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2010 audit of the Maryland inmate healthcare system finds numerous inadequacies in delivery of healthcare and monitoring of for-profit contractors’ performance.

April 6, 2010: In 2007, the Maryland Office of Legislative Audits (OLA) issued a scathing report on the state of inmate healthcare in Maryland prisons and in the Baltimore City Detention Center. The OLA report found significant deficiencies in the private medical contractors’ performance as well as problems with the State’s monitoring of those healthcare contracts. At the time, the OLA advised the Maryland General Assembly that further investigation should be conducted to make sure that the State remedies the many problems OLA found. Despite this recommendation, the Legislature was not interested in further auditing.

Thanks to continued advocacy by the PJC, emails from friends of PJC to the Legislature to urge another audit, and the help of a family whose son died in the Baltimore City Detention Center last March, the Legislature made the necessary request and the follow-up audit was released in March 2010.

Coverage of this story:

Audit probes prison care in Md.

Posted: 7:24 pm Mon, April 5, 2010
By Brendan Kearney

Daily Record Legal Affairs Writer

More than two years after a critical audit of health care for state prison inmates, and six months after the state reached an agreement in longstanding federal litigation over the issue, a follow-up audit published Monday reports progress but also confirms that troubles with continuity of care and monitoring contractors persist.

The Office of Legislative Audits found that, of the seven quality-of-care problem areas it reviewed, only one had been fully corrected and the Department of Public Safety and Correctional Services had made just “minimal progress” on three.

While DPSCS’ Office of Inmate Health Services did establish a methadone detoxification program, and conducts more timely death reviews, advocates said the report confirms that Maryland prison health care, the subject of complaints and scrutiny for decades, has a way to go.

Wendy Hess, an attorney at the Public Justice Center who has litigated the issue on behalf of inmates, said yesterday she is “disappointed but not surprised by the findings.”

“It’s consistent with what we’ve been seeing,” she said. Hess also applauded what improvements have been made, such as the methadone program but said the tough work lies ahead. (The Department of Justice will also monitor the prisons through next year.)

“As far as our settlement going, it’s wonderful that the department has agreed to settle,” Hess said of the resolution reached last August in Duvall, et al. v. O’Malley, et al. that she expects to be officially filed within days. “The crucial point now is the department has to implement those changes.”

A spokesman for the agency disputed auditors’ “minimal progress” finding regarding treatment of inmates with chronic conditions like HIV and diabetes but conceded that problems remain.

“We feel that we have made great improvements, and need to make more,” Mark A. Vernarelli said in a statement.

Sen. Verna L. Jones and Del. Steven J. DeBoy Sr., co-chairs of the legislature’s Joint Audit Committee, which requested the follow-up, could not be reached for comment Monday.

Continuity of care, especially for inmates with chronic conditions, is one of the major problems, said Hess, who receives complaints from prisoners or their families about neglect of serious illnesses which she then passes on to prison authorities. OIHS’ own audit a year ago found more than a quarter — 27 percent — of its 82 HIV-positive inmates were not visited quarterly as required.

“It might sound kind of harmless, but this is a really sick population we’re talking about,” Hess said.

Hess also said the number of people dying in prison and the slowness with which their deaths are independently reviewed is a “concern” because such reviews might reveal bad staff of policies.

“Specifically,” the auditors wrote, “of the 214 inmate deaths that occurred during the period from January 1, 2007 through November 30, 2009, 124 of these deaths had not been reviewed by an independent physician as of January 5, 2010, according to OIHS records, including 98 deaths that had occurred from 181 days to 734 days prior to our review.”

The audit seemed broadly concerned with how well the agency was keeping track of the approximately $150 million spent on prisoner health care in fiscal year 2009. For instance, a member of OIHS management told auditors that the office has been unable to verify whether contractors’ corrective action plans for identified service deficiencies were ever implemented.

“We still don’t have the assurances that we’re getting what we’re paying for,” Hess said, noting that a request for proposals to be the state prisons’ main medical contractor — a $67 million gig in fiscal year 2009 — is pending.


Prison Health Care Under The Microscope In Md

Tuesday, April 06, 2010
Scott Wykoff and Associated Press

A state audit says there have been some improvements in inmate health care at Maryland prisons, but more needs to be done to help inmates with long-term conditions.

The Office of Legislative Audits released a report Monday on the state prison health care system. It says the Department of Public Safety and Correctional Services progressed in areas such as making sure inmates were examined within seven days of an arrest, and with creating a program for methadone addicts.

However, auditors found "minimal progress" in treating inmates with chronic conditions such as HIV and diabetes, and demanding contractors improve in areas where they have shortfalls.

The state promised to make improvements after reaching a settlement last year with groups that sued over prison health conditions.


State health care system for inmates makes some progress, audit says
Corrections agency working toward timely exams, independent reviews, according to report

By Erica Green | egreen@baltsun.com

Baltimore Sun reporter
9:56 PM EDT, April 5, 2010

Maryland's long-troubled prison health care system is making strides toward efficiency, but workers need to more closely monitor the treatment received by those behind bars, according to a review released Monday.

Assessing the findings of a report issued three years ago, state auditors found that inmate health care operations managed by the state Department of Public Safety and Correctional Services made gains in areas such as ensuring that inmates receive examinations within seven days of an arrest. Other areas of progress: the launch of a methadone program for addicts and detailed reviews of inmate deaths.

But auditors found only "minimal progress" in making sure inmates with chronic conditions get appropriate treatment, and in demanding that contractors make improvements in areas where they have fallen short.

Inmate health care, provided by five companies paid a combined $150 million annually, has been a long-standing problem in Maryland. In 1993, the state entered an agreement to fix medical conditions in prisons, after Department of Justice investigators found that the Baltimore jails had not improved since a 1971 lawsuit. 

The state promised improvements after reaching a settlement last year with the American Civil Liberties Union and the Public Justice Center, both of which sued over prison health conditions.

Those advocates said Monday that the prison system needs to take a hard look at the gains and shortcomings of the past three years.

They said they were particularly concerned that prison officials did not appear to keep or review more than five dozen self-assessments that medical contractors were supposed to complete in 2009. And only 124 of the 214 inmate deaths that took place between January 2007 and November 2009 had been investigated by an independent physician.

The areas that need more improvement are "kind of big, systemic things, people just kind of falling through the cracks," said Wendy Hess, an attorney with the Baltimore-based Public Justice Center.

Monday's report "shows that there are serious gaps in the state's oversight of contractors who provide essential medical services," said David Fathi, director of the America Civil Liberties Union's National Prison Project. "A death in a corrections facility is a wealth of information … any system that's interested in improving, would review deaths."

In its response to the audit, corrections officials said they were committed to making improvements.

"Inmate health care in Maryland is a huge undertaking and a job we take very seriously," wrote Mark Vernarelli, spokesman for the state corrections department, in an e-mail.

The follow-up review focused on seven areas identified by auditors as "most directly involving quality of care issues," said Bruce A. Myers, head of the Office of Legislative Audits.

Asked whether the correctional health system was making significant progress, Myers said such an assessment was "in the eye of the beholder."

"Of course I would like to see them all corrected," he said. "They showed some progress ... but they haven't fully resolved all of them."

Copyright © 2010, The Baltimore Sun

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