Inmate Healthcare Performance Audit Report - February 21, 2007

Inmate Healthcare Performance Audit Report - February 21, 2007


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Performance Audit Report Inmate Healthcare Reported Contractor Staffing Levels Could Not Be Verified Contract Monitoring Procedures Were Inadequate Contractor Patient Health Data Were Not Reliable February 2007 OFFICE OF LEGISLATIVE AUDITS DEPARTMENT OF LEGISLATIVE SERVICES MARYLAND GENERAL ASSEMBLY • This report and any related follow-up correspondence are available to the public through the Office of Legislative Audits at 301 West Preston Street, Room 1202, Baltimore, Maryland 21201. The Office may be contacted by telephone at 410-946-5900, 301-970-5900, or 1-877-486-9964. • Electronic copies of our audit reports can be viewed or downloaded from our website at • Alternate formats may be requested through the Maryland Relay Service at 1-800-735-2258. • The Department of Legislative Services – Office of the Executive Director, 90 State Circle, Annapolis, Maryland 21401 can also assist you in obtaining copies of our reports and related correspondence. The Department may be contacted by telephone at 410-946-5400 or 301-970-5400. February 21, 2007 Delegate Charles E. Barkley, Co-Chair, Joint Audit Committee Senator Nathaniel J. McFadden, Co-Chair, Joint Audit Committee Members of Joint Audit Committee Annapolis, Maryland Ladies and Gentlemen: We conducted a performance audit of certain aspects of ...



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   Performance Audit Report           Inmate Healthcare   Reported Contractor StafLfienvge ls Could Not Be Verified  Contract oMnitoring Procedures Were Inadequate  Contractor Patient alHteh Data Were Not Rbellei a
February 2007    
This report and any relatlelod wf-oup correspondence are aabvlea ilto the public through the Office of Legislative Audits at 3s0t 1P rWeeston Street, Room 1202, Baltimore, Maryland 21201. The Office may be contacted by telephone at 410-946-5900, 301-970-5900, or 1-877-486-9964. Electronic copies of our audit reports  at site web ourrfmoed dlnaod woord weievben ca Alternate formats may be requested ht thhroe uMgaryland Relay Service at 1-800-735-2258. The Department of Legislative Services  –o f Otfhfiec eExecutive Director, 90 State Circle, Annapolis, Maryland 21401 can also asus iisnt booni gatnies ocopir ref ouna strop dy related correspondence. The Department may be contacted by telephone at 410-946-5400 or 301-970-5400.
February 21, 2007  Delegate hCarles E. aBrkley, Co-hCair, Joint AuditC ommittee Senator aNthaniel J. McFadden, oC-ChairJ, oint Audit Comitmtee Members of JoinAtuditCommittee Annapolis, Myalrand  Ladies and Gentlemen:  We conducetd a perfomrance aud iotf certain aspects of the Department of Public Safey tand Correctional Serveisc (DPSCS) current inmhaetael thcare system,w hich began i fniscal yea2r 006.  The current syst ecmonsists osfi x different ocntracts covering suceh aasr as medcial, pharamceutical, dental, nd mentalh ealth services.D  uring thayt ear, contractor costs totaled $m1il1li0o n.  The audit ojebctives included (1) thee rwe voif healtharce contractorsa fsfting levels, (2) PDSCS contract monitog rpinrocedures to ensurhee  tdeliveroyf  appropriaetmedical sevirces, and (3) coordiannotoma ng the contractosri  n rendering medical servicesh et oi ntmatep opulation.   Ts haiudit was requested by the hcairmen oftheJoint AuditoCmmittee.  For our firsot bjective, we foceud son the medail,c denatl, and menthale alth contractoras nd foundh tat, although DPSCS did monitoar fsfitng leveltsh, e required levels wenroet e, amplr ex  Foro.sattcc norheeivor deda ybt lleib png DPSCS identifieds ha ortage ofa pproixmately 11 percefnotr May 2  600eht( equivalet nof 66 full-tiem postiionsf or the medailc services contractor).  Furtheromre, DPSCS did not verifya tchceu racy otfh e underlyincgo ntracotr timekeepnig records.  Our tests fo tuhned denatl and mentahle alth tiem records to be genealrly reliable,u tb the medailc contracotrs time recdosr were ont alway sadequatye lsupported.  Alsmo,e dical cotnractor emoplyee soften worked schedulesh tat devaited from htose approved by DPSCS.  DPSCS haalsd on ot formalyl assessed agreed-upon croanct oro nser wchhid sebae  gniffatw—slevel contractors estima tdeart oftped as psoleveh procurement procesos—t determine whether teh estsaffing lev elwsere sufficiefnot r providing inmate healthcare .  For our second objectivef, owcue se don the medcial contract, whci eeemewd d the mos tcritical since ietl artes to the pirmary provider of care to iens.m aWte found incosnistent motnoiring by DSPCS. S pecifcially, DPSCS hado tn required the contarctor to developf oar mal corrective aciotn plan to address known healthcare service deficiencies, wh hiinccluded inmateost  rneceiving initial medical exams (on bionogk or incarcerati.o  nIn) addition,w e identifiepdr oblems previousy lunknown toP DSCS because iotfs  faiulre to veri ftyhe accuracoyf 
contractore crords ande rportsu sed by DPSCS for monito pngpours.seFo   rir example, based ona ialavble record, sinmates d eorecvi etuni aot nires aylw check-upfso r chronic healtohn cditions and timely exaamtiionns for illnesses requested udring sick calls.  Controra crteport sof inmatews ith infectoius diseases,w hich were uesd by DPSCS to mor nitw re eofnu dybO LA to rt,entmea be understated.   Alas or,e quired imnate mehtadone detoxificatiporno gram had not been ipmlementeda,l thoughw ork appaered to bep rogerssing in that area.    With repsect to objective threoeu,r  auidt disclosed thahte t developmenot f the Electronic Patient Heh aRltecords (EPHR )computer system—which is intended to provide a ocmprehensive databaosf ee ac hinmates mediacl historya nd to aid in the coordiantion of sercvei delivery—w asstill onoging.  Although partyi all operational, the EPHRysetaruccani dna e ntieat pc notmepletncomed itain health records and coudl not yet eb used to effectively mothcahealre nrtimni  eta contractoras nd servic.e s Wea lsof ound issuesh att indiactet he neefdo r better coordinatio nbetween contractorcsl, uinding missing medical records.    On January 16, 2007, the Staet reached a seltttnemrga emeentde  wih the Unit States DepartmentJ uosf tice to resolvneu merous previoyu isdlentified health and safeyt violations  atthe Baltimoer City Detteinon Cente r.M anyo f those health violations are siilmar to hte findings in thirse port.    DPSCS alsor ecently eenrted intoa greements requiring tmheed ical sevirces contractoar nd the meanlt healht services contractor to pqayu ildiated admages of $1.75 milthr pee lyvefo, pseritce0,03 ,00, muJyl1irdof ord $1n anio 2005 throughJ anuary 17, 2007.  hTese negotiated agreements psecify htat DPSCS will hold theseo cntractorsh armless form anyf urther claims for liquidataemd adges or costs relating to caocntorr billinsgfor period. Aas htis DPSCS does not result, havea nyf urther financial recourse against these contrafcotro rdse ficiencies occurring during thpaetri od, including those itdifeiend byo ur audit.    We wsih to acknowledge the cooperaetixtoenn ded to us yb DPSCS stafdf uring this audit, especiy atllhe Officeo f Inmate Health Services.      Repsectfulyl submitted,          Bruce A. Myers, CPA  LegislativAeuditor