HomeMy WebLinkAbout1718-3 SO-Jail Inmate Health report (6-4-18 Final)Sheriff’s Office - Jail Inmate Health Services report #1718-3 June 2018
March 2018
Sheriff’s Office –
Jail Inmate Health Services
To request this information in an alternate format, please call (541) 330-4674 or send email to David.Givans@Deschutes.org
Deschutes County,
Oregon
David Givans, CPA, CIA, CGMA
County Internal Auditor
1300 NW Wall St
Bend, OR 97703
Audit committee:
Daryl Parrish, Chair - Public member
John Barnett - Public member
Tom Linhares - Public member
Lindsey Lombard – Public member
Wayne Yeatman - Public member
Anthony DeBone, County Commissioner
Nancy Blankenship, County Clerk
Dan Despotopulos, Fair & Expo Director
Sheriff’s Office - Jail Inmate Health Services report #1718-3 June 2018
March 2018
TABLE OF
CONTENTS:
HIGHLIGHTS
1. INTRODUCTION
1.1. Background on Audit …………..……………………………………………………………. 1
1.2. Objectives and Scope ……………….………………………………….…………………… 1
1.3. Methodology …………………………………….…………………………………………… 2-3
1.4. Background on Jail Inmate Health Care ………….……………………………… 3-4
2. FINDINGS and OBSERVATIONS
2.1. Observations on Jail Inmate Population …………………………………….… 5-13
2.2. Jail Inmate Health Costs …..……………………………………………..…………. 14-16
2.3. Jail Inmate Health Care Service ……..…………………………………………….16-23
3. MANAGEMENT RESPONSE
Deschutes County Sheriff’s Office ……………………………………………..……. 24-27
Sheriff’s Office - Jail Inmate Health Services report #1718-3 June 2018
March 2018
HIGHLIGHTS
Why this audit was
performed:
To review the Sheriff’s
Office Jail inmate medical
costs and services.
What was
recommended:
Recommendations include:
• developing a system to
assure appropriate
project accounting;
• capturing cost savings
in the County financial
system;
• assessing what data
should be gathered to
properly address
services;
• developing appropriate
reports and analyses
on services;
• exploring whether
outsourcing jail medical
services would be
effective and efficient;
and
• utilizing jail medical
performance
measures.
Sheriff’s Office - Jail Inmate Health Services
The Sheriff’s Office has increased jail inmate medical services since 2013 in response to
trends in health and behavioral health issues with inmates.
What was found
With nearly twelve FTE dedicated to jail medical services as of December 2017, the Sheriff’s
Office has moved to increase services as daily populations grow.
Seventy six percent (76%) of inmates identify themselves as having one or more health
issues (health, behavioral health or substance abuse). Fifty-five and older and female
inmates show even higher level of concerns.
Benchmarking on selected areas with larger counties indicates that most larger counties
contract out for medical services.
Estimated jail inmate medical spending has grown 15% per year. The 2017 calendar year
estimated medical cost was $14.40 per inmate per day.
Accounting efforts indicated some additional areas for improvement in identifying medical
costs. The Sheriff’s Office obtains some significant discounts on inmate medical services
provided by some community health providers. These accumulated to $160 thousand
savings over 2016 and 2017.
Data on health services (medical and behavioral health) performed was limited and
indicated relatively consistent levels with a growing daily population. Medical grievances
appear to have declined as a percentage of grievances.
Jail performance measures could be improved over the medical services area.
Deschutes County Internal Audit
Sheriff’s Office - Jail Inmate Health Services report #1718-3 June 2018
March 2018
Page 1
1.
Introduction
1.1 BACKGROUND ON AUDIT
Audit Authority:
The Deschutes County Audit Committee authorized the audit of jail inmate health services in the 2017-
2019 Internal Audit Program Work Plan. The Sheriff’s Office participated in the development of the audit
objectives.
1.2 OBJECTIVES and SCOPE
Audit
objectives define
the goals of the
audit.
Objectives:
1) Gather information on how jail inmate health costs and services are trending and the nature of the
inmate needs.
2) Utilize inmate health care service activity levels and costs to consider potential recommendations for
meeting care standards / staffing levels.
3) {Due to timing, this objective will be addressed in a separate report} With assistance of appropriate
levels of jail staff, identify estimated gaps to seeking compliance with standards for health services in jails
(NCCHC – National Commission on Correctional Health Care ).
4) Be aware of any issues with compliance with federal and state regulations and requirements (HIPAA/42
CFR), as may be applicable.
Scope and Timing:
The audit commenced in January 2018 and extended through May 2018. When possible, the audit will
present trends and benchmarks. Jail medical costs by month were estimated for 2013 to 2017 calendar
periods. Screening questions used by the Sheriff’s Office were scored for health/behavioral health
topics. A lack of electronic health and behavioral health service data made analyses of services less
effective. This audit did not address the extent, nature, or quality of services provided at the jail.
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1.3 METHODOLOGY
Audit procedures
are created to
address the audit
objectives.
Audit procedures include:
Interviewed staff on practices and procedures.
Reviewed research and reports on correction/jail inmate health matters.
Analyzed cost and service trends in inmate health services provided/arranged by the County’s Sheriff’s
Office (Jail division). The audit did not further incorporate additional indirect costs from the Sheriff’s
Office management or the County, though the Sheriff’s Office may want to consider doing some
internal allocations like many of the larger county departments. Costs were established by period
through identification of medical staff, specific categories of medical expenses, and attributable
medical costs. Expenses have been reduced by the nominal revenues collected from inmates for the
services at the jail.
Reviewed, evaluated and analyzed data available from the Sheriff’s Office and County on inmate
health services and costs.
Reviewed, evaluated and analyzed jail systems over inmate health care and associated data being
gathered.
Reviewed credentials for nurses providing health care.
Reviewed responses to inmates’ calls for health service, grievances on health matters and sick
calls.
Reviewed any reports or recommendations received relating to jail health services.
Developed data and analyzed health grievance trends.
Developed and analyzed behavioral health notes in the jail system.
Developed and analyzed jail inmate information from bookings.
Developed and analyzed nurse sick log data. Inputted nurse sick log data for 2017. For a
selected month also inputted information down to the inmate for additional analyses.
Assembled demographic information for comparison.
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We conducted this performance audit in accordance with generally accepted government auditing
standards. Those standards require that we plan and perform the audit to obtain sufficient, appropriate
evidence to provide a reasonable basis for our findings and conclusions based on our audit objectives.
We believe that the evidence obtained provides a reasonable basis for our findings and conclusions
based on our audit objectives.
(2011 Revision of Government Auditing Standards, issued by the Comptroller General of the United States.)
1.4 BACKGROUND ON JAIL INMATE HEALTH CARE
GRAPH I:
Trend in
corrections
budgets at
Sheriff’s Office
by fiscal year.
Since
opening the jail
and the expansion
of medical services,
jail medical costs
have become a
greater share of
correction’s costs.
Budget:
The Sheriff’s Office budget has been on the rise with increased jail size in 2014. Corrections represents
approximately 45% of the Sheriff’s Office budget.
Source: County original adopted budget requirements for Fund 255, without contingency
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GRAPH II:
Trend in Inmate
average daily
population
(ADP).
Employees – Full Time Equivalents (FTE):
Total FTE for Corrections was budgeted to increase to 114 in FY 2018. This represents 50% of the
Sheriff’s Office FTE. Personnel costs within this budget average 83% for personnel costs. The Sheriff’s
Office has increased medical services since FY 17 in response to trends in health and behavioral health
issues with inmates.
Jail and Workcenter Average Daily Population (ADP):
Source: Jail data based on daily occupancy
Total capacity for the jail is 452 beds, which includes 90 workcenter beds. The growth in inmate daily
population has averaged over 5% per year during the period reviewed.
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2. Findings
and
Observations
The audit included procedures to understand the nature of the inmate health population, estimated
medical costs, and health services provided. Audit findings result from incidents of non-compliance
with stated procedures and/or departures from prudent operation. The findings are, by nature,
subjective. The audit disclosed certain policies, procedures, and practices that could be improved. The
audit was neither designed nor intended to be a detailed study of every relevant system, procedure, or
transaction. Accordingly, the opportunities for improvement presented in the report may not be all-
inclusive of areas where improvement may be needed and does not replace efforts needed to design
an effective system of internal control.
The findings noted in this report were not considered significant deficiencies. A significant deficiency is
defined as an internal control deficiency that could adversely affect the entity’s ability to initiate, record,
process, and report financial data consistent with the assertions of management in the financial
statements.
2.1 OBSERVATIONS ON JAIL INMATE POPULATION
It is particularly interesting and relevant to understand the composition of inmates as we look at health
costs. Research indicates the prevalence of health and behavioral health disorders as well as an aging
inmate population can drive additional inmate health care spending 1.
SELECTED DEMOGRAPHICS AND OTHER CHARACTERISTICS OF INMATES – DESCHUTES COUNTY JAIL:
This growth in inmate daily population has averaged over 5% per year during the period reviewed.
• Health: For the audit period (based on screening information), 76% (on average) of inmates express
a historical or current health, behavioral health, and/or substance abuse concern during their stay.
1 State Prison Health Care Spending July 2014 - The Pew Charitable Trusts and the John D. and Catherine T. MacArthur
Foundation
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GRAPH III:
Trend in inmate
health concerns
by calendar
year.
There was
some
indication
that those with
greater health
concerns were
greater users of
health services.
Source: Jail inmate screening questions
Health concerns represent (on average) 62%, whereas behavioral health and substance abuse
represent 32% and 33%, respectively. Substance abuse is showing a 7% increase since 2014.
Inmates have more extensive health needs, including chronic and infectious diseases, substance use
disorders, and mental illnesses. Inmates that have health concerns seem to be a greater utilizer of
nurse services.
• Age (at booking): The average age of inmates is 36. Inmates age 55 or older represent 6-7% of the
jail population. The 55 or older group composition has been pretty consistent for the periods
reviewed (2013-2017). This composition is lower than that age group for Deschutes County and
Oregon, which are at 33% and 30%, respectively.
Older inmates in the 55 or older group have a 10% higher level of health concern (86%) on health
matters than the other inmates.
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The
research
shows that
older inmates can
cost two to three
times more than
other inmates due
to their often
chronic and
terminal illnesses.1
GRAPH IV:
Composition of
inmate stays
(2017) by crime
type.
Research1 indicated that State of Oregon prisons had the highest composition of this 55 or older age
bracket (2007-2011) at 12.4% (highest of the states). This research showed growth in state prison
populations age 55 and older that we are not seeing in Deschutes.
• Gender: The inmate population is 17-18% female. This composition has been consistent over the
period reviewed (2013-2017). As you would imagine this is significantly lower than the Deschutes
County and Oregon percentages of 51% for female composition of the overall population. Female
inmates have a 10% higher level of health concern (84%) than males.
• Crime Type: The review summarized the charges for an inmate into five types: pretrial,
probationary, parole, out of county warrant, and a fifth category where pretrial also had another of
the categories.
1 State Prison Health Care Spending July 2014 - The Pew Charitable Trusts and the John D. and Catherine T. MacArthur
Foundation
Crime types (2017)
Inmate stay composition by crime
type has been fairly consistent over
2013-2017. Pretrial charges (with
some other crime type) is the largest
category and also in the next
analyses has longer stays.
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GRAPH V:
Trend in inmate
stays by crime
type
(2013-2017).
GRAPH VI:
Composition of
length of stay
versus number
of bookings
(2013-2017).
LENGTH OF STAY:
The average inmate length of stay is 14 days. Female inmates have on average shorter stays (10 days),
while the males stays average longer (16 days). The average length of stay seems to vary by type of
crime.
Pretrial offenses with (probation or parole or out of county warrant) have the longest duration stays.
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GRAPH VII:
Average (2013-
2017) Arresting
Agency
Composition.
Graph VI on length of inmate stays shows that most of the inmate bookings have stays of 10 days or
less. However, most of the accumulated jail days are from those spending >50 days in jail.
TOP 10 INMATE CRIME CHARGES (2013-2017):
Inmates have multiple charges of varying types. The following represent the most frequent charges
associated with inmate bookings.
• Drive under influence intoxication
• Probation violation
• Parole violation
• Unlawful possession of
methamphetamine
• Out of county warrant
• Reckless driving
• Criminal driving-suspended/revoked
• Theft 2nd degree
• Assault 4th degree
• Theft 3rd degree
ARRESTING AGENCIES:
The Bend police place the most
inmates in the County jail. On a
booking per capita basis, City of
Redmond exceeds City of Bend
by 48%.
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GRAPH VIII:
Composition of
jail inmate days
by inmate city
(if known) (2013-
2017).
GRAPH IX:
Comparisons of
large county
populations.
For these
counties,
Deschutes is the
fastest growing
county with growth
of 18% since the
2010 census.
INMATE RESIDENCE (if known): Inmates with Bend and Redmond addresses comprise the greatest
share of jail days.
STATE COMPARISONS/BENCHMARKING:
The largest county jails in Oregon were used for comparisons.
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GRAPH X:
Comparisons of
large county jail
beds per capita
(x1000).
GRAPH XI:
Comparisons of
large county
bookings per
capita (x1000).
Jail data in this section is from these selected large counties in the 2017 survey of the Oregon State
Sheriff’s Association. Census data was obtained from www.census.gov. In order to compare such
different Counties, a per capita figure can show some comparisons in a common perspective.
* Adjusted to remove workcenter beds. ADP reflects occupancy of Jail beds
Beds per capita (x1000):
Deschutes has capacity
for 362 Jail beds. After
accounting for unused
capacity at the jail,
Deschutes has a
comparable level of jail
beds to those in the
other large counties.
Bookings per capita
(x1000):
Bookings per capita
appear to fall within a
range similar to the
larger counties.
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GRAPH XII:
Comparisons of
large county
suicide
attempts.
GRAPH XIII:
Comparisons of
large county
medication cost
per capita.
Suicide attempts per
capita (x100,000):
Deschutes attempted
suicides per capita are
on the lower side of
other large counties.
Jail medication costs per
capita:
Deschutes medication
costs per capita are in a
similar range to the next
four larger counties. Not
clear why the largest
counties have such
higher costs.
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TABLE I:
Large county
responses to
whether county
outsources
medical.
Outsourcing
appears to
be used by
a majority of the
larger county
jails.
County Does the County outsource medical?
Deschutes No
Jackson Yes
Marion Yes
Lane Yes
Clackamas Yes
Washington Yes
Multnomah No*
* Outsources to County Health department
Jail management staff has been periodically experiencing difficulty in managing and recruiting health
related staff. Outsourcing appears to be used by a majority of the larger county jails and might be
worth investigating. This would at least need to address additional management requirements, levels
and types of services, and minimum staffing levels.
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2.2 JAIL INMATE HEALTH COSTS
GRAPH XIV:
Trend by year in
estimated
inmate health
costs per day
per inmate.
Observations on estimated jail inmate health costs.
The audit assembled estimated costs attributable to jail inmate health costs. Jail medical costs are
attributable to 8% of the jail’s overall costs.
Source: Calendar estimated inmate health costs / average daily population for yr. / 365 days. See methodology.
Jail inmate costs over this time frame have increased by double digits, averaging 15% per year. In FY
2016 the Sheriff’s Office moved towards more medical staffing. Increases in costs relate primarily to
increases in staffing costs for medical services. Unfilled medical positions in FY2013 and FY2016
reduced actual costs in those years. Recently, the jail has been contracting out for the nurse
practitioner position.
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For some comparison, Oregon Department of Corrections in their 17-19 budget document indicated
their costs per inmate per day for health services in 2013-2015 was $20.30. There was not available
data from the larger counties on their costs per inmate per day.
Jail accounting for medical costs could be more complete.
In the County’s new financial system, the jail is tracking medical expenses using a project code. Some
medical expenses are not being coded to this project. In particular, a nursing contract has not been
coded to this project. New electronic health record software costs have not been included.
Project codes are established into the new financial system to better manage and monitor specific types
of expenditures. The particular code for jail medical is used for most other medical costs associated
with jail medical.
These particular medical costs not accounted for in the project appear to be with new vendors.
The costs not project coded are relatively minor in amount compared to the budget.
It is recommended for the Sheriff’s Office to consider developing a system to assure new vendor
invoices receive appropriate project accounting.
Jail medical costs are reduced through goodwill of community health providers.
Jail medical staff are consistently requesting discounts from community health providers that assist
with care for inmates. The discounts provided can amount to a fraction or upwards of 86% (40% on
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For the
years 2016 and
2017, the savings
amounted to
over $160,000.
average). For the years 2016 and 2017, the savings amounted to over $160 thousand. That is
substantial and reduces the impact on the corrections budget.
Jail medical has been maintaining this invoice savings information on spreadsheets. However, the
County’s new financial system can track these discounts received and they can be monitored if entered
into the system.
These savings, since they occur on payment, could be communicated within the Sheriff’s Office to better
track the associated costs and savings. Doing so would be more efficient than separately tracking and
duplicating information that is already within the accounting system and eliminate redundant efforts.
It is recommended for the Sheriff’s Office to consider capturing these cost savings in the County
financial system.
2.3 JAIL INMATE HEALTH CARE SERVICES
Observations on jail inmate health services.
As of December 2017, the Jail had six nurses and a contracted nurse practitioner. They had unfilled
positions for the nurse practitioner and two correction nurses. All nurses are licensed with the State of
Oregon. The jail currently has limited electronic systems for tracking services. It is working on an
electronic medical records system. To analyze services, the nurse logs of types of services were used.
These counts of service data are only moderately useful and it would be better to have services aligned
with time to provide a better understanding of nurse activities.
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GRAPH XV:
2013-2017 trend
in nurse sick log
service counts
per 100
inmates.
GRAPH XVI:
2013-2017 trend
in behavioral
health service
visits per 100
inmates.
The overall service
count trend is
slightly down. In
2017, we see a
stronger downward
trend in the service
counts.
However, these are counts and service data with time increments would provide a better understanding
of activities.
No data
for 2015
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GRAPH XVII:
Main health
services logged
by nurses for
2013-2017
(excluding 2015).
GRAPH XVIII:
Estimated
composition of
services logged
by type for
January 2017 by
shift
(Day/Night).
As of December 2017, there were 2.5 FTE behavioral health employees that are licensed with the State
of Oregon. Behavioral health services activity, as represented by service notes, appears to be relatively
consistent.
The composition of
services provided to
inmates varies a bit by
year.
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GRAPH XIX:
Trend in ratio
of nurse sick log
service counts.
From the January 2017 logs, only 20% of the service counts were estimated to be night services. Jail
management indicates that activities during night shift vary from the day shift. For 2017, nurse staffing
was pretty consistently scheduled with 2.2 equivalent FTE during the day and 1.2 for night.
This graph show how many services per equivalent FTE are provided during the day and night. This
indicates roughly half as many services are provided in the night shift. However, with the current
systems and data it is difficult to assess whether the staffing mix could be improved. See
recommendation that follows.
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GRAPH XX:
Trend in
grievances
(medical and
other) by year.
Sheriff’s Office lacks consistent system to evaluate health (health and behavioral
health) services provided at jail.
Jail medical staff do not have a system to routinely capture and evaluate medical services provided to
inmates. Written sick call logs and behavioral health notes provide an ineffective means to capture and
understand the nature and extent of services being provided. Nurse logs were not consistently put into
spreadsheets for later analyses. The Sheriff’s Office has not historically done much with these logs.
Records of services can provide meaningful data on the timing and nature of services provided.
The manual system for tracking services provided and a lack of continuity in how this is performed
contribute to inconsistent data on medical services. The jail has other manual information in inmate
Medical grievances declined
in 2017.
Medical grievances are common
in any jail environment. Overall
trends in medical grievances
seem to vary a bit by year.
Overall composition of medical
grievances are down from 72% in
2016.
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medical records documenting services, however it would be too time consuming to pull information
from these records.
In the absence of consistent medical service information, it is difficult to understand the drivers and
barriers to providing sufficient and effective health services.
It is recommended for jail management to assess what data should be gathered to properly address
services. This might include capturing the time services are provided, inmate ID, and service
description (or code).
In FY 2018, the Sheriff’s Office has initiated work on implementing an electronic health record software
(in progress). This system should provide greater opportunity to capture service data.
It is recommended for jail management to develop appropriate reports and analyses on services to be
more effective with their services.
TABLE II :
2013-2017 trend
in jail medical
staffing FTE –
filled and
unfilled.
Medical staffing vacancies difficult to manage.
As of December 2017, the jail had three positions unfilled (1 FTE - psychiatric nurse practitioner; 2 FTE -
correction nurses). In the interim, the Jail has been contracting out for a nurse practitioner. With a
contracted position, this has resulted in increased turnover in that position as well as higher costs.
Jun-13 Jun-14 Jun-15 Jun-16 Jun-17 Dec-17
Filled FTE 4 7 7 7.5 10.5 8.5
Unfilled FTE 2 3 3
TOTAL 6 7 7 10.5 10.5 11.5
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Larger
county jails are
contracting out
jail medical
services.
Jail medical staff have increased significantly since 2013. Since 2013, the jail has doubled its nursing
FTE’s and has more than doubled their behavioral health staff.
As indicated in TABLE I, larger county jails are contracting out jail medical services.
Jail management indicates that some nursing staff receive additional education while at the Jail and
makes them even more successful in finding better jobs.
The Jail has been periodically having these unfilled positions which make it difficult on existing jail and
medical staff to manage the operations.
It is recommended for jail management to explore whether outsourcing jail medical services would be
effective and efficient for Deschutes.
This review would need to address additional contract management requirements, levels and types of
services, and minimum staffing levels. Some initial data indicates larger counties are paying more to
contract out medical services (but it isn’t clear whether they are receiving greater level of services).
If the above is not possible, it is recommended for jail management to explore how they might
better hire, develop, manage, and retain medical staff.
Budget document lacks performance measures for jail medical efforts.
Corrections has not included any medically related performance measures in recent budgets. A good
measure should help inform the discussion of how a service is performing and whether additional or
less resources are required. Trends in measurement data can help decision makers assess if changes
in resources are necessary.
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Some potential measures (from the American Correctional Association) include:
i. Sick admissions for 12 months divided by ADP for 12 months.
ii. Suicides attempts for 12 months divided by ADP for 12 months. (See Graph XII)
iii. Transports off-site for emergency treatment for 12 months divided by ADP for 12 months.
iv. Vacancy rate for FTE in medical area.
v. Benchmarking against other similar sized jails in state?
These measures or others could help with understanding their medical operations. The key measures
should be chosen to address what is trying to be influenced. Measures should strive to be clear to all
audiences, match the direction of other measures, and be built upon quality data.
Without effective and relevant performance measures, it can be difficult for government to
demonstrate accountability and that they achieved their intended goals/objectives. Without consistency
in measures, it can be difficult to assess progress with goals. It is also difficult for policy makers to
assess where best to allocate and direct public funds.
Performance measures tend to be a little complex and threatening. The County continues to work on
how it presents measures in the County budget process. Some County programs have had trouble
identifying meaningful performance information to be used with the budget.
It is recommended for the Sheriff’s Office to consider utilizing some jail medical performance
measures and present this data in the County Budget to demonstrate the services they provide.
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3. Management response
Deschutes
County
Sheriff’s Office
To: David Givans, County Internal Auditor
From: Captain Michael Shults
Subject: Management’s response to Audit report
1. Recommendation: It is recommended for the Sheriff’s Office to consider developing a
system to assure new vendor invoices receive appropriate project accounting
a) Management position concerning recommendation
X Concurs Disagree
b) Comments:
We agree with the auditor’s comments and are working on an internal system to ensure all current and new
vendors have the correct project codes associated with each expense. Ongoing training is now in place for all
individuals entering the Purchase Orders and Contracts. We will be reviewing this on an annual basis to
ensure the appropriate codes are being used. Working with our administrator we are unable to correct
previous expenses but moving forward the correct project codes will be identified and used in Munis.
c) Estimated date of corrective action: Complete.
d) Estimated cost to implement recommendation, if significant $0
2. Recommendation: It is recommended for the Sheriff’s Office to consider capturing these cost savings in the
County financial system.
a) Management position concerning recommendation
X Concurs Disagree
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Sheriff’s Office
Comments –
continued
b) Comments:
We agree with the auditor’s comments The Sheriff’s Office has historically requested discounts from
community professionals to reduce Jail medical costs. We have been tracking this information outside of
Munis up until this point. We are in contact with County Finance to determine how best to utilize Munis to
track our cost savings moving forward to be more efficient to capture that data. Our intention is to implement
as soon as a comparable alternative is identified.
c) Estimated date of corrective action: In progress.
d) Estimated cost to implement recommendation, if significant $0.
3. Recommendation: It is recommended for jail management to assess what data should be gathered to
properly address services. This might include capturing the time services are provided, inmate ID, and
service description.
a) Management position concerning recommendation
X Concurs Disagree
b) Comments:
We agree with the auditor’s comments, The Sheriff’s Office has had spreadsheets for data collection but we
believe there are more efficient ways to gather the complete data. On May 8, 2018 we went live with a new
computer program CorrecTek. This program in an integrated report writer that can find and filter on every
field stored in the CorrecTek Spark system. Authorized users can run statistical, productivity, workflow, cost
analysis, management- by- exception and clinical trend reports. This electronic health record software will be
a single location to store necessary health records information. While improving our ability to gather useful
data related to our services. With CorrecTek we will be able to consistently track and automate all medical unit
activities to improve inmate care.
c) Estimated date of corrective action: Complete.
d) Estimated cost to implement recommendation, approximately $18,000/yearly with a 5 year contract.
4. Recommendation: It is recommended for jail management to develop appropriate reports and analysis on
services to be more effective with their services.
Sheriff’s Office - Jail Inmate Health Services report #1718-3 June 2018
March 2018
Page 26
Sheriff’s Office
Comments -
continued
a) Management position concerning recommendation
X Concurs Disagree
b) Comments:
We agree with the auditor’s comments, CorrecTek can provide automated reports based on any information
stored in the system. With a system tracking medical and behavioral health care we will be better able to
develop treatment plans, manage risk, collaborate with community partners, and guide us through policy
decisions on inmate care. We will be reviewing system data to establish more effective service delivery to
inmates with chronic illnesses and mental health issues in our Jail system.
c) Estimated date of corrective action: In Progress.
d) Estimated cost to implement recommendation, if significant $0.
5. Recommendation: It is recommended for jail management to explore whether outsourcing jail medical
services would be effective and efficient for Deschutes.
a) Management position concerning recommendation
X Concurs Disagree
b) Comments:
We agree with the auditor’s comments, and are in contact with other counties that currently outsource their
jail medical services. With this information we will determine whether outsourcing would be a cost effective
option for the Sheriff’s Office.
c) Estimated date of corrective action: In Progress.
d) Estimated cost to implement recommendation, if significant $0.
6. Recommendation: It is recommended for the Sheriff’s Office to consider utilizing some jail medical
performance measures and present this data in the County Budget to demonstrate the services they
provide.
a) Management position concerning recommendation
X Concurs Disagree
Sheriff’s Office - Jail Inmate Health Services report #1718-3 June 2018
March 2018
Page 27
Sheriff’s Office
Comments -
continued
b) Comments:
We agree with the auditor’s comments. We will look at this as we collect CorrecTek data this year and
determine whether there is an identifiable performance measure we would want to include in next years’
County Budget. We strive to provide adequate medical care for every inmate in our custody. We have a duty
to protect. Inmates rely on our Jail staff to evaluate and manage their medical care while in custody. We
respond to medical emergencies, chronical health issues and behavioral health needs.
c) Estimated date of corrective action: In Progress.
d) Estimated cost to implement recommendation, if significant $0.
{End of Report}
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