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Michigan Auditor Finds Prisoner Health Care Delivery Inadequate

By David M. Reutter

The Michigan Department of Corrections’ (MDOC) efforts to comply with the requirement to deliver medical services are not effective. That is the conclusion drawn in an audit report issued in March 2008 by Michigan’s Office of the Auditor General. That conclusion comes as no surprise to those familiar with the MDOC. PLN previously reported on the continuing deficiencies in MDOC prisoner care, which has resulted in several prisoner deaths. See: PLN, May 2007, p. 1.

The Auditor’s report began by noting that MDOC spent $213.7 million for prisoner health care services in 2005-06, which equates to an annual cost of $4,223 for each of MDOC’s average of 50,595 prisoners. To provide those services, MDOC has a medical care contract with Correctional Medical Services (CMS) and a pharmaceutical company for delivery of prescription medicines, who receives a “fixed per prisoner per month rate plus the cost of pharmaceuticals.

It was found that efforts to provide prisoner with dental care were effective. The delivery of care to chronically ill prisoners, however, was found to be severely deficient. Chronic condition medical evaluations, routine annual health care screenings, and clinic visits resulting from prisoner requests for health care services were not always conducted. Moreover, the evaluation, screenings, and clinic visits that did occur were regularly performed later than procedures require.

In its review, the Auditor reviewed the medical files of 120 prisoners who were identified as having chronic conditions. A full 51% of those prisoners were either not seen for their chronic care visits or they were not seen as often as their condition required to assure their condition was being properly managed.

Of the 373 required visits for those 120 prisoners, it was found that 44 (12%) of the visits were missed and another 42 (11%) were late. For those prisoners, the average number of days between the missed chronic care visits and the next chronic care visit was 237. When the chronic care visit was running late, the average delay was 105 days.

Under MDOC policy, every prisoner enrolled in chronic care treatment must be seen every six months if their condition is well controlled or good. Where a prisoner's condition is fair, a visit is required every three months, and every month if their condition is poor. When the visit was missed or late, there was “no documentation in the prisoners’ medical records that medical staff addressed the prisoner’s chronic conditions” during other visits.

The failure to properly care for chronically ill prisoners has two bad effects. First, it jeopardizes MDOC’s ability to identify, manage, and treat potentially serious medical condition before they become more severe. Second, this failure not only has a negative fiscal impact because the more severe the condition the more it costs to treat, but the condition can become a treat to the prison population and staff by allowing it to be transmitted to them.

That failure was replicated in MDOC’s shortcoming as to annual health care screenings, which are often the only time medical staff may have contact with a prisoner. The average of 103 days late for these screenings could allow tuberculosis and hepatitis B infections to go undetected and spread.

Even when prisoners initiated requests for health care, the odds are pretty good they will either not be seen or they will endure a long delay before being seen. Of the 130 prisoner requests the Auditor review, 4 prisoners were never seen by a health care professional. They had been waiting as average 128 days since submitting their request. Another 55 prisoners were seen 12 days beyond the time frames required by policy, which require appointments between 2 and 7 days.

A bright spot for prisoners, if one can be found, is that MDOC did not consistently charge prisoner medical copayments of $5.00. As a result, MDOC saw a 29.5% decrease in its copayment collection, costing it $55,000. The auditor concluded this failure by MDOC to comply with statutory requirements resulted in prisoner health care services to increase by 20% when the prisoner population only increased 2%.

While the Auditor found MDOC’s electronic prisoner medical system moderately effective, it has some serious defects. The system did not contain complete and accurate data, which hampered collection, analysis, and reporting of data. It could not even be relied upon to determine if a prisoner was on chronic care. 5 of the 120 prisoners reviewed were not chronic care patients as the electronic system labeled them. Another 39 of those 120 prisoners were only listed as being in one chronic care clinic, but their paper medical filed showed they were enrolled in more than one clinic.

It was also found that MDOC failed to properly manage prisoner medications. There was not proper control of restricted medications, the disposal of unused or expired medications was not effectively monitored, and brand name medications were being used where generic equivalents that could have saved MDOC $641,000 were available.

MDOC agreed with the audit’s findings, saying it will fix the problems. It, however, said the audit misrepresents the state of health care in its prisons. Additionally, any problems that exist, MDOC said, is partially to blame on vaccines in its nursing and health care professionals.

Prisoner advocates say the report focused to much on bookkeeping. “It doesn’t address the quality of care provided,” said Sandra Gward, executive director of Prison Legal Services in Michigan. “People with chronic illness just do not receive good care.”

A development unrelated to the audit further will strain the availability of at least one CMS doctor. That physician, Dr. Audberto Cesar Antonini, may himself soon find he needs the care of prison doctors, as that is likely where he is headed. Antonini was arraigned on March 10, 2008, after he was arrested at a sting-house operation at Wayne County house that he was expecting to meet a 13-year-old boy that he expected to have sexual encounter with after numerous internet chats. Antonini now faces 20 years in prison.

The full text of the “performance Audit of prisoner Medical and Dental Services” is available on PLN’s website. Additional Sources: Capital News Service; The Detroit News.

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