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Tennessee Prison Audit Blasts DOC, CCA and CMS
A Tennessee Department of Corrections (TDOC) performance audit for the years 1997-2002, released by the state comptroller's office in September 2003, reveals problems with prison staffing, pre-release preparation, and numerous instances of contract violations by private prison contractors.
A major problem revealed by the audit is the retention of prison guards. The average guard turnover rate in 2002 was 28%, up 1% from 2001. The rates were much higher in some instances. The Tennessee Prison for Women had a whopping 69% turnover rate in 2002. Two prisons in West Tennessee, where industries such as Goodyear and Caterpillar are located, also had higher than average turnover rates. One reason for low retention rates, an employee exit survey revealed, is comparatively low pay. For instance, all four prisons in Davidson County, where the average salary for jail guards was $3,500 higher than that of TDOC, suffered higher than average turnover rates. The warden of one TDOC prison in Davidson County was cited as saying "the department is basically a training facility for local jails because an individual can be trained by Corrections, receive work experience, and then leave for more money by working at county sheriffs' offices." The exit surveys for 2000-2002 revealed that roughly two thirds of TDOC guards left within 2 years of being hired. This is especially problematic as "the department's personnel director indicated that ... it takes the department about three years to recover the cost," of recruiting and training new guards. Other reasons cited for the low retention rates were employee dissatisfaction with supervisors, "burn out," and low job prestige.
The audit also found that more needs to be done to prepare prisoners for release. The TDOC has 120 beds designated for mandatory 90 day pre-release programs at 3 prisons, a yearly capacity of 480. Eleven other prisons offer a voluntary 10-11 week pre-release program, and the Tennessee Prison for Women offers a voluntary 4 week program. By contrast, in the first 10 months of fiscal year 2003, 4,054 prisoners were released from TDOC prisons. Another 3,253 prisoners in TDOC custody were released from local jails, presumably with minimal pre-release services.
The audit recommended the TDOC should "work toward implementing a comprehensive release program ... [and] monitor short- and long-term outcomes, including tracking recidivism rates." Even with the above glaring deficiencies, the audit noted that the TDOC pre-release program still met American Correctional Association (ACA) accreditation standards.
The audit further noted that some prisons are consistently out of compliance with the health services' Continuous Quality Improvement (CQI) program standards. CQI, a result of the Grubbs court case, is a quality assurance program implemented to centralize oversight of TDOC medical services. The audit noted that noncompliance with CQI standards could negatively affect the department's ability to "perform trend analyses to assess infection control; review the distribution of medication; and properly diagnose and treat mental illness, tuberculosis, hepatitis, HIV/AIDS and other STD's, and chronic diseases."
In 1999, the TDOC doled out $275,927 to install a security fence with infrared sensing capability around the West Tennessee State Prison. The infrared system was designed to detect movement by sensing body heat. It was soon discovered, however, that the system could not detect body heat on warm days, possibly facilitating escapes. The contractor's inability to rectify the problem necessitated replacement of the entire fence. Still, the attorney general's office decided that "it was not cost-effective for the state to seek restitution," even though the installing contractor had provided a written guarantee "that the system would meet or exceed design specifications."
Tennessee has gone farther in privatizing its prisons than any other state in the country. In fiscal year 2002-2003 it paid over $54 million for contractor services, including $3,570,738 to Mental Health Management (MHM); $27,608,876 to Correctional Medical Services (CMS); $22,363,233 to Corrections Corporation of America (CCA); and $41,310 to the ACA for the accreditation/reaccreditation of 4 prisons. However, all the evidence suggests that the state is not getting what it pays for. MHM, for instance, was found to be noncompliant in a number of areas, including failure to monitor mental health patients or provide proper progress notes; cancelled medication clinics; prisoners treated by unqualified staff; missing records, delayed record review, and improper patient assessment; patients prescribed treatment without being seen; improperly written psychiatric orders; failure to provide continuous care; late completion of work by providers; no protocol for schedule IV drugs; and staff not completing TDOC mandated training. The audit noted that MHM's contract noncompliance "contributed to multiple failed annual inspections at" the Northeast Correctional Complex.
Numerous instances of contract noncompliance were reported against CMS as well. Violations included failure to set up chronic clinics, monitor chronically ill prisoners, or establish treatment plans; failure to set up and schedule optometry clinics or administer optometry services; failure to adequately maintain health records and properly screen for infectious diseases; routinely understaffed infirmaries; staff working before completing TDOC training; not documenting DNA testing; not consistently documenting, filing, or signing Medical Administration Records (MARs); lack of provider information and late filing of MARs; not including warnings or labeling medication doses; failure to perform minor surgeries in prison clinic, perform timely periodic health appraisals, or provide times and professional titles in medical charts; failure to contract neurology and GI services; failure to administer dental services; and failure to document or properly document initial health screening upon intake. The audit also noted that CMS failed to properly collect co-pays which cost the TDOC an estimated $5,000. It should be noted, however, that it is probably not cost-effective to collect co-pays in the first place.
CCA, which operates the South Central Correctional Facility (SCCF) and the Hardeman County Correctional Facility (HCCF), was found to be noncompliant in many areas. A random sample of recently hired personnel found that 1 employee had no proof of education and 4 had no drivers license; 2 were hired without proper documentation; 4 of 5 senior guards were hired without meeting contract requirements; new guards were not cleared by mental health professionals; and missing criminal background checks. The audit also found numerous instances of unstaffed positions, some of them critical. Additionally, CCA would have been noncompliant in hiring SORT team members without the requisite training experience had the TDOC not granted a policy exemption.
CCA's failure to purchase uniforms from the state, the audit noted, is costing taxpayers. To reduce prisoner idleness, the TDOC has set goals to employ a certain number of prisoners in specific areas. The goal of The Rehabilitative Initiative in Corrections (TRICOR), which produces prisoner uniforms, is to employ 10% of TDOC prisoners. However, it has been able to employ only about 5%, in part because CCA has failed to purchase its prisoner uniforms from TRICOR. The audit does not say if CCA is buying uniforms elsewhere or simply not buying them, thereby increasing their profit by making prisoners go without. The audit did say, however, that CCA's failure to buy uniforms from TRICOR "equates to a loss of inmate training opportunities and jobs for the Department of Corrections." Furthermore, "If this scenario continues, the department and ultimately taxpayers will incur the expenses for providing alternative activities and staff to manage programs for inmates since the department is mandated to prevent inmate idleness."
MHM, CMS, and CCA continually failed to comply with proposed staffing levels, which suggests that "the department is getting less than it paid for," and that prisoner care may suffer. Not meeting proposed staffing levels does, however, increase the contractor's profit. In calendar year 2002, CMS fell short of its primary care obligations by 681 hours, and dental service obligations by 1,538 hours. CCA failed to fill vacant positions in the allotted time. At SCCF security staffing levels were noncompliant for a total of 2,294 days. This money is a taxpayer giveaway as these contractors are being paid for services they are not providing. This also calls into question any "savings" made by privatizing.
Accordingly, one of the audit's main criticisms was the failure of TDOC to assess liquidated damages against prison contractors for nonperformance, even in light of these blatant contract violations. As of June 2002, no damages had been assessed against CMS. However, "after multiple meetings and various memoranda were issued," CMS was fined $8,000 in November 2002 and $1,250 in June 2003a trivial amount considering CMS's $26.6 million dollar contract. It's no wonder that in other states CMS has found it more profitable to take the sanctions than comply with the contract. The audit reported that no damages had been assessed against CCA for its numerous contract violations. Failure to enforce contract compliance is an ongoing issue with private prison contractors. No state has indicated a willingness or the ability to either monitor or enforce contract compliance with private prison companies.
In light of these findings, the audit recommended, among other things, that the TDOC assess damages against contractors for noncompliance, including failure to adhere to proposed staffing patterns; enforce contract obligations; review areas of noncompliance before renewing contracts; and force CCA to purchase prisoner uniforms from TRICOR.
Of note, Appendix I of the audit gives information concerning compliance with Title VI of the Civil Rights Act of 1964, including federal funds received by the TDOC (information necessary to state a claim for violations of the Religious Land Use and Institutionalized Persons Act and the Rehabilitation Act); prisoner program participation and job assignment by ethnicity; population ethnicity (48.5% Black, 50% White, 1.5% other, presumably Latinos are being counted as "white,"); and the number and disposition of prisoners' Title VI actions against the TDOC for the years 1999-2002.
Get a copy of the audit on-line at www.comptroller.state.tn.us/sa/ reports/index.html, or by writing to Comptroller of the Treasury, Division of State Audit, 1500 James K. Polk Building, Nashville, Tennessee 37243-0264.
Sources: Tennessee Department of Corrections Audit (September 2003), The Associated Press, www.knoxnews.com
A major problem revealed by the audit is the retention of prison guards. The average guard turnover rate in 2002 was 28%, up 1% from 2001. The rates were much higher in some instances. The Tennessee Prison for Women had a whopping 69% turnover rate in 2002. Two prisons in West Tennessee, where industries such as Goodyear and Caterpillar are located, also had higher than average turnover rates. One reason for low retention rates, an employee exit survey revealed, is comparatively low pay. For instance, all four prisons in Davidson County, where the average salary for jail guards was $3,500 higher than that of TDOC, suffered higher than average turnover rates. The warden of one TDOC prison in Davidson County was cited as saying "the department is basically a training facility for local jails because an individual can be trained by Corrections, receive work experience, and then leave for more money by working at county sheriffs' offices." The exit surveys for 2000-2002 revealed that roughly two thirds of TDOC guards left within 2 years of being hired. This is especially problematic as "the department's personnel director indicated that ... it takes the department about three years to recover the cost," of recruiting and training new guards. Other reasons cited for the low retention rates were employee dissatisfaction with supervisors, "burn out," and low job prestige.
The audit also found that more needs to be done to prepare prisoners for release. The TDOC has 120 beds designated for mandatory 90 day pre-release programs at 3 prisons, a yearly capacity of 480. Eleven other prisons offer a voluntary 10-11 week pre-release program, and the Tennessee Prison for Women offers a voluntary 4 week program. By contrast, in the first 10 months of fiscal year 2003, 4,054 prisoners were released from TDOC prisons. Another 3,253 prisoners in TDOC custody were released from local jails, presumably with minimal pre-release services.
The audit recommended the TDOC should "work toward implementing a comprehensive release program ... [and] monitor short- and long-term outcomes, including tracking recidivism rates." Even with the above glaring deficiencies, the audit noted that the TDOC pre-release program still met American Correctional Association (ACA) accreditation standards.
The audit further noted that some prisons are consistently out of compliance with the health services' Continuous Quality Improvement (CQI) program standards. CQI, a result of the Grubbs court case, is a quality assurance program implemented to centralize oversight of TDOC medical services. The audit noted that noncompliance with CQI standards could negatively affect the department's ability to "perform trend analyses to assess infection control; review the distribution of medication; and properly diagnose and treat mental illness, tuberculosis, hepatitis, HIV/AIDS and other STD's, and chronic diseases."
In 1999, the TDOC doled out $275,927 to install a security fence with infrared sensing capability around the West Tennessee State Prison. The infrared system was designed to detect movement by sensing body heat. It was soon discovered, however, that the system could not detect body heat on warm days, possibly facilitating escapes. The contractor's inability to rectify the problem necessitated replacement of the entire fence. Still, the attorney general's office decided that "it was not cost-effective for the state to seek restitution," even though the installing contractor had provided a written guarantee "that the system would meet or exceed design specifications."
Tennessee has gone farther in privatizing its prisons than any other state in the country. In fiscal year 2002-2003 it paid over $54 million for contractor services, including $3,570,738 to Mental Health Management (MHM); $27,608,876 to Correctional Medical Services (CMS); $22,363,233 to Corrections Corporation of America (CCA); and $41,310 to the ACA for the accreditation/reaccreditation of 4 prisons. However, all the evidence suggests that the state is not getting what it pays for. MHM, for instance, was found to be noncompliant in a number of areas, including failure to monitor mental health patients or provide proper progress notes; cancelled medication clinics; prisoners treated by unqualified staff; missing records, delayed record review, and improper patient assessment; patients prescribed treatment without being seen; improperly written psychiatric orders; failure to provide continuous care; late completion of work by providers; no protocol for schedule IV drugs; and staff not completing TDOC mandated training. The audit noted that MHM's contract noncompliance "contributed to multiple failed annual inspections at" the Northeast Correctional Complex.
Numerous instances of contract noncompliance were reported against CMS as well. Violations included failure to set up chronic clinics, monitor chronically ill prisoners, or establish treatment plans; failure to set up and schedule optometry clinics or administer optometry services; failure to adequately maintain health records and properly screen for infectious diseases; routinely understaffed infirmaries; staff working before completing TDOC training; not documenting DNA testing; not consistently documenting, filing, or signing Medical Administration Records (MARs); lack of provider information and late filing of MARs; not including warnings or labeling medication doses; failure to perform minor surgeries in prison clinic, perform timely periodic health appraisals, or provide times and professional titles in medical charts; failure to contract neurology and GI services; failure to administer dental services; and failure to document or properly document initial health screening upon intake. The audit also noted that CMS failed to properly collect co-pays which cost the TDOC an estimated $5,000. It should be noted, however, that it is probably not cost-effective to collect co-pays in the first place.
CCA, which operates the South Central Correctional Facility (SCCF) and the Hardeman County Correctional Facility (HCCF), was found to be noncompliant in many areas. A random sample of recently hired personnel found that 1 employee had no proof of education and 4 had no drivers license; 2 were hired without proper documentation; 4 of 5 senior guards were hired without meeting contract requirements; new guards were not cleared by mental health professionals; and missing criminal background checks. The audit also found numerous instances of unstaffed positions, some of them critical. Additionally, CCA would have been noncompliant in hiring SORT team members without the requisite training experience had the TDOC not granted a policy exemption.
CCA's failure to purchase uniforms from the state, the audit noted, is costing taxpayers. To reduce prisoner idleness, the TDOC has set goals to employ a certain number of prisoners in specific areas. The goal of The Rehabilitative Initiative in Corrections (TRICOR), which produces prisoner uniforms, is to employ 10% of TDOC prisoners. However, it has been able to employ only about 5%, in part because CCA has failed to purchase its prisoner uniforms from TRICOR. The audit does not say if CCA is buying uniforms elsewhere or simply not buying them, thereby increasing their profit by making prisoners go without. The audit did say, however, that CCA's failure to buy uniforms from TRICOR "equates to a loss of inmate training opportunities and jobs for the Department of Corrections." Furthermore, "If this scenario continues, the department and ultimately taxpayers will incur the expenses for providing alternative activities and staff to manage programs for inmates since the department is mandated to prevent inmate idleness."
MHM, CMS, and CCA continually failed to comply with proposed staffing levels, which suggests that "the department is getting less than it paid for," and that prisoner care may suffer. Not meeting proposed staffing levels does, however, increase the contractor's profit. In calendar year 2002, CMS fell short of its primary care obligations by 681 hours, and dental service obligations by 1,538 hours. CCA failed to fill vacant positions in the allotted time. At SCCF security staffing levels were noncompliant for a total of 2,294 days. This money is a taxpayer giveaway as these contractors are being paid for services they are not providing. This also calls into question any "savings" made by privatizing.
Accordingly, one of the audit's main criticisms was the failure of TDOC to assess liquidated damages against prison contractors for nonperformance, even in light of these blatant contract violations. As of June 2002, no damages had been assessed against CMS. However, "after multiple meetings and various memoranda were issued," CMS was fined $8,000 in November 2002 and $1,250 in June 2003a trivial amount considering CMS's $26.6 million dollar contract. It's no wonder that in other states CMS has found it more profitable to take the sanctions than comply with the contract. The audit reported that no damages had been assessed against CCA for its numerous contract violations. Failure to enforce contract compliance is an ongoing issue with private prison contractors. No state has indicated a willingness or the ability to either monitor or enforce contract compliance with private prison companies.
In light of these findings, the audit recommended, among other things, that the TDOC assess damages against contractors for noncompliance, including failure to adhere to proposed staffing patterns; enforce contract obligations; review areas of noncompliance before renewing contracts; and force CCA to purchase prisoner uniforms from TRICOR.
Of note, Appendix I of the audit gives information concerning compliance with Title VI of the Civil Rights Act of 1964, including federal funds received by the TDOC (information necessary to state a claim for violations of the Religious Land Use and Institutionalized Persons Act and the Rehabilitation Act); prisoner program participation and job assignment by ethnicity; population ethnicity (48.5% Black, 50% White, 1.5% other, presumably Latinos are being counted as "white,"); and the number and disposition of prisoners' Title VI actions against the TDOC for the years 1999-2002.
Get a copy of the audit on-line at www.comptroller.state.tn.us/sa/ reports/index.html, or by writing to Comptroller of the Treasury, Division of State Audit, 1500 James K. Polk Building, Nashville, Tennessee 37243-0264.
Sources: Tennessee Department of Corrections Audit (September 2003), The Associated Press, www.knoxnews.com
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