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A Review of the Medical Services at the SC Department of Corrections
March 2000

REPORT (PDF)     SUMMARY (PDF)

The President Pro Tempore of the Senate requested that we conduct a review of medical services provided to inmates at the South Carolina Department of Corrections (SCDC). The requester was concerned about the costs and quality of medical services at the department. Although our review focused on contracts between SCDC and Correctional Medical Services (CMS), a private provider, we also reviewed several aspects of medical services provided by SCDC employees. We did not review other procurements or other activities of the Department of Corrections. Our findings are summarized as follows:

  • SCDC has not maintained sufficient data to determine medical costs for its inmate population. As a result, even though we were able to obtain total costs for medical services by provider, we were not able to compare SCDC costs to contracted costs.
  • We reviewed the procurement process for two contracts. One contract was for medical services in nine prisons, and the second contract (an emergency procurement) was for medical services, and subsequently mental health services, in another prison. We found no material problems with the first contract. However, we found that the second contract and the addendum to that contract were not properly executed. SCDC paid the contractor over $1 million without a signed contract.
  • We found that the department has not provided adequate oversight of contracted medical services. SCDC officials have not conducted required audits at the contracted sites, and have not assessed fines for non-compliance with contract requirements.
  • The contracts allowed SCDC to deduct funds from payments to the contractor for deviations in contract requirements. Our review indicated that SCDC has not determined if funds from CMS are due to the department. In one case, the department allowed the contractor to determine the amount of the deduction for HIV/AIDS treatment. Department officials do not know if this amount is fair and reasonable.
  • As required by agency policy, the department has not audited medical operations in sites where services are provided by SCDC employees. Only 1 of 40 medical audits, which review the adequacy of medical procedures and inmate care, was conducted over a two-year period.
  • We experienced problems in obtaining access to contractor records which were required to complete our review. To avoid similar problems in the future, we recommend that state procurement officials include a provision in all requests for proposals (RFPs) to allow access to contractor records for state auditing purposes.
  • While we concluded that the HIV treatment guidelines approved by SCDC in September 1997 conformed with established community standards, revised guidelines of June 1998 allow for treatment which is not generally recommended. Also, we found that a supplemental payment of $632,689 to the contractor for HIV treatment was not justified.
  • The department conducted an audit of medication administration at a contracted site. Even though the rating for this service did not meet the minimal compliance rating established by department policy, SCDC officials did not take any action against the contractor. We found that inmates at this facility are still not receiving their medications in a timely manner.
  • The contractor has not adequately planned for the discharge of inmates treated for chronic mental illness to the community. For two months, the contractor did not assign staff to handle discharge planning. During this period, at least ten inmates were released.
  • We found that counseling staff for inmates at both CMS and SCDC sites did not meet minimum qualifications for their positions.