Overview
The Essex County Sheriff’s Department (ECSD) did not provide physical examinations to all of its inmates who were committed to the facility for 30 or more days within 14 days after their admission. In our testing, we selected a random, statistical sample of 60 inmates out of 8,701 inmates committed to ECSD’s facilities for more than 30 days and found that 6 inmates did not receive physical examinations within the required timeframe. These 6 inmates received physical examinations between 15 to 20 days after their admission to one of ECSD’s facilities.
We projected the test results from our sample of 60 inmates to the total population of 8,701 inmates who were admitted during the audit period. Based on this, we are 95% confident that ECSD did not provide physical examinations in a timely manner to at least 329 inmates who were admitted to ECSD’s facilities during the audit period.
If ECSD does not provide its inmates with timely physical examinations, then those inmates with healthcare issues may not have their issues identified and treated in a timely manner or at all. This could lead to a higher-than-acceptable risk of those inmates’ conditions worsening, which could affect the health and safety of all of ECSD’s inmates.
Authoritative Guidance
Number 1 of Section 11 of ECSD’s “Policy 103 ECSD 220.00 Medical Services” states,
Each inmate committed to the facility for thirty (30) days or more shall receive a thorough physical examination 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 registered nurse.
Reasons for Noncompliance
ECSD has not established sufficient monitoring controls (i.e., policies and procedures) over its physical examination process to ensure that its contracted healthcare provider provides physical examinations to all of ECSD’s inmates in a timely manner.
Recommendation
ECSD should establish monitoring controls (i.e., policies and procedures) over its physical examination process to ensure that its contracted healthcare provider provides physical examinations to all of ECSD’s inmates in a timely manner.
Auditee’s Response
The Department and its contracted healthcare provider are dedicated to ensuring the delivery of quality healthcare to persons in the custody of the Department. The audit period of July 1, 2019–June 30, 2021, was an unprecedented time in the field of healthcare and corrections. The global COVID pandemic resulted in modifications of day-to-day operations in Essex County, just as it did for all correctional facilities across the country. Given the risks inherent in a congregate setting, the Department and Wellpath took a myriad of steps to protect its incarcerated population and contain the spread of the virus. This included the creation of a “New Man” unit at the Middleton facility to house new-Pre-Trial and/or Sentenced inmates for a 14-day period to monitor for signs of COVID, and a myriad of additional measures to limit movement throughout the facility to contain the virus. During this time period, the Department was responsible for the health and safety of approximately 800 employees, vendors and volunteers, as well as one of the largest inmate populations at a county level in the Commonwealth. Staff, both correctional and medical, reported to work in-person on a daily basis and were on the front lines of containing and suppressing the virus within the facility. Significantly, in the face of the pandemic and the resulting staffing and service delivery crisis, all inmates had access to medical care as needed on a daily basis. That said, we acknowledge that some physical examinations may have been performed outside the 14-day window in light of the factors and conditions referenced above. However and of significance, based on the data and access to electronic medical records provided to the audit team, it is important to note that all required medical assessments were completed between 15-20 days after admission despite the conditions referenced above.
It is the belief of both the Department and WellPath that emerging from the pandemic, a comprehensive set of monitoring controls exist over its physical examination process to ensure that all examinations are, and will continue to be, conducted in a timely manner in the future. This includes internal policies, procedures, training, resources, and consistent staffing levels with respect to the administering of medical care, including examinations. As you know, during the audit both the Department and Wellpath provided you with relevant policies and procedures, as well as the provider’s obligations as set forth in the medical contract. Moreover, the Department has a specifically identified contract monitor in place to ensure Wellpath complies with its contractual obligations, including with respect to conducting examinations in a timely manner. This was being monitored throughout the audit period however, as a result of the conditions set forth above, the Department concedes that some examinations were conducted during the 15-20 day period. In addition and as evidenced by the data and information provided to you during the audit, the Department has regular and ongoing communications with Wellpath staff in the form of quarterly Continuous Quarterly Improvement (“CQI”) meetings and Medical Audit Committee (“MAC”) meetings. In fact, MAC meetings now take place on a monthly basis. Moreover, the Department’s contract monitor meets weekly with the Wellpath [health services administrator] to discuss issues as they arise.
Independently, in viewing the provision of medical care and treatment at the Department in a larger context, we would note the following. The Department has been and is currently accredited by the American Correctional Association (“ACA”) and the Department of Correction (“DOC”). In November, 2021 an ACA audit team visited the Middleton facility to address approximately 400 standards, including with respect to medical and staffing. The facility received its highest ever score of a 98.6% compliance rate for non-mandatory standards and 100% compliance for mandatory standards. The DOC audit of the Middleton facility in November, 2021 included an assessment of standards pertaining to medical, which were found to be in full compliance. In addition, WellPath has received accreditation from the National Commission on Correctional Health Care (“NCCHC”).
Accordingly, and in light of the foregoing, we respectfully request that the unique nature of this audit period be taken into consideration and noted in the final audit report. That said and while medical staff are familiar with and aware of the importance of providing physical examinations in a timely manner, we will again remind and emphasize the subject with staff at all levels to ensure future compliance. Moreover, the Department is committed to continuing to monitor the services provided by WellPath to ensure that its contractual obligations are met.
Auditor’s Reply
We acknowledge that this was an unprecedented time in the fields of healthcare and corrections due to the COVID-19 pandemic.
As noted above, under Section 11 of ECSD’s “Policy 103 ECSD 220.00 Medical Services,” ECSD is required to provide all inmates with a physical examination no later than 14 days after admission. Although ECSD requires its contracted healthcare provider to provide physical examinations to its inmates, sufficient monitoring controls (i.e., policies and procedures) over its physical examination process must be in place to ensure that its contracted healthcare provider provides physical examinations to all of ECSD’s inmates in a timely manner.
We acknowledge ECSD’s commitment to emphasize this matter with staff members at all levels to ensure future compliance and believe doing this will support implementation of this recommendation.
| Date published: | April 18, 2024 |
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