Posted: 2/21/2024

Type of Addition: Addendum No. 1

Overview: Please see attached Addendum No. 1, which contains a list of all represented companies at the mandatory site visit held February 9, 2024, at the Dorchester County Detention Center. The sign-in sheet is also included. An addendum containing answers to all written questions will be issued separately. 

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Posted: 3/5/2024

Type of Addition: Addendum No. 3

Overview: Please see the attached contract, addenda, and renewals for Southern Healthcare Partners.

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Posted: 5/1/2024

Type of Addition: No Action

Posted: 2/16/2024

Question: General: 1. What is the current ADP of DCDC? 2. What ADP shall we use to develop a staffing matrix for our proposal? Please provide the below health service statistics (# of patients receiving the service) for the past 3 years - 2021, 2022, 2023: Weekend Care Intake Screenings Conducted Deaths Due to Medical Reasons Deaths Due to Suicide Nurse Sick Calls Healthcare Provider Encounters (Doctor and mid-level Providers) In-house X-rays Medical Observation Unit Admissions Medical Infirmary Admissions On-site Dental Care Encounters Prescription Medications On-site specialty clinics, if applicable Optometrist OB/GYN Radiology Other (please specify type) Patients on HIV medications Patients on Hep C medications Hepatitis C treatment Off-Site Care Inpatient hospitalizations Dental Visit Dialysis Emergency Room Outpatient Admissions (including surgeries) Specialist Office visits Other off-site referrals Ambulance Transportations 3. Please provide a copy of the current medical contract and any amendments /addendums that have been signed since the inception of the contract. 4. What is the average number of grievances received that are founded and unfounded ? Medical Services: 5. Does Dorchester County already have an agreement with local hospitals in the county for inpatient/and or outpatient care, admissions, or visits? If the answer is yes, please provide a copy of these agreements. 6. Which hospitals are utilized most frequently by DCDC for off-site care? 7. How many federal inmates have been housed in DCDC in 2022 and 2023? 8. If you are holding federal inmates, please let us know if you will be continuing to hold or decreasing/ceasing this practice. 9. Please verify if DCDC holds/houses weekenders. If yes, what is the average number of detainees per weekend in 2022 and 2023? 10. Does DCDC have a higher number of intakes/admissions on certain days due to the court schedule or transfers from other locations? 11. Does DCDC currently have on-site dialysis, or is a mobile dialysis company? 12. Are any medical services currently being provide via Telehealth? If not, is Dorchester County open to utilizing this service to supplement and support timely, cost-effective access to care? 13. Does the DCDC have any current or anticipated court-ordered directives or consent- decrees that inform or impact health care service delivery requirements or expectations? If so, please provide information on any such legal decrees. 14. When was the last ACA accreditation date? Are ACA Accreditation results available for review? 15. Is there currently a backlog of patients waiting to be seen for any of the healthcare encounter types that are currently required based on your agreement with your current vendor? 16. If so, please provide the current backlog for each of the following categories: • Mental health (including psychiatrist visit or mental health clinicians) • Primary care (nurse practitioner of physician) • Dental 17. Is there a routine/schedule of optometry clinic onsite or does your current vendor schedule outside providers for glasses prescriptions? 18. Are any specialty services currently conducted through telehealth? If yes, please describe those telehealth services. 19. On average per year, how many inmate patients have been enrolled into your MAT/ MOUD for 2022 and 2023? 20. Does DCDC currently conduct MAT/MOUD programming? If yes, please indicate whether phase one (continuation) and/or phase two (induction). 21. What type of medications are currently used for your MAT/MOUD program? 22. What is the average length for 2022 and 2023? 23. What is the number of infirmary beds and the number of medical observation (MOU) beds? Financial: 24. Is there currently a cap/cost pool based in your agreement with your current vendor? 25. If yes, please tell us what is included in the cost pool? (Examples: off site visits, pharmacy (HIV meds, Hep C meds, blood factors), ambulance transportation, medical supplies, etc.)? 26. If there is a cost pool, please share the amount of what is the maximum financial responsibility of your current vendor. 27. Did Dorchester County end up spending more money than the cost pool allotted for 2022 and 2023? If yes, please provide us with the dollar amount for 2022 and 2023. 28. Currently who is responsible for the following costs (Contractor or County/Facility): a. Pharmaceuticals Please specify for certain types of medications such as HIV, Hep C, blood factors or etc. b. On-site Laboratory Services c. On-site X-rays d. Offsite specialty visits e. Hospitalization services (ER visits, inpatient/outpatient services, etc.) f. Ambulatory services 29. What is your historical spend for 2021, 2022 & 2023 for the following: a. Pharmaceutical costs i. Medical ii. Psychiatric b. On-site Laboratory Services c. On-site X-rays d. Offsite specialty e. Hospitalization services (ER visits, inpatient/outpatient services, etc.) f. Ambulatory services 30. Pertaining to Section 9.4 - The successful Bidder shall provide performance and payment, if applicable, bonds, in a form satisfactory to the County, in the following amounts: Payment Bond: 100% of the total amount of the Contract. Performance Bond: 100% of the total amount of the Contract. Please review the following provided to help you understand the implications a bond request has on a correctional healthcare contract. Understanding Impact of Bid and Performance Bonds Required for Comprehensive Correctional Healthcare Programs Some counties seeking comprehensive correctional healthcare programs may impose a bid and/or performance bond. These types of bonds are typically used when securing construction contracts and may find themselves part of an RFP for correctional healthcare RFP because they are part of County’s “standard” RFPs or “standard” process. Insisting on these types of bonds for a correctional healthcare program will have two immediate effects on the County - both of which may not be in the best interest of the County and its citizens who pay taxes to support such a program. • First, such bonds would increase cost to the County for the contract with no direct or indirect benefit to the program and the inmate population being served. • Second, this requirement significantly would limit the pool of providers bidding for this contract to only a few large companies - all of which are owned and operated by investment companies. Larger companies do not guarantee better service. And, they often provide less personal service - defeating the goal of a true partnership. Counties seeking service contracts want that “personal touch.” This is critical for a comprehensive correctional healthcare company and its program. To achieve this goal and such a relationship, the County should consider the provider’s skills and commitment, not how “deep their pockets are.” Ultimately, neither of the above consequences will improve or guarantee quality of care delivered. It is no big secret that various facilities across this nation, even those with such bonds, have had less than desirable results. Some even under the Department of Justice (DOJ) monitor. Many have been the subject of bad media coverage (which have become part of the company’s history and the Facility/County’s history). And now Congress may get involved. Counties need to protect themselves. And this is important. Certainly, the reasoning behind performance is to act like insurance coverage. But it is critical to evaluate just how this bond affects the contract and the services provided. Contract effect: It affects the contract by increasing costs. For any negotiated contract that presumably costs multiple millions of dollars annually, this amount would be applied to the bond adding tens of thousands or hundreds of thousands to the annual cost of the contract (depending on the contract price). Services effect: These bonds do not increase or even ensure the quality of care delivered. For a construction contract there is a defined beginning, mid-contract milestones and ending of a tangible product. Is the building completed by the agreed time? Is the bridge completed? And so forth. A comprehensive healthcare program is the daily attention to the ever-changing needs of the inmate population. There is not and should not be a definitive end to providing care (other than the end of the contract). But even at the end of the contract, there are no buildings or bridges or roads to inspect. So, for example, if the contract amount increases by a $100,000 annually due to the “investment” of a performance bond, the critical question becomes: Does the facility (and the inmate patients) get $100,000 more service? Bonds make perfect sense for construction contracts because when a contract defaults on the contract, one cannot simply “pick up the pieces” and quickly continue. • The site must be secured. • Inspections and analysis are conducted on quantity and quality of work performed • Any re-work must be identified • Request for bids are re-issued • Bidding process • Work begins This type of damage may be quantified in terms of re-work to be achieved or missed timelines/milestones. Again, this type of default is measured against the expected milestones and product. There is no quick “step-in” course of action. This type of process does not apply to a correctional healthcare program. While an RFP is issued, an emergency contract can bring in a provider and medical services begin. Yes, file reviews and sub-contractor contracts must be secured, but this happens relatively fast. Bottom line is a physician and nurses may be brought in virtually instantly to provide services. An inmate healthcare program is a daily, ongoing and everchanging service - a daily grind - that has ongoing oversight and really needs a trusting partnership with the Facility and the County to succeed. And, at the same time, the provider must earn the respect and trust of the Facility and the County. At the end of the day, we all will discover a reputable correctional healthcare provider and the County are really on the same side. We all want to provide quality care to the inmate population. In order to better serve the County, the Community, the Facility and the inmate population, the County must truly complete a thorough investigation of each potential vendor. With or without a payment and/or performance bond, there is no guarantee that the provider will not default on the contract. This commitment is better demonstrated by the potential vendor’s history that reflects the true essence of the provider, their skills, their commitment and their honesty. Examine the potential vendors by looking at: • their corporate history • ownership • ownership/merger history • corporate structure • investment company relationships (which direct profit over service) • litigation history • negative media coverage history, and • their references (the sites they serve) Conducting this type of analysis before a contract is awarded will better serve the County than a large payment or performance bond (the cost of which is passed on to the County anyway). Finally, providers and Counties continually seek to provide a high level of service at a reasonable cost. MEDIKO does this daily. We place as part of our service at every site a cost containment program. We focus on the care at the site while keeping our overhead costs to a minimum. We focus on providing as many services on site as medically safe (reducing the need for transports and controlling offsite costs). We enforce an effective formulary. We focus on training for our staff and security staff. We focus on proper oversight. All these efforts truly are nullified by the cost of a bond that simply has no impact on the quality of care. Mental Health: 31. How many patients are currently taking psychotropic medication? 32. Is there a designated behavioral health unit? If yes, how many types and the number of beds in each type? 33. Are there any safety cells in the designated unit? 34. What is the average number of patients placed on suicide watch each month in the past 6 months: a) July: b) August: c) September: d) October: e) November: f) December: 35. Where do you hold the patients on suicide watch? 36. How many suicide watch cells are available in the facility? 37. How are patients on suicide watch monitored (1:1, camera, etc.)? 38. Please confirm who is responsible for the 15-minute checks for suicide watches custody or healthcare personnel? 39. Please confirm who is responsible for 1:1 monitoring for actively suicidal patients custody or healthcare personnel? 40. Does the facility utilize suicide watch clothing or smocks? 41. How many inmates are currently on psychotropic medications? 42. How many safety cells (suicidal cells) are there? 43. What is the average number of mental health intakes or assessment completed per month by mental health clinicians in 2022 and 2023? 44. What is the average number of patients with special needs? 45. Are all of your mental health providers licensed? 46. Where do the mental health providers meet with patients (cell, housing unit, medical, or office of mental health clinician)? 47. Is DCDC using a Dr. of psychiatry or psychology for mental health assessment of mental health patients? If you are using a psychologist, does that mean the onsite primary care physician is prescribing the psychotropic medications as they are recommended by the psychologist? 48. Is there currently Mental Health Group counseling being conducted? 49. If yes, are the sessions being conducted by the current contractor’s mental health staff or are the sessions being conducted by outside services? What is the average number of mental health initial intake screenings completed by a mental health clinician per month? What is the average number of patients seen by the psychiatry provider/psychologist in clinic each day? How many hours a week does the psychologist spend time to provide his or her mental health evaluations for your incarcerated individuals? What is the average number of service hours delivered by the psychiatry provider/psychologist each week? How many patients is he/she seeing during this time period? What is the percentage of current inmates receiving ongoing mental health and/or psychiatric services? What is the average number of patients with special needs? What is the number of patients currently being held at the state hospital on a forensic admission? Pharmaceutical: 50. Who is your current Pharmacy vendor? 51. What percentage of the population are prescribed psychotropic medications? 52. Please provide pharmaceutical data for the past three years to include: a. number of inmates on HIV medications each month or an annual average/year (2021, 2022 and 2023) b. number of inmates on Hep C medications each month or an annual average/year (2021, 2022 and 2023) c. blood or plasma factoring medications each month or an annual average/year (2021, 2022 and 2023) 53. How many medication carts does your current vendor currently use for medication and administration pass during each med pass round? 54. On average, how long does each medication administration pass take for completion? 55. How many times do you have medication pass (i.e., once, twice or three times a day)? 56. Do you currently have a KOP program for detainees at the DCDC? If not, are you open to having KOP for the detainees? Information Technology: 57. What EMR system is currently used? 58. Who owns the licensure of the system? 59. Are there any existing networks that are available to be used – either wired, wireless, or both? 60. Does the facility have Wi-Fi capability dedicated for use by the medical department? 61. Where will the patient data be kept (whose server, current medical provider or Jail Facility)? 62. What Jail Management System do you currently use? 63. Are there any Current Integrations (Pharmacy, lab, Radiology, etc.)? 64. Will there be any restrictions on the computers that the Contractor chooses to use? 65. How many laptops are currently in use, and will they be available for use to the new contractor? 66. How many desktops are currently in use, and will they be available for use to the new contractor? 67. How many desktop printers are currently in use, and will they be available for use to the new contractor? 68. How many large copiers/faxes are currently in use, and will they be available for use to the new contractor? 69. Please provide us with a list of the medical equipment (computers, desks, laptops, exam tables, etc) that your new medical contractor can continue to use. Staffing: 70. Is your Social Worker FTE currently filled? 71. Will you please provide a weekly (Monday-Sunday) schedule, work shift, total FTEs (including employees and subcontractors) currently in use by your current vendor for the following positions: a) Health services administrator (HSA) b) Site medical director c) Site staff physician d) Director of Nursing (DON) e) Registered Nurses (RN) f) Licensed Practical Nurses (LPN) g) Advanced Practical Clinician (Nurse Practitioners (NP) or Physician Assistants (PA) h) Administrative Assistant (AA) i) Medical Record (MRC) j) Onsite Dentist (if applicable) k) Dental Assistants l) Certified Personnel including (medication administration technicians (MAT)) m) Certified Medical Technician (CMT) n) Emergency Medical Technician (EMT) o) Certified Nurse Assistant (CNA) p) Psychiatrists q) Psychiatric Nurse Practitioner (PsyNP) r) Licensed Mental Health Clinician s) Master’s Prepared non licensed mental health professional t) Discharge Planner (if applicable) u) Doctor of psychology (if applicable) 72. How many current nursing staff vacancies do you have by position and shift? 73. How many vacant nursing positions, if any, are currently filled by agency nurses? 74. Please specify whether you have experienced a vacancy in the physician position over the past two years. If yes, how long was this position vacant? Was this position filled by an agency physician? 75. Please specify whether you have experienced a vacancy in the midlevel provider (nurse practitioner/physician assistant) position over the past two years. If yes, how long was this position vacant? Was this position filled by an agency provider? 76. Please specify whether you have experienced a vacancy in psychiatrist, and/or mental health staff positions over the past two years. If yes, how long was this position vacant? Were any of these positions filled by an agency provider? 77. Would Dorchester County be interested to see an alternative staffing matrix different from what is currently implemented at your facility (as long as the vendor explains the logic and reasons behind the recommended adjustments in the number of staff pricing both options for your comparison? Where this alternative level of staffing will be sufficient for you to pass NCCHC certification since we understand your goal is to receive this certification.)

Response: Please see addendum.