Report finds gaps in Delaware prison health care system

DOVER, Del. (AP) — The head of Delaware's prison system insisted Thursday that inmates are getting good medical care, but a new report indicates the correction department's health care system is plagued by poor communic ations, little accountability and a lack of data collection and analysis.

The independent review of medical and behavioral health care in state prisons found that "functional governance" and "shared accountability" extending from Department of Correction leadership to prison facilities was "minimally apparent."

Reviewers also said they found no documents that articulated goals for health care delivery within the department, and no evidence of meaningful collaboration between DOC's health care bureau and its medical contractor, Connections Community Support Programs. Organizational changes are needed to ensure both quality improvement and process improvement, reviewers said.

"A culture of reporting, learning, and improving deviations in operational and care process was not present," the 16-page report stated.

The review was conducted in September and October by 15 staff members of Christiana Care Health System, Delaware's largest hospital system, who visited seven DOC facilities.

DOC Commissioner Claire DeMatteis said the report provides a road map on how to improve health care delivery to inmates, and that the suggested improvements represent "a manageable challenge."

“We need to update how we do business in delivering health care,” DeMatteis said. “We used to do much more auditing of our health care vendor and our outcomes and our patients' safety and quality, and we have to ge t back to that.”

DeMatteis was appointed DOC commissioner in June after overseeing efforts to implement recommendations contained in a report on a deadly riot at Delaware's maximum-security prison in February 2017.

"I am confident that offenders are getting good health care in our correctional facilities," she said. "What this report will do is help us make that better and hold our vendor accountable and hold us accountable to key quality assurance measures."

DeMatteis said that, other than fixing the DOC's electronic health record system, none of the recommendations in the report would require additional spending. The cost of fixing the 5-year-old system has been estimated at between $3 million and $5 million, she said.

Stephen Hampton, an attorney who has represented several inmates in lawsuits alleging inadequate medical care, said the report points out problems that have existed for years.

"However, despite general recommendations about needed improvements to the correctional health care system, there is no specific advice on how to solve the problems," he said. "Unless the Department of Correction promptly addresses these problems with a specific plan on remedying them, the report will have been of no consequence."

Christiana's report did not review compliance with industry or regulatory standards, or disease-specific protocols, instead focusing more on organizational and administrative issues.

DOC's medical director, Dr. Awele Maduka-Ezeh, said the biggest health care challenge for the department, from a clinical perspective, is substance abuse disorders. As of last week, more than 940 inmates had received medication-assisted treatment for substance abuse disorders this year.

Earlier this year, Delaware lawmakers unanimously approved a bill reforming a committee charged with monitoring prison health care. The bill was introduced after the attorney general's office confirmed that it was investigating allegations that Connections had ordered staffers to forge documents to falsely state inmates were getting mental health treatment they never received.

DeMatteis said she was told office last week that the investigation is continuing. Connections' current contract with DOC expires June 30.