having said that [we] would ask that it be considered that a majority of the audit period was during the COVID-19 Pandemic, which resulted in staffing shortages and other challenges at our facility.
Notwithstanding, a Corrective Action Plan was put in place where medical staff were re-educated on proper sick slip documentation and process on [June 29, 2023]. Staff not in attendance received a read and sign [acknowledgement document] included in an email with the education at that time. In addition to Education and Training upon hire a quarterly sick call procedure review has been put in place along with a sick slip audit tool. The Assistant Director of Nursing or designee will review daily sick call lines for completion, sick call slips and charts monitored weekly for compliance and the review results will be documented on the sick slip audit tool.
Lastly, ongoing monitoring through the CQI (Continuous Quality Insurance) process and medical records audits will occur and education and training will be initiated with nursing staff if the sick call process is found to be non-compliant with [Correctional Psychiatric Services] policy.
Auditor’s Reply
Based on its response, BCSO has taken measures to address our concerns on this matter.
| Date published: | February 2, 2024 |
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