The state of Vermont spends $20 million a year to provide medical services to inmates, and the Department of Corrections is about to try a new way to oversee the physical and mental health care its prisoners receive.
Decisions about how to treat inmates suffering from various physical and mental health conditions has long fallen to one of two places: the doctors and nurses working for a contractor hired to provide medical care, or the in-house physician employed by the Vermont Department of Corrections.
That model is about to change, and officials hope the new approach will improve the quality of care inmates receive.
“I think I would describe it as administrative oversight of a system of health care delivery versus participation in medical services delivery,” says Deputy Commissioner of Corrections Lisa Menard.
Menard is leading the search for an outside consultant that she says will provide a broader view of the delivery system. The new consultant will be less focused on day-to-day operations and patient interventions than on tracking the sorts of broad indicators that can expose shortcomings or strengths in the overall delivery of care.
“How many sick-call slips are put in a week. What is the length of time it takes for a sick-call slip to be answered?” Menard says.
Menard says having the answers to those kinds of questions will allow the department to focus on areas that might need improvement. She says the consultant will also be able to review the state’s toughest cases, and determine whether the medical service contractor, a firm called Centurion, is meeting those patients’ needs.
While the state will gain one asset, however, it’s about to lose another.
The department’s in-house position of health-services director has always been held by a licensed medical doctor. Under the new system, that will no longer be a requirement for the job.
Defender General Matthew Valerio oversees an office whose duties include protecting prisoner rights. Valerio says the presence of an in-house physician has often been key to resolving disputes over the appropriateness or adequacy of care being provided by the medical-services contractor.
“If we had a particular client or a particular case where specialized attention was necessary, you had somebody with medical authority you could go to to override or dispute any kind of decision that might have been made by the contractor,” Valerio says.
Valerio says he isn’t necessarily opposed to department’s medical restructuring. But he says he has some concerns about losing a state-employed doctor his team can turn to when there’s disagreement over patient care.
“Where do you go for someone with medical authority to override or confirm or reaffirm a decision made down below,” he says.
Menard says the new consulting position will go to a licensed medical doctor. And she says the consultant will be able to provide a far greater breadth of expertise on issues facing inmates than the lone doctor the state employs now.
In the past, Menard says the state had had trouble finding doctors to take the in-house position, which was once vacant for a year.
The state will begin reviewing bids for the new consulting contract later this month.