Contract # 7891
Contractor: Prison Health Services, Inc.
Agency:
Department of Corrections

Change # 1

This contract is amended only as follows:
The following is added at the end of section II. (W), Pharmaceuticals:
"The State will cause a financial plan and design performance audit to be
conducted relative to pharmaceuticals. Said audit will be conducted on or about June
30,2005. If in the determination of the State, savings can be achieved relative to
pharmaceuticals, the State will take the pharmaceutical portion of this contract to bid
and reserves the right commencing January 1,2006 to obtain pharmaceutical products
and services from a different provider. In the event that the State opts to obtain
pharmaceuticals from a different provider, all other terms of this contract shall remain in
effect."

We the undersigned agree to be bound by this amendment.
Contractor

EXHIBIT A

REV DATE 8/10/95
Contract #
c::r
Change #

7'3 f

'--- STATE OF VERMONT
STANDARD CONTRACT FOR PERSONAL SERVICES

L Parties This is a contract for personal services between the State of Vermont, Department of Corrections (hereafter
called "State"), and Prison Health Services, Inc. , with principal place of business in Brentwood, Tennessee; (hereafter
called "Contractor'). Contractor's form of business organization a corporation.. Contractor is required by law to have a.
Business Account Number from the Vermont Department of Taxes. Acc01mt Number is F-26619.

is

2. Subject Matter The subject matter of this contract is personal services generally on the subject of health care to
inmates. Detailed services to be provided by the Contractor are described in Attachment A.
3. Maximwn Amount In consideration of the services tobe performed by Contractor, the State agrees to pay Contractor·
in accordance with the payment provisions specified in Attachment B a sUm not to exceed $29,534,793.00.
4. ·Contract Term The period of Contractor's perfonn,ance shall begin on 211/05 and end on 1/31/08.

- 5. Prior Approvals If approval by the Attorney General's Office or the Secretary ofAdministratioIi is required, (under
current law, bulletins, and interpretations); neither this contract nor any amendment to it is binding until it has been
approved by either or both such persons.
.
.
J~c::.../ Yes 101 Approval by the Attorney General's Office required.
r ~I I~ I Approval by the Secretary ofAdminiStration required.

n

6. Amendment. No changes, modifications, or amendments in the teqns and conditions of this contract shall be effective
unless reduCed to writing, numbered and signed by the duly authorized representative of the State and Contractor.

. .7..CanceUation
. . . . . This
. contract may be cancelled by either party by giving written notice at least 90 days in advance.
.

.

.

8. Attachments This contract consists of 112 pages including the following attachments which are incorporated herein:·
Attachment A - Specifications of Work to be Performed
.
Attaclunent B - Payment Provisions
Attachment C - "CustoIllary State Provisions", Revised 12/01/03
Attachment D -·Modifications of Maximum Insurance Requirements
Attachment E - Business Associate Agreement (Revised 12101103)
Attachment F - Final Adopted Rule for Access to Infonnation .
Attachment G - PHS Irilplementation Plan
Attachment H - Staffing Matrix
Attachment I - Stipulation and Agreement-Vermont State Employees Association, dated 07/31/1996
. Attaclunerit J - Settlement Agreement - Goldsmith, et aI. v. Dean, etal., dated 0411111996
Attachment K - Staffing Coverage Standards
Atttachrnent L -Independence, Liability, Hold Hannless Clause
WE THE UNDERSIGNED PARTIES AGREE TO BE BOUND BY THIS CONTRACT.
by the ST TE OF VERMONT
by the CO
CTOR
Date:
Date:
~~

Signilture'~~rc~f~~~~~

Name: Steven M. GoICl,
Agency: AHS/Correctio

Name: Prison Health Services, Inc.
Address: 105 WestparkDrive, Suite 200
Brentwood, 1N 37027
Fed. TID/SS#: 23-2108853
Title:

APPROVED AS TO FORM:
\ttomey

~Date:

G~cr:al'
d..L
0/0'1·lJJa-.l
I

/.2

- 1~

'-' Table of Contents
Attachment A - Specifications of Work to be Performed

I.

Introduction

II.

Health Care Services

.
,

.

A.

Intake Screening
,
Inmate Orientation - Access to Health Care Services
C. Health Assessment
,
D. Informed Consent
E. . Inmate Workers
F. Sick Call
;
~
G. Health Improvement and Disease Prevention
:
:
H. .First Aid·Kits
I.
Emergency Services
,
:
:
J. Hospitalization and Payments to Health Care Providers
Infirmary Services;:
K.
L.
Services for Incapacitated Persons
M. Special Needs - Chromc and Convalescent..
~
N. Communication on Special Needs
'0. Special Needs. Treatment Plans
Suicide and Self-Injury Prevention Program.
P.
:
Q. Hospice Care
:
R. Diagnosis, Consultation and Treatment.
'
.
Obstetric
and
·GynecologyServices
S.
Specialty Outpatient Services
;
T.
U.
Ancillary Services
,
:
:
V. OpticalServices
W. Pharmaceuticals.:
:
X. Medication Administration
,
Y. Dental Services
Materials, Supplies and Equipment
Z.
M. Inventory Control..
AB. Contaminated Waste.. :
AC. Hepatitis Treatment.
:

B.

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. III.

A.

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D.
E.

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6
7
8
9
9

10
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12

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:

:

Pe.rsonnel Services

B.
C.

5

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Overview
Forensic Activities.
Program Manager..
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Regional Manager I Director
,
Medical Director.. .. .. .. .. ... .. .. .. ... . .

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25
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26
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27

13
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. 17

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24
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25

III.

Personnel Services (cant'd)

'F.
G.
H.
I.
J.
K.

IV.

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:
'" .

;

L.

M.
N.
O.
P.
Q.

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33

Correction Staff Education...................................................... 33
StaffVaccinations
;
33
Coordination with the Department of Health
, ,.. 34

Administrative Services

A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
K.

28
28
29
29
29
30

...

Ancillary Services

A.
B.
C.

V.

Job Descriptions
Recruitment Practices
Licensure/Certification.....
State Oversight.....
...
Performance Review
Staff Training and Retention

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Policies and Procedures
;.........
.
Contract Implementation and Initiation Orientation........
Consultation
,
"
Medical Records
Treatment Protocols
,
,
Continuous Quality Improvement Program................
Interface with DOC's Mental Health Services Provider.. ..
. .. . .
Disaster Management................
Management Information System
:
Purchasing Procedures
Insurance......................
Accreditation Plan.........................
Other Operational and Financial Data Reporting.........................
Claims Processing
Inmate Transfers Between DOC and Out-of-State Facilities........
Mortality.Reviews
,..........
.
Performance Guarantees.....

Attachment B - Payment Provisions..........................

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35
35
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36
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38
43
44
44
45
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46
48
48
49
49
53

Attachment C :... dCustomary state Provisions" (Revised 01Dec03)............

56

Attachment D - Modifications of Maximum Insurance Requirements........

60

. Attachment E - Business Associate Agreement, (Revised 01Dec03)...... ........

61

-3.

\-'Il,ttachment F - Final Adopted Rule for Access to Information
Attachment G - PHS Implementation Plan
Attachment H - Staffing Matrices

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66

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"

Attachment I - Stipulation and Agreement...........

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72
74
84

Attachment J - Settlement Agreement

86

Attachment K - Staffing Coverage Standards..............................

105

Attachment L -Independence, Liability, Hold Harmless Clause..................

106

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ATTACHMENT A
CONTRACT FOR SERVICES

SPECIFICATIONS OF WORK TO BE PERFORMED

I.

Introduction

It is the purpose of this contract to facilitate and enable the delivery of.health care services to the Vermont
Department of Corrections' (hereinafter DOq inmates in Vermont. The Contractor shall:

•

meet the health care nee.ds of inInates in accordance with applicable state and federal laws;

•. deliver all medical services in compliance with current standards set forth by the National Commission on
Correctional Health Care (hereinafter NCCHq. At such time as these standards.are updated, it is
understood that the Contractor shall make necessary adjustments and.modifications to ensure that
Vermont correctional facilities remain in compliance and retain NCCHC accreditation;
• . provide the serVices as set out in this contract in compliance with the applicable terms of the Settlement
Agreement in Goldsmith, et al versus Dean, et al,. dated April 11, 1996 (Attachment J);

•

provide a network sufficient in size, location, and scope to meet all clinical requirements outlined in
Chapter Two - Health Care Services.· The clinical members of this network !):lust also be credentialed
consistent with NCCHC standards;

•

participate in applicable state sponsored quality improvement projects as directed by the DOC (e.g.,
Vermont Program for Quality in Health Care, Diabetes Collaborative);

•

incorporate local community providers in its system of care; and

• . coordinate activities with the Vermont DOC Health Services DireCtor or designee. In the event of a dispute
between the Contractor and the State on a clinically-related matter, the DOC Health Services Director will
have final decision making authority.

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'-.,..-11.

Health Care Services

A. INTAKE SCREENING

Contractor shall conduct a receiving screening on all new commitments (including transfers) inimediately
upon the inmate's arrival at the DOC facility and before the inmate enters the general population of the
facility. This screening shall be conducted by a qualified medical professional and shalT iriclude, at a
minimum:
1) Inquiry into, and documentation of, current and past illnesses, health conditions, and special (including
dietary) requirements:
.
• any past history of serious infectious or disease including HTV/ AIDS and HepatitisC;
• recent symptoms of communicable disease (e.g., chronic cough, hemoptysis, lethargy, weakness,
weight loss, loss of appetite, fever, night sweats) suggestive ofsuch illness;
• . past or current mental illness, including hospitalizations;
• past history of trauma and/ or sexual assault!abuse;
• eligibility for Community Rehabilitation and Treatment (CRT) programs;
• history of, or current suicidal ideation;
• dental problems;
• allergies;
• medications taken (in.cludinglast dose) and special health (including dietary) requirements;
• for females: date of last menstrual period, date of last pap smear, date of last mammogram, current
and past pregnancy, and other gynecological problems;
.
• routine medical treatment;
• health insurance. coverage;
• use of alcohol and other drugs (including last use), and any history of associated withdrawal
symptoms, detoxification needs and stabilization services for a substance abuse disorder; and
• other health problems designated by the responsible physician.
2) Observation of the following:
• appearance (e.g., sweating, tremors, anxious, disheveled);
• behavior, (e.g., disorderly, appropriate, insensible);
• mental status (e.g., state of consciousness, suicidal ideation, alert, responsive, lethargic), using forms
developed by the State;
.
.
• ease of movement;
• breathing (e.g., persistent cough, hyperventilation); and
• skin (e.g., trauma markings;bruises, lesions, jaundice, rashes, scars, tattoos, infestations, and needle
marks or other indications of drug abuse).
.
3) Administration of a screening test for tuberculosis, as soon as practical after admission.
4) Documentation of the findings, date and time the receiving screening is complete.
5) Signature and title~f the person completing the screening.

-

S) Inmate authorization for treatment.

7) Voluntary testing for HTV/ AIDS and Hepatitis C.
-6-

All inmates with questionable health conditions will be medically cleared within twelve (12) hours of intake,
\..,... and before being sent to the general population. Inmates with non-emergent conditions will be referred to the
general population with appropriate follow-up referrals established. Inmates requiring irninediate
intervention will be referred to the.appropriate health care staff for evaiuation and treatment and will be seen
within two (2) hours of intake. Any referral of the inmate for specialhousing will be implemented in four (4)
hours. Any referral for emergency health services will be "stat." Referrals to additional medical specialists
will be as appropriate, and timelines will be imposed with regard to the severity of medical need as
determined by the referring physician. All inmates who are currently taking prescribed medication upon
intake will be medically evaluated and; if medically indicated, those medications will be made available to the
iiunate in accordance with established protocols (see Section W - Pharmaceuticals for DOC protocols).
Contractor staff will be notified of all inmates requiring special housing or having actiVity restrictions.
Dispositions of inmates must be clearly noted on the screening form.
The receiving screening findings will be recorded on a standardized form (to be agreed upon by the parties)
that captures essential baseline health information. The intake form will be included in the inmate's health
care record. The form will be in compliance with all State and national standards.

B. INMATE ORIENTATION - ACCESS TO HEALTH CARE SERVICES

At the time ofinitlal intake, each inmate will be provided with a written health care services orientation and
information on how to access health care services while in the facility. The orientation will include:
• 1) Sick call process and procedures;
"'-" 2) How to access emergency and routine medical, mental and dental health services;
3). Medication administration times and procedures;
4) Information on chronic care clinics;
5) Information on accessing mental health services;
6) Information on accessing dental services;
7) Information on accessing optometry services;
8) Hours of facility health center;
9) Information on health services in segregation; and
10) Issue and grievance procedures.
a.

Incarcerated Inmates with Special Needs

The Contractor shall comply with the Department's ADA policy to ensure proper accommodation for all
inmates with physical and/ or developmental disabilities.
.
Inmates with special needs (e.g. noncEng1ish speakin~ developmentally disabled, illiterate, blind, mentally ill,
or deaf) will receive assistance, as required, to help them communicate with health care personnel and to
understand how to access health services. Contractor personnel will be trained to adequately explain an
inmate's rights to health care services. In addition, signs addressing access to health services will be posted in
the intake area and in all inmate housing areas.

-7-

b.

Incarcerated Females

~ additi?n to the services available to all inmates, the Contractor shall also provide female inmates written
information on how to access (a) gynecological and prenatal care, (b) breast examinationS and mammograms
for age-appropriate or symptomatic inmates, and (c) routine pap tests.

C. HEALTH ASSESSMENT
Inmates housed in a Vermont DOC facility for longer than forty-eight (48) hours. will receive a complete health
assessment within five· (5) days of the inmate's arrival to the facility. If possible, the Contractor shall attempt
to communicate and coordinate with community providers who treated the inmate prior to incarceration. The
health assessment will be completed by a licensed nurse practitioner, physician's assistant or physician.
The initial health assessment will include:
1) A review of the receiving or transfer screening results.
2) The collection of additional health data to complete the medical, dental, mental health and immunization
.histories.!
.
3) A recording of vital signs (i.e., height, weight, pulse, blood pressure and temperature).
4) A complete physical examination as indicated by the inmate's gender, age and risk factors including
preast, rectal, testicular exams, HIV screening and an assessment for tral.\ffiatic brain injury.
5) Pelvic, pap and breast examinations for women,
. \ - 6) Laboratory and/ or diagnostic tests U:> detect communicable diseases including venereal diseases and
tuberculosis. The Medical Director may approve additional diagnostic procedures and testing such as a
m:inalysis, when clinically indicated.
7) Immunization history and the provision of immunizations as clinically indicated.
8) The ini,tiation of therapy and the ordering of other tests and examinations, as clinically appropriate.
9) A written referral fot substance abuse disorder as clinically itldicated.
10) A release signed by the inmate to obtain information from the inmate's community provider (if the
provider is known) will be obtained within five (5) working days.
The form used to document the findings of the health assessment shall be in compliance with all NCCHC
standards. The form will be reviewed and approved by the Coniractor's Medical Director and DOCs Health
Services Director or his/her designee. In addition; a written authorization for health evaluation and treatment
will be obtained from the inmate and witnessed by health care personnel, if a consent has not been obtained
prior to this time. This health assessment form will become part of the inmate's permanent health care. record.
When the results of the health assessment indicate that the inmate requires further evaluation or treatment, the
inmate will be referred to the appropriate physician. The specific time for the follow-up care will be as
follows:
•
•
•

Routine Health Issues - within seven (7) days of the health assessment (or as required by the inmate's
treatment plan);
Urgent Health Issues - within twenty-four (24) hours of the health assessment (or less if required by the
severity of the case); and
Emergent Health Issues - immediate.

------------! The mental health portion of the health assessment shall be developed in collaboration with the DOC Mental
Health Provider and the DOCs Health Services Director and health care professional staff.
•8.

\".. For re-admitte~inmates wh~ have rec~ived a health assessment within the previous ninety (90) calendar days,
the most recent mtake screerung, the pnor health assessment and laboratory results shall be reviewed. The
physician will determine if a complete health assessment is necessary. The extent of the health assessment will
be determined by the Contractor's Medical Director.
. .
Physical examinations shall be conducted annually. Women inmate~ shall be provided: (a) gynecological and
prenatal care, including consultation; (b) breast examinations and mammograms for age-appropriate or
.
symptomatic inmates; and (c) routine pap tests.
When an iru:nate is placedm segregation, the health record will be reviewed within twenty-four (24) hours by
a qualified health care professional to determine whether existing medical, dental or mental health needs
contraindicate placement in segregation or require accommodation. The health record review will be
documented in compliance with NCCHC standards. It is essential that inmates in segregation or close custody
be cleared for placement and actively monitored daily during their period of segregation.
The Superintendent or his/her. designee will be informed of any functional aspect of an inmate's physical or
mental status that may affect security, housing or work asSignments or potential for violent, self-injurious or
suicidal behavior, consistent with NCCHC standards
and DOC. policy. The disposition of inmates not
.
medically suited for confinement will be discussed with the Superintendent or his/her designee. Inmates
segregated from the general population for disciplinary reasons and those who have been moved by the use of
force will be evaluated by the health care staff "stat" but at least within one (1) hour. The evaluation will be
documented in the inmate's health care record.

\D. INFORMED CONSENT
The Contractor shall ensure that a patient's informed consent is obtained prior to all examinations, treatments
and procedures in accordance with applicable State laws and regulations includinginformed consent of next
of kin, guardian or legal custodian when required. Any inmate may refuse health evaluations and treatment.
An inmate's refusal of treatment must be documented by a waiver. signed by the inmate and must be part of
the inmate's medical record.
The Contractor must dod.1ment its policies and procedures for obtaining Wormed consent and an inmate's
right to refuse treatment. The Contractor must ilio submit its consent forms to DOC for approval upon
execution of the Contract.

E. INMATE WORKERS .
Contractor shall examine and provide medical clearance for all inmate workers, including work release
inmates. The medical clearance .process will be initiated within twenty-four (24) hours of receiving the list of
inmates to be cleared.
However, the need for
laboratory testing may increase the time required to provide
.
.
medical clearance.
The inmate worker clearance will be documented on a standardized form and include:

_1) A review of the inmate's health care record.
2) Questions regarding the inmate's past medical history, including communicable disease, cardiac problems,
pulmonary problems, allergies and back problems..
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\"...3) Questions regarding current.signs and symptoms of illness.
4) A physical examination and vital signs.
5) Documentation that the inmate has no conditions that preclude work based on criteria provided by the
Vermont Department of Health.
.
Inmate workers will not be allowed to provide health services or work in the health services area, except for
cleaning purposes. Inmates working in the health services area must be supervised at all times.

F. SICKCALL
All inmates will have a daily opportunity to request health care. Contractor will implement a sick call system
that provides inmates with unimpeded access to health care services. Nursing personnel will collect, triage
and respond to all inmate requests daily: Contractor willutilize the established sick call boxes. For inmates
who do not have access to the sick call boxes, alternative arrangements will be made for filing sick call
requests. The requests will be triaged and the inmates will be scheduled for health care services as medically
indicated. The frequency of sick call will be consistent with NCCHC standards and the facility schedules
shown in Attachment H.
Contractor shall follow nursing protocols, developed and implemented with the approval of the State, to
facilitate the delivery of sick call services by nursing personnel: Health staff will.be trained to effectively triage
the inmate's condition and implement established protocols. Health services will be provided in a manner that
complies with state and federal privacy mandates Within the scope of each facility's physical plant. If the .
\-inmate'scondition requires services beyond the ability of the nurse and/ or the established nursing protocols,
the inmate will be referred to the appropriate health provider for evaluation and treatment Within twenty-four
(24) hours.
.
Contractor shall utilize a three-part sick call request form that allows the inmate's request, triage and
disposition information, and the health care encourlter to be documented allon one form. The form is printed
on no carbon required (NCR) paper to provide additional copies. One copy is kept by the inmate at the time
the request is submitted. The second copy may be used for a variety of purposes. For example, if the inmate's
request does not require a health care encounter, a written response Will be documented on the form and a
copy will be returned to the inmate. The original becomes a part of the inmate's permanent record.
Sick call services, in compliance with NCCHC standards, will be provided at sufficient levels to allow the.
health care staff to provide same-day response to urgent inmate requests for health care services. Nursing sick
call will be conducted daily. Physician sick call will be conducted according to a set schedule agreed upon by
the contractor and the DOC. If the inmate's custody status precludes attendance at sick call; contract staff will
consult with facility security staff to facilitate access to health care services within time frames established for
inmates in the general population.
Timeliness of the response to sick call requests can be an important indicator of quality of care. Failure by
Contractor to respond to sick call requests consistent with DOC requirements will result in penalties (see
Chapter Five, Section Q - Performance Guarantees). Contractor may be charged $50 per each sick call request
outstanding for more than forty-eight (48) hours from Monday to Friday. Contractor shall make a good faith
effort to meet the forty-eight (48) hour standard from Saturday to Sunday, but consistent with the NCCHC
standardsJor sick call response times, Contractor will be held to a maximum of seventy-two (72) hours from
_Saturday to Sunday before a penalty will be taken.
.
The Contractor will monitor sick call responses as part of their continuous quality improvement (CQI) process.
·10·

'-

G. HEALTH IMPROVEMENT AND DISEASE PREVENTION
'

Inmates benefit from individual instruction in self-care and in ways to maintain their optimal health. Health
staff .are expect~d to provide health education during all inmate encounters. Contractor's CQI process will
mOllitor the delivery and documentation of inmate education, .including the topics reviewed, and reference
materials provided. As specific populations are identified, educational programs will be established to
address health .needs in culturally appropriate and gender responsive group settings. .

The Contractor shall coordinate all health improvement and disease prevention activities with the DOC and
the Vermont Department of Health. The health improvement and disease prevention program shall include
smoking cessation, diabetes management including dietary needs, effects of drug and' alcohol use, stress
management, sexually transmitted diseases, HIV!AIDS and Hepatitis. Instructional methods shall include
classes, audiotapes, videotapes, brochUres, or pamphlets. The DOC Health Services Director and the Vermont
Department of Health will review and approve all educational materials. As emerging issues are identified,
new prevention topics and activities shall be added.
Contractor must be willing to coordinate inmate education programs with educators from the community (i.e.,
Public Health Nurses). The Contractor shall act as a consulta.t1t for facility staff in the development of health
education!promotion groups or classes. HIV risk reduction activities shall be coordinated with other State
agents and contractors, as authorized by the DOC and the Vermont Department of Health.
The Contractor shall include a detailed description of its health improvement and disease prevention program
in its CQI program description.
\....,.

H. FIRST AID KITS
Contractor will provide and maintain First Aid Kits fOf Contractor staff and inmates in custody. The First Aid
Kits must be secured with it. plastic tear away lock. EaCh time the'lock is broken, utilizing staff will initiate a
supply request to health care services. Nursing staff will Check and replenish the contents of each kit on a
monthly basis and when requested. The monthly kit Checks will be. documented as required by NCCHC
standards. The location and contents of the first aid kits will be approved by the Contractor's Medical
Director, Program Manager and the correctional facility superintendents.

1.

EMERGENCY SERVICES

Contractor is required to provide an immediate respons.e to inmates in an emergency situation. Contractor will
have twenty-four (24) hour physiCian telephone on-eall coverage arid specific written policies and procedures
to address emergency response and the emergent transfer of inmates. The Contractor also must develop a
coordinated protocol withI the DOC Mental Health Provider to respond to mental health care ·emergencies.
Contractor shall sub-contract or maintain written agreement(s) with one or more local hospitals to provide
emergency services to iru;nates on a twenty-four (24) hour basis and inpatient hospitalization for all inmates in
custody (subject to conditions described in SectionJ below). Additionally, arrangements will be made for
Advanced Cardiac transportation and Basic Life Support transportation with local EMS and ambulance
-services. Contractor shall be responsible for the emergency transport of inmates.

- 11 -

)

\..- Contractor shall ensure that an inmate's medical chart accurately reflects and documents services provided by
outsIde health care providers, as well as any emergency services provided by the Contractor.
The Contractor shall provide and document emergency medical care necessary to stabilize any injured DOC
employee, contract employee, volunteer or visitor who is injured or becomes ill while onsite at a DOC facility.
Any required follow-up care will be the responsibility of the person receiving the emergency care.
a. Emergency Care for Work Release Inmates
,

'

In the event that a work release inmate requires urgentjemergent care, Contractor shall provide care at the
most appropriate facility (community or DOC) based on the inmate's health condition.

For inmates injured while on work release, whose nljuries are covered under workers' compensation
insurance, Contractor shall be responsible for coordinating follow-up care and case management serVices with
the employer's workers' compensation insurer until either the inmate's treating physician has released
him/her to return to work or until the inmate is discharged from the DOC, whichever occurs first. Contractor
mayor may.not provide care for the work~related injury at a DOC facility, depending upon Contractor's
arrangemerits with the State's workers' compensation insurer.
Coritractor retainsrespomlbility for delivering all medically appropriate care, regardless of inmate's access to
third party coverage. Contractor will work with the DOC to develop a specific policy and procedure to ensure
that work release inmates receive appropriate urgent/emergent care, and to ensure·case managemerit and
.follow-up care provision and coordination.
.

',J.

HOSPITALIZATION AND PAYMENTS TO HEALTH CARE PROVIDERS

Contractor shall establish written agreements with local hospitals to provide services when an inmate's
condition requires inpatient hospitalization beyond the scope of the facility tornanage. Contractor Utilization
Review personnel will monitor the condition of inmates in localhospital(s) daily.
Contractor shall identify the need, schedule, and coordinate any inpatient hospitaIization and related services
for State correctional facility inmates. Contractor shall also coordinate with the DOC Mental Health Provider
any hospitalization of inmates requiring mentai health care services.' Inmates may be subsequently
. transferred to a State correctionalfacility infirmary or other appropriate setting when mediCally appropriate
and practicable. Contractor shall ensUre that an inmate's medical chart accurately reflects and documents
.
services provided by outside health care providers.
Under no circumstances shall Contractor limit or delay access to inpatient hospitaIization for inmates
identified as needing this level of care. If the State believes that the Contractor is not transferring inmates
needing inpatient hospitalization in timely fashion, the DOt Health Services Director and Contractor Medical
Director shall review and resolve any dispute. Failure to reach resolution may be grounds for termination of
the contract.

'-'----------

, If a mental health provider admits a patient to a hospital or other health care facility for psychiatric treatment,
s/he must inform the Contractor immediately.

a. Provider,Payments
The C~ntractor.must have in place contracts or written agreements with hospitals for both inpatient and
outpatient selVlces and must negotiate payment rates with these facilities that are adequate to ensure the
frovi~ion ofse:vices to the incarcerated population. The Contractor will be responsible for payment of all
mRatient hospItal claims for inmates. The contractor will be responsible for all costs not covered by Medicaid,
Vermont Health Access Plan (VHAP) or other payors. Some costs may be offset for inmates who are eligible
.
.
for VHAF3 or workers' compensation during a period of hospitalization.
.

.

.Contractor shall make good faith efforts to adjudicate (reimburse, deny or request additional information) all
clean hospital (and other community-based providers) claims within thirty (30) days of the Contractor's receipt
of the claims. Failure to promptly reconcile and pay clean claims may result.in penalties (see Chapter Five,
Section Q - Performance Guarantees) or may be grounds for contract terrriination. All hospital/ community
provider claims thirty (30) days or more in arrears shall be reported to the DOC as a part of the Contract.
or's monthly quality improvement reporting

K. INFIRMARY SERVICES
Contractor shall staff and utilize the infirmary beds available at several of the Vermont DOC facilities for nonacti.te admissions of inmates who may require a higher level of medical attention: Irimatesrequiring
respiratory isolation will be housed in a designated negative air pressure rOom.
\ - The scope of services provided in the infirmary will be organized so that inmates have appropriate
classification, housing and treatment. NCCHC defines an infirmary as "an area within the confinement facility
accommodating two or more inmates for a period of twenty-four (24) hours or more, expressly set up and
operated for the purpose of providing skilled nursing for persons who are not in need of hospitalization}'
.The infirmaries may ~ used for convalescent, medical observation and skilled nursing care. The requirements
of nationaI standards vary depending upon the housing classification, the degree of services provided and the
defined scope of service. The infirmary. beds will be classified and the scope of services will be defined
according to policies andprocedures covering areas including, but not limited to:
1) Twenty-four (24) hours a day direct nursing observation will include daily, or more frequent (if medically
indicated) recording of vital signs and nurses' notes, based on the inmate's condition. Irimateswill always
be able to gilin a health care professionafs attention, either through visual or auditory signals.
2) Admission to, and discharges from the infirmary will be controlled by the Contractor's Medical Director.
3) A physician will be available by telephone twenty-four (24) hours per day, seven (7) days per week, three
hundred and sixty~five (365) days per year.
4) AIl nursing serviteswil1 be under the direction of a Nurse Manager, who will be on-site forty (40) hours
per week. Staffing levels will be appropriate for the number of inmates, the severity of their illnesses and
the level of care required for each, but no less than the staffing reflected in Attachn1ent H.

--, The State of Vermont Agency of Human Services determines eligibility for VHAP in accordance with the
provisions of its State Pian for Medical Assistance. AIl eligibility determinations, including denials, are
binding on the Contractor.
- 13-

'""

5) A separate and complete infirmary medical recordwill be initiated upon admission and incorporated into
the inmate's health care record upon discharge. The record will'include:
•
•
•
•

admitting orders that include the admitting diagnosis, medication, diet, activity restrictions, any
required diagnostic tests, and the frequency of vital sign follow-up;
a complete documentation of the care and treatment given;
the medication administration record; and
a discharge plan and discharge notes.

6) Services will be prOvided according to an established manual of infirmary nursing policies and procedures.
The manual will be consistent with the Vermont's Nurse Practice Act and licensing requirements.

7) The health care staff, in conjunction with Facility Superintendent,will be responsible for ensuring that the
infirmary area is clean and safe for the provision of health care services.,
'

L. SERVICES FOR INCAPACITATED PERSONS

Only after medical clearance by designated community providers has beenobtained, including all required
signatures, shall theContractor provide a medical screening and assistance to incapacitated persons brought to
a correctional facility. The Contractor shall provide an'intake screening and' observation services to these
persons in accordance the policies and procedures agreed to and approved by the State.

'-- M. SPECIAL NEEDS - CHRONIC AND CONVALESCENT
a. General

IIi providing health care services to the State's incarcerated population, Contractor recogniZes that there may
be incarcerated individuals who require chronic and/ or convalescent treatment, including inmates 55 years
and older. It is the State's expec14tion that the Contractor will provide these services in a manner that
incorporates principles of case and disease management for complex cases (see section b00w), and promotes
maximum progress and healing., "Chronic" is defined as health care services rendered to an inmate over a
long period of time for ongoing medical conditions including, but not limited to, diabetes mellitus,
hypertension, asthma and epilepsy. "Convalescent" is defined as medical services rendered to an inmate
patient to assist in recovery from an acute illness or injury.

Health care programs provided by Contractor shall require that inmates requiring chronic or convalescent care
receive timely foI1ow-up, evaluation, treatment and education about the preventive activities avaIlable.
, Irimates with chronic conditions will be evaluated every three (3) months, in chronic-eare clinics, or more
frequently if clinically indicated.
Contractor personnel will collaborate with DOC's Health Services Director to develop individual chronic
treatment plans and disease protocols, which will be individualized to address an inmate's specific needs. The
treatment plans will outline the inmate's course of care and will define and dictate the nursing staff
responsible for day-to-day health care service delivery and inmate education.
Jnder no circumstances shall Contractor limit or delay access to chronic/convalescent treatment for inmates
'-'identified as needing this level of care. If the State believes that the Contractor is not providing
chronic/ convalescent treatment in timely fashion, the State Health Services Director and Contractor Medical
- 14-

.
Director shall review and resolve any dispute. Failure to reach resolution may be grounds for termination of
' - the contract.
b. Case Managementnf Complex Cases

Ac~ve case m~gementis essential for ensuring that inmates with complex medical, mental health and! or
socral needs recelve necessary services in an effective and coordinated manner. The Contractor will have a
system in place within the facilities for providing case management h:> complex medical cases. The decision
about who is to receive active case management will be made jointly by the Contractor and the DOCs
Executive Health Services Committee. The Corrunittee will meet to review cases and make determinations
about adding or removing inmates from case management. Examples of cases that will be candidates for
active case management include, but not be limited to, inmates with HN!AIDS, Hepatitis C, fragile elderly
inmates, insulin-dependent inmates, and inmates with high-risk pregnancies.
Case managers will have education and training in the delivery and monitoring of health services, and be
responsible
for all of the following: .
.
1) Performing a needs assessment and developing individual treatment plans (under the supervision of a
physician, as appropriate) that address, as applicable, diet, exercise;
medication, type and frequency of medical follow-up and adjustment of treatment modality.
2) Monitoring inpatient hospitalizations and conducting discharge planning from both the hospital and! or .
facility.

\-. 3) Coordinating post-discharge follow~up services, including within non-acute settings such as rehabilitation
facilities and nursing homes.
Case managers will also be responsible for ascertaining whether an inmate has health insurance from any
source, including individual or employer-sponsored coverage (self, spouse and! or family), automobile
coverage (ifadrnitted with vehicle-related injuries), workers' compensation (if injured while on work release),
military coverage (TRICARE), Veterans Administration, Medicaid, or Medicare coverage. If so,the case
manager will document the name of the insurer, coverage type, group!policy nuinber, expiration date, and
other information necessary for filing a claim. .The Contractor will then facilitate collection on the State's
behalf.
In those cases where third party reimbursement is available, inmates shall be encouraged, but not required, to
sign insurance claim forms.
.

For inmates injured while on work release, whose injuries are covered under workers' compensation
insurance, Contractor shall be responsible for coordinating follow-up care andcase management services with
the employer's workers' compensation insurer until either the inmate's treating physician has released
him/her to return ·to work or until the inmate is discharged from the DOC, whichever oc=s first. Contractor
mayor may not provide care for· the work-related injury at a DOC facility, depending upon Contractor's
arrangements with the State's workers' compensation insurer. Contractor retains responsibility for delivering
all medically appropriate care, regardiess of inmate's access to third party coverage.
If an inmate does not have any other insurance covering·health care services, the Contractor will assist the
inmate in completing a VHAP (Medicaid) application to be signed and placed in the inmate's health record.

- 15 •

' - ~o th~ extent possible, with or without third party reimbursement, the Contractor shall attempt to coordinate
with community providers who treated the inmate prior to incarceration.

N. COMMUNICATION ON SPECIAL NEEDS
To effectively meet the n~eds of inmates with sp&ial medical and mental health needs, it is absolutely essential
that positive, open and continue communication exists betWeen the Contractor's staff and the DOC's staff.
Regular channels of conununication must be established and maintained between Contractor' s health care staff
and the Facility Superintendent and facility staff to ensure a continuum of care for sick inmates, while
maintaining the security and the health and safety of other inmates and facility staff.
Contractor's health care staff and DOC facility administration will communicate no less than weekly about
inmates who are:
•
•
•
•
•
•
•
•
\--.
•
•
•

chronically ill;
on dialysis;
adolescents in adult faciliti~s;
inf~cted with serious communicable diseases;
physically disabled;
diagnosed with traumatic brain injury;
pregnant;
frail or elderly;
terminally ill;
mentally ill or suicidal;
developmentally disabled; or
seriously ill with significant health conditions..

This co~unicationis vital in order facilitate accurate classification of inmates, which is important for
protecting the health and safety of the inmate, other inmates and staff.

O. SPECIAL NEEDS TREATMENT PLANS
The Contractor will develop and maintain treatment plans for inmates with special needs as listed in Section
M. These treatment plans will include, at a minimum:
.
1) the frequency oHollow-up for medical evaluation and adjustment of treatment modality;
2) the type and frequency of diagnostic testing and therapeutic regimens; and
.
3) irlstructions about diet, exercise, adaptation to the correctional environment, and medications, when
appropriate.
Special needs will be listed on the master problem list in each inmate's medical record. The Contractor will
maintain an ongoing list of special needs inmates, and will make this information continuously available to

facility administration and the DOC Executive Health Committee.

-16 -

"",'. SUICIDE AND SELF-INJURY PREVENTION PROGRAM

M:u~pIe correc~o~' disciplin~s (security, physical health, and mental health care) play an important role in
sUlcldeand self-IDJury.rr~~ention. These roles must be coordinated in terms of. philosophy and in operations.
The Co~tractor has a sIgnificant role to play and shall have policies and procedures that are aligned with, and
subordmate to, DOC policy, directives and procedures.
.
Contractor must coordinate with the State and its agents in the delivery ofa comprehensive suicide and selfinjury prevention program promulgated by the DOC and designed to identify, respond to, monitor, and treat
suicidal and self-injurious inmates. The suicide and self-injury preventiori program mustinclude written
policies and procedures that address key components of the program.
At a minimum, key components include those defined by NCCHC, and are as follows:

•
•

•
•
•
•
•
•
•
•

training
identification
referral
evaluation
hoUSing
monitoring
communication
intervention
notification
reporting
review
critical incident debriefing

Contractor must perform quality monitoring activities at least quarterly in order to assess adherence to the
program.

Q. HOSPICE CARE

The Contractor shall coordinate with the Department and community organizations in the coordination and
delivery of hospice services to inmates. The hospice care uriit Will be located at the Southern State Correctional
Facility in Springfield, Vermont. The DOC Health Services Director will assist in the coordination of the
Contractor's care of hospice patients with other organizational units in the DOC, and with community
organizations regarding aspects of care for these inmates, including the use of medical furlough.
The. Contractor's staff working in the hospice program should be qualified health care professionals with
training in basic hospice theory and techniques. The Contractor shall ensure that enrollment in the program is
an inmate's informed choice, and that an independent evaluation by a physician not directly involved in the
inmate's care is c,?mpleted prior to enrollment. The DOC Health Services Director will approve all transfers to
the hospice unit.

- 17 -

"'-'.\. DIAGNOSIS, CONSULTATION AND TREATMENT
Contractor's health delivery systems will be designed to allow the physician time to concentrate on those
inmates with significant health conditions. Contractor shall provide follow-up and treatment for health
. problems identified by screening or diagnostic tests. When appropriate, nursing protocols will be
implemented.. If an inmate's health condition cannot be appropriately addressed with a nursing protocol, the
mmate will be referred to the Medical Director by the attending nursing staff.
Contractor's Medical Director and DOC's Health Services Director will be avallablefor second opinions and to
review consultation requests. Contractor shall· coordinate all necessary hospitalization, monitoring, diagnostic
testing, prescriptions and specialty consultations to appropriately address an inmate's health condition.

S. OBSTETRIC AND GYNECOLOGY SERVlCES
The Contractor shall provide annual gyn",cological consultations and perform pap and breast examinations on
all female inmates, unless contra-indicated by a qualified medical professional. Annual mammograms shall be
performed on all female inmates over forty (40) years of age, unless contra-indicated by a qualified medical
professional.'
.
Pregnant inmates require close supervision and perinatal care by the Contractor. The Contractor shall also
develop a plan to meet the special needs of pregnant inmates.
..........Currently; the Dale Correctional Facility and Southeast State Correctional Facility house all female inmates.
The Contractor'sstaffing at these facilities should include an OBj GYN trained health care practitioner who is
qualified to meet the needs of the inmates.in these facilities.

T.· SPECIALTY OUTPATIENT SERVICES
Contractor shall develop a network of qualified medical specialists to provide inmates with necessary access to
health services. Contractor shall enter into written agreements with said specialists who practice in the local
areas, and provide the DOC Health Services Director with a current list of all specialists to be utilized.
For HN-positive inmates, treatment shall be coordinated through the Infectious Diseases Unit at Fletcher
Allen Health Care. The Contractor shall make every reasonable effort tocomplywith the clinical management
protocols for inmates who are HN-positive, as directed by the Infectious Diseases Unit, including providing
protease inhibitor drug treatment, as clinically indicated. Disputes over specifics of inmate care shall be
resolved by the DOC's Health Services Director. The. Contractor shall contact (if the inmate gives consent) a
local AIDS Services Organization to facilitate transitional care for inmates with HIV/ AIDS who are being
.
released from the correctional system.
Contractor shall arrange for qualified medical specialists to visit the facilities so that inmates may be
maintained within the security of the Contractor facility.. If necessary, an outside referral will be made for
services that cannot be provided at the facility. To the degree possible, diagnostic testing will be performed
1n-site. A referral process will be initiated to provide specialists with all pertinent information necessary for
_timely diagnosis and treatment. The medical specialist will receive diagnostic testing results, substantive
patient history and clinical findings, in the form of a written referral.
. - 18 -

\.,...-C:~ntractorshall be responsible for ~cheduling, authorizing and coordinating all specialty services. Contractor

will coordinate the movement of inmates to off-site appointments with the Vermont DOC facility .
superintendents and/or their designees. All inmates returning from outside hospital stays or clinic visits will
be seen by a medical professional immediately upon return, and a progress note regarding the review will be
.documented in the inmate's health record. Contractor shall ensure that an inmate's medical chart accurately
.
reflects and documents services providedby the outside health care provider(s).
Under no circumstances shall Contractor limit or delay access to specialty services for inmates identified as
requiring this care. If the DOC believes that the Contractor is not providing specialty services in a timely
fashion, DOCs Health Services Director and the Contractor's Medical Director shall review and resolve any
dispute. Failure to reach resolution may be grounds for termination of the contract or the impositions of
financial penalties reflected in Chapter 5, Section Q - Performance Guarantees.

U. ANCILLARY SERVICES
Contractor shall establish and maintain a comprehensive range of ancillary support services. Contractor shall
identify the need, coordinate and pay for all supporting diagnostic testing and examinations, both inside and
outside the State correctional facilities. All'subcontractors will be required to meet state and local licensure
requirements and provide proof of Professional Liability insurance.
a. Laboratory Services
'-- Contractor shall contract with a laboratory to provide diagnostic testing. Laboratory testing will include
routine, special chemistry and toxicology analysis. The laboratory will meet all requirements of the State of
Vermont for HIV specimen handling, testing and reporting.
All services provided shaIl meet standards set forth by the American College of Pathology. Services will
include timely pickup and delivery and accurate reporting within a reasonable time frame with provisions for
stat lab testing as necessary.
Requests are to be initiated by a phone call to the laboratory. A log will be maintained to document the type
and number of specimens sent, and those returned: A lost specimen will be reported immediately, so that the
lab may be repeated. A physician will review, date arid initial laboratory results. Once reviewed, the results
will be filed in the inmate's health care record. When discrepancies exist, the physician will re-evaluate the
inmate and re-order the laboratory tests, as appropriate. Crisis levels willbe reported to the physician
immediately. Each month the laboratory will provide Contractor with an itemized statement of the service
rendered the prior month.
The laboratory service will meet all State of Vermont requirements for medical pathology.
Contractor shall establish a policy and procedure manual for all laboratory testing performed on-site.
Laboratoiy testing performed on-site or off-site will be· in compliartce with the Clinical Laboratory
Improvement Amendments of 1988.
b. Radiology Services

'-A radiology technician will be on-site to provide radiology service on a scheduled basis.

Inmates will be
referred off-site for procedures beyond the scope of service provided on-site. A Board-Certified radiologist
will read the studies in a timely manner. The radiology report will be documented and maintained in the
- 19-

'-- inmate's health care record. The Contractor's Medical Director will review, initial and date all radiology
rep?rts. A :e~bal notification ~f all positive findings will be furnished to the Medical Director or his/her
~esl~ee ,,:,~m three (3) working days; this verbal notification is to be followed up by a written notice of
. fmdings WIthin ten (10) working days.
.
c. Diet Therapy
Special diets will be available to inmates when medically indicated and prescribed by a physician. Contractor
persoi:mel will complete a Therapeutic Diet Order form and forward it to dietary services. The order will
include the type of diet and the duration for which the diet is to be provided. The inmate's orientation to the
therapeutic diet will be documented in the health care record. In accordance with NCCHC standards,
Contractor shall coordinate reviews of all diets at least every six (6) months with a registered dietitian.
d. EKG Services
Contractor sh~ provide EKG services and necessary EKG equipment: The EKG contract will provide for·
immediate reading and reporting of results of EKG. Nursing staff will receive in-service training related to
EKG services.
.
e. Medical Prosthetics
Contractor shall establish contracts with local prosthetic companies to provide prosthetic devices to inmates as
medically indicated. The contract will require the company representative to make preliminary measurements
' - and fittings for prosthetics oncsite. Prosthetics will be chosen according to community standards, but also
must conform to security requirements of the DOC.

V, OPTICAL SERVICES
Contractor shall respond to the self-reported need or medical referral for optical illtervention and schedule,
coordinate and pay for the dispensing, evaluation, and fitting services of an optometrist. Inmates requesting
health careservices for visual problems will be evaluated using the Snellen eye chart by nursing staff. If a
visual deficiency beyond 20/40 is identified, the inmate will be referred to Contractor's optical service
provider.
Contractor shall provide one (1) set of eyeglasses to inmates if prescribed and deemed necessary by the
optometrist. Inmates requiring treatment and services beyond the scope of services offered on-site will be
transported to specialists in the community. Inmates shall be eligible to receive follow-up eye exams every
two (2) years.
Contact lenses.and tinted lenses will be provided by the Contractor only in resp·onse to a verified medical need
and not for cosmetic purposes.
The Contractor shall not provide replacement eyeglasses more frequently than every two (2) years unless
medically indicated. If the eyeglasses are lost or dama,ged due to the inmate's negligence, he/she will be
responsible for the cost of replacement. The Contractor will only provide a replacement when the need occurs
"-- through no fault of the inmate.

- 20-

'-

W. PHARMACEUTICALS

Contractor shall provide a total pharmaceutical systeIIl in compliance with NCCHC standards that is sufficient
to meet the needs of the DOC iruriates. Contractor shalI also be responsible for the acquisition, storage and
administration of pharmaceuticals. Policies, procedures and practices addressing pharmaceuticals will be in
compliance with all applicable state and federal regulations regarding dispensing, administering, and
procuring pharmaceuticals.
"
.
A costceffective agreement with a pharmaceutical vendor will be established. ' If an agreement is established
,with a national vendor, a contract or other arrangement will also be established with local pharmacies to
provide time-sensitive access to all medications. Under the capitated model, expenses for psychotropic
medications will be billed back to the State with a pass through of any discount negotiated and received by the
Contractor from the pharmacy vendor.
The pharmaceutical system will have the following components and comply with NCCHC standards:,
1) Medication ordered by a qualified provider (physician, psychiatrist, nurse-practitioner, dentist) will be
appropriately labeled and will be in unit-dose paCkaging.
2) A pharmaceutical inventory will be established to facilitate the initiation of pharmaceutical therapy upon
the physician's order. An inventory control system will~ implemented to ensure the availability of
necessary and commonly prescribed meditations, and to protect against the loss of pharmaceuticals. All'
pharmaceuticals will be prepared, maintained and stored under secure conditions.
'
" - 3) An adequate and proper supply of antidotes and emergency medications will be available.
4) Addictive, abusable, and! or psychotropic medication will be administered in cmshed or liquid form,
when the need for such is so determined by DOC requirement, the preSCriber and! or nurse manager.
5) Monthly Quality Improv~ment(Q1) monitoring of meditation administration retords and physician
prescribing reports. Quarterly reviews will be completed by a consulting pharmacist using a Pharmacy &
Therapeutics (P&T) format '
6) Compliance with security and training requirements of the facility and DOC.

7) An automatic stop order system for certain categories of dmgs (i.e. antibiotics, controlled substances, pain ,
medications).
8) The use of generic brand medications whenever possible, unless otherwise specified by the prescribing
provider.
9) A physician will evaluate each iruriate prior'to re-ordering medications.
Contractor will maintain a fo~ulary listing the available medications. The formulary must be submitted to
Health Services
Director or designee for review and approval before being implemented.
the DOCs
. . . .
.
Compliance with the formulary will be encouraged. However, if the DOC Health Services Director or
Contractor Medical Director ,determines that the most effe~tive treatment is a non- formulary medication, this
medication will be made available to the inmate. Non-formulary medications will be obtained by completing
~ non-formulaiy request form.

' -The Contractor will be responsible for monitoring the use and availability ofall pharmaceuticals. Specifically,
'

,

,

'

the Contractor must ensure timely availability of all pharmaceuticals that are part of an inmate's treatment
,21 -

.,-, plan, and s~all re'p0rt all occUrrences of drug unavailability as a part of its monthly CQI reporting. The
Contractor IS subject to performance penalty of $1,000 for every occurrence of not prOviding pharmaceutical
drugs in within two (2) hours of the date and time medication is scheduled to be dispensed for an inmate's
ongoing treatment plan (e.g., insulin for insulin-dependent diabetics, protease inhibitors for HIV/ AIDS .
patients, etc.). For newly ordered prescriptions, Contractor may also be penalized if prescriptions are not
delivered within forty-eight (48) hours of order receipt, from Monday through Friday and seventy-two (72)
hoUrs from Saturday through Sunday, or within one (1) hour of receipt of a "stat" provider's order. (See
Chapter Five, SectionQ -Performance Guarantees.)
.
Contractor shall perform quality improvement monitoring ;n{d tracking of physicians' prescriptive data
provide .for safe, cost effective and efficient pharmacy services. .
.

to

a. Medications for Work Release Inmates
Contractor shall ensure that work release inmates have access to all necessary medications. Contractor shall'
make every effort to provide medications at a DOC facility, but may provide medications on a keep on person
basis in accord wifu DOC policy and procedures.
'
Contractor will work with the DOC to develop a specific policy and procedure for dispensing'medications to
work release inmates.
'
b. Medications Prescribed by Mental Health Providers
" - All mental health medications will be billed as incurred to the state on a monthly basis; with a pass-through of
any disc~unts negotiated and received by the Contractor~ Budgeted amounts for mental health medications
included in this contract (and reflected in the Price Provisions, Attachment B) are $240,000 in Year 1, $270,000
in Year 2 and$300,000 in Year 3. Contractor will not bear any risk for these medications.
c. Methadone and Buprenorphine at DOC Facilities
Contractor shall provide physicians certified to dispense Buprenorphine as part of its narcotic withdrawal
program at DOC facilities.
Contractor shall work With the DOC and'its Mental Health Provider to ensure that J:!lethadone facilitation is
available to inmates, as determined by and in agreement with DOC policy. While Contractor shall not be
" responsible for the provision of methadone, it is responsible for identifying po~tial candidates,
communicating the need for treatment and coordinating methadone, treatment with the Mental Health
Provider for DOC inmates.

X. MEDICATION ADMINISTRATION
,The Contractor shall maintain a medication administration system that meets the DOC's needs. Once a
medication order has been written, nursing staff will transcribe the order onto the medication administration
, record and inform the pharmacy of the medication order. If the prescribed medication is available in the stock
supply, the medication therapy will be initiated on the ne,xt medication round. Contractor'shall ensure that
",-,medications ordered "stat" will be obtained and administered within one (1) hour.

·22·

~ Medication will b'.' a~tere~ to inma:e~ by nurses or other authorized personnel three (3) times daily or as

ordered: ~edications.will be either administered at a health seIVlces unit or delivered to each inmate housing
area: as JOIntly dete~~ed by the Contractor and DOC. It is understood that security considerations,
archit~ture and fa~ility custody level impact the method for distributing medications. Facility
supenntendents will be actively involved in the discussions and determination of most appropriate method at
each site. Contractor may use the State's self-carry protocol. Inmates will have access to over-the-counter
medicationS during scheduled medicatiOn rounds.

The administration of each medication will be documented on a medication administration record.
Documentation on the medication administration record will clearly indicate those instances when an 4Unate
refuses a medication or is not available to receive a medication. Medication administration times will be
adjusted to meet the needs of inmates who participate in work details or classes. If an inmate refuses a specific
medication three (3) times, the inmate will be counseled and requested to sign a refusal form.
Contractor's medication administration program shall contain internal cOhtrols to provide for re-order prior to
the expiration of the initial order, if required. The system must ensure the provision of continuous
pharmaceutical therapy.

Y. DENTAL SERVICES
The Contractor shall provide access to dental services in accordance with NeCHC standards and State law.
The Contractor's sub-contractor arrangements with dentalproviders shall be in conformance ·with Vermont
' - Statute 26 V.SA Chapter 13 § 722,.
Contractpr shall provide on-site dental services which include preventive and restorative care. The Contractor
will provide a schedule, by facility, to the State with the hours that dentists will be on-site actually seeing
patients (i.e., exclusive of time used for set-up and dismantlemet1t of equipment and for administrative
activities). The hours across all facilities must equal at least eighty (80) hours.
The initial dental appraisal and instruction in oral hygiene will be conducted at the time of the initial health
assessment by trained regiStered nurses and within five (5) days of admission. The Contractor's provision of a
dental screening for all referred inmates shall be conducted by a licensed dentist within timeframes established
in the Settlement Agreement (Attachment J) and NCCHC standards, whichever may be shorter. If the
Contractor is unable to provide on-site assessment, screening and!or treatment within these timeframes,
inmates shall receive services through local community dentists, with costs for said services to be borne by the
.Contractor.
In the case of a re-adnrltted inmate who has received a dental examination ~thin the past six (6) months, the
Contractor shall assure that a licensed dentist determines the need for an additional dental evaluation.. Nurses
who provide dental screening and oral hygiene instruction will receive in-service training from a licensed
dentist under contract to, or employed by the Contractor.
Inmates mayrequest dental services by submitting a sick call request. The nurses will t:r:il\ge the requests and
submit them to a licensed dentist. Inmates will be seen based· on the list of dental priorities. Inmates who
require treatment beyond the capabilities of the Contractor's licensed dentist will be referred to a dental
_specialist in the community. Dental prostheses will be provided as determined by the dentist in accordance
with the accepted community standard of care.
.
.
- 23-

Z. MATERIALS, SUPPLIES AND EQUIPMENT

"-

Contractor ~hall provide all medical, dental and office supplies necessary for the provision of health services.
Contractor shall provide all necessary supplies and equipment to carry out the terms of the contract. Supplies
will include, but not be limited to, forms, books, health care record folders and forms, pharmaceuticals,
, prosthetics, dental hand instruments, needles and sharps, special medical items, diagnostic devices, containers
and medical waste receptacles, inmate education materials, personnel protective equipment, and program
manuals.

In addition, all necessary office equipment and supplies will be'provided by the Contractor. Contractor shall
make arrangements to have the necessary equipment and supplies delivered to the DOC's facilities within one
(1) month of contract implementation (date service delivery begins). The DOC owns certain pieces of
equipment (Le.,dental chairs) which may-be used by the contractor.
Contractor shall ensure that the health care services 'area is safe, secure '(e.g., doors and cabinets locked), and
sanitary for the provision of medical and dental care. In addition, all diagnostic equipment and patient items
1:Vill be maintained in working order, as defined by the manufacturer. The DOC will receive copies of all
inspection reports for such equipment.

AA INVENTORY CONTROL
All syringes, needles and sharps will be stored and maintained within security regulations and guidelines set
,-forth by NCCHC standards, VOSHA requirements, and CDC guidelines. The use of each needle, syringe or
scalpel will be documented on a perpetual inventory record. All syringes, needles, sharps and dental
.instruments will be accounted for daily.
, At each change of ~, two nurses will count all narcotics and any other items subject to abuse. 1£ the count is
'
correct, each nurse will sign the control record. The DOC Health Services Director, Contractor Medical
Director, Director of Nursing and the State Correctional
'
Facility Administration will be notified of all unaccounted for discrepancies as soon as practicable, not to
exceed twenty-four (24) hours.
'

AB. CONTAMINATED,WASfE
Contractor will be responsible for the disposal of all contaminated waste. ThIs may include waste generated
outside the facility when an inmate is on temporary authorized absence. Contractor will contract with a
company authorized to provide for the disposal of all biohazardous and contaminated waste. Biohazardous
and contaminated waste will be maintained in accordance with the guidelines established by OSHA.

AC. HEPATITIS TREATMENT
It is recognized by the Parties that Hepatitis in general, and Hepatitis C specifically, represent an increasingly
.erious public health threat to inmates nationally and in Vermont. It is agreed that the Contractor will provide
,--,lppropriate treatment, consistent with NCCHC and/ or CDC guideline~, according to protocols developed by
the Contractor and the State. The State Health Services Director shall make final decisions concerning inmate
eligibility for treatment under these protocols.
- 24-

"""III.

PERSONNEL SERVICES

A. OVERVIEW

Contractor will identify the need for, s<:hedule, coordinate and pay for all non-emergency and emergency
medical and dental care rendered to inmates incarcerated in state correctional facilities, consistent with
NCCHC standards, Vermont State statutes and applicable Federal statutes, and the determination of the
Vermont DOC Health Services Director.
.
Contractor shall hire qualified health care staff as defined in this contract to provide a comprehensive health
care program to meet the medical and dental needs of the inmates housed within the DOC, according to
coverage schedules for each of the facilities per the Staffing Matrix (Attachment H). It shall be the Contractor's
final responsibility to fill all posts in accordance with the staffing standards and coverage schedules per the
Staffing Matrix, exclusive of posts filled by State employees.

If for any reason these posts are not filled by the Contractor with permanent employees within thirty (30) days
after a post has become vacant (as scheduled in the Staffing Matrix), Contractor may he penalized as set forth
in Chapter Five, Section Q - Performance Guarantees, for each day or part thereof that the post is not filled.
Contractor is also expected to provide interim per diem staffing of health professionals trained to provide
health services within a correctional setting for all health services-related positions vacant beyond one (1) week
::Iue to illness, disability, disciplinary actions, and/ or staff dePartures. Failure by the Contractor to fill these
\...- posts with per diem employees while a search is being conducted for 'a permanent replacement rnay also result
in a penalty.
.
Contractor must also ensure that no shift is left uncovered. Attachment K - Staffing Coverage Standards
reflects the minimum staffing required by facility, by shift, by type of clinical staff for Contractor to avoid a
penalty under this provision. Contractor may, at its discretion and cost, fill clinical positions within higher
practice level professionals without penalty. However, the DOC will be billed at the lower level rate. Clinical
staff cannot be asked to operate outside of their scope of practice to cover a shift, Failure by the contractor to .
cover a shift will result in a penalty.
The Contractor must ensure that all personnel are licensed, certified and/or registered in conformance with
Vermont laws and regulatory requirements. The Contractor will be responsible for· the cost of any education
required to maintain licensure and credentWing. A personnel file may be established for each employee or
subcontractor. Each professional employee's file will.contain current licensure and/ or certification
documentation.
.
The health care staff will work as part of the multidisciplinary treatment team with Contractor's;Medical
Director and Regional Manager/Director. The health care staff will be provided with the necessary training
and resources to be proactive in addressing the inmates' health care needs, as described in Chapter Two Health Care SerVices.
Contractor employees will be proVided with a copy of Contractor's personnel policies, All Contractor
.
ersonnel must comply with these policies and all other policies and work rules of the DOC in order to ensure
'-continued employment with Contractor.
.
- 25 -

a. Vermont Health Employees
The health care staff currently classifiedas Vermont State Employees assigned to the State Correctional
facilities will be permitted to retain their state employment status. The State and Contractor shall comply with
the terms of the Stipulation and Agreementbetween the State and the Vermont State Employees Association,
dated July 31, 1996 (Attachment I). It is expressly understood and agreed that the Contractor is not a party to
nor obligated to any contract or agreement with and between the State of Vermont and the Vermont State
Employees Association. The State agrees to hold hannIess and indemnify the Contractor in any dispute
arising under the terms of said contracts andj or agreements. The DOC agrees to waive any and all penalties
related to staffing for one or more of the positions in the contract designated as being filled by a State
employee in the event of a work action or stoppage by the Vermont State Employees Association.

B. FORENSIC ACTNfTIES

The Contractor shall abide by applicable NCCHC standards for foreIUlic activity. Contractor hearth care staff
shalInot be responsible for participating in security activity, including shake-doWns, adversarial proceedings
involving DOC staffor inmates, body cavity searches or any other security function that is inconsistent with
their role as health care staff and acceptable correctional healthcare practices.

C. PROGRAM MANAGER

,"-Six (6) full-time Program Manager(s) shalI.be hired by the Contractor to provide management and
administrative support to the program and serve as the intermediary between Contractor and the State.
Professional qualifications for the position of Program Manager shall include an undergraduate degree,
pr('ferably in Health Services Administration or a minimum of five (5) years administrative experience.in a
correctional health care delivery setting. .
The Program Manager or designee shall beon-call twenty-four (24) hours per. day, seven (7) days per week,
three hundred and sixty-five (365) days per year. The Program Managers shall provide support, information
.and assistance to Contractor's Medical Director and Nurse Manager; to facilitate the accomplishment of all
contract goals.
The Program Manager shall be available to DOC facility administrators on a daily basis. Sjhe shall also
manage the day-tO-day activities of the health care services program; such as recruitment and retention of staff,
staff work schedules, data gathering and reporting, budget monitoring, and the management of heaith care
records.
The Program Manager shall ensure the availability of professional resources and services to meet the health
care needS of the inmate population. It shall be responsibility of the Program Manager to establish an efficient
and effective multidisciplinary health care team..The Program Manager shall make available to the facility
superintendent and DOC Health Services Director a monthly health care services staffing schedule for each
facility prior to the initiation of the schedule. This report· shall include the number of full-time, part-time and
relief staff by day, shift and location.
.
''"-Serving as Contractor's direct liaison to the Facility Administrator and local DOC staff, the Program Manager
shall conduct monthly meetings with DOC Health Services Director to evaluate statistics, program needs,
contract issues, and coordination between custody and health care staff. Sjhe shall also be responsible for
- 26-

'Ilonitoring compliance with the DOCs policies and procedures, Contractor's health care services policies and
'-procedures, state and national standards and contract requirements,including compliance with the applicable
terms of the Settlement Agreement.

D. REGIONAL MANAGER/DIRECTOR
Contractor shall hire a Regional Manager/Director, who will he responsible for coordinating with Vermont
DOC Health Services Director, Facility Superintendents and Facility Executive.the implementation of
programs that provide all inmates with uninipeded access to quality health services in a timely manner,
consistent with the requirements of the Settlement Agreement. The professional requirements for the role of .
Regional Manager/Director include a minimum of five (5) years experience as a registered nurse, with at least
one (1) year of clinical experience in correctioriaI health care, and demonstrated management experience in a
health care or other setting.
The Contractor's Regional'Manager/Director shall be the liaison between the DOCs central office and the
Contractor's central office, as well as with the DOCs Mental Health Services Contractor and other community .
organizations. S/he will be responsible for the management and administration of all Vermont DOC health
care operations, with contract-wide. authority to ensure that Contractor successfully meets
contractual
obligations.

an

S/he shall assist the Program Manager in the clinical management and evaluation of site operations,
lJarticipate in coordinating start-up activities for the contract and routinely visit all DOC facilities to evaluate
\,...dinical and nursing programs. The Regional Manager/Director shall also assist the Program Manager and site
Nursirtg Managers irt the development and implementation of clinical programs, provide technical assistance
in achieving and maintainirtg health care unit accreditation, and follow-upon site evaluation reports to ensure
corrective action has been accomplished.
The Regional Manager/Director will also provide the State correctional facilities with consultation services
upon request.. Consultation may be provided on a variety of topics, to include: employee health programs,
construction planning, new facility staffing pIails; communicable disease management, inmate fee-for-service
and inmate copayment programs and legislative issues. In addition, s/he shall respond to emerging situations
requiring regional support action, conSult with the Vermont Commissioner pf Health or designee on plans,
actions, and time table of corporate or regional response and be involved irt "trouble shooting" at DOC
facilities as requested or directed.

E. MEDICAL DIRECTOR
Contractor will appoint and employ a Medical Director for each site who will be the designatE!d Responsible
Health Authority. TIie Medical Director shall be responsible for arranging all levels of health.care and
overseeing the delivery of health care services.. S/heshall work closely with the DOC HealthServices
D1Tector. All medicaI judgment shall rest with the Contractor's Medical Director subject to consultation with
the DOC Health Services Director on complex or unusual cases. The Medical Director shall ensure that a
physician ison<a1I twenty-four (24) hours per day, seven (7) days per'Week, three hundred and sixty-five
'365) days per year. .

'-

The MedicalDirectorshall serve as the chaIrperson of the Quality Improvement Committee and monitor the
quality ofcare provided to the DOC. The Medical Director shall also be responsible for monitoring the
- 27-

" -practice patterns of all health care staff. The Medical Director shall work closely with the Program Manager
an~ DOC Health Services Director to establish and maintain compliance with contract requirements, and all
· national and state health care standards addressing health· care in correctional facilities.

F. JOB DESCRIPTIONS·
.

.

The Program Manager sha1I be assigned responsibility for a specific facility to coor~te the management of
the health care system for that facility with the Medical Director. To ensure the proper functioning of the
facility's health care staff, job descriptions will be developed for each position: The appropriate job description
will be reviewed with each employee. The employee will be required to acknowledge and sign off on the job
description. The job description will be used for performance reviews and will be updated annually.
G. RECRUITMENT PRACTICES
The DOC will have the opportunity participate in the selection of alI senior-level positions for the contract,
· illcluding but not limited to the six Program Manager, Regional Manager/Director, Medical Directors and
Director of Nursing. A(ter the Contractor has selected a final candidate, the Health Services Director of the
DOC may, at his/her discretion, interview the candidate. Contractor may not extend a final offer to a
candidate prior to the DOC approval.
.
\"... In addition to the Contractor's clinical staff(such as registered nUrses, licensed practical nurses, and physician
assistants) ideritified for each facility ill the Staffing Matrix (Attachment H), it will establish a pool of
additional clinical staff to provide adequate coverage for routine clinical employee absences such as sick and
vacation leave, consistent with the Staffing Coverage Standards delineated in Attachment K. The Contractor's
pool will be of sufficient size to address all routine absences.

To successfully staff its health care programs, Contractor is urged to utilize professional recruiters to identify
the qualifications and experience that are needed to provide quality services in the DOC environment.
· Successful applicants will be selected to complement the health care program and the mission of the DOC.
Qualifications and preferences will be matched with employment criteria to identify suitable candidates for
. each position. The applicant database will include:
.
•
•
•
•
•
•
•

credentials
licensure
certification
training
geographic preference
practice setting preference
experience

Contractor recruiters shalI utilize display and classified advertising, direct mail, electronic/internet posting,
and participation in appropriate professional conferences and health care expositions. When recruiting for
,"-site-specific positions, placements in local newspapers and magazines will be utilized.

- 28-

' - be State and Contractor shall coordinate recruitment efforts as needed to ensure an optimal, qualified staffing
complement is in place at each facility.

H. LICENSURE/ CERTIFICATION

Contractor physicians shall meet all licensure provisions and requirements of the Vermont Medical Practice
Board. Contractor employees performing professional·health care services shall be CPR-certified (including biannual re-certification) and shall maintain all necessary licensure and/or certification to practice their
specialty. Each applicant's background, licensure/certification, work history, and personal and professional
references shall be screened by experienced credentials specialists. Independent references shall be securedto
provide a balanced reporting of the candidate's qualifications and performance history.
The Medical Directors and Program Manager will be responsible for furnishing the State with copies of
licenses and certificates for all health care services staff, upon request.. A copy will be maintained in the
employee's Contractor personnel file. In addition to verifying that all persorthel have the proper license and
credentials at the time they are hired, the Contractor shall ensure that all professional licenses and credentials
are kept current and adhere to NCCHC standards. By using a chronological alert system, Contractor shall
maintain up-to-date references, copies of licenses and CPR certifications for all licensed professionals.
Documentation of current licensure and annual CPR re-certification will be made available to the DOC Health
Services Director. Such documentation shall include all information relative to any pending sanctions or
complaints filed with state or professional licensing boards.
\"...

I.

STA'FE OVERSIGHT

All Contractor personnel, subcontractors. and agents will be required to successfully complete pre-employment
secunty background checks and clearance by the State, Upon successful completion of the pre-employment
security background check and clearance and acceptance of an employment offer, the Program Manager of
each facility shall immediately inform the Superintendent of the name, job title and assigrunent of each newlyhired health care services staff member.
The DOC shall have the right to reject employment and or services of any person or firm retained by
Contractor, when it is determined that such action is irt the best interest of the DOC. The Superintendent shall
have the right to request the termination of any health care services staff member who fails to abide by the
facility's institutional operating procedures, or for any other just cause. .
.
The DOC shall be responsible for providing security to Contractor personnel at all times that they are engaged
in health care duties a.t a state correctional facility.
.

J.. PERFORMANCE REVIEW
Contractor shall utilize an employee evaluation system. The Program Manager and/ or the Nurse Manager
shall complete a performance assessment for each newly hired employee before the ninetieth (90"') day of
\"... ,mployment. The assessment will include a recommendation to offer the employee permanent employment
status, to extend the probationary period, or to terminate the employee. The Frogram Manager or designee
. shall complete a performance review on alI employees~ at least annually. An employee may, however, be
evaluated at any time, including an evaluation as to the employee's ability to help the State comply with the
·29·

~ Settlement Agreement, as deemed necessary by the Contractor or State. Upon completion of the written -

performance evaluation, the supervisor will schedule a meetfug with the employee as part of the review. The
employee will be allowed to either agree or disagree with the evaluation, but will be required to sign and
acknowledge the evaluation. The employee will receive a copy of the evaluation; the original is forwarded to
the central office to be filed in the employee's permanent record. The DOC shall be notified inunediately of all
- health care staff evaluations that reflect sub-standard performance, as well as Contractor's action plan to
inunediately
correct health care staff performance.
Contractor'shall also participate in performance evaluations for health care staff employed by the State,
consistent with the terms of the Stipulation and Agreement between the Vermont State Employees Association
and the State (Attachment I).
. -

K. STAFF TRAINING AND RETENTION
Contractor shall support a well-developed staff training and professional development program to ensure a
strong foundation for performance and consistency in the provision of health care services.
The Contractor shall develop and-implement a comprehensive staff retention program, including a program
specifically oriented to nursing staff. At a minimum, Contractor's retention program must require all new
staff to complete a thirty (30) day orientation period under supervision of an experienced employee. During
this thirty (30) day orientation period, all new staff will be closely supervised and will not be on a shift by
themselves. Annew employees will also be required to complete a series training modules which include
'--an introduction to Vermont's correctional system. a review of DOC's policies and procedures (including
mental health policies and protocols) and security training.
-

or

a. Orientation Training for New Employees
The Contractor orientation program for new employees is presented in three segments: (1) DOC Orientation,
(2) Contractor Employee Orientation, and (3) Oh-the-Job Orientation. Each employee hired after February 1,
2005 mustsuccessfuIIy complete all three segments of the orientation program.
1) DOC Orientation
Contractor shall commit five days of DOC orientation training for all newly-hired fuII·time staff (except
Nurse Managers) within siX months after the hire date. Newly-hired Nurse Managers shall receive DOC
_orientation training within one month after the hire date.
TheStafe and Contractor' shall jointly develop a five-day DOC orientation training curriculum. The
curi:icuIum shall include applicable training sessions from the Vermont Correctional Academy, as well as
training healthcare provision in a correctional setting, and other designated specialty training. The DOC
orientation training curriculUm shall be developed no later than May 1, 20OS.Prior to the development of
the DOC orientation training curriculum, Contractor and the DOC shall ensure that staff receive adequate
orientation either through attendance at the Vermont Correctional Academy's first week of basic training
or through some other DOC-approved process.
-

'-. The Executive Health Committee, comprised of State, Contractor and Mental Health Provider representatives
is responsible for the DOC orientation training curriculum. Assistance will be provided by the DOCHuman
Resources Department staff.
- 30-

Co:,~act~r ~hall work with the DOC to ensure that all employees receive an orientation to the correctional
facility WIthin the first week of the employee's start date. The orientation shall include:
•
•
•
•
•

security policies and procedures;
health care service facilities and equipment;
schedule of services provided by the Contractor;
emergency procedures; a n d .
.
all other information pertinent to the efficiency of the facility's health care services.

All employees shall be required to sign a statement that they are familiar with the institution's operating
procedures and p o l i c i e s . .
.
.
2) Contractor Employee Orientation
Contractor employees·will receive a detailed orientation to the Contractor's programs, policies, procedures
and personnel benefits. In addition to the general employee orientation, an orientation to the
administrative, medical records, pharmaceuticals, clinical. services, infection control,.quality improvement,
emergency procedure issues specific to the assigned DOC facility will also take place within the first week
after an employee's start date.. The pharmaceutical module of the orientation program will require
licensed nurses to take a post-test used to establish the employee's knowledge base and detennine if
individualized training is necessary.
.
3) On-the-JobOrientation
New employees shall receive an in-depth orientation to the post for which they are hired. The new
employee shall work with an employee who has experience in that area,. allowing them to participate in the
daily routine of their new position. Each new employee will have an identified supervisor assigned.
Throughout the orientation process, new clinical staff (registered nurses, licensed practical nurses,
physician assistants, etc.) shall be required to complete a proficiency checklist, addressing the clinical skills
required Jor the position.. The orientation will be completed when proficiency is verified by the clinical
supervisor of the new employee. Clinical proficiency verification will be completed upon the clinical
supervisor's dated ~ignature on the proficiency checklist. The proficiency checklist shall be completed
within the fIrst week after the employee's start date.
Although an employee may have been hired for a specific post, new employees shall be oriented to eaCh area
in the health care services unit within one month after the employee's start date. This is done to familiarize
the employee with all aspects of the health care delivery system.
b. Ongoing Training .
Contractor will seek to retain qualified staH to ensure a fully staffed, experienced employee matrix at each
facility. Contractor's continuing education program Shall build on the foundation established in the
orientation process. Contractor employees shall be encouraged to further their professional development by
attending seminars, lectures and conferences. The Contractor shall provide all health care staH with paid time
off to attend continuing education classes and training, in compliance with NeCHC standards~
....... Quality Improvement studies, incident reports, inmate grievances and infection control review findings will be
used to identify educational topicS specifically needed by a facility. The Contractor educational program will
also contain specific programs designed to acquaint employees with Contractor's goals and objectives, policies
- 31 -

\,., .nd procedures, nursing protocols and programs. Contractor's central office personnel will be utilized to
augment these educational programs.
Contractor shall provide a health care· reference library at each major health care services area. The library will
contain professional reference books and·current periodicals. Reference materials will include but not be
limited to:
.

• . National Commission on Contractor Health Standards for Health Services in State Contractor Facilities;
•

illustrated Medical Dictionary;

•

Physicians Desk Reference;

• Textbook,of Medical.Surgical Nursing; and.
•. Current Medical Diagnosis and Treatment
The Contractor shall develop an employee grievance resolution policy and process that provides all Contractor
staff with a confidential forum to. address work-related issues. Quality Assurance/Improvement reports to
the DOC will describe the nUmber and kind of employee grievances by facility on a monthly basis.
~

- 32-

\....'V. . ANCILLARY SERVICES
A. CORRECTION STAFF EDUCATION

Contractor shall provide training to all DOC Correctional Officers with respect to basic identification of
inmates requiring immediate medical attention and shall be consistent with NCCHC standardS. This will
include training with regard to symptom recognition (shortness of breath, choking, bleeding, etc.) .and the
appropriate steps for triaging and obtaining medical services for the inmate on an urgent or emergent basis.
Training will include in-person orientations and written materials.
Contractor shall conduct in-'Service education and training sessions for Corrections staff, at each facility, on a
quarterly basis. The training curricula will be approved by DOC's Health Services Director and should
. . .
include, at a minimum:
•
•
•
•
•
•
•
•
•
........
•
•
•
•
•
•
. •.
•

administration of first aid;·
recognizing the need for emergency treatment;
recognizing acute n;ianifeitations of chronic illnesses;
recognizing chroriic medical and disabling conditions;
recognizing signs and sYmptoms of mental illness and psychological trauma;
recognizing sign and symptoms of traumatic brain injury;
recognizing signs and symptoms of dementia;
medicationside-effects and administration; .
infectious and communicable diseases;
cardiopulmonary resuscitation;
recognizing suicidal behavior and procedures/protocols for suicide prevention;
sinoking cessation;
stress· management;
hepatitis A, hepatitis B and hepatitis C;
HIV;
Tuberculosis;
utilization of the Contractor's services; and
procedures for the delivery of emergency, acute and chronic illness services by Contractor staff.
.

.

.The Contractor will also develop, in conjUIi.ction with the DOC Mental Health Provider; education on mental
health topics as requested by the State. These topics may include:
'. mental health;
• substance abuse; and
• suicide prevention. .

B. STAFF VACCINATIONS
The Contractor is responsible for the provision and administration of Hepatitis Bvaccine and TB testing items
for use with security staff and/or other staff who are identified as being at significant risk of infection (as
designated under the OSHA Blood-borne Pathogens mandate). Contractor's nurses will give·these injections
'-- rod maintain appropriate documentation of their administration.

- 33 '

....... In addition,.the Contractor's nurses will administer diphtheria-tetanus vaccines when (1) injuries require a

. booster and (2) on a preventative basis (every' ten (10) years) to security staff. The costs for such services and
associated vaccines will be based upon the Co";tractor's accepted price for this service, and paid in accordance
with the Additional Monthly Charges procedure delineated in Attachment B - Payment Provisions.

C COORDINATION WITH THE DEPARTMENT OF HEALTH

The Contractor will.be required to coordinate and work collaboratively with the Vermont Department of
Health. The Contractor will be expected to cooperate with the any program or training module offered by the
Vermont Department of Health. The Department of Health will provide on-going guidance to the Contractor
and DOC on a variety of issues including the following:
•
•
•
•
•
•

quality assurance activities;
infection control;
critical incident investigations;
detection and prevention of HIV/ AIDS;
dissemination of public health Wonnation and education for inmates and staff; and
response to public health threats.

.In addition, the Contractor will coordinate and work collaboratively with the Vermont Department ofHealth
in its implementation of an independent monitoring process for Quality Assurance and Quality Improvement.

-34 -

...... v.

Administrative Services

A. POLICIES AND PROCEDURES

The Contractor shall develop site-specific policies and procedures, which will be reviewed armually by the
. DOC. An electronic copy of each facility's policies and procedures shall be sent to the DOC withfu the two (2)
weeks of contract implementation, February 1, 2005. These policies and procedures will be posted on the
DOC's website.
The Contractor's policies and procedures are subordinato~ to the DOC's policies and procedures. The DOC will
review all Contractor policies and procedures to ensure compliance with all federal and state laws and
regulations, NeCHC standards and all DOC policies and procedures (including mental health policies and
procedures). As necessary, the DOC will request changes to the Contractor's policies and procedures.
Completion of formal policy review and development shall occur withfu four (4) months of February 1,2005.
Compliance with DOC policies and procedures will be monitored through CQI reporting and through
scheduled and unscheduled audits by the Department or the Vermont Department of Health.

B. CONTRACT IMPLEMENTATION AND INITIATION ORIENTATION

a.

Implementation

\.... As part of its proposal, Contractor submitted a Gantt chart summarizing key impiementation tasks and
anticipated timeframes for the completion of these tasks.
consultation with the DOC, Contractor developed
a more detailed implementation plan delineating key milestones and associated start and end dates for the
period prior to contract implementation - February 1, 2005. This revised implementation plan is included as
Attachment G of the contract.

rn

Contractor shall meet with DOC representatives weekly to report implementation status, issues and adhererice
to implementation timeframes reflected in Attachment G. The State and;or its designees shall monitor
Contractor's readiness throughout the implementation period, and may issue requests for corrective action
plans, as appropriate, should Contractor fail to meet key milestones that jeopardiZe successful implementation·.
by February 1, 2005.
In the event that Contractor fails to be fully operational by contract implementation, F~bruary 1, 2005,
Contractor may be charged up to $25,000 per day until full operational status has been achieved. On February
1, 2005, the Vermont DOC Administration will notify Contractor in writing of its assessment of operational
status - fully operational or non-compliant. Compliance shall be based upon completion of the key milestones
.in Attachment G, as determined by the VDOC. The DOC shall detail all compliance shortfalls by facility and
. function. Contractor will develop detailed corrective action plans for all non-compfuint facilities and fwlctions
within five calendar days of receipt of the DOC operational assessment letter.

Once the DOC has notified Contractor in writing that full operational status has been achieved, this provision
(and its associated performance guarantee) will no longer be applicable for the remainder of the contract.

- 35-

b. Orientation·
The State will review all proposed policies, procedures and program materials in advance of Contractor's use.
Contractor central officepersolUlel will conduct an orientation program for the State addressing Contractor's
policies, procedures, programs and persolUlel benefits in January 2005. All Contractor employees and at least
one DOC representative will attend this pre-contract initiation orientation program.
Contractor's six (6) Program Managers, Regional Administrator, Medical DireCtor, and Director of Nursing,
will be on-site at the time of contract initiation to assist on-site personnel and ensure the proper
.
implementation of Contractor's programs. Contractor's Quality Improvement Director and Information
Systems Director will be on call and available as needed during the contract initiation period.

C. CONSULTATION
The Program Managers shall provide support, information and assistance to local management persolUlel,
including the Contractor's Medical DireCtor, to facilitate the accomplishment of all contract goals and will meet
regularly with the DOC administrators to discuss health services. and contract issues. The Contractor's
Regional Manager/Director will be responsible for coordinating with representatives of the DOC, especially
facility management staff (e.g., Superintendents, assistants and Supervisors of Security), to implement
programs that provide all inmates with unimpeded access to health care services in a timely manner, and are
conSistent with the requirements of the Settlement Agreement. .
........ The Contractor's Regional Manager/Director will provide the State correctional facilities with. consultation
services upon request. Consultation IDJiY be provided ort a variety of topics, to include: employee health .
programs,construction planning, new facility staffing plans, communicable disease management, inmate feefor-service and inmate copayment programs and iegisJative issues: Consultation will include furnishing the
DOC Health Services Director with copies of all sub-contracted services and a rationale for the selection of
each vendor.

D.MEDlCALRECORDS
a.. General
. Contractor shall maintain a problem~oriented health.record, consistent with State regulations and community
standards of practice. The health record will include medical; dental, chemical dependency, and mental health
care Worniation, and will be stored separately from custody records.
A health ~ecord will be initiated during the inmate's first health care encounter and shall contain complete and
accurate records of health care services provided during the individual's incarceration.
An inmate's health record will be available for reference during health care encounters. Documentalion will be

. in the SOAP format, legible and completed with the date, time and place of the encounter. The health care
provider's signature and title will be recorded for each encounter.
- . Each form and document in the health record shall contain identification information including the inmate's
name, race, sex, date of birth, and the name of the facility presently maintaining the inmate's health record.
- 36-

\",..-111 outside health services, such as laboratory results, or physician conSultation reports, will be filed as part of
each inmate's permanent health care record.
The Contractor must ensure that health records are kept current. Each encounter between a health care
provider and an irtrnate must be documented in the health record by the end of each staff shift to ensure that
the providers coniing onto the next shift are aware of the medical status of any inmate treated during the prior
shift.
Health records for iiunates transferred to other facilities within the State of Vermont must be securely
. transferred to the receiving facility within four (4) hours of the inmates transfer. hunates transferred to out-ofstate facilities must have complete health records physically accompany them on the out-of-state tranfer.
. The health records of discharged inmates will be maintained in accordance with the laws of the State of
Vermont and policies of the DOC. Existing health records will be incorporated into the new health record on .
an inmate's return to the DOC from both the community and from out-of-state facilities.
At a ·minimum, the standardized health care record shall contain the following information:
• identifying information (i.e.. inmate name, date of birth, gender)
• problem list containing medical and mental health diagnoses and treatments as well as known allergies;
.
• completed intake!receiving screening form;
• health assessment form; .
.
.
• progress (SOAP) notes of all significant findirigs, diagnoses, treatments and referrals;
' - . . provider orders;
• . accommodations requested by or offered to inmates with special needs;
• results of screenings and assessments and treatment plans developed to address substanCe abuse and
addiction issues;
• inmate requests for health care services, including illnesses and injuries;
•. medications administration records;
.
• reports of laboratory, radiology and other diagnostic studies;
• informed consent and refusal forms;
• release of information forms;
• place, date and time of health care encounters;
• health provider's name and title;
• hospital reports and discharge stunmaries;.
• intra-system and inter-system transfer stunmaries;
• specialiied treatment plans;
• consultation forms;
• Health Services reports;
• immunization records, if applicable;
• inmate medical grievance forms; .and
• documentation of all medical, dental and mental health care services provided, whether from inside or
outside the facility.

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\.,..,

b. HIPAA Compliance

To comply with standards promulgated under the Health Insurance Portability and Accountability Act of 1996
.(HIPAA); including the Standards for the Privacy of Individually Identifiable Health Information, Contractor
must enter into a Business Associate's Agreement with the DOC (an example of Vermont's template Business
_
..
Associate's Agreementisincluded as Attachment E ) . .
Health records for inmates at ·each facility must be maintained in a secure location consistent with the
confidentiaIity and security needs of the institution. Healthrecords. shall be maintained in aconfidentiaI and
HIPAA-compIiant rnanrier at all times consistent with the Agency of Human Services RuIe #96-23 (Attachment
F). The Contractor must ensure that all health records are kept secure and intact Health records and reports
are, and will remain,·the property of the DOC.
Because PHI.maY,beused or disclosed without authoriiation for specialized government functions, a
correctional institution or a law enforcement official with lawfuI custody of an inmate may have access to PHI
for the health and safety of such individuaL other inmates, officers or other employees at the correctional
institution, or persons responsible for such inmate's transportation or otherwise for the administration and
maintenance of the safety, security, and good order of the correctional inStitution. Information necessary for
the classification, security and control of inmates will be shared with the appropriate Corrections personnel.
In any ciiminaI or, civil litigation where the physical or mental conditicin of an inmate is at issue; Contractor
will provide fuII and unrestridedaccess to and copies of the appropriate health care record to the State within
the scope of legal and regulatory requirements and in accordance with the DOCs policies, procedures and
directives.
'

E. TREATMENT PROTOCOlS
The Contractor shall employ treatment protocols for chronic conditions common among the Vermont inmate
population. The treatment protOcols shouId be designed <md implemented tb ensure appropriate utilization of
clinically prov~ cost effective treatment inodalities. The protocols should be further implemented in a
manner that ensures that treatment is provided in a generally consistent manner for all inmates requiring
medical care for a particuIar condition., The protocols used shouId be consistent with those of national level
organizations that develop. cIinical protocols for their own use and as guides for others, including those
developed by federally-qualified Health Maintenance Organizations. The use of NCCHS clinical guidelines
for chronic disease management in correctional institUtions is also recomni.ended.

F. CONTINUOUS QUALTIY llvfPROVEMENT PROGRAM
Contractor shall implement a continuous quality 'improvement program as set forth by NCCHC standards.
'Contractor's CQI shall address health, environmental and safety issues. The ContractOr shall perform quality
assurance measurements, compile reports, and morutorthe compliance with the CQI program and the
contract. The format of such reports generated for the DOC will be subject to approval by the DOC Health
Services Director.
_All CQI reports will be received within fifteen (15) working days from the close of each month. Failure by the
Contractor to provide such reports within the prescribed time period will result in a penalty of $1,000 per
month for each month that the report is not received. (See "Performance Guarantees"- Chapter 5~ Section Q.)
- 38-

"-n:e

CQI program will be overseen by a QI Committee, which will be chaired by the Contractor's Medical
Drrector. The QI Committee will meet monthly.and will be attended by the nursing staff, dental staff, medical
records staff and Contractor administrative personnel. The QI Committee will review all reports prepared by
.the Contractor for the DOC.
.
.

The multi-disciplinary QI committee is also responsible for monitoring inmate health, the control and
.prevention of communicable diseases, and safety and sanitation in the facility environment. The primary
purpose of the committee is to identify problems and opportunities for improvement, based upon the data
collected in the monitoring process, including from· inrilate grievances. The Contractor shall develop a written
QUality Improvement Manual that includes policies and procedures for all aspects of the QI program. A copy
of the manual shall be approved by the DOC Health Services Director no later than fifteen (15) days prior to
the start of service delivery under this contract. Updates to the manual shall be provided to the DOC Health
Services Dir.ector on a quarterly basis thereafter. The Contractor's QI manual will be used to provide in. service training to its staff.
. .

.

In addition to monthly QI committee meetings, quarterly meetings will be conducted with the DOC central
office through the Executive Health Services Committee (EHSC) to communicate CQI findings and to describe
actions taken to resolve problems that are specific to health care services. The EHSC will include the DOC's
Health Services Director, State Chief Nursing Officer, Contractor's Program Manager, and Contractor's
Medical Director.

The Executive Health Committee will conduct monitoring and evaluating activities to ensure operation of the
"'-'ongoing CQI problem-solving mechanism designed to monitor and improve inmate health. The Executive
Health Committee will conduct mortality and morbidity reviews and special case reviews and will assure
timely communication and resolution of problems as they arise. The Committee may establish work groups to
address specific clinical or systems issues. In addition, all policies and procedures related to the delivery of
health care services .will be reviewed by the Executive Health Committee.
.
The comprehensive CQI shall contain the following components:
•
•
•
•
•

risk management;
infection control;
utilization of services and cost containment;
inmate grievances; and
quality monitoring.

1) RISK MANAGEMENT - Contractor shall establish a logical and thorough system of policies and
procedures to minimize exposure to liability. Risk management activities focus on the identification of
clinical events which have or may have the potential of placing the inmate, health care provider, or the
facility at risk.'Id~tifiedrisk areas are investigated and analyzed to develop policies and procedures that
reduce risk and maintain a safe clinical setting. .The CQI shall inClude a safety component to provide a safe
environment for inmates, employees and visitors. Contractor shall work with DOC officials to establish a
process to systematically monitor and evaluate the envirorunent. The QI committee will work to maintain
a safe environment and reduce the risk of accidental injuries.
.

"- 2) INFECTION CONTROL - Contractor's infection control policies and procedures shall focus on the
prevention, identification and control of diseases acquired in the facility setting or brought in from the
outside community. The infection control program will. address hand washing, housekeeping,
- 39-

decontamination,disinfection and sterilization of equipment andsupplies, medical isolation, infectious
and parasitic laundry, infectious waste, pest control and parasite infected environments. The primary
functions of the infection control program are:
.
•
•
•

the management of communicable disease surveillance and tre~tment;
daily reading of tuberculosis tests;
reporting of communicable diseases ~d conditions (~.g., tuberculosis, sexually transmitted diseases,
~~~

. . .

•
.•
•

collection, evaluation and reporting of epidemiological data for trends;
deVelopment of effective systems for identification, prevention and control of communicable disease;.
ensure adequate community follow-up and coordination ·after inmates are released from the facility;
and ..
•. provide education to inmat~s and Contractor eml'loyeeson communicable diseaSes, including
symptoms, transmission and analysis.·
.
.

.. Contractor's infection control program will emphasize surveillance activities to facilitate the identification,
prevention and control of communicable diseases. Surveillance activities are also usedto identify the
health education needs of all who live and work in the DOC. Contrador's infection control volume data
reporting forms will be designed to facilitate the coll~~tion of data.on a variety of infection control issues,
to include:
.
• inmates testing positive for venereal disease;
• inmates testing positive for HN;
• inmates diagnosed with AIDS;
.• inmates testing positive for TIl; and
• . inmates testing positive for hepatitis.
Contractor shall develop an extensive infection control manua1 and protocols to provide a resource for onsite staff. A copy of the infection control manual will be placed in each nursing area.
3) UTILIZATION OF SERVICES - COST CONTAINMENT - Contractor will establish a utilization review
. program to use of health care resources in a cost-effective manner. Poli<;ies and procedures will be
established to ensure the delivery of health care services in an effective and efficient manner, with an
emphasis placed on the triage process to appropriately channel inmates to health care providers who can
appropriately evaluate and treat the presenting condition.
Contrac.tor personnel shall colle~t.and monitOr statistical data to detect potential problems. Volume data
reporting forms will be used to report data and to track the utilization of health care services onayear-todate basis. Significant variances will be reviewed for problem identification. Contractor's central office
personnel will monitor the utilizatiori of alI health care s~ces provided off-site, as compared to national
data on incarcerated populations, and will be readily available for telephone.consultations. Contractor
shall provide State Administrators with a report identifying those :inmates transferred off-site to the
hospital emergency departinent, and a.status report on all inmates in local hospitals and the DOC'
infirmary. Contractor's volume data reporting forms will also be used to prepare a monthly narrative
report to the DOC Health Services Director.on the types and numbers of services provided, including:
• . intake medical screenings
• health assessments
• inmate requests for service inmates seen at nursing sick call
• inmates seen by the physician
- 40-

•

\- •
•
•

•
•

•
•
•

•
•
•

•

inmates seen by the nurse practitioner
inmates seen by the dentist
inmates seen by the psychiatrist
inmates seen by the psychiatric nurse practitioner
infirmary admissions, patient days, average length of stay
off-site hospital admissions
medical specialty consultation referrals
diagnpstic studies
percentage of inmates on medications
inmate mortality
health care services manpower report, hours worked at each post
problemS identified and actions taken or pIanned, with timeframes to resolve them,
number and type of employee grievances by facility

Each mortth Contractor shall provide the State Administrators with a report on the costs accrued and/or
paid for all outside and.off-site treatment for each affected inmate. In addition, a cumulative total costwill
also. be provided for the contract term.
'

'-

ContractOr shall use on-site pre-admission testing prior to hospital admission, second opinions for all
planned major surgery, and capitation or hourly type subcontracts with medical specialty providers. With
the exception of life threatening emergencies, all hospitalizations will be pre-authorized and accompanied
by concurrent review designed to minimize the necessary length of stay in the hospital. Contractor shall
assure that the Medical Director or designee may interrupt this process should it become necessary, to treat
an inmate in a more emergent fashion. Retrospective reviews will also be c~rripleted.

4) ISSUE RESOLUTION AND GRIEVANCE PROCESS - When inmates believe they have not received a level
or type of health care to which they are otherwise entitled, theyshall'have access to aresolution process
which will expedite answers to their questions and additional care as determined. The Contractor shall
have policies and procedures for a formal process to respond to these inmate is,sues. The'contractorshall
ensure that all inmates have access to this process in writing and that they understand it. In cases where a
disability may limit an inmate's understanding of the process, accpmmodations will,be provided. A
standardized form shall be used for the filing of inmate issues, unless disability accommodations require
other means. Inmates may request, and must be provided assistance, in completing the form.
The Departmentwill develop an Ombudsman program(separate from the Contractor's issue resolutiQn
process) to ensure the inmates, their families, and advocacy organizations in the community have access to
an individuBI who can assist them in the resolution of inmate complaints about their health care. The
Contractor shall cooperate with the Ombudsman in resolving grievances andother issues. This program is
not seen as a replacing or pre-empting the DOCs grievance process 'as relates to hearth care complaints.
The Contractor shall propose an issue resolution process 'that at a minimUm:
•
•
•

includes policies and procedures that are consistent with the Departmenfs policies and procedures;
coordirtates with DOC's Ombudsman program; and
ensUres the Nurse Manager for each facility is available at least once weekly to meet with the
Ombudsman and inmates.

The Nurse Manager shall be the initial arbiter of all issues and shall work with inmates to resolve
complaints and issues. The Nurse Manager shall have an excellent working relationship with the
·41 "

Ombudsman, who will act as a mediator between the inmate and the Contractor to resolve issues and
grievances.
All issues received by the Contractor must be entered into an automated issue log. The log must include at
a minimum:
•
•
•
•
•
•

the date the issue was filed;
the name and identification number of the inmate filing the issue;
the nature of the issue;
.
the categorization of the issue (routine or urgent);
any investigation conducted by the ContraCtor; and
the resolution ofthe issue and date of resolution..

Inmates may file a: formal grievance with the DOC at any time. All routine and urgent grievances will be
resolved by the DOC in accordance with its policies and procedures. Urgent grievances .are defined as
· those complaints that involve an immediate need on the part of the inmate for health care services to
prevent permanent disability or loss of bodily functions, or for severe pain. Urgent grievances shall be
resolved in consultation with the Contractors Medical Director or his/her designee.
The inmate will be notified in writing of the resolution of the grievance in accordance with DOC policies
and procedures.
.
The Contractormtist provide mo~thly reports to the. DOC on the number, categorization (routine or
urgent), type and disposition of all issues it receives from inmates; and provide Facility Superintendents
on~going access to the automated issues log.
.
5) QUALITY MONITORING ~ Contractor's unit based CQI will monitor, evaluate and improve health care
· services delivery. It will also provide its data, data analyses, and performance improvement plans to the
Vermont Department of Health for use in its independent DOC Quality Assurance/Improvement process.
· Contractor has developed monitoring tools designed to meet the specific needs of the DOC. The
monitoring tools address the following areas:
•

Special inmate events which warrant further evaluation based on the potential of a serious outcome.
.The review of special inmate events focusesort both health care managementand continuity of care.

•

Health care records review, with special attention given to discharge summaries, laboratory and
diagnostic tests, the·appropriate use of protocols, processing of medical records, medical record
retentiOn processes and compliance with national standards.

•

Physician record reviews performed on a specified number of randomly selected medical records by a
. physiciari to review the treatment being provided, determine if it is appropriate, and make changes in
the individualized treatment plan. A summary of the medical record reviews will be presented each
month to the CQI coinmittee by the Medical Diiector.

•

Focused studies performed to monitor specific areas of concern for the purpose of problem
identification in a variety of functional areas such as medication reviews, contract services and chronic
management, including:
.
chest pain
consultations
dental services
- 42-

.

\

EKG
history and physicals
intake screening
medical record
medication adminiStration
mortality review
. patient education
suicide precautions

G. INTERFACE WITH DOC'S MENTAL HEALTHSERVICES PROVIDER
The Contractor shall establish procedures to ensure an ongoirig active interface with the DOCs
mental health provider system. The COntractor slu!ll designate a liaison to work with mental health providers
in establishing.routine and emergency lines of communication and developing procedures to ensure that
ongoing coordination ot services occurs. The purpose of the interface between the parties.is to ensure
coordination of care occurs for inmates bemg treated for both physical and mental health problems. The
. Contractor shall establish treatment teams in conjunction with the mental health providers as appropriate and
necessary to ensure an efficient and effective level of care coordination.
.
a. Alcohol and Substance Abuse Services
Inni.ates admitted to the DOC under the influence of drugs and/or alcohol and those with significant histories
"- related to the use of drugs and alcoholwill be referred for further substance abuse counseling. The counseling
.
will be used to evaluate the inmate and determine the l)eed for substance abuse counseling and treatment.
This process shall include protocols that involve the DOC Mental Health Provider in inmate evaluation a+>d, if
necessary, treatment plan development. Contractor shall assist in discharge planning in anticipation of release
from the DOC.
b. Detoxification
Incapacitated persons brought to a correctional facility pursuant to 33 V.SA Section 708 (d)(1) & (2) shall be
sqeened by medical staff.. Treatment related to their detoxification shall be provided by the Contractor
according to protocols agreed upon by the Contractor and the State. Detoxification treatments shall include the
DOC Mental Health Provider in itlmate evaluation and, if necessary, treatment plan development. Individuals
committed Under the influence of alcohol or drugs will be kept under close observation. The nursing staff will
uiilize established nursing. protocols to monitor intoxicated individUals durmg the detoXification period. If the
individual indica.tesa history or exhibits signs of an intense detoxification period, a physician will evaluate the
inmate to determine wheihei- hospitalization for evaluation and treatment is appropriate.
.
c.

Mental Health Services

The DOC s contractual and State mental health care providers shall provide all services related to the mental
health needs of iruruites; including assessment, diagnosis and treatment. Contractor shall support these
activities as agreed upon with the State and refer inmates to mental health care providers as necessary.
Contractor shall work collaboratively and cooperatively with these providers to ensure open liries of
"- communication and comprehensive care for inmates receiving medical and mental health care services. The
Contractor's Medical Director and the DOC Mental Health Provider's Psychiatric Director shall ensure that
inmates are not referred for mental health treatment in lieu of needed and appropruite medical services.
- 43-

Weekly meetings shall be held to discuss treatment plans in cases involving both 1;he Contractor and DOC
\....Mental Health Provider. Meeting minutes documenting all discussion and decisions shall be sent to the
Executive Health Committee. Any unresolved disagreements over the appropriate course of treatment for an
.inmate shall be forwarded to the Executive Health Committee for final determination.
d. Crisis hitervention and Suicide Prevention
Contractor shall assist the DOC Mental Health Provider in providing training for the correctional and health
care services staff in the identification of signs aild symptoms 'of suicidal behavior. Contractor shall participate
in the continued development and implementation of suicide prevention programs with the DOC Mental
Health Provider.
.
When an inmate is suspected of being at risk of harm to himself/herself; Contractor shall (1) contact the DOC
Mental Health Provider or other designated provider, (2) coordinate with the State for the close observation of
. the inmate for suicidal behavior until a mental health care provider is able to assess the inmate's mental health
status, and (3) assist other personnel in safety~relatedactivities. Contractor shall document all relevant
information and interactions with suicidal inmates and include relevant information in the inmate's medical .
chart.

H. DISASTER MANAGEMENT
Contractor shall work in conjunction with the DOC to develop a health care disaster plan for each facility and
'-- to ensure that the toles of Contractor staff are clearly understood in disaster situations. The health care
services disaster plan will be coordinated with the facility's disaster plan to provide an effective and effective
and efficient response to all disaster situations. ·.Contractor personnel will work cooperatively with State
correctional facility personnel to establish evacuation and disaster policies and procedures specifically for the
DOC. The facilitycspecific policies and procedures will be used for in-service training.
.'

1. MANAGEMENfINFORMATION SYSTEM
Within thirty (30) days of commencement of the contract, Contractor shall evaluate the system in use by the
DOC. Contractor will report to the DOC whether historiCal data maintained on the current system must be
converted to be used by Contractor. If ne:cessary, data conversion of all existing files. must be completed
within seven (7) days of contract commencement, imd within twenty-four (24) hours for the seven (7) day
period before contract commencement.
The principal data collection tool is the patient encounter log. Specified inmate encounters are recorded in the
logon a daily basis, including:
•
•
•
•
•

patient scheduling
chronic tracking and follow-up
infectious inmate follow-up
statistical workload summary
input for clinical quality improvement

-44 -

"-- \dditional data required under this contract include:
•
•
•
•
•
•
•
•

monthly volume and types of services
utilization review (input to the review committee) .
comparison with prior periods and target work load plans
pharmacy dispensing and utilization
.
.
manpower utilization data system
clinical CQI
diagnostic aggregate data
issue/complaint log data

Data collection from each site and compilation for the region will be supervis~d by the Program Manager..
. .Monthly summary reports will be generated and made available for discussion at each QI Committee meeting.
Significant variations will be investigated and discussed by the committee, with the ·goal of modifYing
utilization trends to identifY problems at an early stage.
Any enhancement by the Contractor.of itS corporate management information systems shall be made available
to the State within six (6) months of implementation at any correctional facilities operated by the Contractor.
Any software purchased specifically for operations within the State, along with all historical data IDes shall
remain the property of the State. In the event that the Contractor ceases operations under this contract,
software, martagement information systems, and data files used in the daily management of the program shall
remain available and accessible to the State for a period notto exceed six (6) months.

'--J.

PURCHASING PROCEDURES

Contractor shall assume total responsibility for purchasing all perishable and non-perishable medical and
pharmaceutical supplies. Every effort will be made to purchase medical supplies from Vermont vendors. The
individual authorized to conduct Contractor's contracted purchasing program shall be the assigned Program
Manager. The Program Manager shall act as the day-to-day liaison between the DOC· and Contractor
regarding purchasing issues.

K INSURANCE
Refer to Attachment C, Section 6 and Attachment D.

1. ACCREDITATION PLAN
The Contractor's accreditation plan must include the following elements:
•

Contractor shall survey and assess the NCCHC accreditation potential of any non-accredited sites (or new
sites) within ninety (90) days.of commencement of the contract (or new site)

•

Non-accredited sites must receive at least provisional accreditation within eight (8) months of
commencement of the contract (or opening of a new site)
.

'-0

Contractor shall maintain accreditationJor all accredited sites

- 45-

~ontractor's Regional Manager/Director (or designee) will collaborate with the Contractor's Program
anager, Medical Director, Director of Nursing, and DOC administrators to ensure that all policies,
procedures and programs are in compliance with the most current NCCHC standards for health care services
in jails and prisons. In addition, the Regional Manager/Director (or designee) will perform on-site
.accreditation reviews periodically throughout the contract to ensure contirluedstandards compliance. The
Regional Manager/DIrector (or designee) will instruct the State staff in the proper use of the evaluation tool.
The evaluation tool will be used when establishing or revising policies and procedures, to ensure continued
compliance with NCCHCstandards. Contractor will establish and implement a corrective action plan with
specific completion dates and benchmarks for any discrepancies or shortcomings regarding standards·
compjiance..The corrective action plan and all necessary ddcutneAtation will be submitted to the State for
review.
If the parties agtee that subsequent changes in the NCCHC standards have significant cost implications, the

parties reserve the right to .arnend the contract.

M. OTHER OPERATIONAL AND FINANCIAL DATA REPORTING
Contractor must submit a seri~s of operational and financial reports, using report formats and transmission
methods as defined in collaboration with the State. All ilnmial reporting shall be according to the State's Fiscal·
Year aWy 1 to June 30). Most annual and quarterly reports are due from the Contractor and any
~ubcontractorsto the DOC within forty-five (45) days after the end of each reporting period. Facilitycspecific
,,-",perational and financial reports must be submitted, as well as an aggregated report for the entire system.
The State reserves the right to request additional or differentreporting infonna.tion from the Contractor
throughout the term of the contract, on either an ad hoc or regular basis.
. The DOC and the Vermont Department of Health will conduct sCheduled and unscheduled contract audits to
verify and validate the delivery of services provided by the Contractor. These audits will be s4leduled atleast
one week in advance. The Contractor shall make available detailed personnel records, attendance data, staff
vacancy reports ·and other relevant information as requIred by the·audit team.
a. Operational Reports
Contractor shall prepare the following operational reports, using State-approved templates~ These reports are
due by the fifteenth (15th) of each month for the previous month:·
.
Monthly

•

Contractor Operational Variance Reports - Contractor shall compile a comparison by facility (as well as a
sunimary report of all facilities) of projected versus actual units of services provided, by service type. For
all variances greater than ten (10) percent, an explanation of the negative or positive variance must
accompany the report. The following are required in the variance reports:
Number of receIving screeningS, initial imd annual history and physical examinations, and initial
dental screenings processed m. the period.
.. .
.
Number of units of other health care services rendered by major category of service (e.g., inpatient
hospital days, outpatient hospital procedures, infirmary days, primary care provider encounters,
-46 -

specialist physician encoimters, surgical procedures, pharmaceutical prescriptions dispensed and
dental procedures) during the period.·
. ,

•

Service Disposition/Lag Reports - Contractor shall report on the:
- N~ber of sick call requests received, the number of requests not requiring a health care encounter or
derued, and the number of days from an inmate's initial sick call request imtil a health care encounter
occurs.

• ~te Complaints(Grie:~ces -Summary of inmate complaints/grievances by

category (urgent or
. routine), type and dispOSition. Data shall also be provided to DOC to enable it to determine if inmate
.. . .
grievances were resolved timely.

Quarterly

•
•

QI Reports.- As described in the preceding section.
External Physician Referral Reports - The number of referrals to outside physician providers by major
specialty (cardiologist, pulmonology, gastroenterology, gynecology, neurology, nephrology, oncology and
hematology, ophthalmology, urology, general surgeons, specialty surgeons, infectious diseases,
orthopedics, rheumatology, endocrinology, and other) with associated diagnoses will be tracked and
reported by the Contractor. Included in the report, will be the number of days from initial referral to an
external provider until the encounter occurs.
External Facility/ Other Providers Reports -. The numbe~ of referrals to outside facility/other providers by
type (hospitals, outpatient surgery centers, others) with associated dia:gnoses will be tracked and reported
by' the Contractor. Included in the report, will be the number of days from initial referral to an external
provider for a specific clinicalservice to the date the serVice is provided.
.

•

Dental Utilization Reports - The number of dental encounters by type (emergency, routine) and facility, as
well as the number of irunates on the dental service waiting list within each facility. Included in the report
will be the number of days from initial referral for a specific dental service to the time that the dental
service is rendered.

•

Inmate Patient Demographic Profile Report - A summary of inmate demographics under treatment (age,
sex, race, etc.), along with the healthcare services delivered will be reported. Iricluded in this report will be
data specific to the chronic and convalescent populations, and the number of special needs/chronic
treatment plans developed. .
..

•

Infirmary Admissions Reports - Number of infirmary admissions and days by diagnosis.

•

Food Service Worker Oearance Reports - Number 6f inmate food service worker medical clearances
performed..

•

Staff Vaccinations Reports - Number of staff vaccinations provided by type.
b. Financial Reporting

The Contractor will submit quarterly and annual financial statements, using state-furnished templates, which
'-- 3pecifically report the Contractor's performance under its contract with the Department. The statements will
be prepared in accordance with generally accepted accounting procedures. In addition to the contract specific
financial statements, the Contractor will also submit the entire
organization's quarterly and annual
.
. financial
-47 -

statements. Quarterly reports are due forty-five (45) days after quarter end close. Final annual financial
vtatements are due ninety (90) days after the close of the contract period.

:m- :n

ee onths prior to the en.d of the contract term, the Contractor shall submit the next year's annual budget,
mcluding case load and servlce volume,assumptions, annual cash plan and profit andloss statementto the
State for review and approval for the following contract year.

, N. CLAIMS PROCESSING
The Contractor must have a claims processing system that can accurately adjudicate all types of provider
claims, incltlding hospitals, physicians, ancillary providers, etc.
,Oean claims inust be processed (reimbursed; denied or responded to) within thirty (30) days of receipt. The
Contractor must have in place a process for specifying missing information when provider claims are denied
due to incomplete status. All claim denWs must include detailed information on the reasOns for the denial
and the providers right to appeal.
Failure to promptly reconcile and pay clean hospitaljcommunity-based provider claims within thirty (30) days
of the Contractor's receipt of the claim may be grounds for financial penalties (see Chapter 5, Section Q)
and/ Or contract termination. All provider claims thirty (30) days or more in arrears shall be reported to the
DOC as a part of the Contractor's monthly quality improvement reporting.
'
,-PharmaCy claims may be processed by the Contractor's pharmacy vendor.

O. INMATE TRANSFERS BETWEEN VERMONTDOC FACILITIESAND Om-OF-STATE FAOLITIFS
a. Transfers between V ermont DOC Facilities
The protocol for preparation'of clinical information for inmate transfers between Vermont DOC facilities
includes:
•

Preparation of the medical record inserted into a plain brown folder placed in a sealed envelope with the
inmate's name and the phrase "CONFIDENTIAL - MEDICAL/ MENTAL HEALTH INFORMATION",

•

A supply of all prescription medications ranging from one (1) to seven (7) days or whatever quantity
remains on the inmate's prescription card

These materials are to be provided by the sending facility to the DOC transport team at the time of the
inmate's transfer.
'
b. Transfers OUt-Of-State
The' protocol for preparation of clinical information for inmate transfers between the Vermont DOC and
another state's facility includes:
'
.......

Assembly of ~,photo-copyof the medical and mental health records which include all records for a
minimum of one (1) year from the data of the out-of-state (OOS) medical clearance (i.e., a medical clearance
date of 10/25/04 will iriclude all medical and mental health records from 10/25/03). Diagnostic and
- 48-

laboratory results for up to five (5) years are also to be sent with the health records. The following health
care record documents must be included:
.
-

problem list
currenthistory and physical
all information related to conditions currently under treatment .
relevant labs and data
chrortic carecIinic notes and notes relating to specific conditions
copy of immunization record
IB test results writing in millimeter
mental health care information includingmental health evaluation, treatment plan, and notes related to
any ongoing clinical care

•

Contractor shall retain the original health care record documents, but make a copy to be inserted into a
plain brown folder placed in a sealed envelope with the inmate's name and the phrase "CONFIDENTIALMEDICAL/MENTAL HEALTH INFORMATION." The records designated for 005 will be organized in a
multi-part medical chart folder by the "sending facility" (a sending facility is defined as the Vermont DOC
facility where the inrriate was lodged at the lime the medical clearance was performed.) Each Vermont
DOC facility health center that performs OOS transfers will be provided with such folders· (available for reorder from the DOC Central O f f i c e ) . ·
.
.

•

The photocopied medical record assembled into the folder must physically accompany the inmate upon his .
transfer out-of-state.. Out-of-state health records will be logged out to the 005 transport agency using a
chain of custody form that will be completed at the staging facility by the NUl'se Manager or his/her
designee.

"-•

.A supply of alI prescription medications ranging from four (4) to seven (7) days, depending upon the
State's agreement with the receiving State's facility.

P. MORTALITY REVIEWS
The Contractor shall coordinate with the State in the acquisition and submission of all relevant information
concerning the death of any inmate within ten (10) working days of the death, unless extenuating
circumstances require law enforcement investigation. This shall include preparation of mortality reviews and
other requirements mandated by NCCHC standards, state policies, and state and federallaws. Should a law
enforcement investigation be required, the DOC shall extend the Iimeframe for completion of the mortality
review, notifying Contractor of the revised mortality review due dilte. Failure to meet these mandates may
result in a penalty of up to $5,000.

Q. PERFORMANCE GUARANTEES

All medical services shall be delivered in compliance with standards set forth by the NCCHe. Atsuch time as
these standards are updated, itis understood the standards promulgated under these performance guarantees
will be adjusted to ensure that Vermont DOC facilities remain in compIiance with NCCHC standards, and
retain NCCHC accreditation.
,-:ontractcir is obliged to self-report all performance shortfalls that would trigger a penaIty~ Reports are due to
the DOC within five (5) business days after month-end close. Contractor may send a formal request to the .
DOC requesting that a penalty be reconsidered or reduced due to extenuating circumstances. Should
- 49·

Con~actor choose to,submit such a request, the DOC will render a decision within five (5) business days of
' - receIpt of Contractor s request.
. ' .
. '.
At the discretion of the Vermont DOC, performance guarantee penalties may be waived. Should the DOC
elect to waive a penalty, such waiver does n9t preclude the DOC from exercising its rights to enforce a penalty .
in the future..
a. NCCHC Accreditation
Contractor is required to maintain NCCHC accreditation for every current and future facility in the State
system. If certification accreditation by the NCCHC is lost at any time; a $500 penalty per dayI per nOn- .
accredited facility will be assessed against the vendor until the non-accredited facility(ies) receives either a
provisional accreditation or is fully accredited. lithe NCCHC issues a provisional accreditation, the $500 per
dayI per facility will be waived up to one hundred and eighty (180) days. The beginning and ending dates of
the penalty will be goverrted by any written commUnication from the NCCHe. Any date within any calendar
month will serve as the beginning and end dates and each inclusive month of non-accreditation will be
aSsessed the penalty.
.
It is understood that the SouthemState Correctional Facility is newly-opened arid has not been accredited to
date. The Parties shall develop a plan for the accreditation by NCCHC of this site no later than eight (8)
months following the commencement of the contract.
b. Access to Dental Services
.' -Failure by the Contractor to meet dental hourly requirements or to adequately control the size of the waiting
list for dental services may result in a financial penalty up to $1,000 per.occurrence. The size of the penalty
will be determined based on the extent to which the Contractor has failed to maintain adequate service
accessibility, and will be the subject of contract negotiation. The Contractor shall provide access to dental
services according to the following standards:
•
•

urgent care: within 24 hours; and
routine care: within 28 calendar days of .the sick call request.

Inmates with dental emergE;mcies (i.e. facial fractures, uricontrolled bleeding, and infections not responsive to
.antibiotics) shallreceive immediate medical care, which may include emergency transportation to a hospital,
outpatient or inpatient facility.

c. .Operational and Financial Reports
Failure by the 'Contractor to provide required operational and financial reports within prescribed time periods
may result in a penalty of $1,000 per report per month for each month that any report is not received timely.
The DOC, at its sole discretion, may permit additional time for the submissionof required reports under
extenuating circumstances beyond the Contractor's control.
.

d. Pharmaceutical Drug Availability
Failure to provide prescription drugs to iiunates in accordance with contract standards will resultin a penalty.
"'-- For purposes of this performance guarantee,the following standards shall be applied:
- 50-

.~going treatment plans - Within two (2) hours of the date and time the medication is scheduled to be
........
dispensed;
.
.
.
• . Newly ordered prescriptions - Within forty-eight (48) hours from Monday through Friday, and within
seventyctwo (72) hours from Saturday through Sunday of a provider's non-"stat" order; and
• . "Stat" order - Contractor shall provide"stat" orders within one (1) hour of rec~ipt of a "staf' order.
Failure to provide DOC inmates with medications based on the above time-standards will result ina penalty
of $1,000 per occurrence. The Contractor shall report each instance of non-eompliance as a part of its monthly
CQI reporting.
. e. Staffing Standards and Coverage
It shall be the Contractor's final responsibility to fill all posts in accordance with the staffing standards and
coverage schedules per the Staffing Matrix (Attachment H); exclusive of posts filled by State employees.
Failure by the Contractor to fill these posts with permanent employees within thirty (30) days after a post has
become vacant (as scheduled in'the Staffing Matrix), may result in a penalty 'as follows:
• Registered Nurses, Licensed Practical Nurses, Licensed Nur"mg Assistants, Nurses Aide, Dental Assistant,
and Medical Secretary/Administrative Assistant- $250 for each day or part thereof that the post is not
filled.
'
• Physicians, Physician Assistant, Nurse Practitioner; Dentist, Program Manager and Regional Director '$500 for each day or part thereof that the post is not filled.
Contractor is expected to provide interim per diem staffing of health professionals trained to provide health
,ervices within a correctional setting fOr all health services-related positions vacant beyond one (1) week due
"-to illness, disability, disciplinary actions; and/ or staff departures; Failure by the Contractor to fill these posts
with per diem employees may. result in a penalty of $500 for each day that the post is not filled.
Contractor must also ensure that no shift is left uncovered. Attachment:K - Staffing Coverage Standards
reflects the minimum staffing required by facility, by shift, by type of clinical staff for Contractor to avoid a
penalty under this provision. Contractor may, at its discretion and cost, fill clinical positions within higher
practice level professionals without penalty." Clinical staff cannot be asked to, operate outside of their scope of
practice to cover a shift. Failure by the Contractor to cover a shift will result in a periaIty of $1,000 for each
uncovered shift.
f.

Sick Call Timeliness

Contractor shall provide ~ick call services, in compliance with NCcHC standards, to allow the health care staff
,to provide same-day response to urgerit irimate requests for health care services. Contractor will be charged
$50 per each sick call request ontstandingfor more than forty-eight (48) hours of the requestduring a week day
(Monday through Friday) Contractor shall make a good faith effort to meet the forty-eight (48) hour standard
from Saturday to Sunday, but consistent with the NCCHC standards· for sick call response times, Contractor
will be held to a maximum
of seventy-two (72)
hours.
from Saturday to Sunday
.
.
. before a penaltY will be taken.
g. ImplementationPlan
In the event that Contractor fBiIs to be fully operational by February 1, 2005, Contractor may be charged up to
'125,000 per day until full operational status has been achieved. The siZe of the penalty shall be proportionate
'-to Contractors shortfall In operational readiness. On February 1, 2005, the Vermont DOC Administration will
notify Contractor in writing of its assessment of operational status - fully operational or non-compliant.
- 51 -

Compliance shall be based upon completion of the key milestones in Attac1unent G, as determined by the

~Oc. The DOC shall detail all compliance shortfalls by facility and function. Contractor will develop

detailed corrective action plans for all non-compliant facilities and functions within five calendar days of DOC
. operational assessment letter.
. .
Once the DOC has notified Contractor in writing that full operational status has been achieved, this
performance guarantee will not longer be applied throughout the remainder of the contract period.
h. HospitaJICommuitity Provider Clean Claims Payment
All payments to hospitals and other community providers should be made within thirty (30) 4ays of the
Contractor's receipt of a clean claim. Failure to promptly reconcile and pay hospital/community provider·
claims shall be grounds for penalties or contract termination. All clean claims thirty (30) days or more in
arrears shall be ·reported to the DOC as a part of the Contractor's monthly quality improvement reporting, and
may be assessed twenty (20) percent of .the gross claim amount.
i.

Access to Specialty Services

Under no circumstances shall Contractor limit or delay access to specialty services for inmates identified as
requiring this care.. If the DOC believes that the Contractor is not providing specialty services in a timely
fashion, the DOC's Health Services Director and the Contractor's Medical Director shall review and resolve all
disputes. Should the resolution find in favor of the inmate's need for specialty services, the DOC Health
.Services Director and Contractor's Medical Director shall also agree upon a target date when services will
' - :ornmence.. Failure by Contractor to provide access to these services on the target date may result in a penalty
of $1,000 per day for every day after the target date until services commence. Fallure to reach a resolution may
result in a penalty of $5,000 per incident, and ultimately may be grounds for termination.

j.

Mortality Review. Timeliness

The Contractor shall coordinate with the State in the acquisition and submission of all relevant information
concerning the death of any inmate within ten (10) working days of the dea~ unless extenuating
circumstances require law enforcement investigation. This shall include preparation ofmortality reviews and
other requirements mandated by NCCHC standards, state policies, and state and federal laws. Should a law
enforcement investigation be required, the DOC shall extend the timeframe for completion of the mortality
review, notifying Contractor of the revised mortality review due date, Should Contractor fail to acquire and
submit information before or on the due ·date, or meet NCCHC standards, state policies, state and federal laws .
governing mortality reviews, a penalty of up to $5,000 per occurrence may be taken.

- 52-

ATTACHMENT B
CONTRACT FOR SERVICES
PAYMENT PROVISIONS

Contractor agrees to invoke the State for ~ervices no less frequently than monthly. The Contractor agrees to
render an invoice· to the State by fifteen (15) days following the last day of the month in which the service was
provided. The State will not be liable for payments for any service invoiced after the IS-day limit;
Upon the Contractor's successful performance of the terms set foith in Attachment A, the State agrees to pay
the Contractor according to the procedures described below. .
.
.

.

.

.

.' The Contractor will sublnit two monthly invoices: one for the base se.rvices and one for additioriaI monthly
Charges for mental health medications, Hepatitis B and Diphtheria/Tetanus immunizations and tuberculosis .
testing services for DOC staff, as well incremental charges for the assessment and observation of .'
incapacitated persons.

as

1) .BaB~ Payment

!~-;ii;;;:~:.-:~}K---(~~::r.~--JjI~~~;;01':[:'i'~2~~1~;~~;;~(i:-~~;~r_.3~i~

.'1,' .' .. ~"_.r~O)I .l".\:, it,;

~;. :::'~ "' ;·i:;~~Jll~ /IL ~.,:;,:. _,"I:,.

;

~.c'QJ',I['JJol'cl~> .l::.-2:}~.:JZ.!.}J~~ ,1 ",11 f/: . ..I.~i~r~~' .(,t..L' ~~,"L-::;~""

1,645 .

$ 8,903,244

$ 787,590

.1,645

$ 9,451,075

.$ 839,206

1,645

$ 10,070,474

2/1/05 -1/31/06

$ 451.03

. $ '741,937

2/1/06 -1/31/07

$478.78

2/1/07 -1/31/08

$ 510..16

The Contractor shall submit an invoice the first day of the month for services provided in the previous month.
Resolution of any issues regarding the ADP uSed for a base month payment shall be addressed, and reconciled
in the following month. The State $hall reimburse the Contractor within thirty (30) days of receipt of the
Contractor's invoice. The State shall discuss all deductions and performance penalties with the Contractor in
advance of payinent. If the State does not pay the invoice within thirty (30) days of receipt, it will pay the .
Contractor an additional 1.5 percentper month of the invoiced amount for late charges.
a. PrepaymentjPerformance Guarantee

Contractor has proposed two· options for reducing service d~very costs: (1) prepayment of base monthly fee
at the beginning of each month, and (2) the use of a Performance Guarantee in place of a traditional
performance bond. Should the DOC elect one or both options, the proposed reduction in cost is shown in the
following table:

- 53-

-

---

--

-

----

-

-

-

-~-

•

I

I

l

J

:

I

(

.

p repayment,

.' ___"

Performance
Guarantee

•~

t

•

J r

'_

J

,
,

~

1-

"~_

.

:

$

70,562

$

72,679

$

74/859

$

23A46

$ . 24,889

$

26,520.'

2) Additional Monthly charges
Additional monthly charg~s are invoiced separately from services included in the base payment The
Contractor shall submit an invoice the tenth day of the month for services provided in the previous month.
The additional monthly charges for mcidental adjustment services shall adhere to the following schedule by ,
service.
~j\..r'.J:;:>'{c: '';'-G'\:- t(:·0.1;F-~~~f>·Ji~:~";;~/p'y.:;"'·"JT"·!~:~:._;;:.;:;f;: .:;";~;'~~' 'l:F .~:':.~:"'I~ ·r':'-":7'·~ ,: -" -;", ;:":"":
k~·~).',·11.!\<trt;j~i'~\1;0,oJ,"Y' ..r''l-:?;:W-'#'~·\';;'':-·'lf:·f\!,·.·t·
.'··· ..Ii -'<:~7:"" ;·r:f.l,~·t, .. :C ,f,· .l·I,
,(":Y.-ff'~ .:. 1,
... ' J....
..;,;~

..'

.,

'

....

",'~

I

~ ... -

,'"

"'~r"

~'

L"

'.-"~

Uf~ ;;: :i:'c' rH:'i'i~{H(~i'r'! p·H~~,~~\~_'Y;r$:'~}l·$'r4ij[l0}4.~J/l£l'B~:

. Mental. Health

':-'~~ ~ ~::_

,~~l'"':;~

;"'J

.....

,....

...,

IL

.',

I

l'

-

;i)c'{··~':·!t'·{t·191·Wp;re)J~'k;-;'~f· ,;' " '?O;J[~'/£:WLj~J'f.·,

~~'''=: ~'~L~~~~: ~~-.~r0~~~i:ij~;~~·.~&::,"--2~~~~,"'::j_2:~~~.~~~~~(,~~~~.r&;

Medicationss(including
those mentioned in Att,
A; Section W, Subpart c)
Hepatitis B Vacoine6
Diphtheriaffetanus
Vaccine
TB Testing
Incapacitated Persons
Assessment an97
Observation

\..

c'

,$

,

Z40,OOO,00

$ 270,000.00

$ 300,000.00

$

69.00

$

75.21

$

81.98

$

. 1.00

$

1.09

$'

1.19

$

10.00

$

10.90

$

11.88

$

27.30

$

28.66

$

30.09

The State shall reinlburs~ the Contractor following a reconciliation for cost of services provided arid any
applicable adjust:tn.ents to the invoice. The reconciliation shall include:
.
•

Deductions for performance penalties - Contractor shall report any deficiencies or. occurrences that might
result in a penalty provided for in this contTact's performance guarantees. ' The State shall independently
evaluate ContTactor',s service delivery for any deficiencies or occurrences that might result in a penalty.

5 Amount is the maximum annual budgeted amount. Any amounts over this maximum will be directly paid
by VDOC. Components covered under Mental Health Medications to be reimbursed include: acquisition costs
as. well as back-up pharmacy expenses, courier service and dispensing fees..
, 6 Contractor's price per Hepatitis B shot ($23.00 in Year 1) multiplied by thIee, the reqUired number of shots to
achieve full immunization.
., This amount mcludes a $5,000 annual aggregate offsite cap~ Any offsi~ savings under this $5,000 annual cap
. ~ be refunded to VDOC. Any offsite expense in excess of the annual aggregate cap will be the financial
responsibility ofVDOC.

- 54 ~

•

Any deficiencies in performance may result in payme~t reductions as delineated in Chapter Five, Section Q
- Performance Guarantees. The State shall discuss all proposed performance penalties with the Contractor
in advance of invoice payment.
'

•

Chan~es in VHAP Policy - PHS' price proposal incorporated projected VHAP program payment of certain
mpatient expenses currently covered under the program. In the event of a change in federal and!or state
poli~ and inmate participation in the VHAP program is substantially altered, the Parties will agree to
negotiate a contract amendment responding to the changing fiscal environment.

All adjustments wiI1be fully documented and discussed with Contractor prior to the issuance of an adjusted
payment by the State.
,
"
'
3) Miscellaneous Provisions
It is understood and agreed that Contractor's proposal was based on utilization data furnished by DOC and
the current community standards of care applicable to providing health care services to the incarcerated
population. In the event, over the term of the agreement, there are any changes in the'standards of care or in
the conditions-related representations by the DOC, Contractor shall be entitled to request an amendment.
Contractor's cost proposal is predicated upon the DOC providing mental health care services. Should the
DOC fail to provide these 'services, Contractor shall seek an amendment to the contract.
Change in Standard of Care or Scope of Services: The price in this contract reflects,the scope of services as
mtlined herein, and the current community standard of care with regard to healthcare services. Should there
'-De any change in or modification of inmate distribution, standards 6f care (e.g., changes in HIV/ AIDS therapy,
Hepatitis B therapy, etc.), scope of services, or available workforce pool that results in material costs to the
Contractor, the costs related to such changes or modifications are not covered in this contract, and shall be
negotiated with the State. If the parties are unable to reach a mutual agreement on these costs within thirty
(30) days from either party's request to negotiate, either party may terminate this contract by providing the
other party with ninety (90) days written notification thereof.
Force MajeUre: Neither the State nor the Contractor shall be held responsible for any delay or failure In
performance (other than payment obligations) to the extent that such delay or failure in performance is caused
by fire, flood, hurricane, explosion, 'war, strike, labor action, terrorism, embargo, governmental regulation, riot,
civil or military authority, acts of God, acts or omissions of carriers'or other similar causes beyond their
control.
Additionally, it is hereby agreed and understood that this contract has no minimum amount. The Contractors' services
will be required on an "as needed"
. basis.
,

,

4) Contractor shall submit all invoices to,
Vennont Department of Corrections
103 South Main Street
Waterbury, VT 05671-1001

- 55-

ATTACHMENT C
CONTRACT FOR SERVICES
CUSTOMARY STATE CONT!UCT PROVISIONS (Revised 12/01/03)

1.

Entire Agreement. This contract represents the entire agreement between the parties on the
subject matter. All prior agreements, representations, statements, negotiations,and understandings
shall have no effect.

2.

Applicable Law. This contract will be governed by the laws ofthe State ofVermont.

3.

Appropriations. Iftl1is contract extends into more than one fiscal year of the state (July 1to June
30), and if.appropriations are insufficient to support this contract, the State may cancel at the end of
the fiscal year, or otherwise upon the expiration of existing appropriations authority.

4.

No Employee Benefits for Contractors. The Contractor understands that the. State will not provide
any individual retirement benefits, group life insurance, group health and dental insurance, vacation and
sick leaVe, workers compensation or other benefits or services available to State employees, nor will the
State withhold any federal or state taxes except as required under applicable tax laws, which shall be
deten'nined in advance of execution of the contract. The Contractor understands that all tax returns
required by the Internal Revenue Code and the State of Vetmont, including but not limited to income,
withholding, sales and use, and rooms and meals, must be filed by the Contractor, and information as to
contract income will be provided by the State of Vermont to the Internal Revenue Service and the .
Vermont Department of Taxes.

5.

Independenee. Liability. The ContractOr will act in an independent capacity and not as officers or
employees of the State. The Contractor shall indemnify, defend and hold harmless the State and its
. officers and employees from liability and any claims, suits, judgments, and damages, which arise as a
result of the Contractor's acts and/or omissions in the performance of services undeT this contract.The·
Contractor shall notify its insurance company and the State within 10 days of receiving any claim for
damages, notice of claims, pre-claims, or service ofjudgments or claims, for any act or omissions In the
perfoTmance of this contract. See AttachriIent L for independence liability hold harmless clause.

6.

Insurance. Before commencing work on this contract the Contractor must provide certificates of
insurance to show that the following minimum c.overage are in effect.. The. Contractor must notify the
. State no.more.than 10 days after receiving. cancellation notice of any required insurance policy. It is the
responsibility of the Contractor to maintain current certificates of insurance on file with the State through
the term of the contraCt. Failure to maintain the required insurance shall constitute a material breach of
this contract.
Workers Compensation: With respect to all operations performed, the Contractor shall carry
.workers compensation insurance in accordance with the laws of the State of Vermont.
General Liabillty and Property Damage: With respect to all operations performed under the
contract, the Contractor shall carry general liability insurance having all major divisions of coverage
including; but not limited to:
.
Premises • Operations
Independent Contractors' Protective
Products and Completed Operations
Personal Injury Liability
Contractual Liability

56

The policy shall be on an occurrence. fonn and limits shall not be less than:
$1,000,000 Per Occurrenee
$3,000,000 General Aggregate
$1,000,000 Products/Completed Operations Aggregate
$ 50,000 fire Legal Liability
Automotive Liability: The Contractor shall carry automotive liability insurance covering all
owned, non-owned and hired vehicles used in connection with the contract. Limits of coverage shall
not be less than: $1,000,000 Combined single limit.
.
Professional Liability: Before commencing work on this contract and throughout the tenn of this
contract, the Contractor shall procure and maintain professional liability insurance for any and all
services performed under this contract, with minimum coverage of$I,OOO,ooO per occurrence and
. $3,000,000 general aggregate.
No warranty is made that the coverage and limits listed herein are adequate to cover and protect the
interests of the Co'lltractor for the Contractor's operations. These are solely minimwns that have been set
to protect the interests of the State. .
. .
7.

Reliance by the State on Representations: AU payments by the State under this contract win be made
in reliance upon the accuracy of all prior representations by the Contractor; including but not limited to
biIls, invoices,progress reports and other proofs ofwoik
.

8. .Records Available for Audit. The Contractor wiJI maintain an books; documents, payroll, papers,
accounting records and other evidence pertaining to costs incurred under this agreement and make them
available ilt reasonable times during the period of the contract and for three years thereafter for
inspection by any authorized representatives of!he State or Federal government. If any litigation, claim
or audit is started before the expiration ofthe three year·period, the records shall be retained until all
litigation, claims or audit fmdings involving the records have been resolVed. The state, by any
authorized reprCsentative, shaJ1 have the right at an reasonable times to inspect or otherwise evaluate the
work performed.or being performed under this contract.
9.

Fail' Emplovment Practices and Americans with Disabilities Act: Contractor agrees to comply with
the requirement ofTitle 21 V.SA Chapter 5, Subchapter 6, relating to fair employment practices, to the
full extent applicable. Contractor shall also ensure, to the j'u11 extent required by the Americans with
Disabilities Act of 1990, that qualified individuals with disabilities receive equitable access to the
services, programs, and activities provided by the Contractor under this contract. Contractor further
.
agrees to include this provision in all subcontracts.

10. Set Off: The State may set off any sums which the Contractor owes the State against any sums due the
Contractor under this coritract; provided, however, that any set off of amounts due the State of Vennont
as taxes shall be in accordance with the procedures more specifically provided hereinafter.
II. Taxes Due to the State.
a. COritractor understands and acknowledges responsibility, if applicable, for compliance with State tax
laws, including income tax withholding for employees peiformihg servic.es within the State, payment of
use tax on property used within the State, corporate andlor personal income tax on income earned within
the State.

57

b. Contractor certifies .Wlder the pains and penalti~s ofperjury that, as of the date th~ contract is signed,
.the Contractor is in good standing with respect to, or in full compliance with, a plan to pay any and all
taxes due the State of Vermont.
C.' Contractor Wlderstands that final payment Wlder this contract may be withheld if the Coinnrissioner of
Taxes determines that the Contractor is not in good standing with respect to or in full compliance with a
.
plan to pay any and all taxes due to the State of Vermont.

d: Contractor also understands the State rruiy'set off taxes (and related penalties, interest and fees) due to
the State ofVennont, butonIy if the Contractor has failed to rriake an appeal within the time allowed by.
law, or an appe,,1 has been taken and finally deterniined and the Contractor has no further legal resource'
to contest the amounts due.
12.. Child Support. (Applicable if' Contractor is a natural person, not a cOIpOration or partnership:)
Contractor states that, as of the date the contract is' signed, he/she:
a. is not under any obligation to pay child support; or
b. is Wlder such an obligation ancj is in good standing with respect to that obligation; or
c. has agreed to a payment plan with the Vermont Office of Child Support Services and is in full
compliance with that plan.
Contiactor rriakes this statement with regarcj to support owed to any and all children residing in Vermont.
In addition, if the Contractor is a resident of Vermont, Contractor makes this statement with regard to
support owed to any.and ali children residing in any other state or tenitory of the United States.
13. Subcontractors. The Contractor shall not assign or subcontract the performance of this agreement or
. any portion thereof to any other contractor without the prior written approval of the State.' Contractor
also agrees to mclude in all subcontract agreements a tax certification in accordance with paragraph 11

abOve:

.

.14. No Gifts· or Gratuities. Contractor shall not give' title or possession of any thing of substantial value
(including property, currency, travel and/or education programs) to'any officer or employee of the State
during the term of this contract..

IS. Copies. All written reports prepared Wlder this contractwill be printed using both sides of the paper.
16. Access to Information. The Contractor agrees to comply with the requirements of AHS Rule No. 96-23
concerning access to information. The Contractor ShaIl reqUire all of its employees performing services
Wlder this contract to sign the AHS affirmation of Wlderstanding or an equivalent statement.
17, Suspension and Debarment. Non-federal entities are prohibited by Executive OrderS 12549 and 12689
from contracting with or making sub-awards under covered transactions. to parties that ate suspended or
debarred or whose 'principals are suspended or debarred. Covered transactions include procurement
contracts for goods or services equal to or in eXcess of $100,000 and all non-procurement transactions
(sub-awards to sub-recipients). By signing this contract, current Contractor certifies as applicable, that
the contracting organization and its principals are not suspended or debarred by GSA from federal
procurement and non-procurement programs.
.
18. Health InSurance Portability & Accountability. Act iHll'AA). The confidentiality of any health care
information acquired by or provided to the independent coiltractor shall be maintained in compliance
with any applicable state or federal laws or regiilations.
.

S8

\ ....

19. Abuse Registry. The Contractor agrees not to employ any individual to care for elderly or disabled
adults if there has been a substantiation of abuse, neglect, or exploitation against that individual. The
Contractor will check the Adult Abuse Registry in the Department of Aging and Disabilities for the
names of all suchcun'ent or prospective employees.
.
20. Voter Registration. When designated by the Secretary of State, the Contractor agrees to become a voter
. registration agency as defmed by 17 V.S.A. §2103 (41), and to comply with the requirements of State
and Federal law pertaining to such agencies.
.

59

ATTACHMENTD
CONTRACT FOR SERVICES
MODIFICATION OF MAXIMUM INSURANCE REQUIREMENTS
The requirements contained in Attachment C, Section 6 are hereby modified:

. No Modifications
Type oflnsurance coverage:

Modifications:

Reasons for MOdifications:

Approval:

Assistant Attorney General:

_

Date: .

60

ATTACHMENTE
CONTRACT FOR SERVICES
BUSINESS ASSOCIATE AGREEMENT (REVISED 12/01/03)
THIS BUSINESS ASSOCIATE AGREEMENT ("AGREEMENT") IS ENTERED lNTo BY AND
BETWEEN mE STATE OF VERMONT, AGENCY OF ffiJMAN SERVICES, OPERATING BY AND
THROUGH ITS DEPARlMENT OF CORRECTIONS ("COVERED ENTITIES'') AND' PRISON
HEALm SERVICES, INC ("BUSINESS ASSOCIATE"), AS OF 02101/05 ("EFFECTIVE DATE'').
Preliminary Statement. Covered Entity and Business Associate have entered into the Contract to which
this Business Associate Agreement is an attachment'pursuant to which' Business Associate provides to
Covered Entity' certain semces ("Services") which 'may require the' use and/or disclosure of health '
information. For the avoidance of any doubt~ "Services" includes all work performed by the Business
Associate for or on behalf of Coveted Entity. TIris Agreement supplements and is made a part of the
Contract.
'
The parties enter into this Agreement to comply with, standards promulgated under the Health Insurance
Portability and Accountability Act of 1996 ("HIPAA"), including the Standards ,for the Privacy of
Individually Identifiable Health Information, at 45 CFR Parts 160 and 164 ("Privacy Rule"), and the Security
Standards, at 45 CFR Parts 160 and 164 ("Security Rule").
Agreement. In consideration of the, foregoing, and in consideration of the desire of Covered Entity to
continue receiving Services, and of Business Associate to continue providing Services, the parties agree as
follows:
, ,-.

1.

Definitions. All capitalized tetnjS in this Agteementhave the meanings identified in this Agreement,
45 CFR Part 160, or 45 CPR Part 164. The term "Individual" includes a person who qualifies as a
personal representative in accordance with 45 CFR 164.502(g). All references to PHI mean Protected
,Health Information. All references to Electronic PHI mean Electronic Protected Health Information.

2.

Permitted and Required, UsesIDisclosnres of PHI.
2.1

this

Except as limited in
Agreement, Business Associate may use or disclose PHI to perform the
Services, provided that any use or disclosure would not violate the minimum necessary policies
and procedures of Covered', Entity. Business Associate shall not use or disclose PHI in any
manner that would constitute a violation of the Privacy Rule if used or disclosed 'by Covered
Entity in that manner. Business Associate may not use or disclose PHI other than as permitted or
required by this Agreement or as Required by Law.

22 Business Associate may, make PHI available to its employees who need access to provide Services
(provided that Business Associate makes' such employees aware of the use and disclosure
restrictions in this Agreement and binds them to comply with such restrictions). Business,
Associate may only disclose PHI for the purposes authorized by this Agreement: (a) to its agents
(including sUbcontr~ctors); in aCcordance wiill Sections 6 and 14; or (b) as otherwise permitted by,
'Section 3.
3. ' DnsiDess Activities" Business Associate may use PHI received in its capacity as a "Business
Associate" to Covered Entity, ifnecessary, for its proper management and administration or to carry out
its legal responsibilities. ,In addition, Business Associate may disclose PHI received in its capacity as
"Business Associate" to Covered Entity, for its proper management and administration or to carry out
its legal responsibilities, if a disclosUre :is Required by Law, or: (a) Business Associate obtains
reasonable written assurances (via a written contract) from the person to whom the information is to be
disclosed that the PHI shall remain confidential and be used or further disclosed only as Required by
Law or for the purpose for which it was disclosed to the person; and (b) the person promptly notifies
61

Business Associate (who in tum will promptly notify Covered Entity) in writing of any instances of
which it is aware in which the confidentiality of the Pill has been breached. All uses and disclosures of
Pill for the purposes identified above must be of the minimum.amount otPHI necessary to accomplish
..
.
. .
such purposes.
4,

.Safeguards. Business Associate ·shall implement and use appropriate safegUards to prevent the use or
disClosure of Pill, other than as provided for by this Agreement. Business Associate shall identify in
writing, upon request from Covered Entity, all of the safeguards that it uses to prevent impermissible
uses or disclosures of Pill.

5.

Reporting. Business Associate shall report iii writing to Covered Entity any use or disclosure of PHI in
violation of this Agreement by Business Associate or its agents (including Bubcontractors). Business
· Associate shall provide such written report promptly after it becomes aware of any such use or
disclosure. Business AssOCiate shall provide Covered Eritity with the information necessary for
Covered Entity to investigate. any such. use or disclosure. Business Associate may use Pill to report
violatiOns oflaw to appropriate federal and state authorities, consistent with 45 CFR l64.502G)(I).

6.

AgreementS by Third· Parties. Business· Associate shall ensure. that any agent, including a
· subcontractor, to whom it provides PHI re.ceived from, ore:reated or received by Business Associate on
.behalf of, Covered Entity, agrees in. a written contract to the same restrictions and conditions that apply
through this Agreement to Business Associate, with respect to such PHI. By way of example, the
written contract must include those. restrictions and conditions set forth in Section 12. Business
Associate must enter into the .written coptract before any use or disclosure of Pill by such agent, and
sUch written contract must identify. Covered Entity as a direct and inteIi.ded third party beneficiary, with
the right to enfQrce any breach of the contract· concerning the use or disclosure. of PID. Business
Associate shall provide a copy of the written contract to Covered Entity upon request. Business
·Associate may not make any disclosure of PHI .to any agent without the prior written consent of
· Covered Entity.

7.

.Access to PID. Business Associate shall provide access to Pill in a Designated Record Set to Covered
Entity or, as directed by Covered Entity, to an Individual, to meet the requirements wider 45 CFR
164.524. Business Associate shall provide such access in the time and manner reasonably designated
by Covered Entity. Business Associate shall promptly forward to Covered Entity for handling any
request for liccess to Pill that Business Associate.directly receives from an Individual.

8.

9.

AmendmentofPIiI. Busmess Associate shall make liny~endments toPID in a Designated Record
· Set that Covered Entity directs or agrees to pursuant to 45 CFR 164.526, whether at the request of
Covered Entity or an Individual. Business Associate shall make such amendments in the time and
manner reasonably designated by Covered Entity. Business Associate shall promptly forward to
Covered Entity for handling any request for amendment to PHI that Business Associate directly
receives from an IndiVidual.
Accounting of Disclosures. Business Associate shall document disclosures of Pill. and all information
related to such disclosures as would be required for Covered ,Entity to respond to a request by an
Indiyidual for an accounting of disclosures of PHI in accordance with 45 CFR 164.528. Business
Associate shall provide such information to Covered Entity, or as directed by Covered Entity, to an
Individual, topetmit Covered Entity to respond to an accounting request. Business Associate shall
provide such information in the time and rnannerreasonably designated by Covered Entity. Business
Associate shall promptly forward to· Covered Entity for haodling any aecounting request that Busin.ess
Associate directly receives from an Individual.

62

10. Boob and Records.. S~bject to the. attorney-client and other applicable legal privileges, Business
AsSOCIate ~hall make Its mternal prac!!ces, books, and records (including policies and procedures and
PHI) ~elatmg to the use and dIsclosure of pm received from, or created or received by Business
ASSOCIate on behalf of, Covered Entity available to the Secretary in the time and manner designated by
the Secretary. Business Associate shall make the same information available to Covered Entity
,(without regard to the attorney-client or other applicable legal privileges), upon request, in the time and
manner reasonably designated by Covered Entity, SO that, Covered Entity may' determine whether
Business Associate is in compliance with this Agreement
11. Termination.
11.1

This Agreement commences on the Effective Date and shall remain in effect until terminated by
Covered Entity, or IUltil all of the pm provided by Covered Entity to Business Associate, or
created or received by Business Associate ort behalf of Covered Entity, is destroyed' or returned
to Covered Entity, subject to Section 15.12.

11.2

If Business Associate breaches any material term of this Agreement, Covered Entity may either: '
(a) provide an opportunity for BusinessAssociate to cure the breach, and Covered Entity may
terminate each Services' Agreement, without liability or penalty, if Business Associate does not
cure the breach within the time specified by Covered Entity; or (b) immediately terminate each
Services Agreement, without liability or penalty, if Covered Entity, believes that cure is not
reasonably possible; or (c) if neither termination nOr cure are feasible, Covered Entity ,shall
report the breach to the Secretary. Covered Entity has the right to seek to cure any breach by
Business Associate and this right, regardless of whether Covered Entity cures such breach, does
not lessen any right or remedy available to Covered Entity at law,in equity, or under this
Agreement or any Services Agreement, nor does it lessen Business Associate's responsibility for
such breach or its duty to cure such breach.
'

12. ReturnlDestruction of i'm.
12.1

Business Associate shall, in connection with the expiration or termination of a Services
Agreement, return or destroy all pm received from Covered Entity, or created or received by
Business Associate on behalf of Covered Entity, and pertaining to that Services Agreement, that
Business Associate still maintains in any form or medium (including electronic), within thirty
(30) days after such expiration or termination. Business Associate shall not retain any copies of
such Pill. Business Associate shall certifY for Covered Entity, in writing, when all pm has beeo
returned ordestroyed, and that Business Associate does not,continue to maintliin any pm, with
,such certification to be'provided during such thirty (30) day period.

12.2

Business Associate shall provide to Covered Entity notification of any conditions that Business
Associate believes make the return or destruction of PHI infeasible. If Covered Entity agrees
that return or destructionis infeasible, Business Associate shall extend the protections of this
Agreement to such pm and limit further uses and disclosures of such pm to those purposes that
make the return or destruction infeasible, for so long as Business Associate maintains such pm.

13. NoticeffrainiDg. Business Associate IUlderstands ,that: (a) there may be civil or criminal penalties for
misuse or misappropriation of PHI; and (b) violations of this Agreement may result in notification by
Covered Entity to law enforcement officials and regulatory, accreditation, and licensure organizations.
If requested by Covered Entity, Business Associate shall participate in information security awareness
training regarding the use, confidentiality, and security ofPm.

63

14. Security Rule Obligations. The following provisions of this Section 14 apply to the extent that
Business Associate creates, receives, maintains or transmits Electronic PHI on behalf of Covered Entity.
14.1

Business Associate shall implement and use administrative, physical, and technical safeguards
that reasonably and appropriately protect the Confidentiality, Integrity and Availabilitybf the
Electronic Pill that it creates, receives,. maintains or transmits on behalf of Covered Entity.
Business Associate shall identify in Writing, upon request from Covered Entity, all of the
safeguards that it uses to protect such Electronic PHI.
. .

14.2

Business Associate 'shall ensure that any agent,including a subcontractor, to whom it provides
. Electronic pm agrees in a Written contract to implement and use administrative, physical, and
technical safeguards that reasonably and appropriately protect the Confidentiality; Integrity and
Availability of the Ele.ctronic Pill. BuSiness Associate must enter into the written contract
before any use or disclosure of Electronic' Pill by such agent, and such written contract must
identify Covered Entity as a direct and .intended third party beneficiary, with the right to ~orce
any breach of the contract concerning the use or disclosure of Electronic PHI. Business
Associate shall provide a copy of the Written contract to Covered Entity upon .request. Business
Associate may not make' any disclosure of Electronic Pill to any 'agent without the prior written
.
consent of Covered Entity.

14.3 .Business Associate ,shall report in writing to Covered Entity any Security Incident pertaining to
such Electronic Pill (whether involving Business Associate or an agent, including a
subcontractor). Business Associate shall provide such written report promptly' after,it becomes
aware of any such Security Incident. Business Associate shari provide Covered Entity with the
. information necessary for Covered Entity to investigate any such Security Incident.
14.4

Business Associate shall comply with any· reasonable policies and procedures Covered Entity
implements to obtain compliance under the Security Rule.

15, Miscellaneous.
15;1

Notwithstanding anything to the contrary in any Services Agreement, in no event shall any
provision limiting'Business Associate's liability to Covered Entity, including, but not limited to,
provisions creating a cap on damages, excluding certain types of dam~ges, limiting available
remedies, or shortening a statute of limitations, present in any Services Agreement, apply with
respect to any breach by Business Associate of any term of this Agreement. .

15.2

In the event of any conflict or inconsistency between the terms of this Agreement and the terms
of any Services Agreement, the terms of this Agreetnent shall govern, with respect to its subject
matter. Otherwise, the terms of each Services Agreement continue in effect.

15:3

Any reference to ''promptly'' in this Aliteemen! shall mean no more than seven (7) business days
after the circumstance or event at issue has transpired. A reference in this Agreement to a
section in the Privacy Rule or Security Rule means the section ail in effect or as amended or
renumbered.

15.4

Business Associate shall mitigate, to the extent practicable, any harmful effect that is known to it
'of a use or disclosure of pm in violation of any provision of this Agreement.

64

15.5

15.6

15.7

Business Associate shall cooperate with Covered Entity to amend this Agreement from time to
time as is necessary for Covered Entity to comply with the Privacy Rule, the Se'curity Rule, or
any other standards promulgated under HIPAA.
Any ambi~ity in this Agreement sball be resolved top=itCovered Entity to comply with the
Privacy Rule, Security Rule, or'any other standards promulgated under HIPAA.
In addition to applicable state law, the parties sball rely on applicable federal law (e.g" HIPAA,
the Privacy Rule and Security Rule) in construing the meaning and effect of this Agreement.

15.8' Ibis Agreement may be amended or modified, and any right under this Agreement may be
waived, oiJ.1y by a writing signed by an authorized representative of each party.
15.9

Nothing express or implied in this Agreement is intended to confer, upon any person other than
the parties hereto, any rights, remedies, obligations or liabilities wbatsoever. Notwithstanding
the, foregoing, the Covered Entity in this Agreement is the Agency of Human Services, operating
by and through,its Department of Corrections. Covered Entity and Business Associate agree tbat
the terni "Covered Entity", ali used in this Agreement, also means'any other Department,
Division or Office of the Agency ofHumaiJ Services, to the extent tbat such other Department,
Division, or Office bas a relationship with Business Associate tbat would require, pursuant to the
, Privacy or Security Rules, entry into an agreement of this type, '
'

'15.10 'As between Business Associate and Covered Entity, Covered Entity owns all PHI provided by
Covered Entity to Business Associate, or created or received by Business Associate on bebalf of
Covered Entity.
.
15.11 Business Associate sball abide by the terms and conditions of this Agreement with respect to all
PHI it receives from Covered Entity, or 'creates or receives on behalf of Covered Entity, even if
some of that information relates to specific' Services for which Business Associate may not be a
"B~iness Associate" of Covered Entity under the Privacy Rule.
15.12 The provisions of this Agreement tbat by their terms e~compass continuing rights or
responsibilities sball survive the expiration or termination of this Agreement. For example: (a)
the provisions of this Agreement shall continue to apply if Covered Entity determines tbat it
would be infeasible for Business Associate to return or destroy PHI, as provided in Section 12.2;
and (b) the obligation of Business Associate to provide an accounting of disclosures, as set forth
in Section 9, survives the expiration or termination of this Agreement, with respectto accounting
requests (if any) made after such expiration or termination.
15.13 Ibis Agreement constitutes the entire agreement of the parties-with respectto its subject matter,
superseding all prior oral and written agreements between the parties in such respect.

65

AITACHMENT F
CONTRACT FOR SERVICES
Agency of HumanServices Rule # 9.6-23
.. Final Adopted Rule for
Access to Information
Dec-mition•.
"Agency" means the Agency ofHuman Services or any of the offices, departmentS or
·programs thatcomprise the Agency..
"AHS" means the Vcanont Agency ofHuman Services.
"Client" means an individual or family who is volWltarily served by a department, office,
program, Contractor o~ grantee of the Agency of Human Services.
"ContraCtor" means an individual or entity with whom the Agency or any of its
departments, offices, or programs has a contract to provide personal services..
"Employee" means any person who works in a full-time, p~rtctime, temporary or
contractual position for the Agency or any of its departments, offices, or programs.
1.6
"Graniee" means an indiVidual or entity with whom the Agency or any part thereof
has a· grant to provide personal semces.

1.7
"Prognun" means a set of services, (such as determining and processing ANFC benefits,
verifying and setting up delivery ror WIC foods) for which the Agency bears fiscal responsibility.
1.8
"Administrative Obligations" means activities pursuaot to federal or state laws or
regulations (such as verification of eligibility, verification of service delivery, detention of fraud, monitoring
·of quality assurance, audit of expenditure reports) which provide for accoWltability in the use ofpublic
funds.
Bask Principles
Presumption ofConfidentiality
All infomiation specific to, and identifying of, ipdividuals and families is presumed to be
confidential and subject to these standards. Employees shall not disclose the monnation Wlless a specific
exception to the presumption applies o{the disclosure is authorized by.the client, a court or as ·otherwise
authorized by law or rule.
.
·Existing Statutes
These rules are not intended to expand or diminish current provisions in law rela!iD.g to
.
.
disclosure of confidential information.

Information Collection
Employees shall collect and record only that information needed to fulfill the goal of
66

servin~ the client and meeting administrative or le~al obli~ations.

Informing Clients
At the initial meetin~ with each client, or within two weeks, employees shall review and
offer to provide the rules for access to information to the client.
.

Pennissible DisclosUres
Client consent

No information about a client shall be released without prior consent from the client,
unless directly c\lnnected with the admirtistration of a program or necessary for compliance with federal or
state laws or regulations.
.
. Sharin~ "Non-identifiable" Information
information that does not identify a client may be used for statistical research, forecasting·
program needs, or other such purposes.
.
.
Public Information
'In.formation defined as public by I VSA & 317 or other applicable statute is available to the public.
The procedures in the public records statute sball be followed before public information is released.
Iriformation Sharing for Administrative Purposes
Employees may sbare information which is necessary to satisfy the Agency's administrative
obligations. Departments will develop written agreements lirnitin~ the kinds of information to be
sbaredwhen programs are jointly administered by different Departments. No information shall be
released-to a person or entity that is out of state, unless directly connected with the administration of
a program or necessary for compliance with federal or state. laws or regJllations.

DisclosUr~ Without Consentin Limited Circumstances
.Employees must release sufficient information to comply with mandatory reporting
requirements for·cases involving the abuse; neglect, or exploitation of children and persons who are elderly
or who have disabilities. Information may be released without. consent when Vermont law creates a duty to
warn identified individuals of potential harni to their person. or property; in response to court orders, or to
.investigate or report criminal activity as required by federal or state law or regulation. Only information
relevant to the situation shall be disclosed. The employee sball document the date, purpose and content of
the report, the name, address and affiliation ofthe person to whom the. information was released, and shall
notify the clierit that the information was disclosed.

AHS Rule 96-23
Procedures Related to Consent
Obtaining Informed Consent
.. Prior to releasing confidential information the Agency shallobtain the client's informed .
67

consent. This includes providing information about consent in a language and format underStandable to the
client. Reasonable accommodations shall be made for special needs based on the individual or family's
. educati~n: culture: or disability. Employees shall inform clients that granting consent is not a pre-requisite .
for recelvmg servICes, and shall explain that they inay apply for services separately.
.
Consent of Minors to Release of Information
Employees shall obtain the consent of a minor client to release information concerning
treatment for which. parental consent is not required..

Format for Consent to Share Information
Consent for the sharing or release of information shall ordinarily be in writing. If an
emergency situation requires granting of verbal consent, written consent shall be obtained at the next office
visit or· within thirty days, whichever comes sooner. Required information will include:
1. Names of thepeople about whom information may be shared.
.
2. A checklist of the kinds of information to be shared.
3. A checklist of the departments within the Agency to receive the information.
4. A. statement or date covering expiration of consent
5. A statement about procedures for revoking consent.
. 6. Signature of individuals covered by the consent, or their parents or guardians.
7. Signature of the individual explaining the consent process with their position and job
. title.
8. A space to provide individualized instructions.
A copy of the consent form shall be provided to all signatories.
Client Access to Records
Unless prohibited.by federal or state law or regulation, clients shall be permitted to view
and obtain copies of their records. Each department within the Agency shall have written procedures which
permit clients to verify personal information they have provided for accuracy and ¢ompleteness and for
placing amendrilents to the information in their files. Employees shall take reasonable steps to present
records in ~ form accessible to the client; including but not limited to large type format or verbal review. A
fee not to exceed the actual cost of copying may.be charged for records· exceeding 10 pages. This fee shall
.
be waived if it would· prohibit access.

AHS Rule 96-23
Procedures to Protect Confidentiality
Staff Training
AIl AHS employees and all AHS volunteers and interns, shall be instructed in these rules.
AHS shall train their· Contractors and grantees who shall, in turn, provide the same instruction for their
employees, interns, and volunteers:
.
Response to Requests for Information .

An employee shall not respond to requests from outside the Agency for information

68

about. clients even to aclaiowledge tbat tbe person is a client, unless authorized. If a client bas consented to
or requests that information be released, the employee sball comply with the request.
Designated Individual
Eacb agency or department sball appoint one or more trained staff members to be
responsible for responding to all r~quests for ,client information wben there is no written consent to release,
and no statutory or administrative authority pennitting release of the request.ed information. Tbese
individuals sball be specially trained in maintaining confidentiality. A list ofthe designated individuals for
eacb department ,and office shall be maintained in the Attorney General's Office, Human Services Division.

Affirmation of Understanding
Employees shall sign an affinTIation that they Will comply with these rules. This
affirmation shall be part of their personnel files. Supervisors sball review tbis affrrmation during annual
evaluations. Violation of these rules sball result in disciplinary' action.
Written Agreements with Grant.ees or Coritract.ors
The following assurance, or one similar io it, v,jll be included in all AIlS grants/contracts
signed after these rules bave been approved:
' '
[Grantee/Contractor] agrees to comply with the requirements of AIlS Rule No. 96-23
concerning acceSS to information. The Conlf<ictor shall require all of its employees to sign' the AHS
Affrrmation of Understanding or an equivalent statement.
Client Referrals
When referring a client to another agency for services, if tbe referral does,not meet the
criteria for permissible disclosures under Section 3.4, the initial agency sball obtain the consent ofthe' client
for the referral and alert the receiving agency that confidential client information accompanies the referral.

Documentation of Disclosure
Requests for disclosures ofclient information sball be maintained in the client's file if the
request does not meet the definition of a permissible disclosure under' Section 3.4. Employees sball
document in writing any information actually disclosed, along with the name of the person/agency to wbom
it 'was disclosed and the date of the disclosure. When pennissible disclosures are made under Section 3.4,
, documentation may be limited to the name ofthe department/agency/program t.o whom the disclosure was
made.
Information Systems
Computerized Information
When developing a computerized data system, the Agency sball:
1. Develop security procedures cOnsistent. with the rule;
2. Instruct. staff in t.he security procedures;
3. Inform clients if a computeriiedsystern is being used;

69

4. Establish written agreements with participating agencies outlining procedures for
sharing andi>rotecting information.
S. Develop security procedures in relation to the transmission of information.
Security Procedures
The Agency shall develop a protocol which is consistent with the requirements of this
rule to safeguard confidential client information. Contractors and grantees shall also develop a protocol or
shall adopt the protocol of the Agency. The protocol shall be designed to safeguard written information, data
in computer systems, and verbal exchange of information. The protocol shall prohibit unauthorized access to
records arid include an appropriate disciplinilry process for violations of the security rules.
Procedures·
. Written procedures for implementing these rules shall be used as the basis for employee
.Instruction and shall be available for review in the Agency Central Office.

70

AGENCY OF HUMAN SERVICES
103 South Main· Street
Waterbury, Vermont 05676

AFFIRMATION OF UNDERSTANDING STATEMENT .
As a Contractor for the State of Vermont; I affIrm ~Jiat I have read the Agency of Hnman Services
(AHS) Rule No. 96-23 concerning Access to Information. and. that I agree to comply with the
requirements of AHS Rule No. 96-23.

I shall require all of.my employees perfonirlng services under this'contract, to sign an affIrmation of

understanding statement. Employee statements need not be sent to the State. However, they shall
remain In Contractor's 'personnel records.

The State can request copIes of such documents if

necessary.

•

Prison Health Services, Inc.

Date

Name of Company (print or type)

Authorized Signature

TItle

71

Attachment G
PHS Implementation Plan
..
1 Contract Awarded8
2 Establish managementmeeting schedule and implementation
. aJ1:enda
3 Review implementation time frame and confirm with PHS team
and DOC
4 Inforin PHS subcontractors of contract award
5 EstablishPharmacv Services
6 Arrange for Back-up Pharmacy Services
7 Contact local health department and other community resources

.

..

12/15/04
12/15/04

12/15/04
12/17/04

12/15/04

1/31/05

12/15/04
12/6/04
12/15/04
12/15/04

12/31/04
12/24/04 .
1/10/05
12/20/04

8 Obtain cUrrent employee list and' provide to PHS human resource
11/15/04
department
9 Begin and complete facility assessment tours - all sites to include
11/29/04
inventory of medical supplies
10 Inform CMS personnel of contract award
11/29/04
11 Finalize PHS and operational teams to include on site Management 12/6/04
Team
12 Facility tours status report to client
12/22/04
13 Review employee retention potential with PHS resources unit and . 11/29/04
DOC
14 NeJ1:otiate and finalize facility staffin~ and service matrix
12/6/04
15 Interview and ma1<e offers to current emplovees
12/15/04
.16 Interview and ma1<e offers to new·employees
12/15/04
17 Develop post orders and job responsibilities to each shift to include 12/15/04
clinical aspects and submit to client
18 Obtain security clearance for PHS siafffrom client
12/15/04
19 Submit names of mana~entteam toclierit for approval
12/6/04
20 Develop staff meetin~ schedule and provide copy to client .
1/4/05
21 Re~on8I Director start date
1/3/05
22 Medical Director/Physicians start date (if new staff)
1/17/05
.
23 Program Manae:ers start date
1/17/05
24 RN/LPN start date (if new staff)
.1/17/05
25 Administrative assistants start date (if new staff)
1 24/05
New
staff
orientation
and
training
1 17/05
26
27 Pharmacv Inservice for Staff
1 17/05
28 Orient all current employees to PHS policies to mclude approved
1/3/05
Iprotocols, PHS utilization review
29 Establish site personnel files
1/4/05
30 Establish payroll svstem - installation of Chronos clock
1/17/05
..

11/22/04
12/17/04
12/17/04
1/19/05
12/22/04
12/22/04
12/22/04
.12/22/04
.12/31/04
1/12/05
1/17/05
1/3/05
1/17/05
1/3/05
1/17/05
1/17/05
1/17/05
1/24/05
1/31/05
1/31/05
1/24/05
1/24/05
1/31/05

Implementation dates contained in this Attachment may be adjusted, with DOC approval, should
the contract award date be delayed beyond December 15, 2004. .
.

8

72

31 Develop emergency telephone numbers and contact information
and provide to client (for both implementation and operational.
teams
.

12/1.5/04

1/17/05

32 Orient staff to PHS Infom:mtion S stem te uirements as needed
1/24/05
· 33 Develo in-~ervke trainin annual schedule
1/4/05
34 Complete.review of all client's current policies, procedures,
12/6/04
manuals and forms
35 Develop new policies and procedtires, manuals and forms as .
12/22/04
needed. review with· client and obtain a rovaJ.
36 Develo work schedules arid assi
ents
12/20/04
37 Provide to osed service schedule for client for a roval
12/6/04
· 38 Deve10 on-call schedules as re uired and rovide to client
12/6/04
39 Review and develop chronic care clinic schedules and submit to
12/15/04
. client for informational
oaes
.
40 Obtain insurance certificates and coordinate insurance
12/15/04.
re uirements with co' orate counsel and rovide co ies to client
41 Order all medical Stl lies
1/10/05
.42 Order all office supplies to include forms relevant to providing
1/10/05
~ervices s . cific to client .
.
43 Establish e cash fund
1/17/05
44 Coordinate the transition of Health Service program from current
12/15/04
rovider to ensure cont:i.ri.ui '
45 Coordinate fiscal res onsibili with current rovider9
.12/15/04
· 46 Meet with Mental Health Provider
1/17/05
.47 Assist in'determining the requirements necessary for interface with 12/15/.04
facili MIS s stem
48 Coordinate, receive and install new com uters
12 15/04
49 Install phones, fax machines, computer lines (assuming DOC
12/15/04
network integration. If not achievable, eMS land lines will be
maintained .
50 Facilitate communication access tele hones, a era
1/4/05
51 TranSfer Patient Information via medication administration records 1/15/05
for DOCinniates as of 1/15/OS
52 Transfer Patient Information daily via medication administration
1/15/05
records for DOC inmates with intakes after 1/15/05
53 Test MIS system for reportirig capabilities to meet contract
1/14/05
r uirements

1 31/05
1/31/05
1/3/05
1/17/04
12 31/04
12/31/04
12 31/04
12/31/04
12/31/04
.1/21/05.
1/24/05
1 31/05
1/31/05
2/14/05
1 21/05
1/14/05
1/21/05
1/21/05

1 17/05
1/21/05
1/31/05
1/31/05

Process requires reconciliation between the estimatedsnpplies and equipment to be purchased by
the Contractor from the incumbent and supplies and equipment left on-site as of February I, 2005.
Contractor shall complete reconciliation and compensate the incumbent no later than' February 14,
2005.

9

7'3

,(

(

(

Attachment H -

Sta£f~g Matrix

, A.' CORRECTIONAL FACILITIES SUMMARY - HOURS PER WEEK PER PosmON

Physicians, .
Physician Assistant
Nurse Practitioner
RegiStered Nurse
LPN
Nurses Aide
Dentist
Dental Assistant
Dental Hygienist
Medic~ ~etary /
AdminiStrative Assistant
Other
Program Manager
Vennont Re .onal Director

2

10

6

4

0

0

0
8

8

8
0

4

20
152'
136
112
16
16

.0

'0

0

16010

0

0
40

13.3

0
20

40

0

.0

40

o·
0
4

14
0

. 168
88
0
4
4
,

0
0
0

40
152
0

12
12
0
0

will

16
12

16·
16
0
112
'152
0
16
16

0

o

56
136

112
152

0

O'

0
0

,0
0

0

40
. 0

6
12·

8

16

8

16

o

·0

8

o
12
40
168

o
4

4

o

o

20
-0

24
488.

224
'0

16
16

o

o

0

(j

o

o

13.3

40

20

40

0

o

o

o

Contractor
staff a total of 160 hours per week for medical secretary/administrative assistant positions. The location of these positions has yet
to be determined. Upon completion of facility site visits performed during implementation, Contractor will'assign 120 hours per weekof medical
secretarY/administrative assistant time to other DOC facilities.

10

-74 -

(

(

(

B: INDIVIDUAL l'ACILITIES '

Cald

MedicalDiiector'
Dentist
Dental Assistant
Ph sician Assistant '
Pro amMana er
, Administrative Ast{ t
, Re . tered Nurse
Licensed Practical Nurse
licensed Nursin Ass't

0.05

2

4,

0.10

4

4

0.10
0.10

6

0.35

B

8

8

8

8

0.00
1.00
0.00
'0.00
1.70

8

Re . tered Nurse
Licensed Practical Nurse
Licensed Nursin Ass't

TOTAL HOURS/ FfE-EVENING
I

L'

~--~7 ~~:-7' ~~~~- ~- ~_ - .~~~,~T. ~ _. ,- -- - _~~..~.~,-~_-:--.~ _.~~~ -:-: ~~~~~;,-.,"i~~]-2I(K.1:;Y1I?f=~E2:~~'7~~~->'-, _'i~£~}~~J~' ~~~ ,,::::~:~;~}2;E'S~'~f::~:~'~~-?l
0-

O·

ReRistered Nurse
Licensed Practil:a1 Nurse
Licensed Nursin~ Ass't

0
0

TOTAL HOURS/ FTE-NIGHT
tOTAL HOURSjITE PER WEEK
*res = To be scl1~uled

-75 -

0.00.
0.00
0.00

0

0.00

'68

1.70

(
,-

.

-

- --

-

---

;

... - - . ........... -.-...--

- -- ---

,

-'

':5_

(

-

'

..-

.- -

~ :" ~ ~~~~~~~-. -'1(f(":'::?~:'~~,~1~,~~~~~-"::~-'f;:~2::-~ 7::~:?'/::'~r'§':-::':;;~nr~{.:·',
.. ~
·\"~it::.q.," '1 -;""~\J;~j ;
".J~'1~1;· .~ . . :........ ~1..br
,~
'l.~ :-.:>Jr)'~",J~~'Y"""'''''''L'''',.;'
~ ~'-_'~h;11~
.. -; ,~-- ~-~-"' -~1 , ~:.~ _-.,...!~p"",
~~_~ -'= -~~ _~Ll~&~~~_ t~~ '~:~~~'~~l~:< 1~ ~ ,)}:{~~;]1~:j:i~~\:fi±'_~;,: __ ~t·~· ~r -~~ty~~~:~-=' :~~tf~~~~~~~~~
~

:".

;

,(

~

I

_.

..

-

IVermont Re~ona1 Director

8

Medical Director
Dentist
Dental Assistant
Nurse Practitioner
Progr~ Manag-er
, Administrative Ass't
Registered, Nurse
Licensed Practical Nurse
Licensed Nursing Ass't

2
4'

"

8
2

I,

•

..

.,:
.....

_~~'~~

- -~, ~ .'~~- ~~.~-~~E~; ~,~ ·~~i}i ~:--u~ --~~.::~ ~.~ :-:~~ .:~ ;~H.~._~,r.:, ~~~~~ :~":-'~_ ~~~:.:.·-;-12:·~ ~:~~~::2: :'.~~~~. ~~~~f8
8

8

2

2

4

4

4

4

'4
4

4
8

4
8

'4
4
8

8

8'

,8

4
8
8

8
8

8
8

8

8

8

8

8
2

4
8
8
8'
8

120

8.

8

40

1.00

10
16
16

0.25
0.40

20
40

0.50

160
40
56
0

DAD
1.00
4.00

1.00
1.40
0.00

'9.95
TOTAL HOURS/ FTE-DAY
398
~ --~~~'-".•--' :"/"~~::~:~:~J'",,~- :-.'~~~~~~~~$lDl};~~~::·~~::~~1I~::l~:::Ii~:~G~~~:
Registered Nurse
56
8
8
8
8
8
8
1.40
8·
Licensed Practical Nurse
8
40
1.00
8
8
8
8
8.
Licensed Nurs~~ Ass't·
8
8
56
1.40
8
8
8
8
2
TOTAL
HOURS/
FTE-EVENING
3.80
19
,-.-

~--

,

,

~.--~

~-~---,

.

- --.---'-~(- --~--~ ~ -_F -~:~ - ~'.~ :":' ~~.~:~~~-=~~~~~ ~~~~~l~t~:~/2LlcJ1:t~~~~~~~~~~~-.~~~::\~·~\~~~~~~~~~

Registered Nurse
Licensed·Pral:tical Nurse
Licensed Nursinp; Ass't

8

8

8'

8
8

8'

8
8

8

8
8
8

8
8

,8

8

8
8
8
TOTAL HOURS/ FTE-NIGHT
TOTAL HOURS/FTEPER WEEK

'*TBS = To be scheduled

-76 ~

~,:~~~~~:~~~~'~.~~~~j

56
40
,56
152
' 702

1.40
1.00
1.40
3.80
17.55

.(

Medical Director
Dentist
Dental Assistant
Nurse Practitioner
Pro amMana er
Administrative Ass't
Re 'stered Nurse
licensed Practical Nurse
Licensed Nursin Ass't

(

2

6
4
,4

2

2

2

(

2

2

2
2
5

2
2

2

8

8'

13
0

8

8

8

8

8

8

8

8

8

8

8
'4

8
4

56
48

0

139

0.15
0.10
0.10
0.20
0.33
0.00
1.40
1.20
0.00
3.48

TOTAL HOURS/ ITE-EVENING
~~-

~

~

~ '-~~:~'--'-. ~':-:~:-.~~ ~?~~::'-;~-~~~~~:~i;~(zlJ~1g;',~0~dIEzl~~I~~~~:Ji~I~;(~f·~iz~r~
'8
8
8
8
8
56
8
8
1.40

Registered Nurse .
Ucensed Practical Nurse
Licensed NursinR Ass't

0
0
"

TOTAL HOURS/ FTE-NIGHT
TOTAL ROllRS/ITE PER WEEK

*TBS '" To be scI1eduled

-77 -

56
291

0.00
0.00
1.40
7.28

(

(

Medical Directo.r
Dentist
Dental Assistant
Physician Assistant

. ProRI'am Mana~er

2
4
4
2

2

2

8

0.20
0.30

4

8
12'
12

4

8

4

2j) ,
0
40

.0

0.20
0.50
0.00
1.00
1.40
0.00

156

3.90·

d

0.00
1.40
0.00
1.40

2

'4
4
2

(

..

4
2

8

Adrriinistrative Ass't
Registered NUrse
Licensed Practical Nurse
Licensed Nu:rsin~ Ass't

8
8

8
8

8
8

8
8

8
8

8

8

TOTAL HOURS/ FTE-DAY

Licensed Practical NurSE!
Licensed Nursing Ass't

Registered Nurse
Licensed Practicai Nurse
Licensed NursinK Ass't

8

8

8

,

.

56

8

56

TOTAL HOURS/ FTE-f,vENING

56

8

o
8

8

8

8

o
TOTAL HOURS/ FTE-NIGHT

TOTAL HOlmS/FIT PER WEEK
"TBS = To be sCheduled

-78-

40
252

0.30

,0.00 .
1.00
0.00
1.00
6.30

(

(

Medical Director
Dentist
Dental Assistant·
Physician Assista,nt
Prop;ram Manager
Administrative Ass t
Registered Nurse
Licensed Practical Nurse
licensed Nursm~ Ass't

Registered Nurse
licensed Practical Nurse
Licensed NursinR Ass't

Registered Nurse
Licensed Practical Nurse
Licensed NUISin~ Ass't

8
8

16
·16

8

8

8

8

8

8

8

8

8'

8
8

8

8

8
8

8

16

8
8
8

8

8
8

4

6

6

(

8

8

·8

8

8

8

8

8

40

o
8

·8

.56

4

.4

48

TOTAL HOURSj FTE-DAY

208

8
4

56

o
8
4

0.40
0.40
0.40
0.40
1.00
0.00
. 1.40
'1.20
0.00
5.20

o

1.40
1.20
0.00

TQTAL HOURSj FTE-EVENING

·104

2.60

8

·0
56

8

48

TOTAL HOURS; FTE-NIGHT

56

0.00
1.40
0.00
1.40

TOTAL HOURS/FIT PER WEEK

368

9.20

8

8

*las:: To be scheduled

-79 -

8

o

(
.-

___ r

.

_

~-

-

>

r -- -

l

-

.- ..

(

,'-

,.~. ",~-e~~~
..

w.

-

-~- ~

'I ~I

': -' -, _', :1 _: ~,.~. ',':.

Medical Director
Dentist
Dental Assistant
PhysiC4m Assistant
Program ManaKer
Administrative Ass't
~e~stered, Nurse
licensed Practical Nurse
licensed Nursing Ass't

(

~ _... ~~:;-=:7'-~~r_~1~~-...~Ju~7q8~2~~~::-~~
:T:::'iu~RI.j:~~~T1R~--~,
'-.J~GY-*~~~.j~~11
'<' ,I
_'~i··~·~~ ~I ... J~ .:1 '" .J·;I'~ (,.j( _.-,~aJ-7at
~,~
~···.L'.l'"'~'
tl~:"<'r "=-11'jJ'~~-;"'~f:':' ':"'~(1"1.'_. :( J ,,-,O:.,::;J:":-, ••••- .... j
';· __ 1-:-Jjj.~,"·1

' . - .....

-'

>

-~ .... ',.',_. :~. /~:·~~·~~:~- ..>:~.L:}::i};=~.~~:~:ti~:~~::~~~:!~~·:?~~i~~:~;~:~L~:·~~].~~~~?~~?~~~iti~~:·~~~

2

2

2
4
4

4
4

6

0.15
0.20

8
8.
12
13
0

0.20
4
0.30
~
5
0.33
0.00
8
8
8
8
8
8
8
56
1.40
8,
40'
8
8
8
8
1.00
0
0.00
TOTAL HOURS/ FTE-DAY
143
3.58
. ~------- '------;-~~_--~~-~~~r7~=~.·~ll~{~(~~1S:~~~~[I~~~-~~~:I:~·~: :~~~'~-~'~=-.~~f:2illJ:~
Registered Nurse
0
0.00
8'
8 .
'8
llcensed Practical NUrse
8
8
8
8
56
1.40
Licensed Nwsing- Ass't
0
0.00
..
TOTAL HOURS/ FTE-EVENING
56
1.40
.... - - ,-,
--- ---- '-.~
~~~~=-~_·:-~~~_·~-.-=_·~-_·j.~~~:~~~~~T~~:>;_~~r
~
~~-'~~~:~::::£~~:::~_:·.:~:~~~(~~~~:~5~~~~:,t:~'
Registered Nurse
0
0.00
Licensed Practical Nurse
8
8
8
8
8
1.00
~O
Uc~nsed Nursing Ass't
0
0.00
TOTAL HOURS/FTf-NIGHT
40
1.00
TOTAL HOURS/FIE PER WEEK
239
5.98

4
8

_._~

"

*TBS '" To be schedUl~

- 80-

(

(

Medical Director
Dentist
Dental Ass~tant
Physician Assistant
Program Manager
Administrative Ass't
Regi~leredNU,rse

8

Licensed Practical Nurse
licensed Nursing As.s't

8

RestiStered Nurse
licensed Practical Nurse
licensed Nursing- Ass't

-8

8
-8
6

8

4'

.6

6

8
8
8

(

8
6

8

8

8

40

1.00

o

0.00
1.40
1.20
0.00
5.10

8

8

8

8

8

8

8

8.

4

4

56
48

TOTAL.HOURS/ FTE-DAY

204

o
8
8

8·

8

8

.8

8

8
4:

8

56

4

'48

o
TOTAL HOURS/ FTE.,.EVENING

ReJristered Nurse
Licensed Practical Nurse
Licensed Nursinst Ass't

12

·0.40
0.40
0.40
0.30

16
16

104

o
8

8

8

8

8

8·

8

TOTAL HOURS/ FTE-NIGHT
TOTAL HOURS/FrE PER WEEK
*TBS = To be scl1eduled

- 81 -

56

o

56
364

1.40
1.20
0.00
2.60
0.00
1.40
0.00
1.40

9.10

Medical Director
Dentist
Dental Assistant
Nurse Practitioner
Program Mana:g-er .

4

2

2
2
6

2
2
6
8

8

.8
4

2

8
8

8

20·

4

a

8

8

8

8

8

8

8

8

8

40
'8

8

8

8

8

8

8'

TOTAL HOURS;FTE'-EVENING

Rev;istered NUrse
licenSed Practical Nurse'
licensed NmsinR Ass't

8

8

3.60

12

TOTAL HOURS/ FTE-DAY

Registered Nurse
Licensed Practical Nurse
Licensed Nursin~ Ass't

o
144

4

Administrative Ass't
Registered Nurse
Uc~nsed Practical Nurse
Licensed Nutsin~ Ass't

0.20
. 0.10
0.10
0.30
0.50
0.00
1.00
1.40
0.00

8

8

8

8

·8

TOTAL HOURS/FTE-NIGHT
TOTAL HOURS/FIE PER WEEK

"Tas =lobe scheduled

- 82-

56

o·

0.00

56

lAO

a

0.00

56.

'1.40

0

0.00
1.40
0.00

56
0
56
.256

1.40
.6.40

(

(

Medical Director
Dentist
Dental Assistant
Nurse Practitioner
Program Manager
Administrative Ass't
Registered Nurse
licensed Practical Nurse
Licensed Nursing Ass't

iRN-"

h

J

Rew.stered Nurse
Licensed Practil;al Nurse
Licensed NU1'sing Ass't
RN':''' ~.
,

4

4
8

4

8

8

4

20

8

16
16
24

8.

40

8

8

8

8

4

(

8
8

8

o

>

16
16

16
16

.16
16

16
16

16
16·

16
16

16
16

112
112

8 .

8

8

'8

8

8

8 .

o
56

TOTAL HOURSj FTE-DAY .

396

9.90

'16

112

8

.. 56

280
1.40
0.00
1.40
5.60

16
8

16
8

16
8

16

16

8

8.

16
8

a
B

B

8

8

8

B

8

TOTAL HOURSj FTE-EVENING

Registered Nurse
Licensed Practical Nurse
Licensed NursinK Ass't

16

16

16

16

16

B

8

8

8

8

RN' -"

8

~.

0.50
0.40
0.40
0.60
1.00
0.00'
.2.80
2.80
0.00

8
8

.8
8

56
224
96
56
0

8

8

8

8

8

8

TOTAL HOURSj ITE-NIGHT
TOTAL HOURS/FTE PER WEEK
*TBS ., To be sCheduled

- 83-

.56
208
828

1.40

2.40
1.40
(WO
1.40

5.20
20.70

ATTACHMENT I

STIPULATION AND AGREEMENT

NOW COMES the State of Vermont, Department of Corrections, the Department of
Personnel, and theVermont State Employees' Association, Inc. representing the affected
employees, by and throl(gh their respective representatives, who do hereby stipulate and
agree to the following ,in' furtherance of their public-private partnership endeavor with
regard to the provision of medical services for the Department of Corrections. This
Stipulation and Agreement shall be considered to be part of the Corrections Bargaining
Unit Agreement.
'
1. That. the current, classified service, Corrections Department incumbents In the classes
I!sled below will continue employment in classified positions, when the contractor
commences responsibility for providing correctional health care services to the State. '
Correctional Health Care Specialist A '
,
Correctional Health Gare'Specialist B
Practical Nurse
Patient Care Intern
2. That, the contractor (or delegated representative thereof) shall be the immediate
supervisor(s) of classified employees, in the above listed classes, for ali purposes under
the contract and/or any rules and regulations, and that the provisions of the Supervision
at Classified Employees article of the Corrections contract shall be' waived in this case,
The contractor shall be deemed to be the delegated repres'entative of the appointing
authority for these empioyees for ali purposes, except that corrective action and/or
disciplinary actions will be imposed in collaboration with the Commissioner of Corrections
or his delegated representative.
'
3, That, all other provisions of the :Collective bargaining unit agreement (including the
process for Implementing work schedule and, work shift, challges)' will be applicable, to
classified incumbents in these posltiohs, except as otherwise indicated herein.
.

"

4, That, the parties agree to expedite dis~ipline and performance evaluation/corrective
procedures, grievances, or schedule/shift 'change procedures by means of the existing
contractual Alternative Displ:Jte Resolution (ADR) process, if applicable, or in some other
mutually agreeable manner. Neither party necessarily waives its right to appeal to the
Vermont Labor Relations Board in appropriate cases.
5, That, the parties agree to establis!' a "corrections healih care' labor, management
committee to ,diSCUSS issues and questions of mutuai concern. Regular contract
provisions relating to labor/management committees will apply.
6. That, neither' party waives any statutory or contractual right, prerogative or privilege
with respect to the disposition of positions in the above listed classes when they next
-84-

,:ATTACHMENT "I, cout.d

~.

Stipulation and Agreement
Page 2 '

'

pecome vacant.' N~lther·,party is restrained or restricted In th~ exercise of any such right,
prerogative ,or' privileg~: by the terms of this StipLilation anti Agreement.
..
.
.t .
. .
1..That, the contractor 'shall not actively 'recruit' classified employees to work dIrectly for

~.:.

F~R

THE
,

Ii;· . ,~)'--'.. . .

vs~·

./c,:,-....:.---.-

.

"

--7.L 5~\JCIG
.. FOR THE VERMONT DEPARTMENT OF CORRECTioNS:

_____
.~----'-.42_'
---",~---,--_._.~
Date'

t1J2., I /99 (

~I

FOR THE VERMONT DEPARTMENT OF P~RSONNE,L:
'.'

~{h~i 7b£
~t,
'Date
'..,
.r

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-85emsa.doc 7/25/96

p4

ATTACHMENTJ

SETTLEMENT AGREEMENT
L

PREAMBLE
"

WHEREAS,
on D~cember
13, 1993,'the
National Prison Project ("NPP")
of the American
,... . . .
..' ' .
. ' .
.

Civil
Liqerties
Union
("ACLU"}
brought an .actio(l pursuant, to 28 U,S'.C. §, 1331: §§ 1343(a)(3)
.
.
.
. . ':: .

.'

".'

and (4). §§ ,2201 and 2202,Ai'u.s,c. § 1983. and § 12101 etseq. to ~e(lress the 'alleged

. . .,

.

~

.

,deprivations ofrights protected byfede,rallaw and by the First" fourth, Fifth, Eighth, Nijtth and
Fourteenth Amendments of the united States Constitution, GGldsmitlN et al. v,

-

o

•

. . '

PAA et al., No.

•

•

•

'

2: 93-CY-383 (D.Yt. filed Dec. 13, 1'993) (the"lawsuit" or the "litigation"); and
,

,

.

. , WH:EREAS, on March 9. 1994. the plaintiffclass was certlfie.:t as "persons wh6 'are now
or who Witlin the future be cOnfined in Vermont'prisons and all persons who p,re now or will iit
.

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.";.

,

.

the future be subj~ctto the policies and practices of the Vehnont Department ofCorrections and ,
for Sexual
the.Yermo!!t Parole Board
. with
. respect to the Yennoot Treatment
. Program
. .
Aggressors and the Violent Offender Program;" and, '
WHEREAS, the named plaintiffs and the class they represent seek to remedy alleged

.

.

.;

unconstitutional and unll!.wfui col)ditions ofconfinement through dCl?laratoryand injunctive relief;
and
,WHEREAS, the defendants t~thIs lawsuit dispute the standing ofthe'plahatitrs to bring
this suit and the allegations that they have viol8.t~ plaintiffs' rights and deny an~ liability. and have
asse,rted various defenses to ~e p1alntiff's' claims. and do Dot admit or concede by entering into
this Agreement that any of the pl~tiffs' rights underthe United States.or yennont Constitutions
or under any law or regulation are or have been violated by the Stat~, and

WHEREAS; not~g In this Agreement is Intended to, oor shall be'cOnstrued as. an

'.

-86-

ATTACHMENT J, cont'd

admission of liability of or by any party; and

WHEREAS, the plaintiffs and the defendants are involved'm the discov,ery phase ofthe .
litigation as of the date of this AgreeIIll:nt; and
,

'

,WHEREAS, it is mlltually advantageous for both parties to settle this dispute v,'ithout '
'. '"

.

further disCCivery or a trial;,
NOW THEREFORi in consideration for the mutual covenants contained herein the
parties to this Agreement agree as follows:

II.

DEFINmQNS
1.

"Facilities" means the facilitillS of the DOC, which currently are:
a.
b.
c.'
d.
e.
f.

"g.
h.
'. 2.

'Northwest 8tat\l Correctional FacilitY ("NWSCF'" at St. Alb~);
Northeast Regional Correction,al Facility ('!NERCF" at 51.
Jolms»ury);
,
Southeast State Correctional'Facility ("SESCF" at Windsor);
Chittenden Regional Correctional Facility ("CRCF" at So. '
Burlington); ,
Mathie Valley Regional Correenonal'Faci!ity'("MVRCP" at
Rutland);'
Woodstock Regional Correctional Facility ("WRCF" at
. Woodstock);
,
. Northern State Correctional Facility ("NSCF" at Newport);
The Caledonia Conununity Work Camp ("cewc" at St.
Johnsbury).

"Imparti8i. Eltpert"'or "Experts" sliall mean the consWtantor consultants chosen by

the parties whose function shall bet.o det.ernune whether the State has achieved substantial
. compliance with the t.erms of Section rv ofthe' Agreement for those substantive a.relISassigned to
that Impartial Expert.
3,

The "Parties" shall mean the state and the Plaintiffs..

4.

"Plamtiffs' Counsei"
shall m~ Mitchell L. Pearl, Esq:; Lan~,?k, Speny & Wool,
.
.
"

-87-

ATTACHMENT J, cont'd

,Vennont, and staffatt~meys ofihe National PrisonPrciject oflhe American Civil Liherties UrliOri
Foundation, Washington, D.C.
5.

'''Plaintiffs" shall m~n the plaintiff class.

.

,

'!State;' shall)nean the'named defendant(i) to·,this lawsuit, except, the il'\dependent'

.6.

,

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.'...

medical
in the December
13, 1993, Complaint.
. care pfovidersnained
'.
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'"

"State's C~udsel" shail mean tbe'Attorney General foi-the State ofVerm~~t or his

7.

designee.
,.

III.

PROCEDURE
A.

Dismissal Of Action

8.

Upon signing the Agreement, the Parties shall seek approval of this Agreement

from the
Court pursuant
to Fed.R.Civ.P.
.
.'
. '23(e).
.
Upon th~ District Courts approval, this action shall be dismissed puisuant to

9.

Fed.J;l..tjV~P.41(~)(1)(jj).
As i~ the independent medical care providers named in the D~mber
.
..
.
.
"
13; 1993 Complaint,trus action shall be dismissed with prejudi~:
"

B.

,Effe"ctive Date or Agreement

'10.

This Agreement shall become effective upon: (a) approval oftbe Agreement by the

Court;' and. (b)dismis~ ofthe action as 'provided above.
C.

LitigatiOn During 24-Montb Compliance Period

11.

Except iis expresslyallbwed in 1131, below,'in the'caSe offire safety atWRCF,

from the date of approval ofthis Agreement and during the 24-month cqmpliance p~od provided
,

"

,herein, phiintifFs, individwillyor as'a class, shall not file any action or seek an injunction in either
,

,

state or federal court, under any federal or st;ate law cause ofaetion, on the basis ,of any allegation

-88-

ATTACHMENT J, cont'd

of fatl or C1aim.set. fortli
in. the December
U,l993 CompJai,nl,
..
.
:

'.

Nothing in .~~ 9 or II shaIrpreclude an individual from seeking exclusively on his

12.

or her own behalf; (a) damages for lI'specific claim' based upon operative facts occurring either
i

'

before

,

'"

"

•• :

•

'

.

or after the ~ffeetive date of this. Agrccinent, or; (b)equitabJe relief baS.ecl upon operative
, I

facts existing after .the eff~v~
date. of this Agreement,
including but not l4nited to claims
relating
"
..
.
to tbe Vermont Treatment Program for SexUal Aggressors ("VTPSA H). In additiOn, pa:rascaph II
.'

,'"'

':

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shall not
preclude
. '
~~

,'. " . : - ' .

',.....

" .

.

any individual
or'individuals from seeking reliefunder Vermont State
law
.
.
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.

provided that the relief sou.ght is .not based on any allegation offaet or claim s¢t faith in ~e
December 13, 1993 Complaint.
13.

In an~ action brought pursUant to ~ 12(b);a1?ove, for declaratory or injUnctive .

re1iefrelating to VlPsA, the Parties shall not obj~ to the admissiblity ofthe record of
pro~ingin the class· action qQldsmjth. et ai, y.·P·eM. et al..Civ.. AetionNo. 2: 93.cV-293

(D,Vt), except as to. relevanCe.
Nothing
in·this
paragraph sballlimit
a party's Ijghtto
objeCt
on
"
"
.
' .
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.

any grounds to the weight a court should give to the recOrd.
D.

Determination 9£ Substantial Compliance and Inllj'artial Experts

14.'

In order to determine whether the State has reached substantial compliance with

.,

.

tbe term; of Section rv of the Agreement,. the parties

asree to the appointment ofno more than

four (4) Impartial Experts as provided herein.:
IS.

An InipartiaI Expert or Impartial &perU'shall: (a) monitarthe State's compllance

with the specific terms
ofSec!ion IV of this A2;reement; and, (b).
at !lie'conclusion '
afthe ~4.

.

.

Month Compliance Period dtcidewhethe~ the Sta~e'is in substantial compliance with Section IV

.

of this Agreement. The 24-Moilth Co'mpllance Period shall be de.tin.cd as follows: (a) it shall
.

-89-

ATTACHMENT J, coot'd,

begin on the effective daie of this Agre~ment and shall end 'on the I~st day of the 24th, month
following; (b) if the laSt day of the 24"Month Compliance Period is not the last business day of the
.

;.

,".~.

.

.

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.

month,'
then the compliance
period shall conti~ue
through the last business day of the. month;
and,
·
...
. ." . .
.
~.

~'.

(c) i~ because oran Impai:tl~

, :.

.

'

BXp~'s unavoidable inability to make his or her final de~~ation

of substantial
compliance. a~. pro~ded
for .by. this 'Agreement. a detenilination ofsubstantial
·.
. .
.
compliance has not been made upon the expiration of the 24.Month'Compliance P~riod, the
Impartial Expert may extend'ror'a,reasonable period not to exceed sixty days the Oxpirati~n date
or

of the ·24·Month
as to.".
the neCessary subject areas to allow for the Impartial
.. ComplianCe'Period
.
.

Expert to make promptly his or her final deiermina~on ofsubstantial compliarice.,The Impartial
Expert shall promptly
~o~ the Plirties
in writing <?fthe ext,ensian.
.
.
.
~

Nothing in this Agreeme'tlt shall'change the State's obligation to ~mply with the

16,
,

,

,

specific fire safety
provisions relating to the WRCF, as provided in 1111 38,& 39, below: within .nine
.
'.
months from the effective ,date ofthis Agreement. ',' , ,
17,

The Parties agree to the selection ofthe folloWing Impartial Experts fC?r the

corresponding compliance areas: Robert Powitz, Section IV (B) ,and 1'0 select sri Impartial Expert
accept,Wle to the'Parties.as to Section rv. (A) as it relates to the WRCF and tlie SESCF; Allen
Breed, Section rv (C); ~Q, Ronald Shansky.1t.D;, Section IV (0) & (E),
18,

Except as provided
in: ~ 39; below,'as it. lIPplies to the WRCF, the detenilination of
. .

whether the state is insubstantial compliance with the terms of Section rv ofthis Agreement
shall occur on the last day of the 24-Mont!i:COaipliance Period.
19,

Each Impartial EXpert's determinati~n

of substantial co~pliance shall take mto

account the eXtent to which the'Slate'has achieved
and sustained
compliance
of
.
.
. during'the Course
. '
-90-

. ,'.

~

.",

ATTACHMENT J, cont'd

'.

'.

the 24-Month Compliarice Perioer..
20.

Six months
following the. eff'ective date of.this Agreement,ana every
nine m<;mths·
.' .
. .

thereafter
during the 24,Menth
Compliance
Period, the Impartial Expert(s) shall conduct on-site .
. . .
.
.... ; .
' . '

.'

.'

. tours o(the Vermont Faoilities. The Impartial Expert ~signed lo.determine co~pliance with the.
. .
.:..... .
':. ,,'.. '.
.'
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.
. . . ".
.
",

'"

"

.Fire. Safety provisions ofS~e:ti~n IV ~f this Agreement shall ~nduct an on-site t~ur of the wRCF
.

':"

.'

.nine months following the effective date of this Agreement in addition to his o~ her regular on-site
tours, and shall prepare a report that complies with the provisions of~ 24,'be1ow 'and includes a
..#-.

.

statement indicating whether the. State is in compliance with the requirements of~~ 38 & 39,
below, as they pertaU; to the V(RCF. The State has a responsibility to perinit, but does not have a
responsibility to guarantee, an Impartial Expert's attendaIice at these. agreed-upon intervals.
Plaintiffs' Counsel and the State's Counsel may each select representati~es to accompan~ the
Impartial
Expeits during
these on-site visits.. Plaintiffs' Counsel shall not select as representatives
.
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any. employee, agent, contractor,ailClIor represenl\1tive in any capacity ofthe State .0fVermont.
21.

The State shall' pay fees, expen$es and.eostsassociated with the work of the

Impartial Experts up to, but in no event exceeding, the total aggregate amount ofS4S,000.OO per
year.
22.

The Impartial ExJiert(s) ~y review all documents not privileged under Vermont

...

State law, speak with any D.efendant.
or staffmember
at the ·D.OC Facilities, and. may
'
. engage in
' ,

private conversationswitb any ~ass member.
23.

Following each oftbe
on-site visits referenced .above, each ..
ofthe impartial Experts
'.
'

shall prepare a written interim report ofhis or ber findings within thirty (30) "days arid shall s~d

'.

" , . '

" .

one copy each to Plaintiffs' and the Stat~'s Counsel.

-91-

.

ATTACHMENT J, cont'd

24.

Within thirty (30)' days following an Imparti~1 Expert's final on-site visit, as to

those specific areas
to which the Impartial'Expert haS been assigned.
the Impart,ial Expert shall
. . .
.
prepare a report including a statement. indicating whether. in the Impartial Expert's
.'
' . opili.ion,. the,
Stale is in substantial comp'liance with.the. specific terms :~f Section IV of this Ag!Clelrtent.
... ~'~..

25.

.

.

A1.Ilmparual,Expert's'detenninatiqn of substantial compliance shall tske into

account the extent to which exceptions to ,complilince are isaiated or noncontinuing in nature. or
.

;

'.

.

ate unintentional, or are th" teMporary result of actloi)s by members,ofthe plaintiff class, and are
addressed by corrective action.
,

,

26. . A finding ofsubstantial compliance in one or more ofthe subject areas set forth in
Section rv of this Agreement shall not be 4efeated by findings ofI\on-COinpliance with any other
subject area or areas.
27.·

In the event that an Impartial'Expert-leams at anytime of conditions that may pose

imminent. and
significant health or safety
risks to the'plaintiffs, he or she shall immediately report
.
.
such conditions to the Conunissioner ,of the Department of Corrections and to counsel to the
parties.
28.

Ifcounsel to either, party'communicates Witli an Imp.artial Expert, counsel shall

promptly prepare and produce to co~l to the other party m7"l0randa of conversations and
copies of all written communicationS 'With the. Impartial Expert.
29,

The State shall afford the Impartial Experts reasonable acce.ss to the State's

Facilities; documents, staffand inmates and the parties shall provide their'.full.cooperation to the.
",

Impartial Experts,
to enable them
to carry oUt their responsibilities.
"
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-92-

.,..

, AITA<;:HMENT J, cont'd

,

,

E.

Effect ()f A Detenninatlon Of Substantial Compliance.

30.

if, upon the expirati~n of the 24-Month Compliance Period, or in the ~e offire

safety at WRCF, following,the nine ~onth on-site tour pursuant to ~ 20,above, and ~,~ 38 & 39, '
" below, a,n Imparti~l Expett.finds that the Suite is in substantial compliance with any olthe subjeet '

'.' t.

'.

.

.

areas of Section
Iy
of this Agreement,
'as to any such subject area such .a finding
.
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.shall be a '
" , ;"

compl~te defense to any class action ~mplaint by the plaintiffs, having the same effect as a
dismissal with' prejudice by stipulation of the class action Goldsmjdl. et al, y. D!\an. et a).• Clv.
,

'

Action No.2: 93-CV-Z93 (D. Vt.). pursuant to Fed.RCiv.P. 41(a)(1)(ii).
31.

.

If, upon
24-Month, Compliance Period, or in the case offire
. the expiration ofthe
. . . .

,safety at WRCF, followirtg the nine month on-site tour pUrsuant to llZ0, above, and mr 38 & 39,
below, an Impartial Expertfutds
that .the State is. not
.
. in substantial. compliance
. with' any of the
,

'

subject'areas
of Section IV o£this
Agreement, the plaintiffs inay file a complaint seeking
relief
.
.... .
.' .
with respect to those areas for whiCh that Impartiall;lxpert bas determined that the S~e is not in
compliance.
31.

The parties allfee to accept and bebound by the detenninations of the Impartial

Experts,
F.

Plaintiff's' Counsel Access To Clients

33.

During the24-M~nth Compliance Period of this Agreement, Plaintiffs' coWlSel'

.reserve their right to m~t with their clients privately.
G.
34.

Remedies and Expiration Of Agreement

.

'

Either
ofthe Parties may commence, by and through
or the. State's
.
. tile Plaintiffs'
.

Coullsel, an action to enforce thete~s of SeCtion m a:nd V of'this Agreement;' provided however

-93-

ATTACHMENT J, cont'd

that; (a) any such action for breach of this A,greement ~hall be filed in the Washington Superior
Court in the state of Vennont;
shall be
., . . and,. (b) the
. ex.clusive remedy available in any such. action
.
limited to specific performance.
,35.

. Prior to filing'any such action under the preceding paragraph,.the Parties shall
- .

.'

make good faith efforts

~',

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to'r~olve

'..

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.

the dispute.

36.

In any such action described ill ~ 34, above, each party shall bear its oWn costs and

37.

E~Cept for n26, 30, 31, 32, 89;'and Section VI, this Agreementshal! expire and'

fees.

..

be ofno force or effect upon the expitatiol! of the 24-Month COmpliance Period.
IV.

COMPLIANCE mAS
A.

Fire Safety

38.

The State shall comply with the Vermont Fire Prevention and Building Code,

which incorporates by reference and amends rdevant portions ofthe (a) Buildirig Officials and
Code Administrators National Building
Code;
(b) National Fire Prevention Association ("NFPA")
.
.' .
, National Fire Prevention Code; and, (c;:) NFPA Life Safety Code, as it is applied to the Vermont
prison system by the State of Vermont Department ofLabor and Industry..
39:

. Within Iline'mon~
of the effective
date of~ Agreement the State will make
.
. ..
~.

specific physical plant.modifications to the ~CF which are necesSIIY to comply with ~ 38,.
a1:?ove, in response to the Dep~ent ofLabQr and Industry Auditfor the WRCF dated JanuarY
5, 1996, a copy of which shall be,provided to the Impartial Expert asSigned to detennine
compliance with the Fire Safety provisions ofthis Agreement. Prior to the eipiratiOD oftha 24Month Compliance Period,
to the' SESCF
. the State will make. specific physical plant'modificatioCs
.

-94-

ATTACHMENT J, cont'd.

which are nec~ssary to comply wlth ~ 38, above, in response to the Department ofLabor and

.

·

.

"

Lndostry Auditfo!" the SESCF dated January 5,1996., a·copy of which shall be provided to ~he
..

40.

"'..

If afailure

-

.

:

Iii the State to m~t th'e requirements ofW3 8 & 39, above, is due to

unavoidable construction delay(s) beyond the control ofthe State, and weirk is otherwise
. proceeding'to completion; the Imparlial,&Pert may, in his discretion, extend for up to s~ (60)·

·

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•

.

.

days the nine-month
coml>liance penod established fur the WRCF.
. ,
'

B.

, 41.

Enyjronmental-Health alld Safety ,

The State shall sufficiently maintain and repair, as'~eeded; plumbing at WRcF,

,CRCF, NERCF, MVRCF, NWSCF, and SESCF.
42. .

The State sha1I sufficiently maintain'and clean, as needed. the ventilation systems at

CRCF, NERCF, MVRC;:F•.'WRCF, and NWSCF.
....

43. '

The State shall sufficiently maintain the heatmg system sO that it is capable of

regulating temperatures throughout the facilities'at WRCF, MVRCF, NERCF, and SESCF.
44.

The State spau take reasonable measures; including necessary repairs, to av~rt the

.backup of sewage at WRCE:, CRCF, and SESCF.
45.· The State sha11 sanim;e mattresses between users and replace or repair, as needed,
'tom and ,dirty matti'ess~ at WRCF. CRCF, NERCF. J4VRCF, and SESCF.
'46.

The State
shall provide mattresses made of tire retardant ~terial at WRCF.
,

47,

The State shall provide, as needed, inmates with mattresses that fit the beaframes

.

alMVRCF.

-95,'1n

ATTACHMENT J, cont'd

48.

.

The Stai'e shall
maintain a prog~am for vermin and .insect'·control and extermination
.
.

in the kitchen and food storeroom at WRCF,

.

.

49.

The State shall require that kitchen workers cover their hair at CRCF.

50,

The State shail repair, as needed,..any.leaks.to the roof.over B: and·D pods at
.

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MVRCF.

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51,

The Stafe shall repair, as needed,. windo:ws at MYRCF.

52.

The,State shall·inaintilin sufficient food temperatu~es at MVRq.

53.

The Impartial Expert touring the fa.cilities referenced herein, i.e., WRCF, CRCF,

MVRCF, NERCF, SESCF, arid NWSCF, iil,addition to monitorlngthe State's ~ubstanti~
compliance with the specific ~tems listed herein, shall'determine whether·the State maintains
sufficient.levelsof environmental health and
. safety. at these facilities.
.'
-

c.

Crowding and SySt~mi£ CoqectioniarIssues

1.

Exercise

54,

The
available, for those
inmates'housed in the general
population
' .State shan
. make
.. '
.
.

with a custody.and security. rating of medium or lower, ~'with no disciplinary sancti<:llllimitlog

..

.'

outside recreation iii fo~ce; n6iless th~ ;even haurs ofoutside recreation per week, ,,::

~·.pt in'
..

emergency o~ 'adYers~ weath~ conditi~ns not, cOnducive to outside r~tion. Tpe Sta'te sh,.u
provide all prisoners with access to.out-of-eell time, during.whichthe prisoners

may ex:e~cise, no

.less than one hour per day, live days per week.
2.'

OVercrowding orWomen Prisqners

55.

The state shall provide adequate and safe housing ror women prisoners.

"

.1.•

'-96-

ATTACHMENT J, cont'd

Americans With DisabilitlesAct

3.

.:

.

,

,

'

The State sha:!1 ellsure, to the extent required by tlie Americans .with Disabilities

56.

Act (ADA), that inmate~ with disabilities are not excluded from participation io. or denied the

.

; .,"

~.

.'

benefits af services, {li'ograins1or actiVities because oftheir disabU,ities.
.

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"
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•

4.

,Use of Force 'and Restraints

57.

The. State
slla1l
videotape
cell eXtractions
and uses of force in aCcordance with
.
.
.
' . .

DOC Directive No. 413.02. dated September 22,

..

1993, and shall,maintain these videotape records

of any cell, extraetionsand u~s offorce in the DOC's posSession upon the effective date of this
'

settlement agreement and any re.eordCd during tho 24-Month Conwliance Period for at least as
long as necesstUy to allow
reasonilble .acCess.to the videotapes by:t.heJmparti81
Experts.
.
.
' .

'- '

58"

The State
.shall
. forbid the restriint
.. . ofinmates by securing an inmate's. hands behind
'

his or her back.
and
securing the inmate's
ankles to his or her wrists.
.'
.
.
'

5.

Areas Not Designed As Llylng Areas'

59.

Areas in DOt Facilities not originally,des,igned and built for housing 'inmates shall

not be utilized for the housing of inmates without necessary redesign and remodelling. '
D.

Medical Care

1.

Standard of Cate

60.

the State shall p~vide inmates with health care in accotdarice with constitUtional

standards. Nothing se~ forth below shall prevent the State from implementing additio~a1
'

,

procedures which will improve the, provision of health care to inmates.
,

2.

61.

,

Quality Assurance

, The State shall establish and maintain, a system to assure the qualitY ~f medical
,

.. -

-97-

ATTACHMENT J, cont'd

care for irunates. The qualit:! assurance program shall. be designed to ensure that" the provision of
..

medical care to inmates meets the standard set forth above in ~ 60.

.

..

3.

Medical Administration
..

;62.

The State ~a!1. employ.or otherwise contract for· a licensed.physician or a team .

. {.

comprised of a physician arid 'other medical professionals with a Health Care Organization (HCO)
. .

'.

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.

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to . serve asMedicai Director
to.the
prison
system. The Medical. Director
or HCO shall
.. . . .
. State's '
:'.
.
institute centralized.health care policies and shall review health care siaffing levels and operations
at'each facility and s~ be responsible for overseeing
t!le quality assurance .prograI1t.:
In addition,
.
.
the Medical Director
sball oversee
.
.. the.cllnical· treatment of prisoners. .
63.

..

The State shall maintain adequate policies, directives and procedures for medical

care throughout the System, including policies, directives and procedures for the treatment of
inmates with chronic diseases and inmates
who
require .speci3.J.tycare.
.
.

64. . The State shaI.l maintain liaisons with local hospitals.. The State shall ensure an
adequate and appropriate response for all inmates who need inunedi.ate medical attention and shall
maintain 24-hour access to emergency room Care:

4.

Intake

65.

The State shall conduct timely and adequateintaICe screening for inmatesbr

qualified med.ic81 persolUlel. The screening·shallinclude an appropriately administered test ror
tuberculosis.
66.

The State shall usebest efforts: (a) to screen newly-admitted female inmates for

sexually-transmitted
dis~es; and, (b) to provide
.
. such ~tes with pap. tests and urinalysis
.

.

pregnancy screening..

-98-

ATTACHMENT J, cont'd

·67.

The Sjat.eshall conduct an intake physical assessment by qualified mec;lical

personnel..
5.

Eyeglasses

.68.

The State ~h~1 provide.eyeglasses.te inmates in accordance with DOC Procedure
.

,

.

",.~

No. 412PP, dated March 2; 1992.,
6.

..

.

69.

. Dental Care

The Stat~: shall pro-Ade
deritiI care to treat inm~tes'
known' serious dental needs.. '
..
.
'.'

70.

The State shall schedul~ a 'comprehensive ~eilta1 screening ofall prisoners,within

60 days ofadmission.

71.

The State shall provide toothbrushes, toothpaste, and dental floss for all prisoners.

except
deemed a.
security, custody, or safety. risk by the DOG.
. ~hen reasonably
,
"
7.

MediCJII.Reeords
,
,

72.
The State shall maintain a startdardized fonnat for mlidiCa1 records includirig, but
not limited to:
.
.,

a..
. b.
c,

d.
73,

lab test resultsj
medical flow Charts;
m~ic:al history, and;
physical exam information.

The State shall protect th~ conndentiality ofmedical recorda and mediea\

information
8.

.
Therapeutic
. .Diets

74.. . The State shall maintain therapeutic diets based upon mec!ic;a1 Staff orders.

-

9.

CPR Training

7S.

The State ,sh!Ji provide cPR training for all medical staff and correctional officers.

...

~ "

-99- .

ATTACHMENT J, cont'd

10.

Infectious Disellse Trllinjng

76.

The Sta~e shall provide training tocon-ections and medical staff on infectious

diseases such as tuberculo.sis,hepatitis and AIDS.
11.

HfVCare., .,'

71.

The State. snall offer voluntary testing for AIDS and shall provide appropriate care

.~

"

'to HIV positive inmates.
12.

Women's Health Care

78.,

The State
shall provide women .prisOners access to: (a), gyn~lo8ical and~'.renatal
' . .

"

care; (b) breast examinaiio~ and mammograms for age-appropri~te or symptomatic inmates; and,
(c) routine pap tests.

13.

Medication Distribution.

79.

The State shall maintain an appropriate medication distribution system. The State

shall ensure that asthmatic iiunates have access to inhalers and inmates with corolllUY conditions
have access to nitroglycerin or other prescribed medication.
E.Mental Health 'Care
80.

The State shall provide prisoners with mental health care in accordance with

constitutional standards. Noth4tg shall prevent the State from doing more than whit is required
in this Agreement.
81.

The State shall m8.intain policies and directives for screening,' evaluation, housing,

and'treatment of inmates with.serious mental illne'sses and those indicatin~ withdrawal from
alcohol and drugs. This paragraph does not apply to individuals lodged pursu!Ult to.33 V.S.A.
§708(d)(1) & (2) ..

-100-

ATTACIlMENT J, cont'd

,

'

A suicide risk assessment sl)all be conducted bi' appropriately trained staffduring

82,

tl1e admission process utilizing the current Initial Needs -Survey fQrm, a copy of which shall be
,

"

;"

' .. ",

I

"

.,'

.

:.

.,.

'.

.

.

.

'.

"

pro~ded t~ the Imparti!U Expert assigned to evaluate compliance with this Mental Health Section.
..

.83.

.

"

.. , ~ .:"

'.;

,

. ..

-,'.

~,...'

'.

.

'.

.

:

The State.·shall
for . '.
. ; maintain
. . a 'S)'stem. to assure the·quality of mental health care
.

inmat.es. The quality as~u;ance program shall be desi~ed

t~ ensure that ~he provision of mental

health care to irunates ni~et~ the standard ~et forth above in ~SO ..

..

.

.

84.

85.

All i~ates
shall be adequately screened far any signs ofserious mental ilInes~.
'.....
. . .
. .

.

.'

"',

~"

The
Stat~ shall maintain liaisons ,with locai hospitals. The State shs!I ensu're
. . '.'
. an
.."'

.','

adequate and appropriate response for all inmates who need immediate mental health care, and
. ,.

....

.'

.

.

shall maintain 24-hour
access to. on-call e1,t1ergency. mental health care.
. .
86.·

The State shall maintain written policies, directives and procedures' for suicide

prexention.
87..

The State shall milintain appropriate policies, directives, and procedure~ governing

distribution and review of psychoactive medication; informed co.nsent; and, evaluation,
observation and treatment ofsuicida:l prisoners.
. 88.

The state shali provide a. Secure Care Unit ("SCU") and all Intermediate Care Unit

("ICU"), to ~e ad~uate1y
with qualifi~
mental health professionals and specially trained
. staffCd
.
. .
correctional persoMel.
V. '

ATtORNEYS' fEES
89.

Without any admission, implication, or suggestion py the State ofliability or that

the plaintiffs area.prevailing party pursuant to 42 U.S.C. § 1'988, the State agrees to pay and the
"- .

plaintiffs agree to accept a payIrient ofone hundred ninety five thousand doUars ($195,000.00) to
-101-

ATTACHMENT J, cont'd

be made in three paym'ents, the first to occur on or before July I, 1996 in 'the amoun~ of twenty'
five thousand dqllars ($25,000.00), \he second to occur on or before June 30; 1997 in the amount
ofS85,000,OO and the third to occur on or before Juiy31, 1997 in the ~ount ofS8S;OOO.OO to
.

.

.

. I.

....

.. '

. '

'.'

.

the National Prison Project~ in full satisfaction of any and all claims or deinands'for any and all ..

.. ,'. .

.' ., .. : .'··:'i.'·'· .:.' . ". '. ' .

.'

.. .

. .

fe~s, c~sts, and/or e,xpenses that the Nationa,J Prison PIojec~ its agents, assigns•.or those acting in

· its place, have claimed in the' past, have now, or could have in the future, up to and including the..
.
' .
·expiration' ofthe 24-Month Compliance Period, ki fullsettlement ofany' and.all potential.f~ and
J

,

.

'

..

· cost demands that have been or could be made by the plaintiffs in the aCtion Goldsmith.
, ....
.
:....
....
. '
.

Itt

al, v.

Dean. et al., Civ. Action No. 2:93-CY-3'83 (D. Vt.).
VL

MISCELLANEOUS

90.

This Agreement. is a ~ocl:l111ent whi«h all parties have n~gotiated and drifted and .

since all parties participated equally in c:irafting its .terms,the genei'al rule of construction
..'
.
interpreting a doct!ment ag~st the drafter shall not be applied in futur§ mterpreta,tion <;>f thiS
Agreement.
91.

.'
This Agree~ent r~presilnt~ the entire and .only Agreement between the parties in

.Gold;mith: et af, y. Dean. et a1.. Civ. Aeoon No.2: 93:.c;Y-383 (D. Yt.).. Ail prior agreements,
representations, statements, negotiations,. and
understandings
shall have
. .,.
,. no effect.
,
" .

. 92.

.,

No changes, modifications,. or~endments to the terms and conditio~s ofthis

Agreement shall be effective u~ess redu~. to writing, number~ and signed by Plaintiffs'. Counsel
and 'the State's Counsel.
93.

The law .ofthe Stale ofYennontregarding the Construction ofcontracts shall

govern any dispute regarding lhe construction oftJij:s Agreement.

""

ATTACHMENTJ, cont'd

.

None
of the' terms'contained' in \his Agreement, such as "agree," "shall,," "will,'"
,

94.

"establish," "implement,"
. :

.

"continue,'~

"ll1ainplin," and/or any combination or modification of these
"

,

.

,

, tenns as used in ~his Agreement, nor the assumption of any obligation contained within'the ",'
-

'. .' ':. . .

'.

"

.

.. '

~...

'.

.

..

. .

.

Agreement, imply that the',S~te is not now doing or must 00 any of'the items contained in this'
.'

"';'"

:':.

.

.

"

Agreement in or~er to coniply with the United 'States or VennGnt Constitutions or any statute or
regulation.
•

• ,~5:

TheCourt~s

approval of the dismissal of this action is sought toco~ply with Rule

23(e) of the Fcderal Rules of Civil Pro'ccdure, This Settlement Agreement i~ not a consent decree
"

'

nor do the parties intend it to be coilstrUed as such. It does not ~perate as an adjudication of the
merits of the litigation.
96.

This Agreement shall not beconsti'ued as contemplating, requiring or causing the
,

,

relinqui~hment

.

or ceding of any control by the State of Vermont over anyfacility or activitY ofthe

DOC.
97.

The terms ofthis'contraet are not severable and the finding that any terms

contained herein are illegal or void shall work to defeat all of the tenns 'contained herein.
~

98.

,.

.

By the signatUres below and for the consideration contained herein, the Parties

agree to be bound by tho'terms and, ~nditions of this .A.gTeement.

-103-

. ATTACHMENT J, conttd

VII.

Authority
99.

The ungersigned rep'resentatives of each party to this private agreement certify that.

each is fully authorized, by the party· or parties he or she represents to enter, into the terms and

..

conditions of this' settlement0. agreement
andto execute -and lj'nd that party'to it.
:1
STAT~ OF VERMONT
DEPARMENT OF CORRECTIONS
'103 South Main Street

w.:erbUry,VeItnOnt 05671

{

.BY.~~
F: ~rczyk,
O.mJl'USSIOner
For the Defendants

JEFFREY L. AMESTOY
ATTORNEY GENERAL
109 State Street
Montp· ier, Vermont 05609

'J

.

By:

...

DATED: .

.

NraLi)'srie

\N\.~

David M. Rocchio
Assistant Attorney General
For the Defendants

, .

'

DATED:

By:

,

~ ·11,

."

J' ~,6

~R

By:

~tc~ell L. Peart

n

Attorney for Plaintiffs
National )?risoh Project ACLU Foundation
1875 Connecticut AvenueJ,N.W. Suite 410
Washington, D.C. 20009
DATED:

Attorney for Plaintiffs
Langrock Sperry & Wool
15 South Pleasant Street
M:iddle~ury, Vennont 05753

DATED:.

-104-

'lti

(

(

,(
Attachment K

Staffing Coverage Standards

LPN
LNA

40

LPN

40

LPN

56

LPN

40

LPN

56

'LPN

56

RNInfirm
LPN

56

56

56

The above matrix reflects Contractor's Staffing Matrix (Attacltment H) for PAs, NPs, RNs, LPNs and LNAs with the reduction of forty hOUI~ per week or the
equivalent of one (1) FI:E per shift for the highlighted PClsitions. The intent of Attachmen~K is to provide a definition of an uncovered shift. For highlighted
positions, Contractor will be in compliance if only one (1) of two (2) ,scheduled individuals of the same title
present fcir the shift.. Should Contractor be unable
to fill aU positions as scheduled in Attachment K, a performance p'enalty will be incUIred. Contractor may, afits 'discretion, fill clinical positions with higher'
practice level professionals - charging the DOC at the cost of the regularly scheduled health profession - without penalty.

are

- 105 -

Attachment L

Independence, Liability, Hold Harmless Clause
\""'-According to Attachment C, Paragraph 5, Independence, Liability: "The Contractor will act in an
independent capacity arid not as officers or employees of the State. The Contractor shall indemnify,
defend and hold harmless the State and its officers and employees from liability and any claims,
suits, judgments and damages, which arise as a result of the Contractor's acts and! or omissionsin
theperformanceof services under this contract."
Attachment C,Paragraph 5 of this contract pertaining to defense and indemnrrication is intended by
the parties to include (i) defense of all claims~ and! or lawsuits, including but not limited to actions
for damages and! or for deClaratory or injunctive reiief, to the extent that they contain allegations that
arise as a result of the Contractor's negligence in the performance of services under this contract
and! or intentional misconduct in the performance of services under this contract (intentional
misconduct to include, without limitation; any intentional violation of law or duty of aue to any
inmate) whether or not the Contractor, an employee of the Contractor, or a subcontractor of the
Contractor is a named party to the action and (ii) indemnification to the extent that any such claim or
. lawsuit results in a final detei1:nination, and! or settlement, that liability arose as a result of the
.
Contractor's negligence in the performance of services under this contract and! or intentional
misconduct in the performance of services under this contract (intentional misconduct to include,
without limitation, any intentional violation of law or duty of care to any inmate) whether or not the
Contractor, an employee of the Contractor, or a subcontractor of the Contractor is a named party to
the action. The parties do not intend Paragraph 5 to include liability _
for allegations that'
I""...arise as a result of the acts (including intentional misconduct), oriUssions, policies, procedures or any
other conduct attributable to the State, its agents, officers Or employees.. '
.
lithe Office ofthe Attorney General or other representative of the State teriders, in writing, a claim
and! or lawsuit to Contractor for defense and indemnification in accordance with the aforementioned
paragraph, the Contractor shall respond, in.writing, to the Attorney General or State within ten (10)
business days of such tender. In the event a response to the claim or suit is required prior to the
expiration of the ten (10) business days period of tirrie, including but not limited to court action, the
. Contractor will be so notified. The Contractor'sresponse to the Attorney General's or State's
tendering of any such claim or lawsuit shall include an ackriowledgment of receipt of the claim
and/ or lawsuit, a response on whether Contractor will accept or decline the tendering of any such
.. claim and! or lawsuit and, if accepted, the identity of counSel retamed to defend any such claim
and/or lawsuit. .
.

In the event the Contractor does not comply with any aspect of this provision, and such noncompliance also constitutes a materiai violation of this provision, as so determined either judicially or
by mutual agreement of the parties, the Contractor shall be responsible for any and all costs and/ or
fees that were reasonablycincurred by the Attorney General's Office and! or the State as a direct
ccinsequence of such non-compliance.

-

- 106-

The Contractor agrees to cooperate with the Office of the Attorney General and the State in the
investigation and handling ,of any claim andlor lawsuits filed by inmate(s), andlor other person(s)
andlor entity or entities in connection with the Contractor's performance of services under this
'-contract The Office of the Attorney General and the State will monitor thedefense of all claims
andlor lawsuits and the Contractor and defense counsel shall cooperate fully with such monitoring,
The Office of the Attorney General and the State retain the right to participate, at their own expense,
in the defense andlor trial of any claim andlor lawsuit where the Contractor is providing the defense
and indemnification of such claim andlor lawsuit TheOffice of the Attorney General and the State
shall have the right to approveall proposed settlements oisuch claims andlor lawsuits, which are
. being made against the State andlor State employees. In the event the Office of the Attorney
General or. the State withholds such approval to settle any such claim andlor lawsuit then, the
Contractor shall proceed with the defense of the claim andlor lawsuit but, under those
circumstances, the Contractor's liability and indemnification obligations shall be limited to the
amount of the proposed settlement.
.
.

- 107-

Rev. 02/04/99

CONTRACT # 7891
CHANGE# I

AMENDMENT
It is agreed by and between the State of Vermont, Department of Corrections (hereafter called "State") and Prison

Health Services, Inc of Brentwood, TN (hereafter called "Contractor") that contract # 7891 dated 2/1/05 between
said State and Contractor is hereby amended as follows:
I) Attachment A, Contract For Services, Specifications Of Work To Be Performed, Subsection V.,
Administrative Services, shaIl read as follows:
Subsection B. Contract Implementation and Initiation Orientation

a.

Implementation
As part ofits proposal, Contractor submitted a Gantt chart summarizing key implementation tasks and
anticipated timefrarnes for the completion.ofthese tasks. In consultation with the DOC,. Contractor
developed a more detailed implementation plan delineating key milestones and associated start and
end dates. This revised implementation plan is included as Attachment G of the contract.
Contractor shall meet with DOC representatives weekly to report implementation status, issues and
adherence to·implementation timeframes reflected in Attachment G. The State and/or its designees
shall monitor Contractor's readiness throughout the implementation period, and may issue requests
for corrective action 'plans, as appropriate, should Contractor fail to meet key milestones that
jeopardize successful implementation.
In the event that Contractor fails to be fully operational by April 15, 2005, Contractor maybe
charged up to $25,000 per day until full operational status has been achieved. On April 15,2005, the
Vermont DOC Administration will notify Contractor in writing of its assessment of operational status
-.fully operational or non-compliant. Compliance shall be based upon completion of the key
milestones in Attachment G, as determined by the VDOC. The DOC shall detail all compliance
shortfalls by facility and function. Contractor will develop detailed corrective action plans for all .
non-compliant facilities and functions within five calendar days of receipt of the DOC operational
assessment letter.
Once the DOC has notified Contractor in writing that full operational status has been achieved, this
provision (and its associated performance guarantee) will no longer be applicable for the remainder of
the contract.

Subsection Q. Performance Guarantees
g.
Implementation Plan
In the event that Contractor fails to be fully operational by April 15, 2005, Contractor
may be charged up to $25,000 per day until fuH operational status has been achieved.
The size of the penalty shall be proportionate to Contractor's shortfaH in operational
readiness. The VDOC shaH determine completion of the key milestones in PHS'
Implementation Plan on April 15, 2005, and notify Contractor in writing of its assessment
of operational status -.fu1ly operational or non-compliant- detailing all compliance
shortfails by facility and function. Detailed corrective action plan(s) for all noncompliant facilities and functions are required from PHS within five calendar days of the
DOC operational assessment letter.
Once the DOC has notified Contractor in writing that full operational status has been
achieved, this performance guarantee will not.ionger be applied throughout the remainder
of the contract period.

~he folloWing language is added to the end of Attachment A, III, Personnel Services, A; Overview:

"-

The DOC recognizes that demand for staffing coverage is subject to change as the mission, size
and role of the specific DOC institutions change. It behooves the DOC and the Contractor to
have flexibility in reSponding to these demands. To insure that staff assignments match the
clinical and/or administrative need of each site, and that staff are optimally deployed throughout
the state, the DOC agrees to permit minor changes in the Staffing Matrix (Attachment H). Such
minor changes shall be:
•
•
•
•

Discussed in·.advance by the Executive Health Committee;
Made in accordance with mutually-agreed upon plans between the DOC and Contractor,
.
signed off by both parties,
Contingent upon the total statewide number of positions remaining unchanged, and
Memorialized in· an updated Staffing Matrix, maintained by the Executive Health
Committee, copied in the DOC Buisness Office Contract File.

In .addition, the Departmentof Corrections received and approved a revised staffing proposal from PHS.
. To insure that PHS'staffing matrix met the DOC's clinical and administrative requirements, the DOC
approved the proposed staffing matri?' for the flfst four months of the contract, with the following
provisos:
.
•

The DOC and Contractor shall meet on May 2, 200S to discuss their respective assessments of the
staffing matrix,
• Any changes to the matrix, proposed by either the DOC or Contractor to improve service delivery,
. shall be presented at that meeting;
• Staffmg changes accepted by the DOC and the Contractor which result in a reduction to the agreedupon contract maximum amount (no increase will be accepted by the DOC), will cause the DOC to
.
amend the contract no later than May 31, 2005.

3) The follOWing language is added to the end of Attachrnent A, II, Health Care Services, W., Pharmaceuticals:
.The State will cause a fmancial plan and design a performance audit to be conducted relative to
pharmaceuticals. Said audit will be conducted on or about June 30, 2005. If in the determination of the
State, savings can be achieved relative to pharmaceuticals, the State will take the pharmaceutical portion
of this contract to bid and reserves the right commencing January 1,2006, to obtain pharmaceutical
products and services from a different provider. In the event that the State opts to obtain pharmaceuticals
from a different provider, all other terms of this contract shall remain in effect.
4) This amendinent adds new Attachment G, PHS Implementation Plan, Attachment H, Staffmg Matrix, and .
. Attachment K, Staffmg Coverage Standards (attached).
.
Except as modified by this above amendment, and any and all previous amendments to this contract, all
provisions of this contract #7891 dated 2/1/05 shall remain unchanged and in full force and effect.
The effective date of this amendment is 4/15/05.

3

APPROVED AS TO FORM:

~/},-,-q+-/I -",-0

Date :.-<..1[

I

=c.-("_ - - - - :

STATE OF VERMONT
AGENCY OF HUMAN SERVICES
DEPARTMENT OF CORRECTIONS

Date:,--'_-+--I'-'--

_

(please P
Address: 105 Westpark Drive, Suite 200
Brentwood, TN 37027
SS#/Fed 10#: ?-2l08853
Date:
-</
~

r-'2-8'1

4

Attachment G - PHS Implementation Plan

"

1
2

Contract Awarded!
Establish management meeting schedule and Implementation agenda

12/15/04 01/12/05 Complete
12/15/04 12/17/04 Complete

3

Review Implementation tlme frame and confirm with PHS team and DOC

12/15/04 01/31/05

Complete

4
5
6
7

Inform PHS subcontractors of contract award
Establish Pharmacy Services
Arran)';e for Back-up Pharmacy Services
Contact local health department and other community resources

12/15/04
12/06/04
12/15/04
12/15/04

Complete
Complete
Complete
Complete

8

11/15/04 11/22/04 Complete

10
11

Obtain current employee list and provide to PHS human resource
department
Begmand complete facility assessment tours - all sites to include inventory
of medical supplies
Inform CMS personnel of contract award
Finalize PHS and operational teams to include on site Management Team

12
13

Facility tours status report to client
Review employee retention potential with PHS resources unit and DOC

12/22/04 12/22/04 Complete
11/29/04 12/22/04 Complete

9

Negotiate and finalize facility staffing and service matrix
Interview and make offers to current employees
Interview and make offers to new employees
post orders and job responsibilities to each shift to include clinical
i'-' Develop
aspects and submit to client
Obtain security clearance for PHS stafffrom client
18
19 Submit names of management team to client for approval
Develop staff meeting schedule and provide copy to client
20
Rep;ional Director start date
21
Medical Director/Physicians start date (if new staff)
22
Program Managers "start date
23
RN/LPN start date (if new staff)
24
25
Administrative assistants start date (if new staff)
26· New staff orientation and training
27 Pharmacy In-service for Staff
28
Orientall current employees to PHS policies to include approved protocols,
PHS utilization review
29
Establish site personnel files
30
Establish payroll System - installation of Chronos clock

14
15

12/31/04.
12/24/04
01/10/05
12/20/04

11/29/04 12/17/04 Complete
11/29/04 12/17/04 Complete
12/06/04 01/19/05 Complete

Complete
Complete
Complete
Complete

12/06/04
12/15/04
12/15/04
12/15/04

01/31/052
01/18/05
02/15/05
03/01/05

12/15/04
12/06/04
01/04/05
01/03/05
01/17/05
01/17/05
01/17/05
01/24/05
01/17/05
01/17/05
01/03/05

01/17/05 Complete
01/03/05 Complete
01/17/05 Complete
01/03/05 Complete
01/17/05 Complete
02/01/05 Complete
02/01/05 Complete
02/01/05 Complete
01/31/05 Complete
01/31/05 Complete
03/01/05 Complete
.

01/04/05 01/24/05
01/17/05 04/01/05

Complete
Complete

! Implementation dates contained in this Attachment were adjusted, with DOC approval, due to the delay in the
contract award date from December 15, 2004 to January 12, 2005.
2 To insure that PHS' staffing matrix met the DOC's clinical and administrative requirements, the DOC approved
the proposed staffing matrix for the first four months of the contract, with the following provisos: 1) The DOC
and Contractor shall meet on May 2, 2005 to discuss their respective assessments of the staffing matrix; 2) Any
"hanges to the matrix, proposed by either the DOC or Contractor to Improve service delivery, shall be presented
........ that meeting, 3) Staffing changes accepted by the DOC and the Contractor which result in a reduction to the
agreed-upon contract maximum amount (no increase will be accepted by the DOC), will cause the DOC to amend
the contract no later than May 31, 2005.
5

32
33
34
35
36
37
38
39

40
41
42
43

45
6

7

Develop emergency telephone numbers and contact information and
rovideto client for both im lementation and 0 erational teams)
Orient staff to PHS Information S stem re uirements as needed
·01 24/05 02/15/05
Develo in-service trainin annual schedule .
01/04/05 03/01/05
Complete review of all client's current policies, procedures, manuals and
12/06/0402/28/05
forms
.
.
Develop new policies and procedures, manuals and forms as needed,
12/22/04 02/28/05
oval
review with client and obtain a
ents
Develo work schedules and assi
12/20/04 02/28/05
Provide· ro· osed service schedule for client for a roval
12/06/04 02/28/05
Develo on-call schedules as re uired.and rovide to client
12/06/04 01/31/05
Review and develop chronic care clinic schedules and submit to client for
12/15/04 02/28/05
informational ur oses
Obtain insurance certificates and coordinate insurance requirements with
1U15/04 12/31/04
cor orate counsel and rovide co 'es to client
Order all medical su lies
01/10/05
Order all office supplies to include forms relevant to providing services
·01/10/05
s ecific to dien t
Establish e cash fund
01/17/05 01/31/05
Coordinate the transition of Health Service program from current provider 12/15/04 01/31/05
to ensure continui
Coordinate fiscal res onsibili "With current rovider3
02/25/05
.Meet with Mental Health Provider
01/21/05
Assist in determining the requirements necessary for interface with 6icility
01/14/05

Com lete
Com lete·
Complete
Complete
Com lete
Com lete
Com lete
Complete'
Complete

Com lete
Complete·
Com lete
Com Jete
Complete

MIs s stem
48
49

50
51
52
53

Coordinate, receive and install new com uters
Install phones, fax machines, computer lines (assuming DOC network
inte ation. If not achievable, CMS land lines will be maintained
Facilitate conununicati.on access te1e hones, a ers
Transfer Patient Information via medication administration records for
DOC inmates as of 1/15/05
Transfer Patient Information daily via medication administration records
for DOC inmates "With intakes after 1/15/05
Test MIS system for reporting capabilities to meet contract requirements.

12/15/04 02 01/05 Com lete
12/15/04 02/01/05 Complete
01 04/05 01/17/05 Com Jete
01/15/05 01/21/05 Complete
01/15/05 01/31/05 Complete
01/14/05 01/31/05 Complete

3 Process requires reconciliation between the estimated supplies and equipment to be purchased by the
Contractor from the incumbent and supplies and equipment left on-site as of February 1, 2005. Contractor shall
complete reconciliation and compensate the incumbent no later than February 25, 2005.

6.

(

(

(

Attachment H - Staffing Matrix.

r- .," .,.....

A. CORRECTIONAL FACILITIES SUMMARY - HOURS PER WEEK PER POSITION

,*

':;;1 ~""""i~! I,

~~~~"~~l;~~L>'},~fu}~~:~~~~ ,':+-~"~. r.I't~~f~f;';:jl,t~~~;
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'if,,',' ",~l',. -' - '·"'l' ,', :.• ~' ',':" J ~. 'ic.':·~·c' ;:., ," ,- ., ..:. ,,)', "'j,,, r J;n.
ll\i"''t,~"" ,!I~I' , ,~,e ". j.' "1"{ ~r~' "f~)§r' "'),"I';'\'1;r;.
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t.

~!;,t;t.;;~~ ,~," ,y ':.~::,c:':'J; :":,': ," ~'j,~ :.\';,',; ,j~C·m.~f;;.l~~~t~.l: IT'
Physicians
Physician Assistant
Nurse Practitioner
. Registered Nurse
Licensed Practical Nurse
Licensed Nurses Aide
Dentistl
Dental AssistantS
Dental Hygienist
Medical SecretaryI
Administrative Assistant
Program Manager
Vermont Regional
Director
Senior Program Mami.ger
Patient Advocate

10
0

2

4
0

40

28
0
0
0
0
2

2
0
0
0

78.

'.t

-

6
0
8

16
16

8
8

.-

16
12

8

a

0

0

0

a

12

40

112
1922
0
0
0

40
224

30

40
'1523
0
0
0
0
8

24
24
0
16

40
128
0
0
0
0
0

8
0

30
0

8
0

24
0

0
0
224

0
0

·0
0

396

226

0
0
380

20
80
208

112
56 .

152

112

a

0

32
32
0
24

0
0
0
0

0
0
0
8

40

16
0

40
40
654

0
0
198

16

6
12

..~~~;ff~

1

0

0

.f'-l-L.

i.m~~J!i ~

~':l~

~

'""- ~'~,

i-T~!
- . !~.,r"
.. ~,

'''' ~ ...,....,{'!i

-'-"~"'~~~J]j"~

M~t~r~L,;~.} ~".<:.l~
92
20
52
a
64
24
376
880
1,420
280
112

224

40
40
.0

96
96

72

0
160

24
0

32
0

160
40

0
0
212

0
0
996

40

40
. 3,364

Total Hours
PHS is current staffing RNs (112 hours per week) in LPN positions reflected in the staffing matrix. PHS hired CMS RN ~taff to cover these LPN position to
ensure contfuuity. of service during the transition. PHS believes that the'LPN positions reflect good oper:atipnal and clinical practice, and plans to transition
to LPNs in these positions over time.
.
.
2 See Footnote 1. Northern State has 56 LPN hours staffed by RNs.
3 See Footnote I. Northeast Regional has 96 LPN hours staffed by RNs..
4 Dentist hours are reported.in the tluee facilities where services are rendered; Chittenden, Northwest and Southern, but include hours designated to deliver
services to inmates at all nine DOC facilities.
5 Dental Assistant hours are reported in the tluee facilities where services are rendered: Chittenden, Northwest and Southern, but include hours designated
to deliver services to inmates at all nine DOC facilities.
1

1

I

,

(

(

(

B. INDIVIDUAL FACILITIES

Me4ical Director
Dentist
Dental Assistant
Physician Assistant
Program Mana~er
Administrative Ass't
Registered Nurse
Licensed Pr'actical Nurse
Licensed Nursing Ass't

2

2

o
o.
2

4
2
2

2

2

8

8

8

2
8

40

8

a
a
TOTAL HOURS/ FTE-DA Y

Registered Nurse
Licensed Practical Nurse
Licensed Nursing Ass't

50

a
4

4

4

4

4

4

4

28

a
TOTAL HOURS/ FTE-E VENING

28

a

Registered Nurse
Licensed Practical Nurse
Licensed Nursing Ass't
Total Hours! FIE-NIGHT
Total Hours/·FfE PER WEEK
*TBS = To be sdleduled

2

a
o
78

0.05
0.00
0.00
0.10
0.05
0.05
1.00
0.00
0.00
1.25

0.00
0.70
0.00
0.70

0.00
0.00
0.00
0.00
1.95

(

Medical Director
Dentist.
Den tal Assistant"
Nurse Practitioner
Pro am.Mana er
Administrative Ass't
Re .stered Nurse
Licensed Practical Nurse
Licensed Nursin Ass't

(

(

6

6

a
0
4

4

8

8

8

16

a
8

8

8

8

8

8

8

56

a
0
TOTAL HOURS/ FTE-DAY

86

0.15
.0.00
0.00
0.20
0.40
0.00
1.40
0.00
0.00
2.15

Re 'stered Nurse
Licensed Practical Nurse
licensed Nursin Ass't
TOTAL HOURS/ FTE-EVENING

Registered Nurse
licensed Practical Nurse
Licensed Nursing Ass't

8

8

8

8

8

8

8

TOTAL HOURS/ ITE-NIGHT

TOTAL HOURS/ITE PER WEEK
-TBS " To be scheduled

4

o

0.00

56

o

1.40
0.00

56
198

1.40
4.95

(

(

Medical Director
Dentist
Dental Assistant
Physician Assistant
Program ManaKer
Administrative Ass/t
Registered Nurse
Licensed Practical Nurse
(Filled by RN as of2f1/05)
Licensed Nur~ing Ass/t

(

8

8

8

8

8

8

8
8

8

8

8

. 8

8

8

8

8

8

8.

8

8

8

8

8

TOTAL HOURS/ FTE-EVENING
Registered Nurse
Licensed Practical Nurse
Licensed Nursing Ass t

56

1.40

o
128

0.00
3.20

o

0.00

56

1.40

a

0.00
1.40

o
8

TOTAL HOURS; FTE-DA Y
Registered Nurse
Licensed Practical Nurse
(Filled by RN as of2/1/05)
Licensed Nursing Ass't

8
8
8
40

0.20
0.00
0.00
0.20
0.20
0.20
1.00

o

56

a
8

8

8

8

8

40

a

1

TOTAL HOURS/ FTE-NIGHT
TOTAL HOURSjFTE PER WEEK
*TBS ::: To be scheduled

5

40
224

0.00
1.00
0.00
1.00
5.60

(

Medical Director
Dentist
Dental Assistant
Ph sician Assistant
Pro amMana er
Administrative Ass't
Re .stered Nurse
Licensed Practical Nurse
Licensed Nursin Ass't

'.

(

·8

(

16

8

0

O·
8
8

6

8
6

8
16

8
8

6
8

16

16

8
8
6
"8
8

6

30·

6

30

8

16

8
8

8
8

56
80
0

DAD
0.00
0.00
0.40
0.75
0.75
lAO
2.00
0.00

228

5.70

56

1.40

a

0.00

Re .stered Nurse
licensed Practical Nurse
Licensed Nursin Ass't
TOTAL HOURS/ITE-EVENING

8

8

8

8

8

8

8

TOTAL HOURS/ FTE-NIGHT
TOTAL HOURS/FIT PER WEEK
*TBS :: To be scheduled "

6

56

1.40

396

9.90

(

Medical Director
Dentist
Dental Assistant
Physician Assistant
Program ManaReJ;
Administrative Ass't·
Registered Nurse
Licensed Practical Nurse
licensed Nursing Ass't

(

8
8

8
8
8

6

8

8

8
8

8
8

8
8
8

(

16

8

0.00

24
24

6

12

8
8
8

8

24
16

8
8

40
56

8

8

o

16

16

16

16

16

16

16

TOTAL HOURS/ FTE-EVENING
ReKistered Nurse
licensed Practical Nurse
Licensed Nursing Ass't

a

8
8

TOTAL HOURS/ FTE-DAY

ReRistered Nurse
Licensed Practical Nurse
licensed Nursing Ass't

212

0.40
0.60
0.60
0.30
0.60
0.40
1.00
1.40
0.00
5.30

8

8

8

8

8

8

8

TOTAL HOURS/FTE-NIGHT
rOTALHOURSj ITE PER WEEK
*TBS "To be scheduled

8

112

2.80

a

0.00

112

2.80

o
56

0.00'
1.40

o

0.00

56

1.40

380

9.50

(

(

Medical Director
Dentist
Dental Assistant
Nurse Practitioner
Pro amMana er
Administrative Ass't
Re .stered Nurse
Licensed Practical Nurse
Licensed Nursin Ass't

4

4

6
"8

(

8

o
o

0.00
0.00
0.30 .

o
8

8

8

8

8

40
8

8

16

o

8

8

.8

8

8

8

8

TOTAL HOURS/ FTE-EVENING
Re . tered Nurse
Licensed Practical Nurse
Licensed Nursin Ass't

0.20

12
24

6
8

TOTAL HOURS/ FTE-DAY
Re .stered Nurse
Licensed Practical Nurse
Licensed Nursin Ass't

8

8

8

8

8"

8

8

8

""Tss :: To be scheduled

9

1.00
0040
0.00

" 100

2.50

a

0.00

56

0

1.40
0."00

56

1.40

0
" 56

0

TOTAL HOURS/ FTE-NIGHT
TOTAL HOUR5/ITE PERWEEK

0.60
0.00

56
212

Medical Director
Dentist
. Dental Assistant
Nurse Practitioner
Pro amMana er
Administrative Ass't
Re istered Nurse
Licensed Practical Nurse
Licensed Nursin Ass't
RN - Infirma

4

4

4

4

8
8
8

8

8

·8

8

8

8

8

8

8

8

8
8

16
16
16

·8

8

16

8

16
16

16
16

16
16
16

16
16
16

8
·8

8
8

8
8

8
8

Re .stered Nurse
Licensed Practical Nurse
Licensed Nursin Ass't
RN - Infirm

Registered Nurse
Licensed Practical Nurse
Licensed Nursin Ass't
RN -Infum

4

20
40
40
24 .
32
72

8
8
16
16
8
8
8
S·
8
8
TOTALHOURS FTE-DAY

96
112
56
56
548

0.50
1.00
1.00
0.60
0.80
1.80
2.40
2.80
1.40
1.40
13.70

8

16
.8

8
8
8
TOTAL HOURS/ FTE-EVENING

8
8

8
8

8

8

8

8

8

8

8

8

8

8

"T8S = To be scheduled

10

8
8

8

56

8

56
0

8
8
8
TOTAL HOURS/ FTE-NIGHT
TOTAL HOURS/ITEPER WEEK

56

168
996

1.40
1.40
0.00
1.40
4.20
24.90

Attachment K
Staffing Coverage Standards

56
LPN

40

LPN

56

LPN

40

LPN

56

LPN

40

LPN

56

LPN

56

56

The above matrix reflects Contractor's Staffing Matrix (Attachment II) for PAs, NPs,RNs, LPNs and LNAs with the reduction of forty hours per week or the
equivalent of one (1) FIE per shift for the highlighted positi<:ms. The intent of Attachment K is to provide a definition of an 4llcovered shift. For highlighted
positions, Contractor. VliIl·be in compliance if only one (1) of two (2) scheduled individuals of the same title are present for the shift. Should Contractor be unable
to fill all positions as scheduled in Attachment K, a perfonnance penalty will he incurred. Contractor may, at its discretion, fill clinical positions with higher
practice level professionals - charging the DOC at the cost of the regularly scheduled healt~ profession - without penalty..

-------;1-----

. ,;i.

•

12 Ncrthem day shift has two LPNs on Monday, Wednesday and Friday. Contractor will be in compliance if only one of two scheduled individuals
'He present on these three days.
.
- 11 -

)

)

-

'l:
.....

)

..

.
.