Maryland’s state government failed to provide sufficient oversight of for-profit companies that provide medical and mental health care to thousands of individuals incarcerated in state facilities, according to an audit released Tuesday.

As a result, individuals weren’t always given timely medical exams or suicide risk screenings, they often didn’t have their complaints resolved in a timely manner, and there were not enough providers stationed at state prisons and jails, the audit found.

The report from the Office of Legislative Audits paints a picture of state officials turning over the responsibility of maintaining the health of more than 17,000 individuals to private companies and then rarely checking in.

“It’s really shocking to think that the state is spending billions of dollars and nobody from the department is doing the basic things to make sure that they’re hiring nurses and making sure that incarcerated people are receiving care,” said Corene Kendrick, deputy director of the ACLU’s National Prison Project, and an attorney in a lawsuit challenging the constitutionality of health care in state-run jails.

Maryland, like most states, outsources medical and mental health care at its state-run prisons and the pretrial complex in Baltimore — a total of 18 facilities.

The audit primarily examined the last five years of services offered by a company now known as YesCare, formerly Corizon Health, which held the medical care contract, as well as Centurion of Maryland, which held the mental health care contract during that time period. Combined, the two companies were paid more than $1 billion over five years.

Centurion now holds both contracts, awarded earlier this year.

The state dumped YesCare at the end of its contract, with one official calling the company “uniquely terrible and irresponsible” for its long record of complaints. YesCare is mired in a controversial bankruptcy proceeding and has been the subject of malpractice lawsuits in Maryland and across the country.

YesCare did not respond to a request for comment.

Officials at the state Department of Public Safety and Correctional Services did not immediately respond to questions from The Baltimore Banner on Tuesday afternoon.

In a written response to the auditors, corrections department officials said they had changed some procedures for overseeing contractors and addressed concerns with details of the new contracts.

But corrections department officials also pushed back on the auditors’ findings in some cases, defending their actions.

Key findings of the audit include:

• Failure to monitor contractors: People brought into custody are supposed to get certain exams, including a medical intake within two hours and medical and mental health exams within a week. The state did not ensure these exams were completed; over the course of a few months, for example, auditors found that hundreds of exams were not completed.
• Medical complaints unresolved: State officials did not ensure that the contractors resolved complaints brought by patients in the required 45 days or with the required amount of investigation. In one case, an individual complained after not being tested for sexually-transmitted infections despite showing symptoms, and their complaint was not resolved until seven months later.
• Staffing levels unchecked: The contracts required companies to have a certain number of medical staff available, and never met those standards, according to their own reports. State officials never checked the accuracy of those reports, auditors found.
• Flaws in the contracts: Under the contracts, the companies were paid one lump sum to provide care throughout the whole correctional system, but auditors noted there was no documentation to justify that was the best use of tax dollars. Other states use a per-patient cost model or a model where the companies are reimbursed for the actual cost of care they provide, with a fee to cover their profit on top. DPSCS responded that “it is not standard practice” to document the decision-making process on the structure of the contracts.
• Questionable payout to a contractor: YesCare repeatedly asked the state for more money for a variety of reasons, including to cover rising costs and response to the coronavirus pandemic. The state ultimately paid them $20 million and reduced the required staffing levels, and auditors found no documentation to justify the settlement. At the same time, the state didn’t assess allowed penalties on YesCare or Centurion for never meeting the required staffing levels. DPSCS officials wrote that for any future settlements, they’ll provide more documentation, “including the cost benefit of the settlement.”

Kendrick from the ACLU said the audit underscores the problem with governments outsourcing correctional health care to private companies that are motivated by profit. She said the audit made clear that the department is “asleep at the wheel,” while the private companies are more accountable to shareholders than their patients.

“This audit is not describing a broken privatization system,” she said. “This is exactly how these corporations design the model to work. This is what they’re built on. This idea of maximizing profits: not paying wages that would attract health care staff, not performing services, and just kind of assuming that these state agencies wash their hands of everything.”