Baldacci administration accused of not doing enough to cut prison medical costs

Posted Nov. 15, 2011, at 6:47 p.m.

AUGUSTA, Maine — A study of prisoner medical care in the state’s correctional system released Tuesday has found widespread problems with the quality of care and record keeping in Maine’s prisons.

“The OPEGA [Office of Program Evaluation and Government Accountability] report clearly indicates there were a lot of holes in the system,” said Rep. David Burns, R-Whiting, co-chairman of the Government Oversight Committee. He said the study found the correctional facilities have not had adequate oversight of several aspects of medical care.

Among the findings was that medications often were not administered or recorded properly, that medical records were not complete or maintained and that annual mandatory health exams were not done consistently.

The study also concluded that the response to sick calls often took too long and many times were documented inadequately. The report faulted the Department of Corrections for not adequately monitoring the contractors providing health care services, the lack of cost controls on contracts and the lack of adequate staff training.

“While a lot of this happened in the previous administration, we still need to be sure these problems are all addressed,” Burns said.

Burns said he was particularly upset that there were not adequate safeguards to make sure pain drugs and other prescribed pharmaceuticals actually were consumed by an inmate. He said without proper tracking, there is no way to be sure the inmate didn’t take the pill back into the prison for sale to another inmate.

“It sounds to me like they are putting that [system to track the drugs] in place now,” he said.

Corrections Commissioner Joseph Ponte said there are many problems he is addressing in the area of medical care for prisoners, which he acknowledges is a significant burden on his budget. Among his concerns were contracts that have been in place for nine years with a single provider.

“Our cost on a psychotropic prescription was $35 when the national average was $8,” he said. “We need to get down to the national average and we have made that clear in talks with companies interested in bidding on providing us services.”

Ponte promised the Government Oversight Committee at a meeting that he will reduce costs for medical care and make sure quality care is given when needed. He said the various tracking and record keeping systems need to be improved to make sure inmates get the medications they need.

“We have done [a] substantial amount of reductions already,” he said. “We are going to have quality care, but [also] medically necessary care, [which is] the standard used by insurance companies.”

Ponte told lawmakers there are many examples of medical procedures covered in the past that no longer will be approved. He used the case of an inmate in his 60s who wanted rotator cuff surgery even though his arm still had good movement.

“We used to just do that sort of procedure, but now it will have to be medically necessary,” he said.

Sen. Margaret Craven, D-Lewiston, said she was “shocked” when Ponte said his predecessors apparently did not try to cut costs by using national averages to gauge the reasonableness of what Maine was paying.

“I sat on Appropriations [Committee] for six years and we pressed, as did the chairs of the Criminal Justice Committee, for them to address medical costs,” she said.

Ponte said under the previous administration, there were seven prescriptions on average per inmate. That already has been reduced to an average of five, and he plans to continue to lower that to the national average of two or three.

OPEGA Director Beth Ashcroft said part of the problem with the high number of prescriptions is that even simple pain relievers such as Tylenol required a prescription. Inmates now will be asked to buy such items themselves in the prison commissary.

Ashcroft suggested that many of the Department of Corrections record keeping problems could be resolved by implementing electronic medical records. She said it could save money by helping to catch prescription errors sooner and assure proper tracking of medical services.

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