Prison report calls for better patient health management

 

DOVER — The Delaware Department of Correction needs to improve its patient management, among other priorities, based on a recently completed independent assessment of the prisons’ “sick call” process.

Correction officials said Wednesday, the study — performed by National Conference on Correctional Health Care, Resources Inc. — noted the following findings:

•The grievance process is not clearly defined for health care matters.

•Correctional officer security staff shortage is causing mandatory overtime weekly, and that overtime contributes to fatigue and decreased morale.

•Medical escorts by correctional officer security staff within the facility and off compound contribute to the need for overtime, and this creates tension between health staff and custody staff. That tension is realized within the inmate population.

•Non-emergent patients with medical needs may not be seen in a timely manner because independent policies have resulted in a system that allocates services disproportionately to patients who file frequent complaints.

•Nursing staff is tasked with addressing complaints that are not related to health care.

•Long patient waiting room times sometimes result in multiple trips before an inmate can be seen.

•Seeing pretrial detainees is a challenge due to court schedules.

Despite inefficiencies, the assessment found that officers are properly responding to inmates’ requests for medical attention, medical appointments are properly being made and treatment is being administered, claimed DOC leadership.

The DOC has been working with The Moss Group and NRI since January to perform independent reviews and assessments of health care services for inmates and to evaluate the agency’s grievance process.

DOC Commissioner Perry Phelps noted that the decision to perform the evaluations was based on a recommendation by Gov. John Carney’s Independent Review of the inmate uprising at Vaughn prison on Feb. 1 last year that left Lt. Steven Floyd dead.

Perry Phelps

“We took this recommendation seriously and hired the gold standard in correctional health care to come in and interview officers, medical staff and inmates to assess how we are doing and how we can improve,” said Commissioner Phelps. “We appreciate the validation that our sick call process is operating properly and are committed to implementing changes to expand inmates’ access to health care.”

NRI’s study cost $25,000.

In March, DOC said, three correctional health care consultants visited Delaware and reviewed sick call patient files and other relevant documents, policies and records. They also interviewed inmates, medical staff, correctional officers and DOC leadership.

The chief health officer with NRI, Dr. Brent Gibson said several factors are contributing to the inefficiencies with the DOC’s system.

“While proper sick call procedures are being followed, state and national nursing staff shortages and DOC’s electronic medical records system are contributing to inefficiencies in health care delivery,” he said in a statement.

Recommendations

To improve the effectiveness of health care delivery to inmate patients, NRI suggested restructuring or replacing the DOC’s electronic medical records system, known as iCHRT. The review said:

•Connectivity is a chronic issue.

•The system is slow and frequently loses data.

•Staff enter data on Microsoft Word documents, then “copy and paste” it into iCHRT.

•Documentation often is done after hours due to the fact that data entry is time intensive.

•Late entries in iCHRT are a common occurrence.

•Scheduling of visits: If a patient is not seen one day, the appointment does not automatically roll over and health care staff must manually reschedule the visit.

• Medication renewals are inefficient and cumbersome.

• A lab interface does not exist.

The DOC’s chief of the Bureau of Healthcare Services, Dr. Marc Richman, said the agency is currently conducting its own review of iCHRT and exploring options to enhance or replace it.

Marc Richman

“The connectivity issue is being addressed by the addition of dozens of additional Wi-Fi access points that have been installed at JTVCC over the past several months,” he said. “The DOC has made considerable improvements in these areas, and we remain committed to eliminating all barriers to efficiency in providing health care.”

The report also included numerous other general recommendations such as:

•Implement policy language that prohibits complaints unrelated to health problems that should not be part of the sick call process.

•Revise sick call policies to improve the efficiency of cases that can be handled by a nurse without mandatory escalation to a physician.

•Conduct a process study to address the high volume of patients brought into the clinic waiting room and the lengthy waits to be seen for sick call or by a provider.

•Implement an innovative approach to scheduling visits to reduce the strain during peak hours: For example, rotate staff during evenings or weekends to aid in patient movement and stay current with sick call. This flexing of schedules also can reduce overtime.

•Create a process to ensure that patients on work assignments can be seen during non-work hours. This should be coordinated between health care staff and security.

•Reduce interference with sick call workflow through coordination among health care staff, security and attorneys who visit their clients.

•Conduct a workflow analysis and review prioritization of visits to ensure there is access to care in a reasonable amount of time for a wide array of patients.

•Pay closer attention to programs that provide materials on self-care.

•Regularly use patient information materials (on wellness and disease states) to help increase overall health literacy.

•Increase the use of patient education forms and postings on bulletin boards to increase overall health literacy and reinforce health care policies.

Commissioner Phelps said Wednesday that the agency plans to implement changes in the coming months.

“To better inform inmates of the sick call procedures, JTVCC Warden Dana Metzger issued a new inmate handbook last month, which is provided to all newly incarcerated individuals and available to all inmates,” he said. “We have formed an internal group of medical team leaders, called the Health Care Efficiencies Process Work Group, to review and implement other sick call-related changes at all Level 5 facilities.”

A member of the new work group, Dr. Richman said he and his peers plan to provide a report on the progress they make on the NRI recommendations in July — but he expects “longer-term solutions to take more time.”

Subject of criticism

The DOC’s prison health care has been a frequent recipient of criticism for the past several years. A report released last October by The Pew Charitable Trust said Delaware may lack the cost and quality information required to build a “high-performing” prison healthcare system.

It noted 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.

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

At the time, the DOC felt the report mischaracterized its quality assurance practices, noting that the agency has a quality assurance administrator that reviews monthly reports. Also, they noted that they make quarterly reports to the General Assembly and leadership participates in monthly meetings with Connections Community Support Programs, Inc. — their medical care contractor — to review quality assurance data internally.

Inmate advocates in the state have often voiced poor impressions of the agency’s medical care program as well.

Dover attorney Stephen Hampton, of the law firm Grady & Hampton, LLC, said last June that he’d been contacted by more than 230 inmates through letters or family members since the incident last Feb. 1 to voice complaints of inadequate health care. While conceding late last year that some of the “poor prison conditions have eased up,” he still described the medical care as “abysmal.”

Lori Alberts, the chairman of Link of Love, told this paper last year that 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 health care contractor,” said Ms. Alberts. “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.”

DOC has refuted those claims. DOC spokeswoman Jayme Gravell has said that health care service can often be delayed when a specialist is needed and inmates can be limited by participating physicians’ schedules.

“There are not a large number of specialists who’ve agreed to see inmates,” she said last year. “When we find a provider 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.”

As of Monday, the DOC reported having 23 health care “providers”, 78 registered nurses, 53 licensed practical nurses, 12 dental staff-members and 120 health care workers that fell into an “other” category servicing their current statewide population of 5,265 inmates.

Dr. Richman said that the DOC’s medical program has most positions staffed at an 83 to 84 percent level.

“The report noted that our greatest shortage in nursing,” he said. “As we know though, there is a big national shortage of nurses.”

As far as doctors participating in the program, Dr. Richman said those numbers are higher than they’ve been in the past.

“It’s always a challenge because it’s a very competitive work force, but I believe our provider numbers at this time are probably as high as they’ve been in a long time,” he said.

Reach staff writer Ian Gronau at igronau@newszap.com

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