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Audit Reveals Problems with Maryland’s New Prisoner Health Care System

Audit Reveals Problems with Maryland's New Prisoner Health Care System

by Michael Rigby

Maryland's new prisoner health care program remained understaffed in 2006, and the state Department of Public Safety and Correctional Services (DPSCS) has yet to implement promised drug treatment programs or an electronic database meant to better track prisoner records, an audit of the state's new system has revealed.

In the report, released on April 30, 2007, auditors from the Office of Legislative Audits noted "several significant areas of noncompliance" affecting prisoner medical care.

"We found a number of areas in which inadequate monitoring (by the state) appeared to lead to potential lapses in required medical coverage and certain required medical treatments," auditors wrote.

The audit was state's first independent investigation of the new system, which the DPSCS implemented in 2005 [see PLN, February 2006, pg. 14].

Under the previous system, for-profit prison medical providers were offered fixed-priced contracts for their services. With rising medical costs, however, these contractors balked at signing new contracts, claiming they weren't as profitable as they once were.

Prisoner activists also disliked the fixed-price system because it gave medical contractors an incentive to skimp on prisoner health care services in order to boost their bottom lines.

Under the new system--which consists of six different contracts covering such areas as medical, pharmaceutical, dental, and mental health services--providers "pass through" the cost of their goods and services to the state for reimbursement. This amounted to $110 million in fiscal year 2006.

Despite the huge outlay, auditors found that plans for an electronic health records computer system and a methadone detoxification program remained in the early stages. (The DPSCS is responsible not only for the state's prisons, but also its jails, including Baltimore's notorious city jail and its infamous Central Booking and Intake Center. See PLN indexes or visit for more on Maryland prisons and jails.)

Auditors also discovered problems with chronic care checkups, medical screenings, the dispensing of medication, and timely treatment. The audit does provide a clue as to why: Providers of medical, dental, and mental health care continue to provide insufficient staffing levels.

Although not identified individually in the report, St. Louis-based Correctional Medical Services (CMS), the state's main provider of medical care, was paid $49.2 million for its services in fiscal year 2006. MHM Services of Tysons Corner, Virginia, the state?s mental health care provider, was paid $9.3 million.

Both companies earned less than they could have under their contracts' CMS $13 million less, MHM $1.8 million less?because they failed to provide the appropriate level of staffing and services specified in their contracts. According to the audit, the DPSCS reported an 11% shortage in the staffing provided by its medical contractor (CMS), which equates to 66 full time positions.

(See PLN indexes or visit our website for much, much more on the misdeeds of privately operated prison health care providers.)

In a separate audit of the State Secretary General's Office, auditors with the Office of Legislative Audits noted that the deficiencies uncovered during their fieldwork led two of the contractors to negotiate settlements. Under the agreement, CMS paid $1.75 million in liquidated damages, and MHM $130,000, for the period July 1, 2005, through January 17, 2007.

Still, Richard B. Rosenblatt, assistant secretary for treatment services in the DPSCS, said the new contracts have resulted in higher staffing levels than the previous system.

"It's clearly been improved, if only with the number of feet on the floor," Rosenblatt said. "There's staffing levels now that were never dreamed of under the prior contract. Now, the fact that we?re not at 100 percent [staffing], sure that's disappointing to us."

Prisoner rights activists contend that what the audit reveals is that the system should be scrutinized more regularly by outside agencies because it is so important and costly.

"We certainly don't fault the state for spending too much money on its health care contracts, we just think there should be better oversight to make sure that it's well-spent," said Sally Dvorak-Fisher, an attorney with the Public Justice Center in Baltimore.

Electronic copies of these reports and others can be obtained online at

Sources: The Baltimore Sun; Performance Audit Report: Inmate Health Care, February 2007; Audit Report: Department of Public Safety and Correctional Services Office of the Secretary and Other Units, February 2007

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