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 http://www.ola.state.md.us. • 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 ...
Thisreportandanyrelatlelodwf-oupcorrespondenceareaabvleailtothepublicthroughtheOfficeofLegislativeAuditsat3s0t1PrWeestonStreet,Room1202,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 reportsatsitewebourrfmoeddlnaodwoordweievbenca http://www.ola.state.md.us.AlternateformatsmayberequestedhtthhroeuMgarylandRelayServiceat1-800-735-2258. TheDepartmentofLegislativeServicesofOtfhfieceExecutiveDirector,90StateCircle,Annapolis,Maryland21401canalsoasusiisntboonigatniesocopirrefounastropdy related correspondence. The Department may be contacted by telephone at 410-946-5400 or 301-970-5400.
February 21, 2007 DelegatehCarlesE.aBrkley,Co-hCair,JointAuditCommitteeSenatoraNthanielJ.McFadden,oC-ChairJ,ointAuditComitmteeMembers of JoinAtuditCommittee Annapolis,MyalrandLadies and Gentlemen: WeconducetdaperfomranceaudiotfcertainaspectsoftheDepartmentofPublicSafeytandCorrectionalServeisc’(DPSCS)currentinmhaetaelthcaresystem,whichbeganifniscalyea2r006.Thecurrentsystecmonsistsosfixdifferentocntractscoveringsucehaasrasmedcial,pharamceutical,dental,ndmentalhealthservices.Duringthaytear,contractorcoststotaled$m1il1li0on.Theauditojebctivesincluded(1)theerwevoifhealtharcecontractors’afsftinglevels,(2)PDSCScontractmonitogrpinrocedurestoensurheetdeliveroyfappropriaetmedical sevirces, and (3) coordiannotomangthecontractosrin renderingmedicalserviceshetointmatepopulation.Tshaiuditwasrequestedby the hcairmen oftheJoint AuditoCmmittee. Forourfirsotbjective,wefoceudsonthemedail,cdenatl,andmenthalealthcontractorasndfoundhtat,althoughDPSCSdidmonitoarfsfitngleveltsh,erequiredlevelswenroete,amplrexForo.sattccnorheeivordedaybtlleibpng DPSCSidentifiedshaortageofapproixmately11percefnotrMay2600eht( equivaletnof66full-tiempostiionsforthemedailcservicescontractor).Furtheromre,DPSCSdidnotverifyatchceuracyotfheunderlyincgontracotrtimekeepnigrecords.Ourtestsfotuhneddenatlandmentahlealthtiemrecordstobegenealrlyreliable,utbthemedailccontracotr’stimerecdosrwereontalwaysadequatyelsupported.Alsmo,edicalcotnractoremoplyeesoftenworkedscheduleshtatdevaitedfromhtoseapprovedbyDPSCS.DPSCShaalsdonotformalylassessedagreed-uponcroanctoronserwchhidsebaegniffatwslevel contractors’estimatdeartoftpedaspsolevehprocurement procesost determinewhethertehestsaffinglevelwseresufficiefnotrprovidinginmatehealthcare. Foroursecondobjectivef,owcuesedonthemedcialcontract,whcieeemewddthemostcriticalsinceietlartestothepirmaryproviderofcaretoiens.maWte foundincosnistentmotnoiringbyDSPCS.Specifcially,DPSCShadotnrequiredthecontarctortodevelopfoarmalcorrectiveaciotnplantoaddressknownhealthcareservicedeficiencies,whhiinccludedinmateostrneceivinginitialmedicalexams(onbionogkorincarcerati.onIn)addition,weidentifiepdroblemspreviousylunknowntoPDSCSbecauseiotfsfaiulretoveriftyheaccuracoyf
contractorecrordsanderportsusedbyDPSCSformonitopngpours.seForir example,basedonaialavblerecord,sinmatesdeorecvietuniaotniresaylw check-upfsorchronichealtohncditionsandtimelyexaamtiionnsforillnessesrequestedudringsickcalls.Controracrteportsofinmatewsithinfectoiusdiseases,whichwereuesdbyDPSCStomornitwreeofnudybOLAtort,entmea beunderstated.Alasor,equiredimnatemehtadonedetoxificatipornogramhadnotbeenipmlementeda,lthoughworkappaeredtobeprogerssinginthatarea.Withrepsecttoobjectivethreoeu,rauidtdisclosedthahtetdevelopmenotftheElectronicPatientHehaRltecords(EPHR)computersystemwhichisintendedtoprovideaocmprehensivedatabaosfeeachinmate’smediaclhistoryandtoaidinthecoordiantionofsercveideliverywasstillonoging.Althoughpartyiall operational, the EPHRysetaruccanidnaentieatpcnotmepletncomeditain healthrecordsandcoudlnotyetebusedtoeffectivelymothcahealrenrtimnieta contractorasndservic.esWealsofoundissueshattindiactetheneefdorbettercoordinationbetweencontractorcsl,uindingmissingmedicalrecords.OnJanuary16,2007,theStaetreachedaseltttnemrgaemeentdewihtheUnit StatesDepartmentJuosfticetoresolvneumerousprevioyuisdlentifiedhealthandsafeytviolationsattheBaltimoerCityDetteinonCenter.Manyofthosehealthviolationsaresiilmartohtefindingsinthirseport.DPSCSalsorecentlyeenrtedintoagreementsrequiringtmheedicalsevircescontractoarndthemeanlthealhtservicescontractortopqayuildiatedadmagesof $1.75 milthrpeelyvefo,pseritce0,03,00,muJyl1irdoford$1nanio2005 throughJanuary17,2007.hTesenegotiatedagreementspsecifyhtatDPSCSwillholdtheseocntractorsharmlessformanyfurtherclaimsforliquidataemdadgesorcostsrelatingtocaocntorr billinsgfor period. Aas htis DPSCS does not result, haveanyfurtherfinancialrecourseagainstthesecontrafcotrordseficienciesoccurringduringthpaetriod,includingthoseitdifeiendbyouraudit.WewsihtoacknowledgethecooperaetixtoenndedtousybDPSCSstafdfuringthisaudit,especiyatllheOfficeofInmateHealthServices. Repsectfulyl submitted, BruceA.Myers,CPA LegislativAeuditor