Prisoners in Maryland’s in-state detention centers are missing out on needed healthcare due to a lack of oversight by the Department of Public Safety and Correctional Services, as well as failures by the contractors in charge of health services.

The findings come from a recent report released by the Office of Legislative Audits, which found that the state did not structure its contracts with businesses in ways that justified payment and that Maryland failed to monitor that the companies were properly upholding contracts worth more than a billion dollars.

“Our audit disclosed numerous issues with DPSCS’ procurements of the three healthcare contracts,” the report states. “DPSCS awarded the medical and mental health contracts despite significant concerns with the contractors’ ability to provide the services, failed to disclose the concerns to the Board of Public Works and did not develop a contingency plan in the event the contractors could not fulfill the contract requirements.”

The failures led to dangerous conditions for inmates. For example, the contractors missed hundreds of evaluations for suicide risk and mental health.

The audit calls into question some of the larger national questions about outsourcing medical care in the carceral system.

“The contractors, they're incentivized to make money,” said Edward Rubenstein, a director at OLA. “They want to do that by keeping their costs as low as possible. They're incentivized somewhat, to provide the lowest level of staffing they can get away with to do that.”

Rubenstein said the failures extend throughout the public and private sector.

“Everyone has some blame in the situation, but definitely we felt the department could have done more to make sure that the contractors performed better,” Rubenstein said.

The report caught the attention of the General Assembly’s Joint Audit and Evaluation Committee. It’s holding a hearing on Dec. 10.