Maryland Department of Public Safety and Correctional Services had few answers for lawmakers this week about the mismanagement of prison healthcare contracts that lead to poor staffing, lack of oversight and missed health checks of inmates.
The hours-long hearing left the Joint Audit and Evaluation Committee chairmen baffled at the agency’s decision making in entering into and implementing its previous contract with Yescare and the thought process behind the new $724 million contract the state signed with Centurion Health in August.
“When you look at these contractors and the poor performance that we've had on these contractors in the in the past, it demands a higher level of controls to make sure that the outcomes are different, and that's what makes this report so trouble is so troubling,” said Joshua Adler, a director at the Office of Legislative Audits. “Despite the long history of failed contracts to provide these services, we did not see any evidence that those past failures were considered in developing these contracts.”
The OLA’s report found that Maryland’s prison system is only 53% staffed, leaving one nurse to care for more than 50 patients at times.
The failures led to dangerous conditions for inmates. For example, the contractors missed hundreds of evaluations for suicide risk and mental health.
“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.”
DPSCS Secretary Carolyn Scruggs had few answers for the failures. She frequently blamed the previous administration for entering into the fixed-rate contract with YesCare and said that COVID-19 created problems in implementing proper healthcare.
“There's been a lot of finger pointing and belly aching about how we got to this point, but when you look at the audit report itself, there was no documentation to support why they decided to go with this lowest bidder to provide these services,” said Sen. Clarence Lam, co-chair of the Joint Audit and Evaluation Committee. “It seems as though that health is secondary to the department's addressing of these individuals needs, and these are individuals that are under the care of the state. The inmates are not sentenced to inadequate health and to lasting medical complications.”
The concerns continued as lawmakers started looking into the state’s new contract with Centurion Health.
Del. Jared Solomon, co-chair of the Joint Audit and Evaluation Committee, noted that “a simple Google search” unearths the problems with the company.
Centurion is currently being sued for patient neglect in Kansas and was found to have mismanaged care during COVID-19 in Arizona.
DPSCS says it’s working closely with the company to ensure the contract is upheld properly and that the agency is beefing up its internal auditing office.
However, lawmakers want more oversight. Lam and Solomon both said they are considering writing language in the budget that will dock DPSCS’s funding unless it hits certain oversight benchmarks.
The issue as a whole is making some question the legitimacy of using to private companies for health services.
“It just sort of feels like we're rearranging deck chairs a little bit by working within a framework where they're outsourcing this contract and this work to a for profit company, as opposed to thinking creatively and using the incredible health resources that we have in our state to maybe do something different,” Solomon said.
