A series of emails recently released in a federal lawsuit make clear Department of Correction officials were aware of the shortcomings in the state’s prison health care system in April 2016, two years before the DOC took over inmate health care from UConn’s Correctional Managed Health Care.
Top prison officials were so concerned about the shortcomings, the emails show, they privately assembled a team to improve the quality of care inmates were receiving from UConn, which at that point was nearly two decades into a no-bid contract with the DOC to provide those services. The goal of this special request, according to the DOC, was “to address some of the problems with [the private vendor’s] care.”
The conclusions of this audit and another report, completed by a contractor hired by the DOC, were cited as reasons for the state ending its $140 million annual contract with UConn Health in 2018.
Initially, however, DOC officials recommended working with UConn to improve medical and mental health care in the state’s correctional facilities, proposing 10 immediate and long-term interventions.
“These recommendations may be met with strong objections from CMHC, since they represent a major break from established practice,” wrote Dr. Kathleen Maurer, the former DOC medical director and head of Health and Addiction Services, in an April 19, 2016, email to Dr. Craig Burns, Dr. Thomas Kocienda and Andrea Reischerl, three higher-ups in charge of the department’s mental health services.
“However, to do this effectively, it would almost certainly require support from CMHC,” Maurer wrote. “We should try to work with CMHC to make this program operable.”
The state abandoned this effort a little over two years later and took over inmate health care on July 1, 2018.
The emails are part of a series of documents a federal judge ordered the state to release last week from an internal report on the state’s prison health care system. DOC officials did not immediately respond to a request for comment Friday.
There was ample reason for DOC officials to be concerned about the inmate health care system when they wrote the emails, but the changes they implemented weren’t enough to prevent further problems from occurring. In at least two cases, the state was sued over two inmates who died after being denied timely medical care.
One was William Bennett. In June of 2016, two months after the emails were exchanged by DOC officials, CMHC denied a request from Bennett to see an ear, nose and throat specialist after he began coughing frequently at night and having trouble swallowing. Bennett went without treatment for months before he was sent to the emergency room at Day Kimball Hospital in January 2017 because he was having trouble breathing. Doctors there diagnosed a large, malignant tumor in his throat. He died the following December.
Bennett’s family sued the state in November 2018. That case is pending.
Patrick Camera, who died in March 2019, also sued the state. In the lawsuit Camera filed in September 2018, attorneys Ken Krayeske and DeVaughn Ward alleged Camera suffered from frequent nosebleeds but was never properly tested or treated. Doctors discovered a tumor the size of a baseball when Camera was eventually diagnosed with stage 4 cancer of the face and nasal passage.
Camera had been denied a CAT scan in October 2017, 15 months after the emails were sent.
The documents released by the federal court could impact both of those cases. Lawyers for Bennett and Camera have alleged that DOC officials were aware of the “subpar medical treatment known to endanger human life” and still extended the state’s agreement with UConn Health.
In the April 2016 emails, Maurer circulated what she called a “very preliminary initial document,” an audit plan she revised after Burns provided feedback on how to improve mental health services. The revised document Maurer shared later that day underscored the DOC’s plan to mobilize medical staff to audit CMHC charts and other activities related to providing inmate health care. Recognizing the department’s low staffing levels, the plan stated that officials would identify high-risk patients and focus their limited resources on their care.
The audit said inmates with medical needs scores of 4 or 5, the two highest medical scores patients can be assigned, were identified as the highest risk. Officials planned on using a system to generate a weekly list of all the people in the prison system with high medical scores, then require CMHC to provide a short summary of each case, listing their medications and treatment plans.
With no electronic system in place at the time to track medical health records and requests, the document acknowledges the uphill battle to track the health of the state’s inmates.
“This would take a significant effort to establish the initial list, but updating it would require much less effort,” the document states.
The department would employ a similar method for patients with mental health needs scores of 5, the highest possible score, who are “the sickest persons with mental health conditions … and pose risk for suicide, self-injury and related risks.” The DOC would require CMHC to provide treatment plans for each person with a mental health score of 5, and then update those plans on a weekly basis.
Officials would also review the care of “select” patients with mental health scores of 4, “who came to our attention either as a function of institutional behavior, or as a result of a Warden’s or Deputy Warden’s request, or as the result of an inmate letter or a call from an attorney, or family member, or other source.”
Maurer also identified immediate and longer-term interventions to improve care. Many of the immediate proposed changes dealt with the utilization review committee, which at the time approved consultations for patients who required specialized care. The DOC began approving all doctors’ requests for their patients to see specialists once the state took over health care from UConn Health, in July 2018.
The audit also proposed having DOC medical staff attend all URC meetings and “follow up on questionable decisions made by the committee,” and requiring CMHC to provide a weekly list and explanation of all committee denials for specialist care.
Another recommendation was to examine why incarcerated people were experiencing delays in care. It suggested collecting data showing the time lapse between each URC request, approval and appointment dates, broken down by specialty type.
The longer-term interventions emphasized working collaboratively with CMHC to develop policies to expedite treatment for patients who had, or potentially had, terminal diseases. The plan also proposed improving routine health screening for certain incarcerated individuals upon intake, and offering inmates preventive care exams, labs and screenings, and dental care, including cavity fillings and teeth cleanings.
Despite the changes implemented after the 2016 audit plan, it’s clear from the emails that some DOC officials still had concerns about the quality of care in the state’s correctional institutions.
On July 20, 2017, Tim Bombard, an employee in the DOC Health and Addiction Services Unit, wrote to Maurer and Cheryl Cepelak, the department’s deputy commissioner, to tell them his unit was still receiving referrals for cases with “significant deficits in planning or timing of care in addition to inappropriate care … I have not noticed any significant improvement in the frequency or severity of these cases. Furthermore, I continue to encounter resistance from CMHC leadership concerning specific cases.”
Bombard included in his email a response from CMHC on a specific patient’s case. “CMHC’s responsibility is to ensure that the patient was seen by ... appropriate qualified specialists and review the results of the consult. The specialists are up to date on the most recent literature in their field,” the statement read, adding that the patient was seen by mental health professionals on June 6, 2017, and that he would be scheduled for a yearly cardiology evaluation within the next month.
“I would respectfully suggest that this response is not keeping with the language of the MOU [Memorandum of Understanding] or the community standard of care,” Bombard wrote.