Many issues in Delaware's prison health system remain unaddressed, report says
Despite years of recommendations focusing on problems in the Delaware Department of Correction's healthcare system, a report issued Thursday by the state's largest private healthcare provider found that many have not been addressed.
Take a recommendation from the Pew Charitable Trusts in 2017 that found Delaware "was one of 26% of states that did not report having a quality monitoring system and was among 17% of states that reported that vendor contracts did not include quality metrics," according to the report released Thursday by ChristianaCare.
Those same findings are still present in today's prison system – an issue reflected in the mounting number of lawsuits filed each month by Delaware prisoners against both the DOC and its contracted health provider, Connections Community Support Programs.
The ChristianaCare report, conducted from September to mid-October, also found that the DOC operates as a "highly-siloed" agency, lacking communication between various groups all focused on prison healthcare.
This was apparent to ChristianaCare reviewers through the prison's handling of administering naloxone, the overdose-reversing medication focused on opioids.
"We have to break down those silos," Delaware Department of Correction Commissioner Claire DeMatteis said during a Thursday press conference where she spoke about the report. "A big piece of that is training"
DeMatteis believes this is caused by a lack of communication and staff feeling under-appreciated.
"We have to be very in tune with that and understand that we have to do a better job of communication up and down the line," she said.
Naloxone is an important area to focus on, according to the 19-page report, as six overdoses occurred simultaneously while ChristianaCare was visiting the Sussex Community Corrections Center. All were reversed due to a "robust interprofessional team-based effort," the report said.
BACKGROUND:Inmate's fatal overdose shows how easy it is to get drugs into prison
But there is no comprehensive data among the prisons that documents the doses of naloxone administered to inmates at each facility, the trends of how this medication is being administered, or an assessment of how other interventions aimed at stopping overdoses are working, according to the report.
"Knowing process or outcome related data, along with some other basic analytics, are fundamental requirements to understand the extent of any potential opportunity and to begin to create effective solutions," the report said.
Improving the prison healthcare system is exactly why DeMatteis requested that ChristianaCare come into the state prison facilities and independently review the medical and behavioral healthcare systems.
While the report highlights areas where there DOC is doing well, DeMatteis said it also provides a roadmap on how to improve healthcare services to the more than 5,000 people in custody.
DeMatteis listed eight ares that the department will prioritize, including:
- Restructuring the DOC healthcare bureau to focus on such things as compliance, quality and medical staff proficiency.
- Developing, tracking and analyzing how offenders are being treated and how effective their treatment is.
- Fixing the electronic health record system.
- Recruiting, retraining and rewarding staff that embrace a culture of safety, quality and performance.
"We now will be focused on acting to making the necessary improvements that it highlights over the coming months," DeMatteis said. "This is a manageable challenge and the improvements will benefit offenders, our medical and behavioral health teams, counselors and correctional officers alike."
The team from Christiana, however, “was not reviewing compliance with industry/regulatory standards, disease specific treatment protocols/guidelines used within the facility, or patient specific treatment.”
ChristianaCare has no prior experience with prison healthcare, which is why the review was focused more on practice rather than industry standards, according to the report.
The report's inception raised eyebrows statewide as the contracted healthcare provider Connections has come under increased scrutiny this year.
In May, the state Department of Justice said it was investigating Connections Community Support Programs, which provides physical and mental health care to all inmates in Delaware’s state-run prison system.
News of that probe came after The News Journal published an investigation into reports that the contractor falsified records to conceal inadequate addiction treatment at Crest South, a taxpayer-funded substance abuse program for drug offenders in Georgetown.
No further information on that investigation has been released.
The ChristianaCare report did note that more money is needed to address some of the physical and technological barriers to care.
But it also stressed that money alone won't solve the problems currently inhibiting access to care in the state-run prisons.
For Dover attorney Stephen Hampton, a vocal critic of the Delaware prisons who also has multiple lawsuits against the DOC, it's going to take a lot more than money and recommendations to make a change in the prison system.
"This is written like an academic report identifying problems, but it tells you in general terms aspirational goals," he said. "That's all well and good but there is no specific concrete plan on how to fix anything."
Got information on what's going on in Delaware's prison system? Get in touch with reporters Brittany Horn and Esteban Parra. Horn can be reached at bhorn@delawareonline.com. Parra can be reached at eparra@delawareonline.com.