Audit of the Barnstable County Sheriff’s Office - A Review of Healthcare and Inmate Deaths (March 16, 2023)

This is a Massachusetts State Auditor performance audit of the Barnstable County Sheriff’s Office, focused on inmate healthcare and deaths during a two-year period.

“In accordance with Section 12 of Chapter 11 of the Massachusetts General Laws, the Office of the State Auditor has conducted a performance audit of the Barnstable County Sheriff’s Office (BCSO) for the period July 1, 2019 through June 30, 2021.”

Auditors checked whether the sheriff’s office followed rules for inmate deaths, healthcare oversight, intake medical screenings, health appraisals, and responses to sick-call requests.

“The objectives of this audit were to determine the following:”

If required medical checks are late or not documented, serious health problems may be missed, putting incarcerated people at risk.

“Because BCSO does not ensure that its healthcare vendor completes the health appraisals within the required timeframe and documents each medical form in CorEMR, there is a higher-than-acceptable risk that inmates’ medical issues are not identified and treated, ultimately affecting the health and safety of all BCSO inmates.”

For the public, this matters because the sheriff’s office is a public agency responsible for safely running the county correctional facility and protecting people in its custody.

“The mission of the Sheriff’s Office is to “Protect the public from criminal offenders by operating a safe, secure and rehabilitative correctional facility, assisting local agencies and promoting public safety through our associated specialized services and enforcing the Laws of the Commonwealth of Massachusetts and the Constitution of the United States of America.””

The auditor found BCSO generally met several healthcare-related requirements, but failed on timely and documented health appraisals and had separate concerns about IT controls.

“Below is a list of our audit objectives, indicating each question we intended our audit to answer; the conclusion we reached regarding each objective; and, if applicable, where each objective is discussed in the audit findings.”

The auditor recommended that BCSO monitor its healthcare vendor more closely and make sure the vendor has enough staff to complete required health appraisals.

“BCSO should ensure that its healthcare vendor has enough staff members to complete the health appraisals.”

The finding was not just about a few files: based on the sample, auditors estimated that dozens to nearly two hundred health appraisals may have been late.

“Based on the results of our sample, we estimate, using statistical projection techniques, that the healthcare vendor did not complete between 24 and 196 health appraisals within the required timeframe.”

An admission medical screening means the first health check when someone arrives at the jail, including mental health and medical needs.

“An admission medical screening is an assessment of an inmate’s health needs, including mental health and/or medical conditions.”