A comprehensive inspection of the Piscataquis County Jail's medical unit, healthcare records and policies last month turned up "systemic gaps" in standards for healthcare delivery in a correctional setting.
The gaps in oversight, documentation, infection control and medication management "pose serious risks to inmate health" and are detailed in the auditor's report released to Maine Public by the Maine Department of Corrections on Wednesday.
Included on the list of alleged deficiencies is oversight of the Medication Assisted Treatment program for prisoners with Substance Use Disorder. The inspection team found records and oversight related to MAT "inconsistent."
According to the report, 16 people were receiving the scheduled drug Suboxone but there was "inappropriate administration" of the medication and a lack of counseling records. For example, the report says a prescription for one prisoner was used to provide a dose to three others. In general, it found that medication counts are inaccurate.
Incomplete and inaccessible records is a consistent theme in the report which highlights missing medical notes, missing signatures and poor documentation of releases including about prisoner transfers. Other standards could not be reviewed because of what are described as "incomplete" folders.
Also flagged by the team is infectious disease management. Without specifying exactly what may have happened at the jail in Dover Foxcroft or when, the report says gastrointestinal protocols were not followed; there was a delayed medical response, no quarantine was initiated and no report was made to the Department of Health and Human Services.
Another deficiency is the jail's lack of a policy for pregnant, incarcerated individuals.
Among other things, the inspection team recommends that the jail provide nursing oversight for support and triage, additional oversight of the MAT program to ensure Suboxone compliance, improved infection control for the reporting of outbreaks, enhanced staff training and development of a pregnant care policy.
On Tuesday, Corrections Commissioner Randall Liberty took the unusual step of ordering Piscataquis County Jail administrators to come up with a plan of corrective action by Friday and restricting jail operations because of a substantial "concern for the health and safety of staff, inmates and visitors."
As a result, the jail is prohibited from taking in new prisoners and must return prisoners who are boarded by federal contract to their original facilities. Reached by telephone Tuesday night, Jail Administrator Jean Larsen said that 12 boarders would be transferred.
In an email, Piscataquis County Sheriff Robert Young said the main issue is about how the jail dispenses medications. For decades, the jail has relied on corrections officers to do the job but Young said that has become "more complicated" and more of "a specialty." With the help of medical providers he said he plans to meet Friday's deadline.
"I am confidant we will have a plan in place and these corrections, which we started making 20 days ago when the inspection occurred, will continue as a priority," Young said.
Without a sufficient plan by 3 p.m. Friday, a notice to the jail indicates that the Corrections Commissioner will revoke the facility's operating license and establish a process to transfer the jail's remaining population about two dozen prisoners.
