By Gretchen Gavett

The Department of Correction Advisory Council (AC) was established by Executive Order of Governor Mitt Romney on September 15, 2004, and charged with monitoring and supporting the implementation of recommendations made in the report of the Governor’s Commission on Corrections Reform (GCCR). Led by Chair Scott Harshbarger, the AC was also charged with providing recommendations on female offenders and the medical and mental health services in the Department of Corrections.¹

The GCCR report, Strengthening Public Safety, Increasing Accountability, and Instituting Fiscal Responsibility in the Department of Correction, was released on June 30, 2004. It examined best practices in reducing the rate of re-offense among inmates who return to Massachusetts communities and emphasized the need to improve accountability among managers, staff, and inmates. The Commission’s eighteen recommendations are listed at the end of this article. In its Preliminary Report, issued in June, 2005, the Advisory Council evaluated the DOC’s progress in responding to the GCCR recommendations. Based on this analysis, the Advisory Council issued new recommendations and requested that the DOC provide periodic updates on sixteen concrete performance measures.

On October 25, 2005, the Department of Correction Advisory Council issued its Final Report, which addresses the following areas: female offenders; health and mental health services; and priority reforms. Each section includes statistics supporting its recommendations and focuses on the most immediate changes that need to be made. The work of the Female Offender and Medical Review Panels are discussed in separate articles in this newsletter.

Priority Agenda for Action

The Advisory Council has decided upon actions that must be taken in order for the reform process to proceed effectively. Absent these changes, the Advisory Council warns, the DOC’s other reform efforts may not succeed, nor will they help reduce crime in Massachusetts.

Classification reform. Between 1994 and 2004, the percentage of inmates in minimum security facilities declined from 23% to 11%, and the percentage of inmates in maximum security facilities increased from 9% to 19%. Overclassification, or the placing of inmates in facilities with higher security levels than is called for, “is a barrier to the reduction of recidivism and the successful reentry of prisoners, because prisoners held in maximum security prisons are not eligible for the same programs and rehabilitative services as those held in medium and minimum security facilities.” It also wastes public resources. Emphasis is placed on changing mandatory minimum sentencing as well.

Re-allocation of the DOC budget. Staffing accounts for 73% of the DOC’s budget; inmate programs comprise 12%. Sick leave and unexplained absences among DOC employees only add extra strain to these numbers. The Advisory Council stresses the need to reform DOC staffing budgets while working with labor unions in order to reach acceptable reform without taking away workers’ rights.

Re-entry legislation. Among the barriers to successful re-entry are mandatory minimum sentences, parole eligibility, prohibited crimes, and work release limits. Also, because most inmates receive no supervision upon re-entering the community, post-release supervision is viewed as important. Reform in sentencing practices is also advised, as proper gradual and step-down release is lacking.

Statewide re-entry plan. This recommendation emphasizes that the Parole Board and Probation Department have important community supervision roles. In addition, because many inmates have substance abuse and mental health problems, the Department of Public Health and Department of Mental Health are necessary partners. County Sheriffs, DAs, and the Legislature must also contribute.

Independent inspector general. An outside evaluator with sufficient experience and distance from the DOC is needed.

Culture change inside the DOC. The Advisory Council determined that major resistance to GCCR recommendations has come from labor union leadership, specifically that of the correctional officers’ union, MCOFU. The AC argues that quality, not quantity, of employees is vital. It finds an enormous amount of tension between the labor unions and the DOC, especially involving Commissioner Dennehy, which needs to be resolved. Professionalism and appropriate conduct must be the norm for all organizations involved.

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_{1 In addition to Scott Harshbarger, Proskauer Rose LLP, former Massachusetts Attorney General, the AC included these thirteen members: Sen. Jarrett Barrios (D-Cambridge); R. Michael Cassidy, Boston College Law School; Elizabeth Childs, Commissioner, Department of Mental Health; Elyse Clawson, E.D., Crime and Justice Institute; Pate Cote, Commissioner, Department of Public Health; Frank G. Cousins, Jr., Sheriff, Plymouth County; Timothy Cruz, District Attorney, Plymouth County; Edward Davis, Supt., Lowell Police Department; Michael Fair, Security Response Technologies, Inc., former Commissioner, DOC; Sen. Robert Hedlund (R-Weymouth); Joyce Murphy, President, Caritas Carney Hosp., former Supt. MCI-Framingham; Robert Watson, Chair/CEO, LPM Holding Co.; Douglas H. Wilkins, Anderson and Kreiger LLP, Former Gov. Bureau Chief, Office of the Attorney General. Patrick Bradley, Undersecretary of Criminal Justice, Executive Office of Public Safety, served as an ex officio member.}

August 23, 2003 Death of inmate, former priest John Geoghan

September 4, 2003 Governor appoints three-person “Special Panel”

October 17, 2004 Governor establishes Governor’s Commission on Correctional Reform (GCCR)

March, 2004 Kathleen Dennehey becomes DOC Commissioner

June 30, 2004 GCCR issues its eighty-two report with eighteen recommendations “intended to serve as a blueprint for change”

August 6, 2004 DOC prepares first document with plans for each of 18 recommendations in GCCR report.

September 14, 2004 Governor establishes DOC Advisory Council (AC).

December, 2004 DOC Advisory Council holds first of five meetings held by June 17, 2005. Creates three working groups to examine 1) governance, 2) programs and reentry, and 3) operational systems. DOC Commissioner presents monthly updates of progress on recommendations.

March, 2005 DOC Commissioner gives written progress report in the eighteen areas of the “Strategic Plan.” This was reportedly updated regularly and used in meetings of the AC.

March, 2005 First meetings of two “review panels,” each comprising external participants and two members of the Advisory Committee and staffed and supported by DOC staff. One was charged with reviewing issues regarding female offenders and the other issues of inmate health and mental health.

June 17, 2005- AC offers forty-page Preliminary Report.

August 1, 2005 – Five subgroups of the Female Review Panel submit their written reports and findings, making twenty-three major recommendations.

September 16, 2005 – Four subgroups of the Medical Review Panel submit their reports and findings, making fifty-eight major recommendations.

October 25, 2005 – Advisory Council Chair, Scott Harshbarger submits two letters to Secretary of the Executive Office of Public Safety, summarizing the conclusions Female Offender and Medical Review Panels and prioritizing from their recommendations. Advisory Council submits twenty-six-page Final Report.

December 8, 2005 – Boston Globe obtains former Attorney General Scott Harshbarger’s letter of resignation as Chair of the Advisory Council and publishes an article on the decision.

As stated by members of the group, the Female Offender Review Panel was "formed by the Department of Correction (DOC) and the Governor's Department of Correction Advisory Council [and] comprised of experts in areas including gender-specific programming, prison overcrowding, inmate mental health and others."The Female Offender Review Panel had its first meeting in March, 2004 and submitted five written reports and twenty-three major recommendations on August 1, 2005. Not all have been made public.

According to the AC's Final Report, the panel divided into five subgroups that met biweekly and collected data in a variety of ways, including site visits. Each subgroup was asked by the AC to address one or more of the following nine major issues: overcrowding, booking and admissions, gender-specific medical needs, operations, resources and practices, family connections, reentry, treatment, and fiscal support.

The Female Offender Review Panel has thirty-four members, five of whom served as chairs of the subgroups. The chairs were Sen. Karen Spilka (D-Framingham), Dr. Judith Kirwan Kelley, MCLS Director Leslie Walker, Rep. Kay Kahn (D-Newton), and Rep. Liz Malia (D-Jamaica Plain). The others were Kate DeCou, Eve Slattery, Lisa Core, Jill Vanderbosch, Brian Sylvester, John Renner, Hortensia Mara, Jean Flatley McGuire, Kathy Coughlin, Nan Stromberg, Mary Jo Larson, Maureen Norton-Hawk, James Walsh, Sarah Blumenthal, Stephanie, Mitzenmacher, Jennifer Goldstein, Kelly Doel, Martina Jackson, Susan Moitozo, Lyn Levy, Francine Sherman, Robert Bickerton, Jane Brown, Isa Wodeguiorgis, and Carole Dyer. (Members are listed here as in the Acknowledgements of the Final Report.) The review panel was supposed to include two members of the Advisory Council, but CJPC did not find these specified.

Principal Recommendations

In its Final Report (and October 25 transmittal letter to the EOPS Secretary), the AC stated that it "considers the subgroups' major findings and recommendations to be generally well founded and deserving of critical attention." However, the AC singled out the following two of the panel's twenty-three major recommendations, stating that they are of "highest priority and should be urgently addressed."

1. Pre-trial detainees and those sentenced to country facilities should be housed in their respective counties, not at MCI-Framingham.

2. Women should not be civilly committed to MCI-Framingham.

Achieving these changes, the AC argues, will alleviate the severe overcrowding of MCI-Framingham, reducing the inmate population, according to DOC figures, to 200 from the current total of over 600. "Effective action on these two recommendations will also allow," the AC continued, "for implementation of many of the Panel's remaining recommendations, including those that concern access to programs and services, reentry planning, and staffing--if these issues (overcrowding and inappropriate placement) are addressed, the Department can be held accountable for effective change and reform."

Findings and Sub-Recommendations

In relation to its two priority recommendations, the AC Final Report (and the October 25, 2005 letter to the Commissioner of Public Safety) included the following facts reported by the Female Offender Review Panel:

• MCI-Framingham currently holds more than 600 inmates); it was designed to hold 358; and it has been increasing in population annually. (In one place, the AC reports inmate total of 686.)
• 67% of those admitted annually to MCI-Framingham are either pre-trail detainees or civilly committed women.
• One-sixth of MCI-Framingham inmates are serving county sentences of less than 2 1/2 years.
• The cost per year for housing inmates in MCI-Framingham, a medium/maximum security facility, is generally $10,000 more than it is at a county facility.
• Over the past eight years, the number of civil commitments for substance abuse to MCI-Framingham under M.G.L. 123, Section 35 has risen from five in fiscal year 1998 to 157 in fiscal year 2005. Delays in moving these persons to community based programs though the Department of Public Health has grown --to reach 14-16 days in the summer of 2005.
• The Review Panel found barriers sufficient to keep more than half of those civilly committed to MCI-Framingham from receiving substance abuse services.

To remove pre-trial detainees, inmates with county sentences, and civilly committed women from MCI-Framingham, the AC outlined the following actions (sub-recommendations):

1. return pre-trial detainees to respective counties as soon as possible, with the goal of housing them in local jurisdiction near courts where they will be tried.

2. make efforts to integrate county-sentenced females into lower security facilities.

3. urge each county to assess its ability to house its female offenders and explore establishing regional facilities.

4. appropriate sufficient funds for full and prompt completion of the 200-bed facility for female offenders in western Massachusetts.

5. create a multi-agency task force, possibly aligned with existing efforts like the Governor's Inter-Agency Council on Substance Abuse and Prevention.

6. fund detoxification centers throughout the state, offering community-based services, including secure and non-secure beds that meet the needs of civilly-committed women.

7. inform and educate relevant court personnel on the impact of the current trend toward increasing Section 35 commitments on facility overcrowding and lack of programming and treatment.

A Public Briefing will be held at 10:30 a.m. on March 8th in the House Members Lounge of the State House. At that time, the Female Offender Review Panel will present the panel's findings and recommendations in these five areas:

• overcrowding of the female offender population
• special medical needs of female offenders
• operations at female offender facilities
• maintaining family connections
• the treatment process and fiscal support for managing the female offender population

This will provide an opportunity to learn if Panel members agree with the AC's prioritization among their recommendations, hear what additional actions they urge, and hopefully, get copies of the five subgroup reports.

By Dorothy Weitzman

The Medical Offender Review Panel was formed in like manner to the Female Offender Review Panel and received staffing and research support from the DOC and Advisory Council staff. The panel had its first meeting in March of 2005 and submitted written reports and fifty-eight major recommendations on September 16, 2005.

The panel worked in four subgroups to consider the following issues: 1) the scope of medical, pharmacological, dental, and mental health services provided to inmates, 2) the gender-specific medical and mental health needs of the female population, 3) services provided at Bridgewater State Hospital and the Massachusetts Alcohol and Substance Abuse Center, and 4) services provided at Lemuel Shattuck Hospital. According to the AC, they “reviewed numerous documents, toured correctional facilities, observed operations, reviewed medical records, and conducted focus groups with providers, inmates, correctional officers, and DOC administrators.”

The Medical Review Panel had twenty-four members, including these subgroup chairs: Dr. Alfred DeMaria, Katherine Keough, Dr. David Power, Dr. Anna Karina Mascarenhas, Dr. John Fromson, Michael Boticelli, and Robert Watson. Other members were Dana Bowie, Frank Cousins, Marilyn Delvalle, Lisa Gurland, Dr. Richard Herman, Robert Kinscherff, Gary Larareo, Glynnis LaRosa, Dennis Lyons, Kevin Norton, James Pingeon, Jo-Anna Rorie, Philip Shea, Leslie Walker, Thomas Walsh, Dr. Wanda Wright, and Michael Williams. The two members of this review panel who are members of the Advisory Council are Frank Cousins and Robert Watson.

Seven Priority Recommendations

The AC’s Final Report (and the October 25, 2005 letter to the Commissioner of Public Safety regarding this panel’s work) stated that it found all the Medical Review Panel’s subgroup reports “thoughtful, reality-based, and comprehensive” and its fifty-eight major recommendations “generally well supported.” Included were the following facts and characterizations of current issues and concerns.

1. The department (DOC) should determine what its health and mental health care needs will be over the next ten to twenty years and should plan and prioritize accordingly.

2. Contracts between the DOC and health and mental health providers must explicitly state the scope of medical services, standards of care, and quality measures. compliance, and grievance procedures.

3. The department (DOC) should adopt a plan to improve health and mental health services, including a review of relevant policies and procedures; staffing, education and training; facilities and infirmaries; and technology and equipment.

4. The DOC should review its mental health services and develop a more comprehensive, integrated and sufficient programming.

5. The DOC should review its policies and practices regarding patients at Bridgewater State Hospital. An oversight committee comprised of the DOC, Sheriffs and relevant court personnel should be established to review alternatives to commitment to Bridgewater State Hospital.

6. An oversight committee comprised of DOC, DPH, DMH, and court personnel should be established to review Section 35 commitments.

7. The Department and UMCH should strengthen plans for reentry and after care medical and mental health services. This recommendation is particularly important because 97% of inmates eventually return to their communities.

The Advisory Council stated that these seven recommendations of the Medical Offender Review Panel were “of the highest priority and should be urgently addressed:”

• DOC is contracted, starting January 1, 2003, for four years with University of Massachusetts Correctional Health Services (UMCH) – the FY05 cost exceeded $56 or approximately 15% of the total DOC budget.
• Today’s inmate population is older, sicker and more psychiatrically compromised than those for which medical staffing and programs were designed
• The DOC’s current health services contract does not ensure system-wise standardization of care and accountability; it does not specify minimum standards in important areas; and it does not gear performance measure to quality of serve rather than reporting of quantitative data.
• Inmate medication lines are long, managed inefficiently, and over-the-counter medications are frequently difficult to obtain in a timely fashion.
• DOC health care facilities are old and in disrepair.
• Lemuel Shattuck, the principle hospital utilized by DOC, has no protective custody and an insufficient number of secure beds.
• Problems which DOC must address with other state agencies, the trial courts, and community care providers include “increasing numbers of Section 35 commitments, inappropriate admissions to Bridgewater State Hospital, the aging demographics of inmates, and the lack of coordinated support for reentry.”
• Inmate education in health issues is lacking and materials used are targeted at too high a reading level.
• DOC needs a more efficient system for tracking and maintaining records, prescribing medications, communicating between facilities, and communicating between primary care providers and outside consultants.
• DOC currently lacks essential equipment across all areas of medical services, including medication charts for nurses, autoclaves in dental units, and ultrasound machines for pregnant women. It needs to replace old and defective medical equipment.
• The DOC’s current mental health program is not sufficiently comprehensive or integrated. For example, some male inmates are denied residential treatment because it is only available at one security level.
• There is a lack of coordinated treatment for patients with multiple medical issues, such as mental health and substance abuse problems.
• There are a large number of inappropriate admissions to Bridgewater State Hospital (BSH) from county facilities and state prisons that lack options for alternative treatments.
• At BSH there are needs for increased mental health workers, clinicians, and forensic evaluators and for changes in staffing so that correctional officers assigned to BSH are trained and motivated to work in a psychiatric facility.
• There has been a dramatic increase in the number of men committed under Section 35 to the Massachusetts Alcohol and Substance Abuse Center (MASAC) as well as of females to MCI-Framingham.
• Centralized resources and coordinated support for aftercare plans that meet the medical and mental health needs of inmates transitioning from DOC to care in the community is currently severely limited.

Below are specific recommendations included by the AC in its letter to EOPS and Final Report as sub points to its seven main recommendations (see above).

• A comprehensive demographic and epidemiological study that attempts to project the DOC’s long-term health needs to be undertaken immediately.
• The DOC health services contract should be changed to set minimum standards in the following areas: scope and levels or service, evaluation requirements, staff training, data collection requirements, contract review and compliance, and grievance procedures
• A multi-disciplinary team of health care, treatment, security, and other relevant staff should be charged with the specific task of reviewing and revising medical policies and procedures within each institution, including those related to dispensing medications, response to sick slip requests, transportation, and recommending practical, common sense changes, such as those recommended by the review panel.
• DOC should hire a consultant to evaluate its staffing matrix and patterns. It should review and revise staff education and training on health and mental health issues.
• DOC should seek to improve communication between inmates and providers regarding medical issues.
• DOC should ensure that health related reading materials are culturally and linguistically appropriate for inmates.
• There should be an ongoing review of all health services facilities with the goal of prioritizing projects to increase medical space and improve conditions (with input from clinicians, facility management and staff, central administration, UMCH and outside consultants).
• Capacity should be developed for more short-term rehabilitation, long-term care, assisted living and end of life services outside of current infirmaries.
• Consideration should be given to creating infirmaries at all custody levels.
• DOC should conduct a review and needs assessment of medical equipment and supplies throughout the system.
• The feasibility of establishing a line item in the DOC budget for the purchase of medical equipment and supplies should be explored.
• A more comprehensive, integrated, and efficient means of serving the mental health needs of inmates should be developed, which could include more access to group treatments, coordinated substance abuse and mental health services (perhaps under one contract), better review of open mental health cases, improved communication between security staff and clinicians to ensure better access to care, and opportunity for residential treatment at each security level.
• An oversight committee should be established to review commitments to Bridgewater SH, and explore alternatives such as increasing or restoring mental health services in county facilities and establishing a separate treatment program (outside of BSH).
• Oversight of Section 35 commitments should consider whether responsibility for treating civil commitments and managing MASC should be transferred to DPH.
• The recommended Section 35 oversight committee should review the substance abuse services provided within DOC to insure that treatment is licensed by DPH.
• DOC and UMCH should review the reentry process and increase partnerships with community-based providers to enhance health care reentry programming in home communities and promote effective referrals.

The Final Report’s section on the Medical Panel ends with a statement that calls for immediate attention to the two recommendations by EOPS and the Governor. There is also a statement anticipating that DOC Commissioner Dennehy will move swiftly to do “the kind of excellent, expedited feasibility assessment and implementation plan for all of them (the recommendations) that the DOC did for the original 18 GCCR recommendations.”

To date, CJPC has not learned of any meetings being convened with the goals of sharing the work of the Medical Review Panel, along the lines of one scheduled for March 8 on the Female Offender Panel. (See other article.) However, the legislature’s Mental Health and Substance Abuse Committee will hold an “Oversight Hearing on Mental Health in Prisons” on Monday, March 20, at 11 am. That hearing will likely include testimony from some involved in the Medical Panel, and hopefully all subgroups chairs will cooperate in making their groups’ reports publicly available.