District of Columbia Receivership:

Selected Issues Related to Medical Services at the D.C. Jail

T-GGD-00-173: Published: Jun 30, 2000. Publicly Released: Jun 30, 2000.

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Laurie E. Ekstrand
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Office of Public Affairs
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Pursuant to a congressional request, GAO discussed selected issues concerning the District of Columbia (D.C.) Medical Receiver's contract for medical and mental health services at the D.C. Jail, focusing on: (1) what the costs of providing medical services at the D.C. Jail are as compared with jurisdictions said to be similar; (2) what would constitute an acceptable level of medical service and staffing at the jail; (3) what effect the contracting process had on medical service costs; and (4) whether the failure of the District of Columbia Medical Receiver's employees to resign from their positions prior to being awarded the contract violate D.C. law or regulations.

GAO noted that: (1) GAO's comparison of contract budget data for medical services at the D.C. Jail and two comparable facilities--in Baltimore and Prince George's County, Maryland--indicated that the D.C. Jail's per capita costs were higher; (2) the cost differences between the D.C. Jail and those in Baltimore and Prince George's County are likely due, in part, to differences in staffing levels, which in turn are likely due, in part, to the types of medical services provided; (3) the fact that the D.C. Jail provides a fully staffed on-site pharmacy and mental health and dental services, whereas Baltimore and Prince George's County provide these services differently, offers a context for understanding some of the differences in the inmate to staff ratios; (4) officials with whom GAO spoke and documents GAO reviewed indicated that a court-ordered Remedial Plan is the primary reason why the D.C. Jail provides medical services and has higher staffing levels than other jurisdictions; (5) there is no single specific threshold that determines what an acceptable level of medical service and staffing is at a jail; (6) according to correctional medicine experts, generally, the level of service and staffing is a function of many factors, including the situation and circumstances to be addressed; (7) it is also a function of the specific constraints and demands placed on the service delivery system at a particular location; (8) standards, such as those developed by the National Commission on Correctional Health Care , define minimum recommended medical service requirements for jails to voluntarily obtain accreditation; (9) the current contract maintains levels of medical service and staffing that were already in place at the D.C. Jail, but possibilities exist to reduce future contract costs; (10) the current contract can be modified at any time; (11) the solicitation that resulted in the current contract did not preclude offerors from submitting proposals that would reduce staffing and costs over the existing levels, as long as quality health care services would be provided; (12) the receiver employees that were awarded the contract were not subject to D.C. Personnel Regulations because they were not D.C. employees; and (13) separately, the D.C. Contract Appeals Board stated that, while there was not proof sufficient to challenge the award, certain actions by the Receiver gave an appearance not conducive to confidence in the fairness of the procurement.

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