End Medical Neglect in Massachusetts State Prisons

Posted October 13, 2023

Join us in demanding change that imposes stronger mechanisms for accountability and transparency in the Department of Correction’s medical contract this fall. 

Sign our petition at https://chng.it/CbJGKTvwGz

In the next few weeks, the MA Department of Correction (MADOC) will release a Request for Responses (RFR) soliciting bids from health care providers, one of which will be chosen to provide medical care to all people incarcerated in Massachusetts state prisons. This is a major event that could dramatically improve medical care in MA prisons, where medical neglect is rampant, or it could enable this neglect to continue. 

Organizers with DeeperThanWater have been working for years to end medical neglect in MA prisons. In 2021, DeeperThanWater worked with currently incarcerated activists to conduct a needs assessment to evaluate healthcare services from the current contract holder, Wellpath. Using the findings from this survey, DeeperThanWater released a report describing the horrific medical neglect occurring in Massachusetts prisons. We have also shared stories of medical neglect from incarcerated people.

Over the past year, we worked with people incarcerated in MA prisons to develop demands for change in the language of the upcoming RFR, which is being written by the Massachusetts Department of Correction and UMass Chan Medical School. DeeperThanWater shared these demands directly with UMass on multiple occasions; however, they have thus far been unable to confirm any amount of its incorporation. Moreover, as the ISA form discloses, compensation for UMass to revise the RFR increased from $380k to $510k following a 2020 DOJ investigation of mental health treatment which led to a 2022 agreement between the United States and MADOC. 
This moment is a chance to hold leadership accountable for the harm that their previous negligence inflicted. As always, we demand that Governor Healey and the Massachusetts Department of Correction free all incarcerated people. Until that is met, we demand that they impose stronger mechanisms for accountability and transparency by incorporating the following changes in the upcoming Request for Responses (RFR).

1. Include new language requiring the Contractor to respond to sick slips in a timely manner. 

Requested language (revised from section 4.3): 

The Contractor must confirm the receipt of a sick slip with the involved incarcerated person within 24 hours. For emergencies, appointments must be scheduled within 24 hours of receipt of the sick slip. An emergency may be defined as a life-threatening condition, or anything that if ignored would cause severe repercussions to physical and/or mental health or that would permanently or temporarily disable a person. For non-emergencies, decisions must be made within 3 days, and the incarcerated person must be notified in this timeframe as well. Decisions include rationale and reasoning. For non-emergencies, appointments must be scheduled within 7 days following the decision. Follow-up appointments with Contractor employees must be scheduled no further out than 1 month from the date the sick slip was received. Follow-up appointments with medical providers other than the Contractor must be scheduled as soon as possible, and no further out than 3 months from the date the sick slip was received. If these timelines cannot be met, the Contractor must provide documentation showing that they made multiple attempts to schedule an appointment within 3 months. Incarcerated people are able to request status checks of their sickslips. Staff is responsible for maintaining daily documentation of sick slips and must communicate with incarcerated people regarding questions on sick slip information. Incarcerated people will receive confirmation of their appointment one week and again one day before said appointment. 

2. Include provisions for incarcerated people to see providers outside of the Contractor/prison.

Requested language: 

If a person who is incarcerated wants a second medical opinion, they must be given access to a second opinion by a provider or specialist independent of the prison as soon as possible, and no further out than 3 months from the date the incarcerated person asks for a second opinion.

3. Make fines for not following treatment plans higher. (See current requirements in sections 16, 4.3, 9, 12.)

4. Ensure that staff possess valid credentials and all sites are sufficiently staffed. The ADC has considerable discretion when deciding whether or not to allow the Contractor to provide less staff than required by the contract and/or permit the hiring of personnel whose credentials fail to meet the standard laid out in the contract. As such, the future RFR must remove discretion ADC has to permit under-staffing or staffing by under-qualified professionals.

Requested language:

The Contractor must keep staffing levels at least equal to those required in the contract and personnel must be appropriately licensed, registered, certified and professionally trained without exception. A medical doctor must be onsite for at least 8 hours a day at facilities under this contract.

5. Add oversight from people who are currently incarcerated. (See section 16.) 

Note: The language below was adapted from the Investigation and Corrective Action document and the Continuous Quality Improvement (CQI) document.

Requested language:

An oversight body consisting of 3-5 incarcerated people will attend the monthly Pharmacy and Therapeutics Committee and all CQI meetings scheduled, including the Annual Review of CQI Program.

This oversight body will consist of existing councils or volunteers.

The Oversight Committee will co-lead the Investigation and Corrective Actions procedures, “helping to establish and uphold the guidelines for employee discipline actions that ensure each employee receives a reasonable opportunity to improve their efficiency, conduct, and/or performance, as determined by the” Oversight Committee.

The HSA will assign Oversight Committee counterparts to the CQI Committee Chairperson and CQI Coordinator, as well as any additional CQI committee members. These Oversight Committee members will provide and ensure perspective and feedback from those being served by the Contractor.

The Oversight Committee will participate in the Continuous Quality Improvement Program by “identifying areas for examination, determining (in advance) what constitutes acceptable performance, and re-examining the area to determine if the desired improvement has been accomplished.”

7. Increase public transparency. We request that minutes from meetings of the  Pharmacy and Therapeutics Committee and CQI Committee be made public to increase transparency and opportunities for oversight.

Requested language:

Minutes from meetings of the Pharmacy and Therapeutics Committee and CQI Committee will be available to the public, with any patient information anonymised, on the DOC website within 7 days of the meeting date.

The public will be invited and notified 2-4 weeks in advance of any public hearings involving medical care, where the Contractor will be present and available for a 30-minute minimum of public discourse. 

8. Change language on “inmate specific equipment and medically prescribed devices.” Our intention here is to increase the Contractor’s interest in providing and maintaining quality medical equipment. We also seek to remove language that puts the burden of payment for damaged equipment on incarcerated individuals. 

Requested language (language that has been edited or replaced is in bold):

The Contractor shall be responsible for the purchase or lease of Inmate-specific Equipment (e.g., special beds, wheelchairs or other Equipment not in existing inventory) and Medically Prescribed Devices, including Equipment and Medically Prescribed Devices recommended by a physician’s order or otherwise necessary to provide quality Inmate care and promote Inmate functionality (e.g., eyeglasses, orthotics, sensory therapy products). The Department shall have no obligation to reimburse the Contractor for the cost of any Inmate-specific Equipment or Medically Prescribed Devices purchased or leased by the Contractor. All Inmate Specific Equipment and Medically Prescribed Devices shall become the property of the Contractor. The Contractor shall repair and replace all Inmate Specific Equipment and Medically Prescribed Devices as necessary to ensure that Inmates may receive the benefit of such Inmate Specific Equipment and Medically Prescribed Devices. When a contract changes hands, the new Contractor will be given the opportunity to buy equipment from the preview Contractor.

If the Department determines through its investigatory, disciplinary or grievance process that the Inmate assigned the Medically Prescribed Device or another Inmate is responsible for the loss, damage or destruction of a Medically Prescribed Device, the Department shall bear the financial responsibility for its repair or replacement. Neither the Department nor the Contractor shall pursue reimbursement or payment for Medically Prescribed Devices from the Inmate found responsible for the damage or loss of said device. 

REMOVE: The Contractor shall be responsible for payment of the monthly service charges for all telephone lines designated for the use of the Personnel, for which the previous Contractor bore responsibility for payment.

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