Accrediting agency gives state prisons high marks

By MIKE FUHRMAN of the Tribune's staff
Published Sunday, September 29, 2002

Corrections officials point to the National Commission on Correctional Health Care's accreditation of 17 of the state's 21 prisons as evidence that Missouri inmates receive adequate health care.

Only 10 percent of the nation's 5,000-plus prisons, jails and juvenile justice facilities are accredited by the Chicago-based organization, and only Texas tops Missouri in the number of prisons that meet or exceed the NCCHC's health-care standards.

What does that mean to the 29,000-plus inmates in the custody of the Missouri Department of Corrections and to the tens of thousands who will enter the system after them?

DOC officials say it proves that Correctional Medical Services has been doing what the state has paid the inmate health-care provider more than $350 million to do since 1993 - provide the quality of care mandated by federal law.

Prisons that seek accreditation "want to make sure that the inmates who are in need of health services to address their serious medical problems, that they get it," NCCHC President Edward Harrison said. "The Constitution requires that. The Supreme Court requires it.

"Our standards are devised to make sure the system is in place and that that can and does, in fact, occur."

Only a small percentage of penal institutions that seek accreditation fail to meet the NCCHC's 72 standards of care, Harrison said. Those that fail to meet the standards are given an opportunity to take corrective action and almost always do so.

Three of the four Missouri prisons that are not accredited are too new to go through the process, DOC officials said. The fourth, Jefferson Correctional Center, is too old and is scheduled to close next year.

Critics of CMS contend that accreditation status does not come with a guarantee that individual health-care professionals working for the for-profit company have the best interests of the inmates in mind. They also point out that DOC and CMS have advance notice of accreditation audits.

"They don't have authority to do anything," said Karen Russo, president of the Wrongful Death Institute, a Kansas City organization that advocates for inmate health care. "They just go in and say, Everything looks good. That's the standard they use."

Randee Kaiser, DOC's assistant director for health-care services, said those complaints are off base. He oversees an office of four professionals who work to ensure that CMS complies with its contract and federal law.

Accreditation is only one tool the DOC uses to monitor the contractor's performance. Kaiser's staff investigates inmate complaints, pulls random files to evaluate patient care and conducts its own site audits, some of which are unannounced. An independent doctor reviews all inmate deaths, and University of Missouri-Columbia researchers have given CMS good marks, Kaiser said.

"We're a very transparent system," he said. "If something is awfully, terribly wrong here, someody would have seen evidence of that."

Although the NCCHC is not a watchdog agency, Harrison said his organization works for inmates as much as it works for the institutions and state governments that pay for its services and seal of approval. Accreditation can cost upward of $3,500 annually per prison.

"We're advocates for good health care," he said. "We're advocates for a health-care system that will meet the constitutional requirement that the state and its medical providers are obligated to meet, which means the patients are getting the appropriate level of care to meet their health-care needs."

A team of two or three auditors conducts a site visit, which typically lasts two days, to determine if the facility complies with the organization's standards. The standards include whether nurses carry out a doctor's orders, whether patients get the appropriate tests, whether appropriate follow-up care is given, how infectious diseases are managed, whether inmates have access to a grievance process and more.

Composed of at least one physician and other medical personnel with experience in corrections health care and NCCHC training, the auditing team inspects the medical unit, interviews corrections and medical personnel and reviews medical files - including death investigations - and inmate grievances.

As a rule, NCCHC auditors do not investigate inmate complaints. Institutions, however, are asked to inform inmates of upcoming inspections and give them an opportunity to talk to the auditors. Typically, DOC staff members select inmates from different custody levels to speak to them.

The survey team writes a report containing its findings and forwards it to NCCHC staff members in Chicago, who present the report to an accrediting committee. The committee then determines if a facility should be accredited.

Reprinted with Permission