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SALT LAKE CITY — Most of the problems highlighted in a 2021 audit of how health care is administered to inmates in Utah's prisons are still occurring — particularly in the state's main prison in Salt Lake City.
That's according to a new state audit released Wednesday and concluding that despite the efforts from the Clinical Services Bureau and senior administrators from the Department of Corrections, only four of the 13 recommendations made specifically for the bureau in the last audit have been fully implemented.
Furthermore, the ongoing problems can be attributed, in part, to "a lack of accountability and undefined processes" that are contributing to a "culture of noncompliance," the audit says.
The "culture of noncompliance" was particularly concerning for state lawmakers who make up the Legislative Audit Subcommittee that listened Wednesday at the state Capitol to the presentation from the team that put together the audit.
In October, the Utah Department of Corrections reported to state lawmakers that all but two of the recommendations made in the 2021 audit had been implemented. But on Wednesday, Nicole Luscher, who was the supervisor of the new audit, said in reality, only four of the 13 recommendations made for Clinical Services Bureau have been implemented, one has been partially implemented, and eight are in the process.
"We feel this illustrates the culture of noncompliance and lack of accountability," Luscher said in a recording of Wednesday's subcommittee hearing.
Several committee members, including House Majority Leader Mike Schultz, R-Hooper, and Speaker of the House Brad Wilson, R-Kaysville, expressed their concern about the noncompliance and noted it was problematic for an agency to make a report to lawmakers that wasn't accurate.
"It's very disturbing to see this type of report coming back," said Senate Minority Leader Luz Escamilla, D-Salt Lake City. "Now I'm questioning what's happening with the rest of Corrections."
Approximately a year-and-a-half ago, a state audit found numerous problems with how health care was provided to inmates in Utah's prisons. The audit found "systemic deficiencies" within the Clinical Services Bureau — which provides health care to inmates — including a lack of patient monitoring and follow-up care, inadequate monitoring of diabetic inmates, and a need to improve administrative oversight.
An in-depth follow-up to that 2021 audit was requested. That new audit focuses primarily on the Utah State Correctional Facility in Salt Lake City due to the Central Utah Correctional Facility in Gunnison showing improvements.
In highlighting some of the ongoing problems discovered the new audit, Luscher said 39 Inmate Care Request forms — which inmates are supposed to fill out and submit to the medical staff for health care services — were discovered in shred bins by the audit team and never fulfilled. Additionally, forms with personal health information were found improperly discarded in prison dumpsters. And biohazard bins used to dispose of sharp objects such as needles, were found to be unlocked. In one unlocked bin, a pair of scissors was located, Luscher said. It was a bin that was accessible to inmates.
The audit also found that:
- Cultural challenges have created and perpetuated systemic deficiencies.
- Administered medication is not documented as required.
- Ongoing supervision and monitoring of emergency medical technicians is still lacking.
- Multiple factors negatively impacted the implementation of a new electronic record system.
A term commonly used in the 84-page audit is "noncompliance."
"We observed a culture of noncompliance that needs to be overcome to ensure quality care and improved patient outcomes. Although there are dedicated medical professionals in the bureau working to provide quality care, these efforts can be overshadowed by others that lack the same level of professionalism," the audit states.
That lack of accountability, according to the report, is believed to have contributed to a 97% turnover rate in prison EMTs last year.
"The (Clinical Services Bureau) needs to address the issue of employee retention. However, until the bureau adequately addresses commitment to improvement and change, issues associated with cultural noncompliance, employees that lack individual accountability and professionalism place a heavier burden on other, more dedicated medical staff — which can affect employee retention and invalidate recruiting efforts," the audit states.
"Internal and external challenges such as the hazardous work environment, employee turnover and competitive compensation packages from outside groups have made it difficult for management at the Utah Department of Corrections to achieve a cultural change," the audit continues. "That said, management is ultimately responsible for changing the culture in a way that aligns with the (Clinical Services Bureau's) mission and objectives."
Additionally, the audit found new areas of concern not identified in the previous audit:
- Inadequate documentation of administered medications at the Salt Lake prison.
- Insufficient supervision and oversight of EMTs performing delegated tasks.
- Problems with the electronic health record system.
Utah Department of Corrections Executive Director Brian Nielson told the subcommittee on Wednesday that he does not dispute the new audit and agrees with all of its recommendations.
"I would also acknowledge there were some mistakes in the process on my part, I'm here to take accountability for that," he told the committee.
When asked to explain why the Department of Corrections reported in October that all but two recommendations from the previous audit had been implemented, Nielson said he thought the plans had been put in place, but his own internal audit team had actually not completed its work.
"We had put policies and practices in place to address those recommendations, and hadn't fully vetted the outcomes to where we should have. That was a mistake on my part, to allow us to report something we hadn't completely vetted," he said.
Despite the new audit's findings, the team that put the report together expressed optimism Wednesday that "the needle is definitely moving in the right direction."
The audit team noted that the Clinical Services Bureau recently installed a new director, deputy director and head nurse. The old administrators contributed to the culture of noncompliance, according to auditors.
Furthermore, starting July 1, the Department of Corrections will partner with the Department of Health and Human Services to help with its health care shortfalls.
"There is a vision for where this can go and where it is heading at this point," Nielson said. "We have a detailed plan on how to address each recommendation."
In a prepared statement to KSL.com on Thursday, Nielson said he appreciated the work and close collaboration with the Utah Legislative Auditor General's Office.
"(We) believe these findings will serve as a roadmap as we embark on a collaborative approach to correctional health care with the Department of Health and Human Services. As the Clinical Services Bureau transitions under (Department of Health and Human Services) purview, we are committed to working collectively with our partners and integrating their clinical expertise into a model that improves the quality of care for our incarcerated men and women.
"We are the first correctional organization in the country to deploy health services with this type of collaborative approach, and we are looking forward to implementing each audit recommendation along the way."
