DoC has a constitutional obligation to ensure that medical care is provided  to inmates in its custody, and DoC’s contract with CCHPS requires  CCHPS to provide comprehensive medical services to all inmates assigned  to the Jail and the CTF and to establish a quality improvement program to  monitor the quality of medical services it provides. A key component of  this program is quarterly analyses of random samples of inmate medical  records to measure how consistently CCHPS delivers required services to  inmates. CCHPS Provides Screening and Treatment Services Required in Its Contract and Assists DoC in Obtaining Additional Services

As required by the contract, CCHPS provides a broad range of medical  services to Jail and CTF inmates, including primary care services such as  sick call and chronic care; mental health care; and specialty care, such as  dental and orthopedic services. DoC Established Several Mechanisms to Oversee CCHPS’s Delivery of Medical Services

DoC has developed several mechanisms to oversee CCHPS’s delivery of  medical services to inmates and enforce CCHPS’s compliance with the  contract. For example, DoC’s contract with CCHPS gives DoC the  authority to impose monetary damages if CCHPS fails to meet any of 12  requirements specified in the contract, most of which relate to CCHPS’s  performance in providing key medical services. DoC also requires CCHPS to maintain accreditation  of its services. Since August 2000, the independent reviewer  has conducted 14 quarterly on-site reviews of CCHPS. CCHPS Generally Meets Contract Requirements, but DoC’s Oversight of CCHPS Is Incomplete

Most available evidence indicates that CCHPS has generally complied with  the contract, but DoC has not exercised sufficient oversight to be assured  that problems are not occurring or are quickly corrected. The independent  reviewer has reported that CCHPS’s services meet the contract’s  requirements for access to care and quality. Furthermore, although DoC has authority to impose  monetary damages on CCHPS if it does not meet certain requirements  included in the contract, DoC has not collected data needed to impose  these damages or developed formal procedures for determining whether  CCHPS has met these requirements and for imposing damages if CCHPS  has not met them. For example, the contract requires that CCHPS provide  timely follow-up services to inmates with abnormal chest x-ray results. Although CCHPS has recently improved its performance, the independent  reviewer had repeatedly found that CCHPS did not always provide timely  follow-up services to these inmates. In addition, CCHPS has not regularly submitted the required quarterly and  annual progress reports providing information on quality problems and its  actions to correct them. In addition, DoC has generally not enforced the contract requirement that  CCHPS submit quarterly and annual progress reports describing quality  problems and actions taken to correct them. These reports would allow  DoC to obtain information on how CCHPS is addressing compliance or  other performance problems identified by CCHPS’s own monitoring or the  independent reviewer. The total cost to  provide medical services to inmates at the Jail and the CTF in 2003 was  about $15.8 million, an average of $13.28 per inmate. Cost of Medical Services at Jail Decreased, Despite Growth of Inmate Population

From initiation of the CCHPS contract in 2000 to 2003, the average daily  per inmate cost of medical services at the Jail decreased by almost one- third, from about $19 a day to about $13 a day. 1.) 2.) 3.) Recommendations for Executive Action

To help ensure that CCHPS provides required medical services to inmates  of the District of Columbia Jail and the CTF, we recommend that the  Mayor require the Director of DoC to take the following two actions:    Develop formal procedures—including collection of needed data—to  regularly assess whether CCHPS’s performance meets the contract  requirements that are linked to monetary damages and to impose these  damages. Another contact and key contributors are listed in appendix V.

Appendix I: Scope and Methodology

We examined the medical services provided by the Center for Correctional  Health and Policy Studies, Inc. (CCHPS) to inmates at the Jail and the  Correctional Treatment Facility (CTF), including CCHPS’s internal  monitoring; the District of Columbia Department of Corrections’ (DoC)  oversight of those services; CCHPS’s contract compliance; and the cost of  services under the contract.
Why GAO Did This Study

Since the end of a court-ordered receivership overseeing medical services at the District of Columbia Jail in September 2000, the Department of Corrections (DoC) has contracted with the Center for Correctional Health and Policy Studies, Inc. (CCHPS) to provide inmate medical services. GAO was asked to provide information on (1) the medical services DoC contracted with CCHPS to provide, including CCHPS's monitoring of its services; (2) mechanisms DoC established to oversee CCHPS's services; (3) CCHPS's contract compliance and DoC's efforts to ensure compliance; and (4) the cost of medical services. To collect this information, GAO analyzed documents and interviewed officials from District agencies, CCHPS officials, and an independent reviewer hired by DoC to monitor medical services.

What GAO Found

DoC has contracted with CCHPS to provide a broad range of medical services to inmates at the District of Columbia Jail and the Correctional Treatment Facility (CTF)--an adjacent overflow facility. Services include health screenings at intake; primary care services, including care for chronic conditions; mental health care; and specialty care. In addition, CCHPS assists DoC in helping inmates obtain services not included in the contract, such as specialty or emergency services that cannot be offered on-site. As part of the contract, CCHPS also established a quality improvement program to monitor its services. A key component of the program is a quarterly analysis of random samples of inmate medical records to measure how consistently CCHPS delivers required services. DoC established several mechanisms to oversee CCHPS's delivery of medical services to inmates. For example, DoC retained an independent reviewer to monitor the services provided by CCHPS on a quarterly basis. In addition, the contract gives DoC authority to impose monetary damages on CCHPS if it fails to meet any of 12 requirements specified in the contract, most of which relate to providing key services to a minimum percentage of inmates. The contract also requires CCHPS to submit quarterly and annual progress reports describing quality problems identified by the independent reviewer or its own monitoring and actions taken to correct them. Although available evidence indicates that CCHPS has generally complied with the terms of its contract, DoC has not exercised sufficient oversight to provide assurance that problems are not occurring or are quickly corrected. The independent reviewer has consistently found that CCHPS's services meet the contract's overall requirements for access to care and quality, but has also reported that CCHPS has not always met certain requirements. For example, while CCHPS recently improved its performance in providing timely follow-up services to inmates with abnormal chest x-ray results, the independent reviewer had repeatedly found problems in this area. DoC has not taken actions that would allow it to be assured of CCHPS's compliance with contract requirements linked to monetary damages. The agency has not collected data or developed a formal procedure to determine whether CCHPS has met the requirements, and it lacks a procedure to impose damages if warranted. Also, DoC has not regularly enforced the contract requirement that CCHPS submit quarterly and annual progress reports describing quality problems and corrective actions, and CCHPS has often not submitted these reports. From 2000 to 2003, the average daily cost of providing medical services to a Jail inmate decreased by almost one-third, from about $19 a day per inmate to about $13 a day. In 2003, DoC consolidated the services provided to inmates in the Jail and the CTF under one contract with CCHPS. In that year, during which 17,431 inmates were admitted to the Jail and the CTF, the total cost of providing medical services at both facilities was about $15.8 million.