Final Report of the Court Appointed Expert Lippert v. Godinez

405 Pages·2015·1.81 MB·English

Final Report of the Court Appointed Expert
Lippert v. Godinez
December 2014
Prepared by the Medical Investigation Team
Ron Shansky, MD
Karen Saylor, MD
Larry Hewitt, RN
Karl Meyer, DDS
Contents
Introduction...........................................................................................................................3
Leadershipand Staffing.......................................................................................................5
IDO C O ffice ofH ealthServices StaffingRecom m endations .............................................10
Overview ofMajorServices................................................................................................10
C linicSpace and Sanitation...............................................................................................10
Reception..........................................................................................................................12
Intrasystem Transfer..........................................................................................................14
M edicalRecords................................................................................................................15
N ursingSickC all..............................................................................................................16
C hronicDisease M anagem ent...........................................................................................19
P harm acy/M edicationA dm inistration...............................................................................23
Laboratory.........................................................................................................................24
Unscheduled O nsite and O ffsite Services (Urgent/Em ergent)............................................25
Scheduled O ffsite Services (C onsultations and P rocedures)...............................................28
Infirm ary...........................................................................................................................32
InfectionC ontrol...............................................................................................................34
DentalP rogram .................................................................................................................38
M ortality Reviews.............................................................................................................42
C ontinuous Quality Improvem ent......................................................................................43
Conclusions..........................................................................................................................45
2
Introduction
Towards the end of2013, Dr. Ronald Shansky was nom inated by the parties and appointed by
the court in the Lippert matter as an expert pursuant to Rule 706 ofthe FederalRules of
Evidence.The orderappointinghim lays outthe scope ofthe duties.
“The expert willassist the court indeterm iningwhetherthe Illinois Department of
C orrections (“IDO C ”)is providinghealth care service to the offenders in its
custody that m eet the m inim um constitutionalstandards ofadequacy.”
It furthergoes onto say that the expert “willinvestigate allrelevant components ofthe health
care system except forprogram services and protocols that relate exclusively to mentalhealth.”
Furthermore,
“If system icdeficiencies in IDO C health care are identified he willpropose
solutions forconsiderationby the parties and the court.These proposed solutions,
ifany,willform the bases forfuture negotiations betweenthe parties inaneffort
to craft afinalsettlem ent ofthis m atteror alternatively, m ay be offered into
evidence in the trialofthis m atter. Furthermore, the expert willnot recom m end
specifictreatment forindividualoffenders unless those recom m endations relate to
system icdeficiencies inthe healthcare provided tooffenders inIDO C custody.”
The parties have also accepted KarenSaylor,M .D.,Larry H ewitt,R.N .and KarlM eyer,D.D.S.
as additionalteam m em bers. The expert met withthe parties in late 2013and asecond tim e in
A prilof2014.The first meetingfocused onthe m ethodology to be used as wellas questions that
eitherofthe parties had withregard to the process. The A prilm eetingwas intended to be an
update,havingvisited by that tim e approxim ately halfofthe facilities to be reviewed.The expert
thought this would be valuable because the confidentialdraft report was not due untilthe site
visits and mortality reviews had been completed and therefore there would have been no
opportunity to jointly update the parties untilthey actually received the confidentialdraft report.
B othparties have been extremely supportive ofthis process. W e received fullcooperation at
eachofthe prisons we visited and are extremely appreciative ofthe localefforts to facilitate the
process.
The investigative team was assigned anexplicit task,“To assist the C ourt indeterm iningwhether
the state of Illinois was able to meet m inim al constitutional standards with regard to the
adequacy of its health care program for the population it serves.” In order to reach this
conclusion,the parties determ ined that we should visit at least eight facilities,six ofwhichwere
jointly selected by the parties.The investigative team concurs withthe parties’selections,inthat
those six facilities have special responsibilities within the system and are critical to a
determ inationas to whether,whenthe healthcare system s are most challenged,they are able to
adequately m eet that challenge. Three of the institutions reviewed functioned as reception
centers.These facilities are criticalinthat they perform the initialevaluationuponentry into the
system. P roblem s that they failto identify are m uchmore likely to eithernot be addressed or
som etim es at am inim um,the identificationand the interventions are significantly delayed.Three
facilities were m axim um -security facilities whichhouse the most challengingofpopulations for
3
which to provide health care services. Finally, one of the six houses the system ’s special
geriatrics unit,whichalso creates healthcare challenges.It has beenourexperience that whena
system is able to m eet constitutionalstandards at the most challenged institutions,it is very likely
to meet constitutionalstandards at the less challengingfacilities.The converse,however, inour
experience has not provento be true.
The State indicates that the investigation team should have utilized standards such as the
N ationalC om m issiononC orrectionalH ealthC are orthe A m ericanC orrectionalA ssociationas
the basis forbothourinvestigation and ourrecom m endations. The leaderofthe investigative
team served onthe board ofthe N ationalC om m issiononC orrectionalH ealthC are for10years.
H e has also beeninvolved withthe developm ent ofthe standards forthe last 20years,servingon
three ofthe task forces and advisingthe most recent task force. In addition, he has also been
requested and has provided trainingto allofthe N C C H C surveyors withregard to the quality
im provem ent standard and how to survey it.H e him selfhas done surveys ineachofthe last three
years. A llofthe m em bers ofthe investigative team believe that the N ationalC om m ission on
C orrectionalH ealthC are, throughits standards, its surveys and its training, have contributed
substantially overthe past three to fourdecades inhelpingfacilities im prove the quality ofhealth
care. W hen the survey process occurs, about 80% ofthat process is focused on adm inistrative
m atters;policies,procedures,contracts and otheradm inistrative m atters.A pproxim ately 20% of
the survey process is focused onclinicalcare, and duringthat process the lead investigatorhas
recently beenasked to helpredesignthe m ethodology used to assess care issues.Investigations
that are part oflitigation and assist the court in determ iningwhetherand the extent to which
“deliberate indifference to serious medical needs” m ay exist requires that the focus be
overwhelm ingly onclinicalcare issues.Thus, virtually allofthe tim e that we spent,otherthan
understandinghow services are provided at each facility, dealt with interviewingstaff and
inm ates, observingprocesses and reviewingm edicalrecords. Forthe purposes ofthe court,
clinicalcare is ofoverwhelm ingim portance and adm inistrative issues, thoughim portant, are
m uch,muchless im portant.
A recent article by A lex Friedm ann published in Prison Legal News, O ctober2014, describes
withspecificcitations about how the courts view specifically A C A accreditation, but also how
the courts view accreditation in general. M ore com monly the courts have said that they do not
rely intheirdeterm inations ofconstitutionality onthe presence orabsence ofaccreditation. W e
believe that this is based onthe fact that the focus inconstitutionaldisputes is overwhelm ingly
onclinicalcare m atters,whereas inaccreditationthe focus is overwhelm ingly onadm inistrative
issues. The wordingofthe constitutionaldefinition ofan Eight A m endm ent violation forces
investigators, whetherthey be plaintiffs ordefendants orworkingforbothparties, to heavily
focus onclinicalcare issues.H avingsaid this is not meant inany way to dim inishthe value of
the accreditation process, specifically withthe N ationalC om m ission on C orrectionalH ealth
C are.
H avingreceived the com m ents from bothplaintiffs and defendants, it has been achallenge to
integrate some ofthe com m ents into the finaldraft.The State has indicated it has done several
things whichare consistent withthe investigative team ’s recom m endation. Since we cannot
verify where things are in the process, we are not addressingthose things in the finalreport.
Rather, any ofthe updates willbe available to the C ourt in an appendix whichincludes both
4
plaintiff’s and defendant’s responses.O nthe otherhand,where there are clarifications requested
oralternatives proposed, we have attempted to be responsive. In some instances, the original
paragraphs we feelwere clearenough;in otherinstances, we have modified the originaldraft.
W e feelwe have m ade asincere effort to be responsive tothe parties.
Inorderto perform suchareview, it is necessary to utilize avariety ofinvestigative strategies.
W e interviewed staff, we have interviewed inm ates, we have observed care provided, we have
reviewed policies and procedures and compared practice to the policies and procedures,we have
reviewed m inutes ofmeetings and we have reviewed selected records, includingdeathrecords.
Inorderto best describe acorrectionalhealthcare program,we have found it usefulto organize
the institutionalreviews alongthe lines ofm ajorservices provided.This listingofservices is not
exhaustive;however, it enables a fairly comprehensive snapshot of how the program is
functioning. The criticalservices begin withm edicalreception, whichis designed to create an
awareness and understandingofthe m edicalneeds ofpatients onentry to the system.W e visited
three reception centers;the m ain reception center, whichis the N orthern Reception C enter,
whichreceives inm ates from C ook C ounty;the reception process at the Logan C orrectional
C enter,the majorwom en’s prison;and the M enard C orrectionalC enter,whichreceives farfewer
new inm ates, especially those from Southern Illinois. A n adjunct to the reception process for
when patients are transferred from one facility to anotheris the intrasystem transferprocess.
B othreception and intrasystem transferprocesses are designed to identify problem s and insure
continuity ofcare despite the potentialdisruptionduringatransfer.O therm ajorservices include
nurse and provider sick call (prim ary care services), chroniccare services, medication
m anagem ent services, scheduled offsite services (specialty consultations and procedures),
unscheduled onsite and offsite services (urgent/em ergent responses), infirm ary services (onsite
inpatient care), infection controlservices and dentalservices. A llofthese m ajorservice areas
m ust be supported by aneffective quality im provement program that not only self-monitors but
also effectively identifies perform ance im provem ent needs and im plem ents strategies that
facilitate performance im provem ent.It is these services forwhichwe willprovide anoverview
inthis confidentialdraft report and forwhichwe willattachinstitutionalappendices inwhichour
specificfindings within eachinstitutionare detailed.Finally,the report includes areview of63
deaths by Dr.Saylorand Dr.Joe Goldenson,who was added to the team withthe agreem ent of
the parties inorderto facilitate completionofthe mortality reviews.Inorderto discuss services,
we are forced to address bothleadershipissues as wellas staffingissues,and the degree to which
leadershiporstaffingwere significantly problem aticvaries by institution. In the institutional
appendices,we describe shortcom ings insome detail.
Leadership and Staffing
Leadershipis aproblem at virtually allofthe facilities we visited.The questionvaried only with
regard to degree.The reasonwhy leadershipis so im portant to acorrectionalhealthprogram is
because they are responsible forsettingthe tone withregard to bothstructure and professional
performance as wellas insuringthat the program effectively self-monitors and self-corrects so
that problem s are identified, addressed and ultim ately elim inated. Throughthis self-correcting
process potential harm to patients is continually m itigated. W ithout astrongand effective
leadershipteam aprogram is m uchless able to identify the causes ofsystem icproblem s and to
effectively address those problem s by im plem enting appropriate targeted im provem ent
5
strategies. A t the extreme was Dixon,aspecialm ission(receptioncenter,geriatricunit,special
program for disabled, specialhousingfor patients with medicalor mentalhealthproblem s)
facility,bothm edicaland mentalhealth,whichat the tim e ofourvisit had avacant H ealthC are
Unit A dm inistrator position, avacant Director ofN ursingposition and in essence avacant
M edicalDirectorposition filled by aW exford “travellingmedicaldirector.”Specialm ission
facilities serve afunction for the entire prison system and thus tend to concentrate medical
pathology orproblem s. A s aresult ofthe concentrationofmedicalproblem s, aprogram that is
not effectively m anaged creates the potentialforharm to the patients and legalliability to the
State. The degree ofbreakdowns we found at Dixon were the most severe. There must be a
requirem ent that aM edicalDirectorhired by W exford must be board certified inprim ary care,
preferably either fam ily m edicine or internal m edicine. In addition, the one H ealth C are
A dm inistrator responsible for bothN RC and Stateville had been takingextended leaves of
absence. This is avehicle for failure. A dditionally, the DirectorofN ursingposition at each
facility, com monly avendor position, must have the responsibility on afull-tim e basis for
overseeingnursingclinicalservices. W e are told that at severalsites they have an additional
adm inistrative assignm ent with regard to W exford corporate responsibilities. This is not
acceptable.The oversight ofasubstantialnursingprogram is afull-tim e job.N o tim e should be
takenaway from that responsibility.The leadershipvacuum s at Dixon,Stateville and N RC have
resulted in process and care breakdowns on adaily basis. Reception is not done tim ely and
m edicalrecords are almost im possible to effectively utilize at N RC despite the fact that there is a
persononsite incharge ofm edicalrecords.A t Illinois River,the M edicalDirectorpositionwas
vacant and this was beingfilled two days perweek by the M edicalDirectorfrom East M oline.
There appeared to be aneffective DirectorofN ursingwho attempted to fillinalso as the H ealth
C are Unit A dm inistrator,since that positionwas filled by someone onm ilitary leave forthe past
yearand ahalf. A t H illC orrectionalC enter, boththe H ealthC are A dm inistratorposition and
DirectorofN ursingposition were filled by individuals who appeared to be quite capable. The
M edicalDirectorposition is filled by adoctorforwhom we identified clinicalconcerns during
ourrecord reviews and mortality reviews.A t M enard,the M edicalDirectorpositionis filled by a
clinician trained as ageneralsurgeon. This facility also has no prim ary care trained clinicians,
even thoughthe overwhelm ingm ajority ofclinicalresponsibilities fallwithin the prim ary care
field.There is no DirectorofN ursingat M enard;however,the H ealthC are Unit A dm inistrator
appears quite capable and m akes aneffort to fillin.H owever,as indicated throughthis review of
eight institutions, very few ifany withthe exceptionofP ontiachave acomplete team withall
positions filled by capable individuals. It is not surprisingthat the weakerthe leadershipthe
poorer the medicalperform ance. Each program ’s performance should be m easured at least
annually and,where indicated,leadershipchanges m ust be made.
W e found clinician quality to be highly variable across the institutions we visited and across
m edicalrecords we reviewed.There were exam ples ofhighquality clinicians at some facilities,
but in otherinstances the quality ofclinicalcare was poorand resulted in avoidable harm to
patients.Forexam ple,none ofthe three physicians at one institutionwe visited had any formal
trainingin aprim ary care field. Duringthe course ofourreview ofthe care at this facility, we
came across several exam ples of avoidable harm to patients resultingfrom inappropriate
m anagem ent ofcom monprim ary care conditions.Forexample,at M enard,patient [REDACTED]
developed adiabeticfoot ulcerthat was not appropriately m anaged and resulted in amputation.
This sam e patient,atype 1diabetic, had his insulindiscontinued inresponse to wellcontrolled
6
blood sugars,whichresulted indram aticdeteriorationofhis diabetes control.This errorreflects
alackofunderstandingofthe basicpathophysiology ofthis com mondisease.Inanotherinstance
at this facility, patient [REDACTED] presented withpoorly controlled diabetes and the doctor
tripled his insulindose and quadrupled the dose ofhis oralm edication.This ofcourse resulted in
repeated episodes oflow blood sugar.Luckily the patient knew to refuse his m edicationinorder
to avoid serious harm.
A t Illinois River,a26-year-old man([REDACTED])repeatedly inform ed healthcare staffthat he
had atrial fibrillation, afact that was confirm ed by his jail records, but this history was
discounted untilhe suffered astroke. H ad clinicalstafflistened to the patient and reviewed his
jailrecord, they would have learned that he should have been on blood thinners to reduce the
chances of this devastatingevent. A t the sam e facility, P atient [REDACTED] presented with
classicsigns and sym ptoms oflungcancerfrom the tim e he arrived in IDO C , yet these were
ignored by healthcare staffforthree months. B y the tim e he was finally diagnosed, the only
treatment he was eligible forwas palliative radiation,whichhe declined.H e died nine days later.
The hiringofunderqualified clinicians into the system is problem atic, as evidenced by the
exam ples stated above.B y “underqualified,”we do not meanthat the provideris not qualified to
practice m edicine, but ratherunderqualified to practice the type ofm edicine required ofthe
position. Forexample, ageneralsurgeon is underqualified to practice prim ary care inthe sam e
way aninternist is underqualified to practice generalsurgery.This problem is compounded by a
lack ofclinicaloversight and peerreview, bothlocally and centrally, and alack ofelectronic
resources,whichprevents clinicians from havingaccess to informationvitalto medicaldecision
m akingat the point ofcare. W e recom m end that allM edicalDirectors be board certified in a
prim ary care field and staffphysicians have successfully completed aprim ary care residency.It
is necessary that allclinicians have access to electroniceducationalresources at the point ofcare.
This m eans that computers withinternet access should be present in the exam rooms so that
providers canaccess essentialclinicalinform ationat the tim e they are seeingthe patients.There
should be periodicpeerreview ofclinicalpractice,bothat the local/facility leveland centrally.
A t most ofthe facilities we visited,the M edicalDirectors were functioninginprim arily clinical
roles and spent little ifany tim e reviewingthe clinicalpractice ofthe otherproviders orengaging
inotherim portant adm inistrative duties.
Staffingdeficiencies are facility specificto Stateville and Dixon withregard to the num berof
vacancies. Forexam ple, 23ofStateville’s 66budgeted positions are vacant, and 18ofDixon’s
66budgeted positions are vacant. A ddingto the problem is that key leadershippositions are
vacant at these two facilities. Stateville’s H ealth C are Unit A dm inistrator, who is also
responsible forthe N RC ,has beenonanextended m edicalleave ofabsence.A dded to that is the
issue that 10ofthe 20budgeted correctionalnurse II registered nurse positions are vacant, as
wellas 10ofthe 18budgeted correctionalm edicaltechnician positions. W hile this num berof
vacant positions creates asignificant operationalissue, the problem becomes worse because
Stateville nursingstaffis required to assist at the N RC withintake and operation ofthe N RC
healthcare unit, and Stateville nursingstaffis reassigned to the N RC whenN RC nursingstaff
does not report to work.The N RC schedule E ofapproved budgeted positions only provides for
eight positions, none of which are nursingstaff. A s aresult, health care delivery suffers
significantly, whichaffects access to care and results in delays in treatment. Staffingat N RC
7
m ust be sufficient to insure m edicalintake processingis completed within one week ofentry.
This willrequire additionalclinicians and possibly additionalnursingstaffand m edicalrecords
staff.
O fDixon’s 18vacancies,three are key healthcare unit leadershippositions. A t the tim e ofour
visit, the M edicalDirector, H ealthC are Unit A dm inistratorand DirectorofN ursingpositions
were allvacant.The only leadershippresent inthe healthcare unit was two supervisingnurses,
bothofwhom were new to theirpositions.O ne ofthe supervisors was em ployed by the State and
one by the m edicalvendor.A s aresult,they eachsupervised adifferent groupofstaffwho were
assigned the sam e responsibilities,and eachsupervisorhad herownagendaas aresult ofhaving
different employers. C oupled withthis was that sevenof16budgeted corrections nurse I (RN )
State positions were vacant.
The remainingfacility vacancies (P ontiac,Logan,IL River,H ill,and M enard)ranged from nine
at M enard to only one at H ill, withthe otherfacilities fallingsomewhere in between. Even
thoughthe actualnum berofvacancies was low, there was at least one key leadershippositon
vacant at Logan(DO N ),IL River(H C UA )and M enard (DO N ).
O fadditionalconcernwas that at severalfacilities medicalvendoremployees who were filling
key leadershippositions, suchas the directorofnursing, supervisingnurse orm edicalrecords
director, were assigned additionalcorporate duties such as tim e-keeping, payrollor hum an
resources, whichtook them away from their full-tim e responsibilities. These positions were
included in the schedule E ofapproved budgeted positions to provide full-tim e service to the
facility withintheirjobdescription.Takingthem away from that underm ines the operationofthe
healthcare unit and program.
A t eachfacility, asick callsystem has been developed and im plem ented whichperm its staff
other than registered nurses to review/triage sick callrequests and evaluate/assess and treat
patients. It is ouropinion that this type ofindependent assessm ent (whichis what anurse is
required to perform inrespondingto asickcallsym ptom containingrequest)is beyond the scope
ofpractice for other than registered nursingstaff. The State ofIllinois N urse P ractice A ct
exclusively sanctions registered nurses to perform independent assessm ents, althoughit does
allow forlicensed practicalnurses orothers to assist inperform ingassessm ents.That assistance
could include takingvitalsigns oraskingsome questions regardingthe patient’s history with
regard to aspecificproblem .W henanurse perform s sickcall,the patient has presented arequest
foranassessm ent based onone ormore sym ptom s.A registered nurse has the trainingand skills
to elicit anappropriate history,perform anappropriate physicalassessm ent based onthe history
and then synthesize the datainto anursingdiagnosis and arelated plan. Frequently, system s
provide protocols to aid the registered nurses in completingthese assessm ents. To allow staff
who do not meet the requirem ents by trainingand certificationofaregistered nurse to perform
these assessm ents increases the potentialforharm to the patients as wellas legalliability forthe
State.
It is criticalforthe O ffice ofH ealthServices to establishthe specifications forthe healthcare
contracts as wellas to monitorand oversee the performance ofthose contracts and provide a
direction to the field withregard to policies and procedures as wellas clinicalguidelines. In
8
orderto provide suchguidance the O ffice ofH ealthServices requires appropriate resources.N ot
only is the M edicalDirectorpositioncriticalinprovidingclinicalguidance but also inoverseeing
suchalarge healthcare program,the M edicalDirectorshould be provided withregionalm edical
directors also board certified inprim ary care to assist him orherinprovidingclinicaloversight.
Universally we were inform ed by bothState employed staffas wellas some vendoremployed
staffthat there were significant problem s withthe vendoremployed regionalm edicaldirectors.
W e perceive the transferofthese positions directly to the State M edicalDirectorshould allow
for im proved oversight and guidance. The recom m endations we have m ade are in order to
elim inate the conflict ofinterest inherent incorporate employed physicians reviewingthe work
of corporate employed physicians. A decision of term ination becomes an expense for the
corporation.The leaderofthe investigative team was M edicalDirectorinthe State ofIllinois for
11years.Duringthat tim e,we evaluated the performance ofphysicians regularly and inform ed
vendors whensuchphysicians could no longerbe employed inthe State ofIllinois. W e believe
contractualagreem ents can be changed and in fact should be changed when they are in the
interest ofthe State inprovidingm inim ally adequate constitutionalcare.This investigative team
has beenextrem ely disappointed inthe perform ance ofthe vendorand the facility program s with
regard to both professional performance review, mortality reviews and the entire quality
im provem ent program. The requirem ent that physicians perform ingpeer reviews be board
certified in prim ary care, whichis the type ofservice that they are evaluating, is apparent and
needs not be justified.
Inaddition,because the quality im provem ent program ofany and allhealthcare organizations is
so centralto the developm ent ofan effective program, the centraloffice should have awell-
trained quality im provem ent coordinator responsible for directingthe system-wide quality
im provem ent program. This position would provide trainingand consultation to facilitate for
each site the developm ent of an effective quality im provem ent program. A nalogously, the
statewide infection controlcoordinatorposition should be restored to assist in educatingthe
institutions withregard to infection controlas wellas monitoringthe perform ance ofthose
program s.This personalso has aresponsibility as aliaisonto the State Department ofH ealth.A ll
ofthese changes should facilitate reducingthe potentialforharm to patients by im provingthe
oversight and ability to respond by the State.
Recommendations:
1. A llM edicalDirectors must be board certified in aprim ary care field. The State has
m isread this,indicatingthat allphysicians must be board certified.The investigative team
has indicated that other prim ary care staff physicians should have completed an
accredited residency trainingprogram in internalm edicine or fam ily practice and be
eitherboard certified orbecome board certified withinthree years ofemploym ent.O nly
the State M edicalDirectorcould grant exceptions to this requirem ent based onhis orher
own assessm ent ofthe candidates. The basis for this recom m endation is that in our
experience and discussion with other State M edical Directors, there have been a
disproportionate num ber of preventable negative outcomes related to prim ary care
services provided by non-prim ary care trained physicians. The investigative team does
not believe that experience practicinginafield without the required trainingis adequate
inm itigatingthe preventable negative outcomes.
2. A llclinicians should have access to electronicmedicalreferences at the point ofcare.
9
3. Every specialm edicalm issionfacility m ust have its ownH ealthC are A dm inistrator.
4. The DirectorofN ursingpositionat allfacilities is afull-tim e positionwhose tim e should
not be takenaway by corporate responsibilities.
5. Establishapproved budgeted positions forStateville and the N RC whichallow foreach
facility to functionindependently.
6. P rovide a full-tim e H ealth C are Unit A dm inistrator as well as a full-tim e Quality
Improvement C oordinator/InfectionC ontrolN urse forbothStateville and the N RC .
7. Eachfacility is to developand im plem ent aplan to insure registered nursingstaffis
conductingsickcall.
8. M edicalvendorhealthcare staffassigned to leadershippositions,suchas the directorof
nursing, supervisingnurse ormedicalrecords director, willnot be assigned corporate
duties suchas tim e keeping,payrollorhumanresources activities.
9. IDO C to developand im plem ent aplanwhichaddresses facility-specificcriticalstaffing
needs by num berand key positions and aprocess to expedite hiringofstaffwhen the
criticallevelhas beenbreached.
IDOC Office of Health Services Staffing Recommendations
1. Im m ediately seekapproval,interview and fillthe InfectionC ontrolC oordinatorposition.
2. Establishand fillthe positionforatrained Quality Improvem ent C oordinatorwho willbe
responsible fordirectingthe system wide C QI program.
3. Establish, identify and fillthe positions forthree regionalphysicians trained and board
certified inprim ary care who willreport to the A gency M edicalDirectorand perform at a
m inim um peer review clinical evaluations, death reviews, review and evaluate
difficult/complicated medical cases, review and assist with m edically complicated
transfers,attend C QI meetings and one day aweek,withintheirregion,evaluate patients.
Resources forthese positions could be takenfrom monies allocated to the medicalvendor
forregionalphysicians.
Overview of Major Services
Clinic Space and Sanitation
C linicspace,sanitationand equipm ent are problem aticat eachfacility withthe exceptionofH ill
C orrectionalC enter.The issues ranged from no designated space identified to conduct sick call
inhousingunits,to designated space beinginadequately equipped to designated space providing
no privacy orconfidentiality duringthe healthcare encounter.
Forexam ple,at Statesville,onthe first floorofcellhouses B ,C ,D,E,Fand the X-house,acell
has been converted foruse as asick callarea. These areas in cellhouses B , E and Fhave no
exam inationtables. A dditionally, eachofthe areas retains the “open-front”celldoorwithbars
whichprovides forno privacy orconfidentiality duringasick callencounter.A s aresult,these
identified areas cannot be considered as appropriate clinicalspace. In addition, these areas are
very noisy.
A t the N orthern Reception C enter, cellhouses were originally designed to include aroom for
healthcare encounters on the first floorofeachhousingunit. These areas have allbeen taken
10