Maryland's inmate health care system faced staffing shortages last year, and plans stalled for drug treatment programs and a new electronic database to keep better track of records, a state audit released yesterday showed.
Auditors from the Office of Legislative Audits noted "several significant areas of noncompliance" that affected inmate medical services at facilities across the state, including Baltimore's Central Booking and Intake Center and the city jail, according to the report.
"We found a number of areas in which inadequate [state] monitoring appeared to lead to potential lapses in required medical coverage and certain required medical treatments," auditors wrote.
The audit was the state's first public, independent look at a new system for inmate health care that the state Department of Public Safety and Correctional Services pursued in 2005. Until that year, inmate health care costs had been stable because the state had signed fixed-price contracts with medical providers.
But because of rapidly increasing costs in the health care industry, for-profit companies that Maryland and other states relied on for inmate health care services were no longer agreeing to fixed-price deals.
Faced with pressure to improve the system, particularly in Baltimore, state officials offered separate contracts for the prison system's varying health care needs. Different companies were awarded contracts for medical, dental, mental health and pharmaceutical coverage. These contractors now "pass-through" the costs of their goods and services to the state for reimbursement. For fiscal year 2006, the tab for inmate health care in the state totaled $109.7 million.
Auditors found that medical care, dental care and mental health care providers weren't providing required levels of staff. They also noted problems with medical screenings, chronic care checkups, medication dispensation and timely treatment based on inmate needs.
The contract system requires more monitoring by state staff than the previous system, auditors found, but the state agency hasn't been able to add more staff beyond the 30 employees who have overseen the system since before the new contracts were signed two years ago.
Plans for a methadone detoxification program -- to help treat thousands of inmates dealing with drug addiction -- and for an electronic health records computer system remain in early stages, the audit said.
Richard B. Rosenblatt, assistant secretary for treatment services in the Department of Public Safety and Correctional Services, defended the current contract system but acknowledged room for improvement. He said the new contracts have ensured more staffing and more accountability from the state prison system's health care vendors.
"It's clearly been improved, if only with the number of feet on the floor," Rosenblatt said. "There's staffing levels now that were never dreamed of under the prior contract. Now, the fact that we're not at 100 percent [staffing], sure that's disappointing to us.
"If we've got weaknesses in the system, this is not from a doctor's point of view, it's from an accountant's point of view."
Auditors did not identify individual contractors in their report. Correctional Medical Services Inc., a St. Louis-based inmate health care provider, is the main medical contractor for the state and was paid $49.2 million for its work in the 2006 fiscal year, which ended in June last year.
CMS made $13 million less than it could have made under its contract. MHM Services Inc. of Tysons Corner, Va., provided mental health care services at a cost of $9.3 million -- or $1.8 million less than it could have made under its contract. In both instances, the companies were paid less than what their contracts allowed mainly because they provided less staffing and services, according to Rosenblatt.
Ken Fields, a CMS spokesman, said in a statement that the company has increased staffing coverage over the past year by using overtime and temporary workers. "We will certainly work with the state to answer any questions that may arise from this review, but quality health care services are being provided to inmate patients in state prison facilities," Fields said.
Inmate advocates argued that the audit showed that because the system is so important and costly, it should be scrutinized more regularly by outside entities.
"We certainly don't fault the state for spending too much money on its health care contracts, we just think there should be better oversight to make sure that it's well-spent," said Sally Dworak-Fisher, an attorney with the Public Justice Center in Baltimore.