Joshua W. Martin III, the Independent Monitor who is overseeing an agreement between the U.S. Department of Justice (DOJ) and the Delaware Department of Corrections (DDOC), has issued his first semi-annual report. The agreement with the DOJ followed a public outcry that ensued after The News Herald published a series of damning articles that detailed the abysmal medical care provided to DDOC prisoners. [See: PLN, Dec. 2005, pg. 1; July 2007, pg. 8].
The Monitor retained a team of medical and mental health experts to assist in inspections and making recommendations to help the DDOC come into compliance with adequate medical care practices. The monitoring team made an initial visit to the Delores J. Baylor Women?s Correctional Institution (Baylor), Delaware Correctional Center (DCC), Howard R. Young Correctional Institution (Young), and Sussex Correctional Institution (SCI) during the week of May 21, 2007.
The Monitor?s first report focused on determining the challenges faced by the DDOC to achieve ?substantial compliance? with the agreement. One year of such compliance will terminate its agreement with the DOJ. Future reports will focus on providing technical assistance to the DDOC and addressing specific areas of concern such as sick call, chronic diseases, reception processing, interfacility processing, medication management, mental health services and other areas covered by the agreement.
The Monitor noted that the DDOC had already made some needed changes. For example, when prisoners return from off-site doctor visits, including visits for specialty consultations, emergency room trips and hospitalizations, they are taken to medical rather than returned to their cells, which allows a nurse to begin facilitating continuity of care.
In regard to a requirement that the DDOC develop and implement a unitary record-keeping system that allows all clinically appropriate documents related to a prisoner?s medical and mental health care to be available to the clinician, the Monitor found the DDOC had established an action plan. Such a plan also exists to ensure timely responses for medication and laboratory tests.
It was clear, however, that the DDOC?s for-profit medical vendor, Correctional Medical Services (CMS), had no plan to provide adequate staff and training. In fact, the information the Monitor received ?tends to indicate that CMS? regional or national management has not been willing to take such measures as offering relatively small increases in pay in order to attract and retain individuals that would be qualified to fill the vacant positions, nor has CMS? regional or national management been particularly supportive of facility-level CMS management regarding staffing concerns.?
During the monitoring teams? initial visits, ?it became clear that a major area of concern is the absence of experienced leadership.? CMS has only a part-time contract monitor who is transitioning from another prison system. The State Director of Nursing position was, and remains, vacant. Additionally, the facility-level Director of Nursing at the Young facility is soon to become vacant. That situation, coupled with the fact that Young?s new Health Care Administrator has no correctional setting experience, caused the Monitor to question whether medical care at the facility can be brought into compliance under the DOJ agreement.
The Young facility is of significant concern, as its 1,750 prisoners include both pretrial detainees and sentenced prisoners. Young processes about 60% of all intakes to the DDOC, which causes an additional burden to the prison and medical staff. Since the facility houses a greater number of prisoners than its design capacity, Young already has problems with clinic space and medical equipment. The Warden at Young also noted that the ?turnover of CMS leadership positions has been almost constant over the last few years.?
Problems with medical screening were found at the Baylor facility, which receives about 70 prisoners per week, and intake examinations occur every day, all day. The screening of detainees who are newly or previously tuberculosis (TB) skin test positive, or who have TB symptoms, was a matter of concern. CMS has no timelines for obtaining chest X-rays, which should occur within 72 hours of identification of a positive TB test to identify whether the disease is active. CMS policy only requires the health administrator to be notified if the X-ray is not obtained within two weeks.
Additionally, Licensed Practical Nurses (LPN) were doing the medical screening process. The Monitor noted that a registered nurse or clinician should fulfill that function because ?LPNs typically do not have appropriate education and training to perform exploration of medical symptoms.?
Another problem area was clinical space and equipment. ?While the overall sanitation of the facilities was good,? the Monitor stated, ?the spaces that are used for the provision of medical and mental health services were the least sanitary spaces within the facilities.?
Several problems related to clinic space were found at Young. Those problems not only affected privacy issues for prisoners but also the sanitation of the areas. While the clinical areas were cramped, two rooms in Young?s East Wing that could be used for examinations either had no medical equipment and supplies or were filled with boxes of medical files or medical equipment that was not being used. The infirmary at DCC was found to have very poor sanitation.
The Monitor?s report touched upon each area of concern between the DOJ and the DDOC. For the most part, the DDOC had an action plan in place. More visits will be made by the monitoring team to assess compliance, and another report is due to be issued in January 2008. The Independent Monitor?s report is available on PLN?s website.
Source: First Semi-Annual Report of the Independent Monitor of the Memorandum of Agreement Between the U.S. Dept. of Justice and the State of Delaware, June 29, 2007.
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