State health care system for inmates makes some progress, audit says

Corrections agency working toward timely exams, independent reviews, according to report

April 06, 2010|By Erica Green | | Baltimore Sun reporter

Maryland's long-troubled prison health care system is making strides toward efficiency, but workers need to more closely monitor the treatment received by those behind bars, according to a review released Monday.

Assessing the findings of a report issued three years ago, state auditors found that inmate health care operations managed by the state Department of Public Safety and Correctional Services made gains in areas such as ensuring that inmates receive examinations within seven days of an arrest. Other areas of progress: the launch of a methadone program for addicts and detailed reviews of inmate deaths.

But auditors found only "minimal progress" in making sure inmates with chronic conditions get appropriate treatment, and in demanding that contractors make improvements in areas where they have fallen short.

Rebutting these findings, Mark Vernarelli, spokesman for the state corrections department, pointed out that both emergency room visits and outside hospital admissions for infectious diseases are down.

"We're working very hard to manage chronic conditions like diabetes, heart problems and HIV," Vernarelli said.

Inmate health care, provided by five companies paid a combined $150 million annually, has been a long-standing problem in Maryland. In 1993, the state entered an agreement to fix medical conditions in prisons, after Department of Justice investigators found that the Baltimore jails had not improved since a 1971 lawsuit. The state promised improvements after reaching a settlement last year with the American Civil Liberties Union and the Public Justice Center, both of which had sued over prison health conditions.

Those advocates said Monday that the prison system needs to take a hard look at the gains and shortcomings of the past three years.

They said they were particularly concerned that prison officials did not appear to keep or review more than five dozen self-assessments that medical contractors were supposed to complete in 2009. And only 124 of the 214 inmate deaths from January 2007 to November 2009 had been investigated by an independent physician.

The areas that need more improvement are "kind of big, systemic things, people just kind of falling through the cracks," said Wendy Hess, an attorney with the Baltimore-based Public Justice Center.

Monday's report "shows that there are serious gaps in the state's oversight of contractors who provide essential medical services," said David Fathi, director of the ACLU's National Prison Project. "A death in a corrections facility is a wealth of information ... any system that's interested in improving, would review deaths."

In its response to the audit, corrections officials said they were committed to making improvements.

"Inmate health care in Maryland is a huge undertaking and a job we take very seriously," Vernarelli said.

The follow-up review focused on seven areas identified by auditors as "most directly involving quality of care issues," said Bruce A. Myers, head of the Office of Legislative Audits.

Asked whether there had been significant progress, Myers said such an assessment was "in the eye of the beholder."

"Of course I would like to see them all corrected," he said. "They showed some progress ... but they haven't fully resolved all of them."

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