DOC disputes Pew report on prison healthcare

DOVER — A recently released prison healthcare report noted that Delaware may lack cost and quality information required to build a “high-performing” prison healthcare system.

The report says that Delaware spends the eighth highest amount of money per inmate — $8,408 as of FY 2105 — for medical services in the country. This is well below the top spender, California, which spent $19,796 per inmate in the same time period. Louisiana spent the least at $2,173 per head.

The 135-page report, using data collected from two 50-state surveys administered by The Pew Charitable Trusts and the Vera Institute of Justice, along with interviews with more than 75 state officials, updates previous Pew research on spending trends in prison healthcare.

The crux of the report, however, rested on how states defined and monitored what sort of return on investment they were seeing rather than how much money they were spending.

The report reads:

“Well-run, forward-thinking prison health care systems are vital to state aims of providing care to incarcerated individuals, protecting communities, strengthening public health and spending money wisely. Likewise, poorly performing systems threaten to make states less safe, less healthy and less fiscally prudent. Put simply: The stakes extend far beyond the confines of prison gates.”

According to the report, Delaware is one of 12 states lacking a prison healthcare quality monitoring system.

The criteria this judgement was based on was whether a state’s efforts were “data-driven; overseen by state agencies; broad and consistent; and ongoing” The report noted that Delaware’s quality monitoring activities did not meet these four criteria.

Although the Delaware Department of Correction (DOC) has a “continuous quality improvement policy” and collects mortality data, it doesn’t routinely share that or other “healthcare quality” data with the Legislature or public, claimed the report.

Twenty states (the majority) deliver healthcare services to inmates through a contracted third party. According to the DOC, their current medical provider is Connections Community Support Programs, Inc. (CCSP). They’ve held a four-year contract with the prison system since June 2014.

The Pew report said that as of 2016, Delaware’s DOC was one of only five states that don’t include “quality metrics” in their contract requirements and one of 10 that don’t include financial penalties.

“Delaware may lack both some of the cost and quality information we think is required to build and maintain a high-performing prison healthcare system,” said Maria Schiff, director of Pew’s States’ Health Care Spending Project. “It is certainly advisable to know how much money is being spent on what services and why, what benefits are achieved for those dollars and whether these benefits are preserved post-prison through well-coordinated prison-to-community transitions. While the Delaware DOC does have certain quality oversight pieces in place, other features we identified as necessary are missing.”

Ms. Schiff said the report’s criteria for a sound prison healthcare monitoring system were:

• The system is overseen by one or more state agencies.

• The system is distinct from systems overseen by contracted vendors, though it may interact with them (e.g., incorporate or audit data on particular measures that are collected by a contracted vendor).

• The system is applied to more than half of state prison facilities.

• More than half of the measures used across facilities are identical.

The DOC feels the report mischaracterizes its quality assurance practices.

“A lot of the survey questions were a simple yes or no,” said DOC spokeswoman Jayme Gravell. “If our answer was no, because it didn’t fit exactly with what was asked, it doesn’t mean that we didn’t have quality control measures in place.”

Ms. Gravell pointed out several “controls” that she said ensures the DOC delivers quality healthcare services to inmates.

“We do actually provide a quarterly report to the General Assembly that goes over all the services delivered and their costs,” she said. “Every medical and mental health service provided to inmates is also included in a monthly report which is reviewed by our quality assurance administrator. Additionally, the DOC and CCSP meet for monthly continuous quality improvement meetings to review data internally.”

Ms. Gravell also pointed to the Adult Correctional Healthcare Review Committee (ACHRC), which consists of appointed healthcare professionals tasked with identifying, analyzing and correcting any problems that may impede quality.

“They provide us with a nuetral, educated opinion on what we’re doing well, what needs improvement and steps to take to move forward,” she said.
The committee meets six times per year.

“Also, the DOC is accredited by the American Correctional Association (ACA) and National Commission on Correctional Health Care (NCCHC),” added Ms. Gravell. “As part of the accreditation process, there is a comprehensive review of medical and behavioral health services to include interviewing of provider staff, correctional staff, bureau staff, inmates and in-depth chart review. Our continuous quality improvement committee meets regularly and addresses service provision, corrective action plans and the like.”

The treatment provided to each inmate is individualized so there is no scale or grading system to measure quality, Ms. Gravell said. In addition to the controls in place, each facility holds monthly Medical Advisory Committee (MAC) meetings to review healthcare contracts to include medical, behavioral health, and dental. The MAC members consist of Connections staff and DOC staff from the Bureau of Correctional Healthcare Services and Bureau of Prisons.

Advocates’ opinions

The speed and quality of DOC-provided healthcare has come under frequent fire by prisoner advocates.

Dover attorney Stephen Hampton, of the law firm Grady & Hampton, LLC, said back in June that he’d been contacted by more than 230 inmates through letters or family members since the Feb. 1 inmate uprising at James T. Vaughn Correctional Center that left Lt. Steven Floyd dead. He said complaints of inadequate healthcare increased in the wake of the incident. Many inmates were requesting a class action lawsuit be filed on their behalf.

As of last Tuesday, Mr. Hampton said that some of the poor prison conditions have “eased up.” But he still described the medical care as “abysmal.”

He says he’ll be considering representing inmates’ legal claims stemming from “mistreatment” and poor medical care in the wake of the Feb. 1 incident.

“I am moving forward on civil claims for a large number of inmates, but this involves thousands of pages of documentation and I have not filed anything yet,” he said.

Lori Alberts, the chairman of Link of Love, said the DOC is more interested in cutting costs than providing the most basic medical care. Link of Love is a support group for inmates’ families.

“Since as long as I can remember, the only thing that changes is the name of the healthcare contractor,” said Ms. Alberts. “One of my concerns is for the elderly, if a treatment is too costly, they seem to just postpone it until the inmate dies. They have even cut chronic care back to only life and death situations. Physical therapists come in once or twice a month and by the time you get scheduled, whatever was broken has healed wrong and there is nothing that can be done.”

Because Health Insurance Portability and Accountability Act (HIPAA) protects inmates’ medical information, verifying vague claims of poor healthcare is difficult.

Ms. Gravell said that family members and loved ones of inmates may contact the DOC with questions about medical treatment, plans and diagnoses. As long as the inmate provides written consent, the DOC will share relevant healthcare information with the requester.

Admitting that healthcare can often be delayed when a specialist is needed, she notes that inmates are often limited by participating physicians’ schedules.

“There are not a large number of specialists who’ve agreed to see inmates,” she said. “When we find a provide that does, there can sometimes be long waiting periods. Obviously, if the conditions are dire and an inmate needs to go to the emergency room, we take that route, but if not, we have to wait until an appointment with a specialist becomes available.”

According to Ms. Gravell, the following is the number of inmates who died of natural causes in the past four years: 2014 – 7; 2015 – 14; 2016 – 13; 2017 – 1.

The full Pew report can be seen at

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