The Essex County Sheriff’s Department Did Not Follow Up on All Sick Call Requests in a Timely Manner.

If ECSD does not follow up on all sick call requests, then there is a higher-than-acceptable risk that inmates may not have their healthcare issues properly resolved, either in a timely manner or at all.

Overview

ECSD did not follow up on all sick call requests in a timely manner. In our testing, we selected a random, statistical sample of 60 Healthcare Request Forms (HRFs) out of 16,628 HRFs and found that ECSD did not follow up on 6 HRFs with face-to-face meetings with qualified healthcare professionals (QHPs) within 24 hours upon receipt.

We projected the test results from our sample of 60 HRFs to the total population of 16,628 HRFs that were submitted during the audit period. Based on this, we are 95% confident that ECSD did not follow up on at least 627 HRFs with face-to-face meetings with QHPs within 24 hours upon receipt.

If ECSD does not follow up on all sick call requests, then there is a higher-than-acceptable risk that inmates may not have their healthcare issues properly resolved, either in a timely manner or at all.

Authoritative Guidance

According to Section 6.6 of Wellpath’s “Nonemergency Health Care Requests and Services Policy” (HCD‑100_E-07) for ECSD, “A face-to-face encounter for a health care request is conducted by a qualified health care professional, within 24 hours of receipt by health care staff.”

Reasons for Noncompliance

ECSD has not established effective monitoring controls (i.e., policies and procedures) over its sick call process, and it does not conduct periodic evaluations of its internal controls to ensure that its contracted healthcare provider follows up on all sick call requests in a timely manner.

Recommendations

1. ECSD should establish effective monitoring controls (i.e., policies and procedures) over its sick call process.
2. ECSD should conduct periodic evaluations of its internal controls to ensure that its contracted healthcare provider follows up on all sick call requests in a timely manner.

Auditee’s Response

The Department and its contracted healthcare provider respectfully refute this finding for the reasons set forth in greater detail below [including personally identifiable information related to the inmates who correspond to the 6 sick call requests in question, which is not included in this report]. Auditors were given access to and training on how to interpret all information requested for their 60 patient sample. [Specific information regarding each patient’s sick call request] was provided to the audit team when an explanation was requested on the six (6) patients the audit team determined did not receive a sick call follow-up within 24 hours. . . .

Lastly, while it is our belief that we are in compliance in this area, to the extent that you disagree, we would again ask that you consider the unique nature of the audit period and circumstances on the ground as referenced in response number one (1) above, which is again incorporated herein.

Auditor’s Reply

We acknowledge the unique nature of the circumstances that occurred during our audit period. The global pandemic placed significant and unprecedented strains on our healthcare and correctional systems, which required personnel to change systems and processes with extremely limited time and resources. 

We asked ECSD about 16 of the HRFs from our sample of 60 HRFs. ECSD provided us with supporting documentation for 10 out of the 16 sick call requests for face‑to‑face meetings, which we originally questioned, given the language in Section 6.6 of Wellpath’s “Nonemergency Health Care Requests and Services Policy” (HCD-100_E-07) for ECSD, which we quote in the “Authoritative Guidance” section of this finding. When we asked a Wellpath official to provide supporting documentation regarding these 16 sick call requests, they emailed us on September 28, 2023 with an attached Microsoft Excel spreadsheet. According to that email, Wellpath included in this spreadsheet “only those [sick call requests] with documentation proving a face to face appointment happened within the 24 hour timeframe, 10 total.”

Our audit team provided multiple opportunities for ECSD to submit supporting documentation confirming that each face-to-face meeting between an inmate and the contracted healthcare provider occurred within 24 hours upon receipt of a HRF. We respect ECSD’s perspective on this matter and included ECSD’s response (excluding any personally identifiable information related to the inmates who submitted the 6 sick call requests in question) in the final report. We acknowledge the unprecedented, difficult environment during the audit period. Still, we believe our finding to be substantiated and encourage ECSD to conduct periodic evaluations of its internal controls to ensure that its contracted healthcare provider follows up on all sick call requests in a timely manner.

Date published:	April 18, 2024