Not too long ago I was speaking with a jail commander. She was inquiring about resources we could provide for her county’s facility as they build a new complex.
During the conversation, I asked her to explain what correctional health care services they provided and I was taken aback by her response. “Nothing!” She responded.
Pause for a minute, like I did.
As I gathered my thoughts, I asked again. “No, I’m sorry. I meant, what health care do you provide to your incarcerated population?” Again, “None. We don’t provide our inmates with any health care.” Now that we understand the problem, let’s work on the solution.
In the 1976 Estelle v. Gamble Supreme Court case, three basic rights emerged: right to access to care, right to care that is ordered, and right to a professional medical judgment. The 4th 1979 Circuit Court case Bowring v. Godwin extended the Estelle decision to mental health care as well.
All of us have received education on the importance of deliberate indifference, but that same mindset also translates into the arena of health care for the incarcerated. In our delivery of care, we must ensure that we do not make a conscious or reckless disregard of any consequences from our actions or the omission of actions. This also includes when we knowingly disregard the excessive risk to our inmate’s health or safety. Sound familiar? That’s right, this is the definition of deliberate indifference. That brings us to the topic of this jail commander corner.
I have seen many ways that facilities provide correctional health care. I have seen systems with more staff than a small medical center, and I’ve seen the systems where they beg, borrow, and steal from anyone whom they can.
And, as you now know, I’ve spoken to systems who provide nothing in regards to health care—physical or mental. Removing the former from the equation, take a look at the qualifications of your correctional health care providers.
Even in my own facility, we had everything from a part-time physician to a couple of full-time RNs who were supplemented by LPNs, paramedics, and EMTs. For mental health services, I partnered with our local community provider who came into our facility for four hours a day, three days a week. We received free mental health services, and they received data for grants that funded their own programs. It was a win-win situation. What we did well was to ensure that they were fully qualified and operating under their licensure and professional credentials.
What do you need to do? Ensure that your correctional staff is also verifying the credentials and qualifications of their health providers. In this column, we provide some helpful guidance as you assess and improve your correctional health care staff.
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JIM MARTIN, MPSA, CCHP Vice President, Program Development jamesmartin@ncchc.org
AMY PANAGOPOULOS, MBA, BSN, RN Vice President, Accreditation National Commission on Correctional Health Care amyp@ncchc.org
NCCHC Jail Commander Conversations: Provider Credentialing
The purpose of this standard is to verify that your qualified health care professionals are legally eligible to perform their clinical duties. This standard is intended to ensure that facilities have a process for obtaining and verifying clinical staff qualifications so that these staff can provide care within the facility.
Why Is This Important? This standard is extremely important because it outlines a process to verify the credentials of your licensed providers, such as your doctors, dentists, nurses, NPs and PAs, just to name a few. Verifying credentials helps to ensure that your clinical staff are competent to provide good care to your patients who are often the most vulnerable. The credentialing process is a detailed method to verify credentials, which includes obtaining, verifying, and assessing the qualifications of the clinical staff prior to them providing care. The credential documents are evidence of licensure, education, and training experience, as well as other qualifications. In the correctional setting, the credentialing process is often managed by the credentialing department of the health services vendor due to the complexity of managing these processes and maintaining documentation. If a facility is managing this process in-house and are having trouble tracking all the necessary documentation, there are software programs that can assist with managing these processes.
Standards and Indicators of Compliance Credentialing processes are detailed procedures to verify licensure. To assist with developing and implementing a credentialing process, the following are the recommended best practices to follow:
• Develop a policy that stipulates how your credentialing processes are to be managed and by whom. • Establish a consistent process to ensure health care professionals and providers have current credentials and provide services with their licensure, certification, and registration requirements according to the law and scope of practice. • Require the responsible health authority to ensure that all new hires undergo a credential verification process before seeing patients and that the process includes an inquiry of the National Practitioner Data Bank (NPDB). • Request the health authority who is responsible for establishing a records storage process to ensure all documents are maintained in a confidential location and are readily accessible during a survey.
— If maintained offsite with the corporate vendor, develop a process to ensure the facility can access at any time, especially during the survey. — If maintained offsite, develop a communication process or reporting process to ensure the RHA understand when clinicians are completely credentialed. • Verify that specialists providing on-site or telehealthcare services have appropriate licensure and certifications on file.
NCCHC Sample Survey Observations from Surveyors Not in Compliance Observations
Several nurses have expired licenses as observed during the credential file review.
• Facility stated “corporate” completed credentialing and NPDB process for providers; however, there was no documentation on file at the facility to support credentials were verified. • The LPN who was providing clinical care to patients is not licensed in the state where she is providing care. • The medical director of the facility has a restricted license that is not in compliance with NCCHC standards. • Dental staff were never credentialed and have been providing dental services in the facility for three years. • Credential log maintained by the facility shows missing information in the credential file, such as missing copies of licensure. Credential files are incomplete for the past two years. • Medical assistants and LPN staff are working outside of their scope of practice as defined by the state. They are providing care that is the responsibility of RNs. • Agency and PRN staff have not had their credentials verified by the facility or by the staffing agency. No record regarding their credential status is on file. • Health services vendor conducts credentialing at corporate office, but the facility does not have access to any of the records, which is out of compliance for this standard. • Health services vendor conducts credentialing processes for the facility; however, there is no communication between the facility and corporate office regarding the status of each credential file. • Mental health staff were excluded from the credentialing process despite being licensed professionals in the state. This is not in compliance with the standard.
Potential Contributing Factors
Facility staff did not understand all the components involved with developing and implementing a credentialing program.
• Policies and procedures are not in alignment with all NCCHC compliance indicators in the standards. • Policies and procedures were incomplete and lacked a clear procedure regarding the details of how to conduct the credentialing process. • Facility did not have a clear process for obtaining credential information and documents from health services vendor. • The responsible health authority did not understand scope of practice limitations of clinical staff, such as medical assistants and LPNs. • Facility staff did not understand that all licensed personnel are to be credentialed. The process is to include doctors, RNs, LPNs, mental health staff, dental staff, EMTs, CNAs, the agency staff, and per diem.