Audit of the Bristol County Sheriff’s Office - A Review of Healthcare and Inmate Deaths (February 2, 2024)

This is a Massachusetts State Auditor performance audit of healthcare and inmate deaths at the Bristol County Sheriff’s Office for July 1, 2020 through June 30, 2022.

“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 Bristol County Sheriff’s Office (BCSO) for the period July 1, 2020 through June 30, 2022.”

Auditors checked whether the sheriff’s office followed rules for deaths in custody, healthcare oversight meetings, intake screenings and health assessments, and medical care after sick-call requests.

“The purpose of our audit was to determine the following:”

When sick-call requests are not fully documented or reviewed on time, incarcerated people may face delays or gaps in medical care.

“If BCSO does not ensure that MERFs contain all information and that sick calls are triaged on time, then there is a higher-than-acceptable risk that some inmates may not have their healthcare issues properly resolved in a timely manner or at all.”

For the public, this report shows whether a taxpayer-funded jail system is meeting basic healthcare responsibilities and what needs to improve.

“BCSO’s annual state appropriation was approximately $54.2 million both in fiscal year 2021 and in fiscal year 2022.”

The main problem found was with the sick-call process: some forms lacked key dates or triage information, and one request was not triaged within 24 hours.

“In addition, out of our sample of 60 MERFs, we found that 4 MERFs did not indicate the immediacy of needed intervention, while 1 sick call was not triaged within 24 hours.”

The auditor recommended stronger monitoring of sick-call paperwork and timeliness, and BCSO said it had begun retraining staff, reviewing sick-call procedures quarterly, and auditing sick slips.

“BCSO should implement effective monitoring controls (i.e., policies and procedures) over its sick call process and it should conduct periodic evaluations of its internal controls to ensure that its contracted healthcare provider includes all information on MERFs and triages sick calls on time.”

The audit also notes that after inmate suicides, BCSO took steps aimed at improving suicide prevention, including bringing in an outside specialist and acting on recommendations.

“The actions taken by BCSO thus far—including hiring a consultant to review its policies and procedures related to suicide prevention and implementing the consultant’s recommendations—may have a positive outcome in reducing the reoccurrence of death by suicide at its facility.”

A sick call is the jail process that lets an incarcerated person ask for medical care; a MERF is the form used to make that request.

“Sick call is the process whereby an inmate can initiate a request for health care services on a daily basis.”