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
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
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
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
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.