A report submitted to Mississippi’s legislature found serious deficiencies in the delivery of medical care to prisoners in the Mississippi Dept. of Corrections (MDOC). The December 11, 2007 report was issued by the Joint Legislative Committee on Performance Evaluation and Expenditure Review (PEER). It found that MDOC and its for-profit healthcare contractor, Wexford Health Services, failed to assure that prisoners received timely access to quality medical care.
PEER stated this shortcoming may not only have an adverse effect on prisoner health, but may cost MDOC more in specialty medical expenses. Increased specialty care costs was an issue of concern due to MDOC’s use of a new model for providing prison medical services.
Prior to July 1998, MDOC used the traditional services model, which entailed employing physicians and other medical service providers. From July 1998 to June 30, 2003, MDOC contracted with the University of Mississippi Medical Center to provide prisoner healthcare. On July 1, 2003, Correctional Medical Services took over MDOC’s healthcare contract, but the company decided in July 2005 that it did not want to be reconsidered for renewal once the contract expired on July 30, 2006.
Wexford won the new contract. Rather than accept Wexford’s $41.7 million bid for turnkey services to provide all prisoner medical care, MDOC chose a new model by accepting an annual contract for $31 million, in which MDOC would be responsible for specialty care. The three-year contract, which expires on June 30, 2009, has a total value of $94,312,523. Under the contract Wexford provides prisoners with routine medical and dental care in three broad areas: intake, sick call, and preventive dental services.
Upon intake, Wexford is required to inform prisoners about medical care access procedures, complete an initial health assessment within 30 days, provide an initial dental screening within seven days, give each prisoner a dental exam within 30 days, and complete a psychiatric/mental health screening within five calendar days. Wexford was 85% or more compliant in these areas, reaching 100% in some cases.
When it came to the day-to-day delivery of routine medical care required under the contract, however, Wexford’s services were found wanting. Medical services for prisoners begin with sick call. Under the contract, prisoners are to be provided with sick call access seven days a week, with triage by a nurse within twenty-four hours of the prisoner’s submission of a sick call request. In both areas Wexford failed miserably.
PEER found the company’s average compliance rate was 33%; at Mississippi State Penitentiary, the rate was only 29%. Even those low numbers may be inflated, as the method used to record when triage occurred was inconsistent and failed to prove that “triage is an analytical process that actually occurs and that it occurs within the required time frame.”
This problem resulted, the report found, because the contract failed to delineate a procedure that allows for auditing sick call triage. The result was twofold: There was no way to ensure contract compliance, and prisoners “needing a physician’s care might be delayed in receiving that care.”
The only way a prisoner is able to receive a physician’s care is if the triage nurse deems it necessary. When found necessary, a prisoner is supposed to see a physician within seven days under the MDOC contract. Despite a contractually-required 85-90% compliance rate, Wexford fulfilled its obligation to provide timely physician care in only 53% of the cases reviewed in the PEER report.
PEER stated, “by not assuring that those inmates who are determined through triage to need a physician’s care receive such care within seven days, Wexford’s delays may be allowing some inmates’ medical conditions to decline and create the need for specialty care.”
Providing a dental prophylaxis (i.e., a cleaning intended to help prevent dental disease) for each prisoner is required every two years under the contract. PEER found that Wexford had complied with this provision in only 41% of the cases it reviewed. The failure to provide preventive dental care “could result in the need to see a specialist such as an oral surgeon and ultimately cost the state more money for specialty care,” the report noted.
One area in which Wexford failed to meet compliance requirements, that had an especially high propensity to result in costly specialty care, was the Chronic Care Clinic. Prisoners with asthma, diabetes, hypertension, HIV, seizures and tuberculosis require a physician visit every six months. Yet that occurred only 59% of the time. Wexford’s failure to provide timely care could have caused the chronic care prisoners’ conditions to worsen quickly.
The report noted there was no system-wide method to keep chronic care, mental health care or specialty care logs, or to record the disposition of treatment. The report cited several instances of prisoners’ healthcare requests being lost in the system, or care being discontinued due to an inter-prison transfer.
The PEER report concluded that the reason “neither MDOC or Wexford could ensure appropriate and timely access to quality medical care for state inmates” was because “Wexford’s staffing levels did not comply with contract requirements.” Wexford was providing less than half the nurses it was required to employ. It provided only a third of the mental health staff obligated under the contract. As for dental positions, it employed just over half the required professionals. Of course less staff means less payroll expenses – and thus more profit for the company.
In at least five instances, Wexford employees were not hired with licenses, certifications or registration required by state law. This included three radiology technicians, one pharmacy technician and one dental assistant.
Since the Wexford contract went into effect, MDOC’s chief medical officer has “recommended [imposing] $1,152,810 in liquidated damages for noncompliance with contract standards. Of this total, $931,310 was related to staffing shortages.” Yet state prison officials have assessed no damages against the company.
Considering that MDOC was $2.8 million over budget for prison medical costs in fiscal year 2007, this makes little sense. Then again, MDOC’s new model for healthcare services has no fiscal rationale; the department spent $42.8 million on medical care in FY 2007. In contrast, Wexford’s original turnkey contract proposal was for $41.7 million. Of course, the lesser cost would have been at the expense of appropriate staffing levels for medical positions, and timely and adequate healthcare for prisoners.
The PEER report, Medical Care for State Inmates: The Department of Corrections’ Contract Management and its Provision of Specialty Medical Care, is available on PLN’s website.
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